SOUTH SHORE HOSPITAL CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SOUTH SHORE HOSPITAL CORPORATION (EIN 36-1799520)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-11
- IRS object ID
- 201623169349305212
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-11T20:00:14-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive | AddressLine1Txt |
| Address Line2 | Suite 2600 | AddressLine2Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361799520 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Shore Hospital Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SOUT | BusinessNameControlTxt |
| Phone | 7733565312 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 South Crandon Avenue | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60617 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Schneider | PersonNm |
| Person Title | Officer | PersonTitleTxt |
| Signature | 2016-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NICOLE BENCIK | PreparerPersonNm |
| PTIN | P00756195 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Timothy Caveney | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 South Crandon Avenue | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60617 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $46,127,057 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.southshorehospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | South Shore Hospital Corporation is a not-for-profit hospital dedicated to providing the highest quality of healthcare possible to the south shore community. The charges forgone for services furnished under its charity care policy during the year ended December 31, 2015 approximated $2,404,629. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 692 | TotalEmployeeCnt |
| Total Volunteers | 34 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $164,982 | PYContributionsGrantsAmt |
| CY Contributions Grants | $221,347 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $42,337,702 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,007,301 | CYProgramServiceRevenueAmt |
| PY Investment Income | $173,863 | PYInvestmentIncomeAmt |
| CY Investment Income | $163,793 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,060,514 | PYOtherRevenueAmt |
| CY Other Revenue | $1,710,372 | CYOtherRevenueAmt |
| PY Total Revenue | $44,737,061 | PYTotalRevenueAmt |
| CY Total Revenue | $46,102,813 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,382,689 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,472,552 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,038,736 | PYOtherExpensesAmt |
| CY Other Expenses | $20,387,761 | CYOtherExpensesAmt |
| PY Total Expenses | $44,421,425 | PYTotalExpensesAmt |
| CY Total Expenses | $45,860,313 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $315,636 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $242,500 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,805,431 | TotalAssetsBOYAmt |
| Total Assets EOY | $32,606,204 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,064,740 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,771,784 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,740,691 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,834,420 | NetAssetsOrFundBalancesEOYAmt |
| Mission | South Shore Hospital Corporation is a not-for-profit hospital dedicated to providing the highest quality of healthcare possible to the south shore community. The costs for services and supplies furnished under its charity care policy during the year ended December 31, 2015 approximated $929,832. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $43,836,046 | ExpenseAmt |
| Revenue | $45,727,783 | RevenueAmt |
| Desc | THE HOSPITAL IS AN ACUTE CARE FACILITY PROVIDING SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY DURING THE YEAR ENDED DECEMBER 31, 2015 APPROXIMATED $929,832. IN ADDITION TO CHARITY CARE, THE HOSPITAL ALSO OFFERS OTHER COMMUNITY BENEFITS SUCH AS PROVIDING MENTORS AND VOLUNTEERS, AND IT ALSO SPONSORS HEALTH FAIRS THROUGHOUT THE COMMUNITY. EMPLOYEES OF THE HOSPITAL PARTICIPATE IN A MENTORING PROGRAM FOR CHILDREN WITHIN THE COMMUNITY. THE PROGRAM'S GOAL IS TO MOTIVATE STUDENTS TO COMPLETE THEIR HIGH SCHOOL EDUCATION WITH AN EMPHASIS ON THE OVERALL IMPORTANCE OF EDUCATION AND PRE-EMPLOYMENT PREPARATION. | Desc |
| Total Program Service Expenses | $43,836,046 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 184 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 692 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jim Burstyn | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7733565350 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 SOUTH CRANDON AVENUE | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60617 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Timothy Caveney | |||||||
| President and CEO | 40.0 | Yes (X) | Yes (X) | $234,658 | $0 | $21,232 | |
| Nick Valdez | |||||||
| Chairman of the Board | 10.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Randall A Moll | |||||||
| Vice Chairman | 10.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Lupe Valdez | |||||||
| Vice President/Secretary | 10.0 | Yes (X) | Yes (X) | $0 | $0 | $2,845 | |
| Todd H Stroger | |||||||
