2019-07-10T10:35:08-05:00 2017-12-31 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2017-01-01 362169179 Palos Community Hospital PALO 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Dr Terrence Moisan President & CEO 7089234000 2019-07-10 1 Rebekuh Eley P01247672 3126343400 108.171.133.177 2019-07-10 10:25:18 CD 1591162018284034de06 2018-10-11 P 7C605E2F418ECD3347EC446B51AB1B1A7CC4F3F2 21A2514F5EBC82AA59A188290DF04BB7E1B2C51D 2017 2019-02-21 02:37:17Z X Dr Terrence Moisan 12251 S 80th Avenue Palos Heights IL 604630930 499589818 0 X www.paloshealth.com X 1972 IL Palos Community Hospital (Palos) is a 501(c)(3) community hospital whose primary objective is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County. 10 7 3403 749 99301 -49081 758979 583649 399256889 398082739 1866342 2271874 8050997 8132698 409933207 409070960 0 0 0 0 216990958 214602501 0 0 0 193121327 197488252 410112285 412090753 -179078 -3019793 785684463 762361023 518779759 498196974 266904704 264164049 X The primary objective of Palos is to provide high quality patient care that is responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County. Palos is committed to a continued review and analysis of the changing needs of the community it serves and to respond with services based upon those needs. 0 0 206142913 272684089 It is the policy of Palos Community Hospital to provide quality medical health care to all persons regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The Hospital recognizes that not all individuals possess the ability or means to purchase essential medical services and further, that our mission is to serve our community with respect to providing healthcare services and healthcare education. Therefore, in keeping with the Hospital's commitment to serve all members of the community, charity and/or subsidized care will be considered where the need and/or inability to pay are identified. 28337315 33418123 Palos Community Hospital provides a continuum of cardiovascular services - from diagnosis and treatment through recovery and rehabilitation - to ensure that our patients receive the care they need close to home. Prior to the start of the program in 2005, Palos transferred patients from the local community to other hospitals. Within 3 years, Palos ranked 14th in Illinois for heart volume. This community need has grown as can be seen with continued increases in volume since the program began. To help patients stay healthy, Palos Heart Failure and COPD Clinic has evolved into the Palos Health Heart and Lung Wellness Clinic adding asthma to the condition that that are treated. While admitted to the hospital, nurses teach patients about their condition to help them better understand living with chronic illness. In the clinic, an Advanced Practice Nurse or a Respiratory Therapist, provides one-on-one, disease specific education including a focused physical assessment and treatments or medications at the time of the visit. The clinic staff focuses on helping patients manage their health to avoid readmission. The newly constructed electrophysiology lab at Palos provides the cardiologists with advanced technology to treat complex heart dysrhythmias. Palos now provides our community with a comprehensive state of the art approach to prevention, diagnosing, treating and managing heart disease. Palos recently earned a Blue Distinction Center+ designation for Cardiac Care. 22665342 20423323 Care delivered by Palos Community Hospital extends beyond the four walls of the hospital building through care coordination efforts including Home Health, Private Duty, and Hospice, the Home Delivered Meal Program and Lifeline. A multidisciplinary team comprised of physicians, nurses, ancillary professionals, and information technology specialists developed, revised and implemented systems and process to provide a seamless continuum of care for our patients both inside and outside of the hospital. This collaborative effort focuses on promoting wellness and preventing admission and readmission. Coordination of care through the Nurse Navigators and Care Coordinators support the patients, families and physicians by directing them to the appropriate resources to help to provide high quality care for the patients. Palos continues to foster clinical affiliations bringing specialty/tertiary care to the community. Through our clinical affiliation with Loyola Medicine, cancer treatment services with academic level specialists have been established in the community at the Palos South Campus. This enables local residents access to tertiary level services without leaving the community and is an example of organizations collaborating intended to bring the patients the right care at the right place. In addition, Palos initiated a telestroke program with Loyola allowing for real time clinical evaluation by Loyola specialists of patients with stroke symptoms in Palos Hospital or the emergency department and facilitating expedited treatment, intervention or transfer of these patients to enhance outcomes. This collaboration and a common electronic medical record platform, EPIC, has also allowed for HIPAA compliant exchange of patient information between institutions facilitating continuity of care. During the past year, Palos has instituted a number of collaborative efforts with medical staff members focused on the promotion of population based health including the establishment of a heart failure clinic, participation in the Medicare Shared Savings Program for specific bundles, the development of a palliative care service and other post-acute care efforts focused on decreased readmissions and enhanced care coordination. Palos' Home Health, Private Duty and Hospice services provide quality personal care and support to patients in their homes, nursing homes or hospitals. The Home Health staff assists the chronically ill, persons with functional impairments, those needing specialized skilled care at home, those recovering from a hospital stay and the terminally ill. In 2017, Home Health staff from Palos made more than 89,000 home care visits, more than 22,000 hospice visits and provided nearly 37,000 hours of private duty nursing assistance. Palos