2012-03-01T10:37:05-07:00 2011-06-30 990 2010-07-01 362200248 LORETTO HOSPITAL LORE 7736264300 645 S CENTRAL AVE CHICAGO IL 60644 ANNE LINDSEY 7738545057 2012-01-04 2010 2016-02-24 21:20:13Z STEVE DRUCKER 645 S CENTRAL AVE CHICAGO IL 60644 68860362 0 X WWW.LORETTOHOSPITAL.ORG X 1939 IL LORETTO HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATION, WHICH PARTNERS WITH ITS PHYSICIANS, EMPLOYEES AND THE COMMUNITIES IT SERVES, TO PROVIDE QUALITY PATIENT CENTERED CARE AND PROMOTE WELLNESS AND EDUCATION. 6 4 536 14 0 27787 8201977 17546251 91830525 50671107 1488020 0 -687941 643004 100832581 68860362 0 0 0 0 32347657 34541308 0 0 0 62897692 32046327 95245349 66587635 5587232 2272727 46441719 50512046 15064012 16773056 31377707 33738990 X LORETTO HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATION, WHICH PARTNERS WITH ITS PHYSICIANS, EMPLOYEES AND THE COMMUNITIES IT SERVES, TO PROVIDE QUALITY PATIENT CENTERED CARE AND PROMOTES WELLNESS AND EDUCATION. 0 0 62704416 68860362 LORETTO HOSPITAL IS A COMMUNITY BASED HEALTHCARE ORGANIZATION PROVIDING QUALITY PATIENT CARE AND SERVICES. 0 0 0 62704416 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 536 1 1 1 1 CJ 0 0 0 0 X 6 4 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 IL X X X STEVE DRUCKER 7738545000 645 S CENTRAL AVE CHICAGO IL 60644 RUBY ISOM 40 X 108782 0 1360 JAMES CHANDLER 40.00 X 110557 0 0 DENISE SEAMAN 40.00 X 121665 0 608 EDWARD HOGAN 0 X 0 0 0 JAMES MONTGOMERY 0 X 0 0 0 KIMBERLY LIGHTFORD 0 X 0 0 0 MICHELLE COLLINS 0 X 0 0 0 STEVE DRUCKER 40 X X 307600 0 2307 DEENADAYAL GADDAM 40 X 298805 0 4205 JOHN VALLES 40.00 X 221200 0 1659 LEE M KOTNOUR 40 X 225200 0 1688 PAULA CROSSEN 40 X 120992 0 908 ROSE GEARY 40.00 X 123023 0 893 KATHLEEN DONOHUE 40.00 X 127234 0 1272 JOHN PAPPONE 40.00 X 106279 0 0 CAMILLE LILLY 40.00 X 122829 0 1609 BELA NAND 40 X 367657 0 3899 CLARITA CAPULONG 52 X 158936 0 2372 HARI PAUDEL 40 X 152450 0 0 MILLICENT NARTEY 52 X 151416 0 2262 MELODIA CHUA 50 X 157766 0 1966 2982391 0 27008 21 0 1 0 CHICAGO IMAGING LTD 1421 LAKE ROAD LAKE FOREST IL 60045 IMAGING 206250 HOGAN MARREN LTD 180 NORTH WACKER DRIVE STE 600 CHICAGO IL 60606 LAW FIRM 298924 HORIZON EMERGENY PHYSICIAN GROUP 2000 SPRING ROAD SUITE 200 OAK BROOK IL 60523 EMERGENCY PHYSICIANS 1020804 METRO ANESTHESIA 195 N HARBOR DRIVE 3302 CHICAGO IL 60601 ANESTHESIOLOGIST 289250 RENASSIANCE HOSPITAL MANAGEMENT 1101 WEST LAKE ST SUITE 300 OAK PARK IL 60102 MANAGEMENT COMPANY 1617379 8 0 0 0 0 9344275 8201976 0 17546251 PATIENT REVENUE 622000 100832076 100832076 0 0 CONTRACTUAL ALLOWANCE 622000 -50160969 -50160969 0 0 0 0 0 0 50671107 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA 722210 155370 155370 0 0 INVESTMENTS 900001 1563299 1563299 0 0 RENTAL INCOME 523000 27787 27787 0 0 -1103452 -1103452 0 0 643004 68860362 51314111 0 0 0 0 0 0 0 0 0 0 1607823 1607823 0 0 0 0 0 29172745 27714108 1458637 110787 105248 5539 1460617 1387586 73031 2189336 2079869 109467 4442702 4220567 222135 661046 0 661046 205110 0 205110 3186981 3027632 159349 214781 214781 0 1180578 1180578 0 306 306 3125489 2969215 156274 2382833 2382833 PHYSICIANS FEES 2352562 2234934 117628 0 PHARMACEUTICALS 1979199 1880239 98960 0 PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS 2263796 2150606 113190 0 MISCELLANEOUS 10050944 9548397 502547 66587635 62704416 3883219 0 371673 1484195 0 0 0 0 4761439 4154066 0 0 0 0 0 0 396372 438019 1618992 414766 55622813 35317143 19753167 20305670 0 0 19540076 23715330 0 0 46441719 50512046 6379497 7776854 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8684515 8996202 15064012 16773056 X 30931870 33232345 445837 506645 0 0 31377707 33738990 46441719 50512046 X 2272727 88556 X 1 1 1 X 0 X 0 