TY 2011 Form 990

- TIN:

Form990

Department of the Treasury
Internal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0047

2011

Open to Public Inspection

A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011

BCheck if applicable: Address change Name change Initial return Terminated Amended return Application pending

CName of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER

Doing Business As

Number and street (or P.O. box if mail is not delivered to street address)
2050 Claire Court

Room/suite

City or town, state or country, and ZIP + 4
Glenview, IL60025

D Employer identification number

36-2996608

E Telephone number

G Gross receipts $ 34,637,038

F Name and address of principal officer:
JAMIE O'MALLEY
2050 Claire Court
Glenview,IL60025

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.CARECENTER.ORG

H(a)

Is this a group return for
affiliates? Yes No

H(b)

Are all affiliates included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1978

M State of legal domicile: IL

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: TO PROMOTE INDEPENDENCE, WELLNESS, COMFORT AND QUALITY OF LIFE FOR THE CHRONICALLY AND SERIOUSLY ILL, AGING AND DYING IN OUR REGION THROUGH THE DELIVERY OF A COMPASSIONATE MEDICALLY EXCELLENT CONTINUUM OF PALLIATIVE AND HOSPICE CARE AND SUPPORTIVE SERVICES. CHARITY CARE AND UNCOMPENSATED CARE = $2,345,000.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	20
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	355
6	Total number of volunteers (estimate if necessary) ....	6	373
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
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) .........	3,051,922	3,365,060
9	Program service revenue (Part VIII, line 2g) .........	24,273,061	26,403,067
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	215,948	219,851
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-42,060	-105,191
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	27,498,871	29,882,787
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)	17,339,121	19,898,513
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	77,667	0
b	Total fundraising expenses (Part IX, column (D), line 25) 641,722
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	8,062,858	8,759,010
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	25,479,646	28,657,523
19	Revenue less expenses. Subtract line 18 from line 12.......	2,019,225	1,225,264
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	29,278,907	33,167,715
21	Total liabilities (Part X, line 26).............	4,097,684	6,905,219
22	Net assets or fund balances. Subtract line 21 from line 20.....	25,181,223	26,262,496

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid preparer use only

Print/type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image

Firm's address Right pointing arrowhead image

Phone no.

May the IRS discuss this return with the preparer shown above? See instructions ......... bullet

YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y

Form 990 (2011)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response to any question in this Part III .........

Briefly describe the organization’s mission: TO PROMOTE INDEPENDENCE, WELLNESS, COMFORT AND QUALITY OF LIFE FOR THE CHRONICALLY AND SERIOUSLY ILL, AGING AND DYING IN OUR REGION THROUGH THE DELIVERY OF A COMPASSIONATE MEDICALLY EXCELLENT CONTINUUM OF PALLIATIVE AND HOSPICE CARE, HOME HEALTH AND SUPPORTIVE SERVICES. CHARITY CARE AND UNCOMPENSATED CARE = $2,345,000.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .................... Yes No

If “Yes,” describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program services? .......................... Yes No

If “Yes,” describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 19,098,793 including grants of $ ) (Revenue $ 24,371,977 )
	MIDWEST CARECENTER SERVES PATIENTS AND FAMILY MEMBERS IN 150 COMMUNITIES IN COOK AND LAKE COUNTIES THROUGH COMPREHENSIVE, COMPASSIONATE HOSPICE, PALLIATIVE CARE AND GRIEF SUPPORT SERVICES. IN 2011, 2,014 PATIENTS FACING THE END OF LIFE RECEIVED HOSPICE CARE, WHICH INVOLVES NURSING, MEDICAL MANAGEMENT, SOCIAL WORK, CHAPLAINCY AND VOLUNTEER SERVICES. BEREAVEMENT COUNSELING, IN THE FORM OF INDIVIDUALIZED AND GROUP SUPPORT, WAS PROVIDED TO 373 ADULTS AND 97 YOUTH WHO WERE GRIEVING THE DEATH OF A LOVED ONE. TO SUPPORT THESE PROGRAMS, 373 INDIVIDUALS PROVIDED 17,100 HOURS OF VOLUNTEER SERVICE THROUGH MIDWEST CARECENTER PATIENT CARE, OFFICE SUPPORT, FUNDRAISING, GOVERNANCE AND YOUTH OUTREACH SERVICES. (SEE SCHEDULE O)

4b	(Code: ) (Expenses $ 4,294,484 including grants of $ ) (Revenue $ 2,031,090 )
	PALLIATIVE CARE SERVICES PROVIDED MEDICAL CONSULTATIONS IN THE PALLIATION OF PAIN AND OTHER SYMPTOMS TO 2,149 PATIENTS.

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$ 23,393,277

Form 990 (2011)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A Click to see attachment

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

Yes

Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment

........

Yes

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........

Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I....................

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part II...

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................

Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV...................

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V Click to see attachment

Yes

If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:

Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI. Click to see attachment

11a

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.

11d

Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X. Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X. Click to see attachment

11f

Yes

12a

Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII

12a

Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment

12b

Yes

Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States?....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..

Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment

Yes

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................

20a

Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....

20a

If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.

20b

Form 990 (2011)

Page 4

Part IV

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....

Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment

Yes

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................

24c

Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................

25b

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........

Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................

28a

A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................

28b

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..

28c

Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M Click to see attachment

Yes

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment

Yes

Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........

Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...

35b

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Form 990 (2011)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule O contains a response to any question in this Part V .........

Yes

Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................

355

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?.............................

If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........

If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................

Yes

If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....

Yes

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................

If “Yes,” indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............

Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................

Sponsoring organizations maintaining donor advised funds.

Did the organization make any taxable distributions under section 4966?.........

Did the organization make a distribution to a donor, donor advisor, or related person?......

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.

13a

Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.

13b

Enter the aggregate amount of reserves on hand.

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..

