2014-11-17T11:40:51-06:00 2013-12-31 420714325 MCGLADREY LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2013-01-01 362169179 Palos Community Hospital PALO 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Dr Terrence Moisan Interim President & CEO 7089234000 2014-11-14 1 Wayne Harder P00294296 3126343400 2013 2015-11-30 17:44:51Z Dr Terrence Moisan 12251 S 80th Avenue Palos Heights IL 604630930 1548526047 0 X www.paloscommunityhospital.org X 1972 IL Palos Community Hospital is a 501(c)(3) community hospital whose primary objective is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County. 12 8 3177 810 121603 -20773 398265 762789 324923857 332023935 19921299 26695484 5022942 8877781 350266363 368359989 0 0 0 0 210174162 211780822 0 0 0 119740872 148308256 329915034 360089078 20351329 8270911 742440787 830546184 451159937 507358445 291280850 323187739 X Palos Community Hospital (PCH) is a not-for-profit community hospital, which is operated in accordance with the Ethical and Religious Directives for Catholic Healthcare Facilities. The primary objective of PCH is the provision of inpatient and outpatient services that are responsive to the health care needs of the residents of southwestern Cook County and northeastern sections of Will County.In providing any service - be it preventive, curative or palliative - the overriding concern of the institution shall be that the quality of that service be of the highest caliber. PCH shall be committed to a continued review and analysis of the changing needs of the community it serves and shall respond to those needs with services that are readily available in a form that enhances their efficient use by physicians and patients. In addition, PCH shall maintain an ability to adapt to changes and influence forces in its environment effectively and expeditiously. 0 0 229943932 281259064 It is the policy of Palos Community Hospital to provide quality medical health care to all persons regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The Hospital recognizes that not all individuals possess the ability or means to purchase essential medical services and further, that our mission is to serve our community with respect to providing healthcare services and healthcare education. Therefore, in keeping with the hospital's commitment to serve all members of the community, charity and/or subsidized care will be considered where the need and/or inability to pay are identified. 36636925 26161709 Palos Community Hospital provides a total continuum of cardiovascular services - from diagnosis and treatment through recovery and rehabilitation - to ensure that our patients receive the complete care they need close to home. Prior to the start of the program in 2005, Palos transferred patients from their local community to other hospitals. Within 3 years, Palos ranked 14th in Illinois for heart volume. This community need has grown as can be seen with continued increases in volume since the program began. 21103692 19431811 Palos Community Hospital Home Health, Private Duty, and Hospice services provide quality personal care and support to patients in their homes, nursing homes or hospitals. The Home Health staff assists the chronically ill, persons with functional impairments, those needing specialized skilled care at home, those recovering from a hospital stay and the terminally ill. In 2013, Home Health staff from Palos made over 87,000 home care visits, more than 30,000 hospice visits and provided almost 43,000 hours of private duty nursing assistance. 10270703 5049748 Behavioral Health Services at Palos meet the needs of individuals and families in the community struggling with relationship problems, emotional issues, psychological disorders and even chemical dependency. The programs include alcohol treatment; chemical dependency; group therapies for mental health or substance abuse issues; intensive outpatient programs; Kids Recover Too, since children in the family can be especially hard-hit by a parent's chemical abuse or dependency; and the Partial Hospital Program for those needing more intensive treatment for a psychiatric or duel diagnosis. 