TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) David AnsellMD...................................................................... Chairperson	1.00 ................. 39.00	X				0	852,404	178,909
(2) Joan Kurtenbach...................................................................... Vice Chairperson	1.00 ................. 39.00	X				0	331,881	69,692
(3) Donna Carroll...................................................................... Director	1.00 ................. 0.00	X				0	0	0
(4) Anthony Mitchell...................................................................... Director(Start 7/1/15)	1.00 ................. 0.00	X				0	0	0
(5) Sandra Sokol...................................................................... Director	1.00 ................. 0.00	X				0	0	0
(6) Gary McCullough...................................................................... Director(Start 7/1/15)	1.00 ................. 0.00	X				0	0	0
(7) Bruce Elegant...................................................................... President	39.00 ................. 1.00		X			0	1,034,219	86,693
(8) John Mordach...................................................................... Chief Financial Officer	1.00 ................. 39.00		X			0	1,098,694	174,547
(9) Melissa Coverdale...................................................................... Treasurer	8.00 ................. 32.00		X			0	357,920	65,760
(10) Michael Silver...................................................................... VP Medical Affairs	28.00 ................. 20.00		X			329,244	185,593	51,547
(11) Robert Spadoni...................................................................... VP Admin Services\Secretary	38.00 ................. 2.00		X			0	270,189	39,152
(12) Karen Mayer...................................................................... VP Patient Care Services	40.00 ................. 0.00		X			217,766	0	6,932
(13) Donald Childs...................................................................... Pres. of Medical Staff	40.00 ................. 0.00			X		231,735	0	24,366
(14) Daniel Noonan...................................................................... ER Medical Director	40.00 ................. 0.00				X	297,377	0	26,310
(15) Juan Cobo...................................................................... Employed Physician	40.00 ................. 0.00				X	289,811	0	8,218
(16) Peter Kurko...................................................................... ER Physician	40.00 ................. 0.00				X	275,025	0	16,501
(17) Navtej Sandhu...................................................................... ER Physician	40.00 ................. 0.00				X	265,639	0	25,869

(A) Name and business address	(B) Description of services	(C) Compensation
Vyridian Revenue Mgmt LLC 820 W Jackson Blvd Ste 500 Chicago,IL60607	Billing Services	674,045
HLS Wheeling LLC 13028 Collections Center Dr Chicago,IL60693	Laundry Services	524,182
Maple Avenue Kidney Center 610 S Maple Ave Ste 4100 Oak Park,IL60304	Dialysis Services	464,280
Oak Park Imaging Services LLC 610 S Maple Ave Oak Park,IL60304	MRI Services	394,345
Endocrine Associates LLC 520 S Maple Ave Oak Park,IL60304	Endocrinology Services	393,741
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 17

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization RUSH OAK PARK HOSPITAL INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization RUSH OAK PARK HOSPITAL INC		Employer identification number 36-2183812

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization RUSH OAK PARK HOSPITAL INC			Employer identification number 36-2183812
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

30,387

Total. Add lines 1c through 1i ....................................................................................................

30,387

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	The indirect expense amount was a percentage of total expense paid for IHA dues and AHA dues.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	8,280,216		8,280,216
b	Buildings	42,898,275	24,962,515	17,935,760
c	Leasehold improvements
d	Equipment ...	37,920,165	26,704,398	11,215,767
e	Other ...	30,395		30,395
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				37,462,138

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Reinsurance Receivable				6,788,000
(2) Due to Rush University Medical Center				-2,812,581
(3) Miscellaneous Receivables				269,428
(4) Security Deposits				67,103
(5) Due from Health Delivery Management				16,223
(6) Due from Oak Park Imaging				500
(7) 457B Plan Receivable				1,263,540
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				5,592,213

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Reinsurance Liability	6,788,000
Self Insurance Liability	3,162,886
457B Plan Liability	1,263,540
ARO Liability	787,190
Workers Comp Insurance Liability	786,881
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	12,788,497
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Medical Staff Gala (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	56,550	56,550
2	Less: Contributions . . . .	56,550	56,550
3	Gross income (line 1 minus line 2) . . . . . .

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	22,134	22,134
7	Food and beverages . . .	20,305	20,305
8	Entertainment . . . .	7,300	7,300
9	Other direct expenses . . .	21,834	21,834
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		71,573
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		-71,573

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	21,834	21,834

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 30000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	2,802,520		2,802,520	2.380 %
b	Medicaid (from Worksheet 3, column a) . . . . .	17,613,213	16,574,600	1,038,613	0.880 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	20,415,733	16,574,600	3,841,133	3.260 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	464,072		464,072	0.390 %
f	Health professions education (from Worksheet 5) . . .	248,218	209,619	38,599	0.030 %
g	Subsidized health services (from Worksheet 6) . . . .	5,262,829	3,016,577	2,246,252	1.900 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	13,675		13,675	0.010 %
j	Total. Other Benefits . .	5,988,794	3,226,196	2,762,598	2.330 %
k	Total. Add lines 7d and 7j .	26,404,527	19,800,796	6,603,731	5.590 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	4,664	4,664	0 %
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	20,008	20,008	0.020 %
9	Other
10	Total	24,672	24,672	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,487,056

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

33,037,719

Enter Medicare allowable costs of care relating to payments on line 5.....

38,753,734

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-5,716,015

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Rush Oak Park Hospital Inc 520 S Maple Avenue Oak Park,IL60304 www.roph.org 0001750	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Rush Oak Park Hospital Inc
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V Section C

Other website (list url): http://healthimpactcc.org/

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): https://www.roph.org/sites/default/files/CHIP-12-12.pdf

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Rush Oak Park Hospital Inc
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See part V Section C

The FAP application form was widely available on a website (list url):