14b

Form 990 (2011)

Page 6

Part VI

Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response to any question in this Part VI .........

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent .................

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .........................

Yes

Each committee with authority to act on behalf of the governing body? ..........

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....

Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?

11a

Yes

Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....

12a

Did the organization have a written conflict of interest policy? If “No,” go to line 13.......

12a

Yes

Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

Yes

If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request

Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet

David Bruce
2050 Claire Court
Glenview,IL60025
(847) 467-7423

Form 990 (2011)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response to any question in this Part VII .........

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.

Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(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
(1) JAMIE M O'MALLEY PRESIDENT & CEO - CURRENT YEAR	40.00	X	X	261,564	0	12,378
(2) M MEAD MONTGOMERY CHAIRMAN	4.00	X	X	0	0	0
(3) PETER D MORRIS VICE CHAIRMAN & TREASURER	3.00	X	X	0	0	0
(4) SCOTT F VENDER SECRETARY	3.00	X	X	0	0	0
(5) ANN WEISER DIRECTOR	1.00	X		0	0	0
(6) DARLENE LANDSITTEL DIRECTOR	1.00	X		0	0	0
(7) DAVID M TINGUE DIRECTOR	2.00	X		0	0	0
(8) DIANE M BLAKE DIRECTOR	1.00	X		0	0	0
(9) E DENNIS MURPHY MD FACP DIRECTOR	2.00	X		0	0	0
(10) ELAINE R KURCZEWSKI DIRECTOR	1.00	X		0	0	0
(11) ELIZABETH S FOLEY DIRECTOR	1.00	X		0	0	0
(12) FRANK D CELLA DIRECTOR	2.00	X		0	0	0
(13) HARRY JAFFE MD FACP DIRECTOR	1.00	X		0	0	0
(14) JANICE K HARTWELL DIRECTOR	1.00	X		0	0	0
(15) JULIA CORMIER DIRECTOR	1.00	X		0	0	0
(16) KEVIN J SHRIER DIRECTOR	1.00	X		0	0	0
(17) THOMAS W HODSON DIRECTOR	1.00	X		0	0	0

Form 990 (2011)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(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) TODD R MILLER DIRECTOR	1.00	X				0	0	0
(19) WILLIAM A GIFFORD JR DIRECTOR	1.00	X				0	0	0
(20) WILLIAM E RACINE DIRECTOR	1.00	X				0	0	0
(21) WILLIAM GRAHAM DIRECTOR	1.00	X				0	0	0
(22) DAVID C BRUCE CHIEF FINANCIAL OFFICER	40.00		X			179,742	0	10,588
(23) MARTHA L TWADDLE MD CHIEF MEDICAL OFFICER	40.00		X			273,598	0	22,529
(24) ALAN M SMOOKLER MD ASSISTANT MEDICAL DIRECTOR	40.00			X		213,134	0	32,488
(25) CATHLEEN ADAMS VICE PRESIDENT OF CLINICAL SERVICES	40.00			X		154,977	0	351
(26) JASON SOBEL MD ASSOCIATE MEDICAL DIRECTOR	40.00				X	154,407	0	22,057
(27) LYNN KATTEN MD ASSOCIATE MEDICAL DIRECTOR	40.00				X	153,688	0	16,540
(28) NANCY L O'MALLEY MD ASSOCIATE MEDICAL DIRECTOR	40.00				X	175,319	0	23,287
(29) SAMUEL KATZ MD ASSOCIATE MEDICAL DIRECTOR	40.00				X	138,063	0	15,688
(30) TIMOTHY SHORT MD ASSISTANT MEDICAL DIRECTOR	40.00				X	201,589	0	16,448

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,906,081	0	172,354

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................

Yes

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
NORTH SHORE UNIV HEALTH SYSTEM 9730 EAGLE WAY CHICAGO,IL60678	MEDICAL SERVICES	978,395
NORTHWEST COMMUNITY HOSPITAL P O BOX 95865 CHICAGO,IL60094	MEDICAL SERVICES	260,572
FAUZIA LODHI MD 6501 N SAUGANASH LINCOLNWOOD,IL60712	PHYSICIAN SERVICES	134,800


2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 3

Form 990 (2011)

Page 9

Part VIII

Statement of Revenue

				(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		263,513
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		3,101,547
g	Noncash contributions included in lines 1a-1f:$ 163,849
h	Total. Add lines 1a-1f.......			3,365,060
			Business Code
2a	HOSPICE SERVICES PATIENT REVENUE			24,371,977	24,371,977
b	PALLIATIVE CARE SVCS PATIENT REVENUE			2,031,090	2,031,090
c
d
e
f	All other program service revenue .			0	0	0	0
g	Total. Add lines 2a–2f........			26,403,067
3	Investment income (including dividends, interest
	and other similar amounts).....			178,947	0		178,947
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	4,638,761
b	Less: cost or other basis and sales expenses	4,597,857
c	Gain or (loss)	40,904	0
d	Net gain or (loss)..........			40,904	0		40,904
8a	Gross income from fundraising events (not including $ 263,513 of contributions reported on line 1c). See Part IV, line 18 ...
	a		48,478
b	Less: direct expenses ...b		154,394
c	Net income or (loss) from fundraising events..			-105,916			-105,916
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		2,725
b	Less: direct expenses ...b		2,000
c	Net income or (loss) from gaming activities...			725			725
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..			0
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions....			29,882,787	26,403,067	0	114,660