| Treasurer | 10.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Julius R Alexander II | |||||||
| Director | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Jacqueline Hawkins RN | |||||||
| Director | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Betty Johnson | |||||||
| Director | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| C Tyson MD | |||||||
| Director | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| John C Wu MD | |||||||
| President of Medical Staff | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Arnold Stewart | |||||||
| Director | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Satya Ahuja | |||||||
| Director (Partial Year) | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Jia Hwang | |||||||
| Director (Partial Year) | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Jesus Ong | |||||||
| Director (Partial Year) | 10.0 | Yes (X) | $0 | $0 | $0 | ||
| Mike Schneider | |||||||
| Assistant Treasurer and CFO | 40.0 | Yes (X) | $129,344 | $0 | $15,441 | ||
| Helen Wiersma | |||||||
| Assistant Secretary | 40.0 | Yes (X) | $105,663 | $0 | $8,812 | ||
| Milicia Lukac | |||||||
| Nurse Manager | 73.0 | $232,565 | $0 | $7,034 | Yes (X) | ||
| Vera Ray | |||||||
| Director of lab | 40.0 | $194,468 | $0 | $0 | Yes (X) | ||
| Alfred Bolden | |||||||
| Chief Nursing Executive | 40.0 | $143,535 | $0 | $5,600 | Yes (X) | ||
| James Ritchie | |||||||
| Director of Information Services | 40.0 | $138,698 | $0 | $9,857 | Yes (X) | ||
| Margaret Oshinowo | |||||||
| Director of Nursing Administration | 40.0 | $138,399 | $0 | $10,963 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,317,330 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $81,784 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 26 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| COMPLETE RX | ||||||
| 3100 S GESSNER SUITE 640 | HOUSTON | TX | 77063 | CONTRACT SERVICES | $3,149,489 | |
| HORIZON HEALTH | ||||||
| ACCOUNTS RECEIVABLE | DALLAS | TX | 752640839 | CONTRACT SERVICES | $843,586 | PO BOX 840839 |
| CARDINAL HEALTH | ||||||
| PO BOX 70539 | CHICAGO | IL | 606730539 | CONTRACT SERVICES | $427,349 | |
| ILIND EM-I MEDICAL SERVICES INC | ||||||
| 7032 COLLECTION CENTER DR | CHICAGO | IL | 60693 | CONTRACT SERVICES | $371,401 | |
| FRESENEIUS MANAGEMENT SERVICES INC | ||||||
| 16343 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | CONTRACT SERVICES | $354,889 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Fundraising | $38,806 | FundraisingAmt |
| Government Grants | $81,365 | GovernmentGrantsAmt |
| All Other Contributions | $101,176 | AllOtherContributionsAmt |
| Total Contributions | $221,347 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 900099 | $37,107,983 | $37,107,983 |
| PATIENT SERVICE REVENUE | 900099 | $6,721,927 | $6,721,927 |
| RENTAL INCOME | 900099 | $177,391 | $177,391 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,007,301 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $276,425 | TotalRevenueColumnAmt |
| Exclusion | $276,425 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$112,632 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | -$112,632 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$112,632 | TotalRevenueColumnAmt |
| Exclusion | -$112,632 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $14,134 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $38,806 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $24,244 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$10,110 | TotalRevenueColumnAmt |
| Exclusion | -$10,110 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEANINGFUL USE PAYMENTS | 900099 | $1,161,726 | $1,161,726 |
| CAFETERIA REVENUE | 900099 | $183,457 | $183,457 |
| PHYSICIAN BILLING | 900099 | $325,119 | $325,119 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,180 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $50,180 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,720,482 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,102,813 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,727,783 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $153,683 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $510,830 | TotalAmt |
| Program Services | $102,166 | ProgramServicesAmt |
| Management And General | $408,664 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,154,324 | TotalAmt |
| Program Services | $20,236,532 | ProgramServicesAmt |
| Management And General | $917,792 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258,631 | TotalAmt |
| Program Services | $247,410 | ProgramServicesAmt |
| Management And General | $11,221 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,971,984 | TotalAmt |
| Program Services | $1,886,428 | ProgramServicesAmt |
| Management And General | $85,556 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,576,783 | TotalAmt |
| Program Services | $1,482,926 | ProgramServicesAmt |
| Management And General | $93,857 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,598 | TotalAmt |
| Management And General | $24,598 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,065 | TotalAmt |
| Management And General | $57,065 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,104,008 | TotalAmt |
| Program Services | $9,938,795 | ProgramServicesAmt |
