2013-08-09T12:36:06-05:00 2012-09-30 Deloitte Tax LLP 111 Monument Circle Suite 2000 Indianapolis IN 462045108 990 2011-10-01 362167060 NorthShore University HealthSystem % JEFF BIESCZAT NORT 8475702000 1301 Central Street Evanston IL 60201 GARY E WEISS 2013-07-24 true 3174648600 2011 2016-02-24 21:20:13Z Mark R Neaman 1301 Central Street Evanston IL 60201 1796227749 false X northshore.org X 1891 IL The core mission of NorthShore University HealthSystem is to "preserve and improve human life." 23 0 10635 1881 26009501 -125905 21820514 35236321 1259561280 1308273826 115755104 51678030 41581161 36326858 1438718059 1431515035 45548410 51107501 0 0 574086526 617542056 0 0 2529932 688995935 719347526 1308630871 1387997083 130087188 43517952 2680646127 2881261196 1313904278 1358259332 1366741849 1523001864 X SEE SCHEDULE O false false 1068343468 46247024 1269874296 Patient Care - See Schedule O 54987712 0 11412056 Education - See Schedule O 34745631 4860477 18692365 Research - See Schedule O 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1.0 X 0 0 0 Susan B Sentell 1.0 X 0 0 0 Mark S Talamonti 29.0 X 604816 391913 51693 John R Walter 1.0 X 0 0 0 Sona Wang 1.0 X 0 0 0 Jonathan P Ward 1.0 X 0 0 0 William Wrigley Jr 1.0 X 0 0 0 Gregory K Jones 1.0 X X 0 0 0 A Steven Crown 1.0 X X 0 0 0 Harry M Jansen Kraemer Jr 1.0 X X 0 0 0 Mark R Neaman 41.0 X X 2860672 0 111361 Percy L Berger Sr 1.0 X 0 0 0 Jeffrey H Hillebrand 41.0 X 4423030 0 72264 J Mikesell Thomas 1.0 X 0 0 0 Gary E Weiss 41.0 X 2679815 0 62814 Julian E Bailes 13.0 X 257677 316232 27541 William D Bloomer 24.0 X 393030 645974 53303 Michael S Caplan 27.0 X 329164 248553 28920 Robert R Edelman 38.0 X 699975 260368 57959 Gerald P Gallagher 40.0 X 762082 0 69170 Thomas H Hodges 36.0 X 508468 0 35686 William R Luehrs 40.0 X 2320499 0 54324 Demetrius Maraganore 22.0 X 286473 242383 48445 Frederick E Miller 32.0 X 327339 124304 46987 Kristen Murtos 40.0 X 572419 0 63127 Jesse Peterson Hall 40.0 X 787601 0 65229 William J Robb III 40.0 X 695299 0 25466 Leopold G Selker 40.0 X 1045399 0 45339 Nancy Semerdjian 40.0 X 410794 0 37355 Richard K Silver 20.0 X 400043 504809 53361 Douglas M Silverstein 40.0 X 873234 0 369627 Thomas W Smith 40.0 X 768721 0 39156 Jeffery S Vender 27.0 X 500026 516452 45229 Thomas A Victor 35.0 X 380980 354302 52232 Brian Washa 40.0 X 345432 0 43860 Kenneth P Anderson 40.0 X 478307 0 44884 Harry L Jones 40.0 X 338839 0 45009 Janardan D Khandekar 34.0 X 575671 227434 45965 Jonathan Silverstein 40.0 X 387543 0 38388 Rajiv Udani 40.0 X 311496 0 43497 Sean O'Grady 40.0 X 309651 0 46453 Nicholas A Vick 32.0 X 156000 82092 37595 26478916 3978730 2001570 581 true true true Aramark Management Services 2300 Warrenville Road DOWNERS GROVE IL 60515 Facilities/Diet Mgmt 56506953 Pepper Construction Company 643 North Orleans Street CHICAGO IL 60610 Construction Mgmt 38243607 Power Construction Company 2630 North Palmer Drive SCHAUMBURG IL 60173 Construction Mgmt 37039871 University of Chicago Medical Ctr 5841 South Maryland Avenue CHICAGO IL 60637 Medical Education 13058276 McKesson Technologies 5995 Winward Parkway ALPHARETTA GA 30005 Info Tech Services 7634399 278 58570 563665 514269 8991711 451826 24656280 1148026 35236321 PATIENT REVENUE 621990 815929282 815929282 MEDICARE AND MEDICAID REVENUE 621990 451282888 451282888 RENT FROM AFFILIATED EXEMPT ORGS 900003 21403322 21403322 FEES AND CONTRACTS FROM GOVT AGENCIES 541700 14565422 14565422 GRANT INCOME 541700 4126943 4126943 965969 965969 1308273826 34234290 -288552 34522842 0 110521 110521 3610482 14129678 -10519196 -10519196 -10519196 366304601 149953 343502556 5508258 22802045 -5358305 17443740 17443740 1031552 514269 1001878 29674 29674 44055 4579 39476 39476 964651 565765 398887 398887 LAB REFERENCE TESTING 541380 18239651 18239651 EHR INCENTIVE INCOME 900099 10864405 10864405 OFFSITE PHARMACIES 446110 6829045 6829045 10334395 2243808 1229357 6861230 46267496 1431515035 1299978717 26009501 70290496 51020092 51020092 86909 86909 500 500 0 30705194 4707725 25997469 13781773 4441503 9340270 458198777 410518846 46044668 1635263 32944070 25374268 7569802 50593653 46949018 3272469 372166 31318589 26584361 4628142 106086 91359351 79662435 11696916 10304775 56458 10248317 756000 756000 0 0 0 17393497 17393497 78187017 60227623 17676200 283194 13641384 13641384 32361112 28653575 3621658 85879 11022213 537864 10484349 0 46534884 33057963 13476921 1320273 1049947 259345 10981 0 2056851 1445793 608952 2106 7966639 7966639 0 94819688 73884446 20935242 18183717 17585958 597759 MEDICAL SUPPLIES 233063092 232958580 104512 BAD DEBTS 31916864 31916864 MEDICAID TAX 24827622 24827622 DUES AND SUBSCRIPTIONS 2208503 1109262 1064984 34257 1424044 1419199 4845 1387997083 1158076811 227390340 2529932 25844974 21871464 16382627 17016078 10868057 11520100 172338299 211476195 0 0 0 0 0 0 18527025 20032751 6308512 7125887 1866378041 905333930 890393816 961044111 927770166 974650596 443144648 446210564 0 0 93237674 119416877 75830329 90896573 2680646127 2881261196 157448974 182875621 0 0 4892711 4976116 385411480 376463352 0 0 0 0 0 0 0 0 766151113 793944243 1313904278 1358259332 X 1211767856 1352272712 83854902 98205650 71119091 72523502 1366741849 1523001864 2680646127 2881261196 X 43517952 112742063 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 75575 75575 false Lobbying Activities Part II-B Line 1i NorthShore University HealthSystem (NorthShore) and its employees are members of various organizations that advocate on legal and policy issues that affect healthcare. A portion of the annual membership dues paid by NorthShore to these organizations are attributable to lobbying activities. 103761994 1404411 18276391 8329129 115113667 103298573 1772373 5671678 6980630 103761994 42760422 57871694 3630113 963656 103298573 41297746 2467038 -331934 672428 42760422 1.00000 false false 56783859 56783859 1167347057 522262272 645084785 45629617 22824956 22804661 486673550 348255871 138417679 109943958 11990831 97953127 961044111 HEDGE FUNDS 326408713 C PRIVATE EQUITY FUNDS 85830715 C PRIVATE EQUITY FUNDS 8437543 F REAL ASSET FUND 23465641 F OTHER INVESTMENTS 2067952 F 446210564 0 RESERVE FOR MALPRACTICE LOSSES 266000000 DEFERRED COMPENSATION 207976358 DUE TO AFFILIATES 235700134 DUE TO THIRD PARTIES 65999503 CURRENT MATURITY OF LT DEBT 8860000 ASSET RETIREMENT OBLIGATION 9320120 CURRENT BOND PAYABLE PREMIUM 88128 793944243 1431515035 1387997083 43517952 121898701 -7242847 114655854 158173806 1500749532 121898701 24330216 146228917 1354520615 76994420 76994420 1431515035 1342575726 21060205 21060205 1321515521 66481562 66481562 1387997083 Endowment Funds Part V Line 4 Endowment fund earnings are available for healthcare services, including capital acquisition and maintenance, operations, free care, research, and education. FIN 48 (ASC 740) Footnote Part X NorthShore and its related affiliates, except for NorthShore Physician Associates, Inc. (NPA), known as NorthShore Exempt Group, have been determined to qualify as a tax-exempt organization under 501(c)(3) of the Internal Revenue Code (IRC). Most of the income received by NorthShore Exempt Group is exempt from taxation under Section 501(a) of the IRC, as income related to the mission of the organization. Accordingly, there is no material provision for income tax for these entities. Some of the income received by exempt entities is subject to taxation as unrelated business income. NorthShore and its subsidiaries file federal income tax returns and returns for various states in the U.S. ASC 740-10, Income Taxes, requires that realization of an uncertain income tax position is more likely than not (i.e., greater than 50% likelihood of receiving a benefit) before it can be recognized in the financial statements. Furthermore, this interpretation prescribes the benefit to be recorded in the financial statements as the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. This interpretation also clarifies the financial statement classification of tax-related penalties and interest and sets forth new disclosures regarding unrecognized tax benefits. No amount was recorded for the periods ended September 30, 2012 or 2011. NorthShore currently has a net operating loss carryforward of $12,656,460, which generated assets of $5,111,297. NPA currently has a net operating loss carryforward of $712,282, which generated assets of $286,836. These assets are 100% offset by valuation allowances. Change in Net Assets Part XI Line 8 Amount represents changes in restricted net assets. Reconciliation of Revenues Part XII Lines 2d and 4b Line 2d - Amount represents expenses deducted from revenues in Form 990 Part VIII and changes in restricted net assets. Line 4b - Amount represents transfers to related organzations, Foundation administrative expenses, and investment expenses moved to Form 990 Part IX, and changes in restricted net assets. Reconciliation of Expenses Part XIII Lines 2d and 4b Line 2d - Amount represents expenses deducted from revenues in Form 990 Part VIII. Line 4b - Amount represents transfers to related organzations, Foundation administrative expenses, and investment expenses moved to Form 990 Part IX. true Central America and the Caribbean Insurance 5070760 Central America and the Caribbean Investments 256685752 Central America and the Caribbean Program Services Medical Conferences 2735 Central America and the Caribbean Program Services Medical Services 5443 East Asia and the Pacific Program Services Medical Conferences 35404 East Asia and the Pacific Grantmaking 500 East Asia and the Pacific Program Services Medical Services 9000 Europe (Including Iceland and Greenland) Insurance 14399 Europe (Including Iceland and Greenland) Program Services Medical Conferences 42389 Europe (Including Iceland and Greenland) Program Services Medical Supplies/Svcs 104131 North America Program Services Medical Conferences 32364 North America Program Services Medical Supplies/Svcs 441542 Russia and the Newly Independent States Program Services Medical Services 2000 South America Program Services Medical Conferences 8003 South America Program Services Medical Services 1000 South Asia Program Services Medical Services 4000 Sub-Saharan Africa Program Services Medical Services 1000 262460422 262460422 true false true true true false Grant and Assistance Procedures Part I Line 2 NorthShore University HealthSystem (NorthShore) provides cash and non-cash assistance to organizations that help support NorthShore's mission to preserve and improve human life. Requests to support an outside organization must be reviewed and approved by the Community Relations department and NorthShore management to ensure the organization is aligned with NorthShore's mission and charitable purpose. June Gala 604155 292551 311604 28642 98831 14551 62760 Craft Expo 547881 80157 467724 25669 59906 262841 3 393785 141561 252224 162850 3193 282635 1545821 514269 1031552 217161 161930 14551 608236 1001878 29674 44055 4579 true 1.00000 44055 4579 4579 39476 IL true false false false 1.00000 NorthShore University HealthSystem 1301 Central Street Evanston IL 60201 false Kate Beckering Oversees auxiliary operations including raffle. X false true true X true X true X 600. true true true false true true 22612634 22612634 0.01670 101894505 74355695 27538810 0.02030 124507139 74355695 50151444 0.03700 2082323 2082323 0.00150 54987712 11412056 43575656 0.03210 57725084 37081762 20643322 0.01520 31038221 31038221 0.02290 935503 935503 0.00070 146768843 48493818 98275025 0.07240 271275982 122849513 148426469 0.10940 12346 12346 690 690 98 98 20709 20709 84181 84181 0.00010 5021 5021 123045 123045 0.00010 true 9087981 366840428 452279142 -85438714 X true true HPMOB LP Medical Office Building 0.29620 0.00000 0.70380 Ravine Way LLC Orthopaedic Surgery Center 0.30000 0.00000 0.70000 NorthShoreUSP LLC General Surgery Centers 0.49900 0.00000 0.50100 4 1 Evanston Hospital

