Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Alexian Brothers Health System
Employer identification number
36-3260495
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
(1)
ABHS Inc Investment Trust
363801585
11 III-FI
Yes
Yes
Yes
0
(2)
Alexian Brothers of San Jose Inc
941530037
3
Yes
Yes
Yes
0
(3)
Alexian Brothers Services Inc
431295333
9
Yes
Yes
Yes
0
(4)
Alexian Village of Milwaukee Inc
391351584
9
Yes
Yes
Yes
0
(5)
Alexian Brothers Community Services
364344423
9
Yes
Yes
Yes
0
(6)
Alexian Brothers Senior Neighbors
620646376
7
Yes
Yes
Yes
0
(7)
Alexian Village of Tennessee
621136742
9
Yes
Yes
Yes
0
(8)
Alexian Brothers Senior Ministries
364484290
11 III-FI
Yes
Yes
Yes
0
(9)
Alexian Elderly Services Inc
392039667
9
Yes
Yes
Yes
0
(10)
Alexian Brothers Lansdowne Village
431470362
9
Yes
Yes
Yes
0
(11)
Alexian Brothers Sherbrooke Village
431592502
9
Yes
Yes
Yes
0
(12)
Alexian Brothers Hospital Network
363276552
11 III-FI
Yes
Yes
Yes
0
(13)
Alexian Brothers Medical Center
362596381
3
Yes
Yes
Yes
0
(14)
Alexian Brothers Center for Mental Health
363045007
7
Yes
Yes
Yes
0
(15)
Alexian Brothers Behavioral Health Hospital
364251848
3
Yes
Yes
Yes
0
(16)
St Alexius Medical Center
364251846
3
Yes
Yes
Yes
0
(17)
Alexian Brothers Ambulatory Group
364336931
3
Yes
Yes
Yes
0
(18)
Alexian Brothers of St Louis Inc
430653236
3
Yes
Yes
Yes
0
Total
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A, Part IV, Supplemental Information: ABHS supports the provision of healthcare services at the corporations to which it is a member by the provision of centralized administrative support, including services such as Mission Integration, Accounting, Accounts Payable, Treasury (including Cash, Investment and Debt Management), Insurance, Payroll, Human Resources, Compliance, Legal, Education, Wellness, and Patient Safety and Quality. All costs of ABHS are charged to the members through a management fee. Transactions with each member are delineated on Schedule R.
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Alexian Brothers Health System
Employer identification number
36-3260495
Identifier
Return Reference
Explanation
Form 990, Part VI, Section A, line 6
There is one class of member, Alexian Brothers of America, Inc. (the "Institute Member").
Form 990, Part VI, Section A, line 7a
Alexian Brothers of America, Inc. has the authority to appoint and remove Directors and Executive Officers of Alexian Brothers Health System.
Form 990, Part VI, Section A, line 7b
Alexian Brothers of America, Inc. has all powers which can be vested in members of a corporation under Statute, including, without limitation, the powers set forth below and elsewhere in the Bylaws: - Appointment and removal of members of the Board and Executive Officers; - Adoption, amendment and repeal of fundamental statements of mission, philosophy, values and charity policy of ABHS and its subsidiaries; - Adoption, amendment or repeal of Bylaws and approval of plans of merger, consolidation, dissolution or sale of substantially all assets and amendment of the Articles of Incorporation of ABHS; and - Approval of the adoption or material amendment of a strategic plan and an annual Capital and Operating Budget of ABHS; - Other certain reserved powers which Alexian Brothers of America, Inc. may designate. Alexian Brothers of America, Inc. may require any actions by the Board of Governors, Officers or other agencies of ABHS which may deem appropriate in furtherance of its determinations with respect to the foregoing categories of matters.
Form 990, Part VI, Section B, line 11
ABHS is a Catholic health system. ABHS is the National Member and ultimate parent for each entity within the System. ABHS'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 ABHS's financial officer and the CEO. The Form 990 is also reviewed at the System Corporate level by the Chief Accounting Officer for ABHS. The Vice President and General Counsel for the System review 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. The ABHS Board of Governors 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 review the 2010 Form 990 for ABHS.
Form 990, Part VI, Section B, line 12c
ABHS collects annual attestations from board members, officers, directors and key employees. The attestations are reviewed by the System's Vice President of Compliance and Internal Audit and any conflicts are shared with the ABHS Chief Executive 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
ABHS 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 Health System's financial statements are available through the office of the Illinois Attorney General. Conflicts of Interest and Alexian Brothers Health System's governing documents are not made available to the public.
Form 990, Part VII:
Average hours devoted to related organizations when related compensation is reported: Officers for ABHS provide services to ABHS and its subsidiaries. With the exception of Mark Frey, who works 10 hours per week for ABHS and 30 hours per week for Alexian Brothers Hospital Network ("ABHN"), hours worked are not tracked on an entity by entity basis. Therefore all other officers, directors, trustees and key employees hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employess, and Independent Contractors,represent aggregate hours worked per week for all related entities.
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:
The amount reflected as dividends and interest reflects ABHS's share of interest, dividends and realized gains/losses from ABHS'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 investment. 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:
Transfers to/from affiliates 25,542,001. Recognition of minimum pension liability 3,916,452. Transfer of depreciation from related entity 9,302,377. Unrealized gain 6,182,066. Foundation contributions -5,238,173. Prior period adjustments 51,068. Total to Form 990, Part XI, Line 5: 39,755,791.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.