2011-05-12T13:21:16-07:00 2010-06-30 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 601601612 990 2009-07-01 362379649 Gottlieb Memorial Hospital GOTT 7084504966 701 W North Ave Melrose Park IL 60160 Ellyn Chin 2011-05-12 Ellyn Chin 7084504534 2009 2016-02-24 21:20:13Z Ellyn Chin 701 W North Ave Melrose Park IL 60160 144314391 false false X N/A X 1956 IL 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. 21 17 1352 263 3325652 29078 4017862 127406667 130917977 122754 49350 8713276 9183556 136271775 144168745 0 0 68872889 70225438 0 0 61072607 64109215 129945496 134334653 6326279 9834092 103827112 117982309 76355231 81923750 27471881 36058559 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. false false 121302036 130917977 See Schedule O 121302036 true false false true false false false false false false true false true false false false false false false true false true false false true false false false false false false false false false true false false false false false false true true false false true 94 0 true 1352 true true true false false false false false false true true false 0 false false false false false false false false 21 17 true false true false true true true true true false false false false true true true true true true true true true NC IL X Ellyn Chin 7084504966 701 W North Ave Melrose Park IL 60160 William T Divane Jr 2.00 X 0 0 0 William F Reichert 2.00 X 0 0 0 Thomas P Fitzgerald 2.00 X 0 0 0 Thomas Origitano MD 20.00 X 0 597278 41643 Robert Sulo MD 40.00 X 0 308344 36341 Peter McCauley MD 40.00 X 275218 0 27636 Paul K Whelton MD 40.00 X 0 774055 377309 Patrick J Kelly 3.00 X X 0 0 0 Patricia Cassidy 40.00 X 0 645434 45700 Nancy W Knowles 2.00 X 0 0 0 Michael R Quinlan 2.00 X 0 0 0 Michael R Leyden 2.00 X 0 0 0 Michael J Garanzini SJ 2.00 X 0 0 0 Maurita Adler 40.00 X 145766 0 40070 Kenneth Fishbain 40.00 X 276783 0 63921 Jordan M Hadelman 2.00 X X 0 0 0 John Morgan 0. X 384272 0 73946 John L Keeley Jr 2.00 X 0 0 0 John C Lahey 2.00 X 0 0 0 Jessie D Almonares 40.00 X 144392 0 35222 James C Dowdle 2.00 X 0 0 0 Jackie Taylor Holsten 2.00 X 0 0 0 Jack A Weinberg 2.00 X 0 0 0 Henry S Lang 2.00 X 0 0 0 Henly Del Carpio 40.00 X 175013 0 67645 Frank W Considine 2.00 X 0 0 0 Eric A Reeves 2.00 X 0 0 0 Ellyn Chin 40.00 X 156855 0 23611 Ellen Gaynor MD 32.00 X 0 214534 21454 Elizabeth C McLain 0. X 167651 0 14233 Daniel L Flaherty SJ 2.00 X 0 0 0 Constance Clark 40.00 X 161567 0 50789 Charles ReiterIII 40.00 X 0 742774 87530 Andrew F Knauf 40.00 X 431873 0 76185 Alan Goldberg 40.00 X 164685 0 38848 2484075 3282419 1122083 75 true true false 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 21 16075 4001787 4017862 Patient Care Services 130917977 130917977 130917977 49350 49350 0 0 0 0 84100 16075 78192 5908 5908 0 103274 67454 35820 35820 Reimb. of Occupancy Exp 541900 669306 669306 Outpatient Pharmacy 621400 2117121 2117121 Mgnt. & Prof. Services 541900 5332327 539225 4793102 1023074 1023074 9141828 144168745 130917977 3325652 5907254 0 0 0 0 1191763 369923 821840 384272 384272 51973061 47931920 4041141 5912627 5335429 577198 6957314 6275171 682143 3806401 3439093 367308 0 251497 251497 80976 80976 0 0 0 2143889 2143889 0 23806852 23688880 117972 0 0 2495421 2495421 53519 51439 2080 0 102091 50004 52087 0 0 7511847 7511847 5543899 5543899 Provision for Bad Debts 6967463 6967463 Other Admin. & General 12841766 9829412 3012354 Equipment Rental & Maint. 2297726 2163667 134059 Employee Recognition Events 12269 12269 0 134334653 121302036 13032617 0 26314469 34929833 56507 96027 0 13796452 13965278 0 0 0 2563354 2657012 934111 1102381 181439530 126634215 53593301 54805315 75000 75000 480295 463777 0 0 6013623 9887686 103827112 117982309 62490450 63086914 13864781 18836836 76355231 81923750 X 27371881 35858559 100000 200000 27471881 36058559 103827112 117982309 X false true true X false false X false false false false false false false true 34167 false false false 34167 false false 4894899 4894899 118066549 82100059 35966490 5280884 4832438 448446 52777398 39640653 13136745 419800 61065 358735 54805315 Valuation Allowance Def Tax Asset -329000 Other Receivables 1502347 Due From Affiliates 7983839 Deferred Tax Asset 622000 Deferred Financing 108500 9887686 Est Settlemnts pay to Third Party Payors 18836836 18836836 false Fall Charitable Event 100175 16075 84100 78192 100175 16075 84100 78192 78192 5908 true true true X true X true true true false true true 6214315 6214315 0.04630 17236165 12359871 4876294 0.03630 23450480 12359871 11090609 0.08260 38000 36623 1377 511431 171737 339694 0.00250 153552 153552 0.00110 702983 208360 494623 0.00370 24153463 12568231 11585232 0.08620 true 1268078 634000 51327043 60518010 -9190967 X true true 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

X X X Including oupatient services Upon request The organization did not include any costs attributable to a physician clinic as subsidized health services. 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. Gottlieb's estimate for its Bad Debt expense is based upon management's assessment of historical and expected net collections by payor. 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. 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 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 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. 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. 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 See Schedule O See Schedule O See Schedule O IL X X X true true false false false false false false false false 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 164354 70390 3556 458218 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 159354 72394 3791 508058 Alan Goldberg 160863 3822 33145 5703 203533 Sch J, Part III, Additional Information Part III, Additional Information 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. Peggy A Woods Child-Former Dir 68605 Employed by Gottlieb Hosp false 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. 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 N/A false false Loyola University of Chgo Insurance Co 23 Lime Tree Bay Avenue Grand Cayman CJ Ky1-1102 Malprac Ins NA GottliebWest Towns PHO Inc 701 W North Ave Melrose Park IL 60160 364006263 Med Contract IL N/A 0.50000 Gottlieb Management Services Inc 701 W North Ave Melrose Park IL 60160 363330529 Rent/Mgnt Svcs IL NA true false false false false false false false false false false false false false true true true true 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