ALVERNO PROVENA HOSPITAL LABORATORIES INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- ALVERNO PROVENA HOSPITAL LABORATORIES INC (EIN 20-3238867)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-09
- IRS object ID
- 202133139349303173
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-09T12:37:59-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 191 WEST NATIONWIDE BLVD SUITE 500 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 432152568 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203238867 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALVERNO PROVENA HOSPITAL LABORATORIES | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ALVE | BusinessNameControlTxt |
| Phone | 2199893857 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2434 INTERSTATE PLAZA DRIVE | AddressLine1Txt |
| City | HAMMOND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46324 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SAMUEL C TERESE JR | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 2199893857 | PhoneNum |
| Signature | 2021-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SAMUEL | PersonFirstNm |
| Person Last | TERESE JR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MOLLIE LONGHOUSE | PreparerPersonNm |
| PTIN | P00294881 | PTIN |
| Phone | 6142492300 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SAMUEL C TERESE JR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2434 INTERSTATE PLAZA DRIVE | AddressLine1Txt |
| City | HAMMOND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46324 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $178,792,335 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ALVERNOLABS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $148,187,106 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $178,237,168 | CYProgramServiceRevenueAmt |
| PY Investment Income | $260,984 | PYInvestmentIncomeAmt |
| CY Investment Income | $53,279 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $148,448,090 | PYTotalRevenueAmt |
| CY Total Revenue | $178,290,447 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $148,458,052 | PYOtherExpensesAmt |
| CY Other Expenses | $178,297,312 | CYOtherExpensesAmt |
| PY Total Expenses | $148,458,052 | PYTotalExpensesAmt |
| CY Total Expenses | $178,297,312 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$9,962 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$6,865 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,234,314 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,711,668 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,084,314 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,561,668 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $150,000 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $150,000 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $166,591,914 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $178,237,168 | RevenueAmt |
| Desc | ALVERNO PROVENA HOSPITAL LABORATORIES, INC.'S (APHL) PRIMARY FUNCTION IS TO PROVIDE LABORATORY TESTING SERVICES TO ITS TWENTY-FIVE (25) AFFLIATED NOT-FOR-PROFIT HOSPITALS AND AFFILIATES LOCATED THROUGHOUT ILLINOIS AND INDIANA. THE ORGANIZATION MAINTAINS A STRATEGIC PLAN THAT IS STRUCTURED ON THE FOLLOWING FIVE AREAS: STEWARDSHIP, PEOPLE, SERVICE, GROWTH, AND QUALITY. (CONTINUED IN SCHEDULE O) | Desc |
| Total Program Service Expenses | $166,591,914 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEVE WOJNICKI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2199893857 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2434 INTERSTATE PLAZA DRIVE | AddressLine1Txt |
