2012-10-04T17:47:29-05:00 2011-12-31 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 606064301 990 2011-01-01 364336931 Alexian Brothers Ambulatory Group ALEX 8473857100 3040 West Salt Creek Lane Arlington Heights IL 600051069 Beth Tze 8473857100 2012-10-04 1 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z Beth Tze 3040 West Salt Creek Lane Arlington Heights IL 600051069 50442855 0 X www.alexianbrothershealth.org X 1999 IL ABAG carries out the healing mission of the Catholic Church (See Schedule O) as an Alexian Brothers ministry by identifying and developing effective responses to the health needs of those we are called to serve. 3 0 0 1 0 0 17612 0 47122539 50244164 107007 107279 122248 91412 47369406 50442855 0 0 0 0 31629149 35965334 0 0 0 24294137 22751253 55923286 58716587 -8553880 -8273732 11030550 12152461 10231560 13660156 798990 -1507695 X Alexian Brothers Ambulatory Group ("ABAG") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health needs of those we are called to serve. 0 0 53502740 50335576 Alexian Brothers Health System employs more than 150 physicians and other providers through the Alexian Brothers Ambulatory Group (ABAG).ABAG offers Primary Care, Immediate Care, Specialty Care, Occupational Health Services and/or hospital-based Diagnostic Imaging Services at 25 locations across the primary and secondary service areas, including both hospital campuses. Physicians, who specialize as part of ABAG, practice in the areas of Cardiovascular Surgery, Neurosciences, General Surgery, Breast Surgery, Geriatric and Pediatric Specialties. In 2011, ABAG offices had 219,289 outpatient visits, including 138,941 primary care visits, 31,060 immediate care visits and (See Schedule O) 49,584 occupational health visits. The ABAG physician offices dedicated to serving the healthcare needs of adults over the age of 65 had 16,766 office, hospital and nursing home visits. Specialty physicians of ABAG had, in 2011, 4,965 office visits, 6,186 hospital visits and 2,393 surgeries for adult patients and 14,211 office and hospital visits for pediatric patients. 53502740 1 0 0 0 0 0 0 0 0 0 1 1 0 0 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 1 0 1 84 0 0 1 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 IL X Daniel Isacksen 8473857100 3040 West Salt Creek Lane Arlington Heights IL 600051069 X Brother T Keusenkothen 40.00 X X 0 0 0 Mark Frey 40.00 X X 0 867276 184992 James Sances 40.00 X X 0 642540 143948 Tracy Rogers 40.00 X X 0 497648 78096 Beth Tze 40.00 X 0 324547 62874 Virginia Golembiewski 40.00 X 0 69801 16144 Daniel Isacksen 40.00 X 0 231986 25573 Jim Lewandowski 40.00 X 0 372210 66995 Kim Zimmermann 40.00 X 0 193234 24057 John Wilkerson 40.00 X 0 365868 5421 Rajammal Srinivasan 40.00 X 0 306460 150 Charles Kalenowski 40.00 X 0 304480 32252 Calvin Fischer 40.00 X 2313 271858 28879 Roger Weise 40.00 X 0 255845 45356 2313 4703753 714737 0 0 1 0 Schaumburg Family Phys 25 E Schaumburg Rd Ste 200 Schaumburg IL 60192 Medical Specialist/Physicians 2399494 Rush Univ Med Ctr DBA Univ Neuro 1725 W Harrison St S Chi IL 60612 Medical Specialist/Physicians 194329 Dr Amir Turayhi Rand Medical Clinic SC Mt Prospect IL 60056 Medical Specialist/Physicians 141395 MEA Medical Care Centers LLC 2000 Spring Rd STE 200 Oak Brook IL 60521 Medical Specialist/Physicians 130443 Sinai Medical Group 2750 W 15th Place Chicago IL 60608 Medical Specialist/Physicians 122850 7 Net Patient Svcs Reven 621111 50199462 50199462 Intercompany Affiliate 900099 44702 44702 50244164 107279 107279 91412 0 91412 91412 91412 50442855 50335576 0 107279 31344030 29331918 2012112 704635 669601 35034 2214763 1989254 225509 1701906 1607916 93990 167578 2788 164790 13000 13000 3541341 3360766 180575 5160 2086 3074 950094 694372 255722 16694 6694 10000 4213148 3961299 251849 362880 327115 35765 32202 11021 21181 442817 388312 54505 3338174 3320551 17623 Management Fees 3614881 1837686 1777195 Medical Supplies 1258107 1258107 Bad Debt 817555 817555 3977622 3915699 61923 58716587 53502740 5213847 0 12009 4942624 4525642 529275 752481 215150 155227 8864198 6575024 2034309 2289174 2779968 3804292 302032 549382 227192 64254 11030550 12152461 4113589 3332320 6117971 10327836 10231560 13660156 X 798990 -1507695 0 0 798990 -1507695 11030550 12152461 X -8273732 5967047 X 0 1 1 X 0 X 3233798 2142911 1090887 5234508 4432113 802395 395892 0 395892 2289174 Beneficial Int. in ABHS Invest. Trust 3804292 F 3804292 Due to Affiliates 9583282 Other Liabilities 42920 Reserve for Outstanding Insurance Losses 701634 10327836 Description of Uncertain Tax Positions Under FIN 48: Part X: Alexian Brothers Ambulatory Group 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. 0 1 0 0 0 0 0 0 0 Mark Frey 0 617468 0 172499 0 77309 0 145072 0 39920 0 1052268 0 39114 James Sances 0 477155 0 136544 0 28841 0 115746 0 28202 0 786488 0 28841 Tracy Rogers 0 367650 0 105531 0 24467 0 34778 0 43318 0 575744 0 24467 Beth Tze 0 256610 0 67937 0 0 0 28119 0 34755 0 387421 0 0 Daniel Isacksen 0 196845 0 35141 0 0 0 3060 0 22513 0 257559 0 0 Jim Lewandowski 0 280338 0 56701 0 35171 0 35309 0 31686 0 439205 0 12354 Kim Zimmermann 0 163955 0 29279 0 0 0 6617 0 17440 0 217291 0 0 John Wilkerson 0 365868 0 0 0 0 0 4900 0 521 0 371289 0 0 Rajammal Srinivasan 0 306460 0 0 0 0 0 0 0 150 0 306610 0 0 Charles Kalenowski 0 304480 0 0 0 0 0 11215 0 21037 0 336732 0 0 Calvin Fischer 2313 271858 0 0 0 0 0 7926 0 20953 2313 300737 0 0 Roger Weise 0 245845 0 10000 0 0 0 31057 0 14299 0 301201 0 0 Part I, Line 3 Alexian Brothers Ambulatory Group 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 6 Supplemental Information Part III 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: Mark Frey : $77,808, James Sances : $ 52,060, Tracy Rogers : $ 5,914, Beth Tze: $ 1,896, Jim Lewandowski : $ 5,297 Form 990, Part VI, Section A, line 2 