GOTTLIEB MEMORIAL HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- GOTTLIEB MEMORIAL HOSPITAL (EIN 36-2379649)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201141329349303124
- Schema version
- 2009v1.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T13:21:16-07:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOTTLIEB MEMORIAL HOSPITAL | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W NORTH AVE | AddressLine1 |
| City | MELROSE PARK | City |
| State | IL | State |
| ZIP Code | 601601612 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 362379649 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gottlieb Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOTT | NameControl |
| Phone | 7084504966 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W North Ave | AddressLine1 |
| City | Melrose Park | City |
| State | IL | State |
| ZIP Code | 60160 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Ellyn Chin | Name |
| Title | VP of Finance | Title |
| Date Signed | 2011-05-12 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Ellyn Chin | Name |
| Phone | 7084504534 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ellyn Chin | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W North Ave | AddressLine1 |
| City | Melrose Park | City |
| State | IL | State |
| ZIP Code | 60160 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 144314391 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1956 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | Gottlieb Memorial Hospital is dedicated to providing superior health-care to improve the overall health of all we serve. Individuals within our communities are provided access to medically necessary care regardless of their ability to pay. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 17 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1352 | TotalNbrEmployees |
| Total Nbr Volunteers | 263 | TotalNbrVolunteers |
| Total Gross UBI | 3325652 | TotalGrossUBI |
| Contributions Grants Prior Year | 29078 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4017862 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 127406667 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 130917977 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 122754 | InvestmentIncomePriorYear |
| Investment Income Current Year | 49350 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 8713276 | OtherRevenuePriorYear |
| Other Revenue Current Year | 9183556 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 136271775 | TotalRevenuePriorYear |
| Total Revenue Current Year | 144168745 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 68872889 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 70225438 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 61072607 | OtherExpensePriorYear |
| Other Expenses Current Year | 64109215 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 129945496 | TotalExpensesPriorYear |
| Total Expenses Current Year | 134334653 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6326279 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 9834092 | RevenuesLessExpensesCY |
| Total Assets BOY | 103827112 | TotalAssetsBOY |
| Total Assets EOY | 117982309 | TotalAssetsEOY |
| Total Liabilities BOY | 76355231 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 81923750 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 27471881 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 36058559 | NetAssetsOrFundBalancesEOY |
| Mission Description | Gottlieb Memorial Hospital is dedicated to providing superior health-care to improve the overall health of all we serve. Individuals within our communities are provided access to medically necessary care regardless of their ability to pay. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 121302036 | Expense |
| Revenue | 130917977 | Revenue |
| Description | See Schedule O | Description |
| Total Program Service Expense | 121302036 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 94 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1352 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 17 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | true | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Ellyn Chin | NamePerson |
| Telephone Number | 7084504966 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W North Ave | AddressLine1 |
| City | Melrose Park | City |
| State | IL | State |
| ZIP Code | 60160 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (35 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | OfficerOfficer | FormerFormer | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|---|---|
| William T Divane Jr | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| William F Reichert | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Thomas P Fitzgerald | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Thomas Origitano MD | |||||||||
