Form990
Click to see attachment
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)

MediumBullet 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 09-01-2011 and ending 08-31-2012
BCheck if applicable:
CName of organization
Children's Hospital of Chicago Medical Center
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
225 E CHICAGO AVE PR DEPT BOX 26
 
Room/suite
City or town, state or country, and ZIP + 4
Chicago, IL606112991
D Employer identification number

36-3357004
E Telephone number

G Gross receipts $ 20,178,053
F Name and address of principal officer:
Patrick M Magoon
225 E CHICAGO AVE BOX 269
Chicago,IL606112991
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.luriechildrens.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1984
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: ESTABLISH, DEVELOP, PROMOTE & CONDUCT EDUCATIONAL PROGRAMS, SCIENTIFIC RESEARCH, HEALTHCARE FACILITIES & OTHER CHARITABLE & EDUCATIONAL ACTIVITIES DEVOTED TO HEALTH & WELFARE SERVICES TO INFANTS & CHILDREN.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 106
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 91
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 75
6 Total number of volunteers (estimate if necessary) .... 6 0
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
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 743,847 1,501,525
9 Program service revenue (Part VIII, line 2g) ......... 16,817,104 18,676,528
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 0
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 17,560,951 20,178,053
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,358,107 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) 13,181,881 15,139,559
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 3,836,582 3,640,421
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 19,376,570 18,779,980
19 Revenue less expenses. Subtract line 18 from line 12....... -1,815,619 1,398,073
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 5,532,040 8,491,832
21 Total liabilities (Part X, line 26)............. 2,648,411 4,210,130
22 Net assets or fund balances. Subtract line 21 from line 20..... 2,883,629 4,281,702
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
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
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
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
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 .........
1
Briefly describe the organization’s mission: WE ARE DEDICATED TO THE HEALTH AND WELL-BEING OF ALL CHILDREN. AS THE PEDIATRIC TEACHING FACILITY FOR NORTHWESTERN UNIVERSITY'S FEINBERG SCHOOL OF MEDICINE, THIS COMMITMENT DRIVES US TO BE A LEADER IN: - PEDIATRIC HEALTH CARE DELIVERY - RESEARCH INTO THE PREVENTION, CAUSES AND TREATMENT OF DISEASES THAT AFFECT CHILDREN - EDUCATION FOR PHYSICIANS, NURSES AND ALLIED HEALTH PROFESSIONALS - ADVOCACY FOR CHILDREN AS A CHARITABLE ORGANIZATION, WE SERVE CHILDREN AND THEIR FAMILIES TO THE BEST OF OUR ABILITIES AND TO THE LIMITS OF OUR RESOURCES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
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 $ 17,093,828 including grants of $ 0 ) (Revenue $ 18,676,528 )
The Children's Hospital of Chicago Medical Center ("Medical Center"), an Illinois not-for-profit corporation, engages in budget approval, asset management, resource allocation, investment oversight and strategic planning for Affiliates. Affiliates include organizations for which the Medical Center is either a controlling member or a controlling shareholder. Currently, the Medical Center has the following affiliates: Ann & Robert H. Lurie Children's Hospital of Chicago, Ann & Robert H. Lurie Children's Hospital of Chicago Foundation, Ann & Robert H. Lurie Children's Hospital of Chicago Research Center, Lurie Children's Medical Group, LLC and Pediatric Faculty Foundation, Inc. Lurie Children's Medical Group, LLC ("Medical Group") is an Illinois limited liability company whose sole member is the Medical Center. By virtue of the Medical Center's tax-exempt status, the Medical Group is considered to be an organization described under Section 501(c)(3) of the Code. The Medical Group employs pathologists, radiologists, psychiatrists and dentists who practice at Ann & Robert H. Lurie Children's Hospital of Chicago ("Lurie Children's"). The Medical Group's pathologists comprise the Lurie Children's Department of Pathology and Laboratory Medicine which provides comprehensive services in both Anatomic and Clinical Pathology, utilizing extensive expertise and state-of-the-art technology. Consultative services are provided across the country in collaboration and coordination with Lurie Children's medical, surgical and ancillary departments. The children encompass a cross-section of diagnoses and the department assists in the diagnosis and management of acute and chronic diseases. The Medical Group psychiatrists practice within Lurie Children's Department of Child and Adolescent Psychiatry which offers children and their families specialized services in pediatric mental health. Clinicians in the department provide state-of-the art psychiatric and psychological services, education, and advocacy. The Medical Group psychiatrists provide national leadership in the education of mental health care professionals and advancement of knowledge through research. The Medical Group psychiatrists treat children of all ages and from every socioeconomic background for a wide variety of problems including adjustment disorders, emotional problems related to pediatric disorders, psychoses, mood disorders, anxiety, developmental delays, behavior disorders, ADHD, autism spectrum disorders, and learning disabilities. The Medical Group dentists provide comprehensive and preventive oral health care for infants, children, adolescents, and patients of Lurie Children's with special health care needs. Lurie Children's dentistry service provides a child-centered environment and a comprehensive program emphasizing total health and prevention. The Medical Group dentists provide care related to infant oral healthcare with parent education; nursing and baby bottle caries; dental caries; oral trauma, anxious child; comprehensive oral healthcare for patients of the Lurie Children's medical specialties (including hematology, oncology, infectious disease, allergy, cardiology, neurology and services to address cleft lip and palate); and services requiring sedation and general anesthesia. Radiologists employed by the Medical Group staff the Lurie Children's Department of Medical Imaging which serves pediatric patients in a manner aimed to help minimize radiation dose used during each procedure. The Department performs approximately 109,000 procedures each year, including 9,800 MRIs of which 80 percent are done on medically complex and/or sedated children. All of the radiologists are board certified with subspecialty training in pediatric radiology, interventional radiology and/or neuroradiology. The Medical Group's physicians are members of the faculty practice plan at Lurie Children's, which represents the largest provider of pediatric Medicaid services in Illinois. In FY 2012, the Medical Group physicians had over 4,000 combined inpatient and outpatient Medicaid encounters for 2,269 patients. Medicaid represents over 43.1% of its payor mix. In FY 2012, Medicaid reimbursement for physician services for care to children treated by the Medical Group physicians was approximately $1.6 million less than the costs associated with providing such services. The Medical Center through its management and the Medical Group's services assists Lurie Children's, which owns and operates the only full-service, independent, freestanding pediatric hospital in Illinois, with 288 licensed beds as well as a full range of inpatient and outpatient care and related ancillary services. This not-for-profit, tertiary care hospital, founded in 1882, provides patient care 24 hours per day, 7 days per week and provides more pediatric healthcare than any other hospital provider in Illinois in nearly every pediatric medical and surgical specialty. As a major academic tertiary care medical center, Lurie Children's has served patients from 49 states, and 34 countries. Lurie Children's is a designated Level I pediatric trauma center for the City of Chicago, with a Level III neonatal nursery that serves as a regional referral center in the State of Illinois Perinatal Network. Lurie Children's ability to treat the most critically ill infants in its neonatal intensive care unit ("NICU") is demonstrated by statistics for calendar year 2012 which show that 64% of all transports into its NICU were from other Level III nurseries in metropolitan Chicago. The Lurie Children's has also been ranked among the best in the nation in a U.S. News & World Report opinion-based survey of top pediatric hospitals for the past three years. Lurie Children's is the home to the world's first pediatric center for Autonomic Medicine and was the first pediatric hospital in Illinois to perform the Berlin Heart procedure, a breakthrough technology that helps children awaiting heart transplants. In the fiscal year ending August 31, 2012, Lurie Children's, through nearly 602,580 patient visits, served more than 149,450 children who came from all over the State of Illinois and beyond to access the more than 70 specialties offered by Lurie Children's. During this period there were 480,563 visits including 319,350 outpatient visits in Lincoln Park (including 6,760 observation cases) including 61,767 emergency room visits and 99,446 outpatient visits at the satellite facilities.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 17,093,828
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
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..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
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........................
5
 
