ADVENTIST BOLINGBROOK HOSPITAL: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- ADVENTIST BOLINGBROOK HOSPITAL (EIN 65-1219504)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2025-05-14
- IRS object ID
- 202501349349302660
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-05-14T08:17:41-05:00 | ReturnTs |
| Tax Period End | 2024-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 651219504 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADVENTIST BOLINGBROOK HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ADVE | BusinessNameControlTxt |
| Phone | 6303125000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 REMINGTON BLVD | AddressLine1Txt |
| City | BOLINGBROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LYNN C ADDISCOTT | PersonNm |
| Person Title | ASSISTANT SECRETARY | PersonTitleTxt |
| Phone | 4073572317 | PhoneNum |
| Signature | 2025-05-13 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UCHICAGO MEDICINE ADVENTHEALTH BOLIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEN ROSE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 REMINGTON BLVD | AddressLine1Txt |
| City | BOLINGBROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $255,346,719 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | OPERATION OF A 138-BED ACUTE-CARE HOSPITAL SERVING RESIDENTS IN & AROUND BOLINGBROOK, IL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 22 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 21 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 85 | TotalVolunteersCnt |
| Total Gross UBI | $372,832 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $14,641 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $123,829 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $122,502,325 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $252,649,727 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$47,274 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,573,163 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $122,455,051 | PYTotalRevenueAmt |
| CY Total Revenue | $255,346,719 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $52,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $40,750 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $44,040,553 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,189,594 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $79,926,643 | PYOtherExpensesAmt |
| CY Other Expenses | $243,275,795 | CYOtherExpensesAmt |
| PY Total Expenses | $124,019,696 | PYTotalExpensesAmt |
| CY Total Expenses | $244,506,139 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,564,645 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $10,840,580 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $284,808,847 | TotalAssetsBOYAmt |
| Total Assets EOY | $285,574,027 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $44,278,219 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,503,486 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $240,530,628 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $252,070,541 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST.THE TAXPAYER'S PARENT IS ADVENTIST MIDWEST HEALTH, WHICH IS OWNED 49% BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (ADVENTHEALTH). EFFECTIVE JANUARY 1, 2023, THE TAXPAYER'S PARENT ENTERED INTO A MASTER MANAGEMENT AGREEMENT WITH ADVENTHEALTH. ADVENTHEALTH SEEKS TO BE WIDELY RESPECTED AS A CONSUMER-FOCUSED ORGANIZATION THAT ENGAGES INDIVIDUALS IN THEIR HEALTH BY DELIVERING WHOLISTIC, BEST PRACTICE CARE ACROSS A CONNECTED, COMPREHENSIVE CONTINUUM OF SERVICES. WITH CHRIST AS OUR EXAMPLE, ADVENTHEALTH CARES FOR AND NURTURES PEOPLE: OUR EMPLOYEES, OUR COMMUNITIES, OUR HEALTHCARE PROFESSIONALS, AND THOSE WHO TRUST US FOR CARE AND HEALING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $239,730,669 | ExpenseAmt |
| Grant | $40,750 | GrantAmt |
| Revenue | $252,276,895 | RevenueAmt |
| Desc | OPERATION OF ACUTE CARE HOSPITAL TOTALING 138 BEDS. DURING THE CURRENT YEAR THERE WERE 6,489 ADMISSIONS RESULTING IN 27,879 PATIENT DAYS AND 154,206 OUTPATIENT VISITS. | Desc |
| Total Program Service Expenses | $239,730,669 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 22 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 21 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRISTAN SHAW | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7082452211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 REMINGTON BLVD | AddressLine1Txt |
| City | BOLINGBROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (37 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| BUCHANAN HERBERT | |||||||||
| DIR END 4/24, CEO END 2/24 | 12.50 | 37.50 | Yes (X) | Yes (X) | $162,900 | $488,698 | $26,727 | ||
| DAVARAPALLI MD RAMADEVI | |||||||||
| DIRECTOR (END 12/23) | 0.30 | 50.00 | Yes (X) | $0 | $517,469 | $46,728 | |||
| KOHLI MD MANINDER | |||||||||
| DIRECTOR | 0.20 | 13.50 | Yes (X) | $0 | $39,000 | $0 | |||
| MURREY MD SUSAN | |||||||||
| DIRECTOR (END 3/24) | 0.20 | 9.20 | Yes (X) | $0 | $75,550 | $0 | |||
| THORDARSON THOR | |||||||||
| DIR/PRES (END 11/23) | 12.50 | 37.50 | Yes (X) | $241,722 | $725,165 | $173,900 | |||
| ARQUILLA VENANZIO | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| BACON KENNETH | |||||||||
| DIR/CHAIRMAN (END 11/23) | 0.30 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| BANKS DAVID | |||||||||
| DIR/CHAIRMAN (BEG 11/23-3/24) BEG 5/24 | 0.20 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| DENSLOW KENNETH | |||||||||
| DIRECTOR/VICE CHAIR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| DIXON SUSAN | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| EASTMAN LINDA | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| GRAY JR MARSHALL | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| GRYS D MIN JOHN | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| HAWKINS RONNIE | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| HOLDER BILL | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| JAHN ANDREW | |||||||||
| DIR/CHAIRMAN (CHAIR 4/24-5/24) | 0.20 | 0.40 | Yes (X) | $0 | $0 | $0 | |||
| MILNER MD ROSS | |||||||||
| DIRECTOR (END 6/24) | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| O'CONNOR PETER | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| PATARI MD SANJAY | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| RAMIREZ ELDEN | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| REED MD MONICA | |||||||||
| DIR/PRES/CEO REG (BEG 2/24) | 12.50 | 37.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RYAN MD PAUL | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| SCOTT GLYNN | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| SHAYANI MD VAFA | |||||||||
| DIRECTOR (BEG 1/24) | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| SNYDER BRENT | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| VALAITIS MD SANDRA | |||||||||
| DIRECTOR | 0.20 | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| WRIGHT JONATHAN | |||||||||
| DIRECTOR | 0.20 | 0.60 | Yes (X) | $0 | $0 | $0 | |||
| BROWN JARED | |||||||||
| CFO (END 8/23) | 25.00 | 25.00 | Yes (X) | $125,570 | $125,570 | $23,846 | |||
| ROSE KENNETH | |||||||||
| CEO BOLING/GLENOAKS (BEG 2/24) | 37.50 | 12.50 | Yes (X) | $0 | $0 | $0 | |||
| NOSEWORTHY GORDON E | |||||||||
| CEO-INTERIM (12/23-3/24) | 50.00 | 0.00 | Yes (X) | $155,250 | $0 | $0 | |||
| SHAW TRISTAN | |||||||||
| CFO BOLINGBROOK (BEG 8/23) | 21.00 | 29.00 | Yes (X) | $86,264 | $162,249 | $49,867 | |||
| SPAGNOLIA RN JENNIFER | |||||||||
| INTERIM CNO BOLINGBROOK (3/18-4/14/23) | 50.00 | 0.00 | $153,731 | $0 | $23,134 | Yes (X) | |||
| GALLAGHER RN KAREN | |||||||||
| CNO BOLINGBROOK | 50.00 | 0.00 | $166,892 | $0 | $20,017 | Yes (X) | |||
| KRIKORIAN MD ARMAND | |||||||||
| CMO BOLING/GLENOAKS | 25.00 | 25.00 | $190,939 | $190,939 | $103,518 | Yes (X) | |||
| PAWLIK RN COLLEEN | |||||||||
| CNO BOLING/GLENOAKS | 25.00 | 25.00 | $50,443 | $50,443 | $7,130 | Yes (X) | |||
