2021-05-14T09:02:48-05:00 2020-06-30 135565207 KPMG LLP 191 WEST NATIONWIDE BLVD STE 500 COLUMBUS OH 432152568 990 2019-07-01 362170866 The Ingalls Memorial Hospital INGA 7083332300 One Ingalls Drive Harvey IL 60426 ANN MCCOLGAN VP AND CHIEF TREASURY OFFICER 2021-05-14 true MOLLIE P LONGHOUSE P00294881 6142492300 2019 2022-09-23 18:48:47Z BRIAN SINOTTE One Ingalls Drive Harvey IL 60426 307960063 false X WWW.INGALLS.ORG X 1922 IL INGALLS MEMORIAL HOSPITAL IS A NONPROFIT ACUTE CARE HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING PATIENT CARE, EDUCATION, AND RESEARCH. 15 8 2382 171 1347817 0 1027959 25631857 289475951 273805486 7315093 3966530 2591190 3450167 300410193 306854040 16750 105800 0 117132680 134324136 0 0 186899962 191428454 304049392 325858390 -3639199 -19004350 437512615 493177087 177041285 255214295 260471330 237962792 X INGALLS MEMORIAL HOSPITAL IS A NONPROFIT ACUTE CARE HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING PATIENT CARE, EDUCATION, RESEARCH, AND ASSISTANCE TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION. false false 158948051 105800 126311455 INGALLS MEMORIAL (IMH) INCLUDES A 500+ CERTIFIED BED HOSPITAL AND A NETWORK OF COMPREHENSIVE OUTPATIENT CENTERS THAT FEATURE A FULL ARRAY OF HIGH-TECH DIAGNOSTIC AND TREATMENT SERVICES. IMH MAKES SURE THAT OUR RESOURCES ARE DIRECTED TO AREAS THAT RESULT IN THE GREATEST BENEFIT TO OUR PATIENTS AND THE COMMUNITY. 26137518 29594234 THE PHARMACY PROVIDES SERVICES TO BOTH OUR INPATIENTS AND INFUSION CENTER PATIENTS. INCLUDED IN THE SERVICES PROVIDED ARE ANTIBIOTIC DOSING, DOSING BASED ON KIDNEY FUNCTION, BLOOD GLUCOSE MANAGEMENT, AND ANTICOAGULANT DOSING AND MONITORING. THE INPATIENT PHARMACY IS OPEN 24/7. WE PROCESS APPROXIMATELY 49,000 MEDICATION ORDERS AND MAKE 8,300 INTERVENTIONS PER MONTH. 14659208 91793398 IMH PERFORMS AN ARRAY OF SURGICAL SERVICES INCLUDING ELECTIVE, NON-ELECTIVE, COMPLEX AND HIGHLY SPECIALIZED PROCEDURES. SURGEONS ON STAFF AT INGALLS SPECIALIZE IN EVERY AREA OF SURGERY, INCLUDING, BUT NOT LIMITED TO CARDIOTHORACIC SURGERY, ORTHOPEDIC SURGERY, NEUROSURGERY, SPINE SURGERY, GENERAL SURGERY, AND VASCULAR SURGERY. IN FY2020 INGALLS PERFORMED 1,896 INPATIENT SURGERIES AND 2,288 AMBULATORY SURGERIES. 79610446 28935376 OTHER PROGRAM SERVICES RELATED TO THE PROVISION OF HEALTHCARE INCLUDE LABORATORY SERVICES, PATIENT FINANCIAL SERVICES, COST OF FACILITIES, MALPRACTICE INSURANCE, AND OTHER SUPPORT SERVICES. 79610446 28935376 279355223 true true false true false false false false false true false false true true true false true false false false false false false false false true true false true true true false false false false false false false false false false false false false false false true true true false false true 422 0 true 2382 true true true false false false false false false false false false false false X 15 8 false false false false true true true true true false false true true true true true true true true false IL X RICHARD SILVERIA 7083332300 ONE INGALLS DRIVE HARVEY IL 60426 BRIAN SINOTTE PRESIDENT IMH (EFF. 7/1/19) 1.0 40.0 X X 365110 0 25922 DAVID H ORTH MD CHAIRMAN 1.0 0.0 X X 20363 0 0 DENNIS IRVIN VICE CHAIRMAN 1.0 0.0 X X 0 0 0 SAMUEL CUTRARA JR SECRETARY/TREASURER 1.0 0.0 X X 0 0 0 CORRIN STEINHAUER RN BOARD MEMBER 1.0 40.0 X 0 340100 89779 CRESSA PERISH MD BOARD MEMBER 1.0 40.0 X 0 45765 295 DOROTHY JONES MD BOARD MEMBER 40.0 0.0 X 97007 0 18672 EUGENE FEINGOLD BOARD MEMBER TIL FEB 2020 1.0 1.0 X 0 0 0 FRANCIS ALMEDA MD BOARD MEMBER (EFF. 3/28/19) 1.0 0.0 X 0 0 0 HENRY JOHNSON BOARD MEMBER 1.0 0.0 X 0 0 0 JASON R KEELER BOARD MEMBER TIL 7/15/19 1.0 40.0 X 0 953388 125976 JOHN A FLYNN MD BOARD MEMBER 1.0 40.0 X 0 863915 54047 KEVIN M PURCELL BOARD MEMBER 1.0 1.0 X 0 0 0 MARK F KOZLOFF MD BOARD MEMBER 1.0 1.0 X 0 744128 39722 MILDRED WILLIAMS-REID BOARD MEMBER (EFF. 2/27/20) 1.0 0.0 X 0 0 0 NATHANIEL SUTTON BOARD MEMBER 1.0 0.0 X 0 0 0 RICHARD KING BOARD MEMBER (THRU JAN 2020) 1.0 0.0 X 0 0 0 TIMOTHY JOHNSON BOARD MEMBER 1.0 0.0 X 0 0 0 ANN MCCOLGAN ASST TREASURER/VP TREASURY 1.0 40.0 X 0 384023 82275 MICHAEL LAWRENCE CHIEF FINANCIAL OFFICER (THRU 8/29/19) 40.0 0.0 X 470195 0 48585 RICHARD W SILVERIA CHIEF FINANCIAL OFFICER, UCMC 1.0 40.0 X 0 1031465 187948 THOMASZ SAMEK ASSISTANT SECRETARY 40.0 1.0 X 141495 0 28153 PAUL DONOHUE VP PHILANTHROPY AND COMMUNITY 40.0 1.0 X 230088 0 62587 BETTY HALL RN TEAM LEADER SURGERY 40.0 0.0 X 156181 0 17808 JAMES SWANSON DIRECTOR TECH SVCS/IT SEC OFFI 40.0 0.0 X 179053 0 35239 KIMBERLY SERRANO EXEC DIR PERIOPERATIVE AND CLIN PRACT 40.0 0.0 X 184580 0 22187 MARY JO CRANDALL VP LEAN TRANSFORMATION 40.0 0.0 X 230430 0 11522 SUSAN BJORK DIRECTOR, INGALLS IT APPLICATIONS 40.0 0.0 X 172800 0 23955 GARY GASBARRA INTERIM CFO TIL 6/30/17 0.0 40.0 X 0 683482 84402 JONATHAN GOBLE INTERIM PRESIDENT (THRU APR 2019) 0.0 0.0 X 357513 0 12960 2604815 5046266 972034 90 true true false SYNERGY BEHAVIORAL HEALTHCARE 1566 W ALGONQUIN ROAD 3149 HOFFMAN ESTATES IL 60192 BEHAVIORAL HEALTH 6061795 CROTHALL HEALTHCARE 25271 NETWORK PLACE CHICAGO IL 60673 HEALTHCARE SUPPORT SERVICES 6040955 CERNER HEALTH SERVICES C/O US BANK PO BOX 959167 ST LOUIS MO 63195 IT SUPPORT 5624755 ARAMARK CORP 27310 NETWORK PLACE CHICAGO IL 606731273 FOOD, EVS, CLIN TECH 4541907 MORRISON MANAGEMENT SPECIALIST 400 NORTHRIDGE ROAD SUITE 600 ATLANTA GA 30350 FOOD SERVICES 3790574 116 1135073 24496784 25631857 NET PATIENT REVENUE 900099 269606678 269606678 LAB SERVICES 900099 1347817 1347817 RENTAL INCOME 900099 1250435 1250435 PATIENT TRANSPORTATION 900099 795641 795641 FOOD SERVICE 621500 673680 673680 131235 131235 0 0 273805486 1263477 1263477 1684316 1106023 578293 0 578293 578293 3003803 -300750 3003803 -300750 2703053 2703053 EXPENSE REIMBURSEMENT & MGMT FEES 900099 1474771 1474771 BANK REBATES 900099 363692 363692 340B PROGRAM 900099 328400 328400 705011 662114 0 42897 2871874 306854040 275286646 1347817 4587720 X 105800 105800 1520595 0 1520595 0 110016590 104299812 5716778 2527996 2425355 102641 12851151 11992869 858282 7407804 6894917 512887 4205016 4205016 374082 374082 364539 364539 31558 31558 738836 738836 46904042 36388059 10515983 0 1215470 1215470 1925971 987777 938194 18239219 18239219 5295380 5215574 79806 178208 139711 38497 4460638 4460638 15002421 14682867 319554 10225054 10225054 MEDICAL SUPPLIES 57226556 57226556 PUBLIC ASSESSMENT 17121888 17121888 REPAIRS & MAINTENANCE 5005785 4943452 62333 LAUNDRY SERVICES 1225270 1225270 1688521 1019624 668897 0 325858390 279355223 46503167 0 8177 8177 315525 104752 41057590 34396683 0 0 0 0 6321365 6508086 3942333 3208422 244170610 55460365 191405861 188710245 140885887 137134498 0 0 53575877 123106224 437512615 493177087 52710369 128707603 6061340 6456196 101575923 100654872 0 0 16693653 19395624 177041285 255214295 X 256409081 234256842 4062249 3705950 260471330 237962792 437512615 493177087 X -19004350 232158 -3736346 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 62900 false true 31558 94458 Schedule C, Part II-B, Line 1g DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The Vice President of Government Affairs for University of Chicago Medicine has contact with legislators and government officials on behalf of Ingalls Memorial Hospital. Topics include Medicare and Medicaid funding and proposed staffing legislation. Schedule C, Part II-B, Line 1i DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE HOSPITAL PAYS DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE USED TO SUPPORT LOBBYING BY THE ASSOCIATION FOCUSED ON ADVOCACY AND REPRESENTATION. 