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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
Presence Hospitals PRV
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
9223 WEST ST FRANCIS ROAD
Suite
Room/suite
City or town, state or country, and ZIP + 4
FRANKFORT, IL60423
D Employer identification number

36-4195126
E Telephone number

G Gross receipts $ 1,075,920,571
F Name and address of principal officer:
TONY FILER
19065 HICKORY CREEK
MOKENA,IL60448
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.presencehealth.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: 1997
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION STRIVES TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING SERVICES THAT EMPHASIZE AVOIDING ILLNESS THROUGH PREVENTIVE CARE AND STATE-OF-THE-ART TECHNOLOGIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 8,414
6 Total number of volunteers (estimate if necessary) ............. 6 2,081
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 3,535,846
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 1,250,816
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,464,417 3,198,929
9 Program service revenue (Part VIII, line 2g) ......... 990,095,600 1,054,003,843
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -1,493,050 2,731,206
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 12,985,244 14,958,150
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,006,052,211 1,074,892,128
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 73,650 76,040
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) 462,414,591 467,991,061
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 139,507 35,377
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet3,036,900    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 546,349,620 577,229,361
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,008,977,368 1,045,331,839
19 Revenue less expenses. Subtract line 18 from line 12....... -2,925,157 29,560,289
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 796,734,905 801,750,738
21 Total liabilities (Part X, line 26)............. 230,788,368 194,752,435
22 Net assets or fund balances. Subtract line 21 from line 20..... 565,946,537 606,998,303
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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: THE ORGANIZATION STRIVES TO MAKE AVAILABLE A FULL CONTINUUM OF SERVICES, BOTH PRIMARY AND SPECIALTY, APPROPRIATE TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES. THESE SERVICES EMPHASIZE AVOIDING ILLNESS THROUGH PREVENTIVE PRIMARY CARE, AS WELL AS OFFERING ACCESS TO THE ADVANCED AND STATE-OF-THE-ART TECHNOLOGIES NECESSARY TO RESTORE HEALTH.
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 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 $ 859,725,541 including grants of $ 76,040 ) (Revenue $ 1,050,472,513 )
THE HOSPITALS PROVIDED INPATIENT MEDICAL CARE, MATERNITY SERVICES AND CHARITY CARE. THE HOSPITALS SERVED BOTH THE AGED AND THE POOR BY PARTICIPATION IN THE MEDICARE AND MEDICAID PROGRAMS. THE HOSPITALS PROVIDED OUTPATIENT SERVICES TO MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY.
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 expensesMediumBullet859,725,541
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? 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
 
No
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 IClick to see attachment........................
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 IIClick to see attachment...
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 Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; 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 IVClick to see attachment..............
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 VClick to see attachment......
10
Yes
 
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, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
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 VIIClick to see attachment.......
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 VIIIClick to see attachment.......
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 IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
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 XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
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 and XII is optional Click to see attachment
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, Parts I and IV.........
14b
 
No
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions).... Click to see attachment
17
Yes
 
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............ Click to see attachment
18
Yes
 
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................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
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... Click to see attachment
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........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 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 lines 24b through 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........
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...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
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.........
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 ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
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 direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
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, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
596
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
Yes
 
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
8,414
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
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
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, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
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 as charitable contributions?...
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
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
16
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
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
 
No
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this 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
Yes
 
