2025-05-15T10:07:33+00:00 2024-06-30 135565207 KPMG LLP 200 EAST RANDOLPH STREET SUITE 5500 CHICAGO IL 606016436 990 2023-07-01 922355855 UChicago Medicine Northwest Indiana Inc UCHI 7737021998 10855 VIRGINIA STREET CROWN POINT IN 463070210 IVAN SAMSTEIN EVP AND CHIEF FINANCIAL OFFICER 7737021000 2025-05-15 true ZELJKO POPOVIC P01795951 3126651000 2025-05-15 2023 2025-03-06 01:10:19Z X THOMAS JACKIEWICZ 5841 SOUTH MARYLAND AVE CHICAGO IL 60637 1705577 false X UCHICAGOMEDICINE.ORG X 2022 IN UChicago Medicine Northwest Indiana, IS A NONPROFIT MICRO HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING ADVANCED MULTISPECIALITY PATIENT CARE TO PATIENTS IN NORTHWEST INDIANA. 9 0 3 0 0 0 0 0 0 1705577 0 0 0 0 0 1705577 0 0 0 0 4901102 0 0 0 0 5054761 0 9955863 0 -8250286 0 2047343 0 10297629 0 -8250286 X UChicago Medicine Northwest Indiana IS A NONPROFIT MICRO HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING ADVANCED MULTISPECIALITY PATIENT CARE TO PATIENTS IN NORTHWEST INDIANA. false false 3261012 0 MULTISPECIALTY CARE: UChicago Medicine Northwest Indiana OPENED its two-story, 130,000-square-foot multispecialty care center in Northwest Indiana to patients on April 29, 2024. UChicago Medicine Northwest Indiana offers a range of adult and pediatric specialty services that include: - Infusion therapy, radiation and medical and surgical oncology for cancer patients - MRI, CT, PET, X-ray and ultrasound imaging capabilities, and a breast imaging center - An ambulatory surgery center (ASC) - Laboratory services - Access to the next generation of advanced treatments through UChicago Medicine clinical trials - An eight-bed emergency department and eight-bed inpatient unit The facility - called UChicago Medicine Northwest Indiana - offers advanced specialty care, including pediatric care from UChicago Medicine Comer Children's Hospital experts, in the following areas: For all ages: cancer, digestive diseases, heart and vascular care, and neurosciences For adults: obstetrics and gynecology (OB/GYN), pain management and transplant For children: allergy and immunology, endocrinology, general surgery, infectious diseases, orthopaedic surgery, otolaryngology (ENT), plastic surgery, pulmonary medicine and rheumatology The Crown Point facility is poised to meet a core need: Based on an assessment of the market, UChicago Medicine found that about 15% of patients in Northwest Indiana travel outside the region for medical care, with roughly 1 in 5 of that group visiting the health system's facilities in and around Chicago. 2529882 1705577 EMERGENCY MEDICINE: World-renowned UChicago Medicine emergency medicine experts bring the forefront of care to Northwestern Indiana. With our emergency department in Crown Point, IN, we offer our patients access to board-certified, fellowship-trained emergency medicine physicians and highly skilled support staff with immediate, 24/7 medical care closer to home. Common conditions treated include abdominal pain, back pain, bleeding, broken bones, chest pain, complications from chronic conditions, such as asthma, COPD, diabetes, dizziness, fainting, seizures, severe high fever, skin infections, and upper respiratory infections. At UChicago Medicine Northwest Indiana, patients will find cutting-edge imaging tools, experienced radiologists and emergency medicine doctors skilled at reading those images. There is in-house imaging, including CT, X-ray, PET, MRI, ultrasound capabilities, and in-house lab services. This helps reduce delays in results and treatment. Patients needing an ambulance can request to be taken to UChicago Medicine Northwest Indiana ED as they talk with paramedics. If a patient needs to be admitted directly from the ED for additional care, Crown Point features an eight-bed, fully-equipped inpatient unit with a highly experienced physician staff and medicine subspecialty consultants. 1266818 0 AMBULATORY SURGERY CENTER: UChicago Medicine Northwest Indiana PROVIDES AN AMBULATORY SURGERY CENTER FOR OUTPATIENT SURGERIES, INCLUDING MINIMALLY INVASIVE GYNECOLOGIC SURGERY, PLASTIC AND RECONSTRUCTIVE SURGERY, THORACIC SURGERY, UROGYNECOLOGY AND RECONSTRUCTIVE PELVIC SURGERY, VASCULAR SURGERY, PEDIATRIC ORTHOPAEDIC SURGERY, AND PEDIATRIC PLASTIC & RECONSTRUCTIVE SURGERY. 