Form 990 (2011)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,221,652	732,991	488,661
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	7,392		7,392
7	Other salaries and wages	15,453,167	13,831,914	1,195,209	426,044
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	270,106	227,109	31,556	11,441
9	Other employee benefits .......	1,606,590	1,223,975	353,389	29,226
10	Payroll taxes ...........	1,339,606	1,088,946	215,822	34,838
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	41,424		41,424
c	Accounting ...........	73,383	13,490	59,893
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	10,835		10,835
g	Other ..........	2,487,040	2,136,563	334,718	15,759
12	Advertising and promotion ....	311,440	9,800	253,247	48,393
13	Office expenses .......	537,693	374,673	157,431	5,589
14	Information technology ......	396,505	81,596	280,018	34,891
15	Royalties ..	0
16	Occupancy ...........	981,363	717,182	264,181
17	Travel ............	303,632	281,116	18,568	3,948
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	37,894	17,169	19,815	910
20	Interest ...........	15,130	7,565	7,565
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	783,341	24,326	759,015
23	Insurance ..............	423,757	303,399	120,358
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	BAD DEBT	173,164	173,164
b	DRUGS AND MEDICAL SUPPLIES	2,139,443	2,139,443
c	OTHER	42,966	8,856	3,427	30,683
d
e
f	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24f	28,657,523	23,393,277	4,622,524	641,722
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).	0

Form 990 (2011)

Page 11


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			90	1	90
2	Savings and temporary cash investments .......			2,725,229	2	1,308,693
3	Pledges and grants receivable, net .........			3,495,179	3	2,627,986
4	Accounts receivable, net .........			2,767,796	4	3,953,715
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 .............			45,300	7	0
8	Inventories for sale or use ..............				8
9	Prepaid expenses and deferred charges ............			308,138	9	830,117
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	25,014,915
b	Less: accumulated depreciation. .....	10b	6,251,275	12,664,104	10c	18,763,640
11	Investments—publicly traded securities ..........			7,273,071	11	5,683,474
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)...			29,278,907	16	33,167,715
17	Accounts payable and accrued expenses .			3,337,196	17	6,225,404
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........				20
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 ..				23
24	Unsecured notes and loans payable to unrelated third parties ....			320,664	24	304,464
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			439,824	25	375,351
26	Total liabilities. Add lines 17 through 25.....			4,097,684	26	6,905,219
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			17,486,791	27	16,742,582
28	Temporarily restricted net assets .....			4,779,384	28	6,389,612
29	Permanently restricted net assets .....			2,915,048	29	3,130,302
	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 .....			25,181,223	33	26,262,496
34	Total liabilities and net assets/fund balances .....			29,278,907	34	33,167,715

Form 990 (2011)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response to any question in this Part XI .........

Total revenue (must equal Part VIII, column (A), line 12) ...

29,882,787

Total expenses (must equal Part IX, column (A), line 25) ....

28,657,523

Revenue less expenses. Subtract line 2 from line 1 ...

1,225,264

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

25,181,223

Other changes in net assets or fund balances (explain in Schedule O) ...

-143,991

Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....

26,262,496

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response to any question in this Part XII .........

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?....

Were the organization’s financial statements audited by an independent accountant?........

Yes

If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................

Yes

If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separated basis

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................

If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..

Form 990 (2011)

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

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

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

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

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

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

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

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

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

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

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

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

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

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

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

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

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

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

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

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

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

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

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

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	3,292,235	2,745,944	4,214,126	3,051,922	3,365,060	16,669,287
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......	29,244,924	25,855,676	23,809,355	24,273,061	26,403,067	129,586,083
3	Gross receipts from activities that are not an unrelated trade or business under section 513..						0
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge..						0
6	Total. Add lines 1 through 5.	32,537,159	28,601,620	28,023,481	27,324,983	29,768,127	146,255,370
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...						0
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.						0
c	Add lines 7a and 7b..	0	0	0	0	0	0
8	Public Support (Subtract line 7c from line 6.)						146,255,370

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...	32,537,159	28,601,620	28,023,481	27,324,983	29,768,127	146,255,370
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	184,336	173,773	110,298	220,677	178,947	868,031
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	184,336	173,773	110,298	220,677	178,947	868,031
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.						0
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)	20,513	56,245	57,580	43,028	51,203	228,569
13	Total support (Add lines 9, 10c, 11 and 12.).	32,742,008	28,831,638	28,191,359	27,588,688	29,998,277	147,351,970

Section C. Computation of Public Support Percentage

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

99.260 %

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

99.360 %

Section D. Computation of Investment Income Percentage

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

0.590 %

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

0.520 %

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

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

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

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

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

Facts And Circumstances Test

Explanation
OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - GROSS RECEIPTS FROM FUNDRAISING EVENTS, COLUMN A - 20513, COLUMN B - 56245, COLUMN C - 57580, COLUMN D - 43028, COLUMN E - 51203, COLUMN F - 225844;,

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2011

Name of organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

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

Page 2

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

Page 3

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

Page 4

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

Name of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Part III

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

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

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

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

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

Part V

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

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	3,444,525	3,188,719	2,727,523	2,154,865
b	Contributions ........	215,254	21,997	216,410	708,159
c	Net investment earnings, gains, and losses ...	-19,801	289,373	271,623	-90,133
d	Grants or scholarships .....		0	0	0
e	Other expenditures for facilities and programs ........	118,480	55,564	26,837	45,368
f	Administrative expenses ....		0	0	0
g	End of year balance ......	3,521,498	3,444,525	3,188,719	2,727,523

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

Board designated or quasi-endowment SchDMd Bullet

5.740 %

Permanent endowment SchDMd Bullet

88.900 %

Temporarily restricted endowment SchDMd Bullet

5.360 %

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,762,927		1,762,927
b	Buildings ................	8,864,950	1,416,899	7,448,051
c	Leasehold improvements ............	506,472	506,437	35
d	Equipment ................	6,458,772	4,327,939	2,130,833
e	Other .................	7,421,794		7,421,794
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				18,763,640

Schedule D (Form 990) 2011

Page 3

Part VII

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

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








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

Part VIII

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

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









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

Part IX

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

(a) Description				(b) Book value









Total. (Column (b) must 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) Book value
Federal Income Taxes		0
SUPPLEMENTAL RETIREMENT LIABILITY		375,351








