TY 2017 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)
(1) Michael J Born MD...................................................................... President & CEO	40.00 ................. 6.00	X	X	554,849	0	80,938
(2) Daniel T Ross...................................................................... Chairman of the Board	2.00 ................. 6.00	X	X	100	0	0
(3) William C Roop...................................................................... First Vice Chairman/Secretary	2.00 ................. 6.00	X	X	100	0	0
(4) Rev Dr Kenneth Board...................................................................... Second Vice Chairman/Asst. Secretary	2.00 ................. 6.00	X	X	100	0	0
(5) Thomas R Walsh...................................................................... Audit/Compliance Chairman	2.00 ................. 6.00	X		100	0	0
(6) Patrick Derry...................................................................... Quality and Safety Chairman	2.00 ................. 6.00	X		100	0	0
(7) Jeffrey J Kaney Sr...................................................................... Joint Conference Chairman	2.00 ................. 6.00	X		100	0	0
(8) Michael E Dallman...................................................................... UWRDI Board Representative	2.00 ................. 55.00	X		0	445,366	78,250
(9) Allen D Williams MD...................................................................... Trustee	40.00 ................. 6.00	X		280,971	0	59,510
(10) Amy J Wilcox...................................................................... Trustee	2.00 ................. 6.00	X		100	0	0
(11) Danny L Copeland MD...................................................................... Trustee	40.00 ................. 6.00	X		82,933	0	6,161
(12) David R Rydell...................................................................... Trustee	2.00 ................. 6.00	X		100	0	0
(13) Eric Fulcomer PhD...................................................................... Trustee	2.00 ................. 6.00	X		100	0	0
(14) Frank E Walter...................................................................... Trustee	2.00 ................. 8.00	X		100	0	0
(15) Gregory R Jury...................................................................... Trustee	2.00 ................. 8.00	X		100	0	0
(16) Helen Chung Hill...................................................................... Trustee	2.00 ................. 6.00	X		100	0	0
(17) Jeffrey S Hultman...................................................................... Trustee	2.00 ................. 6.00	X		100	0	0

(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
(18) Marco T Lenis........................................................................ Trustee	2.00 .......................6.00	X					100	0	0
(19) Michael K Broski........................................................................ Trustee	2.00 .......................6.00	X					100	0	0
(20) Michael J Houselog PhD........................................................................ Trustee	2.00 .......................6.00	X					100	0	0
(21) Robert Flannery........................................................................ Trustee	2.00 .......................55.00	X					0	622,795	98,159
(22) Steven C Sjogren........................................................................ Trustee	2.00 .......................8.00	X					100	0	0
(23) Kathleen Kelly MD........................................................................ Trustee	2.00 .......................6.00	X					25,479	0	0
(24) Mark Cormier MD........................................................................ Medical Staff President	2.00 .......................	X					13,000	0	0
(25) Steven Ikenberry MD........................................................................ Medical Staff Vice President	2.00 .......................	X					6,500	0	0
(26) John Shiro MD........................................................................ Past Medical Staff President	2.00 .......................	X					0	0	0
(27) Patricia DeWane........................................................................ Chief Financial Officer	40.00 .......................8.00		X				455,011	0	62,105
(28) Donald Daniels........................................................................ VP & Chief Operating Officer	40.00 .......................8.00		X				511,468	0	109,857
(29) Thomas Schiller MD........................................................................ Chief Clinical Integration Officer	40.00 .......................			X			491,806	0	111,223
(30) Michael Polizzotto MD........................................................................ Chief Medical Officer/CMIO	40.00 .......................			X			341,867	0	56,592
(31) Ann Gantzer MD........................................................................ Chief Nursing Officer	40.00 .......................			X			341,793	0	81,294
(32) Gayatri Sonti DO........................................................................ Physician	40.00 .......................				X		747,885	0	30,566
(33) Martin Gryfinski MD........................................................................ Physician	40.00 .......................				X		698,092	0	28,772
(34) Mohamed Zeater MD........................................................................ Physician	40.00 .......................				X		896,332	0	61,454
(35) Tarek Harb MD........................................................................ Physician	40.00 .......................				X		628,015	0	46,695
(36) Steven Milos MD........................................................................ Physician	40.00 .......................				X		680,621	0	60,965
(37) William R Gorski MD........................................................................ Former President & CEO	0.00 .......................					X	1,222,937	0	38,437
(38) Donald Haring........................................................................ Former Chief Financial Officer	0.00 .......................					X	200,333	0	0
(39) Richard Walsh........................................................................ Former Chief Operating Officer	0.00 .......................					X	193,680	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
University of Illinois 28394 Network Place Chicago,IL60673	Physician Services	5,049,478
Ringland Johnson Construction 1725 Huntwood Drive Cherry Valley,IL61016	Construction Services	3,829,510
Sound Physicians of Illinois 401 S LaSalle Street Chicago,IL60605	Physician Services	2,224,959
Cannon Design 255 N Michigan Avenue Chicago,IL60601	Construction Consulting	2,201,255
Infinity Healthcare Physicians 111 E Wisconsin Avenue Milwaukee,WI53202	Physician Services	2,158,838
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 126

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization SwedishAmerican Hospital

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization SwedishAmerican Hospital		Employer identification number 36-2222696

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization SwedishAmerican Hospital			Employer identification number 36-2222696
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) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

SwedishAmerican Hospital

Employer identification number

36-2222696

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(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

110,492

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

110,492

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:	Portions of the 2017/2018 Illinois Health and Hospital Association and American Hospital Association dues are used for lobbying: $50,492. A law firm was engaged to review legislation affecting hospitals: $60,000.

Schedule C (Form 990 or 990EZ) 2019

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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 ....	6,676,376	6,662,294	7,112,945	7,122,296	7,093,718
b	Contributions ...	90,495	10,754	10,986		15,490
c	Net investment earnings, gains, and losses	632,791	480,152	-203,624	-9,351	405,420
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	327,257	476,824	258,013		392,332
f	Administrative expenses ....
g	End of year balance ......	7,072,405	6,676,376	6,662,294	7,112,945	7,122,296

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

Board designated or quasi-endowment SchDMd Bullet

60.700 %

Permanent endowment SchDMd Bullet

27.390 %

Term endowment SchDMd Bullet

11.910 %

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)

Yes

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

Yes

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 .....	13,941,941		13,941,941
b	Buildings ....	236,904,167	24,366,501	212,537,666
c	Leasehold improvements	21,202,625	5,136,580	16,066,045
d	Equipment ....	108,694,658	48,089,742	60,604,916
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				303,150,568

Schedule D (Form 990) 2019

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) Beneficial Interest in Investment Pool	241,728,295	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	241,728,295

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)Advance to American Restaurant Assoc. (ARA)				189,268
(2)Interest In Net Assets of Recipient Organization				19,608,200
(3)Due from Affiliated Organization				14,917,165
(4)Insurance Recoveries Recievable				8,087,073
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				42,801,706

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	92,755,401
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) 2019

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

Part V, Line 4:

The Hospital's endowment consists of 12 Individual funds established for a variety of purposes. 1) Medical and Non-medical health improvement initiatives 2) Rehabilitation or orthopedic programming and services within the greater Rockford community 3) Oncology patient services 4) Educational materials for the families of oncology patients 5) Chaplaincy program including grief services and counseling 6) Cardiology services 7) Medical programs and care for children 8) Cardiac education for women 9) Ongoing support of surgical service and education of surgical technicians

Part X, Line 2:

The Hospital has received a determination letter from the Internal Revenue Service (IRS) stating it is tax-exempt under Section 501(c)(3) of the Code. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When this return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to hospitals include such matters as the following: tax-exempt status of each entity, the continued tax-exempt status of bonds issued by the obligated group, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income (UBTI). UBTI is reported on Internal Revenue Service Form 990-T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the tax position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with the tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. At June 30, 2018 and 2017, there were no unrecognized tax benefits identified or recorded as liabilities. The Forms 990 and 990-T filed by the Hospital are subject to examination for up to three years from the extended due date of each return. These returns are no longer subject to examination for tax years ended before June 30, 2015.

Schedule D (Form 990) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

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 %

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 60000.0000000000 %

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? . . . . . .

Yes

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) . . .	2,779,572		2,779,572	0.550 %
b	Medicaid (from Worksheet 3, column a) . . . . .	102,266,518	74,631,806	27,634,712	5.480 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	3,553,659	1,759,352	1,794,307	0.360 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	108,599,749	76,391,158	32,208,591	6.390 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	7,476,161	1,938,519	5,537,642	1.100 %
g	Subsidized health services (from Worksheet 6) . . . .	30,441,341	1,335,454	29,105,887	5.770 %
h	Research (from Worksheet 7) .	333,158		333,158	0.070 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1,219,375	213,807	1,005,568	0.200 %
j	Total. Other Benefits . .	39,470,035	3,487,780	35,982,255	7.140 %
k	Total. Add lines 7d and 7j .	148,069,784	79,878,938	68,190,846	13.530 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
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
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

44,107,529

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. ......

6,619,129

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).....

74,589,757

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

91,845,340

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

-17,255,583

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 %
11 Featherstone Partnership LP	Ambulatory Surgery Center	28.570 %	0 %	71.430 %
22 Northern Illinois Vein Clinic LLC	Outpatient Physician Clinic	50.000 %	0 %	50.000 %
33 Forest City Diagnostic Imaging LLC	Outpatient Diagnostic Imaging	49.000 %	0 %	51.000 %
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

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?2Name, 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)							Facility reporting group
1	SwedishAmerican Hospital 1401 E State Street Rockford,IL61104 www.swedishamerican.org IL License: 0002725	X	X	X	X	X	A
2	SwedishAmerican Medical Ctr Belvidere 1625 S State Street Belvidere,IL61008 www.swedishamerican.org IL License: 0005504	X	X			X	A

Schedule H (Form 990) 2019

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)

	Facility Reporting Group - A
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

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. ............................

