2013-08-13T10:32:43-05:00 2012-09-30 861065772 Deloitte Tax LLP 111 S Wacker Dr Chicago IL 60606 990 2011-10-01 362179813 SWEDISH COVENANT HOSPITAL SWED 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 THOMAS GARVEY 7738788200 2013-08-13 1 P00855604 3124861000 2011 2016-02-24 21:20:13Z THOMAS GARVEY 5145 N CALIFORNIA AVE CHICAGO IL 60625 270733293 0 X www.schosp.org X 1907 IL Providing excellent healthcare services for our culturally diverse communities for over 120 years. 22 15 2296 227 2403173 0 335333 7291187 233153424 250010625 1105301 1242801 10929211 12180280 245523269 270724893 0 0 0 0 117999513 115120418 0 0 499964 126367993 136348605 244367506 251469023 1155763 19255870 417055817 451770879 294973852 301520837 122081965 150250042 X Our Mission is to provide a continuum of excellent healthcare services. Rooted in The Evangelical Covenant Church, the hospital is dedicated to serving the physical, spiritual and psychological needs of our culturally diverse communities. 0 0 220685048 259778645 Since 1886, Swedish Covenant Hospital (SCH) has been dedicated to providing community benefit healthcare services and healthcare education. As part of its mission as a not-for-profit, church-based community hospital, Swedish Covenant has served as an educational center, health rehabilitation center, illness prevention center, social support services center, and community center. Swedish Covenant Hospital serves as a solid community structure through employment of over 1,867 individuals.Recognizing its mission to the community, Swedish Covenant Hospital offers the following quality medical healthcare services regardless of race, creed, sex, national origin, handicap, age or ability to pay:General Medicine, Surgery, ICUSwedish Covenant Hospital continually offers the latest technology to meet the vast needs of the community. During the fiscal year, SCH serviced 14,589 inpatients and more than 247,737 outpatients for a total cost of $208,816,218.Physical Medicine/Rehab ServicesSCH is dedicated to providing a comprehensive Rehab Unit that combines the disciplines of physical therapy, speech therapy, occupational therapy and social work to help patients regain their strength and skills. The Rehab unit features a special room that simulates a home environment so patients can practice with home-like carpeting, furniture and fixtures while supervised by nurses. During the fiscal year, 220,612 inpatient and outpatient treatments for rehab, speech and occupational therapy were provided for a total cost of $4,212,586.Cardiac Care and RehabThe Cardiac Rehabilitation program offered by Swedish Covenant Hospital has improved the lives of many individuals with such innovative programs as Coronary Heart Disease Reversal. SCH also offers a state-of-the-art Cardiac Catheterization Lab, and other diagnostic and preventive programs. During the fiscal year, SCH provided 23,190 treatments and 1,777 procedures by the Cardiac Rehab program and Cardiac Catheterization Lab, respectively, for a total cost of $6,147,784.Family Practice CenterThe SCH Family Practice Center is a key component of its community benefit programs, especially for those who are uninsured or underinsured. The Center offers physician office visits and lab work, low-cost obstetric/prenatal care, health screenings and back-to-school physicals. During the fiscal year ended September 30, 2012, the Family Practice Center performed 14,720 procedures for a total cost of $569,251.In addition to the program services listed above, Swedish Covenant Hospital also offers the following services to the community:Health Screening, Health Promotions, Education, PreventionSCH offers year-round health screenings to members of the community. During the fiscal year, SCH offered 8 blood pressure screening events serving 252 participants. Each year free or reduced-cost cancer screenings are offered to the community. These include prostate, skin, oral, and breast screenings. An eight-week smoking cessation class was offered. The program has had a "quit rate" after one year of approximately 50%.During the fiscal year Swedish Covenant Hospital served a total of 18,107 persons through participation in health promotions, education, and prevention for a total cost of $278,462.Community Wellness and Prevention programs continue to serve the community with 262 events held at the Hospital or in the community through collaboration with community partners. These events include health fairs, screenings, daytime and evening lectures, seminars, classes, Speakers Bureau presentations, children's events and other health related activities. Throughout the year the Hospital collaborated with dozens of community organizations to provide wellness and prevention programs.Swedish Covenant Hospital publishes periodic health and wellness information which is distributed through mailings and web-based programs to 153,522 households throughout the surrounding community for a cost of $141,061.During the fiscal year, Swedish Covenant Hospital also offered transportation services to 3,647 members of the community at a cost of $146,509.Interpreter ServicesSwedish Covenant Hospital provides in-house interpreters for patients who speak Korean, Spanish, and