2650 Ridge Avenue Evanston IL 60201

X X X X X 2 Glenbrook Hospital

2100 Pfingsten Road Glenview IL 60026

X X X X X 3 Highland Park Hospital

777 Park Avenue West Highland Park IL 60035

X X X X X 4 Skokie Hospital

9600 Gross Point Road Skokie IL 60076

X X X X X Evanston Hospital 1 true true 200. true 600. true X X X X X X X true true X X true false true X X false false Glenbrook Hospital 2 true true 200. true 600. true X X X X X X X true true X X true false true X X false false Highland Park Hospital 3 true true 200. true 600. true X X X X X X X true true X X true false true X X false false Skokie Hospital 4 true true 200. true 600. true X X X X X X X true true X X true false true X X false false 34 Glenbrook Ambulatory Care Center

2180 Pfingsten Road Glenview IL 60026

Outpatient Clinic Graham Medical Office Building

1000 Central Street Evanston IL 60201

Outpatient Clinic Highland Park Ambulatory Care Building

757 Park Avenue West Highland Park IL 60035

Outpatient Clinic Gurnee Ambulatory Care Center

7900 Rollins Road Gurnee IL 60031

Outpatient Clinic Old Orchard Medical Office Building

9977 Woods Drive Skokie IL 60077

Outpatient Clinic Skokie Medical Office Building

9669 N Kenton Avenue Skokie IL 60076

Outpatient Clinic Highland Park Medical Office Building

767 Park Avenue West Highland Park IL 60035

Outpatient Clinic Glenbrook Medical Office Building (North

2150 Pfingsten Road Glenview IL 60026

Outpatient Clinic Glenbrook Medical Office Building (South

2050 Pfingsten Road Glenview IL 60026

Outpatient Clinic Lakeshore Imaging

680 N Lake Shore Drive Chicago IL 60611

Outpatient Clinic Vernon Hills Specialty Care Center

225 N Milwaukee Avenue Vernon Hills IL 60061

Outpatient Clinic Bannockburn Medical Office Building

2151 Waukegan Road Bannockburn IL 60015

Outpatient Clinic Gurnee Medical Office Building

15 Tower Court Gurnee IL 60031

Outpatient Clinic PM&R Pediatrics Lab Services

9811 Woods Drive Skokie IL 60077

Outpatient Clinic NorthShore Lab Services - Mount Prospect

1329 Wolf Road Mount Prospect IL 60056

Outpatient Clinic Glenview Park Center

2400 Chestnut Avenue Glenview IL 60026

Outpatient Clinic Fetal Diagnostic Center

71 Waukegan Road Lake Bluff IL 60044

Outpatient Clinic PMR Fitness Center

1501 Busch Parkway Buffalo Grove IL 60089

Outpatient Clinic PM&R Benson Avenue

1729 Benson Avenue Evanston IL 60201

Outpatient Clinic Adolescent Day School

3633 W Lake Avenue Glenview IL 60026

Therapeutic Day Northbrook Court Imaging

1182 Northbrook Court Northbrook IL 60062

Outpatient Clinic School Fetal Diagnostic Center

5145 N California Avenue Chicago IL 60625

Outpatient Clinic NorthShore Lab Services - Evanston

2500 Ridge Avenue Evanston IL 60201

Outpatient Clinic Fetal Diagnostic Center

880 W Central Road Arlington Heights IL 60005

Outpatient Clinic Northbrook Pharmacy

1127 Church Street Northbrook IL 60062

Outpatient Pharmacy Fetal Diagnostic Center

755 S Milwaukee Avenue Libertyville IL 60048

Outpatient Clinic Libertyville Pharmacy

1451 W Peterson Road Libertyville IL 60048

Outpatient Pharmacy Lake Forest Pharmacy

825 S Waukegan Avenue Lake Forest IL 60045

Outpatient Pharmacy Breast Health and Mammography Program

71 Old Orchard Shopping Center Skokie IL 60077

Outpatient Clinic River North Same Day Surgery

One East Erie Street Chicago IL 60611

Ambulatory Surgery Ravine Way Surgery Center

2350 Ravine Way Glenview IL 60025

Ambulatory Surgery Center 25 East Same Day Surgery Center

25 East Washington Street Chicago IL 60602

Ambulatory Surgery Center North Shore Same Day Surgery

3725 West Touhy Avenue Lincolnwood IL 60712

Ambulatory Surgery Center Elmwood Park Same Day Surgery

1614 North Harlem Avenue Elmwood Park IL 60707

Ambulatory Surgery Center Percent of Total Expense Part I Line 7 column (f) The amount of bad debt expense that was included in Form 990, Part IX, line 25, column (A) but removed from the figure in Part I, Line 7, column (f) was $31,916,864. Costing Methodology Part I Line 7 NorthShore University HealthSystem calculated the cost of charity care and means-tested government programs using the cost-to-charge ratio derived from Schedule H, Worksheet 2, Ratio of Patient Care Cost-to-Charges. Amounts in the other benefits section of Line 7 were calculated using costs charged directly to the individual programs from the financial accounting system. An indirect cost allocation factor for hospital shared services was also calculated and included for each program indicated in other benefits. Community Building Activities Part II NorthShore University HealthSystem (NorthShore) is involved in numerous community building activities which promote the health of the communities it serves. NorthShore encourages its employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities served. Bad Debt Expense Part III Line 4 Bad debt expense was reported at cost using a cost-to-charge methodology. The Schedule H, Worksheet 2, Ratio of Patient Care Cost-to-Charges calculated to report charity care on Part I, Line 7a was multiplied by the bad debt expense to determine the bad debt expense at cost. Discounts and payments on patient accounts are excluded from bad debt expense in order to reflect the expected amount to be paid. Accounts Receivable Financial Statement Footnote - The Corporation evaluates the collectibility of its accounts receivable based on the length of time the receivable is outstanding, payor class, and the anticipated future uncollectible amounts based on historical experience. Accounts receivable are charged to the allowance for uncollectible accounts when they are deemed uncollectible. Medicare Shortfall Part III Line 8 The Schedule H, Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to determine the Medicare costs reported on Part III, Line 6. NorthShore University HealthSystem (NorthShore) believes that all of the $85,438,714 shortfall should be considered as community benefit. The Internal Revenue Service Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by NorthShore in order to continue treating the elderly in our community. During fiscal year 2012, Medicare accounted for approximately 45% of hospital gross patient revenues. The hospital provides care regardless of this shortfall and thereby relieves the government of the burden of paying the full cost of care for Medicare beneficiaries. Collection Practices Part III Line 9b NorthShore University HealthSystem (NorthShore) follows the Illinois Fair Patient Billing Act. The collection policy is the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. After a patient meets the qualifications for financial assistance, the account balance is either partially or entirely written off. Any remaining balance would be collected under the existing debt collection policy. Publication of Financial Assistance Policy Part V Section B Line 13g Evanston Hospital (Number 1) - The NorthShore University HealthSystem (NorthShore) Financial Assistance program is publicized on the NorthShore website with a summary of the program, application process, and a link to the actual financial application. Information about the NorthShore Financial Assistance program is also publicized with signage (both English and Spanish) in all our facilities' Emergency Departments and at our Central Registration areas. The NorthShore Patient Handbook, which includes a description of the Financial Assistance program, is also available to patients upon admission to a NorthShore hospital. NorthShore billing statements also indicate the Financial Assistance program and necessary contact information. Collection agencies are also instructed to offer charity care to potentially eligible patients. A copy of the complete NorthShore Financial Assistance Policy is also available upon request. Glenbrook Hospital (Number 2) - The NorthShore University HealthSystem (NorthShore) Financial Assistance program is publicized on the NorthShore website with a summary of the program, application process, and a link to the actual financial application. Information about the NorthShore Financial Assistance program is also publicized with signage (both English and Spanish) in all our facilities' Emergency Departments and at our Central Registration areas. The NorthShore Patient Handbook, which includes a description of the Financial Assistance program, is also available to patients upon admission to a NorthShore hospital. NorthShore billing statements also indicate the Financial Assistance program and necessary contact information. Collection agencies are also instructed to offer charity care to potentially eligible patients. A copy of the complete NorthShore Financial Assistance Policy is also available upon request. Highland Park Hospital (Number 3) - The NorthShore University HealthSystem (NorthShore) Financial Assistance program is publicized on the NorthShore website with a summary of the program, application process, and a link to the actual financial application. Information about the NorthShore Financial Assistance program is also publicized with signage (both English and Spanish) in all our facilities' Emergency Departments and at our Central Registration areas. The NorthShore Patient Handbook, which includes a description of the Financial Assistance program, is also available to patients upon admission to a NorthShore hospital. NorthShore billing statements also indicate the Financial Assistance program and necessary contact information. Collection agencies are also instructed to offer charity care to potentially eligible patients. A copy of the complete