also assists the homebound and elderly in the community with two special programs, Home Delivered Meals and Lifeline. Home Delivered Meals are provided to people who are homebound, live alone and are unable to prepare their own meals. The program offers recipients two meals a day which are planned by hospital dietitians, prepared in the hospital kitchen and delivered by Palos volunteers five days a week. The meals are available at a discounted rate by the hospital. The Home Delivered Meals program has an average of 50 recipients living in Palos Heights, Palos Hills, Palos Park, Orland Park and Orland Hills. To further support homebound and elderly area residents, Palos offers Lifeline, a medical alert system. The device, installed in participants' homes, can help detect falls and provide a simplified means to signal for assistance from a loved one or emergency services if needed. Palos can support up to 170 participants at a time. 21160564 14945391 Palos Medical Group is a physician practice that employs primary care physicians and select specialists to help better serve the needs of the community as it relates to the projected shortage of such physicians. During 2017, patients had more than 133,000 visits to Palos Medical Group.Palos initiated the Diabetes and Metabolism Center. Through this program, a team including an advanced practice nurse and registered dietitians, treat conditions such as Type 1 and Type 2 diabetes as well as metabolic conditions such as pre-diabetes, obesity, dyslipidemia and Polycystic Ovarian Syndrome (PCOS). 15674561 40573031 The Palos Emergency Department has increasingly become a resource for health care in the community. Annual visits have increased by 3,200 from 2016 to 2017. A performance improvement project increased capacity in the Emergency Department through earlier patient discharges, improved efficiencies in imaging and laboratory service. Overall patient satisfaction increased. 14126132 6268863 Palos has long served as a community resource for musculoskeletal care. Community education is provided on a variety of topics such as orthopaedic surgery, nutrition and exercise as well as information on improving balance and safety. Additionally, for patients having joint replacement surgery, a transition care coordinator works with patients to streamline their surgical care and track their progress. Patients attend a comprehensive preoperative education program to help better understand the surgical process, how to prepare for surgery, what is involved in the recovery process and what options there are for post hospital care. 9106823 4325743 Palos continues to provide behavioral health care services as other providers have limited access. With the help of Palos Health, the Cook County Court Bridgeview Division established a mental health court to help non-violent offenders. Palos provides care to qualified individuals facing mental health issues while potentially preventing future crimes if left untreated. The commitment to these services incorporates both inpatient and outpatient programs intended to respond to crisis situations while providing ongoing treatment and support programs intended to meet the needs of individuals and families in the community struggling with relationship problems, emotional issues, psychological disorders and substance abuse. The programs include alcohol treatment; chemical dependency; group therapies for mental health or substance abuse issues; intensive outpatient programs; Kids Recover Too, since children in the family can be especially hard-hit by a parent's chemical abuse or dependency; and the Partial Hospital Program for those needing more intensive treatment for a psychiatric or dual diagnosis. 861612 226584 To meet the needs of patients with complex chronic conditions, Palos Health launched a community-medicine based Palliative Care program. Through this service, a team of doctors, nurses and other specialists work together with the primary care physician to provide support with the goal of improving the quality of life for the patient and the family from the patient's residence. To improve access to care for patients unable to physically visit their physician's office, Palos launched a community-based medicine program. This program allows providers to visit patients in their homes, assisted-living facilities or nursing homes to address their primary care needs. The Palos provider communicates regularly with the primary care physician for the duration of the care. 2681419 5118292 Palos Imaging & Diagnostics is a non-provider based imaging center that provides reliable quality imaging services, experienced staff that works closely with board-certified radiologists, advanced imaging technology, competitive pricing, convenient evening and weekend hours and a single bill - charges include both the technical and radiologists fees (global billing). During 2017, Palos Imaging & Diagnostics performed more than 20,000 imaging procedures. 63611111 71457904 320756681 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 408 0 1 3403 1 1 1 1 CJ 0 0 0 1 1 0 0 0 0 X 10 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Roger Russell 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Edward Mulcahy Chairman 2.00 1.00 X X 0 0 0 Dr Terrence Moisan President & CEO 40.00 11.00 X X 814328 0 111055 Lawrence Hunt Vice Chairman (As of 9/20/17) 2.00 2.00 X 0 0 0 Dr Charles Polcaster Vice Chairman (Thru 9/20/17) 2.00 1.00 X 0 0 0 Jason Ley Director 2.00 1.00 X 0 0 0 Lucie Boyadjian Director 2.00 X 0 0 0 Dr Mark Sinibaldi Director/Physician 42.00 1.00 X 326846 0 50501 Dr Michael Sobczak Director (Thru 6/29/17) 2.00 X 0 0 0 Jack Vainauskas Director 2.00 1.00 X 0 0 0 Gary Collins Director 2.00 X 0 0 0 Timothy J McCarthy Director 2.00 X 0 0 0 Rosann S Demask Director (As of 9/20/17) 40.00 X 282451 0 53076 Don Dixon Secretary (As of 4/5/17) 40.00 10.00 X 346368 0 41116 Barbara J Medley Asst. Secretary 40.00 1.00 X 86302 0 15360 Roger A Russell VP Finance/Treasurer 40.00 10.00 X 310556 0 55780 Mary C Denisienko VP Human Resources 40.00 X 267977 0 37936 Patricia Heerlein VP Clinical Services 40.00 X 257802 0 23911 Michael Lynch Physician 40.00 X 473754 