| Director | 20.00 | X | 0 | 597278 | 41643 | ||||
| Robert Sulo MD | |||||||||
| Director | 40.00 | X | 0 | 308344 | 36341 | ||||
| Peter McCauley MD | |||||||||
| Medical Director | 40.00 | 275218 | 0 | 27636 | X | ||||
| Paul K Whelton MD | |||||||||
| Director | 40.00 | X | 0 | 774055 | 377309 | ||||
| Patrick J Kelly | |||||||||
| Chairman | 3.00 | X | 0 | 0 | 0 | X | |||
| Patricia Cassidy | |||||||||
| President | 40.00 | 0 | 645434 | 45700 | X | ||||
| Nancy W Knowles | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Michael R Quinlan | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Michael R Leyden | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Michael J Garanzini SJ | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Maurita Adler | |||||||||
| CIO | 40.00 | 145766 | 0 | 40070 | X | ||||
| Kenneth Fishbain | |||||||||
| COO | 40.00 | 276783 | 0 | 63921 | X | ||||
| Jordan M Hadelman | |||||||||
| Vice Chairman | 2.00 | X | 0 | 0 | 0 | X | |||
| John Morgan | |||||||||
| Former Officer | 0. | 384272 | 0 | 73946 | X | ||||
| John L Keeley Jr | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| John C Lahey | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Jessie D Almonares | |||||||||
| Critical Care RN | 40.00 | 144392 | 0 | 35222 | X | ||||
| James C Dowdle | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Jackie Taylor Holsten | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Jack A Weinberg | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Henry S Lang | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Henly Del Carpio | |||||||||
| RN Weekender II | 40.00 | 175013 | 0 | 67645 | X | ||||
| Frank W Considine | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Eric A Reeves | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Ellyn Chin | |||||||||
| VP of Finance | 40.00 | 156855 | 0 | 23611 | X | ||||
| Ellen Gaynor MD | |||||||||
| Director | 32.00 | X | 0 | 214534 | 21454 | ||||
| Elizabeth C McLain | |||||||||
| RN Weekender II | 0. | 167651 | 0 | 14233 | X | ||||
| Daniel L Flaherty SJ | |||||||||
| Director | 2.00 | X | 0 | 0 | 0 | ||||
| Constance Clark | |||||||||
| VP Nursing | 40.00 | 161567 | 0 | 50789 | X | ||||
| Charles ReiterIII | |||||||||
| Secretary | 40.00 | 0 | 742774 | 87530 | X | ||||
| Andrew F Knauf | |||||||||
| CFO thru 9/2009 | 40.00 | 431873 | 0 | 76185 | X | ||||
| Alan Goldberg | |||||||||
| VP of Adm Svcs | 40.00 | 164685 | 0 | 38848 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2484075 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3282419 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1122083 | TotalOtherCompensation |
| Number Individuals GT100 K | 75 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Quest Diagnostics | |||||
| 12436 Collections Center Dr | Chicago | IL | 606932436 | Lab Service | 289749 |
| Imperial Laundry System Inc | |||||
| 2299 Momentum Place | Chicago | IL | 606895322 | Laundry Service | 300074 |
| George Sollitt Construction | |||||
| 790 N Central Ave | Wooddale | IL | 60191 | Construction Svcs | 866393 |
| Fresenius Medical Care North America | |||||
| 4013 Paysphere Circle | Chicago | IL | 60674 | Kidney Dialysis | 405955 |
| Diversified Clinical Services | |||||
| PO Box 850001 | Orlando | FL | 328850248 | Clinical Services | 394006 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 21 | NumberOfContractorsGT100K |
| Fundraising Events | 16075 | FundraisingEvents |
| All Other Contributions | 4001787 | AllOtherContributions |
| Total Contributions | 4017862 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Care Services | Description |
| Total Revenue Column | 130917977 | TotalRevenueColumn |
| Related Or Exempt Function Income | 130917977 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 130917977 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 49350 | TotalRevenueColumn |
| Exclusion | $49,350 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 84100 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 16075 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 78192 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5908 | TotalRevenueColumn |
| Exclusion | $5,908 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 103274 | GrossSalesOfInventory |
| Cost Of Goods Sold | 67454 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35820 | TotalRevenueColumn |
| Exclusion | $35,820 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| Reimb. of Occupancy Exp | 541900 | 669306 | 669306 | |
| Outpatient Pharmacy | 621400 | 2117121 | 2117121 | |
| Mgnt. & Prof. Services | 541900 | 5332327 | 539225 | $4,793,102 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1023074 | TotalRevenueColumn |
| Exclusion | $1,023,074 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 9141828 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 144168745 | TotalRevenueColumn |