1990819 0 OTHER PROGRAM SERVICES RELATED TO THE PROVISION OF HEALTHCARE INCLUDE RADIOLOGY, LABORATORY SERVICES, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, PHARMACY SERVICES, HEART AND VASCULAR AND NEUROPHYSIOLOGY. 1990819 9048531 true false false true false false false false false false false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 0 0 3 true false false false false false false false false false false false false X 9 0 false false false false true true true true true false false true true true true true true true true false IN X PHILLIP KAUFMAN 7738342065 150 HARVESTER DRIVE SUITE 300 BURR RIDGE IL 60527 KRISTA CURELL BOARD MEMBER & PRESIDENT (EFF. 10/11/23) 10.0 41.0 X X 0 1426714 189501 LAUREN HULL BOARD MEMBER & COO (EFF. 10/11/23) 40.0 0.0 X X 0 311198 52781 PHILLIP KAUFMAN BOARD MEMBER & CFO/TREASURER - NWI (EFF. 10/11/23) 1.0 45.0 X X 0 688969 96318 AMY ROSS BOARD MEMBER (EFF. 10/11/23) 1.0 41.0 X 0 1434747 158579 BLASE POLITE MD BOARD MEMBER EX OFFICIO/PRESIDENT OF THE MEDICAL STAFF (EFF 10/11/23) 1.0 40.0 X 0 493240 106720 EVERETT VOKES MD BOARD MEMBER (EFF 10/11/23) 1.0 40.0 X 0 1065708 53607 JASON KEELER BOARD MEMBER (10/11/23 THRU 2/1/24) 1.0 40.0 X 0 1187360 156304 JOHN CUNNINGHAM MD BOARD MEMBER (EFF 10/11/23) 1.0 40.0 X 0 661629 56252 NISHANT AGRAWAL MD BOARD MEMBER (EFF 10/11/23) 1.0 40.0 X 0 631740 66701 SARAH KUNDRAT BOARD MEMBER (EFF. 10/11/23) 1.0 40.0 X 0 232700 17200 IVAN SAMSTEIN CHIEF FINANCIAL OFFICER 1.0 59.0 X 0 1704200 233504 JENNIFER HILL SECRETARY (EFF. 10/11/23) 1.0 42.0 X 0 260221 61917 0 10098426 1249384 0 false true false COVIDER HEALTH 9351 Lake Conroe Dr Conroe TX 77304 HEALTHCARE CONSULTING SERVICES 119730 1 0 NET PATIENT REVENUE 622110 1699945 1699945 CAPITATION REVENUE 900099 5632 5632 0 0 0 0 1705577 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1705577 1705577 0 0 X 4249150 4092084 157066 46630 41967 4663 345384 310923 34461 259938 233944 25994 1443 1443 100100 100100 1860702 1846543 14159 0 321843 321843 123427 68586 54841 137402 4346 133056 328408 288132 40276 9797 6763 3034 42314 42314 DRUGS AND MEDICAL SUPPLIES 1806661 1806661 EQUIPMENT RENT & MAINT 188786 173969 14817 IMPLANTS 70788 70788 LICENSE AND PERMITS 25938 25938 37152 35573 1579 0 9955863 9048531 907332 0 1379343 0 0 668000 0 0 0 0 0 0 0 0 2047343 1149072 0 0 9148557 0 10297629 X -8250286 0 -8250286 0 2047343 -8250286 0 X false true X true false X false true false false false false true 100100 false false 100100 false Schedule C, Part II-B, Line 1g DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE VICE PRESIDENT OF GOVERNMENT AFFAIRS FOR UNIVERSITY OF CHICAGO MEDICINE HAS CONTACT WITH LEGISLATORS AND GOVERNMENT OFFICIALS ON BEHALF OF UChicago Medicine Northwest Indiana TOPICS INCLUDE Medicaid funding and hospital outpatient department funding. DUE TO AFFILIATES 9148557 9148557 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote UChicago Medicine Northwest Indiana APPLIES ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S CONSOLIDATED 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, 2024 AND 2023, UChicago Medicine Northwest Indiana DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. true true X true X true X 600 true true true false false 45374 45374 0.0046 701973 46544 655429 0.0658 0 0.0 0 0 747347 46544 700803 0.0704 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 0 0 747347 46544 700803 0.0704 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 0 0 0 2012061 -2012061 X true true NONE 1 1 UCHICAGO MEDICINE NORTHWEST INDIANA 10855 Virginia St Crown Point IN 46307 https://tinyurl.com/UCM-NWI 24-015691-1 X X X UCHICAGO MEDICINE NORTHWEST INDIANA 1 true true false false true X 200.0 600.0 X X X X true true X X X X true X https://tinyurl.com/NWI-Financial-Assistance X https://tinyurl.com/NWI-Financial-Assistance X https://tinyurl.com/NWI-Financial-Assistance X X X X X X true X false X X X X X true X false false Schedule H, Part V, Section B, Line 2 NWI is a new hospital facility that began operating on 4/29/24 and does not have to complete its CHNA until 6/30/26 pursuant to the federal regulation section 1.501(r)-3(d)(3). Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - UCHICAGO MEDICINE NORTHWEST INDIANA. THE MEDICAL INDIGENCY DISCOUNT APPLIES TO ALL PATIENTS REGARDLESS OF THE RELATIONSHIP BETWEEN THEIR INCOME AND THE POVERTY GUIDELINES. IN A 12 MONTH PERIOD FOR MEDICALLY NECESSARY HEALTH CARE SERVICES PROVIDED BY NWI TO A PATIENT, THE PATIENT IS NOT RESPONSIBLE TO PAY FOR MORE THAN THAT AMOUNT OF BILLED CHARGES IN EXCESS OF 20% OF THE PATIENT'S FAMILY INCOME. Schedule H, Part V, Section B, Line 15 Facility , 1 Facility , 1 - UChicago Medicine Northwest Indiana. NWI RESPONDS TO THESE QUESTIONS BASED UPON ITS PUBLICATION OF THE FINANCIAL ASSISTANCE INFORMATION, NOT THE WRITTEN HOSPITAL ADMINISTRATIVE POLICY. FOR EXAMPLE, NWI'S BILL CONTAINS A STATEMENT THAT DIRECTS THE PATIENT TO CALL A TELEPHONE NUMBER TO SEEK ASSISTANCE. Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - UChicago Medicine Northwest Indiana. NWI SENDS A BILL TO THE PATIENT GUARANTOR NORMALLY AT LEAST FOUR TIMES, PERFORMS A CREDIT CHECK TO DETERMINE PRESUMPTIVE ELIGIBILITY UNDER ITS FINANCIAL ASSISTANCE POLICY, AND THEN MAY REFER THE ACCOUNT TO A COLLECTION AGENCY AFTER THE EXPIRATION OF 125 DAYS FOLLOWING INITIAL POST DISCHARGE BILLING AFTER COMPLETING A CHECK WITH AN OUTSIDE CONTRACTED VENDOR THAT EVALUATES WHETHER OR NOT THE PATIENT FALLS WITHIN THE UCMC FINANCIAL ASSISTANCE LIMITS. IN ADDITION, AFTER A REVIEW OF THE PATIENT'S INFORMATION, THE HOSPITAL MAY CONTACT THE PATIENT DIRECTLY TO DETERMINE IF THE PATIENT MIGHT QUALIFY FOR MEDICAID, AND OFFERS ACCESS TO A SERVICE TO ASSIST WITH THE APPLICATION PROCESS, OR MAY ON OCCASION GRANT FINANCIAL ASSISTANCE IN DISTRESSED CIRCUMSTANCES. IN ADDITION, PATIENTS WHOSE UCM NORTHWEST BILL FOR ONE YEAR TOTALS 20 PERCENT OR MORE OF THEIR ANNUAL ADJUSTED GROSS INCOME WILL NOT HAVE TO PAY MORE THAN 20 PERCENT OF THEIR INCOME FOR ALL OF THOSE BILLS. Schedule H, Part V, Section B, Line 23 Facility , 1 Facility , 1 - UChicago Medicine Northwest Indiana. NWI CHARGES CONSISTENTLY. IF A PATIENT QUALIFIES UNDER THE FINANCIAL ASSISTANCE POLICY, THE DISCOUNT APPLIES TO THE AMOUNT BILLED. 0 Schedule H, Part III, Line 5 CHARGES NOT INCLUDED ON MEDICARE COST REPORT THE FOLLOWING AMOUNTS REPRESENT REVENUE AND EXPENSES FROM PROFESSIONAL FEES, LABS, AND OTHER MEDICARE CHARGES NOT INCLUDED IN NWI'S MEDICARE COST REPORT FOR THE YEAR: REVENUE RECEIVED FROM MEDICARE $776,741 ALLOWABLE COSTS RELATING TO ABOVE PAYMENTS ($2,210,085) SHORTFALL ($1,433,343) Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs PAYMENT RATES FOR MEDICARE GENERALLY ARE SET BY LAW, RATHER THAN THROUGH A NEGOTIATION PROCESS AS WITH PRIVATE INSURERS. THESE PAYMENT RATES ARE CURRENTLY SET BELOW NWI'S COSTS OF PROVIDING THE CARE, WHICH NWI ACCEPTS AS A VOLUNTARY PARTICIPANT IN THE MEDICARE PROGRAM. NWI TAKES SERIOUSLY ITS COMMITMENT TO PROVIDE CRITICAL PROGRAMS AND SERVICES THAT INCREASE ACCESS TO HEALTHCARE, IMPROVE THE HEALTH OF ITS COMMUNITY, HELP RELIEVE THE BURDENS OF GOVERNMENT WITH RESPECT TO THE PROVISION AND PAYMENT OF HEALTHCARE, AND ATTEND TO ADULT AND PEDIATRIC DISABLED PATIENTS AS WELL AS THE ELDERLY MEDICARE POPULATION, OFTEN THE MORE VULNERABLE MEMBERS OF OUR COMMUNITY. THIS SAME RATIONALE APPLIES TO MEDICAID RECIPIENTS, TOO POOR TO COVER THEIR OWN HEALTH CARE EXPENSES. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance NWI PROVIDES DISCOUNTS FOR A PATIENT WHO QUALIFIES FOR TWELVE (12) MONTHS AFTER HE/SHE QUALIFIES. IN ADDITION, NWI COORDINATES ITS DISCOUNTS WITH UNIVERSITY OF CHICAGO PROVIDER GROUP (UCPG) FOR THE PHYSICIAN BILLING, WHICH IS THROUGH THE UNIVERSITY OF CHICAGO. IN A 12 MONTH PERIOD FOR MEDICALLY NECESSARY HEALTH CARE SERVICES PROVIDED BY NWI TO AN UNINSURED OR UNDERINSURED PATIENT, THE PATIENT IS NOT RESPONSIBLE TO PAY FOR MORE THAN THAT AMOUNT OF BILLED CHARGES IN EXCESS OF 20% OF THE PATIENT'S FAMILY INCOME. THIS "MEDICAL INDIGENCY DISCOUNT" IS SUBJECT TO THE PATIENT'S CONTINUED ELIGIBILITY DURING THE APPLICABLE TIME PERIOD. THE 12 MONTH PERIOD TO WHICH THE MAXIMUM AMOUNT APPLIES SHALL BEGIN ON THE FIRST DATE THE PATIENT RECEIVES MEDICALLY NECESSARY HEALTH CARE SERVICES THAT ARE DETERMINED TO BE ELIGIBLE FOR THE MEDICAL