0 41288 Chaher Alhandalous Hospitalist 40.00 X 396844 0 28728 Romal Gandhi Hospitalist 40.00 X 367756 0 45206 Beatrice Correa-Rivera Hospitalist 40.00 X 367457 0 28317 Zulfiqar Rizvi Physician 40.00 X 355261 0 15767 Charles E Reiter III Former Officer 0.00 X 599514 0 5114 5253216 0 553155 165 1 1 0 Walsh Construction II LLC 929 W Adams Street Chicago IL 60607 Construction Services 42500096 Epic Systems Corporation 1979 Milky Way Verona WI 53593 Computer Software Services 5368812 Pepper Construction Company 18505 W Creek Drive Tinley Park IL 60477 Construction Services 3791904 AVAAP USA LLC 904 Buell Avenue Joliet IL 60435 Computer Software Services 2013900 ARAMARK 12483 Collection Center Drive Chicago IL 60693 Equipment Services 1370701 75 183850 399799 583649 Net Patient Revenue 621110 384977727 384878426 99301 Provider Tax Revenue 900099 12601290 12601290 MRI Joint Venture 900099 503722 503722 398082739 2420868 2420868 1312003 848077 463926 463926 463926 89327572 89476566 -148994 -148994 -148994 65250 183850 194215 -128965 -128965 Intercompany Revenue 900099 3827578 3827578 Cafeteria Revenue 900099 1441235 1441235 Meaningful Use 900099 920359 920359 1608565 1608565 7797737 409070960 404339940 99301 4048070 2575800 2575800 599514 599514 171573141 137897977 33675164 8424282 6630795 1793487 19160887 14944622 4216265 12268877 9675293 2593584 2477459 2477459 714201 299238 414963 170315 170315 342336 342336 23132989 6693700 16439289 449505 72225 377280 4026494 1021968 3004526 6822525 183983 6638542 4816319 4033901 782418 425287 385814 39473 72680 45436 27244 10408467 10408467 31770296 25451766 6318530 5821942 4938690 883252 Medical Supplies/Drugs 64846644 64846644 Bad Debt Expense 18761661 18761661 IL Bed Tax Assessment 13309062 13309062 Repairs and Maintenance 4821338 4821338 4298732 1155439 3143293 412090753 320756681 91334072 0 6155 6155 7916063 8832233 62055615 58273758 3701436 17502 2391270 5504064 3342652 2879686 821863514 272781413 520143453 549082101 175648119 127659605 1738221 0 158113 227073 8583366 9878846 785684463 762361023 107997673 105968351 370115000 360195000 40667086 32033623 518779759 498196974 X 266584925 263810330 319779 353719 266904704 264164049 785684463 762361023 X -3019793 250849 28289 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 38474 38474 0 Part II-B, Line 1: Palos Community Hospital paid $98,651 in dues to Illinois Health and Hospital Association, of which $38,474 was attributed to lobbying activity. 16621127 16621127 524862861 155592377 369270484 165770 165770 213767676 117189036 96578640 66446080 66446080 549082101 Tax Exempt Bond Liability Premium 2314384 Supplemental Executive Retirement Plan Liability 500219 Professional Liability Insurance Reserve 29219020 32033623 X Part X, Line 2: The Hospital has received determination letters from the Internal Revenue Service (IRS) stating that they are exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. Palos Medical Group is a disregarded entity and is considered part of the Hospital for income tax filing purposes. SGA is incorporated under the laws of the Cayman Islands, which imposes no tax on income or capital gains. However, SGA is subject to U.S. federal corporate taxation to the extent that it generates income that is effectively connected with a U.S. trade or business. SGA is not engaged in any such trade or business in the U.S. Accordingly, income taxes are not provided for in the accompanying consolidated financial statements. CHC, the Imaging Center and Sigma are also disregarded entities for income tax purposes. The Hospital follows the FASB-issued guidance for accounting for uncertainty in income taxes. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax exempt status of each entity, the continued tax exempt status of bonds issued by the obligated group, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBTI). UBTI is reported on Form 990-T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more-likely-than-not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB-issued guidance at January 1, 2007, and since that date through December 31, 2017, there were no unrecognized tax benefits identified and recorded as a liability. Forms 990 and 990-T filed by The Hospital are subject to examination by the Internal Revenue Service (IRS) up to three years from the extended due date of each return. Forms 990 and 990-T filed by The Hospital are no longer subject to examination for the years 2013 and prior. Central America and the Caribbean 0 0 Investments 100000 0 0 0 0 0 0 100000 0 100000 0 0 1 0 0 0 Dinner/Celebration 249100 183850 65250 65176 95266 7980 25793 249100 183850 65250 65176 95266 7980 25793 194215 -128965 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 2149091 2149091 0.00550 45307915 25638499 19669416 0.05000 47457006 25638499 21818507 0.05550 820394 73670 746724 0.00190 228839 158096 70743 0.00020 23149738 18820573 4329165 0.01100 93047 93047 0.00020 24292018 19052339 5239679 0.01330 71749024 44690838 27058186 0.06880 1 18761661 128181291 133919072 -5737781 X 1 1 1 1 Palos Community Hospital 12251 S 80th Avenue Palos Heights IL 60463 X X X Palos Community Hospital 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X https://www.paloshealth.com/about-us/ X http://paloscommunity.healthforecast.net X 1 15 0 1 0 1 X 200.000000000000 600.000000000000 X X X X X 1 1 X X X 1 X paloshealth.com/app/files/public/2316/Financial-Assistance-Policy-2018.pdf X paloshealth.com/app/files/public/1996/Financial-Assistance-App-2016.pdf X www.paloshealth.com/patients-visitors/billing/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 0 Palos Community Hospital Part V, Section B, Line 5: As part of the community health needs assessment, survey administrators sought input from key informants, those individuals who have a broad interest in the health of the community. A list of recommended participants was provided by MCHC member hospitals. This list included names and contact information for physicians, public health representatives, other health professionals, social service providers and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 29 community stakeholders in the Palos Community Hospital service