2014-05-15T16:11:26-07:00 2013-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2012-07-01 362338884 Northern Illinois Medical Center NORT 8157885800 4201 Medical Center Drive McHenry IL 60050 David Tomlinson 2014-05-15 true Mollie Longhouse P20029488 6142492300 2012 2015-11-30 17:44:51Z Michael S Eesley 385 Millennium Drive Crystal Lake IL 60012 252649202 false false X www.centegra.org X 1956 IL See Schedule O supplemental information titled Form 990, Part I, Line 1 and Part III, Line 1 Mission. 13 6 1329 237 474188 -18594 562350 480699 231945346 219801434 4777410 8915656 3966510 3240442 241251616 232438231 0 0 90331592 85274672 0 0 136642183 128767153 226973775 214041825 14277841 18396406 244008694 260857048 101298528 112210005 142710166 148647043 X See Schedule O supplemental information titled Form 990, Part I, Line 1 and Part III, Line 1 Mission. false false 193654903 220395318 See Schedule O supplemental narrative titled Form 990, Part III, Line 4a. 193654903 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 false false false true false false false false true true false false false false true 134 0 true 1329 true true false false false false false false 0 false false false false false false false false false false X 13 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 Robert M Rosenberger 1.00 39.00 X X 0 627306 39398 Parmod Narang 1.00 1.00 X 0 0 0 Charie Zanck 0.66 1.34 X X 0 0 0 Charles Ruth 0.33 2.67 X 0 0 0 Kathy Powell 0.33 3.67 X 0 0 0 Jack Porter 0.33 0.67 X 0 0 0 Pat Morehead 0.33 1.67 X X 0 0 0 Angela McAuley 0.33 1.67 X 0 0 0 Michael Luecht 0.33 1.67 X 0 0 0 Luke Johnsos 0.33 1.67 X 0 0 0 Michael S Eesley 1.00 39.00 X X 0 1277730 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35.00 0.00 X 144745 0 31767 Sara M Sigrist 24.00 0.00 X 140735 0 8451 Jeannine C Nosko 40.00 0.00 X 137540 0 31293 1040980 6626477 1127978 33 false true false Total Home Health 780 S Mclean Blvd Elgin IL 60123 Home Med Equipment 789047 Sodexo Inc & Affiliates 4880 Paysphere Circle Chicago IL 60674 Management Services 3348147 McKesson Technologies PO Box 98347 Chicago IL 606938347 Computer Support 2492949 Dell Marketing LP PO Box 677654 Dallas TX 752676021 Computer Support 1039138 Cardiac Surgery Associates PO Box 153 Channahon IL 60410 Physician Services 908681 18 443330 37369 480699 Routine Patient Services 622110 75746615 75746615 IDPA Provider Tax Revenue 622110 5013680 5013680 Charity Care/Admin Allowa 622110 -23422116 -23422116 Ancillary Outpatient Serv 622110 138008391 138008391 Ancillary Inpatient Servi 622110 24454864 24454864 219801434 7089263 7089263 7833 7833 0 0 22025913 3618 20210971 1814942 3618 1818560 1818560 0 0 0 Related Company Revenue 900099 687034 687034 Child Day Care Center 624410 815271 474188 341083 Cafeteria Services & Educ 722210 870724 870724 867413 593884 273529 3240442 232438231 220395318 474188 11088026 X 0 0 0 0 321497 321497 0 69462248 61950925 7511323 1135761 1008278 127483 9443146 8383208 1059938 4912020 4360674 551346 1045525 1045525 0 0 35967 35967 0 0 7460129 6625675 834454 34637 34637 33502200 32955837 546363 20175 16801 3374 0 2255981 914011 1341970 194934 178426 16508 0 86888 71357 15531 3367855 2989833 378022 0 10467938 9292973 1174965 2823157 2506274 316883 IDPA Provider Tax 4950237 4950237 Related Company-Lab 6122630 6122630 Bad Debt 12089690 12089690 Related Company-CHS 39180395 34782624 4397772 5128815 4420813 708001 214041825 193654903 20386922 0 136346 247838 19816348 15083028 0 31241332 29906359 0 0 0 4163547 3987439 1884424 1257686 193641329 126780173 65871828 66861156 83657820 90855755 0 3692707 4533676 111005 33544342 48013106 244008694 260857048 26238964 20172535 70781285 88835515 4278279 3201955 101298528 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should be recorded in the consolidated financial statements. Under ASC 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 a 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, 2013 and 2012, the Health System does not have a liability for unrecognized tax benefits. true true true X true X 600.000000000 true true true false true true 6222978 6222978 0.02910 17670267 6677598 10992669 0.05140 23893245 6677598 17215647 0.08050 13 5522 467958 6715 461243 0.00220 6 1095 400458 1500 398958 0.00190 19 6617 868416 8215 860201 0.00410 19 6617 24761661 6685813 18075848 0.08460 true 3566459 3239026 66700715 79424667 -12723952 X true true ARSC Real Estate Property Management 0.25000 Algonquin Road Surgery Ctr Outpatient Surgical Service 0.12750 1 1 Northern Illinois Medical Ctr

