2024-05-15T15:20:02-05:00 2023-06-30 990 2023-01-01 363208390 ADVENTIST GLENOAKS HOSPITAL ADVE 6305458000 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 LYNN C ADDISCOTT ASSISTANT SECRETARY 4079751492 2024-05-15 LYNN ADDISCOTT 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z VLADIMIR RADIVOJEVIC 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 65445538 0 X WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/ X 1982 IL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 143 BED HOSPITAL. 22 17 0 37 66351 1285 3384216 1018582 111568194 64405977 106718 5758 0 0 115059128 65430317 165081 38903 0 0 50258062 30782446 0 0 0 65636232 36686546 116059375 67507895 -1000247 -2077578 54319438 75177032 20840084 18489777 33479354 56687255 X THE TAXPAYER'S PARENT IS ADVENTIST MIDWEST HEALTH, WHICH IS OWNED 49% BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (ADVENTHEALTH). EFFECTIVE JANUARY 1, 2023, THE TAXPAYER'S PARENT ENTERED INTO A MASTER MANAGEMENT AGREEMENT WITH ADVENTHEALTH. ADVENTHEALTH SEEKS TO BE WIDELY RESPECTED AS A CONSUMER-FOCUSED ORGANIZATION THAT ENGAGES INDIVIDUALS IN THEIR HEALTH BY DELIVERING WHOLISTIC, BEST PRACTICE CARE ACROSS A CONNECTED, COMPREHENSIVE CONTINUUM OF SERVICES. WITH CHRIST AS OUR EXAMPLE, ADVENTHEALTH CARES FOR AND NURTURES PEOPLE: OUR EMPLOYEES, OUR COMMUNITIES, OUR HEALTHCARE PROFESSIONALS, AND THOSE WHO TRUST US FOR CARE AND HEALING. 0 0 64574927 38903 64339626 OPERATION OF A 143-BED ACUTE CARE HOSPITAL. THERE WERE 2,452 PATIENT ADMISSIONS, 13,916 PATIENT DAYS, AND 20,567 OUTPATIENT VISITS. 64574927 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 22 17 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X KYLE GLASS 7082452211 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 BACON KENNETH DIR/CHAIRMAN 0.30 0.60 X 0 0 0 DENSLOW KENNETH DIRECTOR/VICE CHAIR 0.30 0.60 X 0 0 0 ARQUILLA VENANZIO DIRECTOR 0.30 0.60 X 0 0 0 BUCHANAN HERBERT DIRECTOR 0.30 50.00 X 0 0 0 DAVARAPALLI MD RAMADEVI DIRECTOR 0.30 50.00 X 0 0 0 DIXON SUSAN DIRECTOR 0.30 0.60 X 0 0 0 EASTMAN LINDA DIRECTOR 0.30 0.60 X 0 0 0 GRAY JR MARSHALL DIRECTOR 0.30 0.60 X 0 0 0 GRYS DMIN JOHN DIRECTOR (BEGAN 01/2023) 0.30 0.60 X 0 0 0 HAWKINS RONNIE DIRECTOR 0.30 0.60 X 0 0 0 HOLDER BILL DIRECTOR 0.30 0.60 X 0 0 0 KOHLI MD MANINDER DIRECTOR 0.30 9.00 X 0 0 0 MILNER MD ROSS DIRECTOR (BEGAN 01/2023) 0.30 0.60 X 0 0 0 MURREY MD SUSAN DIRECTOR 0.30 28.90 X 0 0 0 O'CONNOR PETER DIRECTOR 0.30 0.60 X 0 0 0 PATARI MD SANJAY DIRECTOR (BEGAN 01/2023) 0.30 0.60 X 0 0 0 RAMIREZ ELDEN DIRECTOR 0.30 0.60 X 0 0 0 SCOTT GLYNN DIRECTOR 0.30 0.60 X 0 0 0 SNYDER BRENT DIRECTOR 0.30 0.60 X 0 0 0 THORDARSON THOR DIR/PRES/SEC/EVP & COO 7.00 43.00 X 0 0 0 VALAITIS MD SANDRA DIRECTOR (BEGAN 01/2023) 0.30 0.80 X 0 0 0 WRIGHT JONATHAN DIRECTOR 0.30 0.60 X 0 0 0 RADIVOJEVIC VLADIMIR CEO 50.00 0.00 X 0 0 0 BROWN JARED CFO 25.00 25.00 X 0 0 0 0 0 0 0 0 0 0 0 X 3558 1015024 1018582 NET PATIENT REVENUE 622110 56808318 56808318 HEALTH EDUCATION PROGRAM 622110 5772336 5772336 RETAIL PHARMACY 622110 1621714 1562759 58955 CAFETERIA REVENUE 622110 182334 182334 MEDICAL OFFICE BUILDING 622110 22205 14809 7396 -930 -930 64405977 20979 20979 15221 -15221 -15221 -15221 65430317 64339626 66351 5758 X 38903 38903 403460 403460 22654442 22593667 60775 944632 928386 16246 5137065 5002942 134123 1642847 1614593 28254 64516 64516 3266 3266 2817 2817 17538189 16714158 824031 879 879 515494 306248 209246 2251551 2028521 223030 1259926 1259926 