2013-02-15T16:29:49-07:00 2012-06-30 990 2011-07-01 362200248 LORETTO HOSPITAL LORE 7736264300 645 S CENTRAL AVE CHICAGO IL 60644 Sonia Mehta 7738545057 2013-02-07 2011 2016-03-07 17:11:31Z X DR SONIA MEHTA 645 S CENTRAL AVE CHICAGO IL 60642 62944759 0 X WWW.LORETTOHOSPITAL.ORG X 1939 IL LORETTO HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATION, WHICH PARTNERS WITH ITS PHYSICIANS, EMPLOYEES AND THE COMMUNITIES IT SERVES, TO PROVIDE QUALITY PATIENT CENTERED CARE AND PROMOTE WELLNESS AND EDUCATION. 6 4 534 13 0 0 17546251 19398747 50671107 41990941 0 0 643004 1555071 68860362 62944759 0 0 0 0 34541308 36982911 0 0 0 32046327 32585536 66587635 69568447 2272727 -6623688 50512046 51932209 16773056 17709444 33738990 34222765 LORETTO HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATION, WHICH PARTNERS WITH ITS PHYSICIANS, EMPLOYEES AND THE COMMUNITIES IT SERVES, TO PROVIDE QUALITY PATIENT CENTERED CARE AND PROMOTES WELLNESS AND EDUCATION. 0 0 65447928 0 0 N/A 0 0 0 65447928 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 534 1 1 1 1 CJ 0 0 0 0 X 6 4 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 IL X X X DR SONIA MEHTA 7738545000 645 S CENTRAL AVE CHICAGO IL 60644 RUBY ISOM 40 X 110654 0 1383 DENISE SEAMAN 40 X 117524 0 1366 PAULA CROSSEN 40 X 118456 0 888 ROSE GEARY 40 X 121642 0 879 JOHN PAPPONE 40.0 X 110131 0 0 JAMES WALLER 40 X 132314 0 0 EDWARD HOGAN 0 X 0 0 0 JAMES MONTGOMERY 0 X 0 0 0 KIMBERLY LIGHTFORD 0 X 0 0 0 MICHELLE COLLINS 0 X 0 0 0 STEVE DRUCKER 40 X 307600 0 2307 JOHN VALLES 40.0 X 221200 0 1659 MARC TRZNADEL 40 X 103099 0 0 DEENADAYAL GADDAM 40 X 262357 0 3935 BELA NAND 40.00 X 407877 0 3123 HARI PAUDEL 40.0 X 159768 0 0 TILAK JOSHI 40 X 169488 0 0 ALIYAH SADAF 40 X 147126 0 0 2489236 0 15540 18 0 1 0 B E SMITH 9777 Ridge Drive Ste 300 Lenexa KS 66219 Consulting 261202 HOGAN MARREN LTD 180 NORTH WACKER DRIVE STE 600 CHICAGO IL 60606 LAW FIRM 338519 HORIZON EMERGENY PHYSICIAN GROUP 2000 SPRING ROAD SUITE 200 OAK BROOK IL 60523 EMERGENCY PHYSICIANS 1020804 CRAWFORD AVENUE ANESTHESIA 19627 S La Grange Rd Mokena IL 60448 ANESTHESIOLOGIST 500000 RENASSIANCE HOSPITAL MANAGEMENT 1101 WEST LAKE ST SUITE 300 OAK PARK IL 60102 MANAGEMENT COMPANY 1695550 8 0 0 0 0 11196773 8201974 0 19398747 PATIENT REVENUE 622000 86117703 86117703 0 0 CONTRACTUAL ALLOWANCE 622000 -44126762 -44126762 0 0 0 0 0 0 41990941 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA 722110 166059 166059 0 0 RENTAL INCOME 531120 4860 4860 0 0 INVESTMENTS 900001 1895282 1895282 0 0 -511130 -511130 0 0 1555071 62944759 43546012 0 0 2489236 2489236 29740879 28253835 1487044 111669 106086 5583 2418422 2297501 120921 2222705 2111570 111135 5449138 5176681 272457 750733 0 750733 250110 0 250110 2036415 1934594 101821 522487 522487 0 1201999 1201999 0 121 0 121 3106453 2951130 155323 1962662 1962662 0 PHYSICIAN FEES 2366874 2248530 118344 0 PHARMACEUTICALS 1686237 1601925 84312 0 PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS 2176789 2067950 108839 0 MISCELLANEOUS 11075518 10521742 553776 0 69568447 65447928 4120519 0 1484195 294547 0 0 4154066 4408739 0 0 0 3500346 438019 453481 414766 397913 62279168 38316739 20305670 23962429 23715330 18914754 50512046 51932209 7776854 9044150 0 0 0 0 0 0 0 8996202 8665294 16773056 17709444 X 33232345 26926614 506645 7296151 0 0 33738990 34222765 50512046 51932209 X -6623688 7107463 X 1 1 0 X 0 X 0 429028 429028 0 33960417 21293020 12667397 0 197413 197413 0 0 21175462 15402465 5772997 0 6516848 1423841 5093007 23962429 LH FOUNDATION 614108 C MERRILL LYNCH AND BOARD DESIGNATED 3930774 C WESTSIDE INSURANCE 14369872 C 18914754 ASSET RETIREMENT OBLIGATION 2467317 SELF INSURANCE 5824402 EST SETTLEMENTS DUE TO THIRD-PARTY 373575 8665294 62944759 69568447 -6623688 0 0 0 0 0 0 -6623688 62944759 0 0 0 0 0 62944759 0 0 0 62944759 69568447 0 0 0 0 0 69568447 0 0 0 69568447 1 1 1 X 300 1 X 1 1 1 0 1 1 1167383 0 11673853 0.17 30283213 21166565 9116648 0.13 25759108 10332702 15426406 0.22 0 0 57209704 31499267 36216907 0.52 169537 115937 53600 0 0 0 169537 115937 53600 0.00 0 0 57379241 31615204 36270507 0.52 1 2176789 1088395 19209070 19209070 0 X 1 1 Renaissance Hospital Management Healthcare Management 0 0.19 0 1 1 Loretto Hospital

645 S Central Ave Chicago IL 60642

X X X X Loretto Hospital 1 0 1 1 300 1 300 1 X X X X X X X 1 1 X X X X X X 1 X 1 X X X X X 1 X 0 0 SchH_P01_S00_L07 Schedule H, Part I, Line 7 The costing methodology used is the Cost-to-Charge Ratio. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f The bade debt expense that is included in Part IX, Line 25 is $2,176,789. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Bad debt expense is the result of patients having the ability to pay, but choosing not to pay. The costing methodology used to dtermine bad debt expense is cost to charge ratio. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The source for the Medicare allowable cost if from the Provider Statisical & Reimbursement Report (PSR) SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The policy of Loretto is to provide charity care to patients whose financial status makes it impossible or impractical to pay for medial services, all patients requesting treatment will be given written notification of Loretto Hospital's financial assistance program. This notification is given to the patients or represenative during the registration process when the notice of privacy practises is explained. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 The hospital facility used the Medicaid rate for those services. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 The health care needs of the community is assessed by PHI's. We may use your PHI to provide, coordinate or manage your in-patient, out-patient, or post-hospital care. We may disclose your PHI to doctors, nurses, hospitals and other healthcare facilities whoe become involved in your care. In the course of your treatment here, your PHI may be disclosed to indirect healthcare providers such as our independent contractor radiologist and pathologists. Similarly, we may refer you to another healthcare provider and as part of the referral process share your PHI with that provider. An example of this would be if you were being treated for a broken leg, and the physician needed to know if you had diabetes, because diabetes may slow the healing process. So the physician treating your leg may refer to another physician who specializes in treating diabetic patients and in doing so, will share your PHI with that physician. Additionally, if you have diabetes, the physician will share your PHI with a dietitation se we can arrage for appropriate meals for you. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 All patients requesting treament will be given notification of Loretto Hospital's financial assistance program. The notification is given to the patient or representative during the registration process when the notice of privacy is explained. The patient or representative will be asked to sign, acknowledging receipt of a copy of the notice of our privacy practices and a notification of Loretto Hospital's financial assistance program. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Austin community is located on the West Side of Chicago, Illinois, and it is the largest (by population) of the city'ss 77 officially defined community areas (neighborhoods), followed by Lake View. Its eastern boundary is Cicero Avenue. Its nothernmost border is the Milwaukee District/West Line. Its southernmost border is at Roosevelt Road fro Cicero Avenue west to Austin Boulevard. The northernmost portion, north of North Avenue, extends west to Harlem Avenue, abutting Elmwood Park. Other suburbs bordering Austin are Cicero and Oak Park. Also nearby is Berwyn. The demographics of the Austin area is 90% African-American community. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Illinois is the only state that we file a community benefit report. X 1 1 X 0 0 0 0 0 0 0 0 0 STEVE DRUCKER 307600 0 0 0 2307 0 0 0 0 0 309907 0 309907 0 JOHN VALLES 221200 0 0 0 1659 0 0 0 0 0 222859 0 222859 0 DEENADAYAL GADDAM 262357 0 0 0 3935 0 0 0 0 0 266292 0 303010 0 BELA NAND 407877 0 0 0 3123 0 0 0 0 0 411000 0 371556 0 TILAK JOSHI 169488 0 0 0 0 0 0 0 0 0 169488 0 0 0 HARI PAUDEL 159768 0 0 0 0 0 0 0 0 0 159768 0 152450 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Determined by the Management Firm. Reviewed and approved/disapproved by the board. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Determined by the management firm. Reviewed and approved/disapproved by the board. F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 Renassiance Hospital Management, Inc. F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 Edward Hogan,321 North Clark Street, Suite 1301,Chicago, IL 0654/Michelle Collins,Urban Partnership Bank,3401 S. King Drive,Chicago, IL 60612/Kimberly Lightford,4th District,10001 S. Roosevelt Road, Suite 202,Westchester, IL 60154/Jim Montgomery,Sr.,Cochran,Cherry,Givens,Smith&Montgomery Law Office, 1 North Lasalle,Suite 2450,Chicago, IL 60602/Dr. Amjad Khan,7435 W. Madison Street,Forest Park,IL 60181 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b A draft of the 990 is initially presented to the board of trustees for review by its finance sub-committee. The final version of form 990 is then presented to the board for approval prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The compliance policy is presnted at the new orientation. Also it is reviewed and discussed at department head meetings. The compliance Officer routinely audits the compliance policy. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 THE CEO and Executive Management compensation is presented and reviewed by the management company. Recommendations and findings are presented for review and approval by the compensation committe of the board of trustees prior to presentation for approval by the board. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The financial statements are made available via website, public newsletter, and upon request. F990_P11_S00_L05 Form 990, Part XI, Line 5 Changes in net assets are contributions for specific purpose and investment income. Loretto Hospital Foundation 645 S Central Ave Chicago IL 60642 362200248 Fundraising IL 501(c)3 N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 Loretto Hospital Foundation n 25000 The percentage of time that is shared between the hospital and the foundation. N/A