429028 429028 0 21767537 19208007 2559530 0 197413 0 197413 0 19724508 13068066 6656442 0 13504327 3041070 10463257 20305670 WESTSIDE INVESTMENT 13064055 C MERRILL LYNCH AND BOARD DESIGNATED 10144630 C LH FOUNDATION 506645 C 23715330 0 ASSET RETIREMENT OBLIGATION 2400492 SELF INSURANCE 6094485 EST SETTLEMENTS DUE TO THIRD PARTY PAYOR 501225 8996202 68860362 66587635 2272727 0 0 0 0 0 0 2272727 68860362 0 0 0 0 0 68860362 0 0 0 68860362 66587635 0 0 0 0 0 66587635 0 0 0 66587635 1 1 1 X 3 1 X 1 1 1 0 1 1 10628882 0 10628882 0.17 30794378 23979023 6815355 0.15 25484167 12113178 13370989 0.08 0 0 66907427 36092201 30815226 0.40 109592 12133 97459 0 318371 115003 203368 0 0 0 427963 127136 300827 0.00 0 0 67335390 36219337 31116053 0.40 1 2263796 1131898 21392005 21392005 0 X 1 1 Renaissance Hospital Management Healthcare Management 0 0.19 0 1 1 Loretto Hospital

645 S Central Ave Chicago IL 60642

X X X X Loretto Hospital 1 1 1 300 1 300 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 SchH_P01_S00_L07 Schedule H, Part I, Line 7 The costing methodology used is the Cost-to-Charge Ratio. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f The bad debt expense that is included in Part IX, line 25 is $2,263,796. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Bad debt expense is the result of patients having the ability to pay, but choosing not to pay. The costign methodology used to determine bad debt expense is cost to charge ratio. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The source for the Medicare allowable cost is from the Provider Statisical & Reimbursement Report (PSR). SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b It is the policy of Loretto to provide charity care to patients whose financial status makes it impossible or impractical to pay for medical services. All patients requesting treatment will be given written notification of Loretto Hospital's financial assistance program. This notification is given to the patient or representative during the registration process when the notice of privacy pratices is explained. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 The hospital facility used thed Medicaid rate for those services. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 The health care needs of the community is assessed by PHI's. We may use your PHI to provide, coordinate or manage your in-patient, out-patient, or post-hospital care. We may disclose your PHI to doctors, nurses, hospitals and other healthcare facilities who become involved in your care. In the course of your treatment here, your PHI may be disclosed to indirect healthcare providers such as our independent contractor radiologists and pathologists. Similarly, we may refer you to another healthcare provider and as part of the referral process share your PHI with that provider. An example of this would be if your were being treated for a broken leg, and the physician needed to know if you had diabetes, because diabetes may slow the healing proecess. So the physician treatingg your leg may refer you to another physician who specializes in treating diabetic patients and in doing so, will share your PHI with that physician. Additionally, if you have diabetes, the physician will share your PHI with a dietitian so we can arrange for appropriate meals for you. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 All patient requesting treatment will be given notification of Loretto Hospital's financial assistance program. The notification is given to the patient or representative during the registration process when the notice of privacy is explained. The patient or representative will e asked to sign acknowledging receipt of a copy of notice of privacy practices and notification of Loretto Hospital's financial assistance program. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Austin community is located on the West Side of Chicago, Illinois, and it is the largest (by population) of the city's 77 officially defined community areas (neighborhoods), followed by Lake View. Its eastern boundary is Cicero Avenue. Its northernmost border is the Milwaukee District/West Line. Its southernmost border is at Roosevelt Road from Cicero Avenue west to Austin Boulevard. The northernmost portion, north of North Avenue, extends west to Harlem Avenue, abutting Elmwood Park. Other suburbs bodering Austin are Cicero and Oak Park. Also nearby is Berwyn. The demographics of the Austin are is 90% African-American community. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Illinois X 1 1 X 0 0 0 0 0 0 0 0 0 STEVE DRUCKER 307600 0 0 0 2307 0 0 0 0 0 309907 0 307275 0 JOHN VALLES 221200 0 0 0 1659 0 0 0 0 0 222859 0 221518 0 LEE M KOTNOUR 225200 0 0 0 1688 0 0 0 0 0 226888 0 225578 0 DEENADAYAL GADDAM 298805 0 0 0 4205 0 0 0 0 0 303010 0 254428 0 BELA NAND 367657 0 0 0 3899 0 0 0 0 0 371556 0 409813 0 CLARITA CAPULONG 158936 0 0 0 2372 0 0 0 0 0 161308 0 153839 0 HARI PAUDEL 152450 0 0 0 0 0 0 0 0 0 152450 0 0 0 MILLICENT NARTEY 151416 0 0 0 2262 0 0 0 0 0 153678 0 171981 0 MELODIA CHUA 157766 0 0 0 1966 0 0 0 0 0 159732 0 155899 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Determined by the Management firm. Reviewed and approved/disapproved by the board. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 DETERMINED BY THE MANAGEMENT FIRM. REVIEWED AND APPROVED/DISAPPROVED BY THE BOARD. F990_P03_S00_L00d Form 990, Part III (Cont. 4) LORETTO HOSPITAL IS A COMMUNITY BASED HEALTHCARE ORGANIZATION PROVIDING QUALITY PATIENT CARE AND SERVICES. F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 Renassiance Hospital Management, Inc. F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 Edward Hogan,321 North Clark Street, Suite 1301,Chicago, IL 60654 /Michelle Collins,Shore Bank,3401 S. King Drive,Chicago, IL 60612/Kimberly Lightford,4th District,10001 S. Roosevelt Road, Suite 202,Westchester, IL 60154/Jim Montgomery, Sr.,Cochran, Cherry,Givens, Smith & Montgomery Law Office,1 North LaSalle, Suite 2450,Chicago, IL 60602/Dr. Amjad Khan,7435 W. Madison Street,Forest Park, IL 60181 F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a A draft of the 990 is initially presented to the board of trustees for subsequent review by its finance sub-committe. The final version of form 990 is then presented to the board for approval prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The compliance policy is presented at the new oorientation. Also it is reviewed and discussed at department head meetings. The Compliance Officer routinely audits the compliance policy. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The CEO and Executive Management compensation is presented and reviewed by the management company. Recommendations and findings are presented for review and approval by the compensation committe of the board of trustees prior to presentation for approval by the board. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The financial statments are made available via website, public newsletter, and upon request. F990_P11_S00_L05 Form 990, Part XI, Line 5 Changes in net assets are contributions for specific purpose and investment income. Loretto Hospital Foundation 645 S Central Ave Chicago IL 60642 362200248 Fundraising IL 501(c)3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Loretto Hospital Foundation n 25000 The amount of time that is involved working with the hospital and the foundation.