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		375,351
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	29,882,787
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	28,657,523
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	1,225,264
4	Net unrealized gains (losses) on investments ..........................	4	-210,906
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	-444
9	Total adjustments (net). Add lines 4 through 8 .........................	9	-211,350
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	1,013,914

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	29,817,440
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-210,906
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d	0
e	Add lines 2a through 2d .....................			2e	-210,906
3	Subtract line 2e from line 1.....................			3	30,028,346
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	10,835
b	Other (Describe in Part XIV.) ...........	4b	-156,394
c	Add lines 4a and 4b.......................			4c	-145,559
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	29,882,787

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	28,803,526
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	156,838
e	Add lines 2a through 2d......................			2e	156,838
3	Subtract line 2e from line 1.....................			3	28,646,688
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	10,835
b	Other (Describe in Part XIV.) ............	4b	0
c	Add lines 4a and 4b.......................			4c	10,835
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	28,657,523

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
Intended uses of endowment funds	Schedule D, Part V, Line 4	THE ORGANIZATION USES THE ENDOWMENT FUNDS TO FUND A PORTION OF THE CHIEF MEDICAL DIRECTOR'S SALARY (ALLOWING TIME TO BE SPENT ON EDUCATIONAL PROGRAMS), FUND PALLIATIVE CARE EDUCATION PROGRAMS, FUND THE DEVELOPMENT AND BUILDING OF A HOSPICE INPATIENT PAVILION, FUND GRIEF SUPPORT SERVICES AND FUND VARIOUS OTHER PROGRAMS DESIGNATED BY THE DONORS (CHILDREN'S PROGRAMS, MUSIC THERAPY, MASSAGE THERAPY, ETC.)
FIN 48 (ASC 740) footnote	Schedule D, Part X, Line 2	CARECENTER HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED ACTIVITIES PURSUANT TO SECTION 501 (A) OF THE IRC. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. DUE TO ITS TAX-EXEMPT STATUS, CARECENTER IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. CARECENTER'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF ILLINOIS FOR THE LAST THREE YEARS. CARECENTER DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. CARECENTER RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. CARECENTER DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT DECEMBER 31, 2011 OR 2010.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and e-mail solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.

(i) Name and address of individual or entity (fundraiser)	(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
	(ii) Activity	Yes	No	(iv) Gross receipts from activity		(vi) Amount paid to (or retained by) organization
Total .................

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2011

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.

		(a) Event #1 CARE AFFAIR (event type)	(b) Event #2 GOLF OUTING (event type)	(c) Other Events (total number)	(d) Total Events (Add col. (a) through col. (c))
1	Gross receipts . . .	217,161	94,830		311,991
2	Less: Charitable contributions . . .	200,538	62,975		263,513
3	Gross income (line 1 minus line 2) . . .	16,623	31,855	0	48,478
4	Cash prizes . . .				0
5	Non-cash prizes . .	55,748	12,773		68,521
6	Rent/facility costs . .	7,100	25,000		32,100
7	Food and beverages . .	36,273	4,438		40,711
8	Entertainment . . .	1,971			1,971
9	Other direct expenses .	8,347	2,744		11,091
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				154,394
11	Net income summary. Combine lines 3 and 10 in column (d)............				-105,916

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (Add col. (a) through col. (c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," Explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," Explain:

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Schedule G (Form 990 or 990-EZ) 2011

Page 3

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Provide the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

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

Identifier	ReturnReference	Explanation

Schedule G (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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? ....

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

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

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

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

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) JAMIE M O'MALLEY	(i) (ii)	244,564 0	17,000 0	0 0	731 0	11,647 0	273,942 0	0 0
(2) NANCY L O'MALLEY MD	(i) (ii)	175,319 0	0 0	0 0	7,280 0	16,007 0	198,606 0	0 0
(3) LYNN KATTEN MD	(i) (ii)	153,688 0	0 0	0 0	6,285 0	10,255 0	170,228 0	0 0
(4) JASON SOBEL MD	(i) (ii)	154,407 0	0 0	0 0	856 0	21,201 0	176,464 0	0 0
(5) ALAN M SMOOKLER MD	(i) (ii)	213,134 0	0 0	0 0	8,382 0	24,106 0	245,622 0	0 0
(6) DAVID C BRUCE	(i) (ii)	167,048 0	12,694 0	0 0	6,770 0	3,818 0	190,330 0	0 0
(7) MARTHA L TWADDLE MD	(i) (ii)	253,995 0	19,603 0	0 0	7,910 0	14,619 0	296,127 0	0 0
(8) TIMOTHY SHORT MD	(i) (ii)	201,589 0	0 0	0 0	0 0	16,448 0	218,037 0	0 0
(9) CATHLEEN ADAMS	(i) (ii)	150,289 0	4,688 0	0 0	0 0	351 0	155,328 0	0 0
(10) SAMUEL KATZ MD	(i) (ii)	138,063 0	0 0	0 0	5,650 0	10,038 0	153,751 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation
Housing allowance or residence for personal use	Schedule J, Part I, Line 1a	CATHLEEN ADAMS, VICE PRESIDENT OF CLINICAL SERVICES, RECEIVED $3,600 FOR RENT IN CONNECTION WITH A JOB RELOCATION AS SPECIFIED BY HER EMPLOYMENT CONTRACT. THE RELATED AMOUNT WAS INCLUDED IN HER W2 AS TAXABLE COMPENSATION.
Non-fixed payments	Schedule J, Part I, Line 7	DURING 2011 THE ORGANIZATION PAID PERFOMANCE BONUSES TO THE CEO, CFO, CHIEF MEDICAL OFFICER AND THE VICE PRESIDENT OF CLINICAL SERVICES. THESE PAYMENTS WERE MADE AFTER REVIEW BY THE CHAIRMAN AND OTHER MEMBERS OF THE BOARD OF DIRECTORS.