 
6
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....................
6
 
No
7
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...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
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...................
9
 
No
10
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
10
 
No
11
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:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.
11a
 
No
b
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
 
No
c
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
 
No
d
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
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.
11e
 
No
f
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.
11f
 
No
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
 
No
b
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
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
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......... Click to see attachment
14b
Yes
 
15
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.. Click to see attachment
15
 
No
16
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.. Click to see attachment
16
 
No
17
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
17
 
No
18
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..........
18
 
No
19
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...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
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)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
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..
21
 
No
22
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.....
22
 
No
23
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
23
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
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
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
 
 
d
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...... Click to see attachment
25a
 
No
b
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................ Click to see attachment
25b
 
No
26
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......................... Click to see attachment
26
 
No
27
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......... Click to see attachment
27
 
No
28
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
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
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.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
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........ Click to see attachment
33
Yes
 
34
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
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
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... Click to see attachment
35b
Yes
 
36
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........... Click to see attachment
36
 
No
37
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 VIClick to see attachment
37
 
No
38
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. ............
38
Yes
 
Form 990 (2011)
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
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
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 .....................
2a
75
b
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)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
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)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
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?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
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?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
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?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
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
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
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
 
 
b
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
 
c
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
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
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
No
1a
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.
1a
106
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
91
2
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? .................
2
Yes
 
3
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? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
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? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
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 .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
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
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
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
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
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
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
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?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
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
 
No
b
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
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
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.
19
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.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
PAULA M NOBLE
225 E CHICAGO AVE PR DEPT BOX 26
CHICAGO,IL606112991
(312) 227-4306
Form 990 (2011)
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.

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

RoundBullet 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.

