TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) PETER KAMBEROS CHAIRMAN AND COO	40.00	X	X		257,239	1,740
(2) MARIO ADAJAR TRUSTEE	4.00	X			3,600	0
(3) EDWIN C LENNOX TREASURER	6.00	X	X		7,800	0
(4) JAMES E NUGENT VICE CHAIR	6.00	X	X		7,800	0
(5) BHAGWAN JAIN TRUSTEE - PART YEAR	4.00	X			0	0
(6) JAY MOHAN TRUSTEE	4.00	X			0	0
(7) ROBERT J BAUDINO TRUSTEE	6.00	X			7,600	0
(8) ANASTASIOS MALLIARIS TRUSTEE	6.00	X			6,400	0
(9) PHILIP GORELICK MD TRUSTEE	4.00	X			2,800	0
(10) DANIEL SHIN MD MEDICAL STAFF PRESIDENT - THRU 12/31	4.00	X	X		0	0
(11) JAMES DIESFELD MD MEDICAL STAFF PRESIDENT - AS OF 1/1	4.00	X			0	0
(12) FRANK SOLARE PRESIDENT AND CEO	40.00		X		267,432	13,830
(13) EDWARD BUDD CHIEF FINANCIAL OFFICER	40.00		X		201,977	17,563
(14) MORGAN FRANCIS MURPHY III SECRETARY	40.00		X		173,735	1,708
(15) MARY MCCAHILL CHIEF NURSING OFFICER	40.00		X		168,505	7,163
(16) NITIN BARMAN CHIEF OF INTERVENTIONAL CARDIOLOGY	32.00			X	354,506	1,341
(17) MARIAN URIARTE HOUSE PHYSICIAN	40.00			X	153,636	3,165

(A) Name and business address	(B) Description of services	(C) Compensation
UNITED MAINTENANCE SERVICE PO BOX 87618 CHICAGO,IL60680	ENVIRONMENTAL SERVICES	630,903
EPMG 2000 GREEN ROAD STE 300 ANN ARBOR,MI481051571	ER GROUP	593,990
ARAMARK HEALTHCARE SUPPORT SERVICE 25271 NETWORK PLACE CHICAGO,IL60673	DIETARY MANAGEMENT & FOOD SUPPLIES	484,850
UNITED SECURITY SERVICE INC PO BOX 87618 CHICAGO,IL60680	SECURITY SERVICES	424,074
UC ANESTHESIA LLC 1770 1ST STREET STE 703 HIGHLAND PARK,IL60035	ANESTHESIA SERVICES	355,950
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 23

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 U.S. See Part IV, line 21
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,080,732		1,080,732
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	18,954,754	15,342,784	3,611,970
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....
9	Other employee benefits .......	3,273,236	2,544,081	729,155
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	40,897		40,897
c	Accounting ...........	90,225		90,225
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........	2,022,065	1,551,711	470,354
12	Advertising and promotion ....	1,695	1,695
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	194,547	194,547
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	786,044	786,044
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	3,686,545	2,829,015	857,530
23	Insurance ..............	621,592		621,592
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	MEDICAL SUPPLIES	9,825,653	7,540,101	2,285,552
b	PURCHASED SERVICES	7,667,143	5,883,684	1,783,459
c	MEDICAID ASSESSMENT	3,864,236	3,864,236
d	BAD DEBT	3,013,138	3,013,138
e
f	All other expenses	38,704	29,701	9,003
25	Total functional expenses. Add lines 1 through 24f	55,161,206	43,580,737	11,580,469	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........		1
2	Savings and temporary cash investments .......	16,593,399	2	17,229,055
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	4,209,472	4	4,246,004
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
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 ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	1,063,470	8	878,903
9	Prepaid expenses and deferred charges ............	938,213	9	1,238,181
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,638,975
b	Less: accumulated depreciation. .....	10b	47,635,386	40,330,231	10c	39,003,589
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	125,594,149	12	160,615,205
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	11,000,518	15	10,065,518
16	Total assets. Add lines 1 through 15 (must equal line 34)...	199,729,452	16	233,276,455
	17	Accounts payable and accrued expenses .	5,371,956	17	5,259,059
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	16,403,334	20	15,275,744
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	181,462	23	101,055
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	24,231,721	25	22,708,760
26	Total liabilities. Add lines 17 through 25.....	46,188,473	26	43,344,618
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	153,540,979	27	189,931,837
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	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 .....	153,540,979	33	189,931,837
34	Total liabilities and net assets/fund balances .....	199,729,452	34	233,276,455

- 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

2010

Open to Public
Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

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) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

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—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. 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) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... 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) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

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, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

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 may 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 pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–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 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable 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, 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, 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 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) 2010

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	Investment earnings or 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 held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

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

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

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	9,426,777		9,426,777
b	Buildings ................	49,620,243	28,826,014	20,794,229
c	Leasehold improvements ............	1,511,394	1,219,011	292,383
d	Equipment ................	25,420,537	17,590,361	7,830,176
e	Other .................	660,024		660,024
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				39,003,589

Schedule D (Form 990) 2010

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
(3)Other (A) CASH & SHORT TERM INVESTMENTS	1,529,158	F
(B) FIXED INCOME SECURITIES	55,541,683	F
(C) EQUITY SECURITY FUNDS	95,602,836	F
(D) GOVERNMENTAL SECURITIES	7,941,528	F





Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)	160,615,205

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) should 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









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
SELF-INSURANCE RESERVE		4,500,000
POST RETIREMENT BENEFITS		80,000
THIRD PARTY PAYOR SETTLEMENTS		8,140,750
OBLIGATIONS UNDER SECURITY LENDING		9,988,010





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		22,708,760
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) 2010

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	73,361,148
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	55,161,206
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	18,199,942
4	Net unrealized gains (losses) on investments ..........................	4	18,190,916
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 - 8 .............................	9	18,190,916
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	36,390,858

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	91,552,064
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	18,190,916
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	18,190,916
3	Subtract line 2e from line 1.....................			3	73,361,148
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	0
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	73,361,148

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1	55,161,206
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	0
3	Subtract line 2e from line 1.....................		3	55,161,206
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	0
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5	55,161,206

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
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X:	THE HOSPITAL IS EXEMPT FROM TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, NO AUDITS ARE CURRENTLY IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2008.

Schedule D (Form 990) 2010

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

2010

Open to Public Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

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

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

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

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

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other 60000.0000000000 %

If the organization does 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 uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care 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 discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does 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.

Charity Care 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 Charity care at cost (from Worksheets 1 and 2) ..	1,256,000		1,256,000	2.410 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	17,548,013	19,927,522	-2,379,509	0 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	18,804,013	19,927,522	-1,123,509	2.410 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	278,298	82,578	195,720	0.380 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..	669,600		669,600	1.280 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..
jTotal Other Benefits ...	947,898	82,578	865,320	1.660 %
kTotal. Add lines 7d and 7j. ..	19,751,911	20,010,100	-258,189	4.070 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does 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 (at cost).....

940,702

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

564,421

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).....

21,476,177

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

14,909,091

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

6,567,086

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

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(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) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	THOREK MEMORIAL HOSPITAL 850 W IRVING PARK ROAD CHICAGO,IL60613	X	X	X

Schedule H (Form 990) 2010

Page 4

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)

Name of Hospital Facility:NOT REQUIRED

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 2010)
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 those 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 all of 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	Development of a community benefit plan for the facility
	d	Participation in 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 CHNA
	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 together with 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	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	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
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times 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 that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 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 a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

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
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	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)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	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
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description 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, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health 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
		PART I, LINE 3C: THOREK PROVIDES MEDICALLY NECESSARY SERVICES TO ALL PATIENTS THAT REQUIRE IT, REGARDLESS OF RACE, CREED, COLOR, GENDER, OR COUNTRY OF NATIONAL ORIGIN AND WITHOUT REGARDS TO ABILITY OF THE PATIENT TO PAY FOR SUCH SERVICES. THOREK PROVIDES A MINIMUM 55% DISCOUNT OF CHARGES FOR ALL PATIENTS WITHOUT INSURANCE, REGARDLESS OF INCOME OR ASSETS. PATIENTS ARE ELIGIBLE FOR AN ADDITIONAL 25% QUICK PAY DISCOUNT ON THE REMAINING AMOUNT DUE AFTER THE INTIAL 55% DISCOUNT. PATIENTS ARE ELIGIBLE FOR ADDITIONAL PAYMENT REDUCTIONS AND OR INTEREST FREE PAYMENT PLANS UP TO AND INCLUDING COMPLETE WRITEOFF OF CHARGES FOR PATIENTS THAT ARE ELIGIBLE FOR THE HOSPITAL'S CHARITY CARE POLICY OR SHOW SEVERE FINANCIAL DISTRESS.
		PART I, LINE 6A: THOREK PREPARES AND FILES THE ANNUAL NON PROFIT HOSPITAL COMMUNITY BENEFITS PLAN REPORT BY DECEMBER 31 OF EACH YEAR WITH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS.
		PART I, LINE 7: FINANCIAL ASSISTANCE AT COST AND UNREIMBURSED MEDICAID: A COST TO CHARGE METHODOLOGY BASED ON THE 2011 MEDICARE COST REPORT (FILED) WAS USED TO CALCULATE THE COSTS OF CHARITY CARE. COSTS WERE DETERMINED IN ACCORDANCE WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION INCLUDING THE FOLLOWING METHODOLOGIES; DIRECT COSTS INCLUDE THE HOURLY WAGES OF EMPLOYEES PROVIDING SERVICES, COST OF SUPPLIES, COST OF SPACE UTILIZED TO PROVIDE SERVICES, AND ANY OTHER DIRECT COSTS INCURRED IN THE PROVISION OF SERVICES AND A COST TO CHARGE METHODOLOGY BASED ON THE 2011 MEDICARE COST REPORT (FILED). INDIRECT COSTS WERE INCLUDED WHERE APPLICABLE BASED UPON A COST TO CHARGE METHODOLOGY BASED ON THE 2011 MEDICARE COST REPORT (FILED) OR CALCULATED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. FOR ALL COSTS, THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN THIS SECTION AS WELL AS THROUGHOUT SCHEDULE H. FOR SOME COSTS, THE BEST AVAILABLE DATA WAS OBTAINED VIA THE HOSPITAL'S COST ACCOUNTING SYSTEM. IN OTHER INSTANCES, A COST TO CHARGE RATIO (2011 MEDICARE FILED) WAS CALCULATED AND APPLIED TO THOSE CHARGES FOR THOSE SERVICES.
		PART I, LINE 7G: THOREK HAS NOT INCLUDED COSTS ATTRIBUTABLE TO ANY PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES.
		PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3013138.
		PART II: IN 2011, THOREK FOCUSED MOST OF ITS COMMUNITY EFFORTS IN TO OTHER COMMUNITY ACTIVITIES SUCH AS HEALTH FAIRS AND PROVIDING SERVICES TO CHICAGO HOUSING AUTHORITY RESIDENTS AND OTHER ACTIVITIES THAT WERE NOT "COMMUNITY BUILDING" AS DESCRIBED BY THE CATHOLIC HEALTH ASSOCIATION.
		PART III, LINE 4: THE COST OF BAD DEBT AS REFLECTED IN PART III LINE 2, WAS CALCULATED USING A COST TO CHARGE RATIO USING THE MEDICARE COST REPORT (2011 FILED). ANY DISCOUNTS PROVIDED OR ANY PAYMENTS RECEIVED AND APPLIED TO A PATIENT ACCOUNT ARE APPLIED TO THE ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFFS AND ARE NOT INCLUDED IN THE PROVISION FOR BAD DEBT IN THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR DOUBTFUL ACCOUNTS IS CALCULATED BASED ON HISTORICAL NET COLLECTIONS AND BAD DEBT WRITE-OFFS CONSIDERING ECONOMIC AND PATIENT FINANCIAL CONDITIONS, CHANGES IN HEALTHCARE COVERAGES, AND OTHER COLLECTION INDICATORS. MANAGEMENT WILL PERIODICALLY ASSESS THE APPROPRIATENESS OF THIS ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORICAL WRITE-OFF PERCENTAGES BY PAYOR. FOR ACCOUNTS WITH REMAINING PATIENT RESPONSIBILITY AFTER INSURANCE PAYMENT, THOREK WILL FOLLOW ITS POLICY (AND REQUIRED BY PAYORS INCLUDING MEDICARE) FOR PLACING CERTAIN OF THESE ACCOUNTS WITH PAST DUE BALANCES AND NO PAYMENT OR COMMUNICATION BY THE PATIENT WITH OUTSIDE AGENCIES SUBJECT TO THE RESTRICTIONS PLACED ON THIS ACTIVITY BY THE HOSPITAL MANAGEMENT. THOREK PATIENT ACCOUNTS MANAGEMENT MANUALLY REVIEWS ALL SELF-PAY ACCOUNTS PRIOR TO PLACING THE ACCOUNTS FOR BAD DEBT. LARGE ACCOUNTS (GREATER THAN $5,000) WILL BE REFERRED TO SENIOR MANAGEMENT FOR REVIEW. THROUGH THIS PROCESS, THE PATIENTS' CREDIT HISTORY AND SCORE IS EXAMINED TO DETERMINE IF THE PATIENT HAS FINANCIAL MEANS TO PAY ANY OF THE AMOUNT OWED. IF THE PATIENT IS NOT COOPERATIVE WITH THIS PROCESS AND THE PATIENT DOES NOT QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY, THE ACCOUNT MAY BE FORWARDED TO A COLLECTION SERVICE, BUT ONLY WHEN ALL OTHER METHODS HAVE FAILED. WE BELIEVE THAT GREATER THAN 60% OF THE ACCOUNTS CHARGED AS BAD DEBT ARE LIKELY ELIGIBLE FOR CHARITY CARE BUT SUFFICIENT INFORMATION OR DOCUMENTATION IS NOT RECEIVED FROM PATIENT IN ORDER TO ALLOW CLASSIFICATION AS CHARITY CARE. THOREK, THEREFORE, BELIEVES THIS PERCENTAGE APPLIES TO THE TOTAL BAD DEBT EXPENSE AS A WHOLE. THEREFORE, OF THE $940,702 (AT COST) OF BAD DEBT EXPENSE, THOREK BELIEVES APPROXIMATELY 60% OF THIS AMOUNT, OR $564,421 (AT COST), LIKELY REPRESENTS CHARITY CARE.THE FINANCIAL STATEMENTS FOR THOREK MEMORIAL HOSPITAL FOR THE YEAR ENDING JUNE 30, 2011 DID NOT CONTAIN A FOOTNOTE THAT REFERENCED THE PROVISION FOR BAD DEBT EXPENSE FOR THE 2011 FISCAL YEAR AUDIT. HOWEVER, THE HOSPITAL DID PROVIDE SIGNIFICANT AMOUNTS OF UNCOMPENSATED CARE TO ITS UNDERINSURED AND UNINSURED PATIENTS DURING THE FISCAL YEARS ENDING 2011. THE HOSPITAL'S PROVISION FOR BAD DEBT WAS INCLUDED IN THE STATEMENT OF OPERATIONS FOR FISCAL YEARS ENDING JUNE 30, 2011 AND AGGREGATED $3,013,138 IN CHARGES WHICH EQUATED TO $940,702 AT COST. THE COST AMOUNT WAS CALCULATED USING A COST TO CHARGE RATIO UTILIZING THE MEDICARE COST REPORT (2011 FILED).ANY CONTRACTUAL ADJUSTMENTS OR OTHER DISCOUNTS AND PAYMENTS ARE NOT INCLUDED IN THE PROVISION FOR BAD DEBT EXPENSE IN THE THOREK MEMORIAL HOSPITAL FINANCIAL STATEMENTS UNLESS THE PAYMENT REPRESENTS A RECOVERY OF AN AMOUNT THAT HAD BEEN PREVIOUSLY WRITTEN OFF AND CLASSIFIED AS PROVISION FOR BAD DEBT EXPENSE. THE RECOVERY IS RECORDED IN THE TIME PERIOD IN WHICH IT OCCURS.
		PART III, LINE 8: MEDICARE COSTS ARE ALLOCATED BY COST CENTER IN ACCORDANCE WITH MEDICARE REGULATIONS. THE COSTS ARE CALCULATED USING A COST TO CHARGE RATIO IN MOST CASES.
		PART III, LINE 9B: THOREK PROVIDES FINANCIAL ASSISTANCE TO ALL PATIENTS THAT REQUEST IT. IN ADDITION, THOREK SEEKS TO ENGAGE PATIENTS PROACTIVELY TO DETERMINE IF FINANCIAL ASSISTANCE IS NEEDED, ESPECIALLY AT THE TIME OF SERVICE. THIS SERVICE IS ACCOMPLISHED BY COMMUNICATING THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THE PATIENT THROUGH POSTED SIGNS THROUGHOUT THE HOSPITAL AS WELL AS NOTICES ON THE HOSPITAL WEBSITE AND ALL BILLING CORRESPONDENCE. FURTHERMORE THE HOSPITAL FINANCIAL COUNSELORS WILL PROVIDE ASSISTANCE RANGING FROM ASSISTANCE IN COMPLETING THE HOSPITAL'S CHARITY CARE POLICY, TO PROVIDING PAYMENT PLANS TO THOSE WITHOUT INSURANCE OR WITH PATIENT RESPONSIBILITIES AFTER REIMBURSEMENT BY THE PRIMARY INSURANCE, AND WILL SEEK INSURANCE COVERAGE FOR THOSE PATIENTS UNINSURED. THE HOSPITAL'S FINANCIAL COUNSELORS WILL SEEK TO MAKE CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP THEM IN ANY WAY POSSIBLE TO MEET THEIR FINANCIAL RESPONSIBILITIES IN A SUPPORTIVE MANNER OR IDENTIFY ELIGIBILITY FOR THE HOSPITAL'S CHARITY CARE POLICY. FINANCIAL COUNSELORS WORK WITH PATIENTS IN PERSON WHILE STILL AN INPATIENT IF APPROPRIATE, AFTER AN OUTPATIENT SERVICE AT THE HOSPITAL, OR SOON AFTER SERVICE IS PROVIDED TELEPHONICALLY. AS PART OF THIS PROCESS, THE COUNSELORS WILL ATTEMPT TO DETERMINE IF THERE ARE ANY THIRD PARTY PAYERS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS. THE COUNSELORS WILL WORK WITH OUR PATIENTS TO DETERMINE IF THEY ARE ELIGIBLE FOR MEDICAID OR OTHER STATE OR LOCAL FUNDED PROGRAMS INCLUDING CRIME VICTIMS, ALTERNATIVE INSURANCE INCLUDING COBRA, WORKER'S COMPENSATION, AND/OR OTHER APPROPRIATE THIRD PARTY LIABILITY PAYOR. THE HOSPITAL CONTRACTS WITH AN OUTSIDE FIRM TO PROVIDE ONE FULL-TIME FINANCIAL COUNSELOR AND SUPPORTING STAFF THAT WORK WITH APPROXIMATELY 150 PATIENT ACCOUNTS PER MONTH.THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE BEGINS WITH A PHONE CALL OR MEETING WITH THE PATIENT TO COMPLETE THE HOSPITAL CHARITY CARE APPLICATION FORMS AND/OR PROVIDED EVIDENCE OF THE NEED FOR FINANCIAL ASSISTANCE. IF THE CHARITY CARE APPLICATION MEETS THE HOSPITAL CHARITY CARE GUIDELINES OF 200% OF THE FEDERAL POVERTY GUIDELINES, NO FURTHER COLLECTION ACTIVITY OCCURS AND THE AMOUNT IS APPROPRIATELY RECORDED AS CHARITY CARE AND WRITTEN OFF AFTER THE 55% INITIAL DISCOUNT IS APPLIED. FOR PATIENTS THAT DO NOT MEET CHARITY CARE GUIDELINES, A 55% (BASED ON 600% OF FEDERAL POVERTY GUIDELINES) INITIAL DISCOUNT IS TAKEN AND THE REMAINDER IS ELIGIBLE FOR A 25% IMMEDIATE PAYMENT DISCOUNT. THE REMAINING AMOUNT WILL BE PAID BASED UPON AN AGREED UPON PAYMENT PLAN (UP TO ONE YEAR) WITH THE PATIENT OR WILL RECEIVE FURTHER DISCOUNT BASED UPON THE INDIVIDUAL PATIENT'S FINANCIAL SITUATION. ANY FINAL AMOUNT THAT WILL BE PAID IS DETERMINED AND PAID IN FULL OR ACCORDING TO AN AGREED UPON PAYMENT PLAN WITH THE PATIENT (UP TO ONE YEAR). EVERY OPPORTUNITY WILL BE MADE TO ENSURE THE PATIENT HAS THE CHANCE TO PAY WHAT THEY CAN AFFORD TO BASED UPON THEIR FINANCIAL SITUATION AT THAT TIME. THE HOSPITAL DOES NOT ATTEMPT TO GARNISH ANY WAGES OF THE PATIENT, DOES NOT FILE LIENS ON ANY PERSONAL PROPERTY OF THE PATIENT, NOR DOES IT PURSUE ANY OTHER AGGRESSIVE COLLECTION TECHNIQUES IN PURSUIT OF PAYMENT.
		PART VI, LINE 2: THOREK WILL BE UTILIZING A COMMUNITY HEALTH ASSESSMENT SURVEY (CONDUCTED IN 2009) WITH AN ASSISTANCE OF AN OUTSIDE RESEARCH FIRM IN ORDER TO CAPTURE PRIMARY AND SECONDARY DATA ON THE HEALTH STATUS AND OPPORTUNITIES FOR IMPROVEMENT OF HEALTH SERVICES IN ITS COMMUNITY. THE PRIMARY DATA WAS OBTAINED THROUGH A TELEPHONE SURVEY OF OVER 1,000 ADULTS IN COOK COUNTY THROUGH A 20-25 MINUTE INTERVIEW WITH 136 INDIVIDUAL QUESTIONS THAT ADDRESSED THE FOLLOWING ISSUES: SELF-REPORTED HEALTH STATUS, PHYSICAL AND MENTAL HEALTH STATUS, INFECTIOUS & CHRONIC DISEASE, MODIFIABLE HEALTH RISKS, ACCESS TO HEALTHCARE SERVICES, HEALTH EDUCATION & OUTREACH, AND HEALTH INFORMATION SOURCES. THESE SURVEYS WERE CONDUCTED IN ENGLISH AND SPANISH. THE PRIMARY DATA WAS SUPPLEMENTED WITH SECONDARY DATA INCLUDING SUCH SOURCES AS CDC, FBI, COUNTY AND STATE PUBLIC HEALTH DEPARTMENTS, NATIONAL CENTER FOR HEALTH STATISTICS, AND THE U.S. CENSUS BUREAU DATA. THE SECONDARY DATA INCLUDES BUT IS NOT LIMITED TO THE FOLLOWING TOPICS: LEADING CAUSES OF DEATH, AGE-ADJUSTED DEATH RATES, VACCINE-PREVENTABLE CONDITIONS (IT WAS NOTED THAT 70% OF ADULTS SURVEYED DID NOT RECEIVE A FLU SHOT WITHIN THE PAST TWELVE MONTHS), STDS, HIV, AND OTHER INFECTIOUS DISEASES, AND FBI CRIME INDEX. THOREK PLANS TO USE THE ASSESSMENT INFORMATION TO EXPAND EXISTING AND CREATE NEW COMMUNITY HEALTH PROGRAMS MOST NEEDED BY UNDERSTANDING THE PREVALENCE OF CHRONIC CONDITIONS, BARRIERS TO ACCESS, AND OTHER HEALTH ISSUES IN THE COMMUNITY.IN ADDITION TO THE SURVEY, THOREK HAS HISTORICALLY AND WILL CONTINUE TO IDENTIFY PRIORITIES FOR COMMUNITY BENEFIT THROUGH THE FOLLOWING INTERNAL REVIEW:THE THOREK MEMORIAL HOSPITAL (TMH) COMMUNITY NEEDS ASSESSMENT IS AN ONGOING PROCESS CONDUCTED BY TMH MANAGEMENT AND SUMMARIZED ANNUALLY IN THE ANNUAL NON PROFIT HOSPITAL COMMUNITY BENEFIT PLAN REPORT SUBMITTED TO THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. THIS PROCESS UTILIZES INFORMATION OBTAINED FROM HEALTH AGENCIES AND PRACTITIONERS, COMMUNITY ORGANIZATIONS, AND COMMUNITY REPRESENTATIVES. THIS INFORMATION HAS BEEN GATHERED EITHER THROUGH REVIEW OF PUBLISHED INFORMATION, WRITTEN FEEDBACK, OR DIRECT INTERVIEWS OR DISCUSSIONS WITH PHYSICIANS AND PATIENTS. INDIVIDUALS INCLUDED ARE PHYSICIANS AND ALLIED HEALTH PROFESSIONALS, REPRESENTATIVES FROM THE ELDERLY POPULATION, LOCAL EMPLOYERS, AND COMMUNITY REPRESENTATIVES. FINDINGS FROM THE ASSESSMENT INDICATE: - TMH SERVES A POPULATION HAVING LIMITED ECONOMIC MEANS - THE POPULATION SERVED BY TMH IS NOT BASED ON GEOGRAPHIC PROXIMITY - THERE IS A CONSENSUS BETWEEN TMH AND ITS MEDICAL STAFF REGARDING GOALS - THERE IS LOW CONSUMER AWARENESS OF TMH SERVICES, HOWEVER, THIS IS IMPROVINGTHE TOP PRIORITY UNMET HEALTH NEEDS, BY AGE GROUP, ARE AS FOLLOWS. - ADULTS: ACCESS TO SERVICES (INSURANCE, COST) - SENIORS:COST; MEDICATIONS; POST-HOSPITAL SUPPORT; AND TRANSPORTATIONTHOREK MEMORIAL HOSPITAL HAS ADDRESSED AND/OR PLANS TO ADDRESS THESE IDENTIFIED PRIORITY NEEDS IN THE FOLLOWING WAYS IN THE COMMUNITY:IMPROVE ACCESS TO SERVICES - AMBULATORY CARE. TMH HAS FOCUSED ON THE EXPANSION AND DIFFERENTIATION OF ITS AMBULATORY CARE PROGRAMS IN ORDER TO IMPROVE ACCESS AND SERVICE. THE AMBULATORY CARE DEPARTMENT HAS BEEN PHYSICALLY EXPANDED AND SEPARATED INTO DISTINCT COMPONENTS. - CENTER FOR PRIMARY CARE. TMH OPERATES ITS CENTER FOR PRIMARY CARE. THIS NOT ONLY INCREASED THE SPACE DEVOTED TO AMBULATORY CARE, BUT PROVIDES A PHYSICALLY DISTINCT AREA DESIGNED TO HAVE THE LOOK AND FEEL OF A PRIVATE MEDICAL OFFICE RATHER THAN A "WALK-IN CLINIC". - COMMUNITY AND LOCAL EMPLOYER HEALTH FAIRS AND EDUCATION SESSIONSFOCUS ON NEEDS AND CONCERNS OF SENIORS - CHA PROGRAM. TMH PROVIDES ACCESS TO MEDICAL SERVICES FOR RESIDENTS OF FIVE NEARBY CHICAGO HOUSING AUTHORITY (CHA) RESIDENTIAL FACILITIES BY OPERATING MEDICAL OFFICES IN THESE BUILDINGS. RESIDENTS OF THESE BUILDINGS ARE PREDOMINANTLY SENIORS WHO QUALIFY FOR SUBSIDIZED HOUSING BASED ON FINANCIAL NEED. TYPICAL OFFICE STAFFING CONSISTS OF AN RN AND A PHYSICIAN. IN ADDITION, PHARMACEUTICALS NEEDED BY RESIDENTS ARE DELIVERED FREE OF CHARGE FOR THOSE RESIDENTS THAT REQUIRE THEM BASED ON AN APPROPRIATE COMPLETED SCRIPTS BY THE PHYSICIANS. IN ADDITION TO THE PROVISION OF HEALTH SERVICES, EDUCATIONAL, SOCIAL, AND OTHER ACTIVITIES ARE ARRANGED BY STAFF FOR THE PATIENTS OF CHA AT FIVE SITES ON THE NORTH SIDE OF CHICAGO, IN THOREK'S PRIMARY SERVICE AREA. NO AMOUNTS ARE BILLED BY THE HOSPITAL FOR HEALTHCARE SERVICES PROVIDED AT THESE SITES. THOREK HOSPITAL ALSO HELPS TO PROVIDE ACCESS TO SPECIALTY (CONSULTANT) PHYSICIAN SERVICES TO MEMBERS ON AN AS NEEDED BASIS. - MEDICATION. RECOGNIZING THE NEED TO PROVIDE ACCESS, EXPAND ALTERNATIVES, AND IMPROVE CONVENIENCE TO THOSE WE SERVE, TMH CONTINUES TO PROVIDE MEDICATION THROUGH ITS OUTPATIENT PHARMACY TO HOSPITAL PATIENTS AND CHA RESIDENTS. - TRANSPORTATION. TMH PROVIDES TRANSPORTATION VIA HOSPITAL VAN AND CONTRACTED TRANSPORTATION SERVICES BASED ON HOSPITAL TRANSPORTATION POLICIES TO 50+ CLUB MEMBERS AND OTHERS WITHIN DESIGNATED GEOGRAPHIC BOUNDARIES, AS DETERMINED APPROPRIATE BASED ON NEED AND CLINICAL STATUS, WHEN HOSPITAL SERVICES HAVE BEEN SCHEDULED IN ACCORDANCE WITH THE HOSPITAL'S TRANSPORTATION POLICY. INCREASE AWARENESS OF HEALTH PROGRAMS AVAILABLE - COMMUNICATION OF SERVICES TO THE COMMUNITY AND ITS ORGANIZATIONS - COMMUNITY HEALTH EDUCATION PROGRAMS DISCUSSING PREVENTION AND WELLNESS - ACCESS TO HOSPITAL AND PHYSICIAN SERVICES
		PART VI, LINE 3: THOREK UTILIZES SEVERAL METHODS TO COMMUNICATE ITS RESPONSIBILITY TO INFORM AND EDUCATE PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER GOVERNMENTAL PROGRAMS OR THE HOSPITAL'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICIES. THE HOSPITAL POSTS THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE IN ENGLISH AND SPANISH IN ALL REGISTRATION AND MOST WAITING AREAS THROUGHOUT THE HOSPITAL. THE AVAILABILITY FOR CHARITY CARE AS WELL AS THE WORKSHEET TO CALCULATE ELIGIBILITY FOR CHARITY CARE IS POSTED ON THE HOSPITAL'S WEBSITE. IN ADDITION, ALL BILLS AND STATEMENTS SENT TO PATIENTS INCLUDE INFORMATION REGARDING THE FINANCIAL ASSISTANCE AND CHARITY CARE OPPORTUNITIES IN ENGLISH AND SPANISH. THE HOSPITAL ALSO CONTACTS FOR A FULL TIME FTE TO PROVIDE FINANCIAL COUNSELING TO PATIENTS WHICH INCLUDES THE ASSISTANCE IN THE MEDICAID APPLICATION PROCESS AS WELL AS A SEARCH FOR OTHER COVERAGE OPTIONS AVAILABLE. MEMBERS OF THE BUSINESS OFFICE ALSO WORK WITH PATIENTS TO SEE WHAT OTHER COMMUNITY RESOURCES MAY BE AVAILABLE TO THE PATIENT FOR CURRENT AND FUTURE CARE PROVISION. THE FINANCIAL COUNSELOR AND MOST OTHER EMPLOYEES IN THE HOSPITAL BUSINESS OFFICE AND PATIENT REGISTRATION ARE FLUENT IN SPANISH, AND PHONE TRANSLATORS ARE USED FOR OTHER LANGUAGES.
		PART VI, LINE 4: THOREK MEMORIAL HOSPITAL IS REPRESENTATIVE OF THE WIDE CROSS-SECTION OF THE POPULATION THAT IT SERVES. ITS COMMUNITY INCLUDES A SIZABLE NUMBER OF AFRICAN AMERICAN, ASIAN, AND HISPANIC RESIDENTS AS WELL AS A VARIETY OF OTHER ETHNIC GROUPS. THOREK MEMORIAL HOSPITAL'S LONG-STANDING STATUS AS A PREFERRED PROVIDER OF MEDICAL SERVICES FOR EMPLOYERS, ALSO WITH A MULTI-ETHNIC MEMBERSHIP, CONTRIBUTES TO A WELL-ESTABLISHED WORKING CLASS ETHNIC CUSTOMER BASE. THE DEMOGRAPHIC SECTION OF THIS PLAN INCLUDES A LISTING THAT GIVES THE ETHNIC DISTRIBUTION OF INPATIENTS FOR FY 2011. SINCE THOREK MEMORIAL HOSPITAL'S MEDICAL STAFF ALSO REFLECTS ETHNIC DIVERSITY, WE EXPECT TO MAINTAIN A SIGNIFICANT ETHNIC CUSTOMER BASE.ALTHOUGH THOREK MEMORIAL HOSPITAL SERVES PATIENTS THROUGHOUT THE CHICAGO METROPOLITAN AREA AND EVEN AS FAR AWAY AS INDIANA AND WISCONSIN, WE HAVE DEFINED OUR COMMUNITY BASED UPON GEOGRAPHIC PROXIMITY. A PRIMARY SERVICE AREA HAS BEEN IDENTIFIED CONSISTING OF NEARBY ZIP CODE AREAS. THOREK MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF THE FOLLOWING:GRACELAND (60613),LINCOLN PARK (60614), KEDZIE-GRACE (60618), RAVENSWOOD (60625), UPTOWN (60640), LOGAN SQUARE (60647), EDGEWATER (60660), W.ROGERS PARK (60645), ROGERS PARK (60626), DIVISION (60651), AUSTIN (60644), CRAGIN (60639), GARFIELD PARK (60624), NEAR WEST (60612), HAWTHORNE (60623), PILSEN (60608), AND NEAR SOUTH (60616), AS WELL AS ZIP CODES 60653, 60615, 60621, 60637, 60620, 60619, 60649, AND 60628. THE PRIMARY NOT-FOR-PROFIT COMMUNITY HOSPITALS ALSO SERVING THIS AREAINCLUDE: WEISS MEMORIAL HOSPITAL, ILLINOIS MASONIC MEDICAL CENTER (ADVOCATE), SWEDISH COVENANT HOSPITAL, ST. JOSEPH HOSPITAL (RESURRECTION), NORWEIGAN AMERICAN HOSPITAL, METHODIST HOSPITAL, AND ST. MARY AND ST ELIZABETH HOSPITALS (RESURRECTION). APPROXIMATELY 85% OF ADMISSIONS SERVED AT THOREK ARE FEDERALLY FUNDED OR SELF PAY/CHARITY. THE HOSPITAL CONTINUES TO MEET THE CRITERIA FOR A DISPROPORTIONATE SHARE HOSPITAL FOR MEDICARE MEDICAID HIGH-VOLUME ADJUSTMENT FOR THE DEPARTMENT OF HUMAN SERVICES (PUBLIC AID).
		PART VI, LINE 6: NET COMMUNITY BENEFITS EXPENSE FOR THOREK IN 2011 IS AS FOLLOWS (FROM THE ANNUAL NON PROFIT HOSPITAL COMMUNITY BENEFITS PLAN REPORT FILED IN ACCORDANCE WITH THE ILLINOIS ATTORNEY GENERAL GUIDELINES):CHARITY CARE AT COST - $1,256,000LANGUAGE ASSISTANT SERVICES - $13,255DONATIONS - $762SUBSIDIZED HEALTH SERVICES - $834,755OTHER COMMUNITY BENEFIT PROGRAMS - $99,125THESE COSTS INCLUDE THE COSTS TO PROVIDE STAFFING AND SERVICES AT VARIOUS HEALTH FAIRS HELD IN THE COMMUNITY THROUGHOUT THE YEAR. THESE HEALTH FAIRS ARE STAFFED BY PHYSICIANS, NURSES, AND MEDICAL ASSISTANTS THAT ARE EMPLOYEES OF THE HOSPITAL. THE SERVICES PROVIDED AT THESE FAIRS INCLUDE BLOOD PRESSURE CHECKS, BLOOD GLUCOSE SCREENINGS, CHOLESTEROL TESTS AS WELL AS FLU SHOTS. ALL SERVICES ARE PROVIDED FREE OF CHARGE AT THESE HEALTH FAIRS. IN ADDITION, THE HOSPITAL PROVIDES (FREE OF CHARGE) GUARDIANSHIP SERVICES THROUGH A LOCAL LEGAL FIRM FOR THOSE INPATIENT PSYCHIATRIC PATIENTS WHO ARE NOT ABLE TO MAKE APPROPRIATE MEDICAL DECISIONS FOR THEMSELVES. ALSO INCLUDED IN OTHER COMMUNITY BENEFIT PROGRAMS IS THE PROVISION OF TRANSPORTATION TO HOSPITAL PATIENTS THAT REQUIRE THIS SERVICE TO RECEIVE APPROPRIATE MEDICALLY NECESSARY HEALTH CARE AND PHYSICIAN SERVICES. THE TRANSPORTATION FOR THESE PATIENTS IS PERFORMED IN ACCORDANCE WITH THE HOSPITAL TRANSPORTATION POLICY TOTAL CHARITY CARE AND COMMUNITY BENEFITS - $2,203,897IN ADDITION, THOREK REPORTED BAD DEBT EXPENSE (AT COST) OF $940,702 IN 2011.THOREK EXTENDS MEDICAL STAFF PRIVLEGES TO QUALIFIED PHYSICIANS IN AND AROUND OUR COMMUNITIES AND SEEKS TO PROVIDE THE PHYSICIANS, NURSES, TECHNICIANS, AND ALL OTHERS INVOLVED IN THE DELIVERY OF CARE WITH THE SAFEST AND MOST CURRENT TECHNOLOGICALLY ADVANCED HEALTHCARE ENVIRONMENT POSSIBLE. ALL SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION IN ORDER TO CONTINUE TO PROVIDE HIGH QUALITY YET EFFICIENT HEALTH CARE SERVICES TO THOREK'S COMMUNITIES IT SERVES AND TO CARRY OUT ITS MISSION FOR PATIENT CARE, EDUCATION, AND OTHER SERVICES AS NEEDED IN THE COMMUNITY. MEMBERS OF THE BOARD OF TRUSTEES ARE APPOINTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO THOREK.
REPORTS FILED WITH STATES	PART VI, LINE 7	IL

Schedule H (Form 990) 2010

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

2010

Open to Public Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

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 orprovision 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.

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? ...............

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 Regs. 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) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space 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) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(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 in prior Form 990 or Form 990-EZ
(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)
(1) PETER KAMBEROS	(i) (ii)	237,129 0	20,110 0	0 0	0 0	1,740 0	258,979 0	0 0
(2) FRANK SOLARE	(i) (ii)	267,325 0	107 0	0 0	0 0	13,830 0	281,262 0	0 0
(3) EDWARD BUDD	(i) (ii)	181,770 0	20,207 0	0 0	0 0	17,563 0	219,540 0	0 0
(4) MORGAN FRANCIS MURPHY III	(i) (ii)	153,634 0	20,101 0	0 0	0 0	1,708 0	175,443 0	0 0
(5) MARY MCCAHILL	(i) (ii)	143,395 0	25,110 0	0 0	0 0	7,163 0	175,668 0	0 0
(6) NITIN BARMAN	(i) (ii)	354,399 0	107 0	0 0	0 0	1,341 0	355,847 0	0 0
(7) MARIAN URIARTE	(i) (ii)	153,426 0	210 0	0 0	0 0	3,165 0	156,801 0	0 0
(8) VIVEK GUPTA	(i) (ii)	164,004 0	51 0	0 0	0 0	0 0	164,055 0	0 0
(9) THOMAS TRANTAFILLOU	(i) (ii)	166,733 0	2,603 0	0 0	0 0	789 0	170,125 0	0 0
(10) JOHN HUNNIFORD	(i) (ii)	233,191 0	103 0	0 0	0 0	460 0	233,754 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) PETER KAMBEROS	CHAIRMAN OF THE BOARD AND COO	59,847	PETER'S NEPHEW THERON PAPPAS IS EMPLOYED BY THOREK MEMORIAL HOSPITAL.		No

Part V

Supplemental Information

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

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

Identifier	Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11		HOSPITAL MANAGEMENT PREPARES A DRAFT OF THE FORM 990 RETURN WITH THE ASSISTANCE OF AN INDEPENDENT ACCOUNTING AND TAX FIRM. THE HOSPITAL'S INDEPENDENT ACCOUNTING AND TAX FIRM PRESENTS THIS DRAFT VERSION OF THE 990 TAX RETURN TO THE HOSPITAL BOARD OF TRUSTEES. THE BOARD OF TRUSTEES HAS THE OPPORTUNITY TO REVIEW THE RETURN, ASK QUESTIONS, AND SUGGEST CHANGES. THE BOARD OF TRUSTEES APPROVES THE FINAL VERSION OF THE RETURN AND MANAGEMENT FILES THIS RETURN WITH THE INTERNAL REVENUE SERVICE.
	FORM 990, PART VI, SECTION B, LINE 12C	THE HOSPITAL REGULARLY AND CONSISTENTLY MONITORS COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL REVIEW AND COMPLETION OF THE ANNUAL BOARD MEMBER QUESTIONNAIRE AND CONFLICT OF INTEREST POLICY BY EACH MEMBER OF THE BOARD OF TRUSTEES. THE CORPORATE COMPLIANCE OFFICER REVIEWS AND ENFORCES THE CONFLICT OF INTEREST POLICY. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM VOTING ON THE RELEVANT ISSUE.
	FORM 990, PART VI, SECTION B, LINE 15	DURING FISCAL YEAR 2011, THE HOSPITAL ENGAGED SULLIVAN AND COTTER MCHC TO PROVIDE A COMPARATIVE SALARY ANALYSIS FOR OFFICERS. THE INFORMATION WAS DISTRIBUTED TO THE COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE WILL THEN MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES ON AN ANNUAL BASIS. ALL DECISIONS BY THE BOARD OF TRUSTEES ARE DOCUMENTED IN THE BOARD MINUTES.
	FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:	FORM 990, PART XI, LINE 5:	NET UNREALIZED GAINS ON INVESTMENTS: 18,190,916.
	FORM 990, PART XII, LINE 2C:	THERE WAS NO CHANGE FROM PRIOR YEAR.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

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

2010

Open to Public Inspection

Name of the organization

THOREK MEMORIAL HOSPITAL

Employer identification number

36-6000085

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 THOREK FOUNDATION 850 WEST IRVING ROAD CHICAGO,IL60613 36-6124318	SUPPORT THOREK MEMORIAL HOSPITAL	IL	501(C)(3)	11C	THOREK MEMORIAL HOSPITAL	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2010

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

Schedule R (Form 990) 2010

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 other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

r Other transfer of cash or property from other 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)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

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

Schedule R (Form 990) 2010

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

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: HEALTH CARE SERVICES
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	8
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	612
6	Total number of volunteers (estimate if necessary) ....	6	2
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	4,790
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	62,986,987	62,183,249
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,659,166	10,019,692
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	811,902	1,158,207
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	69,458,055	73,361,148
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	21,340,299	23,308,722
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)....	33,035,603	31,852,484
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	54,375,902	55,161,206
19	Revenue less expenses. Subtract line 18 from line 12......	15,082,153	18,199,942
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	199,729,452	233,276,455
21	Total liabilities (Part X, line 26)............	46,188,473	43,344,618
22	Net assets or fund balances. Subtract line 21 from line 20 .....	153,540,979	189,931,837