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): www.swedishamerican.org/community-health-needs-assessment

Other website (list url):

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): www.swedishamerican.org/community-health-needs-assessment

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Facility Reporting Group - A
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 200.000000000000%
and FPG family income limit for eligibility for discounted care of 600.000000000000%

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)

Was widely publicized 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):

www.swedishamerican.org/patients/charity-assistance-program

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

www.swedishamerican.org/patients/charity-assistance-program

A plain language summary of the FAP was widely available on a website (list url):
www.swedishamerican.org/patients/charity-assistance-program

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
Part V, Section B	Facility Reporting Group A
Facility Reporting Group A consists of:	- Facility 1: SwedishAmerican Hospital, - Facility 2: SwedishAmerican Medical Ctr. Belvidere
Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 5:	Primary data was obtained from the 2014 Healthy Community Study provided by Rockford Health Council, which contained results and analytics from both a Healthy Community Survey and the Key Informant Questionnaire. The 2014 Healthy Community Study consists of two sections. Section I contains questions relating to four categories (1) general health, (2) behavioral health, (3) maternal, prenatal, and early childhood health and (4) chronic disease and obesity. Section II contains six demographic questions. Surveys were developed in English and Spanish language format with written and electronic versions. The Surveys were distributed in three phases. In Phase 1, the surveys requesting parent survey participation were distributed to students in Rockford Public School District 205. In Phase 2, surveys were mailed to residents of Boone and Winnebago County through a third party vendor. In Phase 3, a postcard was delivered to a random sample of households in Winnebago County providing access information to the survey on the Rockford Health Council Website. The Rockford Health Council identified a group of 49 individuals as Key Informants and distributed a questionnaire to them that asked them to rate their awareness of efforts to address each of the key focus areas identified in the 2010 Healthy Community Study that needed improvement.
Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 6a:	SA Hospital has two hospital facilities, SwedishAmerican Hospital located in Rockford Illinois, and SwedishAmerican Medical Center Belvidere located in Belvidere, Illinois. The definition of the community for purposes of the Community Health Needs Assessment (CHNA) was based on the internal patient origin information by zip code for SAH and SAMC's combined emergency room and inpatient discharges. Both Hospital Facilities defined its community for the CHNA as Boone and Winnebago Counties, Illinois since over 89% of emergency room patients and 84% of inpatients draw from this area. The CHNA was conducted together for both facilities.
Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 11:	Poverty and UnemploymentOur SwedishAmerican Foundation awarded community grants to a number of local not-for-profit organizations. Requests were made to alleviate homelessness, prevent hunger and un/under employment, improve wellness, expand early childhood development and improve offender rehabilitation/reintegration. Nearly $12,000 went to Mosaic for its durable medical equipment (DME) distribution program. The DME program fulfills dozens of request every year for people in need in our community by providing walkers to canes, wheelchairs to shower chairs, hospital beds, portable ramps and more. In addition, $16,000 went to Youth Services Network to support its Parenthood Promise program that provides family support in nine life domains: physical need and living environment, socialization, legal, education and vocation, family attachment, psychological and emotional, cultural and spiritual. The program ultimately focuses on high school graduation rates and school attendance as well as other life domains. In addition, the Foundation granted $17,000 to Rockford Area Habitat for Humanity to support its Midtown Home Rehabilitation. The grant will enable Habitat to make a significant, long-term investment in the Midtown area of our city, while giving families the opportunity to earn a healthier, more secure place to call home. Last fall, Aramark and SwedishAmerican employees, filled 200 backpacks with school supplies and delivered them to Remedies Domestic Violence shelter. This is the third year Aramark has partnered with our organization to provide backpacks to children staying at Remedies. Basic hygiene products, vouchers and bus passes also were part of the donation. In November, SwedishAmerican helped area homeless stay warm by hanging 125 bags each containing a hat, gloves and a scarf on the fence in front of the hospital. This is the fifth year SwedishAmerican has hung the bags out for the homeless. General Health and Wellness and ObesityIn 2018, our Better Life Wellness team offered 60+ classes to the community in the areas of weight management, healthy eating and shopping, smoking cessation and stress management. In addition, they also offered 295 fitness classes ranging from yoga to tightening and toning. In June, our wellness team hosted a Be-Well Fest for the community. A variety of booths were set-up in our Heart Hospital lobby and included groups like the YMCA of Rock River Valley, Fleet Feet Running Store and many other groups to help individuals explore health and wellness.In August, our Ryan Jury Child Development Learning Center hosted a FREE health fair, in conjunction with National Childhood Obesity Awareness Month. Families and children of all ages were invited to attend the FREE health fair that taught families and children new ways to be active, make good choices and stay healthy. The event featured kid-friendly "fun-n-fit" activities for children of all ages. Dieticians and providers from SwedishAmerican also were on-site to provide health information and answer questions.Heart DiseaseThis past year, SwedishAmerican offered free community events to address heart disease. In February, Dr. Srivani Sridhar, Family and Integrative Holistic Medicine, presented Caring for Your Heart the Holistic Way. Dr. Sridhar discussed the integrative & holistic management of hypertension & heart disease as well as cardiac disease prevention. Later that month, SwedishAmerican Interventional Cardiologist Dr. Rehmat Sheikh, gave a free community presentation called Prevention and Control of Heart Disease in the Community. Participants learned about how to prevent heart disease, the role of diet and optimal control of heart risk factors. In April, SwedishAmerican held a free health talk at St. Peter and Paul Church where one of our family physicians, Dr. Marden Torrijos, discussed hypertension and high blood pressure. Individuals learned if they were at risk, and discovered available treatment options and tips for families and individuals to stay healthy. Nurses from SwedishAmerican also were there to conduct free blood pressure checks.CancerIn June, SwedishAmerican Regional Cancer Center hosted National Cancer Survivor Day. All cancer survivors and their families were invited to attend and enjoy a special survivorship celebration. The day was filled with hope, inspiration and friendship and featured a variety of activities including scheduled speakers and educational booths from the American Cancer Society, Pink Heals Association, Livestrong, Leukemia & Lymphoma Society and more.
Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 16j:	The hospital's financial assistance policy is transparent and available to all, at all points in the continuum, in languages appropriate for Hospital's service area. The hospital's financial assistance policy, application form, signage, and financial counselor contact information are available in English and Spanish. Signage is posted prominently at all points of admission and registration (including the emergency department). Written information about the hospital's financial assistance policy and copies of the financial assistance form are available in admission and registration areas. The hospital's financial assistance policy, application form and financial counselor contact information are also posted on the hospital's website. The hospital will make efforts to publicize its policy in print and television media, wherever practicable.Patient billing communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for consideration under the hospital's financial assistance policy. All third-party agents who submit or collect bills on behalf of hospital are required to follow this policy.
Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 5:	Primary data was obtained from the 2014 Healthy Community Study provided by Rockford Health Council which contained results and analytics from both a Healthy Community Survey and the Key Informant Questionnaire. The 2014 Healthy Community Study consists of two sections. Section I contains questions relating to four categories (1) general health, (2) behavioral health, (3) maternal, prenatal, and early childhood health and (4) chronic disease and obesity. Section II contains six demographic questions. Surveys were developed in English and Spanish language format with written and electronic versions. The Surveys were distributed in three phases. In Phase 1, the surveys requesting parent survey participation were distributed to students in Rockford Public School District 205. In Phase 2, surveys were mailed to residents of Boone and Winnebago County through a third party vendor. In Phase 3, a postcard was delivered to a random sample of households in Winnebago County providing access information to the survey on the Rockford Health Council Website. The Rockford Health Council identified a group of 49 individuals as Key Informants and distributed a questionnaire to them that asked them to rate their awareness of efforts to address each of the key focus areas identified in the 2010 Healthy Community Study that needed improvement.
Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 6a:	SA Hospital has two hospital facilities, SwedishAmerican Hospital located in Rockford Illinois, and SwedishAmerican Medical Center Belvidere located in Belvidere, Illinois. The definition of the community for purposes of the Community Health Needs Assessment (CHNA) was based on the internal patient origin information by zip code for SAH and SAMC's combined emergency room and inpatient discharges. Both Hospital Facilities defined its community for the CHNA as Boone and Winnebago Counties, Illinois since over 89% of emergency room patients and 84% of inpatients draw from this area. The CHNA was conducted together for both facilities.
Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 11:	Poverty and UnemploymentOur SwedishAmerican Foundation awarded community grants to a number of local not-for-profit organizations. Requests were made to alleviate homelessness, prevent hunger and un/under employment, improve wellness, expand early childhood development and improve offender rehabilitation/reintegration. Nearly $12,000 went to Mosaic for its durable medical equipment (DME) distribution program. The DME program fulfills dozens of request every year for people in need in our community by providing walkers to canes, wheelchairs to shower chairs, hospital beds, portable ramps and more. In addition, $16,000 went to Youth Services Network to support its Parenthood Promise program that provides family support in nine life domains: physical need and living environment, socialization, legal, education and vocation, family attachment, psychological and emotional, cultural and spiritual. The program ultimately focuses on high school graduation rates and school attendance as well as other life domains. In addition, the Foundation granted $17,000 to Rockford Area Habitat for Humanity to support its Midtown Home Rehabilitation. The grant will enable Habitat to make a significant, long-term investment in the Midtown area of our city, while giving families the opportunity to earn a healthier, more secure place to call home. Last fall, Aramark and SwedishAmerican employees, filled 200 backpacks with school supplies and delivered them to Remedies Domestic Violence shelter. This is the third year Aramark has partnered with our organization to provide backpacks to children staying at Remedies. Basic hygiene products, vouchers and bus passes also were part of the donation. In November, SwedishAmerican helped area homeless stay warm by hanging 125 bags each containing a hat, gloves and a scarf on the fence in front of the hospital. This is the fifth year SwedishAmerican has hung the bags out for the homeless. General Health and Wellness and ObesityIn 2018, our Better Life Wellness team offered 60+ classes to the community in the areas of weight management, healthy eating and shopping, smoking cessation and stress management. In addition, they also offered 295 fitness classes ranging from yoga to tightening and toning. In June, our wellness team hosted a Be-Well Fest for the community. A variety of booths were set-up in our Heart Hospital lobby and included groups like the YMCA of Rock River Valley, Fleet Feet Running Store and many other groups to help individuals explore health and wellness.In August, our Ryan Jury Child Development Learning Center hosted a FREE health fair, in conjunction with National Childhood Obesity Awareness Month. Families and children of all ages were invited to attend the FREE health fair that taught families and children new ways to be active, make good choices and stay healthy. The event featured kid-friendly "fun-n-fit" activities for children of all ages. Dieticians and providers from SwedishAmerican also were on-site to provide health information and answer questions.Heart DiseaseThis past year, SwedishAmerican offered free community events to address heart disease. In February, Dr. Srivani Sridhar, Family and Integrative Holistic Medicine, presented Caring for Your Heart the Holistic Way. Dr. Sridhar discussed the integrative & holistic management of hypertension & heart disease as well as cardiac disease prevention. Later that month, SwedishAmerican Interventional Cardiologist Dr. Rehmat Sheikh, gave a free community presentation called Prevention and Control of Heart Disease in the Community. Participants learned about how to prevent heart disease, the role of diet and optimal control of heart risk factors. In April, SwedishAmerican held a free health talk at St. Peter and Paul Church where one of our family physicians, Dr. Marden Torrijos, discussed hypertension and high blood pressure. Individuals learned if they were at risk, and discovered available treatment options and tips for families and individuals to stay healthy. Nurses from SwedishAmerican also were there to conduct free blood pressure checks.CancerIn June, SwedishAmerican Regional Cancer Center hosted National Cancer Survivor Day. All cancer survivors and their families were invited to attend and enjoy a special survivorship celebration. The day was filled with hope, inspiration and friendship and featured a variety of activities including scheduled speakers and educational booths from the American Cancer Society, Pink Heals Association, Livestrong, Leukemia & Lymphoma Society and more.
Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 16j:	The hospital's financial assistance policy is transparent and available to all, at all points in the continuum, in languages appropriate for Hospital's service area. The hospital's financial assistance policy, application form, signage, and financial counselor contact information are available in English and Spanish. Signage is posted prominently at all points of admission and registration (including the emergency department). Written information about the hospital's financial assistance policy and copies of the financial assistance form are available in admission and registration areas. The hospital's financial assistance policy, application form and financial counselor contact information are also posted on the hospital's website. The hospital will make efforts to publicize its policy in print and television media, wherever practicable.Patient billing communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it, or on it, a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for consideration under the hospital's financial assistance policy. All third-party agents who submit or collect bills on behalf of hospital are required to follow this policy.