Schedule J (Form 990) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

NonCash Contributions

Complete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Part I

Types of Property

	(a) Check if applicable	(b) Number of Contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	11	31,525	MARKET VALUE
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......	X		6,042	MARKET VALUE
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	7	59,292	MARKET VALUE
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...	X	13	5,515	MARKET VALUE
20 Drugs and medical supplies .	X	2	8,622	MARKET VALUE
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( GIFT CERTIFICATES )	X	62	43,110	MARKET VALUE
26 Other ( ART SUPPLIES )	X	3	7,412	MARKET VALUE
27 Other ( OFFICE SUPPLIES )	X	2	1,727	MARKET VALUE
28 Other ( OTHER )	X	3	604	MARKET VALUE

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it

must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ............................

32a

If "Yes," describe in Part II.

If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) 2011

Page 2

Part II

Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
Explanations of reporting method for number of contributions	Schedule M, Part I	ART - WORKS OF ART: NUMBER OF CONTRIBUTIONS CLOTHING AND HOUSEHOLD GOODS: NUMBER OF CONTRIBUTIONS SECURITIES - PUBLICLY TRADED: NUMBER OF CONTRIBUTIONS FOOD INVENTORY: NUMBER OF CONTRIBUTIONS DRUGS AND MEDICAL SUPPLIES: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed.	Schedule M, part I, column (b), Line 1	NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed.	Schedule M, part I, column (b), Line 5	NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed.	Schedule M, part I, column (b), Line 9	NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed.	Schedule M, part I, column (b), Line 19	NUMBER OF CONTRIBUTIONS

