2017-05-15T08:58:20-05:00 2016-06-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2015-07-01 363383867 Little Company of Mary Affiliated Services LITT 7082295111 2800 West 95th Street Evergreen Park IL 60805 Randy Ruther Treasurer 7082295111 2017-05-11 1 Zack Fortsch P00052725 3126343400 2015 2021-01-29 14:40:06Z Randy Ruther 2800 West 95th Street Evergreen Park IL 60805 20647514 0 0928 X www.lcmh.org X 1984 IL Provide medical care to patients. 13 8 235 8 184749 -130639 0 0 15533466 17251188 660408 544545 2335731 2516091 18529605 20311824 0 0 0 0 15772650 18916715 0 0 0 9040170 11438290 24812820 30355005 -6283215 -10043181 32408916 32827651 12459466 13795614 19949450 19032037 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 16555330 14492378 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. 1808785 2758810 Operated and maintained healthcare buildings for physicians and immediate care centers. 2884389 2336199 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. 21248504 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 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 11 0 1 235 1 1 1 0 0 0 0 0 0 0 0 0 X 13 8 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 955375 17913 Randy Ruther Treasurer 1.00 41.00 X X 0 530473 24267 James Miller MD Director (as of 1/1/16) 1.00 0.00 X 0 0 0 Kent Armbruster MD Director 1.00 40.00 X 0 285639 17868 Violet Clark Director (as of 1/1/16) 1.00 1.00 X 0 0 0 Irv Fuld Director 1.00 0.00 X 0 0 0 Stephen M Hallenbeck Director 1.00 0.00 X 0 0 0 Ann Haskins Director 1.00 40.00 X 0 316185 11413 Ken Herlin Director 1.00 0.00 X 0 0 0 Kevin Rehder Director 1.00 40.00 X 0 232995 23006 Daniel Rowan DO Director (as of 1/1/16) 1.00 1.00 X 0 0 0 Marie Ruff Director 1.00 0.00 X 0 0 0 Stephen Ligda Director (thru 5/20/16) 1.00 1.00 X 0 0 0 Michael Schneider Member at Large (thru 11/12/15) 1.00 0.00 X 0 0 0 Nancy Taft Physician 40.00 0.00 X 347950 0 18310 Sujal Desai DO Physician 40.00 0.00 X 340621 0 25708 Robert Bonaminio DO Physician 40.00 0.00 X 396029 0 25942 Michael Fiorucci Physician 40.00 0.00 X 468479 0 23168 Michael Hurtuk Physician 40.00 0.00 X 345918 0 6136 1898997 2320667 193731 40 0 1 0 UIC Department of Surgery 840 S Wood St Suite 619 CSB MC Chicago IL 60612 Physician Services 450000 GDI Services Inc 4952 W 128th Place Alsip IL 60803 Facility Maintenance Services 277692 2 Patient Revenue 621110 12674712 12674712 Other Operating Revenue 561000 4576476 4391727 184749 17251188 521967 521967 2336199 0 2336199 2336199 2336199 358268 335639 51 22629 -51 22578 22578 Real Estate Tax Refund 900099 179892 179892 179892 20311824 19402638 184749 724437 15824523 11077166 4747357 217000 151900 65100 1955478 1368835 586643 919714 643800 275914 5665 3965 1700 1522193 1065535 456658 410384 287269 123115 1762904 1234033 528871 259411 181588 77823 1393189 975232 417957 60323 42226 18097 1190790 833553 357237 712875 499012 213863 LCM Management Services 3516048 2461234 1054814 604508 423156 181352 30355005 21248504 9106501 0 2312531 2224428 1617691 1506175 169776 208325 39117798 19367499 19407917 19750299 8901001 9138424 32408916 32827651 2948356 2992140 9511110 10803474 12459466 13795614 X 19949450 19032037 19949450 19032037 32408916 32827651 X -10043181 -307783 9433551 X 0 0 0 X 13783754 13401899 15116595 17592550 19402638 79297436 13783754 13401899 15116595 17592550 19402638 79297436 0 0 0 79297436 1828 248922 179615 191676 521967 1144008 1828 248922 179615 191676 521967 1144008 17255 17255 11304 33 23323 179892 214552 13785582 13679380 15296243 17807549 20104497 80673251 0.98290 0.99430 0.01420 0.00760 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous - 2012 Amount: $ 11,304. 2013 Amount: $ 33. 2014 Amount: $ 23,323. Real Estate Tax Refund - 2015 Amount: $ 179,892. 2074265 2074265 31897914 19367499 12530415 5145619 5145619 19750299 Self-Insurance Fund 8575950 Goodwill 77984 Pension Investment 484490 9138424 Self-Insurance Reserve 8475181 Due to Hospital 2299731 Other Liabilities 28562 10803474 0 0 0 0 0 0 0 0 0 Dennis Reilly Secretary 0 609831 0 340000 0 5544 0 5300 0 12613 0 973288 0 0 Randy Ruther Treasurer 0 413454 0 115000 0 2019 0 5300 0 18967 0 554740 0 0 Kent Armbruster MD Director 0 258886 0 15000 0 11753 0 5255 0 12613 0 303507 0 0 Ann Haskins Director 0 276239 0 36000 0 3946 0 5300 0 6113 0 327598 0 0 Kevin Rehder Director 0 196035 0 36000 0 960 0 4039 0 18967 0 256001 0 0 Nancy Taft Physician 343873 0 3332 0 745 0 4027 0 14283 0 366260 0 0 0 Sujal Desai DO Physician 340288 0 0 0 333 0 5300 0 20408 0 366329 0 0 0 Robert Bonaminio DO Physician 356545 0 38729 0 755 0 5300 0 20642 0 421971 0 0 0 Michael Fiorucci Physician 279503 0 188552 0 424 0 2815 0 20353 0 491647 0 0 0 Michael Hurtuk Physician 269606 0 75556 0 756 0 5300 0 836 0 352054 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 11 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 9,664,915. Change in Pension Obligation -231,364. 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 11a, 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 05401 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