2015-05-15T09:16:24-05:00 2014-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2013-07-01 362338884 Northern Illinois Medical Center % David Tomlinson NORT 8157885800 4201 Medical Center Drive Suite McHenry IL 60050 David Tomlinson SVP, CIO, CFO 6142492300 2015-05-12 true Mollie P Longhouse P00294881 6142492300 2013 2016-03-07 17:11:31Z Michael S Eesley 385 Millennium Drive Crystal Lake IL 60012 249301952 false X www.centegra.org X 1956 IL See Schedule O, Attachment 1 14 6 1263 237 399157 -28022 480699 286949 219801434 230928713 8915656 5805848 3240442 5804995 232438231 242826505 0 0 0 0 85274672 86072442 0 0 0 128767153 139786632 214041825 225859074 18396406 16967431 260857048 301995790 112210005 124474340 148647043 177521450 X The primary mission of Northern Illinois Medical Center is to provide quality health care services with innovative and responsible use of resources and promote wellness for the greater McHenry County area. Northern Illinois Medical Center's services include, but are not limited to: 179 licensed-bed Comprehensive Medical Center (39,456 patient days in fiscal year ending June 30, 2014), Level Two Trauma Center, 24 hr Emergency Medicine Physicians, On-site Flight for Life Helicopter (374 flights in fiscal year ending June 30, 2014), Portable TDD (Telephone Device for the Deaf) on site, Center for New Life including Level Two Nursery (2,181 newborn patient days in fiscal year ending June 30, 2014), Antenatal Testing Center, Prenatal Classes, Hello Daddy and Dial-A-Dad pagers, Very Important Sibling Classes, Lamaze Classes, Breastfeeding Classes, Intensive and Intermediate Care Units, Sage Cancer Center (17,515 radiation oncology procedures and 2,852 medical oncology visits in fiscal year e false false 198062413 231552168 Northern Illinois Medical Center, in conjunction with Centegra Health System and Memorial Medical Center, sponsors or hosts many support groups for its patients, as well as the community. Each of the following ongoing support groups is held at the Medical Center or in the community and is free of charge. By supporting these groups, the Medical Center is able to provide one or all of the following three benefits: Staff professionals who act either as group facilitators or guest speakers, free education about the programs available, and space offered free of charge. Programs include: Alcoholics' Anonymous, a twelve-step program for individuals recovering from alcohol dependence, Alcoholics' Anonymous, Women's Group, a special group for women, Al-Anon, a twelve-step program group for co dependent individuals, Arthritis Support group, Bariatric Support Group for those individuals who have had weight loss surgery, Better Breathers Club for those with pulmonary disease and their families, Caregiver's Support Group for those who care for someone with a chronic or life-threatening illness, Diabetes Support Group for individuals with diabetes and their families, Families' Anonymous for families with chemically dependent members, Fibromyalgia Support Group for those suffering from Fibromyalgia, Get Help Live Longer, a smoking cessation education and support group, Hat's Off for women with any type of cancer, and Headwinds for survivors of traumatic brain injury and their family members/care givers. This group hosts speakers including medical professionals who specialize in traumatic brain injuries. Northern Illinois Medical Center participates in conjunction with the Pioneer Center. Participants receive information on topics such as dealing with behavioral problems and the financial issues of long-term care. Living with Grief, sponsored by Centegra pastoral care, offers support for adults grieving the loss of a loved one. Make Today Count is a group for anyone with a life-threatening illness as well as their family and friends. The purpose of the program is to help members cope and gain emotional strength. The Group also puts participants in touch with professional resources available to help them. The McHenry County Crisis Line is available for 24 hour mental health information, referral service, and crisis assistance. Multiple Sclerosis (MS) Support Group is under the greater Illinois Chapter of the National Multiple Sclerosis Society. The group is open to persons with MS, their family members and others interested in treatment and management of the disease. Specialists are often invited to speak to the group regarding the symptoms of the disease. NAMI addresses mental illness. Narcotics Anonymous is a twelve-step support program for those recovering from narcotic dependence. Nuts and Bolts is a unique support group for stroke survivors who are 55 years of age or younger. The emphasis of this group is on assisting the families as they adapt to the special lifestyle changes of the young stroke survivor. The group has earned attention from the National Stroke Conference leaders as it is one of the first support groups of its type. Perinatal Grief Support Group is for anyone who has experienced the loss of a newborn or an infant through miscarriage, ectopic pregnancy, or Sudden Infant Death Syndrome (SIDS). St. Peregrine's Cancer Support Group is a non-denominational support group for patients and their families and friends. What's Aphasia? is a group for stroke survivors and family members who have an impairment of their ability to speak or comprehend words. Wingspan is a group that provides the opportunity of open discussions, question and answer sessions, lectures, and social events for people recovering from strokes as well as their families. Y-Me Breast Cancer Support Program is a national program designed to let participants listen to physicians, survivors, social workers, and nurses who have been invited to speak on topics such as handling anger, considered prostheses, and recent concerns about breast implant risks. Northern Illinois Medical Center, in conjunction with Centegra Health System and Memorial Medical Center, works in cooperation with McHenry County College and Health Bridge