HUMBOLDT PARK HEALTH: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- HUMBOLDT PARK HEALTH (EIN 36-1564290)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-10
- IRS object ID
- 201612239349302706
- Schema version
- 2014v6.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-10T18:42:36-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 S RIVERSIDE PLAZA 9TH FLOOR | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 361564290 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORW | BusinessNameControlTxt |
| Phone | 7732928200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60622 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY KRUGEL | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7732928200 | PhoneNum |
| Signature | 2016-08-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID LOWENTHAL | PreparerPersonNm |
| PTIN | P00378651 | PTIN |
| Phone | 3122071040 | PhoneNum |
| Preparation | 2016-08-03 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOSE R SANCHEZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60622 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $121,197,983 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NAHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1935 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | NORWEGIAN AMERICAN HOSPITAL PROVIDES QUALITY AND COMPASSIONATE HEALTH CARE SERVICES BY PARTNERING WITH PATIENTS AND THEIR FAMILIES, OUR EMPLOYEES, PHYSICIANS AND THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1106 | TotalEmployeeCnt |
| Total Volunteers | 165 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $219,946 | PYContributionsGrantsAmt |
| CY Contributions Grants | $517,885 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $117,016,219 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $119,473,777 | CYProgramServiceRevenueAmt |
| PY Investment Income | $809,660 | PYInvestmentIncomeAmt |
| CY Investment Income | $99,665 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$42,431 | PYOtherRevenueAmt |
| CY Other Revenue | -$51,872 | CYOtherRevenueAmt |
| PY Total Revenue | $118,003,394 | PYTotalRevenueAmt |
| CY Total Revenue | $120,039,455 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $55,475,792 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $54,165,228 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $62,010,396 | PYOtherExpensesAmt |
| CY Other Expenses | $62,965,889 | CYOtherExpensesAmt |
| PY Total Expenses | $117,486,188 | PYTotalExpensesAmt |
| CY Total Expenses | $117,131,117 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $517,206 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,908,338 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $104,559,133 | TotalAssetsBOYAmt |
| Total Assets EOY | $107,970,510 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $67,985,841 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $74,861,725 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $36,573,292 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $33,108,785 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | NORWEGIAN AMERICAN HOSPITAL PROVIDES QUALITY AND COMPASSIONATE HEALTH CARE SERVICES BY PARTNERING WITH PATIENTS AND THEIR FAMILIES, OUR EMPLOYEES, PHYSICIANS AND THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $73,568,970 | ExpenseAmt |
| Revenue | $119,473,777 | RevenueAmt |
| Desc | NORWEGIAN AMERICAN HOSPITAL IS A PREMIER HEALTH CARE PROVIDER WHERE THE PATIENT COMES FIRST. AS AN ORGANIZATION OF CAREGIVERS, NORWEGIAN AMERICAN INSPIRES TO CONSISTENTLY HIGH STANDARDS OF QUALITY, FAMILY-CENTERED HEALTH CARE SERVICES AND COST EFFECTIVENESS. NORWEGIAN AMERICAN HOSPITAL SEEKS TO PROMOTE WELLNESS WITHIN THE FAMILY AND TO BE DYNAMIC PARTNERS IN HEALTH WITH THE COMMUNITIES IT SERVES. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2015, NORWEGIAN AMERICAN HOSPITAL ESTIMATES IT PROVIDED $2,555,288 IN CHARITY CARE COST FOR HEALTHCARE SERVICES AND SUPPLIES PROVIDED TO MEMBERS OF THE COMMUNITIES SERVED UNDER ITS CHARITY CARE POLICY. THESE MEMBERS DID NOT HAVE THE ABILITY TO PAY FOR SERVICES RECEIVED. NORWEGIAN AMERICAN ALSO PROVIDED CARE TO PATIENTS WHO ARE BENEFICIARIES OF MEDICARE, MEDICAID, BLUE CROSS AND MANAGED CARE REIMBURSEMENT PROGRAMS. REIMBURSEMENT AMOUNTS FOR THESE PROGRAMS ARE LESS THAN CHARGES AND IN SOME CASES LESS THAN COST. FOR FISCAL YEAR 2014, NORWEGIAN AMERICAN HOSPITAL SERVED 8,357 PATIENTS ADMITTED WHO RECEIVED 40,413 DAYS OF HEALTHCARE SERVICES. | Desc |
| Total Program Service Expenses | $73,568,970 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 92 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1106 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| 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 | GARY KRUGEL CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7732928200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60622 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| BILLY OCASIO | |||||||||
