2012-10-30T13:05:06-05:00 2011-12-31 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 60606 990 2011-01-01 362596381 Alexian Brothers Medical Center ALEX 8474375500 800 Biesterfield Road Elk Grove Village IL 600073397 John Werrbach 8474375500 2012-10-30 1 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z John Werrbach 3040 West Salt Creek Lane Arlington Heights IL 60007 434860212 0 0928 X www.alexianbrothershealth.org X 1971 IL ABMC carries out the healing mission of the Catholic Church. (See Schedule O)Alexian Brothers Medical Center ("ABMC") 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. 11 9 0 959 4968805 -1159961 201678 1921 426067541 431485574 138280 385397 1962674 1329361 428370173 433202253 0 0 0 0 175095528 175599074 0 0 0 239627445 250524213 414722973 426123287 13647200 7078966 338148635 375783468 104241126 137250138 233907509 238533330 X Alexian Brothers Medical Center("ABMC") 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 238493050 218884586 Alexian Brothers Medical Center (ABMC) is a 387-bed acute care hospital located in Elk Grove Village, Illinois that has been providing outstanding healthcare to the residents of the Chicago's northwest suburbs for more than 40 years. Located at 800 Biesterfield Road, ABMC is ranked one of the best regional hospitals by U.S. News and World Report.In 2011, ABMC treated more than 20,000 inpatients, performed 4,541 inpatient surgeries and delivered 2,237 newborns. Our medical staff includes approximately 900 physicians representing more than 80 medical and surgical specialties. (See continuation on Schedule O). ABMC is a full-service hospital with a Neurosciences Institute, Cancer Institute, Heart & Vascular Institute, as well as additional specialties in Older Adult, Pediatrics, Bariatric Surgery, Orthopedics and Obstetrics. It also includes a 66-bed inpatient rehabilitation hospital. ABMC has received Disease Specific Certification from The Joint Commission in Stroke, Heart Failure, Acute Myocardial Infarction, and Joint Replacement. In addition, ABMC is also a HealthGrades Top 50 Hospital, and has received the Blue Cross Blue Star of Distinction.ABMC provides care for all, including the financially disadvantaged, uninsured, underinsured, homeless persons and those who receive public aid. In 2011, ABMC provided $8.3 million of charity care at cost. This was in addition to other community benefits services amounting to $2.2 million dollars, $42 million dollars of unreimbursed Medicare costs to patients; $3.1 million dollars of bad debt expense at cost and $13.7 million dollars of unreimbursed Medicaid at cost. About the Alexian Brothers Health SystemAlexian Brothers Medical Center is a member hospital of the Alexian Brothers Health System, a comprehensive and diversified healthcare organization headquartered in the northwest suburbs of Chicago, serving more than two million people. The Alexian Brothers Health System has an enduring commitment to identifying and developing an effective response to the unique health and housing needs of older adults through a dynamic senior ministries program that operates an array of residential, retirement and community resources.These ministries exist to continue the Alexian Brothers mission of caring for the sick, the poor and the dying and promoting the physical, mental, spiritual and social health and well-being of all individuals we serve.Clinical InstitutesCancer InstituteThe Cancer Institute provides comprehensive oncology services across the entire Alexian Brothers Hospital Network. Accredited by the American College of Surgeons as a Comprehensive Community Hospital Program, our Cancer Institute boasts five-year survival rates that exceed the American Cancer Society's national statistics for breast, ovarian, lung and colon cancers. The comprehensive treatment care center at ABMC utilizes cutting-edge technologies, including 64-slice Computed Tomography (CT) Scan, Positron Emission Tomography (PET) Scan and Breast Magnetic Resonance Imaging (MRI) as diagnostic tools. At ABMC, radiation therapy can be delivered through the following techniques: Intensity Modulated Radiation Therapy Image Guided Radiotherapy Rapid Arc, Low Dose Rate and High Dose Rate Brachytherapy, Savy and MammoSite Breast Therapy Treatment. ABMC is accredited by The American College of Surgeons Commission on Cancer as a Comprehensive Community Cancer Center. In addition, the National Accreditation Program for Breast Centers has accredited ABMC.Heart & Vascular Institute The Heart & Vascular Institute offers high-level cardiovascular care. Our cardiac team includes some of the most highly respected cardiologists and cardiovascular surgeons in the area, many who are regionally and nationally known. Open-heart surgery procedures include coronary artery bypass grafts, valve repair and replacement and repair of congenital heart defects performed using minimally invasive techniques, when appropriate. In addition to coronary angioplasty and stenting, services include coronary arthrectomy and embolectomy, stenting for chronic total occlusions, implantation of pacemakers and internal defibrillators to regulate the heart's electrical impulses and implantation of mechanized heart pumps. Ablation therapy, transmyocardial revascularization, endovascular stenting for abdominal aortic aneurysm and carotid artery stenting are also performed. In addition, the interventional areas perform a full array of limb saving complex peripheral arterial and venous procedures. State-of-the-art diagnostic procedures include electrophysiology mapping and intravascular ultrasound with fractional flow reserve. The latest in technological advancements and minimally invasive procedures are contributing to shorter hospital stays, reduced risk of complications and faster recovery. A comprehensive cardiac rehabilitation program follows patients through their recovery, enabling patients to resume their daily activities safely and confidently.Neurosciences Institute The Neurosciences Institute offers the latest medical advances and technology to help patients with neurological conditions. Our spectrum of care includes advanced diagnostic procedures, treatment strategies, and proven approaches to help patients achieve high quality of life. In addition, we are working to provide scientific insight into how to lower the risk of developing certain neurological diseases. Services include the Center for Brain Research, Clinical Research, the Epilepsy Center, Illinois Gamma Knife Center, Illinois Magnetoencephalography (MEG) Center, Interventional Neuroradiology, Memory Disorders Center, Movement Disorders Center, Neuropsychological Services, Neurosurgery, Pediatric Neuropsychological Services, Stroke Prevention, Second Opinion Stroke Clinic, Stroke Rehabilitation and Vertebroplasty for Spinal Compression Fractures. Alexian Brothers is a Primary Stroke Center.ServicesDiagnostic ServicesOur diagnostic services include the latest technology and practices, which are accredited by nationally recognized agencies and association, such as The American Diabetes Association, American College of Radiology, The College of American Pathologists and The Joint Commission. Diagnostic services offered include:- Diagnostic imaging (general X-ray, CT, MRI, PET, ultrasound, nuclear medicine)- Breast Care Services (screening and diagnostic mammography, breast biopsy ultrasound, stereotactic breast biopsy, bone densitometry, genetic counseling, MammaCare breast self examination instructions)- Cardiology (cardiac catheterization, electrophysiology, EKG, stress testing, elechocardiography, holter monitoring of arrhythmias)- Pulmonary Diagnostics (arterial blood gas analysis)- Gastroenterology (colonoscopy, bronchoscopy)- Laboratory/Pathology (chemistry, microbiology, hematology, histology, cytology, phlebotomy, transfusion services)Emergency DepartmentEmergency medical care is provided 24/7 for all ages and types of patients, regardless of the ability to pay for such services. The emergency department is designated a Level II Trauma Center, which treated nearly 48,000 residents in 2011. In addition, a helipad allows for rapid transport of critical cases to a Level I facility. ObstetricsABMC's caring obstetrical team has the experience and expertise to address the needs of the families we serve. Our highly trained staff includes a multi-lingual group of board certified obstetricians and OB/GYNs who offer expert prenatal and post-delivery care, and lactation educators who are specialists in breastfeeding. As a state-designated Level II Perinatal Center, ABMC offers 24-hour coverage by board certified neonatologists - a pediatrician with special training in the care of healthy newborns as well as those with special needs. A perinatologist is on staff to meet the special needs of mothers whose pregnancies are high risk.Older AdultOur Older Adult Services are designed to provide an innovative, seamless continuum of care for older adults from wellness, to early detection of disease, through inpatient and post-acute care. Our overall goal is to optimize the quality of life, addressing the physical, emotional, social and spiritual needs of older adults. 