See Part V Sedtion C

A plain language summary of the FAP was widely available on a website (list url):
See part V Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Rush Oak Park Hospital Inc
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Rush Oak Park Hospital Inc	Part V, Section B, Line 5: Over a period of 18 months, multiple stakeholders have engaged in significant reflection in preparation for Rush Oak Park Hospital's("ROPH") second iteration of the Community Health Needs Assessment("CHNA'). At ROPH and Rush University Medical Center, the process was led by the Center for Community Health Equity (www.healthequitychicago.org), coordinated by the Office of Community Engagement and Practice, and overseen by the Building Healthy Communities Steering Committee. First, the Rush team reviewed its initial CHNA reports, benchmarked them against others produced three years ago in the region and assessed whether the reports contained the right content to enable us to make an impact. We sought to include more stakeholders in our process of developing the CHNA. We began by gathering input from community members as well as from Rush faculty, students and staff (especially those who live in our service area). We sought perspective from our colleagues at health systems and public health entities in the area; community leaders and members; our colleagues in the Center for Community Health Equity based at Rush University and DePaul University; and those participating in the Health Impact Collaborative of Cook County, a collaborative group convened by the Illinois Public Health Institute and consisting of 26 hospitals, seven health departments and more than 100 community-based organizations. As we developed our recommended actions for this iteration of the CHNA, we again sought input from our key stakeholders.
Rush Oak Park Hospital Inc	Part V, Section B, Line 6a: ROPH, together with Rush University Medical Center, conducted its CHNA with the Health Impact Collaborative of Cook County. This initiative is one of the largest collaborative CHNAs in the country with the current involvement of 22 nonprofit and public hospitals, along with seven local health departments, and representatives of more than 100 community organizations serving on action teams. ROPH also followed best practice to complete a comprehensive CHNA and Community Health Improvement Plan (CHIP) for both Rush Oak Park Hospital and Rush University Medical Center.Participating partner hospitals in the Health Impact Collaborative of Cook County (as of June 2016): Advocate Children's Hospital (adjunct) Advocate Christ Medical Center Advocate Illinois Masonic Medical Center Advocate Lutheran General Hospital Advocate South Suburban Medical Center Advocate Trinity Hospital Gottlieb Memorial Hospital Loyola University Medical Center Mercy Hospital & Medical Center NorthShore Evanston Hospital NorthShore Glenbrook Hospital NorthShore Skokie Hospital Norwegian American Hospital Presence Holy Family Medical Center Presence Resurrection Medical Center Presence Saint Francis Hospital Presence Saint Joseph Hospital Presence Saints Mary and Elizabeth Medical Center Provident Hospital RML Specialty Hospitals Roseland Community Hospital John H. Stroger, Jr. Hospital of Cook County
Rush Oak Park Hospital Inc	Part V, Section B, Line 6b: Participating health departments in the Health Impact Collaborative of Cook County: Chicago Department of Public Health Cook County Department of Public Health Evanston Health Department Oak Park Health Department Skokie Public Health District Stickney Health Department
Rush Oak Park Hospital Inc	Part V, Section B, Line 7d: ROPH has actively worked to promote its Community Health Needs Asswssment (CHNA), bringing it to meetings with community based organizations across the entire west side of Chicago, as we view this as a public good for our respective communities.
Rush Oak Park Hospital Inc	Part V, Section B, Line 11: Rush's previous Community Health Implementation Plan had different identified main strategies for the year ending June 30, 2016 for Rush University Medical Center and Rush Oak Park Hospital respectively. However, as Rush adopted a new Community Health Needs Assessment as a system in June 2016 and therefore a new CHIP in November of 2016, we understand we must relate our efforts ended on June 30, 2016 to the newly adopted CHIP. Rush's newly adopted Community Health Implementation Plan (CHIP), as of November 2016, is a direct reaction to the CHNA needs identified in partnership with the Health Impact Collaborative of Cook County in June 2016. Rush has taken a robust approach to alleviating the identified needs. Our newly adopted CHIP is as follows, which we will connect some of our efforts prior to this adoption as prescribed:1.Goal: Reduce inequities caused by the social, economic and structural determinants of health During the year ending June 30, 2016, Rush has actively been engaged in the Health Impact Collaborative of Cook County since its inception, the Healthy Chicago Hospital Collaborative, and the Accountable Health Communities Grant application / Collaborative, a reaction to the Centers for Medicare and Medicaid Innovation to look at the social determinant needs of communities with hardship. Rush has been on the steering committee of all the organizations, which represent many health departments, all city and most county hospitals, and 100+ community based organizations. Rush has been tackling the social determinant of transportation for patients to and from the hospital system as well as their appointments and social service needs outside of Rush by providing taxi vouchers, and has been exploring and plans to adopt a partnership with a RideShare organization.Rush has actively been working to improve educational attainment through existing longstanding programs such as a partnership with Malcolm X College, Crane Medical Preparatory, and many K-12 programs in affiliation with our Science and Math Excellence Network (SAME) program. 2.Goal: Improve access to mental and behavioral health services Rush has actively been working to address the mental and behavioral health needs of our patients and communities by having social work services offered to our primary care, inpatient, and emergency department patients. In addition, having the College of Nursing and Rush Community Based Practices offering mental health services in the community, for example at Simpson Academy for Young Women, the College of Nursing Faculty Practice sites, and many community sites. Rush has also offered mental/behavioral health services through the Health Legacy Program for Women. The Health Legacy Program for Women is an evidenced based chronic disease program that also addresses mental/behavioral health needs of the participants such as stress, trauma, and life events.3.Goal: Prevent and reduce chronic disease by focusing on risk factors Rush will be implementing more systematic approaches to chronic disease including food and tobacco efforts post adoption of the CHIP in November 2016, but this is building on existing efforts in mental/behavioral health that existed prior to the new CHNA adoption for the year ending June 30, 2016. For example, at Rush Oak Park Hospital, the Food Surplus Project has been working to not only decrease our food waste, but to work with the Oak Park River Forest Food Pantry in offering nutritious meals to their guests. At both Rush University Medical Center and Rush Oak Park Hospital, a nurse has been offering Courage to Quit classes created by the Respiratory Health Association of Metropolitan Chicago to patients, employees, and community members alike with tobacco control and harm reduction to stop using tobacco. Healthy Motivations is Rush Oak Park Hospital's community wellness program. It provides free educational seminars and fitness classes, which are designed to help community members lead healthier lives and address chronic disease. Healthy Motivations provided education on topics such as heart and vascular disease, preventive health and depression.The Rush Community Service Initiative Program Clinic at Facing Forward to End Homelessness, is a student and employee led wellness clinic that occurs on a weekly basis and focuses on disease management, access to healthy food, and tobacco control. Lastly, the Health Promotion: Chronic Disease Self-Management Program through Rush's Department of Health and Aging offers interactive, six-week workshops to help those with ongoing health conditions - such as arthritis, heart or lung disease and asthma - maintain control and confidence in managing their health while doing the things that matter most in life.4. Goal: Increase access to care and community services Rush's relationship with CommunityHealth as a Rush Community Service Initiative Program (RCSIP) clinical program provides free preventive and primary health care services to members of the community who cannot afford or are ineligible for medical insurance. This service improves access to care by offering health services ranging from routine physicals and immunization programs to a full laboratory and pharmacy. The Faculty Practice and Outreach administered by the College of Nursing and the Office of Community Engagement, provides healthcare services to underserved individuals, families, and communities at a variety of diverse community practice sites. These sites include School-Based Health Centers, employee wellness programs, women's health clinics, nurse practitioner primary care, and case management programs for mental illness and substance abuse.
Rush Oak Park Hospital Inc	Part V, Section B, Line 13h: The State of Illinois requires that hospitals make a good faith effort to identify "presumptive" charity care for uninsured patients under 200% of FPG. We complete this process by receiving FPG information from a 3rd party vendor for all uninsured patients.In addition to meeting financial and residency requirements, individuals applying for financial assistance must: cooperate with Rush and provide information and documentation truthfully and in a timely manner; make a good faith effort to honor the terms of reasonable payment terms on open balances if the individual qualifies only for a partial discount; notify ROPH of any change in financial situation which may impact the individual's eligibility for financial assistance or payment plan; AND agree to apply for local, state or federal assistance for which the individual may be eligible to help pay for some or all of the individual's hospital bill.
Rush Oak Park Hospital Inc	Part V, Section B, Line 20e: ROPH conducts all of the efforts described in lines 20a-d prior to initiating any of the extraordinary collection activities (ECA) identified by line 19. The only ECA that ROPH engages in is to report unpaid balances to credit agencies, which generally occurs no sooner than 540 days after the date on which the service giving rise to the unpaid balance was provided.
Rush Oak Park Hospital Inc	Part V, Section B, Line 22d: The state of IL requires 100% free care for uninsured patients with incomes less than 200%. We have extended that to include patients (insured or uninsured) with incomes up to 300%. ROPH has historically offered this type of financial assistance and we budget for this expense as part of our community benefits. The 75% Limited Income discount for patients from 301% - 400% is similar in that ROPH felt these patients also warrant assistance for patient liabilities. Our uninsured discount is 68%, so this is an increase from that amount. In addition, many insured patients that need assistance with patient liability will receive the 75% Limited Income discount.
Part V, Section B, Line 7a	www.roph.org/sites/default/files/Community%20health%20needs%20assessment%20729.pdf
Part V, Section B, Line 16a	https://www.rush.edu/sites/default/files/financial-assistance-policy-2016.pdf
Part V, Section B, Line 16b	https://www.rush.edu/sites/default/files/financial-assistance-application.pdf
Part V, Section B, Line 16c	https://www.rush.edu/sites/default/files/financial-assistance-summary.pdf

