2022-05-13T21:14:24-05:00 2021-06-30 861065772 DELOITTE TAX LLP 50 S 6TH STREET SUITE 2800 MINNEAPOLIS MN 554021844 990 2020-07-01 362170840 COPLEY MEMORIAL HOSPITAL INC C/O RUSH COPLEY MEDICAL CENTER COPL 6309786200 2000 OGDEN AVENUE AURORA IL 605044206 BRENDA VAN WYHE SENIOR VP OF FINANCE AND CFO 6309786200 2022-05-13 1 BRENDA VAN WYHE 999009999 ANNA KOLAKALURI P01275237 6123974000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOHN DIEDERICH 2000 OGDEN AVENUE AURORA IL 605044206 963178295 0 X WWW.RUSHCOPLEY.COM X 1886 IL THE MISSION OF RUSH COPLEY IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. 20 16 2509 105 0 0 7046698 20536656 313765634 376386724 52568203 6754688 2943877 3756528 376324412 407434596 10286 0 0 0 155228223 168590696 0 0 0 167221304 177283966 322459813 345874662 53864599 61559934 768309028 974963685 359349940 440241277 408959088 534722408 X THE MISSION OF RUSH COPLEY IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. 0 0 283383712 378743912 THE MISSION OF RUSH COPLEY IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. IN FY2021, COPLEY MEMORIAL HOSPITAL PROUDLY COLLABORATED WITH DOZENS OF CIVIC AND COMMUNITY GROUPS TO IMPACT THE KNOWLEDGE, HEALTH AND WELL-BEING OF THE COMMUNITY. COPLEY MEMORIAL HOSPITAL OFFERS FREE HEALTH EDUCATION AND WELLNESS PROGRAMS RANGING FROM DIABETES, HEART HEALTH, CANCER PREVENTION, WEIGHT CONTROL, SMOKING CESSATION, CHRONIC HEALTH, CHILDBIRTH EDUCATION AND MORE. 283383712 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 171 0 1 2509 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 16 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X BRENDA VAN WYHE 6309786200 2020 OGDEN AVENUE AURORA IL 60504 ANDREW VANEEKEREN DIRECTOR 1.00 2.00 X 0 0 0 BRUCE W DIENST CHAIRMAN OF THE BOARD 1.00 2.00 X X 0 0 0 CATHERINE CEDEROTH DIRECTOR 1.00 3.00 X 0 0 0 CHRISTINE SOBEK VICE CHAIRMAN OF THE BOARD 1.00 2.00 X X 0 0 0 DAVE MEAD DIRECTOR 1.00 2.00 X 0 0 0 GARRETT KATULA DO END 1220 IMMEDIATE PAST CHIEF OF STAFF/DIRECTOR 40.00 2.00 X 312162 0 24137 HERBERT KNIGHT DIRECTOR 1.00 2.00 X 0 0 0 JAE B JOO MD BEG 0121 VICE CHIEF OF STAFF/DIRECTOR 40.00 2.00 X 517435 0 36705 JAMES BAKA DIRECTOR 1.00 2.00 X 0 0 0 JOHN DIEDERICH PRESIDENT & CEO 40.00 4.00 X X 585210 0 353691 LUIS PEREZ DIRECTOR 1.00 2.00 X 0 0 0 MARK C METZGER DIRECTOR 1.00 2.00 X 0 0 0 MARYANNE LOCKLIN DIRECTOR 1.00 2.00 X 0 0 0 MAUREEN STROBL DIRECTOR 1.00 2.00 X 0 0 0 MICHAEL NUYLES END 1220 IMMEDIATE PAST VICE CHIEF OF STAFF 2.00 1.00 X 0 0 0 PATRICK CARMODY DIRECTOR 1.00 2.00 X 0 0 0 RICHARD EDELMAN DIRECTOR 1.00 2.00 X 0 0 0 RONALD HEM DIRECTOR 1.00 2.00 X 0 0 0 SYED ZAIDI MD BEG 0121 CHIEF OF STAFF/DIRECTOR 40.00 2.00 X 525058 0 31812 TRISH ANEN DIRECTOR 1.00 2.00 X 0 0 0 WILLIAM SKOGLUND DIRECTOR 1.00 2.00 X 0 0 0 BRENDA VAN WYHE SR VP FINANCE & CFO/TREASURER 40.00 3.00 X 411949 0 76515 RYAN ASMUS VP GENERAL COUNSEL/SECRETARY 40.00 3.00 X 321462 0 50947 ALEX POPE VP. PHILANTHROPY & CDO 1.00 40.00 X 273591 0 55441 BRENDA FANN MD ASSISTANT VP MEDICAL AFFAIRS 40.00 0.00 X 326714 0 23419 DAVID PETASNICK ASSISTANT VP, ANCILLARY SVCS 40.00 0.00 X 216895 0 27691 MARY SHILKAITIS SR VP OPERATIONS & COO 40.00 1.00 X 346563 0 70274 STEVE LOWENTHAL MD SR VP MEDICAL AFFAIRS & CMO 40.00 0.00 X 582974 0 19086 ARIF SALEEM MD PHYSICIAN 40.00 0.00 X 782492 0 32758 DIMITRI RUBAN MD PHYSICIAN 40.00 0.00 X 919799 0 34495 JONATHAN L TUETING MD PHYSICIAN 40.00 0.00 X 1129278 0 38083 KEVIN KELLY MD PHYSICIAN 40.00 0.00 X 904701 0 26694 MARK SHARP-SCHINSKY MD PHYSICIAN 40.00 0.00 X 1512385 0 37011 BARRY FINN FORMER PRESIDENT & CEO/DIRECTOR 0.00 0.00 X 407888 0 0 DENNIS DEMASIE FORMER VP, INFORMATION TECH & CIO 0.00 0.00 X 147468 0 0 DIANE HOMAN MD FORMER VP, QUALITY & PSO 0.00 0.00 X 417679 0 23001 10641703 0 961760 342 1 1 0 SODEXO PO BOX 536922 ATLANTA GA 303536922 FOOD AND CLEANING SERVICES 3966847 TRIMEDX PO BOX 636129 CINCINNATI OH 452636129 EQUIPMENT MAINTENANCE 3827109 ATOS DEPT - 772066 PO BOX 78000 DETRIOT MI 482781177 MEDICAL BILLING 2612328 DIVERSIFIED CLINICAL SERVICES PO BOX 636981 CINCINNATI OH 452636981 WOUND CENTER MANAGER 1046452 INTUITIVE SURGICAL INC 1020 KIFER ROAD SUNNYVALE CA 94086 EQUIPMENT MAINTENANCE 852045 25 551744 19984912 20536656 NET PATIENT SVC REV 621110 342438084 342438084 MEDICAID TAX REVENUE 621110 34192390 34192390 OTHER PROGRAM REVENUE 900009 -243750 -243750 376386724 7333766 7333766 1502780 512094 990686 990686 990686 554631880 20647 555231599 6 -599719 20641 -579078 -579078 OUTSIDE SERVICE REV 621990 2357188 2357188 GIFT SHOP REVENUE 453220 393618 393618 CAFETERIA REVENUE 621990 15036 15036 2765842 407434596 378743912 0 8154028 4501613 4501613 1102140 1102140 130226706 97914754 32311952 3233941 2425456 808485 18927304 14195478 4731826 10598992 7949244 2649748 6715393 5036545 1678848 61401 61401 193167 193167 45040 45040 686434 686434 8993263 6744947 2248316 686577 686577 9739376 7304532 2434844 13044840 9783630 3261210 5205259 3903944 1301315 21401 16051 5350 74867 56150 18717 5178479 5178479 25838138 25838138 6686261 5014696 1671565 MEDICAL SUPPLIES 59513664 59513664 MEDICAID PROVIDER TAX 21603345 21603345 DIALYSIS 1181919 1181919 COLLECTION FEES 932046 932046 10883096 