Fitness Center to provide a complete series of specialized training for those interested in developing their knowledge of emergency basics, or in pursuing a career in the emergency health care field. These programs are used extensively by local fire, EMS, and police departments. Northern Illinois Medical Center offers a variety of classes that can help people save lives. By sponsoring these classes, Northern Illinois Medical Center is helping the community in two ways; first, by building skills and confidence levels of the class participants; and second, by making trained help available for the community in case of emergencies. There are three levels of training available. The First Responder is designed to instruct laymen in the following skills: identifying the emergency situation, stabilizing the victim, and providing basic emergency care until emergency medical personnel arrive. The Emergency Medical Technician - Basic course provides a more in-depth study of the recognition and management of victims of traumatic injuries or medical emergencies, and it includes hospital clinical experience. This course enables the participant to become a State of Illinois licensed EMT-Basic. The Emergency Medical Technician - Paramedic program provides an intensive learning experience in the use of advanced life support procedures for the management of traumatic injuries and medical emergencies prior to arrival at the hospital. This course enables the participant to become a State of Illinois licensed Paramedic. An Emergency Medical Dispatcher Course designed to prepare individuals for employment as dispatchers for a public service agency providing dispatch to law enforcement, fire service, and/or Emergency Medical Service is also offered. Continuing education for licensing renewal is also provided. Northern Illinois Medical Center is a designated resource hospital for 16 rescue squads. The Medical Center also provided International Trauma Life Support training, Advanced Cardiac Life Support training, and Pediatric Advanced Life Support training. Centegra Health System is a learning center (clinical site) for students from a multitude of colleges and universities. Students have completed internships in programs such as nurse practitioner, nursing, nurse aide, physician assistant, social work, speech therapy, phlebotomy, diagnostic medical sonography, medical imaging, medical records, pharmacy, medical physics, surgical technology, professional counselor, substance abuse counselor, and medical assistant. Centegra Health System is also a learning site for 3rd and 4th year medical students from the University of Illinois at Rockford. Northern Illinois Medical Center was the first hospital in the state of Illinois to adopt the E.N.C.A.R.E. (Emergency Nurses Cancel Alcohol Related Emergencies) program which lets nurses tell teenagers exactly what they have learned on the job -- that alcohol causes death, disability, and pain to thousands of teenagers throughout the country every year. Northern Illinois Medical Center's Sage Cancer Center, together with the American Cancer Society and Gavers Community Cancer Foundation, sponsor various Cancer Awareness Programs. Each fall, a community cancer symposium is offered in partnership with McHenry County College. National physician experts are invited to speak to area residents. The Center offers colorectal cancer screenings, skin cancer screenings, and reduced fee PSA screenings. Cancer awareness also includes programs on reduction of risk for cancer through good nutrition and healthy lifestyle habits. Northern Illinois Medical Center also sponsors celebrations of cancer survivorship. The Sage Cancer Center participates in McHenry County Tobacco-Free Community Coalition, a community partnership developed to address the hazards of tobacco and develop a county wide smoking cessation campaign. The Sage Cancer Center participates in the McHenry County Breast Cancer Task Force, the Fox Valley Regional Health Initiatives Council of the American Cancer Society. The Cancer Center also provides a resource library for patients to learn more about their conditions through the use of computer research and book loans. Get Checked! is a cancer screening and education program designed to educate all residents about prevention and early detection for breast/colon/prostate/testicular cancers and to motivate all McHenry County residents to have their age appropriate cancer screenings completed. The Cancer Center delivers the message of cancer awareness and the importance of appropriate screenings through a variety of community outreach activities that include appearances at local schools, community groups, church groups, health fairs, business 198062413 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false true false false false false true true false false false true 1 0 true 1263 true true true false false false false false false false false false X 14 6 true true false false true true false true true false false false true true true true true true true true true IL X David Tomlinson 8157885800 385 Millennium Drive Crystal Lake IL 60012 Michael S Eesley CEO 0.0 40.0 X X 1553325 141386 Angela McAuley Board of Governors 0.0 2.0 X Charie Zanck Chairperson 0.0 3.0 X Charles Ruth Board of Governors 0.0 2.0 X Chris Newkirk Board of Governors 0.0 1.0 X Jack Porter Board of Governors 0.0 1.0 X Kathy Powell Board of Governors 0.0 3.0 X Luke Johnsos Board of Governors 0.0 2.0 X Micheal Luecht Board of Governors 0.0 4.0 X Mike Curran Vice Chairman 0.0 2.0 X Pat Morehead Treasurer 0.0 4.0 X Richard Lind Board of Governors 0.0 1.0 X 157825 3479 Terrence J Bugno Board of Governors 0.0 4.0 X Tom Carey Board of Governors 0.0 3.0 X William Cox Secretary 0.0 3.0 X David Tomlinson SVP/CIO/CFO 0.0 40.0 X 427445 50215 Jason R Sciarro President/COO 0.0 40.0 X 890680 87689 Rachel Sebastian VP Site Administrator 40.0 0.0 X 318092 49649 Belinda A Wagner Pharmacist 40.0 0.0 X 145644 4422 Connie K Secor Director 40.0 0.0 X 167571 0 4476 