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
Yes
 
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:
MediumBulletDAVID WRIGLEY100 N RIVER ROAD 2NDDES PLAINESIL60016 (847) 813-3728
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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) MARK HANSON........................................................................
DIRECTOR
 1.0
.......................   		X                
(2) SR CLARA FRANCES KUSEK........................................................................
DIRECTOR
 1.0
.......................   		X                
(3) SUSAN MCDONOUGH........................................................................
DIRECTOR
 1.0
.......................   		X                
(4) Haven Cockerham........................................................................
DIRECTOR
 1.0
.......................   		X                
(5) SR MARY SHINNICK........................................................................
DIRECTOR
 1.0
.......................   		X                
(6) GUY WIEBKING........................................................................
DIRECTOR
 1.0
.......................   		X                
(7) THOMAS HUBERTY MD........................................................................
DIRECTOR
 1.0
.......................   		X                
(8) MARSHA LADENBURGER........................................................................
DIRECTOR
 1.0
.......................   		X                
(9) VICTOR ORLER........................................................................
DIRECTOR
 1.0
.......................   		X                
(10) THOMAS SETTLES........................................................................
DIRECTOR
 1.0
.......................   		X                
(11) JAMES WINIKATES........................................................................
DIRECTOR
 1.0
.......................   		X                
(12) SR PATRICIA KOSCHALKE........................................................................
DIRECTOR
 1.0
.......................   		X                
(13) TERRY MALTBY........................................................................
DIRECTOR
 1.0
.......................   		X                
(14) KENT RUSSELL........................................................................
DIRECTOR
 1.0
.......................   		X                
(15) SR EVELYN VARBONCOEUR........................................................................
DIRECTOR
 1.0
.......................   		X                
(16) SANDRA BRUCE........................................................................
PRESIDENT/CEO & DIRECTOR
 20.0
.......................20.0 		X   X         1,337,831 39,710
(17) FRANK MCHUGH........................................................................
VP FINANCE / CFO
 40.0
.......................   		    X       152,180   9,912
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(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) Anthony Filer........................................................................
SYS CFO, TREASURER
 20.0
.......................20.0 		    X         769,802 123,823
(19) Jeannie Frey........................................................................
Secretary
 20.0
.......................20.0 		    X         522,642 79,530
(20) AMY STEVENS........................................................................
COO
 40.0
.......................   		      X     311,370   32,291
(21) ELIZABETH GARROW........................................................................
VP FOUNDATION
 40.0
.......................   		      X     300,914   10,875
(22) JARED ROGERS........................................................................
CMO
 40.0
.......................   		      X     279,083   39,712
(23) SUZETTE MAHNEKE........................................................................
VP PATIENT CARE SRVS
 40.0
.......................   		      X     274,468   30,068
(24) LAURENCE DRY........................................................................
VP STRATEGY & OPS
 40.0
.......................   		      X     268,463   36,879
(25) JACQUELINE MEDLAND........................................................................
VP PATIENT CARE SRVS
 40.0
.......................   		      X     244,456   45,769
(26) JANICE NEMRI........................................................................
CAO
 40.0
.......................   		      X     247,097   35,921
(27) CATHERINE EMANUEL........................................................................
REG VP STRATEGIC PLG & BUS DEV
 40.0
.......................   		      X     240,254    
(28) LISA DIMARCO........................................................................
VP PATIENT CARE SRVS
 40.0
.......................   		      X     217,336   30,579
(29) DAVID MCNARY........................................................................
VP AMBULATORY SRVS
 40.0
.......................   		      X     197,240   1,301
(30) LISA LAGGER........................................................................
CRO
 40.0
.......................   		      X     196,957   32,236
(31) GARY PLUNDO........................................................................
CMO
 40.0
.......................   		      X     196,173   818
(32) MOLLY NICHOLSON........................................................................
VP PATIENT CARE SRVS
 40.0
.......................   		      X     193,090   25,708
(33) JENNIFER CORD........................................................................
VP OPERATIONS
 40.0
.......................   		      X     158,196   33,466
(34) Connie March-Curtis........................................................................
PRES & CEO PSS
 40.0
.......................   		      X     455,318   21,700
(35) JOMEL LABAYOG........................................................................
PHYSICIAN
 40.0
.......................   		        X   629,381   17,352
(36) SURENDRA GULATI........................................................................
PHYSICIAN
 40.0
.......................   		        X   453,199   10,428
(37) VICTOR ROSTAPSHOV........................................................................
PHYSICIAN
 40.0
.......................   		        X   346,702   8,412
(38) MICHAEL PANUSKA........................................................................
MEDICAL DIRECTOR
 40.0
.......................   		        X   271,753   12,088
(39) JINJENG ZHU........................................................................
PHYSICIST
 40.0
.......................   		        X   247,505   16,509
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,881,135 2,630,275 695,087
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet341
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
MADISON AVENUE ANESTHESIA PLACEMENT, 20201 S CRAWFORD AVEOLYMPIA FIELDSIL60461 ANESTHESIA SERVICES 41,010,548
JOLIET ONCOLOGY HEMATOLOGY ASSOC, 2614 W JEFFERSON STJOLIETIL60435 ONCOLOGY/HEMATOLOGY 12,619,310
CRAWFORD AVE ANESTHESIA PROVIDER, 8701 BROADWAYMERRIVILLEIN46410 ANESTHESIA SERVICES 3,786,412
FELMLEY-DICKERSON, PO BOX 1550BLOOMINGTONIL617021550 CONTRACTOR 2,475,010
ANESTHESIA ASSOC, 2540 HANFORD LANEAURORAIL60502 ANESTHESIA SERVICES 1,573,988
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet101
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 662,865
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		2,536,064
g Noncash contributions included in lines
1a-1f:$ 		0
h Total. Add lines 1a-1f.......MediumBullet 3,198,929
Program Service Revenue Business Code
2a NET PATIENT REVENUE 900099 1,049,292,875 1,049,292,875    
b PHARMACY REVENUE 446110 2,808,678 1,174,193 1,634,485  
c MEDICAL OFFICE BUILDING RENT 531120 1,902,290 1,902,290    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 1,054,003,843
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,715,357   1,018,009 1,697,348
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 352,862  
b Less: rental expenses    
c Rental income or (loss) 352,862 0
d Net rental income or (loss).......MediumBullet 352,862   352,862  
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 110,330 231,514
b Less: cost or other basis and sales expenses 82,580 243,415
c Gain or (loss) 27,750 -11,901
d Net gain or (loss)..........MediumBullet 15,849     15,849
8a Gross income from fundraising events (not including
$ 662,865
of contributions reported on line 1c). See Part IV, line 18 ..
a 917,786
b Less: direct expenses ...b 702,448
c Net income or (loss) from fundraising events..MediumBullet 215,338   215,338
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 MEDICAID MEANINGFUL USE 517000 4,961,604     4,961,604
b CAFETERIA SALES 722100 4,274,136     4,274,136
c GIFT SHOP & AUXILLARY 453220 820,500     820,500
d All other revenue .... 4,333,710 5,445 530,490 3,797,775
e Total. Add lines 11a–11d ...... MediumBullet 14,389,950
12 Total revenue. See Instructions......MediumBullet 1,074,892,128 1,052,374,803 3,535,846 15,782,550
Form 990 (2012)
Form 990 (2012)
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).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 0
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 76,040 76,040
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 .... 3,854,995   3,854,995  
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 369,854,424 351,240,627 17,120,881 1,492,916
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 68,392,934 66,890,655 1,475,707 26,572
10 Payroll taxes ........... 25,888,708 24,585,798 1,198,410 104,500
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 863,209 18,109 845,100  
c Accounting ........... 1,075,203 26,973 1,048,230  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 35,377 35,377
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 3,804,951 620,309 3,184,642  
12 Advertising and promotion .... 4,552,699 288,064 4,239,910 24,725
13 Office expenses ....... 185,400,156 182,359,184 2,804,067 236,905
14 Information technology ...... 49,846,495 15,276,013 34,546,214 24,268
15 Royalties .. 0      
16 Occupancy ........... 20,658,546 18,860,155 1,791,614 6,777
17 Travel ............ 485,824 248,885 217,197 19,742
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 446,664 324,766 91,984 29,914
20 Interest ........... 28,361,134   28,361,092 42
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 50,403,350 50,246,320 156,870 160
23 Insurance .............. 0      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a OTHER PURCHASED SERVICES 98,731,974 90,372,155 7,927,802 432,017
b INTERNAL PURCHASED SERVICES 37,301,940 12,222,316 25,079,624  
c TAXES 36,390,855 1,008,431 35,382,424  
d FOOD 6,608,090 6,447,380 125,258 35,452
e All other expenses 52,298,271 38,613,361 13,117,377 567,533
25 Total functional expenses. Add lines 1 through 24e 1,045,331,839 859,725,541 182,569,398 3,036,900
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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 37,306,915 2 52,640,361
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 175,864,260 4 193,149,954
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 23,621,593 8 24,346,865
9 Prepaid expenses and deferred charges .......... 24,863,725 9 8,110,590
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,051,538,826
b Less: accumulated depreciation ..... 10b 563,155,731 505,920,210 10c 488,383,095
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 29,158,202 15 35,119,873
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 796,734,905 16 801,750,738
Liabilities 17 Accounts payable and accrued expenses ......... 76,670,085 17 73,345,194
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 Loans and other 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.................... 154,118,283 25 121,407,241
26 Total liabilities. Add lines 17 through 25......... 230,788,368 26 194,752,435
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 557,750,919 27 596,399,681
28 Temporarily restricted net assets ........... 6,739,739 28 9,106,755
29 Permanently restricted net assets ........... 1,455,879 29 1,491,867
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 565,946,537 33 606,998,303
34 Total liabilities and net assets/fund balances ........ 796,734,905 34 801,750,738
Form 990 (2012)
Form 990 (2012)
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
1,074,892,128
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,045,331,839
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
29,560,289
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
565,946,537
5
Net unrealized gains (losses) on investments ...............
5
1,224,873
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
10,266,614
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
606,998,303
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
Yes
 
