2015-08-17T13:29:01-05:00 2014-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE STE 4000 INDIANAPOLIS IN 46204 990 2013-10-01 362174832 Silver Cross Hospital and Medical Centers % JOHN KREPPS CFO SILV 8153007084 1900 Silver Cross Blvd Suite New Lenox IL 60451 john krepps CFO 8153007007 2015-08-12 true ANGELA M MOORE P00244342 8153007007 2013 2016-03-07 17:11:31Z JOHN KREPPS 1900 Silver Cross Blvd New Lenox IL 60451 335721395 false X www.silvercross.org X 1895 IL SEE SCHEDULE O 16 15 2507 544 0 946954 1310674 293705712 317437158 9415849 8375497 2596973 2779185 306665488 329902514 249815 575999 0 0 126576559 135755917 0 0 0 173540977 183157551 300367351 319489467 6298137 10413047 710073502 725870229 453628109 459036912 256445393 266833317 X TO ESTABLISH, CONDUCT, MAINTAIN AND OPERATE HOSPITALS AND COMMUNITY MEDICAL CENTERS AND TO FURNISH OTHER FACILITIES FOR THE CARE OF PERSONS SUFFERING FROM ILLNESSES OR DISABILITIES REQUIRING HOSPITAL CARE, COMMUNITY MEDICAL CARE OR CARE IN THE HOME. false false 299070036 575999 310992713 Provision of inpatient and outpatient health care services. Hospital inpatient and observation days for the time period covered by this return totaled 88,522. Outpatient registrations totaled 219,028. 1303901 0 0 Community education programs, health professional education programs, student internships, support groups and support of free community clinic. 160302 0 0 Health screenings and women's and children's services. 1240845 6444445 301775084 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 320 0 true 2507 true false false false false false false false false false false X 16 15 false false false false true true true true true false false false true true true true true false false true true IL X JOHN KREPPS CFO 8153007007 1900 SILVER CROSS BLVD New Lenox IL 60451 STEVE MORRISSETTE CHAIRMAN 1.0 0.0 X X 0 0 0 PAUL PAWLAK PRESIDENT/CEO 1.0 40.0 X X 0 1477677 68831 DOUGLAS HUTCHISON JR First Vice Chairman 1.0 0.0 X X 0 0 0 MARK STOFAN Second Vice Chairman 1.0 0.0 X X 0 0 0 AL MCCOWAN SECRETARY 1.0 0.0 X X 0 0 0 SUSAN PROCK TREASURER 1.0 0.0 X X 0 0 0 JACK CARLSTROM DIRECTOR 1.0 0.0 X 0 0 0 MARK DANIELSON MD Director 1.0 0.0 X 0 0 0 MICHAEL KENNY Director 1.0 0.0 X 0 0 0 DOUG MCFARLEN DIRECTOR (TERM 10/14) 1.0 0.0 X 0 0 0 DAVID MIKOLAJCZAK DO Director 1.0 0.0 X 0 0 0 SCOTT PADDOCK Director 1.0 0.0 X 0 0 0 JOHN PHELAN Director 1.0 0.0 X 0 0 0 JAMES ROOLF Director 1.0 0.0 X 0 0 0 MARY TOTTEN Director 1.0 0.0 X 0 0 0 CHRISTOPHER UDOVICH MD DIRECTOR 1.0 0.0 X 0 0 0 JOHN KREPPS ASST. TREASURER 1.0 40.0 X 0 363443 55687 MARYBETH ANTONE ADM DIR PROCEDURAL CARE 40.0 0.0 X 255977 0 39285 BRANDT FICK ADM DIR EMERGENCY SERVICES 40.0 0.0 X 171227 0 32774 MARY BRENCZEWSKI Adm Dir Clinical Ser 40.0 0.0 X 165852 0 42369 KAY NOVAK DIRECTOR OF ACCOUNTING 40.0 0.0 X 151420 0 17928 JOHN BUSLER SHIFT COORDINATOR ICU 40.0 0.0 X 146408 0 19935 WILLIAM BROWNLOW ASST. TREASURER (TERM 9/13) 0.0 0.0 X 0 708280 46699 890884 2549400 323508 94 true true false AMERICAN HEALTHCARE SERVICES ASSOC PO BOX 945 TRAVERSE CITY MI 49685 Consulting 1558602 Allied Anesthesia Assoc 40 Shuman Blvd Suite 275 NAPERVILLE IL 60563 Anesthesia services 797568 IMPACT ADVISORS LLC 931 W 75TH ST SUITE 137-304 NAPERVILLE IL 60563 CONSULTING 753320 CADENCE PHYSICIAN GROUP 25 N WINFIELD RD WINFIELD IL 60190 NEUROSURGERY 584000 STRATEGIC SOURCING RESULTS 3041 n racine unite 100 CHICAGO IL 60657 Consulting 563510 5 305825 1004849 1310674 NET PATIENT REVENUE 621110 309017824 309017824 DEPARTMENT REVENUE 900099 6547330 6547330 CANCER CENTER