Russian, the primary non-English languages in the community. In FY 2012, the interpreters participated in a total of 1,929 sessions. Additionally, SCH uses professional telephone interpretive assistance and had 9,480 calls. For deaf or hearing impaired patients who request sign language interpreters, the Hospital provides interpreters through CAIRS and Chicago Hearing Society. SCH incurred a total cost of $373,177 for interpreter services serving a total of 37,667 persons.Medical Education ProgramSwedish Covenant Hospital is an independent teaching hospital, with residency programs in family medicine, osteopathic internal medicine, and osteopathic transitional year. As part of our affiliation with Midwestern University, Swedish Covenant Hospital is a training site for residents in Midwestern OB/GYNE, emergency medicine, and critical care residency programs. Our teaching affiliation is with Midwestern University's Chicago College of Osteopathic Medicine.In addition to the above, during the fiscal year ended September 30, 2012, Swedish Covenant Hospital voluntarily extended $4,465,000 at cost in discounts to uninsured patients. Additionally, the hospital provided $6,124,000 at cost in charity care and provided $13,588,000 at cost in unreimbursed Medicaid services. 220685048 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 0 0 1 361 3 1 2296 1 1 1 0 0 0 0 1 1 0 0 0 0 X 22 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X DAVID HERMAN 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 X CHARLES L ADAIR 1.00 X 0 0 0 KURT D ANDERSON 1.00 X 0 0 0 LYLE BANKS 1.00 X 897 0 0 JAMES F BOFFA MD 1.00 X 0 0 0 RENEE BORKOWSKI 1.00 X 0 0 0 RONALD D CURRAN MD 1.00 X 0 596254 21852 JUDITH E DABERTIN 1.00 X 0 0 0 H CLARK FEDERER MD 1.00 X 3129 0 0 W J WESLEY KEE 1.00 X 0 0 0 DAVID J KOO 1.00 X 0 0 0 PATRICIA MERRYWEATHER 1.00 X 0 0 0 DONALD L MEYER 1.00 X 0 147542 25053 REV MARY C MILLER 1.00 X 0 0 0 JAMES B PETERSON 1.00 X 0 0 0 THOMAS M PYRA 1.00 X 0 0 0 TONY R VANCAUWELAERT MD 1.00 X 33887 7632 0 LAWRENCE P ANDERSON 1.00 X 0 655148 64793 DAVID A DWIGHT 1.00 X 0 848677 95681 MARTIN SZANTO MD 1.00 X 1240 0 0 REV GARY B WALTER 1.00 X 0 151985 115788 PAUL A HAWKINSON 1.00 X X 0 0 0 JUDITH A PINS 1.00 X X 0 0 0 DAVID R PUTMAN 1.00 X X 0 0 0 MARK NEWTON 40.00 X X 0 1149321 112982 JUDITH A BORENSTEIN 40.00 X 447851 0 43699 ANTHONY GUACCIO 40.00 X 486987 0 58586 DEREK J KELLY MD 40.00 X 395420 0 20136 GARY M KRUGEL 40.00 X 517960 0 57138 MARY SHEHAN RN 40.00 X 364870 0 24579 KAREN M SHEEHAN 40.00 X 260292 0 39466 JANIS A RUEPING 40.00 X 260307 0 32945 WALTEN BABA 40.00 X 246255 0 14451 MICHAEL FEINZIMER 40.00 X 218810 0 1716 JONATHAN LIND 40.00 X 204297 0 38861 3442202 3556559 767726 84 0 1 0 MIDWESTERN UNIVERSITY 555 31ST STREET DOWNERS GROVE IL 60515 HEALTH CARE 1291610 BSA LIFE STRUCTURES 9365 COUNSELORS ROW INDIANAPOLIS IN 46240 ARCHITECTURE & ENGINEERING 800221 NEPHRON DIALYSIS CENTER 5140 N CALIFORNIA AVE CHICAGO IL 60625 HEALTH CARE 647730 ILLINOIS PHYSICIANS NETWORK LLC 8725 W HIGGENS RD SUITE 482 CHICAGO IL 60631 CONSULTING 647158 PEDIATRIC FACULTY FOUNDATION 2300 CHILDRENS PLAZA CHICAGO IL 60614 HEALTH CARE 471772 38 23935 7160000 107252 7291187 HEALTH CARE SERVICES 900099 248013046 248013046 LABORATORY SERVICES 621500 1997579 1997579 250010625 -1999584 -1999584 4023270 0 4023270 4023270 4023270 3242385 0 3242385 3242385 3242385 4372 23935 0 4372 4372 13115 8400 4715 4715 PARKING GARAGE FEES 812930 1166836 1166836 CHILD CARE CENTER 624410 853336 447742 405594 CAFETERIA 900099 497957 497957 5629794 5629794 8147923 270724893 259778645 2403173 1251888 1869998 645631 1224367 140841 140841 96082253 88514210 7225500 342543 2816987 2560444 246712 9831 7191417 6570710 587446 33261 7018922 6335528 657189 26205 2570444 2570444 876455 876455 159000 159000 194110 194110 22200703 19599218 2556054 45431 1012529 398153 612376 2000 679150 567046 107868 4236 4403621 3888554 515067 331960 218427 96455 17078 8406423 8406423 18683135 17581490 1088892 12753 10553223 9628972 924251 OTHER OPERATING SUPPLIE 32447215 32292618 152842 1755 BAD DEBT EXPENSE 13087564 13087564 IDPA TAX 9808183 9808183 EQUIPMENT REPAIR & MAIN 6905979 6815100 90500 379 4028911 2173200 1851219 4492 251469023 220685048 30284011 499964 7545044 1083799 1063799 24046806 25147052 3074570 3545211 6463580 5235620 436410683 238017786 180043260 198392897 138787295 142927091 63556507 67914165 417055817 451770879 37129112 30869196 196111710 205216888 2500000 0 59233030 65434753 294973852 301520837 X 120575596 148227058 1506369 2022984 122081965 150250042 417055817 451770879 X 19255870 8912207 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 20000 0 0 1 134505 0 1 202908 357413 0 Explanation of Lobbying Activities: Part II-B, Line 1: In the course of regular business activities, the hospital or its lobbyist perform some lobbying activities on matters of interest to itself and its patients. 