2018-05-15T20:01:37-05:00 2017-06-30 861065772 DELOITTE TAX LLP 50 S 6TH STREET SUITE 2800 MINNEAPOLIS MN 554021844 990 2016-07-01 362170840 COPLEY MEMORIAL HOSPITAL INC C/O RUSH-COPLEY MEDICAL CTR COPL 6309786200 2000 OGDEN AVENUE AURORA IL 605044206 BRENDA VANWYHE CFO 6309786200 2018-05-15 1 KRISTINA RASMUSSEN P00143920 6123974000 2016 2022-09-23 18:48:47Z BARRY FINN 2000 OGDEN AVENUE AURORA IL 605044206 352990921 0 X WWW.RUSHCOPLEY.COM X 1886 IL TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. 18 15 2305 364 0 0 2579443 1184698 299653923 305721600 11100528 11311285 6793944 3263860 320127838 321481443 50474 37187 0 0 140740086 141773145 0 0 0 135060609 140580195 275851169 282390527 44276669 39090916 519972246 582894855 270245737 266830962 249726509 316063893 X THE MISSION OF RUSH-COPLEY IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. 0 0 222627409 37187 308904649 COPLEY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. TO THAT END, THE MEDICAL CENTER SEEKS TO SERVE THE COMMUNITY IN WAYS THAT ENGAGE, EDUCATE AND EMPOWER. IN FY2017, COPLEY MEMORIAL HOSPITAL PROUDLY COLLABORATED WITH DOZENS OF CIVIC AND COMMUNITY GROUPS TO IMPACT THE KNOWLEDGE, HEALTH AND WELL BEING OF THE COMMUNITY. COPLEY MEMORIAL HOSPITAL OFFERS FREE EDUCATIONAL PROGRAMS RANGING FROM HAND HYGIENE EDUCATION AIMED AT PRESCHOOL AND PRIMARY GRADE SCHOOL AGED CHILDREN TO ANNUAL SEMINARS EDUCATING ADULTS ABOUT DIABETES, HEART HEALTH, CANCER PREVENTION, WEIGHT CONTROL, SMOKING CESSATION AND MORE.A COMMUNITY NEWSLETTER IS PUBLISHED AND HIGHLIGHTS HEALTH INFORMATION AND CALENDAR OF EVENTS INFO TO 90,000+ HOUSEHOLDS THROUGHOUT THE HOSPITAL SERVICE AREA. FREE AND REDUCED COST HEALTH SCREENINGS ARE REGULARLY OFFERED INCLUDING FREE BLOOD PRESSURE MONITORING ON A WALK-IN BASIS.ELECTRONIC NEWSLETTERS ALSO HIGHLIGHTING HEALTH INFORMATION, NEWS AND EVENTS ARE EMAILED MONTHLY: HEALTHY EUPDATE AND FITNOTES. THESE NEWSLETTERS AVERAGE 50,000 AND 4,900 EMAILS RESPECTIVELY. ADDITIONALLY, CANCER CARE NEWS, TARGETED AT CANCER CARE PATIENTS AND THEIR FAMILY AND CARE GIVERS, WAS SENT TO APPROXIMATELY 2,300 EMAIL ADDRESSES AND AN AVERAGE OF 2,500 FAMILY RESIDENCY PATIENTS RECEIVED HEALTHY ENEWS. 222627409 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 229 0 1 2305 1 0 0 0 0 0 0 0 0 0 0 0 X 18 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X BRENDA VAN WYHE 6309786200 2000 OGDEN AVENUE AURORA IL 60504 THOMAS ALEXANDER DIRECTOR 1.00 2.00 X 0 0 0 TRISH ANEN DIRECTOR 1.00 2.00 X 0 0 0 JAMES BAKA DIRECTOR 1.00 2.00 X 0 0 0 CATI CEDEROTH DIRECTOR 1.00 2.00 X 0 0 0 BRUCE DIENST VICE CHAIR OF BOARD/DIRECTOR 1.00 2.00 X 0 0 0 RICHARD EDELMAN DIRECTOR 1.00 2.00 X 0 0 0 RONALD HEM DIRECTOR 1.00 2.00 X 0 0 0 GARRETT KATULA DO VICE CHIEF OF STAFF/DIRECTOR 41.00 2.00 X 330553 0 38803 STEPHEN KELANIC MD VICE CHIEF OF STAFF/DIRECTOR 41.00 2.00 X 395710 0 36243 HERBERT KNIGHT DIRECTOR 1.00 2.00 X 0 0 0 MARYANNE LOCKLIN DIRECTOR 1.00 2.00 X 0 0 0 DAVE MEAD DIRECTOR 1.00 2.00 X 0 0 0 MARK METZGER CHAIRMAN OF THE BOARD/DIRECTOR 1.00 2.00 X 0 0 0 AVERY MILLER DIRECTOR 1.00 2.00 X 0 0 0 WILLIAM SKOGLUND VICE CHAIR BOARD/DIRECTOR 1.00 2.00 X 0 0 0 CHRISTINE SOBEK DIRECTOR 1.00 2.00 X 0 0 0 ANDREW VANEEKEREN DIRECTOR 1.00 2.00 X 0 0 0 BARRY FINN PRESIDENT & CEO/DIRECTOR 40.00 3.00 X X 4755526 0 39579 RYAN ASMUS VP GENERAL COUNSEL/SECRETARY 40.00 3.00 X 390007 0 77490 BRENDA VAN WYHE SR. VP FINANCE & CFO/TREASURER 40.00 3.00 X 460794 0 81193 GAIL BUMGARNER SR. VP, STRATEGY 40.00 0.00 X 453081 0 20179 DENNIS DEMASIE VP, INFORMATION TECH & CIO 40.00 0.00 X 349342 0 68426 JOHN DIEDERICH SR. VP, OPERATIONS & COO 40.00 1.00 X 583173 0 153834 BRENDA FANN MD ASSISTANT VP, MEDAFFAIRS 40.00 0.00 X 351140 0 25106 DIANE HOMAN MD VP, QUALITY & PSO 40.00 0.00 X 540950 0 40350 STEVE LOWENTHAL MD SR. VP, MEDICAL AFFAIRS & CMO 40.00 0.00 X 736197 0 19638 DAVID PETASNICK ASSISTANT VP, ANCILLARY SVCS 40.00 0.00 X 225076 0 30632 ALEX POPE VP, PHILANTHROPY & CDO 40.00 1.00 X 279789 0 59362 MARY SHILKAITIS VP PATIENT CARE SRVCS & CNO 40.00 0.00 X 360941 0 79102 SUSAN STERCHI ASSISTANT VP, PATIENT CARE 40.00 0.00 X 235327 0 35596 SANTOSH GILL MD PHYSICIAN 40.00 0.00 X 823049 0 27899 KEVIN KELLY MD PHYSICIAN 40.00 0.00 X 924304 0 34405 TARIQ RAHIM MD PHYSICIAN 40.00 0.00 X 769914 0 37701 DIMITRY RUBAN MD PHYSICIAN 40.00 0.00 X 954123 0 34402 VIJAY SHAH MD PHYSICIAN 40.00 0.00 X 737066 0 36501 14656062 0 976441 247 0 1 0 ANTHELIO HEALTHCARE SOLUTIONS 1 LINCOLN DR STE 200 5400 LBJ FRW DALLAS TX 75240 MEDICAL RECORDS MANAGEMENT 4106676 SODEXO 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD AND CLEANING SERVICE MANAGEMENT 3727938 INTUITIVE SURGICAL INC 1020 KIFER ROAD SUNNYVALE CA 94086 MEDICAL EQUIPMENT REPAIR AND SERVICING 2243758 FOX VALLEY ACUTE DIALYSIS 1300 WATERFORD DRIVE AURORA IL 60504 DIALYSIS SERVICES 920988 ADVOCATE MEDICAL GROUP 2311 WEST 22ND STREET OAK BROOK IL 60523 PHYSICIAN SERVICES 840065 30 1184698 1184698 NET PATIENT SVC REV 621110 279740746 