8104117 2778979 345874662 283383712 62490950 0 68736370 60265783 49109312 50744544 6504979 7196280 3627600 1681880 483450388 287457635 209865549 195992753 244398267 383371362 3109951 4395425 182957000 271315658 768309028 974963685 142142511 124212952 130846997 127291589 86360432 188736736 359349940 440241277 X 404194874 528122501 4764214 6599907 408959088 534722408 768309028 974963685 X 61559934 59661386 4542000 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 45040 45040 0 PART II-B, LINE 1: COPLEY MEMORIAL HOSPITAL, INC. IS A MEMBER OF VARIOUS ORGANIZATIONS THAT ADVOCATE ON LEGAL AND POLICY ISSUES THAT AFFECT HEATLHCARE. A PORTION OF THE ANNUAL MEMBERSHIP DUES PAID BY COPLEY MEMORIAL HOSPITAL, INC. TO THESE ORGANIZATIONS IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 13390581 843098 3086208 737401 16582486 13022428 1342373 326685 1300905 13390581 11969298 1771314 806653 1524837 13022428 11691205 1193365 662110 1577382 11969298 10975986 2004750 512030 1801561 11691205 0.39000 0.48300 0.12700 0 1 1 18541798 18541798 260753845 140904884 119848961 3743627 3441776 301851 197619804 143110975 54508829 2791314 2791314 195992753 DUE FROM RELATED PARTIES 233881579 INVESTMENT IN AFFILIATES 21452663 MALPRACTICE GROSS UP 2595956 RIGHT OF USE ASSET 13143223 OTHER RECEIVABLES 242237 271315658 LONG TERM SERP 4271656 LONG TERM MARKET ADJUST SWAP LIABILITY 9139392 DUE TO RELATED PARTY 131722751 UNAMORTIZED BOND DISCOUNT -702398 SHORT TERM/LONG TERM LEASE LIABILITY 13512255 COVID-19 MEDICARE ADVANCE 30910848 LONG TERM DEFERRED RENT OBLIGATION -117768 188736736 PART V, LINE 4: RUSH COPLEY FOUNDATION HOLDS THE VORIS (INCOME FOR CMH CANCER CARE), KOBISK (BOARD RESTRICTED INCOME TO CMH), COPLEY (INCOME RESTRICTED TO HOSPITAL OPERATIONS), DOBBINS (INCOME FOR CMH WOMEN'S HEALTH), AND MOVEMENT DISORDER (INCOME FOR CMH MOVEMENT DISORDER PROGRAM) ENDOWMENTS. RUSH COPLEY FOUNDATION ALSO HOLDS THE FOLLOWING QUASI ENDOWMENTS: NURSING (INCOME FOR CMH FUTURE OF NURSING SCHOLARSHIPS). FOX VALLEY HEART (INCOME FOR THE HEART INSTITUTE), PROMISE FUND (INCOME FOR EMPLOYEE HARDSHIPS), AND WATERFORD PLACE (INCOME FOR CMH CANCER RESOURCE CENTER) ENDOWMENTS. THESE FUNDS ARE HELD FOR THE BENEFIT OF COPLEY MEMORIAL HOSPITAL. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 2959697 2959697 0.01000 80930405 68859522 12070883 0.04090 83890102 68859522 15030580 0.05090 234345 157511 76834 0.00030 4871900 1500205 3371695 0.01140 377539 273955 103584 0.00040 33825 33825 0.00010 5517609 1931671 3585938 0.01220 89407711 70791193 18616518 0.06310 1 50673604 5067360 117234208 132757440 -15523232 X 1 1 1 1 COPLEY MEMORIAL HOSPITAL 2000 OGDEN AVENUE AURORA IL 605044206 WWW.RUSHCOPLEY.COM 2150791 X X X X COPLEY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION C X 1 18 1 SEE PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING THE COMMUNITY NEEDS ASSESSMENT, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED. THIS INCLUDED COMMUNITY RESIDENTS AND EXPERTS IN A RANGE OF AREAS INCLUDING PUBLIC HEALTH, MINORITY POPULATIONS, DISPARITIES IN HEALTH CARE, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH & SOCIAL SERVICES. PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED INCLUDED: BOARD OF DIRECTORS, HOSPITAL ADMINISTRATION, COMMUNITY HEALTH NEEDS COMMITTEE, PARTNERSHIPS WITH KANE COUNTY, PARTNERSHIPS WITH KENDALL COUNTY, COMMUNITY HEALTH SURVEY, FOCUS GROUPS, AND SECONDARY DATA ANALYSIS. FOR COMPLETE DETAILS ABOUT HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED, THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTPS://WWW.RUSH.EDU/ABOUT-US/RUSH-COMMUNITY/CHNACHIP-REPORTS-AND-CBR/RUSH-COPLEY-CHNA-REPORT COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE KANE COUNTY HEALTH DEPARTMENT, RUSH COPLEY MEDICAL CENTER, NORTHWESTERN DELNOR HOSPITAL, AMITA MERCY MEDICAL CENTER, AMITA ST. JOSEPH HOSPITAL (ELGIN), AND ADVOCATE SHERMAN HOSPITAL WORKED TOGETHER ALONG WITH THE INC BOARD TO DEVELOP THE COUNTY'S IPLAN (ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS). THE IPLAN IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY THREE TO FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS. THE COLLABORATIVE PARTICIPATION IN THE PLANNING PROCESS, PLAN DEVELOPMENT, AND IDENTIFICATION OF THE HEALTH NEEDS FOR THE COUNTY SERVED AS A FOUNDATION FOR THE DEVELOPMENT OF EACH OF THE HOSPITAL'S RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENTS. COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: RUSH COPLEY IDENTIFIED THE FOLLOWING AS THE TOP HEALTH NEEDS IN THE COMMUNITY TO BE ADDRESSED IN THE IMPLEMENTATION STRATEGY:1. INEQUITIES CAUSED BY THE SOCIAL, ECONOMIC AND STRUCTURAL DETERMINANTS OF HEALTH, FOCUSING ON REDUCING INEQUITIES IN VULNERABLE POPULATIONS THROUGH IMPROVED IDENTIFICATION AND CONNECTION OF PATIENTS IN NEED TO AVAILABLE COMMUNITY RESOURCES2. MENTAL AND BEHAVIORAL HEALTH, FOCUSING ON REDUCING THE MISUSE OF OPIOIDS AND OPIOID-RELATED DEATHS 3. PREVENT AND REDUCE CHRONIC DISEASE BY FOCUSING ON RISK FACTORS, SPECIFICALLY REDUCING TOBACCO USAGE (INCLUDING SMOKING AND VAPING) RUSH COPLEY HAS IMPLEMENTED STRATEGIES TO ADDRESS ALL OF THESE HEALTH NEEDS, INCLUDING THE FOLLOWING:1) INEQUITIES CAUSED BY