2021-11-15T15:04:35-06:00 2020-12-31 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2020-01-01 361799520 South Shore Hospital Corporation SOUT 7733565312 8012 South Crandon Avenue Chicago IL 60617 Timothy Caveney President and CEO 2021-11-15 true Timothy Caveney 999009999 Kim Scifres P01316095 3128997000 2020 2022-09-23 18:48:47Z Timothy Caveney 8012 South Crandon Avenue Chicago IL 60617 46724553 false X www.southshorehospital.com X 1976 IL South Shore Hospital Corporation is a not-for-profit hospital dedicated to providing the highest quality of healthcare possible to the south shore community. The charges forgone for services furnished under its charity care policy during the year ended December 31, 2020 approximated $5,089,875. 11 9 556 35 0 0 5625619 11203545 35809922 35344253 22706 24118 127293 152637 41585540 46724553 0 0 22282509 25222909 0 0 17345341 19051357 39627850 44274266 1957690 2450287 15183710 19530712 12391440 15210080 2792270 4320632 South Shore Hospital Corporation is a not-for-profit hospital dedicated to providing the highest quality of healthcare possible to the south shore community. The costs for services and supplies furnished under its charity care policy during the year ended December 31, 2020 approximated $1,712,814. false false 30003454 35410064 THE HOSPITAL IS AN ACUTE CARE FACILITY PROVIDING SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY DURING THE YEAR ENDED DECEMBER 31, 2020 APPROXIMATED $1,712,814. IN ADDITION TO CHARITY CARE, THE HOSPITAL ALSO OFFERS OTHER COMMUNITY BENEFITS SUCH AS PROVIDING MENTORS AND VOLUNTEERS, AND IT ALSO SPONSORS HEALTH FAIRS THROUGHOUT THE COMMUNITY. EMPLOYEES OF THE HOSPITAL PARTICIPATE IN A MENTORING PROGRAM FOR CHILDREN WITHIN THE COMMUNITY. THE PROGRAM'S GOAL IS TO MOTIVATE STUDENTS TO COMPLETE THEIR HIGH SCHOOL EDUCATION WITH AN EMPHASIS ON THE OVERALL IMPORTANCE OF EDUCATION AND PRE-EMPLOYMENT PREPARATION. 30003454 true true false true false false false false false true false false false true false false false false false false false false false true false true true false false true false false false false false false false false false false false false false true true false false false true 405 0 true 556 true false false false false false false false false false false false false X 11 9 true false false false false false false true true false false true true true true true true true true false X Tim Caveney 7733565200 8012 SOUTH CRANDON AVENUE Chicago IL 60617 Lupe Valadez Vice President/Secretary 10.0 X X 0 0 0 Nick Valadez Chairman of the Board 10.0 X X 0 0 0 Timothy Caveney President and CEO 40.0 X X 280933 0 40159 Todd H Stroger Treasurer 10.0 X X 0 0 0 Betty Johnson Director 10.0 X 0 0 0 Blair Dietrich Director 10.0 X 0 0 0 Elsie Walker-Thomas Director 10.0 X 0 0 0 Jacqueline Hawkins RN Director 10.0 X 0 0 0 Jason Chen Director 60.0 X 256609 0 0 Julius R Alexander II Vice Chairman 10.0 X 0 0 0 Satya Ahuja Director 10.0 X 0 0 0 Mary E Foley Assistant Secretary 40.0 X 122195 0 11304 Femisayo Ajaja On-call Registry Nurse 40.0 X 165888 0 0 Kally McGill On-call Registry Nurse 40.0 X 181452 0 4186 Lilia Glackin Registered Nurse 40.0 X 232124 0 23664 Nikesha L Dunn Registered Nurse 40.0 X 163997 0 0 Vera H Ray Director of Lab 40.0 X 208237 0 12486 1611435 0 91799 47 false true false COMPLETE RX LTD 3100 S GESSNER SUITE 640 HOUSTON TX 77063 PHARMACY MANAGEMENT 1882412 ILIND EM-I MEDICAL SERVICES INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 EMERGENCY ROOM PHYSICIANS 970578 STEVEN GREENWALD MD 8012 S CRANDON AVE CHICAGO IL 606171124 PHYSICIAN 550957 SYSCO FOOD SERVICE-CHICAGO INC 250 Wieboldt Dr Des Plaines IL 60016 FOOD SERVICE 534881 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 272162140 MEDICAL SUPPLIES 434231 37 202 11203343 11203545 MEDICARE/MEDICAID PAYMENTS 622110 34430112 34430112 PATIENT SERVICE REVENUE 622110 735497 735497 RENTAL INCOME 531120 178644 178644 0 0 0 0 35344253 16799 16799 0 0 7319 0 7319 7319 7319 1948 202 0 1948 1948 CAFETERIA REVENUE 900099 84878 84878 65811 65811 0 0 150689 46724553 35410064 0 110944 X 0 0 0 0 0 0 0 0 454591 0 454591 0 0 0 0 0 21092536 16750420 4342116 248610 248610 2134291 2134291 1292881 433155 859726 0 0 0 0 0 0 0 0 60000 60000 0 0 0 0 0 0 0 0 0 0 0 0 10710506 8147337 2563169 0 0 0 496913 223226 273687 0 0 0 0 0 0 0 0 0 662372 45376 616996 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1152119 0 1152119 0 472940 0 472940 0 Medicaid Provider Tax 3064575 0 3064575 0 MEDICAL SUPPLiES 1696963 1696963 0 Food 470429 264076 206353 0 Medicine 264540 0 264540 0 0 0 