| Management And General | $165,213 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,199 | TotalAmt |
| Program Services | $28,199 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $574,021 | TotalAmt |
| Program Services | $553,558 | ProgramServicesAmt |
| Management And General | $20,463 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $789,325 | TotalAmt |
| Program Services | $789,325 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,027 | TotalAmt |
| Program Services | $8,027 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,396,029 | TotalAmt |
| Program Services | $1,306,889 | ProgramServicesAmt |
| Management And General | $89,140 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,852 | TotalAmt |
| Program Services | $251,448 | ProgramServicesAmt |
| Management And General | $11,404 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medicaid Provider Tax | $2,860,840 | $2,860,840 |
| Medicine | $446,952 | $446,952 |
| Food | $625,257 | $625,257 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,210,588 | TotalAmt |
| Program Services | $3,071,294 | ProgramServicesAmt |
| Management And General | $139,294 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,860,313 | TotalAmt |
| Program Services | $43,836,046 | ProgramServicesAmt |
| Management And General | $2,024,267 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $582,714 | BOYAmt |
| EOY | $744,280 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $534,413 | BOYAmt |
| EOY | $900,412 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,451,953 | BOYAmt |
| EOY | $10,800,811 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $441,723 | BOYAmt |
| EOY | $465,332 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,765 | BOYAmt |
| EOY | $202,455 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $52,275,169 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $39,420,033 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,587,835 | BOYAmt |
| EOY | $12,855,136 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,024,028 | BOYAmt |
| EOY | $6,637,778 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,805,431 | BOYAmt |
| EOY | $32,606,204 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,544,075 | BOYAmt |
| EOY | $5,900,039 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,520,665 | BOYAmt |
| EOY | $8,871,745 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,064,740 | BOYAmt |
| EOY | $14,771,784 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,740,691 | BOYAmt |
| EOY | $17,834,420 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,740,691 | BOYAmt |
| EOY | $17,834,420 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,805,431 | BOYAmt |
| EOY | $32,606,204 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $242,500 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$148,771 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,575,119 | OtherCostOrOtherBasisAmt |
| Book Value | $2,575,119 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,790,291 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,448,260 | DepreciationAmt |
| Book Value | $8,342,031 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $128,084 | OtherCostOrOtherBasisAmt |
| Depreciation | $52,235 | DepreciationAmt |
| Book Value | $75,849 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,611,782 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,449,418 | DepreciationAmt |
| Book Value | $1,162,364 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,169,893 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,470,120 | DepreciationAmt |
| Book Value | $699,773 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,855,136 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DESIGNATED FOR PROPERTY AND EQUIPMENT | $2,237,355 |
| MEDICAL LIABILITY TRUST FUND | $4,150,423 |
| WORKERS' COMPENSATION LIABILITY TRUST FUND | $250,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,637,778 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED LIABILITY FOR PROFFESSIONAL AND GENERAL LIABILITY | $4,803,410 |
| ESTIMATED THIRD-PARTY PAYER SETTLEMENTS | $3,989,965 |
| CAPITAL LEASE OBLIGATIONS | $78,370 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,871,745 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $46,102,813 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $46,102,813 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $46,102,813 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $45,860,313 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $45,860,313 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $45,860,313 | TotalExpensesPerForm990Amt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Amethyst Ball | Event1Nm |
| Gross Receipts Event1 | $52,940 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $38,806 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $14,134 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $18,194 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $6,050 | EntertainmentEvent1Amt |
| Gross Revenue Event2 | $0 | GrossRevenueEvent2Amt |
| Gross Revenue Other Events | $0 | GrossRevenueOtherEventsAmt |