THE SOCIAL, ECONOMIC AND STRUCTURAL DETERMINANTS OF HEALTH, FOCUSING ON REDUCING INEQUITIES IN VULNERABLE POPULATIONS THROUGH IMPROVED IDENTIFICATION AND CONNECTION OF PATIENTS IN NEED TO AVAILABLE COMMUNITY RESOURCESIN COLLABORATION WITH RUSH UNIVERSITY, IMPLEMENTED A SCREENING TOOL FOR RCMC AT-RISK/VULNERABLE PATIENTS THAT WILL BE USED TO HELP IDENTIFY THE SOCIAL, ECONOMIC AND STRUCTURAL DETERMINANTS OF HEALTH THAT COULD BE AFFECTING PATIENT'S HEALTHTRANSITIONED SCREENING TO THE EPIC FOUNDATION SYSTEM FOR SOCIAL DETERMINANTS OF HEALTHPILOTED WITHIN THE FAMILY MEDICINE RESIDENCY PROGRAM, NOW AVAILABLE TO ALL IN THE IN-PATIENT DEPARTMENTS OF THE HOSPITALPROVIDE SURVEY IN ENGLISH AND SPANISHENHANCED AND EXPANDED THE USE OF COMMUNITY CARE MANAGERS IN RCMG PCP PRACTICES TO BETTER IDENTIFY AND ADDRESS THE SOCIAL DETERMINANT NEEDS OF THE PATIENT POPULATIONBEGAN PILOT OF PROMISE PANTRY IN CANCER CARE, IN-PATIENT DEPARTMENTS AND OUTPATIENT PEDIATRIC OFFICES TO ADDRESS FOOD INSECURITYSDOH NURSING RESEARCH STUDY RESULTS OBTAINED IN YEAR ONE. DISSEMINATED RESULTS AND NURSING EDUCATIONSDOH PHYSICIAN EDUCATION AND CME PRESENTED UTILIZING GENDER AFFIRMING CARE MODULES IN CME PORTALSEXUAL ORIENTATION AND GENDER IDENTITY (SOGI) MODULE USED IN EPIC. LEADERSHIP PARTICIPATION IN KANE AND KENDALL COUNTY HEALTH DEPARTMENT2) MENTAL AND BEHAVIORAL HEALTH, FOCUSING ON REDUCING THE MISUSE OF OPIOIDS AND OPIOID-RELATED DEATHS ORDER SETS WERE UPDATED WITH EPIC AND CONTINUE TO BE OPTIMIZED - THESE INCLUDE: - NON-OPIOIDS FOR LOWER PAIN SCORES - DEFAULT DURATIONS REMOVED - PMP ACCESS LINKS IN EPICCONTINUE TO USE OPIOID DASHBOARD IN EPICCLINIC STAFF EDUCATIONAL PROGRAMMINGOPTIMIZATION OF HYDROMORPHONE USE IN THE ED TO REDUCE OPIOID ORDERS AND PRESCRIPTIONS IN ED CONTINUED USE OF LOW DOSE KETAMINE PROTOCOL/POLICY IN ED TO REDUCE USE OF OPIOIDS FOR ACUTE PAINPATIENT DISCHARGE EDUCATIONAL MATERIAL NOW INCLUDES INFORMATION ON HOW TO CORRECTLY TAKE OPIOIDS AND DISPOSE OF THEM.LEADERSHIP PARTICIPATION ON THE KANE COUNTY OPIOID TASK FORCELEADERSHIP PARTICIPATION ON THE KANE COUNTY BEHAVIORAL HEALTH COUNCILLEADERSHIP PARTICIPATION ON THE RUSH UNIVERSITY SYSTEM FOR HEALTH OPIOID WORKFORCEACTIVE SUPPORT OF PATH TO RECOVERY FOUNDATION - A COMMUNITY SUPPORT GROUP FOR FAMILIES DEALING WITH OPIOID USE DISORDERCOLLABORATION WITH KENDALL COUNTY LAW ENFORCEMENT AGENCIES IN AN ONGOING PROGRAM TO EXCHANGE FIRST RESPONDER NALOXONE SUPPLY3) PREVENT AND REDUCE CHRONIC DISEASE BY FOCUSING ON RISK FACTORS, SPECIFICALLY REDUCING TOBACCO USAGE (INCLUDING SMOKING AND VAPING)DEVELOPED/ENHANCED AND IMPLEMENTED EDUCATION, RESOURCES, AND/OR PROGRAMS TO HELP THE COMMUNITY QUIT SMOKING- CONTINUE TO IMPROVE AWARENESS THROUGH CREATING OR UTILIZING MATERIALS IN BOTH ENGLISH AND SPANISH AS WELL AS HAVING ACCESS TO ADDITIONAL RESOURCES IN OTHER NATIVE LANGUAGES FOR THE PATIENT POPULATION AT RUSH COPLEY- CONTINUE TO PROMOTE AND UTILIZE PRO-CHANGE FOR RCMC/RCMG PATIENTS AND EMPLOYEES (WEB-BASED DIGITAL COACHING FOR SMOKING CESSATION)TOBACCO CESSATION PROGRAM, FREEDOM FROM SMOKING WAS PAUSED DUE TO THE COVID19 PANDEMICPARTNERED WITH LOCAL SCHOOL DISTRICTS AND HEALTH DEPARTMENTS TO DISCUSS EFFORTS AROUND VAPING/E-CIGARETTE PREVENTION AND EDUCATION FOR PRE-TEENS, ADOLESCENTS, AND PARENTS. ONCE COUNTY RESUMES, PARTICIPATE IN KANE COUNTY HEALTH DEPARTMENT TOBACCO COALITION INITIAL DEVELOPMENT OF CREATING A UNIVERSAL PRESENTATION TO BE UTILIZED ACROSS THE COUNTY FOR PRESENTATIONS ON VAPING/E-CIGARETTE. RCMG NURSES AND MEDICAL ASSISTANTS WERE CONTINUALLY EDUCATED ON TOBACCO DOCUMENTATION WHICH INCLUDES VAPINGADDITIONALLY, INCORPORATED EDUCATION ON TOBACCO CESSATION SMART SET DURING EPIC EDUCATION TRAININGCONTINUE PARTICIPATION ON THE MONTHLY RUSH SYSTEM TOBACCO OVERSIGHT COMMITTEE PART V, SECTION B, LINE 7A: HTTPS://WWW.RUSH.EDU/ABOUT-US/RUSH-COMMUNITY/CHNACHIP-REPORTS-AND-CBR/RUSH-COPLEY-CHNA-REPORT PART V, SECTION B, LINE 10A: HTTPS://WWW.RUSH.EDU/ABOUT-US/RUSH-COMMUNITY/CHNACHIP-REPORTS-AND-CBR/RUSH-COPLEY-CHNA-REPORT PART V, SECTION B, LINE 16A: HTTPS://WWW.RUSH.EDU/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B: HTTPS://WWW.RUSH.EDU/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C: HTTPS://WWW.RUSH.EDU/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE 6 1 - RADIATION THERAPY CENTER AT RIVERWEST 1221 N HIGHLAND AVENUE AURORA IL 605044206 JV ONCOLOGY 2 - CASTLE SURGICENTER 2111 OGDEN AVE AURORA IL 60504 AMBULATORY SURGERY CENTER 3 - RUSH COPLEY HEALTHCARE CENTER 1100 WEST VETERANS PARKWAY YORKVILLE IL 60560 OUTPATIENT SERVICES 4 - RUSH COPLEY CARDIOVASCULAR CONSULTANTS 2000 OGDEN AVENUE AURORA IL 605044206 CARDIOVASCULAR SERVICES 5 - MIDWEST CENTER FOR ADVANCED IMAGING 4355 MONTGOMERY ROAD NAPERVILLE IL 60564 RADIOLOGY SERVICES 6 - HEALTHPLEX OUTPATIENT REHABILITATION 1900 OGDEN AVENUE AURORA IL 60504 OUTPATIENT REHABILITATION SERVICES PART I, LINE 3C: DETAILS ARE IDENTIFIED UNDER THE FINANCIAL ASSISTANCE POLICY, PATIENTS MUST COMPLETE AN APPLICATION, MEET THE QUALIFICATIONS AND RESPONSE WITH THE REQUESTED DOCUMENTATION UNDER THE POLICY TO DETERMINE THE DISCOUNT AMOUNT, IF ANY, THAT WOULD APPLY TO THEIR HOSPITAL BILL. PART I, LINE 7: A COST ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. A COST TO CHARGE RATIO WAS UTILIZED. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY).COPLEY MEMORIAL HOSPITAL RECEIVED $19,473,152 IN FUNDING FROM THE CORONAVIRUS RESPONSE AND RELIEF SUPPLEMENTAL APPROPRIATIONS ACT (CARES ACT), $511,759 FROM THE ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES CARES ACT AND $20,931 FROM THE HHS FUNDED HOSPITAL PREPARDENESS PROGRAM (HPP) FOR THE PERIOD JULY 1, 2020 THROUGH JUNE 30, 2021. THESE PAYMENTS WERE DISTRIBUTED BY HRSA THROUGH THE PROVIDER RELIEF FUND (PRF) PROGRAM TO REIMBURSE ELIGIBLE HEALTHCARE PROVIDERS FOR HEALTHCARE RELATED EXPENSES OR LOST REVENUES ATTRIBUTABLE TO CORONAVIRUS.ALL RECIPIENTS WILL BE REQUIRED TO REPORT THEIR USE OF ALL PRF PAYMENTS RECEIVED THROUGH JUNE 30, 2021, BY SEPTEMBER 30, 2022, AS SPECIFIED BY HRSA, BY SUBMITTING THE FOLLOWING INFORMATION:1. HEALTHCARE RELATED EXPENSES ATTRIBUTABLE TO CORONAVIRUS THAT ANOTHER SOURCE HAS NOT REIMBURSED AND IS NOT OBLIGATED TO REIMBURSE, WHICH INCLUDES GENERAL AND ADMINISTRATIVE (G&A) AND/OR OTHER HEALTHCARE RELATED EXPENSES.2. PRF PAYMENT AMOUNTS NOT FULLYEXPENDED ON HEALTHCARE RELATED EXPENSES ATTRIBUTABLE TO CORONAVIRUS ARE THEN APPLIED TO PATIENT CARE LOST REVENUES.DOCUMENTATION REQUIREMENTS FOR THESE CALCULATIONS HAVE BEEN PUBLISHED IN THE POST-PAYMENT NOTICE OF REPORTING REQUIREMENTS DATED JUNE 11, 2021.COPLEY MEMORIAL HOSPITAL HAS PERFORMED CALCULATIONS UTILIZING OPTION III, THE ALTERNATE METHODOLOGY FOR CALULATIN GLOST REVNUE ATTRIBUTABLE TO CORONAVIRUS, BASED ON THE JUNE 11TH GUIDELINES AND DETERMINED THAT THE TOTAL OF HEALTHCARE RELATED EXPENSES ATTRIBUTABLE TO CORONAVIRUS AND LOST PATIENT CARE REVENUES FROM JULY 2020 THROUGH JUNE 2021, AS PUBLISHED IN THE APRIL 1, 2021 HHS PROVIDER RELIEF GUIDELINES AS TO HOW THE PROVIDER RELIEF FUNDS CAN BE SPENT, EXCEEDED THE PRF FUNDS RECEIVED PRIOR TO JUNE 30, 2021. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART VIII, LINE, LINE 12(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN, IS $50,673,604. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED BASED ON ACTUAL WRITE OFF'S DURING THE YEAR AND APPLYING HISTORICAL UNCOLLECTED PERCENTAGES TO CURRENT OUTSTANDING BALANCES. PART III, LINE 3: THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS 10% OF THE ORGANIZATION'S BAD DEBT EXPENSE REPORTED ON PART III, LINE 2. PART III, LINE 4: NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYORS, PATIENTS, AND OTHERS FOR SERVICES RENDERED. RCMC HAS AGREEMENTS WITH THIRD PARTY PAYORS THAT PROVIDE FOR PAYMENT AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, PER DIEM PAYMENTS, AND DISCOUNTED CHARGES, INCLUDING ESTIMATED RETROACTIVE SETTLEMENTS UNDER PAYMENT AGREEMENTS WITH THIRD PARTY PAYORS. RCMC RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENT WHO HAVE THIRD PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR SERVICES RENDERED. PROVISIONS FOR ADJUSTMENTS TO NET PATIENT SERVICE REVENUE ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED TO FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, RCMC RECOGNIZES REVENUE BASED ON ITS DISCOUNTED RATES. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OR RCMC'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, RCMC RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.PATIENT ACCOUNTS RECEIVABLE ARE BASED ON GROSS CHARGES AND STATED AT NET REALIZABLE VALUE. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS, BASED ON EXPECTED PAYMENT RATES FROM PAYORS UNDER CURRENT REIMBURSEMENT METHODOLOGIES, AND ALSO BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, RCMC ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), RCMC RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED UNCOLLECTIBLE. PART III, LINE 8: ALL OF THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IF WE DID NOT PROVIDE THE SERVICE, THE BURDEN OF THE COSTS WOULD FALL ON THE GOVERNMENT. PART III, LINE 9B: IT IS OUR POLICY NOT TO PURSUE COLLECTION PRACTICES AGAINST PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. IN CERTAIN CASES IT MAY NOT BE EASILY DETERMINE WHETHER OR NOT A PATIENT QUALIFIES FOR CHARITY CARE OR FINANCIAL ASSISTANCE. HOWEVER, IF AFTER COLLECTION PRACTICES HAVE BEGUN, IT BECOMES KNOWN THE PATIENT QUALIFIES, THE COLLECTION EFFORTS CEASE. PART VI, LINE 2: COMMUNITY NEED IS ASSESSED THROUGH REVIEW OF COMMUNITY AND HOSPITAL DATA, PERIODIC ASSESSMENTS WITH PHYSICIAN AND CLINICIANS, AND REPORTING OF INFORMATION FROM HOSPITAL COMMITTEES. FURTHER INPUT FROM THE COMMUNITY ARISES FROM THE COMMUNITY BASED BOARD OF DIRECTORS, VARIOUS FORMS OF PATIENT INPUT, AND HOSPITAL INVOLVEMENT WITH GOVERNMENT, HEALTH INDUSTRY, AND COMMUNITY AGENCIES. THE HOSPITAL ALSO ACTIVELY PARTICIPATES IN FORMAL NEEDS ASSESSMENTS CONDUCTED BY GOVERNMENT AND COMMUNITY AGENCIES. PART VI, LINE 3: AT THE TIME OF SERVICE, COPLEY MEMORIAL HOSPITAL, INC. PATIENTS ARE GIVEN A BILLING BROCHURE, WHICH DESCRIBES THE FINANCIAL ASSISTANCE/CHARITY CARE PROGRAMS AVAILABLE. THIS INFORMATION IS ALSO POSTED AT THE REGISTRATION CHECK-IN DESKS, IN AN INPATIENT GUIDE, AND ON THE RUSH COPLEY WEBSITE. FINANCIAL COUNSELORS ARE AVAILABLE TO EXPLAIN THE PROGRAM IN DETAIL TO PATIENTS WHO ARE