Public Disclosure
Public Disclosure
Public Disclosure Statement of Northern Illinois Hospice
Date Issued: February 1, 2024
Northern Illinois Hospice is a nonprofit 501(c)(3) professional medical organization. We are committed to meeting quality and safety standards when providing care for our patients and families. Northern Illinois Hospice will annually complete a written public disclosure statement, signed by the Chief Executive Officer.
Upon request, the following information will be made available to the patients of Northern Illinois Hospice, or the public:
a. Names and addresses of individuals or corporations having a combined direct or indirect ownership or controlling interest of 5% or more in Northern Illinois Hospice;
b. Names and addresses of subcontractors in which Hospice has a direct or indirect ownership or 5% or more;
c. Names and addresses of individuals who are related as spouse, parent, child, or sibling to individuals described in the 2 above bullets;
d. Names and addresses of individuals in the above 3 bullets with an ownership or controlling interest in a Medicare or Medicaid facility;
e. Names and addresses of officers, directors, or partners if Northern Illinois Hospice is a corporation or partnership;
f. The circumstances of any criminal offense conviction involving Medicare, Medicaid, or Title XX programs on the part of any person(s) or organization(s) in the above first 3 bullets and/or on the part of any agent or managing employee of Northern Illinois Hospice;
g. Names and addresses of any current employees in managerial, accounting, auditing or similar capacity who were employed by the organization’s fiscal intermediary during the past twelve (12) months;
h. Changes in the Chief Executive Officer, Directors, and/or Medical Director during the past twelve (12) months;
i. The dates of any change in ownership or control during the past twelve (12) months;
j. The dates of anticipated changes in ownership or control in the next twelve (12) months;
k. The dates of anticipated bankruptcy filings;
l. The dates of operational changes by a management company;
m. The dates of leasing arrangements in whole or in part by another organization; and
n. The dates of changes in address for the parent or branches.
This information will be disclosed:
- To the state survey agency at the time of the organization’s initial request for certification;
- For each subsequent survey by the state agency; and
- At the time of any change in ownership or management.