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c:	All uninsured patients whose income is at or below 200% of FPG are automatically granted free care under ROPH's Presumptive Charity Care Program. ROPH utilizes data received from a third party vendor that is filed with the major credit bureaus to determine whether the patient's income meets the income threshold. Charges for services rendered to patients meeting this threshold are written off in full prior to a bill being sent to the patient. A patient may also be eligible for presumptive charity care if the patient is eligible for Medicaid for other dates of service or services deemed non-covered by Medicaid; the patient is enrolled in, or eligible for, an assistance program for low income individuals; or the patient is homeless, deceased with no estate, or mentally incapacitated with no one to act on the patient's behalf. All uninsured patients not meeting the requirements of presumptive charity care are automatically granted an uninsured patient discount ranging from 68% to 33%, based on income level. The uninsured patient discount is an Illinois state mandated discount based on ROPH's cost to charge ratio which is updated annually. Patients may complete an application to determine eligibility under ROPH's Charity Care and Limited Income Programs, one of the programs included in the Financial Assistance Policy. Both programs are income-based and utilize an asset test to determine eligibility. Patients meeting the asset test whose income is 201-300% of FPG qualify for 100% discount to their hospital bill; patients meeting the asset test whose income is 301-400% FPG qualify for a 75% discount to their hospital bill. Discounts under both programs may be applied after primary insurance payment to cover deductibles, coinsurance, and copays.
Part I, Line 6a:	The Community Benefit Report for Rush Oak Park Hospital (ROPH) is included in the report prepared by Rush University Medical Center (RUMC). RUMC prepares and files the Annual Non-Profit Community Benefit Plan Report with the Attorney General's Office of the State of Illinois which report includes Schedule H information about RUMC and ROPH. For the purpose of Schedule H, only financial information for ROPH is reported. There is no data included for RUMC.
Part I, Line 7:	The calculation of the ratio of patient cost to charges was determined utilizing ROPH's 2016 As-Filed Medicare Cost Report and follows the format based on Worksheet 2 of the Instructions to Schedule H. Medicare revenues and costs were extracted from the FY16 As-Filed Medicare Cost Report.
Part I, Ln 7 Col(f):	Part I, Line 7, Column F -- Total expenses reported on Form 990, Part IX, line 25, column (A) include bad debt expense. However, for the purposes of Schedule H this expense has been removed from the denominator when calculating the percent of total expense considered the net community benefit expense and reported on Part I, Line 7, column (f). The amount of bad debt expense excluded from this percentage calculation is $6,263,447.
Part I, Line 7	The calculation of the ratio of patient cost to charges was based on ROPH's FY16 filed Medicare Cost Report. This cost to charge ratio is applied to Part I, line 7a and 7b. ROPH calculates a separate cost to charge ratio for subsidized health services which more accurately portrays those services. ROPH utilizes a cost accounting system to calculate a separate cost to charge ratio for physician clinics and hospital service lines. Those services are then combined to derive a unique cost to charge ratio for subsidized health services. The cost accounting system was used to calculate Lines 7e, 7f, 7h, and 7i.
Part II, Community Building Activities:	Physical Improvements and housing:Food Scrap and Composting Program - The Food Scrap and Composting Program diverts ROPH food waste from landfills, thereby helping diminish greenhouse emissions and promoting better air quality. $2,740Plant It Green Project - PlanItGreen grew out of the Oak Park River Forest Community Foundation's Communityworks initiative, designed to enhance the vibrancy and quality of life of Oak Park and River Forest. $1,924Workforce Development:Community Integrated Education (CITE II) Program - Rush Oak Park Hospital's compassion and commitment to helping those in need includes hosting the Community Integrated Transition Education (CITE II) Program, a young adult transition program that serves students with development disabilities and/or autism who have received a certificate of completion from Oak Park River Forest High School. $20,008
Part III, Line 2:	The cost for the total bad debt provision of $6,263,447 was calculated using the FY16 As-Filed Medicare Cost report as a source for computing an overall cost-to-charge ratio. This reduces the bad debt expense of $6,263,447 to cost of $1,487,056. Due to the process that Rush Oak Park and other hospitals must facilitate to prove a patient's eligibility for discounted or free care, the precise amount of charity care often can be indistinguishable from other categories of uncompensated care. Without the cooperation of the patient in providing appropriate documentation, Rush Oak Park cannot correctly distinguish patients who meet the defined charity care policies and appropriately categorize those individuals as charity care write-offs. Instead these patient cases can be classified as bad debt write-offs due to a lack of support information. This can create a reported charity care amount that is not representative of the true amount of free care provided to low income and indigent patients. This can create a situation in which patients can be mistakenly classified as bad debt that could actually be classified as charity care, but cannot be confirmed. As a matter of policy, this wouldn't happen, but can on occasion.
Part III, Line 4:	During FY16, ROPH's reported provision for bad debts was a total of $6,263,447 which equates to $1,487,056 at cost based on an overall cost to charge ratio. ROPH provides additional information on the bad debt expense in footnote #2 of the financial statements.
Part III, Line 8:	The calculation of the ratio of patient cost to charges was calculated utilizing ROPH's 2016 As-Filed Medicare Cost Report and follows the format based on Worksheet 2 of the Instructions to Schedule H. Medicare revenues and costs were extracted from the FY16 As-Filed Medicare Cost report. There is a Medicare shortfall of $5,716,015. ROPH believes this shortfall should be considered community benefit because these services would need to be provided by either another charitable organization or the government if it was not provided by ROPH.
Part III, Line 9b:	ROPH attempts to notify patients of our financial assistance policy by means of our billing statements that are issued to patients when a balance is due. There is language in all billing statements that financial assistance is available. In addition our collection agencies will make an effort on our behalf to notify patients of ROPH's financial assistance policy before placing accounts with the credit bureau. Accounts are not placed with the credit bureau until such action as occurred.
Part VI, Line 2:	As an academic health system, ROPH assessed the health needs of the communities which it serves in a very collaborative approach. ROPH took a very comprehensive, collaborative approach for its new CHNA, working as part of the Health Impact Collaborative of Cook County one of the largest CHNA collaboratives in the country - consisting of 26 hospitals, 7 health departments, and 100+ community based organizations. Rush recognized the importance of collaborating and aligning to improve health, and helped organize numerous community focus groups and a county-wide survey to discuss health needs of our constituents and ways in which we would improve with the community at the center of the approach. ROPH defined its service area on the communities spanning between its two hospitals, Rush University Medical Center and Rush Oak Park Hospital. For its second CHNA, ROPH decided to approach its community assessment by looking at community areas rather than specific zip-codes, as communities are more connected to their respective neighborhoods rather than zip-codes that might split communities and not completely align. RUMC and ROPH's service area includes the communities of the west side communities in Chicago: Near West Side, Lower West Side, West Town, East Garfield Park, West Garfield Park, North Lawndale, South Lawndale, Austin, Oak Park, River Forest, and Forest Park. The west side of Chicago faces some of the greatest hardship in the entire city of Chicago - for example, one might travel three stops on the El train and the life expectancy can vary by 10-15 years strictly based on the community which you might be in. These geographical areas encompass the location of the medical center as well as the locations of sites for a significant number of community outreach efforts, such as health access programs, wellness centers and healthcare pipeline and workforce development programs.Chicago, like any large urban city, surveys the health services it provides to its citizens. The Chicago Department of Public Health (CDPH) established a strategic planning process aimed to focus the energies of the department into a plan, Healthy Chicago 2.0, which set organizational priorities and guides the allocation of public health resources. Rush worked to align around these areas of improvement.ROPH recently adopted its second Community Health Needs Assessment (CHNA) and corresponding Community Health Implementation Plan (CHIP) as required by the Internal Revenue Service in compliance with the Affordable Care Act. The CHNA and implementation plan were completed during fiscal year 2016 and the board approved the CHNA for FY17-19 and the CHIP was approved in November 2016. A copy of the CHNA and CHIP is available online as described above. The CHIP is closely monitored on an ongoing basis through outcome indicators and continuous data collection and will be further detailed in future Schedule H's as we embark on our continued journey.