JV INCOME 621110 1872004 1872004 317437158 5239178 5239178 0 0 645352 645352 0 645352 645352 8955200 5818881 3136319 3136319 3136319 0 0 0 CAFETERIA REVENUE 722514 2129958 2129958 A/P DISCOUNTS 900099 3875 3875 2133833 329902514 317437158 11154682 575999 575999 0 0 0 0 0 101924989 95809490 6115499 3896197 3662425 233772 22347786 21006919 1340867 7586945 7131728 455217 8036556 8036556 1110419 1110419 145000 145000 0 0 217670 155493 62177 19161777 19161777 770703 770703 17925028 17925028 0 0 3581259 3366383 214876 151195 151195 0 177911 177911 25680145 25680145 0 25911473 25911473 9523703 9523703 MEDICAL SUPPLIES 54709117 54709117 PUBLIC AID STATE TAX 14254558 14254558 DIETARY EXPENSE 830713 830713 DUES, BOOKS, SUBSCRIPTIONS 545213 545213 425111 425111 319489467 301775084 17714383 0 4891411 16463619 5637621 2602772 1881516 1253606 61489422 47638591 0 0 0 0 0 0 1817359 1695013 1817274 1778602 596054122 136200169 474464157 459853953 113364521 142067630 0 0 2340581 4162581 0 0 42369640 48353862 710073502 725870229 32138277 37968194 0 0 0 0 392511594 387296082 0 0 0 0 0 0 0 0 28978238 33772636 453628109 459036912 X 246546898 256720269 4048100 4011103 5850395 6101945 256445393 266833317 710073502 725870229 X 10413047 160442 -185565 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 42588 42588 false false PART II-B, LINE 1i 22.8% of dues paid to American Hospital Association and 38% of dues paid to Illinois Hospital Association are used by these organizations for lobbying activities. 9898495 1224196 527701 1453516 83828 10113048 9799981 1455610 1291913 65183 9898495 8944269 2640930 849257 2418434 216041 9799981 11192893 571496 104273 2871640 52753 8944269 7722097 3425991 371884 128970 198109 11192893 0.00000 0.60000 0.40000 false false 25269734 14801161 40070895 340344755 22794301 317550454 13180425 1967426 11212999 188872561 110061561 78811000 13585486 1376881 12208605 459853953 DUE FROM AFFILIATES 42221937 UNAMORTIZED BOND EXPENSES 1682487 BOND DISCOUNTS 2890219 ASSETS RESTRICTED-CURRENT LIAB 1559219 48353862 0 DUE TO THIRD PARTY PROGRAMS 32881531 OTHER LONG-TERM LIABILITIES 891105 33772636 X Schedule D Part V Line 4 All endowed funds are restricted to use by Silver Cross Hospital and Medical Centers. Some funds have no further restriction and the interest earned may be used for either operational or capital support. All restrictions regarding the uses of endowed funds are documented. Schedule D Part X Line 2 The Corporations account for tax positions in accordance with ASC Topic 740, Income Taxes. ASC Topic 740 clarifies the accounting for uncertainty in tax positions and also provides guidance on when the tax positions are recognized in an entity's financial statements and how the values of these positions are determined. The Corporations do not have any liabilities recognized for uncertain tax positions. true true X true X 300. true X true true false true true 8071000 8071000 0.02530 28558000 22357000 6201000 0.01940 36629000 22357000 14272000 0.04470 3865671 169170 3696501 0.01160 1282575 1282575 0.00400 605315 605315 0.00190 5753561 169170 5584391 0.01750 42382561 22526170 19856391 0.06220 true 4211000 2319000 97703000 111694000 -13991000 X true true 2 1 SILVER CROSS HOSPITAL 1900 SILVER CROSS BLVD NEW LENOX IL 60451 HTTP://SILVERCROSS.ORG 0005827 X X X 2 SILVER CROSS EMERGICARE CENTER 12701 W 143 ST HOMER GLEN IL 60441 http://www.silvercross.org 22001 X Silver Cross Hospital and Medical Cen 1 true X X X X X X X X X 14 true true true X X X X X X X X X X true false true true 300. true 300. true X X