| CHAIRMAN | 5.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WILMI SCHMIDT | |||||||||
| VICE-CHAIRMAN | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SANDRA VALENZULA | |||||||||
| SECRETARY | 8.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LOUIS TINAJERO | |||||||||
| TREASURER | 8.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ADAM BORIS | |||||||||
| TRUSTEE | 2.00 | 0.90 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD A BLABOLI | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CARMEN C HOVANEC | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| LOUIS MANETTI | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MANUEL MARTINEZ MD | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN MONTEVERDE MD | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| OLGA SAAVEDRA MD | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RAFAEL CAMPANINI MD | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $22,000 | $0 | $0 | |||
| SANCHEZ JOSE R | |||||||||
| PRESIDENT AND CEO (EX-OFFICIO) | 40.00 | 0.00 | Yes (X) | $552,300 | $0 | $421,475 | |||
| ABHA AGRAWAL | |||||||||
| VP, MEDICAL AFFAIRS/COO | 40.00 | 0.00 | Yes (X) | $530,094 | $0 | $22,176 | |||
| GARY KRUGEL | |||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0.00 | Yes (X) | $222,888 | $0 | $5,004 | |||
| NARAYAN RAVISHANKAR MD | |||||||||
| ANESTHESIOLOGIST | 40.00 | 0.00 | $406,323 | $0 | $15,624 | Yes (X) | |||
| MAX IZBICKI MD | |||||||||
| PHYSICIAN, OB/GYN | 40.00 | 0.00 | $326,980 | $0 | $200 | Yes (X) | |||
| QAISER JAMAL MD | |||||||||
| CHIEF HOSPITALIST | 40.00 | 0.00 | $246,160 | $0 | $30,925 | Yes (X) | |||
| JANA RICHARDS MD | |||||||||
| HOSPITALIST, OB/GYN | 40.00 | 0.00 | $222,838 | $0 | $2,180 | Yes (X) | |||
| DAGOBERTO CAMACHO MD | |||||||||
| MEDICAL DIRECTOR | 40.00 | 0.00 | $207,282 | $0 | $9,466 | Yes (X) | |||
| ANTHONY EVERS | |||||||||
| FORMER CHIEF FINANCIAL OFFICER | 0.00 | 0.00 | $207,733 | $0 | $6,512 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,944,598 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $513,562 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 59 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SODEXO INC & AFFILIATES | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | DIETARY & FACILITIES MANAGEMENT SERVICES | $2,194,885 |
| QUEST DIAGNOSTICS | |||||
| 12989 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | LAB SERVICE CONTRACT | $1,845,466 |
| US BANK CORPORATE TRUST | |||||
| 2501 SW 1ST AVE SUITE 200 | PORTLAND | OR | 97201 | SHIFTWISE NURSING STAFFING AGENCY | $1,472,676 |
| CONTINENTAL ANESTHESIA | |||||
| 1301 W 22ND ST 610 | OAKBROOK | IL | 60523 | ANESTHESIA SERVICE CONTRACT | $1,323,041 |
| GE HEALTHCARE | |||||
| 5517 COLLECTIONS DRIVE | CHICAGO | IL | 60693 | RADIOLOGY BIOMEDICAL EQUIPMENT SERVICE | $861,355 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 39 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $517,885 | RelatedOrganizationsAmt |
| Total Contributions | $517,885 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 621110 | $69,250,118 | $69,250,118 |
| MEDICAID ASSESSMENT REVENUE | 621110 | $20,798,095 | $20,798,095 |
| NET PATIENT SERVICES | 621110 | $17,312,530 | $17,312,530 |
| ACA ACCESS PAYMENTS | 621110 | $6,316,430 | $6,316,430 |
| OPERATING REVENUE | 621110 | $5,373,155 | $5,373,155 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $423,449 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $423,449 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $119,473,777 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $102,376 | TotalRevenueColumnAmt |
| Exclusion | $102,376 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,590 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $65,462 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$51,872 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$51,872 | TotalRevenueColumnAmt |
| Exclusion | -$51,872 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,090,105 | SecuritiesAmt |
| Other | $250 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,093,066 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$2,961 | SecuritiesAmt |
| Other | $250 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,711 | TotalRevenueColumnAmt |
| Exclusion | -$2,711 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $120,039,455 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $119,473,777 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $47,793 | 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 | $1,251,199 | TotalAmt |
| Management And General | $1,251,199 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,974,227 | TotalAmt |