| CARROLL MD RICHARD | |||||||||
| FORMER CMO BOLINGBROOK/GLENOAKS | 0.00 | 0.00 | $121,440 | $121,440 | $10,228 | Yes (X) | |||
| RADIVOJEVIC VLADIMIR | |||||||||
| FORMER VP/COO BOLINGBROOK/GLENOAK | 0.00 | 50.00 | $0 | $408,240 | $101,478 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,455,151 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,904,763 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $586,573 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PT SOLUTIONS HOLDINGS LLC | |||||
| PO BOX 441146 | KENNESAW | GA | 30160 | THERAPY SERVICES | $8,493,750 |
| CROTHALL HEALTHCARE INC | |||||
| 13028 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | EVS SERVICES | $4,132,706 |
| MORRISON HEALTHCARE | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | FOOD SERVICES | $3,678,635 |
| OBHG ILLINOIS SC | |||||
| 777 LOWNDES HILL RD BLDG 1 | GREENVILLE | SC | 29607 | HOSPITALISTS-MEDICAL DIRECTOR FEES | $1,741,927 |
| R1 RCM INC | |||||
| 39918 TREASURY CENTER | CHICAGO | IL | 60694 | REVENUE CYCLE SERVICES | $1,542,510 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 32 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Related Organizations | $123,829 | RelatedOrganizationsAmt |
| Total Contributions | $123,829 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 622110 | $218,612,030 | $218,580,210 | $31,820 |
| RETAIL PHARMACY | 622110 | $18,441,437 | $18,107,712 | $333,725 |
| SUPPORT PMTS FROM EXEMPT AFFILIAT | 622110 | $14,874,713 | $14,874,713 | |
| CAFETERIA REVENUE | 622110 | $447,647 | $447,647 | |
| HEALTH EDUCATION PROGRAMS | 622110 | $178,564 | $178,564 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $95,336 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $88,049 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $7,287 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $252,649,727 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,525,941 | TotalRevenueColumnAmt |
| Exclusion | $2,525,941 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $31,985 | SecuritiesAmt |
| Other | $15,237 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $31,985 | SecuritiesAmt |
| Other | $15,237 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,222 | TotalRevenueColumnAmt |
| Exclusion | $47,222 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $255,346,719 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $252,276,895 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $372,832 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,573,163 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,750 | TotalAmt |
| Program Services | $40,750 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,189,594 | TotalAmt |
| Management And General | $1,189,594 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,306 | TotalAmt |
| Management And General | $80,306 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,778 | TotalAmt |
| Management And General | $82,778 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,780,852 | TotalAmt |
| Program Services | $145,106,957 | ProgramServicesAmt |
| Management And General | $673,895 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,961 | TotalAmt |
| Management And General | $4,961 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,599,364 | TotalAmt |
| Program Services | $1,912,526 | ProgramServicesAmt |
| Management And General | $686,838 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,575,321 | TotalAmt |
| Program Services | $2,373,248 | ProgramServicesAmt |
| Management And General | $202,073 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,843,760 | TotalAmt |
| Program Services | $4,843,760 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,916 | TotalAmt |
| Management And General | $110,916 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,028 | TotalAmt |
| Management And General | $18,028 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,153,519 | TotalAmt |
| Program Services | $9,153,519 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,690,450 | TotalAmt |
| Program Services | $2,095,963 | ProgramServicesAmt |
| Management And General | $1,594,487 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $63,699,841 | $63,699,841 | |
| STATE TAX INDIGENT ASSE | $9,254,272 | $9,254,272 | |
| REPAIRS & MAINTENANCE | $1,205,434 | $1,205,434 | |
| UBI TAXES | $2,640 | $2,640 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,353 | TotalAmt |
| Program Services | $44,399 | ProgramServicesAmt |
| Management And General | $128,954 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,506,139 | TotalAmt |
| Program Services | $239,730,669 | ProgramServicesAmt |
| Management And General | $4,775,470 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,526 | BOYAmt |
| EOY | $3,375 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,834,226 | BOYAmt |
| EOY | $84,284,915 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,617,757 | BOYAmt |
| EOY | $27,359,260 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,614,369 | BOYAmt |
| EOY | $3,739,957 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $682,080 | BOYAmt |
| EOY | $794,645 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $167,358,557 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,398,081 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,394,570 | BOYAmt |
| EOY | $153,960,476 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,662,319 | BOYAmt |
| EOY | $15,431,399 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $284,808,847 | BOYAmt |
| EOY | $285,574,027 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,404,047 | BOYAmt |
| EOY | $2,633,893 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,874,172 | BOYAmt |
| EOY | $30,869,593 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,278,219 | BOYAmt |
| EOY | $33,503,486 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,530,628 | BOYAmt |
| EOY | $252,070,541 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,530,628 | BOYAmt |
| EOY | $252,070,541 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $284,808,847 | BOYAmt |
| EOY | $285,574,027 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $10,840,580 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $699,333 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $32,896 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $32,896 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND ILLINOIS HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,283,000 | OtherCostOrOtherBasisAmt |
| Book Value | $5,283,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $144,604,985 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,404,820 | DepreciationAmt |
| Book Value | $138,200,165 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,899,874 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,548,935 | DepreciationAmt |
| Book Value | $10,350,939 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $570,698 | OtherCostOrOtherBasisAmt |
| Depreciation | $444,326 | DepreciationAmt |
| Book Value | $126,372 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $153,960,476 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $2,337,139 |
| RECEIVABLE FROM THIRD PARTIES | $2,539,803 |
| DUE FROM AFFILIATED | $8,793,807 |
| RIGHT OF USE ASSET - OPERATING LEAS | $1,760,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $15,431,399 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED | $5,991,295 |
| PAYABLE TO THIRD PARTIES | $18,666,369 |
| AR CREDIT BALANCES | $1,197,651 |
| DEFERRED REVENUE | $969,247 |
| ACCRUED INTEREST PAYABLE | $6,268 |
| DUE TO AFFILIATED | $2,235,571 |