true true X X X X X X true false X X X X true X false false Silver Cross Emergicare Center 2 true X X X X X X X X X 14 true true true X HTTP://SILVERCROSS.ORG X X X X X X X X X false false true true 300. true 300. true X X true true X X X X X X true false X X X X true X false false PART V, LINE 3 The Hospital takes into account the input from persons who represent the broad interests of the community and they are included in the development of the plan. The community involvement included inviting several members of the MAPP Collaborative Executive Committee, action team members, participants in the Forces of Change, and local Public Health System to assist with the assessment and planning phase. In addition, the Executive Committee is comprised of members that broadly represent the community and have the knowledge and expertise necessary to develop the Plan. The Executive committee is comprised of members representing local health care systems and clinics, several charitable organizations, government offices, local businesses, clergy, and individual community representatives. PART V, LINE 4 The other health care providers participating in the community health needs assessment include Adventist Bolingbrook Hospital, Edward Hospital, Presence St. Joseph Hospital, and the Will County Health Department. Part V, Line 7 The Community Health Needs Assessment (CHNA) was developed in 2014 with a three-year action cycle and timeframe to implement and is a continuous process. Throughout the plan action teams will be meeting to prioritize strategies, develop logic models for each strategy and develop action plans. The hospital continues to address all of the needs identified in the most recently conducted CHNA and uses the plan as a resource tool in order to align its programs and services offered to the community, as reported in our Community Benefits Report. Part I Line 3c The Hospital provides charity care assistance to patients who maintain a household income up to 300% above the Federal Poverty Level. In addition, the hospital provides a 50% discount off of hospital charges to all uninsured patients. Part I Line 6a Silver Cross Hospital completes an annual Community Benefits Report which is available on the Hospital website and upon request. Part I, Line 7 Community Benefits Data detail summary and reports along with financial reports were used to complete the information on Part 1, Line 7. Part II There are no Community Building Activities cost to report for Silver Cross Hospital that are not reportable in Part I of Schedule H. The Silver Cross Healthy Community Commission works with Silver Cross Hospital for on-going community health improvement advocacy. Pt III Line 2 Bad debt is calculated using costing methods including cost to charge ratio using financial statements to determine cost of care. Part III, Line 3 Estimated amount based on uninsured patients not qualifying for charity care. Part III, Line 4 Patient's accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectibility of patients' accounts receivable, the hospital analyzes their past history and identifies trends for each of their major payor sources of revenue to estimate the appropriate allowance for uncollectible 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 (e.g., 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 patients without insurance), 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. Part III, Line 8 The Medicare loss sustained is a result of Medicare reimbursing at less than the operating cost. Costs were attained using