10270703 5049748 297955252 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 189 0 1 3177 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Scott Frech 7089234000 12251 S 80th Avenue Palos Heights IL 604630930 Edward Mulcahy Chairman 2.00 1.00 X X 0 0 0 Margaret Lustig Vice Chair 2.00 1.00 X X 0 0 0 Mohamed Askar Director 2.00 X 0 0 0 Thomas F Courtney Director 2.00 1.00 X 0 0 0 Lawrence Hunt Director 2.00 X 0 0 0 Deborah Dooling Director 2.00 X 0 0 0 Dr Terrence Moisan Director 20.00 10.00 X 80850 0 0 Philip A Salvador Director 2.00 X 0 0 0 Dr Michael Sobczak Director 2.00 X 0 0 0 Dr Mark Sinibaldi Director/Physician 2.00 40.00 X 50000 279516 33655 Lynn Egan Secretary 2.00 1.00 X X 0 0 0 William Hanson Director 2.00 X 0 0 0 Sister Margaret Wright President 40.00 2.00 X X 0 0 5692 Sister Anna Doyle Secretary 1.00 1.00 X X 0 0 0 Gregory Paetow Director 2.00 X 0 0 0 Carole Ruzich Director 2.00 1.00 X 0 0 0 James Reilly Director 2.00 1.00 X 0 0 0 Thomas J Lavery VP Medical Affairs 40.00 X 161093 0 16743 David B Manchester VP Professional Services 40.00 X 406969 0 34329 Hugh A Rose VP Finance/CFO 40.00 11.00 X 376925 0 28569 Randall J Oles VP Support Services 40.00 X 333224 0 38247 Timothy J Brosnan VP Planning/Community Rela 40.00 2.00 X 350776 0 38247 Marion J Baron VP Facilities & System Management 40.00 1.00 X 285175 0 33087 Mary C Denisienko VP Human Resources 40.00 X 264045 0 28569 Rosann S Demask VP Nursing 40.00 X 256358 0 33955 Edgardo Tenreiro CEO 40.00 X 146186 0 1543 Margaret J Carroll Chief Information Officer 40.00 X 269757 0 32007 Arthur M Schroeder Staff Physician 40.00 X 325435 0 38247 Mark D Diamond Staff Physician 40.00 X 283032 0 36645 Haris Aleem Staff Physician 40.00 X 281640 0 25102 3871465 279516 424637 125 0 1 0 Pepper Construction Company 18505 W Creek Drive Tinley Park IL 60477 Construction Services 24938948 Matthei & Colin Associates 332 S Michigan Avenue Chicago IL 60604 Architectural Services 3869740 Pepper Environmental Tech 411 Lake Zurich Road Barrington IL 60010 Asbestos Abatement 1843457 Mayo Collaborative Services 200 1st St SW Rochester MN 55905 Laboratory Services 1350756 Executive Health Resources 15 Campus Blvd Newtown Square PA 19073 Biling/Coding Support 1230638 66 176225 586564 762789 Net Patient Revenue 621110 319996259 319874656 121603 Provider Tax Revenue 900099 12217051 12217051 MRI Joint Venture 900099 -189375 -189375 332023935 7334072 7334072 1322040 846793 475247 475247 475247 1198547000 1179185588 19361412 19361412 19361412 52500 176225 133677 -81177 -81177 Meaningful Use 900099 3485150 3485150 Intercompany Revenue 900099 2468717 2468717 Cafeteria Revenue 900099 1027196 1027196 1502648 1502648 8483711 368359989 339613948 121603 28116750 3105999 3105999 60246 60246 158796698 132833902 25962796 9335021 7656117 1678904 29151949 23908970 5242979 11330909 9293045 2037864 2289377 2289377 560998 560998 172228 172228 1131632 1131632 11995850 7089720 4906130 781370 13075 768295 3781100 2285824 1495276 4623608 1129975 3493633 447954 427532 20422 164309 139838 24471 12094949 12094949 21013289 16868689 4144600 1403617 739842 663775 Medical Supplies 48975567 48975567 Bad Debt Expense 16920984 16920984 IL Tax Assessment 13192190 13192190 Utilities 3640597 2912478 728119 5118637 1472555 3646082 360089078 297955252 62133826 0 3875661 15872740 31052727 34579286 1016777 2625430 1580877 1832782 4854254 3809005 635788936 247563134 357256668 388225802 298906063 339308326 43897760 44292813 742440787 830546184 131616440 135507415 279590000 331630000 39953497 40221030 451159937 507358445 X 291166757 323068034 114093 119705 291280850 323187739 742440787 830546184 8270911 23635978 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 30265 30265 0 Part II-B, Line 1: Illinois Hospital Association dues and American Hospital Association fees attributable to lobbying. 14276573 14276573 424596938 117044091 307552847 196915425 130519043 66396382 388225802 Investment in Affiliate 2022642 Collateral Received for Securities Loaned 33500000 Deferred Financing Costs 3574094 Malpractice Insurance Receivable 5196077 44292813 Obligation for Collateral Received for Securities Loaned 33500000 Tax Exempt Bond Liability Premium 6721030 40221030 X 374108532 23635978 846793 24482771 349625761 1131632 17602596 18734228 368359989 342883255 846793 846793 342036462 1131632 16920984 18052616 360089078 Part X, Line 2: The Hospital has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. Accordingly, income taxes are not provided for in the accompanying financial statements. The Hospital adopted the FASB-issued guidance for accounting for uncertainty in income taxes on January 1, 2007. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to hospitals include such matters as the following: the tax exempt status of the entity; the continued tax exempt status of bonds issued by the obligated group; the nature, characterization and taxability of joint venture income, and various positions relative to potential sources of unrelated business taxable income (UBTI). UBTI is reported on Form 990-T, as appropriate. The benefit of a tax position is recognized in the financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying balance sheet along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB issued guidance at January 1, 2007, and since that date through December 31, 2013, there were no unrecognized tax benefits identified and recorded as a liability. Part XI, Line 2d - Other Adjustments: Rental Expense 846,793. Part XI, Line 4b - Other Adjustments: Unrestricted Contributions 681,612. Bad Debt Expense 16,920,984. Part XII, Line 2d - Other Adjustments: Rental Expense 846,793. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 16,920,984. Dinner/Celebration 228725 176225 52500 102263 31414 228725 176225 52500 102263 31414 133677 -81177 1 1 X 1 X 1 X 1000.000000000000 1 1 0 1 1 19605675 19605675 0.05710 30124221 18556619 11567602 0.03370 49729896 18556619 31173277 0.09080 996929 115471 881458 0.00260 26195153 17920819 8274334 0.02410 174390 174390 0.00050 27366472 18036290 9330182 0.02720 77096368 36592909 40503459 0.11800 1 16920984 98982590 127098670 -28116080 X 1 1 1 1 Palos Community Hospital 12251 South 80th Avenue Palos Heights IL 60463 X X X PALOS COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X www.paloscommunityhospital.org/CHNA X http://www.palos.healthforecast.net/ X X X X X X X X X 0 0 1 1 200.000000000000 1 1000.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 1 0 PALOS COMMUNITY HOSPITAL Part V, Section B, Line 3: As part of the community health needs assessment, two focus groups were held with key informants from across Cook County. A list of recommended participants for the focus groups was provided by the sponsors. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Focus group participants included a representative of public health, as well as several individuals who work with low-income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 4: Metropolitan Chicago Healthcare Council; Edward Hospital; Swedish Covenant Hospital; Northwest Community Hospital; Ingalls Memorial Hospital; Little Company of Mary Hospital & Health Care Centers; St. Anthony Hospital; St. Bernard Hospital and Health Care Centers; Central DuPage Hospital; University of Illinois Medical Center at Chicago; Elmhurst Memorial Healthcare; Franciscan St. James Health - Chicago Heights; Thorek Memorial Hospital; Palos Community Hospital; Rush University Medical Center; Northwestern Memorial Hospital; Lake Forest Hospital; Adventist Hinsdale Hospital; University of Chicago Medical Center; Mercy Hospital and Medical Center; Adventist GlenOaks Hospital; Jackson Park Hospital and Medical Center; Adventist LaGrange Memorial Hospital; La Rabida Children's Hospital; Norwegian American Hospital; Rush Oak Park; Vanguard Health Chicago (including: West Suburban Medical Center; Westlake Hospital; Weiss Hospital and MacNeal Hospital); Resurrection Health Care (including: Holy Family Medical Center; Our Lady of the Resurrection Medical Center; Resurrection Medical Center; Saint Francis Hospital; Saint Joseph Hospital and Saints Mary & Elizabeth Medical Center); Alexian Brothers Hospital Network (including: Alexian Brothers Behavioral Health Hospital; Alexian Brothers Medical Center; Alexian Brothers Rehabilitation Hospital and St. Alexius Medical Center). PALOS COMMUNITY HOSPITAL Part V, Section B, Line 7: In acknowledging the wide range of priority health issues that emerged from the CHNA process, Palos Community Hospital will focus on those most within its immediate ability to influence. Some of the priority issues such as injury & violence prevention and those related to maternal & infant health fall more within the purview of the county health department and other community organizations. Others such as kidney and respiratory diseases may be considered in future needs assessment implementations. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 20d: Palos Community Hospital takes its commitment to serving the uninsured and underinsured members of its community very seriously and as a result has implemented a financial assistance policy that goes above and beyond the requirements of Illinois Public Act 095-0965 "Hospital Uninsured Patient Discount Act". This State Law was enacted with an effective date of April 1, 2009 and required that hospitals offer uninsured patients who met the minimum financial requirements (i.e. earnings less than 600% of the FPG and certain asset limitations) a rate equal to 135% of the hospital's most recently filed Medicare cost to charge ratio. PCH expanded the reach of this policy by extending the minimum financial requirements to 1,000% of the FPG to help more of its community