INDIGENCY DISCOUNT AT NWI. IN ORDER FOR NWI TO DETERMINE THE 12 MONTH MAXIMUM AMOUNT THAT CAN BE COLLECTED FROM A PATIENT DEEMED ELIGIBLE, THE PATIENT MUST INFORM NWI IN SUBSEQUENT INPATIENT ADMISSIONS OR OUTPATIENT ENCOUNTERS THAT THE PATIENT HAS PREVIOUSLY BEEN DETERMINED TO BE ENTITLED TO THE MEDICAL INDIGENCY DISCOUNT. SOME PATIENTS ARE NOT RESPONSIVE IN PROVIDING INFORMATION TO APPLY FOR CHARITY CARE, AT WHICH POINT NWI MAY LEARN OF THEIR QUALIFICATIONS AFTER THE BILL IS SENT TO COLLECTIONS. IF A PATIENT/GUARANTOR HAS BEEN APPROVED BY NWI FOR CHARITY CARE AND THE ACCOUNT HAS ALREADY BEEN SENT TO AN OUTSIDE COLLECTION AGENCY, NWI WILL NOTIFY THE AGENCY OF THE APPROVAL. IF THE APPROVAL WAS FOR 100% DISCOUNT, THE AGENCY WILL BE ADVISED TO CLOSE THE ACCOUNT AS CHARITY CARE AND NWI STAFF WILL PROCESS AN AGENCY CODE CHANGE IN THE NWI SYSTEM. IF THE CHARITY CARE ADJUSTMENT IS NOT 100%, THE AGENCY IS NOTIFIED OF THE APPROVED DISCOUNT AND ADVISED TO ADJUST THE BALANCE SHOWN AS DUE BY THE APPROVED DISCOUNT AMOUNT. NWI STAFF WILL CONCURRENTLY AMEND THE BALANCES DUE IN THE BAD DEBT SYSTEM BY THE APPROVED DISCOUNT AMOUNT. Schedule H, Part V, Section B, Line 16a FAP website - UCHICAGO MEDICINE NORTHWEST INDIANA: Line 16a URL: https://tinyurl.com/NWI-Financial-Assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - UCHICAGO MEDICINE NORTHWEST INDIANA: Line 16b URL: https://tinyurl.com/NWI-Financial-Assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - UCHICAGO MEDICINE NORTHWEST INDIANA: Line 16c URL: https://tinyurl.com/NWI-Financial-Assistance; Schedule H, Part VI, Line 2 Needs assessment NWI IS A NEW HOSPITAL FACILITY THAT BEGAN OPERATING ON 4/29/24 AND DOES NOT HAVE TO COMPLETE ITS CHNA UNTIL 6/30/26 PURSUANT TO THE FEDERAL REGULATION SECTION 1.501(R)-3(D)(3). IN PREPARATION OF NWI'S INITIAL CHNA, THE HOSPITAL DEFINED ITS COMMUNITY BENEFIT PRIMARY SERVICE AREA (PSA) FOR THE 6/30/2026 CHNA. THE PSA WAS DETERMINED BY REVIEWING DATA OF PATIENT VISITS TO ALL UCM LOCATIONS BY CITIES AND TOWNS, THE PROXIMITY OF MOST PATIENT VISITS TO THE NEW HOSPITAL, REVIEWING DATA OF CITIES AND TOWNS HISTORICALLY UNDER-RESOURCED, AND THE COMMUNITY BENEFIT SERVICE AREA COVERAGE OF NEIGHBORING HOSPITALS. THE HOSPITAL ALSO IDENTIFIED THE VENDOR PARTNER WITH WHOM IT WILL WORK TO DEVELOP THE HOSPITAL'S FIRST CHNA. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance NWI is a new hospital facility that began operating on 4/29/24 and does not have to complete its CHNA until 6/30/26 pursuant to the federal regulation section 1.501(r)-3(d)(3). Schedule H, Part VI, Line 4 Community information NWI is a new hospital facility that began operating on 4/29/24 and does not have to complete its CHNA until 6/30/26 pursuant to the federal regulation section 1.501(r)-3(d)(3). Schedule H, Part VI, Line 5 Promotion of community health NWI IS A NEW HOSPITAL FACILITY THAT BEGAN OPERATING ON 4/29/24 AND DOES NOT HAVE TO COMPLETE ITS CHNA UNTIL 6/30/26 PURSUANT TO THE FEDERAL REGULATION SECTION 1.501(R)-3(D)(3). THE HOSPITAL STAFF HAS ENGAGED WITH THE COMMUNITY IN THE DEVELOPMENT OF ITS FIRST CHNA. THESE RELATIONSHIPS WITH COMMUNITY PARTNERS WILL CONTRIBUTE TO THE CHNA PROCESS AND HELP IDENTIFY OPPORTUNITIES TO PROMOTE COMMUNITY HEALTH PROGRAMMING ONCE THE CHNA AND THE STRATEGIC IMPLEMENTATION ARE COMPLETED IN 2026. Schedule H, Part VI, Line 6 Affiliated health care system UCHICAGO MEDICINE NORTHWEST INDIANA IS PART OF AN INTEGRATED NONPROFIT HEALTHCARE ORGANIZATION COMPRISING UNIVERSITY OF CHICAGO MEDICAL CENTER AND ITS AFFILIATES (THE SYSTEM). INCLUDED WITHIN UCMC ARE THE FOLLOWING ENTITIES: UNIVERSITY OF CHICAGO MEDICAL CENTER, UCHICAGO MEDICINE NORTHWEST INDIANA, THE UNIVERSITY OF CHICAGO MEDICINE CARE NETWORK, UNIVERSITY OF CHICAGO MEDICINE CARE NETWORK MEDICAL GROUP, UCMC TITLE HOLDING CORPORATION, UCMC TITLE HOLDING CORPORATION II NFP, AND THE UCM COMMUNITY HEALTH AND HOSPITAL DIVISION, INC. INCLUDED WITHIN THE UCM COMMUNITY HEALTH AND HOSPITAL DIVISION, INC. (CHHD), AND ITS SUBSIDIARIES: INGALLS MEMORIAL HOSPITAL, INGALLS DEVELOPMENT FOUNDATION, INGALLS HOME CARE, INGALLS PROVIDER GROUP, INGALLS CARE NETWORK, MEDCENTRIX, INGALLS HEALTH VENTURES, INGALLS CASUALTY