117985131 178087641 Outpatient Services performed in 2011:7,926 outpatient surgeries116,676 Diagnostic images including general X-ray, CT, MRI, PET, Ultrasound, Nuclear Medicine and others816,502 laboratory tests47,909 Emergency Room visitsThe complete description of Alexian Brothers Medical Center Outpatient Programs is included with the Inpatient Programs in line 4a. 24417214 30863559 Inpatient Rehabilitation Services performed in 2011:1,465 inpatients were treatedThe complete description of Alexian Brothers Medical Center Inpatient Rehabilitation Programs is included with the Inpatient Programs in line 4a. 380895395 1 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 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 1 276 0 1 0 1 1 1 BD 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 IL X Deborah L Mau Controller 8475902671 3040 West Salt Creek Lane Arlington Heights IL 600051069 X Brother Theodore Loucks CFA 1.00 X X 0 0 0 Dennis Abella MD 1.00 X 6188 3403 0 John Furiasse MD 1.00 X 0 0 0 Kathleen Gilmer 1.00 X X 0 0 0 Lawrence Herforth 1.00 X X 0 0 0 Brother Daniel McCormick CFA 1.00 X X 0 0 0 Patricia Merryweather 1.00 X 0 0 0 James Mortimer 1.00 X 0 0 0 Thomas Palmer 1.00 X 0 0 0 Robert Rao MD 1.00 X 0 600 0 Barry Glick DO 1.00 X 0 0 0 John Werrbach 40.00 X 0 522985 72001 James Sances 1.00 X 0 642540 143947 Virginia Golembiewski 1.00 X 0 69801 16144 Sherril Vincent 40.00 X 0 377078 40747 Jim Lewandowski 1.00 X 0 372210 66995 Linda Baker 20.00 X 0 204857 61442 Tony DiLorenzo 40.00 X 0 375259 367740 Bryan Bertoglio 28.00 X 0 803826 27181 Timothy Malish 40.00 X 0 775957 30439 Szymon Rosenblatt 40.00 X 0 756639 29409 Paul Robison 40.00 X 0 776976 16052 Franklin Marden 40.00 X 0 551678 16497 Kathleen Gunderson 1.00 X 0 253505 64298 Mary Ann Magnifico 1.00 X 0 288008 70747 Francine McGouey 1.00 X 0 378929 62061 6188 7154251 1085700 0 1 1 0 Sodexho Inc 9801 Washington Blvd Gaihersburg MD 20878 Dietary & Environmental Mgmt 1852038 Rehabilitation Institute of Chicago 345 E Superior Street Chicago IL 60611 Management Services 1425893 Hospital Laundry Services 3723 Reliable Parkway Chicago IL 60686 Laundry & Linen Services 1246870 Suburban Lung 810 Biesterfield Road Elk Grove Village IL 60007 Medical Services 989417 ARUP Laboratories 500 Chipeta Way Salt Lake City UT 84108 Pathology Services 841617 22 1921 1921 General Hospital Svcs 900099 252652924 252652924 Medicare & Medicaid 900099 170942969 170942969 Lab Services 621500 2966149 2966149 Cafeteria Sales 900099 1539537 1539537 Outpatient Pharmacy 446110 671199 671199 2712796 2700356 12440 431485574 344292 344292 1642963 1632619 10344 10344 10344 66445 25340 41105 41105 41105 Workplace Solutions 561000 701533 701533 Answering Service 561000 379925 379925 Insurance Premiums 524292 234022 234022 3537 3537 1319017 433202253 427835786 4968805 395741 6188 6188 143079058 132305925 10773133 6448950 5963118 485832 15807127 14616298 1190829 10257751 9484983 772768 438489 438489 120922 120922 16419133 14630024 1789109 68541 45670 22871 12500946 6227764 6273182 6447 5802 645 13485879 12137291 1348588 340830 315499 25331 345948 227376 118572 11288964 10160068 1128896 17365689 15629120 1736569 11953818 10758436 1195382 Medical Supplies 77647151 77647151 0 0 ABHN & ABHS Mgt. Fee 45542821 27750203 17792618 0 Bad Debt Expense 13557346 13557346 0 0 Medical Purch Svcs 9897417 9897417 0 0 19543872 19535904 7968 426123287 380895395 45227892 0 4875269 35389372 47881731 56358789 8054776 8483717 1080042 1567523 496691108 268030144 223485287 228660964 32000000 33000000 20771530 12323103 338148635 375783468 32686589 23917933 71554537 113332205 104241126 137250138 X 229681020 234681682 3297597 2922756 928892 928892 233907509 238533330 338148635 375783468 X 7078966 -2453145 X 0 1 1 X 0 X 928892 928892 923617 5275 928892 922016 1601 923617 922016 922016 1.00000 0 1 1 1404465 1404465 318929511 122108605 196820906 1481873 1223592 258281 170974689 142068184 28906505 3900570 2629763 1270807 228660964 Beneficial Interest in Alexian Brothers Health System, Inc. Investment Trust 33000000 F 33000000 Due to Third Party Payors 45764410 Due to Affiliates 46137108 Other Current Liabilities 128280 Other Long Term Liabilities 5131380 Reserve for Outstanding Insurance Losses 16171027 113332205 Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment funds are used to support charitable efforts within the Alexian Brothers Health System. Description of Uncertain Tax Positions Under FIN 48: Part X: Part X, Line 2: Alexian Brothers Medical Center 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. Central America & the Caribbean 1 1 Program services Captive Insurance 9336100 1 1 0 0 1 1 9336100 0 9336100 0 0 1 0 0 0 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 2444 8324842 8324842 0.02020 45293 47516858 33823063 13693795 0.03320 47737 55841700 33823063 22018637 0.05340 7 14011 553618 43330 510288 0.00120 4 993 1441586 300361 1141225 0.00280 2 280 406532 406532 0.00100 2 3277 206932 206932 0.00050 15 18561 2608668 343691 2264977 0.00550 15 66298 58450368 34166754 24283614 0.05890 1 166 9019 9019 0.00000 1 939 52509 52509 0.00010 1 500 1502 1502 0.00000 3 1605 63030 63030 0.00010 0 3132000 1932000 158205870 200700931 -42495061 X 1 1 2 1 Alexian Brothers Medical Center

800 Biesterfield Road Elk Grove Village IL 600073397

X X X X 2 Alexian Rehabilitation Hospital

955 Bisner Road Elk Grove Village IL 600073397

X Alexian Brothers Medical Center 1 1 1 200.000000000000 1 600.000000000000 1 X X X X X X 1 1 X X X 1 0 1 X 0 0 Alexian Rehabilitation Hospital 2 1 1 200.000000000000 1 600.000000000000 1 X X X X X X 1 1 X X X 1 0 1 X 0 0 3 ABMC Diagnostic Imaging

1339 West Lake Street Addison IL 60101

Diagnostic imaging services ABMC Diagnostic Imaging

1060 S Elmhurst Road Mount Prospect IL 60056

Diagnostic imaging services ABMC Cardiovascular Imaging

1555 Barrington Road Hoffman Estates IL 60169