279740746 MEDICAID TAX REVENUE 621110 28298104 28298104 OTHER PROGRAM REVENUE 900099 -2317250 -2317250 305721600 6057198 6057198 1000903 1511537 -510634 -510634 -510634 33746536 1505492 29995717 2224 3750819 1503268 5254087 5254087 OUTSIDE SERVICE REV. 621990 3183049 3183049 CAFETERIA REVENUE 621990 309513 309513 GIFT SHOP REVENUE 453220 278140 278140 3792 3792 3774494 321481443 308904649 0 11392096 37187 37187 10546299 10546299 102247610 74020614 28226996 2900629 2175472 725157 16098829 12074122 4024707 9979778 7484834 2494944 7103244 5327433 1775811 666859 666859 250348 250348 47681 47681 50419 37814 12605 6876439 5157329 1719110 961146 961146 15403068 11552301 3850767 15489904 11617428 3872476 7011328 5258496 1752832 137631 103223 34408 92563 69422 23141 3887781 3887781 18018038 18018038 -1086109 -814582 -271527 MEDICAL SUPPLIES 50616251 50616251 MEDICAID PROVIDER TAX 12711948 12711948 LAUNDRY 1043786 1043786 CONSULTING 756390 756390 541480 530976 10504 282390527 222627409 59763118 0 19770549 14069478 50121411 47096725 5185900 5293019 7908846 12924563 391281805 216825360 153510701 174456445 259224374 269805003 3628249 3282363 20622216 55967259 519972246 582894855 138498059 132461230 103120730 101622859 28626948 32746873 270245737 266830962 X 246811368 313148752 2915141 2915141 0 249726509 316063893 519972246 582894855 X 39090916 22976629 4269839 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 47681 47681 0 PART II-B, LINE 1: COPLEY MEMORIAL HOSPITAL, INC. IS A MEMBER OF VARIOUS ORGANIZATIONS THAT ADVOCATE ON LEGAL AND POLICY ISSUES THAT AFFECT HEALTHCARE. A PORTION OF THE ANNUAL MEMBERSHIP DUES PAID BY COPLEY MEMORIAL HOSPITAL, INC. TO THESE ORGANIZATIONS IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 10975986 2004750 512030 1801561 11691205 12538872 1093070 104565 2760521 10975986 11931067 2373022 204733 1969950 12538872 11161160 1178338 1068336 1476767 11931067 11131204 980802 712783 1663629 11161160 0.16880 0.69180 0.13940 0 1 1 18795905 18795905 226244341 115163102 111081239 3743627 2617519 1126108 134186529 99044739 35141790 8311403 8311403 174456445 DUE FROM AFFILIATES 48004865 INVESTMENTS IN JOINT VENTURES 7937394 OTHER 25000 55967259 LONG TERM DEFERRED RENT OBLIGATION 725346 DEFERRED GAIN ON SALE LONG TERM 5934889 LONG TERM SERP 2568760 LONG TERM MARKET ADJUSTMENT SWAP LIABILITY 8465612 DUE TO RELATED PARTY 15752363 UNAMORTIZED BOND DISCOUNT -700097 32746873 X PART V, LINE 4: RUSH COPLEY FOUNDATION HOLDS THE VORIS (INCOME FOR CMH CANCER CARE), KOBISK (BOARD RESTRICTED INCOME TO CMH), COPLEY (INCOME UNRESTRICTED), DOBBINS (INCOME FOR CMH WOMEN'S HEALTH), AND MOVEMENT DISORDER (INCOME FOR CMH MOVEMENT DISORDER PROGAM) ENDOWMENTS. RUSH COPLEY FOUNDATION ALSO HOLDS THE FOLLOWING QUASI ENDOWMENTS; NURSING (INCOME FOR CMH FUTURE OF NURSING SCHOLARSHIPS), FOX VALLEY HEART (INCOME FOR THE HEART INSTITUTE), WATERFORD PLACE (INCOME FOR CMH CANCER RESOURCE CENTER) AND COPLEY (INCOME FROM THE COPLEY ENDOWMENT). THESE FUNDS ARE HELD FOR THE BENEFIT OF COPLEY MEMORIAL HOSPITAL, INC. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION, THE HOSPITAL, VENTURES AND THE FOUNDATION ARE QUALIFIED AS TAX-EXEMPT ORGANIZATIONS UNDER INTERNAL REVENUE CODE SECTION 501(C)(3); ACCORDINGLY, INCOME TAXES ARE NOT PROVIDED FOR IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE MEDICAL GROUP OPERATES AS A TAXABLE CORPORATION AND ACCOUNTS FOR INCOME TAXES UNDER FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740. NO PROVISION FOR INCOME TAXES WAS RECORDED FOR 2017 AND 2016 DUE TO OPERATING LOSSES. AS OF JUNE 30, 2017, THE MEDICAL GROUP HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $87,168,000 FOR INCOME TAX PURPOSES THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME. IF NOT UTILIZED, THESE CARRYFORWARDS WILL BEGIN TO EXPIRE IN 2019. BASED ON THE UNCERTAIN REALIZATION OF THESE CARRYFORWARDS, A VALUATION ALLOWANCE HAS BEEN RECORDED TO FULLY RESERVE THESE CARRYFORWARDS. 1 1 X 1 X 200.000000000000 1 X 600.000000000000 1 1 1 0 1 1 4965373 4965373 0.01760 68139126 52749257 15389869 0.05450 0.00000 73104499 52749257 20355242 0.07210 53120 53120 0.00020 4917414 562750 4354664 0.01540 38854 38854 0.00010 5009388 562750 4446638 0.01570 78113887 53312007 24801880 0.08780 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 1 32419554 3241955 85781543 105345555 -19564012 X 1 1 1 1 COPLEY MEMORIAL HOSPITAL 2000 OGDEN AVENUE AURORA IL 605044206 WWW.RUSHCOPLEY.COM 2150791 X X X X COPLEY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 15 1 0 0 1 X HTTPS://WWW.RUSHCOPLEY.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORT/ X 1 15 1 HTTPS://WWW.RUSHCOPLEY.