Schedule H (Form 990) 2019

Page 9

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?34
Name and address		Type of Facility (describe)
1	1 - Regional Cancer Center 3535 N Bell School Road Rockford,IL61114	Outpatient Clinic
2	2 - SwedishAmerican Heart Institute 1340 Charles Street Suite 300 Rockford,IL61104	Outpatient Clinic
3	3 - Stateline Clinic & Immediate Care 4282 E Rockton Road Roscoe,IL61073	Outpatient Clinic
4	4 - Lundholm Orthopedics 1340 Charles Street Suite 100 Rockford,IL61114	Outpatient Clinic
5	5 - Neuro and Headache Center 1340 Charles Street Suite 400 Rockford,IL61104	Outpatient Clinic
6	6 - Woodside Clinic 3775 N Mulford Road Rockford,IL61104	Outpatient Clinic
7	7 - Wound Care & Hyperbaric Clinics 1415 E State Street Ste 408 609 Rockford,IL61104	Outpatient Clinic
8	8 - Brookside Specialty Center 1253 N Alpine Road Rockford,IL61107	Outpatient Clinic
9	9 - Rockford Vascular Surgery at SA 1340 Charles Street Suite 200 Rockford,IL61104	Outpatient Clinic
10	10 - SAMG Obstetrics & Gynecology 209 9th Street Rockford,IL61104	Outpatient Clinic
11	11 - SwedishAmerican Home Health Care 2550 Charles Street Rockford,IL61108	Home Health
12	12 - Belvidere Clinic 1700 Henry Luckow Lane Belvidere,IL61008	Outpatient Clinic
13	13 - Pulmonary and Critical Care Clinic 1401 E State Street Rockford,IL61104	Outpatient Clinic
14	14 - Rockford Ambulatory Surgery Center 1016 Featherstone Road Rockford,IL61107	Ambulatory Surgery Center
15	15 - Five Points Clinic 2404 Charles Street Suite 800 Rockford,IL61108	Outpatient Clinic
16	16 - Valley Clinic 6824 Newburg Road Rockford,IL61108	Outpatient Clinic
17	17 - SA Immediate Care 2473 McFarland Road Rockford,IL61107	Outpatient Clinic
18	18 - Rock Valley Clinic 6861 Villagreen View Rockford,IL61107	Outpatient Clinic
19	19 - State St OBGYN 1415 E State Street Rockford,IL61104	Outpatient Clinic
20	20 - UW Health Surgery at SwedishAmerican 1340 Charles Street Suite 100 Rockford,IL61104	Outpatient Clinic
21	21 - Midtown Clinic 1340 E State Street Suite 405 Rockford,IL61104	Outpatient Clinic
22	22 - Davis Junction Clinic 5665 North Junction Way Davis Junction,IL61020	Outpatient Clinic
23	23 - Byron Clinic 220 W Blackhawk Drive Byron,IL61010	Outpatient Clinic
24	24 - Woodward Health Network Clinic 2473 McFarland Road Rockford,IL61107	Outpatient Clinic
25	25 - North Main Clinic 2601 N Main Street Rockford,IL61103	Outpatient Clinic
26	26 - Cardiothorasic Surgery 1340 Charles Street Suite 300 Rockford,IL61104	Outpatient Clinic
27	27 - Northern Illinois Vein Clinic 1340 Charles Street Suite 404 Rockford,IL61104	Outpatient Clinic
28	28 - Rochelle Clinic 380 Illinois Route 38 East Rochelle,IL61068	Outpatient Clinic
29	29 - Maternal Fetal Medicine 1401 E State Street Rockford,IL61114	Outpatient Clinic
30	30 - Diabetes Self-Management Center 1415 E State St Suite 700 Rockford,IL61104	Outpatient Clinic
31	31 - Infectious Disease Consultants 1340 Charles St Suite 404 Rockford,IL61104	Outpatient Clinic
32	32 - Strathmoor Pediatrics 5695 Strathmoor Drive Rockford,IL61005	Outpatient Clinic
33	33 - Woodward Occup Health Loves Park 5001 N 2nd Street Loves Park,IL61111	Outpatient Clinic
34	34 - Woodward Occupational Health Rock Cut 1 Woodward Way Loves Park,IL61111	Outpatient Clinic