25208 25208 13260 13260 165847 165847 1776746 1776746 748021 748021 MEDICAL SUPPLIES 8494020 8494020 STATE INDIGENT TAX ASSE 3368902 3368902 REPAIRS AND MAINTENANCE 249589 249589 208315 32479 175836 67507895 64574927 2932968 0 X 2455 2457 11388968 12035096 11231289 1964141 2516491 938597 572101 37424848 1776746 32331548 35648102 7047601 13817624 54319438 75177032 2166788 1461905 18673296 17027872 20840084 18489777 X 33479354 56687255 0 33479354 56687255 54319438 75177032 X -2077578 57780 25227699 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10576 10576 0 PART II-B, LINE 1: DUES WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE ILLINOIS HOSPITAL ASSOCIATION. 2854000 2854000 28718799 998710 27720089 4990694 778036 4212658 861355 861355 35648102 OTHER RECEIVABLES 4348624 RECEIVABLE FROM THIRD PARTIES 6468042 RIGHT OF USE ASSET-OPERATING LEASE 3000958 13817624 DUE TO RELATED 4364464 PAYABLE TO THIRD PARTIES 8121428 AR CREDIT BALANCES 640466 DEFERRED REVENUE 887454 ACCRUED INTEREST PAYABLE 10381 OPERATING LEASE LIABIITY 2985435 OTHER LIABILITIES 18244 17027872 X PART X, LINE 2: THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENT AUDIT OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) AS OF JANUARY 1, 2023. THE CONSOLIDATED FINANCIAL STATEMENTS OF UCMC CONTAIN THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. THE SYSTEM APPLIES ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC TOPIC 740 PRESCRIBES A MORE LIKELY THAN NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC TOPIC 740, TAX POSITIONS ARE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. AS OF JUNE 30, 2023 AND 2022, THE SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. UCM OBLIGATED GROUP IS COMPRISED OF SUBSIDIARIES THAT ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. UCM NON-OBLIGATED GROUPS CONSIST OF SEVERAL NOT-FOR-PROFIT AND TAXABLE ENTITIES. THE TAXABLE ENTITIES INCLUDE UNIVERSITY OF CHICAGO MEDICINE CARE NETWORK, LLC; TRULEN INSURANCE SPC LIMITED; MEDCENTRIX, INC.; INGALLS SAME DAY SURGERY; AND INGALLS PROVIDER GROUP, WHICH ARE TAXABLE ENTITIES UNDER APPLICABLE SECTIONS OF THE CODE. DEFERRED INCOME TAXES ON THE TAXABLE ENTITIES OF THE NON-OBLIGATED GROUPS ARE RECOGNIZED FOR THE TAX CONSEQUENCES OF "TEMPORARY DIFFERENCES" BY APPLYING ENACTED STATUTORY TAX RATES APPLICABLE TO FUTURE YEARS TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS AND THE TAX BASES OF EXISTING ASSETS AND LIABILITIES. AS OF JUNE 30, 2023 AND 2022, THE UCM NON-OBLIGATED GROUPS HAVE DEFERRED TAX ASSETS PRIMARILY RELATING TO NET OPERATING LOSSES (NOL) OF $18,171 AND $19,234, RESPECTIVELY; HOWEVER, IT HAS A FULL VALUATION ALLOWANCE AS MANAGEMENT BELIEVES THAT IT WAS NOT MORE LIKELY THAN NOT THAT THE RESULTS OF FUTURE OPERATIONS WOULD GENERATE SUFFICIENT TAXABLE INCOME TO REALIZE THE NOL. 1 1 X 1 X 250.000000000000 1 X 600.000000000000 1 1 0 1 1 1602860 1602860 0.02370 22549294 25836893 0 0.00000 24152154 25836893 1602860 0.02370 6981 6981 0.00010 30657 30657 0.00050 65379 65379 0.00100 103017 103017 0.00160 24255171 25836893 1705877 0.02530 1 1752178 57632 X 1 1 1 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG 0003814 X X X ADVENTIST GLENOAKS HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, PAGE 8 X X 1 23 1 SEE PART V, PAGE 8 0 1 X 250.000000000000 600.