Diagnostic imaging services Part I, Line 3c: Every uninsured person, regardless of income, receives an automatic 15% discount off of charges. Persons who earn less than 600% of federal poverty guidelines are given more significant discounts, depending on their individual situations.Federal Poverty Level Patient Discount Uninsured0-200% 100% 201-300% 75%301-400% 67.5%401-500% 67.5%501-600% 67.5%> 600% 15% Part I, Line 6a: Alexian Brothers Hospital Network ("ABHN") prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for Alexian Brothers Medical Center ("ABMC"), St. Alexius Medical Center ("St. Alexius") and Alexian Brothers Behavioral Health Hospital ("ABBHH"). Part I, Line 7: The following costing methodologies were used:- Charity at cost - A cost to charge methodology based on the 2011 filed Medicare cost report was used to calculate costs.- Unreimbursed Medicaid - Costs are calculated using the 2011 filed Medicaid cost report.- Other benefits - Costs are determined by activity reported in accordance with guidelines published by the Catholic Health Association; costs could include the value of hourly wages, costs of materials, value of space loaned to community groups for meetings, and indirect costs where applicable. Part I, Line 7g: ABMC has not included costs attributable to a physician clinic as part of subsidized health services. Part I, L7 Col(f): The amount of bad debt expense included in Part IX, Line 25, column (A) that was removed from the calculation was $13,557,346.Part II: In 2011, ABMC concentrated most of its resources in other areas of community benefit that were not "community building" as described by the Catholic Health Association. Part III, Line 4: At the ABHN hospitals, including ABMC, management manually reviews all self-pay accounts greater than $5,000 (where the patient has chosen not to cooperate with our charity process) prior to placing the accounts for bad debt. Through this process, we examine credit data and then proactively grant an average of 80% charity to these accounts prior to placing the accounts in bad debt. Approximately $7,103,251 of accounts with balances less than $5,000 are placed annually into bad debt without going through this labor intensive process. We believe the larger accounts represent an adequate sample population which could be extrapolated to the $7.1 million. Therefore, we assume that 80% or $5,682,601 at charges ($1,932,084 at cost) of our bad debt likely would meet the criteria of our charity program if we allocated the resources to manually review the accounts prior to bad debt placement.Discounts and payments are not included in bad debt expense in the financial statements for ABMC unless the payment is a recovery of amounts previously written off as bad debt. Recoveries are classified as a decrease to bad debt expense.ABMC is part of the Alexian Brothers Health System (ABHS) consolidated audit. There is no footnote specific to bad debt expense in the audit. ABMC's share of bad debt expense for ABHS in 2011 was $13,557,346 at charges ($3,132,000 at cost). Cost is determined in the same manner as charity at cost. Part III, Line 8: Medicare costs are allocated by cost center in accordance with Medicare regulations.The question of whether or not Medicare reimbursement below cost should be treated as a community benefit has been debated for a number of years, pre and post healthcare reform. Some argue that most hospitals find it very difficult to achieve the required level of efficiency in a labor intensive service to provide for a positive margin. Others claim that positive margin or not, Medicare is essential to the overall financial health of hospitals due to the necessary volumes it supplies for a positive return, and therefore benefits the hospital as much as the community. Our view of the future status of Medicare is that regardless of reimbursement, Alexian Brothers Medical Center, as part of ABHN, will serve this part of our community with the same compassion and responsiveness to need as we always have done. In our opinion, a systematic degradation of reimbursement that is already less than the cost of providing the service for the vast majority of hospitals is an expectation on the part of the federal government to provide a substantial community benefit to a population that is growing and requiring more resources. It is for these reasons that we believe that the cost over reimbursement of Medicare should be considered community benefit. Part III, Line 9b: It is the policy of ABHN, including ABMC, to offer patients a payment plan and/or charity assistance when it becomes known or even suspected that a patient needs financial assistance. Financial counselors are notified and every attempt is made to contact and work with the patient or their family to help them complete an application with compassion and dignity. Financial counselors work with patients to help determine if there are any third party payers which may be available to help the patient meet their financial obligation. We work with the patient to determine if they are eligible for federal programs including Medicaid, state funded programs including crime victims, alternative insurance including COBRA, Worker's Compensation and/or other specialized grant programs such as our mammography grant program for low income women. In the event no third party programs are identified, we then work with the patient to help them apply for charity discounts and payment plans. At ABMC, four full-time financial counselors each work with approximately 7,700 patients per year. Two of four counselors are fluent in Spanish, and translators are used for other languages. In addition, all bills and statements include information regarding charity. Alexian Brothers Medical Center Part V, Section B, Line 7: If the hospital facility did not address all of the needs identified in its most recently conducted Needs Assessment, explain which community health needs the hospital facility did not address and the reasons why it has not address such needs. Alexian Rehabilitation Hospital Part V, Section B, Line 7: If the hospital facility did not address all of the needs identified in its most recently conducted Needs Assessment, explain which community health needs the hospital facility did not address and the reasons why it has not address such needs. Alexian Brothers Medical Center Part V, Section B, Line 13g: All bills and statements include information regarding charity. The front of our statements includes this message: "If you are an uninsured Illinois resident and meet certain income requirements, you may qualify for a discount through our Alexian Assistance program in accordance with the Hospital Uninsured Patient Discount Act (effective April 1, 2009). For additional information, please contact us at 866-690-3370 or AlexianAssisntance@alexian.net".The back of our statement includes this message: "If paying this bill presents a financial hardship, you may be eligible for financial assistance. Alexian Brothers Hospital Network provides assistance to patients in need of financial aid to help pay for their hospital bills. You may obtain an application by calling our staff at the number below or you may download the forms from the internet at www.alexianbrotherhealth.org."In addition, all uninsured patients receive a letter from our Patient Financial services department once we complete a process of attempting to identify alternative coverage for uninsured patients. This letter is sent at the beginning of our statement cycle for each uninsured patient. The text of the letter is:"Thank you for choosing Alexian Brothers Medical Center as your healthcare provider. Your account currently has a balance of $xx; additional charges may be pending.We have no record that you have health insurance to help in paying your bill. If you have insurance, please provide the necessary information by filling out the stub above and faxing a copy of your insurance card to 847-483-7058, Attn: Correspondence Team.If you had insurance that ended within the last 60 days, you may be eligible for COBRA coverage from a former employer. Please contact your former employer to determine if you are eligible.Our staff accepts payment by major credit card over the phone, cash payments through a registrar at the hospital, or payment by check or credit card using the payment coupon above.If you are unable to pay the total amount at this time, please call us. We are happy to accept a reasonable monthly payment plan to resolve your balance. Our payment plans carry no interest charges or pre-payment penalties.If paying this bill presents a financial hardship, you may be eligible for financial assistance. Alexian Brothers Hospital Network provides assistance to patients in need of financial aid to help pay their hospital bills. You may obtain an application by calling our staff at the number below or you may download the forms from the internet at www.alexianbrothershealth.org." Alexian Rehabilitation Hospital Part V, Section B, Line 13g: All bills