0 0 44274266 30003454 14270812 0 1043465 3882553 313829 414622 0 0 3464715 5405998 0 0 0 0 0 0 347655 300271 167089 200585 53686011 44873869 9356799 8812142 0 0 0 0 0 0 490158 514541 15183710 19530712 7085700 7738307 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5305740 7471773 12391440 15210080 X 2792270 4320632 0 0 0 0 0 0 0 0 2792270 4320632 15183710 19530712 2450287 793 -922718 0 X false false true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4200 4200 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The Hospital is a member of the Illinois Health and Hospital Association and accordingly pays dues annually for its membership. A portion of South Shore's membership dues are attributable to lobbying activities, which is the amount reported on Schedule C, Part II-B, Line 1i. 2528853 2528853 28821202 23202687 5618515 0 0 0 22335956 21671182 664774 0 0 0 8812142 ESTIMATED LIABILITY FOR PROFFESSIONAL AND GENERAL LIABILITY 4216358 ESTIMATED THIRD-PARTY PAYER SETTLEMENTS 3156187 CAPITAL LEASE OBLIGATIONS 99228 7471773 Golf Outing 2150 202 1948 0 0 2150 202 1948 true true X true X true X true true true false true true 1712814 0 1712814 0.0390 17163992 18343948 0 0.0 0 0 0 0.0 0 0 18876806 18343948 1712814 0.0390 198229 0 198229 0.0045 0 0 0 0.0 5010796 1963339 3047457 0.0694 0 0 0 0.0 0 0 0 0.0 0 0 5209025 1963339 3245686 0.0739 0 0 24085831 20307287 4958500 0.1129 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 279557 12817629 14145789 -1328160 X true true 1 1 South Shore Hospital Corporation 8012 SOUTH CRANDON AVENUE Chicago IL 60617 www.southshorehospital.com 0003459 X X X South Shore Hospital Corporation 1 false false true X X X X X X X X X 19 true true true true X https://www.southshorehospital.com/about-south-shore/ X true 19 true HTTPS://WWW.SOUTHSHOREHOSPITAL.COM/ABOUT-SOUTH-SHORE/ false true X 200.0 400.0 X X X X true true X X X true X https://www.southshorehospital.com/fap-policy/ X https://www.southshorehospital.com/fap-policy/ X https://www.southshorehospital.com/fap-policy/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - SOUTH SHORE HOSPITAL. Between August 2018 and February 2019, Alliance for Health Equity partners collaborated to conduct a total of 57 focus groups with priority populations such as veterans, individuals living with mental illness, communities of color, older adults, caregivers, teens and young adults, LGBTQ+ community members, adults and teens experiencing homelessness, families with children, faith communities, adults with disabilities, and children and adults living with chronic conditions such as diabetes and asthma. Thirty-six focus groups were conducted by IPHI and 21 Learning Map Sessions were led by West Side United, a regional collaboration of hospitals serving the West Side of Chicago and West Suburban Cook County, with notetaking by IPHI. IPHI developed the focus group questions using resources from existing CHNA toolkits and peer-reviewed studies, in consultation with the CHNA committee and colleagues at partner health departments. Each focus group was hosted by a hospital or community organization. The sessions were approximately 60-90 minutes long with an average of 8-12 participants. A total of 5 learning map sessions/focus groups were conducted with residents living within SSH's service area. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - South Shore Hospital. SSH and members of the Alliance for Health Equity (AHE), a collaborative of 35 non-profit hospitals (displayed on page 6 of the CHNA), two public hospitals, six health departments, and nearly 100 community-based organizations, worked together between March 2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (CHNA) for Chicago and Suburban Cook County. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - South Shore Hospital. SSH and members of the Alliance for Health Equity (AHE), a collaborative of 35 non-profit hospitals (displayed on page 6 of the CHNA), two public hospitals, six health departments, and nearly 100 community-based organizations, worked together between March 2018 through March 2019 to conduct a comprehensive Community Health Needs Assessment (CHNA) for Chicago and Suburban Cook County. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - SOUTH SHORE HOSPITAL. SSH has a Geriatric Psych, Detox and Chemical Dependency programs. The Emergency Room had 12,747 visits in 2019. HEALTH PRIORITIES NOT CHOSEN FOR ACTION: CANCER-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS CANCER DEATHS. OTHER HOSPITALS IN THE COMMUNITY HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDE THIS AS AN AREA CHOSEN FOR ACTION. FAMILY PLANNING-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS FAMILY PLANNING ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. HEART DISEASE & STROKE-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS HEART DISEASE & STROKE ISSUES. OTHER COMMUNITY ORGANIZATIONS AND HOSPITAL HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. IMMUNIZATIONS-ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. INJURY & VIOLENCE PREVENTION-SSH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. MATERNAL & INFANT HEALTH-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS MATERNAL & INFANT HEALTH ISSUES. OTHER COMMUNITY ORGANIZATIONS AND HOSPITAL HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. ORAL HEALTH-ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. RESPIRATORY DISEASE-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS RESPIRATORY DISEASE ISSUES. OTHER COMMUNITY ORGANIZATIONS AND HOSPITAL HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. SEXUALLY TRANSMITTED DISEASES-SSH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. TOBACCO USE-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS TOBACCO USE ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. VISION-ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 6 SENIORS & GENERAL WELLNESS CENTER 2525 EAST 83RD STREET CHICAGO IL 60617 PHYSICIAN OFFICE EAST SIDE MEDICAL HEALTH CENTER 10551 SOUTH EWING AVENUE CHICAGO IL 60617 PHYSICIAN OFFICE SOUTH SIDE PROFESSIONAL BUILDING 7906 SOUTH CRANDON AVENUE CHICAGO IL 60617 PHYSICIAN OFFICE HIGHLAND MEDICAL CENTER 8201 SOUTH ASHLAND CHICAGO IL 60620 PHYSICIAN OFFICE FAMILY MEDICAL CENTER 1424 WEST 87TH STREET CHICAGO IL 60620 PHYSICIAN OFFICE SHARED PHYSICIAN OFFICE SPACE 8012 SOUTH CRANDON AVENUE CHICAGO IL 60617 PHYSICIAN OFFICE Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE BAD DEBT RESERVE IS AN ESTIMATE OF THE ACCOUNT BALANCES THAT WE EXPECT TO NOT COLLECT DESPITE THE PATIENTS ABILITY TO PAY. THE ESTIMATE WHICH IS UPDATED MONTHLY IS BASED ON HISTORICAL WRITE OFF PERCENTAGES. THESE PERCENTAGES ARE ADJUSTED TO REFLECT ANY BAD DEBT RECOVERIES. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The Method used to determine the amount that reasonably could be attributed to patients who likely would qualify for financial assistance under our Financial Assistance Policy is based on our outside eligibility vendor's experience with qualifying accounts as financial assistance. Our vendor screens all self pay accounts, and based on an initial screening, will classify the account as falling under our Financial Assistance Program guidelines. OCCASIONALLY, PATIENT ACCOUNTS WILL BE WRITTEN OFF TO BAD DEBT BUT THEN ARE LATER DETERMINED TO BE UNCOLLECTIBLE DUE TO THE PATIENT BEING UNINSURED OR ELIGIBLE FOR PUBLIC AID. ONCE DETERMINED THAT THE PATIENT HAS NO ABILITY TO PAY, THE ACCOUNTS ARE WRITTEN OFF AS CHARITY WRITE-OFFS. THE METHODOLOGY IS TO TAKE TOTAL BAD EXPENSE LESS THE BAD DEBT FROM THE MEDICARE COST REPORT. THE HOSPITAL INCURS A LOSS FOR THE BENEFIT OF THE COMMUNITY. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The provision for bad debts is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in healthcare coverage, and other collection indicators. Accounts receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the Hospital's policies. Recoveries are treated as a reduction to the provision for bad debts. Accounts receivable are reduced by an allowance for doubtful accounts. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by major payor category. Income from incentive payments is subject to retrospective adjustment as the incentive payments are calculated using Medicare cost report data that is subject to audit. Data about the major payor sources of revenue is analyzed to establish an appropriate allowance for uncollectible receivables and provision for bad debts. For receivables associated with services provided to patients who have third-party coverage, contractually due amounts are analyzed and compared to actual cash collected over time to enhance the quality of the estimate of the allowance for doubtful accounts and the provision for bad debts (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), a significant allowance for doubtful accounts is recorded on the basis of historical experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. An estimate of the difference between contracted rates and amounts actually collected, after all reasonable collection efforts have been exhausted, is charged to the provision for bad debts and credited to the allowance for doubtful accounts. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Medicare allowable costs were determined by applying the Medicare cost to charge ratio from the 2020 Medicare cost report to the Medicare charges. Approximately 60% of our patients are seniors with Medicare insurance, but are unable to pay their coinsurance and deductible amounts. Consistent with the Hospital's Financial Assistance policy, these accounts are either written off to Charity care or Bad Debt expense. Most of the Medicare shortfall is the result of these accounts. Hence, the Hospital is subsidizing the Medicare reimbursement as part of our community benefit program. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance In recognizing the medical needs of the indigent, South Shore Hospital provides quality medical health care regardless of race, creed, color, sex, natural origin, sexual orientation, handicap, age or ability to pay. Our financial assistance policy identifies circumstances under which South Shore Hospital will extend care free of charge or at a discount, commensurate with the ability to pay, to a patient whose financial status makes it impractical or impossible to pay for necessary medical expenses. The necessity for medical treatment of any patient is based upon clinical judgement without regard to the financial status of the patient. If a patient is determined to be eligible for financial assistance, then collection actions will be stopped. Schedule H, Part V, Section B, Line 16a FAP website - South Shore Hospital Corporation: Line 16a URL: https://www.southshorehospital.com/fap-policy/; Schedule H, Part V, Section B, Line 16b FAP Application website - South Shore Hospital Corporation: Line 16b URL: https://www.southshorehospital.com/fap-policy/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - South Shore Hospital Corporation: Line 16c URL: https://www.southshorehospital.com/fap-policy/; Schedule H, Part VI, Line 2 Needs assessment The Hospital goes above and beyond the core needs of the community as stipulated in the CHNA, by providing diabetes education, language assistance, and transportation services. Meetings are scheduled throughout the year with ministers, community leaders and representatives of the communities school districts. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance All uninsured patients are advised of our financial assistance policy as part of the admissions process. Whenever possible, South Shore Hospital provides assistance to uninsured patients in obtaining health care insurance at no cost to the patient. This assistance includes visits with the patient while in the hospital, and follow-up visits to their home to ensure that insurance applications are completed and filed in a timely manner. Then appropriate follow up is done with Medicaid and other insurers to ensure the applications are processed timely. All self pays receive a charity application, and are assessed. They are given a discount based on the State of Illinois poverty guidelines. For patients that are presumptive eligible, they are written off to Charity once they go through the process and are denied. According to the Hospital's FAP: 1. Every patient will, upon admission as an inpatient or outpatient, receive a written notice that shall contain information about the availability of financial assistance, including information about this policy as well as contact information for a hospital employee or office from which the person may obtain further information about the policy. 2. Signs will be posted conspicuously in the admission and registration areas to notify patients and visitors about the availability of financial assistance. The signage will contain the following language, in accordance with the Illinois Hospital Fair Patient Billing Act: "You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For more information contact South Shore Hospital Financial Counselors at 773-356-5212." 