| City | HAMMOND | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46324 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| THOMAS GRYZBEK | ||||||||
| CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOUG CARTER | ||||||||
| VICE CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK FRITSCH MD | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBIN PARKER | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BARBARA ANDERSON | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER MARION | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR STUART MARCUS | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR BELA NAND | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DANA GILBERT | ||||||||
| VICE CHAIR - TERMED | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| VICKIE REZAI MD | ||||||||
| DIRECTOR - TERMED | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHLEEN GUNDERSON | ||||||||
| DIRECTOR - TERMED | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SAMUEL C TERESE | ||||||||
| CEO/PRESIDENT | 32.00 | 8.00 | Yes (X) | $0 | $636,551 | $34,600 | ||
| STEVEN G WOJNICKI | ||||||||
| VP FINANCE | 32.00 | 8.00 | Yes (X) | $0 | $387,697 | $29,033 | ||
| BERNARD H HENRY | ||||||||
| VP HUMAN RESOURCES | 32.00 | 8.00 | Yes (X) | $0 | $321,435 | $34,285 | ||
| SHIRLEY J KOREN | ||||||||
| LAB DIRECTOR III | 40.00 | 0.00 | $0 | $145,691 | $30,598 | Yes (X) | ||
| ALEX WLODZIMIERSKI | ||||||||
| LAB DIRECTOR III | 40.00 | 0.00 | $0 | $147,995 | $28,249 | Yes (X) | ||
| SUSAN PIASECKI | ||||||||
| REGIONAL LAB DIRECTOR | 40.00 | 0.00 | $0 | $163,617 | $13,506 | Yes (X) | ||
| ROBIN ADES | ||||||||
| REGIONAL LAB DIRECTOR | 40.00 | 0.00 | $0 | $152,807 | $17,268 | Yes (X) | ||
| MARTHA A LAMPMAN | ||||||||
| REGIONAL LAB DIRECTOR | 40.00 | 0.00 | $0 | $161,192 | $7,939 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,116,985 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $195,478 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PROFESSIONAL CLINICAL LABORATORIES LLC | |||||
| 113 EAST 4TH STREET | MICHIGAN CITY | IN | 46360 | LAB & MANAGEMENT | $40,608,890 |
| ALVERNO CLINICAL LABORATORIES LLC | |||||
| 2434 INTERSTATE PLAZA DRIVE | HAMMOND | IN | 46324 | LAB & MANAGEMENT | $21,662,398 |
| ARUP LABORATORIES INC | |||||
| PO BOX 27964 | SALT LAKE CITY | UT | 84127 | REFERENCE LAB | $4,097,667 |
| AMERIPATH INDIANAPOLIS PC | |||||
| 13179 COLLECTION CENTER DRIVE | CHICAGO | IL | 606930131 | REFERENCE LAB | $1,153,188 |
| MEDSPEED | |||||
| PO BOX 190 | LAKE GENEVA | WI | 53147 | COURIER | $670,598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LAB SERVICES FOR PATRON HOSPITALS | Desc |
| Business | 621500 | BusinessCd |
| Total Revenue Column | $178,237,168 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $178,237,168 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $178,237,168 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,279 | TotalRevenueColumnAmt |
| Exclusion | $53,279 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $501,888 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $501,888 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $178,290,447 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $178,237,168 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $53,279 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,894 | TotalAmt |
| Management And General | $9,894 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,000 | TotalAmt |
| Management And General | $43,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,652,191 | TotalAmt |
