2012-10-29T13:18:23-05:00 2011-12-31 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 606064301 990 2011-01-01 363276552 Alexian Brothers Hospital Network ALEX 8473857100 3040 W Salt Creek Lane Arlington Heights IL 600051069 Mark Frey 8473857100 2012-10-29 1 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z Mark Frey 3040 W Salt Creek Lane Arlington Heights IL 600051069 87538717 0 0928 X www.alexianbrothershealth.org X 1983 IL ABHN carries out the healing mission of the Catholic Church (See Schedule O).Alexian Brothers Hospital Network ("ABHN") carries out the healing mission of the Catholic Church through the Alexian Brothers ministries by identifying and developing effective responses to the health and housing needs of those we are called to serve. 7 1 0 2 173189 0 0 0 68249053 87538717 0 0 0 0 68249053 87538717 0 0 0 0 25139550 28063980 0 0 0 43093477 42692792 68233027 70756772 16026 16781945 75700722 16954000 9548587 1138000 66152135 15816000 X Alexian Brothers Hospital Network ("ABHN") carries out the healing mission of the Catholic Church through the Alexian Brothers ministries by identifying and developing effective responses to the health and housing needs of those we are called to serve. 0 0 50724254 86432244 The 800-year-old Congregation of Alexian Brothers carries out the healing ministry of Jesus Christ in the tradition of the Roman Catholic Church under the guidance of Alexian Brothers Health System (ABHS). Ranked among the nation's best-performing health systems, ABHS Illinois health care ministry (ABHN) is comprised of four hospitals, a center for mental health, four clinical institutes, a diagnostic imaging facility and the Alexian Brothers Medical Group, which includes 13 primary care practices, seven immediate care centers, seven occupational health centers and several specialty programs. We serve the more than two million people across Chicago's northwest suburbs and beyond with innovative care and world-class medical specialists. ABHN strives to provide a prophetic, holistic approach (See Schedule O) to health care, rooted in Gospel values and the legacy of the Alexian Brothers. Through partnerships with our associates, physicians, and the community, we identify and develop effective responses to the health and housing needs of those we are called to serve. These ministries exist to continue the Alexian Brothers mission of caring for the sick, the poor and the dying and promoting the physical, mental, spritual and social health and well-being of all individuals we serve. The Alexian Brothers Health System provides the community with a full range of comprehensive healthcare services and access to the most advanced medical technology. In addition, we offer a wide range of community health services, corporate wellness programs, preventive care and education. 50724254 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 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 1 1 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 1 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 IL X Jeannie Justie 8473857160 3040 West Salt Creek Lane Arlington Heights IL 600051069 X Mark Frey 1.00 X X 0 867276 184992 John Werrbach 1.00 X X 0 522985 72001 Edward Goldberg 1.00 X X 0 628028 170831 Francine McGouey 1.00 X X 0 378929 62061 Clayton Ciha 1.00 X X 0 226829 47746 James Sances 1.00 X X 0 642540 143948 Br Thomas Keusenkothen 1.00 X X 0 0 0 Br James Classon CFA 1.00 X 0 0 0 Virginia Golembiewski 1.00 X 0 69801 16144 Jim Lewandowski 1.00 X 0 372210 66995 Sherrie Russell 40.00 X 0 156859 20031 Rob Wright 40.00 X 0 361885 57637 Kathleen Gunderson 40.00 X 0 253505 64298 Patti Baker 40.00 X 0 283747 77361 Diana Woytko 40.00 X 0 242018 37479 Kelley Clancy 40.00 X 0 245209 75009 Tracy Rogers 1.00 X 0 497648 78096 Kathleen Davis 0.00 X 0 229866 25150 0 5979335 1199779 0 1 1 0 0 Management Fees 900099 83034836 83034836 Alexian Rehab Svcs,LLC 900099 2910000 2910000 Research Revenues 900099 1106473 0 173189 933284 Premier Dividend 900099 242084 242084 CONTRIBUTIONS 900099 94033 94033 151291 151291 87538717 87538717 86432244 173189 933284 20611628 12733893 7877735 6165204 6165204 1287148 753562 533586 1127232 1127232 625715 20846 604869 6275352 5312765 962587 2391315 2391315 374338 105676 268662 20954907 20954907 8014921 5862886 2152035 263890 211446 52444 125094 907 124187 20981 20981 Public Relations 1966453 1966453 0 0 Bad Debt 146235 6820 139415 0 Medical Supplies 123537 123537 0 0 Dietary 55269 30707 24562 0 227553 227553 70756772 50724254 20032518 0 27262 75673460 16954000 75700722 16954000 9548587 1138000 9548587 1138000 X 66152135 15816000 0 0 66152135 15816000 75700722 16954000 X 16781945 -67118080 X 0 1 1 X 0 X X X 0 0 0 Alexian Brothers Medical Center 362596381 501(c)(3) 1 1 1 0 St Alexius Medical Center 364251846 501(c)(3) 1 1 1 0 Alexian Brothers Behavioral Health Hospital 364251848 501(c)(3) 1 1 1 0 Alexian