| Related Or Exempt Function Income | 130917977 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 3325652 | UnrelatedBusinessRevenue |
| Exclusion | $5,907,254 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1191763 | Total |
| Program Services | 369923 | ProgramServices |
| Management And General | 821840 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 384272 | Total |
| Management And General | 384272 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51973061 | Total |
| Program Services | 47931920 | ProgramServices |
| Management And General | 4041141 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5912627 | Total |
| Program Services | 5335429 | ProgramServices |
| Management And General | 577198 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6957314 | Total |
| Program Services | 6275171 | ProgramServices |
| Management And General | 682143 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3806401 | Total |
| Program Services | 3439093 | ProgramServices |
| Management And General | 367308 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 251497 | Total |
| Management And General | 251497 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80976 | Total |
| Management And General | 80976 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2143889 | Total |
| Program Services | 2143889 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23806852 | Total |
| Program Services | 23688880 | ProgramServices |
| Management And General | 117972 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2495421 | Total |
| Management And General | 2495421 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53519 | Total |
| Program Services | 51439 | ProgramServices |
| Management And General | 2080 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102091 | Total |
| Program Services | 50004 | ProgramServices |
| Management And General | 52087 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7511847 | Total |
| Program Services | 7511847 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5543899 | Total |
| Program Services | 5543899 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Provision for Bad Debts | 6967463 | 6967463 | |
| Other Admin. & General | 12841766 | 9829412 | 3012354 |
| Equipment Rental & Maint. | 2297726 | 2163667 | 134059 |
| Employee Recognition Events | 12269 | 12269 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134334653 | Total |
| Program Services | 121302036 | ProgramServices |
| Management And General | 13032617 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26314469 | BOY |
| EOY | 34929833 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56507 | BOY |
| EOY | 96027 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13796452 | BOY |
| EOY | 13965278 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2563354 | BOY |
| EOY | 2657012 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 934111 | BOY |
| EOY | 1102381 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 181439530 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 126634215 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53593301 | BOY |
| EOY | 54805315 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75000 | BOY |
| EOY | 75000 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 480295 | BOY |
| EOY | 463777 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6013623 | BOY |
| EOY | 9887686 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103827112 | BOY |
| EOY | 117982309 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62490450 | BOY |
| EOY | 63086914 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13864781 | BOY |
| EOY | 18836836 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76355231 | BOY |
| EOY | 81923750 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27371881 | BOY |
| EOY | 35858559 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100000 | BOY |
| EOY | 200000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27471881 | BOY |
| EOY | 36058559 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103827112 | BOY |
| EOY | 117982309 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $34,167 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 34167 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4894899 | OtherCostOrOtherBasis |
| Book Value | 4894899 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 118066549 | OtherCostOrOtherBasis |
| Depreciation | 82100059 | Depreciation |
| Book Value | 35966490 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5280884 | OtherCostOrOtherBasis |
| Depreciation | 4832438 | Depreciation |
| Book Value | 448446 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 52777398 | OtherCostOrOtherBasis |
| Depreciation | 39640653 | Depreciation |
| Book Value | 13136745 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 419800 | OtherCostOrOtherBasis |
| Depreciation | 61065 | Depreciation |