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
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
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 supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Presence Hospitals PRV
  		Employer identification number

36-4195126
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Presence Hospitals PRV
  		Employer identification number

36-4195126
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Presence Hospitals PRV
  		Employer identification number

36-4195126
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) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 1,885,241 1,823,675 1,671,727 1,569,474 1,071,590
b Contributions ........ 765,424 61,758 104,516 26,655 489,327
c Net investment earnings, gains, and losses 108,794 43,217 83,936 -2,254 11,557
d Grants or scholarships ..... -13,844 -26,673 12,960 0 3,000
e Other expenditures for facilities
and programs ........ 		1,500 -16,425 19,544 -81,988 0
f Administrative expenses ....   -311 4,000 4,136 0
g End of year balance ...... 2,747,115 1,885,241 1,823,675 1,671,727 1,569,474
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet30.000 %
b
Permanent endowment SchDMd Bullet70.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   22,757,057 22,757,057
b Buildings ................   681,906,033 316,929,245 364,976,788
c Leasehold improvements ............   1,602,816 586,040 1,016,776
d Equipment ................   315,747,363 226,969,986 88,777,377
e Other .................   29,525,557 18,670,460 10,855,097
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 488,383,095
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DUE TO THIRD PARTY PAYORS 89,671,183
DUE TO AFFILIATES 6,933,487
OTHER CURRENT LIABILITIES 10,322,446
OTHER LONG TERM LIABILITIES 14,480,125





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 121,407,241
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
SCHEDULE D, PART V, LINE 4   ENDOWMENT FUND USES THE INTENDED USES OF THE ENDOWMENT FUND INCLUDE THE FOLLOWING: SUPPLEMENTAL HOSPITAL INCOME, EDUCATION, TECHNOLOGY, HEALTH AND HUMAN SERVICES FOR THE POOR, SCHOLARSHIPS, AND DIABETES WELLNESS CENTER. Schedule D, Part X, Line 2 FIN 48 (ASC 740) Footnote disclosure On January 1, 2008, Presence adopted ASC Subtopic 740-10 Income Taxes- Overall, which addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, Presence may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods and requires increased disclosures. At the date of adoption, and as of December 31, 2012, Presence does not have any liabilities for any unrecognized tax benefits.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
GOLD COAST JEWELRY   No 11,779 10,477 1,302
CENTRAL IL BOOKS BOOK FAIR   No 9,870 8,055 1,815
MASQUERADE JEWELRY $5 SALE   No 8,608 7,025 1,583
SCRUBS ON WHEELS UNIFORM FND Yes   6,708 5,475 1,233
DANVILLE GARDENS FLOWER SALE   No 6,139 4,345 1,794
             
             
             
             
             
Total .................right arrow 43,104 35,377 7,727
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
IL, IN
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