Brothers Center for Mental Health 363045007 501(c)(3) 1 1 1 0 4 0 Schedule A, Part IV, Supplemental Information: ABHN supports the provision of healthcare services at the corporations to which it is a member by the provision of centralized administrative support, including Billing and Collections; IT; Managed Care Contracting; Medical Library; CME; Property Management; Administrative Costs for Clinical Institutes (including Oncology, Cardiology, Bariatrics, Pediatrics, Stroke and Neurosciences); Research (including Oncology, Neurosciences, and General Research); Marketing; Logistics; External Affairs; Public Relations; and Construction. Costs of certain of these departments are charged to the members through a management fee. Transactions with each member are delineated on Schedule R. 0 1 0 0 0 0 1 562544 0 0 562544 0 0 Due from Alexian Rehabilitation Services, LLC 16954000 16954000 Other Liabilities- Due to Rehab Institute of Chicago 1138000 1138000 Description of Uncertain Tax Positions Under FIN 48: Part X: Alexian Brothers Hospital Network does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. There were no uncertain tax positions, and as a result there was no disclosure related to FIN 48 (ASC740) in the December 31, 2011 audit report. 1 1 0 0 0 0 0 0 0 Mark Frey 0 617468 0 172499 0 77309 0 145072 0 39920 0 1052268 0 39114 John Werrbach 0 392794 0 91509 0 38682 0 49477 0 22524 0 594986 0 25332 Edward Goldberg 0 461729 0 112010 0 54289 0 107200 0 63631 0 798859 0 21449 Francine McGouey 0 280473 0 63789 0 34667 0 49603 0 12458 0 440990 0 34667 Clayton Ciha 0 199344 0 23297 0 4188 0 11220 0 36526 0 274575 0 0 James Sances 0 477155 0 136544 0 28841 0 115746 0 28202 0 786488 0 28841 Jim Lewandowski 0 280338 0 56701 0 35171 0 35309 0 31686 0 439205 0 12354 Sherrie Russell 0 156859 0 0 0 0 0 9624 0 10407 0 176890 0 0 Rob Wright 0 283799 0 53810 0 24276 0 29394 0 28243 0 419522 0 14660 Kathleen Gunderson 0 214564 0 31499 0 7442 0 44100 0 20198 0 317803 0 0 Patti Baker 0 243844 0 28241 0 11662 0 38749 0 38612 0 361108 0 5811 Diana Woytko 0 195962 0 36100 0 9956 0 22354 0 15125 0 279497 0 9956 Kelley Clancy 0 206209 0 39000 0 0 0 38858 0 36151 0 320218 0 0 Tracy Rogers 0 367650 0 105531 0 24467 0 34778 0 43318 0 575744 0 24467 Kathleen Davis 0 359 0 0 0 229507 0 3137 0 22013 0 255016 0 229507 Part I, Line 3 ABHN follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation of the CEO and other officers and executives of the Corporation. This function is performed by the Compensation Committee of the Board of Governors of ABHS, which is composed of independent board members. 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. All of the items in Schedule J, Part I, Line 3 are used by the Committee to establish compensation for the CEO of the organization. Part I, Lines 4a-b The following individuals listed in Schedule J were paid the referenced amount of severence in 2011: Kathleen Davis - $229,507 Part I, Lines 4a-b Alexian Brothers Health System offers a Supplemental Employee Retirement Plan to all employees who participate in the executive benefits program and whose compensation exceeds the IRS allowable limit for a qualified pension plan. The amount accrued in 2011 was included in income in Schedule J for the following individuals: Mark Frey - $77,208 James Sances - $52,060 Edward Goldberg - $55,673 John Werrbach - $6,784 Jim Lewandowski - $5,297 Rob Wright - $4,619 Kathleen Gunderson - $1,074 Patti Baker - $1,389 Tracy Rogers - $5,914 Form 990, Part VI, Section A, line 6 ABHN has one member, Alexian Brothers Health System (the "National Member"). Form 990, Part VI, Section A, line 7a Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Brothers Hospital Network. Form 990, Part VI, Section A, line 7b Alexian Brothers Health System has principal authority with respect to the following matters: - Adoption of amendment of the Articles of Incorporation; - Amendment of the Bylaws; - Appointment and removal of Directors and Executive Officers; - Adoption, amendment and repeal of fundamental statements of mission, philosophy, spirit, vision, values and charity policy, and the sponsorship of apostolic activities; - Any plan of merger, consolidation, dissolution, sale or lease of all or substantially all of the assets of ABHN; - The annual capital and operating budget and the strategic plan of ABHN; and - Other certain reserved powers which Alexian Brothers Health System may designate. Form 990, Part VI, Section B, line 11 ABHN is an affiliate of Alexian Brothers Health System ("ABHS" or "the System"), which is a Catholic health system. ABHS is the National Member and ultimate parent for each entity within the System. ABHN's Form 990 goes through an intensive review process at the System's Corporate level prior to being filed with the IRS. The entire Form 990 is reviewed by ABHN's financial officer and the CEO. The Form 990 is also reviewed at