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORT/ 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X X X X 1 X HTTPS://RUSHCOPLEY.PATIENTCOMPASS.COM/HC/GUARANTOR/PREPAREBILLINGOPTION2.DO X HTTP://WWW.RUSHCOPLEY.COM/APP/FILES/PUBLIC/1242/PDF-FINANCIAL_ASSISTANCE_FO X HTTPS://RUSHCOPLEY.PATIENTCOMPASS.COM/HC/MEDIA/PLAIN-LANGUAGE-SUMMARY.PDF X X X X X 1 X 0 X X X 1 X 0 0 COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED. THIS INCLUDED COMMUNITY RESIDENTS AND EXPERTS IN A RANGE OF AREAS INCLUDING PUBLIC HEALTH, MINORITY POPULATIONS, DISPARITIES IN HEALTH CARE, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH & SOCIAL SERVICES. PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED INCLUDED: BOARD OF DIRECTORS, HOSPITAL ADMINISTRATION, COMMUNITY HEALTH NEEDS COMMITTEE, PARTNERSHIPS WITH KANE COUNTY, PARTNERSHIPS WITH KENDALL COUNTY, COMMUNITY HEALTH SURVEY, FOCUS GROUPS, AND SECONDARY DATA ANALYSIS. FOR COMPLETE DETAILS ABOUT HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED, THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTP://WWW.RUSHCOPLEY.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORT/ COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE KANE COUNTY HEALTH DEPARTMENT, RUSH-COPLEY MEDICAL CENTER, CADENCE HEALTH DELNOR HOSPITAL, PRESENCE MERCY MEDICAL CENTER, PRESENCE ST. JOSEPH HOSPITAL (ELGIN), AND ADVOCATE SHERMAN HOSPITAL WORKED TOGETHER ALONG WITH THE INC BOARD TO DEVELOP THE COUNTY'S IPLAN (ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS). THE IPLAN IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY THREE TO FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS. THE COLLABORATIVE PARTICIPATION IN THE PLANNING PROCESS, PLAN DEVELOPMENT, AND IDENTIFICATION OF THE HEALTH NEEDS FOR THE COUNTY SERVED AS A FOUNDATION FOR THE DEVELOPMENT OF EACH OF THE HOSPITAL'S RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENTS. COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE KANE COUNTY HEALTH DEPARTMENT, RUSH-COPLEY MEDICAL CENTER, CADENCE HEALTH DELNOR HOSPITAL, PRESENCE MERCY MEDICAL CENTER, PRESENCE ST. JOSEPH HOSPITAL (ELGIN), AND ADVOCATE SHERMAN HOSPITAL WORKED TOGETHER ALONG WITH THE INC BOARD TO DEVELOP THE COUNTY'S IPLAN (ILLINOIS PROJECT FOR LOCAL ASSESSMENT OF NEEDS). THE IPLAN IS A COMMUNITY HEALTH ASSESSMENT AND PLANNING PROCESS THAT IS CONDUCTED EVERY THREE TO FIVE YEARS BY LOCAL HEALTH JURISDICTIONS IN ILLINOIS. THE COLLABORATIVE PARTICIPATION IN THE PLANNING PROCESS, PLAN DEVELOPMENT, AND IDENTIFICATION OF THE HEALTH NEEDS FOR THE COUNTY SERVED AS A FOUNDATION FOR THE DEVELOPMENT OF EACH OF THE HOSPITAL'S RESPECTIVE COMMUNITY HEALTH NEEDS ASSESSMENTS. COPLEY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IMPLEMENTATION STRATEGY TO MEET SIGNIFICANT HEALTH NEEDS IDENTIFIED IN CHNA:RUSH COPLEY COMPLETED THE IMPLEMENTATION OF STRATEGIES IDENTIFIED IN THE FY13-FY16 STRATEGY IMPLEMENTATION PLAN FOR THE THREE HEALTH NEED PRIORITIES. KEY ACCOMPLISHMENT HIGHLIGHTS INCLUDE: - DEVELOPED AND IMPLEMENTED A HEALTHY WEIGHT WEB PAGE AND ADDITIONAL SHARED COMMUNITY RESOURCES. - DEVELOPED AND IMPLEMENTED A HEALTHY WEIGHT PROGRAM, WHICH WAS DEVELOPED BY RUSH-COPLEY STAFF, PHYSICIANS, DIETICIANS, AND HEALTHPLEX PERSONAL TRAINERS. - DEVELOPED AND PILOTED A FAMILY-BASED HEALTHY WEIGHT/LIFESTYLE PROGRAM, WHICH WAS DEVELOPED BY RUSH-COPLEY STAFF, PHYSICIANS, DIETICIANS, AND HEALTHPLEX PERSONAL TRAINERS. - DEVELOPED AND IMPLEMENTED A COMMUNITY WALKING CLUB, WHICH INCLUDED COMMUNITY PRESENTATIONS, RESOURCES, AND PEDOMETERS FOR ALL PARTICIPANTS. - DEVELOPED AND IMPLEMENTED A COMMUNITY TOOLKIT AND RESOURCES FOR RESIDENTS TO START THEIR OWN COUCH TO 5K CLUB. - ENHANCED RELATIONSHIPS WITH COMMUNITY PARTNERS, INCLUDING THE KANE COUNTY HEALTH DEPARTMENT AND THE KENDALL COUNTY HEALTH DEPARTMENTS. THESE PARTNERSHIPS HAVE LEAD TO NEW HEALTH-RELATED COLLABORATIONS INCLUDING SEEKING COMMUNITY GRANT FUNDING FOR NEW PROGRAMS AND PROVIDING RESOURCES FOR NEW HEALTH TOOLS/DASHBOARDS. - WORKED WITH COMMUNITY LEADERS TO DEVELOP A STANDARD EVIDENCE BASED APPROACH FOR DIABETES FOLLOW-UP CARE. - DEVELOPED A PLAN FOR AND ACHIEVED ADVANCED INPATIENT DIABETES CARE CERTIFICATION THROUGH THE JOINT COMMISSION (ONE OF SIX PROGRAMS IN THE STATE OF ILLINOIS). - PROVIDED DIABETES SCREENINGS AND EDUCATION AT A NUMBER OF COMMUNITY EVENTS. - DEVELOPED A FUNDING PROGRAM AND PARTNERSHIP WITH WALGREENS TO PROVIDE MEDICATION ASSISTANCE TO THOSE IN NEED. - PARTNERED WITH WALGREENS TO IMPLEMENT THE WELL TRANSITIONS PROGRAM TO ENSURE CHRONIC DISEASE PATIENTS UNDERSTAND THEIR HOME MEDICATION AND HAVE AN AVAILABLE RESOURCE TO ASK QUESTIONS ONCE DISCHARGED. - CREATED AND IMPLEMENTED A WEB BASED INVENTORY OF UNIVERSAL MEDICATION ASSISTANCE PROGRAM. FOR ADDITIONAL DETAIL, INCLUDING INFORMATION REGARDING NEEDS THAT ARE NOT BEING ADDRESSED, PLEASE SEE THE HOSPITAL'S IMPLEMENTATION STRATEGY, WHICH CAN BE ACCESSED AT: HTTPS://WWW.RUSHCOPLEY.