Adventist Midwest Health F/K/A Adventist Hinsdale Hospital

“Adventist midwest health (the filing organization) has one member. The sole member of the filing organization is adventist health system/sunbelt, inc. (ahssi). Ahssi is a florida, not-for-profit corporation that is exempt from federal income tax under internal revenue code (irc) section 501(c)(3). There are no other classes of membership in the filing organization.”

“The members of the board of directors (governing board) of the filing organization are appointed by the corporate member, adventist health system/sunbelt, inc. The corporate member is entitled to elect not less than eighteen (18) and no more than twenty three (23) voting members to the board of directors of the filing organization pursuant to the provisions of the bylaws, subject to the ratification of the amita health board of directors.”

“The filing organization is one of two members and is a covered affiliate of the joc known as amita health. The other member of amita health is alexian brothers health system. The sole member of the filing organization is adventist health system/sunbelt, inc. (ahssi). The top-tier parent of amh is ahsshc (sponsor). The governing documents of the filing organization provide for certain reserved powers to exercise financial, managerial, and operational authorities over the filing organization by ahsshc, as sponsor, by ahssi as member, by both members of the joc, namely, amh and alexian brothers health system (members), and by the board of directors of the joc. Certain governance powers are reserved to ahssi as the member of the filing organization. These reserved powers include the alteration, restatement or repeal of the articles of incorporation, bylaws or mission statement of the filing organization, provided that such actions are not inconsistent with the joc bylaws or the affiliation agreement and the appointment of the filing organization's board of directors, subject to the ratification of the joc board of directors. Financial authorities reserved to the sponsor, the board of directors of the joc, and by both members of the joc include the approval of any disposition of the filing organization's assets and any internal transfer of the filing organization's assets. The sponsor, the board of directors of the joc, and both members of the joc may approve such dispositions or transfers up to established asset dollar values as set forth in the bylaws of the filing organization. Annual operating and capital budgets of the filing organization must be ratified by both sponsors of the joc. The board of directors of the joc must approve any capital expenditure to be made by the filing organization in excess of $10 million. Operational authorities reserved to the board of directors of the joc include the determination of the services to be provided by the filing organization, including the authority to direct the expansion, reduction and consolidation of clinical programs, patient care services and administrative capabilities or other major changes in the operation of the filing organization.”

“The filing organization's current year form 990 was reviewed by the board chairman, board finance committee chair, ceo and by the cfo prior to its filing with the irs. The review conducted by the board chairman, board finance committee chair, ceo and the cfo did not include the review of any supporting workpapers that were used in preparation of the current year form 990, but did include a review of the entire form 990 and all supporting schedules.”

“The conflict of interest policy of the filing organization applies to members of its board of directors and its principal officers (to be known as interested persons). In connection with any actual or possible conflict of interests, any member of the board of directors of the filing organization or any principal officer of the filing organization (i.e. Interested persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the board of directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant board member or principal officer, the remaining members of the board of directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's conflict of interest policy, an interested person may make a presentation to the board of directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each interested person, as defined under the filing organization's conflict of interest policy, shall annually sign a statement which affirms that such person has received a copy of the conflict of interests policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's conflict of interest policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes.”

“The filing organization's ceo, other officers and key employees are not compensated by the filing organization. As noted in our response to part vi, section a, line 7b, the filing organization is a covered affiliate of the joc known as amita health. Compensation for the officers and key employees is determined and approved by amita health. Please see the discussion concerning the process followed by amita health in determining executive compensation in our response to schedule j, line 3.”

“The filing organization is a part of the system of healthcare organizations known as adventist health system (ahs). The audited consolidated financial statements of ahs and of the ahs "obligated group" are filed annually with the municipal securities rulemaking board (msrb). The "obligated group" is a group of ahsshc subsidiaries that are jointly and severally liable under a master trust indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with generally accepted accounting principles (gaap) are also filed with msrb for ahs on a consolidated basis and for the grouping of ahs subsidiaries comprising the "obligated group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public.”

“For those board of director members (not including physician members of the board), officer(s) and key employees who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (b) on page 7 of the return) the compensation amounts shown in columns (e) and (f) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within adventist health system or amita health. Physician members of the board of directors received compensation from related organizations as a result of providing various medical services to those related entities.”

“The amounts shown in part viii, lines 7a and 7c of the form 990 represents an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program.”