the Medicare cost report. Part III, Line 9b The hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The hospital does not pursue collection of amounts determined to qualify as charity care. Part VI, Line 2 Silver Cross Hospital participates with other healthcare and community organizations to create the Will County Health Needs Assessment and Plan through participation in a Community group called Mobilizing for Action through planning and Partnerships (MAPP) process. MAPP has enabled organizations to engage in county-wide strategic process to ensure that area residents receive the best possible public health services. Silver Cross Hospital has used the Will County Needs Assessment and Strategic Plan as a resource tool to develop its community programming. Silver Cross' programs and services fall into the following categories: Access to Healthcare, Awareness of Services, Prevention, and Management of Chronic Care Issues. Part VI, Line 3 Information regarding assistance for charity care is provided to patients by conducting interviews, posted notices on the hospital's website, and on the patient bill. Part VI, Line 4 Silver Cross Hospital cares for people that reside in areas primarily located in Will County, and portions of Grundy County and southwestern Cook County. Median incomes range broadly throughout the community with distinct pockets that have very low incomes. Our service area is composed of widely diverse cross sections of the population. Part VI, Line 5 Silver Cross Hospital promotes the health of the community by providing over 250 community outreach programs which promote healthier lifestyles and improve health including: educational seminars, health prevention screening, health prevention lectures, health fairs, expos, CPR/First Aid classes, prenatal classes, internships, speakers bureau presentation and support group meetings. Through these outreach programs Silver Cross Hospital touched the lives of 45,000 residents in our community. Impacting the health of thousands of individuals through education and prevention. true Silver Cross Healthy Community Commission 1900 Silver Cross Blvd New Lenox IL 60451 263094005 501(c)(3) 218499 N/A N/A operational support 1 0 PART I, LINE 2 THE ORGANIZATION SHALL ADVISE AND MONITOR THE INVESTMENTS OF ENDOWMENTS AND GENERAL FUNDS THROUGH ITS BOARD OF DIRECTORS AND THE SCHS BOARD OF DIRECTORS. false true false false false false false false false PAUL PAWLAK PRESIDENT/CEO 0 698673 0 420118 0 358886 0 17850 0 50981 0 1546508 0 420118 JOHN KREPPS ASST. TREASURER 0 269031 0 70858 0 23554 0 17850 0 37837 0 419130 0 70858 WILLIAM BROWNLOW ASST. TREASURER (TERM 9/13) 0 379633 0 161691 0 166956 0 17850 0 28849 0 754979 0 161691 MARYBETH ANTONE ADM DIR PROCEDURAL CARE 192345 0 63552 0 80 0 17850 0 21435 0 295262 0 0 0 BRANDT FICK ADM DIR EMERGENCY SERVICES 149859 0 21368 0 0 0 12432 0 20342 0 204001 0 0 0 MARY BRENCZEWSKI Adm Dir Clinical Ser 142746 0 22464 0 642 0 11758 0 30611 0 208221 0 0 0 KAY NOVAK DIRECTOR OF ACCOUNTING 139678 0 11341 0 401 0 10954 0 6974 0 169348 0 0 0 JOHN BUSLER SHIFT COORDINATOR ICU 144222 0 2186 0 0 0 0 0 19935 0 166343 0 0 0 PART I, Line 3 Silver Cross Health System, the parent organization of Silver Cross Hospital, uses the following to establish executive compensation: 1) Compensation committee 2) Independent compensation consultant PART I, LINE 4B The Supplemental Executive Retirement Program (SERP) is a non-qualified deferred compensation program designed to provide additional, market-competitive retirement benefits to certain management