6464807 6464807 164710613 21931163 142779450 69758075 32341998 37416077 3237115 1187204 2049911 188710245 DUE FROM AFFILIATES 118877063 RESTRICTED INVESTMENTS - FDN 3705950 INSURANCE CLAIMS RECEIVABLE 435599 OTHER LONG TERM ASSETS 87612 123106224 LEASE OBLIGATIONS 1401636 SWAP PAYABLE 11435996 OTHER PAYABLES 4969851 DEFERRED SOCIAL SECURITY PAYABLE 1588141 19395624 X 303717040 232158 -3736345 -3504187 307221227 738836 -1106023 -367187 306854040 326225577 1106023 1106023 325119554 738836 0 738836 325858390 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM APPLIES ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S CONSOLIDATED 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, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. AS OF JUNE 30, 2020 AND 2019, THE SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENTS - -2317914 LOSS ON REFINANCE OF DEBT - -1062131 CHANGE IN INTEREST OF FOUNDATION - -356300 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements RENTAL EXPENSES - -1106023 Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 RENTAL EXPENSES - 1106023 true true X true X true X 600 true true true false true true 7895292 0 7895292 0.0242 97412935 77405984 20006951 0.0614 0 0 0 0.0 0 0 105308227 77405984 27902243 0.0856 172114 0 172114 0.0005 2055507 621960 1433547 0.0044 0 0 0 0.0 0 0 0 0.0 105996 0 105996 0.0003 0 0 2333617 621960 1711657 0.0053 0 0 107641844 78027944 29613900 0.0909 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 9826698 113275863 124862081 -11586218 X true true NONE 1 1 INGALLS MEMORIAL HOSPITAL ONE INGALLS DRIVE HARVEY IL 60426 WWW.INGALLS.ORG 0001099 X X X INGALLS MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 18 true false true true X https://issuu.com/communitybenefit-ucm/docs/ucm-ingalls-2019-chna?fr=xKAE9_zU1NQ X X true 18 true https://issuu.com/communitybenefit-ucm/docs/ucm-ingalls-2020-2022-strategic-implementation-pla false true X 200.0 600.0 X X X X X true true X X X true X https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance X ttps://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance X https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. THE CHNA PROCESS INVOLVED ENGAGEMENT WITH MULTIPLE STAKEHOLDERS TO PRIORITIZE HEALTH AREAS TO ASSESS AS WELL TO COLLECT, CURATE AND INTERPRET THE DATA. INGALLS COLLABORATED WITH 35 HOSPITALS AND TWO HEALTH DEPARTMENTS AND REGIONAL AND COMMUNITY-BASED ORGANIZATIONS IN COOK COUNTY ILLINOIS, THROUGH A MEMBERSHIP COLLABORATION CALLED THE ALLIANCE FOR HEALTH EQUITY, WHICH WAS LED BY THE ILLINOIS PUBLIC HEALTH INSTITUTE. INGALLS ALSO ENGAGED INTERNAL AND EXTERNAL STAKEHOLDERS THROUGHOUT THE CHNA PROCESS. INTERNAL STAKEHOLDERS INCLUDED THE MEMBERS OF THE COMMUNITY BENEFIT STEERING COMMITTEE AND THE MEMBERS OF THE COMMUNITY MANAGEMENT TEAM. ADDITIONALLY, APPROXIMATELY 20 STAKEHOLDERS REPRESENTING BROAD INTERESTS OF THE COMMUNITY ATTENDED A MEETING IN APRIL 2019 TO REVIEW DATA AND TO DISCUSS PERTINENT ISSUES FOR IMH TO ADDRESS THROUGH THE IMPLEMENTATION PLAN. PRIMARY DATA COLLECTION METHODS FOR THE CHNA WERE: 1) 240 COMMUNITY INPUT SURVEYS AVAILABLE IN ENGLISH, SPANISH, CHINESE AND POLISH 2) ONE COMMUNITY INPUT FOCUS GROUP WITH PRIORITY POPULATIONS TEENS AND YOUNG ADULTS 3) HEALTH CARE AND SOCIAL SERVICE PROVIDER FOCUS GROUPS 4) TWO STAKEHOLDER ASSESSMENTS LED BY THE CHICAGO DEPARTMENT OF PUBLIC HEALTH FORCES OF CHANGE ASSESSMENT AND 5) HEALTH EQUITY CAPACITY ASSESSMENT. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. IMH JOINED THE ALLIANCE FOR HEALTH EQUITY TO CONDUCT THE CHNA AND PARTICIPATED IN ITS COLLABORATIVE EFFORTS FOR COOK COUNTY. THE ALLIANCE FOR HEALTH EQUITY IS A COLLABORATIVE OF 37 HOSPITALS WORKING WITH HEALTH DEPARTMENTS AND REGIONAL AND COMMUNITY-BASED ORGANIZATIONS TO IMPROVE HEALTH EQUITY, WELLNESS, AND QUALITY OF LIFE ACROSS CHICAGO AND COOK COUNTY. USING THE DATA GATHERED FROM THIS EFFORT, INGALLS CREATED A CHNA FOCUSED ON ITS SERVICE AREA AND ALSO COMPLEMENTED IT WITH ADDITIONAL DATA AND INFORMATION. THE FACILITIES OTHER THAN HOSPITALS THAT PARTICIPATED IN THE ALLIANCE FOR HEALTH EQUITY ARE CHICAGO DEPARTMENT OF PUBLIC HEALTH, COOK COUNTY, DEPARTMENT OF PUBLIC HEALTH, EVANSTON HEALTH AND HUMAN SERVICES, AND THE VILLAGE OF SKOKIE HEALTH DEPARTMENT. THE PARTICIPATING HOSPITALS WERE: ADVOCATE AURORA CHILDREN'S HOSPITAL ADVOCATE AURORA CHRIST MEDICAL CENTER ADVOCATE AURORA ILLINOIS MASONIC MEDICAL CENTER ADVOCATE AURORA LUTHERAN GENERAL HOSPITAL ADVOCATE AURORA SOUTH SUBURBAN HOSPITAL ADVOCATE AURORA TRINITY HOSPITAL AMITA ADVENTIST MEDICAL CENTER LA GRANGE AMITA ALEXIAN BROTHERS MEDICAL CENTER, ELK GROVE VILLAGE AMITA HOLY FAMILY MEDICAL CENTER AMITA RESURRECTION MEDICAL CENTER AMITA ST. ALEXIUS MEDICAL CENTER AND ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL AMITA SAINT FRANCIS HOSPITAL AMITA SAINT JOSEPH HOSPITAL AMITA SAINTS MARY AND ELIZABETH MEDICAL CENTER ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO COOK COUNTY HEALTH- PROVIDENT HOSPITAL COOK COUNTY HEALTH- STROGER HOSPITAL JACKSON PARK HOSPITAL THE LORETTO HOSPITAL LOYOLA MEDICINE- GOTTLIEB MEMORIAL HOSPITAL LOYOLA MEDICINE- LOYOLA UNIVERSITY MEDICAL CENTER LOYOLA MEDICINE- MACNEAL HOSPITAL MERCY HOSPITAL & MEDICAL CENTER NORTHWESTERN MEMORIAL HOSPITAL NORWEGIAN AMERICAN HOSPITAL PALOS COMMUNITY HOSPITAL ROSELAND COMMUNITY HOSPITAL RUSH OAK PARK RUSH UNIVERSITY MEDICAL CENTER SINAI HEALTH SYSTEM- HOLY CROSS HOSPITAL SINAI HEALTH SYSTEM- MOUNT SINAI HOSPITAL SINAI HEALTH SYSTEM- SCHWAB REHABILITATION HOSPITAL SOUTH SHORE HOSPITAL SWEDISH COVENANT HOSPITAL UNIVERSITY OF CHICAGO MEDICINE UNIVERSITY OF CHICAGO MEDICINE-INGALLS MEMORIAL HOSPITAL UNIVERSITY OF ILLINOIS HOSPITAL AND HEALTH SCIENCES SYSTEM Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - INGALLS MEMORIAL HOSPITAL. The results of the report have been discussed at community meetings, with reference to the full report's availability on the hospital's website. The CHNA has also been made widely available to various Chicagoland community news outlets, including the Chicago Sun-Times and WVON-1690 AM. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. THE MOST RECENT CHNA WAS CONDUCTED IN 2018. THE CHNA FOR YEARS 2020-2022 WAS ADOPTED BY THE UNIVERSITY OF CHICAGO MEDICAL CENTER'S BOARD OF DIRECTOR'S GOVERNMENT AND COMMUNITY RELATIONS COMMITTEE. THIS COMMITTEE RECEIVED AND REVIEWED THE 2019 CHNA REPORT, 2016-2019 EVALUATION REPORT, AND 2020-2022 STRATEGIC IMPLEMENTATION PLAN AND FORMALLY APPROVED ALL THREE DOCUMENTS ON MAY 23, 2019. THE HEALTH PRIORITIES IDENTIFIED IN THE MOST RECENT CHNA WERE: 1. PREVENT AND MANAGE CHRONIC DISEASE -- ASTHMA, DIABETES AND HEART DISEASE. 