John G Geinopolos Medical Physicist 40.0 0.0 X 169701 25516 Susan H Corcoran Pharmacist 40.0 0.0 X 145225 25254 Todd A Meyers Chief Medical Physicist 40.0 0.0 X 177237 26546 1123470 3029275 418632 43 false true false McKesson Technologies PO Box 98347 Chicago IL 606938347 Computer Support 3992474 Sodexo Inc Affliates 4880 Payshere Circle Chicago IL 60674 Management Services 3480005 Dell Marketing LP PO Box 677654 Dallas TX 752676021 Computer Support 2441573 Cardiac Surgery Associates PO Box 153 Channahon IL 60410 Physician Services 938329 Total Home Health 780 S Mclean Blvd Elgin IL 60123 Home Med Equipment 759542 22 258469 28480 286949 ANCILLARY OUTPATIENT SERVICES 621110 137309041 137309041 ROUTINE PATIENT SERIVCES 621110 79444436 79444436 ANCILLARY INPATIENT SERVICES 621110 22987075 22987075 IDPA PROVIDER TAX REVENUE 621110 11844820 11844820 CHARITY CARE/ADMIN ALLOWANCE 621110 -20656659 -20656659 230928713 4768803 4768803 588 588 0 0 0 0 7510619 1285 6475447 1035172 1285 1036457 1036457 0 0 0 CAFETERIA SERVICES AND EDUCATION 722210 971790 971790 CHILD DAY CARE CENTER 624410 778356 399157 379199 RELATED COMPANY REVENUE 900099 627069 627069 3427780 623455 2804325 5804995 242826505 231552168 399157 10588231 X 0 0 0 0 367741 367741 0 69862353 61719196 8143157 897403 792802 104601 10081481 8906385 1175096 4863464 4296579 566885 978672 978672 0 0 36648 36648 0 0 8354854 1119359 7235495 15227 15227 35803249 35262409 540840 11357 6499 4858 0 2187083 958897 1228186 214492 189950 24542 0 85556 67180 18376 3263721 2883302 380419 0 10318858 9116093 1202765 2944148 2600978 343170 RELATED COMPANY - CHS 42520138 37888868 4631270 BAD DEBT 12284453 12284453 RELATED COMPANY - LAB 5487963 5487963 IDPA PROVIDER TAX 10031176 10031176 5249037 4435097 813940 225859074 198062413 27796661 0 247838 50285 15083029 18364355 0 0 29906359 38059244 0 0 0 0 0 0 3987439 4224410 1257686 1590094 201164032 137023036 66861156 64140996 90855755 107369678 0 0 4533676 6135475 111005 74009 48013105 61987244 260857048 301995790 20172535 24625530 0 0 0 0 88835515 96263546 0 0 0 0 0 0 0 0 3201955 3585264 112210005 124474340 X 147237552 174778073 1409491 2743377 0 0 148647043 177521450 260857048 301995790 X 16967431 10452793 1454183 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 36648 36648 false Description of Lobbying Activities Schedule C, Part II-B, Line 1i As part of our dues payments to the Illinois Hospital Association, American Hospital Association and Metropolitan Chicago Healthcare Council, approximately 30% of dues, on average, are allocable to lobbying activities. 65000 65000 81429870 39172778 42257092 1764249 1578972 185277 117400804 96271286 21129518 504109 504109 64140996 INTERCOMPANY RECEIVABLES 58297192 OTHER RECEIVABLES 3690052 61987244 0 PROFESSIONAL LIABILITY 3585264 3585264 X FIN 48 (ASC 740) Footnote Schedule D, Part X, Line 2 ACS Topic 740, Income Taxes, addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded on the consolidated financial statements. Under ACS Topic 740, the Health System must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has the greater than fifty percent likelihood of being realized upon ultimate settlement. ASC Topic 740 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. As of June 30, 2014 and 2013 the Health System does not have a liability for unrecognized tax benefits. true true X true X true X 600. true true true false true true 4816086 4816086 0.02130 17207043 10327923 6879120 0.03050 22023129 10327923 11695206 0.05180 15 3196 149724 44830 104894 0.00050 4 208 184931 184931 0.00080 19 3404 334655 44830 289825 0.00130 19 3404 22357784 10372753 11985031 0.05310 true 3561263 2445945 60837043 79383416 -18546373 X true true Algon Rd Surgery Ctr Outpatient Surgical Services 0.12750 ARSC Real Estate Property Management 0.25000 1 1 Northern Illinois Medical Center 4201 Medical Center Drive McHenry IL 60050 X X X X Cancer Center Northern Illinois Medical Center 1 true X X X X X X X X X 14 true true true X www.centegra.com X X X X X X X X X X false false true true 200. true 600. true X X X X X X X X true true X X X X true false X X X X true X false false Needs Assessment Schedule H, Part V, Line 1j Centegra Health System is an active participant in the McHenry County Health Department's on-going MAPP (Mobilizing for Action through Planning & Partnerships) process. MAPP priorities include the following: 1) Increase Access to Medical, Dental and Mental Health care * Provide increased access to follow up care (medical, dental, mental) for the under/uninsured residents of McHenry County. * Increase access to (medical, dental, mental) prevention, education, and screening programs available for all residents of McHenry County. 2) Information & Referral * Centralize and update Information and Referral located on Crisis Services website * Market Crisis Line #/Website (future 2-1-1) to community to increase visibility * 2-1-1 Information and Referral System 3) Cardiovascular Care * By 2017, reduce the death rate from cardiovascular disease by 20% Centegra Health System identifies community health care priorities and develops activities and strategies to meet the health care needs of at risk populations within its service area. These community benefit programs promote community wellness and disease prevention, enhance community health education, and improve the quality of clinical education. Account Input from Person Who Represent the Community Schedule H, Part V, Line 3 The Health System works with the Department of Public Health and other area Hospitals to conduct the assessment. Community Survey. A description of community issues and problems based on a sample of McHenry County residents. The survey was conducted online with the link widely broadcast by partner organizations, and supplemented by a paper version disseminated at numerous events and locations. Survey respondents numbered 744 with a 60/40 split between online and paper respondents. Questions in the survey covered: * Community features * Financial