| Gross Receipts Total | $52,940 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $38,806 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $14,134 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $18,194 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $6,050 | EntertainmentTotalEventsAmt |
| Direct Expense Summary Events | $24,244 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$10,110 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $851,749 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $851,749 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0186 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,246,251 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,242,023 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $21,098,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,242,023 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $851,749 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0186 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $104,152 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $104,152 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0023 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,041,788 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,307,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,733,889 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0378 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $4,145,940 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,307,899 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,838,041 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0401 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $25,243,940 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,549,922 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,689,790 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0587 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $679,462 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $72,747 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,352,258 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,230,136 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$877,878 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Shore Hospital Corporation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 SOUTH CRANDON AVENUE | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60617 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.southshorehospital.com | WebsiteAddressTxt |
| State License | 0003459 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Shore Hospital Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.southshorehospital.com/about-south-shore/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.southshorehospital.com/about-south-shore/ | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.southshorehospital.com/FAP-POLICY/ | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.southshorehospital.com/FAP-SUMMARY/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - SOUTH SHORE HOSPITAL. Focus groups held as part of this Community Health Needs Assessment incorporated input from 16 key informants (or community stakeholders), with special emphasis on persons who work with or have special knowledge about vulnerable populations in South Chicago and throughout Cook County, including low-income individuals, minority populations, those with chronic conditions, and other medically underserved residents. A list of these participants is provided in the CHNA, page 227/228. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - SOUTH SHORE HOSPITAL. SSH has a Geriatric Psych, Detox and Chemical Dependency programs. The Emergency Room had 15,820 visits in 2015. HEALTH PRIORITIES NOT CHOSEN FOR ACTION: CANCER-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS CANCER DEATHS. OTHER HOSPITALS IN THE COMMUNITY HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDE THIS AS AN AREA CHOSEN FOR ACTION. FAMILY PLANNING-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS FAMILY PLANNING ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. HEART DISEASE & STROKE-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS HEART DISEASE & STROKE ISSUES. OTHER COMMUNITY ORGANIZATIONS AND HOSPITAL HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. IMMUNIZATIONS-ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. INJURY & VIOLENCE PREVENTION-SSH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. MATERNAL & INFANT HEALTH-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS MATERNAL & INFANT HEALTH ISSUES. OTHER COMMUNITY ORGANIZATIONS AND HOSPITAL HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. ORAL HEALTH-ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. RESPIRATORY DISEASE-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS RESPIRATORY DISEASE ISSUES. OTHER COMMUNITY ORGANIZATIONS AND HOSPITAL HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. SEXUALLY TRANSMITTED DISEASES-SSH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. TOBACCO USE-SSH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS TOBACCO USE ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. VISION-ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. |
| Schedule H, Part V, Section B, Line 22 Facility , 1 | Facility , 1 - SOUTH SHORE HOSPITAL. ALL PATIENTS ARE BILLED THE SAME. IF THEY QUALIFY FOR FAP, THEY ARE ADJUSTED TO CHARITY. THEY ARE NOT CHARGED MORE THAN MEDICARE PATIENTS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| WEST PULLMAN CENTER | ||||