| Book Value | 358735 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 54805315 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Valuation Allowance Def Tax Asset | -329000 |
| Other Receivables | 1502347 |
| Due From Affiliates | 7983839 |
| Deferred Tax Asset | 622000 |
| Deferred Financing | 108500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 9887686 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Est Settlemnts pay to Third Party Payors | Description |
| Amount | $18,836,836 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 18836836 | TotalOfAmounts |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agreement Ref Fundraising | false | AgreementRefFundraising |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Fall Charitable Event | NameOfEvent1 |
| Gross Receipts Event1 | 100175 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 16075 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 84100 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 78192 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 100175 | GrossReceiptsTotal |
| Charitable Contributions Total | 16075 | CharitableContributionsTotal |
| Gross Revenue Total Events | 84100 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 78192 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 78192 | DirectExpenseSummaryEvents |
| Net Income Summary | 5908 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6214315 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 6214315 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04630 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17236165 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12359871 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4876294 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03630 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23450480 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12359871 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11090609 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08260 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 38000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 36623 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1377 | NetCommunityBenefitExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 511431 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 171737 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 339694 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 153552 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 153552 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 702983 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 208360 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 494623 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 24153463 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12568231 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11585232 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08620 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,268,078 | BadDebtExpenseAmount |
| Amount Attributable To | 634000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 51327043 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 60518010 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -9190967 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | OtherOther | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|
| Gottlieb Adult Day Care Center | |||||||
| 555 W North Ave | Melrose Park | IL | 60160 | Adult Day Care Center | |||
| Gottlieb Transitional Care | |||||||
| 701 W North Ave | Melrose Park | IL | 60160 | Transitional Care Program | |||
| Gottlieb Home Health & Hospice | |||||||
| 905 W North Ave | Melrose Park | IL | 60160 | Home Health and Hospice Program | |||
| Gottlieb Memorial Hospital | |||||||
| 701 W North Ave | Melrose Park | IL | 60160 | Including oupatient services | X | X | X |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Annual Community Benefit Expln | Upon request | AnnualCommunityBenefitExpln |
| Subsidized Health Services Expln | The organization did not include any costs attributable to a physician clinic as subsidized health services. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Bad debt expense of $6,967,463 is included in the denominator for the calculation of Part I, column f. Our software does not accomodate the exclusion of bad debt expense. Please see additional information for true percentages. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Gottlieb's estimate for its Bad Debt expense is based upon management's assessment of historical and expected net collections by payor. | BadDebtFootnote |