Schedule M (Form 990) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

Identifier	Return Reference	Explanation
PROGRAM SERVICE ACCOMPLISHMENTS - GENERAL INFORMATION	FORM 990, PART III, LINE 4A	(CONTINUED FROM FORM 990, PART III, LINE 4A) THE ORGANIZATION STRIVES TO ENSURE CONTINUED ACCESS TO SERVICES FOR ANYONE IN THE COMMUNITY. IN 2011, $2,208,000 OF FREE AND SUBSIDIZED CARE WAS PROVIDED THROUGH CHARITY CARE AND COMMUNITY-FUNDED, COMPLEMENTARY PROGRAMMING, WHICH INCLUDED MUSIC SERVICES AND CULTURALLY SENSITIVE INITIATIVES. MUSIC-THANATOLOGISTS HELD 448 VIGILS TO BENEFIT A TOTAL OF 301 PATIENTS AND FAMILIES. MUSIC THERAPISTS PROVIDED 1,571 MUSIC THERAPY SESSIONS FOR 295 HOSPICE PATIENTS. ADDITIONALLY, THROUGH THE ORGANIZATION'S JEWISH CARE SERVICES PROGRAM, 560 PATIENTS RECEIVED HOSPICE CARE WITH AN EMPHASIS ON JEWISH CUSTOMS AND TRADITIONS. MIDWEST PALLIATIVE & HOSPICE CARECENTER, A COMMUNITY-BASED PROVIDER OF HOSPICE, PALLIATIVE CARE AND GRIEF SUPPORT SERVICES, IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MIDWEST CARECENTER PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF RACE, COLOR, NATIONAL ANCESTRY, RELIGION, AGE, HANDICAPPING CONDITION, GENDER, SEXUAL ORIENTATION OR SOURCE OF PAYMENT. IN 2011, THE ORGANIZATION SERVED PATIENTS AND FAMILIES IN 150 COMMUNITIES IN COOK AND LAKE COUNTIES. MIDWEST CARECENTER OPERATES THE LARGEST NONPROFIT, NON-HOSPITAL-AFFILIATED HOSPICE IN THE CHICAGO AREA, AND IS RECOGNIZED AS A LEADER IN THE PROVISION OF HOSPICE CARE, PALLIATIVE MEDICINE, BEREAVEMENT SERVICES, AND EDUCATION IN END-OF-LIFE ISSUES AND PRACTICE BOTH LOCALLY AND NATIONALLY. IN RECOGNITION OF ITS LEADERSHIP ROLE, MIDWEST CARECENTER WAS AWARDED THE PRESTIGIOUS CIRCLE OF LIFE AWARD (2001) BY THE AMERICAN HOSPITAL ASSOCIATION FOR EXCELLENCE IN END-OF-LIFE CARE. MIDWEST CARECENTER OFFERS HOSPICE SERVICES FOR THE BENEFIT OF PATIENTS AND FAMILIES WHO ARE COPING WITH THE CHALLENGES OF A TERMINAL ILLNESS. THE ORGANIZATION'S GOALS ARE TO CARE FOR THE PATIENT AND FAMILY AS A WHOLE AND TO PROMOTE THE PATIENT'S DIGNITY AND QUALITY OF LIFE BY MANAGING SYMPTOMS, RELIEVING PAIN AND PROVIDING TOTAL PATIENT CARE. IN 2011, 2,014 PATIENTS RECEIVED HOSPICE CARE FROM MIDWEST CARECENTER PHYSICIANS, NURSES, SOCIAL WORKERS, CHAPLAINS AND VOLUNTEERS. THE ORGANIZATION FIRST EARNED ACCREDITATION FROM THE JOINT COMMISSION IN 1996, AND ITS HOSPICE SERVICES HAVE CONTINUOUSLY RECEIVED FULL ACCREDITATION IN SUBSEQUENT SURVEY VISITS, MOST RECENTLY IN JUNE 2011. IN ADDITION TO THE CORE HOSPICE SERVICES REQUIRED BY THE FEDERAL GOVERNMENT UNDER THE MEDICARE HOSPICE BENEFIT-NURSING, MEDICAL MANAGEMENT, SOCIAL WORK, SPIRITUAL CARE AND VOLUNTEER SERVICES-THE MIDWEST CARECENTER PATIENT BASE BENEFITED FROM ADDITIONAL COMPLEMENTARY THERAPIES, INCLUDING, MUSIC (1,571 SESSIONS IN 2011) AND MUSIC-THANATOLOGY (448 BEDSIDE VIGILS IN 2011). THESE SERVICES ARE PROVIDED AT NO ADDITIONAL COST TO THE PATIENT. THROUGH THE ORGANIZATION'S JEWISH CARE SERVICES PROGRAM, 560 PATIENTS RECEIVED HOSPICE CARE WITH AN EMPHASIS ON JEWISH CUSTOMS AND TRADITIONS. A PARTNERSHIP WITH THE JEWISH HEALING NETWORK OF CHICAGO HAS MADE IT POSSIBLE FOR MIDWEST CARECENTER TO OFFER MORE INFORMATION AND SUPPORT FOR THOSE WITH ADVANCED ILLNESS IN THE JEWISH COMMUNITY. ADDITIONALLY, TO IMPROVE ACCESS TO HOSPICE CARE AND PALLIATIVE MEDICINE FOR NON-ENGLISH-SPEAKING IMMIGRANT POPULATIONS, MIDWEST CARECENTER PROVIDES BI-LINGUAL MATERIALS TO POPULATIONS IN ITS SERVICE AREA. THROUGH ITS PALLIATIVE CARE SERVICES PROGRAM, MIDWEST CARECENTER SUPPORTS THE EFFECTIVE MEDICAL PRACTICE OF AREA PHYSICIANS BY PROVIDING CONSULTATIONS ON PAIN AND SYMPTOM MANAGEMENT FOR PATIENTS FACING SERIOUS, COMPLEX ILLNESS. IN 2011, 2,149 PATIENTS RECEIVED PALLIATIVE CARE CONSULTATIONS TO DEFINE, MANAGE AND COORDINATE HEALTHCARE GOALS AND PLANS. ON-SITE PALLIATIVE CARE CONSULTATIONS WERE PROVIDED TO PATIENTS WHO WERE HOSPITALIZED IN EIGHT AREA HOSPITALS. MIDWEST CARECENTER OFFERS COMMUNITY BEREAVEMENT SERVICES AT NO CHARGE TO THE PUBLIC. IN ADDITION TO INDIVIDUAL COUNSELING, GROUP SUPPORT, ARTISTIC AND EXPRESSIVE THERAPIES AND OTHER COUNSELOR-FACILITATED MODALITIES FOR FAMILY MEMBERS OF HOSPICE PATIENTS, THE ORGANIZATION OFFERS GRIEF SUPPORT SERVICES FREE TO ANY GRIEVING PERSON IN ITS SERVICE AREA. IN 2011, 373 ADULTS AND 97 YOUTH RECEIVED BEREAVEMENT SERVICES. MIDWEST CARECENTER ALSO CONTINUED ITS "NAVIGATING GRIEF" WORKSHOP IN 2011 TO HELP GRIEVING ADULTS FIND THEIR BEARINGS IMMEDIATELY AFTER A LOSS. THROUGH ITS FAMILIES WITH CHILDREN PROGRAM, MIDWEST CARECENTER COUNSELORS PROVIDED BEREAVEMENT COUNSELING TO 195 GRIEVING CHILDREN AND TEENS IN 2011. CAMPCARE, THE ORGANIZATION'S GRIEF SUPPORT SUMMER PROGRAM FOR YOUTH, OFFERED A FOUR-DAY OVERNIGHT CAMP AND AN FOUR-DAY ADVENTURE CANOE TRIP, SERVING A TOTAL OF 50 CHILDREN AND TEENS (4TH- 12TH GRADE) WHO WERE IMPACTED BY