issues * Health status - perception of health and prevalence of diseases and conditions (physical and mental) * Access to care * Health insurance status * Abuse, suicide, care of other persons Key Informants. Interviews with 21 community leaders, agency directors, and other people considered experts in their field based on professional expertise, knowledge of local human services system or position of influence. As selected by the partners, many key informants or their predecessors at their organizations had been interviewed for the 2010 study. Interview questions focused on community assets, challenges, target groups in need of services, and perception of strengths and weaknesses of health and human services delivery. Key informants were interviewed by four volunteer interviewers, recorded, and transcribed by Health Systems Research staff. CHNA conducted with other hospital facilities Schedule H, Part V, Line 4 McHenry County Healthy Communities 2013-2014 was directed by 12 partner organizations. Those organizations and their representatives are: Advocate Good Shepherd Hospital Advocate Sherman Hospital Centegra Health System Family Alliance Inc. McHenry County College McHenry County Community Foundation McHenry County Department of Health McHenry County Mental Health Board McHenry County Regional Office of Education Pioneer Center for Human Services Senior Services Associates Inc. United Way of Greater McHenry County How CHS made CHNA widely available to public Schedule H, Part V, Line 5d Community presentation held on May 21, 2014 at McHenry County College. The meeting was open to the public. Did hospital facility address all the needs Schedule H, Part V, Line 7 Some needs fell outside the scope of our services. Other Factors Used in Determining Amounts Charged Patients Schedule H, Part V, Line 12i All patients are charged the same for services rendered. Patients may qualify for free or discounted care as described in Part VI, Line 3. Eligibility for financial assistance depends on factors such as income level, asset level and medical indigency. Other Billing Determination of Individuals Without Insurance Schedule H, Part V, Line 20d See Part VI Supplemental Information for Billing and collection policies regarding persons eligible for financial assistance. 6 Crystal Lake Medical Arts Imaging Center 360 Station Drive Suite 150 Crystal Lake IL 60014 Medical Imaging Center Gavers Breast Center 360 N Terra Cotta Road Crystal Lake IL 60012 Medical Imaging and Breast Care Center NIMC Rehab & Sports Medicine Clinic 200 Congress Parkway Crystal Lake IL 60014 Sports Medicine and Rehabilitation Clinic NIMC Neuro-Rehabilitation Center 500 Coventry Lane Crystal Lake IL 60014 Neurotrauma Day Treatment Center NIMC Rehab & Sports Medicine Clinic 2507 N Richmond Road McHenry IL 60050 Physical Rehabilitation Clinic NIMC Back to Work Program 200 Congress Parkway Crystal Lake IL 60014 Physical Rehabilitation Clinic Schedule H, Part I, Line 7 Line 7a-7c AMOUNTS ARE CALCULATED USING THE MEDICARE COST TO CHARGE RATIO. LINE 7E-7I AMOUNTS ARE CALCULATED FROM COMMUNITY BENEFIT REPORTS THAT ARE SUBMITTED BY THE HOSPITAL DEPARTMENTS FOR VARIOUS ACTIVITIES AND SUPPORT GROUPS THAT BENEFIT THE COMMUNITY. Schedule H, Part I, Line 7, Column F Bad Debt Expense in the amount of $12,284,451 is included on Form 990, Part IX, Line 24(B), Column A, but was subtracted for purposes of calculating the percentages in Schedule H, Part I, Line 7, Column (f). Methodology of Est Amount & Rational for Including in Community Benefit Schedule H, Part III, Line 2 The actual gross bad debt write-offs of $12,284,453 were multiplied by the cost to charge ratio of .2899 to estimate the cost of bad debt. Methodology of Est Amount & Rational for Including in Community Benefit Schedule H, Part III, Line 3 The estimated amount of bad debt expense (at cost) which could be reasonably attributable to patients who would likely qualify for financial assistance under the organization's charity care policy if sufficient information had been available to make a determination of their eligibility was based on the self pay patient accounts which were written off as bed debts. These amounts were then multiplied by the cost to charge ratio. Any payments received during the fiscal year on these accounts were deducted from the cost. The amount of cost that exceeds reimbursement is actual cost to treat patients and is therefore treated as a community benefit. Bad Debt Expense Schedule H, Part III, Line 4 In estimating allowances for doubtful accounts, the Health System analyzes past history, existing trends, and payer sources to determine the reserves needed. Please REFERENCE pages 14 and 17-18 of the audited financial statements for notes on the allowances for doubtful accounts. Explanation of Shortfall as Community Benefit Schedule H, Part III, Line 8 The amount of cost that exceeds reimbursement is actual cost to treat patients and is therefore treated as a community benefit. Provisions On Collection Practices For Qualified Patients Schedule H, Part III, Line 9b Centegra provides patients with consistent information on payment expectations and assists them in meeting their financial obligations. A written explanation of the payment requirements categorized by type of payor is given prior to admission/registration or upon admission/registration of each Centegra Health System (CHS) patient. Centegra will bill the patient's insurance carrier. Procedures will be implemented over time and by area to collect as much as possible of the time of service unless payor contracts require billing (i.e., no assignments). 1. Admission reservation/outpatient appointment made by physician/patient. Walk-in and Emergency Department patients present for service. 2. Perform the patient pre-registration for applicable scheduled registrations. 