| 12251 SOUTH HALSTED STREET | CHICAGO | IL | 60628 | PHYSICIAN OFFICE |
| SENIORS & GENERAL WELLNESS CENTER | ||||
| 2525 EAST 83RD STREET | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
| EAST SIDE MEDICAL HEALTH CENTER | ||||
| 10551 SOUTH EWING AVENUE | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
| SOUTH SIDE PROFESSIONAL BUILDING | ||||
| 7906 SOUTH CRANDON AVENUE | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
| HIGHLAND MEDICAL CENTER | ||||
| 8201 SOUTH ASHLAND | CHICAGO | IL | 60620 | PHYSICIAN OFFICE |
| FAMILY MEDICAL CENTER | ||||
| 1424 WEST 87TH STREET | CHICAGO | IL | 60620 | PHYSICIAN OFFICE |
| SHARED PHYSICIAN OFFICE SPACE | ||||
| 8012 SOUTH CRANDON AVENUE | CHICAGO | IL | 60617 | PHYSICIAN OFFICE |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | THE BAD DEBT RESERVE IS AN ESTIMATE OF THE ACCOUNT BALANCES THAT WE EXPECT TO NOT COLLECT DESPITE THE PATIENTS ABILITY TO PAY. THE ESTIMATE WHICH IS UPDATED MONTHLY IS BASED ON HISTORICAL WRITE OFF PERCENTAGES. THESE PERCENTAGES ARE ADJUSTED TO REFLECT ANY BAD DEBT RECOVERIES. |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | The Method used to determine the amount that reasonably could be attributed to patients who likely would qualify for financial assistance under our Financial Assistance Policy is based on our outside eligibility vendor's experience with qualifying accounts as financial assistance. Our vendor screens all self pay accounts, and based on an initial screening, will classify the account as falling under our Financial Assistance Program guidelines. OCCASIONALLY, PATIENT ACCOUNTS WILL BE WRITTEN OFF TO BAD DEBT BUT THEN ARE LATER DETERMINED TO BE UNCOLLECTIBLE DUE TO THE PATIENT BEING UNINSURED OR ELIGIBLE FOR PUBLIC AID. ONCE DETERMINED THAT THE PATIENT HAS NO ABILITY TO PAY, THE ACCOUNTS ARE WRITTEN OFF AS CHARITY WRITE-OFFS. THE METHODOLOGY IS TO TAKE TOTAL BAD EXPENSE LESS THE BAD DEBT FROM THE MEDICARE COST REPORT. THE HOSPITAL INCURS A LOSS FOR THE BENEFIT OF THE COMMUNITY. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The provision for bad debts is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in healthcare coverage, and other collection indicators. Accounts receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the Hospital's policies. Recoveries are treated as a reduction to the provision for bad debts. Accounts receivable are reduced by an allowance for doubtful accounts. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by major payor category. Income from incentive payments is subject to retrospective adjustment as the incentive payments are calculated using Medicare cost report data that is subject to audit. Data about the major payor sources of revenue is analyzed to establish an appropriate allowance for uncollectible receivables and provision for bad debts. For receivables associated with services provided to patients who have third-party coverage, contractually due amounts are analyzed and compared to actual cash collected over time to enhance the quality of the estimate of the allowance for doubtful accounts and the provision for bad debts (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), a significant allowance for doubtful accounts is recorded on the basis of historical experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. An estimate of the difference between contracted rates and amounts actually collected, after all reasonable collection efforts have been exhausted, is charged to the provision for bad debts and credited to the allowance for doubtful accounts. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | Medicare allowable costs were determined by applying the Medicare cost to charge ratio from the 2015 Medicare cost report to the Medicare charges. Approximately 60% of our patients are seniors with Medicare insurance, but are unable to pay their coinsurance and deductible amounts. Consistent with the Hospital's Financial Assistance policy, these accounts are either written off to Charity care or Bad Debt expense. Most of the Medicare shortfall is the result of these accounts. Hence, the Hospital is subsidizing the Medicare reimbursement as part of our community benefit program. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | In recognizing the medical needs of the indigent, South Shore Hospital provides quality medical health care regardless of race, creed, color, sex, natural origin, sexual orientation, handicap, age or ability to pay. Our financial assistance policy identifies circumstances under which South Shore Hospital will extend care free of charge or at a discount, commensurate with the ability to pay, to a patient whose financial status makes it impractical or impossible to pay for necessary medical expenses. The necessity for medical treatment of any patient is based upon clinical judgement without regard to the financial status of the patient. If a patient is determined to be eligible for financial assistance, then collection actions will be stopped. |