FESTIVAL OF TRE
(event type) 		(b) Event #2

GALA
(event type) 		(c) Other events

13
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 402,621 249,016 929,014 1,580,651
2 Less: Contributions . . 295,953 88,529 278,383 662,865
3 Gross income (line 1
minus line 2) . . . 		106,668 160,487 650,631 917,786
VerticalDirectExpenses 4 Cash prizes . . .     5,500 5,500
5 Noncash prizes . .     12,411 12,411
6 Rent/facility costs . . 13,500   113,525 127,025
7 Food and beverages .        
8 Entertainment . . .        
9 Other direct expenses . 140,879 84,016 332,617 557,512
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 702,448
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow 215,338
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
1400 W PARK
URBANA,IL61801
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    28,764,538   28,764,538 3.200 %
b Medicaid (from Worksheet 3,
column a) .... 		    170,963,343 131,954,619 39,008,724 4.300 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    199,727,881 131,954,619 67,773,262 7.500 %
Other Benefits
     3,687,217 269,388 3,417,829 0.400 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    5,659,326 517,175 5,142,151 0.600 %
g Subsidized health services
(from Worksheet 6) .. 		    16,486,059 15,250,178 1,235,881 0.100 %
h Research (from Worksheet 7)     320,932   320,932  
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    1,017,977   1,017,977 0.100 %
j Total. Other Benefits ..     27,171,511 16,036,741 11,134,770 1.200 %
k Total. Add lines 7d and 7j .     226,899,392 147,991,360 78,908,032 8.700 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     3,307   3,307  
2 Economic development            
3 Community support     258,878 23,161 235,717 0.030 %
4 Environmental improvements     31,556   31,556  
5 Leadership development and training for community members            
6 Coalition building     1,847   1,847  
7 Community health improvement advocacy            
8 Workforce development     5,297   5,297  
9 Other            
10 Total     300,885 23,161 277,724 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
130,443,369
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
463,090,167
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
421,694,638
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
41,395,529
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1Alliance PHO
  		Physician Hospital Org. 50.000 %   50.000 %
2KANKAKEE VALLEY DLY
  		Dialysis Center 50.000 %   50.000 %
3Kendail PT Surgery
  		Surgery Center 15.000 %   50.000 %
4Dreyer Provena Amb
  		Ambulatory Care Center 40.000 %   60.000 %
5Ctr Digestive Dis
  		Digestive Health Center 10.000 %   80.000 %
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?6
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 PRESENCE ST JOSEPH MEDICAL CENTER
333 N MADISON STREET
JOILET,IL60435 		X X         X      
2 PRESENCE MERCY MEDICAL CENTER
1325 N HIGHLAND
AURORA,IL60506 		X X         X      
3 PRESENCE ST JOSEPH HOSPITAL
77 NORTH AIRLITE AVENUE
ELGIN,IL60123 		X X         X      
4 PRESENCE ST MARY'S HOSPITAL
500 WEST COURT STREET
KANKAKEE,IL60901 		X X         X      
5 PRESENCE COVENANT MEDICAL CENTER
1400 PARK STREET
URBANA,IL61801 		X X         X      
6 PRESENCE UNITED SAMARITANS MED CNTR
812 N LOGAN
DANVILLE,IL61832 		X X         X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PRESENCE ST JOSEPH MEDICAL CENTER
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 11
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PRESENCE MERCY MEDICAL CENTER
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 2
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PRESENCE ST JOSEPH HOSPITAL
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 3
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PRESENCE ST MARY'S HOSPITAL
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 4
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PRESENCE COVENANT MEDICAL CENTER
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 5
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 11
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PRESENCE UNITED SAMARITANS MED CNTR
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 6
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?35
Name and address Type of Facility (describe)
1 Provena Caton Farm Immediate Care
7000 Caton Farm Road
Plainfield,IL60586 		Immediate Care Ctr
2 Provena Caton Farm Imaging Center
7000 Caton Farm Road
Plainfield,IL60586 		Imaging Center
3 Provena Physical Therapy
3000 W Jefferson St
Joliet,IL60435 		Physical Therapy
4 Provena Physical Therapy Services
1280 Windham Parkway
Romeoville,IL60446 		Physical Therapy
5 Provena Center for Wound Care
301 North Madison St
Joliet,IL60435 		Wound Care Center
6 Provena Physical TherapyIndustrial Reha
852 Sharp Avenue
Shorewood,IL60404 		physical therapy
7 Provena Health Ctr-Diagnostic Imaging
1416 South Randall Road
Geneva,IL60134 		Imaging Center
8 Provena Occupational HealthDiabetes Ctr
87 North Airlite Street Suite 130
Elgin,IL60123 		Occupational Health
9 Provena Outpatient Rehab Services
87 North Airlite Street
Elgin,IL60123 		Rehabilitation Services
10 Provena Occupational Health
1320 N Highland Suite B
Aurora,IL60506 		Occupational Med.
11 Provena Physical Therapy
1975 Melissa Lane
Aurora,IL60506 		Physical Therapy
12 Provena Health Institute
1975 Melissa Lane
Aurora,IL60506 		outpatient clinic
13 Mercy Professional Building Pharmacy
1315 N Highland
Aurora,IL60506 		Outpatient Pharmacy
14 Provena Physical Rehab & Sport Injury
2132 Jefferson Street
Joliet,IL60435 		Physical Therapy
15 Provena Physical Therapy Services
1812 Lincoln Highway
New Lenox,IL60451 		Physical Therapy
16 Provena Physical Therapy Services
15120 Wallin Drive
Plainfield,IL60544 		Physical Therapy
17 Provena Sleep Disorder Center
2132 Jefferson Street
Joliet,IL60435 		Sleep Disorder Center
18 Provena Physical Therapy Services
7000 Caton Farm Road
Plainfield,IL60586 		Physical Therapy
19 Medcare 24 hour Acute Care
2250 West Algonquin Road
Lake in the Hills,IL60156 		Immediate Care Center
20 Provena Sleep Lab
412 Sheridan
Danville,IL61832 		Sleep Disorder Center
21 Provena United Samaritans Open MRI
412 Sheridan
Danville,IL61832 		Imaging Center
22 Provena United Samaritans Oncology Ctr
806 North Logan Avenue
Danville,IL61832 		Oncology Center
23 Provena Yorkville Medical Office Bldg
1500 Sycamore Road
Yorkville,IL60560 		Medical Office Building
24 Provena Manteno Medcentre
501 S Locust Street
Manteno,IL60950 		Medical Office Building
25 Provena Medcentre East
455 West Court Street
Kankakee,IL60901 		Medical Office Building
26 Provena Medcentre West
555 West Court Street
Kankakee,IL60901 		Medical Office Building
27 Provena Momence Medcentre
739 North Dixie Highway
Momence,IL60954 		Medical Office Building
28 Provena Peotone Medcentre
117 South Harlem Avenue
Peotone,IL60468 		Medical Office Building
29 Provena St Mary's Regional Cancer Center
100 Provena Way
Bourbonnais,IL60914 		Regional Oncology Center
30 Provena St Mary's Imaging Center
100 Provena Way
Bourbonnais,IL60914 		Imaging Center
31 Provena St Mary's Occupational Health
230 W John Casey Road
Bourbonnais,IL60914 		Occupational Medicine
32 Provena Wellness Center