2. INCREASE ACCESS TO MATERNAL SERVICES -- PRENATAL CARE. 3. PROMOTE CANCER AWARENESS -- BREAST CANCER AND PROSTATE CANCER. BEGINNING IN 2020, INGALLS BEGAN TO ADDRESS THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA THROUGH EXECUTION OF THE IMPLEMENTATION STRATEGY. IN THE PREVIOUS CHNA,INGALLS WAS FULLY ENGAGED IN THE ALLIANCE FOR HEALTH EQUITY, A MEMBERSHIP COLLABORATION OF 30 NON PROFITS AND PUBLIC HOSPITALS AND 7 HEALTH DEPARTMENTS TO IMPROVE HEALTH EQUITY, WELLNESS, AND QUALITY OF LIFE ACROSS CHICAGO AND COOK COUNTY. MANY OF INGALLS ACTIONS TO ADDRESS THESE NEEDS ARE INCLUDED IN PROGRAMS THAT ARE NOT LIMITED TO THESE NEEDS. IN 2020, THE SELECTED PRIORITY AREAS (SIGNIFICANT NEEDS) WERE ADDRESSED THROUGH THE FOLLOWING APPROACHES: 1. CARE DELIVERY INITIATIVES. THE CARE DELIVERY INITIATIVES INCLUDE A MYRIAD OF INITIATIVES THAT PROVIDE DIRECT HEALTH AND WELLNESS SERVICES TO COMMUNITY MEMBERS. THESE SERVICES ARE EXECUTED IN MULTIPLE WAYS THAT INCLUDE LEVERAGING INGALLS RESOURCES AND PARTNERING WITH COMMUNITY HEALTH CENTERS AND COMMUNITY-BASED CLINICAL SERVICES. 2. COMMUNITY BENEFIT GRANTS. GRANT OPPORTUNITIES ARE PROVIDED TO COMMUNITY-BASED ORGANIZATIONS THAT IMPLEMENT PROGRAMS TO ADDRESS THE INGALLS PRIORITY AREAS WITHIN THE INGALLS SERVICE AREA. 3. COMMUNITY-BASED EDUCATION & OUTREACH. INGALLS OUTREACH AND ENGAGEMENT COMPONENTS ARE DIRECTLY ALIGNED WITH THE HOSPITALS' PRIORITY AREAS, PROMOTING EDUCATION AND AWARENESS TO COMMUNITY MEMBERS IN THE TARGETED SERVICE AREAS. AND THESE ACTIVITIES ARE INTENDED TO BETTER INFORM AND EDUCATE THE COMMUNITY REGARDING HEALTH PROMOTION AND DISEASE SELF-MANAGEMENT PRACTICES. IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, INGALLS DETERMINED THAT IT COULD ONLY EFFECTIVELY FOCUS ON THOSE WHICH FIT WITHIN THE CURRENT RESOURCES AVAILABLE. WHILE FOOD INSECURITY WAS NOT SELECTED AS A HEALTH PRIORITY AREA FOR 2020-2022, IT AFFECTS THE HEALTH STATUS OF THE WHOLE COMMUNITY. CONSEQUENTLY, IT IS ADDRESSED IN RELATION TO EACH OF THE PRIORITY HEALTH AREAS WITH A FOCUS ON THE CHRONIC DISEASE DOMAIN. INGALLS DID NOT DIRECTLY ADDRESS MENTAL HEALTH & SUBSTANCE ABUSE OR STI/HIV; HOWEVER, IT DOES NOT IGNORE THESE ISSUES EITHER. INGALLS HAS LEVERAGED ITS INTERNAL AND EXTERNAL RESOURCES TO CONTINUE TO ADDRESS THESE AS WELL AS OTHER ISSUES. ALSO, INGALLS CONTINUES TO WORK WITH COMMUNITY PARTNERS, INCLUDING THE LOCAL PUBLIC HEALTH DEPARTMENTS, COMMUNITY ORGANIZATIONS AND FEDERAL QUALIFIED HEALTH CENTERS. PLEASE SEE A REPORT OF ALL INGALLS COMMUNITY ACTIVITIES IN PART VI, LINE 5. RATIONALE FOR UNADDRESSED NEEDS: THROUGHOUT THE CHNA PROCESS, A WIDE RANGE OF PRIORITY HEALTH ISSUES EMERGED. ALTHOUGH MULTIPLE STAKEHOLDERS PRIORITIZED TOP HEALTH NEEDS FOR INGALLS TO FOCUS ON, INGALLS DETERMINED THAT IT COULD ONLY EFFECTIVELY FOCUS ON TOP HEALTH NEEDS WHICH FIT WITHIN THE CURRENT RESOURCES AVAILABLE. WHILE FOOD INSECURITY WAS NOT SELECTED AS A HEALTH PRIORITY AREA FOR 2020-2022, IT AFFECTS THE HEALTH STATUS OF THE ENTIRE COMMUNITY. CONSEQUENTLY, IT IS ADDRESSED IN RELATIONSHIP TO EACH OF THE PRIORITY HEALTH AREAS WITH A FOCUS ON THE CHRONIC DISEASE DOMAIN (DIABETES, ASTHMA AND HEART DISEAE). INGALLS DID NOT DIRECTLY ADDRESS MENTAL HEALTH & SUBSTANCE ABUSE OR STI/HIV; IT DID NOT IGNORE THESE ISSUES EITHER. INGALLS LEVERAGED ITS INTERNAL RESOURCES TO CONTINUE TO ADDRESS THESE AS WELL AS OTHER ISSUES. ALSO, INGALLS WILL DILIGENTLY WORK WITH COMMUNITY PARTNERS, INCLUDING THE LOCAL PUBLIC HEALTH DEPARTMENT, COMMUNITY ORGANIZATIONS AND FEDERAL QUALIFIED HEALTH CENTERS TO ADDRESS ISSUES IN ITS SHARED COMMUNITY. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. A PATIENT IS NOT REQUIRED TO PAY MORE THAN 20% OF HIS/HER FAMILY INCOME FOR ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY IMH IN A 12-MONTH PERIOD. THE MEDICAL INDIGENCY DISCOUNT APPLIES TO ANY PATIENT WHOSE PATIENT BALANCE DUE FOR EMERGENCY AND OTHER MEDICALLY NECESSARY SERVICES EXCEEDS 20% OF HIS/HER ADJUSTED GROSS INCOME IN THE YEAR THAT THE PATIENT RECEIVED CARE. 7 INGALLS FAMILY CARE CENTER 1600 TORRENCE AVENUE CALUMET CITY IL 60409 URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES INGALLS FAMILY CARE CENTER 19550 GOVERNORS HIGHWAY FLOSSMOOR IL 60422 URGENT AID AND SPECIALIST SERVICES INGALLS FAMILY CARE CENTER 6701 WEST 159TH STREET TINLEY PARK IL 60477 URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES INGALLS CARE CENTER 4742 CAL SAG ROAD CRESTWOOD IL 60445 QUICK CARE CENTER AND OCCUPATIONAL HEALTH INGALLS CARE CENTER 16246 PRINCE DRIVE SOUTH HOLLAND IL 60473 INDUSTRIAL, MEDICAL REHABILITATION AND PHYSICIAN OFFICES INGALLS WELLNESS CENTER 2920 WELLNESS CENTER HOMEWOOD IL 60430 COMPLEMENTARY MEDICINE AND COMMUNITY HEALTH PROGRAMS THE VILLA AT SOUTH HOLLAND 16300 WAUSAU AVENUE SOUTH HOLLAND IL 60473 HEALTHCARE AND REHABILITATION CENTER Schedule H, Part I Line 3c AUTOMATIC UNINSURED SELF-PAY DISCOUNT A DISCOUNT OF 80% OF GROSS CHARGES, PROVIDED TO ALL UNINSURED PATIENTS WITHOUT REQUIRING EVIDENCE OF INABILITY TO PAY. THIS DISCOUNT IS DESIGNED TO ENSURE THAT PATIENTS ARE CHARGED AT A RATE GENERALLY COMPARABLE TO THAT APPLIED TO INSURED PATIENTS. 1. THERE IS NO APPLICATION PROCESS FOR THE PATIENT TO RECEIVE THE UNINSURED DISCOUNT. THE DISCOUNT IS APPLIED BASED ON THE ACCOUNT'S SELF-PAY/UNINSURED STATUS. 2. PATIENTS RECEIVING PRE-NEGOTIATED DISCOUNTS FOR HOSPITAL SERVICES WILL NOT BE ELIGIBLE FOR THIS UNINSURED DISCOUNT. 3. IF A PATIENT IS SUBSEQUENTLY APPROVED FOR FINANCIAL ASSISTANCE, THE AUTOMATIC DISCOUNT WILL BE REVERSED SO THAT THE FULL AMOUNT CAN BE RECOGNIZED AS A CHARITY ALLOWANCE. 4. IF A PATIENT SUBSEQUENTLY PROVIDES EVIDENCE OF INSURANCE COVERAGE, THE AUTOMATIC DISCOUNT WILL BE REVERSED AND THE INSURANCE COVERAGE PROVIDED WILL BE BILLED ACCORDINGLY. 5. PATIENT WHO ARE OTHERWISE INSURED AND CHOOSE NOT TO USE THEIR INSURANCE COVERAGE ARE INELIGIBLE FOR THIS AUTOMATIC DISCOUNT. Schedule H, Part I Line 7 INGALLS UTILIZES A COST TO CHARGE METHODOLOGY. CHARGES ASSOCIATED WITH THE RELATED CATEGORIES ARE THEN USED TO DETERMINE COST RELATED TO SUCH REVENUE. Schedule H, Part V, Section B, Line 4 THE HOSPITAL IS REPORTING THE TAX YEAR BEGINNING FOR WHICH IT LAST CONDUCTED ITS CHNA. THE CHNA WAS FINALIZED DURING THE TAX YEAR ENDED JUNE 30, 2019. Schedule H, Part III Line 1 INGALLS FOLLOWS GAAP PRINCIPLES AND UNDER THE NEW REPORTING STANDARD ASC 606, BAD DEBT IS NOW IMPLICIT PRICE CONCESSIONS. THE REPORTING OF BAD DEBT ALSO CONFORMS TO THE UPDATED HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION NO. 15. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED AS BAD DEBT EXPENSE IS DETERMINED BY APPLYING THE RATIO OF COST TO CHARGES (RCC) TO THE TOTAL CHARGES WRITTEN OFF TO BAD DEBT AS REPORTED IN THE AUDITED FINANCIAL STATEMENTS. THE RCC WAS DETERMINED UTILIZING WORKSHEET 2 FROM FORM 990, SCHEDULE H INSTRUCTIONS. THE BASIS FOR THIS COSTING METHODOLOGY IS THE HOSPITAL'S OPERATING EXPENSES (EXCLUDING BAD DEBT) ADJUSTED BY OTHER OPERATING REVENUE AND COMMUNITY BENEFIT EXPENSE DIVIDED BY GROSS PATIENT CHARGES. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IMH RUNS PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE WHEN SUFFICIENT INFORMATION CANNOT BE OBTAINED. AS A RESULT, IMH DOES NOT BELIEVE THERE IS ANY BAD DEBT FOR INDIVIDUALS THAT WOULD OTHERWISE QUALIFY FOR ASSISTANCE. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote FOOTNOTE TO FINANCIAL STATEMENTS: IN ACCORDANCE WITH ASC TOPIC 606, REVENUE FROM CONTRACTS WITH CUSTOMERS, THE SYSTEM DOES NOT ADJUST THE PROMISED AMOUNT OF CONSIDERATION FROM PATIENTS AND THIRD-PARTY PAYORS FOR THE EFFECTS OF A SIGNIFICANT FINANCING COMPONENT DUE TO THE EXPECTATION THAT THE PERIOD BETWEEN THE TIME THE SERVICE IS PROVIDED TO A PATIENT AND THE TIME THAT THE PATIENT OR A THIRD-PARTY PAYOR PAYS FOR SERVICE WILL BE ONE YEAR OR LESS. REVENUES ARE RECOGNIZED IN THE AMOUNTS TO WHICH IT EXPECTS TO BE ENTITLED, WHICH ARE THE TRANSACTION PRICES ALLOCATED TO THE DISTINCT SERVICES. THE SYSTEM HAS AGREEMENTS WITH GOVERNMENTAL AND OTHER THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE SYSTEM AT AMOUNTS DIFFERENT FROM ESTABLISHED CHARGES. PAYMENT ARRANGEMENTS FOR MAJOR THIRD-PARTY PAYORS MAY BE BASED ON PROSPECTIVELY DETERMINED RATES, REIMBURSED COST, DISCOUNTED CHARGES, PER DIEM PAYMENTS, OR OTHER METHODS. THE TRANSACTION PRICE IS DETERMINED BASED ON GROSS CHARGES FOR SERVICES PROVIDED, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYERS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE PROGRAM, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO UNINSURED PATIENTS. THE ESTIMATES OF EXPLICIT PRICE CONCESSIONS AND DISCOUNTS ARE BASED ON CONTRACTUAL AGREEMENTS, DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. THE ESTIMATES OF IMPLICIT PRICE CONCESSIONS ARE BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THESE CLASSES OF PATIENTS USING THE PORTFOLIO APPROACH. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE HOSPITAL BELIEVES THE FULL AMOUNT OF THE SHORTFALL FROM MEDICARE SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IT SERVES ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY, AND IT CANNOT NEGOTIATE CONTRACTUAL RATES WITH THE MEDICARE PROGRAM. THE HOSPITAL MUST ACCEPT WHAT THE MEDICARE PROGRAM PAYS. THE METHODOLOGY USED IN DETERMINING MEDICARE SHORTFALL REPORTED IN THE COMMUNITY BENEFITS REPORT IS MEDICARE NET PATIENT SERVICE REVENUE LESS MEDICARE CHARGES MULTIPLIED BY THE MEDICARE COST REPORT COST TO CHARGE RATIO. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance INGALLS MEMORIAL HOSPITAL HAS A FIDUCIARY DUTY TO SEEK REIMBURSEMENT FOR SERVICES IT HAS PROVIDED FROM INDIVIDUALS WHO ARE ABLE TO PAY, FROM THIRD PARTY INSURERS WHO COVER THE COST OF CARE, AND FROM OTHER PROGRAMS OF ASSISTANCE FOR WHICH THE PATIENT IS ELIGIBLE. TO DETERMINE WHETHER A PATIENT IS ABLE TO PAY FOR THE SERVICES PROVIDED AS WELL AS TO ASSIST THE PATIENT IN FINDING ALTERNATIVE COVERAGE OPTIONS IF THEY ARE UNINSURED OR UNDERINSURED, THE HOSPITAL FOLLOWS THE FOLLOWING CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. COLLECTING INFORMATION ON PATIENT HEALTH COVERAGE AND FINANCIAL RESOURCES PATIENT OBLIGATIONS: PRIOR TO THE DELIVERY OF ANY HEALTH CARE SERVICES (EXCEPT FOR CASES THAT ARE AN EMERGENCY OR URGENT CARE SERVICE LEVEL), THE PATIENT IS EXPECTED TO PROVIDE TIMELY AND ACCURATE INFORMATION ON THEIR INSURANCE STATUS, DEMOGRAPHIC INFORMATION, CHANGES TO THEIR FAMILY INCOME OR INSURANCE STATUS, AND INFORMATION ON ANY DEDUCTIBLES OR CO-PAYMENTS THAT ARE OWED BASED ON THEIR EXISTING INSURANCE OR FINANCIAL PROGRAM'S PAYMENT OBLIGATIONS. THE DETAILED INFORMATION WILL INCLUDE: A. FULL NAME, ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, CITIZENSHIP AND RESIDENCY INFORMATION, AND THE PATIENT'S APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY THEIR BILL; B. FULL NAME OF THE PATIENT'S GUARANTOR, THEIR ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, AND THEIR APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY FOR THE PATIENT'S BILL; AND C. OTHER RESOURCES THAT MAY BE USED TO PAY THEIR BILL, INCLUDING OTHER INSURANCE PROGRAMS, MOTOR VEHICLE OR HOMEOWNERS INSURANCE POLICIES IF THE TREATMENT WAS DUE TO AN ACCIDENT, WORKER'S COMPENSATION PROGRAMS, AND STUDENT INSURANCE POLICIES, AMONG OTHERS. IT IS ULTIMATELY THE PATIENT'S OBLIGATION TO KEEP TRACK OF AND TIMELY PAY THEIR UNPAID HOSPITAL BILL, INCLUDING ANY EXISTING CO-PAYMENTS, CO-INSURANCE, AND DEDUCTIBLES. THE PATIENT IS FURTHER REQUIRED TO INFORM EITHER THEIR CURRENT HEALTH INSURER (IF THEY HAVE ONE) OR THE AGENCY THAT DETERMINED THE PATIENT'S ELIGIBILITY STATUS IN A PUBLIC HEALTH INSURANCE PROGRAM OF ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS. THE HOSPITAL MAY ALSO ASSIST THE PATIENT WITH UPDATING THEIR ELIGIBILITY IN A PUBLIC PROGRAM WHEN THERE ARE ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS, BUT ONLY IF THE HOSPITALS MADE AWARE BY THE PATIENT OF FACTS THAT MAY INDICATE A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS. PATIENTS ARE REQUIRED TO NOTIFY THE STATE PUBLIC PROGRAM (OFFICE OF MEDICAID), INFORMATION RELATED TO ANY LAWSUIT OR INSURANCE CLAIM THAT WILL COVER THE COST OF THE SERVICES PROVIDED BY THE HOSPITAL. HOSPITAL OBLIGATIONS: INGALLS MEMORIAL HOSPITAL WILL MAKE ALL REASONABLE AND DILIGENT EFFORTS TO COLLECT THE PATIENT INSURANCE STATUS AND OTHER INFORMATION TO VERIFY COVERAGE FOR THE HEALTH CARE SERVICES TO BE PROVIDED BY INGALLS MEMORIAL HOSPITAL. THESE EFFORTS MAY OCCUR WHEN THE PATIENT IS SCHEDULING THEIR SERVICES, DURING PREREGISTRATION, WHILE THE PATIENT IS ADMITTED IN THE HOSPITAL, UPON DISCHARGE, OR DURING THE COLLECTION PROCESS WHICH MAY OCCUR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THIS INFORMATION WILL BE OBTAINED PRIOR TO THE DELIVERY OF ANY NONEMERGENT AND NON-URGENT HEALTH CARE SERVICES (I.E., ELECTIVE PROCEDURES AND SCHEDULED PROCEDURES). INGALLS MEMORIAL HOSPITAL WILL DELAY ANY ATTEMPT TO OBTAIN THIS INFORMATION DURING THE DELIVERY OF ANY EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) LEVEL EMERGENCY LEVEL OR URGENT CARE SERVICES, IF THE PROCESS TO OBTAIN THIS INFORMATION WILL DELAY OR INTERFERE WITH EITHER THE MEDICAL SCREENING EXAMINATION OR THE SERVICES UNDERTAKEN TO STABILIZE AN EMERGENCY MEDICAL CONDITION. THE HOSPITAL'S REASONABLE AND DILIGENT EFFORTS WILL INCLUDE, BUT IS NOT LIMITED TO, REQUESTING INFORMATION ABOUT THE PATIENT'S INSURANCE STATUS, CHECKING ANY AVAILABLE PUBLIC OR PRIVATE INSURANCE DATABASES, AND FOLLOWING THE BILLINGS RULES OF A KNOWN THIRD PARTY PAYER. IF THE PATIENT OR GUARANTOR/GUARDIAN IS UNABLE TO PROVIDE THE INFORMATION NEEDED, AND THE PATIENT CONSENTS, THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO CONTACT RELATIVES, FRIENDS, GUARANTOR/GUARDIAN, AND THE THIRD PARTY FOR ADDITIONAL INFORMATION. INGALLS MEMORIAL HOSPITAL WILL ALSO MAKE REASONABLE AND DILIGENT EFFORTS TO INVESTIGATE WHETHER A THIRD PARTY RESOURCE MAY BE RESPONSIBLE FOR THE SERVICES PROVIDED BY THE HOSPITAL, INCLUDING BUT NOT LIMITED TO: (1) A MOTOR VEHICLE OR HOMEOWNER'S LIABILITY POLICY, (2) GENERAL ACCIDENT OR PERSONAL INJURY PROTECTION