| Schedule H, Part V, Section B, Line 16a FAP website | - South Shore Hospital Corporation: Line 16a URL: http://www.southshorehospital.com/FAP-POLICY/; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - South Shore Hospital Corporation: Line 16c URL: http://www.southshorehospital.com/FAP-SUMMARY/; |
| Schedule H, Part VI, Line 2 Needs assessment | The Hospital goes above and beyond the core needs of the community as stipulated in the CHNA, by providing diabetes education, language assistance, and transportation services. Meetings are scheduled throughout the year with ministers, community leaders and representatives of the communities school districts. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | All uninsured patients are advised of our financial assistance policy as part of the admissions process. Whenever possible, South Shore Hospital provides assistance to uninsured patients in obtaining health care insurance at no cost to the patient. This assistance includes visits with the patient while in the hospital, and follow-up visits to their home to ensure that insurance applications are completed and filed in a timely manner. Then appropriate follow up is done with Medicaid and other insurers to ensure the applications are processed timely. All self pays receive a charity application, and are assessed. They are given a discount based on the State of Illinois poverty guidelines. For patients that are presumptive eligible, they are written off to Charity once they go through the process and are denied. According to the Hospital's FAP: 1. Every patient will, upon admission as an inpatient or outpatient, receive a written notice that shall contain information about the availability of financial assistance, including information about this policy as well as contact information for a hospital employee or office from which the person may obtain further information about the policy. 2. Signs will be posted conspicuously in the admission and registration areas to notify patients and visitors about the availability of financial assistance. The signage will contain the following language, in accordance with the Illinois Hospital Fair Patient Billing Act: "You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For more information contact South Shore Hospital Financial Counselors at 773-356-5212." 3. Each hospital bill, invoice, or other summary of charges to an uninsured patient shall include with it, or on it, a prominent statement, in accordance with the Illinois Hospital Uninsured Patient Discount Act, to the effect that an uninsured patient who meets certain income requirements may qualify for an uninsured discount and information regarding how an uninsured patient may apply for consideration under South Shore Hospital's FAP. 4. The FAP, Financial Assistance Application and plain language summary of the FAP will be available on South Shore Hospital's website at southshorehospital.com (http://www.southshorehospital.com). The documents will be posted in a format that will allow any individual with access to the Internet to access, download, view, and print a hard copy of the documents without requiring special computer equipment and without the payment of a fee. South Shore Hospital will provide any individual who asks how to obtain online access to a copy of the FAP, Financial Assistance Application form, or plain language summary of the FAP with the direct website address, or URL, of the web page on which these documents are posted. 5. Paper copies of the FAP, Financial Assistance Application and plain language summary of the FAP will be readily available in the admitting department and waiting areas. Patients may also call to obtain a copy and it will be mailed it to them at no cost. 6. The Patient Access Department will also notify those patients with no insurance of the availability of Financial assistance and will give a copy of the Financial Assistance Application and plain language summary of the FAP to patients. |
| Schedule H, Part VI, Line 4 Community information | The South Shore Hospital service area consists of twelve zip codes in the southeast side of the city of Chicago. Six of the zip codes comprise about 80% of our admissions (Zips 60617, 60619, 60649, 60620, 60637, and 60628). These zip code areas have a combined estimated population of about 200,000. Some of the key healthcare needs of this core zip code area are: -There is a disproportionately large population of uninsured people in this area. As a result, South Shore Hospital treats a large percentage of our patients free of charge or at a discount. -There is a disproportionately large population of insured people in this area that cannot afford to pay their copays and deductibles. As a result, the annual Hospital bad debt expense is very large. -There is also a disproportionately large population of indigent people insured with Medicaid in this area. On average, about 25% of our Inpatients have Medicaid health coverage. About 30% of the emergency room outpatient visits are Medicaid patients using the emergency room as a doctors office. Drug abuse is a serious problem in our area with the need for Detox and Rehab services. An increasing number of people in our core zip codes are infected with HIV. There are three other hospital serving the community: St. Bernard Hospital, Advocate Trinity Hospital, and Jackson Park Hospital. South Shore Hospital serves the medically under served. African Americans are nearly 90 percent of inpatient admits. |