qualify for a financial benefit and to give families that earn a lower percentage of the FPG deeper discounts. This policy was also extended to all clinically-necessary procedures and was not limited to emergency care only. Using the FPG, PCH created a set of discounts for patients without insurance that ranged from free care for those who earned less than 200% of the FPG to a 40% discount off of regularly billed charges for any uninsured patient who earned less than 1,000% of the FPG. PCH also created a policy to help those who are underinsured. Similar to its uninsured policy, the underinsured policy creates a set of discounts that can be applied to co-payments and deductibles owed for those patients that earn less than 300% of the FPG. PALOS COMMUNITY HOSPITAL Part V, Section B, Line 21: Please see explanation in Part V, Section B, Line 20d above. 5 Palos Primary Care Center 15300 West Avenue Suite 122 Orland Park IL 60462 Primary Care Center Palos Immediate Care Center 7340 W College Drive Palos Heights IL 60463 Immediate Care Center Palos Home Health Care 15295 E 127th St Lemont IL 60439 Home Health Care Palos Diagnostic & Women's Center 17333 S LaGrange Rd Tinley Park IL 60477 Diagnostic Testing and Women's Health Palos Sleep Disorders Center 11900 Southwest Highway Palos Park IL 60464 Sleep Studies Part I, Line 3c: Palos Community Hospital charity care is based on a sliding scale of the Federal Poverty Guidelines. PCH set the sliding scale to allow charity in access of the regional minimum amount set forth by Illinois in the Hospital Uninsured Patient Discount Act by extending discounted care up to 1,000% of the FPG vs. the minimum 600% as determined by law.All self-pay patients are provided information regarding our charity care program at the time of registration; self-pay patients are requested to complete a one-page application. This enables the Hospital to expedite the charity care approval process. For balances after insurance, patients are made aware of our charity care program via the statement they receive. Additional information is available on the Hospital's website.On average our financial counselors see 6 patients each day, approximately 1,560 patients annually. However, these are just patients that come into the Hospital to meet with our staff. PCH in-house collectors processed over 5,500 charity applications in 2013, 4,947 applications were approved and 556 applications were denied (over income or refusal to complete all paperwork needed to process the application). We have seen a decrease in the number of applications as a result of the Affordable Health Care Act. With the expansion of Medicaid, we have seen an increase in the number of patients now covered under Medicaid. We also help with the uninsured patients to screen/assist for Medicaid eligibility. Part I, Line 7: The best available data was used to calculate the cost amounts reported in Item 7. This includes the overall hospital cost to charge ratio as well as direct and indirect costs for certain specific departments of the hospital.Part I, Line 7 Col(f): The bad debt expense of $16,920,984 was included on Form 990, Part IX, Line 25, but subtracted for purposes of calculating the percentage in this column. Part II, Community Building Activities: The health of the communities that PCH serves is a very important piece of PCH's mission statement. To date, our focus has been on providing the care needed within our community at high level of quality. As such we have implemented and/or maintained programs that we feel help to improve the wellness of the people we serve. PCH believes that given limited resources and time this serves our community better than community building activities as defined in this schedule. Part III, Line 4: PCH calculates Charity Care cost using the hospital wide cost to charge ratio and applying that ratio to the charges written off to charity care per the hospital policy. No other Bad Debt amounts are included in the community benefit report.The Hospital provides care to all patients regardless of their ability to pay. Uncompensated care and community service provided by the Hospital are excluded from net patient service revenue. Part III, Line 8: Medicare costs are calculated using the hospital wide cost to charge ratio. PCH does include the Medicare shortfall in its Illinois state community benefits report as PCH continues to treat its Medicare community despite the fact that its costs for these patients exceed reimbursement. Part III, Line 9b: It is the policy of PCH not to pursue collection practices against patients known to qualify under the Charity