SEEN WITHOUT INSURANCE COVERAGE. ALL PATIENT BILLING STATEMENTS ADVISE THE PATIENTS TO CALL AND INQUIRE ON THE DETAILS AS NEEDED. PART VI, LINE 4: COPLEY MEMORIAL HOSPITAL INC.'S PRIMARY SERVICE AREA IS LOCATED 45 TO 55 MILES SOUTHWEST OF CHICAGO AND INCLUDES ALL OF AURORA AND MOST OF SOUTHERN KANE COUNTY AND KENDALL COUNTY, ILLINOIS. KANE COUNTY IS PREDOMINANTLY URBAN AND SUBURBAN, AND THE POVERTY RATE IS 10%. KENDALL COUNTY, TO THE SOUTH OF KANE, IS MOSTLY RURAL WHILE THE NORTHWEST SECTION OF THE COUNTY IS SUBURBAN, AND THE POVERTY RATE IN THE COUNTY IS 5.3%. THE PRIMARY SERVICE AREA HAS A POPULATION OF OVER 383,000 RESIDENTS. APPROXIMATELY 33.5% OF THE POPULATION IS OF HISPANIC OR LATINO ORIGIN. THE MEDIAN AGE OF THE COMMUNITY IS 34.3 YEARS. THE COMMUNITY CONTINUES TO RECOVER FROM THE ECONOMIC DOWNTOWN AND HAS SHOWN SIGNIFICANT IMPROVEMENT IN A NUMBER OF AREAS SINCE 2015, INCLUDING AN INCREASE IN MEDIAN HOUSING VALUES, MEDIAN HOUSEHOLD INCOME, AND IMPROVEMENT IN FORECLOSURE RATES, UNEMPLOYMENT RATES, AND ATTAINMENT OF HIGHER EDUCATION. PART VI, LINE 5: COPLEY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. TO THAT END, THE MEDICAL CENTER SEEKS TO SERVE THE COMMUNITY IN WAYS THAT ENGAGE, EDUCATE AND EMPOWER. COPLEY MEMORIAL HOSPITAL SERVES ALL PATIENTS WHO PRESENT FOR CARE AND SERVES THE SURROUNDING COMMUNITY ALONG WITH A BOARD OF DIRECTORS WITH A STRONG COMMUNITY BASE. THE BOARD MEMBERS ARE INDEPENDENT COMMUNITY LEADERS AND ARE SELECTED BASED UPON THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS OF BENEFIT TO THE ORGANIZATION AND THEIR ROLE AS BOARD MEMBERS WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT OUR MISSION. BOARD MEMBERS ARE NOT COMPENSATED FOR THEIR SERVICE.AS A CHARITABLE ORGANIZATION, ALL SURPLUS FUNDS ARE USED TO FURTHER OUR CHARITABLE PURPOSE, MISSION AND TO SERVE THE COMMUNITY. SOME OF OUR PRIMARY PROGRAMS ARE: COMMUNITY HEALTH FAIRS, BREASTFEEDING EDUCATION CLASSES, CHILD CARE CLASSES, FREE AND REDUCED COST HEALTH SCREENINGS, LANGUAGE ASSISTANCE SERVICES, ETC. COPLEY MEMORIAL HOSPITAL PROVIDES ACCESS TO PHYSICIAN, ACUTE CARE, DIAGNOSTIC, AND REHABILITATIVE SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY, THROUGH A NUMBER OF FACILITIES AND SERVICES LOCATED THROUGHOUT THE SERVICE AREA. IT PROVIDES PROGRAMMING RELATING TO HEALTH EDUCATION, PREVENTION, AND SUPPORT TARGETED TO SPECIFIC POPULATIONS. MEDICAL EDUCATION EXTENDS TO CLINICAL SETTINGS FOR NURSING EDUCATION AND A FAMILY PRACTICE RESIDENCY. EMPLOYEES FILL BOARD AND COMMITTEE LEADERSHIP POSITIONS FOR A NUMBER OF ECONOMIC DEVELOPMENT AND SOCIAL SERVICE AGENCIES IN COMMUNITIES THROUGHOUT THE SERVICE AREA. PART VI, LINE 6: RUSH SYSTEM FOR HEALTH ("RUSH"), IS A MULTIHOSPITAL HEALTH SYSTEM WITH OPERATIONS THAT CONSIST OF SEVERAL DIVERSE ACTIVITIES WITH A SHARED MISSION OF PATIENT CARE, EDUCATION, RESEARCH, AND COMMUNITY SERVICE. RUSH CONSISTS OF AN ACADEMIC MEDICAL CENTER, RUSH UNIVERSITY MEDICAL CENTER ("RUMC"), TWO COMMUNITY HOSPITALS, RUSH COPLEY MEDICAL CENTER ("RCMC") AND RUSH OAK PARK HOSPITAL ("RPPH"), THAT EACH SERVE DISTINCT MARKETS IN CHICAGO, ILLINOIS, METROPOLITAN AREA AND RUSH HEALTH, A PHYSICIAN HOSPITAL ORGANIZATION AND CLINICALLY INTEGRATED NETWORK. PART VI, LINE 7, REPORTS FILED WITH STATES IL X 1 0 X X X X X 1 1 0 0 0 0 0 1 0 MARK SHARP-SCHINSKY MD PHYSICIAN 983012 0 520920 0 8453 0 3120 0 33891 0 1549396 0 0 0 JONATHAN L TUETING MD PHYSICIAN 688333 0 437214 0 3731 0 9750 0 28333 0 1167361 0 0 0 DIMITRI RUBAN MD PHYSICIAN 915303 0 3803 0 693 0 9750 0 24745 0 954294 0 0 0 JOHN DIEDERICH PRESIDENT & CEO 579413 0 0 0 5797 0 327750 0 25941 0 938901 0 0 0 KEVIN KELLY MD PHYSICIAN 897275 0 3803 0 3623 0 1560 0 25134 0 931395 0 0 0 ARIF SALEEM MD PHYSICIAN 641460 0 141017 0 15 0 7125 0 25633 0 815250 0 0 0 STEVE LOWENTHAL MD SR VP MEDICAL AFFAIRS & CMO 497780 0 0 0 85194 0 9750 0 9336 0 602060 0 0 0 SYED ZAIDI MD BEG 0121 CHIEF OF STAFF/DIRECTOR 501123 0 12964 0 10971 0 6375 0 25437 0 556870 0 0 0 JAE B JOO MD BEG 0121 VICE CHIEF OF STAFF/DIRECTOR 502096 0 13803 0 1536 0 8372 0 28333 0 554140 0 0 0 BRENDA VAN WYHE SR VP FINANCE & CFO/TREASURER 405575 0 0 0 6374 0 53950 0 22565 0 488464 0 0 0 DIANE HOMAN MD FORMER VP, QUALITY & PSO 189503 0 203 0 227973 0 7540 0 15461 0 440680 0 0 0 MARY SHILKAITIS SR VP OPERATIONS & COO 338928 0 0 0 7635 0 45500 0 24774 0 416837 0 0 0 BARRY FINN FORMER PRESIDENT & CEO/DIRECTOR 0 0 0 0 407888 0 0 0 0 0 407888 0 0 0 RYAN ASMUS VP GENERAL COUNSEL/SECRETARY 317227 0 0 0 4235 0 38400 0 12547 0 372409 0 0 0 BRENDA FANN MD ASSISTANT VP MEDICAL AFFAIRS 312215 0 9043 0 5456 0 6351 0 17068 0 350133 0 0 0 GARRETT KATULA DO END 1220 IMMEDIATE PAST CHIEF OF STAFF/DIRECT 243667 0 62594 0 5901 0 5640 0 18497 0 336299 0 0 0 ALEX POPE VP. PHILANTHROPY & CDO 269811 0 0 0 3780 0 27800 0 27641 0 329032 0 0 0 DAVID PETASNICK ASSISTANT VP, ANCILLARY SVCS 214511 0 0 0 2384 0 2750 0 24941 0 244586 0 0 0 DENNIS DEMASIE FORMER VP, INFORMATION TECH & CIO 7535 0 0 0 139933 0 0 0 0 0 147468 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES TO ALL EMPLOYEES THE USE OF AN ATHLETIC FACILITY THAT IS OWNED AND OPERATED BY A RELATED TAX EXEMPT ORGANIZATION. THESE AMOUNTS ARE NON-TAXABLE. PART I, LINE 