POLICIES, (3) WORKER'S COMPENSATION PROGRAMS, (4) STUDENT INSURANCE POLICIES, AMONG OTHERS. IN ACCORDANCE WITH APPLICABLE STATE REGULATIONS OR THE INSURANCE CONTRACT, FOR ANY CLAIM WHERE INGALLS MEMORIAL HOSPITAL'S REASONABLE AND DILIGENT EFFORTS RESULTED IN A PAYMENT FROM A PRIVATE INSURER OR PUBLIC PROGRAM, INGALLS MEMORIAL HOSPITAL WILL REPORT THE RECOVERY AND OFF SET IT AGAINST THE CLAIM PAID BY THE PRIVATE INSURER OR PUBLIC PROGRAM.THE HOSPITAL FURTHER MAINTAINS ALL INFORMATION IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE PRIVACY, SECURITY AND ID THEFT LAWS. Schedule H, Part V, Section B, Line 16a FAP website - INGALLS MEMORIAL HOSPITAL: Line 16a URL: https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - INGALLS MEMORIAL HOSPITAL: Line 16b URL: ttps://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - INGALLS MEMORIAL HOSPITAL: Line 16c URL: https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment INGALLS ASSESSES THE HEALTH CARE NEEDS OF THE SOUTH SUBURBAN SERVICE AREA THROUGH THE IMPLEMENTATION OF THE CHNA, THE EVALUATION REPORT AND COMMUNITY IMPACT GRANT PROGRAM. BUILDING ON INGALLS'S PAST CHNA, THE DATA PRIORITY SETTING TEAM, WHICH INCLUDED THE MANAGER OF COMMUNITY BENEFITS AND COMMUNITY AFFAIRS AT INGALLS AND STAFF FROM UNIVERSITY OF CHICAGO MEDICINE'S (UCM'S) COMMUNITY BENEFIT AND EVALUATION TEAM, WORKED WITH THE COMMUNITY BENEFIT MANAGEMENT TEAM AND THE COMMUNITY BENEFIT STEERING COMMITTEE AS WELL AS SEVERAL WORKGROUPS TO PRIORITIZE HEALTH ISSUES FOR INGALLS NEXT THREE YEARS OF COMMUNITY BENEFIT PROGRAMMING FROM 2020-2022. USING THE CHNA AS A FOUNDATIONAL TOOL, THE DATA PRIORITY SETTING TEAM REVIEWED AND COMPARED THE 2018-2019 INGALLS SERVICE AREA HEALTH OUTCOME DATA TO PREVIOUS HEALTH OUTCOME DATA. NEW DATA AND HEALTH ISSUES THAT WERE WORSE THAN PREVIOUS YEARS WERE SLATED FOR CONSIDERATION. FOR MORE INFORMATION ON INGALLS'S SELECTED HEALTH PRIORITY AREAS PLEASE SEE PART V, SECTION B, LINE 11. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THE ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNS THROUGHOUT THE PATIENT REGISTRATION AREAS REGARDING PATIENT PAYMENT OPTIONS. IN ADDITION, PATIENTS ARE INFORMED VIA THE HOSPITAL'S WEBSITE, INDIVIDUAL PATIENT STATEMENTS, AND FINANCIAL COUNSELORS. BELOW ARE SOME ADDITIONAL DETAILS REGARDING HOW THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE: SIGNS OR SIMILAR WRITTEN NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM WILL BE VISIBLE AT ALL HOSPITAL POINTS OF SERVICE TO CREATE AWARENESS OF THE FINANCIAL ASSISTANCE PROGRAM. AT A MINIMUM, SIGNAGE WILL BE POSTED IN THE EMERGENCY DEPARTMENT AND ADMISSION REGISTRATION AREA. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISION OF FINANCIAL ASSISTANCE PROGRAM WILL USE LANGUAGES THAT ARE APPROPRIATE FOR THE SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. HOSPITAL BILL/INVOICE: PATIENT BILLS OR STATEMENTS INCLUDE A PROMINENT STATEMENT THAT PATIENTS WHO MEET CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR FINANCIAL ASSISTANCE AND INFORMATION REGARDING HOW A PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE FOLLOWING ARE MADE PUBLICLY AVAILABLE VIA THE HOSPITAL'S WEBSITE, HTTPS://WWW.INGALLS.ORG/FINANCIAL-ASSISTANCE 1. PATIENT BROCHURES 2. FINANCIAL ASSISTANCE POLICY 3. APPLICATION FORMS USED TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. 4. PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE POLICY Schedule H, Part VI, Line 4 Community information INGALLS SERVICE AREA CONSISTS OF A LARGE, MEDICALLY UNDER RESOURCED, LOWER INCOME POPULATION IN SOUTH SUBURBAN COOK COUNTY. BASED ON THE RESULTS OF THE 2018-2019 CHNA, THE POPULATION OF INGALLS SERVICE AREA IS APPROXIMATELY 61 PERCENT AFRICAN AMERICAN, 20 PERCENT WHITE AND 17 PERCENT HISPANIC/LATINO. FORTY PERCENT OF SUBURBAN COOK COUNTY'S AFRICAN AMERICAN POPULATIONS LIVE WITHIN THE INGALLS SERVICE AREA. THE INGALLS SERVICE AREA IS RELATIVELY LOW-INCOME COMPARED TO THE REST OF SUBURBAN COOK COUNTY. ABOUT 22% OF RESIDENTS IN THE INGALLS SERVICE AREA LIVE BELOW 200% OF THE FEDERAL POVERTY LEVEL (FPL) COMPARED TO 18% IN SOUTH SUBURBAN COOK COUNTY OVERALL, 11% IN SUBURBAN COOK COUNTY, 14% IN ILLINOIS, AND 15% IN THE US. INGALLS IS LOCATED IN HARVEY, ILLINOIS THE CITY WITH THE HIGHEST POVERTY RATES. INGALLS SERVICE AREA IS THORNTON TOWNSHIP, WHICH CONSISTS OF 13 ZIP CODES, 20 CITIES/MUNICIPALITIES. IT IS HOME TO MORE THAN 260,000 RESIDENTS, MANY OF WHOM ARE UNDERSERVED BY INGALLS. SOME OF THE COMMUNITIES IN INGALL SERVICE AREA HAS SOME OF THE HIGHEST CHRONIC DISEASE AND MORTALITY RATES IN SUBURBAN COOK COUNTY. Schedule H, Part VI, Line 5 Promotion of community health INGALLS IS A COMMUNITY HOSPITAL THAT WORKS WITH ITS COMMUNITY AND PARTNERS TO IMPROVE HEALTH, PREVENT DISEASES AND ADDRESS THE SOCIAL DETERMINANTS OF HEALTH IN ITS SERVICE AREA. BELOW ARE SOME OF THE ACTIVITIES THAT TARGET UNDERSERVED POPULATIONS. HEALTHY BABY NETWORK WAS ESTABLISHED TO ADDRESS THE NUMBER OF WOMEN GIVING BIRTH THAT HAVE RECEIVED NO PRENATAL CARE. THE LACK OF PRENATAL CARE RESULTS IN PREMATURE BIRTHS, BABIES WITH LOW BIRTH WEIGHTS, INCREASED MORBIDITY AND MORTALITY AND NUMEROUS OTHER COMPLICATIONS THAT HAVE BEEN EASILY TREATED. IN 2020, 137 INDIVIDUALS ENROLLED IN THE PROGRAM, 103 DELIVERIES, 88 FULL-TERM DELIVERIES AND 97 DELIVERIES THAT WERE NORMAL BIRTH WEIGHTS. THROUGH THE INGALLS COMMUNITY IMPACT GRANT PROGRAM, COMMUNITY ORGANIZATIONS APPLY FOR FUNDING TO PROVIDE PROGRAMS AND SERVICES THAT HELP TO IMPROVE THE HEALTH OUTCOMES OF RESIDENTS IN INGALLS CHNA SERVICE AREA, WITH A FOCUS ON ONE OF THE PRIORITY HEALTH AREAS. LAST GRANT CYCLE, FOUR GRANTS WERE AWARDED TO COMMUNITY ORGANIZATIONS WHOSE PROGRAMS ADDRESSED THE PREVENTION AND MANAGEMENT OF CHRONIC DISEASES: HEART DISEASE, DIABETES AND ASTHMA, AS WELL AS BREAST AND PROSTRATE CANCERS. INGALLS PROVIDED FOUR PARTNER ORGANIZATONS WITH FUNDING TO ADDRESS THE INCREASED NEED CAUSED BY THE COVID-19 PANDEMIC. SOME OF THE NEEDS ADDRESSED WERE EMERGENCY FOOD DISTRIBUTIONS AND PPE DISTRIBUTIONS. COMMUNITY BOARD: THE INGALLS BOARD OF DIRECTORS MEMBERSHIP IS COMPRISED OF LOCAL BUSINESS AND COMMUNITY MEMBERS THAT LIVE IN THE CHICAGO AND THE SOUTH SUBURBAN REGION. IN ADDITION TO THE PRESIDENT, ONE EMPLOYED PHYSICIAN SERVES AS AN ELECTED BOARD MEMBER. ALL MEMBERS ARE IN COMPLIANCE WITH THE BOARD CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO COMPLETE AN ANNUAL CERTIFICATION AND DISCLOSURE FORM. QUALIFIED PHYSICIANS: INGALLS RESPONDS TO REQUESTS FOR APPLICATIONS TO JOIN THE MEDICAL STAFF MADE BY QUALIFIED PHYSICIANS IN THE COMMUNITY. THE INGALLS PROFESSIONAL AFFAIRS COMMITTEE REVIEWS INQUIRIES AND PROVIDES APPLICATIONS TO PHYSICIANS WHO MEET THE MINIMUM QUALIFICATIONS FOR MEDICAL STAFF MEMBERSHIP IF THERE IS A NEED FOR A PARTICULAR SERVICE AND/OR A PATIENT NEED EXISTS WITHIN THE COMMUNITY. STAFF EDUCATION: THE INGALLS MEDICAL STAFF SUPPORTS IMPROVEMENTS IN PATIENT CARE AND ONGOING EDUCATION TO THE MEDICAL AND PROFESSIONAL STAFF THROUGH FUNDING OF MEDICAL EDUCATION ACTIVITIES. INGALLS IS ACCREDITED BY THE ILLINOIS