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 5: ADVENTIST GLENOAKS HOSPITAL (AGOH OR THE HOSPITAL) IS A 143-BED ACUTE CARE HOSPITAL LOCATED IN DUPAGE COUNTY IN ILLINOIS. AGOH'S PRIMARY SERVICE AREA INCLUDES 42 ZIP CODES ACROSS MAINLY DUPAGE COUNTY. AGOH IS THE ONLY DISPROPORTIONATE SHARE HOSPITAL IN DUPAGE COUNTY. IN CONDUCTING ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL SOLICITED INPUT DIRECTLY FROM THE COMMUNITY AND FROM INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY COMMUNITY MEMBERS. THE HOSPITAL PARTNERED WITH THE IMPACT DUPAGE COLLABORATIVE IN CONDUCTING ITS 2022 CHNA. THE IMPACT DUPAGE COLLABORATIVE HAS REPRESENTATION FROM SOCIAL SUPPORT AND COMMUNITY ORGANIZATIONS, HEALTH CARE SYSTEMS, AS WELL AS PUBLIC HEALTH AND EDUCATION INSTITUTIONS. A SMALLER COMMITTEE WAS FORMED BY THE COLLABORATIVE TO LOCALIZE THE DATA COLLECTION AND COMMUNITY INPUT PROCESS FOR THE HOSPITAL. COMMUNITY ORGANIZATIONS INCLUDED IN THE SMALLER COMMITTEE INCLUDED UNITED WAY OF METRO CHICAGO, DUPAGE FEDERATION ON HUMAN SERVICES REFORM, PEOPLE'S RESOURCE CENTER, DUPAGE FOUNDATION, DUPAGE COUNTY HEALTH DEPARTMENT, DUPAGE HEALTH COALITION, DUPAGE COUNTY PUBLIC DEFENDER'S OFFICE, DUPAGE COUNTY, AND PRAIRIE STATE LEGAL SERVICES, INC. AGOH ALSO FORMED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) WHOSE PURPOSE WAS TO SELECT THE NEEDS THE HOSPITAL WOULD ADDRESS RESULTING FROM THE FINDINGS IN THE ASSESSMENT. THE COLLABORATIVE COLLECTED BOTH PRIMARY AND SECONDARY DATA. PRIMARY DATA INCLUDED A COMMUNITY SURVEY, A LOCAL SYSTEM ASSESSMENT, AND A FORCES OF CHANGE ASSESSMENT. AN INTENTIONAL EFFORT WAS MADE TO COLLECT INPUT FROM ALL MEMBERS OF THE HOSPITAL'S COMMUNITY AND TO OBTAIN PERSPECTIVES ACROSS AGE, RACE/ETHNICITY, GENDER, PROFESSION, HOUSEHOLD INCOME, EDUCATION LEVEL, AND GEOGRAPHIC LOCATION. THE COMMUNITY SURVEY WAS PROVIDED IN ENGLISH AND SPANISH TO ANYONE IN DUPAGE COUNTY AND WAS ACCESSIBLE ONLINE THROUGH WEBLINKS AND QR CODES. THE LOCAL SYSTEM ASSESSMENT WAS AN ONLINE SURVEY TARGETING PUBLIC HEALTH, LOCAL HOSPITALS AND HEALTH SYSTEMS, MENTAL AND BEHAVIORAL HEALTH, EDUCATION, HOUSING, PUBLIC SAFETY, LOCAL GOVERNMENT, LOCAL NON-PROFIT AND FAITH-BASED ORGANIZATIONS. THE FORCES OF CHANGE ASSESSMENT WAS A SERIES OF BRAINSTORMING SESSIONS CONDUCTED WITH A NUMBER OF SOCIAL SERVICE ORGANIZATIONS AND THE DUPAGE COUNTY HEALTH DEPARTMENT. ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 11: THE FILING ORGANIZATION IS FILING THIS SHORT PERIOD RETURN FOR THE PERIOD FROM JANUARY 1, 2023 THROUGH JUNE 30, 2023, AS IT IS CHANGING ITS TAX YEAR END TO JUNE 30 FROM DECEMBER 31. AS A CALENDAR-YEAR TAXPAYER IN 2022, THE FILING ORGANIZATION COMPLETED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT BY DECEMBER 31, 2022. THE FILING ORGANIZATION'S 2023-2025 IMPLEMENTATION STRATEGY (COMMUNITY HEALTH PLAN) WAS COMPLETED BY MAY 15, 2023. AS THIS SHORT PERIOD RETURN INCLUDES ONLY 46 DAYS IN THE COMMUNITY HEALTH PLAN THREE-YEAR IMPLEMENTATION PERIOD, PART V, SECTION B, LINE 11 IS NOT ABLE TO BE COMPLETED FOR THIS SHORT PERIOD FILING. THE NARRATIVE FOR SCHEDULE H, PART V, SCHEDULE B, LINE 11 FOR THE TAX YEAR BEGINNING JULY 1, 2023 THROUGH JUNE 30, 2024 WILL INCLUDE HOW THE FILING ORGANIZATION HAS ADDRESSED THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE PERIOD FROM MAY 15, 2023 THROUGH JUNE 30, 2024. SCHEDULE H, PART V, SECTION B, LINE 7A THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 10A: THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG/FINANCIAL-ASSISTANCE 2 1 - THERAPEUTIC DAY SCHOOL PHEASANT RIDGE 43 E STEVENSON DRIVE GLENDALE HEIGHTS IL 