2017-05-11T06:12:48-05:00 2016-06-30 861065772 Deloitte Tax LLP 50 S 6th Street Suite 2800 Minneapolis MN 554021844 990 2015-07-01 362170840 Copley Memorial Hospital Inc c/o Rush-Copley Medical Ctr COPL 6309786200 2000 Ogden Avenue Aurora IL 605044206 Brenda VanWyhe CFO 6309786200 2017-05-10 1 Kristina Rasmussen P00143920 6123974000 2015 2021-01-29 14:40:06Z Barry Finn 2000 Ogden Avenue Aurora IL 605044206 340490039 0 X www.rushcopley.com X 1886 IL To provide advanced medicine with quality outcomes and extraordinary care. 18 15 2305 360 0 0 1298770 2579443 290263450 299653923 11171382 11100528 7946784 6793944 310680386 320127838 54863 50474 0 0 130954530 140740086 0 0 0 132805142 135060609 263814535 275851169 46865851 44276669 464071482 519972246 242506219 270245737 221565263 249726509 X The mission of Rush-Copley is to provide advanced medicine with quality outcomes and extraordinary care. 0 0 221729762 50474 306483024 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 FY2016, 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 28,900 and 2,800 emails respectfully. Additionally, Cancer Care News, targeted at Cancer Care patients and their family and care givers, was sent to approximately 1,200 email addresses and an average of 900 Family Residency patients received Healthy eNews.During FY2016, Copley Memorial Hospital sponsored, partnered or participated in over 600 community-based programs and events, specifically groups aimed at improving the lives of children and adults. Programming highlights includes car seat safety checks, nutrition and weight loss information, heart health advice, cancer survivorship and more.Copley Memorial Hospital offers a free physician referral service, provides a free speaker's bureau to community-based groups and routinely participates and sponsors health fairs aimed at minority populations including the yearly African American Health Fair and the annual Latino Community Health Festival.Copley Memorial Hospital's website, with translation into dozens of languages, offers free health information and online resources.Together, these initiatives provided a positive influence for thousands of residents in the communities served by Copley Memorial Hospital.Charity Care -- It is an inherent part of the Hospital's mission to provide necessary medical care free of charge, or at a discount, to individuals without insurance or other means of paying for such care. As the amounts determined to qualify for charity care are not pursued for collection, they are not reported as net patient service revenue. Patients who would otherwise qualify for charity care but who do not provide adequate information would be characterized as bad debt and included in the provision for uncollectible accounts. The Hospital also incurs losses related to the unreimbursed costs of providing services to Medicaid patients.The Hospital has an established charity care policy and maintains records to identify and monitor the level of charity care it provides. The Hospital provides free care to all patients who apply and support income and asset levels of less than 200% of the current-year poverty level and a 30% discount to all uninsured patients regardless of ability to pay, and discounts balances to patients under 600% of the poverty level. Patients up to 600% of the Federal poverty level, with an approved application, are eligible for a discount equal to the Amounts Generally Billed for emergency or medically necessary services. Interest-free payment plans are also provided. These charity care records include the estimated cost of unreimbursed services provided and supplies furnished under its charity care policy and the excess of cost over reimbursement for Medicaid patients. The estimated cost of charity care provided is determined using a ratio of cost to gross charges and multiplying that ratio by the gross unreimbursed charges associated with providing care to charity patients. The Hospital also monitors the unreimbursed cost of patient bad debts. 