Schedule H (Form 990) 2019

Page 10

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 7g:	The following subsidized health services are for physicians. These physicians are necessary to serve the community, are difficult to recruit, and the reimbursement does not cover the cost of the services.Hospital based physicians' specialty clinics and coverage payments: $25,563,504Emergency department physicians: $1,260,487Total: $26,823,991
Part I, Ln 7 Col(f):	The bad debt expense on Part IX, Column A subtracted for the purpose of calculating the percentage of expense is $44,107,529.
Part I, Line 7:	7a and 7f costs were calculated using the 2018 Medicare cost report cost to charge ratio. Lines 7b and 7c costs were calculated using the cost accounting system. The cost accounting system addresses all patient segments. All other amounts in Line 7 were calculated using direct costs.
Part III, Line 2:	Methodology for determining bad debt expense: It is our practice to identify, to the extent possible, charity cases at the time of service. If a patient provides documentation they meet our charity care policy, they are not sent to collection. Those patients who do not meet presumptive eligibility and fail to apply or provide documentation are sent to collection after 90 days. The organization and its agents follow the fair patient billing act. If during the collection process we or our agents become aware of a patient qualifying for charity care or financial assistance and the patient cooperates with the requirements of the charity care policy, collection efforts are ceased and the account is written off to charity. Bad debt expense reported on line 2 represents the allowance for doubtful accounts. It is determined based on historical experience of uncollectible amounts, after contractual discounts, patient payments and amounts qualifying under charity assistance policy.
Part III, Line 3:	SwedishAmerican Hospital's charity policy allows a 100% charity write-off for those with household income of 200% or less of the federal poverty level and partial charity write-off for those up to 600% of the poverty level. The latest data from the U.S. Census bureau QuickFacts for Winnebago and Boone counties, which are the counties served by the healthcare facilities, indicates the following: Winnebago County 14.2% of the population is below the poverty level, the median household income was $51,110 and a household size of 2.47, Boone County 8.8% of the population is below the poverty level, the median household income was $62,701 and a household size of 2.85. The 2018 poverty guidelines per the Office of Assistant Secretary for Planning and Evaluation, (https://aspe.hhs.gov/poverty-guidelines) indicate for the household size of 3, and income of $41,560 is 200% of the poverty level and $124,680 is 600% of the poverty level. Approximately 79% of our charity write-offs are for patients without insurance while 65% of our bad debt write-offs are for patients without insurance. In 2018 only 6% of all accounts written off to bad debt were recovered. This portion was not included as community benefit in Part I because it is an estimate based on the small percentage of bad debt this is recovered and the demographics of our service area.
Part III, Line 4:	Patient accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the hospital identifies troubled accounts, reviews historical experience and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patientswith deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts.
Part III, Line 8:	SA Hospital must treat patients regardless of their ability to pay. The government sets non-negotiable Medicare rates and the reimbursement from Medicare has not kept pace with the rising cost of providing those services. The cost of care has increased due to: wages and benefits necessary to keep high demand skilled practitioners, medical supplies in particular cardiovascular and orthopedic implants and pharmaceuticals, malpractice insurance costs, and capital equipment. SA Hospital's treatment of Medicare beneficiaries relieves the federal government burden of directly providing medical care which by law they are required to provide to eligible beneficiaries. Due to the requirement to provide care and the inability of Medicare reimbursement to keep pace with the cost of providing services, we feel the loss from services provided to Medicare beneficiaries is a part of our mission and is a benefit to our community. The following is a reconciliation of the shortfall from Medicare reported on the cost report on Line 7 to the Medicare shortfall from all of the Medicare programs at SA Hospital. These shortfalls were calculated using the cost to charge ratio.Medicare shortfall hospital programs Part III, line 7: ($17,255,583)Medicare shortfall physician programs: ($14,532,793)Total Medicare Shortfall ($31,788,376)
Part III, Line 9b:	The organization and its agents follow the fair patient billing act. If during the collection process we or our agents become aware of a patient qualifying for charity care of financial assistance and the patientcooperates with the requirements of the charity care policy, collection efforts are ceased.
Part VI, Line 2:	SA hospital has provided monetary support for the 2014 Healthy Community Study, conducted by the Rockford Health council. The Council consists of the major health care providers in our metropolitan area such as the three hospitals, Crusader Clinic (a federally qualified healthcare clinic), the University of Illinois College of Medicine, Janet Wattles Mental Health Center, Rosecrance Substance Abuse Center as well as several representatives of not-for-profit agencies, and member of the corporate community. Since 2001, an assessment has been completed every three years to identify and track trends as well as areas to address. These stakeholders understand the need for a comprehensive community study that is focused on the overall needs of the community. SA has used this data to launch innovative programs and collaborative partnerships such as cardiac screenings within minority communities. In April of 2015, SA Hospital contracted with RSM-US LLP to complete a three year follow-up Community Health Needs Assessment (CHNA) for both SA Hospital and SA Medical Center Belvidere as required by the Internal Revenue Code, Section 501(r). An implementation strategy has been adopted to meet the prioritized needs identified by the CHNA.
Part VI, Line 3:	For services provided in the hospital, our employees and our agents follow the fair patient billing act and provide information regarding the availability of charity and financial assistance at all points during the collection process. We have posted signage disclosing the availability of charity care and financial assistance in emergency rooms and on our website. Inpatients are provided various written communications regarding the availability of charity care and financial assistance and any uninsured discount eligibility. For services provided in physician offices, financial counselors are instructed to make the patients aware of the charity care and financial assistance policy during the collection process and educate them on the process of applying for Medicaid. For services provided by home health, social workers assist patients by screening for Medicaid eligibility and completing the application, completing charity care application, assisting in applying for Medicare and social security disability benefits, and assisting with applications for food stamp, low income energy assistance, and circuit breaker/Illinois cares prescription programs.
Part VI, Line 4:	The communities served by SA Hospital include the Rockford Metropolitan Service Area (MSA) and the counties of Winnebago, Boone, and to a lesser degree Ogle and Stephenson Counties. Ogle and Winnebago counties have medically underserved area (MUA) designations for the White Rock Service Area (MUA 916) and Winnebago Service Area (MUA 7011). The U.S. Census bureau had the 2015 estimated population for the Rockford MSA at 340,663. Today, the unemployment rate of the Rockford MSA is 5.8%, ranking in the bottom 10% of the nation. SA Hospital is located in the City of Rockford, Illinois, in Winnebago County, where the percentage of households below the poverty level is 14.7%. SwedishAmerican Medical Center Belvidere is located in the city of Belvidere, Illinois, in Boone County, where the percentage of households below the poverty level is 10.3%. Of the patients served by SA Hospital at all facilities, 28.4% are uninsured or Medicaid recipients. Five different facilities exist in the community to address inpatient needs, all of which offer discounts or charity care to uninsured and needy patients. There is one federally qualified healthcare facility.SA Hospital helped fund the 2014 Rockford Healthy Community Study in partnership with the University of Illinois, College of Medicine at Rockford and the Rockford Health Council. In addition to general health issues, the study also focuses on three other areas of need identified by Rockford Health Council. They are: 1) Behavioral Health 2) Maternal, Prenatal, and Early Childhood Health 3) Chronic Disease and ObesityGeneral Health:Both Boone and Winnebago counties have a lower rate of primary care physicians (PCP) 78% compared to the state 96% and the nation 86% and the rate of access to PCP is lower for Boone County 59% than for Winnebago Counties 82%. In contrast, the percentage of adults in the region without a regular doctor 14% is lower than the state 18% and the nation 22%. Nevertheless, 54% of Boone and Winnebago population has been identified as living within an area where there is a shortage of healthcare professionals.Behavioral Health:The Study revealed that half of the respondents know where to find resources for mental health and suicide issues and almost half believe that both issues have no impact on their neighborhoods. Approximately 20% believe there is a lack of social or emotional support for the region, which is consistent with that of the state and national rates.Maternal, Prenatal, and Early Childhood Health:The Study found that most respondents believe that regular prenatal care is necessary and that it is easy for mothers and their children to access these types of resources within their neighborhoods. Only 6% of mothers in the region are without prenatal care or receive it late in their pregnancy compared to 5% for the state and 17% for the nation. This is further supported by low infant mortality rates for Boone County 5% and below state and national rates but not for Winnebago County at 8% and above the state and national rates per 1,000 live births. Additionally, the teen birth rate for Boone County 30% is lower than the state 35% and Winnebago County at 46% and the incidences of teen birth rate for all comparative groups have declined over a 10 year period between 2002 and 2012.Chronic Disease:Respondents to the Healthy Community Study recognize that obesity plays a significant role in chronic disease and that it has an impact on their neighborhood. More than half acknowledge that healthy food options and access to community parks, recreational areas and fitness facilities are crucial to a reduction in chronic disease and obesity. However, the Study illustrates less than 5% of Boone County and 11% of Winnebago County live within a half mile of a park and for each 100,000 it is estimated that 5 facilities exist in Boone County and 9 facilities in Winnebago County with an estimated regional population of 350,000.By virtue of its mission, location in the central city and relationships with other providers, SwedishAmerican serves the needs of many of the community's underserved. Finding ways to improve the health of all and to make Rockford a model community in which to live, work and worship are significant and strategic initiatives for SA Hospital.
Part VI, Line 5:	Although SA Hospital's community service efforts reach a broad segment of the population throughout northern Illinois, the hospital devotes a great deal of its energy and resources to serving the city's neediest people, many of whom live in the urban core where SwedishAmerican is located. Ourorganization contributes millions of dollars to charity and Medicaid care each year.Recognizing that healthy communities are characterized by strong interconnections between residents, infrastructure, organizations and services, we have worked in partnership with other community-based organizations as part of the non-profit Rockford Health Council Inc. The council seeks to build and improve community health through education, action, dialogue and legislative activity and serves as a catalyst and coordinator for agency and individual action to ensure access, cost effectiveness and quality. Beyond our work with the council, some of our initiatives take place in concert with other individual community organizations and healthcare providers, while others are carried out by SA Hospital teams.For example, SwedishAmerican has worked with the City of Rockford and other area development groups-including ZION Development, Habitat for Humanity and Kids Around the World-to serve as a catalyst for revitalizing the area surrounding our campus with homes, green space and commerce. A large part of this movement was a $100 million campus expansion and renovation project. Despite economic and strategic pressures to move eastward, as many businesses in our area have done, SwedishAmerican joined several other area organizations and made a commitment to remain in central Rockford. One immediate benefit of our redevelopment effort was the expansion of the hospital's emergency department. Among the state's busiest, this is where many of our community's underserved residents come for medical care.In order to improve the low rate of home ownership identified in the healthy community studies, SwedishAmerican initiated a Neighborhood Revitalization Program in an 81-block area adjacent to our hospital campus. Working with the City of Rockford and local Habitat for Humanity officials, we have replaced substandard dwellings with new Habitat homes. Additionally, we partnered with the William Charles Charitable Trust and Kids Around the World to build a new playground that allows neighborhood children the opportunity for play, without having to cross major thoroughfares and traffic hazards.In the past decade, The Foundation purchased two, 12-unit apartment buildings adjacent to the hospital campus which were in a state of disrepair. Approximately three-quarters of a million dollars were invested in these two buildings to bring them to "market rate" status.Encouraged by our commitment to renovate our campus and revitalize the surrounding area, a number of commercial developments have occurred. Among them is a Walgreens' drug store, which returned retail pharmacy services to the area for the first time in years. A three-story office building south of the new Walgreens' was completed, followed by a 60,000 square-foot medical office building south of the hospital.SwedishAmerican has sought to improve the community's health by taking effective lifestyle modification programs to the people who need them most. Although this applies to the community at large, we have taken special efforts to bring these strategies to the city's elderly and underserved residents. This is demonstrated by our successful program to improve the health of residents at Longwood Plaza, a senior housing facility located two blocks from our hospital's campus. Finally, beyond lifestyle modification our ongoing community health initiatives involve research-based health screening programs, as well as unique health education events that target both at-risk members of the community and healthcare providers.SwedishAmerican organization-led efforts to improve the quality of life in our community are not exclusively health-related. One example is the partnership we formed twenty years ago with nearby public schools, where a very high percentage of the students come from underserved families. The long-term and ongoing goal of our partnership with area schools has been to improve the academic and socioemotional wellbeing of the school environment and student body. While SwedishAmerican has come forward with a number of ideas and proposals for additional ways in which it can impact the students and faculty at area schools, it always has been sensitive to the wishes and desires of the community in implementing only those programs that correspond with the school's agenda and strategic goals.Beyond large-scale, organization-led initiatives, our employees independently devote extensive amounts of time and resources to a large number of programs, services and activities throughout northern Illinois.