and statements include information regarding charity. The front of our statements includes this message: "If you are an uninsured Illinois resident and meet certain income requirements, you may qualify for a discount through our Alexian Assistance program in accordance with the Hospital Uninsured Patient Discount Act (effective April 1, 2009). For additional information, please contact us at 866-690-3370 or AlexianAssisntance@alexian.net."The back of our statement includes this message: "If paying this bill presents a financial hardship, you may be eligible for financial assistance. Alexian Brothers Hospital Network provides assistance to patients in need of financial aid to help pay for their hospital bills. You may obtain an application by calling our staff at the number below or you may download the forms from the internet at www.alexianbrotherhealth.org."In addition, all uninsured patients receive a letter from our Patient Financial services department once we complete a process of attempting to identify alternative coverage for uninsured patients. This letter is sent at the beginning of our statement cycle for each uninsured patient. The text of the letter is:"Thank you for choosing Alexian Rehabilitation Hospital as your healthcare provider. Your account currently has a balance of $xx; additional charges may be pending.We have no record that you have health insurance to help in paying your bill. If you have insurance, please provide the necessary information by filling out the stub above and faxing a copy of your insurance card to 847-483-7058, Attn: Correspondence Team.If you had insurance that ended within the last 60 days, you may be eligible for COBRA coverage from a former employer. Please contact your former employer to determine if you are eligible.Our staff accepts payment by major credit card over the phone, cash payments through a registrar at the hospital, or payment by check or credit card using the payment coupon above.If you are unable to pay the total amount at this time, please call us. We are happy to accept a reasonable monthly payment plan to resolve your balance. Our payment plans carry no interest charges or pre-payment penalties.If paying this bill presents a financial hardship, you may be eligible for financial assistance. Alexian Brothers Hospital Network provides assistance to patients in need of financial aid to help pay their hospital bills. You may obtain an application by calling our staff at the number below or you may download the forms from the internet at www.alexianbrothershealth.org." Alexian Brothers Medical Center Part V, Section B, Line 19d: Alexian Brothers Medical Center uses the State of Illinois, Hospital Uninsured Patient Discount Act guidelines which specify that eligible patients should be charged 135% of hospital costs which for Alexian Brothers Medical Center approximates 32% of charges. Alexian Rehabilitation Hospital Part V, Section B, Line 19d: Alexian Rehabilitation Hospital uses the State of Illinois, Hospital Uninsured Patient Discount Act guidelines which specify that eligible patients should be charged 135% of hospital costs which for Alexian Rehabilitation Hospital approximates 32% of charges. Part V, Section A: In Part V of Schedule H, ABMC reports that it has two licensed hospitals (an acute care medical/surgical hospital and a rehabilitation hospital), one research facility that is part of the acute care hospital, and one emergency room. Part VI, Line 7: ABHN prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for ABMC, St. Alexius Medical Center (SAMC) and Alexian Brothers Behavioral Health Hospital (ABBHH). Part VI, Line 2: As part of ABHN, ABMC has been performing Community Health Assessments for our primary and secondary service areas since 1998. The first document was produced internally and contained secondary data only (data collected by local, state and federal agencies). The following three Community Health Assessments for the years 2002, 2006 and 2009 have been performed by an outside research firm in order to capture secondary and primary data (original data compiled in this case via telephone survey).In identifying priorities for community action and designing strategies for implementation, a variety of criteria are applied to the consideration process, including:Impact - The degree to which the issue affects or exacerbates other quality of life and health-related issues. Example, poor nutrition leads to overweight and Type II diabetes.Magnitude - The number of persons affected, also taking into account variance from benchmark data. Example, number of adults diagnosed with asthma in our region still below national benchmarks, but much higher compared to our own benchmarks.Seriousness - The degree to which the problem leads to death, disability or impairs one's life.Feasibility - The ability of organizations to reasonably impact the issue, given available resources.Consequences of Inaction - The risk of exacerbating the problem by not addressing it at the earliest opportunity.The 2009 Community Health Assessment surveyed fifty-six zip codes representing a total population of more than 1,800,000 persons. Primary research was conducted by telephone survey of 1,000 households. This is a very robust sample size and the sample was stratified and weighted to assure that the maximum rate of error was +/-3% at the 95% confidence level. Secondary data was gathered from the Census Update, Claritas population projections, the National Center for Health Statistics, Illinois Department of Public Health, Department of Health and Human Services and County Health Departments.The 2009 Community Health Analysis performed by Alexian Brothers Hospital Network that included Alexian Brothers Medical Center, revealed a slightly higher incidence of breast cancer in our service area than in the rest of Illinois, especially in suburban Cook County. Research suggests that most breast lumps are found by women themselves as opposed to clinicians. Mammograms are the best method of detecting cancer, but women who perform routine breast self exams can vastly improve their chances of survival by finding a lump at its earliest stage.In 1974, the National Cancer Institute supported a research payment with the goal of developing a program to teach effective manual breast examination. From this research, MammaCare(TM) was developed. The program involves using the pads of the three middle fingers, three levels of pressure, and an organized search pattern on breast models and breast tissue. MammaCare(TM) techniques have been extensively studied and reported in medical journals.The consistent findings are that these techniques produce significantly more thorough and sensitive manual breast examination. The clinical data confirm that MammaCare(TM) technique assists in finding the smallest meaningful changes in breast tissue.Alexian Brothers Medical Center has sent nurses to be trained and certified in the clinical training courses that teach clinicians how to conduct proficient MammaCare(TM) exams. Through these specially trained nurses, Alexian Brothers Medical Center provides free MammaCare classes to the community. Specially trained nurses educated 162 women in 2011 at the MammaCare(TM) Training Center at Alexian Brothers Medical Center, in private settings in homes, as well as businesses. In addition, 34 professionals and 31 medical students were trained.Alexian Brothers Medical Center collaborated with Illinois Department of Public Health in 2011 to provide Polish speaking members of our community with smoking cessation classes. Five classes were offered in the Polish language and marketed through the hospital website, church bulletins in Polish neighborhoods, direct mail and in both Polish and English newspapers. Interested parties registered by calling AlexianConnects which has a Polish-speaking operator to field those calls. The classes were very successful and taught by a Polish-speaking psychologist who was able to assist attendees with their effots to stop smoking through