Part VI, Line 3:	In keeping with ROPH's mission to provide comprehensive, coordinated health care services to our patients, ROPH offers several financial assistance programs to help patients with their hospital bill.Through utilization of a patient eligibility service ROPH is extremely proactive in enrolling patients, who present for service without insurance coverage, for coverage under various state and federal programs. The maintenance of this service for our patients has a significant impact on decreasing the amount of charity care provided and ensuring that patients have the opportunity to obtain insurance. In addition to achieving appropriate, available coverage for our patients' medical services, this eligibility service also obtains eligibility for SSI or SSA benefits for applicable patients. Guiding the patient through this often time-consuming and arduous process is extremely beneficial to the patient, as once SSI/SSA eligibility is approved, the patient will begin receiving a monthly assistance check which provides a benefit well beyond their health care at ROPH. To assist the patient in deciding which is the right program for them, ROPH offers the services of Financial Counselors and Billing Customer Service Representatives. These individuals will assist patients in completion of financial application forms, obtaining an estimated cost of anticipated hospital services, providing an explanation and copy of their hospital bill, and notary services. ROPH makes all financial assistance information and policies available on the hospital's website.
Part VI, Line 4:	ROPH provides patient care services to a much broader audience than is defined in its CHNA, but ROPH defines its respective community as the West Side of Chicago. This is an area of great need and hardship and we are in their backyard. ROPH's patient population is varied in regard to ethnicity, economic status and insurance status, but many on the west side face hardship and are members of more vulnerable populations - racial/ethnic minorities, lower socio-economic status, crowded housing, higher levels of joblessness and less access to education, transportation, and other community resources such as grocery stores and healthcare centers. Rush's defined community, the West Side of Chicago, while incredibly resilient, faces some of the greatest hardship and health disparities in the City of Chicago - ROPH hopes to serve as an anchor to alleviate some of these issues through the empowerment of communities and the wonderful individuals that call the West Side home.Some of the general population demographics are that we are seeing a great deal of diversity in our communities served. For example, there are approximately 500,000 people living in our defined west sides communities. The racial / ethnic breakdowns of our communities are quite diverse, with Austin, West and East Garfield Park, and North Lawndale averaging at least 85% of the population identifying as black, South Lawndale and Lower West Side being over 80% Hispanic/Latino and Forest Park, Oak Park, and River Forest being more varied, with whites making up the majority. We also recognize that there are a great number of youth in our communities, with 19 and under making up in some communities close to a third of the population.The City of Chicago's hardship index ranks each community area's socioeconomic hardship on a scale of 0-100, with a higher number representing a greater level of hardship. The index measures: socioeconomic indicators of public health significance; the percentage of occupied housing units with more than one person per room; the percentage of households living below the federal poverty level; the percentage of people over 16 who are unemployed; the percentage of people over 25 without a high school diploma; the percentage of the population that is under 18 or over 64; per capita income. We know that most of our communities fall under the definition of "high hardship" in particular East Garfield Park, West Garfield Park, Austin, North Lawndale, South Lawndale, Lower West Side, and Austin.Some highlighted demographic information of our respective communities is that they face some of the greatest hardship in the City of Chicago. For example, life expectancy varies widely on the West Side of Chicago, as if you travel from the Loop to the West Side, in particular the West Garfield Park Community, life expectancy goes from 85 years to just under 69 years. If you look at issues such as insurance status, we have some of the highest need communities, with 34.8% of the population in South Lawndale lacking health insurance. Income segregation and employment is also of high need in some of our areas, with North Lawndale having a median household income of $23,066 and an unemployment rate of 27.4 in West Garfield Park. There are many other hospitals serving these communities, but we know that access to care and community resources is still of great need and that we must work together to improve the health of our communities. Based on market scan and our community health needs assessment, we have identified 15+ hospitals located in our communities. For more information on our neighborhood breakdowns and specific demographic information, please visit our FY17-FY19 CHNA at https://www.rush.edu/quality-care/commitment/community-benefits/community-health-needs-assessment
Part VI, Line 5	Community Coalitions - Numerous employees of Rush Oak Park Hospital volunteer their time to serve as board members for various organizations within the community. These organizations include the following: Infant Welfare Society PHC Wild About Wellness, Oak Park-River Forest Lion's Club, Rotary Club, Chamber of Commerce, PlanItGreen Project ROPH representatives with these organizations lend their expertise in health care and promote health well-being in the community in which Rush Oak Park Hospital serves through collaboration. Through these relationships Rush Oak Park Hospital also participates in collaborative activities to promote health well-being. For example, this past year stroke screenings were conducted by ROPH staff at the Rotary Club's Festival of the Trees, eye glasses were collected by Rush Oak Park Hospital to support the Lions Club efforts to supply eye wear to those in need and an educational event about childhood obesity was spearheaded by Rush Oak Park.Community Integrated Education (CITE II) Program - Rush Oak Park Hospital's compassion and commitment to helping those in need includes hosting the Community Integrated Transition Education (CITE II) Program, a young adult transition program that serves students with development disabilities and/or autism who have received a certificate of completion from Oak Park River Forest High School. The partnership between Rush Oak Park Hospital and the local high school began back in 1995 as a work study program for students before expanding to the current young adult transition program, which serves 18 to 22 year olds that require significant needs of support as they transition to adulthood. Funded by the Illinois Department of Human Services, the program provides job placements, job coaching and ongoing support for the young adult students who work or volunteer at local businesses. Students participate in the components of the program that assist them in moving toward their desired post school outcomes, particularly with an emphasis on job training and acquiring gainful employment. Over the years, approximately 300 students have learned not only important job skills at Rush Oak Park Hospital, but they have also gained self confidence, self respect and a sense of commitment through their participation in the program. At Rush Oak Park Hospital, students are trained by on site staff and representatives of ROPH in the areas of environmental services and food and nutrition.Contributions/Employee Drives - Each year, Rush Oak Park Hospital sponsors drives to support local organizations, such as local schools and community groups. Drives are conducted by ROPH staff who work with community partners to collect and distribute items such as school supplies, eye glasses and food. Diabetes Fair - The annual Diabetes Health Fair at Rush Oak Park Hospital is free to community members and offers the following services: Blood pressure testing; Cholesterol blood screening, including HDL and LDL; A1c testing; Foot screening by a podiatrist for people with diabetes; Health information. Participants are provided results of their lab tests as well as explanations of what their results means by nurse educators. Those who are identified as being at risk for diabetes based on findings from the health fair are offered education on managing their conditions to avoid future complications.Food Scrap and Composting Program - The Food Scrap and Composting Program diverts ROPH food waste from landfills, thereby helping diminish greenhouse emissions and promoting better air quality. In a hospital environment where recovering patients aren't always able or willing to finish a meal, food waste can be inevitable, but Rush Oak Park Hospital has found a way to reduce the impact of this environmental problem. According to the Environmental Protection Agency, the U.S. generates more than 34 million tons of food waste each year. As a nation, we spend approximately $1 billion to dispose of this waste. Food scraps in landfills produce methane, a potent greenhouse gas. Since then, approximately 57 tons of food scraps have been composted and thereby diverted from landfills. Hospital management, which monitors waste data to gauge the program's progress, has seen a steady increase in the landfill diversion rate since the beginning of the program. The hospital currently composts waste left over from patient trays and from food preparation in its kitchen. Food scraps are collected in bins and picked up twice a week. A vendor delivers them to a facility equipped with composting equipment. The waste is then converted into a nutrient rich product beneficial to the environment and sold to local farmers, landscapers and other interested businesses. Planning and implementing the program at ROPH required coordination and communication among a variety of groups. Preliminary research was conducted in partnership with a local non profit environmental organization called Seven Generations Ahead. This effort enabled hospital staff to create a program tailored for the specific layout and size of the facility.