RoundBullet 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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JOHN J ALLEN
DIRECTOR
 1.0 X           0 0 0
(2) JOHN AMBOIAN JR
DIRECTOR
 1.0 X           0 0 0
(3) SARAH BAINE
EX-OFFICIO DIRECTOR
 1.0 X           0 0 0
(4) STEPHEN W BAIRD
DIRECTOR
 1.0 X           0 0 0
(5) PETER B BENSINGER
DIRECTOR
 1.0 X           0 0 0
(6) ANDREW BERLIN
DIRECTOR
 1.0 X           0 0 0
(7) BARBARA L BOWLES
DIRECTOR
 1.0 X           0 0 0
(8) JILL BRENNAN
DIRECTOR
 1.0 X           0 0 0
(9) DAVID BUNNING
DIRECTOR
 1.0 X           0 0 0
(10) GREGORY C CASE
DIRECTOR
 1.0 X           0 0 0
(11) JOHN A CHALLENGER
DIRECTOR
 1.0 X           0 0 0
(12) ALAN CHAPMAN
DIRECTOR
 1.0 X           0 0 0
(13) ROBERT CLARK
DIRECTOR
 1.0 X           0 0 0
(14) ELEANOR O CLARKE
DIRECTOR
 1.0 X           0 0 0
(15) KEVIN M CONNELLY
DIRECTOR
 1.0 X           0 0 0
(16) JOHN D COONEY
DIRECTOR
 1.0 X           0 0 0
(17) JOHN M CROCKER JR
VICE-CHAIR & DIRECTOR
 1.0 X           0 0 0
Form 990 (2011)
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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) LESTER CROWN
DIRECTOR
 1.0 X           0 0 0
(19) PAULA H CROWN
DIRECTOR
 1.0 X           0 0 0
(20) LETICIA PERALTA DAVIS
DIRECTOR
 1.0 X           0 0 0
(21) SUSAN DEPREE
DIRECTOR
 1.0 X           0 0 0
(22) JAMES DEROSE
DIRECTOR
 1.0 X           0 0 0
(23) WILLIAM J DEVERS JR
DIRECTOR
 1.0 X           0 0 0
(24) JOHN DOERGE JR
DIRECTOR
 1.0 X           0 0 0
(25) JAMES DONALDSON MD
EX-OFFICIO DIRECTOR
 1.0 X           533,339 0 218,543
(26) CHARLES W DOUGLAS
DIRECTOR
 1.0 X           0 0 0
(27) DENNIS J DRESCHER
DIRECTOR
 1.0 X           0 0 0
(28) ANA DUTRA
DIRECTOR
 1.0 X           0 0 0
(29) MICHAEL EVANGELIDES
DIRECTOR
 1.0 X           0 0 0
(30) TYRONE C FAHNER
DIRECTOR
 1.0 X           0 0 0
(31) LESLI FALK
EX-OFFICIO DIRECTOR
 1.0 X           0 0 0
(32) MITCHELL FEIGER
DIRECTOR
 1.0 X           0 0 0
(33) DIANA S FERGUSON
DIRECTOR
 1.0 X           0 0 0
(34) MICHAEL W FERRO JR
DIRECTOR
 1.0 X           0 0 0
(35) DAVID FOX JR
DIRECTOR
 1.0 X           0 0 0
(36) JOHN S GATES JR
DIRECTOR
 1.0 X           0 0 0
(37) LAURENCE S GELLER
DIRECTOR
 1.0 X           0 0 0
(38) BERT A GETZ JR
DIRECTOR
 1.0 X           0 0 0
(39) JEFFREY GLASSROTH MD
EX-OFFICIO DIRECTOR
 1.0 X           0 0 0
(40) LAUREN GORTER
DIRECTOR
 1.0 X           0 0 0
(41) THOMAS P GREEN MD
EX-OFFICIO DIR/PRES&CHAIR PFF
 1.0 X           0 686,258 58,102
(42) JOSEPH GREGOIRE
DIRECTOR
 1.0 X           0 0 0
(43) DAVID D GRUMHAUS
DIRECTOR
 1.0 X           0 0 0
(44) ARLINGTON GUENTHER
DIRECTOR
 1.0 X           0 0 0
(45) JOSEPH D GUTMAN
DIRECTOR
 1.0 X           0 0 0
(46) BRUCE R HAGUE
DIRECTOR
 1.0 X           0 0 0
(47) TODD M HAMILITON
DIRECTOR
 1.0 X           0 0 0
(48) PAUL F HANZLIK
DIRECTOR
 1.0 X           0 0 0
(49) BRETT J HART
DIRECTOR
 1.0 X           0 0 0
(50) DAVID A HELFAND
DIRECTOR
 1.0 X           0 0 0
(51) MARY J C HENDRIX PHD
EX-OFF DIR PRS/SI OFF RCH.CTR.
 1.0 X           0 575,155 87,442
(52) DANIEL J HENNESSY
VICE CHAIR & DIRECTOR
 1.0 X           0 0 0
(53) JAMES HICKEY
DIRECTOR
 1.0 X           0 0 0
(54) GARY E HOLDREN
DIRECTOR
 1.0 X           0 0 0
(55) MARK HOPPE
DIRECTOR
 1.0 X           0 0 0
(56) CHARLES H JAMES III
DIRECTOR
 1.0 X           0 0 0
(57) KIRK B JOHNSON
DIRECTOR
 1.0 X           0 0 0
(58) W BRUCE JOHNSON
DIRECTOR
 1.0 X           0 0 0
(59) GEORGE D KENNEDY
DIRECTOR
 1.0 X           0 0 0
(60) ANTHONY K KESMAN
DIRECTOR
 1.0 X           0 0 0
(61) RICHARD P KIPHART
DIRECTOR
 1.0 X           0 0 0
(62) FRED L KREHBIEL
DIRECTOR
 1.0 X           0 0 0
(63) ADAM A KRIGER
DIRECTOR
 1.0 X           0 0 0
(64) GERALD R LANZ
DIRECTOR
 1.0 X           0 0 0
(65) ERIC LEFKOFSKY
DIRECTOR
 1.0 X           0 0 0