3. Each hospital bill, invoice, or other summary of charges to an uninsured patient shall include with it, or on it, a prominent statement, in accordance with the Illinois Hospital Uninsured Patient Discount Act, to the effect that an uninsured patient who meets certain income requirements may qualify for an uninsured discount and information regarding how an uninsured patient may apply for consideration under South Shore Hospital's FAP. 4. The FAP, Financial Assistance Application and plain language summary of the FAP will be available on South Shore Hospital's website at http://www.southshorehospital.com. The documents will be posted in a format that will allow any individual with access to the Internet to access, download, view, and print a hard copy of the documents without requiring special computer equipment and without the payment of a fee. South Shore Hospital will provide any individual who asks how to obtain online access to a copy of the FAP, Financial Assistance Application form, or plain language summary of the FAP with the direct website address, or URL, of the web page on which these documents are posted. 5. Paper copies of the FAP, Financial Assistance Application and plain language summary of the FAP will be readily available in the admitting department and waiting areas. Patients may also call to obtain a copy and it will be mailed it to them at no cost. 6. The Patient Access Department will also notify those patients with no insurance of the availability of Financial assistance and will give a copy of the Financial Assistance Application and plain language summary of the FAP to patients. Schedule H, Part VI, Line 4 Community information The South Shore Hospital service area consists of twelve zip codes in the southeast side of the city of Chicago. Six of the zip codes comprise about 80% of our admissions (Zips 60617, 60619, 60649, 60620, 60637, and 60628). These zip code areas have a combined estimated population of about 200,000. Some of the key healthcare needs of this core zip code area are: -There is a disproportionately large population of uninsured people in this area. As a result, South Shore Hospital treats a large percentage of our patients free of charge or at a discount. -There is a disproportionately large population of insured people in this area that cannot afford to pay their copays and deductibles. As a result, the annual Hospital bad debt expense is very large. -There is also a disproportionately large population of indigent people insured with Medicaid in this area. On average, about 25% of our Inpatients have Medicaid health coverage. About 30% of the emergency room outpatient visits are Medicaid patients using the emergency room as a doctors office. Drug abuse is a serious problem in our area with the need for Detox and Rehab services. An increasing number of people in our core zip codes are infected with HIV. There are three other hospital serving the community: St. Bernard Hospital, Advocate Trinity Hospital, and Jackson Park Hospital. South Shore Hospital serves the medically under served. African Americans are nearly 90 percent of inpatient admits. Schedule H, Part VI, Line 5 Promotion of community health In addition to the services previously noted in this schedule, the Hospital also provides free immunizations, patient education assistance, language assistance, transportation services, and senior wellness programs, at no cost to the patient. The Hospital also participates with local, independent organizations in conducting about 50 health screening events per year. In addition, the Hospital contributes funds to local, non-profit organizations actively engaged in meeting the social, economic, spiritual, mental and healthcare needs of our community. While most of our patients have healthcare insurance through Medicare or Medicaid, neither of these programs cover the cost of providing the care. As a result, the Hospital usually operates at a loss while subsidizing these programs. The members of the governing body are comprised of persons who reside in the organization's primary service area who are neither employees nor independent contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified physicians in the community for all of its departments and specialties. Schedule H, Part VI, Line 7 State filing of community benefit report IL X X false false false false false false false false false Timothy Caveney President and CEO 272412 0 0 0 8521 0 17042 0 23117 0 321092 0 0 0 Jason Chen Director 256609 0 0 0 0 0 0 0 0 0 256609 0 0 0 Vera H Ray Director of Lab 201994 0 0 0 6243 0 12486 0 0 0 220723 0 0 0 Kally McGill On-call Registry Nurse 179359 0 0 0 2093 0 4186 0 0 0 185638 0 0 0 Lilia Glackin Registered Nurse 225063 0 0 0 7061 0 14122 0 9542 0 255788 0 0 0 Femisayo Ajaja On-call Registry Nurse 165888 0 0 0 0 0 0 0 0 0 165888 0 0 0 Nikesha L Dunn Registered Nurse 163997 0 0 0 0 0 0 0 0 0 163997 0 0 0 Form 990, Part VI, Line 20 AUDITED FINANCIAL STATEMENTS SECTION 6033(B)(15)(B) REQUIRES HOSPITAL ORGANIZATIONS TO SUBMIT A COPY OF THEIR AUDITED FINANCIAL STATEMENTS TO THE IRS. PLEASE NOTE, AT THE TIME OF FILING, THE 