21 Heritage Drive
Bourbonnais,IL60914 		Health And Fitness Center
33 Provena Center For Healthy Aging
401 East University Suite 102
Champaign,IL61820 		Senior Health Center
34 Provena Regional EMS
408 S Neil Street
Champaign,IL61820 		EMS Paramedic Services
35 Pro Ambulance Services
408 S Neil Street
Champaign,IL61820 		Ambulance Services
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Schedule H, Part I Financial Assistance and Certain Other Community Benefits at Cost: PART I LINE 6A Presence PRV Health (EIN: 36-3366652), the corporate sponsor of Presence Hospitals, published community Benefit Report with 2012 data, which details the combined charitable impact our ministries have within the communities we serve. Each ministry creates ministry-specific Implementation Strategies which outline the goals and objectives they have established to address the prioritized needs of their communities. PART I LINE 6B The Presence Health Community Benefit Report 2012 was made publicly available through a variety of ways to share the information with the community at large: o Print version of report - The report was mailed from the system office to community partners, elected officials, and local leaders. o Website - a robust community section has been developed and can be found online at www.presencehealth.org/community. This section includes an online, downloadable flipbook of the 2012 Community Benefit Report. There are also links to each of the ministries, where you will find Community Health Needs Assessment downloadable documents and links. This section is a work in progress and will be added to in the future. o PowerPoint presentation - A standard PowerPoint of the entire 2012 Community Benefit Report has been made available. A customized version of this presentation has also been created for each ministry to share with the community, which shows the local community benefit contributions, persons served, and the 2013 Prioritized Community Needs. PART I LINE 7F Per 2012 Instructions for Schedule H (Form 990), the Bad Debt Expense of $130,443,369 has been removed from the denominator in calculating the percentage of total expense. PART I LINE 7G Costs from physician clinics are not included in subsidized service totals. Part I, Line 7 Costs included in part I, line 7 were calculated using a combination of cost to charge ratio, medicare and medicaid cost reports, a cost accounting system including all patient segments and community benefit Software. Worksheet 2 was used for calculating the cost to charge rates.
Schedule H, Part II COMMUNITY BUILDING ACTIVITIES: Community building activities include programs that improve the community's health and safety by addressing the root causes of health problems, such as poverty, homelessness and environmental hazards. Participation in collaborative community efforts to promote public health initiatives is also included, such as engagement in coalitions and advocacy for health improvement. These activities strengthen the community's capacity to promote the health and well-being of its residents by offering the expertise and resources of the health care organization. Presence Health hospital ministries engage in a variety of community-building activities which ultimately improve the health and well-being of the communities we are privileged to serve, even though they are not specific health activities. Examples of community building activities include: o The work of all of our hospitals in support of disaster readiness and emergency preparedness. This work goes above and beyond any licensure requirements to proactively ensure that our communities are safe and prepared if a disaster should present itself. o Physical Improvements/Neighborhood Revitalization: Presence Covenant Medical Center has been an active partner in assisting with the community garden to supply fresh produce to vulnerable populations in Champaign County. o Community Support: Donations from our ministries to organizations addressing the root causes of health problems. o Coalition Building: Presence Saint Joseph Medical Center leads a community coalition, Joliet Partners for Healthy Families (JPHF), with the goal of making Will County a healthier place to live. JPHF is working with local legislators on policy, systems and environmental changes. o Workforce Development: Presence St. Mary's Hospital partners with the Kankakee Regional Volunteer Services coalition. This coalition allows local teen participants the opportunity to use their time and talents for those in need, while providing themselves with excellent exposure to many health-related careers, as well as business communications and early childhood teaching.
Schedule H, Part III BAD DEBT, MEDICARE & COLLECTION PRACTICES: PART III, SECTION A, LINE 2 The Hospital has adopted HFMA Statement 15 and in accordance with the Statement is reporting the amount of bad debt the payor was expected to pay rather than bad debt costs. The discounts are guaranteed for self-pay patients per Illinois law and for other payers we use the poverty guidelines or a minimum of $300.00 PART III, LINE 3 Presence Health believes it is important for the community and the IRS to be made aware of government shortfalls, specifically Medicare. However, we acknowledge that a Medicare shortfall is not unique to non-profit healthcare. As such, Presence Health does not believe that Medicare shortfall should be considered community benefit. PART III, LINE 4 Please see pages 21 and 22 of the Audited Financial Statements of Presence Health Network and Affiliates, a copy of which is attached to this return. PART III, LINE 8 Presence Health computes the Medicare shortfall based on a ratio of cost to charges. PART III, LINE 9B Collection policies are the same for all Presence Health entities. Patients are notified of the financial assistance policy at the time of registration via posted notifications and on every account statement that is sent to them. This information is available in a number of languages. Patients may apply for financial assistance at any time during the revenue cycle. Per the Provision for Financial Assistance Policy, the collection process is as follows: 1. Pre-Litigation Review. Prior to an account being authorized for the filing of suit for nonpayment of a patient bill, a final review of the account will be conducted and approved by the Financial Counseling Representative (or designee) to make sure that no application of financial assistance was ever received and that there exists objective evidence that the patient does have sufficient financial means to pay all or part of his/her bill. Prior to a collections suit being filed, the Self-pay Collections Director must review and approve. 2. Residential Liens. No hospital will place a lien on the primary residence of a patient who has been determined to be eligible for Financial Assistance/Charity Care, for payment of the patient's undiscounted balance due. Further, in no case will any hospital execute a lien by forcing the sale or foreclosure of the primary residence of any patient to pay for any outstanding medical bill. 3. No Use of Body Attachments: No hospital will use body attachment to require any person, whether receiving Financial Assistance/Charity Care discounts or not, to appear in court. 4. Collection Agency Referrals. Each hospital Finance accounting will ensure that all collection agencies used to collect patient bills promptly refer any patient who indicates financial need, or otherwise appears to qualify for Financial Assistance/Charity Care discounts, to a financial counselor to determine if the patient is eligible for such a charitable discount. For more information about Presence Health's Financial Assistance Program, visit http://presencehealth.org/patients-and-visitors/financiaI-assistance. http://presencehealth.org/patients-and-visitors/financiaI-assistance.