counseling and follow up referrals to appropriate resources.Part VI, Line 3: ABMC uses multiple methods of communicating its mission of providing care to all who need it regardless of ability to pay. Signs posted at registration clearly point out that charity care or financial assistance is available. Alexian Brothers Health System's (ABHS) website, the main website for all System hospitals, including ABMC, features information on how to apply for charity care on-line. In the hospital setting, we employ four financial counselors who are available to work with patients and we also have Medicaid application specialists to assist patients that may qualify. A Community Outreach Director is employed by ABHN to serve patients who need help understanding and accessing community health services. This individual works with patients at ABMC and the other ABHN hospitals. In addition, all bills and statements include information regarding charity.Part VI, Line 4: ABMC, a member hospital of the ABHN, serves Chicago's northwest suburbs spanning the counties of McHenry, Lake, Kane, DuPage and Cook. With more than 1.8 million residents overall, the primary service area alone is comprised of nearly 20 communities with a diverse demographic and ethnic base.The zip codes/communities served include: Primary Service Area 60007 Elk Grove Village 60004 Arlington Heights 60010 Barrington 60005 Arlington Heights 60018 Des Plaines 60008 Rolling Meadows 60056 Mount Prospect 60013 Cary 60067 Palatine 60014 Crystal Lake 60101 Addison 60016 Des Plaines 60103 Bartlett 60047 Lake Zurich 60106 Bensenville 60050 McHenry 60107 Streamwood 60073 Round Lake 60108 Bloomingdale 60074 Palatine 60110 Carpentersville 60089 Buffalo Grove 60120 Elgin 60090 Wheeling 60133 Hanover Park 60098 Woodstock60139 Glendale Heights 60102 Algonquin60143 Itasca 60118 Dundee60169 Hoffman Estates 60123 Elgin 60172 Roselle 60124 Elgin60173 Schaumburg 60126 Elmhurst 60191 Wood Dale 60136 Gilberts 60192 Hoffman Estates 60137 Glen Ellyn60193 Schaumburg 60140 Hampshire60194 Schaumburg 60142 Huntley60195 Schaumburg 60148 Lombard Secondary Service Area 60156 Lake in the Hills 60185 West Chicago 60157 Medinah 60187 Wheaton 60175 St. Charles 60188 Carol Stream60177 South Elgin 60634 Chicago60181 Villa Park 60707 Elmwood ParkThe primary not-for-profit community hospitals also serving this area include: Northwest Community Hospital, Sherman Hospital, Provena Saint Joseph Hospital, Central DuPage Hospital, Elmhurst Memorial Hospital, Advocate Good Shepherd Hospital and Advocate Lutheran General Hospital. ABHN has referral arrangements with academic medical centers including: Children's Memorial Hospital, Loyola University Medical Center, University of Chicago Medical Center and Rush University Medical Center.ABMC's racial/ethnic distribution for 2008 (Claritas) within its service area is as follows:Race Population PercentageWhite 1,300,192 69.2%Hispanic 337,866 18.0%Asian 155,757 8.3%Black 53,787 2.9%Two Plus 26,776 1.4%Indian 2,998 0.1%Other 1,653 0.1%Pacific Is. 568 0.0%Total 1,878,897 100%The median age for 2008 was 37.1 years.Overall Median Age: 37.1Median Age Male: 36.0Median Age Female: 38.2The average annual household income for 2008 was $74,160.The communities ABHN serves enjoy a relatively positive health status. In comparison to the whole of Illinois and the nation, incidence of heart disease, stroke, cancers and most other diseases are favorable. However, access to care, insurance status and other health indicators are trending negatively. For example, ABHN's 2009 Community Health Assessment Survey found that one in every ten community residents is having difficulty getting an appointment to see a doctor for primary care. Summary highlights from the survey included the following additional points of concern/interest.Access to Care- Among respondents 18 to 64, 13.6% have no health insurance. This is a sharp rise from 2002 at 7.3% and 9.3% in 2006.- A total of 11.9% of adults in the service area said that cost prevented them from seeing a physician, a steep increase from 5.8% in 2002.The northwest suburban area is home to the corporate headquarters for AT&T, Motorola and Sears, and has a significant manufacturing and industrial base. It is thought that due to the recent economic recession, a significant number of community residents may have lost their jobs and subsequently their insurance coverage thereby worsening the trend. 8.1% of community residents are currently reporting being (one or more years) out of work. As mentioned previously, ABHN provides assistance to help patients take advantage of the various benefits and services available through ABHN. As access to health insurance expands because of new legislation, we will help to support and guide patients as appropriate.Part VI, Line 5: ABMC's governing body is the Quality Council. The Quality Council reports up through the Alexian Brothers Health System Board of Governors. The majority of the Quality Council members live and work in the community and serve to support the mission and values of the Alexian Brothers. ABMC extends medical staff privileges to all qualified physicians in our community and endeavors to provide them with the safest and most technologically advanced environment possible through the effective use of surplus funds. Some of our surplus funds have been used to purchase technology for non-invasive brain mapping and non-invasive technology for treating brain tumors in prior years. As necessary, ABMC recruits medical specialists and subspecialists who provide the expertise for emerging technologies that advance patient care.ABMC strives to fully serve the community through participation in government sponsored healthcare programs such as Medicare, Medicaid, CHAMPUS and Tricare. ABMC also participates in research and education. In 2010 we had affiliations with 7 schools of nursing for undergraduate placement and numerous graduate level programs for clinical rotation. Pre-med students from a nearby university shadow health professionals for a semester to help guide their future career choices. Community members also use ABMC as a conduit for volunteering as evidenced by almost 1,000 volunteers (comprising almost 100,000 hours of service) who assist with patient services, administration and the gift shop.Part VI, Line 6: ABMC is an affiliate of ABHS. ABHS is the national member and ultimate parent of ABMC. ABHS, with its corporate offices located in Arlington Heights, Illinois, is sponsored by Alexian Brothers of America, Inc., a Roman Catholic religious order of men committed to caring for the sick, the aged, the poor and the dying for more than seven centuries. The basic Judeo-Christian beliefs that inspired the founders of this worldwide Catholic religious congregation sustain its ministry today; to promote the physical, mental, spiritual and social well-being of individuals of all creeds, races, nationalities and socioeconomic levels served through this health care ministry.ABHS carries out its exempt purposes by coordinating and managing the activities of the regional corporations for which it is the National Member. Through these regional corporations, ABHS provides healthcare and other services to communities in suburban Chicago, Illinois; St. Louis, Missouri; Milwaukee, Wisconsin; and Signal Mountain and Chattanooga, Tennessee. As a charitable organization, it is recognized that not all individuals possess the ability to purchase essential medical services and further that our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping with ABHS' commitment to serve all members of its community, free care and/or subsidized care, care to persons covered by government programs at or below cost, and health activities and programs to support the community are considered and provided when appropriate. These activities include wellness programs, community education programs, special programs for the elderly and medically underserved, and a variety of broad community support activities including but not limited to educational