2011-02-14T16:12:03-07:00 2010-06-30 990 2009-07-01 362200248 LORETTO HOSPITAL LORE 7738545000 645 S CENTRAL AVENUE CHICAGO IL 60644 ANNE LINDSEY 7738545567 2010-09-24 2009 2016-02-24 21:20:13Z STEVE DRUCKER 645 S CENTRAL AVE CHICAGO IL 60644 100832581 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 4 544 14 0 29568 8201975 8201977 89980968 91830525 492566 1488020 1328758 -687941 100004267 100832581 0 0 0 0 31180448 32347657 0 0 0 66051427 62897692 97231875 95245349 2772392 5587232 39974526 46441719 15634308 15064012 24340218 31377707 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 91495041 0 93881292 LORETTO HOSPITAL IS A COMMUNITY BASED HEALTHCARE ORGANIZATION PROVIDING QUALITY PATIENT CARE AND SERVICES 0 0 0 91495041 1 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 544 1 1 1 1 CJ 0 0 0 6 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X STEVE DRUCKER 7738545000 645 S CENTRAL AVENUE CHICAGO IL 60644 EDWARD HOGAN 0 X 0 0 0 KIMBERLY LIGHTFORD 0 X 0 0 0 MICHELE COLLINS 0 X 0 0 0 STEVE DRUCKER 40 X X 307600 0 2307 DEENADAYAL GADDAM 40 X 246435 0 3760 VINCE WILLIAMS 0 X 0 0 0 JOHN VALLES 40 X 221200 0 1659 LEE M KOTNOUR 40.00 X 225200 0 1688 PAULA CROSSEN 40 X 106529 0 828 KATHIE DONOHUE 40 X 118692 0 1209 ROSE GEARY 40 X 112230 0 872 CAMILLE LILLY 40 X 105955 0 1589 BELA NAND 40 X 408431 0 1382 MILLICENT NARTEY 58 X 169440 0 2542 CLARITA CAPULONG 52 X 151566 0 2273 HENRIELLA JONES 52 X 152167 0 1894 MELODIA CHUA 40 X 138263 0 1741 2463708 0 23744 12 0 1 0 KNELL CONSULTING P O BOX 17161 SNOWMASS CO 81615 CONSULTING 204167 METRO ANESTHESIA 195 N HARBOR DRIVE 3302 CHICAGO IL 60601 ANESTHESIOLOGIST 267000 CHICAGO IMAGING LTD 1421 LAKE ROAD LAKE FOREST IL 60045 IMAGING 200000 RENASSIANCE HOSPITAL MANAGEMENT 1101 WEST LAKE ST SUITE 301 OAK PARK IL 60301 MANAGEMENT COMPANY 1617379 HORIZON EMERGENCY PHYSICIAN GROUP 2000 SPRING ROAD SUITE 200 OAK BROOK IL 60523 EMERGENCY PHYSICIANS 1029154 13 0 0 0 0 8201977 0 0 8201977 PATIENT REVENU 622000 91830525 91830525 0 0 0 0 0 0 91830525 1488020 1488020 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 135025 135025 0 0 RENTAL INCOME 532000 29568 29568 0 0 MEDICAL RECORDS 514000 20994 20994 0 0 -873528 -873528 0 0 -687941 100832581 92630604 0 0 0 0 0 0 0 0 0 0 761867 0 761867 0 0 0 0 0 28128536 26722109 1406427 0 175619 166838 8781 0 1049138 996681 52457 0 2232497 2120872 111625 0 4632546 4447244 185302 0 256257 0 256257 0 190400 0 190400 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 114701 110113 4588 0 3207429 3207429 0 0 470564 470564 0 0 0 0 0 0 997250 997250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2590468 2460945 129523 0 1463606 1463606 0 0 CONTRACTUAL ALLOWANCE 31952905 31952905 0 0 PHYSICIANS FEES 2455569 2357346 98223 0 PHARMACEUTICALS 1863844 1770652 93192 0 PROVISIONS FOR BAD DEBT 3668826 3668826 0 0 MISCELLANEOUS 9033327 8581661 451666 0 95245349 91495041 3750308 0 518230 371673 0 0 4348385 4761439 0 0 0 0 0 0 396372 396372 369734 1618992 52051684 32298517 18529621 19753167 0 0 15812184 19540076 39974526 46441719 7836428 6379497 0 0 0 0 0 0 0 0 0 0 38674 962644 0 0 7759206 7721871 15634308 15064012 X 24185867 30931870 154351 445837 0 0 24340218 31377707 39974526 46441719 X 1 1 1 X 0 X 0 0 0 0 0 0 0 0 0 0 0 429028 429028 0 21654715 17436133 4218582 0 197413 0 197413 0 17473603 12074794 5398809 0 12296925 2787590 9509335 19753167 0 0 0 WESTSIDE INS INVESTMENT 11778495 C MERRILL LYNCH AND BOARD DESIGNATED FUND 7315744 C LH FOUNDATION 445837 C 19540076 0 SELF INSURANCE 5361744 ASSET RETIREMENT OBLIGATION 2360127 7721871 100832581 95245349 5587232 0 0 0 0 0 0 5587232 100832581 0 0 0 0 0 100832581 0 0 0 100832581 95245349 0 0 0 0 0 95245349 0 0 0 95245349 SchD_P10_S00_L00 Schedule D, Part X N/A 1 1 1 X 3 1 X 1 1 0 1 1 11165479 0 11165479 0.2 28919206 14283739 14722470 0.16 25321155 7511567 17809588 0.2 0 0 65405840 21795306 43697537 0.56 0 0 106400 11780 89220 0 373473 109843 263630 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 479873 121623 352850 0.00 0 0 65885713 21916929 44050387 0.56 1 3668826 2417271 22015930 22015930 0 X 1 1 RENAISSANCE HOSPITAL MGMT INC HEALTHCARE MANAGEMENT 0 0.19 0 LORETTO HOSPITAL