Schedule H, Part V Section B   Presence Saint Joseph Medical Center (1) Part V Line 3: Presence Saint Joseph Medical Center (PSJMC) used the Mobilizing for Action through Planning and Partnerships (MAPP) process to conduct its CHNA. This process is a thorough, collaborative process which includes four separate assessments that engage representatives from all community sectors to obtain input and feedback on what the identified needs are in the community. The assessments are listed below, including the agencies who provided input: Community Health Status Assessment: The CHSA committee comprised of MAPP Steering Committee members, data and planning staff from the three local hospitals and the health department's epidemiologist. The assessment initiated in June 2009 and was completed in March 2010. This team reviewed key health indicators and the health department's epidemiologist analyzed the data gathered to provide insight into the trends and top issues. Local Public Health System Assessment (LPHSA): Over 100 public health system partners were invited to participate in the Will County Public Health System forum held in September 2009 at New Life Church in New lenox. Approximately 70 partners participated in assessing how well the Will County public health system provides the ten Essential Public Health Services (EPHS) in Will County. Community Themes and Strengths Assessment(CTSA): Three separate methods of data collection were used in conducting the CTSA: a community survey, focus groups and photovoice. o Community Survey: In a county-wide random sample, 5,000 residents were mailed a community survey between October and December 2009. The survey was 10 pages in length and took about 20 minutes to complete. It asked questions about residents' perceptions on the quality of life in Will County. There were 485 respondents. o Focus Groups: After survey results were collected, the MAPP Steering Committee realized that the survey respondents did not reflect the demographics of Will County. In order to obtain the perspective of residents underrepresented in the survey, ten targeted focus groups were held from January through March 2010 to get a broader perspective from those who did not complete the survey. Over 100 participants gave their input on strengths and assets of their community and their perception about the quality of life in Will County through these focus groups. o Photovoice: Photovoice was the third method used for data collection. Photovoice is a technique that enables community residents of all ages and languages to share information about their communities through pictures. Five residents responded by submitting photos of their community. PSJMC engaged the following agencies as part of its CHNA process: Will County Board Three Rivers Manufacturers' Association Governors State University Will County Health Department Silver Cross Hospital Aunt Martha's Health Center Presence Health Will County Workforce Investment Board United Way of Will County Services Inc. Adventist Bolingbrook Hospital Presence Saint Joseph Medical Center Aunt Martha's Health Center Adventist Bolingbrook Hospital Aunt Martha's Health Center Stepping Stones, Inc. Adventist Bolingbrook Hospital Will County Executive Office Will-Grundy Medical Clinic Catholic Charities Edward Hospital Catholic Charities Chestnut Health Systems Community Members Part V Line 4 PSJMC partnered with Silver Cross Hospital, Adventist Bolingbrook Hospital and Edward Hospital to complete their CHNA. Part V Line 5a PSJMC's CHNA can be accessed at this url: http://presencehealth.org/aboutpresence/community-reports/presence-saint-j oseph-medicaI-center-joliet. Presence Mercy Medical Center (2) Part V Line 3: The CHNA process was initiated by PMMC and PSJH in collaboration with the community they serve and the Kane County Health Department, Delnor Hospital, Rush-Copley Medical Center, Sherman Hospital, Fox Valley United Way and the United Way of Elgin. Engagement of Public Health Expertise The Kane County Health Department facilitated the CHNA process by using the Mobilizing for Action through Planning and Partnerships (MAPP) tool. PMMC served as one of eight partners that participated in the Kane County Community Health Needs Assessment. This provided the opportunity for PMMC to actively provide expertise, input, and financial support. Partners also involved in this process included the four other hospitals in Kane County including Delnor Hospital, Presence Saint Joseph Hospital, Rush-Copley Medical Center, Sherman Hospital, as well as Fox Valley United Way and the United Way of Elgin. CHIP: Community Health Improvement Plan (CHIP) Committee To provide community level oversight for the process, a diverse group of community stakeholders and PMMC representatives were invited to participate on the CHIP Steering Committee. To ensure representative engagement, personal invitations were sent to organizations representing cultural, linguistic, racial, ethnic, and other minority groups. In addition, individuals with specialized qualifications in dealing with special populations or clinical groups were solicited for their participation. Finally, efforts were made to include individuals on the CHIP Steering Committee with public health expertise. Those who committed to the assessment and planning process became the eight members of the CHNA Steering Committee, which continues to meet regularly to provide feedback and overSight, assess progress, and modify plans as needed. The Kane County Community Health Improvement Plan (CHIP) Steering Committee members are listed below: Kane County Health Department United Way of Elgin Presence Mercy Medical Center Presence Saint Joseph Hospital Sherman Hospital Fox Valley United Way INC Board Cadence Health Rush-Copley Medical Center Approach. Kane County approached the 2011 Community Health Needs Assessment differently than in years past. In late 2010, the Kane County Health Department (KCHD) engaged the five hospitals in the county and the INC Board in a formal Community Health Assessment Committee to fund and lead the assessment effort. In early 2011, the Fox Valley United Way and the United Way of Elgin both formally agreed to fund and support the assessment process as well. This partnership allowed all agencies to meet their community assessment requirements and provided an efficient use of assessment and planning resources from all involved agencies. Methodology. The assessment partnership funded a comprehensive telephone survey of Kane County residents to collect health status information for over 1,500 adults and the caregivers of over 400 children. The survey questions