area took part in the Online Key Informant Survey. Palos Community Hospital Part V, Section B, Line 6a: The 2015 Community Health Needs Assessment was facilitated by the Metropolitan Chicago Healthcare Council (MCHC) on behalf of participating member hospitals and health systems. These hospitals and health systems include: Alexian Brothers Health System/Amita Health (Alexian Brothers Behavioral Health Hospital, Alexian Brothers Medical Center, St. Alexius Medical Center); Amita Health (Adventist Bolingbrook Hospital, Adventist GlenOaks Hospital, Adventist Hinsdale Hospital, Adventist LaGrange Memorial Hospital); Edward Elmhurst Healthcare (Edward Hospital & Health Services, Elmhurst Memorial Hospital); Franciscan Alliance (Franciscan St. James Health); Ingalls Health System (Ingalls Memorial Hospital); Little Company of Mary Hospital and Health Care Centers; Loretto Hospital; Northwest Community Healthcare (Northwest Community Hospital, Northwestern Memorial Hospital); Northwestern Medicine (Central DuPage Hospital, Northwestern Lake Forest Hospital); Palos Community Hospital; Rush System for Health (Rush Oak Park Hospital, Rush University Medical Center); Saint Anthony Hospital; St. Bernard Hospital and Health Care Center; Swedish Covenant Hospital; Thorek Memorial Hospital; and the University of Chicago Medicine. Palos Community Hospital Part V, Section B, Line 11: Palos Community Hospital formed an internal, multi-disciplinary committee to review the results of the CHNA and to evaluate, discuss and prioritize health issues as identified. The committee used the criteria focused on magnitude, scope/severity, Palos' ability to impact and the risk of inaction in determination of the areas of opportunity on which to focus.In consideration of the top health priorities identified through the CHNA process and taking into account hospital resources and overall alignment with the hospital's mission, goals and strategic priorities - it was determined that Palos would focus on developing and/or supporting strategies and initiatives to improve: - Access to Health Care Services - Cancer - Diabetes - Stroke, Heart Disease & Respiratory Diseases - Immunizations & Infectious Diseases - Mental Health & Substance AbuseIn acknowledging the wide range of priority health issues that emerged from the CHNA process, Palos Community Hospital determined that it could only effectively focus on those which it deemed most pressing, most under-addressed and most within its ability to influence. As a consequence there were areas of opportunity identified in the CHNA which Palos has not prioritized to address due to the availability of other community based programs and services to better address these opportunities and the low volume of respondents within Palos' immediate service area requiring services. The areas of opportunity not addressed include: - Infant Health and Family Planning - Chronic Kidney Disease - HIV/AIDS - Tobacco Use - Nutrition, Physical Activity and Weight - Sexually Transmitted Diseases - Potentially Disabling Conditions - Oral Health - Injury and Violence PreventionWhile these opportunities were not addressed as priorities, it should be noted that many of the issues associated with these opportunities are routinely addressed through programs and services which have been developed in response to areas of opportunities on which Palos is focused. For example, nutrition counseling would always be an integral component in the provision of services focused on cardiac disease, cancer and diabetes. Likewise, substance abuse services would incorporate the teaching of harm reduction strategies as means for primary prevention of HIV/AIDS. Palos also offers access to smoking cessation information and education and incorporates smoking risk information in all clinical programs. Furthermore, Palos offers access to services to improve ADL and mobility through its home care and rehab services along with internal and external education initiatives designed to support independence and support people with activity limitations.Please refer to attached CHNA Implementation Plan for additional details. Part V, Section B, line 3 The sample design used for this effort consisted of a random sample of 380 individuals age 18 and older in the Palos Community Hospital Service Area. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). Part V, Section B, Line 16i To be in compliance with section 501(r)(4)(v), Palos Community Hospital translated its FAP, FAP application form, and plain language summary of the FAP in the languages spoken by each LEP language group as described in Treas. Reg. 1.501(r)-4. The languages determined include Spanish, Polish, and Arabic and Palos posted translations to the Hospital's website before filing the Form 990.Please visit the following URL: www.paloshealth.com/patients-visitors/billing/financial-assistance/. Part V, Section B, line 22 It is the policy of Palos Community Hospital to provide quality medical health care to all persons regardless of race, creed, gender, national origin, handicap, age, ability to pay or other protected status. PCH recognizes that not all individuals possess the ability or means to purchase essential medical services, and further, that our mission is to serve our community with respect to providing health care services and health care education. Therefore, in keeping with PCH's commitment to serve all members of the community, free and/or discounted care ("Financial Assistance") will be considered where the need and/or inability to pay are identified as set forth in the Financial Assistance Policy. This policy was also extended to all clinically-necessary procedures and was not limited to emergency care only. Palos has created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 80% discount off of regularly billed charges for any uninsured patient who earned less than 600% of the FPG. Palos also created a policy to help those who are underinsured. Similar to its uninsured policy, the underinsured policy creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 400% of the FPG. 3 1 - Palos Primary Care Center 15300 West Avenue Suite 122 Orland Park IL 60462 Primary Care