LOSS. AS PART OF THE ORGANIZATION'S EDUCATIONAL OUTREACH PROGRAMS IN 2011, FWC CONDUCTED SEVERAL EDUCATION PROGRAMS AT AREA SCHOOLS ON CHILDREN'S GRIEF AND ASSISTED THE SCHOOLS OF THE ARCHDIOCESE OF CHICAGO WHEN DEATH IMPACTED THEIR COMMUNITIES. VOLUNTEERS ARE AN INTEGRAL FORCE IN ADVANCING THE MISSION OF THE ORGANIZATION THROUGH DIRECT CARE OR ADMINISTRATIVE SUPPORT. IN 2011, 373 VOLUNTEERS PROVIDED 17,076 HOURS OF SERVICE THROUGH MIDWEST CARECENTER PATIENT CARE, OFFICE SUPPORT, FUNDRAISING, GOVERNANCE AND YOUTH OUTREACH SERVICES. DIRECT PATIENT CARE WAS PROVIDED TO 375 PATIENTS BY 190 VOLUNTEERS. IN ADDITION, 60 YOUNG VOLUNTEERS PARTICIPATED IN CARING KIDS IN ACTION, WHICH GIVES AREA YOUTH THE OPPORTUNITY TO SERVE ELDERLY INDIVIDUALS AND HOSPICE PATIENTS. THROUGH MIDWEST CARECENTER CHARITY CARE AND SUBSIDIZED PROGRAMS, SERVICES ARE PROVIDED TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. BECAUSE MIDWEST CARECENTER SERVES AN OLDER PATIENT BASE AS AN END-OF-LIFE PROVIDER, MOST OF ITS PATIENT SERVICES ARE PAID FOR BY MEDICARE. NONETHELESS, WHILE OVER 90% OF PATIENTS WHO SOUGHT SERVICES FROM MIDWEST CARECENTER IN 2011 WERE COVERED BY GOVERNMENTAL PLANS OR BY PRIVATE INSURANCE, PATIENTS RECEIVED $2,208,000 OF FREE CARE OR SUBSIDIZED CARE UNDER THE PROGRAM. PATIENTS SEEKING HOSPICE AND PALLIATIVE CARE SERVICES WITHOUT GOVERNMENTAL OR PRIVATE INSURANCE QUALIFY FOR CHARITY CARE AND RECEIVE SERVICES FREE OF CHARGE. PATIENTS WITH INADEQUATE INSURANCE OR WITH OTHER FINANCIAL NEED RECEIVE CARE AT REDUCED RATES, BASED ON A SLIDING SCALE. DETERMINATION OF NEED IS BASED ON INDIVIDUALIZED ASSESSMENT OF ASSETS AND TOTAL COSTS FOR CARE; PRIMARY RESIDENCES ARE EXCLUDED FROM ASSETS.
PROGRAM SERVICE ACCOMPLISHMENTS - GENERAL INFORMATION	FORM 990, PART III, LINE 4A	PATIENTS ARE INFORMED OF THE AVAILABILITY OF FREE AND SUBSIDIZED CARE AT THEIR INITIAL REFERRAL FOR SERVICES; APPLICATION FORMS ARE INCLUDED WITH ADMISSIONS FORMS; AND ADMISSIONS STAFF ARE AVAILABLE TO ASSIST PATIENTS OR FAMILIES WITH COMPLETING THE APPLICATIONS. MIDWEST CARECENTER PROMOTES ITS CHARITY CARE AND SUBSIDIZED CARE PROGRAMS AGGRESSIVELY THROUGH ADVERTISING AND PROMOTIONAL MATERIALS. MIDWEST CARECENTER BUILDS RELATIONSHIPS WITH OTHER PROVIDERS TO ENHANCE HEALTHCARE SERVICES FOR PATIENTS AND FAMILIES IN ITS SERVICE AREA. THE ORGANIZATION CONTRACTED WITH EIGHT AREA HOSPITALS TO DELIVER HOSPICE CARE IN THE HOSPITAL SETTING AND PROVIDED CARE TO RESIDENTS OF MORE THAN 100 SENIOR CARE FACILITIES IN ITS SERVICE AREA. IN ADDITION, OUTREACH ACTIVITIES INCLUDED COLLABORATIONS WITH HOWARD BROWN HEALTH CENTER, CJE SENIORLIFE, HEARTLAND ALLIANCE AND RUSH UNIVERSITY MEDICAL CENTER TO PROVIDE HEALTHCARE AND RESOURCES FOR LESBIAN, GAY, BISEXUAL AND TRANSGENDERED OLDER ADULTS IN CHICAGO THROUGH "AGING AS WE ARE." CENTRAL TO THE MIDWEST CARECENTER MISSION ARE EDUCATION, TRAINING AND RESEARCH. THE ORGANIZATION SPONSORS AND CONDUCTS SEMINARS AND TRAINING SESSIONS, FREE OF CHARGE, ON A VARIETY OF TOPICS RELATED TO END-OF-LIFE CARE FOR MEDICAL PROFESSIONALS AND FOR MEMBERS OF THE GENERAL PUBLIC. OVER 3,000 HEALTHCARE PROFESSIONALS, STUDENTS AND COMMUNITY MEMBERS LEARNED ABOUT HOSPICE, ADVANCE DIRECTIVES, HOW TO HELP GRIEVING CHILDREN AND ADULTS, AND OTHER RELATED HEALTHCARE TOPICS IN 2011. EDUCATION AND RESEARCH IS LARGELY SUPPORTED THROUGH PATIENT REVENUES, WITH SOME GRANT SUPPORT. MIDWEST CARECENTER ALSO PARTICIPATES IN AN INTEGRATED FELLOWSHIP PROGRAM WITH RUSH UNIVERSITY MEDICAL CENTER AND JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY TO TRAIN PHYSICIANS TO DEMONSTRATE COMPETENCE IN SPECIALIST-LEVEL EXPERTISE IN PALLIATIVE CARE. IN 2009, THE PROGRAM WAS ACCREDITED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION. MIDWEST CARECENTER ASSUMED THE COST FOR THREE FELLOWS AND CONTRIBUTED ONE-THIRD OF SALARY AND BENEFITS FOR EACH. FINALLY, TO ENSURE THAT ALL PATIENTS HAVE ACCESS TO AN EXCEPTIONAL LEVEL OF CARE NOW AND IN THE YEARS AHEAD, MIDWEST CARECENTER LAUNCHED THE KEEPING OUR PROMISE CAMPAIGN IN 2009. THE $18-MILLION CAPITAL AND ENDOWMENT CAMPAIGN INCLUDES PLANS TO BUILD AN INPATIENT HOSPICE PAVILION AND CREATE A HEALING GARDEN ON ITS GLENVIEW CAMPUS AS WELL AS SECURE AN ENDOWMENT TO ENSURE QUALITY END-OF-LIFE CARE FOR FUTURE GENERATIONS. LEAD NAMING GIFTS WERE SECURED: THE MARSHAK FAMILY INPATIENT PAVILION AND THE WAUD FAMILY HEALING GARDEN.
Review of form 990 by governing body	Form 990, Part VI, Section B, Line 11b	PRIOR TO FILING THE RETURN WITH THE IRS, A DRAFT OF THE COMPLETED FORM 990 IS REVIEWED BY THE ORGANIZATION'S FINANCE COMMITTEE. AFTER REVIEW, COPIES OF THE FINAL FORM 990 ARE DISTRIBUTED TO THE FULL BOARD FOR REVIEW. SUBSEQUENT TO THE BOARD'S REVIEW THE RETURN IS FILED WITH THE IRS.