were created based on the Behavioral Risk Factor Surveillance System survey, allowing the results to be compared with state and national figures. The Northern Illinois University Public Opinion Laboratory was contracted to conduct the phone survey between March and July of 2011. In addition to quantitative data, the department gathered qualitative information from residents about the health of the community through the Quality of Kane Public Meetings, Focus Groups, Community Cafes and Community Meetings. These events provided an opportunity to hear directly from residents about the factors most influencing health in their communities. This information was used to help planners understand the health data collected. Over 200 residents participated in at least one of these events. Community and Stakeholder Participation. Community and stakeholder input were obtained to determine the needs of the community. The Quality of Kane Public Meetings were held in April,May, and November 2011. These meetings provided community members an opportunity to hear about and provide their input on planning initiatives in Kane County from different planning disciplines: health, land use, and transportation. There were six meetings total, two from each of the three planning areas in the county. The planning areas are defined by the county and are used by all departments. Part V Line 4 PMMC partnered with Sherman Hospital, Cadence Health, Presence Saint Joseph Hospital and Rush-Copley Medical Center to complete their CHNA. Part V Line 5a PMMC's CHNA can be accessed at this url: http://presencehealth.org/aboutpresence/community-reports/presence-mercy-m edical-center-aurora. Presence Saint Joseph Hospital - Elgin (3) Part V line 3 The CHNA process was initiated by PSJH and PMMC in collaboration with the community they serve and the Kane County Health Department, Delnor Hospital, Rush-Copley Medical Center, Sherman Hospital, Fox Valley United Way and the United Way of Elgin. Engagement of Public Health Expertise The Kane County Health Department facilitated the CHNA process by using the Mobilizing for Action through Planning and Partnerships (MAPP) tool. PSJH served as one of eight partners that participated in the Kane County Community Health Needs Assessment. This provided the opportunity for PSJH to actively provide expertise, input
NEEDS ASSESSMENT   Part VI, 2 Presence Hospital ministries join forces with local community organizations to assess the health needs of the community. Community needs assessments are completed for the individual counties we serve with community partners every 3-5 years depending on the community needs and available resources. To supplement the community needs assessment Presence Hospitals also review and analyze Inpatient and Emergency Department utilization on an annual basis to uncover any new community health trends. In addition to assessing the health needs, Presence Hospital ministries also complete medical staff development plans. The plans are conducted by external consultants, who provide an independent assessment of the need for physicians by specialty within the hospital's primary service area as defined by Stark regulations. Identifying community needs is just one step in the needs assessment process. The most critical step is prioritizing and aligning expertise to make an impact on the identified needs. To facilitate this process, each hospital ministry has a Mission Committee of the Board that is ultimately responsible for the oversight and direction of the community benefit initiatives. On an annual basis this board committee, which is made up of community and board members, recommends approval to the hospital Board of Directors the hospital's community benefit plan. This plan identifies the priorities and action that will take place over the next year. Part VI, 3 Presence Health hospital ministries proactively communicate the availability of our financial aSSistance/charity care programs by using multiple types of appropriate media and in multiple appropriate languages. The mechanisms used by Presence Health hospitals to communicate the availability of Financial Assistance/Charity Care include, but are not limited to the following: 1. Signage. Signs are posted prominently throughout high traffic areas of our ministries, as well as within our inpatient and outpatient registration/patient admitting areas and emergency departments. Signs state that patients may be eligible for Financial Assistance/Charity Care discounts, and describe how to obtain more information, including identification of appropriate hospital representatives by title. Signs are in multiple languages. 2. Provision of Financial Assistance Materials to Uninsured Patients. Presence Health hospitals provide a summary of its Financial Assistance Programs and a Financial Assistance application to all persons receiving hospital care that it identifies as uninsured patients at the time of in-person registration, admission, or such later time that the patient is first identified as an uninsured patient. For patients presenting in the Emergency Department, all Presence Health hospitals provide such Financial Assistance materials at such time and in such manner as is consistent with their obligations under EMTALA to access and stabilize the patient before making inquiry of the patient's ability to pay. 3. Brochures. Brochures, information sheets and similar forms of written communication regarding the hospital's Financial ASSistance/Charity Care policy are maintained in appropriate areas of the hospital (e.g. Emergency Department, organized registration areas, the Business Office). These communications state in multiple languages that the hospital offers Financial Assistance/Charity Care discounts and describes how to obtain more information. 4. Website. Comprehensive information about our financial assistance programs - including eligibility criteria, application details, and contact information - is also available on our consumer Web site (http://presencehealth.org/patients-and-visitorslfinancial-assistance). 5. Billing Notices. Each Presence Health hospital includes a note on or with the hospital bill and/or statement regarding the hospital's Financial Assistance/Charity Care program and how the patient may apply for consideration under this program. 6. Financial Counselors. Each Presence Health hospital has one or more financial counselors whose contact information is listed or provided with other information concerning the Financial Assistance/Charity Care discount program. These counselors are available to discuss eligibility and other questions concerning the program, and provide assistance with applications. They are also available to meet with patients during their stay if they have questions about their ability to pay for services and our financial assistance programs. 