2011-09-12T15:47:10-05:00 2010-12-31 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 606064301 990 2010-01-01 364336931 Alexian Brothers Ambulatory Group ALEX 8473857100 3040 West Salt Creek Lane Arlington Heights IL 600051069 Beth Tze 8473857100 2011-09-12 1 Laura Gillespie 3124861000 2010 2016-03-07 17:11:31Z Beth Tze 3040 West Salt Creek Lane Arlington Heights IL 600051069 47369406 0 X www.alexianbrothershealth.org X 1999 IL Alexian Brothers Ambulatory Group ("ABAG") carries out the healing mission of the Catholic Church (See Schedule O).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. 3 1 444 0 0 0 34564 17612 29474701 47122539 76672 107007 0 122248 29585937 47369406 0 0 0 0 19607127 31629149 0 0 0 16210409 24294137 35817536 55923286 -6231599 -8553880 10497462 11030550 10592066 10231560 -94604 798990 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 50859516 47244787 ABAG provides primary care, immediate care, occupational health, and specialty care physician services to patients in the northwestern suburbs of Chicago and surrounding communities. ABAG operates 14 physician offices located throughout the community which provide varying combinations of primary care, immediate care and/or occupational health services. During 2010, ABAG physicians in these offices combined to serve patients in the community through 209,738 outpatient visits including 134,135 primary care visits, 26,019 immediate care visits and 49,584 occupational health visits. (See Schedule O).ABAG also maintains two physician offices specifically dedicated to serving the healthcare needs of adults over the age of 65 in the community. Experienced physicians specialize in treating illness and caring for patients in this unique stage of life. During 2010, older adults were served through a combined 16,336 office, hospital and nursing home visits. In addition, ABAG offers a team of experienced, highly trained specialist physicians who provide specialty healthcare services for both adults and children living in our community and surrounding areas. During 2010, specialty physicians, serving patients in the areas of Cardiovascular Surgery, Neurosciences, General Surgery, Breast Surgery, Pediatric Specialties and other areas, combined to provide 13,642 office visits, 6,143 hospital visits and 2,362 surgeries for adult patients and 14,708 office and hospital visits for pediatric patients. 50859516 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 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 94 0 444 1 0 0 0 0 0 0 0 0 0 0 X 3 1 0 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 Mark Frey 1.00 X X 0 794003 188333 James Sances 1.00 X X 0 622253 134046 Brother T Keusenkothen 1.00 X X 0 0 0 Beth Tze 40.00 X 0 323290 61666 Tracy Rogers 1.00 X 0 476765 64395 Virginia Golembiewski 1.00 X 0 67752 15425 Daniel Isacksen 40.00 X 0 229135 24756 Jim Lewandowski 1.00 X 0 358777 63763 Kim Zimmermann 40.00 X 0 188721 22546 Robert Arensman 40.00 X 455426 0 22127 Adrienne Baksinski 40.00 X 233835 0 15203 Charles Kalenowski 40.00 X 317537 0 26812 Calvin Fischer 40.00 X 250245 30800 28517 Roger Weise 40.00 X 260434 0 26892 Dean Grant 0.00 X 0 404813 57146 1517477 3496309 751627 59 1 1 0 MEA Medical Care Centers LLC 2000 Spring Rd - Suite 200 Oak Brook IL 60523 Medical Specialists/Physicians 2658474 Schaumburg Family Physicians 25 E Schaumburg Road Schaumburg IL 60192 Medical Specialists/Physicians 2352803 Chest Medicine Consultants 2800 N Shedian Rd - Suite 301 Chicago IL 60657 Medical Specialists/Physicians 1775951 Sinai Medical Group 2750 W 15th Place Chicago IL 60608 Medical Specialists/Physicians 189050 Rush University Medical Center 1725 W Harrison St - Ste 1106 Chicago IL 60612 Medical Specialists/Physicians 185585 6 17612 17612 Net Patient Svcs Rev 621111 47094172 47094172 Intercompany Rent 900099 28367 28367 47122539 107007 107007 122248 122248 122248 122248 47369406 47244787 0 107007 27050022 24426368 2623654 521717 484705 37012 2490850 2081988 408862 1566560 1421191 145369 80148 593 79555 31750 31750 10746142 10450802 295340 6384 5148 1236 941212 681983 259229 11622 11622 3678808 3493378 185430 310634 284531 26103 45634 14785 30849 504372 390038 114334 3302660 3273810 28850 Management fees 2130948 1355749 775199 Bad Debt 1219210 1219210 Medical Supplies 1183338 1183338 Miscellaneous 101275 80277 20998 55923286 50859516 5063770 0 4507517 4942624 717885 529275 139393 215150 8166516 6132207 1608622 2034309 3214487 2779968 229232 302032 80326 227192 10497462 11030550 4627713 4113589 5964353 6117971 10592066 10231560 X -94604 798990 -94604 798990 10497462 11030550 X -8553880 9447474 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3129789 1896086 1233703 5036727 4236121 800606 2034309 Beneficial Interest in Alexian Brothers Health System, Inc. Investment Trust 2779968 F 2779968 Due to Affiliates 5366303 Other Liabilities 50034 Reserve for Outstanding Insurance Losses 701634 6117971 Description of Uncertain Tax Positions Under FIN 48: Part X: ABAG does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. The text of the FIN48 (ASC 740) footnote in this audit report is as follows: On January 1, 2008, the Corporations adopted Interpretation No. 48, Accounting for Uncertainty in Income Taxes, included in FASB ASC Subtopic 740-10, Income Taxes - Overall. ASC Subtopic 740 addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, the Corporations must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. As of December 31, 2010 and 2009, the Corporations do not have a liability for unrecognized tax benefits. 1 1 0 0 0 0 0 0 0 Mark Frey 0 565468 0 165000 0 63535 0 143387 0 44946 0 982336 0 33766 James Sances 0 462621 0 132244 0 27388 0 111754 0 22292 0 756299 0 27388 Beth Tze 0 248124 0 70500 0 4666 0 19540 0 42126 0 384956 0 0 Tracy Rogers 0 356803 0 102211 0 17751 0 29867 0 34528 0 541160 0 17751 Daniel Isacksen 0 191135 0 38000 0 0 0 2522 0 22234 0 253891 0 0 Jim Lewandowski 0 272185 0 50985 0 35607 0 32953 0 30810 0 422540 0 12292 Kim Zimmermann 0 158721 0 30000 0 0 0 7129 0 15417 0 211267 0 0 Robert Arensman 341958 0 113468 0 0 0 8575 0 13552 0 477553 0 0 0 Adrienne Baksinski 229522 0 4313 0 0 0 9060 0 6143 0 249038 0 0 0 Charles Kalenowski 314811 0 2726 0 0 0 6789 0 20023 0 344349 0 0 0 Calvin Fischer 238811 30800 11434 0 0 0 8575 0 19942 0 278762 30800 0 0 Roger Weise 211194 0 49240 0 0 0 13349 0 13543 0 287326 0 0 0 Dean Grant 0 0 0 0 0 404813 0 34300 0 22846 0 461959 0 17323 Supplemental Information Part III Part I, Line 3: ABAG 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 4a: The following individual listed in Schedule J was paid the referenced amount of severance in 2010: Dean Grant - $389,358 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 2010 was included in income in Schedule J for the following individuals: Mark Frey - $68,038 James Sances - $48,808 Tracy Rogers - $3,363 Jim Lewandowski - $4,547 Beth Tze - $1,820 Form 990, Part VI, Section A, line 6 ABAG 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 ABAG. 