Part VI, Line 6:	SA Hospital a division of UW Health offers services at two acute care hospital facilities, physician clinics, physician emergency services, and home health care. SwedishAmerican Foundation is a subsidiary of SA Hospital and supports it through fundraising activities.Following a campus renovation project that began in 2000, the SwedishAmerican Foundation (SAF) implemented a massive neighborhood revitalization and replacement initiative to transform a large areasurrounding the hospital campus into "a neighborhood of choice...not chance." This project brought together the forces of SwedishAmerican, SAF, the City of Rockford and countless charitable and commercial entities to improve the quality and availability of area housing.In March of 2015, the program was recognized by The United Way of Rock River Valley with the inaugural Strong Neighbor Award. Because strong neighborhoods make a strong community, United Way is leading a place based strategy that will dramatically improve the quality of life for children and families. Two of the region's most challenged neighborhoods (Ellis Heights and Midtown District) are the strategic focus of thisplan. SwedishAmerican was cited for being a vital partner to the Strong Neighborhoods initiative and for building better neighborhoods for our children and families. United Way noted SwedishAmerican's commitment to transforming the area surrounding the Hospital from an at-risk, predominantly rental-occupied part of Rockford to a stable, owner occupied neighborhood.SwedishAmerican's neighborhood revitalization effort includes:Habitat for Humanity Homes: Several years ago SwedishAmerican entered into a formal agreement with the Rockford Habitat for Humanity Chapter to construct new area homes. By the end of 2015, dozens of Habitat for Humanity homes have now been completed and sold to low-income home owners who qualify through Habitat For Humanity. Habitat For Humanity now holds annual application seminars on SwedishAmerican campus for our employees and members of the neighborhood.Midtown Community Work Day: In June 2016 SwedishAmerican Foundation collaborated and co-sponsored the first annual Midtown Community work day. Together with Rockford Habitat for Humanity and Thrivent Financial we initiated an exterior home improvement grant application for Midtown District homeowners. This was a one day event that utilized volunteers from Swedes, Habitat, Rockford Police, Thrivent, East High School, Rockford Fire and community members to work with grant recipients to help complete exterior repairs to 10 homes which totaled $25,000 of improvements to the community since inception! SwedishAmerican again teamed up with Rockford Area Habitat for Humanity and Thrivent Financial to give four $2,500 grants to homeowners to help improve the exterior of their homes. The homeowners had to provide $100 toward the renovation and participate in the improvement process.Neighborhood Playground and Parks: Because area children did not have a safe place to play, SAF purchased three contiguous pieces of property, removed existing commercial and residential structures and partnered with two local charities to construct a new neighborhood playground. Since the completion of these projects, SwedishAmerican Foundation maintains their appearances with regular visits from our landscaping company. This ensures we maintain the beauty of the parks and playgrounds for our neighborhood to enjoy.Homeowner Grants to Employees: Since 2004, SwedishAmerican has offered $5,000 down payment assistance to employees to help encourage home ownership in the six-block area surrounding the hospital. This initiative includes a five-year forgivable grant to employees in good standing-with no income restrictions. Since inception, this program has assisted 34 employees purchase homes in the SwedishAmerican neighborhood.Home Restoration: Beginning in 2004, SAF has purchased dozens of homes in the neighborhood target area, rehabbed them and made them available to employees, firefighters, police officers and public school teachers, at discount (less than the cost of purchase and repairs). In 2015, 14 additional properties were identified and work completed. In 2017, SwedishAmerican tore down the home at 1505 7th Avenue and sold the land to the neighbor so they could have a larger yard. Strong Neighborhood House:In 2017, SwedishAmerican Foundation and the Rockford Police Department celebrated three years of success in the first-ever community "Strong Neighborhood House." In May 2016, SwedishAmerican purchased and renovated the house and licensed it to the Rockford Police Department as a place for officers to build a closer relationship with neighbors. Additionally, it is a space where officers can help facilitate problem solving and ultimately reduce crime in the neighborhood. The house has set office hours each morning, Monday through Friday. Officers patrol the neighborhood throughout the day and evening and stop by the house at any time. Showing a strong police presence in the neighborhood has given residents a hope for change and a better future.Over the last year the Rockford Community Police Officer has been working hard to increase programing and utilization of the house to better serve the needs of the neighborhood. Jackson Oaks Neighborhood Association holds monthly meetings at the Strong House. Other organizations hold meetings there such as The Fatherhood Project, and Girl Scouts of Northern Illinois. Lifestyle Medicine and Wellness Programs:SwedishAmerican is committed to building a healthier community of senior adults. In 2001, the health system and ZION Development Corporation began discussing the unique health needs of low-income senior residents living at Longwood Plaza, a 65-unit facility located two blocks from SwedishAmerican Hospital's campus. The two partners wanted to not only provide a way for seniors to have safe housing; they also wanted to equip residents with the tools and education for living healthier lives. With the assistance of a generous donation by the Walter D. Williams estate, SwedishAmerican and ZION created a wellness program to meet the needs of seniors' right where they lived. The program has been going strong since 2001.Every week, participants check in with a registered nurse for blood pressure, weight and fasting glucose if needed. Current health status, medication adherence, diet and nutrition are some of the topics discussed. Twice weekly, participants receive a therapeutic massage and meet individually with a fitness trainer for exercise. Monthly, healthy meals and nutrition presentations are held. Periodically, speakers from the community such as Fire and Police Departments provide presentations. Several participants take advantage of the Licensed Clinic Professional Counselor that the program provides. As an incentive for participation, residents receive up to $40 off of their monthly rent.Better Life Wellness/YMCA Partnership:SwedishAmerican created a medical wellness center called BetterLife Wellness within the downtown Rockford YMCA. In 2018, the medical wellness center moved to the lower level of Camelot Tower on the hospital campus. The center offers a variety of services for members and the general public, including: Wellness educational programs, classes and support groups Screenings and health risk assessments Personal health coaching Weight management programs Therapeutic massages, Reiki and reflexology Healthy cooking classes and grocery tours Smoking cessation classes Relaxation and stress management education Healthy Heart screensBetterLife expands our capacity to help people of all ages, physical abilities and limitations lead healthier lives. Our unique holistic health experience and expertise will be incorporated into the individualized wellness prescriptions and coaching offered to our participants. The powerful combination of active medical oversight, experienced and credentialed staff, and the utilization of an individual's personal health status are intended to reduce health risks, improve well-being and bring a measureable impact upon improving the overall health of our community.
Part VI, Line 6 Continued:	Academic & Career Promotion:In order to help young people understand the economics of life and open their minds to career possibilities within the business world, SwedishAmerican has made a major commitment to the community's public school system. Our employees have shared their professional experiences in the classroom and served as volunteers to tutor students. We've partnered with area schools as a part of our mission to care for our community through compassionate service. We realize that a stronger neighborhood, with achieving children and fully functioning families, is an environment where tomorrow's leaders may be nurtured and protected. As a major corporate anchor in the neighborhood and a source of influence within the greater community, SwedishAmerican believes that it has a responsibility to help create an environment at area schools that enables it to serve as an agent for growth, maturation and positive change. A SwedishAmerican representative has been involved with the schools' planning process since our partnerships began two decades ago. Over the last 20 years, SwedishAmerican has positively impacted students and faculty in a number of ways, including: Academy Expo: In 2018, we continued our efforts as a key community partner in expanding Rockford's Academy Expo. The purpose of the Academy Expo was to expose Rockford Public Schools 9th, 10th and 11th graders to a variety of careers to assist them in making an academy and forge a relevant link between high school curriculum and future careers. Unlike a job fair where students visit companies, the Academy Expo invited companies to present career options for students to explore. The main focus of the event, therefore, was to showcase a broad spectrum of possible careers. Students at the Academy Expo learned about classroom curriculum that will prompt them to develop professional behaviors and to evaluate their strengths/interests related to careers. Scholarships: Physicians, Practitioners and The Foundation Partner To Change Kids' Futures For many years, SwedishAmerican Medical Group (SAMG) has supported a special fund within the Foundation, the SAMG Community Benefit Fund. Through this, we have pooled resources to aid organizations in need throughout the community. A new initiative is supporting scholarships through Rockford Promise, an organization whose vision is to change the community by ensuring the secondary education of its youth. In April 2017, we presented two students with fully funded, two-year scholarships to Rock Valley College.Health Education:According to the Community Assessment, cancer and heart disease are the leading causes of death in the three-county area surrounding SwedishAmerican Hospital. These conditions also are leading contributors to "years of life lost" before age 65. In the last decade, the number of baby boomers born between 1946 and 1964 increased 31.3 percent in the Rockford area. As this demographic segment continues to age, it will result in an increased incidence of disease, as well as a range of health issues affecting midlife women. Among the 202,808 people living in Winnebago County, 9,823 or 4.8% reported having been diagnosed with heart disease. The Illinois average is 3.8% while the nation is slightly higher at 4.4%. Because of these challenges rates, SwedishAmerican is committed to educating public and professional audiences within our community about matters of prevention, detection and treatment.Cardiac Care Professional and Public Events: In its community assessment, the Rockford Health Council found that chest pain and heart failure were leading reasons for hospitalization in the Rockford area. In response to community needs SwedishAmerican created a large-scale educational event in 1999 to help healthcare professionals stay current on patient care and inform the public about heart disease prevention and treatment.Heart Care: Ask the Experts is two free public events: a heart health fair and an educational program. The fair allows our community to learn more about prevention, screenings, treatment, technologies and complementary care at more than 30 exhibits. The program, which varies each year, has included heart-healthy cooking demos, live open-heart surgery beamed via satellite from SwedishAmerican Hospital and panel discussions that allow dialogue between the audience and SwedishAmerican physicians. Community response has been tremendous, with annual attendance exceeding 500. Although Heart Care is an evening event, its health impact is real; many people requested a referral to either a primary care physician or cardiologist.Breast Cancer Awareness Event/Partnership with A Silver Lining Foundation:National statistics indicate that one in nine women will be diagnosed with breast cancer during her lifetime. The aforementioned community assessment revealed that, of the nearly 1,600 cases of cancer that occur in the Rockford area each year, breast cancer is the leading site among women. To provide area women with vital information on breast cancer prevention, detection and treatment, SwedishAmerican annually hosts a free breast cancer awareness event. For 19 years, this event has given breast cancer survivors, the newly diagnosed and those at high risk due to family history an opportunity to hear the latest clinical recommendations. This event has included both national speakers and expert panels of primary care physicians, radiologists, oncologists, surgeons and allied health professionals that engage the audience. Over the years, we have enhanced the program by targeting underserved minority populations for this program and offering discounted mammogram coupons to encourage screenings. More than 500 women attend this annual event. In 2015, SwedishAmerican partnered with A Silver Lining Foundation (ASLF) to offer free mammograms for women and men who can't afford one. Screenings took place at three SwedishAmerican locations in and around Rockford. The foundation was launched more than a decade ago with a mission to ensure dignified, respectful and equal access to quality cancer education and services for all. ASLF ensures that socioeconomic status does not affect an individual's ability to obtain information, timely cancer screening and diagnosis. SwedishAmerican is excited to partner with an organization such as ASLF because the more people who get screened, the more people we can educate and the more lives we can save.Ryan Jury Learning Center FREE Health FairMore than 23 million children and teenagers in the United States between the ages of 2 and 19 are obese or overweight. To help combat this problem, SwedishAmerican's Ryan Jury Child Development Learning Center hosted a FREE health fair in September 2017, in conjunction with National Childhood Obesity Awareness Month. The event took place at the UW Health Sports Factory in downtown Rockford, Illinois.Child's Safety Fair:In May, SwedishAmerican hosted the 8th annual SAM's Safety Fair on the grounds of our hospital campus. More than thirty different agencies were represented at the event, which was held in conjunction with Emergency Medical Services Week. Kids were able to explore the inside of an ambulance; learn about bicycle safety; poison prevention; water and sun safety; sports safety; and animal safety. Children also could visit the splinting and casting station. Engine and ladder trucks from local fire departments, as well as the Rockford Fire Department Smoke House, were on site for kids to explore. Bicycle safety rodeo and car-seat safety checks rounded out the offerings. The Safety Fair provides a place for families to learn about safety and healthy habits. This event is a great place for parents and caregivers to learn what safety resources are available in our community.Community ServiceCommunity Paramedic Programs:In 2017, SwedishAmerican, a division of UW Health continued to help connect underutilized resources to the underserved population at SwedishAmerican through its Mobile Integrated Healthcare (MIH) program with Rockford Fire Department. Officials from both SwedishAmerican and Rockford Fire provided the community with an update on its partnership and the benefits it's had on the City of Rockford and surrounding communities.From August 2016 to December 2017, SwedishAmerican patients enrolled in the program experiences a reduction of Emergency Department (ED) visits by 35%, ambulance runs by 42% and hospital admission by 40%.Rockford Fire firefighter Brian Park is currently the MIH Manager for the program. Brian is both an eleven year veteran of the department and a Registered Nurse (RN) in the community for the past 11 years. Through the MIH program, he works directly with SwedishAmerican case managers, EMS department, pharmacists, physician and nurses at the hospital to identify patients and develop individualized care plans for each of them.
Part VI, Line 6 Continued:	Brian currently sees 20 patients on a weekly basis often times accompanied by a SwedishAmerican nurse case manager. Each patient receives regularly scheduled home visits where Brian provides a medical assessment, ensures the patient is taking their prescribed medications and is following up with their primary care provider. He offers community resource support to help improve the patients' health and wellbeing. In addition, he checks smoke detectors, CO2 detectors and any hazards that may exist in the patient's home.In addition to the MIH program with Rockford Fire Department, SwedishAmerican has an MIH program in place with Byron, Harlem-Roscoe and Rockton Fire Departments.Fall and Spring Neighborhood Association Group Summits and GatheringsOur city is faced with challenges, but along with challenges comes many opportunities for our community. That's why in May 2017, the SwedishAmerican Foundation, Rockford Police Department and Keith Creek Neighborhood Association hosted a Strong Neighborhood Association Groups Gathering. The Summit was FREE and open to local community members. Judge Rosemary Collins discussed domestic violence. She also shared how the community can work together to help find solutions to this growing issue. In October 2017, the SwedishAmerican Foundation, Rockford Police Department and Neighborhood Association's from Jackson Oaks, Keith Creed, North Highland, Rockview and South Highland hosted a Fall Neighborhood Association Group Summit at another location with the same availability to the community. The Great Neighborhoods Project piloted by urban planners engages neighborhoods to focus on the assets that they have to build relationships thereby strengthening their neighborhoods.Little Free Libraries:The percentage of children in grade 4 whose reading skills tested below the "proficient" level for the English Language Arts portion of the state-specific standardized test are relevant because an inability to read English well is linked to poverty, unemployment, and barriers to healthcare access, provider communications, and health literacy/education. In the Healthy Community Study, nearly two-thirds of 4th graders (65.6%) were found to not be proficient with reading skills in 2015. This was higher than the state rate of 60.7% and much higher than the national rate of 45.6%. To help combat this, SwedishAmerican maintains four Little Free Libraries around the SwedishAmerican Hospital campus and its surrounding neighborhoods. Little Free Libraries are an international movement where people place small, weatherproof boxes in their communities. These boxes are stocked with books which are free to the public to take, return, or add to the collection. The hope is that when someone takes a book, they will return it or replace it with another book. Since inception of this program, we have added two more Little Free Libraries at the Regional Cancer Center and the other on the campus of the SwedishAmerican Hospital in Belvidere. Over the last three years, five Little Free Libraries have been strategically placed within the adjoining SwedishAmerican neighborhoods allowing easy access to books and library materials by those who wish to take advantage of this wonderful resource.
Part VI, Line 7:	SA Hospital files a community benefit report with the Illinois Attorney General.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SwedishAmerican Hospital