STATE MEDICAL SOCIETY TO AWARD CME CATEGORY 1 CREDIT. THE CME COMMITTEE IS RESPONSIBLE FOR OVERSIGHT OF MONTHLY CME ACTIVITIES WHICH ARE SPONSORED BY THE HOSPITAL. BOTH MEDICAL AND PROFESSIONAL (NURSING, QUALITY MANAGEMENT, ETC.) STAFF ARE INVITED AND ENCOURAGED TO ATTEND THE PROGRAMS. TO PROMOTE COMMUNITY HEALTH ACTIVITIES AND PROGRAMS, INGALLS DISTRIBUTES INFORMATION VIA: -EXTERNAL NEWSLETTERS -COMMUNITY PARTNERS -MESSAGE BOARDS -SOCIAL MEDIA PLATFORMS Schedule H, Part VI, Line 6 Affiliated health care system THE INGALLS MEMORIAL HOSPITAL IS PART OF THE INGALLS HEALTH SYSTEM THAT IS NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE INGALLS HEALTH SYSTEM WAS INCORPORATED TO SUPPORT AND ENCOURAGE HEALTH AND HUMAN SERVICES THROUGH THE FOLLOWING AFFILIATES: *THE INGALLS MEMORIAL HOSPITAL *INGALLS HEALTH VENTURES *MEDCENTRIX, INC. *INGALLS DEVELOPMENT FOUNDATION *INGALLS HEALTH COUNCIL *INGALLS HOME CARE *INGALLS PROVIDER GROUP *INGALLS CASUALTY INSURANCE *INGALLS SAME DAY SURGERY, LTD. *INGALLS CARE NETWORK *PRIMARY HEALTHCARE ASSOCIATES, SC Schedule H, Part VI, Line 7 State filing of community benefit report IL true SCHOLARSHIPS 157 105800 CASH N/A Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. SCHOLARSHIPS ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS IN ORDER TO ENSURE THE FUNDS ARE USED FOR THEIR INTENDED PURPOSE. X true true X X X X true true false false false false false false false BRIAN SINOTTE PRESIDENT IMH (EFF. 7/1/19) 230601 0 65000 0 69509 0 19615 0 6307 0 391032 0 0 0 JOHN A FLYNN MD BOARD MEMBER 0 637423 0 150000 0 76492 0 22400 0 31647 0 917962 0 0 MARK F KOZLOFF MD BOARD MEMBER 0 688035 0 43333 0 12760 0 7000 0 32722 0 783850 0 0 CORRIN STEINHAUER RN BOARD MEMBER 0 289536 0 42260 0 8304 0 41066 0 48713 0 429879 0 0 JASON R KEELER BOARD MEMBER TIL 7/15/19 0 575661 0 322270 0 55457 0 116288 0 9688 0 1079364 0 0 MICHAEL LAWRENCE CHIEF FINANCIAL OFFICER (THRU 8/29/19) 251575 0 32762 0 185858 0 8023 0 40562 0 518780 0 37722 0 ANN MCCOLGAN ASST TREASURER/VP TREASURY 0 266033 0 53842 0 64148 0 45306 0 36969 0 466298 0 23757 THOMASZ SAMEK ASSISTANT SECRETARY 132530 0 8965 0 0 0 2613 0 25540 0 169648 0 0 0 RICHARD W SILVERIA CHIEF FINANCIAL OFFICER, UCMC 0 746255 0 241433 0 43777 0 151812 0 36136 0 1219413 0 0 PAUL DONOHUE VP PHILANTHROPY AND COMMUNITY 203945 0 24521 0 1622 0 22238 0 40349 0 292675 0 0 0 MARY JO CRANDALL VP LEAN TRANSFORMATION 202858 0 27572 0 0 0 11522 0 0 0 241952 0 0 0 KIMBERLY SERRANO EXEC DIR PERIOPERATIVE AND CLIN PRACT 169955 0 14625 0 0 0 5727 0 16460 0 206767 0 0 0 JAMES SWANSON DIRECTOR TECH SVCS/IT SEC OFFI 162246 0 13904 0 2903 0 9308 0 25931 0 214292 0 0 0 SUSAN BJORK DIRECTOR, INGALLS IT APPLICATIONS 156852 0 13225 0 2723 0 12500 0 11455 0 196755 0 0 0 BETTY HALL RN TEAM LEADER SURGERY 153426 0 2755 0 0 0 5563 0 12245 0 173989 0 0 0 GARY GASBARRA INTERIM CFO TIL 6/30/17 0 459009 0 118122 0 106351 0 61484 0 22918 0 767884 0 44666 JONATHAN GOBLE INTERIM PRESIDENT (THRU APR 2019) 175131 0 65000 0 117382 0 4423 0 8537 0 370473 0 0 0 Schedule J, Part II TAXABLE INCOME REPORTED IN COLUMN (B) MAY INCLUDE PAYMENTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN MOST CASES, THESE PAYMENTS WERE EARNED OVER MANY YEARS OF EMPLOYMENT AND THE AMOUNTS HAD PREVIOUSLY BEEN SUBJECT TO VESTING RULES. SERP PAYMENT AMOUNTS EARNED IN PRIOR YEARS WERE PREVIOUSLY REPORTED ON THE FORM 990 AS DEFERRED COMPENSATION AND ARE REPORTED IN THIS 2019 FORM 990 ON SCHEDULE J, PART II, COLUMN (F). AN INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD ANNUALLY REVIEWS THESE BENEFITS IN COMPARISON TO MARKET DATA AND HAS CONCLUDED THAT THESE BENEFITS AND ALL OTHER FORMS OF COMPENSATION PROVIDED TO THESE INDIVIDUALS ARE REASONABLE. The independent compensation committee of the board conducts its review and approval of all executive compensation, including these SERP amounts, in a manner that qualifies for the rebuttable presumption of reasonableness under federal tax law. This is a rigorous review process designed for tax-exempt organizations by the Internal Revenue Service, and it means that the board compensation committee does not have any conflicts of interest, and relies on market data compiled by an independent compensation consultant to support all executive pay as market competitive and reasonable. FOR THE INDIVIDUALS LISTED ON SCHEDULE J, PART II THAT ARE IDENTIFIED AS FORMER OFFICERS OR KEY EMPLOYEES, THE COMPENSATION LISTED IS EITHER THE FAIR MARKET VALUE COMPENSATION PAID TO THEM FOR SERVICES THEY PERFORMED AS ACTIVE EMPLOYEES OF IMH OR A RELATED ORGANIZATION (AND WAS NOT PAID TO THEM DUE TO THEIR FORMERLY HAVING BEEN LISTED AS OFFICERS OR KEY EMPLOYEES), OR COMPENSATION AS A COMBINATION OF SERVICES AND SEVERANCE: JONATHAN GOBLE. Schedule J, Part I, Line 1a Tax indemnification and gross-up payments DURING 2019, THE ORGANIZATION PROVIDED A VERY LIMITED NUMBER OF AD HOC TAX-RELATED PAYMENTS. BRIAN SINOTTE RECEIVED A TAX-RELATED PAYMENT IN CONNECTION WITH THE REIMBURSEMENT OF MOVING EXPENSES. ALL TAX-RELATED PAYMENTS ARE INCLUDED IN TAXABLE COMPENSATION, AND ARE CONFIRMED AS BEING REASONABLE WHEN CONSIDERED WITH ALL OTHER FORMS OF COMPENSATION. Schedule J, Part I, Line 4a Severance or change-of-control payment SOME OF THE INDIVIDUALS LISTED ON THE FORM 990 HAVE A SEVERANCE PROVISION IN CONJUNCTION WITH THEIR EMPLOYMENT WITH THE HOSPITAL. DURING CALENDAR YEAR 2019, THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS: MICHAEL LAWRENCE - $114,554 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan CERTAIN INDIVIDUALS LISTED IN SCHEDULE J, PART II PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH UCMC MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTURE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN IN JANUARY 2020 FOR CALENDAR YEAR 2019: ANN MCCOLGAN BRIAN SINOTTE CORRIN STEINHAUER GARY GASBARRA JASON KEELER PAUL DONOHUE RICHARD SILVERIA THE FOLLOWING INDIVIDUALS BECAME VESTED IN, AND WERE TAXED ON, AMOUNTS PREVIOUSLY CREDITED UNDER THE PLAN TO THE INDIVIDUAL FOR SERVICES PROVIDED TO THE ORGANIZATION IN PRIOR YEARS (INCLUDED IN THE 2019 W-2'S): ANN MCCOLGAN - $23,757 GARY GASBARRA - $44,666 MICHAEL LAWRENCE - $37,722 A ILLINOIS FINANCE AUTHORITY 2017 861091967 000000000 2017-12-29 41180000 REFUNDING 2004 BONDS false false false A 4875000 41180000 349422 40830578 2017 true false true true A false true true true false 0.003 0.003 false false true A false true false false false false false false true A true Schedule K, Part V BOND POLICY WRITTEN TAX-EXEMPT BOND PROCEDURES WERE ADOPTED ON FEBRUARY 12, 2018. Form 990, Part III, Line 4d Description of other program services (Expenses $ 79,610,446 including grants of $)(Revenue $ 28,935,376) OTHER PROGRAM SERVICES RELATED TO THE PROVISION OF HEALTHCARE INCLUDE LABORATORY SERVICES, PATIENT FINANCIAL SERVICES, COST OF FACILITIES, MALPRACTICE INSURANCE, AND OTHER SUPPORT SERVICES. Form 990, Part VI, Line 1a PART VI, LINE 1A THE BOARD OF DIRECTORS SHALL APPOINT ANNUALLY FROM ITS MEMBERSHIP AN EXECUTIVE COMMITTEE OF NOT LESS THAN FIVE (5) NOR MORE THAN NINE (9) MEMBERS, OF WHICH THREE (3) MEMBERS SHALL BE THE CHAIRMAN, THE VICE CHAIRMAN, AND THE SECRETARY/TREASURER OF THE HOSPITAL. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS NOT PROHIBITED BY STATUTE OR SECTION 1 OF THE HOSPITAL'S BYLAWS BETWEEN MEETINGS THEREOF. Form 990, Part VI, Line 6 Classes of members or stockholders PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE VOTING MEMBER OF THE ORGANIZATION IS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., A RELATED TAX-EXEMPT ORGANIZATION. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, IT HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body DIRECTORS, OTHER THAN THE DIRECTORS EX OFFICIO, SHALL BE ELECTED ANNUALLY BY UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., OR AT SUCH OTHER TIMES AS MAY BE DETERMINED BY THE SOLE MEMBER OF THE CORPORATION. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. SHALL RETAIN THE RIGHT TO REMOVE ANY DIRECTOR, OTHER THAN DIRECTORS EX OFFICIO, WITH OR WITHOUT CAUSE, AT ANY TIME. UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. MUST APPROVE ANY MODIFICATION OR AMENDMENT TO ANY MISSION STATEMENT, STATEMENT OF GOALS OR VALUES, THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; AND THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS PREPARED INTERNALLY AND REVIEWED IN DETAIL BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. THE FULL FORM 990, INCLUDING SUPPLEMENTAL SCHEDULES, WAS PRESENTED BY THE CHIEF FINANCIAL OFFICER TO THE FINANCE COMMITTEE AT A COMMITTEE MEETING. THE FULL BOARD HAS GRANTED TO THE FINANCE COMMITTEE AUTHORITY TO APPROVE THE FORM 990. THE FULL BOARD WILL RECEIVE A REPORT FROM THE FINANCE COMMITTEE DESCRIBING THE FINANCE COMMITTEE'S REVIEW PERFORMED. PRIOR TO FILING WITH THE IRS, THE FORM 990 WILL BE AVAILABLE AT THE ORGANIZATION'S BOARD MEETING FOR EACH MEMBER'S REVIEW. Form 990, Part VI, Line 12c Conflict of interest policy PURSUANT TO THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, ALL OFFICERS, DIRECTORS, BOARD MEMBERS, AND KEY EMPLOYEES MUST AVOID SITUATIONS IN WHICH THEIR PERSONAL INTERESTS MAY CONFLICT, OR APPEAR TO CONFLICT, WITH THE INTEREST OF INGALLS, AND INGALLS REVIEWS ITS OWN RELATIONSHIPS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, AND PAYERS TO DETERMINE IF POTENTIAL CONFLICTS EXISTS. BOARD MEMBERS AND EMPLOYEES SHALL HAVE THE CONTINUING AFFIRMATIVE DUTY TO REPORT TO THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (CEO) OF INGALLS ANY PERSONAL OWNERSHIP OF INTEREST OR OTHER RELATIONSHIP THAT MIGHT AFFECT THEIR ABILITY TO EXERCISE IMPARTIAL, ETHICAL BUSINESS JUDGMENTS IN THE AREA OF THEIR RESPONSIBILITIES. PER THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, BOARD MEMBERS AND EMPLOYEES AT MANAGEMENT LEVEL WILL BE REQUIRED TO COMPLETE A CERTIFICATION AND DISCLOSURE FORM, ON A SCHEDULE DETERMINED BY THE CORPORATE COMPLIANCE OFFICER. COMPLETION OF THIS FORM IS A REQUIREMENT FOR ALL BOARD MEMBERS AND MANAGERIAL EMPLOYEES, AND MAY BE REQUIRED OF NON-MANAGEMENT EMPLOYEES AS DETERMINED BY THE PRESIDENT AND CEO AND CORPORATE COMPLIANCE OFFICER. EMPLOYEES ALSO HAVE A DUTY TO REPORT CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST OF WHICH THEY MAY BE AWARE OF INVOLVING OTHER EMPLOYEES. EACH SITUATION REPORTED SHALL BE REVIEWED BY THE PRESIDENT AND CEO, AND INGALL'S CORPORATE COMPLIANCE OFFICER, AND A DETERMINATION SHALL BE MADE AS TO WHETHER A CONFLICT OF INTEREST EXISTS OF MAY ARISE FROM SUCH SITUATION. THE DECISION OF THE PRESIDENT AND CEO AND CORPORATE COMPLIANCE OFFICER REGARDING WHETHER A CONFLICT EXISTS SHALL BE FINAL. PERSONS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S RESOLUTION OF SUCH CONFLICT. THE ORGANIZATION FURTHER PROMOTES KNOWLEDGE AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY IN THE EMPLOYEE HANDBOOK. EACH EMPLOYEE IS REQUIRED TO SIGN AN ACKNOWLEDGEMENT OF THE HANDBOOK UPON EMPLOYMENT. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UCMC CORPORATE STRUCTURE. ALL COMPENSATION AND BENEFIT APPROVALS ARE MADE (BY THE UCM CHHD COMPENSATION COMMITTEE, AS EXPLAINED BELOW) AS RECOMMENDATIONS TO THE UCMC COMPENSATION COMMITTEE AND ARE SUBJECT TO FURTHER REVIEW AND APPROVAL BY THE UCMC COMPENSATION COMMITTEE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND SENIOR EXECUTIVES. THE UCM COMMUNITY HEALTH AND HOSPITAL DIVISION, INC. (UCM CHHD) COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES (THE COMMITTEE) IS RESPONSIBLE FOR THE OVERSIGHT OF THE INGALLS MEMORIAL HOSPITAL EXECUTIVE COMPENSATION DECISION-MAKING PROCESS. ITS REVIEW PROCESS IS DESIGNED TO SATISFY THE PROCEDURAL CRITERIA NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS (UNDER INTERMEDIATE SANCTIONS REGULATIONS) WITH RESPECT TO THE TOTAL COMPENSATION AND BENEFITS PROVIDED. THE COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS, ALL OF WHOM ARE "DISINTERESTED" WITHIN THE MEANING OF THE INTERMEDIATE SANCTIONS REGULATIONS. IT REVIEWS AND APPROVES COMPENSATION AND EMPLOYEE BENEFITS PROVIDED TO THE ORGANIZATION'S PRESIDENT AND KEY EXECUTIVES BY FOLLOWING ITS WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT AND WRITTEN COMPENSATION REVIEW PROCESS, WHICH INCLUDES SEEKING COUNSEL FROM OUTSIDE PROFESSIONAL ADVISORS AND RELYING IN ADVANCE ON APPROPRIATE COMPARABILITY DATA (FOR FUNCTIONALY SIMILAR POSITIONS AT SIMILARLY SITUATED HEALTHCARE ORGANIZATIONS) PROVIDED BY AN INDEPENDENT THIRD-PARTY CONSULTANT. THE COMMITTEE REVIEWS AND APPROVES ALL NEW COMPENSATION RANGES, AS WELL AS CURRENT PACKAGES FOR NEWLY HIRED EXECUTIVES, AS NEEDED, BUT AT LEAST ANNUALLY. IT PREPARES A TIMELY AND THOROUGH WRITTEN RECORD OF ITS DELIBERATIONS AND CONCLUSIONS. Form 990, Part VI, Line 15b Process to establish compensation of other employees AN INDEPENDENT COMPENSATION CONSULTANT REVIEWS THE REASONABLENESS OF PROPOSED TOTAL DIRECT COMPENSATION FOR EACH EXECUTIVE BY PERFORMING A MARKET COMPARISON FOR EACH EXECUTIVE. THE MARKET COMPARISON INVOLVES COLLECTING SURVEY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILAR HEALTHCARE ORGANIZATIONS. PERFORMANCE GOALS ARE NORMALLY ESTABLISHED BASED ON THE BUDGET/BUSINESS PLAN APPROVED BY THE BOARD FOR THE FISCAL YEAR. THE OUTSIDE CONSULTANT OPINES WHETHER OR NOT PERFORMANCE GOALS HAVE BEEN REACHED BEFORE A FISCAL YEAR END. PAYMENTS ARE PRESENTED TO THE COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL. THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES PREPARES A TIMELY AND THOROUGH WRITTEN RECORD OF ITS DELIBERATIONS AND CONCLUSIONS. Form 990, Part VI, Line 19 Required documents available to the public ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue CLIENT SERVICE REVENUE - Total Revenue: 131235, Related or Exempt Function Revenue: 131235, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue All other revenue - Total Revenue: 662114, Related or Exempt Function Revenue: 662114, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Parking income - Total Revenue: 42897, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 42897; Form 990, Part IX, Line 11g Other Fees PATIENT CARE SERVICES - Total Expense: 