| Program Services | $51,671,265 | ProgramServicesAmt |
| Management And General | $1,980,926 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $811,427 | TotalAmt |
| Program Services | $811,427 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,146 | TotalAmt |
| Program Services | $171,146 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,310 | TotalAmt |
| Program Services | $65,310 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,469 | TotalAmt |
| Program Services | $5,469 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $333,951 | TotalAmt |
| Program Services | $333,951 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| COMPENSATION PAID BY AC | $76,516,566 | $70,573,789 | $5,942,777 |
| MEDICAL SUPPLIES | $28,753,788 | $28,753,788 | |
| REFERENCE LABORATORY | $9,933,602 | $9,933,602 | |
| ALL OTHER EXPENSES | $5,794,515 | $2,065,714 | $3,728,801 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,206,453 | TotalAmt |
| Program Services | $2,206,453 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,297,312 | TotalAmt |
| Program Services | $166,591,914 | ProgramServicesAmt |
| Management And General | $11,705,398 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $2,246,764 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,904 | BOYAmt |
| EOY | $1,990 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $429,654 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,143 | BOYAmt |
| EOY | $342,418 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $895,759 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $895,759 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,017,849 | BOYAmt |
| EOY | $8,900,370 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,635,764 | BOYAmt |
| EOY | $4,324,367 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,234,314 | BOYAmt |
| EOY | $16,711,668 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,110,433 | BOYAmt |
| EOY | $10,548,914 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,973,881 | BOYAmt |
| EOY | $6,012,754 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,084,314 | BOYAmt |
| EOY | $16,561,668 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,000 | BOYAmt |
| EOY | $150,000 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,000 | BOYAmt |
| EOY | $150,000 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,234,314 | BOYAmt |
| EOY | $16,711,668 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$6,865 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $6,865 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $895,759 | OtherCostOrOtherBasisAmt |
| Book Value | $895,759 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $895,759 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MONEY MARKET FUND | Desc |
| Book Value | $8,900,370 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $8,900,370 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM RELATED PARTIES | Desc |
| Book Value | $4,324,367 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,324,367 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTIES | $4,727,354 |
| RETIREMENT BENEFIT LIABILITY | $1,285,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,012,754 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $178,799,200 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $6,865 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $501,888 | OtherRevenueAmt |
| Revenue Not Reported | $508,753 | RevenueNotReportedAmt |