221729762 1 1 0 1 0 0 0 0 0 1 1 0 0 0 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 1 197 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 1 1 IL X Brenda VanWyhe 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 Alice Daniele MD Chief of Staff/Director 1.00 2.00 X 15500 0 0 Bruce Dienst Vice Chairman of the 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 Stephen Kelanic MD Vice Chief of Staff/Director 1.00 2.00 X 378639 0 41229 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 Chairman of the 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 Suresh VelagapudiMDEnd 1215 Past Chief of Staff/Director 1.00 2.00 X 1250 0 0 Barry Finn President & CEO/Director 40.00 3.00 X X 1042276 0 474450 Ryan Asmus VP General Counsel/Secretary 40.00 3.00 X 346439 0 80169 Lynn Scott Assistant Secretary 40.00 3.00 X 82231 0 21930 Brenda VanWyhe Sr. VP, Finance & CFO/Treasurer 40.00 3.00 X 413291 0 80960 Gail Bumgarner Sr. VP, Strategy 40.00 0.00 X 409377 0 20420 Dennis DeMasie VP, Information Technology & CIO 40.00 0.00 X 325692 0 70182 John Diederich Sr. VP, Operations & COO 40.00 1.00 X 536878 0 156767 Brenda Fann MD Assistant VP, MedAffairs 40.00 0.00 X 333927 0 44026 Diane Homan MD VP, Quality & PSO 40.00 0.00 X 773054 0 35132 Steve Lowenthal MD Sr. VP, Medical Affairs & CMO 40.00 0.00 X 667761 0 32625 Mary Shilkaitis VP, Patient Care Services & CNO 40.00 0.00 X 326065 0 81726 David Petasnick Assistant VP, Ancillary Services 40.00 0.00 X 208178 0 37864 Alex Pope VP, Philanthropy & CDO 40.00 1.00 X 271091 0 62436 Suzanne Sterchi Assistant VP, Patient Care 40.00 0.00 X 221254 0 43075 Teressa Alexander MD Physician 40.00 0.00 X 644344 0 48927 Santosh Gill MD Physician 40.00 0.00 X 624350 0 41992 Edward Lipman MD Physician 40.00 0.00 X 564234 0 43725 Dimitry Ruban MD Physician 40.00 0.00 X 1000568 0 44448 Sepehr Sani MD End 915 Physician 40.00 0.00 X 627901 0 32519 9814300 0 1494602 284 0 1 0 Leopardo Companies 5200 Prairie Stone Pkwy Hoffman Estates IL 60192 Construction 3947099 Anthelio One Lincoln Drive Suite 200 5400 Dallas TX 75240 Medical Records Management 3720929 Sodexo 4880 Paysphere Circle Chicago IL 60674 Food and Cleaning Service Management 3671055 Ruddy Brothers Inc 721 Airport Rd North Aurora IL 60542 Construction 3410729 Anderson Mikos Architects 1420 Kensington Road Suite 306 Oak Brook IL 60523 Architects 1401546 32 2579443 2579443 Net Patient Svc Rev 621110 279276183 279276183 Medicaid Tax Revenue 621110 22349152 22349152 Other Program Revenue 900099 -1971412 -1971412 299653923 6775901 6775901 984609 1529582 -544973 -544973 -544973 21617649 1539597 18832312 307 2785337 1539290 4324627 4324627 Outside Service Rev. 621990 6829101 6829101 Cafeteria Revenue 621990 268667 268667 Gift Shop Revenue 453220 228583 228583 12566 12566 7338917 320127838 306483024 0 11065371 50474 50474 7619144 7619144 102834819 77126114 25708705 4109495 3082121 1027374 16836879 12627659 4209220 9339749 7004812 2334937 6836076 5127057 1709019 423241 423241 221731 221731 44383 44383 59159 59159 5860628 4395471 1465157 910025 910025 14826101 11119576 3706525 13807735 10355801 3451934 7334540 5500905 1833635 128556 96417 32139 70312 52734 17578 4311396 4311396 17002607 17002607 1030103 772577 257526 Medical Supplies 48992075 48992075 Medicaid Provider Tax 10990428 10990428 Laundry 930082 930082 Consulting 672260 672260 609171 609171 275851169 221729762 54121407 0 3093073 12379679 19770549 43613785 50121411 4866214 5185900 8686033 7908846 358780865 205270164 138543566 153510701 246440896 259224374 3974135 3628249 2474101 20622216 464071482 519972246 114017505 138498059 105163568 103120730 23325146 28626948 242506219 270245737 X 216735015 246811368 4830248 2915141 0 221565263 249726509 464071482 519972246 X 44276669 -6020403 -10095020 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 44383 44383 0 Part II-B, Line 1: Copley Memorial Hospital, Inc. is a member of various organziations 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. 12538872 1093070 104565 2760521 10975986 11931067 2373022 204733 1969950 12538872 11161160 1178338 1068336 1476767 11931067 11131204 980802 712783 1663629 11161160 10648390 1409175 364134 1290495 11131204 0.09000 0.73000 0.18000 0 1 1 18568340 18568340 191776680 110710856 81065824 129841004 94559308 35281696 18594841 18594841 153510701 Long Term Deferred Rent Obligation 696521 Deferred Gain on Sale Long Term 7344069 Long Term SERP 5618530 Long Term Market Adjustment Swap Liability 11879897 Due to Related Parties 3087931 28626948 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), and Waterford Place (income for CMH Cancer Resource Center Endowments. 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 (formerly, FASB Statement No. 109, Accounting for Income Taxes). No provision for income taxes was recorded for 2016 and 2015 due to operating losses. 