Part VI, Line 5	Food Surplus Project - The Food Surplus Project redistributes surplus food from the patient and employee cafeteria to the Oak Park River Forest Food Pantry. It was created to alleviate food insecurity in our community. This is a collaborative community effort that arose from a leadership program at Dominican University in nearby River Forest. Representatives from several local organizations, including Rush Oak Park Hospital, the Oak Park River Forest Day School, Oak Park River Forest, Thrive Counseling Center and the Oak Park River Forest Food Pantry, worked together to create the infrastructure of the program and implement strategies to reduce food insecurity. The hospital employees volunteering with the Food Surplus Project all have received the food handler certifications that state and federal laws require for people to repackage prepared foods into individual servings. In addition to providing food for clients at the OPRF Food Pantry, hospital nurses and nursing assistants perform simple health screenings and distribute health care information.Healthy Motivations Community Wellness Program - Healthy Motivations is Rush Oak Park Hospital's community wellness program. It provides free educational seminars and fitness classes, which are designed to help community members lead healthier lives. In FY16, Healthy Motivations provided education on topics such as heart and vascular disease, preventive health and depression. It also began providing free Zumba Gold classes which are designed to be inclusive of participants with limited mobility to community members, an effort to promote heart health and mental well being via physical activity and social connectivity. Heart Walk - Rush Oak Park Hospital is closely aligned with the American Heart Association's (AHA) mission of building healthier lives free of cardiovascular diseases and stroke. Our partnership is evidenced in our patient care, community education and employee wellness programs, as well as our Heart Walk participation. Rush Heart Walk team promotes heart health and associate camaraderie while raising lifesaving funds. This year we showed our commitment to the health of our employees and community fundraising over $40,000.Homeless Shelter Health Education Initiative - Nurses at Rush Oak Park Hospital partner with West Suburban PADS (now Housing Forward), an organization dedicated to transitioning people from housing crisis to housing stability. Nurses provide health education to Housing Forward clients on an ongoing basis.Housing Forward Homeless Shelter - Donation of linen: 3,990 flat sheets, 1,995 pillow cases, 525 towels, 525 wash cloths. Laundry Services for Homeless Shelters - Rush Oak Park Hospital helps finance the laundering of sheets and bedding for West Suburban PADS (now Housing Forward), an organization dedicated to transitioning people from housing crisis to housing stability. Nursing Community Health Outreach: Screenings and Education - Organizers of local events request screenings, first aid and health education support from Rush Oak Park Hospital. These events include local health fairs as well as fitness events, where blood pressure and BMI screenings take place as well as screening tests. Most of these efforts are coordinated and overseen by the community engagement coordinator and are staffed by ROPH nurses.Nursing Leadership Development - Nurses at Rush Oak Park Hospital participate in professional organizations such the Illinois Organization of Nurse Leaders and Gamma Phi Chapter of Sigma Theta Tau International as committee members to advance the profession of nursing. They also share expertise gained through their experiences in nursing management and bedside care with organizations and students from local universities, such as Dominican University, via presentations and lectures.Plan It Green Project - PlanItGreen grew out of the Oak Park River Forest Community Foundation's Communityworks initiative, designed to enhance the vibrancy and quality of life of Oak Park and River Forest. Through PlanItGreen, Seven Generations Ahead is directing the ongoing implementation of the Environmental Sustainability Plan for Oak Park and River Forest. The PlanItGreen Sustainability Plan reduces the environmental footprint and advances common sustainability objectives of Oak Park and Forest through 2020.Professional Education: Diet and Nutrition - Rush Oak Park Hospital serves as a clinical site for diet and nutrition students. Employees dedicate their time to support the on-site students and educate them about the nutritional needs of different populations of patients.Professional Education: Nursing - Nurses at Rush Oak Park Hospital dedicate their time to foster the education of nursing students who spend time at ROPH as part of their graduation requirements. Rush Oak Park Hospital serves as a site for nursing students from from the following universities: Rush University- Registered Nursing- MSN, DNP, APN, PhD and Respiratory Therapy; Dominican University- Registered Nursing- BSN; Aurora University- Registered Nursing- RN to BSN; Gold Canyon University- Registered Nursing- DNP; University of Illinois-Chicago- Registered Nursing- DNP APN; Resurrection University- Registered Nursing- MSN APN, MSN CNL Lewis University- Registered Nursing- BSN; University of St Francis- MSN APN; DePaul University- MSN APN.
Part VI, Line 5	Project Lifestyle Change: Diabetes Education - Project Lifestyle Change is a free, 12-month program offered at Rush Oak Park Hospital that was designed to help prevent the development of type II diabetes. It is supported by a grant. Participants implement lifestyle changes on their own while continuing to meet with the PLC group once a month for ongoing support and classes, which are led by a clinical team member. Additionally, at these classes, education is given to the participants regarding recipes for healthy cooking and strategies for dining out, as well as relaxation and stress management techniques. The program partners with the West Cook YMCA of Oak Park to support participants' fitness, a key component in preventing type II diabetes, by providing certified fitness professionals to teach participants the ins and outs of safe and effective exercise techniques.RN & Unlicensed Personnel Training - Many educational opportunities are provided for the clinical nursing staff. Education meets standards of care and regulatory guidelines as well as meeting nursing excellence outcomes and also allowed achievement of nursing certifications.Senior Employment Training - Rush Oak Park Hospital serves as a host site for the National Able Network. National Able Network, Inc., is a leading non-profit organization headquartered in downtown Chicago that specializes in providing workforce development programming for individuals, families, and communities. They provide services to businesses in all major sectors and help job seekers of all ages, skills, and income levels achieve economic self-sufficiency through gainful employment. As a host site, Rush Oak Park Hospital provides work for one low-income senior as a host on the 7th floor where the surgical waiting room is located. The host acts as a liaison between patient family members and staff regarding the patients' surgical procedures, greets visitors, and provides directions to them.Support Groups - Rush Oak Park Hospital welcomes support groups to meet on its campus and helps promote these groups via its website and community newsletter. The following groups meet at ROPH: Diabetes Education/Support Group; Women Affected by Heart Disease; Chronic Fatigue Syndrome/Myalgic Encephalopathy and Fibromyalgia; Parkinson's Disease Support Group; epilepsy Support Group. Warming/Cooling Center - In conjunction with the Village of Oak Park, ROPH offers space in its emergency room for those without adequate air conditioning or heat in instances of extreme temperatures. This effort helps prevent hypothermia and frostbite in extreme cold; and heat stroke and other heat-related illnesses when the thermometers spike. This was particularly important in the winter of 2015, when temperatures dipped below zero on several occasions. In FY16, the emergency provided a safe haven in 192 instances, helping those seeking refuge from the elements.
Part VI, Line 6	Rush is an academic health system that includes Rush Oak Park Hospital (ROPH) in addition to Rush University Medical Center (RUMC). Together, ROPH and RUMC provide patients across the West Side with access to advanced medical treatments without having to leave their neighborhoods. ROPH is committed to balancing clinical excellence with compassionate care and greater community outreach programs in order to provide a lifetime of care for individuals and their entire family. For the purposes of Schedule H, only financial information for ROPH is reported. There is no data included for Rush University Medical Center.
Part VI, Line 7	List of States Receiving Community Benefit Report:IL

