Form990
Click to see attachment
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Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 07-01-2021 , and ending 06-30-2022
BCheck if applicable:
CName of organization
SwedishAmerican Hospital
 
 
Doing business as
UW Health
 
Number and street (or P.O. box if mail is not delivered to street address)
1401 E State Street
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Rockford, IL61104
D Employer identification number

36-2222696
E Telephone number

G Gross receipts $ 786,993,926
F Name and address of principal officer:
Travis Andersen
1313 East State Street
Rockford,IL61104
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.uwhealth.org/locations/swedishamerican
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1911
M State of legal domicile: IL
Part I
Summary
Activities  & Governance 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 MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 4,540
6 Total number of volunteers (estimate if necessary) ............. 6 23
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 124,713
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 19,533
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 27,684,305 8,416,264
9 Program service revenue (Part VIII, line 2g) ......... 669,493,409 749,696,911
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 11,777,915 13,008,090
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 5,886,381 7,131,450
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 714,842,010 778,252,715
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 225,000 200,000
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) 337,153,103 374,473,625
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 348,813,587 374,927,022
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 686,191,690 749,600,647
19 Revenue less expenses. Subtract line 18 from line 12....... 28,650,320 28,652,068
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,121,572,006 1,043,826,863
21 Total liabilities (Part X, line 26)............. 515,582,906 467,656,393
22 Net assets or fund balances. Subtract line 21 from line 20..... 605,989,100 576,170,470
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
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Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: Through excellence in healthcare and compassionate service, we care for our community.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 405,254,297 including grants of $ 200,000 ) (Revenue $ 567,180,077 )
SwedishAmerican Hospital (SAH) operates two full service acute care hospitals with a combined total of 339 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 2022, we cared for 19,627 inpatients and performed 1,439,107 outpatient procedures. This includes 73,754 emergency room visits and 2,936 deliveries. We sponsor the University of Illinois - College of Medicine Program and provided $5.5 million in education for primary care residents. Our employees and volunteers provided near 2,900 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 $ 127,673,963 including grants of $ 0 ) (Revenue $ 99,434,244 )
SwedishAmerican Hospital employs primary care and specialty physicians who practice at 42 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 2022, our physician encounters were 507,110.
4c (Code:   ) (Expenses $ 53,959,686 including grants of $ 0 ) (Revenue $ 83,795,264 )
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 2022, our out-patient encounters were over 27,000.
(Code:   ) (Expenses $ 5,533,261 including grants of $ 0 ) (Revenue $ 4,648,693 )
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 and patient education/teaching. Our therapists provide assessments and treatments. Medical social workers assist with assessments, counseling and helping patients and their families' access available community resources. CNAs 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 2022, we recorded 14,109 visits.
4d Other program services (Describe in Schedule O.)
(Expenses $ 5,533,261 including grants of $ 0 ) (Revenue $ 4,648,693 )
4e Total program service expensesMediumBullet592,421,207
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
Click to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I .... Click to see attachment
25a
Yes
 
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................Click to see attachment
25b
Yes
 
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part IIClick to see attachment...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part IIIClick to see attachment.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................Click to see attachment
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
Yes
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
254
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
4,540
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
19
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletPatricia DeWane1313 East State Street   Rockford,IL61104 (779) 696-4727
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Elizabeth Bolt......................................................................
Trustee
2.00
.................
55.00
X           0 1,351,385 199,872
(2) Peter D Newcomer MD MMM......................................................................
Trustee
2.00
.................
55.00
X           0 947,971 175,206
(3) Thomas O'Connor......................................................................
President & CEO (until 10/15/21)
40.00
.................
6.00
X   X       950,597 0 36,304
(4) William Cunningham MD......................................................................
Medical Staff President
40.00
.................
0.00
X           650,086 0 62,086
(5) Allen D Williams MD......................................................................
Trustee
40.00
.................
6.00
X           298,360 0 58,811
(6) Tiffanie Ferry MD......................................................................
Trustee
40.00
.................
6.00
X           229,402 0 54,087
(7) Travis Andersen......................................................................
President & CEO (as of 10/15/21)
40.00
.................
8.00
X   X       243,788 0 0
(8) Jeffrey J Kaney Sr......................................................................
Chairman of the Board
2.00
.................
8.00
X   X       0 0 0
(9) Daniel T Ross......................................................................
1st Vice Chairman/Secretary
2.00
.................
8.00
X   X       0 0 0
(10) Eric Fulcomer PhD......................................................................
2nd Vice Chairman/Asst. Secretary
2.00
.................
6.00
X   X       0 0 0
(11) Thomas R Walsh......................................................................
Audit/Compliance Chairman
2.00
.................
8.00
X           0 0 0
(12) Patrick Derry......................................................................
Quality and Safety Chairman
2.00
.................
6.00
X           0 0 0
(13) Marco Lenis......................................................................
HR Committee Chairman
2.00
.................
6.00
X           0 0 0
(14) Amy J Wilcox......................................................................
Trustee (until 10/1/21)
2.00
.................
4.00
X           0 0 0
(15) Anqunette Parham......................................................................
Trustee
2.00
.................
6.00
X           0 0 0
(16) Frank E Walter......................................................................
Trustee
2.00
.................
8.00
X           0 0 0
(17) Helen Chung Hill......................................................................
Trustee
2.00
.................
6.00
X           0 0 0
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Jeffrey S Hultman........................................................................
Trustee
2.00
.......................6.00
X           0 0 0
(19) Kathleen Kelly MD........................................................................
Trustee
2.00
.......................6.00
X           0 0 0
(20) Michael K Broski........................................................................
Trustee
2.00
.......................6.00
X           0 0 0
(21) Steven C Sjogren........................................................................
Trustee
2.00
.......................8.00
X           0 0 0
(22) Michael Polizzotto MD........................................................................
CMO/CMIO (until 12/31/21)
40.00
.......................6.00
    X       574,249 0 85,225
(23) Patricia DeWane........................................................................
VP, CFO, & Treasurer
40.00
.......................8.00
    X       586,379 0 68,193
(24) Timothy Flynn MD........................................................................
President, SA Medical Group
40.00
.......................6.00
    X       533,112 0 96,607
(25) Julia Zimmerman........................................................................
VP Strategic Growth
40.00
.......................6.00
    X       519,241 0 84,826
(26) Ann Gantzer MD........................................................................
VP Patient Services/CNO
40.00
.......................6.00
    X       498,796 0 91,164
(27) Jedediah Cantrell........................................................................
VP Operations (until 3/18/22)
40.00
.......................8.00
    X       370,188 0 75,154
(28) Celia Shaughnessy........................................................................
VP Human Resources (until 3/31/22)
40.00
.......................6.00
    X       228,500 0 0
(29) Sal Ababneh........................................................................
COO & President of UWNI Hospitals
40.00
.......................6.00
    X       0 0 0
(30) Rosa Jeschke........................................................................
VP Human Resources (as of 4/4/22)
40.00
.......................6.00
    X       0 0 0
(31) James Cole DO........................................................................
VP Medical Affairs/CMO(as of 1/1/22)
40.00
.......................6.00
    X       0 387,488 43,563
(32) Jateen Patel MD........................................................................
Physician
40.00
.......................0.00
        X   1,152,492 0 27,127
(33) Mohamed Zeater MD........................................................................
Physician
40.00
.......................0.00
        X   952,355 0 53,793
(34) Ben Durkee MD........................................................................
Physician
40.00
.......................0.00
        X   822,686 0 62,916
(35) Tarek Harb MD........................................................................
Physician
40.00
.......................0.00
        X   786,360 0 57,438
(36) Yaser Siraj MD........................................................................
Physician
40.00
.......................0.00
        X   795,989 0 26,403
(37) Don F Daniels........................................................................
Former VP & COO
0.00
.......................0.00
          X 1,005,768 0 16,983
(38) Michael J Born MD........................................................................
Former President & CEO
0.00
.......................0.00
          X 526,651 0 0
(39) Gerard Guinane........................................................................
Former VP Human Resources
0.00
.......................0.00
          X 401,354 0 25,246
(40) Thomas Schiller MD........................................................................
Former Chief Clinical Integ. Officer
0.00
.......................0.00
          X 332,510 0 117,634
(41) Noel Nickel........................................................................
Former VP Strategy & BusDev
0.00
.......................0.00
          X 120,571 0 23,296
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 12,579,434 2,686,844 1,541,934
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet561
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
Ringland Johnson Construction