INSURANCE, TRULEN INSURANCE SPC LIMITED, AND INGALLS SAME DAY SURGERY. Schedule H, Part VI, Line 7 State filing of community benefit report IN X X X X false true false false false false false false false KRISTA CURELL BOARD MEMBER & PRESIDENT (EFF. 10/11/23) 0 815935 0 493570 0 117209 0 164864 0 24637 0 1616215 0 78734 LAUREN HULL BOARD MEMBER & COO (EFF. 10/11/23) 0 251943 0 48125 0 11130 0 41255 0 11526 0 363979 0 0 PHILLIP KAUFMAN BOARD MEMBER & CFO/TREASURER - NWI (EFF. 10/11/23) 0 399616 0 99823 0 189530 0 67741 0 28577 0 785287 0 179087 NISHANT AGRAWAL MD BOARD MEMBER (EFF 10/11/23) 0 536240 0 95500 0 0 0 26400 0 40301 0 698441 0 0 JOHN CUNNINGHAM MD BOARD MEMBER (EFF 10/11/23) 0 561629 0 100000 0 0 0 26400 0 29852 0 717881 0 0 JASON KEELER BOARD MEMBER (10/11/23 THRU 2/1/24) 0 646454 0 503804 0 37102 0 132580 0 23724 0 1343664 0 0 SARAH KUNDRAT BOARD MEMBER (EFF. 10/11/23) 0 208046 0 23636 0 1018 0 15715 0 1485 0 249900 0 0 BLASE POLITE MD BOARD MEMBER EX OFFICIO/PRESIDENT OF THE MEDICAL STAFF (EFF 10/11/23) 0 461740 0 31500 0 0 0 26400 0 80320 0 599960 0 0 AMY ROSS BOARD MEMBER (EFF. 10/11/23) 0 670624 0 445700 0 318423 0 134305 0 24274 0 1593326 0 301076 EVERETT VOKES MD BOARD MEMBER (EFF 10/11/23) 0 865708 0 200000 0 0 0 26400 0 27207 0 1119315 0 0 JENNIFER HILL SECRETARY (EFF. 10/11/23) 0 236436 0 3500 0 20285 0 20161 0 41756 0 322138 0 0 IVAN SAMSTEIN CHIEF FINANCIAL OFFICER 0 1067829 0 598691 0 37680 0 195751 0 37753 0 1937704 0 0 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan CERTAIN INDIVIDUALS LISTED IN SCHEDULE J, PART II PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH UCMC MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTURE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN IN JANUARY 2024 FOR CALENDAR YEAR 2023: KRISTA CURELL LAUREN HULL PHILLIP KAUFMAN JASON KEELER AMY ROSS IVAN SAMSTEIN THE FOLLOWING INDIVIDUALS BECAME VESTED IN, AND WERE TAXED ON, AMOUNTS PREVIOUSLY CREDITED UNDER THE PLAN TO THE INDIVIDUAL FOR SERVICES PROVIDED TO THE ORGANIZATION IN PRIOR YEARS (INCLUDED IN 2023 W-2S): KRISTA CURELL - $78,734 PHILLIP KAUFMAN - $179,087 AMY ROSS - $301,076 Schedule J, Part I, Line 1a DISCRETIONARY SPENDING ACCOUNT DISCRETIONARY SPENDING ACCOUNTS ARE AVAILABLE TO UCMC-EMPLOYED EXECUTIVES ONLY, SERVING UCHICAGO MEDICINE NORTHWEST INDIANA THOSE WHO MADE USE OF THE DISCRETIONARY SPENDING ACCOUNT RECEIVED BETWEEN $0 AND $10,000 DURING THE YEAR. THESE BENEFITS ARE ALL CONSIDERED TAXABLE COMPENSATION INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). Schedule J, Part I, Line 3 COMPENSATION OF THE PRESIDENT OF UChicago Medicine Northwest Indiana IS REVIEWED AND RECOMMENDED FOR APPROVAL BY THE COMPENSATION COMMITTEE OF UCMC. THE COMMITTEE'S DETERMINATION PROCESS UTILIZES A COMBINATION OF AN INDEPENDENT COMPENSATION CONSULTANT AND COMPENSATION STUDIES/SURVEY, WHICH IS THEN REVIEWED AND APPROVED BY THE UCMC COMPENSATION COMMITTEE. THE UCMC COMPENSATION COMMITTEE CONDUCTS ITS REVIEW AND APPROVAL PROCESS IN A MANNER DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW. THIS IS A RIGOROUS REVIEW AND APPROVAL PROCESS DESIGNED FOR TAX-EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE AND IS DESIGNED TO RESULT IN COMPETITIVE AND REASONABLE COMPENSATION. Schedule J, Part II TAXABLE INCOME REPORTED IN COLUMN (B) MAY INCLUDE PAYMENTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN MOST CASES, THESE PAYMENTS WERE EARNED OVER MANY YEARS OF EMPLOYMENT AND THE AMOUNTS HAD PREVIOUSLY BEEN SUBJECT TO VESTING RULES. SERP PAYMENT AMOUNTS EARNED IN PRIOR YEARS WERE PREVIOUSLY REPORTED ON THE FORM 990 AS DEFERRED COMPENSATION AND ARE REPORTED IN THIS 2023 FORM 990 ON SCHEDULE J, PART II, COLUMN (F). AN INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD ANNUALLY REVIEWS THESE BENEFITS IN COMPARISON TO MARKET DATA AND HAS CONCLUDED THAT THESE BENEFITS AND ALL OTHER FORMS OF COMPENSATION PROVIDED TO THESE INDIVIDUALS ARE REASONABLE. THE INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD CONDUCTS ITS REVIEW AND APPROVAL OF ALL EXECUTIVE COMPENSATION, INCLUDING THESE SERP AMOUNTS, IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW. THIS IS A RIGOROUS REVIEW PROCESS DESIGNED FOR