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1David AnsellMDChairperson	(i) (ii)	0 ------------- 515,725	0 ------------- 146,808	0 ------------- 189,871	0 ------------- 168,503	0 ------------- 10,406	0 ------------- 1,031,313	0 ------------- 144,782
2Joan KurtenbachVice Chairperson	(i) (ii)	0 ------------- 262,761	0 ------------- 61,792	0 ------------- 7,328	0 ------------- 51,338	0 ------------- 18,354	0 ------------- 401,573	0 ------------- 0
3Bruce ElegantPresident	(i) (ii)	0 ------------- 337,149	0 ------------- 75,969	0 ------------- 621,101	0 ------------- 78,175	0 ------------- 8,518	0 ------------- 1,120,912	0 ------------- 597,079
4John MordachChief Financial Officer	(i) (ii)	0 ------------- 715,818	0 ------------- 354,086	0 ------------- 28,790	0 ------------- 157,291	0 ------------- 17,256	0 ------------- 1,273,241	0 ------------- 0
5Melissa CoverdaleTreasurer	(i) (ii)	0 ------------- 292,856	0 ------------- 59,341	0 ------------- 5,723	0 ------------- 54,302	0 ------------- 11,458	0 ------------- 423,680	0 ------------- 0
6Michael SilverVP Medical Affairs	(i) (ii)	272,970 ------------- 167,732	56,274 ------------- 15,718	0 ------------- 2,143	7,950 ------------- 23,850	17,216 ------------- 2,531	354,410 ------------- 211,974	0 ------------- 0
7Robert SpadoniVP Admin Services\Secretary	(i) (ii)	0 ------------- 231,569	0 ------------- 38,545	0 ------------- 75	0 ------------- 21,200	0 ------------- 17,952	0 ------------- 309,341	0 ------------- 0
8Karen MayerVP Patient Care Services	(i) (ii)	186,604 ------------- 0	31,162 ------------- 0	0 ------------- 0	6,932 ------------- 0	0 ------------- 0	224,698 ------------- 0	0 ------------- 0
9Donald ChildsPres. of Medical Staff	(i) (ii)	213,348 ------------- 0	18,387 ------------- 0	0 ------------- 0	7,150 ------------- 0	17,216 ------------- 0	256,101 ------------- 0	0 ------------- 0
10Daniel NoonanER Medical Director	(i) (ii)	297,377 ------------- 0	0 ------------- 0	0 ------------- 0	7,950 ------------- 0	18,360 ------------- 0	323,687 ------------- 0	0 ------------- 0
11Juan CoboEmployed Physician	(i) (ii)	227,668 ------------- 0	62,143 ------------- 0	0 ------------- 0	7,950 ------------- 0	268 ------------- 0	298,029 ------------- 0	0 ------------- 0
12Peter KurkoER Physician	(i) (ii)	275,025 ------------- 0	0 ------------- 0	0 ------------- 0	4,254 ------------- 0	12,247 ------------- 0	291,526 ------------- 0	0 ------------- 0
13Navtej SandhuER Physician	(i) (ii)	265,639 ------------- 0	0 ------------- 0	0 ------------- 0	7,950 ------------- 0	17,919 ------------- 0	291,508 ------------- 0	0 ------------- 0
14Nancy EisemanER Physician	(i) (ii)	250,227 ------------- 0	0 ------------- 0	0 ------------- 0	7,506 ------------- 0	0 ------------- 0	257,733 ------------- 0	0 ------------- 0
15John HardekPres. of Medical Staff(former)	(i) (ii)	200,537 ------------- 0	53,111 ------------- 0	0 ------------- 0	7,950 ------------- 0	16,957 ------------- 0	278,555 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 3	The CEO's compensation is determined by a related organization which includes the use of the following methods. Compensation committee Independent compensation consultant Compensation survey Approval by the board
Part I, Line 4b	The Rush Executive Retirement Plan (the "Rush ERP or the "Plan") provides supplemental retirement benefits to eligible executives of Rush University Medical Center (the "Medical Center"). These benefits are in addition to those provided under the Retirement Plan (a tax-qualified defined benefit pension plan), the 403(b) Retirement Savings Plan, and the 457(b) Supplemental Retirement Savings Plan. The Rush ERP is effective January 1, 2014, and replaces the Supplemental Executive Retirement Plan (the "SERP"), which was frozen effective December 31, 2013. Any benefits earned under SERP will be preserved. The Rush ERP is a defined contribution plan designed to provide funds to participants that can be used to provide supplemental retirement income. Once vested, the amount contributed plus investment gains (and minus losses) is paid. The retirement benefits provided under the Plan, like those provided by the SERP prior to 2014, are in addition to those provided under the Medical Center's Retirement Plan, a defined benefit pension plan, the 403(b) Retirement Savings Plan, and the 457(b) Supplemental Retirement Savings Plan. The amounts paid out from this plan were as follows: David A. Ansell, MD-$144,782, and Bruce M. Elegant-$597,079. The amounts listed in Schedule J, Part II, Column F reflect these distributions less the accrued earnings (which were not previously reported).
Part I, Line 7	Incentive payments are based on a formula. The amounts are calculated after certain performances and operating goals are achieved. The plan provides limited discretionary parameters if needed.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Donor 4	Substantial Contributor	439,808	Purchase Services		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Return Reference	Explanation
Form 990, Part VI, Section A, line 2	Bruce Elegant,Joan Kurtenbach,David Ansell,Melissa Coverdale and Robert Spadoni have a business relationship.
Form 990, Part VI, Section A, line 6	The sole corporate sponsor of Rush Oak Park Hospital is Rush University Medical Center.
Form 990, Part VI, Section A, line 7a	Rush University Medical Center has the authority to elect one or more members of the governing body.
Form 990, Part VI, Section A, line 7b	The organization's governing documents identify certain reserved powers of its member,Rush University Medical Center. For these specific matters, the governing board's actions are subject to the approval of and reserved powers of Rush University Medical Center, as applicable.
Form 990, Part VI, Section B, line 11	The information is compiled and reviewed internally by the finance department and the controller. The return is reviewed by Deloitte Tax LLP before being submitted to the Board of Directors of Rush Oak Park Hospital for review and approval. The approved return is signed by the CEO of Rush Oak Park Hospital and Deloitte Tax LLP. A copy of the return is distributed to the board members of Rush Oak Park Hospital prior to filing.
Form 990, Part VI, Section B, line 12c	Rush Oak Park Hospital mails a conflict of interest policy and questionnaire to officers,key employees and trustees to complete annually. The responses from these questionnaires are compiled and the information is shared with senior management and the Board of Directors of Rush Oak Park Hospital. When a conflict is noted(either upon review of the questionnaires with the Board of Directors or self-reported by the party with a conflict), the subject party may voluntarily excuse hinself or herself from the Board's deliberation or voting upon the transaction in question or the Board may determine a conflict exists and require the subject party to excuse himself or herself from the Board's deliberations or voting upon the transaction.
Form 990, Part VI, Section B, line 15	Rush Oak Park Hospital relies on Rush University Medical Center to follow a comprehensive procedure for determining compensation. The procedure followed by Rush Univeristy Medical Center is as follows: The compensation and Human Resources Committee uses an independent review, comparability data and contemporaneous substantiation to establish compensation packages for the CEO,Executive Director and other top managemnet officials. All such officer compensation packages are approved by the Compensation and Human Resources Committee.
Form 990, Part VI, Section C, line 19	Rush Oak Park Hospital does not make its governing documents or conflict of interests policy available to the public. The financial statements are available through the Illinos Attorney General's office which are filed by Rush University Medical Center.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