| Program Services | $33,644,996 | ProgramServicesAmt |
| Management And General | $11,329,231 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,499 | TotalAmt |
| Program Services | $6 | ProgramServicesAmt |
| Management And General | $573,493 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,356,747 | TotalAmt |
| Program Services | $3,589,211 | ProgramServicesAmt |
| Management And General | $767,536 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,009,556 | TotalAmt |
| Program Services | $2,419,442 | ProgramServicesAmt |
| Management And General | $590,114 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $788,308 | TotalAmt |
| Program Services | $422,057 | ProgramServicesAmt |
| Management And General | $366,251 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,000 | TotalAmt |
| Management And General | $109,000 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,981 | TotalAmt |
| Management And General | $103,981 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,716 | TotalAmt |
| Management And General | $247,716 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,579 | TotalAmt |
| Management And General | $73,579 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,806,799 | TotalAmt |
| Program Services | $11,085,952 | ProgramServicesAmt |
| Management And General | $3,720,847 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,169 | TotalAmt |
| Program Services | $96,891 | ProgramServicesAmt |
| Management And General | $67,278 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,784,905 | TotalAmt |
| Program Services | $53,367 | ProgramServicesAmt |
| Management And General | $1,731,538 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,351,382 | TotalAmt |
| Program Services | $234,974 | ProgramServicesAmt |
| Management And General | $1,116,408 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,092 | TotalAmt |
| Program Services | $59,596 | ProgramServicesAmt |
| Management And General | $42,496 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,560,119 | TotalAmt |
| Program Services | $2 | ProgramServicesAmt |
| Management And General | $1,560,117 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,121,307 | TotalAmt |
| Program Services | $2,264,303 | ProgramServicesAmt |
| Management And General | $2,857,004 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,888,422 | TotalAmt |
| Program Services | $121,719 | ProgramServicesAmt |
| Management And General | $4,766,703 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $9,222,557 | $9,257,623 | -$35,066 |
| IL MEDICAID TAX ASSESSM | $7,512,945 | $7,512,945 | |
| PROVISION FOR BAD DEBT | $5,460,096 | $5,460,096 | |
| NON-MEDICAL SUPPLIES | $1,580,745 | $1,300,507 | $280,238 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,087,767 | TotalAmt |
| Program Services | $3,558,228 | ProgramServicesAmt |
| Management And General | $4,529,539 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,131,117 | TotalAmt |
| Program Services | $73,568,970 | ProgramServicesAmt |
| Management And General | $43,562,147 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,793,979 | BOYAmt |
| EOY | $8,080,779 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,683,536 | BOYAmt |
| EOY | $6,492,228 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,998,649 | BOYAmt |
| EOY | $21,869,359 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,027,308 | BOYAmt |
| EOY | $970,432 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,362,379 | BOYAmt |
| EOY | $1,176,713 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $129,687,218 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $96,547,767 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,638,364 | BOYAmt |
| EOY | $33,139,451 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,293,461 | BOYAmt |
| EOY | $17,299,833 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,761,457 | BOYAmt |
| EOY | $18,941,715 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,559,133 | BOYAmt |
| EOY | $107,970,510 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,192,063 | BOYAmt |
| EOY | $14,103,129 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,013,014 | BOYAmt |
| EOY | $129,029 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,882,009 | BOYAmt |
| EOY | $18,567,547 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,898,755 | BOYAmt |
| EOY | $42,062,020 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,985,841 | BOYAmt |
| EOY | $74,861,725 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,271,416 | BOYAmt |
| EOY | $31,181,939 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,301,876 | BOYAmt |
| EOY | $1,926,846 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,573,292 | BOYAmt |
| EOY | $33,108,785 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,559,133 | BOYAmt |