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORTS/.ADDITIONALLY, RUSH-COPLEY IS CURRENTLY WORKING ON THE IMPLEMENTATION OF STRATEGIES IDENTIFIED IN THE FY17-FY19 STRATEGY IMPLEMENTATION PLAN FOR THE THREE HEALTH NEED PRIORITIES IDENTIFIED IN THE FY2016 CHNA. KEY ACCOMPLISHMENT HIGHLIGHTS TO DATE INCLUDE THE FOLLOWING: - DEVELOPED AND IMPLEMENTED A HEALTHY FAMILY PROGRAM FOR THE HISPANIC/LATINO COMMUNITY - DEVELOPED AND IMPLEMENTED A HEALTHY EATING EDUCATION PROGRAM AT THREE OF THE LOCAL FOOD PANTRIES - BEGAN THE DEVELOPMENT OF A COLLABORATIVE COOKING DEMONSTRATION SERIES WITH THE CITY OF AURORA. - BEGAN PARTNERSHIP AND PROGRAM DEVELOPMENT WITH KANE COUNTY'S FOOD HUB FOR A PILOT FOOD PRESCRIPTION PROGRAM - CONTINUED FACILITATION OF COMMUNITY WALKING CLUB EDUCATION - DEVELOPED PROCESS AND BEGAN IMPLEMENTATION FOR SCHEDULING POST-DISCHARGE FOLLOW-UP APPOINTMENTS WITH PRIMARY CARE PHYSICIAN FOR HIGH RISK CHRONIC DISEASE PATIENTS TREATED IN EMERGENCY DEPARTMENT FOR THEIR CHRONIC DISEASE - DEVELOPED PROCESS AND BEGAN IMPLEMENTATION FOR SCHEDULING POST-DISCHARGE FOLLOW-UP APPOINTMENTS FOR THE FOLLOWING HIGH-RISK CHRONIC DISEASE INPATIENTS: STROKE, HEART FAILURE, DIABETES/ESRD, AND COPD. - IMPLEMENTED A PROCESS FOR EMERGENCY DEPARTMENT PATIENTS WHO NEED A PRIMARY CARE PHYSICIAN REFERRAL TO BE SEEN BY A CARE MANAGER BEFORE DISCHARGE - DEVELOPED AND IMPLEMENTED A "MEDICATION BAG" PILOT PROGRAM FOR HIGH RISK CARDIAC PATIENTS TO REVIEW AND RECONCILE PRESCRIPTION MEDICATIONS TO IMPOVE ADHERENACE AND CHRONIC DISEASE OUTCOMES. PART V, SECTION B, LINE 7A HTTPS://WWW.RUSHCOPLEY.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORTS/ PART V, SECTION B, LINE 16I THE FOLLOWING DISCLOSURE IS IN ACCORDANCE WITH REV. PROC 2015-21 SECTION 7 IN REGARDS TO SCHEDULE H, PART V, SECTION B, LINE 16I:FOR THE FISCAL YEAR ENDED 6/30/17, COPLEY MEMORIAL HOSPITAL, INC. (CMH) PROVIDED SPANISH TRANSLATIONS OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATION. ADDITIONALLY, CMH PROVIDES LANGUAGE ASSISTANCE FREE OF CHARGE FOR MANY OTHER LANGUAGES (SEE HTTPS://WWW.RUSHCOPLEY.COM/ABOUT/LANGUAGE-ASSISTANCE/). HOWEVER, DURING THE TAX YEAR, (CMH) DID NOT HAVE THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATION TRANSLATED INTO EACH OF THE PRIMARY LANGUAGES SPOKEN BY LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS. DUE TO THE AVAILABILITY OF TRANSLATION ASSISTANCE, CMH IS NOT AWARE OF ANY INDIVIDUALS WHO WERE ADVERSELY IMPACTED BY THIS MINOR OVERSIGHT. CMH WILL HAVE THE TRANSLATIONS COMPLETE AND AVAILABLE ON THE WEBSITE ON OR BEFORE JULY 31, 2018. CMH HAS ALSO IMPLEMENTED PROCEDURES TO ENSURE COMPLIANCE WITH THIS REQUIREMENT IN THE FUTURE BY ANNUALLY REVIEWING THE LEP POPULATIONS AND ADDING ADDITIONAL TRANSLATIONS AS NEEDED AND UPDATING THE TRANSLATIONS SHOULD THERE BE CHANGES TO THE DOCUMENTS. PART V, SECTION B, LINE 22B THE FOLLOWING DISCLOSURE IS IN ACCORDANCE WITH REV. PROC 2015-21 SECTION 7 IN REGARDS TO SCHEDULE H, PART V, SECTION B, LINE 22B:DURING THE TAX YEAR, COPLEY MEMORIAL HOSPITAL, INC. (CMH) CORRECTLY COMPLETED THE AGB CALCULATION AND APPLIED IT TO PATIENT ACCOUNTS. HOWEVER, CMH DID NOT INCLUDE IN ITS FINANCIAL ASSISTANCE POLICY THE CALCULATION OF AMOUNTS GENERALLY BILLED (AGB). CMH'S AGB CALCULATION USES THE LOOK-BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12-MONTH PERIOD. CMH WILL UPDATE THE FINANCIAL ASSISTANCE POLICY TO INCLUDE THE CALCULATION OF AGB BEFORE JUNE 30, 2018. THIS OVERSIGHT DID NOT CAUSE ANY PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE TO BE CHARGED GREATER THAN AGB AS THE PERCENTAGE WAS CORRECTLY CALCULATED AND APPLIED TO PATIENT ACCOUNTS. CMH HAS ALSO IMPLEMENTED PROCEDURES TO ENSURE ANNUAL COMPLIANCE WITH THIS REQUIREMENT IN THE FUTURE. 5 1 - RIVER WEST RADIATION CENTER LLC 1221 N HIGHLAND AVENUE AURORA IL 605044206 JV ONCOLOGY 2 - CASTLE SURGICENTER 2111 OGDEN AVE AURORA IL 60504 AMBULATORY SURGERY CENTER 3 - RUSH-COPLEY HEALTHCARE CENTER 1100 WEST VETERANS PARKWAY YORKVILLE IL 60560 FREE STANDING EMERGENCY CARE, RADIOLOGY, LAB, AND OCCUPATIONAL HEALTH SERVIC 4 - RUSH-COPLEY CARDIOVASCULAR CONSULTANTS 2000 OGDEN AVENUE AURORA IL 605044206 CARDIOVASCULAR SERVICES 5 - MIDWEST CENTER FOR ADVANCED IMAGING 4355 MONTGOMERY ROAD NAPERVILLE IL 60564 RADIOLOGY SERVICES PART I, LINE 7: THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS REPORTED IN TABLE A. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY). PART III, LINE 4: NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYORS, PATIENTS, AND OTHERS FOR SERVICES RENDERED. RCMC HAS AGREEMENTS WITH THIRD PARTY PAYORS THAT PROVIDE FOR PAYMENT AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, PER DIEM PAYMENTS, AND DISCOUNTED CHARGES, INCLUDING ESTIMATED RETROACTIVE SETTLEMENTS UNDER PAYMENT AGREEMENTS WITH THIRD PARTY PAYORS. RCMC RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENT WHO HAVE THIRD PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR SERVICES RENDERED. PROVISIONS FOR ADJUSTMENTS TO NET PATIENT SERVICE REVENUE ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED TO FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, RCMC RECOGNIZES REVENUE BASED ON ITS DISCOUNTED RATES. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OR RCMC'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, RCMC RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.PATIENT ACCOUNTS RECEIVABLE ARE BASED ON GROSS CHARGES AND STATED AT NET REALIZABLE VALUE. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS, BASED ON EXPECTED PAYMENT RATES FROM PAYORS UNDER CURRENT REIMBURSEMENT METHODOLOGIES, AND ALSO BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, RCMC ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), RCMC RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED UNCOLLECTIBLE. PART III, LINE 8: ALL OF THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IF WE DID NOT PROVIDE THE SERVICE, THE BURDEN OF THE COSTS WOULD FALL ON THE GOVERNMENT. PART III, LINE 8: COSTS OF TREATING MEDICARE PATIENTS ARE CALCULATED USING THE IRS CALCULATED PERCENTAGE. PART III, LINE 9B: IT IS OUR POLICY NOT TO PURSUE COLLECTION PRACTICES AGAINST PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. IN CERTAIN CASES IT MAY NOT BE EASILY DETERMINED WHETHER OR NOT A PATIENT QUALIFIES FOR CHARITY CARE OR FINANCIAL ASSISTANCE. HOWEVER, IF AFTER COLLECTION PRACTICES HAVE BEGUN, IT BECOMES KNOWN THE PATIENT QUALIFIES, THE COLLECTION EFFORTS CEASE. PART VI, LINE 2: COMMUNITY NEED IS ASSESSED THROUGH REVIEW OF COMMUNITY AND HOSPITAL DATA, PERIODIC ASSESSMENTS WITH PHYSICIAN AND CLINICIANS, AND REPORTING OF INFORMATION FROM HOSPITAL COMMITTEES. FURTHER INPUT FROM THE COMMUNITY ARISES FROM THE COMMUNITY BASED BOARD OF DIRECTORS, VARIOUS FORMS OF PATIENT INPUT, AND HOSPITAL INVOLVEMENT WITH GOVERNMENT, HEALTH INDUSTRY, AND COMMUNITY AGENCIES. THE HOSPITAL ALSO ACTIVELY PARTICIPATES IN FORMAL NEEDS ASSESSMENTS CONDUCTED BY GOVERNMENT AND COMMUNITY AGENCIES. PART VI, LINE 3: AT THE TIME OF SERVICE, COPLEY MEMORIAL HOSPITAL, INC. PATIENTS ARE GIVEN A BILLING BROCHURE, WHICH DESCRIBES THE FINANCIAL ASSISTANCE/CHARITY CARE PROGRAMS AVAILABLE. THIS INFORMATION IS ALSO POSTED AT THE REGISTRATION CHECK-IN DESKS, IN AN INPATIENT GUIDE, AND ON THE RUSH COPLEY WEBSITE. FINANCIAL COUNSELORS ARE AVAILABLE TO EXPLAIN THE PROGRAM IN DETAIL TO PATIENTS WHO ARE SEEN WITHOUT INSURANCE COVERAGE. ALL PATIENT BILLING STATEMENTS ADVISE THE PATIENTS TO CALL AND INQUIRE ON THE DETAILS AS NEEDED. PART VI, LINE 4: COPLEY MEMORIAL HOSPITAL INC.'S PRIMARY SERVICE AREA IS APPROXIMATELY SOUTHERN KANE COUNTY AND KENDALL COUNTY, ILLINOIS LOCATED 45 TO 55 MILES SOUTHWEST OF CHICAGO. KANE COUNTY HAS A POPULATION OF 527,000 PEOPLE AND IS PREDOMINANTLY URBAN AND SUBURBAN. NEARLY 32% OF THE POPULATION IS OF HISPANIC OR LATINO ORIGIN. PERSONS OVER THE AGE OF 65 COMPRISE 11.6% OF THE POPULATION, AND THE POVERTY RATE IS 11.1%. AURORA, THE SECOND LARGEST CITY IN ILLINOIS, DOMINATES THE COUNTY. HISTORICALLY AN INDUSTRIAL CITY, AURORA HAS EXPERIENCED A CONSIDERABLE LOSS OF MANUFACTURING JOBS AND IS TRANSITIONING ITS ECONOMY. KENDALL COUNTY, TO THE SOUTH OF KANE, HAS A POPULATION OF 121,000. PERSONS OVER THE AGE OF 65 COMPRISE 9.0% OF THE POPULATION, AND THE POVERTY RATE IS 4.8%. THE NORTHWEST SECTION OF THE COUNTY IS SUBURBAN WHILE THE REMAINDER IS RURAL. PART VI, LINE 5: COPLEY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE ADVANCED MEDICINE WITH QUALITY OUTCOMES AND EXTRAORDINARY CARE. TO THAT END, THE MEDICAL CENTER SEEKS TO SERVE THE COMMUNITY IN WAYS THAT ENGAGE, EDUCATE AND EMPOWER. COPLEY MEMORIAL HOSPITAL SERVES ALL PATIENTS WHO PRESENT FOR CARE AND SERVES THE SURROUNDING COMMUNITY ALONG WITH A BOARD OF DIRECTORS WITH A STRONG COMMUNITY BASE. THE BOARD MEMBERS ARE INDEPENDENT COMMUNITY LEADERS AND ARE SELECTED BASED UPON THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS OF BENEFIT TO THE ORGANIZATION AND THEIR ROLE AS BOARD MEMBERS WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT OUR MISSION. BOARD MEMBERS ARE NOT COMPENSATED FOR THEIR SERVICE. AS A CHARITABLE ORGANIZATION, ALL SURPLUS FUNDS ARE USED TO FURTHER OUR CHARITABLE PURPOSE, MISSION AND TO SERVE THE COMMUNITY. SOME OF OUR PRIMARY PROGRAMS ARE: COMMUNITY HEALTH FAIRS, BREASTFEEDING EDUCATION CLASSES, CHILD CARE CLASSES, ETC. COPLEY MEMORIAL HOSPITAL PROVIDES ACCESS TO PHYSICIAN, ACUTE CARE, DIAGNOSTIC, AND REHABILITATIVE SERVICES TO PEOPLE, REGARDLESS OF ABILITY TO PAY, THROUGH A NUMBER OF FACILITIES AND SERVICES LOCATED THROUGHOUT THE SERVICE AREA. IT PROVIDES PROGRAMMING RELATING TO HEALTH EDUCATION, PREVENTION, AND SUPPORT TARGETED TO SPECIFIC POPULATIONS. MEDICAL EDUCATION EXTENDS TO CLINICAL SETTINGS FOR NURSING EDUCATION AND A FAMILY PRACTICE RESIDENCY. EMPLOYEES FILL BOARD AND COMMITTEE LEADERSHIP POSITIONS FOR A NUMBER OF ECONOMIC DEVELOPMENT AND SOCIAL SERVICE AGENCIES IN COMMUNITIES THROUGHOUT THE SERVICE AREA. PART VI, LINE 7, REPORTS FILED WITH STATES IL X 1 0 X X X X X 0 1 0 0 0 0 0 1 0 GARRETT KATULA DO VICE CHIEF OF STAFF/DIRECTOR 231535 0 96504 0 2514 0 10600 0 28203 0 369356 0 0 0 STEPHEN KELANIC MD VICE CHIEF OF STAFF/DIRECTOR 269032 0 123993 0 2685 0 10600 0 25643 0 431953 0 0 0 BARRY FINN PRESIDENT & CEO/DIRECTOR 705318 0 424775 0 3625433 0 10600 0 28979 0 4795105 0 3574174 