Care policy. In some cases, this determination is not immediately known and collection processes are followed, but once it has been determined that a patient may be eligible for charity care, these practices are ceased. Part III, Line 2: Bad debt expense is estimated by totaling the amounts sent to and written off by collection agencies plus an estimate of Accounts Receivable aged by financial class all multiplied by the appropriate cost to charge ratio. Part III, Line 3: Information to determine this amount is not available. Part VI, Line 2: PCH consistently seeks to serve the needs of its community in a variety of ways. In order to better identify these needs, PCH teamed with the Metropolitan Chicago Healthcare Council (MCHC) to prepare a Community Health Assessment for the primary counties that PCH serves. This Community Health Assessment is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in Cook, DuPage and Lake counties, Illinois. This Community Health Assessment will serve as a tool toward reaching three basic goals:- To improve residents' health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life.- To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at-risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio-economic factors which have historically had a negative impact on residents' health.- To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late-stage diseases resulting from a lack of preventive care. Part VI, Line 3: PCH utilizes several techniques to communicate a patient's eligibility for assistance under various programs. At the time of registration, each patient is referred to a copy of PCH's Charity Care Policy and asked to fill out a simple registration form that may help them qualify for Charity Care. This policy clearly lays out the eligibility requirements and what the patient must do to qualify. Also at registration, any patient without insurance is advised as to what other programs they may qualify for and are given assistance in applying as necessary. PCH employs a company that helps patients apply for Medicaid coverage and SSI disability. Upon discharge, each patient receives a summary bill that includes information related to eligibility for the Charity Care Policy. All inpatients without insurance are visited by a financial counselor who helps direct the patient and their families to the appropriate level of assistance. Signage regarding the charity care policy is posted at all registration areas and in the Emergency department. Finally, PCH proudly displays the assistance polices on their website along with a Charity application form. Part VI, Line 4: Palos Community Hospital serves growing communities that expect to experience further growth in the coming years. Communities within the hospital's service area have seen overall growth in population of approximately 7.6% from 2000 to 2011 with a current estimated population of 622,571. Continued growth is anticipated. From 2014 to 2019, the population is expected to grow by 1.3%. Zip codes within the Palos Community Hospital service area include:60462, 60467, 60463, 60464, 60465, 60482, 60445, 60452, 60477, 60487, 60453, 60455, 60457, 60458, 60459, 60415, 60805, 60655, 60803, 60439, 60441, 60491, 60423, 60448, 60451Of those living within the service area of Palos Community Hospital:50.91% are female87.62% are white79% are English-speakingThe median age is 40.1 years30% are high school graduates23% have had some college, and29.5% have earned a bachelor's degree or beyond.14.00% of the residents would be considered uninsured or Medicaid eligible.There are no other hospitals located in PCH's primary service area. Part VI, Line 5: Palos Community Hospital is an acute care facility with 366 operating beds, 14 operating rooms, nearly 500 affiliated physicians and approximately 2,900 employees. Within the service area, PCH serves as a resource for health education and wellness initiatives for residents. PCH continues to monitor the health care needs of its service area to assure the need for the services it offers and evaluates the opportunity to develop new programs and services as necessary. PCH works with and in support of other not-for-profit, educational, governmental, civic or community organizations, as appropriate, to promote health and wellness through awareness, education, research, access or support. Demonstrating PCH's commitment to disease prevention and wellness, 149 community education programs were held with approximately 3,000 participants during the year. Additionally, PCH participated in health-focused events in Palos Heights, Orland Park and Homer Glen