19626213 8677201 127001 7855178 20575237 18814654 1270179 20979 479599 19626213 18354856 1341311 -13043 868470 18814654 18234850 795551 675545 18354856 0.14020 0.85980 0 1 1 7960138 7960138 185969405 75228527 110740878 1680580 1680580 0 216557099 145865734 70691365 24243461 15242945 9000516 198392897 CMB BOND & EQUITY FUND - FMV 109803569 F US BANK 21091875 F MESIROW 9246856 F NMTC - FMV 2744689 F MERRILL LYNCH - FMV 40102 F 142927091 OTHER INVESTMENTS 1755266 CAPTIVE RECOVERIES A/R 5192366 CHRPP RECOVERIES A/R 7440000 DUE FROM AFFILIATES 46226815 ASSETS WHOSE USE IS LIMITED 3141512 CAPITAL GRANT FMP 3500000 ALL OTHER CURRENT ASSETS 658206 67914165 ACCRUED LONG TERM MALPRACTICE LIABILITY 20208466 FAIR VALUE OF INTEREST RATE SWAPS 26975993 ASSET RETIREMENT OBLIGATION 1426989 DUE TO THIRD PARTY PAYERS 16823305 65434753 Description of Intended Use of Endowment Funds: Part V, Line 4: Part V, line 4: The earnings are to be used for education, charity care, the Healing Garden and other hospital programs. Swedish Covenant Hospital is the related beneficiary of the endowment funds held by Swedish Covenant Hospital Foundation. GALA 11 15702 12190 3512 GALA 12 9712 9712 1 2893 2033 860 28307 23935 4372 4372 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 10600701 10600701 0.04450 59698245 56358089 3340156 0.01400 70298946 56358089 13940857 0.05850 906647 906647 0.00380 3792304 2769523 1022781 0.00430 1132412 204717 927695 0.00390 12500 12500 0.00010 5843863 2974240 2869623 0.01210 76142809 59332329 16810480 0.07060 17504 17504 0.00010 17504 17504 0.00010 1 2617513 87011717 88419871 -1408154 X 1 1 1 SWEDISH COVENANT SURGERY CENTER LLC OUTPATIENT MEDICAL SERVICES 0.54000 0.00000 0.36000 2 CHICAGO CK ENTERPRISES LLC OUTPATIENT MEDICAL SERVICES 0.06000 0.00000 0.74000 3 CK PROPERTY DEVELOPMENT LLC PROPERTY MANAGEMENT SERVICES 0.33000 0.00000 0.00000 1 1 SWEDISH COVENANT HOSPITAL

5145 N CALIFORNIA AVENUE CHICAGO IL 60625

X X X X I/P & OP HOSPITAL SERVICES, SKILLED NURSING FACILITY SWEDISH COVENANT HOSPITAL 1 1 1 200.000000000000 1 600.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 2 LIFE CENTER ON THE GREEN INC

5157 N FRANCISCO AVENUE CHICAGO IL 60625

PHYSICAL REHABILITATION SERVICES SWEDISH COVENANT HOME HEALTH CARE

2965 W PETERSON AVENUE CHICAGO IL 60659

HOME HEALTH CARE SERVICES Part I, Line 7: Each net community benefit expense is divided by total hospital expenses to determine the percent of community benefits provided for fiscal year 2012.Costing Methodology - For all community benefits, we utilize the cost to charge ratio to calculate the benefit. The net operating costs are calculated by taking the total operating costs less the following: the PA tax and the non-patient care activity costs. The net gross charges are calculated as follows: gross charges less charges for community benefits. Net operating costs divided by net gross charges provides the cost to charge ratio.Part I - Line 7d - column dFor Schedule H, line 7b, column (c) the $59,698,245 in the Community Benefit Expense includes the provider assessment tax of $9,808,183 million. Had the provider tax been excluded, the total Community Benefit expense would have been $49,890,062. On Schedule H, line 7b, column (d), the direct offsetting revenue of $56,358,089 includes the provider tax revenue of $20,055,920 million. Had the public aid provider revenue been excluded from Schedule H, the direct offsetting revenue would have been $36,302,169. Using an adjusted total community benefit expense of $49,890,062 noted above, minus an adjusted direct offsetting revenue amount of $36,302,169, also noted above, the resulting community benefit dollar amount on Schedule H, line 7b, column (e) would have been $13,587,893. On Schedule H, line 7b, column (f) percentage of total expense would have increased from 1.40% to 5.70%.The PA tax benefit is not reimbursement for direct patient care and therefore we believe it should be excluded from the Schedule H calculations. Part I, Line 7g: Costs attributable to a physician clinic of $248,869 were included in subsidized health services. Part I, L7 Col(f): The amount of bad debt which was included on Form 990 Part IX Line 24 was $13,087,564. This was subtracted out for Schedule H calculations. Part II: Members of Swedish Covenant Hospital staff work with other organizations and participate in many activities to advocate for health improvement in our community. These include:Involvement with the Association for Community Safety Net Hospitals, participation in the Medicaid Rate Reform Tag Group, community meetings, education, and seeking of resources with regard to the planning and development of an Erie Family Health Center facility on the hospital campus to expand health services to the community. Members of the Swedish Covenant Hospital Staff have also worked to establish an affiliation with Rush University Medical Center to allow our emergency room physicians to communicate with Rush University Medical Center neurologists using robotic equipment which enables the Rush neurologists to remotely examine Swedish Covenant emergency department patients for signs of a stroke. This resource can improve patient outcomes by early and accurate diagnosis of stroke. Part III, Line 4: The audited financial statements do not contain a specific footnote related to the bad debt expense. The costing methodology is applying the cost-to-charge ratio of 20% to total bad debt expense.There are no bad debt amounts included in community benefits. Part III, Line 8: The hospital