60139 BEHAVORIAL HEALTH 2 - THERAPEUTIC DAY SCHOOL WEST CAMPUS 940 MOOSEHEART ROAD NORTH AURORA IL 60542 BEHAVORIAL HEALTH PART I, LINE 3C: PERSONS WHO EARN LESS THAN 600% OF THE FEDERAL POVERTY GUIDELINES ARE GIVEN MORE SIGNIFICANT DISCOUNTS, DEPENDING ON THEIR INDIVIDUAL SITUATIONS.FEDERAL POVERTY LEVEL - 0-250% UNINSURED PATIENT DISCOUNT - 100%FEDERAL POVERTY LEVEL - 251-300% UNINSURED PATIENT DISCOUNT - 95%FEDERAL POVERTY LEVEL - 301-400% UNINSURED PATIENT DISCOUNT - 90%FEDERAL POVERTY LEVEL - 401-600% UNINSURED PATIENT DISCOUNT - 85% PART I, LINE 6A: THE FILING ORGANIZATION WAS A PARTIALLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 30 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 14. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. PART III, LINE 8: COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS ARE CALCULATED USING A COST-TO-CHARGE RATIO.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT. PART III, LINE 9B: THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4)-(R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAN 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. PART III, SECTION B, LINES 5 AND 6: LINES 5 AND 6 OF SECTION B OF SCHEDULE H ARE NOT ABLE TO BE COMPLETED FOR THE SHORT-PERIOD FORM 990 BEGINNING JANUARY 1, 2023 AND ENDING ON JUNE 30, 2023. THE FILING ORGANIZATION FILES IT ANNUAL MEDICARE COST REPORT ON A CALENDAR YEAR BASIS. THE MEDICARE COST REPORT FOR THE YEAR ENDED DECEMBER 31, 2023 IS NOT YET FINALIZED FOR THE FILING ORGANIZATION, AS THE DUE DATE OF THE 2023 MEDICARE COST REPORT IS MAY 31, 2023. THE FILING ORGANIZATION WILL INCLUDE THE 2023 MEDICARE COST REPORT DATA IN ITS FORM 990 FOR THE YEAR BEGINNING JULY 1, 2023 AND ENDING ON JUNE 30, 2024. PART VI, LINE 2: THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2022 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2022, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2022 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART VI, LINE 4: THE FILING ORGANIZATION IS LOCATED IN GLENDALE HEIGHTS, ILLINOIS. IT CURRENTLY OPERATES A HOSPITAL FACILITY AND IS LICENSED FOR 143 BEDS. THE HOSPITAL PROVIDES A FULL RANGE OF SERVICES, INCLUDING EMERGENCY CARE, SURGICAL, ONCOLOGY, OBSTETRICAL, CARDIOLOGY, INTERVENTIONAL RADIOLOGY, BEHAVIORAL HEALTH AND MORE. THE HOSPITAL OPERATES A TWO-CAMPUS THERAPEUTIC DAY SCHOOL WHERE STUDENTS IN 3RD GRADE THROUGH HIGH SCHOOL ARE PROVIDED AN ENVIRONMENT THAT BLENDS ACADEMIC EDUCATION WITH THERAPIES THAT NURTURE EACH STUDENT'S EMOTIONAL GROWTH AND INDEPENDENCE. THE HOSPITAL IS AN ACCREDITED CHEST PAIN CENTER AND CERTIFIED PRIMARY STROKE CENTER. AS THE ONLY DISPROPORTIONATE SHARE HOSPITAL IN DUPAGE COUNTY, THE HOSPITAL IS A SAFETY NET FOR THE MOST VULNERABLE AND UNDERSERVED POPULATIONS - PROVIDING CARE MANY PATIENTS CANNOT ACCESS ELSEWHERE.THE ADVENTIST GLENOAKS HOSPITAL COMMUNITY CONSISTS PRIMARILY OF GLENDALE HEIGHTS AND THE SURROUNDING AREA. WE DEFINE THE PRIMARY SERVICE AREA (PSA) AS THE COLLECTION OF ZIP CODES WHERE APPROXIMATELY 75-80% OF HOSPITAL PATIENTS RESIDE, AND WE FOCUS OUR COMMUNITY HEALTH IMPROVEMENT ON THIS SERVICE AREA. THE SERVICE AREA INCLUDES 42 ZIP CODES ACROSS MAINLY DUPAGE COUNTY AND SMALLER AREAS IN WILL, KANE AND COOK COUNTIES.FOR THIS SHORT PERIOD TAX YEAR, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. FOR THE FIRST SIX MONTHS OF 2023, ABOUT 67.6% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 38.8% - MEDICAID PATIENTS 