providing health screenings focused on either heart or bone health. Through the PCH Speakers Bureau, numerous speaking engagements were arranged in 2013. The presentations were hosted by local non-profit community groups. To educate area residents about heart disease and to support the American Heart Association in their outreach efforts, 200 PCH employees and their loved ones participated in the AHA Heart Walk.Each year, a few community education programs as well as the direction of the Cancer Program at PCH are designed in response to our community's needs based on guidance provided by the PCH Oncology Committee. This group, consisting of hospital leaders, caregivers and physicians, provides direction on how to better meet the needs of cancer patients in our community. Palos Community Hospital is governed by the Board of Directors comprised of community leaders from the Hospital's service area. Further demonstrating the Hospital's connection to the community is the representation from community members to help shape our programs to better meet the needs of our residents. An example of this is the Diabetes Advisory Council. This group, consisting of community members as well as hospital leaders, provides input on how to better shape our Diabetes program to meet the needs of our residents. All qualified physicians are eligible for consideration for staff privileges.For the purpose of disease prevention, PCH provides the influenza vaccination to all employees and patients during flu season. To help Heart Failure and COPD inpatients transition from the hospital to home, Palos Community Hospital launched the Heart Failure/COPD Wellness Clinic. The Hospital applies surplus funds to the improvement of patient care. Part VI, Line 6: Palos Community Hospital is not part of an affiliated health care system. Part VI, Line 7, Reports Filed With States IL X X 0 0 0 0 0 0 0 0 0 Dr Mark Sinibaldi Director/Physician 50000 279516 0 0 0 0 0 18935 0 14720 50000 313171 0 0 Thomas J Lavery VP Medical Affairs 155861 0 0 0 5232 0 11987 0 4756 0 177836 0 0 0 David B Manchester VP Professional Services 389469 0 0 0 17500 0 19125 0 15204 0 441298 0 0 0 Hugh A Rose VP Finance/CFO 359921 0 0 0 17004 0 19125 0 9444 0 405494 0 0 0 Randall J Oles VP Support Services 315724 0 0 0 17500 0 19125 0 19122 0 371471 0 0 0 Timothy J Brosnan VP Planning/Community Rela 333276 0 0 0 17500 0 19125 0 19122 0 389023 0 0 0 Marion J Baron VP Facilities & System Management 267675 0 0 0 17500 0 19125 0 13962 0 318262 0 0 0 Mary C Denisienko VP Human Resources 246545 0 0 0 17500 0 19125 0 9444 0 292614 0 0 0 Rosann S Demask VP Nursing 238858 0 0 0 17500 0 18751 0 15204 0 290313 0 0 0 Margaret J Carroll Chief Information Officer 252257 0 0 0 17500 0 19125 0 12882 0 301764 0 0 0 Arthur M Schroeder Staff Physician 325435 0 0 0 0 0 19125 0 19122 0 363682 0 0 0 Mark D Diamond Staff Physician 283032 0 0 0 0 0 19125 0 17520 0 319677 0 0 0 Haris Aleem Staff Physician 281640 0 0 0 0 0 7650 0 17452 0 306742 0 0 0 Part I, Line 3 During 2013, PCH had two different CEOs and an interim CEO to bridge the gap. Sister Wright's contract was a management contract with the religious order. The Executive Committee of the Board of Directors has the responsibility for the contract and fees. The interim CEO was a VP of the facility and continued to be paid at his VP salary. The second CEO signed an employment contract that was signed by the Chairman of the Board of Directors. This contract was reviewed by legal counsel and approved by the outside consultant that was utilized for the placement of this position. All of these salaries are the responsibility of the Executive Committee of the Board of Directors. Annually, Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations with similar size and characteristics (FTEs, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and, if available, the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes. A Ill Fin AuthorityPalos Comm Hospital 861091967 45200B3U0 2007-05-17 124814955 Fund construction of parking garage & power plant 0 1 0 B ILl Fin AuthorityPalos Comm Hospital 861091967 45200F2Z1 2010-05-06 151146301 Fund construction of new patient bed pavilion and backfill of current struct 0 1 0 C Ill Fin AuthorityPalos Comm Hospital 861091967 2010-04-12 100000000 Fund construction of new patient bed pavilion and backfill of current struct 0 1 0 A 124814955 2675871 122139084 2010 1 0 1 1 B 157566708 1950637 155616071 2012 0 0 1 1 C 100000000 500000 99500000 2013 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 Thomas F Courtney & Associates Thomas F. Courtney, Director, is owner of Thomas F. Courtney & Associates 256693 Thomas F. Courtney & Associates assists Palos with collecting certain workers' compensation and motor vehicle accident claims. 