has used the standard single apportionment step down cost allocation methodology for the allocation of allowable costs (as defined by the Medicare principles of reimbursement) to the revenue cost centers. Allowable allocated costs are divided by the revenues in each ancillary department and by the days in each nursing unit to determine the appropriate ratios and cost per diems to be applied to the related Medicare ancillary charges and nursing unit days to determine the cost of Medicare services.None of the shortfall has been treated as a community benefit. The allowable costs of care for Medicare are higher than the reimbursement received from Medicare, which places a financial burden on Swedish Covenant Hospital of having to fund this loss from other areas of its operations. Therefore, we believe that the shortfall from Medicare represents a community benefit to our primary service area as we would never turn patients away. Part III, Line 9b: Charity Care Patients:If a patient has been determined to meet Hospital Charity Care Guidelines no collection agencies, lien attachments or attempts to possess real or personal property will be made.During the fiscal year 2012, the organization policy of using the Federal Poverty Guidelines to determine eligibility for providing free care to low income individuals was amended from 150% to 200% of the family income limit.During the fiscal year ending September 30, 2012, the organization implemented a policy of Presumptive Charity Care for health care services to uninsured patients that are not expected to result in payment and no financial assistance application is completed. Patients will qualify for Presumptive Charity assistance based on their individual life circumstances, homeowner status, living address and other measurable socio-economic factors.Financial Assistance:Patients with a self-pay balance and without the resources to pay their obligations will be assessed for financial assistance by the Credit Services Department. The assessment involves an evaluation for eligibility for all appropriate levels of assistance, including governmental or partial reductions or complete charity care. Part VI, Line 2: Needs AssessmentThe Community Benefit Plan must identify the populations and communities served by the Hospital, health care needs that were considered in developing the plan and the goals and objectives for providing community benefits including charity and government-sponsored indigent health care.As a ministry of The Evangelical Covenant Church, Swedish Covenant Hospital is dedicated to providing a continuum of care and to serving the physical, spiritual, and psychological needs of its culturally diverse community. The hospital has developed the Community Benefit Plan, a strategic plan that addresses the priority health care needs of the hospital's service area. These priority needs were identified by analyzing and prioritizing the data collected during the community needs assessment.The Community Benefit Plan identifies the four goals for providing community benefit. Measurable strategies and tactics support each priority. The following is a summary of the four priorities and supporting strategies of the Community Benefit Plan. 1. Enhance access to health care services: Continue and enhance, when possible, the level of assistance to consumers and patients in obtaining health plan coverage, subject to federal, state and private funding. Provide referral support for free clinics in the community. Continue to provide accessibility to multi-lingual and culturally competent providers and health information. Continue and enhance efforts to provide effective and actionable community health education.2. Address excess mortality related to key health conditions: Provide health screenings to the community. Heighten awareness of health risks through assessments. Promote fitness throughout the community.3. Address identified needs for individuals at risk: Address issues of the elderly living at home. Address childcare issues for women seeking health care at the hospital.4. Goals for charity and government-sponsored programs Continue to provide financial programs for patients who qualify for charity care and discounted care consistent with the mission of the hospital and any legislation that may be enacted. Enhance discount program for the uninsured patients. Continue to participate in the Medicare program. Continue to provide essential health care services for Illinois Department of Public Aid beneficiaries.In Fiscal Year 2009, Swedish Covenant Hospital participated in a Community Needs Assessment, in collaboration with the Metropolitan Chicago Healthcare Council and other regional hospitals. 258 of respondents were within the SCH target service area, and 2201 total participants were within the total metro area. The report provided detailed geographic information on the prevalence of chronic health conditions, access to care barriers and other health issues. Part VI, Line 3: Patient Education of eligibility for AssistanceCharity or discounted care is available for medically necessary services as defined by Medicare, to patients who meet the financial and documentation criteria defined below. Each situation is reviewed on an individual case-by-case basis. While not absolutely essential, the need for potential charity or discounted care should be established in advance of admission or rendering of service, or shortly thereafter.The charity care policy is provided during admission procedures to all patients admitted through the Admitting Department and the Emergency Room. Signage informing patients about charity care and the availability of financial counseling is posted in the Emergency Room and the Admitting Department.In order to be eligible for charity or discounted care, the patient must be willing to provide verification of income, assets, etc. by filling out the Patient Financial Statement. It is the responsibility of the patient to voluntarily submit any and all documentation in order to be eligible to receive this discount. During the registration and information gathering process, the financial counselors will first determine if the patient qualifies for medical assistance from other existing financial resources such as Medicare, Medicaid, Kid Care, Family Care or other state or federal programs. If the patient refuses to apply for existing financial resources or to provide information necessary to the application process, charity or discounted care cannot be granted. If the application for existing financial resources is denied, or has been previously denied, consideration for charity or discounted care will then be given.Once the information on the Financial Assistance Application form is received, Credit Services Department will determine the eligibility of the patient for charity or discounted care. SCH will suspend the collection process while the Financial Assistance Application is being reviewed. The only criteria to be considered for Financial Assistance will be income and family size. Income will be evaluated against the matrix of Federal Poverty Guidelines to determine whether full or partial discount can be approved. Documentation of income can be submitted in the form of paycheck stubs, income tax returns, Social Security checks, and other documents that are indicative of income. If the information submitted is not perceived to be accurate or reliable, SCH reserves the right to request additional documentation to substantiate income or family size.The insured patient with a large balance due to deductibles and/or co-payments may be eligible for charity or discounted care. In order to qualify, the patient must complete the Patient Financial Statement and return it to the financial counselors for evaluation and recommendation.If a patient has been determined to meet the Hospital Charity Care Guidelines, no collection agencies, lien attachments or attempts to possess real or personal property will be made.No legal action by the collection agency will be taken against uninsured patients for the first one hundred twenty (120) days after discharge.If after 120 days, an uninsured patient does not provide the completed financial assistance application, SCH will utilize the PARO Presumptive Charity model to qualify the patient as appropriate for a Presumptive Charity care Discount.Illinois residents who have a family income that is no more than 600% of the Federal Poverty Guidelines (as determined each year), and who do not have any health insurance as documented through SCH's insurance verification procedures, will receive a discount in accordance with the Hospital Uninsured Patient Discount Act (210 ILCS 89/) (the Act). Part VI, Line 4: Community InformationThe geographic area assessed includes the following 12 Chicago communitiesserved by the hospital: Albany Park, Edgewater, Forest Glen, Irving Park, Jefferson Park, Lincoln Square, North Center, North Park, Portage Park, Rogers Park, Uptown, and West Ridge.Also included in the area served is Lincolnwood, a small village of approximately 12,000 residents. This community is in close proximity to the hospital, just north of the north boundary of Chicago.The hospital serves a very diverse multicultural community, with the Albany Park neighborhood serving as a key entry point for many new immigrants. In order to better address the needs of our highly diverse community, the hospital has formed a Community Health Advisory Group. This group is comprised of leaders from nearly 40 local ethnic groups, legislators, and community and business organizations, including: the Albany Park Community Center, Centro Romero, World Relief Chicago, Erie Family Health, Heartland Health, Korean American Community Services, Asian Human Services, Cambodian Association and the Albany Park Chamber of Commerce. This group serves as a link between the hospital and the many surrounding niche communities and communicates regularly online and in-person to propose solutions to issues including Access to Care and health reform. The Spanish and Korean languages represent the majority of interpretative assistance requested at the hospital. To meet this need on an inpatient and outpatient basis, the hospital employs a full time Spanish and Korean interpreter. The Korean interpreter also serves as Korean Community Relations Manager, facilitating deeper, ongoing communication between the hospital and its local