35.3% - SELF-PAY PATIENTS 3.2% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S DUPAGE COUNTY COMMUNITY IS AS FOLLOWS: - POPULATION 1,226,882 - POPULATION OVER 65 15.5% - POVERTY (BELOW 100% FPL) 6.8% - HIGH SCHOOL GRADUATION RATE 91.0% - UNINSURED ADULTS 6.6% - FOOD INSECURITY RATE 9.8% - POPULATION WITH LOW FOOD ACCESS 67.8% PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTIST GLENOAKS HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE PERIOD FROM 1/1 TO 6/30 OF 2023, THE HOSPITAL EXPENDED $5,093,301 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: AS EXPLAINED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6, THE FILING ORGANIZATION HAS TWO TOP-TIER MEMBERS. THE MEMBERS ARE THE UNIVERSITY OF CHICAGO MEDICAL CENTER AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI). AHSSI IS A WHOLLY-OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. THE FILING ORGANIZATION CAN DRAW UPON THE EXPERTISE AND LEADERSHIP OF BOTH ITS HEALTH SYSTEM MEMBERS IN ITS EFFORT TO CREATE EXCELLENT PATIENT EXPERIENCES AND OFFER A BROAD SPECTRUM OF HEALTH SERVICES NEEDED IN THE COMMUNITY. DURING ITS CURRENT TAX YEAR, THE FILING ORGANIZATION WAS MANAGED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 50 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AHSSHC (MANAGER) PROVIDES MANAGEMENT SERVICES TO THE FILING ORGANIZATION PURSUANT TO A MASTER MANAGEMENT SERVICES AGREEMENT. MANAGEMENT SERVICES PROVIDED INCLUDE THE PROVISION AND LEASING OF PERSONNEL, AND DAY-TO-DAY MANAGEMENT OF THE BUSINESS AFFAIRS AND OPERATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING REVENUE CYCLE SUPPORT, FINANCIAL OPERATIONS SUPPORT, CLINICAL PROTOCOLS, ACCREDITATION AND CONDITIONS OF PARTICIPATION COMPLIANCE, AND A COMPLIANCE PROGRAM. THE MANAGER ALSO PROVIDES DEVELOPMENT AND FACILITY MANAGEMENT, FINANCE AND ACCOUNTING SERVICES, HUMAN RESOURCES, INTERNAL AUDIT, LEGAL, GOVERNMENT RELATIONS, PURCHASING/MATERIALS MANAGEMENT, INFORMATION, MEDICAL AND PROFESSIONAL MATTERS, AND REGULATORY SERVICES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. THE FILING ORGANIZATION PAYS A MANAGEMENT FEE TO AHSSHC FOR THE SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH OR THE UNIVERSITY OF CHICAGO MEDICAL CENTER AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEBSITE AT WWW.UCHICAGOMEDICINEADVENTHEALTH.ORG TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF THE FILING ORGANIZATION. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 ICNA RELIEF USA PROGRAMS INC 8791 144TH STREET JAMAICA NY 11435 043810161 501(C)(3) 7200 0 GENERAL SUPPORT ILLINOIS ASSOCIATION OF SEVENTH-DAY ADVENTISTS 619 PLAINFIELD ROAD WILLOWBROOK IL 60527 237311734 501(C)(3) 15000 0 GENERAL SUPPORT HINSDALE ADVENTIST ACADEMY 631 E HICKORY STREET HINSDALE IL 60521 364090219 501(C)(3) 12500 0 GENERAL SUPPORT 3 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. PART V, LINE 1A: EFFECTIVE JANUARY 1, 2023, THE FILING ORGANIZATION'S PARENT ENTERED INTO A MASTER MANAGEMENT AGREEMENT WITH ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AHSSHC HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AHSSHC SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AHSSHC AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AHSSHC, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AHSSHC WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AHSSHC IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 1, 2023, THE FILING ORGANIZATION'S PARENT