| Revenue Subtotal | $178,290,447 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $178,290,447 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $178,799,200 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $501,888 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $501,888 | ExpensesNotReportedAmt |
| Expenses Subtotal | $178,297,312 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $178,297,312 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | APHL INC. HAS ESTABLISHED ITS STATUS AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER THE INTERNAL REVENUE CODE ("THE CODE") SECTION 501(E) AND THE LAWS OF THE STATES IN WHICH IT OPERATES. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. THE COMPANY RECOGNIZES INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST AND INCOME TAX EXPENSE, RESPECTIVELY. THE COMPANY HAS NO AMOUNTS ACCRUED FOR INTEREST OR PENALTIES AS OF DECEMBER 31, 2020 AND 2019. DUE TO ITS TAX-EXEMPT STATUS, THE COMPANY IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE COMPANY DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. TAX RETURNS FILED BY THE COMPANY ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. TAX RETURNS FILED BY THE COMPANY ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED DECEMBER 31, 2016 AND PRIOR. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD 501,888. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD 501,888. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMUEL C TERESE | ||||||||||||||
| CEO/PRESIDENT | $0 | $499,009 | $0 | $130,844 | $0 | $6,698 | $0 | $11,400 | $0 | $23,200 | $0 | $671,151 | $0 | $0 |
| STEVEN G WOJNICKI | ||||||||||||||
| VP FINANCE | $0 | $324,991 | $0 | $61,420 | $0 | $1,286 | $0 | $11,400 | $0 | $17,633 | $0 | $416,730 | $0 | $0 |
| BERNARD H HENRY | ||||||||||||||
| VP HUMAN RESOURCES | $0 | $264,080 | $0 | $51,901 | $0 | $5,454 | $0 | $10,096 | $0 | $24,189 | $0 | $355,720 | $0 | $0 |
| SUSAN PIASECKI | ||||||||||||||
| REGIONAL LAB DIRECTOR | $0 | $161,715 | $0 | $1,000 | $0 | $902 | $0 | $5,637 | $0 | $7,869 | $0 | $177,123 | $0 | $0 |
| SHIRLEY J KOREN | ||||||||||||||
| LAB DIRECTOR III | $0 | $143,818 | $0 | $1,000 | $0 | $873 | $0 | $5,970 | $0 | $24,628 | $0 | $176,289 | $0 | $0 |
| ALEX WLODZIMIERSKI | ||||||||||||||
| LAB DIRECTOR III | $0 | $144,549 | $0 | $1,000 | $0 | $2,446 | $0 | $5,960 | $0 | $22,289 | $0 | $176,244 | $0 | $0 |
| ROBIN ADES | ||||||||||||||
| REGIONAL LAB DIRECTOR | $0 | $151,003 | $0 | $1,000 | $0 | $804 | $0 | $6,178 | $0 | $11,090 | $0 | $170,075 | $0 | $0 |
| MARTHA A LAMPMAN | ||||||||||||||
| REGIONAL LAB DIRECTOR | $0 | $158,584 | $0 | $1,000 | $0 | $1,608 | $0 | $6,331 | $0 | $1,608 | $0 | $169,131 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | ALVERNO CLINICAL LABORATORIES, LLC (ACL), A RELATED ORGANIZATION IS THE PAY AGENT FOR ALVERNO PROVENA HOSPITAL LABORATORIES, INC. (APHL). ACL USED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR APHL'S TOP MANAGEMENT OFFICIALS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 PART I, LINE 1 | BRINGING CHRIST'S MINISTRY TO THOSE WE SERVE THROUGH TIMELY HIGH-QUALITY LAB TESTING TO OUR 25 NOT-FOR-PROFIT HOSPITALS AND AFFILIATES LOCATED THROUGHOUT ILLINOIS AND INDIANA. |
| FORM 990 PART III, LINE 1 | BRINGING CHRIST'S MINISTRY TO THOSE WE SERVE THROUGH TIMELY HIGH-QUALITY LABORATORY TESTING TO OUR 25 NOT-FOR-PROFIT HOSPITALS AND AFFILIATES LOCATED THROUGHOUT ILLINOIS AND INDIANA. |
