2019-05-15T14:44:30-05:00 2018-06-30 420714325 RSM US LLP 1 S Wacker Drive Ste 800 Chicago IL 60606 990 2017-07-01 363383867 Little Company of Mary Affiliated Services LITT 7082295111 2800 West 95th Street Evergreen Park IL 60805 Timothy Kelleher Treasurer 7082295111 2019-05-15 1 Zack Fortsch P00052725 3126343400 66.98.98.10 2019-05-15 11:54:09 CD P F6217F2D6ED5C2D75B43E0AF4E216B671259B073 8C7237D2AFEDFB09D88626A2D3FB2BC60A40D8C2 2017 2019-02-21 02:37:17Z Timothy Kelleher 2800 West 95th Street Evergreen Park IL 60805 20624089 0 0928 X www.lcmh.org X 1984 IL Provide medical care to patients. 12 6 283 10 144817 -110653 0 0 16980064 14711453 1024233 678465 2397909 2226097 20402206 17616015 0 0 0 0 20663494 22387949 0 0 0 13667660 11436448 34331154 33824397 -13928948 -16208382 39986402 37096755 18602284 18185783 21384118 18910972 X In Solidarity with the Sisters of the Little Company of Mary, we are entrusted to serve the community through our ministry of Catholic Health Care. We are the empowered laity - the greater Company of Mary. Rooted in a deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity. 0 0 21966551 14382184 Little Company of Mary Affiliated Services provides ambulatory healthcare services for the community at a variety of locations. It accomplishes this program by employing over 35 employed physicians, nurse practitioners, and a midwife. Each individual physician office provides clinical excellence above and beyond traditional medicine in a peaceful, clean, and caring environment. The office utilizes the best information and state-of-the-art technology to deliver and manage care and improve the health of the community. 2321177 2224676 Operated and maintained healthcare buildings for physicians and immediate care centers. 961907 184452 Little Company of Mary Affiliated Services maintains additional services for patients and employees in order to further promote quality health care and a healthy work environment. For example, Little Company of Mary Affiliated Services purchased and maintains an Electronic Medical Record (EMR) system. The EMR system provides physicians with the most up-to-date information concerning their patients, which increases the safety and quality of the healthcare services provided to the community. 25249635 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 283 1 1 1 0 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X Walter Furtner 7082295100 2800 West 95th Street Evergreen Park IL 60805 Thomas Fahey Chairperson 1.00 1.00 X X 0 0 0 Dennis Reilly Secretary 1.00 40.00 X X 0 942799 25946 Randy Ruther Treasurer 1.00 41.00 X X 0 527816 23629 James Miller MD Director 1.00 0.00 X 0 0 0 Kent Armbruster MD Director 1.00 40.00 X 0 190819 21583 Violet Clark Director 1.00 1.00 X 0 0 0 Irv Fold Director 1.00 0.00 X 0 0 0 Stephen M Hallenbeck Director (Until 1/1/18) 1.00 0.00 X 0 0 0 Ann Haskins Director (Until 2/1/18) 1.00 40.00 X 0 310110 14236 Ken Herlin Director 1.00 0.00 X 0 0 0 Kevin Rehder Director 1.00 40.00 X 0 232030 32060 Daniel Rowan DO Director 1.00 1.00 X 0 0 0 Marie Ruff Director 1.00 0.00 X 0 0 0 Sujal Desai DO Physician 40.00 0.00 X 612255 0 34760 Robert Bonaminio DO Physician 40.00 0.00 X 598320 0 34703 Bassel Atassi Physician 40.00 0.00 X 462577 0 31639 Khalid Yousuf Physician 40.00 0.00 X 344800 0 21494 Jessica Bender Physician 40.00 0.00 X 348459 0 5662 2366411 2203574 245712 40 0 1 0 UIC Department of Surgery 840 S Wood St Suite 619 CSB MC Chicago IL 60612 Physician Services 600000 Southwest Town Mechanical 780 AEC Drive Wood Dale IL 60191 Facility Maintenance Services 338188 GDI Services Inc 4952 W 128th Place Alsip IL 60803 Facility Maintenance Services 295907 Loyola University Medical Center 2160 S First Avenue Maywood IL 60153 Physician Services 114364 4 Patient Revenue 621110 13644429 13644429 Other Operating Rev. 561000 1067024 922207 144817 14711453 361541 361541 2224676 0 2224676 2224676 2224676 3324998 3008074 316924 316924 316924 Real Estate Tax Refund 900099 