1725 Huntwood Drive
Cherry Valley,IL61016
Construction Services 14,066,332
Sound Physicians of Illinois

401 S Lasalle Street
Chicago,IL60605
Physician Services 5,817,536
University of Illinois

28394 Network Place
Chicago,IL60673
Physician Services 4,286,240
Rockford Anesthesiologists

2202 Harlem Road
Loves Park,IL61111
Physician Services 4,240,723
BRG Prism Healthcare

2200 Powell St
Everyville,CA94608
Consulting 3,127,230
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet82
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 338,445
e Government grants (contributions)1e 8,047,776
f All other contributions, gifts, grants, and similar amounts not included above1f 30,043
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 8,416,264
 Program Service RevenueAmt Business Code
2a Patient Services 621990 489,523,872 489,523,872    
b Medicare/Medicaid 621990 259,236,710 259,236,710    
c
d
e
f All other program service revenue. 936,329 936,329    
g Total. Add lines 2a–2f .....MediumBullet 749,696,911
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 8,763,588     8,763,588
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   10,995 6a
b Less: rental expenses   62,476 6b
c Rental income or (loss)   -51,481 6c
d Net rental income or (loss).......MediumBullet -51,481     -51,481
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 157,260 12,765,977 7a
b Less: cost or other basis and sales expenses 112,412 8,566,323 7b
c Gain or (loss) 44,848 4,199,654 7c
d Net gain or (loss).........MediumBullet 4,244,502     4,244,502
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..MediumBullet      
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..MediumBullet        
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..MediumBullet        
Business Code Miscellaneous Revenue
11a Day Care Center 624410 1,696,851     1,696,851
b Interdept. Billing 561000 1,528,165 1,528,165    
c Cafeteria & Vending 722514 1,391,440 1,382,292 9,148  
d All other revenue .... 2,566,475 2,450,910 115,565  
e Total. Add lines 11a–11d ...... MediumBullet 7,182,931
12 Total revenue. See instructions.....MediumBullet 778,252,715 755,058,278 124,713 14,653,460
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 200,000 200,000
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
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 ........... 9,097,814 1,589,299 7,508,515  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 366,126 183,063 183,063  
7 Other salaries and wages........ 284,112,384 244,901,694 39,210,690  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 12,820,478 2,033,831 10,786,647  
9 Other employee benefits ....... 48,858,843 5,074,792 43,784,051  
10 Payroll taxes ........... 19,217,980 16,602,585 2,615,395  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 397,091   397,091  
c Accounting ........... 236,250   236,250  
d Lobbying ........... 128,238   128,238  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 729,935   729,935  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 74,641,227 64,055,097 10,586,130  
12 Advertising and promotion .... 2,791,599 46,115 2,745,484  
13 Office expenses ....... 7,029,817 3,328,552 3,701,265  
14 Information technology ...... 8,379,900 1,834,821 6,545,079  
15 Royalties ..        
16 Occupancy ........... 17,655,576 12,759,102 4,896,474  
17 Travel ............ 276,680 134,229 142,451  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 292,573 136,497 156,076  
20 Interest ........... 4,067,241 1,167,791 2,899,450  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 27,737,821 26,413,398 1,324,423  
23 Insurance ... 12,735,983 3,237,027 9,498,956  
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 146,987,298 145,886,737 1,100,561  
b Bad Debts 22,985,125 22,985,125    
c IPA Provider Tax 21,884,243 21,884,243    
d UBI Tax Expense 24,553   24,553  
e All other expenses 25,945,872 17,967,209 7,978,663  
25 Total functional expenses. Add lines 1 through 24e 749,600,647 592,421,207 157,179,440 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1  
2 Savings and temporary cash investments ......... 170,934,753 2 135,092,845
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 77,164,818 4 75,566,897
5 Loans and other receivables from 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 ............ 11,654,942 8 12,101,611
9 Prepaid expenses and deferred charges ...... 10,534,985 9 12,995,702
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 577,126,431
b Less: accumulated depreciation 10b 172,666,893 408,647,295 10c 404,459,538
11 Investments—publicly traded securities . 23,928,605 11 15,273,415
12 Investments—other securities. See Part IV, line 11 ..... 323,188,412 12 301,838,368
13 Investments—program-related. See Part IV, line 11 .. 4,784,279 13 5,095,127
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 90,733,917 15 81,403,360
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,121,572,006 16 1,043,826,863
Liabilities 17 Accounts payable and accrued expenses ..... 108,257,550 17 114,792,710
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 236,581,937 20 233,621,324
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 170,743,419 25 119,242,359
26 Total liabilities. Add lines 17 through 25.. 515,582,906 26 467,656,393
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 597,179,092 27 568,631,430
28 Net assets with donor restrictions ........... 8,810,008 28 7,539,040
Organizations that do not follow FASB ASC 958, check here MediumBullet 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 ........... 605,989,100 32 576,170,470
33 Total liabilities and net assets/fund balances ........ 1,121,572,006 33 1,043,826,863
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
778,252,715
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
749,600,647
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
28,652,068
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
605,989,100
5
Net unrealized gains (losses) on investments ...............
5
-56,168,380
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-2,302,318
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
576,170,470
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2021

Schedule A (Form 990) 2021
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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (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 on 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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
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.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on 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.
9c
 
 
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
 
 
b
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) 2021

Schedule A (Form 990) 2021
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described on line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 0.015 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 0.035 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  
7
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI
). See instructions
8  
9 Distributable amount for 2021 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2021
(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2021:
a From 2016.......  
b From 2017.......  
c From 2018.......  
d From 2019.......  
e From 2020.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2021 distributable amount  
i Carryover from 2016 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2021 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2021 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2021, 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 2021. 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 2022. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2017.....  
b Excess from 2018.....  
c Excess from 2019.....  
d Excess from 2020.....  
e Excess from 2021.....  
Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021
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) 2021


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
SwedishAmerican Hospital
 
Employer identification number

36-2222696
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... 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) (2021)
Schedule B (Form 990) (2021) Page 2
Name of organization
SwedishAmerican Hospital
 
Employer identification number
36-2222696
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
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
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) (2021)
Schedule B (Form 990) (2021)
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2021)
Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990)

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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(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? ...................................................................................................................

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) 2018 (b) 2019 (c) 2020 (d) 2021 (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) 2021


Schedule C (Form 990) 2021
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
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
128,238
j
Total. Add lines 1c through 1i ....................................................................................................
128,238
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
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 2021/2022 Illinois Health and Hospital Association and American Hospital Association dues are used for lobbying: $68,238. A law firm was engaged to review legislation affecting hospitals: $60,000.
Schedule C (Form 990) 2021


Additional Data


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SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
2021
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 .... 7,855,142 6,911,513 7,189,894 7,072,405 6,676,376
b Contributions ... 10,983 8,944 10,679 12,701 90,495
c Net investment earnings, gains, and losses -1,195,892 946,640 -13,961 320,291 632,791
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
272 11,955 275,099 215,503 327,257
f Administrative expenses ....          
g End of year balance ...... 6,669,961 7,855,142 6,911,513 7,189,894 7,072,405
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet62.170 %
b
Permanent endowment SchDMd Bullet28.990 %
c
Term endowment SchDMd Bullet8.840 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
No
(ii) Related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
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 .....   9,343,856 9,343,856
b Buildings ....   379,527,668 61,588,863 317,938,805
c Leasehold improvements   22,885,056 12,756,401 10,128,655
d Equipment ....   154,744,329 93,530,289 61,214,040
e Other .....   10,625,522 4,791,340 5,834,182
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 404,459,538
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 3
Part VII
Investments - Other 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
301,838,368 F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 301,838,368
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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 18,261,897
(3)Due from Affiliated Organization 18,265,217
(4)Insurance Recoveries Recievable 29,385,560
(5)Lease Assets 15,301,418
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 81,403,360
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.)Small Bullet 119,242,359
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) 2021

Schedule D (Form 990) 2021
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 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, 2022 and 2021, 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, 2018.
Schedule D (Form 990) 2021


Additional Data


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SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2021
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
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
b
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: . . . . . . . .
3b
Yes
 