Employer identification number
36-2222696

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Aunt Martha's Youth Service Center Inc 19990 Governors Hwy Olympia Fields,IL60461	23-7188150	501(c)(3)	334,320				Federally qualified health center that provides health services to uninsured and underserved in our community
(2) Illinois Hospital Research & Education Foundation 1151 East Warrenville Road Naperville,IL60566	23-7421930	501(c)(3)	259,473				Quality healthcare for Illinois

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) Scholarship - educational scholarship for children of non-management employees.	14	14,000
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Part I, Line 2:

IHREF is a tax-exempt research entity whose mission is to provide educational opportunities and grants designed to foster and encourage the provision of the highest standard of patient care by hospitals in Illinois. Aunt Martha's Youth Service Center, Inc. is a federally qualified health center that provides health services to uninsured and underserved in our community. SA Hospital works closely with both grantee organizations or receives reports from them as appropriate.

Schedule I (Form 990) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

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 on 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 on 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 nonfixed
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) 2019

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)
1Michael J Born MD President & CEO	(i) (ii)	447,672 ------------- 0	78,479 ------------- 0	28,698 ------------- 0	55,296 ------------- 0	25,642 ------------- 0	635,787 ------------- 0	0 ------------- 0
2Michael E Dallman UWRDI Board Representative	(i) (ii)	0 ------------- 399,241	0 ------------- 44,337	0 ------------- 1,788	0 ------------- 61,281	0 ------------- 16,969	0 ------------- 523,616	0 ------------- 0
3Allen D Williams MD Trustee	(i) (ii)	280,971 ------------- 0	0 ------------- 0	0 ------------- 0	19,575 ------------- 0	39,935 ------------- 0	340,481 ------------- 0	0 ------------- 0
4Robert Flannery Trustee	(i) (ii)	0 ------------- 555,603	0 ------------- 60,775	0 ------------- 6,417	0 ------------- 72,672	0 ------------- 25,487	0 ------------- 720,954	0 ------------- 0
5Patricia DeWane Chief Financial Officer	(i) (ii)	334,697 ------------- 0	63,823 ------------- 0	56,491 ------------- 0	52,427 ------------- 0	9,678 ------------- 0	517,116 ------------- 0	0 ------------- 0
6Donald Daniels VP & Chief Operating Officer	(i) (ii)	382,918 ------------- 0	88,467 ------------- 0	40,083 ------------- 0	82,027 ------------- 0	27,830 ------------- 0	621,325 ------------- 0	0 ------------- 0
7Thomas Schiller MD Chief Clinical Integration Officer	(i) (ii)	371,178 ------------- 0	62,111 ------------- 0	58,517 ------------- 0	74,006 ------------- 0	37,217 ------------- 0	603,029 ------------- 0	0 ------------- 0
8Michael Polizzotto MD Chief Medical Officer/CMIO	(i) (ii)	301,188 ------------- 0	17,221 ------------- 0	23,458 ------------- 0	21,625 ------------- 0	34,967 ------------- 0	398,459 ------------- 0	0 ------------- 0
9Ann Gantzer MD Chief Nursing Officer	(i) (ii)	274,627 ------------- 0	42,090 ------------- 0	25,076 ------------- 0	41,091 ------------- 0	40,203 ------------- 0	423,087 ------------- 0	0 ------------- 0
10Gayatri Sonti DO Physician	(i) (ii)	747,885 ------------- 0	0 ------------- 0	0 ------------- 0	6,895 ------------- 0	23,671 ------------- 0	778,451 ------------- 0	0 ------------- 0
11Martin Gryfinski MD Physician	(i) (ii)	698,092 ------------- 0	0 ------------- 0	0 ------------- 0	9,720 ------------- 0	19,052 ------------- 0	726,864 ------------- 0	0 ------------- 0
12Mohamed Zeater MD Physician	(i) (ii)	896,332 ------------- 0	0 ------------- 0	0 ------------- 0	13,500 ------------- 0	47,954 ------------- 0	957,786 ------------- 0	0 ------------- 0
13Tarek Harb MD Physician	(i) (ii)	628,015 ------------- 0	0 ------------- 0	0 ------------- 0	12,420 ------------- 0	34,275 ------------- 0	674,710 ------------- 0	0 ------------- 0
14Steven Milos MD Physician	(i) (ii)	680,621 ------------- 0	0 ------------- 0	0 ------------- 0	17,332 ------------- 0	43,633 ------------- 0	741,586 ------------- 0	0 ------------- 0
15William R Gorski MD Former President & CEO	(i) (ii)	469,388 ------------- 0	188,137 ------------- 0	565,412 ------------- 0	26,100 ------------- 0	12,337 ------------- 0	1,261,374 ------------- 0	454,953 ------------- 0
16Donald Haring Former Chief Financial Officer	(i) (ii)	0 ------------- 0	20,892 ------------- 0	179,441 ------------- 0	0 ------------- 0	0 ------------- 0	200,333 ------------- 0	167,484 ------------- 0
17Richard Walsh Former Chief Operating Officer	(i) (ii)	0 ------------- 0	20,892 ------------- 0	172,788 ------------- 0	0 ------------- 0	0 ------------- 0	193,680 ------------- 0	160,831 ------------- 0

Schedule J (Form 990) 2019

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	All compensation is determined by the Executive Compensation Committee of SwedishAmerican Health System Corporation and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President & CEO and other Officers, SwedishAmerican Health System Corporation follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by SwedishAmerican Health System Corporation's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes.
Part I, Line 4b	Contributions to the 457(f) plan during 2017 include: Michael Born M.D. - $42,876; Donald Daniels - $42,427; Patricia DeWane - $30,827; Thomas Schiller, M.D. - $34,406; Ann Gantzer $23,884; Michael Polizzotto M.D. $11,905. Payments from the 457(f) plan during 2017 include: William Gorski, M.D. - $454,953; Rich Walsh - $160,831 and Donald Haring - $167,484. These payments are reported as taxable income on Part II, column (B)(iii).
Part I, Line 7	SwedishAmerican Hospital has a formal plan for short-term incentives and bonuses. The incentives are paid based on a combination of both individual goal achievement and corporate goal achievement (i.e. the Pillar goals). The Executive Compensation Committee, comprised of Board members, has discretion to approve the incentives and bonuses.
Part II, Column F	The amounts shown in column F were reported as deferred compensation in prior years but paid out in the current year. The amounts are also included in column B(iii).