the System Corporate level by the Chief Accounting Officer for the System. The Vice President and General Counsel for the System reviews all sections of the Form 990 with the exception of the compensation section. The Vice President of Human Resources for ABHS reviews all compensation disclosures for each entity in ABHS. These reviews were conducted before the Form 990 was signed and filed with the IRS. In addition, there is also a Compensation Committee that reports to the ABHS Board of Governors. This Committee reviews the Compensation disclosures for all entities in the System. The ABHN board reports to the ABHS Board of Governors, which has ultimate oversight of the activities of all entities within the System. The Audit Committee of the ABHS Board of Governors has responsibility for and oversight of the Tax Compliance process. The Audit Committee provides oversight for the Form 990 process for the entire System and reviews detailed Forms 990 for the System as requested. It then reports back to the ABHS Board of Governors on the results of these activities. The Forms 990 not reviewed by the Audit Committee are available to the Audit Committee members upon request. The Audit Committee did not review the 2011 Form 990 for ABHN. Form 990, Part VI, Section B, line 12c ABHN collects annual attestations from board members, officers, directors and key employees. The attestations are reviewed by the ABHN compliance officer and any conflicts are shared with the ABHN Chief Executive Officer. The conflicts are also reveiwed by the System's Vice President Officer, Corporate Responsibility Officer. The Audit Committee of the ABHS Board of Governors monitors and receives reports on the completion of this process. Form 990, Part VI, Section B, line 15 ABHN follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation of the CEO and other officers and executives of the Corporation. This function is performed by the Compensation Committee of the Board of Governors of ABHS, which is composed of independent board members. 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. Form 990, Part VI, Section C, line 19 ABHN's financial statements are available through the office of the Illinois Attorney General. Conflicts of Interest and ABHN's governing documents are not made available to the public. related compensation is reported: Form 990, Part VII: Average hours devoted to related organizations when Disclosure for estimated hours per week devoted to related organizations for which compensation was reported: -Mark Frey worked 40 hours per week for Alexian Brothers Health System. -Jim Sances worked 40 hours per week for Alexian Brothers Health System; -Virginia Golembiewski worked 40 hours per week for Alexians Brothers Health System; -Jim Lewandowski worked 40 hours per week for Alexian Brothers Health System; -Edward Goldberg worked 40 hours per week for St. Alexius Medical Center; -Clayton Ciha worked 40 hours per week for Alexian Brothers Behavioral Health Hospital; -Francine McGouey worked 40 hours per week for Alexian Brothers Behavioral Health Hospital; -John Werrbach worked 40 hours per week for Alexian Brothers Medical Center; -Tracy Rogers worked 40 hours per week for Alexian Brothers Health System; -All others listed in Part VII devoted 100% of their time to Alexian Brothers Hospital Network. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Equity Transfer - Alexian Brothers Health System -56,642,000. ABHN Depreciation & Amortization - Alexian Brothers Health System -9,616,124. Released from Restricted 13,219. Investment in subsidiary -388,000. ABHN activity -610,000. Other adjustment 124,825. Total to Form 990, Part XI, Line 5: -67,118,080. Reasonable Effort made to obtain Compensation from Related Organizations: Form 990, Part VII: Payroll records are kept that identify which officers/key employees are paid by a related entity. These documents also show the organization being charged for the officer's/key employee's salary. Alexian Brothers of America Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 362606768 Religious order of Roman Catholic men TX Section 501(c)(3) 1 N/A 0 Brothers of St Alexius Health and Welfare Fund Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 362976617 Provides for health & welfare payments for religious sponsor TX Section 501(c)(3) 1 Alexian Brothers of America Inc 1 Alexian Brothers Bonaventure House 825 Wellington Avenue Chicago IL 606570000 363527899 Housing and supportive care services for persons with HIV/AIDS IL Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 600051069 363260495 Supports provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Health System Inc Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 600051069 363801585 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Alexian Brothers of America Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 600051069 364390471 