| EOY | $107,970,510 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,908,338 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$124,005 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$6,248,840 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $190,000 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $57,716 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $247,716 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | HOSPITAL REPRESENTATIVES HAVE DIRECT CONTACT WITH LEGISLATORS, THEIR STAFF, AND OFFICIALS WITHIN THE ADMINISTRATION REGARDING ISSUES RELATED TO THE PROVISION OF HEALTHCARE AND HEALTHCARE FINANCING. HOSPITAL REPRESENTATIVES HAVE ENGAGED IN DIRECT MEETINGS WITH LEGISLATORS, LEGISLATIVE STAFF, AND AGENCY STAFF. THEY HAVE ALSO HAD PHONE CONVERSATIONS AND CORRESPONDED BY EMAIL. WRITTEN COMMUNICATION IN THE FORM OF MEMOS AND LETTERS IS ALSO USED. ADDITIONALLY, A PORTION OF MEMBERSHIP DUES PAID TO THE ILLINOIS HOSPITAL ASSOCIATION AND THE METROPOLITAN HEALTHCARE COUNCIL ARE USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,529,913 | OtherCostOrOtherBasisAmt |
| Book Value | $4,529,913 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,253,795 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,208,706 | DepreciationAmt |
| Book Value | $13,045,089 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,602,004 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,082,119 | DepreciationAmt |
| Book Value | $519,885 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $73,387,224 | OtherCostOrOtherBasisAmt |
| Depreciation | $59,256,942 | DepreciationAmt |
| Book Value | $14,130,282 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $914,282 | OtherCostOrOtherBasisAmt |
| Book Value | $914,282 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,139,451 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INSURANCE RECOVERIES RECEIVABLE | $5,308,230 |
| PROPERTY HELD FOR FUTURE USE | $1,189,446 |
| INVESTMENT IN JOINT VENTURE | $8,359,018 |
| DUE FROM AFFILIATES | $102,946 |
| BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION | $1,766,846 |
| INVESTMENT IN SUBSIDIARY | $1,178,713 |
| OTHER ASSETS | $1,036,516 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $18,941,715 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED MALPRACTICE LIABILITY | $21,421,366 |
| CONDITIONAL ASSET RETIREMENT OBLIGATION | $2,757,600 |
| NET PENSION LIABILITY | $15,781,697 |
| DUE TO THIRD PARTY PROGRAMS | $2,086,915 |
| EQUIPMENT LOANS | $14,442 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $42,062,020 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2012. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 600.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,555,287 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,555,287 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $59,436,635 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $63,422,313 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$3,985,678 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03500 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $61,991,922 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $63,422,313 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$1,430,391 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05790 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $479,363 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $519,743 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$40,380 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,331,290 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,890,474 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$559,184 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,810,653 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,410,217 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$599,564 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,802,575 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $65,832,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$2,029,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06290 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,460,096 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $23,001,995 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $21,161,575 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,840,420 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CENTURY PHO INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | TO OBTAIN AND MANAGE CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS. | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.50000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 0.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.50000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 N FRANCISCO | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60660 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.NAHOSPITAL.