Korean community partners and physicians. In addition, the hospital uses a telephonic interpretative service to meet interpretative needs in other languages, as well as for Korean and Spanish interpretation when the interpreters are not present.To better serve the Korean community, the hospital partners each year with Korean American Community Services, the Korean Medical Society and the Korean Nurses Association to host an annual Korean Health Fair at the hospital. This is an annual event, targeting the uninsured working population. More than 400 Koreans residing in the greater Chicago area attend this event to receive free or reduced cost screenings and services. While better off than Chicago as a whole, the Swedish Covenant Hospital area lags substantially behind the total US averages for the following: High School Graduates, Unemployment, Are below the poverty level.In FY2012, Swedish Covenant Hospital delivered more than 250 community programs to nearly 20,000 individuals in partnership with over 100 community organizations, legislators, chambers of commerce, local businesses and schools. Topics included nutrition, fitness, stroke awareness, heart health, cancer prevention, diabetes education, women's health and pediatrics. Ongoing partnerships exist between many organizations but highlights include Budlong Elementary School (healthy nutrition for kids; heart health for teen girls; laboratory tours; career information), American Cancer Society (cancer screening events), National Kidney Foundation (kidney disease screening), 47th Ward Alderman Ameya Pawar (Annual Wellness Fair and senior activities), Whole Foods Market Sauganash (healthy eating and lifestyle choices), kickSprout (classes for pregnancy, newborns and toddlers), Purple Asparagus (Delicious Nutritious Adventures at Budlong School), Indo-American Center (ongoing health talks for community), Polish National Alliance (health talks and screenings) and Sulzer Regional Library (health talks). Part VI, Line 5: In keeping with the Hospital's mission to provide a continuum of excellent healthcare services, any surplus funds are invested in capital improvements related to patient care or in community benefit programs.The hospital extends medical staff privileges to all qualified physicians in the communities it serves, in accordance with our medical staff development process. The hospital has an active Board of Directors who meet every two months. In addition to reviewing the hospital's financial results, they discuss the hospital's plans and programs in support of our efforts to enhance the health care environment for the entire community we service. The hospital operates the "HouseCalls" program to provide medical care to the homebound.The Hospital helps community members gain access to health care services by assisting low income families in applying for the Illinois Department of Public Aid's KidCare and FamilyCare programs. Reports Filed With States Part VI, Line 7 IL X 1 1 X X X X 0 1 0 0 0 0 0 0 0 RONALD D CURRAN MD 0 574254 0 0 0 22000 0 0 0 21852 0 618106 0 0 DONALD L MEYER 0 129472 0 0 0 18070 0 3689 0 21364 0 172595 0 0 LAWRENCE P ANDERSON 0 358985 0 76500 0 219663 0 48398 0 25385 0 728931 0 0 DAVID A DWIGHT 0 505032 0 0 0 343645 0 67314 0 28367 0 944358 0 0 REV GARY B WALTER 0 151985 0 0 0 0 0 27623 0 88165 0 267773 0 0 MARK NEWTON 0 491144 0 103643 0 554534 0 98416 0 14566 0 1262303 0 18948 JUDITH A BORENSTEIN 223938 0 20051 0 203862 0 35353 0 8345 0 491549 0 0 0 ANTHONY GUACCIO 323985 0 25650 0 137352 0 34974 0 23612 0 545573 0 0 0 DEREK J KELLY MD 321500 0 23689 0 50231 0 0 0 20136 0 415556 0 0 0 GARY M KRUGEL 283404 0 26497 0 208059 0 32026 0 25112 0 575098 0 0 0 MARY SHEHAN RN 212557 0 23949 0 128364 0 23773 0 806 0 389449 0 0 0 KAREN M SHEEHAN 211775 0 17052 0 31465 0 21775 0 17691 0 299758 0 0 0 JANIS A RUEPING 167207 0 13977 0 79123 0 17317 0 15628 0 293252 0 0 0 WALTEN BABA 215062 0 0 0 31193 0 0 0 14451 0 260706 0 0 0 MICHAEL FEINZIMER 218810 0 0 0 0 0 0 0 1716 0 220526 0 0 0 JONATHAN LIND 146478 0 10285 0 47534 0 15059 0 23802 0 243158 0 0 0 Part I, Line 1a As part of their compensation package, vice presidents of the organization are offered a $900 reimbursement for membership dues to the health club of their choice. This benefit is treated as taxable compensation. Part I, Line 3 The Hospital and Covenant Ministries of Benevolence follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. This function is performed by the governance committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Part I, Line 4b Executive Benefit Plan Covenant Ministries of Benevolence (CMB) provides certain supplemental retirement benefits to its officers and key employees. These benefits are provided through a nonqualified deferred compensation plan, under which a portion of the benefits being earned are subject to a substantial risk of forfeiture. The supplemental retirement benefits are structured to provide a retention incentive that has been determined by the Compensation Committee of CMB's Board to be of substantial value to the organization. The Committee approves all retirement benefits, together with all other forms of compensation and benefits for these and other executives, in