TAX-EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE, AND IT MEANS THAT THE BOARD COMPENSATION COMMITTEE DOES NOT HAVE ANY CONFLICTS OF INTEREST, AND RELIES ON MARKET DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT TO SUPPORT ALL EXECUTIVE PAY AS MARKET COMPETITIVE AND REASONABLE. FOR THE INDIVIDUALS LISTED ON SCHEDULE J, PART II THAT ARE IDENTIFIED AS FORMER OFFICERS OR KEY EMPLOYEES, THE COMPENSATION LISTED IS EITHER THE FAIR MARKET VALUE COMPENSATION PAID TO THEM FOR SERVICES THEY PERFORMED AS ACTIVE EMPLOYEES OF IMH OR A RELATED ORGANIZATION (AND WAS NOT PAID TO THEM DUE TO THEIR FORMERLY HAVING BEEN LISTED AS OFFICERS OR KEY EMPLOYEES), OR COMPENSATION AS A COMBINATION OF SERVICES AND SEVERANCE. Form 990, Part III, Line 4d Description of other program services (Expenses $ 1,990,819 including grants of $)(Revenue $ 0) OTHER PROGRAM SERVICES RELATED TO THE PROVISION OF HEALTHCARE INCLUDE RADIOLOGY, LABORATORY SERVICES, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, PHARMACY SERVICES, HEART AND VASCULAR AND NEUROPHYSIOLOGY. Form 990, Part VI, Line 6 Classes of members or stockholders Pursuant to the organization's governing documents, the sole member of the organization is University of Chicago Medical Center, a related tax-exempt organization. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Directors, excluding the Ex Officio Directors, are elected annually by University of Chicago Medical Center. The President of the corporation and the President of the Medical Staff shall be the Ex Officio members of the board and are elected by the University of Chicago Medical Center. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE POLICY-MAKING POWERS OF THE CORPORATION SHALL BE VESTED IN THE BOARD OF DIRECTORS, WHICH SHALL HAVE CHARGE, CONTROL, AND MANAGEMENT OF THE POLICIES, PROPERTY, AFFAIRS, AND FUNDS OF THE CORPORATION AND SHALL DETERMINE COMPLIANCE WITH THE CORPORATION'S STATED PURPOSES; SHALL APPOINT THE OFFICERS OF THE CORPORATION, WITH THE EXCEPTION OF THE PRESIDENT, AND FILL VACANCIES OCCURRING IN SUCH OFFICES; SHALL DETERMINE THE COMPENSATION OF THE OFFICERS FOR SERVICES ACTUALLY PERFORMED FOR THE CORPORATION AND SHALL HAVE THE POWER AND AUTHORITY TO DO AND PERFORM ALL ACTS OR FUNCTIONS NOT INCONSISTENT WITH THE RESERVED POWERS OF THE MEMBER, APPLICABLE LAW, THESE BYLAWS OR THE CORPORATION'S ARTICLES OF INCORPORATION. THE BOARD SHALL CONSIST OF NO MORE THAN 13 DIRECTORS. THE BOARD SHALL BE APPOINTED BY THE MEMBER AND CONSIST OF INDIVIDUALS WHO MEET SUCH CRITERIA FOR APPOINTMENT TO THE BOARD AS MAY BE ESTABLISHED FROM TIME TO TIME BY THE MEMBER. A DIRECTOR MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE, BY THE MEMBER ACTIING IN THE BEST INTERESTS OF THE CORPORATION AS DETERMINED BY THE MEMBER AT ITS SOLE DISCRETION. THE SOLE MEMBER OF THE CORPORATION SHALL BE THE UNIVERSITY OF CHICAGO MEDICAL CENTER, AN ILLINOIS NOT-FOR-PROFIT CORPORATION. MEMBERSHIP IN THE CORPORATION IS NOT TRANSFERABLE OR ASSIGNABLE. THE GENERAL POWERS OF THE CORPORATION SHALL BE VESTED IN THE MEMBER (EXCEPT FOR SUCH POWERS AS ARE DELEGATED IN THESE BYLAWS OR BY THE MEMBER TO THE BOARD OF DIRECTORS OF THE CORPORATION (THE "BOARD")), WHICH SHALL HAVE COMPLETE CHARGE, CONTROL AND MANAGEMENT OF THE PROPERTY, AFFAIRS, FUNDS AND OPERATIONS OF THE CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 is prepared internally by the UCMC tax department using information provided by management and reviewed in detail by an independent accounting firm. At its regularly scheduled meeting, the compensation committee of the UCMC Board of Trustees is provided a draft copy of portions of the Form 990. The final complete version of the Form 990 is then distributed to all voting members of the Board of Trustees prior to its filing. Form 990, Part VI, Line 12c Conflict of interest policy UCHICAGO MEDICINE NORTHWEST INDIANA HAS A ROBUST CONFLICTS OF INTEREST POLICY FOR EMPLOYEES, OFFICERS, AND TRUSTEES. THE POLICY CONTAINS CERTAIN PROHIBITIONS AS WELL AS DISCLOSURE REQUIREMENTS, AND ENCOURAGES QUESTIONS DIRECTED TO THE COMPLIANCE OFFICE AND LEGAL AFFAIRS. DURING THIS TAX YEAR, UCHICAGO MEDICINE NORTHWEST INDIANA ESTABLISHED ITS PRACTICE OF SURVEYING