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2016/01/CHNA-2014.PDF | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2016/01/CHNA-2014.PDF | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 600.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| NORWEGIAN AMERICAN HOSPITAL, INC. | PART V, SECTION B, LINE 22D: THE HOSPITAL DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO THE FAP-ELIGIBLE INDIVIDUALS BY CALCULATING THE UNINSURED PATIENT DISCOUNT AMOUNT AND APPLYING IT TO PATIENT ACCOUNT. THE DISCOUNT AMOUNT IS CALCULATED BY SUBTRACTING FROM 100% THE PRODUCT OF THE HOSPITAL'S COST TO CHARGE RATIO (FROM WORKSHEET C PART 1 FROM THE MEDICARE COST REPORT) AND 135% (MEDICARE COST ALLOWED TO CHARGE TO UNINSURED PATIENTS). NORWEGIAN AMERICAN HOSPITAL'S UNINSURED DISCOUNT FOR FY 2015 IS 60% AS ROUNDED UP FROM THE CALCULATION AS SHOWN BELOW. 2014 COST TO CHARGE RATIO = 29.27%29.27% X 135% = 39.51%100% - 39.51% = 60.49% |
| PART V, LINE 16B, FAP WEBSITE: | HTTP://WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2015/11/FB-300-FINANCIAL-ASSISTANCE.PDF |
| PART V, LINE 16B, FAP APPLICATION WEBSITE: | HTTP://WWW.NAHOSPITAL.ORG/WP-CONTENT/UPLOADS/2015/11/ASSISTANCE.PDF |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| NORWEGIAN AMERICAN HOSPITAL, INC. PART V, SECTION B, LINE 16A WEBSITE: | SEE PART V |
| NORWEGIAN AMERICAN HOSPITAL, INC. PART V, SECTION B, LINE 16B WEBSITE: | SEE PART V |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NORWEGIAN AMERICAN HOSPITAL USES THE FPG TO DETERMINE FREE AND DISCOUNTED CARE. PATIENTS WITH ELIGIBLE ASSETS AND INCOME ABOVE THE 200%, BUT NOT EXCEEDING 600% OF FPG, ADJUSTED FOR FAMILY SIZE, WILL RECEIVE A DISCOUNT ON MEDICALLY NECESSARY SERVICES PROVIDED TO THEM, BASED UPON A SLIDING SCALE ESTABLISHED BY HOSPITAL POLICY. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED ON LINES 7A AND 7B IS THE COST-TO-CHARGE RATIO DERIVED FROM THE IRS'S SCHEDULE H, WORKSHEET 2 INSTRUCTIONS. NORWEGIAN AMERICAN HOSPITAL USED ITS INTERNAL ACCOUNTING RECORDS TO CALCULATE THE AMOUNTS REPORTED IN LINES 7E AND 7F.MANAGEMENT DOES NOT CONCUR WITH WORKSHEET 3 INSTRUCTIONS IN REGARDS TO INCLUDING THE PROVIDER TAX EXPENSES IN WITH COLUMN (C) TOTAL COMMUNITY BENEFIT EXPENSE, AS WELL AS INCLUDING THE PROVIDER TAX REVENUE IN COLUMN (D) DIRECT OFFSETTING REVENUE. IF THESE WERE REMOVED FROM THE WORKSHEET 3 CALCULATION, NET COMMUNITY BENEFIT EXPENSE ON LINE 7B, COLUMN (B) WOULD HAVE BEEN $9,299,472 OR 8.33 PERCENT OF TOTAL EXPENSE. THIS WOULD HAVE INCREASED THE TOTAL NET COMMUNITY BENEFIT EXPENSE ON LINE 7K, COLUMN (E) FROM ($2,029,955) TO $11,255,195 OR 10.08 PERCENT OF TOTAL EXPENSE. |
| PART I, LINE 7G: | NORWEGIAN AMERICAN HOSPITAL DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES. |
| PART I, LN 7 COL(F): | THERE WAS A TOTAL OF BAD DEBT EXPENSE OF $5,460,096 SUBTRACTED FROM TOTAL EXPENSES. |
| PART III, LINE 4: | AUDITED FINANCIAL STATEMENTS FOOTNOTE REGARDING BAD DEBT EXPENSE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (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), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS 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 STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) 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 TO BE UNCOLLECTIBLE.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX.ALL OF THE HOSPITAL'S PATIENTS AUTOMATICALLY QUALIFY FOR FINANCIAL ASSISTANCE IF THEY DO NOT HAVE INSURANCE (THEY ARE CONSIDERED "SELF-PAY AND GIVEN 60% DISCOUNT). ONCE THE HOSPITAL DETERMINES THAT A PATIENT HAS NO INSURANCE, THEY AUTOMATICALLY DISCOUNT THE BILL BY 60%. SO THERE ARE NO INDIVIDUALS THAT MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE AND DID NOT RECEIVE ANY. BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WITH INSURANCE THAT MAY NOT HAVE PAID THEIR SHARE/CO-PAY OF THE BILL OR ATTRIBUTABLE TO PATIENTS THAT RECEIVED FINANCIAL ASSISTANCE (60% DISCOUNT) BUT DID NOT PAY THEIR 40%. THEREFORE, ZERO HAS BEEN REPORTED IN PART III, LINE 3.PART III, SECTION B: MANAGEMENT DOES NOT CONCUR WITH PART III, SECTION B MEDICARE, LINE 6 REPORTING INSTRUCTIONS REGARDING UTILIZING ALLOWABLE COSTS FROM MEDICARE WORKSHEET B. IF MANAGEMENT USED THE ACTUAL AMOUNT OF COSTS TO CARE FOR MEDICARE PATIENTS, ALLOWABLE COSTS WOULD HAVE BEEN REPORTED AS $32,070,982 AND THE AMOUNT OF (SHORTFALL) WOULD HAVE BEEN ($9,068,987). |
| PART III, LINE 8: | COSTING METHODOLOGY USED IS THE MEDICARE COST REPORT WHICH UTILIZES A STEP-DOWN METHOD OF COST ALLOCATION. THIS ORDER OF ALLOCATION FOR OVERHEADS HAS BEEN PREDETERMINED BY MEDICARE AND IS PRINTED OUT ON THE COST REPORT. THE MOST COMMON OVERHEAD IS ALLOCATED FIRST TO ALL OTHER OVERHEADS AND THE PATIENT CARE COST CENTERS. THEN THAT COST CENTER IS CLOSED AND THE NEXT MOST COMMON OVERHEAD IS ALLOCATED. THIS IS CONTINUED UNTIL ALL THE OVERHEADS ARE ALLOCATED OUT. THE SEPTEMBER 30, 2014 COST REPORT DID NOT SHOW A SHORTFALL. |