4201 Medical Center Drive McHenry IL 60050

X X X X Cancer Center Northern Illinois Medical Ctr 1 true X X X X X X X 10 true true true X X X X X X X X X true false false true true 200.0000 true 600.0000 true X X X X X X X X true true X X X X true false true X false false 6 NIMC Back to Work Program

200 Congress Parkway Crystal Lake IL 60014

Physical Rehabilitation Clinic. NIMC Rehab & Sports Medicine Clinic

2507 N Richmond Road McHenry IL 60050

Physical Rehabilitation Clinic NIMC Neuro-Rehabilitation Center

500 Coventry Lane Crystal Lake IL 60014

Neurotrauma Day Treatment Center NIMC Rehab & Sports Medicine Clinic

200 Congress Parkway Crystal Lake IL 60014

Sports Medicine and Rehabilitation Clinic Gavers Breast Center

360 N Terra Cotta Road Crystal Lake IL 60012

Medical Imaging and Breast Care Center Crystal Lake Medical Arts Imaging Center

360 Station Drive Suite 150 Crystal Lake IL 60014

Medical Imaging Center Part VI - Additional Information Schedule H, Part I, Line 7a-7c dollars are calculated using the Medicare cost to charge ratio. Line 7e-7i dollars 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, Line 7, column f percentages are automatically calculated by the software based on total functional expenses. If bad debt expense were removed from the functional expense total, then the percent of total expense would be 8.95%. Part V - Explanation of Number of Facility Type Northern Illinois Medical Center is a 177 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. Part VI - States Where Community Benefit Report Filed IL Part VI - Affilated Health Care System Roles and Promotion Northern Illinois Medical Center of McHenry, IL is affliated 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. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose Please see Schedule O for a detailed description of the Medical Center's program service accomplishments. Part VI - Community Information Centegra Health System defines its primary service area as McHenry County, an area of approximately 603 square miles and 308,760 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 0-19 with 0.6% and the 65+ age group with 15.3% growth. The county's overall population is projected to increase by 1.4% in the next five years (2012 to 2017). 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 2011 was $76,909 compared to the IL state median income of $56,576. The 2013 unemployment rate was 9.3% which is lower than the state average of 9.4%. For 2011, the percentage of the county's population holding a high school diploma was 27.4%, while the percentage holding a bachelor's degree was 21.7%. 5.4% of families fell below the poverty level. Part VI - Patient Education of Eligibility for Assistance 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 Systems 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. CHSs 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 time line 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. CHSs 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 systems website offers FAQs and answers as well as encourages patients to contact our Customer Service Team when they are unable to pay for services. Our health systems 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 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. Part VI - Needs Assessment Centegra Health System is an active participant in the McHenry County Health Departments 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 System3) Cardiovascular Care * By 2017, reduce the death rate from cardiovascular disease by 20%Cemtegra 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. Number of Hospital Faciltiy - 1 Part V, Line 20d - Other Billing Determination of Individuals Without Insurance See Part VI Supplemental Information for billing and collection policies regarding persons eligible for financial assistance. Number of Hospital Faciltiy - 1 Part V, Line 12h - Other Factors Used in Determing Amounts Charged Patients 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,& medical indigency. Number of Hospital Faciltiy - 1 Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment Department of Public Health and other area Health Care Facilities Number of Hospital Faciltiy - 1 Part V, Line 3 - Account Input from Person Who Represent the Community The Health Systems works with the Department of Public Health and other area Hospitals to conduct the assessment. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients 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. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The amount of cost that exceeds reimbursement is actual cost to treat patients and is therefore treated as a community benefit. Part III, Line 4 - Bad Debt Expense 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 2, 13, and 16-17 of the audited financial statements for notes on the allowances for doubtful accounts. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit 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 bad 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. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The actual gross bad debt write offs of $12,089,690 were multiplied by the cost to charge ratio of .295 to estimate the cost of bad debt. X X X X X false true false false false false false false false false Zbigniew T Lorenc 249763 48001 3406 14700 9589 325459 Todd A Meyers 173649 10852 21833 206334 Susan M Milford 223295 63642 66549 23170 376656 5506 Susan H Corcoran 144745 9125 22642 176512 Sheila Senn 133314 16824 9492 22762 182392 Robin K Purdy 271332 28862 14700 16087 330981 Robert M Rosenberger 469516 122154 35636 15893 23505 666704 19889 Rachel L Sebastian 243577 37150 17520 23250 321497 Pasquale G Bernardi 322584 60820 23129 406533 Neil W Murphy 225156 59634 5394 290184 Michael S Eesley 822323 451843 3564 335234 11677 1624641 261678 Mattias Carlen 124601 6200 25775 156576 Matthew Towler 193313 35778 22461 251552 Kumar Nathan 213992 10431 13925 17913 256261 John G Geinopolos 163584 10404 22715 196703 Jeannine C Nosko 137540 8611 22682 168833 Jason R Sciarro 564364 156422 3928 73224 23574 821512 19515 Gail D Rudolph 178816 5056 16541 200413 David Tomlinson 276560 55165 14700 23418 369843 Christopher Westerkamp 162609 14670 4786 1498 183563 Bernadette S Szczepanski 194954 24957 13327 5636 238874 Barbara J Johnson 312899 56261 9966 10762 389888 56261 Aaron T Shepley 333458 95430 52000 23450 504338 14724 Tom Carey Board Member 488932 Electrical Services false Rachel Sebastian Family membe 321497 Employee false American Community Bank Board Director 107217 Investment Services false Home State Bank Board Treasurer 103027 Investment Services false American Community Bank Board Chairperson 107217 Investment Services false Home State Bank Board Member 103027 Investment Services false All business transactions are arms length transactions. See conflict of interst discloures in Schedule O for Form 990, part VI, Line 2. 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 a related company (Centegra Health System, FEIN 36-3196559). The allocation method is reviewed annually. Expense detail is as follows: Salaries $14,387,044; Benefits $2,527,839; Payroll Taxes $1,107,512; Purchased Services/Professional Fees $10,990,128; IT Expenses $3,647,130; Office Expenses $2,544,095; Advertising and Promotional $1,426,301; Other Expenses $2,550,347. 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 Systems Form 990. Form 990, Part III, Line 4 Program Service Accomplishments Cont'd 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. Form 990, Part III, Line 4 - Program Service Accomplishments Cont'd 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 expos, the McHenry County Fair, and the McHenry Township Senior Resource Expo. Northern Illinois Medical Center, in conjunction with Centegra Health System and Memorial Medical Center, offers specialized exercise programs which help participants get moving and stay active for a healthier lifestyle. These include: Arthritis Water Exercise Program; Senior Citizen's Exercise Group; The Get Off Your Rocker Program designed for individuals at least 55 years of age to improve flexibility, strength, and endurance; and the Stroke Exercise Program which is a general physical conditioning exercise program for stroke patients to improve coordination and increase range of motion. Yoga, Tai-Chi, weight management, and a variety of other programs are offered through Health Bridge Fitness Center. The Rehabilitation and Sports Medicine Clinic at Health Bridge Fitness Center provides sports medicine, aquatics, and outpatient physical and occupational therapy programs. The Back to Work Program, an industrial injury prevention and rehabilitation program, provides physical therapy, ergonomic consultation, and back safety programs. The program also uses the aquatic pool located at the Rehabilitation and Sports Medicine Clinic at Health Bridge Fitness Center. Additional education programs are offered to assist community members in taking charge of their own special needs and their changing lifestyles. Programs inform the community about Advance Medical Directives including living wills, durable power of attorney issues, and organ donations. Education programs include Understanding Medicare, Critical Care Class, Healthy Heart Nutrition, Stroke: Are You Doing All You Can?, Food and Feelings, and Weight Management Programs. Integrative programs include mindful eating, understanding the healing potential of food, and journaling. The Medical Center sponsors programs focusing on women's health issues. The Center also provides reduced fee mammograms, programs on osteoporosis, and programs on menopause. Depression and anxiety screenings are also offered. Relaxation Training teaches techniques to bring the body and mind in balance. Improving Your Blood Pressure is a program which promotes understanding of the factors that affect blood pressure, the early warning signs of heart attack, how to better control risk factors. Form 990, Part III, Line 4 - Program Service Accomplishments cont'd In addition to the programs described above, Northern Illinois Medical Center, in conjunction with Centegra Health System and Memorial Medical Center, participates in various community projects such as Meals on Wheels, free Flu Vaccination Clinics, National Depression/Anxiety Screening Day, and health fairs/county fairs. The Medical Center offers career shadowing opportunities for area high school students, Flight for Life Helicopter appearances, poison awareness programs, blood drives to support local banks, mammograms, colorectal cancer screenings and lipid