Center, Physician Group and Imaging Center 2 - Palos Home Health Care 15295 E 127th St Lemont IL 60439 Home Health Care 3 - Palos Diagnostic & Women's Center 17333 S LaGrange Rd Tinley Park IL 60477 Diagnostic Testing and Women's Health Part I, Line 3c: Palos has created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 80% discount off of regularly billed charges for any uninsured patient who earned less than 600% of the FPG. Palos also created a policy to help those who are underinsured. Similar to its uninsured policy, the underinsured policy creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 400% of the FPG.All self-pay patients are provided information regarding our charity care program at the time of registration and are asked to complete a two-page application. This enables the Hospital to expedite the charity care approval process. For balances after insurance, patients are made aware of our charity care program via the statement they receive. Additional information is available on the Hospital's website.The Financial Counselors see approximately 20 patients daily for assistance with screening for Medicaid applications, financial assistance, payment plans, estimated pricing for services, account review/inquiries/complaints, Medicare liability, etc. The Financial Counselors assist patients with current, past and future visits. The Financial Counselors and Self Pay Collectors processed 3,271 financial assistance applications in 2017. There were 2,808 charity adjustments including 1,381 presumptive eligibility charity adjustments. Part I, Line 7: Cost amounts reported in Item 7 were calculated using available data including the overall hospital cost to charge ratio as well as direct and indirect costs for certain specific departments of the hospital. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 18,761,661. Part II, Community Building Activities: Our focus has been on providing quality medical services to residents of the service area. However, Palos has also taken seriously its role as a corporate citizen and one of the area's largest employers. As such we have implemented and/or maintained programs/relationships that we feel help to improve the overall health of the community and the wellness of the people we serve. Palos Community Hospital serves as a site for transitional employment training through the Southwest Cook County Cooperative Association for Special Education. This program is intended to introduce career options for youths with disabilities as they transition from school to adult life better positioned for employment success.Palos Community Hospital representatives serve on committees focused on the betterment of the surrounding community. One representative is a member of the City of Palos Heights Economic Development Committee. This committee acts as an advisory board to the city council on matters of business district redevelopment, special events and more to assist in the promotion of current businesses. Another representative serves on the board of the Palos Chamber of Commerce focused on promoting the businesses as well as community amenities to the surrounding communities. Representatives from Palos' Behavioral Health department actively participate in a community-based collaborative effort to address the increasing use of illegal drugs in the surrounding area. The Orland Park Substance Awareness Forum includes representatives from village administration, police and fire departments, along with other agencies that assist in addressing substance abuse. Palos believes that given limited resources and time this serves our community more appropriately than the community building activities as defined in this schedule. Part III, Line 2: Estimated bad debt expense is calculated by totaling the amounts from patient accounts written off as uncollectible plus an estimate of the uncollectible portion of accounts receivable, aged by financial class, all multiplied by the appropriate cost to charge ratio. Part III, Line 3: Information to determine this amount is not available. Part III, Line 4: Patient receivables due directly from patients are carried at the original charge for the service provided less amounts covered by third-party payors and less estimated allowances for doubtful accounts. Management estimates the allowance for doubtful accounts based on the aging of its accounts receivable and its historical collection experience for each payor type. Recoveries of accounts receivable previously written off as uncollectible are recorded as a reduction of the provision for doubtful accounts when received. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for doubtful accounts if necessary (for example, for unexpected 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), the Hospital records a significant provision for doubtful 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. Patients who meet certain criteria under the Hospital's charity care policy are eligible for discounts from the Hospital's established rates. The difference between the standard rates (or the discounted rates if applicable) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.The past due status of receivables is determined on a case-by-case basis depending on the payor responsible. Interest is generally not charged on past due accounts.The Hospital's allowance for doubtful accounts for self-pay patients was approximately 18 and 24 percent of patient accounts receivable at December 31, 2017 and 2016, respectively. The Hospital's self-pay write-offs were $24,848 and $25,485 in 2017 and 2016, respectively. The decrease in the allowance for doubtful accounts is primarily the result of allowance adjustments based upon observed collection results throughout the year and the result of the resolution of accounts from the prior patient accounting system that had been included in the allowances in 2016. The Hospital does not maintain a material allowance for uncollectible accounts from third-party payors, nor did it have significant write-offs from third-party payors. Part III, Line 8: Medicare costs are calculated using the hospital wide cost to charge ratio. Palos does include the Medicare shortfall