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . .
    9,112,659 0 9,112,659 1.250 %
b Medicaid (from Worksheet 3, column a) . . . . .     178,565,801 155,758,299 22,807,502 3.140 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     9,126,936 7,379,260 1,747,676 0.240 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     196,805,396 163,137,559 33,667,837 4.630 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     277,909 0 277,909 0.040 %
f Health professions education (from Worksheet 5) . . .     8,285,909 2,695,771 5,590,138 0.770 %
g Subsidized health services (from Worksheet 6) . . . .     38,270,988 7,100,605 31,170,383 4.290 %
h Research (from Worksheet 7) .     405,718 0 405,718 0.060 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     574,632 33,309 541,323 0.070 %
j Total. Other Benefits . .     47,815,156 9,829,685 37,985,471 5.230 %
k Total. Add lines 7d and 7j .     244,620,552 172,967,244 71,653,308 9.860 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
22,985,125
3
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. ......
3
0
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
73,117,469
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
84,927,107
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-11,809,638
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 SwedishAmerican Hospital dba UW Health
1401 East State Street
Rockford,IL61104
www.uwhealth.org
IL License: 0002725
X X   X   X X   n/a A
2 SwedishAmerican Medical Ctr Belvidere
1625 S State Street
Belvidere,IL61008
www.uwhealth.org
IL License: 0005504
X X         X   n/a A
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.uwhealth.org/population-health/community-health-improvement
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2021
Schedule H (Form 990) 2021
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 No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.uwhealth.org/billing-insurance
b
www.uwhealth.org/billing-insurance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 dba UW Health, - Facility 2: SwedishAmerican Medical Ctr. Belvidere
Group A-Facility 1 -- SwedishAmerican Hospital dba UW Health Part V, Section B, line 5: SwedishAmerican Hospital (SAH) and Belvidere Medical Center (SAMC) have completed this CHNA to identify community health priorities and make decisions on where to commit resources that can most effectively improve overall community health and wellness.SAH and SAMC partnered with Advis, Inc. (hereinafter Advis), a third-party healthcare consulting firm, to conduct a systematic, data-driven approach to provide a CHNA that incorporated data from both qualitative and quantitative sources. Conducting this CHNA allows SAH and SAMC to better understand the unique needs, concerns and priorities of the community it serves. To complete this CHNA, the Advis team and SwedishAmerican leadership drew upon the 2020 Healthy Community Study conducted by the Rockford Regional Health Council and internal information for primary data. Secondary data was collected from other agencies and organizations to provide insight into community health needs and priorities, challenges, resources, and potential solutions.The Rockford Regional Health Council is comprised of steering committee partners from several health and community organizations including the Boone County Health Department, Mercyhealth, OSF, SwedishAmerican Health System, Transform Rockford, United Way of Rock River Valley, University of Illinois College of Medicine Rockford, Department of Family and Community Medicine and the Division of Health Policy and Social Science Research. Data collection was gathered using surveys distributed on paper and digitally. The paper and digital versions of the survey were available in English and Spanish. Respondents included a wide cross section of residents in Boone and Winnebago counties. This cross section includes residents of units operated by the Rockford Housing Authority, Winnebago County Housing Authority and Zion Development; parents/guardians of students in the Harlem School District and Belvidere District 100; a purchased list of email and physical addresses for 13,000 residents of Boone and Winnebago Counties; clients of Crusader Clinic and Northern Illinois Food Bank; and people who learned about the survey on social media platforms.Health needs were identified across all socio-economic groups, races, ethnicities, ages and genders. Special considerations were made to ensure health disparities and the needs of medically underserved and uninsured populations were analyzed. While several health needs were identified throughout the development of this CHNA, SAH and SAMC prioritized health needs with the largest impact on the community as well as those that would be best addressed through a coordinated response from healthcare and community resources.
Group A-Facility 1 -- SwedishAmerican Hospital dba UW Health Part V, Section B, line 6a: SwedishAmerican Hospital (SAH) in Rockford, Illinois and SwedishAmerican Medical Center (SAMC) in Belvidere, Illinois collaborated for the purposes of executing the Community Health Needs Assessment. Both hospital facilities defined their communities geographically in the same way, serve the same demographic and geographic areas, work with the same community organizations and strategic partners, and in the same arenas for community benefit activities. Additionally, SAH and SAMC are part of the same legal entity, SwedishAmerican, and share a leadership team and medical staff.
Group A-Facility 1 -- SwedishAmerican Hospital dba UW Health Part V, Section B, line 11: SAH and SAMC prioritized the following significant health needs, which are a continuation of the priorities from the 2019 CHNA. Below is a list of the identified health priorities for 2022-2025 as well as some of the impacts in these areas from the 2019 CHNA implementation plan:CancerCancer remains a top health priority for SwedishAmerican as it is a leading cause of death within the SwedishAmerican community service area. The percentage of deaths caused by cancer was 18.4% in Winnebago County and 17% in Boone County.Since the 2019 CHNA, SwedishAmerican has implemented the following related to cancer care within the community:- Expanded radiation oncology procedures not yet offered to patients in the service area to include Space OAR Program.- Met patient education and perception goals for lung cancer clinical indicators.- Completed National Accreditation Program for Breast Centers (NAPBC) standards, applied for and received accreditation.- Participated in American Cancer Society "Real Men Wear Pink".- Provided keynote speaker at prostate cancer Annual Purple Tea Coalition.- Provided patient education on aromatherapy for cancer patients, benefits of oncology rehabilitation, palliative care and the anti-inflammatory benefits of spices as a part of Cancer Survivor Week.ObesityThe issues related to obesity remain two-fold: factors causing the development of obesity and the diseases that result from obesity. As determined through the 2020 Health Community Study and Survey, 12% of the survey participants were obese. Moreover, the survey included a self-assessment of the participants' weight. Across all samples, "overweight" was the most common answer given by respondents.According to the CDC, obesity is a leading cause of diabetes, hypertension, high cholesterol and heart diseases. Data gathered from the Centers for Disease Control (CDC) indicate high rates of diabetes, hypertension, high cholesterol and heart diseases in both Winnebago and Boone Counties.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Obesity within the community:- Created Employer Based Clinics (EBC) and Woodward Health Center (WHC). - Health Coaching - Walk with a coach at WHC- Referred patients to New Directions weight loss program.- Utilized Better Life Wellness (BLW) for corporate clients focused on wellness.- Offered Grocery tours with a registered dietician.- Offered HRA (health risk assessment) and wellness screenings with corporate clients (aggregate data reports include BMI (body mass index)).- Held various wellness challenges.- Prior to COVID restrictions offered Walk with a Doc.- Ensured that BMI was obtained at every patient visit.- Established questionnaire regarding activity level/exercise regimen at all wellness visits (pediatrics and adult).- Recommendations regarding lifestyle included in all assessment/plan for wellness visits (pediatrics and adult).- EMR reminders for missing cholesterol screening; we start this at age 9 years old (pediatric population) and continue through adulthood.- Partnership with Diabetes center/nutrition center for additional referrals as needed.Tobacco CessationApproximately a quarter of adults in the region are current smokers, an increase from the last time the region was surveyed, but only 3% are regular smokers (smoke every day). The rate of adults in the region who currently smoke cigarettes is higher than the state and national findings, which only shows 15% of the population being current smokers.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Tobacco Cessation within the community:- Tobacco use screening at all visits, tobacco cessation encouraged at all wellness visits.- Provider education regarding Lung Cancer Screening for tobacco use history.- Provider education regarding smoking cessation counseling.- EMR reminders regarding need for Abdominal Aortic Aneurysm screening in males' age 65+ with history of tobacco use.- EMR reminders for Pneumonia vaccine in all patients with tobacco use.- Smoking cessation program offered to EBC and BLW corporate clients.Poverty and UnemploymentApproximately 14.6% of the total Winnebago County population lives in poverty, compared to the 11% of population that live in poverty in the State of Illinois. Moreover, both Boone and Winnebago counties have a significantly higher penetration of low-income residents compared to the penetration of low-income residents across the state. Specifically, Winnebago County has a 49.5% rate of penetration of low-income residents, and Boone County has a rate of 43.7% penetration of low-income residents. Comparatively, the State of Illinois has a rate of 38.8%.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Poverty and Unemployment within the community:- Provided grants and resources to area non-profits that support unmet, basic needs in our service area such as:- $15,000.00 - Provide tutors for struggling students Pre-K to 12 in reading and math.- $17,735.00 - Counseling for those who have anxiety, depression, bullying, self-harm and suicide along with childhood trauma and abuse.- $6,265.00 - Youth weightlifting outreach which targets at-risk youth who live in poverty, have experienced trauma and struggle with social-emotional well being.- $10,000.00 - Community partnership with Rockford East High School students to provide a new construction trades program.- $10,000.00 - Project name "Happy Kids are Healthy Kids" to provide students enrolled in summer camp cooking classes that taught them about making healthier food options.- $5,000.00 - Provide 24-hour medical advocacy at hospitals in Winnebago, Boone and Ogle counties. Staff and volunteers provided support, education, referrals and/or clothes to sexual assault survivors.- $17,500.00 - Equip a home for relational mentoring with at-risk and justice involved youth, ages 15-23.- $5,000.00 - Provide field trip enrichment opportunities for inner city children ages 6-16.- $11,188.65 - Improve the social and emotional well-being of school age kids through physical activity and strength training.- $10,000.00 - Re-engage youth in outdoor activities that will improve their health and keep them safe and active. Also provides financial assistance to anyone in need that cannot afford the programs, team sports, lessons and camps.- $6,609.00 - Purchase equipment for education and employment center at homeless shelter to help the unemployed get a job.- $4,500.00 - Conduct a musical theatre to introduce children of color in poverty the skills learned from participating in musical theatre which offers future career opportunities in this field.- $12,000.00 - Further development of the Juvenile Justice Ministry program.Access to Medical CareAccess to medical care remains a challenge to the SwedishAmerican community for a wide range of reasons including transportation availability, communication barriers, clinic hours and supply and availability.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Access to Medical Care within the community:- Provided $4 million per year to the University of Illinois College of Medicine family practice residency to educate physicians.- Provided school physicals to Lincoln School (neighborhood school).- Partnered with Rockford Fire Department to provide mobile integrated health outreach to community.- Partnered with local FQHC's (federally qualified health centers) to assure access to hospital services.- Contracted with all Medicaid Managed Care organizations to assure access to our physicians and hospital for all of the Medicaid population in our service area.- Set a goal of 48% of new primary care patients seen within 10 days; currently at 45.86%.Vulnerable Populations: Hispanic/Latino PopulationThe Hispanic and Latino population was identified as particularly vulnerable within the community, and especially impacted by adverse health issues and outcomes. For example, the survey indicated that compared to some other races, Hispanics have higher incidences of high cholesterol, arthritis, obesity and liver disease. Moreover, Hispanic adults were identified as more likely to be current drinkers in the region compared to other races.See Line 11 continuted at the end of Part V.
Group A-Facility 1 -- SwedishAmerican Hospital dba UW Health 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: SwedishAmerican Hospital (SAH) and Belvidere Medical Center (SAMC) have completed this CHNA to identify community health priorities and make decisions on where to commit resources that can most effectively improve overall community health and wellness.SAH and SAMC partnered with Advis, Inc. (hereinafter Advis), a third-party healthcare consulting firm, to conduct a systematic, data-driven approach to provide a CHNA that incorporated data from both qualitative and quantitative sources. Conducting this CHNA allows SAH and SAMC to better understand the unique needs, concerns and priorities of the community it serves. To complete this CHNA, the Advis team and SwedishAmerican leadership drew upon the 2020 Healthy Community Study conducted by the Rockford Regional Health Council and internal information for primary data. Secondary data was collected from other agencies and organizations to provide insight into community health needs and priorities, challenges, resources, and potential solutions.The Rockford Regional Health Council is comprised of steering committee partners from several health and community organizations including the Boone County Health Department, Mercyhealth, OSF, SwedishAmerican Health System, Transform Rockford, United Way of Rock River Valley, University of Illinois College of Medicine Rockford, Department of Family and Community Medicine and the Division of Health Policy and Social Science Research. Data collection was gathered using surveys distributed on paper and digitally. The paper and digital versions of the survey were available in English and Spanish. Respondents included a wide cross section of residents in Boone and Winnebago counties. This cross section includes residents of units operated by the Rockford Housing Authority, Winnebago County Housing Authority and Zion Development; parents/guardians of students in the Harlem School District and Belvidere District 100; a purchased list of email and physical addresses for 13,000 residents of Boone and Winnebago Counties; clients of Crusader Clinic and Northern Illinois Food Bank; and people who learned about the survey on social media platforms.Health needs were identified across all socio-economic groups, races, ethnicities, ages and genders. Special considerations were made to ensure health disparities and the needs of medically underserved and uninsured populations were analyzed. While several health needs were identified throughout the development of this CHNA, SAH and SAMC prioritized health needs with the largest impact on the community as well as those that would be best addressed through a coordinated response from healthcare and community resources.
Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 6a: SwedishAmerican Hospital (SAH) in Rockford, Illinois and SwedishAmerican Medical Center (SAMC) in Belvidere, Illinois collaborated for the purposes of executing the Community Health Needs Assessment. Both hospital facilities defined their communities geographically in the same way, serve the same demographic and geographic areas, work with the same community organizations and strategic partners, and in the same arenas for community benefit activities.
Group A-Facility 2 -- SwedishAmerican Medical Ctr. Belvidere Part V, Section B, line 11: SAH and SAMC prioritized the following significant health needs, which are a continuation of the priorities from the 2019 CHNA. Below is a list of the identified health priorities for 2022-2025 as well as some of the impacts in these areas from the 2019 CHNA implementation plan:CancerCancer remains a top health priority for SwedishAmerican as it is a leading cause of death within the SwedishAmerican community service area. The percentage of deaths caused by cancer was 18.4% in Winnebago County and 17% in Boone County.Since the 2019 CHNA, SwedishAmerican has implemented the following related to cancer care within the community:- Expanded radiation oncology procedures not yet offered to patients in the service area to include Space OAR Program.- Met patient education and perception goals for lung cancer clinical indicators.- Completed National Accreditation Program for Breast Centers (NAPBC) standards, applied for and received accreditation.- Participated in American Cancer Society "Real Men Wear Pink".- Provided keynote speaker at prostate cancer Annual Purple Tea Coalition.- Provided patient education on aromatherapy for cancer patients, benefits of oncology rehabilitation, palliative care and the anti-inflammatory benefits of spices as a part of Cancer Survivor Week.ObesityThe issues related to obesity remain two-fold: factors causing the development of obesity and the diseases that result from obesity. As determined through the 2020 Health Community Study and Survey, 12% of the survey participants were obese. Moreover, the survey included a self-assessment of the participants' weight. Across all samples, "overweight" was the most common answer given by respondents.According to the CDC, obesity is a leading cause of diabetes, hypertension, high cholesterol and heart diseases. Data gathered from the Centers for Disease Control (CDC) indicate high rates of diabetes, hypertension, high cholesterol and heart diseases in both Winnebago and Boone Counties.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Obesity within the community:- Created Employer Based Clinics (EBC) and Woodward Health Center (WHC). - Health Coaching - Walk with a coach at WHC- Referred patients to New Directions weight loss program.- Utilized Better Life Wellness (BLW) for corporate clients focused on wellness.- Offered Grocery tours with a registered dietician.- Offered HRA (health risk assessment) and wellness screenings with corporate clients (aggregate data reports include BMI (body mass index)).- Held various wellness challenges.- Prior to COVID restrictions offered Walk with a Doc.- Ensured that BMI was obtained at every patient visit.- Established questionnaire regarding activity level/exercise regimen at all wellness visits (pediatrics and adult).- Recommendations regarding lifestyle included in all assessment/plan for wellness visits (pediatrics and adult).- EMR reminders for missing cholesterol screening; we start this at age 9 years old (pediatric population) and continue through adulthood.- Partnership with Diabetes center/nutrition center for additional referrals as needed.Tobacco CessationApproximately a quarter of adults in the region are current smokers, an increase from the last time the region was surveyed, but only 3% are regular smokers (smoke every day). The rate of adults in the region who currently smoke cigarettes is higher than the state and national findings, which only shows 15% of the population being current smokers.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Tobacco Cessation within the community:- Tobacco use screening at all visits, tobacco cessation encouraged at all wellness visits.- Provider education regarding Lung Cancer Screening for tobacco use history.- Provider education regarding smoking cessation counseling.- EMR reminders regarding need for Abdominal Aortic Aneurysm screening in males' age 65+ with history of tobacco use.- EMR reminders for Pneumonia vaccine in all patients with tobacco use.- Smoking cessation program offered to EBC and BLW corporate clients.Poverty and UnemploymentApproximately 14.6% of the total Winnebago County population lives in poverty, compared to the 11% of population that live in poverty in the State of Illinois. Moreover, both Boone and Winnebago counties have a significantly higher penetration of low-income residents compared to the penetration of low-income residents across the state. Specifically, Winnebago County has a 49.5% rate of penetration of low-income residents, and Boone County has a rate of 43.7% penetration of low-income residents. Comparatively, the State of Illinois has a rate of 38.8%.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Poverty and Unemployment within the community:- Provided grants and resources to area non-profits that support unmet, basic needs in our service area such as:- $15,000.00 - Provide tutors for struggling students Pre-K to 12 in reading and math.- $17,735.00 - Counseling for those who have anxiety, depression, bullying, self-harm and suicide along with childhood trauma and abuse.- $6,265.00 - Youth weightlifting outreach which targets at-risk youth who live in poverty, have experienced trauma and struggle with social-emotional well being.- $10,000.00 - Community partnership with Rockford East High School students to provide a new construction trades program.- $10,000.00 - Project name "Happy Kids are Healthy Kids" to provide students enrolled in summer camp cooking classes that taught them about making healthier food options.- $5,000.00 - Provide 24-hour medical advocacy at hospitals in Winnebago, Boone and Ogle counties. Staff and volunteers provided support, education, referrals and/or clothes to sexual assault survivors.- $17,500.00 - Equip a home for relational mentoring with at-risk and justice involved youth, ages 15-23.- $5,000.00 - Provide field trip enrichment opportunities for inner city children ages 6-16.- $11,188.65 - Improve the social and emotional well-being of school age kids through physical activity and strength training.- $10,000.00 - Re-engage youth in outdoor activities that will improve their health and keep them safe and active. Also provides financial assistance to anyone in need that cannot afford the programs, team sports, lessons and camps.- $6,609.00 - Purchase equipment for education and employment center at homeless shelter to help the unemployed get a job.- $4,500.00 - Conduct a musical theatre to introduce children of color in poverty the skills learned from participating in musical theatre which offers future career opportunities in this field.- $12,000.00 - Further development of the Juvenile Justice Ministry program.Access to Medical CareAccess to medical care remains a challenge to the SwedishAmerican community for a wide range of reasons including transportation availability, communication barriers, clinic hours and supply and availability.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Access to Medical Care within the community:- Provided $4 million per year to the University of Illinois College of Medicine family practice residency to educate physicians.- Provided school physicals to Lincoln School (neighborhood school).- Partnered with Rockford Fire Department to provide mobile integrated health outreach to community.- Partnered with local FQHC's (federally qualified health centers) to assure access to hospital services.- Contracted with all Medicaid Managed Care organizations to assure access to our physicians and hospital for all of the Medicaid population in our service area.- Set a goal of 48% of new primary care patients seen within 10 days; currently at 45.86%.Vulnerable Populations: Hispanic/Latino PopulationThe Hispanic and Latino population was identified as particularly vulnerable within the community, and especially impacted by adverse health issues and outcomes. For example, the survey indicated that compared to some other races, Hispanics have higher incidences of high cholesterol, arthritis, obesity and liver disease. Moreover, Hispanic adults were identified as more likely to be current drinkers in the region compared to other races.See Line 11 continued at the end of Part V.
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.
Group A-Facility 1 -- SwedishAmerican Hospital Part V, Section B, line 11, continuted:Since the 2019 CHNA, SwedishAmerican has implemented the following related to the vulnerable Hispanic and Latino Populations and other underserved populations within the community:- Created diversity, equity and inclusion committee to address diverse needs of our population - most recent project included providing hair care products to our African American inpatients.- Participated on Rockford transit committee to make sure our patients have bus access to our hospital from anywhere in Rockford.- Teamed up with two local hospitals to provide better in-person sign language interpreter access.- Employed in-person Spanish interpreters.- Maintain 40 video interpreter computers that provide interpretation in over 200 languages available to the entire hospital.Heart CareThe SwedishAmerican community service area leading causes of death include heart disease, with 21% of deaths in Winnebago County, and 19.3% of deaths in Boone County caused by heart disease.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Heart Care within the community:- Created and sustained a Heart Institute: Recruited a complete cardiology team, renovated the clinic space for expansion and increased the number of providers.- Expanded Cardiac Catheterization Labs.- Offered full-time pediatric general cardiology services and some pediatric electrophysiology services in Rockford.Maternal/Prenatal/Early Childhood HealthMaternal, Prenatal and Early Childhood health continue to be a top priority for SwedishAmerican as a large portion of the SwedishAmerican diagnoses-related groups from 2019-2021 were related to Pregnancy, Childbirth & the Puerperium, coupled with the fact that Winnebago County has a teen pregnancy rate much higher than the state average.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Maternal/ Prenatal/Early Childhood Health within the community:- Completed a new patient tower for Women and Children.- Converted the 10 bed special care nursery to a NICU and added 14 additional NICU beds to offer 24 NICU beds to our patients.- Offered donor breast milk program including a drop-off site for donors.- Promoted bonding between birth mom and child with rooming together.- Supported and educated patients on breastfeeding.Substance AbuseThe percentage of adults in the region that reported using drugs is around 27%. Adults reporting using/illegally using a wide variety of illicit drugs including marijuana or TCH products, prescription opioids, cocaine, amphetamines and heroin.Since the 2019 CHNA, SwedishAmerican has implemented the following related to combating substance abuse within the community:- Implemented state grant for opioid response to create program named Screening, Outreach, Linkage And Referral At SwedishAmerican (SOLARAS).- SOLARAS has connected with local FQHC's, mental health providers and substance abuse organizations to create referral source for treatment.- SOLARAS peer recovery specialists have been hired to assist with warm hand-off from treatment to local support services. Staff participated in warm hand-off meetings and have hired a case manager to assist with community involvement and connectivity to support services.- SOLARAS staff have created a relationship with Remedies, a local support group for addiction and recovery, to address women's needs to address housing and violence.- Collaboration between SOLARAS staff and our Women and Children's services staff to participate on Opioid committee and develop a screening tool to identify high risk patients and reduce narcotic use after surgery.The health priorities from the 2019 CHNA are continuing for the 2022-2025 CHNA and SAH and SAMC will develop a three-year implementation plan to address some of the most crucial health needs of the population defined within its community service area. The findings from this CHNA will determine how best to commit resources to address priority health needs that improve the overall health and well-being of its community.Group A-Facility 2 -- SwedishAmerican Medical Ctr. BelviderePart V, Section B, line 11, continuted:Since the 2019 CHNA, SwedishAmerican has implemented the following related to the vulnerable Hispanic and Latino Populations and other underserved populations within the community:- Created diversity, equity and inclusion committee to address diverse needs of our population - most recent project included providing hair care products to our African American inpatients.- Participated on Rockford transit committee to make sure our patients have bus access to our hospital from anywhere in Rockford.- Teamed up with two local hospitals to provide better in-person sign language interpreter access.- Employed in-person Spanish interpreters.- Maintain 40 video interpreter computers that provide interpretation in over 200 languages available to the entire hospital.Heart CareThe SwedishAmerican community service area leading causes of death include heart disease, with 21% of deaths in Winnebago County, and 19.3% of deaths in Boone County caused by heart disease.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Heart Care within the community:- Created and sustained a Heart Institute: Recruited a complete cardiology team, renovated the clinic space for expansion and increased the number of providers.- Expanded Cardiac Catheterization Labs.- Offered full-time pediatric general cardiology services and some pediatric electrophysiology services in Rockford.Maternal/Prenatal/Early Childhood HealthMaternal, Prenatal and Early Childhood health continue to be a top priority for SwedishAmerican as a large portion of the SwedishAmerican diagnoses-related groups from 2019-2021 were related to Pregnancy, Childbirth & the Puerperium, coupled with the fact that Winnebago County has a teen pregnancy rate much higher than the state average.Since the 2019 CHNA, SwedishAmerican has implemented the following related to Maternal/ Prenatal/Early Childhood Health within the community:- Completed a new patient tower for Women and Children.- Converted the 10 bed special care nursery to a NICU and added 14 additional NICU beds to offer 24 NICU beds to our patients.- Offered donor breast milk program including a drop-off site for donors.- Promoted bonding between birth mom and child with rooming together.- Supported and educated patients on breastfeeding.Substance AbuseThe percentage of adults in the region that reported using drugs is around 27%. Adults reporting using/illegally using a wide variety of illicit drugs including marijuana or TCH products, prescription opioids, cocaine, amphetamines and heroin.Since the 2019 CHNA, SwedishAmerican has implemented the following related to combating substance abuse within the community:- Implemented state grant for opioid response to create program named Screening, Outreach, Linkage And Referral At SwedishAmerican (SOLARAS).- SOLARAS has connected with local FQHC's, mental health providers and substance abuse organizations to create referral source for treatment.- SOLARAS peer recovery specialists have been hired to assist with warm hand-off from treatment to local support services. Staff participated in warm hand-off meetings and have hired a case manager to assist with community involvement and connectivity to support services.- SOLARAS staff have created a relationship with Remedies, a local support group for addiction and recovery, to address women's needs to address housing and violence.- Collaboration between SOLARAS staff and our Women and Children's services staff to participate on Opioid committee and develop a screening tool to identify high risk patients and reduce narcotic use after surgery.The health priorities from the 2019 CHNA are continuing for the 2022-2025 CHNA and SAH and SAMC will develop a three-year implementation plan to address some of the most crucial health needs of the population defined within its community service area. The findings from this CHNA will determine how best to commit resources to address priority health needs that improve the overall health and well-being of its community.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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?42