employees. The SERP was designed to provide retirement benefits that take into account an employee's total compensation, without regard to the annual limit on compensation that applies under qualified retirement plans. The Board has reviewed and approved the SERP benefit, concluding that it is a market-competitive benefit, and that total retirement benefits and total compensation are reasonable when compared to the benefits and compensation provided by similarly situated organizations to employees in comparable positions. For the reporting year, the following reported persons participated in the SERP and received the following payments: Paul Pawlak - $307,142 William Brownlow - $106,256 John Krepps - $23,554 A ILLINOIS FINANCE AUTHORITY 861091967 45200FXY0 2009-06-11 252872007 REPLACEMENT HOSPITAL false false false B ILLINOIS FINANCE AUTHORITY 861091967 45200FLE7 2008-06-18 85528084 Refunding prior bonds false false false C ILLINOIS FINANCE AUTHORITY 861091967 45200BSW9 2005-12-08 92224786 Refunding & capital true false false D ILLINOIS FINANCE AUTHORITY 861091967 45200BSY5 2005-12-08 33625000 Refunding & capital true false false A 275000 0 263373596 21286277 49944701 0 3955535 0 0 185041232 3145851 0 2012 false false true true B 3910000 0 87789515 9035200 1153764 0 839288 0 0 0 76761262 0 2008 true false true true C 9735000 69350000 94676525 1820288 659983 0 994324 1976955 0 45702490 43522485 0 2007 false true true true D 8675000 10625000 34868735 1786307 0 0 269556 701346 0 12229983 19881543 0 2007 true false true true A false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false true B false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true C false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true D false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true A false true false false 0 false 0 false true B true false false 0 false 0 false true C true true false 0 false 0 false true D true true false 0 false 0 false true A true B true C true D true Schedule K, Part I THE 2009 BONDS (LINE A) WERE ISSUED TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A REPLACEMENT HOSPITAL. THE 2008A BONDS (LINE B) WERE ISSUED SOLELY FOR THE REFINANCING OF THE 2005B AND 2005D BOND ISSUES, ORIGINALLY ISSUED 12/8/05. THE 2005A AND 2005B BONDS (LINE C) WERE ORIGINALLY ISSUED 12/8/05. THE 2005 BONDS HAVE BEEN DEFEASED BY THE 6/18/08 BOND ISSUE; THE 2005A BONDS REMAIN. THE 2005C AND 2005D BONDS (LINE D) WERE ORIGINALLY ISSUED 12/8/05. THE 2005A, B, C, AND D BOND ISSUES WERE USED TO CONSTRUCT AND EQUIP A NEW EMERGENCY DEPARTMENT, ADD PATIENT ROOMS TO THE EXISTING HOSPITAL FACILITY, EXPAND AND RENOVATE EXISTING PATIENT CARE AREAS, CONSTRUCT ADDITIONAL PARKING SPACE AND PURCHASE ROUTINE EQUIPMENT. SCHEDULE K, PART IV, LINE 2 - THE 2005 BONDS ISSUED ORIGINALLY AT VARIABLE RATES ARE NOW ISSUED AT FIXED RATES AS PART OF THE REFINANCING IN 2008 (SEE NOTE FOR SCHEDULE K, PART I ABOVE). SCHEDULE K, PART IV, LINE 2C - REBATE COMPUTATION DATES ARE: COLUMN B - 2008 BONDS - 3/25/14 COLUMN C - 2005 BONDS - 3/11/11 Part I, Line 1 TO ESTABLISH, CONDUCT, MAINTAIN AND OPERATE HOSPITALS AND COMMUNITY MEDICAL CENTERS AND TO FURNISH OTHER FACILITIES FOR THET CARE OF PERSONS SUFFERING FROM ILLNESSES OR DISABILITIES. Part III, Line 4D Other program services Medical records, chemical dependency, cardiac rehab, recycling, EMS courses. PART VI, LINE 6 Silver Cross Health System is the sole corporate member of Silver Cross Hospital and Medical Centers. Part VI, LINE 7a Silver Cross Health System may appoint members to the