NorthShore Financial Assistance Policy is also available upon request. Skokie Hospital (Number 4) - The NorthShore University HealthSystem (NorthShore) Financial Assistance program is publicized on the NorthShore website with a summary of the program, application process, and a link to the actual financial application. Information about the NorthShore Financial Assistance program is also publicized with signage (both English and Spanish) in all our facilities' Emergency Departments and at our Central Registration areas. The NorthShore Patient Handbook, which includes a description of the Financial Assistance program, is also available to patients upon admission to a NorthShore hospital. NorthShore billing statements also indicate the Financial Assistance program and necessary contact information. Collection agencies are also instructed to offer charity care to potentially eligible patients. A copy of the complete NorthShore Financial Assistance Policy is also available upon request. Amounts Charged to Individuals Eligible for Financial Assistance Part V Section B Line 19d Evanston Hospital (Number 1) - NorthShore follows the Illinois Hospital Uninsured Patient Discount Act, which requires discounts to patients who qualify for financial assistance that result in bills of no more than 135% of cost. The discount requirements under Illinois law are also monitored to ensure they do not exceed the average of the three lowest negotiated commercial insurance rates. Glenbrook Hospital (Number 2) - NorthShore follows the Illinois Hospital Uninsured Patient Discount Act, which requires discounts to patients who qualify for financial assistance that result in bills of no more than 135% of cost. The discount requirements under Illinois law are also monitored to ensure they do not exceed the average of the three lowest negotiated commercial insurance rates. Highland Park Hospital (Number 3) - NorthShore follows the Illinois Hospital Uninsured Patient Discount Act, which requires discounts to patients who qualify for financial assistance that result in bills of no more than 135% of cost. The discount requirements under Illinois law are also monitored to ensure they do not exceed the average of the three lowest negotiated commercial insurance rates. Skokie Hospital (Number 4) - NorthShore follows the Illinois Hospital Uninsured Patient Discount Act, which requires discounts to patients who qualify for financial assistance that result in bills of no more than 135% of cost. The discount requirements under Illinois law are also monitored to ensure they do not exceed the average of the three lowest negotiated commercial insurance rates. Needs Assessment Part VI Line 2 NorthShore University HealthSystem (NorthShore) consistently assesses the needs of its communities and those of the underserved to ensure that its community benefits programs are in alignment with the health needs of the communities it serves. In addition to collecting and analyzing available quantitative and qualitative data on mortality, disease incidence, utilization of and access to health care services, NorthShore established a mechanism in which to actively seek the involvement of our community and public health leaders in an ongoing manner to ensure that our analysis reflects the current public health needs in our area. Community Needs Assessment Methodology - In order to produce a comprehensive health assessment, NorthShore utilized a range of available data sources. Public health statistics on mortality, maternal, infant, and child health, emotional well-being and access to care were obtained for 2006 from the Illinois Department of Public Health website. As public health data often lags by several years, and is only available at the state, Metropolitan Statistical Area, or county level, NorthShore also identified sources of zip-code level estimates of disease incidence metrics and socioeconomic status. This data assisted in understanding local levels of need and variation across our specific service area. (The zip-code level metrics included data from Thomson/Reuters from 2008, a health care information company, which creates estimates based on Census data, Medicare and third party insurance claims, and a nationally-representative household survey that includes self-reported health status, health care utilization, and self-report diagnoses.) NorthShore also identified zip-code level rates of preventable hospitalizations based on Agency for Healthcare Research and Quality (AHRQ) definitions. Preventable hospitalizations served as an indicator of the quality and depth of the outpatient management of chronic diseases, such as hypertension, high cholesterol, diabetes and obesity. The causes that trigger hospitalization were identified using the Illinois Hospital Associations COMPData database. Based on the compilation of these sources, NorthShore found that mortality and non-obstetric hospitalizations are driven predominantly by heart disease, cancer, stroke, pneumonia, diabetes and psychiatric conditions. Areas of greatest socioeconomic need within NorthShore's service area are concentrated in northern Lake County and the North Chicago neighborhoods. NorthShore also identified differences across the service area in the self-reported health status and diagnosis of disease, and compared overall rates to Healthy Goals 2010 (where applicable). Community Involvement - NorthShore utilizes multiple mechanisms for seeking out the collective voice of the community in understanding the unmet health needs. For example, each NorthShore hospital has a community advisory committee that includes a range of community leaders. These leaders represent local public health agencies, non-profit organizations serving low-income residents, faith based groups, and business and civic leaders. They advise each hospital and NorthShore on services or initiatives from a community perspective and provide strategic recommendations for community benefits programs. NorthShore's key senior administrators as well as its community relations staff maintain strong working relationships with local leaders, public health agencies, township officials and social service agencies not represented in the community advisory committee. In their role as community liaison, the community relations personnel serve as a point of contact for NorthShore's involvement with community requests. In addition, community relations personnel coordinate the hospital presidents' role in NorthShore advocacy programs. Senior administrators at NorthShore also participate regularly in outreach to local leaders. NorthShore physicians and staff play an equally important role in identifying health trends and needs through their leadership, board participation and involvement in local, regional and national organizations. Information related to the health assessments and findings are communicated at the department level to NorthShore leadership. NorthShore continues to track both quantitative and qualitative sources of public health information as it becomes available, as well as feedback from community leaders. Community health needs data is used in our annual strategic planning processes. Stakeholder participation is critical and greatly influences NorthShore's prioritization and execution of its community benefits programs. In addition, collaboration with local leadership allows NorthShore to detect urgent and growing needs that may be underrepresented or absent from aggregate data, in a timely and effective manner. Lastly, collaboration with local leaders has facilitated the development of signature programs, such as Be Well-Lake County and real time solutions to critical health challenges. Strategic Approach for Meeting Community Health Needs - NorthShore implements a three-fold strategy to address the health needs of the communities that it serves as follows: 1) Community benefits programs, signature initiatives and partnerships will address a need identified in the community health needs assessment conducted by NorthShore, 2) Community benefits programs, initiatives and partnerships will address a need identified by the community, 3) Community benefits programs, initiatives and partnerships will be aligned with the guiding principles outlined in Advancing the State of the Art of Community Benefits for Nonprofit Hospitals. The guiding principles are: disproportionate unmet health-related needs; primary prevention; seamless continuum of care; build community capacity; and community collaboration. All of NorthShore's community benefits programs, initiatives and partnerships are documented in a report that provides the date(s), describes the initiative, identifies assessed need(s) met, highlights outcomes and identifies guiding principles met. NorthShore will continue to place priority on providing community benefits and services in the communities located nearest to our hospitals, where we believe we have the greatest capacity and responsibility to serve. NorthShore conducted its most recent assessment in 2010, and therefore, will complete its next assessment in 2013. Patient Education of Eligibility for Assistance Part VI Line 3 NorthShore informs and educates potentially impacted patients of the Financial Assistance program by posting signage (both English and Spanish) in all the facilities' Emergency Departments and at our Central Registration areas. The NorthShore Patient Handbook is also available to patients upon admission and it describes the Financial Assistance program that includes Charity Care. NorthShore also has approximately 16 full time