7 INCENTIVE BONUS PLAN BASED ON A SERIES OF APPROVED STRATEGIC ACCOMPLISHMENTS. PART I, LINE 4A: BARRY FINN, FORMER PRESIDENT & CEO AND DIRECTOR, WAS PAID $407,888 IN 2020 PURSUANT TO HIS SEVERANCE AGREEMENT. DENNIS DEMASIE, FORMER VP, INFORMATION TECH & CIO, WAS PAID $139,933 IN 2020 PURSUANT TO HIS SEVERANCE AGREEMENT. DIANE HOMAN, FORMER VP, QUALITY & PSO, WAS PAID $174,000 IN 2020 PURSUANT TO HER SEVERANCE AGREEMENT. PART I, LINE 4B: CMH OFFERS A SUPPLEMENTAL RETIREMENT PLAN TO CERTAIN EMPLOYEES WHO PARTICIPATE IN THE EXECUTIVE BENEFITS PROGRAM. THERE IS NO CONSTRUCTIVE RECEIPT OF THESE AMOUNTS BY THE INDIVIDUALS UNTIL THEY ARE PAID OUT AS THEY ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE UNTIL INDIVIDUALS MEET THE REQUIRED VESTING PERIOD. ONCE VESTED, PAYOUTS WOULD BE INCLUDED AS REPORTABLE COMPENSATION ON THE RECIPIENTS ANNUAL FORM W-2. THE AMOUNTS PAID OUT OF THIS PLAN IN 2020 WERE AS FOLLOWS: STEVE LOWENTHAL - $65,000, DIANE HOMAN - $45,240 PART III: VOLUNTARY LEADERSHIP PAY REDUCTIONS IN AN EFFORT TO PRESERVE RUSH'S FINANCIAL VIABILITY AMID THE UNPARALLELED FINANCIAL CHALLENGES RESULTING FROM THE SIGNIFICANT REDUCTION OF NON-EMERGENT SURGERY AND THE COSTS OF HANDLING THE COVID-19 PANDEMIC, RUSH TOOK A MEASURED AND BALANCED APPROACH IN IMPLEMENTING COST CONTAINMENT INITIATIVES AND SOLUTIONS ACROSS THE SYSTEM. IN APRIL OF 2020, SOME OF THE LEADERSHIP OF THE RUSH COPLEY MEDICAL CENTER TOOK VOLUNTARY PAY REDUCTIONS. A ILLINOIS FINANCE AUTHORITY 861091967 45203HS45 2015-02-11 105601668 REFUND BONDS ISSUED 5/28/2008, 2/10/2009, AND 7/29/2009 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 000000000 2019-08-29 36752000 BUILDINGS AND EQUIPMENT 0 0 0 A 7955000 105601668 824030 145 104777493 0 1 1 1 B 934000 36752000 252000 36500000 2019 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/06/2020 PART IV, LINE 6, COLUMN A: THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF THE BONDS. FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICE: SUMMARY OF FY21 HEALTH PROGRAMMING THE PANDEMIC HAD SIGNIFICANT IMPACT ON THE COMMUNITIES' PUBLIC PROGRAMMING AND, RELATEDLY, COPLEY MEMORIAL HOSPITAL SPONSORSHIP, PARTNERSHIP AND PARTICIPATION IN COMMUNITY PROGRAMS. IN FY21, THE HOSPITAL PARTICIPATED IN NEARLY 200 COMMUNITY-BASED PROGRAMS AND EVENTS WITH SPECIAL EMPHASIS ON IMPROVING THE HEALTH AND WELLNESS OF ADULTS, CHILDREN AND UNDERSERVED POPULATIONS. DIABETES EDUCATION PROGRAM FREE DIABETES EDUCATION IS PROVIDED TO LOW-INCOME PATIENTS, GIVING THEM THE KNOWLEDGE AND SKILLS THEY NEED TO AVOID OR DELAY LONG-TERM COMPLICATIONS OF DIABETES. IN FY21, FREE FASTING GLUCOSE SCREENINGS AND EDUCATION WERE PROVIDED TO APPROXIMATELY 150 COMMUNITY MEMBERS. HEALTH EXHIBITS AT SCI-TECH HANDS ON MUSEUM EXHIBITS CONTINUE TO BE DISPLAYED IN THE LUNCH ROOM AND ADJACENT CORRIDOR OF THE MUSEUM TARGETING VISITORS IN THE 5-16 AGE RANGE. THE EXHIBITS ENABLE VISITORS TO MEASURE THEIR HEART RATE AFTER EXERCISING AND MAKE THE LINK BETWEEN EXERCISE AND HEART HEALTH. ANOTHER TESTS VISITORS' KNOWLEDGE ABOUT THE AMOUNT OF SUGAR IN POPULAR BEVERAGES AND EDUCATES THEM ABOUT DIABETES. SMALLER EXHIBITS ON THE LUNCH ROOM PILLARS DISPLAY THE USDA'S "MY PLATE" GRAPHIC, THE "5-4-3-2-1-GO!" PROGRAM, "EAT-THIS-NOT-THAT" INFORMATION, AND OTHER KID-FRIENDLY INFORMATION ABOUT NUTRITION AND HEALTH. A HAND-WASHING EXHIBIT TO DEMONSTRATE THE IMPORTANCE OF EFFECTIVE HAND-WASHING TECHNIQUES WAS PLACED IN THE LUNCHROOM AT SCITECH TO ENSURE THAT THE MESSAGE REACHES CHILDREN AT A TIME WHEN THEY CAN APPLY THE LESSONS LEARNED DIRECTLY TO THEIR OWN EATING HABITS FOR IMMEDIATE REINFORCEMENT. CHILDREN PLACE THEIR HANDS IN THE SINK TO START AN INTERACTIVE VIDEO THAT SHOWS THE RIGHT TECHNIQUE AND LENGTH OF TIME NEEDED TO REMOVE DIRT AND GERMS. PINK LIGHTS SHINE ON THEIR HANDS, SIMULATING GERMS, UNTIL THE RIGHT AMOUNT OF TIME AND ACTIVITY HAS ELAPSED. WHILE CLOSED DURING THE PANDEMIC, IN ADDITION TO THE DAILY VISITORS THE MUSEUM HOSTS DAILY (75,000 VISITORS A YEAR), SCI-TECH HANDS ON MUSEUM CONTINUES TO PARTICIPATE IN FIRST FRIDAYS, A VENUE IN THE DOWNTOWN THAT PROVIDES ARTS AND CULTURE TO THE COMMUNITY AND DRAWS 100 - 300 COMMUNITY MEMBERS AND VISITORS TO THE MUSEUM FOR THE FIVE HOUR EVENT MOST MONTHS OF THE YEAR. PREGNANCY AND CHILDBIRTH PRE-AND POSTNATAL CLASSES ARE OFFERED TO COUPLES AND FAMILIES WHO ARE EXPECTING OR HAVE A BABY. CLASS TOPICS INCLUDE: CHILDBIRTH EDUCATION. BABY CARE BASICS, BIRTH CHOICES/WATER BIRTH, UNDERSTANDING BREASTFEEDING, BREASTFEEDING PART II, WORKING & BREASTFEEDING, BECOMING A GRANDPARENT, BOOT CAMP FOR NEW DADS, BRINGING HOME BABY, INFANT MASSAGE, FAMILY BIRTH CENTER TOURS, CHILD SEAT SAFETY, SIBLING CLASS, SIBLING TOURS, FIRST STEPS AND NOT WHAT I EXPECTED SUPPORT GROUPS, AND INFANT CPR AND HOME SAFETY. NEARLY 1,500 PEOPLE PARTICIPATED IN FY21. CHILD PASSENGER SAFETY COPLEY MEMORIAL HOSPITAL SERVES AS THE REGIONAL TRAFFIC SAFETY RESOURCE CENTER FOR SUBURBAN COOK AND SIX COLLAR COUNTIES (LAKE, DUPAGE, MCHENRY, KANE, KENDALL AND WILL). SIX OF THE SEVEN COUNTIES IN OUR REGION ARE PART OF THE ILLINOIS DEPARTMENT OF TRANSPORTATION'S 23-COUNTY MODEL. IN FY21, THE PROGRAM EDUCATED MORE THAN 5,000 CITIZENS ON TRAFFIC SAFETY, PEDESTRIAN SAFETY, MOTORCYCLE SAFETY, OLDER DRIVERS, AND BICYCLE SAFETY IN COOK AND COLLAR COUNTIES. TEEN PROGRAMMING FROM GIRL TO YOUNG WOMAN IS A PROGRAM FOR GIRLS 9 TO 12 YEARS OLD AND FOCUSES ON THE PHYSICAL AND MENTAL CHANGES THAT HAPPEN DURING THIS AGE. DURING FY21, 100 GIRLS AND THEIR FEMALE CAREGIVERS ATTENDED. MOVEMENT DISORDERS RUSH COPLEY'S MOVEMENT DISORDERS PROGRAM PROVIDES SUPPORT AND MANAGEMENT OF PARKINSON'S DISEASE, ESSENTIAL TREMOR, DYSTONIA AND ATAXIA TO HELP PATIENTS MAXIMIZE THEIR MOBILITY, COORDINATION, AND QUALITY OF LIFE. PROGRAM OFFERINGS WERE OFFERED VIRTUALLY IN FY21, AND INCLUDED SUPPORT GROUPS, EXERCISE CLASSES BOTH ON LAND AND WATER, GROUP BOXING, ART AND MUSIC THERAPY, MONTHLY MIND/BODY CLASSES AS WELL AS SPECIAL EVENTS WITH GUEST SPEAKERS TO MORE THAN 150 PARTICIPANTS. CANCER AWARENESS AND INFORMATION WATERFORD PLACE CANCER RESOURCE CENTER OFFERED 40 PROGRAMS PER MONTH IN FY21 ALL VIRTUAL. PROGRAMS INCLUDED VIRTUAL WELLNESS, EXERCISE, SALON AND SPA, AND EDUCATION PROGRAMS REACHING HUNDREDS OF PEOPLE ONLINE. PHYSICIAN REFERRAL AND SERVICE LINE COPLEY MEMORIAL HOSPITAL OFFERS A FREE PHYSICIAN AND INFORMATION REFERRAL TELEPHONE SERVICE TO THE COMMUNITY. THIS SERVICE ALLOWS COMMUNITY MEMBERS TO TALK WITH A CALL ADVISOR TO MATCH A PERSON'S HEALTH NEEDS AND PREFERENCES WITH THE PHYSICIAN OF THEIR CHOICE, LINKS CALLERS TO SERVICES PROVIDED BY THE MEDICAL CENTER AND MANAGES REGISTRATION FOR RUSH COPLEY CLASSES AND PROGRAMS. OVER 8,000 PEOPLE USED THIS SERVICE IN FY21. HEALTH TALKS HEALTH TALKS IS A SERIES OF FREE COMMUNITY HEALTH PROGRAMS HOSTED IN PERSON AND VIRTUALLY DURING FY21 ON A VARIETY OF TOPICS DESIGNED TO HELP IMPROVE WELL-BEING. RESPECTED RUSH EXPERTS SHARE INSIGHTS AND TIPS FOR HEALTHY LIVING. TOPICS INCLUDED: ABCS OF HEALTH, CRACKING THE TEEN CODE, DIGESTIVE HEALTH DURING THE HOLIDAYS, LEARNING TO BREAK BAD HABITS, EXPLORING COSMETIC PROCEDURES, MARIJUANA AND VAPING, AND PARENTING DURING A PANDEMIC (ENGLISH AND SPANISH). MORE THAN 220 PARTICIPANTS ATTENDED VIRTUALLY. WEBSITE COPLEY MEMORIAL HOSPITAL'S WEBSITE, RUSHCOPLEY.COM, WITH TRANSLATION AVAILABLE INTO DOZENS OF LANGUAGES, OFFERS ACCESS TO FREE HEALTH INFORMATION. IN FY21, WWW.RUSH.EDU/RUSHCOPLEY HAD MORE THAN 1 MILLION SESSIONS. FORM 990, PART VI, SECTION A, LINE 2 ALL OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED RUSH COPLEY MEDICAL CENTER ENTITY BOARDS. FORM 990, PART VI, SECTION A, LINE 6 RUSH COPLEY MEDICAL CENTER, INC. ("RCMC") IS THE SOLE CORPORATE MEMBER OF COPLEY MEMORIAL HOSPITAL, INC. ("CMH"), RUSH COPLEY MEDICAL GROUP, NFP ("RCMG"), COPLEY VENTURES, INC. ("CV"), AND RUSH COPLEY FOUNDATION ("RCF"). FORM 990, PART VI, SECTION A, LINE 7A CMH'S BOARD OF DIRECTORS INCLUDES AT LEAST NINE (9) INDIVIDUALS ELECTED BY THE SOLE CORPORATE MEMBER, RCMC. EACH OF THESE ELECTED DIRECTORS IS ALSO A MEMBER OF THE GOVERNING BOARD OF CMH'S SOLE CORPORATE MEMBER, RCMC. THE ELECTION AND RE-ELECTION OF ALL CMH DIRECTORS IS AT THE DIRECTION OF RCMC AT THE ANNUAL GOVERNING BOARD MEETING. VACANCIES ON THE CMH BOARD OF DIRECTORS ARE FILLED BY CMH'S SOLE CORPORATE MEMBER, RCMC. IN ACCORDANCE WITH CERTAIN PROCEDURAL REQUIREMENTS STATED IN THE BYLAWS, ELECTED DIRECTORS MAY BE REMOVED BY THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE BOARD OF DIRECTORS OF CMH'S SOLE CORPORATE MEMBER, RCMC. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF CMH'S SOLE CORPORATE MEMBER, RCMC, HAS THE FOLLOWING EXCLUSIVE POWERS OVER CMH: (1) THE ELECTION OF THE BOARD OF DIRECTORS; (2) ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION (3) THE BORROWING OF ANY SUM, THE PRINCIPAL OF WHICH EXCEEDS $500,000.00, OR WHICH HAS A STATED TERM OF GREATER THAN ONE YEAR, OR WHICH IS SECURED BY A MORTGAGE OF ALL OR ANY PORTION OF THE CORPORATION'S REAL PROPERTY OR THE CREATION OF A SECURITY INTEREST IN THE CORPORATION'S ASSETS, INCLUDING PERSONAL PROPERTY AND REVENUES, FOR THE BENEFIT OF THE LENDER, LESSOR OR VENDOR, OR THE DEFEASANCE, ADVANCE PAYMENT OR CANCELLATION OF ANY OUTSTANDING DEBT OF THE CATEGORY DESCRIBED HEREIN; (4) ANY VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION, SALE OR TRANSFER OF ANY OF THE CORPORATION'S ASSETS (ABOVE A MATERIAL DOLLAR THRESHOLD AS A PERCENTAGE OF THE CORPORATION'S ASSETS AS DETERMINED IN CONJUNCTION WITH THE CORPORATE MEMBER) OR ANY CREATION OF A SUBSIDIARY OR AFFILIATE OF THIS CORPORATION; (5) APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD OR ANY SUCCESSOR FOR A PERMIT OR CERTIFICATE OF NEED FOR A PROPOSED ACTIVITY, WHETHER OR NOT INVOLVING A CAPITAL EXPENDITURE; (6) APPROVAL OF ALL NEW OR CHANGES TO EXISTING ANNUAL AND LONG-TERM CAPITAL AND OPERATIONAL BUDGETS OR LONG-TERM OR MASTER STRATEGIC PLANS; (7) ANY AGREEMENT OR TRANSACTION, EITHER OF WHICH IS OF A MATERIAL NATURE, WITH ANOTHER CORPORATION CONTROLLED BY OR AFFILIATED WITH THE CORPORATE MEMBER OR WHICH IS A SUBSIDIARY OF THE CORPORATE MEMBERS; (8) SALE OF ANY OF THE CORPORATION'S REAL PROPERTY OR INTEREST THEREIN OR PURCHASES OF ANY ADDITIONAL REAL ESTATE; (9) THE AUDITED FINANCIAL STATEMENTS AND BOND DISCLOSURES OF THE CORPORATION; (10) SELECTION AND ANNUAL EVALUATION OF THE PRESIDENT; AND (11) THE ANNUAL AUDITED FINANCIAL