| Schedule H, Part VI, Line 5 Promotion of community health | In addition to the services previously noted in this schedule, the Hospital also provides free immunizations, patient education assistance, language assistance, transportation services, and senior wellness programs, at no cost to the patient. The Hospital also participates with local, independent organizations in conducting about 50 health screening events per year. In addition, the Hospital contributes funds to local, non-profit organizations actively engaged in meeting the social, economic, spiritual, mental and healthcare needs of our community. While most of our patients have healthcare insurance through Medicare or Medicaid, neither of these programs cover the cost of providing the care. As a result, the Hospital usually operates at a loss while subsidizing these programs. The members of the governing body are comprised of persons who reside in the organization's primary service area who are neither employees nor independent contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified physicians in the community for all of its departments and specialties |
| Schedule H, Part VI, Line 7 State filing of community benefit report | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Timothy Caveney | ||||||||||||||
| President and CEO | $233,422 | $0 | $0 | $0 | $1,236 | $0 | $7,164 | $0 | $14,068 | $0 | $255,890 | $0 | $0 | $0 |
| Milicia Lukac | ||||||||||||||
| Nurse Manager | $232,272 | $0 | $0 | $0 | $293 | $0 | $6,970 | $0 | $64 | $0 | $239,599 | $0 | $0 | $0 |
| Vera Ray | ||||||||||||||
| Director of lab | $194,468 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $194,468 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | LUPE VALDEZ & NICK VALDEZ - Family relationship |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | FULL COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD MEMBERS VIA EMAIL FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Each officer, director, trustee and key employee is subject to the conflict of interest policy. the board's conflict of interest committee reviews each member's conflict of interest statement on an annual basis. the board compares prior and current year conflict of interest statements, and reports any potential or actual conflicts of interest to the organization's human resources department. actual conflicts of interest are documented with the organization's human resources department annually. Officers, Directors, Trustees and employees are all covered under the organizations conflict of interest policy. Should there become known, at any time, a conflict of interest between any member staff, hospital personnel or other healthcare providers and the hospital, and the hospital or any of its agents, the individual (s) may excuse himself/ herself from discussions and/ or determinations with the identified healthcare provider(s). |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | The Compensation Committee of the board of directors reviews the CEO's performance on an annual basis. In setting the compensation of the organization's CEO, the Committee compares industry compensation figures to the CEO's compensation package. The final determination and deliberations regarding the CEO's compensation package are documented in the minutes of the board of directors meeting. The process for determining compensation of the CEO was last undertaken in March of 2015. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | The Compensation Committee of the board of directors reviews the performance of the officers and key employees on an annual basis In setting the compensation of these individuals, the Committee compares industry compensation figures to their financial packages. If any individual's compensation is discussed during the meeting, that individual is required to recuse themselves. The process for determining compensation of other officers and key employees was last undertaken in March of 2015. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | MEDICAL RECORDS REVENUE - Total Revenue: 38364, Related or Exempt Function Revenue: 38364, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; OTHER - Total Revenue: 11816, Related or Exempt Function Revenue: 11816, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part IX, Line 11g Other Fees | PURCHASED SERVICES - Total Expense: 6717720, Program Service Expense: 6552507, Management and General Expenses: 165213, Fundraising Expenses: ; PHYSICIAN FEES - Total Expense: 2828485, Program Service Expense: 2828485, Management and General Expenses: , Fundraising Expenses: ; REPAIRS AND MAINTENANCE - Total Expense: 557803, Program Service Expense: 557803, Management and General Expenses: , Fundraising Expenses: ; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH SHORE HOSPITAL AUXILIARY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8012 S CRANDON AVE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606171199 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363200759 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3 | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SSHC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |