TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Phillip Blankenburg Chairman of Board	.5	X	X		0	0
(2) Donna Greene Vice Chairman of Board	.5	X	X		0	0
(3) Cora E Musial Phd MD Secretary of Board	35.0	X	X		204,938	35,754
(4) Mathew Gibb MD Trustee	11.0	X			888,290	32,727
(5) J Michael Martin Trustee	.5	X			0	0
(6) Marty Smith Immediate Past Chair	1.0	X			0	0
(7) Paul Tender MD Trustee	10.0	X			493,822	29,294
(8) David Ikenberry Phd Trustee (through 9/15/11)	.2	X			0	0
(9) E Phillips Knox Trustee (through 9/15/11)	.6	X			0	0
(10) James C Leonard MD ex-officio, President/CEO	11.0	X	X		1,040,335	246,421
(11) R Bruce Wellman MD ex-offico, Trustee	19.0	X	X		805,580	226,995
(12) John Snyder EXEC VP, COO	15.0		X		640,038	160,811
(13) Dennis Hesch Exec VP & CFO	16.0		X		510,086	139,104
(14) Philip Kubow SVP Human Resources	13.5			X	408,185	95,490
(15) Pamela Bigler Chief Nursing Officer	25.0			X	288,538	66,917
(16) Lynne Barnes VP Hospital Operations	20.0			X	260,271	57,268
(17) Mark Berlin VP-Surgical Spec	20.0			X	234,340	74,664

(A) Name and business address	(B) Description of services	(C) Compensation
PNC BANK NATIONAL ASSOCIATION PO BOX 931034 CLEVELAND,OH44193	EQUIPMENT LEASING	2,111,797
REGIONAL HEALTH RESOURCE CENTER 1408 WEST UNIVERSITY AVENUE URBANA,IL61801	BLOOD SERVICES	1,405,067
AMERICAN MOBILE NURSES HEALTHCARE I 2735 COLLECTION CENTER DRIVE CHICAGO,IL60693	STAFFING	791,868
QUEST DIAGNOSTICS PO BOX 12989 CHICAGO,IL60693	TESTING SERVICES	722,804
ASD SPECIALTY HEALTHCARE INC ASD HEALTHCARE PO BOX 848104 DALLAS,TX75284	PHARMACEUTICALS	600,489
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 33

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	3,822,286	3,822,286
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	98,632,198	94,795,563	3,836,635
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,868,322	4,706,220	162,102
9	Other employee benefits .......	13,512,534	12,783,784	728,750
10	Payroll taxes ...........	7,135,802	6,864,817	270,985
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	205,001	197,943	7,058
c	Accounting ...........	360,087	341,516	18,571
d	Lobbying ...........	308,598	308,598
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	18,091,383	17,083,247	1,008,136
12	Advertising and promotion ....	85,158	85,158
13	Office expenses .......	9,684,794	7,423,847	2,260,947
14	Information technology ......	4,291,643	3,960,609	331,034
15	Royalties ..	0
16	Occupancy ...........	20,441,303	18,469,335	1,971,968
17	Travel ............	689,282	659,520	29,762
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	461,297	453,101	8,196
20	Interest ...........	131,839	57,178	74,661
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	5,876,648	5,175,162	701,486
23	Insurance ..............	21,255	17,342	3,913
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	Internal Management Fees	64,305,997	60,275,744	4,030,253
b	Taxes	10,171,640	9,649,634	522,006
c	Patient Care Supplies	62,954,855	62,295,748	659,107
d	All other expenses	519,769	391,724	128,045
e
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	326,571,691	309,818,076	16,753,615	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	112,000	1	124,000
2	Savings and temporary cash investments .......	0	2	0
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	76,045,181	4	86,175,599
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	8,130,434	8	6,391,661
9	Prepaid expenses and deferred charges ............	4,549,292	9	1,739,894
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	70,818,713
b	Less: accumulated depreciation. .....	10b	28,336,432	42,270,824	10c	42,482,281
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	57,293,730	15	101,381,057
16	Total assets. Add lines 1 through 15 (must equal line 34)...	188,401,461	16	238,294,492
	17	Accounts payable and accrued expenses .	23,119,172	17	20,492,866
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	56,776,595	25	50,822,173
26	Total liabilities. Add lines 17 through 25.....	79,895,767	26	71,315,039
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	108,505,694	27	166,979,453
28	Temporarily restricted net assets .....	0	28	0
29	Permanently restricted net assets .....	0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	108,505,694	33	166,979,453
34	Total liabilities and net assets/fund balances .....	188,401,461	34	238,294,492

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

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. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

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).

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 ..................................................

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

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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).

Gross receipts from related activities, etc. (See instructions.) ..................

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.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. 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 ...................... right arrow

33 1/3% support test—2010. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2011. 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 .................................................. right arrow

10%-facts-and-circumstances test—2010. 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 .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. 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 .......... right arrow

33 1/3% support tests—2010. 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 .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

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 (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

Carle Foundation Hospital

Employer identification number

37-1119538

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization Carle Foundation Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization Carle Foundation Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
Carle Foundation Hospital

Employer identification number

37-1119538

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

271,741

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

36,857

Total. Add lines 1c through 1i ...............................

308,598

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Description of other Lobbying activites		Schedule C, Part II-B, Line (G) The Hospital has contract professionals to provide consulting services for the hospital. As a portion of the contractors' duties, the contractors interact with governmental officials on behalf of the Hospital. Schedule C, Part II-B, line (i) $28,969 - portion of Illinois Hospital Association (IHA) dues attributed to lobbying. $7,888 - portion of American Hospital Association (AHA) dues attributed to lobbying.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	485,000		485,000
b	Buildings ................	7,716,311	2,275,595	5,440,716
c	Leasehold improvements ............	1,973,548	1,432,398	541,150
d	Equipment ................	56,888,063	23,556,168	33,331,895
e	Other .................	3,755,791	1,072,271	2,683,520
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				42,482,281

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Inter-Company receivable				97,270,338
(2) Other receivables				4,110,719







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				101,381,057

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
Estimated Third Party Settlements		22,043,503
Compensation and paid leave accrual		25,458,911
EST LIAB FOR SELF INSURED LOSSES		3,317,188
Other long term liabilities		2,571





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		50,822,173
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
SUPPLEMENTAL INFORMATION	Sch D, Part X, line 2	The Foundation adopted the guidance for accounting for uncertainty in income taxes on July 1, 2007. This guidance clarifies the accounting for uncertainty in income taxes recognized in an organization's financial statement. The guidance prescribes a more-likely-than-not recognition threshold and measurement attribute for financial statement recognition of a tax position taken or expected to be taken. Amounts requiring recognition under tax accounting guidance is reflected as a liability for uncertain tax benefits along with any associated interest and penalties that would be payable to the taxing authorities upon examination. There are no uncertain tax benefits identified or recorded as a liability as of December 31, 2011.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	15,753,168	0	15,753,168	4.890 %
b Medicaid (from Worksheet 3, column a) .....	44,441,634	47,161,376	-2,719,742	0.840 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .	6,051,719	0	6,051,719	1.880 %
dTotal Financial Assistance and Means-Tested Government Programs .....	66,246,521	47,161,376	19,085,145	5.930 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	535,174	0	535,174	0.170 %
f Health professions education (from Worksheet 5) ..	7,383,115	0	7,383,115	2.290 %
g Subsidized health services (from Worksheet 6) ..	7,571,993	0	7,571,993	2.350 %
h Research (from Worksheet 7)	9,285,568	0	9,285,568	2.880 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	4,635,176	0	4,635,176	1.440 %
jTotal Other Benefits ...	29,411,026	0	29,411,026	9.130 %
kTotal. Add lines 7d and 7j. ..	95,657,547	47,161,376	48,496,171	15.060 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	12,568	12,568	0 %
2	Economic development	53,620	53,620	0.020 %
3	Community support	44,076	44,076	0.010 %
4	Environmental improvements	3,942	3,942	0 %
5	Leadership development and training for community members	0	0	0 %
6	Coalition building	1,299	1,299	0 %
7	Community health improvement advocacy	5,446	5,446	0 %
8	Workforce development	108,336	108,336	0.030 %
9	Other	6,664	6,664	0 %
10	Total	235,951	235,951	0.060 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

6,051,719

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

3,025,860

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

88,826,779

Enter Medicare allowable costs of care relating to payments on line 5.....

91,596,930

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-2,770,151

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	THE CARLE FOUNDATION HOSPITAL 611 W PARK STREET URBANA,IL61801	X	X	X	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

THE CARLE FOUNDATION HOSPITAL

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address		Type of Facility (describe)
1	CARLE THERAPY SERVICE 810 W ANTHONY DR URBANA,IL61801	THERAPY SERVICES
2	CARLE RX EXPRESS 602 W UNIVERSITY URBANA,IL61801	PHARMACEUTICAL SERVICES
3	Carle SurgiCenter - Danville 2300 North Vermilion St Danville,IL61832	GENERAL MEDICAL & SURGICAL
4	Carle SurgiCenter - Champaign 1702 South Mattis Ave Champaign,IL61821	GENERAL MEDICAL & SURGICAL
5
6
7
8
9
10

Schedule H (Form 990) 2011

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
1. REQUIRED DESCRIPTIONS	PART I, LINE 7B	During the 12 months ending 12/31/2011 there were circumstances which contributed to IPA costs being fully reimbursed. A market based revenue rate increase was effective January 1, 2011. Meaningful use grant revenue for electronic health records was netted against costs. The organization has implemented a cost containment program. Due to the revenue rate increase, meaningful use grant revenue and cost containment program the cost to charge ratio decreased. The IPA pending accounts receivable which were historically identified as IPA were reclassified to the current payor resulting in a decrease in the IPA reserve and an increase in calculated reimbursement. Explanation of Costing Methodology (Part I, line 7 and Part III, line 4) To compute and convert charity care, unreimbursed Medicaid, means-tested programs and bad debt charges to cost; a consistent GAAP (Generally Accepted Accounting Principles) based cost-to-charge ratio was used across all payers. Although the methodology was similar to Worksheet #2, for simplicity purposes certain immaterial values were omitted. Other benefits costs were reported at the actual expense incurred. Patients' receivable payments were recorded at time of receipt and related discounts were also recorded at actual amounts at the time of payment receipt. A separate GAAP based provision for estimated bad debts and discounts was recognized for accounts in process and pending adjudication and payment. The estimated portion was based on historical trends and adjusted to actual in future periods when the account's adjudication and payment occur. Accounts determined to be eligible for charity care were processed immediately for charity care discount with no collection effort. For accounts with insufficient information and documentation to determine charity care eligibility, the hospital consulted with a variety of alternative sources to help determine an individual's financial means (or lack of means) to pay. Based on related trends, the hospital further developed a general estimate of charity care which continued to reside within bad debts. Explanation of Medicare Cost Report Costing Methodology (Part III,line 8) The numerator (total expense) and denominator (total gross charges) of the simple ratio of patient care cost to charges is adjusted by eliminating non-patient care that generates other revenue, bad debt expense, Medicaid and other provider taxes and the total cost of community benefit activities and programs. Also, any gross patient charges for programs not relying on the ratio are eliminated from both the numerator and denominator of the ratio. These adjustments are designed to eliminate "double counting" of community benefit expenses. The resultant ratio aligns with Schedule H requirements. While the Medicare shortfall is not included in the form 990 community benefit reportable number, the cost of unreimbursed Medicare charges for CY11 was $3,741,423 (calculated using the stated method). As an Illinois-based hospital, we are required to report community benefits provided to the Office of the Attorney General by the Community Benefit Act of 2003. For that report, Illinois law defines governmental-sponsored indigent health care as the unreimbursed cost of Medicare, Medicaid and other Federal, State or local indigent care programs. To reduce public confusion caused by variations in our reports, for consistency, we have included the Medicare shortfall in all of our community benefit related reports. However, we do believe this is a community benefit because, as a hospital, we are stepping up to carry the burden of the government, assuring care to seniors, where 14.2% are 60 years of age or older in Champaign County alone. According to Family Service of Champaign County, in 2010, those 85 and older - the fastest growing demographic in the county - have experienced increasing costs over the past decade while living on fixed incomes determined 20 years ago. In CY 2011, 22.91% of Carle Foundation Hospital's patients were Medicare recipients. In CY 2011, inpatient Medicare cases that had a secondary plan code of Medicaid comprised 20% of total Medicare inpatient cases. Outpatient Medicare cases that had a secondary plan code of Medicaid comprised 15.50% of total Medicare outpatient cases. (Patients with Medicare Advantage as the primary payer are not included in these figures.) Debt collection practices (Part III-line 9b, Part V-B-19d) It is the responsibility of our patients to request and complete a Community Care Discount Program (CCDP) application. They are informed about Community Care on multiple occasions throughout the collection process. If a patient does not request or complete and return the application, then the balance is deemed his or her responsibility to pay. We presume eligibility for traditional Medicaid for homeless patients (based on current area shelters or Social Worker verification). Patients may apply for the CCDP at any time, including before care is received. Out of pocket medical expenses are limited to 40% of the patient's annual gross income if the patient is uninsured or underinsured and earns at or below 400% of the Federal Poverty Level. Once all applicable discounts have been applied, we make every attempt to work with the patient to set up payment arrangements on the remaining balance due. The current minimum is 5% or $25.00 a month. If they cannot meet these guidelines, our in-house collectors work with them to set up a temporary/short term payment arrangement until they can make the minimum payment. If they are unable to make payment on the remaining balance after the CCDP discounts, then the balance may be listed with the collection agency. When the account is still in-house, the minimum notifications are one collection letter, one phone call and monthly itemized statements. If a patient does not respond to us, then the account is final noticed (additional letter) and sent to the agency. Carle will not file collection suit liens on a primary residence, nor do we allow the collection attorneys to use "body attachments." The agencies are aware of our Community Care Discount Program and have been advised to refer the patients back to Carle if they deem the patient is unable to pay. We then make one more attempt to work with the patient to see if help is available. If Carle then determines that the patient might qualify, we send the patient a CCDP application and put a hold on the account listed with the agency for as long as we have determined necessary; the average is 60 days. If the patient is then approved for charity care, the balance is adjusted and then the account is closed. If they are approved for less than 100%, the adjustments are reported to the agency and the balance is left with the agency for collection. Text of the Community Benefit and Charity Care footnote in the Carle Foundation Hospital's Financial Statements (Part III, line 4) Carle Foundation Hospital is committed to providing quality health care to all, regardless of their ability to pay. Under the Foundation's charity care policy, patients meeting certain criteria receive care without charge or with a significant reduction in charges. Because the Foundation does not pursue collection of amounts identified as charity care, they are not reported in net patient service revenues. Charges forgone, based on established rates, totaled $96.5 million for the twelve months ended December 31, 2011. The forgone charges represent 5.6% of the gross patient service revenue. Management believes that the difference between the costs to provide care and the amounts actually received from the Medicaid program, including the net amounts received from the Hospital Assessment Program, should be considered charity care. Using the overall ratio of cost to charges, the costs exceed the reimbursement for the Foundation by $23.6 million for the twelve months ended December 31, 2011. This amount comprises 1.1% of gross patient service revenue. In addition to providing direct charity health services, Carle Foundation Hospital periodically conducts a comprehensive community needs assessment including active partnering with various community service organizations. The assessment helps identify areas of under-served and under-insured populations and further helps promote a common and joint approach to responding to identified community needs. The Hospital is a key financial supporter to the Frances Nelson Health Center, a federally qualified community health center, and also financially supports other health and educational service access for eligible at-risk populations. The Hospital plays a vital role in Champaign County's emergency preparedness and home land security initiatives. These are in addition to numerous other community health and wellness programs identified by the community needs assessment.
2. NEEDS ASSESSMENT		Carle Foundation Hospital used existing data, informal discussions, and comprehensive qualitative community health needs assessment (CHNA) to determine if existing programs are on track; what needs to be added, deleted or enhanced; and where our focus needed to be placed in the future. This year the CHNA not only included secondary research (noted below), but also four focus groups conducted by an independent research firm, to query community leaders, human service agency administrators, and Carle Foundation Hospital leadership. These focus groups were conducted in Champaign, Vermilion, and Coles counties. Data was also drawn from these sources and used to affirm and re-shape our Community Benefit Plan for 2011 through 2013 as needed: * Robert Wood Johnson County Health Rankings, Feb. 2010 * County QuickFacts from the U.S. Census Bureau for Champaign, Coles & Vemilion counties * Hunger in America Study with participation by the Eastern Illinois Foodbank, Feb. 2010 * Current and future workforce shortage statistics * The Affordable Care Act: Opportunities for the Aging Network; A presentation by ECI Area n Aging, 2010 * Current statewide health reports * Poverty trends in Vermilion County, IL, August 2008 * Coles County Health Department IPLAN 2010-2015 * Homeland Security initiatives * Input from CU Public Health and Human service agencies (on-going) * A Senior Needs Assessment Focus Group, commissioned by Carle Foundation Hospital, September 2007. * Oral Health in Champaign-Urbana, IL, a review prepared by the CU Public Health District * Unanticipated opportunities or challenges in the local markets with respect to community health and wellness offerings. * Champaign County regularly conducts disaster preparedness committee meetings to plan for and practice community wide disaster preparedness. Taking these sources into account, the Community Benefit Plan is written to be aligned with the long-term strategic plan of the Hospital. Current community benefit priorities include: Access to healthcare, which encompasses The Carle Community Discount Program (charity care) Childhood obesity Children-at-risk Communications to foster outreach and collaboration *Maintenance of existing Carle community benefit programs. In every way, these activities and programs meet established community benefit criteria-but moreso, in every way contribute to a significantly healthier community. In 2011, our Community Benefit Plan, reflected the first year of a three-year plan and primarily addressed needs identified in the Champaign-Urbana area within the scope of the determined Plan priorities. It also included community building activities, as well as research and education initiatives-all of which were reviewed and confirmed through the annual budgeting process.
3.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE		Carle is acutely aware of the need for access to care, making that a mainstay of our community benefit program, with a strong charity care program that is based in a philosophy of doing the right thing for their community and patients and balanced by a careful stewardship of the community's resources. By focusing on determining the financial status of patients up-front, we have been able to pinpoint those needing financial assistance early in the process, minimizing bad debt and optimizing our ability to help them. Staff is also diligent in following up with patients during hospitalization and after discharge if there's any reason to believe the patient could benefit from charity care. Carle Foundation Hospital has made a concerted, continuous effort to be sure that people have access to information that will help them with their medical bills. These include: Advertising to promote awareness of the Community Care Discount Program. This past year, we used radio, bus panels and outdoor billboards to advertise this service. We continued a presence in appropriate special event program booklets as well as utilizing messages on our onsite digital displays, static displays throughout the hospital, clinics and web sites. Billing envelopes that carry this message prominently on the outside of the envelope: Need help with your medical bill? Call 888-479-0008. All billing statements have messaging on the back of the statements regarding the availability of the CCPD. Community Care application forms and brochures available at all inpatient and outpatient registration points, as well as in the Hospital's main lobby. These forms have also been translated into Spanish. A simplified application form. Packets including application forms, instructions and a checklist that are distributed to area free clinics and FQHCs. Information and application forms are easily found and accessed at www.carle.org. Staff at Frances Nelson Health Center, the local FQHC and free clinics have a supply of application forms and have been trained to assist their patients in completing them. Informational meetings are held with local legislators to help assist constituents with healthcare needs, including financial assistance. All collection letters indicate the availability of the Community Care program. Hospital admission packets contain information regarding Community Care. We meet with our own staff to keep them informed about the program and what benefits are available to patients. *Community Care representatives are available at various community events. 4. COMMUNITY INFORMATION Targeted populations include the uninsured and underinsured, and children at risk-from conception through childhood. Carle's service area is generally defined as east central Illinois, including all or parts of more than 25 counties in east central Illinois and western Indiana. For the 2011 plan, research and remedies are directed towards community health issues identified in Champaign, Coles and Vermilion counties, with the primary focus being on Champaign County. These areas represent our headquarters and two other counties where Carle has a thriving presence. Our reach extends from these three counties-also identified in this report as Champaign-Urbana (Champaign County), Mattoon-Charleston (Coles County) and Danville (Vermilion County) areas into 14 adjoining, rural Illinois counties. These areas comprise nearly 50% of the Carle service area's population of about 1.2 million residents. And the three core counties represent about 25% of the total service area population. Pockets of extreme poverty exist throughout this region. The programs within our community benefit plan generally have impact upon all of these targeted communities, with certain programs directed at specific communities and populations. Generally, targeted populations include the uninsured and underinsured, and children-at-risk-from conception through childhood. In 2011, a greater proportion of our resources were spent in Champaign County, where the largest population in our service area resides and where our community benefit program has long been established. Carle Foundation Hospital serves as the region's only Level I Trauma Center and maintains a 42-bed Level III Neonatal Intensive Care Unit, comprised of 25 NICU and 17 step-down beds. As provider of the region's Level III perinatal services, Carle provides care to patients who live throughout the area extending from Kankakee to the southern-most tip of Illinois, and spanning from as far west as Decatur into western Indiana. For the purposes of our Community Care Discount Program, coverage encompasses this entire region-40 counties in Illinois and Indiana. Qualifying trauma patients, regardless of their place of residency, are covered for their trauma care, hospitalization, and follow-up care.
5.PROMOTION OF COMMUNITY HEALTH		Carle Foundation Hospital has an open medical staff and is governed by a community board. Surplus funds are reinvested into the organization for technology replacement and advancement, building renovation or construction, clinical service expansion and quality improvement. Surplus funds are also invested into our communities to meet identified health needs which contribute to the overall well-being of the residents of the communities we serve. Because the needs are great and varied and it would be unreasonable to address each and every identified need, we set priorities and use our resources to focus primarily on identified needs within the community benefit priorities set. Many of these needs are addressed through partnerships and collaborative efforts. Our progress is shown below and presented with the respective community benefit priority: Community Benefit Priority: -Additional Access to Care Programming Financial and leadership support of community programs has been central to providing access to primary, dental, preventive, and mental health services. Carle has identified and sought ways to initiate and expand healthcare services for the underinsured and uninsured by working collaboratively with community organizations and leaders. A. Free Clinic Support Champaign County Christian Health Center - $59,000 As the lead funder of the Champaign County Christian Health Center, Carle helps the free health clinic fulfill its mission to provide quality, holistic care at no cost to as many people as possible during hours limited only by the availability of volunteer healthcare providers and the energy of three part-time paid administrative staff. They provide primary care, dental and mental health services, with 1,044 patient visits and 498 new patients served in CY 11. A significant number of the volunteer medical staff is Carle physicians, nurses and techs who have personally chosen to serve their community through the Champaign County Christian Health Center. Carle has continued to cover the facility's rent-$40,000 per year-as well as provide substantial support for operations. Since this clinic's inception in 2003, Carle has provided nearly $324,000 to help maintain this small clinic that provides huge benefits to people who are underinsured or uninsured. Avicenna Carle also supports the activities of Avicenna, a local Muslim-based clinic that provides free care to all. Avicenna currently uses the Christian Health Center space on weekends. Carle also works with them so they can access specialty care as well as lab results for their patients. B. Frances Nelson Health Center - $95,608 We also continued to financially support and provide leadership to Frances Nelson Health Center, a Federally Qualified Health Center. In 2005, in concert with a community effort, Carle Foundation Hospital purchased a former furniture store in Champaign, renovated it for $1.2 million, provided free rent for three years and continued to support the operations of the facility: The Hospital continues to pay utilities and operating costs associated with the facility's maintenance, cleaning and security, which totaled $58,331 in CY11. As always, some of the more expensive medications were provided. This year, the facility required improvements due to wear and tear, bringing the total to $80,274. Carle also pays the property taxes. Carle's All About Baby staff regularly provides prenatal, breastfeeding and newborn care education at the clinic. They also offered a teen pregnancy program. Cost of these programs totaled $14,333. Carle Family Medicine residents provide obstetrical care. C. Community Dental Initiative for Adults and Children Frances Nelson Dental Center - $102,175 Carle Foundation Hospital made a significant contribution towards renovation of space within the Frances Nelson Health Center facility for a newly-opened community dental center that's making access to adult and senior dental services a reality, having opened in October 2011. Meanwhile, we continue to provide leadership and support to this community dental initiative headed by United Way of Champaign County. Carle leadership played an important role on the Community Dental Initiative Coalition, with their time valued at $1,858. And Carle covered some of the costs associated the public open house-$317-as well. SmileHealthy for Mobile Dental Care - $26,808 Prior to the opening of the Dental Center within Frances Nelson Health Center, an interim, mobile service was housed on the Urbana Carle Medical Campus, serving uninsured adults, as well as children. Cost to provide the space was $26,808. D. Providing Access to Care through Subsidized Services Over the years, multiple Carle initiatives have provided additional access to care. Because these services continue to meet an enormous need, these programs have been maintained, even though several of them operate at a loss: AirLife; HomeMeds, a medication management program for seniors; free health screenings; Low Vision Center; Neonatal Intensive Care Unit; Patient Advisory Nurse, ECHO (Expanding Children's Hearing Opportunities-Pediatric Hearing Services); free and discounted prenatal and family education; free sports injury evaluations and discounted Sports Medicine coverage at local and area school sporting events; Carle's Community Parish Nurse Program; and the Carle Breastfeeding Clinic. The Community Parish Nurse Program-designed to train nurses from local and regional churches to educate congregants and to advocate for their healthcare interests. Tuition costs are minimal. In 2011, 18 RNs completed our training program. This program is one of the largest in the nation, with 454 total nurses trained to provide service to 223 congregations in 31 counties and three states. Altogether, they logged over 7,000 hours of volunteer services to their congregations. The Carle Breastfeeding Clinic -the certified lactation specialists with Carle's Breastfeeding Clinic have been helping thousands of women successfully breastfeed and manage challenges along the way since 1997. This service is free and available to any nursing mother, regardless of where they receive care. Located at Carle Foundation Hospital, and now at clinics in Champaign and Urbana, the Breastfeeding Clinic operates a 24/7 pager service where breastfeeding mothers can call in with questions or concerns around-the-clock. During Carle's fiscal year 2011 there were 7,060 visits to the hospital-based, urban clinic, including 2,644 walk-ins. Staff also responded to 2,463 call requests for assistance. At the two Carle regional outpatient facilities, they had 475 visits during their first month opening. Community Benefit Priority: -Children-at-Risk Child Safety Programs and other Activities (some also involving adults) which focus on reducing unintentional injury and accidental deaths. Playing It Safe-in its 15th year of bringing together public safety and other safety-minded organizations and agencies to teach children and their families how to prevent unintentional injuries, this free safety fair-co-sponsored with Safe Kids Champaign County-involved more than 50 interactive displays, stage presentations and points of interest. Attendance was remarkably high with more than 1,800 children and parents present. Center for Rural Health and Farm Safety-the Center for Rural Health and Farm Safety at Carle accomplished a record-setting year during its 20th anniversary year, 2011. Carle formed the Center after recognizing the need to provide education on agricultural safety and health to both children and adults in the farming community. All programs remain free to those in Carle's service area. -Of the nearly 5,000 people trained in 2011, more than 3,500 were children. Last year, the Center reached more than 2,000 youth in surrounding rural communities through 31 school programs-the highest number ever achieved annually in Carle history. In addition, 995 children were reached at Progressive Ag Safety Days, coordinated by Carle and hosted in Vermilion, Piatt and Ford Counties. -The Center also certified more than 600 adults (14 years and older) in CPR and first aid last year. -Five emergency responder training courses included Agricultural Emergency Response classes as well as tractor rollover and grain entrapment sessions and involved 89 participants. An innovative program-Emergency Action Tubes-was launched in 2010 to protect farmsteads and aid emergency responders. The Center placed sealed plastic cylinders with detailed farm info and maps on an additional 31 farms in 2011, bringing the number of protected farmsteads to 39. Interpersonal Violence Program-provides community education with a focus on reducing domestic violence as well as training for Sexual Assault Nurse Examiners (SANE) and others who treat rape and abuse victims. Carle has nine SANE nurses in the Emergency Department, assisting approximately 115 adult/adolescent and pediatric sexual assault patients this year. Carle
PROMOTION OF COMMUNITY HEALTH (CONTD)		Community Benefit Priority: -Childhood Obesity The newest addition to our community benefit plan is an effort to join the fight against childhood obesity, first by joining with schools which have shown an interest in helping their students and families to live a healthier lifestyle through better nutrition and physical activity. During CY 11, Carle donated $2,500 to each school to boost their existing programs. Late in 2011, we began an initiative, at the request of the schools, to provide a customized, monthly health and wellness-related article featuring Carle expertise. These articles were provided to each school monthly for distribution in their PTA newsletters. In Champaign County, we partnered with Booker T. Washington STEM Academy (BTW), a Champaign School. In collaboration with the Champaign-Urbana Public Health Department, we teamed with a parent-teacher committee to create a plan which complemented what the school's leadership had already put into place. The multi-faceted program was kicked off in the spring of 2011 with baseline testing-BMI assessments and a food quiz. We also connected BTW's leadership with the principal of Northeast Elementary Magnet School in Danville, our partnership school in Vermilion County. Northeast has been recognized for its health and wellness program with a gold award from the Healthy Generations, a national organization headed by former President Bill Clinton. In Vermilion County, we continued our partnership with Northeast Elementary Magnet School. Our progress is reported later on in this report where we focus on community benefit provided to Vermilion and Coles counties. Community Benefit Priority: -Communications to Foster Outreach and Collaboration Carle has been active in facilitating community engagement and collaboration to connect, update, and expand existing databases and technology currently available to assist agencies, social workers, clergy, healthcare providers, and family members with referrals for their clients, patients and loved ones. www.HelpSource.org-taking a leadership role in its development more than 11 years ago, we have continued to support HelpSource.org and provide guidance to the maintenance and promotion of this on-line directory of human services resources in east central Illinois. Created the Community Communications Coalition (C-3) to convene area leaders in human service agencies to discuss how existing resources could be enhanced to include more information, reach more people and to incorporate social media technology. Continued following updates on the status of 2-1-1- in Illinois and our region, and began considering the impact on activities of the Communications Coalition as well as HelpSource. Community Benefit Priority: -Carle Community Benefit Programs Maintained There are a host of other programs identified in earlier years that have been clearly answering the needs of our community which Carle continues to stand behind, support, and monitor to meet our obligation as a not-for-profit charitable organization. Besides maintaining the Carle Community Care Discount Program and serving Medicaid and Medicare patients, even though government reimbursement is typically below our costs, we continue to focus on the additional major categories of existing, identified health needs that Carle has consistently addressed over the years: Subsidized health services, initiated and maintained to improve the health of the community AirLife Carle Breastfeeding Clinic Carle Community Parish Nurse Program Carle Low Vision Center ECHO (Expanding Children's Hearing Opportunities-Pediatric Hearing Services) Carle Auditory Oral School Home health services Neonatal Intensive Care Unit Patient Advisory Nurse Pulmonary Rehabilitation Funding programs and shortages This represents a significant portion of our financial, in-kind, and leadership support of health and human service organizations with similar/compatible missions. The new Stephens Family YMCA in Champaign County was the recipient of an 11-acre land transfer valued at $1,704,401 for construction of this modern, replacement facility which includes Larkin's Place, a recreational area dedicated to the health, wellness and fitness needs of children with all levels of abilities. Included in the donation value was approximately $200,000 in costs related to engineering, permit and water retention at the site. Seventy-six additional community organizations received support. Some of those are: - Alzheimer's Association - American Diabetes Association - Arthritis Foundation - Camp Kesem (for children who have a parent with cancer) - Champaign County CASA - Champaign County YMCA - Coles County Council on Aging - Coles County Crisis Response Team - Community Elements - Cunningham Children's Home - Danville Rescue Mission - Developmental Services Center - Eastern Illinois Food Bank - Faith in Action - Faith United Methodist Church Christmas Meal Program - Make a Wish Foundation - Muscular Dystrophy Association - United Way-$158,105 $138,177: Carle's corporate campaign contribution was $115,000 plus an additional $8,558 in fundraising. Campaign expenses and staff time are also included. $4,558: Carle's corporate contribution to Stuff the Bus, a one-day event where supplies are gathered for distribution to clients through various human service agencies. $15,370: Miscellaneous contributions throughout the year for various purposes. Health professions education/workforce development Through a variety of activities including significant donations, scholarship programs, and physician, nurse, and allied health education, more than $7.3 million was invested in programs that address community-wide workforce issues, strengthening the training and availability of professionals to care for our communities' healthcare needs now and in the near and distant future. In CY 11, the most significant contributions went towards these programs: Graduate Medical Education programs. Maintaining a geriatric fellowship and five medical residency programs, including a general surgery residency program, and serving as a clinical site for a sixth. There were 31 residents practicing on Carle's campus in CY 11. Continuing Medical Education programs for regional providers who are not members of the Carle Foundation Hospital medical staff, including Carle Foundation Day. Support of the University of Illinois College of Medicine at Urbana-Champaign, with monies earmarked for the MD/PhD program. Research Carle Foundation Hospital is actively involved in research and education initiatives. The overall purpose of the research program is helping to discover new diagnostic and treatment modalities that will improve the delivery and/or quality of health care. The research program is predominantly in conjunction with Carle physicians and University of Illinois scientists, and entrepreneurial companies. Emphasis has been on continuing to create an infrastructure for a robust research program, including: Setting up a research component of the electronic medical record system that allows for the identification of patients involved in research and assures that billing for the research is accurate and in alignment with all regulatory requirements. Implementing a central clinical trials management system for optimal tracking of studies and subjects, and As of December 2011, the Carle Research Institute had 126 active research studies, with another 21 research studies pending. Of the total of 147 studies, the breakdown of studies into various areas was 23 translational, 30 investigator-initiated, 29 nursing, 17 clinical trials, and 37 residency program and student research studies. Reaching out to Vermilion and Coles Counties While the focus of the first year (2011) of our three-year plan is primarily on community benefits geared towards Champaign County (donations excluded), here are some of the ways we extended community benefit activities to the residents of Vermilion and Coles County: Access to Care: In Vermilion County: We began collaborative talks with Provena United Samaritan Hospital in Danville to reduce the number of low birth weight babies born at Provena USMC to 2008 levels In Coles County: We continued to provide Board leadership to the Coles County Community Health Center and also made a $5,000 annual pledge with a three-year commitment, beginning in 2012. We are taking steps to strengthen mental health services for adults and children in Coles County. Last year we began to explore having additional mental health providers at our clinic, in the same building as the referring physicians-for a more private venue-and with crisis-sensitive access for the patient. We gave consideration to hiring a masters-prepared social worker at Carle Foundation Physician Services -Mattoon to be on site and immediately intervene with patients with mental health issues, but we put that position on hold. We also maintain a presence on the LifeLinks board. C
SCHEDULE H, PART V- B, LINE 19
STATE FILING OF COMMUNITY BENEFIT REPORT	990 SCHEDULE H, PART VI	IL,

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Carle Foundation Hospital

Employer identification number
37-1119538

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) YMCA2501 Fields South Dr Champaign,IL61822	37-0673564	501c3	1,704,401	Building site
(2) University of Illinois506 S Mathews Ave Urbana,IL61801	37-6000511	501c3	1,309,908	Scholarships & Sponsorships
(3) United Way of Champaign County404 W Church St Champaign,IL61820	37-0662519	501c3	211,640	Campaign
(4) Parkland College Foundation2400 West Bradley Ave Champaign,IL61821	37-0892090	501c3	163,000	Scholarships & Sponsorships
(5) Champaign County Christian HealthPO Box 1400 Champaign,IL61824	56-2421584	501c3	79,220	OPERATIONS AND FACILITIES
(6) Land of Lincoln Legal Assistance Fndn302 SOUTH FIRST ST Champaign,IL61820	37-0958448	501c3	30,000	Volunteer Stipend
(7) Vermilion County Advantage28 W Norht St Danville,IL61832	37-0238000	501c3	17,110	Membership, program support
(8) Smile HealthyPO Box 154 Champaign,IL61824	14-1880824	501c3	10,000	CENTER ASSISTANCE
(9) Don Moyer Boys & Girls Club201 East Park St Champaign,IL61820	37-0906638	501c3	9,450	Boys and girls program support
(10) Mahomet Area Youth Club601 E Franklin St Mahomet,IL61853	81-0615577	501c3	8,000	Program support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
Form 990, Schedule I	Description of Organization's Procedures for Monitoring the Use of Grants	The majority of the requests for funding are to The Carle Foundation or its affiliates located in the communities we serve. Any charitable organization wishing to request funds is asked to submit their request in writing. Emailed requests are acceptable. The request must include a description of the purpose of the contribution and other relevant information such as requestors name, amount of the request, etc. The requests are reviewed, evaluated, and administered by the public relations director, seeking additional information from the requestor, as needed, and input from any appropriate Carle administrator or director. A set of established guidelines drive these decisions, and most are made to improve healthcare/access to healthcare or are in line with our role as a corporate citizen. Assessed need is a common criteria. In the case of most donations of $5,000 or more, such as to colleges and universities or community clinics, written agreements are in place and we have regular, casual contact with those organizations, oftentimes through a Carle contact person to assure that the donations are being used as agreed upon. Records are maintained either in administration or public relations.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) Cora E Musial Phd MD	(i) (ii)	0 185,965	0 0	0 18,973	0 31,336	0 4,418	0 240,692	0 0
(2) Mathew Gibb MD	(i) (ii)	0 785,511	0 0	0 102,779	0 28,756	0 3,971	0 921,017	0 0
(3) Paul Tender MD	(i) (ii)	0 436,180	0 0	0 57,642	0 19,051	0 10,243	0 523,116	0 0
(4) James C Leonard MD	(i) (ii)	0 811,190	0 165,375	0 63,770	0 229,762	0 16,659	0 1,286,756	0 0
(5) R Bruce Wellman MD	(i) (ii)	0 664,501	0 116,375	0 24,704	0 216,931	0 10,064	0 1,032,575	0 0
(6) John Snyder	(i) (ii)	0 517,644	0 76,197	0 46,197	0 142,807	0 18,004	0 800,849	0 0
(7) Dennis Hesch	(i) (ii)	0 420,264	0 62,125	0 27,697	0 120,254	0 18,850	0 649,190	0 0
(8) Philip Kubow	(i) (ii)	0 319,403	0 37,333	0 51,449	0 79,214	0 16,276	0 503,675	0 17,401
(9) Pamela Bigler	(i) (ii)	0 244,781	0 22,750	0 21,007	0 62,783	0 4,134	0 355,455	0 0
(10) Lynne Barnes	(i) (ii)	0 232,635	0 20,125	0 7,511	0 55,228	0 2,040	0 317,539	0 0
(11) Stephanie Beever	(i) (ii)	0 226,358	0 17,561	0 2,638	0 52,693	0 17,308	0 316,558	0 0
(12) Mark Berlin	(i) (ii)	0 196,419	0 18,812	0 19,109	0 55,161	0 19,503	0 309,004	0 0
(13) Dawn Walden	(i) (ii)	0 223,334	0 0	0 6,689	0 33,905	0 16,904	0 280,832	0 0
(14) Diane Wasson term 2911	(i) (ii)	21,803 0	8,825 0	176,524 0	1,020 0	1,958 0	210,130 0	0 0
(15) Gregory Puszkiewicz term 7111	(i) (ii)	84,003 0	9,500 0	110,567 0	9,374 0	12,858 0	226,302 0	0 0
(16) Vijay Bavda	(i) (ii)	174,991 0	324 0	669 0	13,418 0	13,900 0	203,302 0	0 0
(17) Cynthia Gordon	(i) (ii)	173,779 0	294 0	101 0	13,979 0	10,075 0	198,228 0	0 0
(18) Robert Tonkinson	(i) (ii)	0 6,220	0 0	0 303,713	0 0	0 0	0 309,933	0 122,321
(19) Linda Fred	(i) (ii)	151,181 0	11,173 0	2,700 0	13,109 0	19,669 0	197,832 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
Supplemental Compensation Information		FORM 990, SCHEDULE J, PART 1, QUESTION 3 THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF THE CARLE FOUNDATION HOSPITAL, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES, WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT, HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS, ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED, AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. THE COMMITTEE APPROVES ALL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. THE COMPENSATION COMMITTEE USES A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS ANALYSIS INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND REPORTS DIRECTLY TO THE COMPENSATION COMMITTEE. FORM 990, SCHEDULE J, PART 1, QUESTION 4A THE FOLLOWING THREE EMPLOYEES RECEIVED THE NOTED AMOUNT OF SEVERANCE PAY DURING CALENDAR YEAR 2011; ROBERT TONKINSON- $209,809, DIANE WASSON- $156,816 AND GREGORY PUSZKIEWICZ- $79,630.

Schedule J (Form 990) 2011

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.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

Identifier	Return Reference	Explanation
FORM 990, SUPPLEMENTAL INFORMATION		FORM 990, PART VI, QUESTION 2 TRUSTEES E. PHILLIPS KNOX AND DAVID IKENBERRY HAD A BUSINESS RELATIONSHIP FORM 990, PART VI, QUESTION 6 CARLE FOUNDATION HOSPITAL HAS ONE MEMBER WHICH IS THE PARENT COMPANY, THE CARLE FOUNDATION. FORM 990, PART VI, QUESTION 7A CARLE FOUNDATION HOSPITAL'S SOLE MEMBER, THE CARLE FOUNDATION, ACTING THROUGH ITS BOARD OF TRUSTEES, HAS THE EXCLUSIVE POWER TO ELECT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES FOR THE CORPORATION IN ADDITION TO FILLING VACANCIES. FORM 990, PART VI, QUESTION 7B CARLE FOUNDATION HOSPITAL'S BOARD OF TRUSTEES MUST HAVE THE APPROVAL OF ITS SOLE MEMBER, THE CARLE FOUNDATION, THROUGH IT'S BOARD OF TRUSTEES, WHEN VOTING ON MATTERS INCLUDING THE AMENDING OF THE BY-LAWS; AMENDMENTS TO THE ARTICLES OF THE CORPORATION; AUTHORIZING ANY NON-BUDGETED EXPENDITURE IN EXCESS OF $100,000 (THE EXCESS OF ANY PROPOSED EXPENDITURE OVER THE PREVIOUSLY APPROVED BUDGETED AMOUNT SHALL BE DEEMED A NON-BUDGETED EXPENDITURE); TO ADOPT ANY NEW OR ANY CHANGES TO EXISTING LONG TERM OR MASTER INSTITUTIONAL PLANS OF THE CORPORATION; TO ORGANIZE OR ACQUIRE, OR TO AUTHORIZE OR APPROVE THE ORGANIZATION'S ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; AND THE AUTHORIZATION TO ENTER INTO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION OR ACTIVITY WHICH REQUIRES APPLICATION TO THE ILLINOIS HEALTH FACILITIES PLANNING BOARD FOR A PERMIT OR CERTIFICATE OF NEED. FORM 990, PART VI, QUESTION 11 THE FORM 990 WAS PREPARED BY STAFF AND AN EXTERNAL TAX ADVISOR AND REVIEWED BY MANAGEMENT. PRIOR TO FILING THIS FORM 990, A FULL AND COMPLETE COPY WAS PROVIDED TO THE GOVERNING BODY BY POSTING TO THE ORGANIZATION'S DIRECTOR COMMUNICATION PORTAL. ALSO BEFORE FILING, THE GOVERNING MEMBERS RECEIVED NOTIFICATION THAT THE FORM 990 WAS POSTED AND AVAILABLE FOR THEIR REVIEW. AS NECESSARY, THE GOVERNING MEMBERS HAVE THE OPPORTUNITY TO DISCUSS AND ADDRESS CONCERNS AT SUBSEQUENT BOARD MEETINGS. FORM 990, PART VI, QUESTION 12C THE ORGANIZATION'S ESTABLISHED CONFLICT OF INTEREST POLICIES REQUIRE ANNUAL DISCLOSURE OF ACTUAL AND POTENTIAL CONFLICTS OF INTEREST FOR OFFICERS, DIRECTORS, TRUSTEES, MEMBERS OF BOARD COMMITTEES, ADMINISTRATIVE AND MANAGERIAL EMPLOYEES AS WELL AS ALL EMPLOYEES OF THE PURCHASING DEPARTMENT. IF CIRCUMSTANCES CHANGE DURING THE COURSE OF A YEAR, INTERIM DISCLOSURE IS ALSO REQUIRED OF THE SAME INDIVIDUALS. THE DISCLOSURES OF EMPLOYEES ARE REVIEWED INITIALLY BY THE HUMAN RESOURCES DEPARTMENT AND ANY IDENTIFIED CONFLICTS ARE REFERRED TO, AND ADDRESSED BY, THE ORGANIZATION'S INTERNAL LEGAL COUNSEL AND/OR CORPORATE INTEGRITY OFFICER. THE DISCLOSURES OF TRUSTEES AND MEMBERS OF BOARD COMMITTEES ARE REVIEWED BY THE CHAIR OF THE BOARD. THE ENTIRE BOARD ABSENT THE SUBJECT TRUSTEE OR COMMITTEE MEMBER DETERMINES WHETHER A CONFLICT EXISTS. TRUSTEES AND/OR BOARD COMMITTEE MEMBERS WITH IDENTIFIED CONFLICTS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS RELATED TO THEIR CONFLICTS. THE ORGANIZATION ALSO MAINTAINS PURCHASING POLICIES REQUIRING COUNTER SIGNATURES TO FURTHER MINIMIZE THE RISK ASSOCIATED WITH CONFLICTS OF INTEREST. FORM 990, PART VI, QUESTION 15A & 15B Carle Foundation Hospital does not compensate its officers and key employees. These individuals are compensated by The Carle Foundation. THE BOARD OF TRUSTEES OF THE CARLE FOUNDATION, THE PARENT COMPANY OF CARLE FOUNDATION HOSPITAL, THROUGH ITS COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT MEMBERS FREE OF CONFLICT, ANNUALLY REVIEWS EXECUTIVE COMPENSATION LEVELS AND ESTABLISHES APPROPRIATE SALARY RANGES AND OTHER FEATURES OF THE COMPENSATION PLAN IN ACCORDANCE WITH THE ORGANIZATION'S APPROVED COMPENSATION PHILOSOPHY AND STRATEGY: THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES, WHO ARE INDEPENDENT OF THE CARLE FOUNDATION MANAGEMENT, HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS, ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED, AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH THE CARLE FOUNDATION. THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE IN RELATION TO APPROPRIATE COMPARABILITY DATA. COMPENSATION FOR OTHER MEMBERS OF THE EXECUTIVE STAFF IS DEVELOPED BY THE CEO, EVALUATED AGAINST MARKET DATA, AND REVIEWED AND APPROVED BY THE COMMITTEE. THE COMMITTEE APPROVES ALL COMPENSATION DECISIONS IN ADVANCE OF THEIR IMPLEMENTATION AND DOCUMENTS ITS DETERMINATIONS AND DISCUSSIONS. THE COMPENSATION COMMITTEE USES A NUMBER OF EXTERNAL RESOURCES AND COMPARISONS, AND ITS REVIEW INCLUDES TOTAL COMPENSATION (CASH COMPENSATION PLUS BENEFITS PROVIDED BY THE CARLE FOUNDATION) IN RELATION TO ORGANIZATIONAL PERFORMANCE AND PREVAILING INDUSTRY PRACTICES FOR LIKE RESPONSIBILITIES AT COMPARABLY-SIZED ORGANIZATIONS. THE COMMITTEE HAS ENGAGED THE SERVICES OF A COMPENSATION CONSULTING FIRM SPECIALIZING IN THE NOT-FOR-PROFIT SECTOR WHICH HAS WORKED WITH THE CARLE FOUNDATION AND REPORTS DIRECTLY TO THE COMPENSATION COMMITTEE. FORM 990, PART VI, QUESTION 19 THE CARLE FOUNDATION, THE PARENT COMPANY OF CARLE FOUNDATION HOSPITAL, PUBLISHES THROUGH WWW.DACBOND.COM ITS QUARTERLY UNAUDITED FINANCIAL STATEMENTS, ANNUAL AUDITED FINANCIAL STATEMENTS, A MANAGEMENT'S DISCUSSION & ANALYSIS TO ACCOMPANY THE FINANCIAL STATEMENTS, AND AN ANNUAL REPORT OF CERTAIN OPERATING AND FINANCIAL INFORMATION. ADDITIONALLY, OFFICIAL STATEMENTS FOR OUTSTANDING MUNICIPAL BOND ISSUES FOR WHICH THE CARLE FOUNDATION IS OBLIGATED ARE AVAILABLE AT THIS WEBSITE. THESE DOCUMENTS INCLUDE EXTENSIVE INFORMATION ABOUT THE ORGANIZATION'S HEALTH CARE DELIVERY SYSTEM MODEL, RECENT HIGHLIGHTS/ACCOMPLISHMENTS, GOVERNANCE AND ADMINISTRATION, STRATEGIC PLAN, FACILITIES, CLINICAL PROGRAMS, MEDICAL STAFF, SERVICE AREA, COMPETITIVE ENVIRONMENT, DEMOGRAPHIC DATA, UTILIZATION STATISTICS, SUMMARY FINANCIAL INFORMATION, ACADEMIC AFFILIATIONS AND EDUCATIONAL PROGRAMS, MEDICAL RESEARCH, ACCREDITATIONS, AND ITS EMPLOYEES. THIS INFORMATION IS AVAILABLE AT NO CHARGE TO THOSE WHO REGISTER AT THE WWW.DACBOND.COM WEBSITE. IN ADDITION, THE FORM 990S OF THE ORGANIZATION'S FILING ENTITIES ARE AVAILABLE THROUGH DACBOND. A COMMUNITY BENEFIT REPORT IS ALSO PUBLISHED AND DISTRIBUTED ANNUALLY TO THE COMMUNITY. QUARTERLY FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST DELIVERED TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE ALSO AVAILABLE UPON REQUEST TO THE ORGANIZATION'S ADMINISTRATIVE OFFICES. PART VII, SECTION A, COLUMN B THE AVERAGE ESTIMATED HOURS PER WEEK LISTED FOR THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS ARE BASED ON A STANDARD 40 HOUR WEEK. MEMBERS MAY FREQUENTLY DEVOTE MORE THAN 40 HOURS OF SERVICE TO THE ENTIRE ORGANIZATION DURING AN AVERAGE WEEK. FORM 990, PART XI, LINE 5 THE CARLE FOUNDATION HOSPITAL SETTLED VARIOUS INTERCOMPANY RECEIVABLE/PAYABLE BALANCES THROUGH EQUAL OFFSETTING EQUITY TRANSFERS. THE INTERCOMPANY RECEIVABLE/PAYABLE BALANCE RESULTED FROM THE NORMAL COURSE OF OPERATIONS AND WERE PRIMARILY ATTRIBUTABLE TO CENTRALIZED CASH MANAGEMENT AND DISBURSEMENT ACTIVITIES. THESE INTERCOMPANY RECEIVABLE/PAYABLE SETTLEMENTS HELPED PROVIDE SUPPLEMENTAL FUNDING FOR CERTAIN RELATED ORGANIZATIONS TO FURTHER THEIR EXEMPT PURPOSES. Equity transfers (to)/from affiliates (49,567,000) Rounding (403) Net income - CRIMCO 32,063 Net other changes in net assets or fund balances (47,535,340) FORM 990, PART XII, #2A,B,C AND PART IV, LINE 12,12A THE FINANCIAL STATEMENTS FOR CARLE FOUNDATION HOSPITAL WERE REVIEWED ON A CONSOLIDATED BASIS UNDER THE PARENT ORGANIZATION, THE CARLE FOUNDATION. THE CARLE FOUNDATION DOES HAVE AN AUDIT COMMITTEE CONSISTING OF MEMBERS OF THE GOVERNING BOARD AND THE CHIEF FINANCIAL OFFICER WHO TOGETHER ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE REVIEW AND AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. FORM 5471 FILING REQUIREMENTS CARLE FOUNDATION HOSPITAL (CFH) EIN 37-1119538 FORM 5471 FILING REQUIREMENTS HAVE BEEN SATISFIED. CFH CONSTRUCTIVELY OWNED A CONTROLLED FOREIGN CORPORATION IN 2011 THROUGH ITS PARENT THE CARLE FOUNDATION EIN 37-0673465. PURSUANT TO IRS SECTION 6038, THE 2011 CONTROLLED FOREIGN CORPORATION FILING REQUIREMENT OF CFH WAS FULFILLED ON THE 2011 FORM 5471 FILED ON ITS BEHALF BY THE CARLE FOUNDATION. RETURN WITH WHICH THE REQUIRED INFORMATION WAS FILED: THE CARLE FOUNDATION 2011 FORM 990-T EIN 37-0673465 611 WEST PARK URBANA, IL 61801 THE 2011 FORM 5471 WAS FILED WITH THE CARLE FOUNDATION 2011 FORM 990-T. IRS SERVICE CENTER WHERE THE RETURN WAS FILED - OGDEN, UTAH.
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Phillip Blankenburg TITLE:Chairman of Board HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Donna Greene TITLE:Vice Chairman of Board HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Cora E. Musial, Phd MD TITLE:Secretary of Board HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Mathew Gibb, MD TITLE:Trustee HOURS:29
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:J. Michael Martin TITLE:Trustee HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Marty Smith TITLE:Immediate Past Chair HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Paul Tender, MD TITLE:Trustee HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:David Ikenberry, Phd TITLE:Trustee (through 9/15/11) HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:E. Phillips Knox TITLE:Trustee (through 9/15/11) HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:James C. Leonard, MD TITLE:ex-officio, President/CEO HOURS:29
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:R. Bruce Wellman, MD TITLE:ex-offico, Trustee HOURS:21
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:John Snyder TITLE:EXEC VP, COO HOURS:25
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Dennis Hesch TITLE:Exec VP & CFO HOURS:24
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Philip Kubow TITLE:SVP Human Resources HOURS:22
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Pamela Bigler TITLE:Chief Nursing Officer HOURS:15
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Lynne Barnes TITLE:VP Hospital Operations HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Mark Berlin TITLE:VP-Surgical Spec HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Dawn Walden TITLE:VP-Revenue Cycle Ops HOURS:21
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Stephanie Beever TITLE:VP Strat Devl & Diag Svces HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Linda Fred TITLE:Inpt Pharm Director HOURS:16
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Robert Tonkinson TITLE:SVP & CFO-former HOURS:

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Carle Foundation Hospital

Employer identification number

37-1119538

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) The Carle Foundation 611 W Park St Urbana,IL61801 37-0673465	Parent/Invest	IL	501(c)(3)	11b Type II	na		No
(2) Carle Development Foundation 611 W Park St Urbana,IL61801 37-1159978	Fundraising	IL	501(c)(3)	7	TCF	Yes
(3) Carle Health Care Incorporated 611 W Park St Urbana,IL61801 37-1140016	Var svcs	IL	501(c)(3)	9	TCF	Yes
(4) Carle Retirement Centers Inc 611 W Park St Urbana,IL61801 37-1160033	RTRMT LIVING	IL	501(c)(3)	9	TCF	Yes
(5) Carle Community Health Corp 611 W Park St Urbana,IL61801 36-4458371	FDN MISSION	IL	501(c)(3)	11a, Type I	TCDF	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) Health Systems Insurance LIMITED GOVERNORS SQ 2ND FL BLDG 3 Grand Cayman KY1-1102 CJ	Insurance	CJ	na	C-CORP
(2) Carle Holding Company Inc 611 W Park St Urbana,IL61801 37-1188284	HOLDING COMPANY	IL	tcf	C-CORP
(3) Carle Risk Management Co 611 W Park St Urbana,IL61801 37-1217973	Risk management	IL	tcf	c-corp	31,628	54,571	100.000 %

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) Carle Community Health Care	c	2,618,160	COST
(2) Carle Development	c	449,575	COST
(3) Carle Health Care Incorporated	k	861,687	COST
(4) Carle Health Care Incorporated	l	8,794,559	COST
(5) Carle Health Care Incorporated	p	67,554	COST
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation
Schedule R, Supplemental Information		SCHEDULE R, PART II CARLE HEALTH CARE INCORPORATED PRIMARY ACTIVITY: EMERGENCY TRANSPORT, DAY CARE, PHYSICIAN SERVICES.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CARLE FOUNDATION HOSPITAL'S MISSION IS TO SERVE PEOPLE THROUGH HIGH QUALITY CARE, MEDICAL RESEARCH AND EDUCATION. HEALTH CARE SERVICES ARE PROVIDED TO INDIVIDUALS IN THE COMMUNITY REGARDLESS OF ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	7
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	2
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	2,397
6	Total number of volunteers (estimate if necessary) ....	6	865
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	2,930,169
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-352,672

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,809,583	7,314,083
9	Program service revenue (Part VIII, line 2g) .........	224,646,088	415,262,724
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	21,935	6,498,279
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,467,256	5,505,704
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	232,944,862	434,580,790
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,000,520	3,822,286
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	62,526,289	124,148,856
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	113,848,410	198,600,549
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	177,375,219	326,571,691
19	Revenue less expenses. Subtract line 18 from line 12.......	55,569,643	108,009,099
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	188,401,461	238,294,492
21	Total liabilities (Part X, line 26).............	79,895,767	71,315,039
22	Net assets or fund balances. Subtract line 21 from line 20.....	108,505,694	166,979,453

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 284,779,340 including grants of $ 2,470,638 ) (Revenue $ 417,165,389 )
	Serving people through high quality medical care Carle Foundation Hospital is an Illinois not-for-profit Corporation established for the purpose of operating the Carle Foundation's 325-licensed bed hospital and related facilities and, conducting patient care related activities of the Foundation. The hospital, a level one trauma center, offers a full range of inpatient and outpatient diagnostic and therapeutic services for medical, surgical, obstetrical and gynecological patients. The hospital provides various ancillary support services to both inpatients and outpatients such as autopsy, blood bank, emergency services, respiratory therapy, operating room, occupational therapy, pastoral counseling, social services, pharmacy and physical therapy. Carle Foundation Hospital's mission is to serve people through high quality care, medical research and education. We make sure those who need care, get care, whether or not they can pay. Through our Community Care Discount Program for hospital services and our partnerships with area health agencies, access to dental, vision and general healthcare has been improved for those who are struggling financially. As the second tenet in our mission, research gives us tomorrow's answers, today. In collaboration with the University of Illinois scientists and the Carle Physician Group physicians, we are turning the latest medical knowledge into practical applications for the bedside. We are now conducting more than 126 active studies relating to cancer, gastro-intestinal disease, cardiovascular disease and more. Educational programs for both our professionals and the community ensure everyone is better prepared. For the community, we offer a myriad of opportunities like babysitting certification and new dad courses, along with free CPR and first aid classes. For our professionals, we have continuing education courses, three levels of management training classes and courses for physician leaders. Carle Foundation Hospital's continued success is rooted in our ability to adapt to a changing healthcare environment, plan diligently for our future and maintain a commitment to our patients and community. Not-for-Profit hospitals have a long standing practice of providing support, donations and services to their communities. This stems not from economic opportunity, but rather from a responsibility to address and improve the health of all the people they serve. At Carle Foundation Hospital, we also believe that we have an obligation to generously give back to our community in exchange for our tax exemption. All of these factors lead to Carle Foundation Hospital being a champion of access to healthcare and a pillar of community support. For the twelve months ended December 31, 2011 (CY11), the Carle Foundation's total community benefit was $55,193,287. Community benefit programs are based on assessed needs and designed to improve the health of those who live and work in our area, with a focus on serving those less fortunate. Areas of Community Benefit include: hospital services that operate at a loss, cash and in-kind donations, translational research, community education, community-building activities and workforce development. Another role of the Community Benefit is to step in where government falls short. As State and Federal budgets get tighter, funding for important health-related services rarely cover costs and, at a minimum, is usually slow in coming. That is most clearly evidenced by the hospital's unpaid costs of Medicare and Medicaid in the amount of $3,741,423 included in the Community Benefit total above. Carle Foundation Hospital strives to eliminate barriers that keep area residents from receiving the care they need. Carle Foundation Hospital's Community Care Discount Program is one of the most generous charity care discount programs in the country. We want to make sure that the people who qualify know about their options. Our advertising throughout the region is targeted to reach people who qualify so they are aware financial assistance is available. As a not-for-profit hospital, it is our obligation to reach out to those who cannot afford healthcare. Summary: Total Community Benefit = $55,193,287 less Medicaid "revenue" of $2,719,742, less Medicare shortfall of $3,741,423, less Community Building Activities of $235,917 = $48,496,171.

4b	(Code: ) (Expenses $ 15,753,168 including grants of $ 0 ) (Revenue $ 0 )
	The Carle Community Care Discount Program (Charity Care) As a tax-exempt organization, Carle provides care to patients regardless of their ability to pay for that care or source of payment. We also recognize that some patients need help to pay their bills. Carle Foundation Hospital's Community Care Discount Program (charity care) provides discounts or free care to those who need it. The most recent revision of September 1, 2011, is focused primarily on providing greater clarity around covered services, based on our experiences and feedback following the inclusion of outpatient services.) An additional policy reflects our compliance with the Illinois Hospital Uninsured Patient Discount Act, established in 2009, it was last revised in January 2012. Our Community Care Discount Program is continually evaluated and managed as needed to meet the needs of our community. Evaluation involves input from administrative leaders, Patient Accounts staff, local consumer advocacy groups, and patients. For the twelve months ended December 31, 2011 (CFY11), charity care totaled $15,753,168 and served 6,295 people.

4c	(Code: ) (Expenses $ 9,285,568 including grants of $ 1,366,648 ) (Revenue $ 0 )
	Research and Education initiatives Carle Foundation Hospital is actively involved in Research and Education Initiatives. The overall purpose of the Research Program is helping to discover new diagnostic and treatment technologies and methods that will improve the delivery and/or quality of healthcare. The Research Program is done in conjunction with area physicians and scientists, The University of Illinois and entrepreneurial companies. Carle Foundation Hospital's efforts in research and education have steadily grown in recent years with strategic emphasis now placed on Translational Research with The University of Illinois. In November 2010, University of Illinois researchers began to move into the Carle Biomedical Research Center, enjoying state-of-the-art laboratory facilities on our Urbana Medical Campus. As of December 2011, the Carle Research Institute had 126 active, with another 21 pending research studies underway. Of the total of 147 studies, the breakdown of studies into various areas was 23 translational, 30 investigator-initiated, 29 nursing, 17 clinical trials, and 37 residency program and student research studies. Carle physicians and University of Illinois scientists frequently collaborate on research projects within the Carle Research Institute. Besides patient and community education, significant resources are expended on the education and training of medical students, physician residents, nurses, allied health professionals and the general healthcare workforce. Through a variety of activities including significant donations, scholarship programs, and physician, nurse, and allied health education, more than $9.2 million was invested in programs that address community-wide workforce issues, strengthening the training and availability of professionals to care for our healthcare needs now and in the near and distant future. -Graduate Medical Education programs. Maintaining a geriatric fellowship and three medical residency programs, and serving as a clinical site for a fourth. There are 31 residents practicing on Carle's campus at any point in time. -Continuing Medical Education programs for regional providers who are not members of the Carle Foundation Hospital medical staff. This includes Carle Foundation Day, which is an event for providers held at the Forum. There are multiple presentations, speakers and displays which count toward required continuing medical education credit for physicians in the region who attend. -Support of the University of Illinois College of Medicine at Urbana-Champaign, with monies earmarked for the MD/PhD program.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses$ 309,818,076

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Dawn Walden VP-Revenue Cycle Ops	19.0	X			0	230,023	50,809
(19) Stephanie Beever VP Strat Devl & Diag Svces	20.0	X			0	246,557	70,001
(20) Diane Wasson term 2911 Home Svcs & CMS Exec Dir	40.0		X		207,152	0	2,978
(21) Gregory Puszkiewicz term 7111 Rx Express Director	40.0		X		204,070	0	22,232
(22) Vijay Bavda Pharmacist-Inpt	40.0		X		175,984	0	27,318
(23) Cynthia Gordon Pharmacist-Inpt	40.0		X		174,174	0	24,054
(24) Linda Fred Inpt Pharm Director	24.0		X		165,054	0	32,778
(25) Robert Tonkinson SVP & CFO-former	0.0			X	0	309,933	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	926,434	6,560,936	1,395,615

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		3,346,075
e	Government grants (contributions)1e		3,519,679

f	All other contributions, gifts, grants, and similar amounts not included above1f		448,329
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			7,314,083
			Business Code
2a	Net Patient Care		621,110	413,153,806	413,153,806
b	Net Patient Care - ASC		621,110	2,108,918	2,108,918
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			415,262,724
3	Investment income (including dividends, interest
	and other similar amounts).....			323,608			323,608
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents		5,455,983
b	Less: rental expenses		4,034,052
c	Rental income or (loss)		1,421,931
d	Net rental income or (loss).......			1,421,931		1,421,931
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		9,183,591
b	Less: cost or other basis and sales expenses		3,008,920
c	Gain or (loss)		6,174,671
d	Net gain or (loss)..........			6,174,671		107,169	6,067,502
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		20,443,279
b	Less: cost of goods sold ..b		19,042,210
c	Net income or (loss) from sales of inventory..			1,401,069		1,401,069
Miscellaneous Revenue			Business Code
11a	Internal Management Fees		900,099	800,015	800,015
b	INCOME TAX REFUNDS		900,099	312,720	312,720
c	HOSPICE HOMECARE SERVICES ROOM AND BOARD		900,099	350,711	350,711
d	All other revenue ....			1,219,258	439,219		780,039
e	Total. Add lines 11a–11d ......			2,682,704
12	Total revenue. See Instructions....			434,580,790	417,165,389	2,930,169	7,171,149


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			112,000	1	124,000
2	Savings and temporary cash investments .......			0	2	0
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			76,045,181	4	86,175,599
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			8,130,434	8	6,391,661
9	Prepaid expenses and deferred charges ............			4,549,292	9	1,739,894
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	70,818,713
b	Less: accumulated depreciation. .....	10b	28,336,432	42,270,824	10c	42,482,281
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			57,293,730	15	101,381,057
16	Total assets. Add lines 1 through 15 (must equal line 34)...			188,401,461	16	238,294,492
17	Accounts payable and accrued expenses .			23,119,172	17	20,492,866
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			56,776,595	25	50,822,173
26	Total liabilities. Add lines 17 through 25.....			79,895,767	26	71,315,039
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			108,505,694	27	166,979,453
28	Temporarily restricted net assets .....			0	28	0
29	Permanently restricted net assets .....			0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			108,505,694	33	166,979,453
34	Total liabilities and net assets/fund balances .....			188,401,461	34	238,294,492