1115 1115 306 306 1421 17616015 16791312 144817 679886 19013472 14033598 4979874 223401 165317 58084 2044800 1509267 535533 1106276 816542 289734 4028 4028 94120 94120 1795206 881476 913730 411696 411696 754265 490272 263993 248986 199189 49797 1974429 1678265 296164 2801 2801 62124 45039 17085 1369334 1095467 273867 2649682 2624210 25472 Medical Supplies 1378885 1378885 LCM Management Service 295216 295216 Bad Debt Expense 239536 239536 156140 92572 63568 33824397 25249635 8574762 0 1604 3910768 4559795 1444090 1634463 277175 249403 65043 45192131 21133965 21242455 24058166 13139686 6500509 39986402 37096755 2911146 4358203 15691138 13827580 18602284 18185783 X 21384118 18910972 21384118 18910972 39986402 37096755 X -16208382 298525 -104334 13541045 X 0 1 X 1 0 X 15116595 17592550 19402638 19124512 16791312 88027607 15116595 17592550 19402638 19124512 16791312 88027607 0 0 0 88027607 179615 191676 521967 701631 361541 1956430 179615 191676 521967 701631 361541 1956430 33 23323 179892 90022 1421 294691 15296243 17807549 20104497 19916165 17154274 90278728 0.97510 0.97510 0.02170 0.02120 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous - 2013 Amount: $ 33. 2014 Amount: $ 23,323. 2017 Amount: $ 306. Real Estate Tax Refund - 2015 Amount: $ 179,892. 2016 Amount: $ 90,022. 2017 Amount: $ 1,115. 2538004 2538004 36679031 16442676 20236355 5975096 4691289 1283807 24058166 Self-Insurance Fund 5793339 Goodwill 16149 Pension Investment 691021 6500509 Self-Insurance Reserve 11742480 Due to Hospital 2052746 Other Liabilities 32354 13827580 X 17914540 298525 298525 17616015 0 17616015 33824397 0 33824397 0 33824397 Part X, Line 2: The Corporation has received a determination letter from the Internal Revenue Service (IRS) stating that it is exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. The Corporation adopted the FASB-issued guidance for accounting for uncertainty in income taxes on July 1, 2007. The Corporation files a Form 990 (Return of Organization Exempt from Income Tax) annually. When the 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 include the tax-exempt status of the entity and various positions relative to potential sources of unrelated business income (UBI). UBI is reported on Form 990-T, as appropriate. The benefit of a tax position is recognized in the financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the 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 percent likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above would be reflected as a liability for unrecognized tax benefits in the balance sheet, along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB-issued guidance at July 1, 2007, and since that date through June 30, 2018, there were no unrecognized tax benefits identified and recorded as a liability. Forms 990 and 990-T filed by the Corporation are subject to examination by the IRS up to three years from the extended due date of each return. Forms 990 and 990-T filed by the Corporation are no longer subject to examination for the years 2014 and prior. 0 0 0 0 0 0 0 0 0 Dennis Reilly Secretary 0 637255 0 300000 0 5544 0 5400 0 20546 0 968745 0 0 Randy Ruther Treasurer 0 433873 0 90000 0 3943 0 5400 0 18229 0 551445 0 0 Kent Armbruster MD Director 0 185178 0 2500 0 3141 0 3436 0 18147 0 212402 0 0 Ann Haskins Director (Until 2/1/18) 0 286566 0 18000 0 5544 0 5400 0 8836 0 324346 0 0 Kevin Rehder Director 0 205437 0 25000 0 1593 0 4244 0 27816 0 264090 0 0 Sujal Desai DO Physician 517941 0 93776 0 538 0 5300 0 29460 0 647015 0 0 0 Robert Bonaminio DO Physician 424633 0 172845 0 842 0 5400 0 29303 0 633023 0 0 0 Bassel Atassi Physician 398975 0 63225 0 377 0 2030 0 29609 0 494216 0 0 0 Khalid Yousuf Physician 343451 0 1065 0 284 0 4363 0 17131 0 366294 0 0 0 Jessica Bender Physician 242988 0 105281 0 190 0 4530 0 1132 0 354121 0 0 0 Part I, Line 3 The Board Executive Committee of Little Company of Mary Hospital, Inc. annually reviews external benchmark compensation