3. Patient verbal consent obtained and annotated except where prohibited by law. On (date) at about (time), (patient or representative) orally authorized (Site Name) to release information concerning the patient's medical care, treatment and diagnosis to employers, insurance companies, government agencies or third-party payors and their agents, for verification of benefits and pre-certification. I (the Pre-Registrar) did not obtain a written consent signed by the patient, due to the patient not being physically present and limited time constraints. This statement would be signed and dated by the Pre-Registrar. Patient refusal to provide oral consent requires patient notification of potential penalties and places the burden on the patient to complete payor requirements. 4. Complete insurance verification and initiate pre-certification. 5. Estimate the approximate cost of services and advise the responsible party. Explanation of the cost will fluctuate based on services ordered by the physicians. 6. Discuss the financial requirements, including payment expectations with the patient/guarantor prior to admission/registration when applicable. 7. Interview conducted by Financial Counselor of patients who express difficulty in meeting Centegra's payment requirements. 8. Admission/registration of patient is completed. Patient/guarantor signature for the Consent to Release Information obtained. 9. Collect the estimated patient share. The deductible and co-payments and any non-covered amounts quoted by the carrier are due from inpatients prior to discharge and where possible, for outpatients prior to or at the time of registration. 10. Self-Pay accounts are to be paid in full or screened by the Financial Counselor for potential State or Federal Program, Financial Assistance application or payment plan. 11. Policy regarding non-compliance with respect to payment arrangements or plans: Self-Pay: Patients who have not completed arrangements for one of the payment options within 120 days of the billing date will be automatically turned over to a collection agency. Broken Promise/Defaults: Patients with delinquent payments, 15 or more days late, will be turned over to a collection agency. After Insurance: Processing patients who have not made payments or enrolled in one of the payment options for co-insurance and deductible amounts within 120 days of insurance payment will be turned over to a collection agency. Needs Assessment Schedule H, Part VI, Line 2 CENTEGRA HEALTH SYSTEM IDENTIFIES COMMUNITY HEALTH CARE PRIORITIES AND DEVELOPS ACTIVITIES AND STRATEGIES TO MEET THE HEALTH CARE NEEDS OF AT RISK POPULATIONS WITHIN ITS SERVICE AREA. THESE COMMUNITY BENEFIT PROGRAMS PROMOTE COMMUNITY WELLNESS AND DISEASE PREVENTION, ENHANCE COMMUNITY HEALTH EDUCATION, AND IMPROVE THE QUALITY OF CLINICAL EDUCATION. IN 2013, CENTEGRA HEALTH SYSTEM PARTNERED WITH THE MCHENRY COUNTY HEALTH DEPARTMENT, UNITED WAY OF MCHENRY COUNTY AND OTHER HOSPITALS AND ORGANIZATIONS TO CONDUCT THE 2014 MCHENRY COUNTY HEALTHY COMMUNITY STUDY. THE INTENT OF THE NEEDS ASSESSMENT WAS TO UNDERSTAND AND ADDRESS THE COUNTY'S MOST PRESSING NEEDS, INVOLVING PARTNERS FROM DIVERSE ORGANIZATIONS, IN ORDER TO IMPROVE THE HEALTH OF COUNTY RESIDENTS. A THOROUGH UNDERSTANDING OF THE COUNTY'S HEALTH WAS MEASURED USING FOUR ASSESSMENTS, EACH FROM A DIFFERENT PERSPECTIVE INCLUDING RESIDENTS, POPULATIONS IN NEED OF SERVICES, COMMUNITY LEADERS, AND DESCRIPTORS USING SECONDARY DATA SOURCES. THROUGH THE ASSESSMENTS, KNOWLEDGE WAS GAINED ABOUT THE CURRENT HEALTH STATUS OF COUNTY RESIDENTS, DEMOGRAPHIC TRENDS, SOCIAL AND ECONOMIC INDICATORS, HEALTH BEHAVIORS, AND UTILIZATION OF HEALTH SERVICES. THE ASSESSMENTS ALSO ATTEMPTED TO UNDERSTAND THE PERCEPTIONS OF COMMUNITY STRENGTHS AND WEAKNESSES AS WELL AS ANSWER QUESTIONS ABOUT THE HEALTH AND HUMAN SERVICES DELIVERY SYSTEM, UNMET NEEDS, GAPS, AND BARRIERS TO CARE. UNMET NEEDS, GAPS, AND BARRIERS TO CARE. Patient Education of Eligibility of Assistance Schedule H, Part VI, Line 3 Uninsured patients arriving at our emergency department and/or direct admits are screened at time of service by either an Emergency Department Financial Counselor or the Health System's In-Patient Financial Counseling Team, Public Aid Representatives, and a Medication Assistance Coordinator to identify eligibility guidelines for federal, state and local government programs, as well as charity care. CHS's Self Pay Process includes a screening which is completed by using hospital form C910050 03-09 prompting an interview offering payment options and eligibility guidelines. It is at this time that a patient becomes aware of the Hospital Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of timeline for completing application processes at time of service in person. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid. Uninsured patients opting for elective services are contacted by phone prior to their date of service by the CHS Outpatient Financial Counseling Team. CHS's Self Pay Process is followed and includes a screening for federal, state and local government programs as well as charity care. An interview offering payment options and eligibility guidelines using hospital form C910050 03/09 prompts a quick eligibility determination. It is at this time that a patient becomes aware of the Uninsured Patient Discount Act, Medicaid, Medication Assistance Programs, Crime Victims, IBCCP, Cash Pay Fee Schedules, and other hospital discount incentives. Patients are advised of time line for completing application processes prior to their elective services via phone. Appropriate scripting is followed by CHS Associates. Discounts were established following the 200%, 350% and 600% federal poverty guidelines to assist in determining charity adjustments. Applications were designed by CHS Self Pay Committee in accordance to our Financial Policy (Policy Number 9850-2) identifying qualifications for the medically needy/catastrophic aid. Our health system's website offers FAQ's and answers as well as encourages patients to contact our Customer Service Team when they are unable to pay for services. Our health system's statements also identify detailed account