0 RYAN ASMUS VP GENERAL COUNSEL/SECRETARY 243000 0 125710 0 21297 0 51671 0 25819 0 467497 0 0 0 BRENDA VAN WYHE SR. VP FINANCE & CFO/TREASURER 321808 0 133748 0 5238 0 63812 0 17381 0 541987 0 0 0 GAIL BUMGARNER SR. VP, STRATEGY 252827 0 133466 0 66788 0 10600 0 9579 0 473260 0 0 0 DENNIS DEMASIE VP, INFORMATION TECH & CIO 243217 0 100144 0 5981 0 49647 0 18779 0 417768 0 0 0 JOHN DIEDERICH SR. VP, OPERATIONS & COO 378358 0 194054 0 10761 0 125403 0 28431 0 737007 0 0 0 BRENDA FANN MD ASSISTANT VP, MEDAFFAIRS 262014 0 66926 0 22200 0 0 0 25106 0 376246 0 0 0 DIANE HOMAN MD VP, QUALITY & PSO 300206 0 159709 0 81035 0 10600 0 29750 0 581300 0 0 0 STEVE LOWENTHAL MD SR. VP, MEDICAL AFFAIRS & CMO 429783 0 210495 0 95919 0 10600 0 9038 0 755835 0 0 0 DAVID PETASNICK ASSISTANT VP, ANCILLARY SVCS 179974 0 41991 0 3111 0 7289 0 23343 0 255708 0 0 0 ALEX POPE VP, PHILANTHROPY & CDO 193498 0 82260 0 4031 0 33166 0 26196 0 339151 0 0 0 MARY SHILKAITIS VP PATIENT CARE SRVCS & CNO 217808 0 119125 0 24008 0 50802 0 28300 0 440043 0 0 0 SUSAN STERCHI ASSISTANT VP, PATIENT CARE 158798 0 51705 0 24824 0 7444 0 28152 0 270923 0 0 0 SANTOSH GILL MD PHYSICIAN 408139 0 382943 0 31967 0 10600 0 17299 0 850948 0 0 0 KEVIN KELLY MD PHYSICIAN 917920 0 3600 0 2784 0 8762 0 25643 0 958709 0 0 0 TARIQ RAHIM MD PHYSICIAN 501362 0 260200 0 8352 0 10600 0 27101 0 807615 0 0 0 DIMITRY RUBAN MD PHYSICIAN 926491 0 7244 0 20388 0 10600 0 23802 0 988525 0 0 0 VIJAY SHAH MD PHYSICIAN 382530 0 320815 0 33721 0 10600 0 25901 0 773567 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES TO ALL EMPLOYEES THE USE OF AN ATHLETIC FACILITY THAT IS OWNED AND OPERATED BY A RELATED TAX EXEMPT ORGANIZATION. PART I, LINE 4B SERP PLAN OF CMH (ACCRUALS): MARY SHILKAITIS $34,738, JOHN DIEDERICH $110,213, STEVE LOWENTHAL $0, DENNIS DEMASIE $35,790, DIANE HOMAN $0, BRENDA VAN WYHE $46,414, ALEX POPE $23,652, GAIL BUMGARNER $0, AND RYAN ASMUS $35,877. PLEASE NOTE THAT THESE AMOUNTS ARE INCLUDED IN THE AMOUNTS LISTED ON SCHEDULE J, PART II, COLUMN C. THERE IS NO CONSTRUCTIVE RECEIPT OF THESE AMOUNTS BY THE INDIVIDUALS UNTIL THEY ARE PAID OUT AS THEY ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. ANY INDIVIDUAL PAYOUTS WOULD BE INCLUDED AS REPORTABLE COMPENSATION ON THE RECIPIENT'S ANNUAL W2 FORM. BARRY FINN RECEIVED PAYMENTS IN 2016 OF $3,594,452, STEVE LOWENTHAL RECEIVED PAYMENTS IN 2016 OF $76,688, DIANE HOMAN RECEIVED PAYMENTS IN 2016 OF $52,038 AND GAIL BUMGARNER RECEIVED PAYMENTS IN 2016 OF $41,390. PART I, LINE 7 INCENTIVE BONUS PLAN BASED ON A SERIES OF APPROVED STRATEGIC ACCOMPLISHMENTS. A ILLINOIS FINANCE AUTHORITY 861091967 45203HS45 2015-02-11 105601668 REFUND BONDS ISSUED 5/28/2008, 2/10/2009, AND 7/29/2009 0 0 0 A 1600000 105601668 91458250 824030 145 15799417 0 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 PART IV, LINE 6, COLUMN A: THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF THE BONDS. FORM 990, PART III, LINE 4A: SUMMARY OF FY17 HEALTH PROGRAMMING DURING FY17, COPLEY MEMORIAL HOSPITAL SPONSORED, PARTNERED OR PARTICIPATED IN OVER 600 COMMUNITY-BASED PROGRAMS AND EVENTS WITH SPECIAL EMPHASIS ON IMPROVING THE HEALTH AND WELLNESS OF ADULTS, CHILDREN AND UNDERSERVED POPULATIONS. NUTRITION AND WEIGHT LOSS YOUFIT HELD THREE 12-WEEK SESSIONS WITH A TOTAL OF 13 PARTICIPANTS ENROLLED IN THE PROGRAM. PARTICIPANTS LEARNED FROM A VARIETY OF EXPERTS INCLUDING RUSH COPLEY PHYSICIANS, HEALTHPLEX PERSONAL TRAINERS AND REGISTERED DIETICIANS. COMMUNITY WALKING CLUB RUSH COPLEY CONTINUES TO OFFER THE COMMUNITY THE TOOLS AND RESOURCES TO START THEIR OWN WALKING CLUB. PRESENTATIONS ARE PROVIDED TO ORGANIZATIONS SUCH AS SCHOOLS, PARK DISTRICTS AND ANYONE INTERESTED IN WALKING THEIR WAY TO HEALTH. A PRE AND POST TEST IS GIVEN TO THE PARTICIPANTS TO OBSERVE THEIR PROGRESS AND PEDOMETERS AND WALKING LOGS ARE PROVIDED TO KEEP THEM MOTIVATED. 30 NEW COMMUNITY MEMBERS WERE ADDED TO THE COMMUNITY WALKING CLUB. DIABETES FREE FASTING GLUCOSE SCREENINGS WERE PROVIDED TO OVER 72 COMMUNITY MEMBERS. SMOKING CESSATION THE FREEDOM FROM SMOKING CLASS WAS OFFERED FOUR TIMES WITH A TOTAL OF 14 PARTICIPANTS. THIS FREE EIGHT-WEEK PROGRAM PROVIDES SUPPORT AND THE SKILLS NEEDED TO QUIT SMOKING. THREE SESSIONS WERE CONDUCTED IN ENGLISH AND ONE SESSION WAS CONDUCTED IN SPANISH. CANCER AWARENESS AND INFORMATION RUSH COPLEY GASTROENTEROLOGISTS PRESENTED GET THE SCOOP ON THE SCOPE TWO TIMES WITH A TOTAL OF 64 PARTICIPANTS AND DR. ZHANG PRESENTED TO SCREEN OR NOT TO SCREEN TO 22 PARTICIPANTS. [FIVE SESSIONS OF THE CARING FORWARD CANCER SURVIVORSHIP PROGRAM WERE PROVIDED WITH AT TOTAL OF 37 ATTENDEES.] AT THE ANNUAL CELEBRATION OF NATIONAL CANCER SURVIVORS DAY, THERE WERE MORE THAN 150 PARTICIPANTS IN ATTENDANCE. DR. BERGEN AND KELLER PRESENTED ON HPV CANCER WITH FIVE PARTICIPANTS IN ATTENDANCE. COMMUNITY HEALTH TALKS COMMUNITY HEALTH TALKS IS AN EDUCATIONAL SERIES GEARED TOWARD THE HEALTHCARE NEEDS OF THE LATINO POPULATION. COMMUNITY HEALTH TALKS