Board of Directors of Silver Cross Hospital and Medical Centers. Part VI, Line 7b All decisions made by the Directors of Silver Cross Hospital and Medical Centers are subject to the approval of the Board of Directors of Silver Cross Health System. Part VI, Line 11B The form is provided to the Chairman of the Governance and Management Effectiveness Committee of the Board of Directors. The form is prepared with the assistance of a public accounting firm. Part VI, Line 12c Any conflict of interest on the part of a Director, Officer, or Key Employee shall be disclosed on an annual basis using a questionnaire tool and is monitored and reviewed by the Corporate Compliance Officer. Indentified conflicts may be reviewed by the Board and when such interest becomes a matter of Board action, the Directors shall not vote or use personal influence on the matter and shall not be counted in a quorum for a meeting at which Board action is to be taken on the interest. IF IT IS DETERMINED THAT A DIRECTOR, OFFICER, OR KEY EMPLOYEE IS NON-COMPLIANT WITH THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL MAY BE SUBJECT TO DISCIPLINARY ACTIONS UP TO AND INCLUDING DISMISSAL. Part VI, Line 15 Silver Cross Health System, the parent organization of Silver Cross Hospital, uses the following to establish executive compensation: 1) Compensation Committee 2) Independent Compensation Consultant 3) Compensation Survey 4) Approval by the Board of Directors Part VI, Line 19 Governing documents, conflicts of interest policy and financial statements are available to individuals upon request. OTHER CHANGES TO FUND BALANCE Other changes in fund balance consists of distributions from temporarily and permanently restricted funds AND PLEDGE WRITEOFFS. Distributions from temporarily and permanentlly restricted funds ($99,087) Writeoffs of pledges to temporarily and permanently restricted funds ($86,478) ------------- Total ($185,565) SILVER CROSS HEALTH CONNECTIONS LLC 1900 SILVER CROSS BLVD NEW LENOX IL 60451 453127542 MANAGED CARE IL 0 0 SCH SILVER CROSS HEALTH SYSTEM 1900 Silver Cross Blvd New Lenox IL 60451 363185353 HEALTH SYSTEM IL 501(c)(3) 11a NA false SILVER CROSS FOUNDATION 1900 Silver Cross Blvd New Lenox IL 60451 363185350 FUNDRAISING IL 501(c)(3) 7 SCHS true MIDWEST COMMUNITY REAL ESTATE CORP 1900 Silver Cross Blvd New Lenox IL 60451 363461020 REAL EST MNGT IL 501(c)(3) 11b SCHS true SILVER CROSS MEDICAL ASSOCIATES 1900 Silver Cross Blvd New Lenox IL 60451 364179805 MEDICAL CARE IL 501(c)(3) 11a SCHS true SILVER CROSS HEALTHY COMMUNITY COMM 1900 Silver Cross Blvd New Lenox IL 60451 263094005 COMM DEVEPT IL 501(C)(3) 11a SCH true HEALTH SERVICES SYSTEMS INC 1900 Silver Cross Blvd New Lenox IL 60451 363262450 PHYSICIAN SVS IL NA C false SILVER CROSS MANAGED CARE ORGANIZATION 1900 Silver Cross Blvd New Lenox IL 60451 363876019 HEALTHCARE MNgmnt IL NA C false PREFERRED PROVIDER ORG OF JOLIET 1900 Silver Cross Blvd New Lenox IL 60451 363330680 HEALTHCARE SU IL NA C 43514 130602 0.50000 false false true true true false false false false false false true false true true true true true true true Midwest Community Real Estate Corporation q 3289734 FMV Midwest Community Real Estate Corporation s 1550000 FMV Midwest Community Real Estate Corporation k 1010973 FMV Midwest Community Real Estate Corporation r 144790 FMV Silver Cross Healthy Community Commission b 218499 FMV Silver Cross Foundation c 305825 FMV Silver Cross Foundation r 850000 FMV Silver Cross Foundation p 212193 FMV Silver Cross Foundation s 455887 FMV PPO Joliet m 85520 FMV