| Shortfall As Community Benefit | Gottlieb provides quality patient care and promotes health to its surrounding community through a variety of educational and support programs. As such, the Medicare cost report related shortfall would be considered a community benefit.The medical allowable costs of care on Part III, Line 6 were computed using the cost to charge ratio from the Medicare cost report times the Medicare charges. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Gottlieb's collection policy contains provisions on the collection practices to be followed for patients who are known to qualify for charity care for financial assistance. There are many instances when a patient does not formally complete a charity/financial application, but would qualify for charity or financial assistance if the application were completed. Before an account is turned over to a collection agency, the Patient Accounts staff follows the process of evaluating whether a patient could meet charity or financial assistance by reviewing of the following information: Patient history Patient demographics Employment status Financial information, including credit check Returned mail Citizenship Valid Identification | DebtCollectionPolicy |
| General Explanation | Part I, Line 3b - The "Other" box should be checked with 600%. Our software is unable to check this box.Part I, Line 7a-7kOur software is not able to exclude Bad Debt expense from the denominator in calculating Part I, Line 7a-7k(column f)Part I, Line 7a, Column (f) should be 4.88Part I, Line 7b, Column (f) should be 3.83Part I, Line 7d, Column (f) should be 8.71Part I, Line 7g, Column (f) should be 0.27Part I, Line 7i, Column (f) should be 0.12Part I, Line 7j, Column (f) should be 0.39Part I, Line 7k, Column (f) should be 9.10 | GeneralExplanation |
| Needs Assessment | Gottlieb determines and evaluates the needs of the Community on an ongoing basis. The process includes information from the Medical staff and community leaders. Patient comments are considered along with input from Gottlieb employees, many of which live in the Community. Information is also gathered from various healthcare organizations and societies and consultants are periodically engaged to prepare market studies, including breakdowns by age, gender, and ethnicity. | NeedsAssessment |
| Patient Education Assistance | In advising patients, a financial counselor will explain GMH's payment policy and discuss a payment plan for the services. Patients who are not able to comply with the request for payment will then be evaluated for possible Medicaid eligibility. The financial counselor will initiate the Medicaid application or direct the patient to the Public Aid Office whenever it appears the patient would qualify. A copy of the Medicaid denial may be requested prior to extending charity or financial assistance. A patient when requesting charity care must provide the following documentation within 14 days of the request.When patients qualify for charity care or financial assistance, they will receive the applicable discount for that calendar year. This will be indicated on the registration system by the appropriate assigned plan code of each level of discount.The following documentation is required for evaluation for charity care or financial assistance review and approval:1. A copy of most current tax year W-2, 1040, and any other applicable tax forms that were filed.2. Copies of the last three (3) most recent employer paycheck stubs.3. If patient is paid in cash, a letter from the employer stating amount paid weekly.4. Copies of Social Security check is applicable.5. Copy of last three (3) checking and/or saving account statements.If patient does not provide documentation, a credit check will be run on patient. Based on the information provided by Trans Union Services, a charity determination will be made. | PatientEducationAssistance |
| Community Information | Gottlieb Memorial Hospital ("Gottlieb") embraces its commitment and responsibility to provide quality healthcare to the community it serves. Gottlieb was founded as and continues to be a community-based hospital. Gottlieb defines the community it serves by the areas indicated by zip codes below: Core Market Population Franklin Park 60131 20,628 Melrose Park 60160 20,026 Melrose Park 60164 21,956 Stone Park 60165 5,174 River Grove 60171 10,971 Schiller Park 60176 11,345 Elmwood Park 60707 42,274 Southeast Market Bellwood 60104 Forest Park 60130 Maywood 60153 Westchester 60154 Broadview 60155 Oak Park 60301 Oak Park 60302 Oak Park 60304 River Forest 60305 Berwyn 60402 Chicago 60623 Chicago 60638 Chicago 60644 Chicago 60651 Cicero 60804 West Market Addison 60101 Bensenville 60106 Elmhurst 60126 Glendale Heights 60139 Lombard 60148 Hillside 60162 Berkeley 60163 Villa Park 60181 Wood Dale 60191 Northeast Market Des Plaines 60018 Chicago 60618 Chicago 60624 Chicago 60630 Chicago 60631 Chicago 60634 Chicago 60639 Chicago 60641 Chicago 60647 Chicago 60656 Harwood Heights 60706 | CommunityInformation |
| Community Building Activities | See Schedule O | CommunityBuildingActivities |
| Other Information | See Schedule O | OtherInformation |