| OPERATING LEASE LIABILITY | $1,803,192 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $30,869,593 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | AS A RESULT OF ITS CONTROLLING MEMBER INTEREST, THE OPERATIONS OF THE FILING ORGANIZATION ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENT AUDIT OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) FOR THE TWELVE-MONTH PERIOD ENDED JUNE 30, 2024. THE CONSOLIDATED FINANCIAL STATEMENTS OF UCMC CONTAIN THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE. PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. THE SYSTEM APPLIES ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC TOPIC 740 PRESCRIBES A MORE LIKELY THAN NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC TOPIC 740, TAX POSITIONS ARE EVALUATED FOR RECOGNITION, DE-RECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. AS OF JUNE 30, 2024 AND 2023, THE SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. UCM OBLIGATED GROUP IS COMPRISED OF SUBSIDIARIES THAT ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. UCM NON-OBLIGATED GROUPS CONSIST OF SEVERAL NOT-FOR-PROFIT AND TAXABLE ENTITIES. THE TAXABLE ENTITIES INCLUDE UNIVERSITY OF CHICAGO MEDICINE CARE NETWORK, LLC; TRULEN INSURANCE SPC LIMITED; MEDCENTRIX, INC.; INGALLS SAME DAY SURGERY; AND INGALLS PROVIDER GROUP, WHICH ARE TAXABLE ENTITIES UNDER APPLICABLE SECTIONS OF THE CODE. DEFERRED INCOME TAXES ON THE TAXABLE ENTITIES OF THE NON-OBLIGATED GROUPS ARE RECOGNIZED FOR THE TAX CONSEQUENCES OF "TEMPORARY DIFFERENCES" BY APPLYING ENACTED STATUTORY TAX RATES APPLICABLE TO FUTURE YEARS TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS AND THE TAX BASES OF EXISTING ASSETS AND LIABILITIES. AS OF JUNE 30, 2024 AND 2023, THE UCM NON-OBLIGATED GROUPS HAVE DEFERRED TAX ASSETS PRIMARILY RELATING TO NET OPERATING LOSSES; HOWEVER, IT HAS A FULL VALUATION ALLOWANCE AS MANAGEMENT BELIEVES THAT IT WAS NOT MORE LIKELY THAN NOT THAT THE RESULTS OF FUTURE OPERATIONS WOULD GENERATE SUFFICIENT TAXABLE INCOME TO REALIZE THE NOL. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 600.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,025,239 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,025,239 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02460 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,282,478 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,819,093 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,463,385 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04690 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,307,717 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,819,093 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,488,624 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07150 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,298 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $132,019 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $132,019 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $161,317 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $161,317 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,469,034 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,819,093 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,649,941 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07210 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,517,805 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $157,960 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $27,922,367 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $31,803,200 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,880,833 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADVENTIST BOLINGBROOK HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 REMINGTON BLVD | AddressLine1Txt |
| City | BOLINGBROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG | WebsiteAddressTxt |
| State License | 0005496 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADVENTIST BOLINGBROOK HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 23 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 600.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | PART V, PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ADVENTIST BOLINGBROOK HOSPITAL | PART V, SECTION B, LINE 5: ADVENTIST BOLINGBROOK HOSPITAL (ABH OR THE HOSPITAL) IS A 138-BED ACUTE CARE HOSPITAL LOCATED IN WILL COUNTY IN ILLINOIS. ABH'S PRIMARY SERVICE AREA INCLUDES 16 ZIP CODES PRIMARILY IN WILL COUNTY. IN CONDUCTING ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL SOLICITED INPUT DIRECTLY FROM THE COMMUNITY AND FROM INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY COMMUNITY MEMBERS. THE HOSPITAL PARTNERED WITH THE WILL COUNTY MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) COLLABORATIVE IN CONDUCTING ITS 2022 CHNA. THE MAPP COLLABORATIVE HAS REPRESENTATION FROM ALMOST 100 SOCIAL SUPPORT AND COMMUNITY ORGANIZATIONS, HEALTH CARE SYSTEMS, AS WELL AS PUBLIC HEALTH AND EDUCATION INSTITUTIONS. A SMALLER COMMITTEE WAS FORMED BY THE COLLABORATIVE TO LOCALIZE THE DATA COLLECTION AND COMMUNITY INPUT PROCESS FOR THE HOSPITAL. COMMUNITY ORGANIZATIONS INCLUDED IN THE SMALLER COMMITTEE INCLUDED AUNT MARTHA'S HEALTH & WELLNESS, CATHOLIC CHARITIES, EASTERSEALS JOLIET REGION, INC., GREATER JOLIET YMCA, HOLSTEIN HUMAN CAPITAL DEVELOPMENT, NATIONAL HOOKUP OF BLACK WOMEN, NORTHERN ILLINOIS FOOD BANK, SENIOR SERVICES OF WILL COUNTY, SPANISH COMMUNITY CENTER, STEPPINGSTONES, INC. AND UNITED WAY OF WILL COUNTY. THE SMALLER COMMITTEE ALSO INCLUDED REPRESENTATIVES FROM THE WILL COUNTY HEALTH DEPARTMENT AND THE WILL COUNTY COMMUNITY HEALTH CENTER. ABH ALSO FORMED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) WHOSE PURPOSE WAS TO SELECT THE NEEDS THE HOSPITAL WOULD ADDRESS RESULTING FROM THE FINDINGS IN THE ASSESSMENT. THE COLLABORATIVE COLLECTED BOTH PRIMARY AND SECONDARY DATA. PRIMARY DATA INCLUDED A COMMUNITY SURVEY, A LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, AND A FORCES OF CHANGE ASSESSMENT. AN INTENTIONAL EFFORT WAS MADE TO COLLECT INPUT FROM ALL MEMBERS OF THE HOSPITAL'S COMMUNITY AND TO OBTAIN PERSPECTIVES ACROSS AGE, RACE/ETHNICITY, GENDER, PROFESSION, HOUSEHOLD INCOME, EDUCATION LEVEL, AND GEOGRAPHIC LOCATION. THE COMMUNITY SURVEY WAS PROVIDED IN ENGLISH AND SPANISH TO ANYONE IN WILL COUNTY AND WAS ACCESSIBLE ONLINE THROUGH WEBLINKS AND QR CODES. THE LOCAL PUBLIC HEALTH ASSESSMENT WAS AN ONLINE SURVEY TARGETING SOCIAL SERVICE AGENCIES, SCHOOLS, GOVERNMENT, FAITH INSTITUTIONS AND ANY AGENCY THAT INFLUENCES HEALTH. THE FORCES OF CHANGE ASSESSMENT WAS AN ONLINE SURVEY DESIGNED TO ELICIT BROAD COMMUNITY INPUT. |
| ADVENTIST BOLINGBROOK HOSPITAL | PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. |
| ADVENTIST BOLINGBROOK HOSPITAL | PART V, SECTION B, LINE 11: SEE FOOTNOTE BELOW |
| PART V, SECTION B, LINE 11: | THE FILING ORGANIZATION FILED A SHORT PERIOD RETURN FOR THE PERIOD FROM JANUARY 1, 2023 THROUGH JUNE 30, 2023, AS IT CHANGED ITS TAX YEAR END TO JUNE 30 FROM DECEMBER 31. THE TAXPAYER'S SHORT PERIOD RETURN FOR JANUARY 1, 2023 THROUGH JUNE 30, 2023 DID NOT INCLUDE ANY INFORMATION IN RESPONSE TO SCHEDULE H, PART V, SECTION B, LINE 11 AS THE FILING ORGANIZATION'S 2023-2025 IMPLEMENTATION STRATEGY (COMMUNITY HEALTH PLAN) WAS COMPLETED BY MAY 15, 2023 AND SO INCLUDED ONLY 46 DAYS IN THE COMMUNITY HEALTH PLAN THREE-YEAR IMPLEMENTATION PERIOD. THE NARRATIVE FOR SCHEDULE H, PART V, SCHEDULE B, LINE 11 FOR THE TAX YEAR BEGINNING JULY 1, 2023 THROUGH JUNE 30, 2024 INCLUDES HOW THE FILING ORGANIZATION HAS ADDRESSED THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE PERIOD FROM MAY 15, 2023 THROUGH JUNE 30, 2024. ADVENTIST BOLINGBROOK HOSPITAL DBA UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK, WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH BOLINGBROOK OR "THE HOSPITAL". THE HOSPITAL IS A PARTIALLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC PROVIDES MANAGEMENT SERVICES TO THE FILING ORGANIZATION. AHSSHC IS THE 501(C)(3) PARENT ORGANIZATION OF A HOSPITAL AND HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. THIS IS THE FIRST-YEAR UPDATE FOR THE HOSPITAL'S 2023-2025 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITAL DEVELOPED THIS PLAN AND POSTED IT IN MAY 2023 AS PART OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA INTERVIEWS AND SURVEYS; SECONDARY DATA FROM LOCAL, REGIONAL, AND NATIONAL HEALTH-RELATED SOURCES; AND HOSPITAL PREVALENCE DATA TO HELP THE HOSPITAL DETERMINE THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. ONCE THE DATA WAS GATHERED, THE HEALTH ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY PRIORITIES FOR THE HOSPITAL TO ADDRESS IN ITS COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIES IDENTIFIED IN 2022 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE PRIORITIZED NEEDS. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED NEEDS THAT THE HOSPITAL DID NOT PRIORITIZE TO ADDRESS. THE HOSPITAL'S CHOSEN PRIORITIES ARE LISTED BELOW.1. BEHAVIORAL HEALTH AND SUBSTANCE MISUSE2. ACCESS TO CAREPRIORITY 1: BEHAVIORAL HEALTH AND SUBSTANCE MISUSE2022 DESCRIPTION OF THE PRIORITY:DURING THE ASSESSMENT, 47.2% OF COMMUNITY SURVEY RESPONDENTS SHARED DEPRESSION/ANXIETY WERE A PROBLEM IN THEIR HOME. IT WAS ALSO FOUND THAT 5.3% BELIEVED PRESCRIPTION DRUG USE WAS A PROBLEM IN THEIR HOME AND NEARLY 53% BELIEVE IT IS A PROBLEM IN WILL COUNTY. PUBLIC DATA ALSO FOUND THAT 56% OF 12TH GRADERS USE ALCOHOL, WITH 16% REPORTING THEY HAVE ENGAGED IN BINGE DRINKING IN THE LAST TWO WEEKS. AWARENESS AND THE NEED TO ADDRESS BEHAVIORAL HEALTH HAS BEEN GROWING IN THE COUNTRY AND LOCALLY.2023 UPDATE:GOAL 1.1: INCREASE THE PROPORTION OF PEOPLE WHO GET A REFERRAL FOR MENTAL HEALTH AND/ OR SUBSTANCE MISUSE SERVICES AFTER AN EMERGENCY DEPARTMENT VISIT.OBJECTIVE 1.1.1: BY DECEMBER 31, 2025, INCREASE THE PERCENTAGE OF MENTAL HEALTH AND SUBSTANCE MISUSE PATIENTS WHO ARE ASSESSED IN THE EMERGENCY DEPARTMENT AND RECEIVE A REFERRAL FOR COMMUNITY-BASED BEHAVIORAL HEALTH RESOURCES FROM 33.8 % TO 43.8%.IN 2023, THE HOSPITAL SAW A DECREASE IN THE PERCENTAGE OF MENTAL HEALTH AND SUBSTANCE MISUSE PATIENTS BUT WILL CONTINUE TO COLLECT AND REVIEW DATA TO BE ASSESSED DOWN THE LINE. OBJECTIVE 1.1.2: BY DECEMBER 31, 2025, CREATE A LOOP REFERRAL AGREEMENT WITH AT LEAST TWO AGENCIES FOR THE WHOLE HEALTH HUB. THE WHOLE HEALTH HUB IS AN ADVENTHEALTH BRANDED PLATFORM OUR CLINICAL TEAMS USE TO REFER PATIENTS TO NEARBY SOCIAL SERVICES AGENCIES BASED ON THE PATIENT'S INDIVIDUAL NEEDS.IN 2023, THE HOSPITAL REENGAGED WITH LEADERS TO DISCUSS CURRENT COMMUNITY PARTNERS TO DECIDE ON WHO WILL BE REFERRED THROUGH WHOLE HEALTH HUB. GOAL 1.2: INCREASE AWARENESS OF MENTAL HEALTH AND SUBSTANCE MISUSE CHALLENGES TO REDUCE STIGMAOBJECTIVE 1.2.1: BY DECEMBER 31, 2025, 90% OF PARTICIPANTS WILL HAVE A KNOWLEDGE INCREASE AFTER ATTENDING THE COMMUNITY-WIDE MENTAL HEALTH AND SUBSTANCE MISUSE EDUCATIONAL SERIES.IN 2023, THE HOSPITAL DID NOT HOST ANY EDUCATIONAL SERIES. OBJECTIVE 1.2.2: BY DECEMBER 31, 2025, INCREASE KNOWLEDGE AND SKILLS (EX. HOW TO INTERVENE WHEN A PERSON IS EXPERIENCING A MENTAL HEALTH CHALLENGE/CRISIS) OF AT LEAST 90% OF MENTAL HEALTH FIRST AID (MHFA) TRAINING PARTICIPANTS.IN 2023, THE HOSPITAL IN COLLABORATION WITH THE NATIONAL ALLIANCE FOR MENTAL ILLNESS METRO SUBURBAN, OFFERED A MHFA TRAINING TO FAITH LEADERS. TEN PEOPLE WERE TRAINED.PRIORITY 2: ACCESS TO CARE2022 DESCRIPTION OF THE PRIORITY:ACCESS TO CARE IS A KEY DRIVER TO HEALTH. ACCESS CAN BE INFLUENCED BY BOTH COST AND AVAILABILITY. ACCORDING TO 30% OF COMMUNITY SURVEY RESPONDENTS, THEIR HOUSEHOLDS ARE NEVER, RARELY OR ONLY SOMETIMES ABLE TO PAY FOR HEALTH CARE (FAMILY DOCTOR, PRESCRIPTIONS, ETC.). AN IMPORTANT FACTOR IS AVAILABILITY OF CARE AND REQUIRES HAVING AN ADEQUATE NUMBER OF PROVIDERS IN A COMMUNITY. THERE IS A SHORTAGE OF PRIMARY CARE, MENTAL HEALTH AND DENTAL CARE PROVIDERS IN THE COUNTY. THE COUNTY HAS FEWER PROVIDERS BY POPULATION COMPARED TO BOTH THE STATE AND THE NATION. FOR EXAMPLE, THE RATE OF PRIMARY CARE PROVIDERS IN WILL COUNTY IS 1,810:1, COMPARED TO THE IL RATE OF 1,240:1 AND THE NATIONAL RATE OF 1,030:1.2023 UPDATE:GOAL 2.1: INCREASE ACCESS TO COMPREHENSIVE AND HIGH-QUALITY HEALTH CARE SERVICES.OBJECTIVE 2.1.1: BY DECEMBER 31, 2025, HOST 12 ENROLLMENT EVENTS TO GIVE PATIENTS AND COMMUNITY MEMBERS AN OPPORTUNITY TO ENROLL IN HEALTH CARE COVERAGE.IN 2023, THE HOSPITAL DID NOT HAVE THE INTERNAL RESOURCES OR BUDGET AND WILL HAVE TO RELY ON COMMUNITY PARTNERS TO HOST THE EVENTS. PRIORITIES NOT ADDRESSED BY THE HOSPITAL: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE HEALTH NEEDS THROUGH THE COLLECTION OF PRIMARY AND SECONDARY DATA. AFTER REVIEWING THE DATA, THE HOSPITAL AND COMMUNITY STAKEHOLDERS CONDUCTED A PRIORITIZATION PROCESS. LISTED BELOW ARE THE PRIORITIES NOT ADDRESSED AND THE REASON WHY THEY WERE NOT SELECTED TO BE ADDRESSED.1. STABILIZING THE BUILT ENVIRONMENT: THE HOSPITAL DECIDED THAT HOUSING AND TRANSPORTATION, ALTHOUGH AN IDENTIFIED NEED FOR A MULTITUDE OF REASONS, IS BEING ADDRESSED AS COUNTYWIDE BY OTHER ORGANIZATIONS BETTER POSITIONED TO ADDRESS IT AND THE HOSPITAL COULD NOT MAKE MEANINGFUL CHANGE IN THE TIME ALLOTTED FOR THE NEXT COMMUNITY HEALTH PLAN.2. ACCESS TO FOOD AND NUTRITION: ALTHOUGH ACCESS TO HEALTHY AFFORDABLE FOOD IS A KEY DRIVER OF HEALTH OUTCOMES, THE HOSPITAL DID NOT CHOOSE TO ADDRESS THIS PRIORITY. THE HOSPITAL BELIEVES THAT OTHER ORGANIZATIONS ARE BETTER POSITIONED IN THE COMMUNITY TO ADDRESS THIS NEED DIRECTLY AND WILL SUPPORT THOSE EFFORTS WHEN ABLE. |
| SCHEDULE H, PART V, SECTION B, LINE 7A: | THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS |
| SCHEDULE H, PART V, SECTION B, LINE 10A: | THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS |
| SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: | THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT URL:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/FINANCIAL-ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - UCMC AH CANCER INST - RETAIL PHARMACY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SALT CREEK LANE | AddressLine1Txt |
| City | HINSDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60521 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | CANCER CENTER - RETAIL PHARMACY | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL IS ELIGIBLE FOR A 100% REDUCTION FROM APPLICABLE CHARGES IF THE INDIVIDUAL'S HOUSEHOLD INCOME IS AT OR BELOW 250% OF THE CURRENT FEDERAL POVERTY GUIDELINES (FPG). UNINSURED PATIENTS WITH HOUSEHOLD INCOMES THAT EXCEED 250% OF THE FPG BUT ARE LESS THAN 401% ARE GRANTED A 98% DISCOUNT ON APPLICABLE BALANCES. INSURED PATIENTS WITH OUT-OF-POCKET BALANCES WITH HOUSEHOLD INCOMES BETWEEN 250% AND 400% OF THE FPG MAY RECEIVE A 75% DISCOUNT FROM APPLICABLE CHARGES. UNINSURED PATIENTS WITH HOUSEHOLD INCOMES BETWEEN 401% AND 600% OF THE FPG ARE GRANTED AN 85% DISCOUNT ON APPLICABLE BALANCES. ALTERNATIVELY, A PATIENT MAY ALSO QUALIFY FOR A 100% REDUCTION FROM CHARGES WHEN THE UNPAID PORTION OF A PATIENT'S BILL EXCEEDS 20% OF THE INDIVIDUAL'S ANNUAL HOUSEHOLD INCOME, WHERE THE PATIENT HAS QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE CURRENT FPG WITHIN A 12-MONTH PERIOD, AND THE PATIENT'S HOUSEHOLD INCOME DOES NOT EXCEED 600% OF FPG FOR UNINSURED PATIENTS AND 400% FOR INSURED PATIENTS. MEDICARE RECIPIENTS MAY ALSO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DEPENDING UPON THE INDIVIDUAL'S INCOME AND RESOURCES. RESOURCES ARE GENERALLY DEFINED AS ASSETS SUCH AS MONEY IN CHECKING OR SAVINGS ACCOUNTS, STOCKS, AND BONDS. |
| PART I, LINE 6A: | THE FILING ORGANIZATION WAS A PARTIALLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING 2024, AHSSHC SERVED AS A PARENT ORGANIZATION TO 33 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND OTHER SUBSIDIARY HEALTH CARE ORGANIZATIONS THAT OPERATED IN 12 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. THE FILING ORGANIZATION PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT ON A SEPARATE ENTITY BASIS FOR THE HOSPITAL(S) THAT IT OWNS AND OPERATES. THE SEPARATE ANNUAL COMMUNITY BENEFIT REPORT IS GENERALLY UTILIZED FOR STATE COMMUNITY BENEFIT REPORTING AND/OR FOR OTHER LOCAL COMMUNITY PURPOSES. |
| PART I, LINE 7: | THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. |