financial counselors and 38 customer service agents representing our hospitals, clinics, and physician offices. They are responsible for helping patients understand their bills and coordinating financial assistance and eligibility. Any uninsured patient admitted into the hospital will have their case reviewed by a financial counselor. NorthShore billing statements also indicate the Financial Assistance program and necessary contact information. NorthShore's physician offices and collection agencies are also instructed to coordinate charity care to potentially eligible patients. The NorthShore website is another useful resource that informs patients about the Financial Assistance program with links to the application process and the financial application. Any patient having difficulty paying their portion of the bill or wanting to know if they are eligible will have their case reviewed by a financial counselor or by calling the Customer Service department. Community Information Part VI Line 4 NorthShore University HealthSystem (NorthShore) has four hospital facilities located in the northern suburbs of Chicago, Illinois. The NorthShore service area has a total population size of approximately 1.6 million*. The average household income is approximately $90,000*. During fiscal year 2012, approximately 5% of NorthShore's patients had no insurance and 7% qualified for Medicaid. Within NorthShore's service area, there are three federally-designated medically underserved areas. NorthShore's service area also includes eight other hospitals. *Source: US Census via Thomson Reuters Market Planner Plus Promotion of Community Health Part VI Line 5 NorthShore University HealthSystem (NorthShore) extends medical staff privileges to all qualified physicians in the NorthShore community. A majority of the NorthShore Board members also reside in NorthShore's service area and are not employees, independent contractors, or family members thereof. NorthShore also uses surplus funds to add new buildings and renovate existing facilities to better serve patients and the community. Additional programs conducted by NorthShore to help promote the health of the community include: Residency and Education Programs - NorthShore is committed to excellence in its academic mission and supports teaching and research in its role as the principal teaching affiliate of the University of Chicago Pritzker School of Medicine. NorthShore also has additional teaching affiliation agreements with Rush University Medical Center, University of Illinois-Chicago, Stroger Hospital, and Northwestern University Feinberg School of Medicine. NorthShore has an extensive selection of training programs and fellowships to offer physicians at our own teaching and research facilities. During fiscal year 2012, a total of 192 residents and 25 fellows participated in the NorthShore and affiliate-based programs. The NorthShore residency program areas included: Dentistry, Internal Medicine, Pathology, Preliminary Medicine (intern year), Transitional Medicine (1st Year prior to specialization), and Family Medicine. The NorthShore fellowship program areas included: Female Pelvic Medicine and Reconstructive Surgery, Musculoskeletal Imaging, Surgical Pathology, and Endocrine Surgery. The affiliate-based residency program areas included: Anesthesiology, Dermatology, Emergency Medicine, Obstetrics and Gynecology, Orthopaedic Surgery, Pediatrics, Psychiatry, Radiology, General Surgery, Neurology, Neurosurgery, Ophthalmology, Otolaryngology, Plastic Surgery, Podiatry, and Urology. The affiliate-based fellowship program areas included: Advanced Cardiovascular Imaging and Research, Cardiology, Cardiothoracic Surgery, Child Neurology, Child Psychiatry, Colon Rectal Surgery, Electrophysiology, Gastroenterology, Gynecologic Oncology, Hematology/Oncology, Infectious Disease Research, Maternal-Fetal Medicine, Neonatal-Perinatal Medicine, Nephrology, Neuroradiology, Orthopaedic Hand, Orthopaedic Sports, Palliative Medicine, Peripheral Vascular Surgery, and Surgical Oncology. The NorthShore School of Nurse Anesthesia operates out of Evanston Hospital. The program has full accreditation from the Council of Accreditation of Nurse Anesthesia Educational Programs. The mission of the school is to prepare qualified professional registered nurses for the advanced practice of nurse anesthesia in a variety of practice settings. The graduate nurse anesthetist demonstrates the knowledge, skills, and attitude necessary to take on leadership roles in the practice of nurse anesthesia. During fiscal year 2012, 65 students participated in the program. NorthShore also provided clinical training and internships during the 2012 academic year for 1,239 high school and college students. Student interned in the following areas: Nursing, Cardiology, Laboratory, Medical Social Work, Occupational Therapy, Infection Control, Perinatal Family Support Center, Physical Therapy, Radiology, Radiation Oncology, Speech Pathology, and Hospital Administration. Community Advisory Committees - The Community Advisory Committees' (CAC) role is to advise hospital administration on services and initiatives from a community perspective. CACs are structured to ensure NorthShore's accountability to the community by working to fulfill our community relations vision that the more NorthShore and the community connect, the stronger and healthier both will become. The CACs are comprised of primarily community members, along with hospital administrative and professional staff. NorthShore strives for diverse membership to include business, faith community, social services, civic organizations, government officials, elected officials, interested citizens, former patients, and healthcare professionals. The role of the CACs is to serve as an advocate for the greater good of the community and its health, and to provide recommendations for annual community benefit planning. The CACs also help identify opportunities for partnerships between the hospitals and community organizations, and they identify gaps in healthcare services within the community. Be Well Lake County - Be Well Lake County is a collaboration between NorthShore, Lake County Health Department and Community Health Center, and supporting community partners. The program's goal is to build greater access through a coordinated network of healthcare targeting the underserved diabetes population in Lake County. The program enables the partner organizations to effectively pool and maximize resources in order to provide high quality comprehensive diabetes management, education, and support resources that will address one of the nation's fastest growing health threats. Evanston Hospital Outpatient Clinic - The Outpatient Clinic at Evanston Hospital provides medical care to adults and children who lack private medical insurance. Medical services include, but are not limited to: primary care, obstetrics/gynecology, general surgery, orthopaedics, diabetes education, and podiatry. In fiscal year 2012, the clinic treated 4,819 adult patients at 13,231 visits and 2,736 adolescent patients at 6,795 visits. Dental Center - The Dental Center at Evanston Hospital provides primary care dental services and special consultations for medically underserved adult patients, pre-screenings for cardiovascular patients, and management for oral complications in oncology patients and those with refractory dental problems. The Dental Center provided free and discounted care for 356 adult patients making 3,478 visits at a cost of $207,782 during fiscal year 2012. Evanston Township High School Health Center - Established as a collaborative partnership with Evanston Township High School, the Evanston Health Department, and NorthShore, the Health Center is a free school-based health clinic for the school's approximately 3,000 students. The Health Center is staffed by NorthShore employees, including a physician, two part-time nurse practitioners, and a social worker. During the 2011-2012 school year, 721 students utilized the Health Center at 3,478 visits at a cost of $577,577. Medication Assistance Program - NorthShore's Medication Assistance Program helps patients with the cost of paying for prescription drugs. The Medication Assistance Program assisted 2,566 patients in filling 35,103 prescriptions at a cost of $281,158 during fiscal year 2012. Home Health and Hospice Services - NorthShore provides intermittent care including skilled nursing, physical therapy, occupational therapy, speech therapy, infusion therapy, and home health aides. Home and Hospice also provides hospice and palliative care services to NorthShore patients and their families. During fiscal year 2012, there were 76,647 patient visits and 5,851 admissions. Perinatal Depression Program - The Perinatal Depression Program identifies women who are suffering from perinatal depression and offer referrals for women who many need additional support. The program screens women for perinatal depression during and after their pregnancy and offers a 24/7 crisis hotline for women and their family members who may find themselves in an emergent situation. The hotline provides multilingual interpretation services to assist those with limited or no English-speaking ability. All services are provided free of charge. In fiscal year 2012, NorthShore physicians conducted 6,917 screenings to identify at-risk patients, and the hotline received 752 calls. Free psychological support and referrals were provided for 510 women identified through the screenings as at-risk for perinatal mood disorders. Employee