Schedule J (Form 990) 2019

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SwedishAmerican Hospital

Employer identification number
36-2222696

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Illinois Finance Authority - 2012	86-1091967	45203HLW0	09-27-2012	41,833,485	See Part IV		X		X		X
B	Illinois Finance Authority - 2015	86-1091967	45203HY89	03-27-2015	76,980,000	See Part IV		X		X		X
C	Illinois Finance Authority - 2010A	86-1091967		10-11-2016	8,820,000	See Part IV		X		X		X
D	Illinios Finance Authority - 2010B	86-1091967		10-26-2016	8,370,000	See Part IV		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................			9,840,000		1,260,000		930,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	41,888,629		76,980,000		8,820,000		8,370,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	648,001
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	41,240,628
11 Other spent proceeds .............			76,980,000		8,820,000		8,370,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2007		2010		2010
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........		X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X	X		X		X
c No rebate due? .........	X			X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

Date Rebate Computation Performed

Issuer Name: Illinois Finance Authority - 2012 Date the Rebate Computation was Performed: 09/27/2017

Part I, column (f):

2012 Bond: Construction & Equipment Regional Cancer Center The arbitrage rebate computation was performed on September 27, 2017. 2015 Bond: Construction & Equipment Cardiac pavilion, renovate operating room & catheterization lab completed in 2007. The bond was remarketed on 3/27/15. 2010A and 2010B Bonds: Original bond issue in 2005 for Construction & Equipment Cardiac pavilion, renovation of operating room & catheterization lab completed in 2007. Bond was re-issued in 2010 as a direct bank placement, and reissued in 2016.

Schedule K (Form 990) 2019

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the 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) 2019

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) Andrea Fulcomer	See Part V	58,873	See Part V		No

Part V

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

Return Reference	Explanation
Sch L, Part IV, Business Transactions Involving Interested Persons:	(b) Relationship Between Interested Person and Organization:Spouse of trustee Eric Fulcomer(d) Description of Transaction: Compensation

Schedule L (Form 990 or 990-EZ) 2019

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

Return Reference	Explanation
Form 990, Part VI, Section A, line 2	Michael Broski, Jeffrey Hultman and Frank Walter have a business relationship.
Form 990, Part VI, Section A, line 6	SwedishAmerican Health System Corporation (SAHSC) is the sole corporate member of SwedishAmerican Hospital.
Form 990, Part VI, Section A, line 7a	SwedishAmerican Health System Corporation is the sole corporate member of SwedishAmerican Hospital and as such appoints all trustees.
Form 990, Part VI, Section A, line 7b	SAHSC shall have powers and voting rights to do the following: (a) Appoint all the Trustees of the Hospital. (b) Elect the President and Chief Executive Officer of SAHSC, who shall automatically become the Hospital's President and Chief Executive Officer (this officer is sometimes also referred to in these Bylaws as the "President"). (c) Approve expressly all amendments to the Hospital's Articles of Incorporation and Bylaws. (d) Approve annual budgets, and strategic, long-range and health manpower development plans of the Hospital. (e) Approve all contracts of indebtedness that exceed One Million Dollars ($1,000,000.00) in principal amount or that are effective for longer than sixty (60) months. "Contracts of Indebtedness" shall mean notes, bonds or other written evidences of borrowings. (f) Approve all plans of merger or consolidation of the Hospital; or the sale, lease, exchange, mortgage, pledge or other disposition of all or substantially all, the property and assets of the Hospital; or a voluntary dissolution of the Hospital. (g) Require the Hospital's Board of Trustees to take any action (including amending the Hospital's Articles of Incorporation or Bylaws), or to modify or rescind an action already taken, if either the Hospital or SAHSC receives notification from a federal agency that failure to take the action, or to modify or rescind an action already taken, may result in the Hospital's failure to obtain or maintain its exemption as an organization described m Section 501(c)(3) of the Code; provided, however, that: (i) SAHSC shall exercise this authority only to the extent necessary to eliminate the basis for the federal agency's position and only after the Hospital and/ or SAHSC have exhausted other alternative means available to each of them to address the matter (to the extent the exhaustion of such other alternatives will not, through lapse of time or otherwise, cause the Hospital not to obtain or maintain its federal tax exemption); and (ii) in the event SAHSC is required to exercise this authority, prior to or as soon as possible thereafter, the Hospital's Board of Trustees and SAHSC jointly shall use their best efforts to develop a mutually acceptable plan of action to appropriately address the objections of the Hospital's Board of Trustees, if any, to the actions of SAHSC.
Form 990, Part VI, Section B, line 11b	A draft version of the Form 990 was reviewed by Legal Counsel and the Chief Financial Officer. Subsequently, the Audit/Compliance Committee of the Board of Directors of SwedishAmerican Health System reviewed a final draft of the Form 990 and were provided with the opportunity to comment and ask questions. The entire Board of Trustees were provided with a copy of the Form 990 before it was filed.
Form 990, Part VI, Section B, line 12c	The organization regularly and consistently monitors and enforces compliance with its conflict of interest policies, which apply to all members of the Board of Trustees and to all employees. Procedures are in place to identify conflicts of both trustees and employees. Trustee conflicts are handled by Board deliberation and Board vote from which the interested director is excluded. Employee conflicts are handled by the compliance department and in certain instances may require separate Board action. The Board is provided with periodic compliance reports regarding conflicts of interest.
Form 990, Part VI, Section B, line 15	All compensation is determined by the Executive Compensation Committee of SwedishAmerican Health System Corporation and is paid by SwedishAmerican Hospital. All compensation decisions are made by independent persons. With respect to the President & CEO and other Officers, SwedishAmerican Health System Corporation follows a compensation approval procedure annually that involves approval of proposed and final compensation arrangements by SwedishAmerican Health System Corporation's Executive Compensation Committee using comparability data, as well as contemporaneous documentation of compensation decisions in the minutes.
Form 990, Part VI, Section C, line 19	The governing documents, conflict of interest policy and financial statements have not been previously made available to the public. The consolidated audited financial statements of SwedishAmerican Hospital are available from the Illinois Attorney General Website and from the U.S. Securities and Exchange Commission electronic municipal market access system through MSRB.org.
Form 990, Part XI, line 9:	Interest in SwedishAmerican Foundation 1,331,846. Joint Ventures Book/Tax Difference 416,013. Transfer from SwedishAmerican Foundation -1,980,078.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SwedishAmerican Hospital

Employer identification number

36-2222696

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)University of WI Hospital and Clinics Authority 600 Highland Avenue Madison,WI53792 39-1835630	Hospital and Clinics	WI	501(c)(3)	Line 6	N/A		No
(2)University of WI Medical Foundation 600 Highland Avenue Madison,WI53792 39-1824445	Physician Services	WI	501(c)(3)	Line 10	University of WI Hospital and Clinics Authority		No
(3)Regional Division Inc 301 South Westfield Road Suite 320 Madison,WI53717 39-1446049	Regional Parent Corp. to manage and direct activities of entities	WI	501(c)(3)	Line 12a	University of WI Hospital and Clinics Authority		No
(4)University Health Care Inc 301 South Westfield Road Suite 320 Madison,WI53717 47-2553196	Support Organization	WI	501(c)(3)	Line 12a	University of WI Hospital and Clinics Authority		No
(5)SwedishAmerican Health System Corporation 1401 East State Street Rockford,IL61104 36-3241458	Parent Corporation to manage and direct activites of entities	IL	501(c)(3)	Line 12a	Regional Division Inc		No
(6)SwedishAmerican Foundation 1415 East State Street Rockford,IL61104 36-3097493	Supports fundraising for SwedishAmerican Hospital	IL	501(c)(3)	Line 7	SwedishAmerican Hospital	Yes
(7)SwedishAmerican Realty Corporation 1313 East State Street Rockford,IL61104 36-3248013	Title Holding Company	IL	501(c)(2)		SwedishAmerican Health System Corporation	Yes
(8)SwedishAmerican Hospital Self Insurance Trust 1401 East State Street Rockford,IL61104 36-6652702	Hospital Malpractice Trust	IL	501(c)(3)	Line 12a	SwedishAmerican Hospital	Yes
(9)Wisconsin Therapies Inc 600 Highland Avenue Madison,WI53792 39-1807425	Infusion Therapy	WI	501(c)(3)	Line 12d	University of WI Hospital and Clinics Authority		No
(10)Generations Fertility Care 2365 Deming Way Middleton,WI53562 27-3496527	Reproductive endocrinology and infertility services	WI	501(c)(3)	Line 10	N/A		No
(11)Wisconsin Dialysis 3034 Fish Hatchery Road Fitchburg,WI53713 30-0072647	Dialysis Services	WI	501(c)(3)	Line 12c	N/A		No
(12)Madison Surgery Center 7974 UW Health Court Middleton,WI53562 39-1940656	Health care services and training	WI	501(c)(3)	Line 10	N/A		No
(13)UW Health ACO Inc 7974 UW Health Court Middleton,WI53562 45-5490584	Accountable Care Organization	WI	501(c)(3)	Line 10	University of WI Hospital and Clinics Authority		No
(14)Gundersen Health Plan Minnesota Inc 3190 Gundersen Drive Onalaska,WI54650 45-2633920	Health Insurance	MN	501(c)(4)		Gundersen Health Plan Inc		No
(15)Gundersen Health Plan Inc 3190 Gundersen Drive Onalaska,WI54650 39-1807071	Health Insurance	WI	501(c)(4)		University Health Care Inc		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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?		(k) Percentage ownership
(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) Three Rivers Partners LLC 1313 East State Street Rockford,IL61104 26-2231757	Information Technology Services	IL	N/A	N/A				No			No
(2) Northern Illinois Vein Clinic 2550 Charles Street Rockford,IL61108 20-1642329	Outpatient Health Services	IL	N/A	RELATED	30,708	129,474		No		Yes		50.000 %
(3) Chartwell Wisconsin Enterprises LLC 2241 Pinehurst Drive Middleton,WI53562 39-1796267	Parent entity of CMW and CMW-HR	WI	N/A	N/A				No			No
(4) Madison Medical Center LLP 7974 UW Health Court Middleton,WI53562 39-1329429	Real Estate	WI	N/A	N/A				No			No
(5) Sixth Street Medical LLC 7974 UW Health Court Middleton,WI53562 47-2705724	Real Estate	WI	N/A	N/A				No			No

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) SARI Insurance Company 76 St Paul Street Suite 500 Burlington,VT054014477 03-0308753	Captive Insurance Company	VT	N/A	C			Yes
(2) State & Charles Inc 1313 East State Street Rockford,IL61104 36-3321193	Holding Company	IL	N/A	C			Yes
(3) SwedishAmerican Health Management Corp 1401 East State Street Rockford,IL61104 36-3246511	Management Services	IL	N/A	C			Yes
(4) Unity Health Plans Insurance Corporation 840 Carolina Street Sauk City,WI53583 39-1450766	Health Maintenance Organization	WI	N/A	C				No
(5) Health Professionals of Wisconsin 301 South Westfield Road Madison,WI53717 39-1806711	Real Estate	WI	N/A	C				No
(6) Physician's Care Network 1313 East State Street Rockford,IL61104 36-3455791	Health Services	IL	N/A	C			Yes
(7) Quartz Holding Company 840 Carolina Street Sauk City,WI53583 82-1728929	Holding Company	WI	N/A	C				No
(8) Quartz Health Solutions 840 Carolina Street Sauk City,WI53583 46-5710709	Insurance	WI	N/A	C				No
(9) Physicians Plus Insurance Corporation 840 Carolina Street Sauk City,WI53583 39-1565691	Health Maintenance Organization	WI	N/A	C				No
(10) One South Park Parking Condominium Association Inc 1 South Park Street Madison,WI53701	Condominium Association	WI	N/A	C				No
(11) Charitable Remainder Unitrusts (3)	Trust	IL	N/A	T			Yes

Schedule R (Form 990) 2019

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) ............................