| PART III, LINE 2: | THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. |
| PART III, LINE 3: | METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON MEETING CERTAIN SPECIFIED CONDITIONS, SUCH AS SELF-IDENTIFYING AS BEING HOMELESS. PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE MAY ALSO BE BASED ON THE HOSPITAL'S USE OF INDEPENDENT ELIGIBILITY ASSESSMENT SCORING TOOLS THAT ARE DESIGNED TO ASSIST IN DETERMINING A PATIENT'S ECONOMIC MEANS. SUCH INFORMATION MAY INCLUDE DOCUMENTATION FROM CREDIT REPORTS, OTHER THIRD-PARTY ASSET INFORMATION, AND INCOME VERIFICATION. INDIVIDUALS WHO HAVE BEEN FOUND TO HAVE A PAYMENT CAPABILITY SCORE OF LOW OR UNKNOWN BASED UPON THE INDEPENDENT ELIGIBILITY ASSESSMENT TOOLS ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL MAY BE WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOLS IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS ONE OR MORE 24/7 EMERGENCY ROOM(S) PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME-PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. |
| PART III, LINE 4: | FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 13 - 15. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. |
| PART III, LINE 8: | PART III, LINE 8:COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS ARE CALCULATED USING A COST-TO-CHARGE RATIO.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT. |
| PART III, LINE 9B: | THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4)-(R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAN 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY EXTRAORDINARY COLLECTIONS ACTIONS AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL TAKE ALL AVAILABLE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTIONS ACTIONS AGAINST THE INDIVIDUAL. |
| SCHEDULE H, PART III, SECTION B, LINE 8: | RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICES TO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (3,880,833)- DIFFERENCE IN COSTING METHODOLOGY: 3,442,672- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (5,578,847) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $ (6,017,008)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION. |
| PART VI, LINE 2: | THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2022 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2022, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2022 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. |
| PART VI, LINE 3: | THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROK HAS 138 BEDS AND IS ONE OF FOUR HOSPITALS IN COOK, DUPAGE AND WILL COUNTIES THAT COMPOSES THE ADVENTHEALTH GREAT LAKES DIVISION. IN 2022, ADVENTHEALTH PARTNERED WITH UCHICAGO MEDICINE TO BRING TOGETHER ONE OF THE NATION'S TOP ACADEMIC MEDICAL INSTITUTIONS AND A NATIONAL LEADER IN WHOLE-PERSON HEALTHCARE. WITH ADVENTHEALTH'S MISSION OF EXTENDING THE HEALING MINISTRY OF CHRIST, UCHICAGE MEDICINE ADVENTHEALTH BOLINGBROOK PROVIDES WHOLE PERSON CARE TO HEAL THE BODY, MIND AND SPIRIT. IT IS ACTIVE WITHIN THE COMMUNITY BY PARTNERING WITH LOCAL PART DISTRICTS, OFFERING AN ANNUAL FAMILY FUN MOVIE NIGHT EVENT, PROVIDING AN ONSITE COMMUNITY PANTRY, ATTENDING LOCAL EVENTS AND HEALTH FAIRS AND PROVIDING EDUCATIONAL LECTURES. SERVICES OFFERED AT THE HOSPITAL INCLUDE EMERGENCY CARE, HEART & VASCULAR CARE, CANCER CARE, INFUSION THERAPY, INTERVENTIONAL RADIOLOGY, SURGICAL SERVICES, OBSTETRICS, WOMEN'S SERVICES, BARIATRIC AND WEIGHT LOSS, EXECUTIVE HEALTH SERVICES, RHEUMATOLOGY, ORTHOPEDICS, PAIN MANAGEMENT, BEHAVIORAL GERIATRIC CARE, IMAGING AND LAB SERVICES.DURING 7/1/23 - 6/30/24, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. DURING 7/1/23 - 6/30/24, ABOUT 78.6% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 40.9% - MEDICAID PATIENTS 20.5% - SELF-PAY PATIENTS 3.0%THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION 523,630 - POPULATION OVER 65 13.8% - POVERTY (BELOW 100% FPL) 6.3% - HIGH SCHOOL GRADUATION RATE 92.7% - UNINSURED ADULTS 5.2% - FOOD INSECURITY RATE 9% - POP. WITH LOW FOOD ACCESS 72% |
| PART VI, LINE 5: | THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTIST BOLINGBROOK HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $7,723,992 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. |
| PART VI, LINE 6: | THE FILING ORGANIZATION HAS TWO TOP-TIER MEMBERS. THE MEMBERS ARE THE UNIVERSITY OF CHICAGO MEDICAL CENTER AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI). AHSSI IS A WHOLLY-OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. THE FILING ORGANIZATION CAN DRAW UPON THE EXPERTISE AND LEADERSHIP OF BOTH ITS HEALTH SYSTEM MEMBERS IN ITS EFFORT TO CREATE EXCELLENT PATIENT EXPERIENCES AND OFFER A BROAD SPECTRUM OF HEALTH SERVICES NEEDED IN THE COMMUNITY. DURING ITS CURRENT TAX YEAR, THE FILING ORGANIZATION WAS MANAGED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 50 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AHSSHC (MANAGER) PROVIDES MANAGEMENT SERVICES TO THE FILING ORGANIZATION PURSUANT TO A MASTER MANAGEMENT SERVICES AGREEMENT. MANAGEMENT SERVICES PROVIDED INCLUDE THE PROVISION AND LEASING OF PERSONNEL, AND DAY-TO-DAY MANAGEMENT OF THE BUSINESS AFFAIRS AND OPERATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING REVENUE CYCLE SUPPORT, FINANCIAL OPERATIONS SUPPORT, CLINICAL PROTOCOLS, ACCREDITATION AND CONDITIONS OF PARTICIPATION COMPLIANCE, AND A COMPLIANCE PROGRAM. THE MANAGER ALSO PROVIDES DEVELOPMENT AND FACILITY MANAGEMENT, FINANCE AND ACCOUNTING SERVICES, HUMAN RESOURCES, INTERNAL AUDIT, LEGAL, GOVERNMENT RELATIONS, PURCHASING/MATERIALS MANAGEMENT, INFORMATION, MEDICAL AND PROFESSIONAL MATTERS, AND REGULATORY SERVICES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. THE FILING ORGANIZATION PAYS A MANAGEMENT FEE TO AHSSHC FOR THE SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH OR THE UNIVERSITY OF CHICAGO MEDICAL CENTER AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEBSITE AT WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF THE FILING ORGANIZATION. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IL |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| HINSDALE ADVENTIST ACADEMY | ||||||||
| 631 E HICKORY STREET | HINSDALE | IL | 60521 | 364090219 | 501(C)(3) | $25,000 | $0 | GENERAL SUPPORT |
| WILL COUNTY CHAMBER OF COMMERCE | ||||||||
| 203 N OTTAWA ST SUITE 100 | JOLIET | IL | 60432 | 363772737 | 501(C)(6) | $16,250 | $0 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE GENERALLY MADE ONLY TO AFFILIATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THORDARSON THOR | ||||||||||||||
| DIR/PRES (END 11/23) | $203,519 | $610,556 | $27,433 | $82,298 | $10,770 | $32,311 | $38,597 | $115,792 | $4,878 | $14,633 | $285,197 | $855,590 | $0 | $0 |
| BUCHANAN HERBERT | ||||||||||||||
| DIR END 4/24, CEO END 2/24 | $123,997 | $371,991 | $10,648 | $31,943 | $28,255 | $84,764 | $4,432 | $13,295 | $2,250 | $6,750 | $169,582 | $508,743 | $0 | $0 |
| DAVARAPALLI MD RAMADEVI | ||||||||||||||
| DIRECTOR (END 12/23) | $0 | $424,827 | $0 | $84,535 | $0 | $8,107 | $0 | $18,150 | $0 | $28,578 | $0 | $564,197 | $0 | $0 |
| RADIVOJEVIC VLADIMIR | ||||||||||||||
| FORMER VP/COO BOLINGBROOK/GLENOAK | $0 | $343,098 | $0 | $38,893 | $0 | $26,249 | $0 | $69,378 | $0 | $32,100 | $0 | $509,718 | $0 | $0 |
| KRIKORIAN MD ARMAND | ||||||||||||||
| CMO BOLING/GLENOAKS | $188,245 | $188,245 | $0 | $0 | $2,694 | $2,694 | $36,556 | $36,556 | $15,203 | $15,203 | $242,698 | $242,698 | $0 | $0 |
| SHAW TRISTAN | ||||||||||||||
| CFO BOLINGBROOK (BEG 8/23) | $75,918 | $146,259 | $0 | $0 | $10,346 | $15,990 | $0 | $7,600 | $9,686 | $32,581 | $95,950 | $202,430 | $0 | $0 |
| BROWN JARED | ||||||||||||||
| CFO (END 8/23) | $74,026 | $74,026 | $9,095 | $9,095 | $42,449 | $42,449 | $1,368 | $1,368 | $10,555 | $10,555 | $137,493 | $137,493 | $0 | $0 |
| CARROLL MD RICHARD | ||||||||||||||
| FORMER CMO BOLINGBROOK/GLENOAKS | $0 | $0 | $545 | $545 | $120,895 | $120,895 | $0 | $0 | $5,114 | $5,114 | $126,554 | $126,554 | $0 | $0 |