IS OFFERED SEVEN TIMES A YEAR FROM SEPTEMBER THROUGH APRIL AND TARGETS WOMEN, MEN AND CHILDREN OVER THE AGE OF 12 IN THE FOX VALLEY AREA. SOME OF THE TOPICS PRESENTED BY PROFESSIONAL HEALTHCARE PROVIDERS INCLUDE: A HEALTHY DIGESTIVE SYSTEM, YOGA SESSION, PLANT-BASED NUTRITION, HEALTHY RELATIONSHIPS AND RADON. TYPICALLY, BETWEEN 10 AND 25 WOMEN, MEN AND CHILDREN OVER THE AGE OF 12 ATTEND THE MONTHLY SESSIONS. CLOSE TO 100 PARTICIPANTS ATTENDED AND BENEFITTED FROM THE PRESENTATIONS IN FY17. HEALTH EXHIBITS AT SCI-TECH HANDS ON MUSEUM EXHIBITS CONTINUE TO BE DISPLAYED IN THE LUNCH ROOM AND ADJACENT CORRIDOR OF THE MUSEUM TARGETING VISITORS IN THE 5-16 AGE RANGE. THE EXHIBITS ENABLE VISITORS TO MEASURE THEIR HEART RATE AFTER EXERCISING AND MAKE THE LINK BETWEEN EXERCISE AND HEART HEALTH. ANOTHER TESTS VISITORS' KNOWLEDGE ABOUT THE AMOUNT OF SUGAR IN POPULAR BEVERAGES AND EDUCATES THEM ABOUT DIABETES. SMALLER EXHIBITS ON THE LUNCH ROOM PILLARS DISPLAY THE USDA'S "MY PLATE" GRAPHIC, THE "5-4-3-2-1-GO!" PROGRAM, "EAT-THIS-NOT-THAT" INFORMATION, AND OTHER KID-FRIENDLY INFORMATION ABOUT NUTRITION AND HEALTH. A HAND-WASHING EXHIBIT TO DEMONSTRATE THE IMPORTANCE OF EFFECTIVE HAND-WASHING TECHNIQUES WAS PLACED IN THE LUNCHROOM AT SCITECH TO ENSURE THAT THE MESSAGE REACHES CHILDREN AT A TIME WHEN THEY CAN APPLY THE LESSONS LEARNED DIRECTLY TO THEIR OWN EATING HABITS FOR IMMEDIATE REINFORCEMENT. CHILDREN PLACE THEIR HANDS IN THE SINK TO START AN INTERACTIVE VIDEO THAT SHOWS THE RIGHT TECHNIQUE AND LENGTH OF TIME NEEDED TO REMOVE DIRT AND GERMS. PINK LIGHTS SHINE ON THEIR HANDS, SIMULATING GERMS, UNTIL THE RIGHT AMOUNT OF TIME AND ACTIVITY HAS ELAPSED. IN ADDITION TO THE DAILY VISITORS THE MUSEUM HOSTS DAILY (75,000 VISITORS A YEAR), SCI-TECH HANDS ON MUSEUM CONTINUES TO PARTICIPATE IN FIRST FRIDAYS, A VENUE IN THE DOWNTOWN THAT PROVIDES ARTS AND CULTURE TO THE COMMUNITY AND DRAWS 100 300 COMMUNITY MEMBERS AND VISITORS TO THE MUSEUM FOR THE FIVE HOUR EVENT MOST MONTHS OF THE YEAR. HEALTHY HANDS TO HELP SCHOOL-AGED CHILDREN UNDERSTAND THE IMPORTANCE OF HAND WASHING, RUSH COPLEY MEDICAL CENTER OFFERS A FUN AND EDUCATIONAL PROGRAM FOR SCHOOLS AND COMMUNITY GROUPS CALLED HEALTHY HANDS. THE PROGRAM PROVIDES AN EXPLANATION OF GERMS AND HOW THEY SPREAD. AN INTERACTIVE PRESENTATION INCLUDES THE USE OF "GLOW" GERMS USING A GEL AND THE USE OF A BLACK LIGHT TO SHOW "GERMS." IF THE PARTICIPANTS WASH THEIR HANDS CORRECTLY AND FOR THE PROPER AMOUNT OF TIME USING ANTIBACTERIAL HAND GEL, THEIR HANDS SHOULD NOT SHOW THE "GLOW" GERMS WHEN THEY ARE PLACED UNDER THE BLACK LIGHT A SECOND TIME. THE CHILDREN ARE GIVEN A BOOK MARK THAT SHOWS HOW TO PROPERLY WASH THEIR HANDS. IN FY17 A TOTAL OF 210 CHILDREN PARTICIPATED IN THE HEALTHY HANDS DEMONSTRATION. OLDER ADULT EDUCATION EDUCATIONAL AND INTERACTIVE TALKS DESIGNED TO PROVIDE SENIORS WITH HEALTH INFORMATION AND EDUCATION ARE PRESENTED REGULARLY AT THE BEECHER COMMUNITY CENTER IN YORKVILLE IN COLLABORATION WITH SENIOR SERVICES ASSOCIATES, INC. THIS PROGRAM CALLED WELLNESS IS A WAY OF LIFE, REACHES OVER 200 SENIORS ANNUALLY. THE BREAKFAST CLUB, A PROGRAM THAT TARGETS THE SENIOR COMMUNITY AT LARGE, PROVIDES PRESENTATIONS THAT INCLUDE QUESTION AND ANSWER SESSIONS ON HEALTHCARE TOPICS. THE PROGRAM TAKES PLACE AT SUNNYMERE, AN ASSISTED LIVING FACILITY IN AURORA. RUSH COPLEY PARTNERED WITH THIS PROGRAM TO PRESENT TO A 20 MEMBER AUDIENCE ON THE TOPIC OF BACK SURGERY. RUSH COPLEY, IN COLLABORATION WITH THE OSWEGO SENIOR CENTER, THE UNIVERSITY OF ILLINOIS EXTENSION AND THE KENDALL COUNTY HEALTH DEPARTMENT, IS HOSTING AN ONGOING WORKSHOP AND CHALLENGE SERIES FOR SENIORS IN KENDALL COUNTY TO COMBAT OBESITY. KNOWN AS HEALTHY HABITS FOR SUCCESSFUL LIVING, THIS IS A 9-WEEK PROGRAM DESIGNED FOR SENIORS WHO WANT TO BE HEALTHIER - PARTICIPANTS ARE ENCOURAGED TO MAKE SUSTAINABLE LIFE CHANGES TO MEET THEIR HEALTH GOALS. RUSH COPLEY HEALTHPLEX FITNESS TRAINERS PROVIDE EXERCISE DEMONSTRATIONS FOR PARTICIPANTS TO ENCOURAGE AN ACTIVE LIFESTYLE. TEN SENIORS ENROLLED AND PARTICIPATED IN THE SESSION HELD FEBRUARY THROUGH APRIL 2017. IN FY17, RUSH COPLEY PROVIDED SPEAKERS FOR TEN SCHEDULED PRESENTATIONS IN THE DOCTOR'S NOTES SERIES HELD AT THE OSWEGO SENIOR CENTER. THIS SERIES EDUCATES SENIORS ON VARIED HEALTH TOPICS RELATED TO AGING. OVER 100 SENIORS ATTENDED. ADDITIONAL PROGRAMS SCHEDULED FOR SENIORS WERE HELD AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY AND INCLUDED TOPICS SUCH AS HEART HEALTH, DIABETES EDUCATION, STROKE AWARENESS, ADVANCED CARE PLANNING, HOW TO USE AN AED, AND JOINT REPLACEMENT. FORM 990, PART VI, SECTION A, LINE 2 MANY OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED RUSH-COPLEY MEDICAL CENTER ENTITY BOARDS. BARRY FINN, CMH PRESIDENT & CEO/DIRECTOR, AND WILLIAM SKOGLUND, CMH VICE CHAIRMAN OF THE BOARD/DIRECTOR, HAVE A BUSINESS RELATIONSHIP. BARRY FINN IS A BOARD MEMBER AT OLD SECOND NATIONAL BANK AND WILLIAM SKOGLUND IS THE FORMER CHAIRMAN AND CEO AT OLD SECOND