ENTERED INTO A MASTER MANAGEMENT AGREEMENT WITH ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND SERVES AS THE PARENT ORGANIZATION TO A HEALTH CARE SYSTEM THAT OPERATES 50 HOSPITALS IN THE U.S. ADVENTIST HEALTH SYSTEM/SUNBELT, INC., A DIRECT 501(C)(3) SUBSIDIARY OF AHSSHC, HOLDS A 49% MEMBER INTEREST IN THE FILING ORGANIZATION. UNDER THE MASTER MANAGEMENT AGREEMENT, AHSSHC PROVIDES GENERAL MANAGEMENT OF THE DAY-TO-DAY OPERATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, THE HOSPITAL FACILITIES OF THE FILING ORGANIZATION'S TWO RELATED HOSPITAL ENTITIES, AND THE RELATED PHYSICIAN CLINIC ENTITIES. MANAGEMENT SERVICES MUST BE PROVIDED IN A MANNER THAT IS CONSISTENT WITH THE TENETS OF THE SEVENTH-DAY ADVENTIST CHURCH AND UNDER THE DIRECTION OF THE FILING ORGANIZATION'S GOVERNING BODY. MANAGERIAL SERVICES PROVIDED UNDER THE MASTER MANAGEMENT AGREEMENT INCLUDE THE FOLLOWING: PROVISION OF ALL C-SUITE PERSONNEL; PROVISION OF ALL PERSONNEL NECESSARY FOR OPERATIONS OF THE HOSPITAL; MANAGEMENT OVERSIGHT; OPERATIONS SUPPORT, INCLUDING REVENUE CYCLE, FINANCIAL OPERATIONS, CLINICAL PROTOCOLS, ACCREDITING, AND COMPLIANCE; DEVELOPMENT AND FACILITY MANAGEMENT, INCLUDING STRATEGIC PLANNING, MANAGED CARE, REAL ESTATE, AND CONSTRUCTION AND EQUIPMENT PLANNING; FINANCE AND ACCOUNTING, INCLUDING BUDGET DEVELOPMENT, TREASURY, TAX, ACCOUNTING, INSURANCE AND PAYMENT OF EXPENSES; HUMAN RESOURCES; INTERNAL AUDIT; LEGAL SERVICES; GOVERNMENT RELATIONS; PURCHASING/MATERIALS MANAGEMENT; INFORMATION SERVICES; MEDICAL AND PROFESSIONAL MATTERS; AND REGULATORY ISSUES. FORM 990, PART VI, SECTION A, LINE 6 ADVENTIST GLENOAKS HOSPITAL (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST MIDWEST HEALTH. ADVENTIST MIDWEST HEALTH IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THE CORPORATE MEMBER, AMH. THE CORPORATE MEMBER IS ENTITLED TO ELECT NOT LESS THAN EIGHTEEN (18) AND NO MORE THAN TWENTY THREE (23) VOTING MEMBERS TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION PURSUANT TO THE PROVISIONS OF THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN RESERVED POWERS ARE RETAINED SOLELY BY THE MEMBER WITH CERTAIN OTHER RESERVED POWERS SUBJECT TO THE APPROVAL OF EITHER THE UNIVERSITY OF CHICAGO MEDICAL CENTER, ADVENTIST HEALTH SYSTEM/SUNBELT, INC., OR BOTH. THE RESERVED POWERS RETAINED SOLELY BY THE MEMBER ARE THE FOLLOWING: - APPROVE MATERIAL CHANGES IN THE CATEGORY OF SERVICES OFFERED BY THE FILING ORGANIZATION; - AUTHORITY TO REQUIRE THE FILING ORGANIZATION'S ADHERENCE TO THE SYSTEM-WIDE NAMING NOMENCLATURE AND SERVICE STANDARDS ADOPTED BY THE MEMBER; - AUTHORITY TO SET AND ENFORCE POLICIES FOR PHYSICIAN COMPENSATION INCLUDING COMMERCIAL REASONABLENESS AND FAIR MARKET VALUE; - AUTHORITY TO ADOPT RULES AND REGULATIONS FOR THE MANAGEMENT OF THE FILING ORGANIZATION AS DEEMED PROPER; - APPOINTMENT OF AN INDIVIDUAL PROPOSED BY ADVENTHEALTH TO HOLD THE OFFICE OF PRESIDENT OF THE FILING ORGANIZATION AND THE TERMINATION OF SUCH APPOINTMENT; AND - THE COMPENSATION OF SUCH INDIVIDUAL HOLDING THE OFFICE OF PRESIDENT. THE FOLLOWING RESERVED POWERS ARE RETAINED BY THE MEMBER SUBJECT TO APPROVAL BY THE UNIVERSITY OF CHICAGO MEDICAL CENTER: - THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION, ALL UNBUDGETED EXPENDITURES IN EXCESS OF $1 MILLION DOLLARS AND THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION; - THE INCURRENCE OF ANY CONTRACTUAL OBLIGATION IS EXCESS OF $1 MILLION DOLLARS; - THE STRATEGIC AND OPERATING