affiliations, health screenings, counseling programs, continuing medical education (CME) programs and donations to community groups.For example, ABHS owns and operates a community mental health center that serves primarily lower income, uninsured or underinsured or Medicaid recipients. This facility treats the chronically mentally ill with counseling, medication and social support. The center is supported through state grants and philanthropy. Because of the uptick in depression, we have experienced more demand for services combined with less support from the State which has strained our resources. However, ABHN remains committed to this program and the members of the community that it serves. Another program offered to the community through ABBHH is Alexian Brothers Parish Services (ABPS, formerly Interfaith Parish Support Services/IPSS). ABPS was created in response to the faith community's requests for services to support the mental health needs of their parishes, to serve as a bridge between faith communities and our healthcare ministry. ABPS has active partnerships with 70 faith communities. Clinical professionals from ABPS provide consultation around mental health concerns, support group facilitation or consultation, speakers for women's or men's ministries, retreats, labyrinth walks, suicide prevention, pro-social (anti-bullying) programming, staff trainings and congregational health ministry development provided by a Faith Community Nurse. The following are two specific examples of the partnerships ABPS has with parishes:- School Social Worker and Counselor: ABPS partners with parochial schools to provide direct support services to the students, not usually available in a private school setting. There are two programs: school social worker/counselor to assist students with their academic, social, emotional or faith development, and resource teacher to provide special educational support. Students in parochial schools do not have access to supportive services from a public school due to cut backs and financial restraints school districts are facing. In 2011, ABPS had partnerships with 18 different Catholic Schools, poviding 31 days of social work services and 5 days of resource teacher services; collectively serving 7,600 students. During the school year preventative programs are provided on various topics: pro-social skills (anti-bullying), conflict resolution, resilience training, empathy, friendship skills, mental health awareness, drug abuse prevention, personal responsibility, and leadership development.- Interfaith Counseling Services: ABPS partners with 10 local faith communities to provide spiritually integrated therapy, the parish provides the space (at no charge) and ABPS provides the clinical professional to provide services out in the community. In 2011, over 2,300 hours of therapy have been offered in four languages: English, Polish, Spanish, and Tagalog. Services are offered for a fee and a sliding fee scale may be available based upon financial need. ABBHH subsidized ABPS at $364,000 in 2011. This allowance allows ABPS to continue to grow its ministry and serve the community in more locations. By supporting local communities through spiritually integrated therapy, school outreach, and parish support, ABPS seeks to bring healing and hope to individuals and families with their needs, whether physical, mental or spiritual.One of our most valuable community services is performed by the Alexian Brothers Behavioral Health Hospital. Twenty-four hours a day, seven days per week, a crisis intervention service is available to anyone in the community either by phone or in person. Master's prepared clinicians provide, on average, a 35 minute screening consisting of a brief social history and a current functionality determination. The outcome is behavioral health treatment recommendations as well as referrals as needed. This program provided over 16,000 screenings in 2011 and is considered invaluable by regional mental health professionals and first responders.Net community benefits expense for ABHS in 2011 is as follows:Charity Care at Cost - $17,759,062Language Assistant Services - $707,502Excess of Government Sponsored Health Care Cost Over Reimbursement - Medicaid - $27,733,877 Donations - $190,093Education - $2,384,921Government-Sponsored Program Services - $0Subsidized Health Services - $1,669,456Other Community Benefit Programs - $3,887,754 Total Charity Care and Community Benefits - $54,332,665Information has been included for all exempt entities in ABHS. The information for the hospitals included has been calculated on a basis consistent with the requirements for the Illinois Attorney General Community Benefit report.In addition, ABHS reported bad debt expense (at cost) of $10,169,004 in 2011 and excess of Medicare costs over reimbursement of $58,209,000 in 2011.Certain affiliated entities within ABHS and the services they provide, are described below:St. Alexius Medical Center - An acute care hospital located in Hoffman Estates, Illinois that provides inpatient, outpatient and emergency services, including specialties in the areas of cardiology, neurosciences, orthopedics, oncology, bariatrics and pediatrics.Alexian Brothers Behavioral Health Hospital - A behavioral health hospital located in Hoffman Estates, Illinois that provides inpatient and outpatient psychiatric services, including specialties in chemical dependency, eating disorders and self-injury programs.Alexian Brothers Center for Mental Health - Provides community mental health services in northwest suburban Chicago, including vocational training programs, transitional living programs, partial hospital programs and nursing home programs.Alexian Brothers Bonaventure House - Provides supportive services and transitional housing for persons with AIDS.Alexian Brothers Hospital Network - The area member for Illinois hospitals and related entities, ABHN provides community education classes, health screenings and counseling and other services on a sliding fee scale to surrounding communities and performs research activities geared towards improving the health of those we serve.Alexian Brothers Ambulatory Group - Provides a multitude of ambulatory services to suburban Chicago, including primary care physician services; pediatric physician services; older adult physician services; other specialty physician services; occupational health services; and immediate care services; also provides wellness services through its various locations and practices.Alexian Brothers Speciality Group - Provides cardiology services through employment of cardiologists to suburban Chicago residents.Alexian Village of Milwaukee, Inc. - A continuing care retirement community located in Milwaukee, Wisconsin; provides all levels of care to residents and community members, including skilled nursing care, adult day care services, assisted living and care for those with Alzheimer's disease and dementia.Alexian Village of Tennessee - A continuing care retirement community located in Signal Mountain, Tennessee; provides all levels of care to residents and community members, including skilled nursing care, assisted living and care for those with Alzheimer's disease and dementia.Alexian Brothers Lansdowne Village and Alexian Brothers Sherbrooke Village - Skilled nursing facilities located in St. Louis, Missouri; provides nursing care, assisted living and care for those with Alzheimer's disease and dementia, rehabilitation services and transitional care services (Lansdowne only).Alexian Brothers Community Services - Programs for All Inclusive Care for the Elderly (PACE) located in St. Louis, Missouri and Chattanooga, Tennessee; provides care for frail, elderly, Medicaid eligible individuals; provides primary care, daily activities and transportation services; also coordinates care when hospitalization or placement in a skilled nursing facility is required.Alexian Brothers Senior Neighbors - Provides community based services to seniors in Chattanooga, Tennessee.Alexian Brothers Services, Inc. - Housing and Urban Development (HUD) housing project in St. Louis, Missouri. Part VI, Line 7: ABHN prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for ABMC, St. Alexius Medical Center (SAMC) and Alexian Brothers Behavioral Health Hospital (ABBHH). 