0 Kathleen Wright Sibling of Sister Margaret Wright, CEO 60246 Employment 0 Palos Anesthesia Associates Dr. Michael Sobczak, Director is the President of Palos Anesthesia Assoc. 950004 Palos Anesthesia Associates provides anesthesia services for Palos patients 0 Form 990, Part VI, Section A, line 6 St. George Corporation is the sole Corporate Member. Form 990, Part VI, Section A, line 7a St. George Corporation holds the power to appoint members of the governing body. Form 990, Part VI, Section A, line 7b St. George Corporation can exercise action on the following matters: (a) removal of directors, with or without cause; (b) all amendments to these bylaws or the Corporation's Articles of Incorporation; (c) The sale or transfer of substantially all of the property of the corporation, except for leases in excess of one year; (d) all long term borrowing in excess of one year; (e) merger or consolidation by the Corporation with any other institution, hospital, corporation or legal entity; (f) formal affiliation with a medical school or research facility; (g) acceptance of any gift, bequest or legacy that imposes a permanent or continuing obligation on the Corporation for a period of more than one year; (h) decisions to authorize voluntary dissolution of the Corporation or to revoke proceedings therefor; (i) adoption of a plan for the distribution of the assets of the Corporation; and (j) any other matters required by law to be submitted to the Corporate Member or which the Board determines by resolution to submit. Form 990, Part VI, Section B, line 11 Before filing Form 990, the organization presented the completed Form 990 to the Finance Committee of the Board for review and approval. After the Finance Committee approved Form 990, it was submitted to the Board for final approval. Form 990, Part VI, Section B, line 12c On an annual basis directors, key personnel (VP, department heads (budget administrators)), and all purchasing staff must complete a Conflict of Interest Form disclosing any conflict of interest that may exist or be perceived to exist between themselves and/or family members and vendors, contractors and others PCH has a contract/transaction agreement. These annual disclosure statements are reviewed by the VP of Human Resources. Any issue identified as part of this annual disclosure is referred to the President of PCH for disposition. Persons completing the conflict of interest form know to disclose any potential conflicts on an ongoing basis. An individual with a conflict of interest would be excluded from any discussion, vote, or decision that involved the conflict or decision. Form 990, Part VI, Section B, line 15 During 2013, PCH had two different CEOs and an interim CEO to bridge the gap. Sister Wright's contract was a management contract with the religious order. The Executive Committee of the Board of Directors has the responsibility for the contract and fees. The interim CEO was a VP of the facility and continued to be paid at his VP salary. The second CEO signed an employment contract that was signed by the Chairman of the Board of Directors. This contract was reviewed by legal counsel and approved by the outside consultant that was utilized for the placement of this position. All of these salaries are the responsibility of the Executive Committee of the Board of Directors. Annually, Human Resources gathers market data on executive positions from a variety of published survey sources such as Metropolitan Healthcare Council (MCHC), Mercer, Watson Wyatt, etc. The market data is analyzed for organizations with similar size and characteristics (FTEs, revenue, beds, region, non-for profit, stand alone institutions, etc.) The mean, median and, if available, the 90th percentile rates are provided to the President/CEO for consideration and reviewed with the Board of Directors. Discussion and process are contemporaneously documented in the minutes. Form 990, Part VI, Section C, line 19 All policies, governing documents and financial statements required to be available to the public are available upon request. Requests can be made from the Financial Department of Palos Community Hospital. St George Corporation 12251 S 80th Avenue Palos Heights IL 60463 364383840 Health Care Provider IL 501(c)(3) 11 a, Type I N/A 0 St George Wellness Center 15430 West Avenue Orland Park IL 60462 364383845 Fitness Center IL 501(c)(3) 9 St George Corporation 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0