| FORM 990 PART III LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS: APHL'S LONG TERM OBJECTIVE IS TO CONTINUE TO GROW SO AS TO PROVIDE QUALITY LABORATORY SERVICES TO OUR PATRON FAITH BASED HOSPITALS. IN SO DOING, APHL'S LONG TERM OBJECTIVE IS TO CONTROL COSTS, AND TO INCREASE THE NUMBER OF TESTS AVAILABLE, WITH A FOCUS ON HIGHLY RELIABLE SCIENTIFIC TEST RESULTS WHILE BUILDING A CULTURE OF SERVICE. APHL SEEKS TO ATTRACT A WORK FORCE DEDICATED TO SERVICE OF ITS PATIENTS. APHL'S SHORT TERM OBJECTIVES INCLUDE THE ENHANCEMENT OF THE COST MODEL TO IMPROVE THE RELATIVE VALUE UNIT THAT CAPTURES THE COMPLEXITY AND QUANTITATES THE PRODUCTION COST SO AS TO PROVIDE THE COOPERATIVE WITH AN INTEGRATED DELIVERY SYSTEM TO PROVIDE FOR PATIENT NEEDS ON THE PRODUCTION SIDE. THE USE OF LEAN CONCEPTS PROMOTES THE ELIMINATION OF WASTE AND THE EFFICIENT FLOW OF PRODUCTION. SCORE CARDS ARE IN PLACE AND MONITORED FOR QUALITY INTERVENTION NEED. APPROXIMATELY 16,544 TESTS A DAY ARE PERFORMED AT THE CENTRAL LABORATORY WHILE MAINTAINING RAPID RESPONSE LABORATORIES AT EACH HOSPITAL SITE. EACH LABORATORY SITE IS INSPECTED BY CAP AND PROVIDED A CERTIFICATION IN ADDITION TO THE INTERNAL APHL QUALITY DEPARTMENT INSPECTIONS AND PROGRAMS PROMOTING EXCELLENCE IN LABORATORY SCIENCE. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS TWO CLASSES OF MEMBERS, VOTING AND NON-VOTING. THE ORGANIZATION HAS ONE CLASS OF VOTING MEMBERS, REFERRED TO AS PARTICIPANT HOSPITALS. EACH PARTICIPANT HAS THE RIGHT TO APPOINT BOARD MEMBERS WHO HAVE THE RIGHT TO VOTE ON ALL MATTERS PRESENTED TO THE MEMBERS OF THE CORPORATION, INCLUDING THE ELECTION OF DIRECTORS. THE PATRONS DO NOT HAVE VOTING RIGHTS. CURRENTLY, APHL, INC. HAS THREE PARTICIPANTS AND NO PATRONS. |
| FORM 990, PART VI, SECTION A, LINE 7A | PARTICIPANT HOSPITAL SYSTEM REPRESENTATIVES ARE APPOINTED BY THE PARTICIPANT HOSPITAL SYSTEM OF APHL'S PARENT ORGANIZATIONS. THE PARTICIPANT HOSPITAL SYSTEM REPRESENTATIVES CAN ACT ON BEHALF OF THE PARTICIPANT HOSPITAL SYSTEM CEO ON ALL MATTERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE PARTICIPANT HOSPITAL SYSTEMS SHALL HAVE THE EXCLUSIVE POWER TO: A) APPROVE THE ADMISSION OF ADDITIONAL PARTICIPANTS OF THE CORPORATION; B) APPOINT AND REMOVE DIRECTORS AND FILL VACANCIES ON THE BOARD OF DIRECTORS; C) APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION; D) APPROVE AMENDMENTS AND/OR RESTATEMENTS FROM TIME TO TIME TO THE ARTICLES PROPOSED BY THE BOARD OF DIRECTORS; E) APPROVE AMENDMENT OR REPEAL OF THE BYLAWS AND THE ADOPTION OF NEW BYLAWS; F) APPROVE THE SALE, LEASE, PURCHASE, EXCHANGE, OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION OR THE DISPOSITION OF ASSETS OF THE CORPORATION OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; G) APPROVE THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR THE MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER CORPORATION; H) APPROVE THE PLAN FOR ALLOCATION AND DISTRIBUTION OF THE CORPORATION'S PROPERTY UPON DISSOLUTION IF NOT OTHERWISE PROVIDED FOR UNDER THE BYLAWS; I) APPROVE PARTICIPANTS' REQUIRED CAPITAL CONTRIBUTIONS TO THE CORPORATION OR DUES PAYABLE TO THE CORPORATION; J) APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION IN EXCESS OF AMOUNTS DETERMINED FROM TIME TO TIME BY THE PARTICIPANTS; K) ADOPT THE ANNUAL CAPITAL AND OPERATING BUDGETS OF THE COMPANY, AND ANY MATERIAL DEVIATIONS THEREFROM, SUCH ANNUAL BUDGETS TO INCLUDE ANY PREVIOUSLY APPROVED CAPITAL CONTRIBUTIONS; L) ADOPT THE STRATEGIC PLANS FOR THE CORPORATION AND APPROVE ANY MATERIAL CHANGES TO THE SERVICES OFFERED BY THE CORPORATION WHICH ARE NOT EXPRESSLY IDENTIFIED IN THE PREVIOUSLY APPROVED STRATEGIC PLANS; M) ORGANIZE OR ACQUIRE, OR AUTHORIZE THE ORGANIZATION OR ACQUISITION OF, ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; AND N) APPROVE ANY AMENDMENTS TO THE COOPERATIVE SERVICES AGREEMENT AMONG THE CORPORATION AND THE PARTICIPANTS, EFFECTIVE AS OF JULY 1, 2005 OR SUCH OTHER DATE AGREED UPON BY THE PARTICIPANTS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S MANAGEMENT. THEN A FINAL DRAFT OF THE FULL FORM 990, INCLUDING APPLICABLE SCHEDULES, IS MADE AVAILABLE TO THE FINANCE COMMITTEE AT A REGULARLY SCHEDULED MEETING WITH OUR TAX ADVISORS PRESENT. EACH REMAINING MEMBER OF THE BOARD OF GOVERNANCE IS ALSO PROVIDED A FINAL DRAFT OF THE FULL FORM 990 FOR REVIEW. THESE REVIEWS OCCUR PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | COVERED PERSONS: ALL MANAGEMENT PERSONNEL AND MEMBERS OF THE BOARD OF DIRECTORS ARE COVERED UNDER THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. MANAGEMENT PERSONNEL INCLUDE SUPERVISORS THROUGH THE PRESIDENT/CEO OF THE ORGANIZATION. POLICY SUMMARY: THE CONFLICT OF INTEREST POLICY IS SENT OUT TO COVERED PERSONS FOR REVIEW. EACH PERSON IS REQUIRED TO COMPLETE THE CONFLICT OF INTEREST QUESTIONNAIRE AND RETURN IT. IT IS THE RESPONSIBILITY OF HUMAN RESOURCES AND THE EXECUTIVE ASSISTANT TO ENSURE THE QUESTIONNAIRES ARE RETURNED AND COMPLETED. THE COMPLETED QUESTIONNAIRES ARE FORWARDED TO THE VICE PRESIDENT OF HUMAN RESOURCES FOR REVIEW TO DETERMINE IF CONFLICTS EXIST. AN INTERESTED PERSON HAS A CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT, TRANSACTION OR ARRANGEMENT IN WHICH ALVERNO PROVENA HOSPITAL LABORATORIES, INC. (APHL) IS (OR WOULD BE, IF APPROVED) A PARTY IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH A BUSINESS, INVESTMENT, FAMILY OR OTHER RELATIONSHIP: A) AN OWNERSHIP OR INVESTMENT INTEREST IN ANY ENTITY INVOLVED IN SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; B) A COMPENSATION ARRANGEMENT WITH AN INDIVIDUAL OR ENTITY INVOLVED IN SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; C) A POTENTIAL OWNERSHIP OR INVESTMENT INTEREST IN, OR COMPENSATION ARRANGEMENT WITH, AN INDIVIDUAL OR ENTITY WITH WHICH APHL IS NEGOTIATING SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; OR D) A FIDUCIARY POSITION (E.G., MEMBER, OFFICER, DIRECTOR, COMMITTEE MEMBER) WITH RESPECT TO AN ENTITY IN SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; OR E) A NON-ECONOMIC AFFILIATION OR RELATIONSHIP, DIRECTLY (OR INDIRECTLY, THROUGH A THIRD PARTY) WITH AN INDIVIDUAL OR ENTITY WITH WHICH APHL IS NEGOTIATING OR MAINTAINS A CONTRACT. TRANSACTION OR ARRANGEMENT SUCH THAT THE AFFILIATION OR RELATIONSHIP COULD RENDER THE INTERESTED PERSON INCAPABLE OF MAKING A DECISION WITH ONLY THE BEST INTERESTS OF APHL IN MIND. IN ADDITION, AN INTERESTED PERSON HAS A CONFLICT OF INTEREST IN ANY EXISTING OR POTENTIAL COMPENSATION ARRANGEMENT BETWEEN APHL AND THAT INTERESTED PERSON OR ANY BUSINESS, INVESTMENT OR FAMILY MEMBER RELATED TO THAT PERSON. FOR PURPOSES OF THIS SECTION, COMPENSATION INCLUDES DIRECT AND INDIRECT REMUNERATION, AS WELL AS GIFTS OR FAVORS THAT ARE SUBSTANTIAL IN NATURE. SERVICE OF INDIVIDUALS ON THE BOARD OF DIRECTORS FOR ALVERNO PROVENA HOSPITAL LABORATORIES, INC. (AND COMMITTEES THEREOF), BOARDS OR COMMITTEES OF THE MEMBER ORGANIZATIONS OR EMPLOYMENT BY A MEMBER ORGANIZATION OR ALVERNO CLINICAL LABORATORIES, A RELATED ORGANIZATION, IS NOT CONSIDERED A CONFLICT OF INTEREST, AS DEFINED IN THE POLICY. THE VP OF HUMAN RESOURCES COMPILES THE RESULTS AND FORWARDS THE RESULTS TO THE CEO. THE ASSESSMENTS OF ANY POTENTIAL CONFLICT ARE MADE IN COLLABORATION WITH LEGAL COUNSEL AS APPROPRIATE. THE CEO REVIEWS ANY CONFLICTS WITH THE BOARD DURING A