and billing information encouraging the patient to contact our Customer Service Team and inquire about Financial Assistance options. Documentation is essential in effective communication. Follow up teams will then move forward in a timely manner with the appropriate actions to insure all necessary documents (if applicable) are received for eligibility determinations. CHS advertises a Price Line encouraging patients to inquire about estimated costs for future services. The Price is manned by our outpatient financial counselors from 8:00am to 7:00pm. When calls are returned with estimated costs, a conversation ensues to identify a possible financial hardship. Our Self Pay Process is put into effect at this time. Site Registrars will notify the CHS Financial Counseling Team when a financial hardship is identified. Emergency Department Financial Counseling positions have been created to meet the needs of our ED patients. In addition to these new roles, a full time Financial Counselor position was created to meet the special needs of our cancer patients. A Financial Assistance Coordinator reviews all financial applications, gathers needed documents, determines financial assistance and prepares each patient file for leadership approval. Community Information Schedule H, Part VI, Line 4 Centegra Health System defines its primary service area as McHenry County, an area of approximately 603 square miles and 327,502 residents. This county is among the fastest growing counties in Illinois with an 18.7% population growth from 2000-2010. The age groups with projected population growth from 2012 to 2017 are the 20-44 with 0.4% and the 65+ age group with 15.8% growth. The county's overall population is projected to increase by 0.9% in the next five years (2013 to 2018). For 2010, the age distribution of the population was as follows: 30% 0-19, 32% 20-44, 28% 45-64, and 10% 65+. McHenry County has relatively high socioeconomic status compared to the rest of Illinois. Median household income for 2012 was $76,683 compared to the IL state median income of $55,137. The March 2014 unemployment rate was 7.8% which is lower than the state average of 8.3%. For 2012, the percentage of the county's population holding a high school diploma or higher was 92.0%, while the percentage holding a bachelor's degree or higher was 33.1%. The McHenry County uninsured rate in 2012 was 9.8% compared to the state uninsured rate of 12.8%. Promotion of community health Schedule H, Part VI, Line 5 Please see Schedule O for a detailed description of the Medical Center's program service accomplishments. Affiliated health care system Schedule H, Part VI, Line 6 Northern Illinois Medical Center of McHenry, IL is affiliated with Memorial Medical Center of Woodstock, IL. Both Hospitals are acute care facilities serving the greater McHenry County area. Centegra Health System is the parent of both Northern Illinois Medical Center and Memorial Medical Center. Northern Illinois Medical Center is affiliated with Health Bridge Fitness Centers in Crystal Lake, and the Medical Center provides outpatient physical rehabilitation services to the community from a clinic within that location. The Centegra Health System Foundation supports Hospital operations through fundraising activities. Please see schedule R for complete listing of all affiliated organizations. State filing of community benefit report Schedule H, Part VI, Line 7 IL Facility reporting group(s) Schedule H, Part VI Northern Illinois Medical Center is a 179 bed facility with a Level II nursery and a center for cancer care, Sage Cancer Center. In addition, NIMC operates four off-site physical rehabilitation centers offering therapy services, as noted in Part V. NIMC also operates two sites where medical imaging services are offered, as noted in Part V. X X X X X false true false false false false false false false Michael S Eesley CEO 1103127 449064 1134 0 123402 0 17984 0 1694711 0 0 Richard Lind Board of Governors 157825 0 0 0 0 0 4499 0 162324 0 0 David Tomlinson SVP/CIO/CFO 375965 45503 5977 0 25871 0 32287 0 485603 0 0 Jason R Sciarro President/COO 784519 105132 1029 0 63191 0 32140 0 986011 0 0 Rachel Sebastian VP Site Administrator 284185 33907 0 25355 0 37039 0 380486 0 0 0 Belinda A Wagner Pharmacist 145644 0 0 3240 0 2119 0 151003 0 0 0 Connie K Secor Director 159980 0 7591 0 0 0 4002 0 474 0 172047 0 0 0 John G Geinopolos Medical Physicist 169701 0 0 1734 0 28924 0 200359 0 0 0 Susan H Corcoran Pharmacist 145225 0 0 1521 0 31676 0 178422 0 0 0 Todd A Meyers Chief Medical Physicist 177237 0 0 4371 0 29369 0 210977 0 0 0 Received Severance, Supplemental NQ Retirement, equity-Based Compensation Schedule J, Part I, Line 4b The following people received the following amounts as part of a supplemental nonqualified retirement plan: Michael Eesley $420,534 Jason Sciarro $57,353 Rachel Sebastian $18,475 David Tomlinson $20,053 Home State Bank Board Member 103027 Investment Services false American Community Bank Board Chairperson 107217 Investment Services false Home State Bank Board Treasurer 103027 Investment Services false American Community Bank Board Director 107217 Investment Services false Rachel Sebastian Officer's Family member 367741 Employee Compensation false Carey Electric Board Member 117543 Electrical Services false Business Transactions Involving Interested Persons Schedule L, Part IV All business transactions are arms length transactions. See conflict of interest disclosures in Schedule O for Form 990, part VI, Line 2. FORM 990, PART IV, LINE 24 NORTHERN ILLINOIS MEDICAL CENTER HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, CENTEGRA HEALTH SYSTEM. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON CENTEGRA HEALTH SYSTEM'S FORM 990. Business or Family Relationship of Officers, Directors, Etc. Form 990, Part VI, Line 2 Northern Illinois Medical Center, (NIMC), adopted specific conflict of interest policies for its governing and management staff. The policy includes, but is not limited to, when an individual, governor, committee member, officer, agent or employee believes that he or she, or a member of his or her immediate family might have or does have a real or apparent conflict, he or she should in addition to filing the disclosure notice required, abstain from making motions, voting, executing agreements, or taking any other similar direct action on behalf of the Medical Center. During fiscal year 2014, Northern Illinois Medical Center purchased certain goods and/or services from organizations with director affiliation. All transactions were competitively bid and were conducted at arm's length. The fees paid were at fair market value. Director Kathy Powell is an employee and Vice President of Home State Bank. Treasurer Patrick Morehead is on the Board of Directors and a 2% owner of Home State Bank. Chairman Charie Zanck is a Director of American Community Bank & Trust. Director Charles Ruth is the Board Chairman of American Community Bank & Trust. Tom Carey is Vice President of Carey Electric. Vice President Rachel Sebastian is the daughter of CEO Michael Eesley. Description of Delegated Duties to Management Company Form 990, Part VI, Line 3 Management companies were used for the daily operations and management of the following services for the health system: Sodexho Inc. & Affiliates was used to manage Food & Nutrition and Environmental Services work. Perot (Dell) provided management and support services for the Information Systems area. None of the outsourced managers or directors are executive level staff, and none of them need to be named in Part VII. Explanation of Classes of Members or Shareholder Form 990, Part VI, Line 6 Centegra Health System is the sole member of NIMC. Centegra Health System has a single class of members. How Members or Shareholders Elect Governing Body Form 990, Part VI, Line 7a The powers and duties of the Centegra Health System members in fulfilling the purposes and objectives of the Corporation shall include, but not be limited to, the taking of action with respect to the following matters: The election of governors and the filling of vacancies on the Board of Governors, which shall be in accordance with the procedures set forth in the Bylaws. The Nominating Committee shall select one candidate for each position on the Board having a term to be voted upon for the office of governor at the next annual meeting of members. The Nominating Committee shall consider and approve a list of candidates and submit such list to the Board of Governors not less than 10 days prior to the date of the last meeting of the Board of Governors prior to the date on which notice of the annual meeting of members is to be sent, and the candidates set forth on such list shall be subject to approval by the Board of Governors. The names of the candidates so selected by the Nominating Committee and approved by the Board of Governors shall be included in the notice of the annual meeting of the members of the Corporation and shall be presented to the members of the Corporation at the annual meeting. The voting members of the Corporation may nominate candidates for the positions on the Board of Governors. Nominations by such members may be effected by means of written nomination signed by not less than 20 voting members in good standing, accompanied by a written statement of such nominee indicating a willingness to serve as a governor of the Corporation if elected. Any such nomination must be received by the Nominating Committee of the Corporation not less than 60 days prior to the annual meeting of members in order to be considered at such annual meeting. All elections shall be by secret ballot if there are more nominees than vacancies to be filled on the Board. All voting members present in person or by proxy at a meeting at which an election occurs shall be entitled to vote for governors. To be valid a ballot must not have more votes than there are vacancies. If there are more nominees than vacancies to be filled on the Board, those nominees who receive the most votes shall be elected to the Board of Governors. Members shall not be entitled to cumulate their votes in the election of governors. Form 990 Review Process Form 990, Part VI, Line 11b The Form 990 and related schedules are compiled by CHS staff. The review process for the 990 includes detailed review by an outside auditor, bond counsel, Controller, and Chief Financial Officer, prior to submission to the IRS. The tax return will be made available for the Board to review after submission to the IRS. Explanation of Monitoring and Enforcement of Conflicts Form 990, Part VI, Line 12c As stated in Centegra's Bylaws, the Bylaws recognize that both real and apparent conflicts of interest sometimes naturally occur in the course of conducting daily affairs. Conflicts occur because the many persons associated with Centegra should be expected to have and do, in fact, generally have multiple interests and affiliations and various positions of responsibility within the community. The long-range interests of Centegra do not require the termination of all association with persons who may have real or apparent conflicts if a prescribed and effective method can render such conflicts harmless to all concerned. Centegra Health System has a conflict of interest policy that is intended to address such matters. 1. Duty to Disclose: In connection with any actual or possible conflicts of interest, an interested person or other person subject to this policy must disclose the existence and nature of his or her financial interest in writing to the President of Centegra or the Chief Corporate Responsibility Officer or designee, who shall provide such written disclosure to the Governors Affairs Committee of Centegra, which shall consider all conflicts of interest issues and, if appropriate, to the directors and members of committees with board-delegated powers considering the proposed transaction or arrangement. The disclosure must occur, at minimum, annually, with a Conflict of Interest Disclosure Statement being submitted no later than January 31st of each year. Copies of disclosure statements filed by Board members shall be distributed to the Board annually at the February Board meeting. 