| PART III, LINE 9B: | THE COLLECTION POLICIES CONTAIN PROVISIONS ON THE COLLECTIONS PRACTICES TO BE FOLLOWED FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. SUCH PRACTICES ARE: CHARITY - UPON APPROVAL OF PATIENT'S CHARITY APPLICATION THE COLLECTIONS ARE STOPPED, PATIENT'S BALANCE IS WRITTEN OFF ACCORDINGLY AND PATIENT IS NOTIFIED IN WRITING; UNINSURED PATIENT - UPON DETERMINATION THAT PATIENT HAS NO INSURANCE, 60% DISCOUNT IS APPLIED TO PATIENT ACCOUNT AND PATIENT IS NOTIFIED IN WRITING FOR THE OUTSTANDING BALANCE. |
| PART VI, LINE 2: | NORWEGIAN AMERICAN HOSPITAL'S COMMUNITY BENEFIT PLAN WAS DEVELOPED TO ESTABLISH STRATEGIES FOR IMPROVING ACCESS TO CARE AND POSITIVELY AFFECTING THE HEALTH OF THE COMMUNITIES THAT IT SERVES. ADDITIONALLY, THE PLAN SETS THE COURSE FOR STRENGTHENING EXISTING PARTNERSHIPS AND BUILDING NEW ONES WITH INDIVIDUALS AND ORGANIZATIONS WITHIN NORWEGIAN AMERICAN HOSPITAL'S PRIMARY SERVICE AREAS IN ORDER TO LEVERAGE AND MAXIMIZE THE IMPACT OF ITS PROGRAMS. DEVELOPMENT OF THE PLAN IS DERIVED THROUGH THE STRATEGIC PLANNING OF NORWEGIAN AMERICAN HOSPITAL'S BOARD OF TRUSTEES AND THROUGH ORGANIZATIONAL INVOLVEMENT IN COMMUNITY PARTNERSHIPS. THE GOALS DEVELOPED FOR PLANNING COMMUNITY SERVICES INVOLVED MEETING WITH PHYSICIANS AND COMMUNITY PARTNERS TO DETERMINE WHERE THE GAPS OF CARE AND SERVICES COULD BE FILLED THROUGH NORWEGIAN AMERICAN HOSPITAL INVOLVEMENT. IN DEVELOPING ITS COMMUNITY BENEFITS PLAN, NORWEGIAN AMERICAN HOSPITAL SET THE FOLLOWING GOALS:1) SERVE AS A CATALYST/CONVENER FOR THE OBESITY AND DIABETES INITIATIVES IN HUMBOLDT PARK.2) HOST COMMUNITY-BASED EDUCATION EVENTS SUCH AS ESL, LIFE SKILLSTRAINING, JOB SEEKING SKILLS, ETC.3) PROMOTE INITIATIVES THAT ENHANCE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED.4) NORWEGIAN AMERICAN HOSPITAL LEADERSHIP TO ASSUME AN ACTIVE ROLE IN COMMUNITY BASED ORGANIZATIONS BOARDS, TASK FORCES AND COMMUNITY EVENTS. |
| PART VI, LINE 3: | NORWEGIAN AMERICAN HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS, WHO MAY BE BILLED FOR PATIENT CARE, ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY ON ITS INTRANET AND THROUGH FLYERS. PATIENTS ARE PROVIDED THESE POLICIES AT THE TIME OF REGISTRATION AND ARE ALSO AVAILABLE UPON REQUEST |
| PART VI, LINE 4: | NORWEGIAN AMERICAN HOSPITAL SERVES A PRIMARY COMMUNITY AREA AND A SECONDARY COMMUNITY AREA.THE PRIMARY COMMUNITY AREA CONSISTS OF THE FOLLOWING AREAS, ZIP CODES AND POPULATION:- AUSTIN- BELMONT-CRAGIN- HERMOSA- HUMBOLDT PARK- LOGAN SQUARE- WEST TOWN- IRVING PARK- NORTH CENTER- EAST GARFIELD PARK- WEST GARFIELD PARK- NORTH LAWNDALE WHITE HISPANIC AFRICAN-AMERICANPRIMARY ZIP CODES POPULATION - PERCENTAGE 60618 46,754 51% 42,771 46% 2,559 3%60622 33,399 64% 15,289 29% 3,860 7%60624 958 3% 1,160 3% 35,987 94%60639 8,056 9% 68,639 76% 13,712 15%60647 34,357 39% 47,697 55% 5,237 6%60651 2,538 4% 21,756 34% 39,973 62%THE SECONDARY AREA CONSISTS OF THE FOLLOWING AREAS, ZIP CODES AND POPULATION:- ARCHER HEIGHTS- BRIGHTON PARK- CAGE PARK- GARFIELD RIDGE- WEST ELSDON- SOUTH LAWNDALE- PORTAGE PARK- PULLMAN WHITE HISPANIC AFRICAN-AMERICANPRIMARY ZIP CODES POPULATION - PERCENTAGE 60612 8,738 26% 4,319 13% 20,412 61%60623 2,301 2% 59,438 65% 30,369 33%60625 47,050 60% 28,304 36% 3,297 4%60632 12,939 14% 76,902 84% 1,485 2%60641 32,054 45% 38,057 53% 1,552 2%60644 1,506 3% 1,583 3% 45,559 94%60640 44,239 67% 9,923 15% 11,628 18%NORWEGIAN AMERICAN HOSPITAL'S AGE FOR THE FISCAL YEAR WAS AS FOLLOWS:AGE PERCENTAGE0-14 2%15-44 44%45-64 37%65-74 9%75+ 8%NORWEGIAN AMERICAN HOSPITAL'S RACE AND ETHNICITY FOR THE FISCAL YEAR WAS AS FOLLOWS:RACE PERCENTAGEASIAN 1%AMERICAN INDIAN OR NATIVE ALASKAN 0%BLACK OR AFRICAN-AMERICAN 43%WHITE 13%OTHER 43%ETHNICITY PERCENTAGEHISPANIC 41%NON-HISPANIC 59% |
| PART VI, LINE 5: | IN ADDITION TO PROVIDING QUALITY INPATIENT AND OUTPATIENT SERVICES, NORWEGIAN AMERICAN HOSPITAL REACHES BEYOND ITS WALLS AND INTO COMMUNITIES THROUGH AN ARRAY OF ACTIVITIES AND PROGRAMS DESIGNED AND DELIVERED TO BENEFIT THE COMMUNITIES IT SERVES. THESE COMMUNITY BENEFITS INCLUDE: - CARE THAT IS PROVIDED FREE, SUBSIDIZED OR WITHOUT FULL REIMBURSEMENT FROM MEDICARE, MEDICAID OR OTHER GOVERNMENT INSURANCE PROGRAMS.-SERVICES RESPONDING TO UNIQUE COMMUNITY NEEDS, SUCH AS DIABETES SERVICES, EMERGENCY CARE, BEHAVIORAL HEALTH SERVICES, SUBSTANCE ABUSE, PEDIATRIC CARE-A-VAN; AS WELL AS HEALTH SCREENINGS, IMMUNIZATION PROGRAMS, SCHOOL-BASED HEALTH CARE AND OTHER COMMUNITY OUTREACH PROGRAMS.-EDUCATION TO TRAIN PHYSICIANS, NURSES, RADIOLOGY TECHNICIANS, AND OTHER HIGHLY SKILLED HEALTH CARE PROFESSIONALS.-VOLUNTEER SERVICES PROVIDED BY HOSPITAL EMPLOYEES WHO VOLUNTEER IN THEIR COMMUNITIES AND COMMUNITY MEMBERS WHO VOLUNTEER AT THE HOSPITAL.-LANGUAGE-ASSISTANCE SERVICES, SUCH AS TRANSLATORS, SIGNAGE, FORMS, BROCHURES, PATIENT EDUCATION MATERIALS AND OTHER INFORMATION IN LANGUAGES OTHER THAN ENGLISH.-DONATIONS BY NORWEGIAN AMERICAN HOSPITAL OF MEETING AND CLINIC SPACE, AS WELL AS OTHER ASSISTANCE TO COMMUNITY GROUPS. |