| GALLAGHER RN KAREN | ||||||||||||||
| CNO BOLINGBROOK | $165,008 | $0 | $0 | $0 | $1,884 | $0 | $7,567 | $0 | $12,450 | $0 | $186,909 | $0 | $0 | $0 |
| SPAGNOLIA RN JENNIFER | ||||||||||||||
| INTERIM CNO BOLINGBROOK (3/18-4/14/2 | $152,553 | $0 | $0 | $0 | $1,178 | $0 | $4,824 | $0 | $18,310 | $0 | $176,865 | $0 | $0 | $0 |
| NOSEWORTHY GORDON E | ||||||||||||||
| CEO-INTERIM (12/23-3/24) | $0 | $0 | $0 | $0 | $155,250 | $0 | $0 | $0 | $0 | $0 | $155,250 | $0 | $0 | $0 |
| PAWLIK RN COLLEEN | ||||||||||||||
| CNO BOLING/GLENOAKS | $38,389 | $38,389 | $9,743 | $9,743 | $2,311 | $2,311 | $0 | $0 | $3,565 | $3,565 | $54,008 | $54,008 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE FILING ORGANIZATION'S PARENT IS OWNED 49% BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE PARENT CORPORATION OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. THE REMAINING 51% MEMBER IS THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC). BOTH AHSSHC AND UCMC ARE 501(C)(3) TAX-EXEMPT ORGANIZATIONS. EFFECTIVE JANUARY 1, 2023, THE FILING ORGANIZATION ENTERED INTO A MASTER MANAGEMENT AGREEMENT WITH AHSSHC WHEREBY AHSSHC SUPERVISES AND MANAGES THE DAY-TO-DAY OPERATIONS OF THE FILING ORGANIZATION. PURSUANT TO THE MASTER MANAGEMENT AGREEMENT, AHSSHC, AS MANAGER, PROVIDES THE CHIEF EXECUTIVE OFFICER (CEO), CHIEF OPERATING OFFICER (COO), CHIEF FINANCIAL OFFICER (CFO), CHIEF NURSING OFFICER (CNO), CHIEF MEDICAL OFFICER (CMO), AND THE CEO THE FILING ORGANIZATION. THE CEO OF THE FILING ORGANIZATION IS RESPONSIBLE FOR APPOINTING THE OTHER KEY MEMBERS OF HIS OR HER MANAGEMENT TEAM. THESE APPOINTED MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM ARE SUPPLIED BY AHSSHC AS MANAGER AND ARE W-2 EMPLOYEES OF AHSSHC. AS THE ABOVE ENUMERATED C-SUITE PERSONNEL AND OTHER MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM ARE PROVIDED TO THE FILING ORGANIZATION BY AHSSHC, THE COMPENSATION PRACTICES AND POLICIES OF AHSSHC ARE FOLLOWED BY THE FILING ORGANIZATION AND ITS SUBSIDIARIES. MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF AHSSHC. AS AHSSHC IS NOT CONSIDERED A RELATED ORGANIZATION PURSUANT TO THE FORM 990 DEFINITIONS AND INSTRUCTIONS, COMPENSATION AND BENEFIT INFORMATION FOR THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM SHOWN ON PART VII IS BEING REPORTED FOR THAT PORTION OF EACH INDIVIDUAL'S COMPENSATION AND BENEFITS THAT IS PROVIDED IN EXCHANGE FOR SERVICES PROVIDED TO THE FILING ORGANIZATION AND ITS RELATED SUBSIDIARIES. FIRST-CLASS OR CHARTER TRAVEL: PURSUANT TO THE ADVENTHEALTH SYSTEM-WIDE GENERAL POLICY REGARDING BUSINESS TRAVEL, NO REIMBURSEMENT WILL BE PROVIDED FOR ANY ADDITIONAL COST INCURRED WITH RESPECT TO FIRST-CLASS OR CHARTER AIR TRAVEL BEYOND THE COST OF A REGULAR COACH AIRFARE. AS A MEANS OF PROVIDING ADDITIONAL BUSINESS TRAVEL REIMBURSEMENT FOR THOSE MEMBERS OF THE AHSSHC SENIOR EXECUTIVE MANAGEMENT TEAM THAT TRAVEL FREQUENTLY ON BEHALF OF ADVENTHEALTH, A SPECIAL ANNUAL TRAVEL ALLOWANCE IS PROVIDED FOR THOSE EXECUTIVES. AS ADVENTHEALTH OPERATES 50 HOSPITALS IN 9 STATES, THE SENIOR LEADERSHIP OF AHSSHC TRAVEL EXTENSIVELY AND OFTEN VISIT MULTIPLE HOSPITAL LOCATIONS IN DIFFERENT STATES AS A PART OF A SINGLE BUSINESS TRIP. THE SPECIAL TRAVEL ALLOWANCE CAN PROVIDE REIMBURSEMENTS TO THE EXECUTIVE FOR SUCH ITEMS AS THE PURCHASE OF AIR TRAVEL UPGRADE COUPONS, TO COVER THE COST DIFFERENTIAL BETWEEN COACH AND FIRST-CLASS TRAVEL, OR TO COVER THE COST OF A CHARTER FLIGHT. THE SPECIAL TRAVEL ALLOWANCE BENEFIT WAS ORIGINALLY AUTHORIZED BY AND CODIFIED INTO A POLICY BY THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE), AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS, WHO ALSO APPROVES THE ANNUAL CAP ON THE AMOUNT OF THE ALLOWANCE. THE SPECIAL TRAVEL ALLOWANCE HAS AN ANNUAL CAP OF $24,000 FOR MEMBERS OF THE LEADERSHIP EXECUTIVE TEAM (15 ADVENTHEALTH CABINET MEMBERS AND THE ADVENTHEALTH MULTI-STATE CFO) AND $15,000 FOR ADVENTHEALTH CORPORATE OFFICE SENIOR VICE PRESIDENTS, REGIONAL CEO'S, AND DIVISION CHIEF OFFICERS (GENERALLY 45-55 INDIVIDUAL EXECUTIVES). THE REGIONAL CEO/BOARD MEMBER LISTED ON PART VII OF THE FILING ORGANIZATION'S FORM 990 IS ON THE PAYROLL OF AHSSHC AND IS PROVIDED TO THE FILING ORGANIZATION PURSUANT TO THE MASTER MANAGEMENT SERVICES AGREEMENT. WHILE THE SPECIAL TRAVEL ALLOWANCE BENEFIT IS AN AHSSHC COMPENSATION POLICY AND PRACTICE, THE COST OF PROVIDING THIS BENEFIT IS CHARGED TO AND REIMBURSED BY THE FILING ORGANIZATION. ACCORDINGLY, THE FILING ORGANIZATION HAS CHECKED THE BOX IN SCHEDULE J, PART I, LINE 1A FOR FIRST-CLASS OR CHARTER TRAVEL SINCE IT HAS PAID FOR THE COST OF PROVIDING THIS BENEFIT. THOSE EXECUTIVES WHO RECEIVE THE SPECIAL TRAVEL ALLOWANCE ARE RESPONSIBLE FOR TRACKING THE EXPENSES REIMBURSABLE UNDER THE SPECIAL TRAVEL ALLOWANCE AND MUST SUBMIT SUCH EXPENSES ON THEIR ACCOUNTABLE PLAN EXPENSE REPORT. A REPORT ON CHARTER TRAVEL IS PROVIDED TO THE AHSSHC BOARD COMPENSATION COMMITTEE AT EACH MEETING. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES UNDER THE SPECIAL TRAVEL ALLOWANCE ARRANGEMENT ARE TREATED AS TAXABLE COMPENSATION TO THE EXECUTIVE. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO CERTAIN EXECUTIVE LEADERS AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL ADVENTHEALTH PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ADVENTHEALTH HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL BY THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: OCCASIONAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH PRESIDENT'S COUNCIL, CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING. PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. |
| PART I, LINE 3 | THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), AN UNRELATED ENTITY AS DISCLOSED IN OUR RESPONSE TO FORM 990, SCHEDULE J, PART I, LINE 1A, FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO PURSUANT TO THE MASTER MANAGEMENT AGREEMENT BETWEEN AHSSHC AND UCMC. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION SECTION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT, OTHER THAN THE CHIEF PEOPLE OFFICER, WHO REMAINS AT THE REQUEST OF THE CHAIRMAN/COMMITTEE TO PROVIDE ASSISTANCE/INFORMATION AS NEEDED. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD-PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO ADVENTHEALTH AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF ADVENTHEALTH WILL NOT EXCEED THE 50TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. |
| PART I, LINES 4A-B | DURING THE YEAR ENDING DECEMBER 31, 2023, RICHARD CARROLL AND JARED BROWN RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $221,658 AND $72,693 RESPECTIVELY. PURSUANT TO THE AHSSHC CORPORATE EXECUTIVE POLICY GOVERNING EXECUTIVE SEVERANCE, SEVERANCE AGREEMENTS FOR EXECUTIVES OPERATING AT THE VICE PRESIDENT LEVEL AND ABOVE ARE ENTERED INTO UPON ELIGIBILITY TO FACILITATE THE TRANSITION TO SUBSEQUENT EMPLOYMENT FOLLOWING AN INVOLUNTARY SEPARATION FROM EMPLOYMENT WITH ADVENTHEALTH. INTRODUCTION TO LINE 4B: PURSUANT TO THE AFFILIATION AGREEMENT BETWEEN AHSSHC AND UCMC, THE INDIVIDUALS LISTED IN PART VII INCLUDE INDIVIDUALS WHO ARE COMPENSATED BY AHSSHC AS MANAGER. ACCORDINGLY, THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS SPONSORED BY AHSSHC ARE DISCUSSED BELOW. THE OFFICERS AND KEY EMPLOYEES LISTED IN PART VII ARE PROVIDED TO THE FILING ORGANIZATION BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) PURSUANT TO THE MASTER MANAGEMENT AGREEMENT. THE EXECUTIVE MANAGEMENT TEAM PROVIDED TO THE FILING ORGANIZATION PARTICIPATES IN THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS SPONSORED BY AHSSHC. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS ARE DESCRIBED BELOW AND INCLUDES ALL PLANS IN WHICH THERE WERE ANY PARTICIPANTS IN 2023. SERP III PLAN: THE SERP III PLAN PROVIDES ELIGIBLE EXECUTIVES A PERCENTAGE OF THEIR BASE PAY, WHICH IS CREDITED TO A DEFERRED COMPENSATION ACCOUNT. THE PLAN ALSO PROVIDES FOR COMPENSATION DEFERRAL AND SELECTION OF LIFE INSURANCE COVERAGE AND LONG-TERM CARE INSURANCE. TO BE ELIGIBLE TO PARTICIPATE IN THE SERP III PLAN, EXECUTIVES MUST BE ON THE AHSSHC CORPORATE PAYROLL AND BE EITHER A CEO OF AN ADVENTHEALTH ENTITY, AN AHSSHC VICE PRESIDENT (VP) OR VP OF AN ADVENTHEALTH ENTITY WITH A BASE SALARY OF AT LEAST $330,000 IN 2023 (ADJUSTED ANNUALLY BY THE SAME PERCENTAGE AS IRC SECTION 401(A)(17) LIMIT INCREASES), OR OTHER LEADER SPECIFICALLY APPROVED BY THE ADVENTHEALTH PRESIDENT. ELIGIBLE EXECUTIVES DO NOT INCLUDE GRANDFATHERED EXECUTIVES, MEANING THOSE EXECUTIVES WHO WOULD SATISFY ALL THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN PRIOR TO DEC 31, 2027, HAD THE PLAN NOT BEEN AMENDED AND RESTATED AS OF JAN. 1, 2020. CONTRIBUTION CREDITS WILL BE ESTABLISHED AND MAINTAINED BY CLASS YEAR ACCOUNTS FOR EACH PARTICIPANT USING TIERED CONTRIBUTION CREDIT PERCENTAGES OF ANNUAL BASE COMPENSATION. CONTRIBUTION CREDIT PERCENTAGES RANGE BETWEEN 15% AND 19% OF BASE COMPENSATION. CONTRIBUTION CREDITS WILL BE MADE EACH QUARTER IN 25% INCREMENTS WITH REDUCTIONS IN CONTRIBUTIONS IF THE EXECUTIVE IS ALSO A GRANDFATHERED FLEX PARTICIPANT (SEE BELOW). SERP III PROVIDES FOR A CLASS YEAR VESTING AND PAYMENT SCHEDULE (7 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S DEFERRED COMPENSATION ACCOUNT. UPON ATTAINMENT OF A NORMAL RETIREMENT AGE (AGE 62), OR UPON CERTAIN OTHER CIRCUMSTANCES AS DEFINED IN THE SERP III PLAN DOCUMENT, ALL DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT. FOR ANY EXECUTIVES WORKING BEYOND THE NORMAL RETIREMENT AGE, FUTURE EMPLOYER CONTRIBUTIONS WILL BE MADE QUARTERLY FROM SERP III DIRECTLY TO THE PARTICIPANT AS A TAXABLE CASH BONUS. SERP II PLAN: THE SERP II PLAN IS A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO ADVENTHEALTH AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. UNDER THE PROVISIONS OF THE SERP II PLAN, BENEFITS ARE PROVIDED TO QUALIFYING EXECUTIVE PARTICIPANTS ON A PRO-RATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF ADVENTHEALTH AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. ELIGIBLE EMPLOYEES ARE RESTRICTED TO THOSE EXECUTIVES WHO, AS OF JANUARY 1, 2020, SATISFIED, OR IF EMPLOYMENT CONTINUES, WILL SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II PRIOR TO DECEMBER 31, 2027. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP II) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM ADVENTHEALTH ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO SERP II AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN: THE FLEX PLAN WAS ORIGINALLY DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES AN OPPORTUNITY TO SELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. IN 2020, THE FLEX PLAN WAS AMENDED TO EXCLUDE EMPLOYED EXECUTIVES WHO ARE HIRED OR PROMOTED AFTER A CERTAIN DATE FROM BEING ELIGIBLE TO PARTICIPATE IN THE FLEX PLAN EXCEPT FOR CERTAIN INSURANCE COVERAGE FEATURES OF THE PLAN. THE FLEX PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS IS DEDUCTED. THE BENEFITS ALLOWANCE CREDIT PERCENTAGE FOR ANY PLAN YEAR SHALL NOT BE GREATER THAN THE MAXIMUM DOLLAR AMOUNT OR THE PERCENTAGE OF COMPENSATION AS DETERMINED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. FOR GRANDFATHERED ELIGIBLE EMPLOYEES, THE ANNUAL PRE-DETERMINED FLEX ALLOWANCE IS CONTRIBUTED AND ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED ARE, AT THE EMPLOYEE'S OPTION, CONTRIBUTED TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT WILL BE FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. |
| FORM 990, PART I, LINE 4B: | WITH RESPECT TO GRANDFATHERED PARTICIPANTS, THE FLEX PLAN DOCUMENTS DEFINE ELIGIBLE EMPLOYEES TO INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY WAS AT LEAST EQUAL TO THE INTERNAL REVENUE CODE SECTION 401(A)(17) COMPENSATION LIMIT EACH YEAR. FLEX PLAN FLEX PLAN SERP III SERP III CONTR. DISTR.* CONTR. DISTR.* THORDARSON,THOR $ 0 $ 0 $ 147,790 $ 0 BUCHANAN, HERBERT $ 0 $ 0 $ 73,311 $ 73,311 RADIVOJEVIC, VALADMIR $ 0 $ 0 $ 51,651 $ 0 KRIKORIAN, ARMAND $ 0 $ 0 $ 55,385 $ 0 * INCLUDING INVESTMENT EARNINGS |
| FORM 990, PART VII, SECTION A, LINE 5: | THE CEO, CFO, COO, CMO, AND CNO WERE COMPENSATED BY AHSSHC, AN UNRELATED ORGANIZATION, DURING THE FISCAL YEAR ENDED JUNE 30, 2024, FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. PLEASE SEE OUR RESPONSE TO FORM 990, SCHEDULE J, PART I, LINE 1A FOR A DISCUSSION CONCERNING THE PROVISION OF EXECUTIVE MANAGEMENT PERSONNEL BY AHSSHC AS MANAGER TO THE FILING ORGANIZATION. COMPENSATION FOR THESE EXECUTIVES IS DISCLOSED IN PART VII AND SCHEDULE J, PART II. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 1A: | EFFECTIVE JANUARY 1, 2023, THE FILING ORGANIZATION'S PARENT ENTERED INTO A MASTER MANAGEMENT AGREEMENT WITH ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AHSSHC HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AHSSHC SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AHSSHC AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AHSSHC, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AHSSHC WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AHSSHC IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. |
| FORM 990, PART VI, SECTION A, LINE 6 | ADVENTIST BOLINGBROOK HOSPITAL (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST MIDWEST HEALTH. ADVENTIST MIDWEST HEALTH (AMH) IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THE CORPORATE MEMBER, AMH. THE CORPORATE MEMBER IS ENTITLED TO ELECT NOT LESS THAN EIGHTEEN (18) AND NO MORE THAN TWENTY THREE (23) VOTING MEMBERS TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION PURSUANT TO THE PROVISIONS OF THE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | CERTAIN RESERVED POWERS ARE RETAINED SOLELY BY THE MEMBER WITH CERTAIN OTHER RESERVED POWERS SUBJECT TO THE APPROVAL OF EITHER THE UNIVERSITY OF CHICAGO MEDICAL CENTER, ADVENTIST HEALTH SYSTEM/SUNBELT, INC., OR BOTH. THE RESERVED POWERS RETAINED SOLELY BY THE MEMBER ARE THE FOLLOWING: - APPROVE MATERIAL CHANGES IN THE CATEGORY OF SERVICES OFFERED BY THE FILING ORGANIZATION; - AUTHORITY TO REQUIRE THE FILING ORGANIZATION'S ADHERENCE TO THE SYSTEM-WIDE NAMING NOMENCLATURE AND SERVICE STANDARDS ADOPTED BY THE MEMBER; - AUTHORITY TO SET AND ENFORCE POLICIES FOR PHYSICIAN COMPENSATION INCLUDING COMMERCIAL REASONABLENESS AND FAIR MARKET VALUE; - AUTHORITY TO ADOPT RULES AND REGULATIONS FOR THE MANAGEMENT OF THE FILING ORGANIZATION AS DEEMED PROPER; - APPOINTMENT OF AN INDIVIDUAL PROPOSED BY ADVENTHEALTH TO HOLD THE OFFICE OF PRESIDENT OF THE FILING ORGANIZATION AND THE TERMINATION OF SUCH APPOINTMENT; AND - THE COMPENSATION OF SUCH INDIVIDUAL HOLDING THE OFFICE OF PRESIDENT. THE FOLLOWING RESERVED POWERS ARE RETAINED BY THE MEMBER SUBJECT TO APPROVAL BY THE UNIVERSITY OF CHICAGO MEDICAL CENTER: - THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION, ALL UNBUDGETED EXPENDITURES IN EXCESS OF $1 MILLION DOLLARS AND THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION; - THE INCURRENCE OF ANY CONTRACTUAL OBLIGATION IS EXCESS OF $1 MILLION DOLLARS; - THE STRATEGIC AND OPERATING PLANS OF THE FILING ORGANIZATION; - THE SELECTION, REMOVAL, OR MODIFICATION OF THE AUTHORITY AND RESPONSIBILITIES OF ACCOUNTANTS AND AUDITORS; - BORROWINGS AND CAPITAL LEASES OF MORE THAN $1 MILLION DOLLARS; - THE APPROVAL OR AMENDMENT OF MANAGED CARE PRICING, PRICING STRATEGIES, AND CONTRACTING PARAMETERS; AND - THE CONFESSION OF A JUDGMENT OR SETTLEMENT OF A CLAIM THAT WOULD EXCEED INSURANCE LIMITS. THE FOLLOWING RESERVED POWERS ARE RETAINED BY THE MEMBER SUBJECT TO THE APPROVAL BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC: - CHANGES TO RELIGIOUS AFFILIATION AND ANY CHANGES IN OPERATION POLICIES, PLANS, AND PROCEDURES RELATED TO SUCH RELIGIOUS AFFILIATION OF ANY FACILITY OWNED BY THE FILING ORGANIZATION; - TERMINATION OF THE INDIVIDUAL HOLDING THE OFFICE OF PRESIDENT IF TERMINATION IS RELATED TO THAT PERSON'S MEMBERSHIP STATUS IN THE SEVENTH-DAY ADVENTIST CHURCH; AND - CHANGES TO THE MISSION, VISION, OR VALUES OF THE FILING ORGANIZATION. THE