profiles. Glaucoma, hearing, and other screenings are offered in order to promote health and awareness in the community. The Referral Line offers toll-free, computerized service to callers who require information or physician referrals. The line is staffed by a trained counselor. Several medical specialties are represented, and physicians are on staff for referrals. The line also gives information regarding physicians' office hours, locations, insurance, and languages spoken. Additionally, counselors give information on Self-help and Support Groups. Centegra S.H.I.P. (Senior Health Insurance Program) provides trained volunteers to answer questions on a weekly basis regarding insurance coverage. Together We Can Immunization Partnership Clinics were instituted at Northern Illinois Medical Center, Memorial Medical Center, and other medical office buildings in Cary, Huntley, and Woodstock, Illinois to provide immunizations for the unvaccinated children of McHenry County. Clinics are held once per month at the medical centers and office buildings providing Hepatitis B, DPt, Hib, OPV, MMR, and Td immunizations. Fees are based upon ability to pay with a maximum charge of $15.00 per immunization. Centegra Health System absorbs 87% of the cost of this program. During fiscal year ending June 30, 2013, 267 persons received 577 vaccines at Centegra Health System sites. Form 990, Part III, Line 4 - Program Service Accomplishments 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, 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. Form 990, Part III, Line 1 - Mission 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: 177 licensed-bed Comprehensive Medical Center (40,050 patient days in fiscal year ending June 30, 2013), Level Two Trauma Center, 24 hr Emergency Medicine Physicians, On-site Flight for Life Helicopter (417 flights in fiscal year ending June 30, 2013), Portable TDD (Telephone Device for the Deaf) on site, Center for New Life including Level Two Nursery (2,051 newborn patient days in fiscal year ending June 30, 2013), 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 (17,775 radiation oncology procedures and 2,651 medical oncology visits in fiscal year ending June 30, 2013), Cardiac Surveillance, Cardiac Catherization Suite, Three-level Cardiac Rehabilitation Program (24,359 visits in fiscal year ending June 30, 2013), Heart Failure Clinic, Full-body CT Scanner and Magnetic Resonance Imaging (MRI) (18,364 CT Scans and 4,141 MRI procedures performed in fiscal year ending June 30, 2013), PET/CT scans, Women's Diagnostic Services (In Medical Imaging), Center for Physical Rehabilitation (4,369 patient days in fiscal year ending June 30, 2013), Inpatient Unit, Independence Square, Occupational, Physical and Speech Therapies, Outpatient Therapies, Respiratory Therapy, Home Health Care (30,159 visits in fiscal year ending June 30, 2013), Back to Work Program for Industrial Injury Prevention and Rehabilitation, Neurotrauma Day Treatment Program, Sports Medicine Clinic, Occupational Health, Patient Express! Transportation, Extra Touch Program, Pastoral Care, Social Service, Community Education Programs, Support Programs/Groups, and Nutritional Therapy Services. Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases LOSS ON DEFEASANCE OF DEBT = -$789406 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases INCOME ON '02 BONDS = $78616 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases FOUNDATION = $445973 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases AFFILIATE TRANSFERS = -$11811085 Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available All governing documents, policies, and financial statements are available upon request. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees 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 Chief Executive Officer's compensation is determined by the Compensation Committee in relation to appropriate comparability data. Compensation for other members of the executive staff are developed by the CEO, reviewed by the Committee, evaluated against market data, and approved by the Committee. The 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. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts 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. Form 990, Part VI, Line 11b Form 990, Part VI, Line 11b: Form 990 Review Process 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. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Centegra Health System is the sole member of NIMC. Centegra Health System has a single class of members. Form 990, Part VI, Line 3 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company 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, Plant Operations and Maintenance (during the first quarter of FY13 only), 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. Form 990, Part VI, Line 2 Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et 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 2013, Northern Illinois Medical Center purchased certain goods and/or services from organizations with director affiliation. All transactions were competitively bid and were conducted at arms 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 1% 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. 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