Mark Frey, James Sances, and Tracy Rogers have a business relationship due to joint employment by a common health system entity. Form 990, Part VI, Section A, line 6 Alexian Brothers Ambulatory Group 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 Ambulatory Group. Form 990, Part VI, Section A, line 7b Alexian Brothers Health System has principal authority with respect to the following matters: - Amendment of the Articles of Incorporation and Bylaws of the Corporation 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, sales or lease of all or substantially all of the assets of the Alexian Brothers Ambulatory Group. - The annual capital and operating budget and the Strategic Plans of the Alexian Brothers Ambulatory Group; and - Other certain reserved powers which Alexian Brothers Health System may designate. Form 990, Part VI, Section B, line 11 Alexian Brothers Ambulatory Group 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 Ambulatory Group'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 Ambulatory Group'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. The 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 Ambulatory Group'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 on a rotating basis. 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 Alexian Brothers Ambulatory Group. Form 990, Part VI, Section B, line 12c Alexian Brothers Ambulatory Group collects annual attestations from board members, officers, directors and key employees. The attestations are reviewed by the ABAG compliance officer and any conflicts are shared with the ABAG 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 Ambulatory Group 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 The financial statements of Alexian Brothers Ambulatory Group are available through the Office of the Illinois Attorney General. Conflict of Interest statements and the governing documents of Alexian Brothers Ambulatory Group are not made available to the public. Column E and F Disclosure: Form 990, Part VII: Disclosure for estimated hours per week devoted to related organizations for which compensation was reported: Mark Frey, James Sances, Tracy Rogers, Virginia Golembiewski, and Jim Lewandowski all worked 40 hours per week for Alexian Brothers Health System. Form 990, 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 or key employee's services. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -32,953. Equity transfers from affiliates: 6,000,000. Total to Form 990, Part XI, Line 5: 5,967,047. Form 990, Part VIII, Line 3, Schedule D, Part VII: The amount reflected as dividends and interest reflects Alexian Brothers Ambulatory Group's share of interest, dividends and realized gains/losses from Alexian Brothers Ambulatory Group'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. Form 990, Schedule A, Part I, Line 3: The Internal Revenue Service has issued different definitions of a "hospital" for Form 990 Schedules A and H. Although Alexian Brothers Ambulatory Group qualifies as a hospital for purposes of Schedule A, the Organization operates physician care practices but does not operate a state licensed hospital as required for Form 990, Schedule H. Alexian Brothers Ambulatory Group is not recognized as a hospital by the State of Illinois and, as such, is not required to complete Form 990 Schedule H. 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 60657 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 60005 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 Ln Arlington Heights IL 60005 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 53223 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 37404 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 37402 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 37377 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 63116 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 63125 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 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 600051069 363276552 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI 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 60194 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 60194 364251846 Acute care hospital 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 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 N/A N/A 0 0 Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 60005 363853289 Medical office building IL N/A N/A 0 0 Workplace Solutions LLC 1100 East Woodfield Road Schaumburg IL 60173 364095007 Provision of EAP services IL N/A N/A 0 1 Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights IL 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 N/A 0 0 St Alexius Center for Sleep Health LLC 665 W North Avenue Lombard IL 60148 205876371 Operation of sleep lab IL N/A N/A 0 0 Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 600051069 363266316 Owns/leases property; joint venture partner IL N/A C Edessa Insurance Company Ltd 3040 W Salt Creek Lane Arlington Heights IL 600051069 Captive insurer located in Bermuda BD N/A C Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853286 Messenger model IPA IL N/A C Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 943465394 Tax credit financed housing IL N/A C Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 600051069 352211303 Tax credit financed housing IL N/A C 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 Alexian Brothers Medical Center P 4620420 FMV Alexian Brothers Medical Center J 268005 FMV St Alexius Medical Center P 6281790 FMV Savelli Properties Inc J 1780817 FMV Thelen Corporation J 59631 FMV Alexian Brothers Health System O 4543811 FMV Alexian Brothers Health System R 8760790 FMV Schedule R, Part V, Line 2: Alexian Brothers Ambulatory Group 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.