0 1 0 0 0 0 0 0 0 John Werrbach 0 392794 0 91509 0 38682 0 49477 0 22524 0 594986 0 25332 James Sances 0 477155 0 136544 0 28841 0 115746 0 28202 0 786488 0 28841 Sherril Vincent 0 307353 0 51215 0 18510 0 28334 0 12413 0 417825 0 18510 Jim Lewandowski 0 280338 0 56701 0 35171 0 35309 0 31686 0 439205 0 12354 Linda Baker 0 164954 0 28241 0 11662 0 28417 0 33025 0 266299 0 5811 Tony DiLorenzo 0 283247 0 50114 0 41898 0 351813 0 15926 0 742998 0 25398 Bryan Bertoglio 0 787326 0 0 0 16500 0 6953 0 20228 0 831007 0 0 Timothy Malish 0 775957 0 0 0 0 0 8946 0 21493 0 806396 0 0 Szymon Rosenblatt 0 756639 0 0 0 0 0 7881 0 21528 0 786048 0 0 Paul Robison 0 747553 0 0 0 29423 0 0 0 16052 0 793028 0 0 Franklin Marden 0 503251 0 48427 0 0 0 9527 0 6970 0 568175 0 0 Kathleen Gunderson 0 214564 0 31499 0 7442 0 44100 0 20198 0 317803 0 0 Mary Ann Magnifico 0 230526 0 45431 0 12051 0 42714 0 28033 0 358755 0 12051 Francine McGouey 0 280473 0 63789 0 34667 0 49603 0 12458 0 440990 0 34667 Supplemental Information Part III Part I, Line 3: Alexian Brothers Medical Center 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, Line 4b: 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: John Werrbach - $6,784 Sherril Vincent - $3,110 James Sances - $52,060 Mary Ann Magnifico - $4,317 Jim Lewandowski - $5,297 Kathleen Gunderson - $1,074 Tony DiLorenzo - $1,656 Advanced Surgical Assoc Robert Rao, MD (Board Member) 127525 On-call Services 0 Cardiovascular Associates John Furiasse, MD (Board Member) 107141 Independent Contractor 0 Christopher Werrbach Son of John Werrbach (CEO) 45094 Wages 0 Program Service Statement Form 990, Part III, Line 4a, Program Service Accomplishments (cont'd) Orthopedics Recognized as one of the leading centers for orthopedics in the Midwest, our Orthopedic Services enlists a comprehensive leading-edge approach to the prevention, assessment, treatment and rehabilitation of musculoskeletal injuries, including aching backs, arthritis pain, sports injuries, and work injuries. We offer treatment and services for emergency fractures, foot and ankle, hand and upper extremity, wrist, shoulder and elbow, partial joint replacements with alternative options, sports medicine, surgical spine procedures, pediatric care and total joint replacement and reconstruction. Pediatrics Our pediatric services offer care by physicians, nurses and staff who have expertise in pediatric medical care. Our staff of pediatricians includes sub-specialists covering a wide range of medicine, including many who are board certified and fellowship trained in their specialties. Special Outpatient Services - Cancer Program: Diagnostics, chemotherapy & surgery - Community Outreach: Health education classes/programs & health screenings - Diabetes Program: Treatment and education - Outpatient Rehabilitation (Day Rehab programs) - Home Health Services - Home Infusion Services - Hospice Services - Sleep Lab - Procedure Clinic: For patients undergoing procedures requiring a short hospital stay (no more than 12 hours). Procedures include blood transfusions, CT biopsies, arteriogram, angiograms, outpatient chemotherapy, antibiotic therapy, pain management and other treatments - Rehabilitation: Physical, Occupational & Speech Therapy - Physician Referral - Volunteer Program - Vein Clinic - Wound Clinic (Hyperbaric chamber) - Golden Circle: Lifestyle & social issues for adults age 50 and over Surgical Services Surgical procedures are performed in our state-of-the-art facility. We offer a wide-range of procedures in orthopedic, gynecology, urology, general surgery, podiatry, ear, nose and throat, pain management, neurosurgery, cosmetic surgery, oral/maxillofacial, and ophthalmology. Weight Management Alexian Brothers Advanced Weight Loss Solutions offer expert medical treatment, behavioral support and surgical interventions for weight loss such as Lap Band, sleeve gastrectomy, "Optifast" and gastric bypass surgery. The American Society for Bariatric Surgery (ASBS), the largest society for this specialty, named the ABMC Bariatric surgery program a nationally designated "Center of Excellence." The Blue Cross Blue Shield Association has also identified ABMC as a Designated Center for Bariatric Surgery. Inpatient Rehabilitation Hospital Alexian Rehabilitation Hospital, part of ABMC, is a 66-bed inpatient rehabilitation facility. Its doctors, nurses and therapists are experts in every aspect of rehabilitation medicine. They work together through a team approach to meet the physical, emotional and spiritual needs of patients and families. The staff strives to provide each patient with the best possible care by recognizing that every patient's needs and goals are different. For many patients, the first phase of rehabilitation can be the most important, requiring the most intensive treatment and the daily care of a physiatrist, a doctor who specializes in physical medicine and rehabilitation. Rehabilitation is an active process, and before being admitted to inpatient care, the patient should be able to do a minimum of three hours of therapy each day. Our Stroke Rehabilitation Program offers a breadth of services along with a highly experienced professional staff to help patients achieve the highest quality of life possible. Treatment is provided for patients recovering from strokes of all types including: Ischemic, Intracerebral, Subarachnoid hemorrhage. Patient learning to walk again after a stroke and neurological injuries are benefiting from a revolutionary new device in the KineAssist Robot, which represents a giant leap forward in effectiveness for people learning to walk again after a stroke or neurological injuries. The KineAssist Robot applies robotic technology to help patients learn to walk forward and backward, step sideways, climb stairs and regain the balance, strength and mobility to carry on daily activities without the fear of falling. Our professional experience, expertise and team approach to rehabilitation translates into higher rates of patient satisfaction and better overall patient outcomes. Form 990, Part VI, Section A, line 6 The Organization has two classes of members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Hospital Network (the "Area 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 Medical Center. Form 990, Part VI, Section A, line 7b Alexian Brothers Health System ("ABHS") has principal authority with respect to the following matters: - Adoption or amendment of the Articles of Incorporation; - Amendment of the Bylaws as provided by Statute; - 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 Alexian Brothers Medical Center; - The annual capital and operating budget and the Strategic Plan of Alexian Brothers Medical Center; and - Other certain reserved powers which Alexian Brothers Health System may designate. Form 990, Part VI, Section B, line 11 Alexian Brothers Medical Center 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. Alexian Brothers Medical Center'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 Alexian Brothers Medical Center'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. Alexian Brothers Medical Center's 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 review the 2011 Form 990 for Alexian Brothers Medical Center. Form 990, Part VI, Section B, line 12c Alexian Brothers Medical Center collects annual attestations from board members, officers, directors and key employees. The attestations are reviewed by the Alexian Brothers Medical Center compliance officer and any conflicts are shared with the Alexian Brothers Medical Center Chief Executive Officer. The conflicts are also reviewed by the System's Vice President, 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 Alexian Brothers Medical Center 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 Alexian Brothers Medical Center's financial statements are available through the Office of the Illinois Attorney General. Conflicts of Interest and ABMC's governing documents are not made available to the public. Form 990, Part VII: Average hours devoted to related organizations when compensation is reported: - Linda Baker worked 20 hours per week for St. Alexius Medical Center; - Virginia Golembiewski worked 40 hours per week for Alexian Brothers Health System; - Jim Lewandowski worked 40 hours per week for Alexian Brothers Health System; - Mary Ann Magnifico worked 40 hours per week for Alexian Brothers Health System; - Francine McGouey worked 40 hours per week for Alexian Brothers Behavioral Health Hospital; - James Sances worked 40 hours per week for Alexian Brothers Health System. - All others listed in Part VII devoted 100% of their time to Alexian Brothers Medical Center; and - Kathleen Gunderson worked 40 hours per week for Alexian Brothers Hospital Network. Part VII, Column E (Reasonable Efforts): 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 services. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfers to Alexian Brothers Health System -2,043,594. Net activity -244,728. Insurance Reserve -164,823. Total to Form 990, Part XI, Line 5: -2,453,145. Part VIII, Line 3; Schedule D, Part VII: The amount reflected as dividends and interest reflects Alexian Brothers Medical Center's share of interest, dividends and realized gains/losses from Alexian Brothers Medical Center's beneficial share in the Alexian Brothers Health System, Inc. Investment Trust (ABHSIT). ABHSIT is a related entity whose purpose is to pool the investments of the not-for-profit entities in ABHS and acts as an internal mutual fund. Details of gains and losses are shown on the Form 990 of ABHSIT. Alexian Brothers of America Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 362606768 Religious order of Roman Catholic men TX 501(c)(3) Line 1 N/A 0 Brothers of St Alexius Health and Welfare Fund Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 362976617 Provides for health & welfare payments for religious sponsor TX 501(c)(3) Line 1 Alexian Brothers of America Inc 1 Alexian Brothers Bonaventure House 825 Wellington Ave Chicago IL 60657 363527899 Housing and supportive care services for persons with HIV/AIDS IL 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 60005 363260495 Supports the provision of healthcare services for related corporations for w IL 501(c)(3) Line 11c, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Health System Inc Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 60005 363801585 Manages pooled investments of related not-for-profit entities IL 501(c)(3) Line 11c, III-FI Alexian Brothers Health System 1 Alexian Brothers of America Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 60005 364390471 Manages pooled investments of related not-for-profit entities IL 501(c)(3) Line 11c, III-FI Alexian Brothers of America Inc 1 Alexian Brothers of Chicago 3040 W Salt Creek Lane Arlington Heights IL 60005 Inactive Corporation IL 501(c)(3) Line 9 Alexian Brothers of America Inc 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 941530037 Acute care hospital (sold in 1998) TX 501(c)(3) Line 3 Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 431295333 HUD housing MO 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Village of Milwaukee Inc 9301 N 76th Street Milwaukee WI 53223 391351584 Continuing care retirement community WI 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Suite 110 Chattanooga TN 37404 364344423 Provides comprehensive and coordinated community based services IL 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 37402 620646376 Supports the provision of community services for senior citizens TN 501(c)(3) Line 7 Alexian Brothers Health System 1 Alexian Village of Tennessee 437 Alexian Way Signal Mountain TN 37377 621136742 Continuing care retirement community TN 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 60005 364484290 Supports the provision of healthcare for related corporations IL 501(c)(3) Line 11c, III-FI Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 392039667 Community outreach WI 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled nursing facility MO 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Sherbrooke Village 4005 Ripa Avenue St Louis MO 63125 431592502 Skilled nursing facility MO 501(c)(3) Line 9 Alexian Brothers Health System 1 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 60005 363276552 Supports the provision of healthcare services for related corporations IL 501(c)(3) Line 11c, III-FI Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363308965 Owns or leases properties where healthcare services are delivered IL 501(c)(3) Alexian Brothers Health System 1 Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates IL 60194 364251848 Behavioral health hospital IL 501(c)(3) Line 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 60194 364251846 Acute care hospital IL 501(c)(3) Line 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 60005 364336931 Physician services IL 501(c)(3) Line 3 Alexian Brothers Health System 1 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 430653236 Acute care hospital (sponsorship transferred in 1997) MO 501(c)(3) Line 3 Alexian Brothers Health System 1 Alexian Brothers Specialty Group 3040 W Salt Creek Lane Arlington Heights IL 60005 800710751 Specialty physician practice group IL 501(c)(3) Line 3 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 501(c)(3) Line 7 Alexian Brothers Health System 1 Alexian Rehabilitation Services LLC 935 Beisner Road Elk Grove Village IL 60007 300221481 Rehabilitation Hospital IL N/A N/A 0 0 Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 870783164 Provision of NeuroMeg services IL Alexian Brothers Medical Center Related -344572 1157218 0 0 0.71430 Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853289 Medical office Building IL N/A Workplace Solutions LLC 1100 East Woodfield Rd Schaumburg IL 60173 364095007 Provision of EAP services IL Alexian Brothers Medical Center Unrelated 27289 30999 0 0 0.05000 Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights DE 60005 363978153 Manages managed care contracts DE N/A N/A 0 0 Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 861115516 Ownership of Gamma Knife IL N/A St Alexius Center for Sleep Health LLC 665 W North Avenue Lombard IL 60148 205876371 Operation of sleep labs IL N/A N/A 0 0 Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 60005 363266316 Owns/ leases property; joint venture partner IL N/A C Edessa Insurance Company Ltd 3040 W Salt Creek Lane Arlington Heights IL 60005 Captive insurer located in Bermuda BD Alexian Brothers Medical Center C 22000 108501000 1.00000 Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363853286 Messenger model IPA IL N/A C Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 60005 352211303 Tax credit financed housing IL N/A C Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 943465394 Tax credit financed housing IL N/A C 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 Alexian Brothers Health System P 8413916 Fair market value Alexian Brothers Hospital Network P 42446953 Fair market value Alexian Brothers Health System Q 13290369 Fair market value St Alexius Medical Center O 791927 Fair market value Alexian Brothers Behavioral Health Hospital L 74067 Fair market value Alexian Brothers Behavioral Health Hospital P 605544 Fair market value Thelen Corporation L 9097 Fair market value Savelli Properties Inc L 540802 Fair market value Alexian Brothers Ambulatory Group L 253439 Fair market value Alexian Brothers Health System L 58371 Fair market value Neurosciences Equipment LLC J 1458448 Fair market value Illinois NeuroMeg Center LLC B 46356 Fair market value Alexian Brothers Ambulatory Group L 344977 Fair market value Schedule R, Part V, Line 2: Alexian Brothers Medical Center 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.