“Amita health hinsdale clinical institutes amita health cancer institute & outpatient center: amita health hinsdale includes the amita health cancer institute & outpatient center (the center), which opened in hinsdale in february 2016. The 54,000-square-foot center provides a centralized location for patients on their journey from diagnosis to recovery, consolidating into one facility a comprehensive range of services formerly scattered across amita health hinsdale and amita health la grange. Patients visiting the center can see their physician, have lab work performed, and receive chemotherapy and radiation treatments in a comforting, healing environment featuring state-of-the-art technology. Having a comprehensive array of services under one roof facilitates coordination of treatment among multidisciplinary team members while saving time and reducing stress for patients. The center's design and its emphasis on patient convenience reflect the input of cancer survivors, physicians and associates called upon for their ideas as plans for the facility were developed. The facility's first floor is dedicated to cancer treatment, and its second floor offers outpatient imaging services, such as mammography, ultrasound and x-ray. The facility has separate entrances for the two different groups of patients it serves. The center features two linear accelerators for radiation treatment and 28 chemotherapy infusion chairs, including 17 in private rooms, four in semi-private rooms, and seven in community rooms designed to foster patient-to-patient support and communication. The center also has 21 exam rooms for doctor-patient consultations, a testing laboratory and a pharmacy specializing in chemotherapy. Another convenience is the center's wellness house office. Wellness house is a not-for-profit organization that offers an extensive array of support services for people living with cancer. The office reflects the center's focus on providing "adjacencies, or closely related services, in one convenient setting. Other adjacencies offered at the facility include nutrition counseling and genetic counseling. Amita health hinsdale services diagnostic services: amita health hinsdale's diagnostic services include the latest technology and practices, which are accredited by nationally and state recognized agencies and associations, such as the illinois emergency management agency, the american college of radiology, the college of american pathologists, the clinical laboratory improvement amendments and the joint commission. Diagnostic services offered include: -- diagnostic imaging (general x-ray, ct, mri, pet, ultrasound, nuclear medicine) -- breast-care services (screening and 3-d diagnostic mammography, breast biopsy ultrasound, stereotactic breast biopsy, bone densitometry, genetic counseling, mammacare breast self-examination instructions) -- cardiology (cardiac catheterization, electrophysiology, electrocardiograms [ekgs], stress testing, echocardiography, holter monitoring of arrhythmias) -- pulmonary diagnostics (arterial blood gas analysis) -- gastroenterology (colonoscopy, bronchoscopy) -- laboratory/pathology (chemistry, microbiology, hematology, histology, cytology, phlebotomy, transfusion services) emergency department: emergency medical care is provided 24/7 for all ages and types of patients, regardless of their ability to pay for such services. Outpatient services performed in 2017: -- 3,577 outpatient surgeries -- 58,969 diagnostic images, including general x-ray, ct, mri, pet, ultrasound, nuclear medicine and others -- 517,815 laboratory tests -- 27,294 emergency room visits.”

“Amita health adventist medical center la grange (amita health la grange, or the hospital) is a 222-bed acute-care hospital in la grange, illinois, that has served the healthcare needs of the la grange community and surrounding areas since 1955. Located at 5101 south willow springs road, amita health la grange is a full-service hospital that includes a medical office building on its campus in la grange, as well as the amita health cancer institute & outpatient center in hinsdale. In addition to cancer care, other specialty care and services offered by the hospital include clinical research trials, emergency services, endocrinology, geriatrics, gastroenterology, heart and vascular, home health, hospice, imaging, interventional radiology, lab services, neurology, obstetrics, orthopedics, pastoral care, pediatrics, physical rehabilitation, rheumatology, sleep disorders, surgical services, urology, women's care and wound care. The hospital has an imaging facility in westchester, illinois, and operates an outpatient physical rehabilitation site in willowbrook, illinois, in partnership with pt solutions. The hospital has a 16-bed acute inpatient rehabilitation unit that includes an apartment where therapists train patients to resume daily living activities. A 2016 expansion and renovation of the hospital's emergency department increased the number of treatment bays from 16 to 23. Each bay is a private room enclosed with solid walls and a door, instead of the thin curtains that had separated bays in the old emergency department. The new emergency department also features a fast-track area for patients with more-minor emergencies to decrease wait times for those patients and to free up exam rooms for more-serious cases. Through the years, amita health la grange has built numerous partnerships with community organizations to address local healthcare needs. Addressing the needs of older adults is a key focus for the hospital, which serves a large medicare population. Amita health la grange has a special collaborative relationship with sister hospital amita health adventist medical center hinsdale (amita health hinsdale) in hinsdale, illinois. About two miles separate the hospitals, and because of their proximity to each other, they have worked to integrate their services and to work collaboratively instead of competing against each other. The hospitals share the same senior management team, department leaders, and medical staff, and they partnered to develop the amita health cancer institute and outpatient center, which opened in 2016 in hinsdale. The integration process has reduced operating costs for the two hospitals, and they have reinvested the savings to expand and enhance services. The two hospitals also operate a family-practice residency program in which medical-school graduates serve their residencies, doing clinical rotations, caring for 18,000 patients annually -- including many medicaid recipients -- at a primary-care clinic at amita health hinsdale, and providing obstetrical services at a dupage county health department clinic in westmont. The program is a consistent source of family-practice physicians for the community. Amita health la grange is certified by the joint commission and the american heart association/american stroke association as a primary stroke center and has received national quality approval from the joint commission. The blue cross and blue shield association has awarded its blue distinction center+ designation to the hospital for delivering safe, high-quality and cost-efficient maternity care. In december 2017, amita health la grange earned a five-star rating - the highest possible - in ratings posted on the centers for medicare & medicaid services' hospital compare website. The hospital earned an "a," the highest possible score, in the spring 2017 and fall 2017 editions of the leapfrog group's biannual hospital safety grade study. In addition, amita health la grange was rated as high-performing in two”