NATIONAL BANK. MR. SKOGLUND DOES NOT SERVE ON COPLEY MEMORIAL HOSPITAL, INC.'S COMPENSATION COMMITTEE AND HAS RECUSED HIMSELF FROM ANY DISCUSSIONS OR VOTES THAT INVOLVE MR. FINN'S SALARY. FORM 990, PART VI, SECTION A, LINE 6 RUSH-COPLEY MEDICAL CENTER, INC. ("RCMC") IS THE SOLE CORPORATE MEMBER OF COPLEY MEMORIAL HOSPITAL, INC. ("CMH"), RUSH-COPLEY MEDICAL GROUP, NFP ("RCMG"), COPLEY VENTURES, INC. ("CV"), AND RUSH-COPLEY FOUNDATION ("RCF"). FORM 990, PART VI, SECTION A, LINE 7A CMH'S BOARD OF DIRECTORS INCLUDES AT LEAST NINE (9) INDIVIDUALS ELECTED BY THE SOLE CORPORATE MEMBER, RCMC. EACH OF THESE ELECTED DIRECTORS IS ALSO A MEMBER OF THE GOVERNING BOARD OF CMH'S SOLE CORPORATE MEMBER, RCMC. THE ELECTION AND RE-ELECTION OF ALL CMH DIRECTORS IS AT THE DIRECTION OF RCMC AT THE ANNUAL GOVERNING BOARD MEETING. VACANCIES ON THE CMH BOARD OF DIRECTORS ARE FILLED BY CMH'S SOLE CORPORATE MEMBER, RCMC. IN ACCORDANCE WITH CERTAIN PROCEDURAL REQUIREMENTS STATED IN THE BYLAWS, ELECTED DIRECTORS MAY BE REMOVED BY THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE BOARD OF DIRECTORS OF CMH'S SOLE CORPORATE MEMBER, RCMC. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF CMH'S SOLE CORPORATE MEMBER, RCMC, HAS THE FOLLOWING EXCLUSIVE POWERS OVER CMH: (1) THE ELECTION OF THE BOARD OF DIRECTORS; (2) ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION (3) THE BORROWING OF ANY SUM, THE PRINCIPAL OF WHICH EXCEEDS $500,000.00, OR WHICH HAS A STATED TERM OF GREATER THAN ONE YEAR, OR WHICH IS SECURED BY A MORTGAGE OF ALL OR ANY PORTION OF THE CORPORATION'S REAL PROPERTY OR THE CREATION OF A SECURITY INTEREST IN THE CORPORATION'S ASSETS, INCLUDING PERSONAL PROPERTY AND REVENUES, FOR THE BENEFIT OF THE LENDER, LESSOR OR VENDOR, OR THE DEFEASANCE, ADVANCE PAYMENT OR CANCELLATION OF ANY OUTSTANDING DEBT OF THE CATEGORY DESCRIBED HEREIN; (4) ANY VOLUNTARY DISSOLUTION, MERGER, CONSOLIDATION, SALE OR TRANSFER OF ANY OF THE CORPORATION'S ASSETS (ABOVE A MATERIAL DOLLAR THRESHOLD AS A PERCENTAGE OF THE CORPORATION'S ASSETS AS DETERMINED IN CONJUNCTION WITH THE CORPORATE MEMBER) OR ANY CREATION OF A SUBSIDIARY OR AFFILIATE OF THIS CORPORATION; (5) APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD OR ANY SUCCESSOR FOR A PERMIT OR CERTIFICATE OF NEED FOR A PROPOSED ACTIVITY, WHETHER OR NOT INVOLVING A CAPITAL EXPENDITURE; (6) APPROVAL OF ALL NEW OR CHANGES TO EXISTING ANNUAL AND LONG-TERM CAPITAL AND OPERATIONAL BUDGETS OR LONG-TERM OR MASTER STRATEGIC PLANS; (7) ANY AGREEMENT OR TRANSACTION, EITHER OF WHICH IS OF A MATERIAL NATURE, WITH ANOTHER CORPORATION CONTROLLED BY OR AFFILIATED WITH THE CORPORATE MEMBER OR WHICH IS A SUBSIDIARY OF THE CORPORATE MEMBERS; (8) SALE OF ANY OF THE CORPORATION'S REAL PROPERTY OR INTEREST THEREIN OR PURCHASES OF ANY ADDITIONAL REAL ESTATE; (9) THE AUDITED FINANCIAL STATEMENTS AND BOND DISCLOSURES OF THE CORPORATION; (10) SELECTION AND ANNUAL EVALUATION OF THE PRESIDENT; AND (11) THE ANNUAL AUDITED FINANCIAL STATEMENTS AND BOND DISCLOSURES OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 TAX RETURN IS PREPARED BY OUR EXTERNAL TAX ADVISOR WITH DATA PROVIDED BY OUR ORGANIZATION. A DRAFT OF THE FORM 990 IS PROVIDED TO MANAGEMENT FOR REVIEW AND COMMENT. THE BOARD OF DIRECTORS IS PROVIDED WITH AN APPROVED COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, OFFICERS, DIRECTORS, KEY EMPLOYEES, MANAGEMENT TEAM (DEPARTMENT DIRECTORS AND MANAGERS), AND BILLING OFFICE PERSONNEL OF COPLEY MEMORIAL HOSPITAL, INC. ARE REQUIRED TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED AND REVIEWED BY THE CHIEF COMPLIANCE OFFICER AND THE AUDIT AND CORPORATE INTEGRITY COMMITTEE OF THE BOARD. THOSE KEY PERSONNEL WITH CONFLICTS ARE ADVISED TO RECUSE THEMSELVES FROM PARTICIPATING IN DECISION-MAKING RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 WITH RESPECT TO THE CEO/VPS OF THE ORGANIZATION AND KEY SENIOR MANAGEMENT, THE ORGANIZATION FOLLOWS A COMPENSATION APPROVAL PROCEDURE ANNUALLY THAT INVOLVES APPROVAL OF PROPOSED AND FINAL COMPENSATION ARRANGEMENTS BY THE ORGANIZATION'S COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN MINUTES. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 IS AVAILABLE UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. COPIES OF THE FINANCIAL STATEMENTS (WHETHER OR NOT AUDITED) ARE PROVIDED UPON REASONABLE REQUEST SUCH AS FOR A BANK LOAN OR TO A BOND RATING AGENCY. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE ATTORNEY GENERAL'S WEBSITE. FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS TO AFFILIATES-NET CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 848,943. SWAP VALUE ADJUSTMENT 3,414,285. OTHER 6,611. FORM 990, PART XII, LINES 2A & 2B: ALTHOUGH THE ORGANIZATION DOES NOT RECEIVE STAND ALONE GAAP FINANCIAL STATEMENTS IT DOES RECEIVE ON AN ANNUAL BASIS FROM INDEPENDENT AUDITORS CONSOLIDATED ENTITY GAAP FINANCIAL STATEMENTS (AUDITED) FOR IT AND ITS AFFILIATES. 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