(66) LYLE LOGAN
DIRECTOR
 1.0 X           0 0 0
(67) SHELLEY A LONGMUIR
DIRECTOR
 1.0 X           0 0 0
(68) DANIEL TW LUM MD
EX-OFFICIO DIRECTOR
 1.0 X           0 0 0
(69) PATRICK M MAGOON
EX-OFF DIR/CEO, MED.CTR/HOSP.
 1.0 X   X       0 1,169,917 417,827
(70) MITCHELL J MANASSA
DIRECTOR
 1.0 X           0 0 0
(71) JOHN F MANLEY
VICE CHAIR & DIRECTOR
 1.0 X           0 0 0
(72) ROXANNE MARTINO
DIRECTOR
 1.0 X           0 0 0
(73) PETER D MCDONALD
DIRECTOR
 1.0 X           0 0 0
(74) JACK L MCGINLEY
DIRECTOR
 1.0 X           0 0 0
(75) ANDREW J MCKENNA
DIRECTOR
 1.0 X           0 0 0
(76) WILLIAM J MCKENNA
DIRECTOR
 1.0 X           0 0 0
(77) JAMES J MCNULTY
DIRECTOR
 1.0 X           0 0 0
(78) LOUISE C MILLS
DIRECTOR
 1.0 X           0 0 0
(79) JOHN C MOORE
DIRECTOR
 1.0 X           0 0 0
(80) ROBERT S MURLEY
VICE CHAIR & DIRECTOR
 1.0 X           0 0 0
(81) ERIC G NEILSON MD
DIRECTOR
 1.0 X           0 0 0
(82) DAVID NEITHERCUT
DIRECTOR
 1.0 X           0 0 0
(83) LESLIE NEWMAN
DIRECTOR
 1.0 X           0 0 0
(84) EDWARD OGATA MD
EX-OFFICIO DIR/CMO/HOSP.
 1.0 X           0 699,385 51,203
(85) NANCY PACHER
DIRECTOR
 1.0 X           0 0 0
(86) CHAKA PATTERSON
DIRECTOR
 1.0 X           0 0 0
(87) PEER PEDERSEN
VICE CHAIR & DIRECTOR
 1.0 X           0 0 0
(88) DOUGLAS A PERTZ
DIRECTOR
 1.0 X           0 0 0
(89) LORNA S PFAELZER
DIRECTOR
 1.0 X           0 0 0
(90) DAVID C PISOR
DIRECTOR
 1.0 X           0 0 0
(91) ASHISH PRASAD
DIRECTOR
 1.0 X           0 0 0
(92) SETH PROSTIC
DIRECTOR
 1.0 X           0 0 0
(93) GERALD D PUTNAM
DIRECTOR
 1.0 X           0 0 0
(94) MOHAN RAO PHD
DIRECTOR
 1.0 X           0 0 0
(95) ANDREA REDMOND
DIRECTOR
 1.0 X           0 0 0
(96) SUSAN REGENSTEIN
DIRECTOR
 1.0 X           0 0 0
(97) THOMAS R REUSCH
DIRECTOR
 1.0 X           0 0 0
(98) J CHRISTOPHER REYES
MED. CNTR/HOSP. CHAIR
 1.0 X           0 0 0
(99) MARLETA REYNOLDS MD
EX-OFFICIO DIRECTOR
 1.0 X           0 0 0
(100) PETER C ROBERTS
DIRECTOR
 1.0 X           0 0 0
(101) MANUEL SANCHEZ
DIRECTOR
 1.0 X           0 0 0
(102) DEBORAH M SAWYER
DIRECTOR
 1.0 X           0 0 0
(103) H WILLIAM SCHNAPER MD
EX OFFICIO DIRECTOR/PFF MD
 1.0 X           0 293,633 51,915
(104) CHRISTOPHER SEGAL
DIRECTOR
 1.0 X           0 0 0
(105) STEPHEN A SMITH
DIRECTOR
 1.0 X           0 0 0
(106) THOMAS S SOULELES
DIRECTOR
 1.0 X           0 0 0
(107) STEPHEN T STEERS
DIRECTOR
 1.0 X           0 0 0
(108) DIANE SWONK
DIRECTOR
 1.0 X           0 0 0
(109) EDWARD S TRAISMAN MD
EX-OFFICIO DIRECTOR
 1.0 X           0 0 0
(110) MONSIGNOR KENNETH VELO
DIRECTOR
 1.0 X           0 0 0
(111) MATTHEW WALSH
DIRECTOR
 1.0 X           0 0 0
(112) EDWARD J WEHMER
DIRECTOR
 1.0 X           0 0 0
(113) MRS DERRY WEYERHAEUSER
DIRECTOR
 1.0 X           0 0 0
(114) BRIAN E WILLIAMS
DIRECTOR
 1.0 X           0 0 0
(115) LINDA S WOLF
DIRECTOR
 1.0 X           0 0 0
(116) JAMES WOOTEN JR
DIRECTOR
 1.0 X           0 0 0
(117) MS JIA ZHAO
DIRECTOR
 1.0 X           0 0 0
(118) PAULA M NOBLE
CFO/TREAS/MED.CTR.&AFFLTS
 1.0     X       0 543,142 229,178
(119) DONNA S WETZLER
GEN CNSL&CORP SEC/MED.CTR.&AFF
 1.0     X       0 408,331 381,116
(120) ELIZABETH J PERLMAN MD
CHAIR/DEPT OF PATH & LAB MED
 40.0         X   465,949 0 167,707
(121) FRANK M PRENDERGAST MD
CHAIR/DEPT OF PATH & LAB MED
 40.0         X   410,684 0 44,635
(122) CYNTHIA K RIGSBY MD
VICE CHAIRMAN MEDICAL IMAGING
 40.0         X   433,298 0 54,732
(123) MARTHA C SAKER MD
STAFF RADIOLOGIST
 40.0         X   390,162 0 33,518
(124) RICHARD M SHORE MD
STAFF RADIOLOGIST
 40.0         X   421,771 0 40,737
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,655,203 4,375,821 1,836,655
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet38
Yes
No
3
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 .............
3
 
No
4
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...........................
4
Yes
 
5
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 .....
5
 
No
Section B. Independent Contractors
1
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
Northwestern Medical Faculty Founda
375 N ST CLAIR
CHICAGO,IL60611 		PHYSICIAN SERVICES 855,092
Arnold Shkolnik MD
225 E CHICAGO AVE
CHICAGO,IL60611 		PHYSICIAN SERVICES 118,551
Medcentrix Inc
15620 S Wood Street
HARVEY,IL60426 		BILLING SERVICES 564,629
SPI HEALTHCARE
8151 W 83RD ST B
TINLEY PARK,IL60487 		BILLING SERVICES 257,300
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet4
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,501,525
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		0
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,501,525
Program Service Revenue Business Code
2a Net patient revenue 621,110 10,596,622 10,596,622    
b Medical, Administrative, & Teaching 621,110 3,004,841 3,004,841    
c MISCELLANEOUS OPERATING INCOME 621,110 1,478,091 1,478,091    
d Medicaid 621,110 3,596,974 3,596,974    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 18,676,528
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 0      
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 20,178,053 18,676,528 0 0
Form 990 (2011)
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 .... 797,624 762,672 34,952  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 11,538,826 11,033,085 505,741  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 1,922,803 1,823,087 99,716  
10 Payroll taxes ........... 880,306 853,975 26,331  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 13,500   13,500  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 102,745 102,745    
12 Advertising and promotion .... 0      
13 Office expenses ....... 42,603 42,603    
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 0      
17 Travel ............ 77,548 77,548    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 627 627    
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 0      
23 Insurance .............. 480,158 477,083 3,075  
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 provision 389,054 389,054    
b Billing and collection fee 983,340   983,340  
c Patient expenses 1,197,406 1,197,406    
d Plan tax 182,668 182,668    
e
f All other expenses 170,772 151,275 19,497  
25 Total functional expenses. Add lines 1 through 24f 18,779,980 17,093,828 1,686,152 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 4,360,044 1 5,817,337
2 Savings and temporary cash investments ....... 0 2 0
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 601,747 4 2,189,839
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation. ..... 10b   0 10c  
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 120,000 13 120,000
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 450,249 15 364,656
16 Total assets. Add lines 1 through 15 (must equal line 34)... 5,532,040 16 8,491,832
Liabilities 17 Accounts payable and accrued expenses . 2,648,411 17 4,210,130
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 0 25 0
26 Total liabilities. Add lines 17 through 25..... 2,648,411 26 4,210,130
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 2,883,629 27 4,281,702
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 2,883,629 33 4,281,702
34 Total liabilities and net assets/fund balances ..... 5,532,040 34 8,491,832
Form 990 (2011)
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 .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
20,178,053
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
18,779,980
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
1,398,073
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
2,883,629
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
 
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
4,281,702
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
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. ...........................
2c
Yes
 
d
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:
3a
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? ................
3a
 
No
b
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. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
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
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
No
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
(1) ANN & ROBERT H LURIE CHILDREN'S HOSPITAL OF CHICAGO
  		362170833 03 Yes   Yes   Yes   17,093,828
(2) ANN & ROBERT H LURIE CHILDREN'S HOSPITAL OF CHICAGO FDN
  		363357006 07 Yes   Yes   Yes   0
(3) PEDIATRIC FACULTY FOUNDATION INC
  		363279680 0 Yes   Yes   Yes   0
(4) ANN & ROBERT H LURIE CHILDREN'S HOSPITAL OF CHICAGO RES CTR
  		363357005 04 Yes   Yes   Yes   0
Total                 17,093,828