in its Illinois state community benefit report as Palos continues to treat its Medicare community despite the fact that its costs for these patients exceed reimbursement. Part III, Line 9b: It is the policy of Palos not to pursue collection practices against patient balances known to qualify under the financial assistance policy. Part VI, Line 2: In addition to the CHNA, Palos monitors trends in diseases, medical conditions, utilization of medical services and demographics that may affect the patients served and community at large. Palos uses this information as it designs and modifies programs and services to meet the needs of its patients and community either on its own or in collaboration with other entities. This information has demonstrated the need to focus on the management of an aging patient population, chronic health conditions, the incidence of readmission, and coordination of care from pre-hospitalization to post-acute.Specific initiatives undertaken by Palos in response to the assessment of the health care needs of its patients and the community include: - The employment of a dedicated addictionologist who provides care to patients with substance use disorders. - Palos opened Palos Imaging and Diagnostics, a non-hospital based, free-standing imaging center. - Palos launched the community-based medicine program in which select providers are dedicated to deliver medical care to patients unable to leave their residence for a physician's office visit. - The development of the Diabetes and Metabolism Center. Part VI, Line 3: At the time of registration, each patient is referred to a copy of Palos' financial assistance policy and asked to fill out a simple registration form that may help them qualify for charity care. This policy lays out the eligibility requirements and what the patient must do to qualify. Also at registration, any patient without insurance is advised as to what other programs they may qualify for and are given assistance in applying as necessary. Palos employs a company that helps patients apply for Medicaid coverage and SSI disability. Upon discharge, each patient receives a summary bill that includes information related to eligibility for financial assistance. All inpatients without insurance are visited by a financial counselor who helps direct the patient and their families to the appropriate level of assistance. Brochures explaining the charity care policy are displayed and available at registration areas and in the Emergency Department. Palos also displays the plain language summary of the financial assistance policy on the website along with the financial assistance application. Part VI, Line 4: Communities within the hospital's service area have seen overall growth in population of approximately 7.6% from 2000 to 2014 with a current estimated population of 622,571. From 2014 to 2019, the population is expected to grow by 1.3%. Zip codes within the Palos Community Hospital service area include:60462, 60467, 60463, 60464, 60465, 60482, 60445, 60452, 60477, 60487, 60453, 60455, 60457, 60458, 60459, 60415, 60805, 60655, 60803, 60439, 60441, 60491, 60423, 60448, 60451Of those living within the service area of Palos Community Hospital:51% are female87% are white84% use English as their primary language at homeThe median age is 40.2 years30% are high school graduates23% have had some college, and30% have earned a bachelor's degree or beyond.7% of households are estimated to fall under the national poverty level.There are no other hospitals located in Palos' primary service area. Part VI, Line 5: Palos Community Hospital is an acute care facility with 425 licensed beds, 14 operating rooms, nearly 600 medical staff physicians and approximately 3,100 employees. Within the service area, Palos serves as a resource for health education and wellness initiatives for residents. Palos continues to monitor the health care needs of its service area to insure the need for the services it offers and evaluate the opportunity to develop new programs and services as necessary. Palos works with and in support of other not-for-profit, educational, governmental, civic or community organizations, as appropriate, to promote health and wellness through awareness, education, research, access or support.Demonstrating Palos' commitment to disease prevention and wellness, more than 150 community education programs were held during the year with approximately 3,000 participants. Programs included our annual Fall Prevention Fair, for seniors looking to prevent falls, a Low-Sodium Cooking class, which taught participants how to cook for individuals with heart failure, and a Diabetes Fair for those diagnosed with diabetes or pre-diabetes. Our relationship with the Cancer Support Center brought additional support services to patients battling cancer and their loved ones, including a support group, group yoga, and individualized visits from a Support Center representative. Our special event for cancer survivors, "Survive and Thrive: Living Well After Cancer," included a panel discussion made up of cancer survivors, a motivational message from a local humorist, and information on health resources at the hospital and within the community.Additionally, Palos serves as a resource for health information to community members. Palos participated in health-focused events in Palos Heights, Orland Park and Homer Glen providing health screenings focused on either heart or bone health. Palos uses direct mail to inform service area residents about certain health conditions, community education programs offered through the hospital by subject matter experts as well as the related services available at Palos. To support local non-profit organizations, Palos provided more than twenty speaking presentations throughout 2017. Topics covered during these presentations include heart health, stress management, healthy eating and fall prevention. Palos has a very active Community Volunteer Program. In 2017 we managed 673 volunteers, ranging from 15 to 93 years of age. Our volunteers drive for our Home Delivered Meals Program and help patients and visitors navigate our facilities. Some of our patient care volunteers provide