645 S CENTRAL AVE CHICAGO IL 60644

X X X X The costing methodology used is the Cost-to-Charge Ratio. THE BAD DEBT EXPENSE THAT IS INCLUDED IN PART IX, LINE 25 IS $3,668,826. BAD DEBT EXPENSE IS THE RESULT OF PATIENTS HAVING THE ABILITY TO PAY, BUT CHOOSING NOT TO PAY. THE COSTING METHODOLOGY USED TO DETERMINE BAD DEBT EXPENSE IS COST TO CHARGE RATIO. THE SOURCE FOR THE MEDICARE ALLOWABLE COST IS FROM THE PROVIDER STATISICAL & REIMBURSEMENT REPORT (PSR) IT IS THE POLICY OF LORETTO TO PROVIDE CHARITY CARE TO PATIENTS WHOSE FINANCIAL STATUS MAKES IT IMPOSSIBLE OR IMPRACTICAL TO PAY FOR MEDCIAL 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 PRACTICES IS EXPLAINED. 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 you were being treated for a broken leg, and the physician needed to know if you had diabetes, because diabetes may slow the healing process. So the physician treating 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. ALL PATIENTS 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 BE ASKED TO SIGN ACKNOWLEDGING RECEIPT OF A COPY OF NOTICE OF PRIVACY PRACTICES AND NOTIFICATION OF LORETTO HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. 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 bordering Austin are Cicero and Oak Park. Also nearby is Berwyn. The demographics of the Austin area is 90% African-American community. Loretto Hospital offers courtesy transportation services for our patients that are in need of them. These services are designed to ensure patients without access to transportation are able to make it to their medical appointments on time. Loretto Hospital promises to ensure vehicle safety, transport our patients in a safe and timely manner to and from their appointments, and to maintain professionalism at all times during their care. Loretto Hospital is the largest non-governmental employer in the Austin community employing more than 500 hard-working people. Loretto offers one of the most comprehensive substance abuse programs in Chicago, including detoxification, in- patient hospitalization, outpatient mental healthcare, and substance abuse counseling and assistance. Our 187-beds serve more than 32,000 patients annually. We have special programs and services that include but are not limited to: Breathe Easy Asthma/Allergy Program, James D. Montgomery Men's Health Program, HIV/AIDS Family Counseling Program, and Breast Cancer Awareness Program. N/A IL 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 JOHN VALLES 221200 0 0 0 1659 0 0 0 0 0 222859 0 0 0 LEE M KOTNOUR 225200 0 0 0 1688 0 0 0 0 0 226888 0 0 0 DEENADAYAL GADDAM 250668 0 0 0 3760 0 0 0 0 0 254428 0 0 0 BELA NAND 408431 0 0 0 1382 0 0 0 0 0 409813 0 0 0 MILLICENT NARTEY 169440 0 0 0 2541 0 0 0 0 0 171981 0 0 0 CLARITA CAPULONG 151566 0 0 0 2273 0 0 0 0 0 153839 0 0 0 HENRIELLA JONES 154005 0 0 0 1894 0 0 0 0 0 155899 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a The hospital has provided health club dues. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 DETERMINED BY THE MANAGEMENT FIRM. REVIEWED AND APPROVED/DISAPPROVED BY THE BOARD EDWARD HOGAN TRUSTEE 204167 LEGAL COUNSEL 0 F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 RENASSIANCE HOSPITAL MANAGEMENT, INC F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 A draft of the 990 is initially presented to the board of trustees for subsequent review by its finance sub-committee. The final version of form 990 is then presented to the board for its approval prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The compliance policy is presented at the new hire orientation. Also it is reviewed and discussed at department head meetings. The Compliance Officer routinely audits the compliance policies. 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 committee 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 statements are made available via website, public newsletter, and upon request. LORETTO HOSPITAL FOUNDATION 645 S CENTRAL AVE CHICAGO IL 60645 FUNDRAISING FOR HOSPITAL IL 501(c)3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 An extension has been filed.