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Children's Hospital of Chicago Medical Center
  		Employer identification number

36-3357004
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




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Children's Hospital of Chicago Medical Center
  		Employer identification number

36-3357004
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
Children's Hospital of Chicago Medical Center
  		Employer identification number

36-3357004
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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Program Services INSURANCE 3,504,866
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 3,504,866
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 3,504,866
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



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
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
 
 
2
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? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) JAMES DONALDSON MD (i)
(ii)		 441,714
0 		89,526
0 		2,099
0 		196,979
0 		21,564
0 		751,882
0 		0
0
(2) THOMAS P GREEN MD (i)
(ii)		 0
486,587 		0
198,879 		0
792 		0
24,500 		0
33,602 		0
744,360 		0
0
(3) MARY J C HENDRIX PHD (i)
(ii)		 0
477,924 		0
96,715 		0
516 		0
65,528 		0
21,914 		0
662,597 		0
0
(4) PATRICK M MAGOON (i)
(ii)		 0
669,904 		0
460,460 		0
39,553 		0
395,080 		0
22,747 		0
1,587,744 		0
54,248
(5) EDWARD OGATA MD (i)
(ii)		 0
390,921 		0
219,482 		0
88,982 		0
25,687 		0
25,516 		0
750,588 		0
0
(6) H WILLIAM SCHNAPER MD (i)
(ii)		 0
254,059 		0
38,782 		0
792 		0
24,500 		0
27,415 		0
345,548 		0
0
(7) PAULA M NOBLE (i)
(ii)		 0
359,324 		0
182,200 		0
1,618 		0
214,043 		0
15,135 		0
772,320 		0
0
(8) DONNA S WETZLER (i)
(ii)		 0
268,758 		0
137,717 		0
1,856 		0
364,116 		0
17,000 		0
789,447 		0
0
(9) ELIZABETH J PERLMAN MD (i)
(ii)		 386,626
0 		78,383
0 		940
0 		152,125
0 		15,582
0 		633,656
0 		0
0
(10) FRANK M PRENDERGAST MD (i)
(ii)		 299,887
0 		110,343
0 		454
0 		20,714
0 		23,921
0 		455,319
0 		0
0
(11) CYNTHIA K RIGSBY MD (i)
(ii)		 309,837
0 		121,778
0 		1,683
0 		24,134
0 		30,598
0 		488,030
0 		0
0
(12) MARTHA C SAKER MD (i)
(ii)		 299,453
0 		72,143
0 		18,566
0 		24,956
0 		8,562
0 		423,680
0 		0
0
(13) RICHARD M SHORE MD (i)
(ii)		 317,561
0 		102,043
0 		2,167
0 		28,483
0 		12,254
0 		462,508
0 		0
0



Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Supplemental Compensation Information Schedule J, Part I, Line 3 Pursuant to the bylaws of Children's Hospital of Chicago Medical Center ("Medical Center"), the Governance Committee of the Medical Center is charged to review and approve senior executive compensation for the Medical Center and its affiliates. The Governance Committee has adopted a written executive compensation philosophy which it follows when it reviews and approves the compensation and benefits of the organization's senior management, including the President/Chief Executive Officer and the other senior managers. The compensation philosophy is subject to periodic review for continued appropriateness by the Governance Committee. With the assistance of a compensation consultant and information from a variety of sources (specified on Schedule J), the Governance Committee confirmed the total amounts to be paid were reasonable and comparable to amounts paid by similarly situated organizations. Outside legal counsel also serves an integral role in advising the Governance Committee with respect to federal tax requirements in setting compensation and the establishment of the "rebuttable presumption of reasonableness" under the federal tax law intermediate sanctions rules. The process followed by the Governance Committee, including a description of the data relied upon and the Governance Committee's decisions, was thoroughly and contemporaneously documented. The Governance Committee has expressly reviewed the reasonableness of all such payments, and has concluded, as the result of a process that is designed to qualify for the rebuttable presumption of reasonableness, that all such amounts are reasonable and do not exceed fair market value for the services provided. The Governance Committee was comprised of members of the Medical Center and the Ann and Robert H. Lurie Children's Hospital of Chicago Boards of Directors who were determined to be disinterested for these purposes. The Governance Committee conducts an ongoing, regular review of the disinterested status of its members, and will take appropriate action with respect to anyone having an interest with respect to one or more executives so as to preserve the application of the rebuttable presumption of reasonableness. Schedule J, Part I, Question 4b The following listed individuals have an amount included in Schedule J, Part II, Column (C) for an amount accrued but not vested under a supplemental executive retirement plan ("SERP"): James Donaldson, MD $166,689 Patrick M. Magoon $361,818 Paula M. Noble $188,823 Elizabeth J. Perlman $129,761 Donna S. Wetzler $342,069 Benefits earned under the SERP are non-vested forms of deferred compensation that fund the employee's eventual retirement benefit. These benefits are provided in exchange for all of the employee's years of service to the organization, and the cost of the benefits will vary from year to year based on interest rates, age, and many other factors. The amounts are at risk and will not be paid unless and until the employee has provided substantial future services to the organization. Benefits under the SERP vest at age 62, and are forfeited if the employee leaves the organization voluntarily before age 62 (except upon the sole discretion of the Board, and only if the participant has reached at least age 55 with at least 10 years of service). Participants who voluntarily leave the organization before age 55 forfeit their entire SERP benefit upon termination. Schedule J, Part I, Question 5a Employed physicians are compensated on the basis of personal professional productivity that takes into account, in part, the revenues of the organization generated by the physician. Schedule J, Part II The following individuals are not compensated by the reporting organization for his or her service as a director. Rather, the compensation reported on Form 990, Part VII and on Schedule J, Part II reflects compensation paid by Pediatric Faculty Foundation for the individual's substantial and full-time services as an employee. For more details, please refer to the 2011 Form 990 of Pediatric Faculty Foundation, EIN 36-3279680. Thomas P. Green, MD Mary J. C. Hendrix, PhD H. William Schnaper, MD The following individuals are not compensated by the reporting organization for his or her service as a director or officer. Rather, the compensation reported on Form 990, Part VII and on Schedule J, Part II reflects compensation paid by Ann & Robert H. Lurie Children's Hospital of Chicago (Lurie Children's) for the individual's substantial and full-time services as an employee. For more details, please refer to the 2011 Form 990 of Lurie Children's, FEIN 36-2170833. Patrick M. Magoon Edward Ogata, MD Paula M. Noble Donna S. Wetzler
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) JP Morgan Chase L. Crown is a director 137,727 Financial Services   No
(2) JP Morgan Chase P. Crown is a director 137,727 Financial Services   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