a manner intended to qualify for the rebuttable presumption of reasonableness under the intermediate sanctions rules of federal income tax law. The following individuals participated in the Executive Benefit Plan: David Dwight: - $78,251 Lawrence Anderson - $72,088 Mark Newton - $80,283 Judith Borenstein - $35,353 Anthony Guaccio - $34,974 Gary Krugel - $32,026 Mary Shehan - $23,773 Karen Sheehan - $21,775 Janis Rueping - $17,317 Jonathan Lind - $15,059 Pension Restoration Plan As certain individuals' pension benefits may be limited by tax code maximums on both eligible compensation and benefits, Covenant Ministries of Benevolence (CMB) provides a Pension Restoration Plan which entitles the individuals listed below to a pension benefit based on total cash compensation. David Dwight - $6,814 Lawrence Anderson - $15,422 Mark Newton - $23,808 Supplemental Information Part III Part II, Column B (iii): Other Reportable Compensation - During the 2010 calendar year, Covenant Ministries of Benevolence (CMB) discontinued its sponsorship of a particular deferred benefit program that included employer contributions to split dollar life insurance arrangements for certain employees, including some individuals whose compensation is disclosed on this Form 990 Part VII and in Schedule J. While the sponsorship and employer contributions to the split dollar life insurance arrangements were discontinued in 2010, federal tax law rules prevented CMB from transferring the insurance policies to the affected employees, and fully terminating these arrangements, for 12 months following the Board action to end its sponsorship and contributions. As a result, affected employees were taxed on the value of those split dollar life insurance policies in 2011, when the policies or the value of them was actually transferred to the employees. Although these benefits were earned over many years of employment, the full value of the benefits must be treated as taxable compensation in the year that the employee receives the policy or the benefit. In prior years, the premiums paid for the life insurance arrangements were reported in Part II Column B(iii) as non-taxable benefits in the years they were paid. The portions of reportable compensation that were due to this acceleration treatment are as follows: David Dwight - $283,443 Lawrence Anderson - $96,738 Mark Newton - $473,055 Judith Borenstein - $127,734 Mary Shehan -$102,537 Janis Rueping - $71,149 Jonathan Lind -$41,936 Illinois Finance Authority 861091967 45200FEW5 2008-04-08 60000000 2008A IFA Revenue Bonds - Cap Adds & Ref of 01/16/98 & 07/22/99 issues. 0 0 0 Illinois Finance Authority 861091967 45200FR35 2010-02-02 99390260 2010A IFA Revenue Bonds - Ref of 11/17/03 & 06/17/08 issues. 0 0 0 Illinois Finance Authority 861091967 2010-11-03 20000000 2010C IFA Revenue Bonds - Cap Adds 0 0 0 Illinois Finance Authority 861091967 2011-06-28 20000000 2011A IFA Revenue Bonds - Cap Adds & Construction 0 0 0 3190000 60846284 142083 837840 7508444 52500000 2009 1 0 1 1 2710000 99390260 9882321 1982568 88150000 1 0 1 1 1402156 20001791 318305 18186447 1815344 0 0 0 1 470000 20075567 37926 799036 19276531 0 0 0 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.01500 0.00000 0.01500 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 X Schedule K Supplental Information Form 990 - Schedule K - Part I - Line B - Column f The original 8038 filing for the 2010A bonds listed the issue date of the 2008B refunded bond incorrectly as April 8, 2008. The correct issue date of the 2008B refunded bond is June 17, 2008. Form 990 - Schedule K - Part II - Line 3 Difference between Issue Price and Total Proceeds of issue: The total amount of proceeds of the bond issues entered on Part II Line 3 include the investment earnings. Form 990 - Schedule K - Part II - Line 4 Gross Proceeds in Reserve Funds The amounts shown here consist of debt service reserve fund and sinking fund deposits. Brooke Newton Family member of Mark Newton (CEO of Swedish Covenant Hospital) 65914 Wages paid as an employee of Swedish Covenant Hospital 0 Emily Flatley Family member of Mark Newton (CEO of Swedish Covenant Hospital) 30004 Wages paid as an employee of Swedish Covenant Hospital. 0 Kathryn Shehan Family member of Mary Shehan (VP of Swedish Covenant Hospital) 14525 Wages paid as an employee of Swedish Covenant Hospital 0 Samantha Shehan Family member of Mary Shehan (VP of Swedish Covenant Hospital) 11103 Wages paid as an employee of Swedish Covenant Hospital 0 Elizabeth Pyra Family member of Thomas M. Pyra (Member of the Board of Directors) 18767 Wages paid as an employee of Swedish Covenant Hospital 0 James F Boffa MD Member of the Board of Directors 90085 Office Rent - The hospital leases office space in its medical office building to its physician board members at the same rate as is charged to all other occupants of the building. The hospital also leases billing software and telephone services at the same rate as is charged to other physicians. 