| Affiliated Health Care System | See Schedule O | AffiliatedHealthCareSystem |
| Reports Filed With States | IL | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thomas Origitano MD | ||||||||||||
| 578037 | 15159 | 4082 | 20982 | 20661 | 638921 | |||||||
| Robert Sulo MD | ||||||||||||
| 306187 | 2157 | 20990 | 15351 | 344685 | ||||||||
| Peter McCauley MD | ||||||||||||
| 268425 | 6793 | 21333 | 6303 | 302854 | ||||||||
| Paul K Whelton MD | ||||||||||||
| 734247 | 16463 | 23345 | 367303 | 10006 | 1151364 | 16463 | ||||||
| Patricia Cassidy | ||||||||||||
| 362165 | 99509 | 183760 | 35699 | 10001 | 691134 | 99509 | ||||||
| Maurita Adler | ||||||||||||
| 142905 | 2861 | 32868 | 7202 | 185836 | ||||||||
| Kenneth Fishbain | ||||||||||||
| 271854 | 4929 | 57918 | 6003 | 340704 | ||||||||
| John Morgan | ||||||||||||
| 212335 | 7583 | 70390 | 3556 | 458218 | 164354 | |||||||
| Jessie D Almonares | ||||||||||||
| 142705 | 1687 | 32822 | 2400 | 179614 | ||||||||
| Henly Del Carpio | ||||||||||||
| 175013 | 64710 | 2935 | 242658 | |||||||||
| Ellyn Chin | ||||||||||||
| 153672 | 3183 | 15530 | 8081 | 180466 | ||||||||
| Ellen Gaynor MD | ||||||||||||
| 203730 | 9260 | 1544 | 15433 | 6021 | 235988 | |||||||
| Elizabeth C McLain | ||||||||||||
| 167651 | 11412 | 2821 | 181884 | |||||||||
| Constance Clark | ||||||||||||
| 157845 | 3722 | 47292 | 3497 | 212356 | ||||||||
| Charles ReiterIII | ||||||||||||
| 441570 | 301204 | 65062 | 22468 | 830304 | ||||||||
| Andrew F Knauf | ||||||||||||
| 265167 | 7352 | 72394 | 3791 | 508058 | 159354 | |||||||
| Alan Goldberg | ||||||||||||
| 160863 | 3822 | 33145 | 5703 | 203533 | ||||||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch J, Part III, Additional Information | Identifier |
| Return Reference | Part III, Additional Information | ReturnReference |
| Explanation | Paul K. Whelton, M.D. paid by related organization Loyola University Medical Center, Tax ID #36-4015560Patricia Cassidy paid by related organization Loyola University Medical Center, Tax ID #36-4015560Part II, Column B(ii)The organization paid an annual attendance bonus. Any full-time and 0.9 employee who has a accumulated 30 or more earned unused sick days was eligible for a yearly attendance bonus. Earned sick days in excess of 30 days were paid in an annual bonus of one day's pay for every two unused sick days.Part I, 4aSeverance payments were made to John Morgan, Andrew Knauf, Kenneth Fishbain and Alan Goldberg. Payments to these executives were obligated under the Gottlieb Health Resources, Inc. Supplemental Executive Retirement Plan (the SERP). The SERP agreement was effective since January 1995. The SERP agreement provided for severance payments to these executives upon a qualified termination of the SERP agreement. A qualified termination was defined in the SERP as a Change in Control. The affiliation with Loyola University Health System on July 1, 2008 resulted in a Change in Control. The amounts are reported in Part II, Column B(iii).Part II and Form 990, Part VIEllen Gaynor, Thomas Origitano and Robert Sulo are employed full time as physicians, by a related organization, and are not compensated for their positions on the board. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Peggy A Woods | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Child-Former Dir | Relationship |
| Amount Of Transaction | 68605 | AmountOfTransaction |
| Description Of Transaction | Employed by Gottlieb Hosp | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The organization makes its governing documents, conflict of interest policy and financial statements available to the public by mail, upon written request. The filing organization's Financial Statements are available on the Illinois Attorney General web site at: http://www.illinoisattorneygeneral.gov/charities/search/index.jsp. Financial performance summaries are contained in the LUHS Annual Report and made available to the public on the LUHS web site at: http://www.loyolamedicine.org/News/Publications/LUHS_Annual_Report/index.cf |
| Form 990, Part VI, Line 15b | Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | A compensation committee reviewed compensation of the President and Secretary. This survey covers the CEO, COO and CFO positions. Additionally, Gottlieb Memorial Hospital participates in an annual management compensation survey conducted by the Metropolitan Chicago Healthcare Council which surveys VP and management level salaries. Executive compensation survey data was used by the board as part of the annual compensation review process for key executive staff. |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | On an annual basis, directors, officers, key employees and various classes of employees are obligated to complete a disclosure statement that includes a list of questions to identify conflicts of interest. Disclosure information is reviewed through the Board Audit and Corporate Compliance Committee. |