FOLLOWING RESERVED POWERS ARE RETAINED BY THE MEMBER SUBJECT TO THE APPROVAL OF BOTH THE UNIVERSITY OF CHICAGO MEDICAL CENTER AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC.: - AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS - THE FORMATION OF ANY SUBSIDIARY OF THE FILING ORGANIZATION; - ENTERING INTO ANY AFFILIATION AGREEMENT OR JOINT VENTURE AGREEMENT; - ANY CHANGE IN THE NAME OR BRANDING OF THE HOSPITAL; - THE ADDITION OF NEW MEMBERS OF THE FILING ORGANIZATION; - THE APPOINTMENT AND REMOVAL OF ANY MEMBER OF THE BOARD OF DIRECTORS; - DISTRIBUTIONS OF CASH AND OTHER PROPERTY TO THE MEMBER OR OTHERWISE; - THE ADOPTION AND AMENDMENT OF THE QUALITY AND/OR RISK MANAGEMENT PLANS OF THE HOSPITAL; - THE SELECTION OF THE ACCREDITING BODY OF THE HOSPITAL; - THE TRANSFER OF ANY PROPERTY OF THE HOSPITAL IN EXCESS OF $1 MILLION DOLLARS; - ANY SALE, LEASE, TRANSFER, MERGER OR CONSOLIDATION OF THE FILING ORGANIZATION; - THE DISSOLUTION OF THE FILING ORGANIZATION; - THE FILING OF ANY VOLUNTARY PETITION IN BANKRUPTCY; - REQUIRING ANY ADDITIONAL CAPITAL CONTRIBUTIONS FROM THE MEMBER; AND - THE APPOINTMENT OR REMOVAL OF THE CHAIR OF THE BOARD OF DIRECTORS AND ANY OF THE OTHER BOARD OFFICERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO, CFO AND MEMBERS OF THE UCHICAGO MEDICINE FINANCE LEADERSHIP TEAM PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO, CFO AND MEMBERS OF THE UCHICAGO MEDICINE FINANCE LEADERSHIP TEAM DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), AN UNRELATED ENTITY. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY AHSSHC IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION, ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC AS A WHOLE. |
| PART VIII, LINES 7A, B AND C: | THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM OPERATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE SYSTEM. |
| FORM 990, PART IX, LINE 11G | PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 30,468,779. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,468,779. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 5,118,514. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,118,514. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 11,446,635. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,446,635. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 2,774,489. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,774,489. RECRUITING: PROGRAM SERVICE EXPENSES 7,298. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,298. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 3,398,368. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,398,368. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,174,365. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,174,365. AHS MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 751,146. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 751,146. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 427,055. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 427,055. LEASE PERSONNEL COSTS: PROGRAM SERVICE EXPENSES 87,312,733. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,312,733. LEASE PERSONNEL COSTS MGMT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,179,383. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,179,383. MANAGEMENT FEES REBATES: PROGRAM SERVICE EXPENSES -4,594,224. MANAGEMENT AND GENERAL EXPENSES -1,683,689. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -6,277,913. |
| FORM 990, PART X, LINE 2 | THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, ONE OF THE FILING ORGANIZATION'S TOP-TIER PARENTS. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. |
| PART XII: | FOR GAAP REPORTING, THE AFFILIATION AGREEMENT BETWEEN UCMC AND ADVENTIST MIDWEST HEALTH AND ITS PARENT ORGANIZATIONS, ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC., WAS ACCOUNTED FOR AS A DECONSOLIDATION UNDER ACCOUNTING STANDARDS CODIFICATION (ASC) 810. PLEASE NOTE THAT THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) REFLECT UCMC'S CONTROLLING INTEREST IN THE NET ASSETS AND OPERATIONS OF THE FILING ORGANIZATION. THE CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ITS SUBSIDIARY ORGANIZATIONS INCLUDE ITS 49% INTEREST IN THE FILING ORGANIZATION TO ACCOUNT FOR ITS 49% RETAINED NONCONTROLLING INTEREST IN THE FILING ORGANIZATION UNDER THE EQUITY METHOD OF ACCOUNTING. THE APPROXIMATE NET ASSETS INCLUDED IN THE JUNE 30, 2024 FUND BALANCE AS SHOWN IN PART XI, LINE 10 ASSOCIATED WITH THE 49% NONCONTROLLING INTEREST IS $(35,761,000). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ADVENTIST BOLINGBROOK HOSPITAL | |||||||||||
| 500 REMINGTON BLVD | BOLINGBROOK | IL | 60440 | 651219504 | HOSPITAL | IL | 501(C)(3) PUBLIC CHA | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| ADVENTIST GLENOAKS HOSPITAL | |||||||||||
| 701 WINTHROP AVE | GLENDALE HEIGHTS | IL | 60139 | 363208390 | HOSPITAL | IL | 501(C)(3) PUBLIC CHA | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| ADVENTIST HEALTH PARTNERS INC | |||||||||||
| 5101 S WILLOW SPRINGS RD | LA GRANGE | IL | 60525 | 364138353 | PHYSICIAN PRACTICES | IL | 501(C)(3) PUBLIC CHA | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| ADVENTIST MIDWEST HEALTH | |||||||||||
| 120 N OAK STREET | HINSDALE | IL | 60521 | 362276984 | 2 HOSPITALS | IL | 501(C)(3) PUBLIC CHA | LINE 3 | 0 | N/A | |
| AHP SPECIALTY CARE NFP | |||||||||||
| 5101 S WILLOW SPRINGS RD | LA GRANGE | IL | 60525 | 811105774 | PHYSICIAN PRACTICES | IL | 501(C)(3) PUBLIC CHA | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| AHS MIDWEST MANAGEMENT INC | |||||||||||
| 500 REMINGTON BLVD | BOLINGBROOK | IL | 60440 | 363354567 | EMPLOYEE LEASING | IL | 501(C)(3) PUBLIC CHA | LINE 12C, III-FI | 0 | N/A | |
| MIDWEST HEALTH FOUNDATION | |||||||||||
| 120 N OAK STREET | HINSDALE | IL | 60521 | 352230515 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | IL | 501(C)(3) PUBLIC CHA | LINE 7 | 0 | N/A | |
| HINSDALE HOSPITAL FOUNDATION | |||||||||||
| 7 SALT CREEK LN | HINSDALE | IL | 60521 | 521466387 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | IL | 501(C)(3) PUBLIC CHA | LINE 7 | MIDWEST HEALTH FOUNDATION | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (10 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ADVENTIST MIDWEST HEALTH | ||
| P | $46,032,298 | COST |
| ADVENTIST MIDWEST HEALTH | ||
| Q | $48,619,838 | COST |
| ADVENTIST HEALTH PARTNERS INC | ||
| P | $24,603,466 | COST |
| ADVENTIST GLENOAKS HOSPITAL | ||
| Q | $2,007,609 | COST |
| MIDWEST HEALTH FOUNDATION | ||
| C | $123,829 | ACTUAL AMOUNT RECEIVED |
| ADVENTIST HEALTH PARTNERS INC | ||
| Q | $25,089,707 | COST |
| ADVENTIST GLENOAKS HOSPITAL | ||
| P | $2,214,708 | COST |
| AHS MIDWEST MANAGEMENT INC | ||
| P | $92,005,364 | COST |
| AHS MIDWEST MANAGEMENT INC | ||
| Q | $3,950,631 | COST |
| MIDWEST HEALTH FOUNDATION | ||
| R | $50,971 | ACTUAL AMOUNT TRANSFERRED |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART VII | FormAndLineReferenceDesc |
| Explanation | EFFECTIVE JANUARY 1, 2023, THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) AND ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) AND ITS WHOLLY-OWNED SUBSIDIARY, ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI), ENTERED INTO AN AFFILIATION AGREEMENT (THE AFFILIATION) WHEREBY AHSSI SOLD 51% OF ITS MEMBERSHIP INTEREST IN ADVENTIST MIDWEST HEALTH (AMH) TO UCMC. UCMC, AHSSHC, AHSSI, AND AMH ARE ALL RECOGNIZED AS TAX-EXEMPT ORGANIZATIONS UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). AHSSHC, AHSSI, AND AMH ARE PART OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH (AH). THE AFFILIATION BETWEEN UCMC AND AH COMBINES THE EXPERTISE AND RESOURCES OF BOTH ORGANIZATIONS. ALTHOUGH NEITHER UCMC OR AH HAVE CONTROL OVER THE FILING ORGANIZATION AS DEFINED FOR PURPOSES OF SCHEDULE R, THE AFFILIATION BETWEEN THESE TWO HEALTHCARE SYSTEMS IS SIGNIFICANT AND WILL BUILD UPON THE COMPLEMENTARY STRENGTHS OF THE TWO ORGANIZATIONS. | ExplanationTxt |