| PART VI, LINE 6: | NOT AFFILIATED |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SANCHEZ JOSE R | ||||||||||||||
| PRESIDENT AND CEO (EX-OFFICIO) | $535,500 | $0 | $0 | $0 | $16,800 | $0 | $417,165 | $0 | $4,310 | $0 | $973,775 | $0 | $0 | $0 |
| ABHA AGRAWAL | ||||||||||||||
| VP, MEDICAL AFFAIRS/COO | $430,094 | $0 | $100,000 | $0 | $0 | $0 | $5,200 | $0 | $16,976 | $0 | $552,270 | $0 | $0 | $0 |
| GARY KRUGEL | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $160,000 | $0 | $62,888 | $0 | $0 | $0 | $4,458 | $0 | $546 | $0 | $227,892 | $0 | $0 | $0 |
| NARAYAN RAVISHANKAR MD | ||||||||||||||
| ANESTHESIOLOGIST | $406,323 | $0 | $0 | $0 | $0 | $0 | $5,200 | $0 | $10,424 | $0 | $421,947 | $0 | $0 | $0 |
| MAX IZBICKI MD | ||||||||||||||
| PHYSICIAN, OB/GYN | $326,980 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $200 | $0 | $327,180 | $0 | $0 | $0 |
| QAISER JAMAL MD | ||||||||||||||
| CHIEF HOSPITALIST | $245,785 | $0 | $375 | $0 | $0 | $0 | $4,457 | $0 | $26,468 | $0 | $277,085 | $0 | $0 | $0 |
| JANA RICHARDS MD | ||||||||||||||
| HOSPITALIST, OB/GYN | $222,838 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,180 | $0 | $225,018 | $0 | $0 | $0 |
| DAGOBERTO CAMACHO MD | ||||||||||||||
| MEDICAL DIRECTOR | $207,282 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,466 | $0 | $216,748 | $0 | $0 | $0 |
| ANTHONY EVERS | ||||||||||||||
| FORMER CHIEF FINANCIAL OFFICER | $117,565 | $0 | $0 | $0 | $90,168 | $0 | $0 | $0 | $6,512 | $0 | $214,245 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | NAH PAYS MEMBERSHIP DUES ON BEHALF OF JOSE SANCHEZ TO A SOCIAL CLUB. THE MEMBERSHIP IS USED EXCLUSIVELY FOR BUSINESS PURPOSES. |
| PART I, LINES 4A-B | FORMER CFO ANTHONY EVERS RECEIVED A SEVERANCE PAYMENT OF $90,168 IN APRIL OF 2014. JOSE SANCHEZ PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. $417,165 WAS CREDITED TO HIS ACCOUNT IN THE FISCAL YEAR 2015. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 | ||||||||
| A | 861091967 | 45200FMQ9 | 2008-08-15 | $4,500,000 | SEE PART VI | 0 | 0 | 0 |
| ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 | ||||||||
| B | 861091967 | 45200FMS5 | 2008-08-15 | $5,000,000 | SEE PART VI | 0 | 0 | 0 |
| ILLINOIS FINANCE AUTHORITY REVENUE BONDS SERIES 2008 | ||||||||
| C | 861091967 | 45200FMT3 | 2008-08-15 | $14,450,000 | SEE PART VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $4,500,000 | $798,333 | $1,159,612 | $157,619 | $2,384,436 | 2008 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $5,000,000 | $798,334 | $1,159,612 | $157,619 | $2,884,435 | 2008 | Yes (1) | 0 | Yes (1) | Yes (1) |
| C | $14,450,000 | $798,333 | $1,159,612 | $157,620 | $12,334,436 | 2008 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THE ARBITRAGE GROUP | |||||||||||
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| THE ARBITRAGE GROUP | |||||||||||
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| THE ARBITRAGE GROUP | |||||||||||
| C | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K SUPPLENTAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | THE SERIES 2008 BOND PROCEEDS, TOGETHER WITH OTHER AVAILABLE FUNDS, WERE USED TO REFUND THE OUTSTANDING PRINCIPAL AMOUNTS OF CERTAIN BONDS IN THE AMOUNT OF $3,467,000, TO PAY OR REIMBURSE THE HOSPITAL FOR THE PAYMENT OF THE COST OF ACQUIRING, CONSTRUCTING AND EQUIPPING CERTAIN OF THE HOSPITAL'S HEALTH CARE FACILITIES, TO FUND A DEBT SERVICE RESERVE FUND FOR THE BENEFIT OF THE SERIES 2008 BONDS, AND TO PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2008 BONDS. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN MONTEVERDE MD | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | TRUSTEE | RelationshipDescriptionTxt |
| Transaction | $192,999 | TransactionAmt |
| Transaction | THE HOSPITAL PAID ST. JOHN HEART CLINIC S.C. FOR MEDICAL SERVICES. TRUSTEE JOHN MONTEVERDE OWNS 100% OF ST. JOHN HEART CLINIC. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD RETAINS THE SERVICES OF AN INDEPENDENT CPA FIRM TO PREPARE THE ORGANIZATION'S FORM 990. MEMBERS OF THE FISCAL SERVICES DEPARTMENT, THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER REVIEW THE COMPLETED FORM 990 AND PROVIDE A FULL COPY TO ALL MEMBERS OF THE FINANCE & AUDIT COMMITTEE. AFTER FORM 990 IS REVIEWED AND ACCEPTED BY THE FINANCE & AUDIT COMMITTEE, A COPY IS MADE AVAILABLE TO ALL VOTING MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. THE GOVERNING BODY IS PROVIDED A REASONABLE AMOUNT OF TIME TO REVIEW THE RETURN AND ASK ANY QUESTIONS DIRECTLY TO ORGANIZATION MANAGEMENT OR THE CONTACT AT THE INDEPENDENT CPA FIRM PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL TRUSTEES, OFFICERS, AND KEY EMPLOYEES AND KEY PHYSICIANS (AS DEFINED IN THE BOARD'S CONFLICT OF INTEREST POLICY) OF THE CORPORATION ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. IN ADDITION, ALL INDEPENDENT CONTRACTORS WHO PROVIDE SERVICES AND/OR MATERIALS TO THE CORPORATION IN EXCHANGE FOR $20,000 OR MORE IN PAYMENT DURING ANY FISCAL YEAR SHALL BE SUBJECT TO THESE PROVISIONS. ALL PERSONS SUBJECT HERETO SHALL BE HEREINAFTER REFERRED TO AS "COVERED PERSONS." THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION IS RESPONSIBLE FOR PUBLICIZING THE PROVISIONS OF THIS ARTICLE TO THE PERSONS AFFECTED THEREBY. NO PERSON SHALL BECOME A TRUSTEE, OFFICER, OR EMPLOYEE OR MEDICAL DEPARTMENT DIRECTOR OF THE CORPORATION WITHOUT FIRST ACKNOWLEDGING IN WRITING TO THE CORPORATION THAT HE OR SHE HAS REVIEWED, FULLY UNDERSTANDS AND IS IN COMPLIANCE WITH THE PROVISIONS OF THE CONFLICT OF INTEREST POLICY. ALL COVERED PERSONS SHALL PROMPTLY DISCLOSE TO THE BOARD OF TRUSTEES OF THE CORPORATION ALL SUBSTANTIVE POTENTIAL CONFLICTS OF INTEREST WHICH SUCH PERSON DISCOVERS OR WHICH IS BROUGHT TO HIS OR HER ATTENTION. SUCH DISCLOSURE SHALL INCLUDE SUBMISSION TO THE BOARD OF A WRITTEN STATEMENT OF THE FACTS SURROUNDING THE CONFLICT OF INTEREST AND AN OPPORTUNITY TO MAKE A BRIEF ORAL STATEMENT TO THE BOARD WITH RESPECT TO THE MATTER IN QUESTION. AN ANNUAL DISCLOSURE STATEMENT SHALL BE CIRCULATED TO ALL COVERED PERSONS TO ASSIST THEM IN CONSIDERING SUCH DISCLOSURES. IN ADDITION, THE POLICY IS MONITORED PERIODICALLY THROUGHOUT THE YEAR FOR ANY CONFLICTS OF INTEREST. PROMPT DISCLOSURE NOTICES OF CONFLICT SHALL BE FILED WITH THE PRESIDENT OF THE CORPORATION OR ANY OTHER PERSON DESIGNATED BY HIM FROM TIME TO TIME TO RECEIVE SUCH NOTIFICATIONS. ALL DISCLOSURE NOTICES RECEIVED HEREUNDER SHALL BE NOTED FOR RECORD IN THE MINUTES OF A MEETING OF THE BOARD OF TRUSTEES. THE PRESENCE OF THE TRUSTEE WHO IS DIRECTLY OR INDIRECTLY A PARTY TO THE TRANSACTION IN QUESTION OR A TRUSTEE WHO IS OTHERWISE NOT DISINTERESTED MAY BE COUNTED IN DETERMINING WHETHER A QUORUM IS PRESENT FOR THE PURPOSE OF THE MEETING, BUT SHALL NOT BE PRESENT OR HAVE A VOTE WHEN THE BOARD OF TRUSTEES OR A COMMITTEE OF THE BOARD DISCUSSES AND TAKES ACTION ON THE TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER/VICE PRESIDENT MEDICAL AFFAIRS AND CHIEF FINANCIAL OFFICER WERE REVIEWED BY AN EXTERNAL ORGANIZATION SPECIALIZING IN COMPENSATION MANAGEMENT. THE RESULTS OF THAT REVIEW WERE PROVIDED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | NORWEGIAN AMERICAN HOSPITAL INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES NONMEDICAL: PROGRAM SERVICE EXPENSES 1,386,478. MANAGEMENT AND GENERAL EXPENSES 1,663,810. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,050,288. OUTSOURCED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 512,551. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 512,551. TEMP AGENCY: PROGRAM SERVICE EXPENSES 4,372,317. MANAGEMENT AND GENERAL EXPENSES 404,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,777,068. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 5,304,373. MANAGEMENT AND GENERAL EXPENSES 893,018. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,197,391. CONSULTING FEES: PROGRAM SERVICE EXPENSES 4,439. MANAGEMENT AND GENERAL EXPENSES 246,717. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 251,156. LAB SERVICES FOR CLINICS: PROGRAM SERVICE EXPENSES 18,345. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,345. |
| FORM 990, PART XI, LINE 9: | INCOME (LOSS) FROM NORWEGIAN AMERICAN HOSPITAL FOUNDATION -633,026. INCOME (LOSS) FROM INVESTMENTS IN JOINT VENTURES 462,313. PENSION RELATED CHANGES, OTHER THAN NET PERIOD PENSION COST -6,048,049. NET ASSETS RELEASED FROM RESTRICTION -30,078. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60622 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363257131 | EIN |
| Primary Activities | SUPPORTING FOUNDATION | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTENNIAL MEDICAL MANAGEMENT CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1044 NORTH FRANCISCO AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60622 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363394548 | EIN |
| Primary Activities | OUTPATIENT PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORWEGIAN AMERICAN HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $599,971 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,210,572 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| NORWEGIAN AMERICAN HOSPITAL FOUNDATION | ||
| A | $4,800 | BOOK VALUE |
| CENTENNIAL MEDICAL MANAGEMENT CORPORATION | ||
| A | $9,722 | BOOK VALUE |
| NORWEGIAN AMERICAN HOSPITAL FOUNDATION | ||
| C | $517,885 | BOOK VALUE |