STATEMENTS AND BOND DISCLOSURES OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 TAX RETURN IS PREPARED BY OUR EXTERNAL TAX ADVISOR WITH DATA PROVIDED BY OUR ORGANIZATION. A DRAFT OF THE FORM 990 IS PROVIDED TO MANAGEMENT FOR REVIEW AND COMMENT. THE BOARD OF DIRECTORS IS PROVIDED WITH AN APPROVED COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, BOARD MEMBERS, DIRECTORS, MANAGEMENT TEAM (ADMINISTRATION, DIRECTORS AND MANAGERS) AND OTHER KEY EMPLOYEES OF RUSH COPLEY MEDICAL CENTER, INC. AND SUBSIDIARIES ("RCMC") ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT TO DISCLOSE ANY PERSONAL OR BUSINESS INTERESTS THAT MAY GIVE RISE TO A CONFLICT WITH THE WORK THEY DO FOR RCMC . THE DISCLOSURES ARE SUBMITTED AND REVIEWED BY THE CORPORATE INTEGRITY OFFICER, WHO IS AN EMPLOYEE OF COPLEY MEMORIAL HOSPITAL BUT REPRESENTS RUSH COPLEY MEDICAL CENTER, INC. AND SUBSIDIARIES, AND A REPORT IS SUBMITTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF RCMC. THOSE KEY PERSONNEL WITH CONFLICTS ARE ADVISED TO RECUSE THEMSELVES FROM PARTICIPATING IN DECISION-MAKING RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 WITH RESPECT TO THE CEO/VPS OF THE ORGANIZATION AND KEY SENIOR MANAGEMENT, THE ORGANIZATION FOLLOWS A COMPENSATION APPROVAL PROCEDURE ANNUALLY THAT INVOLVES APPROVAL OF PROPOSED AND FINAL COMPENSATION ARRANGEMENTS BY THE ORGANIZATION'S COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN MINUTES. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 IS AVAILABLE UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. COPIES OF THE FINANCIAL STATEMENTS (WHETHER OR NOT AUDITED) ARE PROVIDED UPON REASONABLE REQUEST SUCH AS FOR A BANK LOAN OR TO A BOND RATING AGENCY. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE ATTORNEY GENERAL'S WEBSITE. FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS TO AFFILIATES-NET CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 1,835,693. SWAP VALUE ADJUSTMENT 2,706,307. RECOGNITION OF DEFERRED GAIN RUSH COPLEY MEDICAL CENTER INC 2000 OGDEN AVENUE AURORA IL 60504 363193787 PARENT COMPANY IL 501(C)(3) 12B, II RUSH SYSTEM FOR HEALTH 1 RUSH COPLEY FOUNDATION 2000 OGDEN AVENUE AURORA IL 60504 363093877 GRANTS TO CHARITABLE ORGANIZATIONS IL 501(C)(3) 7 RUSH COPLEY MEDICAL CENTER INC 1 COPLEY VENTURES INC 2000 OGDEN AVENUE AURORA IL 60504 363370216 RENTAL PROP., INFIRMARY CARE, AND HEALTHPLEX FITNESS CENTER IL 501(C)(3) 3 RUSH COPLEY MEDICAL CENTER INC 1 RUSH UNIVERSITY MEDICAL CENTER 1700 WEST VAN BUREN STREET CHICAGO IL 60612 362174823 HEALTHCARE IL 501(C)(3) 3 RUSH SYSTEM FOR HEALTH 1 RUSH SYSTEM FOR HEALTH 1725 W HARRISON STREET CHICAGO IL 60612 364046278 HOSPITAL IL 501(C)(3) 12C, III-FI N/A 0 RUSH OAK PARK HOSPITAL INC 520 S MAPLE AVENUE OAK PARK IL 60304 362183812 HOSPITAL IL 501(C)(3) 3 RUSH UNIVERSITY MEDICAL CENTER INC 1 AMENDED & RESTATED GENERAL MALPRACTICE & WORKER'S COMP 1700 WEST VAN BUREN CHICAGO IL 60612 366673233 HEALTHCARE INSURANCE IL 501(C)(3) 12C, III-FI RUSH UNIVERSITY MEDICAL CENTER INC 1 AUXILIARY OF RUSH OAK PARK HOSPITAL 520 S MAPLE AVE OAK PARK IL 60304 362255350 HOSPITAL SUPPORT IL 501(C)(3) 12A, I RUSH OAK PARK HOSPITAL 1 CIRCLE IMAGING PARTNERS LP 1725 W HARRISON STREET CHICAGO IL 60612 363539382 OPERATING IMAGING IL N/A 0 0 RUSH SURGICENTER AT THE PROFESSIONAL BUILDING LP 1725 W HARRISON STREET CHICAGO IL 60612 363853026 SURGERY CENTER IL N/A 0 0 RUSH COPLEY CARDIOVASCULAR CONSULTANTS LLC 2000 OGDEN AVENUE AURORA IL 60504 273234201 CARDIOVASCULAR MEDICINE IL COPLEY MEMORIAL HOSPITAL INC RELATED -892169 0 0 0.99000 RUSH COPLEY HOSPITALISTS LLC 2000 OGDEN AVENUE AURORA IL 60504 611787188 MEDICAL SERVICES IL COPLEY MEMORIAL HOSPITAL INC RELATED -53656 0 0 0.99000 RUSH COPLEY ORTHOPEDICS LLC 2000 OGDEN AVENUE AURORA IL 60504 611801175 MEDICAL SERVICES IL N/A 0 0 RUSH COPLEY SURGICENTER 2000 OGDEN AVENUE AURORA IL 60504 384012268 MEDICAL SERVICES IL COPLEY MEMORIAL HOSPITAL INC CO RUSH COPLEY MEDICAL CENTER RELATED 328894 15428577 0 1 0.99000 RUSH UNIVERSITY MEDICAL CENTER INSURANCE PO BOX 1051 GRAND CAYMAN CJ INSURANCE CJ N/A C 1 RUSH COPLEY MEDICAL GROUP NFP 2000 OGDEN AVENUE AURORA IL 60504 363235315 PHYSICIAN PRACTICES IL N/A C 1 ROOM FIVE HUNDRED 1725 W HARRISON STREET CHICAGO IL 60612 237139832 DINING ROOM IL N/A C 1 RUSH UNIVERSITY MEDICAL CENTER MASTER RETIREMENT TRUST 1700 W VAN BUREN STREET CHICAGO IL 60612 912043520 PENSION TRUST IL N/A T 1 RUSH HEALTH 1645 WEST JACKSON BLVD SUITE 501 CHICAGO IL 606123276 363972171 CLINICALLY INTEGRATED NETWORK IL N/A C 1 RUSH HEALTH ACO INC 1645 WEST JACKSON BLVD SUITE 501 CHICAGO IL 606123276 821632136 ACO IL N/A C 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 1 1 RUSH COPLEY MEDICAL GROUP NFP A 629805 FAIR MARKET VALUE RUSH COPLEY FOUNDATION C 551744 FAIR MARKET VALUE COPLEY VENTURES INC M 570000 FAIR MARKET VALUE COPLEY VENTURES INC R 1153505 FAIR MARKET VALUE RUSH UNIVERSITY MEDICAL CENTER J 316858 FAIR MARKET VALUE RUSH UNIVERSITY MEDICAL CENTER P 16102275 FAIR MARKET VALUE RUSH COPLEY FOUNDATION Q 652816 FAIR MARKET VALUE RUSH HEALTH M 1647970 FAIR MARKET VALUE RUSH HEALTH P 473798 FAIR MARKET VALUE RUSH HEALTH P 57093 FAIR MARKET VALUE RUSH HEALTH S 3507891 FAIR MARKET VALUE