DIRECTORS, OFFICERS, MANAGERIAL EMPLOYEES, AND INFLUENTIAL MEDICAL STAFF MEMBERS, SEEKING DISCLOSURES OF VARIOUS RELATIONSHIPS, INCLUDING RELATIONSHIPS DISCLOSED IN THIS FORM 990. IN ADDITION, MANAGERS AT MONTHLY MEETINGS ASK FOR ORAL DISCLOSURES OF POTENTIAL CONFLICTS. THE COMPLIANCE OFFICER AND THE OFFICE OF LEGAL AFFAIRS PROVIDE EDUCATIONAL SESSIONS. THE UNIVERSITY OF CHICAGO MANAGES RESEARCHER CONFLICTS. THE CONFLICT-OF INTEREST POLICY SPECIFICALLY REQUIRES DISCLOSURE, AND ABSTENTION OR RECUSAL AS NECESSARY, WHENEVER A TRUSTEE OR RELATED PARTY HAS A POTENTIAL CONFLICT OF INTEREST. Form 990, Part VI, Line 15a Process to establish compensation of top management official UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UNIVERSITY OF CHICAGO MEDICAL CENTER, CORPORATE STRUCTURE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND SENIOR EXECUTIVES. THE UCMC COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES (THE COMMITTEE) IS RESPONSIBLE FOR THE OVERSIGHT OF UCM CARE NETWORK MEDICAL GROUP'S EXECUTIVE COMPENSATION DECISION-MAKING PROCESS. ITS REVIEW PROCESS IS DESIGNED TO SATISFY THE PROCEDURAL CRITERIA NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS (UNDER INTERMEDIATE SANCTIONS REGULATIONS) WITH RESPECT TO THE TOTAL COMPENSATION AND BENEFITS PROVIDED. THE COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES WHO ARE "DISINTERESTED" WITHIN THE MEANING OF INTERMEDIATE SANCTIONS REGULATIONS. IT REVIEWS AND APPROVES COMPENSATION AND EMPLOYEE BENEFITS PROVIDED TO UCM CARE NETWORK MEDICAL GROUP INC.'S PRESIDENT AND KEY EXECUTIVES BY FOLLOWING ITS WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT AND WRITTEN COMPENSATION REVIEW PROCESS, WHICH INCLUDES SEEKING COUNSEL FROM OUTSIDE PROFESSIONAL ADVISORS AND RELYING IN ADVANCE ON APPROPRIATE COMPARABILITY DATA (FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED HEALTHCARE ORGANIZATIONS) PROVIDED BY AN INDEPENDENT THIRD PARTY CONSULTANT. THE COMMITTEE REVIEWS AND APPROVES ALL NEW COMPENSATION RANGES, AS WELL AS CURRENT PACKAGES FOR NEWLY HIRED EXECUTIVES, AS NEEDED, BUT AT LEAST ANNUALLY. IT PREPARES A TIMELY AND THOROUGH WRITTEN RECORD OF ITS DELIBERATIONS AND CONCLUSIONS. Form 990, Part VI, Line 15b Process to establish compensation of other employees AN INDEPENDENT COMPENSATION CONSULTANT REVIEWS THE REASONABLENESS OF PROPOSED TOTAL DIRECT COMPENSATION FOR EACH BY PERFORMING A MARKET COMPARISON FOR EACH EXECUTIVE. THE MARKET COMPARISON INVOLVES COLLECTING SURVEY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILAR HEALTH CARE ORGANIZATIONS. PERFORMANCE GOALS ARE NORMALLY ESTABLISHED BASED ON THE BUDGET/BUSINESS PLAN APPROVED BY THE BOARD FOR THE FISCAL YEAR. THE OUTSIDE CONSULTANT OPINES WHETHER OR NOT PERFORMANCE GOALS HAVE BEEN REACHED BEFORE A FISCAL YEAR END PAYMENTS ARE PRESENTED TO THE COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL. Form 990, Part VI, Line 19 Required documents available to the public UChicago Medicine Northwest Indiana BYLAWS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, AUDITED FINANCIALS ARE AVAILABLE TO THE PUBLIC THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE, AND THE FOLLOWING DOCUMENT WAS, AS OF THE TIME OF COMPLETE OF THIS QUESTION, ON UCMC'S WEBSITE: -UNIVERSITY OF CHICAGO MEDICINE UNAUDITED FINANCIAL INFORMATION -2024 AUDITED FINANCIAL STATEMENTS Form 990, Part IX, Line 11g Other Fees Contract Labor - Total Expense: 1591363, Program Service Expense: 1591363, Management and General Expenses: , Fundraising Expenses: ; Billing Fees - Total Expense: 141586, Program Service Expense: 127427, Management and General Expenses: 14159, Fundraising Expenses: ; Physician Services - Total Expense: 106633, Program Service Expense: 106633, Management and General Expenses: , Fundraising Expenses: ; Laundry services - Total Expense: 21120, Program Service Expense: 21120, Management and General Expenses: , Fundraising Expenses: ; ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 HOSPITAL IL 501(c)(3) 3 ADVENT MIDWEST HEALTH false ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 363208390 HOSPITAL IL 501(c)(3) 3 ADVENT MIDWEST HEALTH false ADVENTIST HEALTH PARTNERS INC 5101 S WILLOW SPRINGS RD B1013 