1 1 X 1 X 300.000000000000 1 X 600.000000000000 1 1 1 0 1 1 4548664 4548664 0.01650 67440159 48988006 18452153 0.06690 0.00000 71988823 48988006 23000817 0.08340 55062 55062 0.00020 5037651 583539 4454112 0.01610 0.00000 0.00000 51947 51947 0.00020 5144660 583539 4561121 0.01650 77133483 49571545 27561938 0.09990 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 1 31327510 3132751 87792789 97966188 -10173399 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 X 15 1 0 0 1 X https://www.rushcopley.com/about/community-health-needs-assessment-reports/ X 1 15 1 https://www.rushcopley.com/about/community-health-needs-assessment-reports/ 0 0 1 X 300.000000000000 600.000000000000 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 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- Partnershhips with Kendall County- Communtiy Health Survey- Focus Groups- Secondary Data AnalysisFor 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 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 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 is continuing progress on the implementation of strategies identified in the FY13-FY16 strategy implementation plan for the three health need priorities. Key progress and accomplishment highlights include: - Developed and implemented a healthy weight web page and shared community resources. - Developed and implemented a healthy weight program, which was developed by Rush-Copley staff, physicians, dieticians, and personal trainers. - Developed 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: http://www.rushcopley.com/about/community-health-needs-assessment-report/. Also, 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 will be included with the FY2017 tax filing. Copley Memorial Hospital Part V, Section B, Line 16i: Our financial assistance policy is listed on our website. Also we have a spot on the bills that we send to the patients that states we have a financial assistance policy. In addition, our patient financial staff will discuss the policy with the patients if they see that a need for assistance might exist. Copley Memorial Hospital Part V, Section B, Line 22d: Total charges before discounts are the same for all patients. Discounts are then applied to total charges to determine amounts billed to patients. At a minimum, patients with income less than or equal to 300% of the Federal Poverty Level (FPL) will be eligible for 100% charity care write off of charges for services that havebeen provided to them. Also, at a minimum, patients with incomes above 300% of the FPL but not exceeding 600% of the FPL will receive a discount on the services provided to them. Additionally, for any pure self pay patient (someone presenting with no insurance regardless of income), there is a 30% uninsured discount automatically applied against total charges. Part V, Section B, Line 7a https://www.rushcopley.com/about/community-health-needs-assessment-reports/ 5 1 - River West Radiation Center LLC 1221 N Highland Avenue Aurora IL 605044206 JV Oncology 2 - Community Alliance Home Health 4050 Healthway Drive Aurora IL 605044206 JV Home Health 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: A cost accounting system was used to calculate the amounts reported in the table and a cost to charge ratio was utilized. 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 payments 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 patients who have third-party payor coverage on the basis of contractual rates for the 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 in 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 of RCMC's uninsured patients will be unable or unwilling to pay for the 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, RCMC 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 reported in line 7 should be treated as community benefit because if we did not provide the service, the burden of the costs would fall on the government. 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 later 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 program availability. 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 Inc.'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, Inc. 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, support groups (stroke, Parkinson's and heart disease), movement disorders programming and child safety seat checks, as well as many other programs. Copley Memorial Hospital, Inc. 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 related 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 6: Copley Memorial Hospital, Inc. has an affiliation with Rush University Medical Center that covers governance and other organizational relationships. Both organizations are parties to a master trust indenture that established an obligated group for purposes of issuing long-term debt. 