help for a safe transition when going home by providing important information from our Social Service department. Our high school students help deliver equipment and provide essential needs such as fresh ice water to our patients. We have a well-rounded program to help our community and our staff. The Palos Volunteer program provides high school student with the opportunity to fulfill community service requirements annually. Additionally, hundreds of adult volunteers donate their time to Palos while having the opportunity to make new friends and experience the feeling of contributing to the community.Palos patients and the surrounding community benefit from many of the services provided by the American Cancer Society. During 2017, Palos sponsored the ACS's Making Strides Against Breast Cancer event in Orland Park. ACS uses monies raised to support groundbreaking breast cancer research; provide free, educational materials: support breast cancer patients and their loved ones; and help people take steps to reduce their breast cancer risk or find cancer early when it is most treatable.Palos served as a sponsor for an event benefitting the Crisis Center of South Suburbia, a non-profit community organization that provides emergency shelter and other essential services for individuals and families victimized by domestic violence, while addressing the societal issues that contribute to domestic violence.Palos sponsored the 2017 Southwest Half Marathon & 10K, an annual race that takes place in Palos Heights. This premier event brings many elite athletes to the Palos community each year, and is held in connection with a community Health Fair focused on healthy living, at which Palos also has a presence. Proceeds from this event are donated to the South West Special Recreation Association, an organization dedicated to serving individuals with disabilities in their need for recreation so that all persons may experience and enjoy positive leisure opportunities.Palos assists members of the nursing staff by administering two scholarship funds. Annual scholarships are awarded to nurses continuing their education.Each year, community cancer screening programs, as well as the direction of the Cancer Program at Palos, are designed in response to our community's needs based on guidance provided by the Palos Oncology Committee. This group, consisting of hospital leaders, caregivers and physicians, provides direction on how to better meet the needs of cancer patients in our community. In 2017, Palos nurses attended several events throughout the service area to educate individuals on skin cancer prevention. Free colorectal cancer screening kits were distributed at local events to help promote early detection. Palos Community Hospital is governed by the Board of Directors, comprised of community leaders from the hospital's service area. Further demonstrating the hospital's connection to the community is the representation from community members to help shape our programs to better meet the needs of our residents. An example of this is the Diabetes Advisory Council. This group, consisting of community members as well as hospital leaders, provides input on how to better shape our diabetes program to meet the needs of our residents. In 2017, Palos hosted its annual Diabetes Fair to help individuals with diabetes and their loved ones learn how to manage the condition. Palos serves as a Senior Health Insurance Program (SHIP) site. This is a free statewide health insurance counseling service for Medicare beneficiaries and their caregivers. The hospital provides office space and other resources to support volunteers offering community members information and resources regarding applying for Medicare and Medicare coverage.Palos provides financial assistance to people with limited means. Uninsured or underinsured individuals may be eligible for discounts on the cost of care. Financial counselors are available to help patients determine terms befitting of the financial situation, as well as provide patients with information regarding local, state and federal assistance programs.Palos provides the influenza vaccination to all employees, volunteers and patients during flu season. During 2017, Palos hosted flu vaccination fair offering discounted flu shots to the community.To help heart failure, asthma and COPD inpatients transition from the hospital to home, Palos Community Hospital offers the Heart & Lung Wellness Clinic. To address patient access issues, Palos opened the Palos Imaging and Diagnostic Center. This non-hospital based imaging facility, provides patients with an imaging option with a global charge and competitive pricing. To help patients manage Type 1 or Type 2 diabetes and other metabolic conditions, Palos opened the Diabetes and Metabolism Center. Palos sponsorship of the Palos Heights Farmers Market provides the community with another option for fresh, local healthy fruits and vegetables, including residents with an Illinois LINK card (for those receiving cash assistance or Food Stamps). The LINK card can be used for food purchases at the market. Part VI, Line 6: Palos Community Hospital is not part of an affiliated health care system. Part VI, Line 7, Reports Filed With States IL X X X X 1 1 0 0 0 0 0 0 0 Dr Terrence Moisan President & CEO 718236 0 0 0 96092 0 88201 0 22854 0 925383 0 67951 0 Dr Mark Sinibaldi Director/Physician 326098 0 748 0 0 0 28000 0 22501 0 377347 0 0 0 Rosann S Demask Director (As of 9/20/17) 258048 0 0 0 24403 0 27801 0 25275 0 335527 0 7551 0 Don Dixon Secretary (As of 4/5/17) 307473 0 0 0 38895 0 30895 0 10221 0 387484 0 20895 0 Roger A Russell VP Finance/Treasurer 290539 0 0 0 20017 0 31501 0 24279 0 366336 0 2017 0 Mary C Denisienko VP Human Resources 242850 0 0 0 25127 0 26179 0 11757 0 305913 0 6545 0 Patricia Heerlein VP Clinical Services 240252 0 0 0 17550 0 12982 0 10929 0 281713 0 0 0 Michael Lynch Physician 411156 0 44598 0 18000 0 20250 0 21038 0 515042 0 0 0 Chaher Alhandalous Hospitalist 389344 0 7500 0 0 0 3967 0 24761 0 425572 0 0 0 Romal Gandhi Hospitalist 342316 0 7500 0 17940 0 20250 0 24956 0 412962 0 0 0 Beatrice Correa-Rivera Hospitalist 342017 0 7500 0 17940 0 20250 0 