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 43,580,737 including grants of $ ) (Revenue $ 62,183,249 )
	THOREK MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THOREK HOSPITAL, WE RECOGNIZE THAT IT IS THE HOSPITAL'S MISSION TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION AND THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES.THEREFORE, IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, WE PROVIDE FREE CARE AND OR SUBSIDIZED CARE TO INDIVIDUALS WHO ARE UNABLE TO PAY FOR ESSENTIAL SERVICES; AND PROVIDE HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT OUR COMMUNITY. DURING 2011, THOREK HOSPITAL PROVIDED OVER 28,195 DAYS RELATED TO INPATIENT CARE FOR OVER 6,200 ADMISSIONS, AND PROVIDED OVER 126,000 OUTPATIENT TREATMENTS. IN ADDITION, THE HOSPITAL TREATED OVER 10,900 PATIENTS THROUGH ITS EMERGENCY ROOM. A LARGE PORTION OF THE COST OF PROVIDING SERVICES TO THE COMMUNITY THROUGH THE ER WAS SUBSIDIZED BY THE HOSPITAL.RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED COST OF PROVIDING CARE TO CHARITY CARE PATIENTS IN 2011 WAS APPROXIMATELY $1,256,000. THE HOSPITAL PROVIDES FREE CARE TO PATIENTS WHO MEET CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE. IN ADDITION, THE HOSPITAL PROVIDES DISCOUNTS OFF ESTABLISHED RATES TO PATIENTS THAT DO NOT MEET CHARITY CARE REQUIREMENTS. THESE DISCOUNTS ARE AVAILABLE TO ALL PATIENTS WHO CANNOT AFFORD THE COST OF TREATMENT. ALL PATIENTS WITHOUT INSURANCE RECEIVE AN AUTOMATIC DISCOUNT OF APPROXIMATELY 55% OF CHARGES.IN ADDITION, THE HOSPITAL PROVIDED THE FOLLOWING SERVICES TO THE COMMUNITY: - $3.1 MILLION OF CHARGES WERE FORGONE IN 2011 FOR CHARITY CARE. - PROVIDED FREE BLOOD PRESSURE SCREENINGS AT VARIOUS COMMUNITY EVENTS AND HEALTH FAIRS THROUGHOUT THE YEAR.PROVIDED MEETING FACILITIES AT THE HOSPITAL FOR SEVERAL COMMUNITY ORGANIZATIONS AT NO COST; - PROVIDED SPECIFIC ON-SITE HEALTHCARE SERVICES WITH NURSES FREE OF CHARGE FOR RESIDENTS OF SEVERAL OF THE CHICAGO HOUSING AUTHORITYS BUILDINGS HOUSING THE LOWER-INCOME ELDERLY. - PROVIDED LANGUAGE ASSISTANCE FREE OF CHARGE FOR ANY PATIENT REQUIRING THIS ASSISTANCE - OBTAINED LEGAL GUARDIANSHIP FOR PATIENTS REQUIRING THIS SERVICE AT NO COST TO THE PATIENTS - PROVIDED REDUCED PRICE MAMMOGRAM SCREENINGS TO THE COMMUNITY. - PROVIDED FREE NEED ASSESSMENTS FOR EMERGENCY ROOM WALK IN PATIENTS; - PROVIDED FREE AND DISCOUNTED VACCINES (INCLUDING INFLUENZA) AND OTHER HEALTH SERVICES TO MEMBERS OF OUR COMMUNITY; - PROVIDED REDUCED COST MEALS TO SENIOR CITIZENS; - PROVIDED TRANSPORTATION TO THOSE PATIENTS WHO NEED HEALTH SERVICES BUT WHO CANNOT AFFORD TRANSPORTATION COSTS OR ARE UNABLE OF MAKING THE APPROPRIATE ARRANGEMENTS IN ACCORDANCE WITH THE HOSPITAL'S TRANSPORTATION POLICY; - PROVIDED FREE PARKING TO ALL VISITORS AND PATIENTS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 43,580,737

(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) VIVEK GUPTA PHYSICIAN	30.00	X	164,055	0	0
(19) THOMAS TRANTAFILLOU HOUSE PHYSICIAN	40.00	X	169,336	0	789
(20) JOHN HUNNIFORD HOUSE PHYSICIAN	65.00	X	233,294	0	460

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,179,715	0	47,759

				(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
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......
			Business Code
2a	NET PATIENT REVENUE		621,110	55,129,737	55,129,737
b	MEDICAID ASSESSMENT RE		621,110	7,042,217	7,042,217
c	CAPITATION REVENUE		621,110	11,295	11,295
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			62,183,249
3	Investment income (including dividends, interest
	and other similar amounts).....			3,742,546			3,742,546
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents	598,495
b	Less: rental expenses
c	Rental income or (loss)	598,495
d	Net rental income or (loss).......			598,495			598,495
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	53,311,180
b	Less: cost or other basis and sales expenses	47,028,017	6,017
c	Gain or (loss)	6,283,163	-6,017
d	Net gain or (loss)..........			6,277,146			6,277,146
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..
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...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	MISCELLANEOUS		900,099	447,998			447,998
b	DIETARY CASH SALES		900,099	106,924			106,924
c	REFERENCE LAB		900,003	4,790		4,790
d	All other revenue ....
e	Total. Add lines 11a–11d ......			559,712
12	Total revenue. See Instructions....			73,361,148	62,183,249	4,790	11,173,109


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........				1
2	Savings and temporary cash investments .......			16,593,399	2	17,229,055
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			4,209,472	4	4,246,004
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
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 ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			1,063,470	8	878,903
9	Prepaid expenses and deferred charges ............			938,213	9	1,238,181
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,638,975
b	Less: accumulated depreciation. .....	10b	47,635,386	40,330,231	10c	39,003,589
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			125,594,149	12	160,615,205
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			11,000,518	15	10,065,518
16	Total assets. Add lines 1 through 15 (must equal line 34)...			199,729,452	16	233,276,455
17	Accounts payable and accrued expenses .			5,371,956	17	5,259,059
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			16,403,334	20	15,275,744
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			181,462	23	101,055
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			24,231,721	25	22,708,760
26	Total liabilities. Add lines 17 through 25.....			46,188,473	26	43,344,618
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			153,540,979	27	189,931,837
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	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 .....			153,540,979	33	189,931,837
34	Total liabilities and net assets/fund balances .....			199,729,452	34	233,276,455