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 Stephen Kelanic MD Vice Chief of Staff/Director 255649 0 115303 0 7687 0 10600 0 30629 0 419868 0 0 0 Barry Finn President & CEO/Director 712612 0 311448 0 18216 0 434066 0 40384 0 1516726 0 0 0 Ryan Asmus VP General Counsel/Secretary 247329 0 90160 0 8950 0 46477 0 33692 0 426608 0 0 0 Brenda VanWyhe Sr. VP, Finance & CFO/Treasurer 311314 0 93330 0 8647 0 57014 0 23946 0 494251 0 0 0 Gail Bumgarner Sr. VP, Strategy 264610 0 101652 0 43115 0 10600 0 9820 0 429797 0 0 0 Dennis DeMasie VP, Information Technology & CIO 242514 0 73746 0 9432 0 45760 0 24422 0 395874 0 0 0 John Diederich Sr. VP, Operations & COO 380036 0 146250 0 10592 0 120813 0 35954 0 693645 0 0 0 Brenda Fann MD Assistant VP, MedAffairs 269345 0 55342 0 9240 0 10600 0 33426 0 377953 0 0 0 Diane Homan MD VP, Quality & PSO 311167 0 105028 0 356859 0 10600 0 24532 0 808186 0 0 0 Steve Lowenthal MD Sr. VP, Medical Affairs & CMO 427923 0 156792 0 83046 0 10600 0 22025 0 700386 0 0 0 Mary Shilkaitis VP, Patient Care Services & CNO 234958 0 80306 0 10801 0 45055 0 36671 0 407791 0 0 0 David Petasnick Assistant VP, Ancillary Services 176880 0 23815 0 7483 0 7328 0 30536 0 246042 0 0 0 Alex Pope VP, Philanthropy & CDO 191235 0 70840 0 9016 0 28650 0 33786 0 333527 0 0 0 Suzanne Sterchi Assistant VP, Patient Care 175162 0 34703 0 11389 0 7954 0 35121 0 264329 0 0 0 Teressa Alexander MD Physician 444935 0 184887 0 14522 0 10600 0 38327 0 693271 0 0 0 Santosh Gill MD Physician 411680 0 193428 0 19242 0 10600 0 31392 0 666342 0 0 0 Edward Lipman MD Physician 364058 0 190547 0 9629 0 10600 0 33125 0 607959 0 0 0 Dimitry Ruban MD Physician 987986 0 5125 0 7457 0 10600 0 33848 0 1045016 0 0 0 Sepehr Sani MD End 915 Physician 498140 0 124092 0 5669 0 10600 0 21919 0 660420 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): Barry Finn $423,466, Mary Shilkaitis $34,738, John Diederich $110,213, Steve Lowenthal $0, Dennis DeMasie $35,790, Diane Homan $0, Brenda VanWyhe $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. Steve Lowenthal received payments in 2015 of $65,078, Diane Homan received payments in 2015 of $343,437 and Gail Bumgarner received payments in 2015 of $34,167. 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 205000 105601668 97050511 824030 145 9267221 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 FY16 Health Programming During FY16, 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 Two programs aimed at providing nutrition advice were held during the year with a total of 29 people attending. YouFit held four 12-week sessions with a total of 37 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. 38 new community members were added to the community walking club. Rush-Copley collaborated with VNA Health Care to assist them with their Step by Step program by meeting with them to share the community walking program model and provided the materials to get their program started. Diabetes Free fasting glucose screenings were provided to over 101 community members. Smoking Cessation The Freedom from Smoking class was offered four times with a total of 20 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 Dr. Joo presented a program Get the Scoop on the Scope to 20 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 200 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. Over 100 participants attended and benefitted from the presentations in FY16. Continuing the collaboration with the Aurora Public Library, nine participants attended the presentation on The Benefits of Fruits and Vegetables presented by the University of Illinois Extension. 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 now participates 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. 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, and is attended annually by 100 seniors. 