2020 AUDITED FINANCIALS WERE NOT SIGNED AND ISSUED. Form 990, Part VI, Line 1a Delegate broad authority to a committee THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN OF THE BOARD OF DIRECTORS AS CHAIRMAN, VICE-CHAIRMAN, THE PRESIDENT, TREASURER, AND SUCH OTHER DIRECTORS AS THE CHAIRMAN OF THE BOARD MAY APPOINT. THE PRESIDENT OF THE MEDICAL STAFF SHALL BE A MEMBER OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT ANY ACTION SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF DIRECTORS. IN ADDITION, THE EXECUTIVE COMMITTEE MAY ACT IN ALL PERSONNEL MATTERS INVOLVING EXECUTIVE PERSONNEL AND MEDICAL STAFF AS WELL AS OTHER PERSONNEL, INCLUDING SEARCH, SELECTION, EMPLOYMENT, COMPENSATION, CONTRACTS, GENERAL WAGE SCALES, BENEFITS FOR ALL EMPLOYEES AND PERFORMANCE EVALUATION. THE CHAIRMAN MAY APPOINT AN AD HOC COMMITTEE TO RECOMMEND TO IT ANY PARTICULAR SITUATION. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons LUPE VALADEZ & NICK VALADEZ - Family relationship Form 990, Part VI, Line 11b Review of form 990 by governing body PRINTED COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy Each officer, director, trustee and key employee is subject to the conflict of interest policy. the board's conflict of interest committee reviews each member's conflict of interest statement on an annual basis. the board compares prior and current year conflict of interest statements, and reports any potential or actual conflicts of interest to the organization's human resources department. actual conflicts of interest are documented with the organization's human resources department annually. Officers, Directors, Trustees and employees are all covered under the organizations conflict of interest policy. Should there become known, at any time, a conflict of interest between any member staff, hospital personnel or other healthcare providers and the hospital, and the hospital or any of its agents, the individual (s) may excuse himself/ herself from discussions and/ or determinations with the identified healthcare provider(s). Form 990, Part VI, Line 15a Process to establish compensation of top management official The Compensation Committee of the board of directors reviews the CEO's performance on an annual basis. In setting the compensation of the organization's CEO, the Committee compares industry compensation figures to the CEO's compensation package. The final determination and deliberations regarding the CEO's compensation package are documented in the minutes of the board of directors meeting. The process for determining compensation of the CEO was last undertaken in 2020. Form 990, Part VI, Line 15b Process to establish compensation of other employees The Compensation Committee of the board of directors reviews the performance of the officers and key employees on an annual basis In setting the compensation of these individuals, the Committee compares industry compensation figures to their financial packages. If any individual's compensation is discussed during the meeting, that individual is required to recuse themselves. The process for determining compensation of other officers and key employees was last undertaken in 2020. Form 990, Part VI, Line 19 Required documents available to the public Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are available upon request Form 990, Part VII, Section A Reportable Compensation No board member received compensation for services performed as a board member. Board members who have reported compensation from the filing entity were paid for provision of other services to the organization. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Miscellaneous - Total Revenue: 65811, Related or Exempt Function Revenue: 65811, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees PURCHASED SERVICES - Total Expense: 5990646, Program Service Expense: 4297137, Management and General Expenses: 1693509, Fundraising Expenses: ; PHYSICIAN FEES - Total Expense: 2971967, Program Service Expense: 2892613, Management and General Expenses: 79354, Fundraising Expenses: ; REPAIRS AND MAINTENANCE - Total Expense: 608948, Program Service Expense: 296732, Management and General Expenses: 312216, Fundraising Expenses: ; OTHER - Total Expense: 1138945, Program Service Expense: 660855, Management and General Expenses: 478090, Fundraising Expenses: ; SOUTH SHORE HOSPITAL AUXILIARY 8012 S CRANDON AVE CHICAGO IL 606171199 363200759 FUNDRAISING IL 501(c)(3) 3 SSHC true false false false false false false false false false false false false false false false false false false false