Yes

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) .......................

Yes

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 ............................

Yes

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

Yes

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) SwedishAmerican Foundation	C	1,980,078	Cost
(2) SwedishAmerican Hospital Self Insurance Trust	Q	419,090	Cost
(3) SwedishAmerican Hospital Self Insurance Trust	R	5,747,941	Cost
(4) SwedishAmerican Realty Corporation	K	6,693,343	Cost
(5) Three Rivers Partners LLC	J	335,133	Cost
(6) University of WI Medical Foundation	P	3,608,186	Cost
(7) University of WI Hospital and Clinics	P	7,067,218	Cost
(8) Regional Division Inc	K	240,995	Cost
(9) Regional Division Inc	Q	1,366,421	Cost
(10) Regional Division Inc	P	446,537	Cost

Schedule R (Form 990) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Through excellence in healthcare and compassionate service, we care for our community.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	26
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	3,812
6	Total number of volunteers (estimate if necessary) .............	6	255
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	704,574
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	142,116

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,007,157	2,144,230
9	Program service revenue (Part VIII, line 2g) .........	531,739,773	568,533,203
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,580,265	24,722,822
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,410,324	5,695,329
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	547,737,519	601,095,584
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	411,503	607,793
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)	254,810,198	270,353,842
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)....	272,348,315	277,697,760
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	527,570,016	548,659,395
19	Revenue less expenses. Subtract line 18 from line 12.......	20,167,503	52,436,189
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	708,282,537	757,629,414
21	Total liabilities (Part X, line 26).............	250,827,806	268,695,782
22	Net assets or fund balances. Subtract line 21 from line 20.....	457,454,731	488,933,632

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 330,063,268 including grants of $ 607,793 ) (Revenue $ 430,792,723 )
	SwedishAmerican Hospital (SAH) operates two full service acute care hospitals with a combined total of 367 licensed beds serving the greater Rockford region, Northern Illinois and Southern Wisconsin. Our vision is to develop a fully integrated healthcare delivery network that will continuously set the standard for quality care and service, accept responsibility for building a healthier population, provide regional access, improve resource utilization through collaboration with key stakeholders, and manage patient care and our resources in such a way that we create value for our patients and benefit for our community. During 2018, we cared for 15,581 inpatients and performed 789,226 outpatient procedures. This includes 84,207 emergency room visits and 1,622 deliveries. We sponsor the University of Illinois - College of Medicine Program and provided $5.6 million in education for primary care residents. Our employees and volunteers provided over 26,000 hours in unpaid community services. SwedishAmerican recognizes its responsibility to all the people of our community, regardless of their ability to pay for care.

4b	(Code: ) (Expenses $ 97,827,984 including grants of $ ) (Revenue $ 82,093,498 )
	SwedishAmerican Hospital employs primary care and specialty physicians who practice at 34 locations throughout our service area. We employ specialists in orthopedics, cardiology, cardiothoracic surgery, endocrinology, allergy, neurology, neurosurgery, pulmonology/critical care, hematology/oncology, obstetrics and gynecology, maternal fetal medicine, rheumatology, psychiatry, podiatry, otolaryngology, as well as internal medicine, family practice, immediate care and pediatric physicians. During 2018, our physician encounters were 409,747.

4c	(Code: ) (Expenses $ 38,199,358 including grants of $ ) (Revenue $ 53,644,566 )
	SwedishAmerican Regional Cancer Center opened to the public in October 2013 and has been providing leading edge cancer care treatment for the Rock River Valley. The center is part of a collaborative with UW Health and its nationally recognized University of Wisconsin Carbone Cancer Center. The two-story facility offers radiation therapy, medical oncology, chemotherapy and infusion services. Patients have access to clinical trials, state-of-the-art linear acceleratory treatments such as IGRT, IMRT, Rapid Arc, OBI and stereotactic services, and advanced medical imaging. The Regional Cancer Center is staffed by medical and radiation oncologists, physicists, dosimetrists, radiation therapists and nurses. During 2018, our out-patient encounters were over 22,867.

	(Code: ) (Expenses $ 7,802,644 including grants of $ ) (Revenue $ 6,924,642 )
	SwedishAmerican Home Health Care is a quality leader in providing individualized care in patients' homes. Working in partnership with a patient's doctor, our certified, trained staff provides a wide range of services and specializes in helping patients to remain independent and comfortable. Our experienced caregivers include registered nurses; certified nursing assistants, dietitians; physical, occupational and speech therapists; and medical social workers. RNs provide assessments, treatments and medication administration. Our therapists provide assessments and treatments. Medical social workers assist with assessments, counseling and helping patients and their families' access available community resources. SNAs provide baths and personal grooming. Our staff has the credentials and advanced training needed to assure that patients receive the highest quality of care possible. During 2018, we recorded 27,382 visits.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 7,802,644 including grants of $ ) (Revenue $ 6,924,642 )
4e	Total program service expenses473,893,254

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,375,272	1,068,161	1,010,978

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,980,078
e	Government grants (contributions)		1e	142,976

f	All other contributions, gifts, grants, and similar amounts not included above		1f	21,176

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,144,230

		Business Code
2a	Patient Services	621990	340,503,590	340,503,590
b	Medicare/Medicaid	621990	226,214,256	226,214,256
c
d
e
f	All other program service revenue.		1,815,357	1,815,357
g	Total. Add lines 2a–2f .....		568,533,203

3 Investment income (including dividends, interest, and othersimilar amounts) ......			8,017,361			8,017,361
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		37,232	6a
b	Less: rental expenses		46,053	6b
c	Rental income or (loss)		-8,821	6c
d	Net rental income or (loss).......			-8,821			-8,821
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	561,210	160,064,576	7a
b	Less: cost or other basis and sales expenses	675,482	143,244,843	7b
c	Gain or (loss)	-114,272	16,819,733	7c
d	Net gain or (loss).........			16,705,461			16,705,461
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Day Care Center		624410	1,628,611	1,628,611
b	Cafeteria & Vending		561000	1,443,600	1,434,055	9,545
c	Interdept. Billing		561000	1,370,711	1,370,711
d	All other revenue ....			1,261,228	488,849	695,029	77,350
e	Total. Add lines 11a–11d ......			5,704,150
12	Total revenue. See instructions.....			601,095,584	573,455,429	704,574	24,791,351

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	593,793	593,793
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	14,000	14,000
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	7,029,941	1,660,048	5,369,893
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	915,614		915,614
7	Other salaries and wages........	204,280,154	177,665,506	26,614,648
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,570,372	8,683,009	887,363
9	Other employee benefits .......	34,612,198	33,250,258	1,361,940
10	Payroll taxes ...........	13,945,563	12,010,930	1,934,633
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,301,943		1,301,943
c	Accounting ...........	196,608		196,608
d	Lobbying ...........	110,492		110,492
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	540,461		540,461
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	41,370,980	34,420,572	6,950,408
12	Advertising and promotion ....	2,583,270	50,427	2,532,843
13	Office expenses .......	9,139,960	5,193,488	3,946,472
14	Information technology ......	7,864,470	6,564,182	1,300,288
15	Royalties ..
16	Occupancy ...........	17,434,468	12,965,420	4,469,048
17	Travel ............	256,710	221,764	34,946
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	483,715	289,073	194,642
20	Interest ...........	2,967,722	1,182,711	1,785,011
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	20,951,272	18,806,509	2,144,763
23	Insurance ...	5,531,637	2,437,239	3,094,398
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	Patient Supplies	93,366,152	92,061,016	1,305,136
b	Bad Debts	44,107,529	44,107,529
c	IPA Provider Tax	13,252,034	13,252,034
d	Repairs & Maintenence	8,637,160	6,537,558	2,099,602
e	All other expenses	7,601,177	1,926,188	5,674,989
25	Total functional expenses. Add lines 1 through 24e	548,659,395	473,893,254	74,766,141	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 ........				1
2	Savings and temporary cash investments .........			26,964,223	2	62,095,370
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			78,044,560	4	64,618,929
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			10,019,994	8	9,792,168
9	Prepaid expenses and deferred charges ......			11,706,843	9	9,897,020
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	380,743,391
b	Less: accumulated depreciation	10b	77,592,823	292,423,437	10c	303,150,568
11	Investments—publicly traded securities .			249,998,752	11	18,472,301
12	Investments—other securities. See Part IV, line 11 .....				12	241,728,295
13	Investments—program-related. See Part IV, line 11 ..			4,348,125	13	5,073,057
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			34,776,603	15	42,801,706
16	Total assets. Add lines 1 through 15 (must equal line 33)...			708,282,537	16	757,629,414

17	Accounts payable and accrued expenses .....	50,562,141	17	57,593,601
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	123,122,852	20	118,346,780
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
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	77,142,813	25	92,755,401
26	Total liabilities. Add lines 17 through 25..	250,827,806	26	268,695,782

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	457,454,731	32	488,933,632
33	Total liabilities and net assets/fund balances ........	708,282,537	33	757,629,414