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. Thirteen seniors enrolled and participated in the session held February through April 2016. In FY16, Rush-Copley provided speakers for three out of twelve scheduled presentations at the Caregiver Education Series hosted by the Oswego Senior Center. This monthly series incorporates informative presentations, along with lunch or dinner, to caregivers who are supporting loved ones with chronic health issues. Thirty-five seniors attended these three programs. Pregnancy and Childbirth Prenatal education classes are offered to couples who are pregnant or considering having a baby. Class topics include Childbirth Education, Baby Care Basics, Breastfeeding, Becoming a Grandparent, Boot Camp, C-Section, Bringing Home Baby and Child Safety. Tours of the Family Birth Center are also provided. Over 2,300 people participated in FY16. Vascular Presentations on the causes, symptoms and treatments for varicose veins had 46 participants. Attendees receive a free vein screening. The Heart Disease Survivor breakfast and walk had 116 participants. Movement Disorders Three community programs were offered to people who were experiencing or care for a person experiencing a movement disorder. Nearly 440 people attended these programs which include Living Well with Parkinson's, Managing Advancing Parkinson's Disease and Physical Rehabilitation for Parkinson's Disease. Ongoing programs include land exercises, water exercises, art therapy, Parkinson's disease and essential tremor support with over 200 participants. Women Over 300 women attended programs aimed specifically for them. Topics in the Women to Women series included Beyond Babies, Bladder, Bone & Breast Health for Women, Your Health and the "S" Factor: Sleep, Stress & Sitting and Nine Health Trends to Try (or skip) in FY16. Rush-Copley partnered with the national organization, Red Hot Mamas, to host a support group for women experiencing menopause. Five sessions were held with a total of 85 participants. Stroke A program on Stroke education was held with nine participants in attendance. Physician Referral and Service Line Copley Memorial Hospital offers a free physician and information referral telephone service to the community. This service allows community members to talk with a call advisor to match a person's health needs and preferences with the physician of their choice or link callers to services provided by the medical center. Over 9,300 people used this service in FY16. Website Copley Memorial Hospital's website, rushcopley.com, with translation available into dozens of languages, offers access to free health information, a health encyclopedia, and a symptom checker. In FY16, there were over 1.2 million sessions at rushcopley.com and its online resources. 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 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 11 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 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 -4,288,056. Change in interest in net assets of Foundation -1,915,107. Swap value adjustment -3,462,995. Other -428,862. Form 990, Part XII, Lines 2a & b: 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. Rush Copley Medical Center Inc 2000 Ogden Avenue Aurora IL 60504 363193787 Parent Company IL Section 501(c)(3) Schedule A, Line 11a N/A 0 RushCopley Health Care System Inc 2000 Ogden Avenue Aurora IL 60504 363584043 Bridge Board RCMC & RUMC IL Section 501(c)(3) Schedule A, Line 11a N/A 0 Rush-Copley Foundation 2000 Ogden Avenue Aurora IL 60504 363093877 Grants to Charitable Organizations IL Section 501(c)(3) Schedule A, Line 7 Rush-Copley Medical Center Inc 1 Copley Ventures Inc 2000 Ogden Avenue Aurora IL 60504 363370216 Rental Prop., Infirmary Care, and Healthplex Fitness Center IL Section 501(c)(3) Schedule A, Line 3 Rush-Copley Medical Center Inc 1 Rush University Medical Center 1700 West Van Buren Street Chicago IL 60612 362174823 Hospitals IL Section 501(c)(3) Schedule A, Line 3 N/A 0 Yorkville Physical Therapy & Sports Medicine Center LLC 2000 Ogden Avenue Aurora IL 60504 364236345 Physical Therapy & Sports Medicine IL N/A Rush Copley Cardiovascular Consultants LLC 2000 Ogden Avenue Aurora IL 60504 273234201 Cardiovascular Medicine IL Rush-Copley Medical Center Inc Related -1961139 6154709 0 0 0.99000 Rush Copley Medical Group NFP 2000 Ogden Avenue Aurora IL 60504 363235315 Physician Practices IL N/A C 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 Rush Copley Medical Group A 630188 Fair Market Value Rush-Copley Foundation C 2579443 Fair Market Value Rush-Copley Foundation Q 240760 Fair Market Value Rush-Copley Foundation S 725840 Fair Market Value Rush Copley Medical Center Inc I 4288056 Fair Market Value Copley Ventures Inc K 753953 Fair Market Value Copley Ventures Inc R 468000 Fair Market Value Rush Copley Cardiovascular Consultants A 26112 Fair Market Value Rush University Medical Center A 24570 Fair Market Value Rush University Medical Center P 462337 Fair Market Value Rush University Medical Center R 1087042 Fair Market Value