8067 0 395774 0 0 0 Zulfiqar Rizvi Physician 295978 0 41283 0 18000 0 0 0 15767 0 371028 0 0 0 Charles E Reiter III Former Officer 73257 0 0 0 526257 0 0 0 5114 0 604628 0 0 0 Part I, Lines 4a-b Charles E. Reiter, III received a severance payment of $442,320 during 2017. The following individuals participate in a 457(f) plan and the amounts are the contributions to each plan during 2017: Dr. Terrence Moisan - $67,951 Roger Russell - $26,049 Rosann S. Demask - $7,551 Mary C. Denisienko - $6,545 Dr. Mark Sinibaldi - $7,750 Don Dixon - $14,380 The following individuals report amounts vested under a 457(f) plan on Part II, column B(iii). Dr. Terrence Moisan - $78,592 Roger Russell - $2,017 Rosann S. Demask - $8,199 Mary C. Denisienko - $7,127 Don Dixon - $20,895 The following individual participates in a 457(f) plan and the amount is the distribution from the plan during 2017: Charles E. Reiter, III - $82,857 A Ill Fin AuthorityPalos Comm Hospital 861091967 45200F2Z1 2010-05-06 151146301 Fund construction of new bed tower and modernization of existing bed tower 0 1 0 B Ill Fin AuthorityPalos Comm Hospital 861091967 NoneAvail 2015-10-01 232015000 Refinanced Series 2015A bonds and advance refund Series 2007A bonds 0 1 0 A 15645000 151146301 1950637 149195664 2012 0 0 1 1 B 3700000 232015000 230865171 1149829 2015 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: Ill Fin Authority/Palos Comm Hospital Date the Rebate Computation was Performed: 02/25/2015 Form 990, Page 1, Box B: Palos Community Hospital is amending Form 990 for the following information: - Compensation on Part VII, Section A, Column (D) corrected to agree to 2017 Forms W-2C, Corrected Wages and Tax Statements. - Schedule J, Part II, Columns (B)(iii) and (F) report amounts vested under a 457(f) nonqualified retirement plan. - Schedule J, Part III reports names of listed persons and amounts vested. Form 990, Part VI, Section A, line 6 St. George Corporation is the sole Corporate Member. Form 990, Part VI, Section A, line 7a St. George Corporation holds the power to appoint members of the governing body. Form 990, Part VI, Section A, line 7b St. George Corporation can exercise action on the following matters: (a) removal of directors, with or without cause; (b) all amendments to the bylaws or the Corporation's Articles of Incorporation; (c) the sale or transfer of substantially all of the property of the corporation, except for leases in excess of one year; (d) all long term borrowing in excess of one year; (e) merger or consolidation by the Corporation with any other institution, hospital, corporation or legal entity; (f) formal affiliation with a medical school or research facility; (g) acceptance of any gift, bequest or legacy that imposes a permanent or continuing obligation on the Corporation for a period of more than one year; (h) decisions to authorize voluntary dissolution of the Corporation or to revoke proceedings therefor; (i) adoption of a plan for the distribution of the assets of the Corporation; and (j) any other matters required by law to be submitted to the Corporate Member or which the Board determines by resolution to submit. Form 990, Part VI, Section B, line 11b Senior management reviewed the Form 990 that was prepared by our tax advisors with the information we provided to them. Once reviewed by senior management it was made available to our Board prior to filing. Form 990, Part VI, Section B, line 12c On an annual basis, directors, key personnel (VP, department heads (budget administrators)), and all purchasing staff must complete a Conflict of Interest Form disclosing any conflict of interest that may exist or be perceived to exist between themselves and/or family members and vendors, contractors and others with whom Palos has a contract/transaction agreement. Annual disclosure statements of key personnel are reviewed by the VP of Human Resources. Any issue identified as part of this annual disclosure is referred to the Compliance Officer, in consultation with General Counsel, for disposition. The full Board reviewed the disclosure statement of each Director that identified an interest. Form 990, Part VI, Section B, line 15 Palos engaged an independent consultant to complete a market analysis of executive positions. The market analysis included base rates, bonuses and benefits resulting in a total remuneration benchmark. They compared Palos executives to executives in organizations of similar size and with similar characteristics. The consultants presented their report and findings to the Compensation Committee of the Board. The independent members of the Compensation Committee approved compensation and this approval was documented in the minutes at the time of approval. Form 990, Part VI, Section C, line 19 All policies, governing documents and financial statements required to be available to the public are available upon request. Requests can be made from the Finance Department of Palos Community Hospital. Documents are available for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part XI, line 9: Net Asset Transfer to St. George Corporation -7,803. Change in Temporarily Restricted Net Assets 33,940. Adjustment to Net Assets 2,152. Palos Medical Group LLC 12251 S 80th Avenue Palos Heights IL 60463 271472342 Health Care IL 15160450 8843075 Palos Community Hospital Chicago Health Colleagues LLC 12251 S 80th Avenue Palos Heights IL 60463 362169179 Health Care IL 224071 300592 Palos Community Hospital Palos Imaging LLC 12251 S 80th Avenue Palos Heights IL 60463 364836347 Health Care IL 5118292 2672960 Palos Community Hospital St George Corporation 12251 S 80th Avenue Palos Heights IL 60463 364383840 Holding Company IL 501(c)(3) Line 12b, II N/A 0 St George Wellness Center 12251 S 80th Avenue Palos Heights IL 60463 364383845 Fitness Center IL 501(c)(3) Line 10 St George Corporation 0 South Campus Partners Inc 15300 West Avenue Orland Park IL 60462 320517854 Health Care IL 501(c)(3) Line 3 Palos Community Hospital 1 St George Assurance LTD PO Box 1159 878 W Bay Road Grand Cayman CJ KY1-1102 981313176 Captive Insurance CJ Palos Community Hospital C 16922 36296415 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1