SCHEDULED BOARD MEETING. POLICY VIOLATIONS: IF THE BOARD OR MANAGERS HAS REASON TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO COMPLY WITH THE DISCLOSURE OBLIGATIONS OF THIS POLICY, THE BOARD OF MANAGERS SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND PROVIDE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE TO DISCLOSE. AFTER HEARING THE RESPONSE OF SUCH A PERSON AND CONDUCTING FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD OF MANAGERS SHALL DETERMINE WHETHER SUCH PERSON HAS IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THE CONFLICT OF INTEREST POLICY. IF THE BOARD DETERMINES THAT THERE HAS BEEN A VIOLATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH MAY INCLUDE REMOVAL (IF THE INTERESTED PERSON IS A BOARD OR COMMITTEE MEMBER, DIRECTOR OR MANAGEMENT EMPLOYEE) OR TERMINATION (IF THE INTERESTED PERSON IS AN EMPLOYEE OF ALVERNO PROVENA HOSPITAL LABORATORIES, INC., ALVERNO CLINICAL LABORATORES, LLC OR A MEMBER ORGANIZATION). RESTRICTIONS IMPOSED ON PERSONS WITH A CONFLICT ARE DETERMINED ON A CASE BY CASE BASIS BY THE CEO IN COLLABORATION WITH LEGAL COUNSEL. AS OF THIS DATE, NO MATERIAL CONFLICTS OF INTEREST HAVE BEEN IDENTIFIED. IF A MATERIAL CONFLICT IS IDENTIFIED IN THE FUTURE, THAT PERSON WOULD BE REQUIRED TO RECLUSE THEMSELVES FROM PARTICIPATING IN DECISIONS AND/OR VOTING PRIVILEGES DIRECTLY RELATED TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | FORM 990 PART VI LINE 15A THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS PAID BY ALVERNO CLINICAL LABORATORIES, LLC, A RELATED ORGANIZATION; THEREFORE, THIS QUESTION HAS BEEN ANSWERED NO IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. THE BOARD OF DIRECTORS APPOINTED A COMPENSATION COMMITTEE, WHICH IS A SUB-COMMITTEE OF THE BOARD. THE COMPENSATION FOR THE PRESIDENT/CEO IS REVIEWED BY SYSTEM REPRESENTATIVES APPOINTED TO THE BOARD. SALARY INCREASES ARE APPROVED ANNUALLY. THE BUDGET IS RECOMMENDED FOR APPROVAL OR APPROVED ANNUALLY BY THE FINANCE COMMITTEE, BOARD MEMBERS FROM EACH PARTICIPATING SYSTEM AND SYSTEM REPRESENTATIVES APPOINTED TO THE BOARD BY THE SYSTEM CEO'S. FORM 990 PART VI LINE 15B THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES ARE PAID BY ALVERNO CLINICAL LABORATORIES, LLC, A RELATED ORGANIZATION; THEREFORE, THIS QUESTION HAS BEEN ANSWERED NO IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. SEE NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SVC-OTHER: PROGRAM SERVICE EXPENSES 1,052,482. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,052,482. PCL LAB SERVICES: PROGRAM SERVICE EXPENSES 44,161,742. MANAGEMENT AND GENERAL EXPENSES -603,985. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,557,757. ACL MANAGEMENT SERVICES: PROGRAM SERVICE EXPENSES 6,457,041. MANAGEMENT AND GENERAL EXPENSES 2,584,911. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,041,952. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| ALVERNO LAB LLC | |||||||||
| 2434 INTERSTATE PLAZA DR | HAMMOND | IN | 46324 | 203240648 | MANAGEMENT SVCS | IN | N/A | 0 | 0 |
| PROF LAB LLC | |||||||||
| 2434 INTERSTATE PLAZA DR | HAMMOND | IN | 46324 | 300711211 | MEDICAL SERVICES | IN | N/A | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART III | FormAndLineReferenceDesc |
| Explanation | LISTED BELOW ARE THE COMPLETE NAMES AND STREET ADDRESSES FOR PART III: 1) ALVERNO CLINICAL LABORATORIES, LLC; 2434 INTERSTATE PLAZA DRIVE; HAMMOND, IN 46324 2) PROFESSIONAL CLINIC LABORATORIES, LLC; 2434 INTERSTATE PLAZA DRIVE; HAMMOND, IN 46324 | ExplanationTxt |
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