0 Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a business relationship with each other by virtue of sitting on related Swedish Covenant Hospital entity boards. Kurt D. Anderson, Director, and Lawrence P. Anderson, Director, have a family relationship. Form 990, Part VI, Section A, line 6 The sole member is Covenant Ministries of Benevolence (CMB). Form 990, Part VI, Section A, line 7a The member elects the Board of Directors. Form 990, Part VI, Section A, line 7b S 3.1 of the Bylaws grant reserved powers to the member, such as approval of amendments to the Bylaws of the corporation, approval of certain acquisitions, dispositions and financing, and the power to elect or remove the members of the Board of Directors of the Corporation. Form 990, Part VI, Section B, line 11 Management Review: The draft Form 990 was reviewed by multiple levels of management and by the CFO of Swedish Covenant Hospital. Board Review: The Finance Committee of the Board of Directors reviewed the final Form 990 prior to filing. The final Form 990 was provided to each member of the Board of Directors prior to filing. The key provisions of the form will be discussed at a subsequent board meeting. Form 990, Part VI, Section B, line 12c Swedish Covenant Hospital has an Administrative Policy on conflict of interest, identifying the parameters of a conflict of interest and the requirement to disclose any such conflict of interest. Each September, the policy is distributed to the board members, key employees, directors and officers. They are asked to sign acknowledging receipt of policy and to disclose if they have any conflicts of interest. If someone is absent from the meeting or fails to return the acknowledgement, there is a follow-up with the individual until the signed acknowledgement is provided. Form 990, Part VI, Section B, line 15 The Hospital and Covenant Ministries of Benevolence (listed on Schedule R) follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. This function is performed by the governance committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Form 990, Part VI, Section C, line 18 A copy of the organization's Form 990 is available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. HOURS WORKED AT RELATED ORGANIZATIONS FORM 990 - PART VII - SECTION A Lawrence P. Anderson worked 40 hours per week at Covenant Ministries of Benevolence. David A. Dwight worked 40 hours per week at Covenant Ministries of Benevolence. Gary Walter worked 40 hours per week at Evangelical Covenant Church. Donald L. Meyer worked 40 hours per week at Evangelical Covenant Church. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 6,540,429. Equity transfer from Swedish Covenant Hospital Foundation 500,000. Net assets released from restriction - Capital 607,044. Equity transfer from SC Insurance Company 5,000,000. Equity transfer to Covenant Ministries of Benevolence -5,000,000. Net restricted funds transfers from Swedish Covenant Hospital Foundation 1,325,701. Other restricted funds activity -60,967. Total to Form 990, Part XI, Line 5: 8,912,207. FINANCIAL STATEMENTS & REPORTING FORM 990 - PART IVLINE 12B & PART XII - LINE 2B-C The audited financial statements of Swedish Covenant Hospital for the year ended September 30, 2012, are presented on a consolidated basis which includes its subsidiary organizations. The audit was performed by an independent accountant. The Hospital has an Audit Committee which assumes responsibility for oversight of the audit and selection of an independent accountant. Evangelical Covenant Church (ECC) 5101 N Francisco Avenue Chicago IL 60625 362167730 Church IL 501(c)(3) Line 1 N/A 0 Swedish Covenant Faculty Group (SCFG) 5145 N California Avenue Chicago IL 60625 363686216 Patient Treatment/Education IL 501(c)(3) Line 11a, I Swedish Covenant Hospital (SCH) 1 Swedish Covenant Hospital Foundation (SCHF) 5145 N California Avenue Chicago IL 60625 205055155 Supporting Organization of Swedish Covenant Hospital IL 501(c)(3) Line 7 Swedish Covenant Hospital (SCH) 1 SC Insurance Company 6970 E Chauncey Lane Suite 100 Phoenix AZ 85054 273312053 Insurance AZ 501(c)(3) Line 11a, I Swedish Covenant Hospital (SCH) 1 Covenant Village of PortlandLP 420 NE Mason St Portland OR 97211 364356838 Assisted Living Community OR N/A N/A 0 0 Coast Asset Management LLC 2450 Colorado Avenue Suite 100 E To Santa Monica CA 90404 954763400 Hedge Fund Investment CA N/A N/A 0 0 Swedish Covenant Surgery Center LLC 5215 N California Avenue Chicago IL 60625 272485300 Outpatient Medical Services IL N/A N/A 0 0 Covenant International Insurance Company Ltd Crawford House 50 Cedar Avenue Hamilton BD Insurance BD N/A Covenant Trust Company 5215 Old Orchard Road Suite 725 Skokie IL 60077 363583163 Financial Services IL N/A C Swedish Covenant Management Services Inc (SCMS) 5145 N California Avenue Chicago IL 60625 364073303 Physician Practice Management IL N/A C Swedish Covenant Managed Health Care Alliance (SCMCA) 2740 W Foster Suite 409 Chicago IL 60625 364118659 Physician - Hospital Organization IL N/A C 0 0 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 Swedish Covenant Hospital Foundation K 402674 Intercompany Contract Swedish Covenant Hospital Foundation L 402674 Intercompany Contract Swedish Covenant Hospital Foundation R 2089601 Cash Value Swedish Covenant Management Services Inc Q 8565949 Cash Value SC Insurance Company L 4384703 Cash Value SC Insurance Company R 5000000 Cash Value