Volunteerism - NorthShore employees participate in various volunteer activities that meet community needs and promote good will. Several NorthShore publications include information about volunteer organizations and employee volunteer opportunities. NorthShore also recognizes and rewards employees for community service and volunteerism through the annual Sharing Spirit Volunteer Award. Affiliated Health Care System Part VI Line 6 NorthShore University HealthSystem (NorthShore) is a comprehensive, fully integrated, healthcare delivery system that includes four hospitals, as well as numerous outpatient departments and clinics. In addition to the hospital organization, there are the following affiliates that help to meet the needs of the community: NorthShore University HealthSystem Foundation - The NorthShore University HealthSystem Foundation (Foundation) seeks to obtain the philanthropic support required to ensure that NorthShore can provide medical care, advanced research, and state-of-the-art facilities and equipment. The Foundation builds relationships with individuals and the community to increase awareness of high-quality services and giving opportunities. NorthShore University HealthSystem Research Institute - The NorthShore University HealthSystem Research Institute (Research Institute) was organized to provide a means for integrating leading-edge research into improved clinical care. The Research Institute also creates an environment to recruit and retain externally-funded research leadership in order to achieve the mission and goals of the organization. The Research Institute now houses nearly 200 externally funded research faculty who currently occupy over 100,000 net square feet of research space and work on nearly 1,000 active research protocols. Total external funding is now over $100 million. In addition, NorthShore has made a substantial commitment to develop a new Center for Clinical and Research Informatics to conduct expanded research using informatics. Such infrastructure will enable large scale efforts on comparative effectiveness, clinical quality/outcomes, and practice based research. The Center and its work will build on our award winning Epic medical records system, providing a focus for growing faculty involvement in research. NorthShore University HealthSystem Faculty Practice Associates - NorthShore University HealthSystem Faculty Practice Associates (FPA) represents more than 800 physicians with over 100 offices in virtually every specialty all on staff at the hospitals of NorthShore. FPA physicians provide professional health care services for patients of NorthShore, as well as conduct medical education and research activities on behalf of NorthShore. Radiation Medicine Institute - Radiation Medicine Institute (RMI) provides professional health care services for patients of NorthShore. RMI physicians also conduct medical education and research activities on behalf of NorthShore. State Filing of Community Benefit Report Illinois true American Cancer Society 820 Davis St Evanston IL 60201 362167721 501(c)(3) 27575 Community Event Contributions American Heart Association 208 South LaSalle St Chicago IL 60604 360900700 501(c)(3) 20000 Community Event Contributions Cancer Wellness Center 215 Revere Dr Northbrook IL 60062 363604463 501(c)(3) 7500 Community Contribution Council for Jewish Elderly 3003 W Touhy Ave Chicago IL 60645 362727597 501(c)(3) 5800 FMV Office Space Community Contribution Crohns and Colitis Foundation 386 Park Avenue South New York NY 10016 136193105 501(c)(3) 15000 General Contribution Evanston Chamber of Commerce 1840 Oak Ave Evanston IL 60201 361051450 501(c)(6) 9700 Community Contribution Evanston Community Foundation 1007 Church St Evanston IL 60201 363466802 501(c)(3) 6750 Community Contribution Glenview Education Foundation PO Box 373 Glenview IL 60025 363789505 501(c)(3) 8000 Community Contribution Housing Options Mentally Ill Evanston Inc 1132 Florence Ave Evanston IL 60202 363611260 501(c)(3) 10000 Community Contribution Infant Welfare Society of Evanston Inc 2200 Main St Evanston IL 60202 362167753 501(c)(3) 10000 Community Contribution Lake County Health Department 3010 Grand Ave Waukegan IL 60085 366006600 115 510000 Be Well Lake County Program Lake County Partners for Economic Develop 100 Tri-St Int Dr Lincolnshire IL 60069 364206288 501(c)(3) 10000 Community Contribution Medical Eye & Dental International Org 2955 Dawn Dr Georgetown TX 78628 742587018 501(c)(3) 54168 Cost Medical Supplies Donation to Honduras Northeast Illinois Council of Boy Scouts 2745 Skokie Val Rd Highland Park IL 60035 362663224 501(c)(3) 25000 Community Contribution Northfield Township 3801 West Lake Ave Glenview IL 60026 366008650 115 10000 Community Contribution NorthShore Faculty Practice Associates 1301 Central Street Evanston IL 60201 363738206 501(c)(3) 44888583 General Support Skokie Public Library 5215 Oakton St Skokie IL 60077 366006102 115 5300 Community Contribution The Josselyn Center NFP 405 Central Ave Northfield IL 60093 362217996 501(c)(3) 8000 Community Contribution Village of Niles 1000 Civic Center Dr Niles IL 60714 366006016 115 10000 Community Contribution Atlantic Health System PO Box 48328 Newark NJ 07101 521958352 501(c)(3) 17800 Research Delve LLC 11971 Westline Ind Dr St Louis MO 63143 200684635 829319 Research Emory University 1599 Clifton Rd Atlanta GA 30322 580566256 501(c)(3) 63627 Research Indiana Institute for Medical Research 1481 W 10th St Indianapolis IN 46202 351781809 501(c)(3) 5754 Research Massachusetts General Hospital 55 Fruit St Boston MA 02114 041564655 501(c)(3) 27691 Research Mayo Clinic 200 First St SW Rochester MN 55905 416011702 501(c)(3) 88860 Research Monell Chemical Senses Center 3500 Market St Philadelphia PA 19104 232020897 501(c)(3) 9184 Research Mount Auburn Professional Services Inc 330 Mount Auburn St Cambridge MA 02138 043026897 6700 Research Northwestern University 633 Clark St Evanston IL 60208 362167817 501(c)(3) 2895515 Research Regents of the University of Michigan 3003 S State St Ann Arbor MI 48109 386006309 115 106561 Research Rehabilitation Institute of Chicago 345 E Superior St Chicago IL 60611 362256036 501(c)(3) 56581 Research Temple University 1803 N Broad St Philadelphia PA 19122 231365971 501(c)(3) 14629 Research Texas Biomedical Research Institute PO Box 760549 San Antonio TX 78245 741109630 501(c)(3) 167529 Research The Brigham and Women's Hospital Inc 75 Francis St Boston MA 02115 042312909 501(c)(3) 87138 Research The Regents of the University of California 1200 Dutton Hall Davis CA 95616 946036493 115 66855 Research University of Chicago 5801 S Ellis Ave Chicago IL 60637 362177139 501(c)(3) 26715 Research University of Pittsburgh 580 S Aiken Ave Pittsburgh PA 15232 250965591 501(c)(3) 30884 Research University of South Florida 4202 E Fowler Ave Tampa FL 33620 593102112 115 143326 Research University of Southern California 1450 San Pablo St Los Angeles CA 90033 951642394 501(c)(3) 23438 Research University of Washington 3917 University Way NE Seattle WA 98105 916001537 115 53800 Research University of Wisconsin Milwaukee 3202 N Maryland Ave Milwaukee WI 53202 391805963 115 78044 Research Westat Inc PO Box 1004 Rockville MD 20850 840529566 34010 Research 37 4 Scholarships in Medical Field 51 86909 Monitoring of Grant Funds Schedule I Part I line 2 NorthShore University HealthSystem (NorthShore) provides cash and non-cash assistance to organizations that help support NorthShore's mission to preserve and improve human life. Requests to support an outside organization must be reviewed and approved by the Community Relations department and NorthShore management to ensure the organization is aligned with NorthShore's mission and charitable purpose. NorthShore also provides cash grants to sub-recipients of grant awards. NorthShore requires all sub-recipients to sign a consortium agreement stating that the sub-recipient understands and agrees to all applicable compliance requirements. NorthShore meets with the sub-recipients on a regular basis and reviews the sub-recipients' A-133 reports. In addition, NorthShore provides cash support to related organizations. Support to related organizations is monitored through the NorthShore budget and reporting procedures for the consolidated financial statements. Finally, NorthShore provides nursing scholarships to individuals. The scholarship amount depends on the degree sought, and the number of scholarships awarded depends on the available funds for each year. Scholarships are awarded on an annual basis to applicants that meet the eligibility criteria. Applicants must be current employees of NorthShore as a staff nurse or other related clinical position. Applicants must also be currently enrolled in a nursing degree program, and enrollment must be maintained for the year the scholarship is received. In addition, applicants must sign a Statement of Agreement to work for NorthShore as a staff nurse or in a related clinical position for one year following receipt of the scholarship. X X X true false X X X X false true false false false false false true false Bernard G Ewigman 382126 0 25000 0 0 0 59957 0 55644 0 522727 0 0 0 Theodore Mazzone 281295 33705 0 25000 0 5209 18684 2239 2507 300 302486 66453 0 0 Mark S Talamonti 604816 246858 0 100000 0 45055 14858 6065 21851 8919 641525 406897 0 0 Mark R Neaman 912047 0 1424400 0 524225 0 95705 0 15656 0 2972033 0 489061 0 Jeffrey H Hillebrand 612162 0 794000 0 3016868 0 54108 0 18156 0 4495294 0 1240325 0 Gary E Weiss 402617 0 510000 0 1767198 0 43702 0 