| Form 990, Part VI, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | 1. The Form 990 is prepared by information provided by Gottlieb staff and led by senior management of Gottlieb.2. A detailed summary of the draft Form 990 is presented to the organization's Audit & Corporate Compliance Committee. In addition to the detailed summary presented, each member of the Audit & Compliance Committee and the organization's senior officers are provided a copy of the organization's draft Form 990 (including all required schedules), prior to finalizing the form. The organization's officers and directors discuss the Form 990. A summary of the draft Form 990 is provided to the Board of Directors.3. Once finalized, a copy of the organization's Form 990 (including all required schedules), is made electronically available to each voting member of the organization's governing body, prior to its filing with the IRS. |
| Form 990, Part VI, Line 7a | Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | See response to Part VI, Section A, question 4. |
| Form 990, Part VI, Line 6 | Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | See response to Part VI, Section A, question 4. |
| Form 990, Part VI, Line 4 | Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents | On July 1, 2008, Loyola University Health System ("LUHS") became the sole member of Gottlieb Memorial Hospital and Gottlieb Health Resources, Inc. Both qualify as exempt organizations under section 501(c)(3) of the Code and are described in section 509(a)(1) or (3) respectively (collectively "Gottlieb"). The membership substitution was accomplished through certain bylaws amendments and changes to the LUHS and Gottlieb articles of incorporation. The amended Loyola University Health System ("LUHS") bylaws provide certain LUHS director positions for a given period of time to directors who have been designated as Gottlieb Legacy Directors. All LUHS Directors are elected by the Loyola University of Chicago Board of Trustees. LUHS reserves the authority to approve certain Gottlieb major corporate decisions such as the incurrence of debt and approval of benefit changes. The amended articles of incorporation establish LUHS as a supporting organization. No directors are compensated for their director role. |
| Form 990, Part VI, Line 2 | Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | Patrick J. Kelly, Thomas Fitzgerald and Patricia Cassidy have identified a business relationship with each other. Patrick J. Kelly and Eric Reeves have identified a business relationship with each other. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| Trust Fund for the Plan of Self Insuranc | ||||||||||
| 701 W North Avenue | Melrose Park | IL | 60160 | 366634432 | Supporting Organization | IL | 501(c)(3) | 11 | N/A | |
| Gottlieb Memorial Foundation | ||||||||||
| 701 W North Avenue | Melrose Park | IL | 60160 | 743260011 | Supporting Organization | IL | 501(c)(3) | 11 | N/A | |
| Loyola University Medical Center | ||||||||||
| 2160 S First Avenue | Maywood | IL | 60153 | 364015560 | Healthcare | IL | 501(c)(3) | 3 | Loyola University Health System | |
| Loyola University Health System | ||||||||||
| 2160 S First Avenue | Maywood | IL | 60153 | 363342448 | Healthcare | IL | 501(c)(3) | 11 | Loyola University of Chicago | |
| Gottlieb Community Health Services | ||||||||||
| 701 W North Ave | Melrose Park | IL | 60160 | 363332852 | Physician Svcs/Center for Fitness & Wellness | IL | 501(c)(3) | 9 | Gottlieb Memorial Hospital | |
| Gottlieb Health Resources Inc | ||||||||||
| 701 W North Ave | Melrose Park | IL | 60160 | 363225661 | Supporting Organization | IL | 501(c)(3) | 11 | Loyola University Health System | |
Form990 Schedule R Part III Form990ScheduleRPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Disproportionate Allocations | false | DisproportionateAllocations |
| General Or Managing Partner | false | GeneralOrManagingPartner |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Primary ActivityPrimaryActivity | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Loyola University of Chgo Insurance Co | |||||||||||||
| 23 Lime Tree Bay Avenue | Grand Cayman | CJ | Ky1-1102 | Malprac Ins | NA | ||||||||
| GottliebWest Towns PHO Inc | |||||||||||||
| Med Contract | 701 W North Ave | Melrose Park | IL | 60160 | 364006263 | IL | N/A | 0.50000 | |||||
| Gottlieb Management Services Inc | |||||||||||||
| Rent/Mgnt Svcs | NA | 701 W North Ave | Melrose Park | IL | 60160 | 363330529 | IL | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Gottlieb Management Services Inc | |
| p | 1493410 |
| Loyola University Medical Center | |
| o | 1241855 |
| Gottlieb Community Health Services | |
| r | 48647 |
| Gottlieb Community Health Services | |
| q | 296202 |
| Gottlieb Community Health Services | |
| a | 88278 |
| Gottlieb Health Resources Inc | |
| r | 3279107 |