Name and address Type of Facility (describe)
1 1 - Regional Cancer Center
3535 N Bell School Road
Rockford,IL61114
Outpatient Clinic
2 2 - Women's and Children's Hospital
1350 Charles Street
Rockford,IL61104
Outpatient Clinic
3 3 - SwedishAmerican Heart Institute
1340 Charles Street Suite 300
Rockford,IL61104
Outpatient Clinic
4 4 - Breast Health Center
1340 Charles Street Suite 201
Rockford,IL61104
Outpatient Clinic
5 5 - Orthopedic and Sports Therapy
8451 Orth Road
Loves Park,IL61111
Outpatient Clinic
6 6 - Stateline Clinic & Immediate Care
4282 E Rockton Road
Roscoe,IL61073
Outpatient Clinic
7 7 - Creekside Medical Center
3505 N Bell School Road
Rockford,IL61114
Outpatient Clinic
8 8 - Lundholm Orthopedics
1340 Charles Street Suite 100
Rockford,IL61114
Outpatient Clinic
9 9 - Wound Care & Hyperbaric Clinics
1415 E State Street Ste 101 609
Rockford,IL61104
Outpatient Clinic
10 10 - Physical Therapy Center
209 9th Street Suite 201
Rockford,IL61104
Outpatient Clinic
11 11 - Neuro and Headache Center
1340 Charles Street Suite 400
Rockford,IL61104
Outpatient Clinic
12 12 - UW Health Surgery at SwedishAmerican
1340 Charles Street Suite 100
Rockford,IL61104
Outpatient Clinic
13 13 - SAMG Obstetrics & Gynecology
209 9th Street Ste 200
Rockford,IL61104
Outpatient Clinic
14 14 - Brookside Specialty Center
1253 N Alpine Road
Rockford,IL61107
Outpatient Clinic
15 15 - Rockford Vascular Surgery
1340 Charles Street Suite 200
Rockford,IL61104
Outpatient Clinic
16 16 - Belvidere Clinic
1700 Henry Luckow Lane
Belvidere,IL61008
Outpatient Clinic
17 17 - SA Immediate Care
2473 McFarland Road
Rockford,IL61107
Outpatient Clinic
18 18 - Edgewater Medical Center
2909 N Main Street
Rockford,IL61103
Outpatient Clinic
19 19 - Valley Clinic
6824 Newburg Road
Rockford,IL61108
Outpatient Clinic
20 20 - SwedishAmerican Home Health Care
2550 Charles Street
Rockford,IL61108
Home Health Care
21 21 - Rock Valley Testing Center
6861 Villagreen View
Rockford,IL61107
Outpatient Clinic
22 22 - Pediatric Theraphy and Adult Speech Ther
209 9th Street Suite 302
Rockford,IL61104
Outpatient Clinic
23 23 - Byron Clinic
220 W Blackhawk Drive
Byron,IL61010
Outpatient Clinic
24 24 - Five Points Clinic
2404 Charles Street Suite 800
Rockford,IL61108
Outpatient Clinic
25 25 - Davis Junction Clinic
5665 North Junction Way
Davis Junction,IL61020
Outpatient Clinic
26 26 - Woodward Health Network Clinic
2473 McFarland Road
Rockford,IL61107
Employer Based Clinic
27 27 - State St OBGYN
1415 E State Street
Rockford,IL61104
Outpatient Clinic
28 28 - River West Clinic
815 Marchesnano Drive
Rockford,IL61102
Outpatient Clinic
29 29 - Rochelle Clinic
380 Illinois Route 38 East
Rochelle,IL61068
Outpatient Clinic
30 30 - Cardiothorasic Surgery
1340 Charles Street Suite 300
Rockford,IL61104
Outpatient Clinic
31 31 - FCA family Health and Wellness Center
1625 South State Street
Belvidere,IL61008
Employer Based Clinic
32 32 - Rockford Ambulatory Surgery Center
1016 Featherstone Road
Rockford,IL61107
Ambulatory Surgery Center
33 33 - Partners Health Clinic
2601 N Main Street
Rockford,IL61103
Employer Based Clinic
34 34 - Baptist Pediatric Clinic
461 N Mulford Road Suite 4
Rockford,IL61107
Outpatient Clinic
35 35 - North Main Internal Medicine Clinic
2601 N Main St
Rockford,IL61103
Outpatient Clinic
36 36 - District 100 Wellness Center
1320 East Ave
Belvidere,IL61008
Employer Based Clinic
37 37 - Diabetes Self-Management Center
1415 E State Street Suite 700
Rockford,IL61104
Outpatient Clinic
38 38 - Infectious Disease Consultants
1340 Charles Street Suite 404
Rockford,IL61104
Outpatient Clinic
39 39 - Northern Illinois Vein Clinic
1340 Charles Street Suite 404
Rockford,IL61104
Outpatient Clinic
40 40 - Winnebago County Employee & Family Welln
526 W State Street
Rockford,IL61107
Employer Based Clinic
41 41 - Woodward Occupational Health Rock Cut
1 Woodward Way
Loves Park,IL61111
Employer Based Clinic
42 42 - Woodward Occup Health Loves Park
5001 N 2nd Street
Loves Park,IL61111
Employer Based Clinic
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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: $24,860,533Emergency department physicians: $2,916,732Total: $27,777,265
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 $22,985,125.
Part I, Line 7: 7a and 7f costs were calculated using the 2022 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. 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: As of January 2022, SwedishAmerican Hospital's charity policy allows a 100% charity write-off for those with household income of 300% 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 2022 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 $57,779 and a household size of 2.44, Boone County 10.1% of the population is below the poverty level, the median household income was $74,076 and a household size of 2.82. The 2022 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 $69,090 is 300% of the poverty level and $138,180 is 600% of the poverty level. Approximately 90% of our charity write-offs are for patients without insurance while 60% of our bad debt write-offs are for patients without insurance. During FY2022 only .5% 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: Please refer to Pages 12 and 14 of the attached audit report for footnotes describing accounts receivable and patient service revenue.
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: ($11,809,638)Medicare shortfall physician programs: ($46,163,424)Total Medicare Shortfall ($57,973,062)
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 patient cooperates with the requirements of the charity care policy, collection efforts are ceased.
Part VI, Line 2: SA hospital has provided monetary support for the 2020 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 June of 2022, 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: Explanation on Brand ChangeSwedishAmerican Health System was founded in 1911 and has a rich tradition in the Rock River Valley of being committed to caring for the community. Since 2015, when SwedishAmerican became a division of UW Health, that involvement continued as we worked together to provide remarkable patient care. On September 9, 2021, SwedishAmerican transitioned from a division to fully integrate with the UW Health brand. Aligning with the UW Health brand will continue to bring greater access to medical specialties, research and physicians to northern Illinois. Legally, SwedishAmerican Health System still exists but is doing business as UW Health. For the purposes of this report, we will refer to the community involvement in the northern Illinois area only, excluding the many additional gifts the Madison-based team brings to its community in Wisconsin.SwedishAmerican HospitalTwo of the remaining entities that still bear the SwedishAmerican name are the SwedishAmerican Foundation and the UW Health SwedishAmerican Hospital in downtown Rockford. The hospital was founded in 1911 and serves residents of 12 counties in northern Illinois and southern Wisconsin through a major acute care hospital; a medical center in Belvidere; a free-standing outpatient cancer center; a large network of primary care and multi-specialty clinics; a home healthcare agency; a full spectrum of outpatient, wellness and education programs; and the charitable endeavors of the SwedishAmerican Foundation. Recognized nationally for quality and excellence, UW Health SwedishAmerican Hospital has won many national awards, including designation as a 100 Top Hospital, a Magnet-designated hospital and a J.D. Power and Associates Distinguished Hospital. Community DescriptionFor more than 100 years, Rockford, IL has been known as a major industrial manufacturing center of machine tools, industrial fasteners, automotive parts and aerospace components. The Rockford metropolitan population was recorded as 153,283 (2010 US Census) people. Recent estimates show that the current population has since declined to 147,070 (V2020, Census.gov). Major employers in our service area include Fiat Chrysler Automobiles, Collins Aerospace, Woodward, City of Rockford, Rockford Public Schools, UPS, and three area hospitals. Rockford boasts many great parks, shopping, dining, cultural activities, entertainment and educational opportunities. But like many cities in the upper Midwest, it also continues to struggle to compete in what is now a global manufacturing economy. In the 1980s, Rockford's unemployment rate reached 25 percent, the highest in the nation, and it became a symbol for the plight of a "rust belt" city. Although the economy is more diversified now, Rockford remains heavily dependent on manufacturing. Also in the 1980s, charges of discrimination were leveled at the public school district, culminating in a federal lawsuit and 12 years of federal supervision. These two major developments have had their effect on the local economy, the stability of good paying jobs and the psyche and self-esteem of the community. They also have affected Rockford's changing role and importance to the region, state, and to some degree the nation.Unquestionably, these dynamics have impacted healthcare in the community. Today, Rockford's metro area unemployment rate is 13.8 (October 2020) percent, which is an 8.8 percent increase from 2019. Community surveys have identified coronary heart disease, obesity, diabetes, cancer, pre-natal care and depression as major healthcare issues in our market.By virtue of its mission, location in the central city and relationships with other providers, UW Health 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 UW Health.UW Health's Vision for a Healthier Community Community ChallengesIn recent years, UW Health helped fund the Winnebago and Boone Counties Healthy Community Study in partnership with the Rockford Regional Health Council. The purpose of the study was to develop information on the quality of life in the Rockford area to create and implement strategies to improve the lives of all residents. The study is an invaluable opportunity to connect with community stakeholders and discover unmet needs. The most recent study (2020) was dramatically impacted by COVID-19. Strengths included that 80-90 percent of respondents said they were able to get medical care when they needed it and that nearly 70 percent of people had seen a doctor for a checkup within the last 12 months. Weaknesses included that only half of the people in the region reported being able to access mental health/substance abuse care and that Blacks and Hispanics report being able to access medical care less easily than whites.The survey also found that 39 percent of local residents are overweight. Poverty, access to healthy food and activity-friendly spaces and a lack of education about nutrition and following nutritional guidelines are culprits, according to community leaders who responded to surveys as part of the study.Behavioral health: In 2020, the local area had 167 mental health care providers - psychiatrists, psychologists, clinical social workers and counselors - for every 100,000 residents, substantially lower than the same ratios for the state (230) and nation (202).Maternal/prenatal/early childhood: The rate of total births to women age 15-19 per 1,000 female population age 15-19 was 24.6, significantly higher than the state ratio of 19.2.Access to care: The Affordable Care Act reduced by half the number of adults and children who lacked health insurance. But among those with less than a high school education, 25 percent of adults say it is hard for them to understand information that doctors and nurses and other health professionals tell them.Demographic ProfileIndividuals between ages 18 and 64 (working-aged adults) constitute 59.4% of the total population in Boone County and 58.7% of the total population in Winnebago County. Of the remaining population, 16.1% are ages 65 and older and 24.5% are under 18 in Boone County, and 18% are ages 65 and older and 23.34% are under 18 in Winnebago County. Overall, the population aged 65 and older in Winnebago County is slighter higher than that of Boone County and even higher than that of the State of Illinois.Population: The majority of the population in Boone County identified as White (72%). The next largest race is Hispanic (22%), followed by Black (3%). The majority of the population in Winnebago County identified as White (68%). The next largest races are Hispanic (13%) and Black (13%) followed by Asian (3%) and Other (3%).Ethnicity: Boone County has a higher Hispanic population than Winnebago County. Both Counties reported slightly lower Hispanic populations than the state and national metrics. Boone County has approximately 8500 individuals with a primary language of Spanish. This represents 16.9% of the population and is significantly higher than Winnebago County and State percentages.Social/Economic ProfileBoone County has an average per capita income of approximately $51,000, while Winnebago has a slightly lower average per capita income of around $47,000. The per capita income in Boone County is slightly higher than the state average, whereas the per capita income in Winnebago County is slightly lower than the state average of $50,000. Approximately 14.6% of the total Winnebago County population live in poverty. This is significantly higher than the total population living in Boone County and higher than the population living in poverty across both the state and county.Poverty is defined as the percent of low-income residents living below 300% of the Federal Poverty Level in the county. Both Boone and Winnebago counties see a significantly higher penetration of low-income residents vs. the penetration of low-income residents across the state.Education RatesBoth Boone and Winnebago Counties have lower percentages of the population with high school degrees compared to both sate and national percentages. Similarly, both counties have significantly lower percentages of the population with bachelor degrees or higher education compared to both state and national percentages.Health OutcomesWinnebago County has a medically underserved area (MUA 7011). The MUA designation was developed by the Health Resources and Services Administration (HRSA) and indicates that a combination of four components exists in the area:- A low ratio of primary medical care physicians per 1,000 population;- A high infant mortality rate;- A high percentage of the population with incomes below the poverty level;- A high percentage of the population age 65 or over.