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 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 or merger, consolidation, dissolution, sales or lease of all or substantially all of the assets of the ABAG. - The annual capital and operating budget and the Strategic Plan of the ABAG; and - Other certain reserved powers which Alexian Brothers Health System may designate. Form 990, Part VI, Section B, line 11 ABAG 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. ABAG'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 ABAG'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. ABAG'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 2010 Form 990 for ABAG. Form 990, Part VI, Section B, line 12c ABAG 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 of Compliance and Internal Audit. 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 ABAG 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 ABAG's financial statements are available through the Office of the Illinois Attorney General. Conflicts of Interest and ABAG's governing documents are not made available to the public. Average hours devoted to related org(s) when related comp is reported: Form 990, Part VII: - Mark Frey worked 30 hours per week for Alexian Brothers Hospital Network and 10 hours per week for Alexian Brothers Health System; - James Sances worked 40 hours per week for Alexian Brothers Health System; - Tracy Rogers worked 40 hours per week for Alexian Brothers Hospital Network; - Virginia Golembiewski worked 40 hours per week for Alexian Brothers Health System; - Jim Lewandowski worked 40 hours per week for Alexian Brothers Health System; - Dean Grant is a former officer. - All others listed in Part VII devoted 100% of their time to ABAG. 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/key employee's services. Form 990, Part VIII, Line 3; Schedule D, Part VII: The amount reflected as dividends and interest reflects ABAG's share of interest, dividends and realized gains/losses from ABAG'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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 58,474. Equity transfers from affiliates: 9,389,000. Total to Form 990, Part XI, Line 5: 9,447,474. 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 ABAG 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. ABAG 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 60005 362606768 Religious order of Roman Catholic men TX 501(c)(3) 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) 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) 9 Alexian Brothers of America Inc 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 60005 363260495 Supports the provision of healthcare services for related corporations IL 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Health System Inc Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 60005 363801585 Manages pooled investments of related not-for-profit entities IL 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 60005 364390471 Manages pooled investments of related not-for-profit entities IL 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 The Alexian Brothers Hospital School of Nurses 3040 W Salt Creek Lane Arlington Heights IL 60005 Inactive corporation IL 501(c)(3) 9 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) 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) 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) 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) 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 424 Cumberland Street Suite 110 Chattanooga TN 37402 364344423 Provides comprehensive and coordinated community based services IL 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 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 501(c)(3) 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 corporations IL 501(c)(3) 11, 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) 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled nursing facility MO 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 501(c)(3) 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) 11, III-FI Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX 501(c)(3) 3 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)(2) N/A Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3350 W Salt Creek Lane Arlington Heights IL 60005 363045007 Outpatient community mental health services IL 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 501(c)(3) 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 60194 364251846 Actue care hospital IL 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 60005 363260495 Physician services IL 501(c)(3) 3 Alexian Brothers Health System 1 Chicago Catholic Healthcare System Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363693486 Inactive corporation IL 501(c)(3) 9 Alexian Brothers Hospital Network 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) 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 60005 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 0 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 60005 861115516 Ownership of Gamma Knife IL N/A N/A 0 0 Alexian Cardiovascular Institute Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 300307978 Lease and sub-lease of 64-slice CT equipment IL N/A N/A 0 0 St Alexius Center for Sleep Health LLC 665 W North Ave 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 N/A C 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 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 Alexian Brothers Medical Center P 4480639 FMV Alexian Brothers Medical Center J 247746 FMV St Alexius Medical Center P 4684783 FMV Savelli Properties Inc J 1661842 FMV Thelen Corporation J 59257 FMV Alexian Brothers Health System O 9226408 FMV Alexian Brothers Health System R 9388000 FMV