“Amita health la grange clinical institutes amita health cancer institute & outpatient center: amita health la grange includes the amita health cancer institute & outpatient center (the center), which opened in hinsdale in february 2016. The 54,000-square-foot center provides a centralized location for patients on their journey from diagnosis to recovery, consolidating into one facility a comprehensive range of services formerly scattered across amita health hinsdale and amita health la grange. Patients visiting the center can see their physician, have lab work performed, and receive chemotherapy and radiation treatments in a comforting, healing environment featuring state-of-the-art technology. Having a comprehensive array of services under one roof facilitates coordination of treatment among multidisciplinary team members while saving time and reducing stress for patients. The center's design and its emphasis on patient convenience reflect the input of cancer survivors, physicians and associates called upon for their ideas as plans for the facility were developed. The facility's first floor is dedicated to cancer treatment, and its second floor offers outpatient imaging services, such as mammography, ultrasound and x-ray. The facility has separate entrances for the two different groups of patients it serves. The center features two linear accelerators for radiation treatment and 28 chemotherapy infusion chairs, including 17 in private rooms, four in semi-private rooms, and seven in community rooms designed to foster patient-to-patient support and communication. The center also has 21 exam rooms for doctor-patient consultations, a testing laboratory and a pharmacy specializing in chemotherapy. Another convenience is the center's wellness house office. Wellness house is a not-for-profit organization that offers an extensive array of support services for people living with cancer. The office reflects the center's focus on providing "adjacencies, or closely related services, in one convenient setting. Other adjacencies offered at the facility include nutrition counseling and genetic counseling. Amita health la grange services diagnostic services: amita health la grange's diagnostic services include the latest technology and practices, which are accredited by nationally and state recognized agencies and associations, such as the illinois emergency management agency, the american college of radiology, the college of american pathologists, the clinical laboratory improvement amendments and the joint commission. Diagnostic services offered include: -- diagnostic imaging (general x-ray, ct, mri [including open mri], pet, ultrasound, nuclear medicine) -- breast-care services (screening and 3-d diagnostic mammography, breast biopsy ultrasound, stereotactic breast biopsy, bone densitometry, genetic counseling, mammacare breast self-examination instructions) -- cardiology (cardiac catheterization, electrophysiology, electrocardiograms [ekgs], stress testing, echocardiography, holter monitoring of arrhythmias) -- pulmonary diagnostics (arterial blood gas analysis) -- gastroenterology (colonoscopy, bronchoscopy) -- laboratory/pathology (chemistry, microbiology, hematology, histology, cytology, phlebotomy, transfusion services) emergency department: emergency medical care is provided 24/7 for all ages and types of patients, regardless of their ability to pay for such services. Outpatient services performed in 2017: -- 2,765 outpatient surgeries -- 56,464 diagnostic images, including general x-ray, ct, mri, pet, ultrasound, nuclear medicine and others -- 151,940 laboratory tests -- 32,063 emergency room visits. Inpatient rehabilitation services performed in 2017: -- 501 inpatients were treated”

“Payments to healthcare professionals: program service expenses 10,269,788. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,269,788. Professional fees: program service expenses 340,538. Management and general expenses 0. Fundraising expenses 0. Total expenses 340,538. Purchased medical services: program service expenses 9,125,250. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,125,250. Environmental services: program service expenses 6,792,648. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,792,648. Recruiting: program service expenses 52,781. Management and general expenses 0. Fundraising expenses 0. Total expenses 52,781. Food service contracts: program service expenses 6,397,360. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,397,360. Other purchased services: program service expenses 35,812,430. Management and general expenses 0. Fundraising expenses 0. Total expenses 35,812,430. Billing & collection services: program service expenses 0. Management and general expenses 49,795. Fundraising expenses 0. Total expenses 49,795. Ahs management fees: program service expenses 0. Management and general expenses 15,473,600. Fundraising expenses 0. Total expenses 15,473,600. Transcription expense: program service expenses 22,730. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,730.”

“Net transfer to tax-exempt related organizations -13,820,016. Allocations to tax-exempt parent with respect to debt -80,490. Interest in foundation 1,394,839. Transfer to top-tier tax-exempt parent -4,105,564. Swap loss amortization 538,740. Gifts 6,442. Transfer for expenses -424,582. Other change 759. Rounding 2.”

“The amounts shown on line 2 of part x of this return include the filing organization's interest in a central investment pool maintained by adventist health system sunbelt healthcare corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value.”