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
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
Identifier Return Reference Explanation
Description of Relationships Form 990, Part VI, Question 2 *Allan Bulley III serves as an officer for a firm that provided construction services to Thomas Souleles. *Allan Bulley III serves as an officer for a firm which provided construction services to Donald J. Edwards. *Gregory Case serves as an officer for a firm in which Andrew McKenna served as a director during the reporting period. *Edward J. Wehmer serves as an officer for a company for which Charles James III and Bert Getz serve as a director. *Lester Crown is the father-in-law of Paula H. Crown. *William Devers, Jr. serves as a director for a company for which Andrew McKenna serves as an officer. *Andrew J. McKenna is the father of William J. McKenna. *Linda Wolf serves as a director for a company for which Eric Lefkofsky serves as a director.
Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Question 11B A copy of the organization's fiscal year 2012 tax return ("Form 990") was provided to each member of the organization's Audit Committee (of the Board) before a special Audit Committee meeting and before the Form 990 was filed. The Audit Committee is the Committee of the Medical Center charged with the oversight of audit and tax matters for the parent and affiliates. The audit committee was provided a detailed overview of the form 990 by the chief financial Officer ("CFO") and the organization's director of tax compliance. The CFO and director of tax compliance also responded to the Audit Committee members' questions and afforded the opportunity for detailed discussion of the Form 990, prior to the audit committee taking action to approve The filing of the Form 990. As part of its tax preparation process, the Organization on an ongoing basis consulted its tax consulting firm and outside tax legal counsel, both of which possess expertise in health care and tax-exempt return preparation, to advise and assist in the preparation of Form 990. These advisors worked closely with the organization's Finance and internal legal personnel and other members of the organization's team assembled to participate in the preparation of The Form 990. Prior to presenting the Form 990 to the board's audit Committee, the organization's team, including its advisors, met frequently to discuss and review drafts of the form.
Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Question 12c On an annual basis, the Medical Center and its affiliates provide a comprehensive questionnaire to its board members, senior management and purchasing personnel posing questions about actual or potential conflicts of interest. The Medical Center initiates follow up contact to those who do not respond and to clarify responses, where necessary. The Medical Center reviews each disclosure and provides a summary of relevant disclosures for the review and approval of its governance committee. Pursuant to the conflicts of interest policy of the Medical Center and affiliates ("Corporation"), directors, officers, physician leaders, and others who are subject to the policy are required to promptly and fully disclose in writing any actual, apparent or potential conflict of interest to the president of the Corporation and General Counsel. This disclosure shall be provided to the Governance Committee of the Corporation which shall consider all conflicts of interest issues and, if appropriate, shall provide such written disclosure to the directors, board committees considering the proposed transaction or other appropriate parties. In addition, on an annual basis, the corporation surveys each individual subject to the policy as to the existence of actual or potential conflicts of interest. The corporation will not enter into an agreement, transaction or other arrangement involving a conflict of interest unless the disinterested members of the Governance Committee of the Corporation's Board of Directors determine by a majority vote that appropriate safeguards to protect the charitable mission of the Corporation have been implemented. The subject interested person may not be present when the vote is taken. If it is determined that a conflict of interest exists, a disinterested person or committee of disinterested members may be assigned to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board or committee shall determine whether the Corporation can obtain a more advantageous transaction or arrangement, with reasonable efforts, from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by a majority vote of the disinterested directors whether the transaction is in the Corporation's best interest and for its own benefit and whether the transaction is fair and reasonable to the Corporation, and shall make its decision as to whether to enter into the transaction or arrangement.
Offices & Positions for Which Process was Used, & Year Process was Begun Form 990, Part VI, questions 15a and 15b The authority to review and approve executive compensation has been delegated to the Governance Committee of the Medical Center Board of Directors ("Governance Committee"). The Governance Committee has adopted a written executive compensation philosophy which it follows when it reviews and approves the compensation and benefits of the organization's senior management, including the President/Chief Executive Officer and the other senior managers. The compensation philosophy is subject to periodic review for continued appropriateness by the Governance Committee. With the assistance of a compensation consultant and information from a variety of external sources (specified on Schedule J), the Governance Committee confirmed the total amounts to be paid were reasonable and comparable to amounts paid by similarly situated organizations for functionally similar positions. Outside legal counsel also serves an integral role in advising the Governance Committee with respect to federal tax requirements in setting compensation and the establishment of the rebuttable presumption of reasonableness. The process followed by the Governance Committee, including a description of the data relied upon and the Governance Committee's decisions, was thoroughly and contemporaneously documented. The Governance Committee has expressly reviewed the reasonableness of all such payments, and has concluded, as the result of a process that is designed to qualify for the rebuttable presumption of reasonableness under federal tax law, that all such amounts are reasonable and do not exceed fair market value for the services provided. The Governance Committee was comprised of members of the Medical Center and the Medical Center Boards of Directors who were determined disinterested for these purposes. The Governance Committee conducts an ongoing and periodic review of the disinterested status of its members, and will take appropriate action with respect to anyone having an interest with respect to one or more executives so as to preserve the application of the rebuttable presumption of reasonableness.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 The organization's financial statements are publicly available online at www.dacbond.com. The organization's articles of incorporation and annual reports are available through the Illinois Secretary of State. The organization also makes its general governing documents available to the general public upon request.
AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONS FORM 990, PART VII Elizabeth J. Perlman, MD and James Donaldson, MD are employees of the Medical Center and generally work 40 hours per week. Approximately 2 hours of additional time each week is spent providing services to related organizations. The following individuals are employees of the children's memorial hospital and generally work 40 hours per week. In general, approximately 2 hours of additional time each week is spent providing services to related organizations: Patrick M. Magoon Paula M. Noble Edward Ogata, MD Donna S. Wetzler The following individuals are employees of Pediatric Faculty Foundation and generally work 40 hours per week. Approximately 2 hours of additional time each week is spent providing services to related organizations: Thomas P. Green, MD Mary J. C. Hendrix, PhD H. William Schnaper, MD
INFORMATION ABOUT SUPPORTED ORGANIZATION SCHEDULE A, PART I For a description of the manner in which the Medical Center supports Lurie Children's, please see the statement of program accomplishments included in Schedule O.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Children's Hospital of Chicago Medical Center
 