RUSH OAK PARK HOSPITAL INC

Employer identification number

36-2183812

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Rush Copley Health Care SystemInc 2000 Ogden Avenue Aurora,IL60504 36-3584043	Healthcare	IL	501(c)(3)	Line 11a, I	Rush University Medical Center	Yes
(2)Copley Venture 2000 Ogden Avenue Aurora,IL60504 36-3370216	Property & Healthplex Owner	IL	501(c)(3)	Line 3	Rush Copley Medical Center	Yes
(3)Rush Copley Foundation 2000 Ogden Avenue Aurora,IL60504 36-3093877	Contribution Solicitation	IL	501(c)(3)	Line 7	Rush Copley Medical Center	Yes
(4)Copley Memorial Hospital 2000 Ogden Avenue Aurora,IL60504 36-2170840	Healthcare	IL	501(c)(3)	Line 3	Rush Copley Medical Center	Yes
(5)Rush Copley Medical Center 2000 Ogden Avenue Aurora,IL60504 36-3193787	Healthcare	IL	501(c)(3)	Line 11a, I	Rush Copley Health Care System	Yes
(6)Rush System for Health 1653 W Congress Parkway Chicago,IL60612 36-4046278	Healthcare	IL	501(c)(3)	Line 11c, III-FI	Rush University Medical Center	Yes
(7)Riverside Health System 350 N Wall Street Kankakee,IL60901 36-3167726	Healthcare	IL	501(c)(3)	Line 11c, III-FI	Riverside Rush Corporation	Yes
(8)Oakside Corporation 350 N Wall Street Kankakee,IL60901 36-3166804	Healthcare	IL	501(c)(3)	Line 11b, II	Riverside Rush Corporation	Yes
(9)Riverside Medical Center 350 N Wall Street Kankakee,IL60901 36-2414944	Healthcare	IL	501(c)(3)	Line 3	Riverside Rush Corporation	Yes
(10)Riverside Senior Living Center 350 N Wall Street Kankakee,IL60901 36-3670744	Healthcare	IL	501(c)(3)	Line 9	Riverside Rush Corporation	Yes
(11)Riverside Medical Health Care Foundation 350 N Wall Street Kankakee,IL60901 36-3166033	Healthcare	IL	501(c)(3)	Line 11b, II	Riverside Rush Corporation	Yes
(12)The Core Foundation 2020 W Harrison Street Chicago,IL60612 36-3991833	Real Estate Holding	IL	501(c)(3)	Line 11a, I	None	Yes
(13)Rush University Medical Center Professional Liabilty Loss Trust 2000 Ogden Avenue Chicago,IL60612 36-6673233	Healthcare Insurance	IL	501(c)(3)	Line 11c, III-FI	Rush University Medical Center	Yes
(14)Auxiliary of Rush Oak Park Hospital 520 S Maple Avenue Oak Park,IL60304 36-2255350	Hospital Support	IL	501(c)(3)	Line 11a, I	Rush Oak Park Hospital	Yes
(15)Rush University Medical Center 1653 W Congress Parkway Chicago,IL60612 36-2174823	Healthcare	IL	501(c)(3)	Line 3	None	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Circle Imaging PartnersLP 1725 W Harrison Street Chicago,IL60612 36-3539382	Operation Imaging	IL	N/A
(2) Rush Surgicenter at the Professional Office BuildingLP 1725 W Harrison Street Chicago,IL60612 36-3853026	Surgery Center	IL	N/A
(3) Rush Oak Brook Orthopaedic CenterLLC 1653 W Congress Parkway Chicago,IL60612 35-2539357	Orthopaedic Healthcare	IL	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Room Five Hundred 1700 W Van Buren Street Chicago,IL60612 23-7139832	Dining Room	IL	N/A	C				No
(2) Rush University Medical Center Insurance Co PO Box 1051 CJ	Insurance	CJ	N/A	C				No
(3) Rush Copley Medical GroupNFP(Copley Services) 2000 Ogden Avenue Aurora,IL60504 36-3235315	Healthcare	IL	N/A	C				No
(4) Rush Health 1653 W Congress Parkway Chicago,IL60612 36-3972171	Healthcare	IL	N/A	C				No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Rush Health	P	1,575,231	FMV
(2) Rush System for Health	P	160,835	FMV
(3) Rush University Medical Center	K	798,729	FMV
(4) Rush University Medical Center	O	2,402,640	FMV
(5) Rush University Medical Center	P	4,590,623	FMV