23866218, Program Service Expense: 20775702, Management and General Expenses: 3090516, Fundraising Expenses: ; LABORATORY SERVICES - Total Expense: 1668543, Program Service Expense: 1668543, Management and General Expenses: , Fundraising Expenses: ; FOOD SERVICES - Total Expense: 4913687, Program Service Expense: , Management and General Expenses: 4913687, Fundraising Expenses: ; ENVIRONMENTAL/HOSPITALITY SVCS - Total Expense: 5242726, Program Service Expense: 5242726, Management and General Expenses: , Fundraising Expenses: ; PATIENT TRANSPORTATION - Total Expense: 1484063, Program Service Expense: 1484063, Management and General Expenses: , Fundraising Expenses: ; PATIENT FINANCIAL SERVICES - Total Expense: 3565461, Program Service Expense: 3565461, Management and General Expenses: , Fundraising Expenses: ; FAMILY CARE CENTERS - Total Expense: 2301049, Program Service Expense: 2301049, Management and General Expenses: , Fundraising Expenses: ; OTHER - Total Expense: 3862295, Program Service Expense: 1350515, Management and General Expenses: 2511780, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FAIR VALUE OF DERIVATIVE INSTRUMENTS - -2317915; CHANGE IN INTEREST OF FOUNDATION - -356299; LOSS ON REFINANCE OF DEBT - -1062132; ARCH DEVELOPMENT CORPORATION 5555 S WOODLAWN AVENUE CHICAGO IL 60637 363485244 TECH TRANSFER IL 501(c)(3) Type I UNIV CHICAGO false ASIAN HEALTH COALITION 180 W WASHINGTON ST SUITE 1 CHICAGO IL 60602 311607193 HLTH ACCESS IL 501(c)(3) 10 UNIV CHICAGO false CHAPIN HALL CENTER FOR CHILDREN 1313 E 60TH STREET CHICAGO IL 60637 362167012 POL RES CTR IL 501(c)(3) 7 NA false CHICAGO HOME FOR THE INCURABLES 5801 S ELLIS AVENUE CHICAGO IL 60637 362169138 SUPP RESEARCH IL 501(c)(3) Type I UNIV CHICAGO false CHICAGO TUMOR INSTITUTE 5801 S ELLIS AVENUE CHICAGO IL 60637 237136019 SUPP RESEARCH IL 501(c)(3) Type I UNIV CHICAGO false COURT THEATRE FUND 5535 S ELLIS AVENUE CHICAGO IL 60637 363203660 SUPP THE ARTS IL 501(c)(3) Type I UNIV CHICAGO false FERMI RESEARCH ALLIANCE LLC PO BOX 500 BATAVIA IL 60510 571239010 MANAGE LAB IL 501(c)(3) 7 NA false HYMEN MILGROM SUPPORTING ORGANIZATION 33 N LASALLE ST STE 2131 CHICAGO IL 60602 466789522 SUPP EDU RES VA 501(c)(3) Type III-O NA false INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY IL 60426 363189150 SUPPORT IL 501(c)(3) 7 UCHHD false INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY IL 60426 363239703 AMBULATORY IL 501(c)(3) Type I UCHHD false INGALLS HOME CARE ONE INGALLS DRIVE HARVEY IL 60426 363367939 HEALTHCARE IL 501(c)(3) 10 IMH true LAKE PARK ASSOCIATES 5801 S ELLIS AVENUE CHICAGO IL 60637 366111317 PROP HOLDG IL 501(c)(2) UNIV CHICAGO false NATIONAL OPINION RESEARCH CENTER (NORC) 55 E MONROE AVENUE CHICAGO IL 60603 362167808 SO SCI SRVYS IL 501(c)(3) 7 NA false PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY IL 60426 364132865 HEALTHCARE IL 501(c)(3) 10 UCHHD false THE JOHN CRERAR FOUNDATION 5730 S ELLIS AVENUE CHICAGO IL 60637 363155157 SUPP LIBRARY IL 501(c)(3) Type III-O UNIV CHICAGO false THE MARINE BIOLOGICAL LABORATORY 7 MBL STREET WOODS HOLE MA 02543 042104690 RES & EDU MA 501(c)(3) 7 UNIV CHICAGO false THE QUADRANGLE CLUB 5801 S ELLIS AVENUE CHICAGO IL 60637 361655190 SOCIAL CLUB IL 501(c)(7) UNIV CHICAGO false THE UNIV OF CHICAGO FDN IN THE HONG KONG LTD FUNDRAISING HK UNIV CHICAGO false THE UNIVERSITY OF CHICAGO CLOISTERS CLUB 1212 E 59TH STREET CHICAGO IL 60637 SOCIAL CLUB IL UNIV CHICAGO false UCHICAGO RESEARCH BANGLADESH LTD RESEARCH BG UCH RS INTL false UCHICAGO RESEARCH INTERNATIONAL LIMITED 5801 S ELLIS AVENUE CHICAGO IL 60637 262741573 RESEARCH IL 501(c)(3) Type I UNIV CHICAGO false UCM CARE NETWORK MEDICAL GROUP INC 5841 S MARYLAND AVE MC 1086 CHICAGO IL 60637 474221241 HEALTH SERVICE IL 501(c)(3) 10 UCMC false UCM COMMUNITY HEALTH & HOSPITAL DIVISION ONE INGALLS DRIVE HARVEY IL 60426 363181170 MANAGEMENT IL 501(c)(3) Type I UCMC false UCMC TITLE HOLDING CORPORATION 5841 S MARYLAND AVE MC 1086 CHICAGO IL 60637 812126789 TITLE HOLD IL 501(c)(3) Type I UCMC false UCMC TITLE HOLDING CORPORATION II NFP 5841 S MARYLAND AVE MC 1086 CHICAGO IL 60637 821736040 TITLE HOLD IL 501(c)(3) Type I UCMC false UNIV OF CHI BOOTH SCH OF BUS (SINGAPORE) EDUCATION SN UNIV CHICAGO false UNIV OF CHI BOOTH SCH OF BUS (UK) EDUCATION UK UNIV CHICAGO false UNIV OF CHICAGO CANCER RESEARCH FD 5801 S ELLIS AVENUE CHICAGO IL 60637 366056201 SUPP RESEARCH IL 501(c)(3) Type I UNIV CHICAGO false UNIV OF CHICAGO CENTER IN PARIS (FRANCE) EDUCATION FR UNIV CHICAGO false UNIV OF CHICAGO CHARTER SCHOOL CORP 5801 S ELLIS AVENUE CHICAGO IL 60637 364225812 EDUCATION IL 501(c)(3) 2 UNIV CHICAGO false UNIV OF CHICAGO PROPERTY HOLDING CO 5801 S ELLIS AVENUE CHICAGO IL 60637 366108743 PROP HOLDG IL 501(c)(2) UNIV CHICAGO false UNIV OF CHICAGO RETIREE MEDICAL TRUST 5801 S ELLIS AVENUE CHICAGO IL 60637 363999692 MEDICAL TRUST IL 501(c)(3) Type I UNIV CHICAGO false UNIV OF CHICAGO SELF INSURANCE TRUST 5801 S ELLIS AVENUE CHICAGO IL 60637 363020034 MALPRAC TR IL 501(c)(3) Type I UNIV CHICAGO false UNIVERSITY OF CHICAGO 5801 S ELLIS AVENUE CHICAGO IL 60637 362177139 EDUCATION IL 501(c)(3) 2 NA false UNIVERSITY OF CHICAGO MEDICAL CENTER 5841 S MARYLAND AVENUE CHICAGO IL 60637 363188183 HOSPITAL IL 501(c)(3) 3 UNIV CHICAGO false UNIVERSITY OF CHICAGO TRUST (INDIA) L-9 East Wing Raheja Towers MG Road BANGALORE Karnataka IN 560001 FUNDRAISING IN UNIV CHICAGO false INGALLS SAME DAY SURGERY CTR 6701 W 159TH ST TINLEY PARK IL 60477 363368549 SURGERY CENTER IL NA N/A false false UCMC-SOLIS ON-CAMPUS MAMMOGRAPHY LLC 15601 DALLAS PARKWAY SUITE 500 ADDISON TX 75001 352641914 MAMMOGRAPHY DE NA N/A false false UCMC-SOLIS OFF-CAMPUS MAMMOGRAPHY SERVICES LLC 15601 DALLAS PARKWAY SUITE 300 ADDISON TX 75001 384108853 MAMMOGRAPHY DE NA N/A false false CHARITABLE LEAD TRUST (1) 5801 S ELLIS AVENUE CHICAGO IL 60637 CHAR LEAD TRUST IL NA Trust false CHARITABLE REMAINDER TRUSTS (80) 5801 S ELLIS AVENUE CHICAGO IL 60637 CHAR RMDR TRUST IL NA Trust false INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY IL 60426 980485714 LIAB INSURANCE CJ NA C Corporation false INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY IL 60426 273226539 PURCHASING GROUP IL UCHHD C Corporation false INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY IL 60426 363485578 INSURANCE SERVICE IL IMH C Corporation 14280486 1946657 1 true MEDCENTRIX INC ONE INGALLS DRIVE HARVEY IL 60426 363374228 BILLING & MGMT IL NA C Corporation false PHOENIX OVERLAY FUND LTD 401 N MICHIGAN AVE C/O INVST OFFICE CHICAGO IL 60611 INVESTMENT CJ NA false POOLED INCOME FUND (1) 5801 S ELLIS AVENUE CHICAGO IL 60637 POOLED INCO FUND IL NA C Corporation false SC CURRICULUM INC 70 WEST MADISON ST CHICAGO IL 60602 SCNC CURRICULUM IL NA C Corporation false UCHICAGO (BEIJING) CONSULTING CO LTD CONSULTING CH NA false UCHICAGO CENTER IN INDIA PRIVATE LIMITED CONSULTING IN NA C Corporation false true false true false false false false false false false false true true true true true true true true INGALLS PROVIDER GROUP - Q Q 2196439 FMV INGALLS HOME CARE - A(iv) A 84000 FMV