19112 0 2742629 0 164370 0 Julian E Bailes 157677 314208 100000 0 0 2024 6991 13932 2211 4407 266879 334571 0 0 William D Bloomer 393030 260112 0 335000 0 50862 12590 8333 19485 12895 425105 667202 0 0 Michael S Caplan 326329 163287 0 56000 2835 29266 13945 6978 5330 2667 348439 258198 0 0 Robert R Edelman 699975 38511 0 207600 0 14257 19832 1091 35105 1931 754912 263390 0 0 Gerald P Gallagher 341808 0 418500 0 1774 0 44215 0 24955 0 831252 0 133587 0 Thomas H Hodges 346466 0 152000 0 10002 0 20923 0 14763 0 544154 0 0 0 William R Luehrs 311065 0 421800 0 1587634 0 37904 0 16420 0 2374823 0 824423 0 Demetrius Maraganore 286473 187894 0 50000 0 4489 12636 8287 16621 10901 315730 261571 0 0 Frederick E Miller 327339 80505 0 25000 0 18799 16793 4130 20919 5145 365051 133579 0 0 Kristen Murtos 280283 0 290000 0 2136 0 36713 0 26414 0 635546 0 110000 0 Jesse Peterson Hall 335617 0 447000 0 4984 0 39198 0 26031 0 852830 0 146853 0 William J Robb III 570000 0 100000 0 25299 0 20923 0 4543 0 720765 0 0 0 Leopold G Selker 312443 0 408000 0 324956 0 20923 0 24416 0 1090738 0 144187 0 Nancy Semerdjian 273127 0 124000 0 13667 0 20923 0 16432 0 448149 0 0 0 Richard K Silver 400043 418041 0 75000 0 11768 10231 10692 15862 16576 426136 532077 0 0 Douglas M Silverstein 376398 0 491500 0 5336 0 359259 0 10368 0 1242861 0 162623 0 Thomas W Smith 317312 0 432000 0 19409 0 20923 0 18233 0 807877 0 144187 0 Jeffery S Vender 500026 245422 0 250000 0 21030 14035 6888 16304 8002 530365 531342 0 0 Thomas A Victor 380980 55162 0 241004 0 58136 18277 2646 27349 3960 426606 360908 0 0 Brian Washa 253696 0 89300 0 2436 0 20923 0 22937 0 389292 0 0 0 Kenneth P Anderson 363215 0 109800 0 5292 0 20923 0 23961 0 523191 0 0 0 Harry L Jones 229849 0 106000 0 2990 0 20923 0 24086 0 383848 0 0 0 Janardan D Khandekar 500270 91142 75000 88000 401 48292 17699 3224 21183 3859 614553 234517 0 0 Jonathan Silverstein 287449 0 99300 0 794 0 20923 0 17465 0 425931 0 0 0 Rajiv Udani 224346 0 21347 0 65803 0 20923 0 22574 0 354993 0 0 0 Sean O'Grady 230273 0 79000 0 378 0 20923 0 25530 0 356104 0 0 0 Nicholas A Vick 156000 41682 0 1164 0 39246 16666 4453 13002 3474 185668 90019 0 0 Benefits Provided Part I Line 1a First-class airfare was provided to the Chief Executive Officer and Chief Operating Officer for business travel purposes and was not treated as taxable compensation. The first-class airfare was purchased through a prepaid airline mileage account, which provided discounted airline fare rates. Spousal travel was provided for one trip during calendar year 2011 to the Chief Executive Officer and was treated as taxable compensation. Tax indemnification and gross-up payments are occasionally provided to employees for achievement awards and other benefits, which are reviewed and approved by management. During calendar year 2011, nine employees listed in Part VII received gross-up payments. These amounts were treated as taxable compensation. Reimbursement Substantiation Part I Line 2 A prepaid airline mileage account was purchased for the travel of the Chief Executive Officer and Chief Operating Officer. At the time of the purchase, it was not known what specific travel would occur and therefore the travel could not be substantiated at purchase. The business purpose of each trip was substantiated at the time of travel. Supplemental Nonqualified Retirement Plan Part I Line 4b The following individuals participated in a supplemental nonqualified retirement plan and accrued the following benefits: Mark R Neaman, President and Chief Executive Officer - $501,419, Jeffrey H Hillebrand, Chief Operating Officer - $2,995,991, William R Luehrs, Chief Human Resources Officer - $1,580,140, Leopold G Selker, President, Research Institute - $303,246, Douglas M Silverstein, President, Glenbrook Hospital - $316,168, Gary E Weiss, Chief Financial Officer - $1,758,577. Non-Fixed Payments Part I Line 7 NorthShore University HealthSystem provides incentive payments to certain employees after operating and performance goals are achieved. Incentive payment plans are reviewed and approved by the Compensation Committee of the Board of Directors. Compensation from Unrelated Organizations Core Form 990 Part VII Line 5 The salary and benefits reported on Schedule J totaling $522,727 for Dr. Bernard G Ewigman were paid by the University of Chicago Medical Center for services provided to NorthShore University HealthSystem as the Chairman of the Department of Family Medicine. Illinois Finance Authority 861091967 45200F4D8 2010-07-14 138786145 See Part VI false false false Illinois Finance Authority 861091967 45200MU93 2008-12-11 75000000 See Part VI false false false 7130000 0 138786145 0 0 0 1017771 0 0 0 137768374 0 2010 true false true true 0 0 75000000 0 0 0 433044 131875 0 74435081 0 0 2008 false false true true 0 false false true true true true 0.00300 0.00200 0.00500 true false false false 0 false 0 false true false true false 0 false 0 false true X A-To refund bonds issued 7/3/2001. Proceeds were also used to pay 0 termination costs of derivative agreements related to the refunded bonds. 0 B-To reimburse NorthShore for the costs of construction, renovation, and 0 equipment for projects at Evanston, Glenbrook, and Highland Park Hospitals 0 NorthShore Physician Associates Inc See Part V 20721002 Capitation Payments, Other false NorthShore Insurance International Bd Mbr - Gerald Gallagher 5066774 Insurance Premiums false Ravine Way Surgery Center LLC See Part V 1080000 Earnings Distributions true NorthShoreUSP Surgery Center II LL See Part V 2245500 Earnings Distributions true Advisory Board Company Bd Mbr - Mark Neaman 295550 Membership Dues false Vocera Communications Inc Bd Mbr - Jeff Hillebrand 1646814 Communications Equipment false VHA Inc Bd Mbr - Jeff Hillebrand 3165446 Net Purch Rebates/Mbr Charges false Medline Industries Officer - Andrew Mills 450739 Medical Supplies false Blue Cross Blue Shield of Illinois Bd Mbr - Sona Wang 434115367 Net Patient Revenues false Thomas M Selker Family Mbr-Leopold Selker 59364 Employment false April F Victor Family Mbr-Thomas Victor 52731 Employment false Alexis A Washa Family Mbr-Brian Washa 188860 Employment false Business Transactions with Interested Persons Part IV Column (b) NorthShore Physician Associates, Inc. board members and officers were: Leon S Benson, Michael S Caplan, Toure S Claiborne, A Steven Crown, William L Davis, Mary Dillon, Connie K Duckworth, Bernard G Ewigman, Jeffrey H Hillebrand, Ike Hong, Gregory K Jones, Richard L Keyser, Lester B Knight III, Harry M Jansen Kraemer Jr, Theodore Mazzone, Samuel M Mencoff, Andrew J Mills, Kristen Murtos, Mark R Neaman, Scott C Schweighauser, Susan B Sentell, Mark S Talamonti, Thomas A Victor, John R Walter, Sona Wang, Jonathan P Ward, William Wrigley Jr Ravine Way Surgery Center LLC board members were Gerald P Gallagher and Jeffrey H Hillebrand. NorthShore/USP Surgery Center II LLC board members were Jeffrey H Hillebrand and Thomas H Hodges. X 24 1148026 Sale Proceeds false true false Independence of Voting Members of Governing Body Part I Line 4 and Part VI Section A Line 1b Voting members of the NorthShore University HealthSystem (NorthShore) Board of Directors are also members of the Board of Directors for NorthShore Physician Associates, Inc. (NPA), a related for-profit corporation. Because transactions between NorthShore and NPA are required to be reported on Schedule L, the voting members of the NorthShore Board of Directors are not considered independent for 990 reporting purposes. Mission Statement Part III Line 1 The core mission of NorthShore University HealthSystem is to "preserve and improve human life." This mission will be achieved through the provision of superior clinical care, academic excellence, and innovative research. NorthShore is a not-for-profit organization principally formed to provide quality healthcare services for the communities it serves. The delivery of healthcare services is provided in a wide range of inpatient and ambulatory healthcare settings, community-wide, employing modern technology and expertise. Support for qualified patients who may not be able to pay the entire cost of their care is a part of the organization's commitment. In support of its primary mission of patient care, the organization engages in a wide range of academic activities in medical education and research. This statement recognizes the Board of Directors' responsibility to maintain the organization's viability to meet its long-term commitment to the communities it serves. It further recognizes the responsibility to maintain technologically current assets for this purpose. This includes the cultivation and development of our physicians, graduate medical students, employees, physical plant, equipment and other resources to assure orderly growth of our services. Statement of Program Services - Patient Care Part III Line 4a Headquartered in Evanston, Illinois, NorthShore University HealthSystem, (NorthShore), is a comprehensive, fully integrated, healthcare delivery system serving the Chicago region. NorthShore includes four hospitals: Evanston Hospital, Glenbrook Hospital, Highland Park Hospital, and Skokie Hospital. NorthShore has approximately 10,000 employees and 2,100 affiliated physicians, including a multispecialty group practice with over 800 physicians and 100-plus office locations under the NorthShore University HealthSystem Faculty Practice Associates. The integrated health system has significant capabilities in a wide spectrum of leading clinical programs, including cancer, neurology, cardiovascular