The SwedishAmerican CSA lies within the 40420 (Rockford, IL) Core-Based Statistical Area ("CBSA"). A CBSA is a U.S. geographic area defined by the Office of Management and Budget (0MB) that consists of one or more counties (or equivalents) anchored by an urban center of at least 10,000 people plus adjacent counties that are socioeconomically tied to the urban center by commuting.The SwedishAmerican CBSA has a Hierarchical Condition Categories (HCC) Risk Score of 1.02. The CMS-HCC risk score for a beneficiary is the sum of the score or weight attributed to each of the demographic factors and HCCs within the model. The CMS-HCC model is normalized to 1.0 (the national average). Beneficiaries would be considered relatively healthy, and therefore less costly, with a risk score less than 1.0. Thus, the beneficiaries in the SwedishAmerican CBSA are considered slightly less healthy and more costly compared to the national average (approximately a 1.09% difference).Other key findings from across the CBSA include a higher number of emergency department visits per 1,000 beneficiaries compared to the national average. Additionally, the number of emergency department visits and number of acute hospital readmissions at SwedishAmerican make up .1% of all emergency department visits and number of acute hospital readmissions throughout the county. Finally, the hospital readmission rate for the CBSA is consistent with the national average.The SwedishAmerican CSA leading causes of death include heart disease, influenza and pneumonia, kidney disease, accidents, chronic lower respiratory diseases, Alzheimer's, cancer, COVID-19 and diabetes. Within the CSA, chronic health conditions, particularly cancer, chronic lower respiratory disease, kidney disease and heart disease, were shown to be among the leading causes of death higher than the state average. Additionally, it was identified that the teen birth rate in Winnebago County was significantly higher than the State average. Other health conditions of note include the prevalence of diabetes and obesity are approximately equal to or higher than the state averages.Access to primary care remains a challenge within the SwedishAmerican CSA for both Boone and Winnebago counties. On average, the ratio of patient visits to primary care physicians in Boone County far exceeds ratio for the same in Winnebago County and both counties saw in 4-5% increase over the previous year. An analysis of patient visit data between 2019-2021 shows that approximately 60% of all SwedishAmerican patient visits fall within the following DRG categories: 1) Pregnancy, childbirth and puerperium; 2) Circulatory System; 3) Musculoskeletal System and Connective Tissue; 4) Respiratory system; and 5) Endocrine, nutritional & metabolic diseases and disorders.
Part VI, Line 5: Making a DifferenceAlthough UW Health'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. Our organization 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 serve 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 UW Health teams.In the past, 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, UW Health 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.UW Health 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.In the spring of 2022, UW Health Northern Illinois launched a mobile health unit in partnership with the City of Rockford, Rockford Fire Department, and Molina Health. The van is intended to serve as a mobile clinic, taking care to people who need it and removing as many barriers as possible.UW Health's organization-led efforts to improve the quality of life in our community are not exclusively health-related. One example is the partnership we formed 20 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 well-being of the school environment and student body. While UW Health 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.We continue to recognize that improving the health of our community means investing in our community. Following a detailed assessment of the region's population trends and projected healthcare needs, and keeping in line with our well-thought-out strategic planning process, UW Health announced completed plans for a $165 million investment in our community. This major construction, modernization and expansion project will help us continue to provide the outstanding, top-quality healthcare that residents of Rockford and surrounding communities expect and deserve. UW Health's building, renovation and modernization project has benefitted the community in a number of important ways. The total project consisted of these major components:Four-Story Women's and Children's Tower. With nearly 2,000 deliveries and growing each year, we've designed this new facility to provide state-of-the-art care for new mothers and their infants. The Hospital is home to the region's newest Level III NICU, and includes in-house specialists from the University of Wisconsin American Family Children's Hospital. The facility features private labor and delivery suites and mother/baby suites as well as outpatient pediatric specialty clinics.New and Expanded Behavioral Health Services. Despite the increase of psychiatric afflictions such as depression and personality disorders, and the presence of a massive opioid epidemic sweeping our nation, many communities have downsized or eliminated behavioral health services. SwedishAmerican has chosen to go in a different direction. In response to the increased need for these services, we expanded our behavioral health program to 26 beds including a new, much-needed, 16-bed child and adolescent unit - a service that has not been available in Rockford for more than 15 years.Three Additional Rockford Clinics. UW Health opened two primary care clinics in 2019 (Riverwest Clinic on the southwest side of Rockford and Creekside Medical Center on the north east side) and one in 2020 (Edgewater Medical Center on the north west side), illustrating the organization's unwavering commitment to provide services where they are most needed. These locations have proven to be of particular importance to our community with the 2021 from a competing hospital that they are removing west-side services on Rockton Avenue.Community Benefits Plan SummaryUW Health SwedishAmerican Hospital's Community Benefits Plan is focused on five objectives:1. Caring For Our Community Contributions2. Lifestyle Medicine and Wellness3. Academic & Career Promotion4. Health Education5. Community ServiceInitiatives designed to meet these objectives are on the following pages. Together, they illustrate our concerted effort to make improvements in the lives of residents at every life stage and income level. These programs reach young children, the elderly and underserved, people who are at risk for chronic diseases and healthcare professionals.
Part VI, Line 6: Caring For Our Community ContributionsUW Health gives back directly to local non-profit organizations serving community members' greatest needs. Our strongest partnerships are with organizations aligned with our community health improvement priorities, addressing social determinants of health, and providing crucial health services. In fiscal year 2023, we will donate $300,000 locally. Key contributions in 2022 include:- $30,000 to the Boys and Girls Club of Rockford. This unrestricted contribution helps the club continue to offer critical afterschool programs, educational support, character and leadership training, career exploration and more. The club is a safe, trusted place for youth to go outside of school. For many children, especially during the pandemic, the programs help improve their mental health by offering healthy role models and structure.- $25,000 to the Crusader Community Health, the local federally qualified health center. Crusader is a valuable partner to UW Health Northern Illinois and serves some of the most vulnerable people in our community.- $10,000 to the Rockford Fire Department to support fire prevention and community risk reduction programs.- $10,000 to Rosecrance. UW Health Northern Illinois has a long history of supporting their work addressing mental health and substance use. Their services are needed more than ever, and they provide the path people need to successfully manage their recovery.- $10,000 to the University of Illinois College of Medicine - Rockford. UW Health partners with the College of Medicine to develop the future of the healthcare workforce.- $10,000 to the YWCA of Northwestern Illinois. The YWCA offers a wide variety of programs and services aligned with UW Health's priorities, and the two organizations continue to grow a partnership.- $5,000 to The Haven Network, which provides critical services to families facing the loss of an infant. UW Health's Women & Children's Services team work closely with The Haven and connect patients with their services.- $5,000 to Northern Illinois Hospice, which provides compassionate end of life care for many UW Health patients.Lifestyle Medicine and Wellness ProgramsUW Health 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 the fire and police department 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 PartnershipIn 2014, 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 SwedishAmerican associates, corporate partners and the general public, including:1) Wellness educational programs, classes and support groups2) Screenings and health risk assessments3) Personal health coaching4) Healthy cooking classes and grocery tours5) Relaxation and stress management education6) Weight management programs7) Nutrition education8) Therapeutic Massage9) Smoking Cessation programs10) Interactive customized wellness web portalBetterLife expands our capacity to help people of all ages, physical abilities and limitations lead healthier lives. 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 wellbeing and bring a measurable impact upon improving the overall health of our community.Academic & Career PromotionIn order to help young people understand the economics of life and open their minds to career possibilities within the business world, UW Health 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, UW Health 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 UW Health representative has been involved with the schools' planning process since our partnerships began two decades ago. Over the last 20 years UW Health has positively impacted students and faculty in a number of ways, including:Academy ExpoIn 2022, 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.Employees' Children Scholarship ProgramIn 2022, UW Health awarded 10 one-year $1,000 scholarships to children of UW Health associates. The Associates' Children Scholarship Program is designed to assist children of UW Health associates pursue higher education. Ready to Learn With the Basics initiative with Alignment RockfordUW Health partnered with Alignment Rockford in the fall of 2022 to launch the Ready to Learn With the Basics program. The program distributes educational kits to parents by UW Health providers. The kits also have links to connect families to community resources for assistance with housing, food security, domestic violence, immigration and more. The kits are uniquely designed to encourage healthy and proper emotional, physical, social and intellectual development. It has activity books, handouts, a list of phone apps to support language and literacy, as well as materials that can connect a child with their parent. Health EducationAccording 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 more than 31 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 older adults. UW Health is committed to educating public and professional audiences within our community about matters of prevention, detection and treatment.
Opioid Education, Free Narcan Kits Drug overdose is the #1 cause of accidental death for adults in Illinois - 80% involve heroin. UW Health's EMS services in partnership with the Winnebago County Health Department and Hope Over Addiction offer free Narcan training classes. Free Narcan kits are provided after completion of the class. Our hospital also still participates in the Opioid Warm Hand-Off Program. Additionally, we have a partnership with Rockford Fire for our Mobile Integrated Health Behavioral Program that will allow us to meet patients in the community to assist with linking them to outpatient resources.Community ServicePartnership with IDHS in Fight against Opioid AddictionSwedishAmerican has been recognized by the Illinois Department of Human Services (IDHS) as one of only 14 Illinois hospitals that will participate in its Warm Hand-off Program to combat opioid addiction. The IDHS Hospital Warm Hand-off Program connects recovery support specialists directly to patients with opioid use disorder while they are in the hospital recovering from an overdose or receiving other hospital treatment. SwedishAmerican will now have a recovery specialist that will do a Warm Hand-off with a patient when they leave the hospital to enter a treatment center. The grant will allow SwedishAmerican to hire and train nine employees to be involved in the collaborative relationship between the patient and recovery support specialist.Community Paramedic ProgramsIn 2016, 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. 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, the program concentrated on SwedishAmerican patients with a high probability of readmission. Patients enrolled in the program experienced a reduction of Emergency Department (ED) visits by 35 percent, ambulance runs by 42 percent and hospital admissions by 40 percent.In 2018 the patients enrolled in the program came from referrals made by the Case Management program. During this time the MIH Manager saw 20 patients on a weekly basis often accompanied by a SwedishAmerican nurse case manager. Each patient received regularly scheduled home visits where the MIH Manager provided a medical assessment, ensured the patient was taking their prescribed medications and was following up with their primary care provider. The MIH Manager offered community resource support to help improve the patients' health and wellbeing. In addition, the MIH Manager checked smoke detectors, CO2 detectors and any hazards that may exist in the patient's home.Additionally, in 2018 expanded to include a partnership with Humana Inc., a large health insurance provider. With an expanded population to serve, an additional MIH Manager was appointed in April. MIH Managers made nearly 500 patient visits in 2018 and served 250 individual patients. The MIH Program's success can be measured by both evaluating the impact on the enrollee's overall health, and the cost savings to the healthcare system.1) MIH Patients had a 50% decrease in ED arrival by ambulance.2) MIH Patients had a 22% decrease in hospital admissions.3) Rockford Fire and Swedish American realized a cost savings of $3,289.77 per enrolled MIH Patient.The MIH program began a program called "Knock and Talk" in 2018 to begin addressing the opioid epidemic in Rockford. This initiative was put in place due to a 28% increase in overdose deaths in Winnebago County from 2017 to 2018. This program involves an MIH Manager visiting an overdose patient transported by Rockford Fire within 72 hours to provide Naloxone. Naloxone is the only medication that is able to reverse an opioid overdose. This program is offered in conjunction with the Winnebago County Health Department Drug Overdose Prevention Program. Through a grant the Health Department is able to provide the Naloxone at no charge to the patient. Naloxone distribution through the MIH program was expanded to include patients who were active in their addiction, attempting to be in recovery, and many community groups. In all, the MIH program distributed over 2,000 Naloxone kits in the community including many SwedishAmerican staff who work in the hospital and SwedishAmerican clinics in order to raise awareness of the program and the local epidemic. In 2019, instead of the prediction of another year with increased overdose deaths, Winnebago County experienced a 27% reduction of overdose deaths. MIH also continued to provide in home patient visits providing over 600 patient interventions for patient education, medication reconciliation, connections to local resources such as food banks and housing, and home safety inspections.The MIH program has continued with the programs that began in 2019. In addition to the referrals from UW Health Case Management there has been an increase of referrals from within Rockford Fire as well. An additional MIH Manager was hired. The program began a pilot utilizing an MIH Manager and UW Health nursing staff from the Center for Mental Health. Connections with local resources have expanded to include Community Services for the homeless population. Drives and DonationsSwedishAmerican employees have long been committed to serving the community by organizing several drives and donations throughout the year. Even with their challenging and busy schedules, employees have given back to the community in multiple ways, including:1) Rock River Valley Food Pantry Drive2) Child Life Wish List Donations3) Foster Care Alliance Adopt-An-Angel Drive 4) Rock House Kids Donation5) Goodwill Drive6) Hat, Scarf and Mittens Drive to benefit the local homeless community and the Rockford Rescue Mission7) Riverwest Clinic Backpack Drive8) Riverwest Clinic Trunk or Treat
Part VI, Line 7: SA Hospital files a community benefit report with the Illinois Attorney General.
Schedule H (Form 990) 2021
Additional Data