PLANS OF THE FILING ORGANIZATION; - THE SELECTION, REMOVAL, OR MODIFICATION OF THE AUTHORITY AND RESPONSIBILITIES OF ACCOUNTANTS AND AUDITORS; - BORROWINGS AND CAPITAL LEASES OF MORE THAN $1 MILLION DOLLARS; - THE APPROVAL OR AMENDMENT OF MANAGED CARE PRICING, PRICING STRATEGIES, AND CONTRACTING PARAMETERS; AND - THE CONFESSION OF A JUDGMENT OR SETTLEMENT OF A CLAIM THAT WOULD EXCEED INSURANCE LIMITS. THE FOLLOWING RESERVED POWERS ARE RETAINED BY THE MEMBER SUBJECT TO THE APPROVAL BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC: - CHANGES TO RELIGIOUS AFFILIATION AND ANY CHANGES IN OPERATION POLICIES, PLANS, AND PROCEDURES RELATED TO SUCH RELIGIOUS AFFILIATION OF ANY FACILITY OWNED BY THE FILING ORGANIZATION; - TERMINATION OF THE INDIVIDUAL HOLDING THE OFFICE OF PRESIDENT IF TERMINATION IS RELATED TO THAT PERSON'S MEMBERSHIP STATUS IN THE SEVENTH-DAY ADVENTIST CHURCH; AND - CHANGES TO THE MISSION, VISION, OR VALUES OF THE FILING ORGANIZATION. THE FOLLOWING RESERVED POWERS ARE RETAINED BY THE MEMBER SUBJECT TO THE APPROVAL OF BOTH THE UNIVERSITY OF CHICAGO MEDICAL CENTER AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC.: - AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS - THE FORMATION OF ANY SUBSIDIARY OF THE FILING ORGANIZATION; - ENTERING INTO ANY AFFILIATION AGREEMENT OR JOINT VENTURE AGREEMENT; - ANY CHANGE IN THE NAME OR BRANDING OF THE HOSPITAL; - THE ADDITION OF NEW MEMBERS OF THE FILING ORGANIZATION; - THE APPOINTMENT AND REMOVAL OF ANY MEMBER OF THE BOARD OF DIRECTORS; - DISTRIBUTIONS OF CASH AND OTHER PROPERTY TO THE MEMBER OR OTHERWISE; - THE ADOPTION AND AMENDMENT OF THE QUALITY AND/OR RISK MANAGEMENT PLANS OF THE HOSPITAL; - THE SELECTION OF THE ACCREDITING BODY OF THE HOSPITAL; - THE TRANSFER OF ANY PROPERTY OF THE HOSPITAL IN EXCESS OF $1 MILLION DOLLARS; - ANY SALE, LEASE, TRANSFER, MERGER OR CONSOLIDATION OF THE FILING ORGANIZATION; - THE DISSOLUTION OF THE FILING ORGANIZATION; - THE FILING OF ANY VOLUNTARY PETITION IN BANKRUPTCY; - REQUIRING ANY ADDITIONAL CAPITAL CONTRIBUTIONS FROM THE MEMBER; AND - THE APPOINTMENT OR REMOVAL OF THE CHAIR OF THE BOARD OF DIRECTORS AND ANY OF THE OTHER BOARD OFFICERS. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO, CFO AND MEMBERS OF THE UCHICAGO MEDICINE FINANCE LEADERSHIP TEAM PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO, CFO AND MEMBERS OF THE UCHICAGO MEDICINE FINANCE LEADERSHIP TEAM DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990 BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS APPOINTED AND COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) AN UNRELATED ENTITY AS DISCLOSED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 3. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION SECTION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT, OTHER THAN THE CHIEF PEOPLE OFFICER, WHO REMAINS AT THE REQUEST OF THE CHAIRMAN/COMMITTEE TO PROVIDE ASSISTANCE/INFORMATION AS NEEDED. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD-PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO ADVENTHEALTH AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF ADVENTHEALTH WILL NOT EXCEED THE 50TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION, ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC AS A WHOLE. PART VIII, LINES 7A, B AND C: THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM OPERATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 8,360,752. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,360,752. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,021,128. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,021,128. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,682,101. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,682,101. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,209,995. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,209,995. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 1,460,450. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,460,450. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,979,732. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,979,732. AHS MANAGEMENT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 477,355. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 477,355. AH SHARED SERVICES FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 324,970. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 324,970. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,706. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,706. FORM 990, PART X, LINE 2 THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, ONE OF THE FILING ORGANIZATION'S TOP-TIER PARENTS. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFER WITH TAX-EXEMPT PARENT 4,281,679. CASH TRANSFER FROM TAX-EXEMPT PARENT 21,202,695. PREPAID INTERCOMPANY IT COSTS -288,993. GIFT FROM SUPPORTING FOUNDATION 32,316. ROUNDING 2. ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST HEALTH PARTNERS INC 5101 S WILLOW SPRINGS RD SUITE B101 LA GRANGE IL 60525 364138353 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST MIDWEST HEALTH 120 NORTH OAK STREET HINSDALE IL 60521 362276984 OPERATION OF HOSPITALS & RELATED SERVICES IL 501(C)(3) LINE 3 N/A 0 AHP SPECIALTY CARE NFP 5101 S WILLOW SPRINGS RD SUITE B101 LA GRANGE IL 60525 811105774 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 HINSDALE HOSPITAL FOUNDATION 120 NORTH OAK STREET HINSDALE IL 60521 521466387 FUND-RAISING FOR SUPPORTED EXEMPT HOSPITALS IL 501(C)(3) LINE 7 MIDWEST HLTH FOUNDATION 0 MIDWEST HEALTH FOUNDATION 120 NORTH OAK STREET HINSDALE IL 60521 352230515 FUND-RAISING FOR SUPPORTED EXEMPT HOSPITALS IL 501(C)(3) LINE 7 N/A 0 AHS MIDWEST MANAGEMENT INC 500 REMINGTON BOULEVARD BOLINGBROOK IL 60440 363354567 EMPLOYEE LEASING IL 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 ADVENTIST MIDWEST HEALTH P 7371469 COST ADVENTIST BOLINGBROOK HOSPITAL Q 232985 COST ADVENTIST MIDWEST HEALTH S 21202695 CASH TRANSFER SCH. R, PART VII: EFFECTIVE JANUARY 1, 2023, THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) AND ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) AND ITS WHOLLY-OWNED SUBSIDIARY, ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI), ENTERED INTO AN AFFILIATION AGREEMENT (THE AFFILIATION) WHEREBY AHSSI SOLD 51% OF ITS MEMBERSHIP INTEREST IN ADVENTIST MIDWEST HEALTH (AMH) TO UCMC. UCMC, AHSSHC, AHSSI, AND AMH ARE ALL RECOGNIZED AS TAX-EXEMPT ORGANIZATIONS UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). AHSSHC, AHSSI, AND AMH ARE PART OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH (AH). THE AFFILIATION BETWEEN UCMC AND AH COMBINES THE EXPERTISE AND RESOURCES OF BOTH ORGANIZATIONS. ALTHOUGH NEITHER UCMC OR AH HAVE CONTROL OVER THE FILING ORGANIZATION AS DEFINED FOR PURPOSES OF SCHEDULE R, THE AFFILIATION BETWEEN THESE TWO HEALTHCARE SYSTEMS IS SIGNIFICANT AND WILL BUILD UPON THE COMPLEMENTARY STRENGTHS OF THE TWO ORGANIZATIONS.