care, orthopaedics, and high-risk maternity. Further, NorthShore supports teaching and research as the principal teaching affiliate for the University of Chicago Pritzker School of Medicine. NorthShore is a Magnet recognized organization, the only one in Illinois designated as a system to receive this prestigious honor that demonstrates excellence in nursing and high standards of patient care. NorthShore is a national leader in the implementation of innovative technologies, including electronic medical records (EMR). In 2003, NorthShore was among the first hospital systems in the country to successfully launch a system-wide EMR with demonstrable benefits in quality, safety, efficiency, and service to patients. NorthShore has been recognized by multiple national organizations for this notable achievement. As part of a formalized relationship between NorthShore and the Mayo Clinic, physicians from these two organizations are working together on the most complex medical cases. NorthShore physicians have direct access to Mayo Clinic physicians to collaborate on the best treatment for patients with hard to solve cases. NorthShore has also been recognized as one of the nation's 100 Top Hospitals by Truven Health Analytics, formerly the healthcare business of Thomson Reuters. NorthShore has been named to the list 16 times, which is more than any hospital in the country during the award's 20-year history. The 100 Top Hospitals study measures the performance of health systems based on several metrics, including in-hospital mortality, medical complications, patient safety, average length of stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, post-discharge mortality, and readmission rates. NorthShore's Evanston and Glenbrook hospitals were named to the annual class of top national hospitals by the Leapfrog Group's Top Hospitals List for 2012. NorthShore's hospitals were among 67 selected from a field of nearly 1,200 hospitals nationally based on the results of the Leapfrog Group's annual hospital survey, which measures performance on patient safety and quality. All of NorthShore's four hospitals also received A grades as part of the Leapfrog semi-annual Hospital Safety Scores. NorthShore is nationally ranked in two specialties and rated as high performing in nine others, according to the U.S. News and World Report annual Best Hospitals survey. The survey looked at about 5,000 hospitals nationwide, ranking them in 16 different specialties, and a total of fewer than 150 hospitals received at least one national ranking. NorthShore was nationally ranked in Gynecology and Gastroenterology, and rated as high-performing in the following specialties: Cancer, Diabetes and Endocrinology, Ear, Nose, and Throat, Geriatrics, Nephrology, Neurology and Neurosurgery, Orthopaedics, Pulmonology, and Urology. NorthShore recognizes and embraces its responsibility to ensure that it fulfills its charitable obligations in the most cost-effective and sustainable manner. In order to achieve this goal, NorthShore has aligned its community benefits program with the guiding principles outlined in Advancing the State of the Art of Community Benefit for nonprofit hospitals, which provides a set of uniform standards to increase accountability and align governance, management, and operations to return benefit to local communities. The five guiding principles are: 1) Disproportionate Unmet Health-Related Needs, 2) Primary Prevention, 3) Seamless Continuum of Care, 4) Build Community Capacity, and 5) Community Collaboration. NorthShore informs and educates potentially impacted patients of the Financial Assistance program by posting signage (both English and Spanish) in all the facilities' Emergency Departments and at our Central Registration areas. The NorthShore Patient Handbook is also available to patients upon admission and it describes the Financial Assistance program that includes Charity Care. NorthShore also has approximately 16 full time financial counselors and 38 customer service agents representing our hospitals, clinics, and physician offices. They are responsible for helping patients understand their bills and coordinating financial assistance and eligibility. Any uninsured patient admitted into the hospital will have their case reviewed by a financial counselor. NorthShore billing statements also indicate the Financial Assistance program and necessary contact information. NorthShore's physician offices and collection agencies are also instructed to coordinate charity care to potentially eligible patients. The NorthShore website is another useful resource that informs patients about the Financial Assistance program with links to the application process and the financial application. Any patient having difficulty paying their portion of the bill or wanting to know if they are eligible will have their case reviewed by a financial counselor or by calling the Customer Service department. Evanston Hospital - With a history dating back to 1891, Evanston Hospital is a 354-licensed bed comprehensive acute-care facility and the nucleus of NorthShore University HealthSystem. Evanston Hospital is a leader in cardiac care, cancer care via the Kellogg Cancer Center and a variety of surgical specialties: neurosurgery, gynecological surgery, robot-assisted surgery, surgical oncology, and urology surgery. Evanston Hospital is certified by the Joint Commission in palliative care and as a Primary Stroke Center. The hospital also is a licensed Level I Trauma Center. Evanston Hospital is also the regional center for high-risk obstetrics. The Infant Special Care Unit and the Women's Hospital offer a comfortable birthing environment where high-risk mothers and their babies have access to the latest technology and a highly trained staff. Evanston Hospital also houses the NorthShore Center for Simulation and Innovation, which provides nurses, physicians, residents, paramedics, firefighters and police with simulated clinical care, trauma and emergency preparedness training in a controlled environment. During fiscal year 2012, Evanston Hospital total admissions were 18,685, and total patient days were 99,869. Statement of Program Services - Patient Care - Continued Part III Line 4a Glenbrook Hospital - Glenbrook Hospital, established in 1977, is a 173-licensed bed comprehensive medical center providing advanced diagnostic and therapeutic interventions. In addition to being a Level II Trauma Center, Glenbrook Hospital is certified by the Joint Commission as a Primary Stroke Center. Glenbrook Hospital provides advanced medical and surgical care for all specialties. Specific specialties include the Kellogg Cancer Center, NorthShore Neurological Institute, NorthShore Spine Center, John and Carol Walter Center for Urological Health, Patricia Nolan Center for Breast Health, Simms Family GI Lab, Eye and Vision Center, Surgical Specialty Suite, and Total Joint Replacement Center. In addition, the hospital offers leading-edge interventional radiology and cardiac catheterization laboratory. During fiscal year 2012, Glenbrook Hospital total admissions were 9,240, and total patient days were 44,883. Highland Park Hospital - Founded in 1918, Highland Park Hospital has provided high-quality healthcare and a wide range of clinical programs for the people of Lake County and beyond for nearly a century. The 149-licensed bed hospital is the site of the first open-heart surgery in Lake County, and continues to provide a full range of cardiac diagnosis and intervention services. Highland Park Hospital's Kellogg Cancer Center offers the most comprehensive subspecialty care for oncology patients. Specialized physicians provide care for the following types of cancer: thoracic and lung, hematology, breast, ovarian, head and neck, melanoma and sarcoma, gastrointestinal, prostate, and stomach. Highland Park Hospital is a Joint Commission certified Primary Stroke Center. The Emergency Department at Highland Park Hospital acts as the region's "pod" hospital for disaster-response activities, coordinating Lake County's efforts when confronted with a disaster. The Pediatric Preparation Program helps to familiarize young patients with the hospital environment through hospital tours and play sessions prior to surgery. NorthShore also has a partnership with the Lake County Health Department and Community Health Center known as Be Well Lake County. The program goal is to build greater access through a coordinated network of healthcare targeting the underserved diabetes population in Lake County. The program enables the partner organizations to effectively pool and maximize resources in order to provide high quality comprehensive diabetes management, education, and support resources that will address one of the nation's fastest growing health threats. During fiscal year 2012, Highland Park Hospital total admissions were 9,077, and total patient days were 41,600. Skokie Hospital - Established in 1963, Skokie Hospital is a 156-licensed bed facility that has provided high-quality healthcare for nearly five decades and is nationally recognized for its expertise in orthopaedics and cardiac care. Key hospital specialties and features also include minimally invasive surgery, total joint replacement, spine surgery, clinical cardiology, and graduate medical education (residency) programs in internal medicine, general surgery, and anesthesia. In addition, Skokie Hospital's Level II Trauma Center-Emergency Department-is staffed by an experienced trauma team specially trained in pediatric life support. During fiscal year 