Employer identification number

36-3357004
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







(1) LURIE CHILDREN'S MEDICAL GROUP LLC
225 E CHICAGO AVE
CHICAGO,IL60611
36-4187449 		HEALTH CARE IL 19,493,727 8,295,807 MEDICAL CTR
 










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
Yes No
(1) LURIE CHILDREN'S HOSP OF CHIC RSCH CTR

225 E CHICAGO AVE

CHICAGO,IL60611
36-3357005 		RESEARCH IL 501(C)(3) 4 Medical Ctr
 
Yes
 
(2) LURIE CHILDREN'S HOSPITAL OF CHICAGO FDN

225 E CHICAGO AVE

CHICAGO,IL60611
36-3357006 		FUNDRAISING IL 501(C)(3) 7 Medical Ctr
 
Yes
 
(3) PEDIATRIC FACULTY FOUNDATION INC

225 E CHICAGO AVE

CHICAGO,IL60611
36-3279680 		HLTH CRE/RSCH IL 501(C)(3) 11 III-FI Medical Ctr
 
Yes
 
(4) LURIE CHILDREN'S

225 E CHICAGO AVE

CHICAGO,IL60611
36-2170833 		HOSPITAL IL 501(C)(3) 3 Medical Ctr
 
Yes
 
(5) CMH Self Insurance Foundation

225 E CHICAGO AVE

Chicago,IL60611
36-6638400 		Insurance IL 501(C)(3) 11 III-FI MEDICAL CTR
 
Yes
 




For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No 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) CMMC INSURANCE CO LTD
225 E CHICAGO AVE
CHICAGO,IL60611
000000000 		SELF INSURANCE CJ MEDICAL CTR
  		CORPORATION 73,199 16,672,135 100.000 %












Schedule R (Form 990) 2011
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
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) Lurie Childrens

 c 1,501,525 cost
(2) Lurie Childrens

 o 5,585,910 cost
(3) CMMC INSURANCE CO LTD

 q 3,504,866 cost
(4)
(5)
(6)
Schedule R (Form 990) 2011
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) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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 V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
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


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