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Specialty Group 3040 W Salt Creek Lane Arlington Heights IL 600051069 800710751 Specialty physician practice group IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers of Chicago 3040 W Salt Creek Lane Arlington Heights IL 600051069 Inactive Corporation IL Section 501(c)(3) 9 Alexian Brothers of America Inc 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 941530037 Acute care hospital (sold in 1998) TX Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 431295333 HUD housing MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Village of Milwaukee Inc 9301 N 76th Street Milwaukee WI 532230000 391351584 Continuing care retirement community WI Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Suite 110 Chattanooga TN 374040000 364344423 Provides comprehensive & coordinated community based services IL Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 374020000 620646376 Supports the provision of community services for senior citizens TN Section 501(c)(3) 7 Alexian Brothers Health System 1 Alexian Village of Tennessee 437 Alexian Way Signal Mountain TN 373770000 621136742 Continuing care retirement community TN Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 600051069 364484290 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 392039667 Community outreach WI Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 631160000 431470362 Skilled nursing facility MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Sherbrooke Village 4005 Ripa Avenue St Louis MO 631250000 431592502 Skilled nursing facility MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 430653236 Acute care hospital (sponsorship transferred in 1997) MO Section 501(c)(3) 3 Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363308965 Owns or leases properties where healthcare services are delivered IL Section 501(c)(2) N/A Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3436 N Kennicott Avenue Arlington Heights IL 60004 363045007 Outpatient community mental health services IL Section 501(c)(3) 7 Alexian Brothers Health System 1 Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates IL 601940000 364251848 Behavioral health hospital IL Section 501(c)(3) 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 601940000 364251846 Acute care hospital IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 600051069 364336931 Physician services IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Rehabilitation Services LLC 935 Beisner Road Elk Grove Village IL 600070000 300221481 Rehabilitation Hospital IL Alexian Brothers Hospital Network Related 2909826 944996 0 0 0.51000 Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 870783164 Provision of NeuroMeg Services IL Alexian Brothers Medical Center Related 0 0 Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853289 Medical Office Building IL Thelen Corporation N/A 0 0 Workplace Solutions LLC 1100 E Woodfield Road Schaumburg IL 60173 364095007 Provision of EAP Services IL Alexian Brothers Medical Center Unrelated 0 0 Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 363978153 Manages Managed Care Contracts DE Alexian Brothers Health System Related 0 1 0.50000 Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 861115516 Ownership of Gamma Knife IL Thelen Corporation N/A 0 0 St Alexius Center for Sleep Health LLC 665 W North Avenue Lombard IL 601480000 205876371 Operation of Sleep Labs IL St Alexius Medical Center Related 0 0 Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 600051069 363266316 Owns/leases property; joint venture partner IL Alexian Brothers Hospital Network C -136000 4264000 1.00000 Edessa Insurance Company Ltd 3040 W Salt Creek Lane Arlington Heights IL 600051069 Captive insurer located in Bermuda BD Alexian Brothers Health System C Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853286 Messenger model IPA IL Alexian Brothers Health System C Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 943465394 Tax credit financed housing IL Alexian Brothers Health System C Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 600051069 352211303 Tax credit financed housing IL Alexian Brothers Community Services C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Other Intercompany Transfers-Various O 337164 Fair Market Value Alexian Brothers Medical Center P 38512369 Fair Market Value St Alexius Medical Center P 28598033 Fair Market Value Alexian Brothers Behavioral Health Hospital P 5223888 Fair Market Value Alexian Brothers Ambulatory Group P 2994433 Fair Market Value Alexian Brothers Senior Ministries P 43299 Fair Market Value Alexian Brothers Health System P -75709186 Fair Market Value Supplemental Information: Part V, Line 2: ABHN tracks all transactions with related organizations in the general ledger or subsidiary schedules to the general ledger. Amounts are valued based on the fair market value of the transaction.