2012, Skokie Hospital total admissions were 6,612, and total patient days were 34,786. NorthShore University HealthSystem Faculty Practice Associates - In order to increase the efficiency and quality of health care NorthShore provides, NorthShore University HealthSystem Faculty Practice Associates (FPA) was organized to serve as an integral part of its health care mission and activities. FPA represents more than 800 physicians with over 100 offices in virtually every specialty all on staff at the hospitals of NorthShore. FPA physicians provide professional health care services for patients of NorthShore, as well as conduct medical education and research activities on behalf of NorthShore. NorthShore University HealthSystem Foundation - NorthShore University HealthSystem Foundation (Foundation) is dedicated to assisting the integrated healthcare delivery system to fulfill NorthShore's mission to "preserve and improve human life." The Foundation seeks to obtain the philanthropic support required to ensure that NorthShore can provide medical care, advanced research, and state-of-the-art facilities and equipment. The Foundation builds relationships with individuals and the community to increase awareness of NorthShore's high-quality services and giving opportunities. Statement of Program Services - Education Part III Line 4b NorthShore University HealthSystem (NorthShore) is committed to excellence in its academic mission and supports teaching and research in its role as the principal teaching affiliate of the University of Chicago Pritzker School of Medicine. NorthShore also has additional teaching affiliation agreements with Rush University Medical Center, University of Illinois-Chicago, Stroger Hospital, and Northwestern University Feinberg School of Medicine. NorthShore has an extensive selection of training programs and fellowships to offer physicians at our own teaching and research facilities. During fiscal year 2012, a total of 192 residents and 25 fellows participated in the NorthShore and affiliate-based programs. The NorthShore residency program areas included: Dentistry, Internal Medicine, Pathology, Preliminary Medicine (intern year), Transitional Medicine (1st Year prior to specialization), and Family Medicine. The NorthShore fellowship program areas included: Female Pelvic Medicine and Reconstructive Surgery, Musculoskeletal Imaging, Surgical Pathology, and Endocrine Surgery. The affiliate-based residency program areas included: Anesthesiology, Dermatology, Emergency Medicine, Obstetrics and Gynecology, Orthopaedic Surgery, Pediatrics, Psychiatry, Radiology, General Surgery, Neurology, Neurosurgery, Ophthalmology, Otolaryngology, Plastic Surgery, Podiatry, and Urology. The affiliate-based fellowship program areas included: Advanced Cardiovascular Imaging and Research, Cardiology, Cardiothoracic Surgery, Child Neurology, Child Psychiatry, Colon Rectal Surgery, Electrophysiology, Gastroenterology, Gynecologic Oncology, Hematology/Oncology, Infectious Disease Research, Maternal-Fetal Medicine, Neonatal-Perinatal Medicine, Nephrology, Neuroradiology, Orthopaedic Hand, Orthopaedic Sports, Palliative Medicine, Peripheral Vascular Surgery, and Surgical Oncology. The NorthShore School of Nurse Anesthesia operates out of Evanston Hospital. The program has full accreditation from the Council of Accreditation of Nurse Anesthesia Educational Programs. The mission of the school is to prepare qualified professional registered nurses for the advanced practice of nurse anesthesia in a variety of practice settings. The graduate nurse anesthetist demonstrates the knowledge, skills, and attitude necessary to take on leadership roles in the practice of nurse anesthesia. During fiscal year 2012, 65 students participated in the program. NorthShore also provided clinical training and internships during the 2012 academic year for 1,239 high school and college students. Student interned in the following areas: Nursing, Cardiology, Laboratory, Medical Social Work, Occupational Therapy, Infection Control, Perinatal Family Support Center, Physical Therapy, Radiology, Radiation Oncology, Speech Pathology, and Hospital Administration. Statement of Program Services - Research Part III Line 4c The NorthShore University HealthSystem Research Institute (Research Institute) was organized in 1996 to provide a means for integrating leading-edge research into improved clinical care. The Research Institute also creates an environment to recruit and retain externally-funded research leadership in order to achieve the mission and goals of the organization. The Research Institute now houses nearly 200 externally funded research faculty who currently occupy over 100,000 net square feet of research space and work on nearly 1,000 active research protocols. Total external funding is now over $100 million. In addition, NorthShore has made a substantial commitment to develop a new Center for Clinical and Research Informatics to conduct expanded research using informatics. Such infrastructure will enable large scale efforts on comparative effectiveness, clinical quality/outcomes, and practice based research. The Center and its work will build on our award winning Epic medical records system, providing a focus for growing faculty involvement in research. Business Relationships Part VI Section A Line 2 The following directors, officers, and key employees are directors or officers of NorthShore Physician Associates, Inc., a related for-profit corporation, and have a business relationship: Leon S Benson, Michael S Caplan, Toure S Claiborne, A Steven Crown, William L Davis, Mary Dillon, Connie K Duckworth, Bernard G Ewigman, Jeffrey H Hillebrand, Ike Hong, Gregory K Jones, Richard L Keyser, Lester B Knight III, Harry M Jansen Kraemer Jr, Theodore Mazzone, Samuel M Mencoff, Andrew J Mills, Kristen Murtos, Mark R Neaman, Scott C Schweighauser, Susan B Sentell, Mark S Talamonti, Thomas A Victor, John R Walter, Sona Wang, Jonathan P Ward, William Wrigley Jr Business relationship - Harry M Jansen Kraemer Jr and Samuel M Mencoff. Business relationship - Gerald P Gallagher and Jeffrey H Hillebrand. Business relationship - Jeffrey H Hillebrand and Thomas H Hodges. Governing Body Review of 990 Part VI Section B Line 11b The NorthShore University HealthSystem (NorthShore) Form 990 was reviewed by executive management and an outside accounting firm. The NorthShore Form 990 was then provided to each member of the Board of Directors via email for their review and ability to ask questions of management prior to filing. Conflict of Interest Policy Monitoring Part VI Section B Line 12c On an annual basis, the Chief Compliance Officer requires all officers, directors, and key employees to complete, sign and return a Conflict of Interest Disclosure Statement. Timely and accurate completion of the Statement is mandatory, and completed Statements must be returned to the Chief Compliance Officer within 15 days. Any disclosures included on the Statements are reviewed and acted upon as necessary by the Chief Compliance Officer and the Corporate Compliance Committee. Determination of Compensation Part VI Section B Line 15 A detailed compensation review of the top 15 executives, including the Chief Executive Officer, is conducted annually. Market data is collected and assessed by an external independent compensation consultant who specializes in compensation consulting within the healthcare industry. The work product from this study is reviewed separately with Board-retained legal counsel. Market data for base and variable compensation is assessed annually for local, regional and national hospitals, integrated delivery systems and academic medical centers. A detailed total compensation market review is conducted every two years. The market assessment includes assessing job content in order to make appropriate market data comparisons. Specific recommendations are then reviewed, discussed and approved as appropriate with the Compensation Committee of the Board, in session with legal counsel present, in advance of implementation. Public Disclosure of Documents Part VI Section C Line 19 The NorthShore University HealthSystem (NorthShore) governing documents, conflict of interest policy and financial statements are available to the public upon request. The NorthShore annual audit report and financial statements are also available to the public through GuideStar and the Illinois Attorney General's Office websites as part of the federal and state tax return filings. The NorthShore quarterly and annual financial statements and annual audit are also made available to the public through the Electronic Municipal Market Access (EMMA) website as part of the tax-exempt bond offerings. Average Hours per Week for Related Organizations Part VII Section A Column B Certain individuals listed in Part VII had the following average hours per week devoted to related organizations: Bernard G Ewigman - 1, Theodore Mazzone - 5, Mark S Talamonti - 13, Mark R Neaman - 2, Jeffrey H Hillebrand - 1, Julian E Bailes - 28, William D Bloomer - 17, Michael S Caplan - 14, Robert R Edelman - 3, Demetrius (Jim) Maraganore - 17, Frederick E Miller - 9, Richard K Silver - 21, Jeffery S Vender - 14, Thomas A Victor - 6, Janardan D Khandekar - 7, Nicholas A Vick - 8 Other Changes in Net Assets Part XI Line 5 Other changes in net assets of $112,742,063 included unrealized gains of $132,908,381 and negative equity adjustments for the pension and supplemental executive retirement plans of $20,166,318. 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