2. Determining Whether a Conflict of Interest Exists: When a conflict of interest is disclosed at meeting of the board or committee thereof, after disclosure of the financial interest, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. The interested person's leaving such meeting shall not affect whether a quorum exists at such meeting. 3. Procedures for Addressing the Transaction or Arrangement from Which the Conflict Arose: A. The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. B. After exercising due diligence, the board or committee shall determine whether Centegra can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. C. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction or arrangement is in Centegra's best interest and for its own benefit and whether the transaction is fair and reasonable to Centegra and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. 4. Violations of the Conflicts of Interest Policy: A. If the administration, the board, or a committee has a reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. B. If, after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has, in fact, failed to disclose an actual or possible conflict of interest, it shall refer the matter to the Governors Affairs Committee for consideration, which shall subsequently recommend appropriate disciplinary and corrective action to such board or committee. Compensation Review & Approval Process - Officers and & Key Employees Form 990, Part VI, Line 15b The Board of Directors of Centegra Health System, through the Compensation Committee comprised of independent members free of conflict, reviewed executive compensation levels and other features of the compensation plan in accordance with the organization's approved compensation philosophy and strategy. The Committee is comprised of members of the Board of Directors, who are independent of Centegra management, have no personal interest in the compensation arrangements, are not related to, or under the control of any individual whose compensation arrangement is being reviewed and have no material business relationship with Centegra. The C-Suite's compensation is determined by the Compensation Committee in relation to comparable peers based on 990 market data. Compensation for other members of the executive staff is recommended by the CEO, reviewed by the Committee, and evaluated against market data. The compensation Committee approves all compensation decisions in advance of their implementation and documents its determinations and discussions. Its decisions and deliberations are thoroughly documented and meeting minutes are kept and distributed to the Committee members (for historical reference). The Compensation Committee uses a number of external resources and comparisons, and their review includes total compensation (cash compensation, plus benefits provided by Centegra) in relation to organizational performance and prevailing industry practices of comparably-sized organizations. They have engaged the services of a compensation consulting firm (Sullivan Cotter) specializing in the not-for-profit sector that has worked with Centegra and reports directly to the Compensation Committee. Reasonableness letters and documentation are provided to the organization after each review. Other Organization Documents Publicly Available Form 990, Part VI, Line 19 All governing documents, policies, and financial statements are available upon request. Form 990, Part IX , Line 24a It should be noted that the Related Company expenses in Form 990, Part IX, line 24a are allocated at 65% of total expense of the related company (Centegra Health System, FEIN 36-3196559). The allocation method is reviewed annually. Expense detail is as follows: Salaries $14,843,730; Benefits $3,270,631; Payroll Taxes $1,084,799; Purchased Services/Professional Fees $12,447,939; IT Expenses $4,199,673; Office Expenses $2,511,582; Advertising and Promotional $1,528,810; Other Expenses $2,632,974. Other changes in net assets FORM 990, PART XI, LINE 9 AFFILIATE TRANSFERS $185,297 INTEREST IN FOUNDATION $1,333,886 IMDSOFT GE SETTLEMENT ($65,000) ----------- TOTAL $1,454,183 Centegra Insurance Services LTD PO Box 1051 Grand Cayman CJ KY1-1102 Malprctce Ins CJ 0 0 Centegra HS Centegra Health Bridge Fitness Ctr LLC 385 Millennium Drive Crystal Lake IL 60012 261277524 FITNESS CTR DE 0 0 HLTH BRIDGE Centegra Primary Care LLC 385 Millennium Drive Crystal Lake IL 60012 364085398 PHYS PRACTICE DE 0 0 Centegra HS Centegra Clinical Laboratories LLC 385 Millennium Drive Crystal Lake IL 60012 364706465 LAB/PATH SVC DE 0 0 Centegra HS Centegra Health & Wellness Network LLC 385 Millennium Drive Crystal Lake IL 60012 364740459 CNT Mgmt ORG DE 0 0 Centegra HS Centegra Health System 385 Millennium Drive Crystal Lake IL 60012 363196559 HEALTH SYSTEM IL 501(c)(3) 11c NA false Centegra Health System Foundation 385 Millennium Drive Crystal Lake IL 60012 363723610 Fundraising IL 501(c)(3) 11a Centegra HS false NIMED Corporation 385 Millennium Drive Crystal Lake IL 60012 363119911 Property MGMT IL 501(c)(3) 11c Centegra HS false Health Bridge Corporation 385 Millennium Drive Crystal Lake IL 60012 363196550 Health Ft CTR IL 501(c)(3) 11c Centegra HS false Oak Creek Lodge 385 Millennium Drive Crystal Lake IL 60012 363591359 Hospital IL 501(c)(3) 3 Centegra HS false Centegra Hospital Huntley 10400 Haligus Road Huntley IL 60142 453449737 Hospital IL 501(c)(3) 3 Centegra HS false Memorial Medical Center 3701 Doty Road Woodstock IL 60098 362179764 Hospital IL 501(c)(3) 3 Centegra HS false Centegra Management Services INC 385 Millenium Drive Crystal Lake IL 60012 364028114 Management IL Centegra HS C Corp 0 0 false false false true false false false false false false false false false true false true true true true true