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Software Version:  

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
2021
Open to Public
Inspection
Name of the organization
SwedishAmerican Hospital
 
Employer identification number
36-2222696
Part I
General Information on Grants and Assistance
1
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? ........................
2
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) 75,000 0     Federally qualified health center that provides health services to uninsured and underserved in our community
(2) City of Rockford Fire Department
PO Box 15537
Rockford,IL61132
36-6006082 City of Rockford 125,000 0     Funding for a paramedic for the mobile integrated healthcare program
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
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)
(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: Aunt Martha's Youth Service Center, Inc. is a federally qualified health center that provides health services to uninsured and under served in our community. SA Hospital works closely with the grantee organization or receives reports from them as appropriate. SwedishAmerican Hospital has enterened into an agreement with the City of Rockford to provide EMS training and also provides funding for one paramedic for the Mobile Integrated Healthcare Program.
Schedule I (Form 990) 2021



Additional Data


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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
2021
Open to Public Inspection
Name of the organization
SwedishAmerican Hospital
 
Employer identification number

36-2222696
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .....
1b
Yes
 
2
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? ....
2
Yes
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
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, 1099-MISC compensation, and/or 1099-NEC (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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1Elizabeth Bolt
Trustee
(i)

(ii)
0
-------------
922,657
0
-------------
417,870
0
-------------
10,858
0
-------------
162,055
0
-------------
37,817
0
-------------
1,551,257
0
-------------
0
2Jateen Patel MD
Physician
(i)

(ii)
1,149,942
-------------
0
0
-------------
0
2,550
-------------
0
16,759
-------------
0
10,368
-------------
0
1,179,619
-------------
0
0
-------------
0
3Peter D Newcomer MD MMM
Trustee
(i)

(ii)
0
-------------
600,661
0
-------------
347,310
0
-------------
0
0
-------------
173,770
0
-------------
1,436
0
-------------
1,123,177
0
-------------
0
4Don F Daniels
Former VP & COO
(i)

(ii)
140,306
-------------
0
185,168
-------------
0
680,294
-------------
0
7,920
-------------
0
9,063
-------------
0
1,022,751
-------------
0
554,959
-------------
0
5Mohamed Zeater MD
Physician
(i)

(ii)
952,355
-------------
0
0
-------------
0
0
-------------
0
14,500
-------------
0
39,293
-------------
0
1,006,148
-------------
0
0
-------------
0
6Thomas O'Connor
President & CEO (until 10/15/21)
(i)

(ii)
669,277
-------------
0
142,002
-------------
0
139,318
-------------
0
0
-------------
0
36,304
-------------
0
986,901
-------------
0
0
-------------
0
7Ben Durkee MD
Physician
(i)

(ii)
822,686
-------------
0
0
-------------
0
0
-------------
0
22,623
-------------
0
40,293
-------------
0
885,602
-------------
0
0
-------------
0
8Tarek Harb MD
Physician
(i)

(ii)
773,810
-------------
0
0
-------------
0
12,550
-------------
0
17,545
-------------
0
39,893
-------------
0
843,798
-------------
0
0
-------------
0
9Yaser Siraj MD
Physician
(i)

(ii)
789,939
-------------
0
0
-------------
0
6,050
-------------
0
16,035
-------------
0
10,368
-------------
0
822,392
-------------
0
0
-------------
0
10William Cunningham MD
Medical Staff President
(i)

(ii)
628,846
-------------
0
0
-------------
0
21,240
-------------
0
21,025
-------------
0
41,061
-------------
0
712,172
-------------
0
0
-------------
0
11Michael Polizzotto MD
CMO/CMIO (until 12/31/21)
(i)

(ii)
365,070
-------------
0
202,791
-------------
0
6,388
-------------
0
47,962
-------------
0
37,263
-------------
0
659,474
-------------
0
0
-------------
0
12Patricia DeWane
VP, CFO, & Treasurer
(i)

(ii)
374,826
-------------
0
206,455
-------------
0
5,098
-------------
0
59,352
-------------
0
8,841
-------------
0
654,572
-------------
0
0
-------------
0
13Timothy Flynn MD
President, SA Medical Group
(i)

(ii)
371,290
-------------
0
123,625
-------------
0
38,197
-------------
0
53,668
-------------
0
42,939
-------------
0
629,719
-------------
0
0
-------------
0
14Julia Zimmerman
VP Strategic Growth
(i)

(ii)
178,981
-------------
0
81,213
-------------
0
259,047
-------------
0
44,889
-------------
0
39,937
-------------
0
604,067
-------------
0
256,431
-------------
0
15Ann Gantzer MD
VP Patient Services/CNO
(i)

(ii)
339,238
-------------
0
155,019
-------------
0
4,539
-------------
0
53,111
-------------
0
38,053
-------------
0
589,960
-------------
0
0
-------------
0
16Michael J Born MD
Former President & CEO
(i)

(ii)
0
-------------
0
0
-------------
0
526,651
-------------
0
0
-------------
0
0
-------------
0
526,651
-------------
0
0
-------------
0
17Thomas Schiller MD
Former Chief Clinical Integ. Officer
(i)

(ii)
321,229
-------------
0
0
-------------
0
11,281
-------------
0
95,829
-------------
0
21,805
-------------
0
450,144
-------------
0
0
-------------
0
18Jedediah Cantrell
VP Operations (until 3/18/22)
(i)

(ii)
251,816
-------------
0
115,460
-------------
0
2,912
-------------
0
42,567
-------------
0
32,587
-------------
0
445,342
-------------
0
0
-------------
0
19James Cole DO
VP Medical Affairs/CMO(as of 1/1/22)
(i)

(ii)
0
-------------
387,488
0
-------------
0
0
-------------
0
0
-------------
43,500
0
-------------
63
0
-------------
431,051
0
-------------
0
20Gerard Guinane
Former VP Human Resources
(i)

(ii)
119,930
-------------
0
138,423
-------------
0
143,001
-------------
0
12,002
-------------
0
13,244
-------------
0
426,600
-------------
0
32,265
-------------
0
21Allen D Williams MD
Trustee
(i)

(ii)
282,627
-------------
0
4,500
-------------
0
11,233
-------------
0
21,655
-------------
0
37,156
-------------
0
357,171
-------------
0
0
-------------
0
22Tiffanie Ferry MD
Trustee
(i)

(ii)
206,399
-------------
0
7,500
-------------
0
15,503
-------------
0
15,536
-------------
0
38,551
-------------
0
283,489
-------------
0
0
-------------
0
23Travis Andersen
President & CEO (as of 10/15/21)
(i)

(ii)
243,788
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
243,788
-------------
0
0
-------------
0
24Celia Shaughnessy
VP Human Resources (until 3/31/22)
(i)

(ii)
228,500
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
0
-------------
0
228,500
-------------
0
0
-------------
0
25Noel Nickel
Former VP Strategy & BusDev
(i)

(ii)
119,687
-------------
0
0
-------------
0
884
-------------
0
3,900
-------------
0
19,396
-------------
0
143,867
-------------
0
0
-------------
0
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
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 1a During Calendar year 2021, the Interim CEO received a housing allowance. This benefit was included in taxable income.
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, Lines 4a-b Severance payments during 2021 include: Michael Born - $526,651; Tom O'Connor - $136,539; Don F. Daniels - $124,077; Gerard Guinane - $105,638. These payments are reported as taxable compensation on Part II, column (B)(iii). Contributions to the 457(f) plan during 2021 include: Peter Newcomer - $115,770; Elizabeth Bolt - $139,290; Patricia DeWane - $29,743; Michael Polizzotto - $29,218; Ann Gantzer - $27,061; Timothy Flynn MD - $21,126; Jedediah Cantrell - $20,290; Julia Zimmerman - $14,725. Payments from the 457(f) plan during 2021 include: Don F. Daniels - $554,959; Gerard Guinane - $32,265; Julia Zimmerman - $256,431. These payments are reported as taxable income on Part II, column (B) (iii).
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) 2021

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part , line 24a. Provide descriptions,
explanations, and any additional information in Part .
SchKMediumBullet Attach to Form 990.

SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SwedishAmerican Hospital
 
Employer identification number
36-2222696
Part
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
Yes No Yes No Yes No
A Illinois Finance Authority - 2010A
 
86-1091967   10-11-2016 8,820,000 See Part IV   X   X   X
B Illinios Finance Authority - 2010B
 
86-1091967   10-26-2016 8,370,000 See Part IV   X   X   X
C University of Wisconsin Hospitals and Clinics Authority - 2018A
 
39-1835630 915260CQ4 11-15-2018 120,913,330 See Part IV   X   X X  
D University of Wisconsin Hospitals and Clinics Authority - 2018C
 
39-1835630 915260CQ4 11-15-2018 63,918,493 See Part IV   X   X X  
University of Wisconsin Hospitals and Clinics Authority - 2020D
 
39-1835630 915260AA0 12-18-2020 45,200,000 See Part IV   X   X X  
Part
Proceeds
A B C D
1 Amount of bonds retired .................. 3,780,000 3,410,000 2,257,227 363,493
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 8,820,000 8,370,000 125,733,091 63,918,493
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 130,297   913,330 363,493
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............     124,819,761  
11 Other spent proceeds ............. 8,820,000 8,370,000   63,555,000
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2010 2010 2021 2007
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 2020, a current refunding issue)? ........
X   X     X X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........
  X   X   X   X
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  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part
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
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 ....SchKMediumBullet        
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 ......... SchKMediumBullet        
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
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 the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X   X X  
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
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? ........                
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
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
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Part I, column (f): 2010A and 2010B Bonds: Original bond issue in 2005 for Construction & Equipment Cardiac pavilion, renovation of operating room & catheterization lab completed in 2004. Bond was re-issued in 2010 as a direct bank placement and reissued in 2016. 2018A Bond: UWHCA parent of SAHS issued on behalf of Hospital fixed rate revenue bonds to fund the Master Facility Plan. Used for construction and equipment for Women's and Children's tower, and three new clinics. 2018C Bond: UWHCA parent of SAHS issued on behalf of Hospital variable rate revenue bonds to refund the Hospital Series 2004 bonds. 2020D Bonds: UWHCA parent of SAHS issued on behalf of Hospital fixed rate revenue bonds to refund the Hospital Series 2012 bonds.
Part I, column (e): The issue price for the 2018A and 2018C Bonds is the allocated portion from the total issue price on the Form 8038.
Part II, Line 3: The total proceeds of the 2018A Bond issue received is different than the amount reported on Part I, column (e) because of investment earnings.
Schedule K (Form 990) 2021

Additional Data


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

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part , line 24a. Provide descriptions,
explanations, and any additional information in Part .
SchKMediumBullet Attach to Form 990.

SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SwedishAmerican Hospital
 
Employer identification number
36-2222696
Part
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
Yes No Yes No Yes No
A Illinois Finance Authority - 2010A
 
86-1091967   10-11-2016 8,820,000 See Part IV   X   X   X
B Illinios Finance Authority - 2010B
 
86-1091967   10-26-2016 8,370,000 See Part IV   X   X   X
C University of Wisconsin Hospitals and Clinics Authority - 2018A
 
39-1835630 915260CQ4 11-15-2018 120,913,330 See Part IV   X   X X  
D University of Wisconsin Hospitals and Clinics Authority - 2018C
 
39-1835630 915260CQ4 11-15-2018 63,918,493 See Part IV   X   X X  
University of Wisconsin Hospitals and Clinics Authority - 2020D
 
39-1835630 915260AA0 12-18-2020 45,200,000 See Part IV   X   X X  
Part
Proceeds
A B C D
1 Amount of bonds retired .................. 3,780,000 3,410,000 2,257,227 363,493
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 8,820,000 8,370,000 125,733,091 63,918,493
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 130,297   913,330 363,493
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............     124,819,761  
11 Other spent proceeds ............. 8,820,000 8,370,000   63,555,000
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2010 2010 2021 2007
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 2020, a current refunding issue)? ........
X   X     X X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........
  X   X   X   X
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  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part
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
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 ....SchKMediumBullet        
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 ......... SchKMediumBullet        
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
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 the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X   X X  
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
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? ........                
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
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
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Part I, column (f): 2010A and 2010B Bonds: Original bond issue in 2005 for Construction & Equipment Cardiac pavilion, renovation of operating room & catheterization lab completed in 2004. Bond was re-issued in 2010 as a direct bank placement and reissued in 2016. 2018A Bond: UWHCA parent of SAHS issued on behalf of Hospital fixed rate revenue bonds to fund the Master Facility Plan. Used for construction and equipment for Women's and Children's tower, and three new clinics. 2018C Bond: UWHCA parent of SAHS issued on behalf of Hospital variable rate revenue bonds to refund the Hospital Series 2004 bonds. 2020D Bonds: UWHCA parent of SAHS issued on behalf of Hospital fixed rate revenue bonds to refund the Hospital Series 2012 bonds.
Part I, column (e): The issue price for the 2018A and 2018C Bonds is the allocated portion from the total issue price on the Form 8038.
Part II, Line 3: The total proceeds of the 2018A Bond issue received is different than the amount reported on Part I, column (e) because of investment earnings.
Schedule K (Form 990) 2021

Additional Data


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Schedule L
(Form 990)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
(1) Julie Wiest See Part V See Part V   No
(2) Chad Jury See Part V See Part V   No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
3,252
3
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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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) 2021
Schedule L (Form 990) 2021
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?
Yes No
(1) Andrea Fulcomer See Part V 71,341 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 I, Excess Benefit Transactions: (a) Name of Person: Julie Wiest(b) Relationship with Disqualified Person: Family member of trustee(c) Unpaid Child Care Services(a) Name of Person: Chad Jury(b) Relationship with Disqualified Person: Family member of trustee(c) Unpaid Child Care ServicesOrganization Managers:Don F. Daniels, Former VP & Chief Operating OfficerGerard Guinane, Former VP Human ResourcesGregory R. Jury, Former Trustee
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) 2021


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SCHEDULE O
(Form 990)

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
2021
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 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 the Chief Financial Officer. 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 made available to the public. The consolidated audited financial statements of SwedishAmerican Health System, which includes SwedishAmerican Hospital, are available upon request.
Form 990, Part XI, line 9: Interest in SwedishAmerican Foundation -2,670,756. Joint Venture Book/Tax Difference 368,438.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


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Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
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?
Yes No
(1)Generations Fertility Care
2365 Deming Way

Middleton,WI53562
27-3496527
Reproductive endocrinology and infertility services WI 501(c)(3) Line 10 N/A
 
No
(2)Isthmus Project Inc
600 Highland Avenue

Madison,WI53792
83-2278676
Research and innovation WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority
 
 
No
(3)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
(4)Quartz Health Plan Corporation
840 Carolina Street

Sauk City,WI53583
49-1807071
Health Maintenance Organization WI 501(c)(4)   University Health Care Inc
 
 
No
(5)Quartz Health Plan MN Corporation
840 Carolina Street

Sauk City,WI53583
45-2633920
Health Insurance WI 501(c)(4)   Quartz Health Plan Corporation
 
 
No
(6)Regional Division Inc
7974 UW Health Court No MC1020

Middleton,WI53562
39-1446049
Regional Parent Corp. to manage and direct activities of entities WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority
 
 
No
(7)SwedishAmerican Foundation
1415 East State St

Rockford,IL61104
36-3097493
Supports fundraising for SwedishAmerican Hospital IL 501(c)(3) Line 7 SwedishAmerican Hospital
 
Yes
 
(8)SwedishAmerican Health System Corporation
1401 East State St

Rockford,IL61104
36-3241458
Parent Corporation to manage and direct activites of entities IL 501(c)(3) Line 12a, I Regional Division Inc
 
 
No
(9)SwedishAmerican Hospital Self Insurance Trust
1401 East State Street

Rockford,IL61104
36-6652702
Hospital Malpractice Trust VT 501(c)(3) Line 12a, I SwedishAmerican Hospital
 
Yes
 
(10)SwedishAmerican Realty Corporation
1313 East State Street

Rockford,IL61104
36-3248013
Title Holding Company IL 501(c)(2)   SwedishAmerican Health System Corporation
 
Yes
 
(11)University Health Care Inc
7974 UW Health Court

Middleton,WI53562
47-2553196
Support Organization WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority
 
 
No
(12)University of Wisconsin Hospital and Clinics Authority
7974 UW Health Court

Middleton,WI53562
39-1835630
Hospital and Clinics WI 501(c)(3) Line 3 N/A
 
No
(13)University of Wisconsin Medical Foundation
7974 UW Health Court

Middleton,WI53562
39-1824445
Physician Services WI 501(c)(3) Line 10 University of WI Hospital and Clinics Authority
 
 
No
(14)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
(15)Wisconsin Therapies Inc
7974 UW Health Court

Middleton,WI53562
39-1807425
Infusion Therapy WI 501(c)(3) Line 12a, I University of WI Hospital and Clinics Authority
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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


Yes No Yes No
(1) Chartwell Wisconsin Enterprises LLC

2241 Pinehurst Drive
Middleton,WI53562
39-1796267
Parent Entity of CW and CMw-HR WI N/A
N/A       No     No  
(2) Madison Medical Center LLP

7974 UW Health Court
Middleton,WI53562
39-1329429
Real Estate WI N/A
N/A       No     No  
(3) Northern Illinois Vein Clinic

2550 Charles Street
Rockford,IL61108
20-1642329
Outpatient Health Services IL N/A
RELATED 15,789 358,209   No   Yes   50.000 %
(4) Sixth Street Medical LLC

7974 UW Health Court
Middleton,WI53562
47-2705724
Real Estate WI N/A
N/A       No     No  
(5) Three Rivers Partners LLC

1313 East State Street
Rockford,IL61104
26-2231757
Information Technology Services IL 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
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Health Professionals of Wisconsin

301 South Westfield Road
Madison,WI53717
39-1806711
Real Estate WI N/A
C         No
(2) Physician's Care Network

1313 East State Street
Rockford,IL61104
36-3455791
Health Services IL N/A
C       Yes  
(3) Quartz Health Benefit Plans Corporation

840 Carolina Street
Sauk City,WI53583
39-1450766
Health Maintenance Organization WI N/A
C         No
(4) Quartz Health Insurance Corporation

840 Carolina Street
Sauk City,WI53583
39-1565691
Health Maintenance Organization WI N/A
C         No
(5) Quartz Health Solutions Inc

840 Carolina Street
Sauk City,WI53583
46-5710709
Insurance WI N/A
C         No
(6) Quartz Holding Company

840 Carolina Street
Sauk City,WI53583
82-1728929
Holding Company WI N/A
C         No
(7) SARI Insurance Company

76 St Paul Street Suite 500
Burlington,VT054014477
03-0308753
Captive Insurance Company VT N/A
C       Yes  
(8) State & Charles Inc

1313 East State Street
Rockford,IL61104
36-3321193
Holding Company IL N/A
C       Yes  
(9) SwedishAmerican Health Management Corp

1401 East State Street
Rockford,IL61104
36-3246511
Management Services IL N/A
C       Yes  
(10) Wisconsin Dialysis

3034 Fish Hatchery Road
Fitchburg,WI53713
30-0072647
Dialysis Services WI N/A
C         No
(11) Charitable Remainder Unitrusts (5)

 
 
Trust IL N/A
T       Yes  
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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 338,445 Cost
(2) SwedishAmerican Hospital Self Insurance Trust

Q 383,828 Cost
(3) SwedishAmerican Realty Corporation

K 6,645,144 Cost
(4) Three Rivers Partners LLC

J 354,535 Cost
(5) University of WI Medical Foundation

P 5,543,111 Cost
(6) University of WI Hospital and Clinics

P 22,443,700 Cost
(7) Regional Division Inc

Q 2,646,324 Cost
(8) University of WI Hospital and Clinics

E 221,886,241 Cost
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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) 2021

Additional Data


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