drafts and determines compensation adjustments based on market data and internal performance results for the Secretary and Treasurer positions. The Hospital uses an outside consultant and outside surveys to determine appropriateness of executive pay. The process of determining executive compensation is documented and retained by the CEO of the Hospital. For other top management positions, the compensation committee is comprised of the CEO, CFO, and COO of the Hospital. Form 990, Part VI, Section A, line 6 The sole member of the organization is Little Company of Mary Health Systems of Evergreen Park, an Illinois not-for-profit corporation. Form 990, Part VI, Section A, line 7a Little Company of Mary Health Systems of Evergreen Park has the power to appoint members of the governing body. Form 990, Part VI, Section A, line 7b The sole corporate member retains reserved powers to approve, among other things, Affiliated Services' annual budget, election of Directors, and the incurrence of debt or transfer of property in excess of certain limits. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the Accounting Manager and Treasurer prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Each director, principal officer, key employee and member of a committee with Board delegated powers shall annually sign a Conflict of Interest Statement which affirms that such person has received, read, understood, and agreed to comply with the directive. All conflict of interest statements are reviewed annually by the CEO and the Corporate Compliance Officer and the results are presented to the Corporate Compliance Committee. The results and any recommendations are reported at the next Board of Directors' meeting. If a conflict is deemed to exist, such person shall not vote on, nor use his or her personal influence on, nor participate (other than to present factual information or to respond to questions) in the discussions or deliberations with respect to such contract or transaction. Such person may not be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted upon. The minutes of the meeting shall reflect the disclosures made, the vote thereon and, where applicable, the abstention from voting and participation, and whether a quorum was present. Form 990, Part VI, Section B, line 15 The Board Executive Committee of Little Company of Mary Hospital, Inc. annually reviews external benchmark compensation drafts and determines compensation adjustments based on market data and internal performance results for the Secretary and Treasurer positions. The Hospital uses an outside consultant and outside surveys to determine appropriateness of executive pay. The process of determining executive compensation is documented and retained by the CEO of the Hospital. For other top management positions, the compensation committee is comprised of the Hospital's CEO, CFO, and COO. Form 990, Part VI, Section C, line 19 The conflict of interest policy is available by request. Form 990, Part XI, line 9: Net Assets Transferred from Other Organizations 13,869,741. Change in Pension Obligation -328,696. Little Company of Mary Hospital Inc 2800 West 95th Street Evergreen Park IL 60805 362246719 Hospital IL 501(c)(3) Line 3 American Province 0 Little Company of Mary Health Systems 2800 West 95th Street Evergreen Park IL 60805 363823627 Health Services IL 501(c)(3) Line 1 American Province 0 Little Company of Mary Foundation 2800 West 95th Street Evergreen Park IL 60805 363993337 Support Organization IL 501(c)(3) Line 12a, I Little Company of Mary Hospital 0 American Province of The Little Company of Mary Sisters 2800 West 95th Street Evergreen Park IL 60805 237294648 Religious IL 501(c)(3) Line 1 N/A 0 Southwest Health Systems Inc 2800 West 95th Street Evergreen Park IL 60805 363425870 Managed Care IL N/A C 0 Mary Cap Insurance Inc 76 St Paul Street Suite 500 Burlington VT 50401 030304812 Captive Insurance VT N/A C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0