LA GRANGE IL 60525 364138353 PHYSICIAN PRACTICES IL 501(c)(3) 3 AHS MIDWEST MGMT false ADVENTIST MIDWEST HEALTH 120 N OAK STREET HINSDALE IL 60521 362276984 2 HOSPITALS IL 501(c)(3) 3 NA false AHP SPECIALTY CARE NFP 5101 S WILLOW SPRINGS RD B1013 LA GRANGE IL 60525 811105774 PHYSICIAN PRACTICES IL 501(c)(3) 3 AHS MIDWEST MGMT false AHS MIDWEST MANAGEMENT INC 500 REMINGTON BLVD BOLINGBROOK IL 60440 363354567 PHYSICIAN PRACTICE MANAGEMENT IL 501(c)(3) Type I ADVENT MIDWEST HEALTH false ARCH DEVELOPMENT CORPORATION 5555 S WOODLAWN AVENUE CHICAGO IL 60637 363485244 TECH TRANSFER IL 501(c)(3) Type I UNIV CHICAGO false ASIAN HEALTH COALITION 180 W WASHINGTON ST SUITE 1 CHICAGO IL 60602 311607193 HLTH ACCESS IL 501(c)(3) 10 UNIV CHICAGO false CHAPIN HALL CENTER FOR CHILDREN 1313 E 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MAMMOGRAPHY DE NA N/A false false CHARITABLE LEAD TRUST (0) 5801 S ELLIS AVENUE CHICAGO IL 60637 CHAR LEAD TRUST IL NA Trust false CHARITABLE REMAINDER TRUSTS (68) 5801 S ELLIS AVENUE CHICAGO IL 60637 CHAR RMDR TRUST IL NA Trust false CAPSTONE CPP 2012 1 FUND INVESTMENT CJ NA C Corporation false EMPLOYED PHYSICIANS SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 981571310 LIAB INSURANCE CJ UCHHD false HPL-GL SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 981571446 LIAB INSURANCE CJ UCHHD false INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY IL 60426 980485714 LIAB INSURANCE CJ NA C Corporation false INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY IL 60426 273226539 PURCHASING GROUP IL NA C Corporation false INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY IL 60426 363485578 INSURANCE SERVICE IL NA C Corporation false KOHINOOR CORE (CAYMAN) FUND INVESTMENT CJ NA C Corporation false MEDCENTRIX INC ONE INGALLS DRIVE HARVEY IL 60426 363374228 BILLING & MGMT IL NA C Corporation false NON-EMPLOYED PHYSICIANS SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC L TD 981571387 LIAB INSURANCE CJ UCHHD false PENSO FUND PLATFORM SPC - SEG PORTFOLIO 981360251 INVESTMENT CJ NA C Corporation false PHOENIX OVERLAY FUND LTD 401 N MICHIGAN AVE C/O INVST OFFICE CHICAGO IL 60611 INVESTMENT CJ NA C Corporation false POOLED INCOME FUND (1) 5801 S ELLIS AVENUE CHICAGO IL 60637 POOLED INCO FUND IL NA C Corporation false SC CURRICULUM INC 70 WEST MADISON ST CHICAGO IL 60602 SCNC CURRICULUM IL NA C Corporation false SP 4 A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 981745253 LIAB INSURANCE CJ UCHHD false STANDARD GENERAL OFFSHORE FUND LTD 767 5TH AVE 12TH FLOOR NEW YORK CITY NY 10153 INVESTMENT CJ NA C Corporation false TARPON ALL EQUITIES FUND LP INVESTMENT CJ NA C Corporation false TRULEN INSURANCE SPC LIMITED 981571288 LIAB INSURANCE CJ UCHHD false UCHICAGO (BEIJING) CONSULTING CO LTD CONSULTING CH NA C Corporation false UCHICAGO CENTER IN INDIA PRIVATE LIMITED CONSULTING IN NA C Corporation false VIEWFORTH EUROPEAN EQUITY FUND LIMITED INVESTMENT CJ NA C Corporation false false false false false false false false false false false true false false true true false false false true Schedule R, Part II Although each of UCMC and Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) and its wholly-owned subsidiary, Adventist Health System/Sunbelt, Inc. (AHSSI), appoint only half of Adventist Midwest Health (AMH's) Board of Directors, and thus neither technically has control over AMH based on the definition of "control" in the Schedule R instructions, the affiliation between UCMC and AMH gives UCMC a significant amount of control over AMH, and therefore AMH and its subsidiaries are being reported on the Schedule R of UCMC. For GAAP reporting, UCMC's consolidated financial statements reflect UCMC's controlling interest in the net assets and operations of AMH. Furthermore, the University of Chicago controls both UCMC (by virtue of being its sole member) and AMH and its subsidiaries (within the meaning of Reg §53.4968-3(b)(2)(iii)). As a result, UCMC and AMH and its subsidiaries are related by reason of both being controlled by the University of Chicago (though the University's control over AMH is within the meaning of Reg §53.4968-3(b)(2)(iii)) rather than the Schedule R instructions).