2017-08-04T16:33:36-05:00 2016-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2016-01-01 362302593 UNION HEALTH SERVICE INC UNIO 3124234200 1634 WEST POLK STREET CHICAGO IL 60612 W JOE GARRETT EXECUTIVE DIRECTOR 3124234200 2017-08-04 1 COLIN THOMPSON P01460524 3123680500 12.197.118.215 2017-08-04 16:33:19 CD P D56625F7C0621E1EB8BA8C5A7372C18F0F4BC985 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z W JOE GARRETT 1634 WEST POLK STREET CHICAGO IL 60612 80433468 0 X WWW.UNIONHEALTH.ORG X 1952 IL TO OPERATE A VOLUNTARY HEALTH SERVICES PLAN AND HEALTH MAINTENANCE ORGANIZATION 7 5 274 0 0 0 0 0 69874835 73610377 249732 400225 112014 115735 70236581 74126337 0 0 39095505 41219652 25137085 27113612 0 0 0 5163467 5597637 69396057 73930901 840524 195436 25856723 29582171 8805825 10742781 17050898 18839390 TO OPERATE A VOLUNTARY HEALTH SERVICES PLAN AND HEALTH MAINTENANCE ORGANIZATION AND EDUCATE CONSUMERS, PROVIDERS, GOVERNMENT AND THE BUSINESS SECTOR ABOUT THE CONCEPT AND ADVANTAGES OF PREPAID HEALTH CARE 0 0 68584349 73610377 PREPAID GROUP HEALTH PLAN INCLUDING OUTPATIENT MEDICAL, DENTAL, VISION AND INPATIENT MEDICAL CARE. 68584349 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 560 0 1 274 1 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 1 1 0 X W JOE GARRETT 3124234200 1634 W POLK ST CHICAGO IL 60612 LEON WOLIN BOARD PRESIDENT 1.00 X X 0 0 0 THOMAS BALANOFF BOARD VICE PRESIDENT 0.50 X X 0 0 0 LAURA GARZA TRUSTEE 0.50 X 0 0 0 KENNETH CLIFF TREASURER 0.50 X X 0 0 0 ROBERT WIGGS TRUSTEE 0.50 X 0 0 0 DR RADOMIR JOVANOVICH BOARD SECRETARY/PHYSICIAN 32.00 X X 64996 0 12135 DR AGNIESZKA BANKOWSKA-BRUKASZ TRUSTEE/PHYSICIAN 33.50 X 209094 0 44089 W JOE GARRETT EXECUTIVE DIRECTOR 37.50 X 263319 0 87736 RAMESH B JOSHI DIRECTOR OF OPERATIONS 37.50 X 265434 0 100974 DR YEVGENYA KAYDANOVA MEDICAL DIRECTOR 42.50 X 107616 0 3908 DR TIPBHRAPA JAOJAROENKUL PHYSICIAN 36.00 X 263060 0 101333 DR CHARANJEET S RAY PHYSICIAN 24.00 X 320070 0 26941 DR SUBHASH GOYAL PHYSICIAN 46.50 X 300548 0 84785 DR DORIS J MCCULLEY PHYSICIAN 36.00 X 237954 0 155646 DR HARRY P POULOS PHYSICIAN 42.50 X 280500 0 69984 2312591 0 687531 52 0 1 0 ADVOCATE NORTHSIDE HEALTH NETWORK 75 REMITTANCE DR STE 6994 CHICAGO IL 60122 MEDICAL SERVICES 4258122 UNIVERSITY OF ILLINOIS 7732 SOLUTION CENTER CHICAGO IL 60677 MEDICAL SERVICES 2192454 FRESENIUS MEDICAL CARE 7600 SOLUTION CENTER CHICAGO IL 60434 MEDICAL SERVICES 1459961 ADVOCATE MEDICAL GROUP 75 REMITTANCE DR STE 1787 CHICAGO IL 60678 MEDICAL SERVICES 1126065 LCMH CARE STATION PHYSICIANS 2800 WEST 95TH STREET EVERGREEN PARK IL 60805 MEDICAL SERVICES 472238 48 PREMIUMS EARNED 900099 65265548 65265548 PATIENT CHARGES 900099 4994693 4994693 MEDICARE PAYMENTS 900099 3108843 3108843 THIRD PARTY REIMBURSEMENTS 900099 241293 241293 73610377 273034 273034 6434322 6307131 127191 127191 127191 MISCELLANEOUS 900099 115735 115735 115735 74126337 73610377 0 515960 41219652 41219652 1159301 441838 717463 18826008 16615457 2210551 2537558 2239649 297909 3273630 2889306 384324 1317115 1134307 182808 79648 5838 73810 48500 48500 66567 66567 710333 251320 459013 5791 5791 828784 529609 299175 556237 398162 158075 1565791 1475626 90165 10017 10017 8962 8962 523658 500556 23102 1117097 876481 240616 DUES & SUBSCRIPTIONS 46689 46689 CORPORATE SPONSORED EVE 23015 23015 HEALTH PROMOTION LIBRAR 6548 6548 73930901 68584349 5346552 0 2102230 2693363 3746415 3112876 1382403 2624767 772213 745383 1935457 3465821 9742818 8867663 730197 875155 14207877 14963632 979931 1101174 25856723 29582171 8165894 9961607 639931 781174 8805825 10742781 X 17050898 18839390 17050898 18839390 25856723 29582171 X 195436 764135 828921 X X 0 1 X 1 0 X 2473551 2181684 291867 7269267 6685979 583288 875155 GROUP ANNUITY CONTRACT 781174 781174 X 74823905 764135 764135 74059770 66567 66567 74126337 73864334 0 73864334 66567 66567 73930901 PART X, LINE 2: THE CORPORATION IS A CERTIFIED HEALTH MAINTENANCE ORGANIZATION UNDER THE PROVISIONS OF THE ILLINOIS HEALTH MAINTENANCE ORGANIZATION ACT. THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ALSO DETERMINED THAT THE CORPORATION IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. X 0 0 0 0 0 0 0 0 0 DR AGNIESZKA BANKOWSKA-BRUKASZ TRUSTEE/PHYSICIAN 209094 0 0 0 0 0 13481 0 30608 0 253183 0 0 0 W JOE GARRETT EXECUTIVE DIRECTOR 263319 0 0 0 0 0 61012 0 26724 0 351055 0 0 0 RAMESH B JOSHI DIRECTOR OF OPERATIONS 265434 0 0 0 0 0 73629 0 27345 0 366408 0 0 0 DR TIPBHRAPA JAOJAROENKUL PHYSICIAN 263060 0 0 0 0 0 71728 0 29605 0 364393 0 0 0 DR CHARANJEET S RAY PHYSICIAN 320070 0 0 0 0 0 0 0 26941 0 347011 0 0 0 DR SUBHASH GOYAL PHYSICIAN 300548 0 0 0 0 0 55308 0 29477 0 385333 0 0 0 DR DORIS J MCCULLEY PHYSICIAN 237954 0 0 0 0 0 126345 0 29301 0 393600 0 0 0 DR HARRY P POULOS PHYSICIAN 280500 0 0 0 0 0 39214 0 30770 0 350484 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO THE ENTIRE BOARD FOR ITS THROUGH REVIEW PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT OF THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE COMPENSATION, INCLUDING RAISES AND ANY BONUSES, FOR EXECUTIVE DIRECTOR, MEDICAL DIRECTOR AND DIRECTOR OF OPERATIONS. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN PENSION PLAN FUNDED STATUS 828,921. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.