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Caring for the community and the patients served is the core of Rush Oak Park Hospital's mission.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,082
6	Total number of volunteers (estimate if necessary) .............	6	112
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	139,769	338,584
9	Program service revenue (Part VIII, line 2g) .........	123,498,512	131,096,427
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	94,289	201,029
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,120,577	849,968
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	124,853,147	132,486,008
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	18,975
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	61,115,488	67,420,205
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	56,329,592	57,699,291
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	117,445,080	125,138,471
19	Revenue less expenses. Subtract line 18 from line 12.......	7,408,067	7,347,537
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	90,040,796	96,305,177
21	Total liabilities (Part X, line 26).............	41,829,973	40,562,970
22	Net assets or fund balances. Subtract line 21 from line 20.....	48,210,823	55,742,207

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 100,304,771 including grants of $ 18,975 ) (Revenue $ 118,539,718 )
	Patient Care- Rush Oak Park Hospital(ROPH) is a community hospital committed to balancing clinical excellence, a professional and healing environment and community outreach programs to address various healthcare issues. Patient care was provided in over 4,665 inpatient admissions and over 84,824 outpatient visits.

4b	(Code: ) (Expenses $ 10,915,441 including grants of $ ) (Revenue $ 9,664,426 )
	Physician Practices- A group of seven employed physician practices provide a variety of community healthcare services. Rush Oak Park Physician Group primarily serves residents in Oak Park,IL. Other communities include but are not limited to River Forest,Forest Park,Elmwood Park,Hillside,Berwyn, and North Riverside. In 2016, the physicians provided services in over 48,000 visits. Types of services provided include family medicine,internists,gynecology,geriatric,and neurology. The hospital supports the staff,physicians and operations of the practices. The practices adhere to the mission statement of the hospital.

4c	(Code: ) (Expenses $ 4,098,493 including grants of $ ) (Revenue $ 3,574,369 )
	Emergency Room Outpatient Services- A group of twenty ROPH employed ER physicians serve the emergency needs of the community at Rush Oak Park Hospital. In 2016, the ER served over 37,000 persons for a variety of healthcare symptons. In line with ROPH's strategic iniatives, the ER aims to increase safety and satisfication. Successful directives have been implemented to ensure that the ER remains the community's best option for emergency care.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses115,318,705

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,410,472	4,130,900	806,909

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Nancy Eiseman........................................................................ ER Physician	40.00 .......................0.00	X		250,227	0	7,506
(19) John Hardek........................................................................ Pres. of Medical Staff(former)	40.00 .......................0.00		X	253,648	0	24,907

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	56,550
d	Related organizations		1d	29,309
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	252,725

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		338,584

		Business Code
2a	Net Patient Revenue	611710	110,630,048	110,630,048
b	Net Physician Grp Rev	611710	9,664,426	9,664,426
c	Medicaid Tax Revenue	611710	6,984,967	6,984,967
d	Net ER Phys Grp Rev	611710	3,574,369	3,574,369
e	Net Nocturnists Rev	611710	242,617	242,617
f	All other program service revenue.
g Total.Add lines 2a–2f.....			131,096,427

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			201,029			201,029
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		150,752
b	Less: rental expenses		303,842
c	Rental income or (loss)		-153,090
d	Net rental income or (loss)......			-153,090			-153,090
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ 56,550of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		71,573
c	Net income or (loss) from fundraising events..			-71,573			-71,573
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Cafe Sales		900099	392,545			392,545
b	Medicare Incentive Pay		900099	145,755	145,755
c
d	All other revenue ....			536,331	536,331
e	Total. Add lines 11a–11d ......			1,074,631
12	Total revenue. See Instructions......			132,486,008	131,778,513	0	368,911

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	18,975	18,975
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	778,746		778,746
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	253,648		253,648
7	Other salaries and wages	53,099,895	50,451,456	2,648,439
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,704,347	2,682,315	22,032
9	Other employee benefits .......	6,798,586	6,357,307	441,279
10	Payroll taxes ...........	3,784,983	3,759,350	25,633
11	Fees for services (non-employees):
a	Management ......	2,607,971		2,607,971
b	Legal .........	69,379		69,379
c	Accounting ...........	54,996		54,996
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	6,473,811	5,838,578	635,233
12	Advertising and promotion ....	117,643	117,643
13	Office expenses .......	673,118	423,093	250,025
14	Information technology ......	203,883	198,914	4,969
15	Royalties ..
16	Occupancy ...........	9,733,768	9,106,092	627,676
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	32,963	1,771	31,192
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,909,119	2,909,119
23	Insurance ...	635,767	94,000	541,767
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Supplies	20,393,061	20,353,461	39,600
b	Bad Debt Provision	6,263,447	6,263,447
c	Medicare Tax Assessment	2,847,771	2,847,771
d	Equipment Rental & Main	2,574,116	2,500,209	73,907
e	All other expenses	2,108,478	1,395,204	713,274
25	Total functional expenses. Add lines 1 through 24e	125,138,471	115,318,705	9,819,766	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			12,848,605	1	19,008,560
2	Savings and temporary cash investments .........			14,158,105	2	14,497,571
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			14,678,382	4	16,375,282
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			2,776,181	8	2,789,305
9	Prepaid expenses and deferred charges ......			545,230	9	580,108
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	89,129,051
b	Less: accumulated depreciation	10b	51,666,913	36,010,790	10c	37,462,138
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			9,023,503	15	5,592,213
16	Total assets. Add lines 1 through 15 (must equal line 34)...			90,040,796	16	96,305,177

17	Accounts payable and accrued expenses .....	13,161,853	17	13,657,455
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	16,085,235	23	14,117,018
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	12,582,885	25	12,788,497
26	Total liabilities. Add lines 17 through 25..	41,829,973	26	40,562,970

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	48,195,108	27	55,609,839
28	Temporarily restricted net assets ...........	15,715	28	132,368
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	48,210,823	33	55,742,207
34	Total liabilities and net assets/fund balances ........	90,040,796	34	96,305,177