Conflict of interest policy	Form 990, Part VI, Section B, Line 12c	ANNUALLY, THE ORGANIZATION REQUIRES ALL INTERESTED PERSONS TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST. THE CHIEF FINANCIAL OFFICER THEN REVIEWS THE POTENTIAL OR ACTUAL CONFLICTS TO DETERMINE IF AN ACTUAL CONFLICT OF INTEREST EXISTS. ADDITIONALLY, ANY POSSIBLE CONFLICT OF INTEREST OF ANY DIRECTOR (OR MEMBER OF THE DIRECTOR'S IMMEDIATE FAMILY) SHALL BE FULLY DISCLOSED TO THE OTHER DIRECTORS AND MADE A MATTER OF RECORD. WHEN ANY POSSIBLE CONFLICT OF INTEREST BECOMES RELEVANT TO ANY MATTER REQUIRING BOARD OF DIRECTORS OR COMMITTEE ACTION, THE DIRECTOR SHALL NOT VOTE ON THE MATTER, SHALL NOT USE PERSONAL INFLUENCE IN CONNECTION WITH THE MATTER, AND SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. HOWEVER, THE DIRECTOR MAY BRIEFLY STATE THE DIRECTOR'S POSITION IN THE MATTER AND ANSWER PERTINENT QUESTIONS WHEN THE DIRECTOR'S KNOWLEDGE OF THE MATTER WILL ASSIST THE BOARD OR COMMITTEE. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, AND THAT THE INTERESTED DIRECTOR ABSTAINED FROM VOTING AND WAS NOT COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. THIS POLICY SHALL ALSO APPLY TO ANY PERSON, OTHER THAN A DIRECTOR, WHO IS SERVING AS A MEMBER OF A BOARD COMMITTEE. A CONFLICT OF INTEREST ARISES WHEN A DIRECTOR, OFFICER, OR MANAGEMENT EMPLOYEE HOLDS A DIRECT OR INDIRECT FINANCIAL INTEREST IN OR WILL RECEIVE A BENEFIT FROM A BUSINESS FURNISHING GOODS OR SERVICES TO CARECENTER. A DIRECT FINANCIAL INTEREST IS THE RECEIPT OF REMUNERATION OF ANY SORT. AN INDIRECT FINANCIAL INTEREST EXISTS IF A DIRECTOR, OFFICER, OR MANAGEMENT EMPLOYEE, OR A MEMBER OF HIS/HER IMMEDIATE FAMILY, HAS A MATERIAL FINANCIAL INTEREST IN, OR A SUBSTANTIAL BUSINESS RELATIONSHIP WITH, OR IS AN OFFICER, DIRECTOR, OR GENERAL PARTNER OF A PERSON OR ENTITY TRANSACTING BUSINESS WITH CARECENTER. IT IS PERMISSIBLE FOR A DIRECTOR, OFFICER, OR STAFF TO BE A DIRECT OR INDIRECT PARTY TO A TRANSACTION WHICH MIGHT CREATE THE APPEARANCE OF A CONFLICT OF INTEREST IF THE ABOVE DISCLOSURE AND OTHER REQUIREMENTS ARE MET AND IF THE TRANSACTION IS FAIR AS DETERMINED BY THE BOARD.
Process used to establish compensation of top management official	Form 990, Part VI, Section B, Line 15a	THE HUMAN RESOURCES COMMITTEE (AN INDEPENDENT GROUP OF BOARD MEMBERS) REVIEWS AND APPROVES THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANCIAL OFFICER AND THE CHIEF MEDICAL OFFICER ON AN ANNUAL BASIS. THE LAST REVIEW WAS CONDUCTED IN DECEMBER 2011 AND THE PRIOR REVIEW WAS CONDUCTED IN SEPTEMBER 2010. THE REVIEW AND APPROVAL OF COMPENSATION BY THE HUMAN RESOURCES COMMITTEE INCLUDES COMPARABILITY DATA AND SURVEYS PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS. THE PROCESS FOR DETERMINING, REVIEWING AND APPROVING COMPENSATION IS DOCUMENTED ON A TIMELY BASIS. THE COMPENSATION ARRANGEMENT FOR THE TOP MANAGEMENT OFFICIAL IS DOCUMENTED IN A WRITTEN EMPLOYMENT CONTRACT.
Process used to establish compensation of other officers/key employees	Form 990, Part VI, Section B, Line 15b	USING THE DATA PROVIDED BY A COMPENSATION CONSULTANT AND INPUT FROM THE ORGANIZATION'S DIRECTOR OF HUMAN RESOURCES, THE CEO CONDUCTED ANNUAL PERFORMANCE REVIEWS OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES. THE RESULTS OF THE PERFORMANCE REVIEWS ARE THE BASIS FOR THE DETERMINATION OF THE OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION PACKAGES AND ANY ADJUSTMENTS TO ESTABLISHED AMOUNTS. IN 2011 AN INDEPENDENT SUBCOMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWED AND APPROVED THE COMPENSATION PACKAGES OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES.
Governing documents, conflict of interest policy and financial statements available to the public	Form 990, Part VI, Section C, Line 19	FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. THE ORGANIZATION INCLUDES ITS ANNUAL REPORT ON ITS WEBSITE THAT IS AVAILABLE TO THE PUBLIC.
Other changes in net assets or fund balances	Form 990, Part XI, Line 5	NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -210906; PRIOR PERIOD ADJUSTMENTS - 74597; PCCNS PRIVATE CARE, INC. - NET ASSETS - -7682;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

MIDWEST PALLIATIVE & HOSPICE CARECENTER

Employer identification number

36-2996608

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

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

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

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

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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) PCCNS PRIVATE CARE INC 2050 CLAIRE COURT GLENVIEW,IL60025 36-4218039	PRIVATE CARE SERVICES	IL	NA	C CORPORATION	-444	7,238	100 %

Schedule R (Form 990) 2011

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

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

Yes

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) 2011

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0