7. Notification of Determination. When a Presence Health hospital makes a determination that a patient's bill is discounted or adjusted based on a determination of financial need, the hospital notifies the patient of such eligibility determination and that there is no further collection action taken on the discounted portion of the patient's bill. PART VI, 4 Presence Hospital ministries provide services at 150 sites, including twelve acute care hospitals with a total of 2,997 staffed beds and over 90 primary and specialty care clinic. These ministries offer a broad range of services from highly specialized tertiary services to an extended network of primary and ambulatory care. Presence Health hospital ministries have identified a separate service area for each of its acute care hospitals utilizing a consistent methodology and reflecting a combination of geographic location and market share criteria. The total service area of each ministry represents approximately 80% to 90% of the total inpatient discharges from that facility. THERE ARE 19 OTHER HOSPITALS SERVING THE TOTAL SERVICE AREA. The primary service area (the "Primary Service Area") of each facility represents approximately 65 to 75% of such discharges and the secondary service area (the "Secondary Service Area") of each facility represents approximately 15 to 25% of such discharges. The Primary Service Areas and Secondary Service Areas have been determined by utilizing a patient origin analysis to identify those zip codes that represent inpatient discharges. These zip codes are then mapped to identify geographic coverage of the Primary Service Areas and Secondary Service Areas. Many of the Presence Health hospital ministries facilities are located in population growth areas. Based upon population estimates and projections obtained from Claritas, Inc., the population of the our hospitals' combined service area is expected to grow at a rate of 1.9% annually between 2012 and 2017, compared with a growth rate of 1.3% and 1.6% per year in the Chicago MSA and in Illinois, respectively. Of Presence's total service area population, 10.7% is over the age of 65, compared to 11 .1 % and 12.3% in the Chicago MSA and in Illinois, respectively. Presence Covenant Medical Center, Champaign, IL (PCMC): Champaign County is the tenth largest county in the state of Illinois with a 2010 population of 201,801. In the primary service area, 10.6% of the population is over the age 65 and the average household income is $44,462. The primary demographic make-up of Champaign County is as follows: 74.8% white, 12.7% black or African American, 9.4% Asian, 5.5% Hispanic/Latino. 21.8% of families in Champaign County live below the poverty level. The PCMC service area is defined by zip codes below. Service Area: Primary Market - ZIP CODE CITY 61821 Champaign 61801 Urbana 61820 Champaign 61866 Rantoul 61802 Urbana 61953 Tuscola 61880 Tolono 61873 Saint Joseph 61956 Villa Grove 61874 Savoy 61849 Horner 61878 Thomasboro 61822 Champaign 61847 Gifford 61877 Sidney 61943 Oakland 61851 Ivesdale 61884 White Heath 61839 De Land 61931 Humboldt 61844 Fithian 61862 Penfield 61882 Weldon 61773 Sibley 61930 Hindsboro 61812 Armstrong 60933 Elliott 61932 Hume 61871 Royal 60926 Claytonville 61845 Foosland 61941 Murdock Service Area: Secondary Market - Zip code City 60948 Loda 60957 Paxton 61856 Monticello 61853 Mahomet 61938 Mattoon 61910 Arcola 60936 Gibson City 61920 Charleston 61942 Newman 61813 Bement Presence United Samaritans Medical Center (PUSMC), Danville, IL: PUSMC's primary and secondary service areas have an estimated population of 81,625 residents. In the primary service area, 16.7% of the population is over the age 65 and the average household income is $40,463. The primary demographic make-up of Vermillion County is as follows: 83.6% white, 13.3% black or African American, 4.5% Hispanic/Latino. 18.8% of families in Vermillion County live below the poverty level. The PUSMC service area is defined by zip codes below. Service Area: Primary Market - ZIP CODE CITY 61832 Danville 61834 Danville 61846 Georgetown 61883 Westville 61833 Tilton Service Area: Secondary Market - Zip Code City 47932 Covington, IN 60942 Hoopeston 61817 Catlin 61858 Oakwood 61870 Ridge Farm 61924 Chrisman 60963 Rossville 47987 Veedersburg, IN 61841 Fairmont 47974 Perrysville, IN 47993 Williamsport, IN 61814 Bismark 61865 Potomac 47928 Cayuga, IN 47952 Kingman, IN 61876 Sidell 61811 Alvin 61844 Fithian 61850 In
PART VI, 5   Presence Health hospitals are faith-based ministries that provide services based upon the ethical and religious directives of the Catholic Church. Presence Health hospitals enhance the public health of our communities by: 1. Ensuring our medical staff is open to all qualified physicians 2. All of our hospitals are accredited and in good standing with the Joint Commission Accreditation of Healthcare Organizations. 3. Ensuring our board of directors is diverse and able to provide expertise, and made up of independent members of the communities we serve. Our board members must follow a conflict of interest policy. 4. Reinvesting surplus funds into the organization to improve patient care though new programs and technology. 5. Providing financial assistance, sliding scale discounts and has collection practices that are in compliance with state and federal guidelines. In addition, we follow the financial assistance and charity guidelines of the Catholic Health Association. 6. Participating in all government sponsored health care programs, Medicare, Medicaid, CHAMPUS, Tricare, SCHIP and others. 7. Providing emergency room services in all of our communities and providing training to local fire departments and ambulances. Our emergency room participates with local police and fire departments in disaster drills. 8. Staffing Board Certified Emergency Room Physicians in our emergency room and urgent care services. We treat patients according to EMTALA guidelines and serve all patients regardless of ability to pay. In addition, we are committed to determining the needs of our communities and creating ways to meet those needs. The obligation to reach out to those in need and improve health flows directly from our Catholic identity and the heritage of our founding congregations. Below are a few examples of how each of our hospitals promote the health of our communities. Presence Covenant Medical Center, Champaign, IL (PCMC) 2012 Community Benefit Highlights: SmileHealthy Partnership Almost 2,000 people per year present to the Emergency Department(ED) with dental issues in Champaign/Urbana. Over 1,000 referrals are on an active waiting list (consent forms/medical history completed) at the non-profit SmileHealthy. Patients who are seen in the ED are referred to the Nutrition Dental Education Program for nutritional education to aid in healthy food choice on a budget and importance of the food group to have good oral health. This free service is held in a PCMC meeting room twice a month. Once the education is complete, patients then receive assistance to find treatment in the Champaign area; either at Frances Nelson Dental Center (FNDC) or to a PCMC-sponsored mobile dental clinic. SmileHealthy treated over 100 patients with dental services at 12 mobile clinics in 2012 funded by PCMC. 25 were referrals from the nutrition and dental education program and were previously PCMC ED patients. This nutrition and dental education program helps navigate low income patients to the agency that can best serve their dental treatment needs and improve food habits. The Dental Advisory Committee, composed of Frances Nelson Health Center, Parkland College, SmileHealthy, PCMC, and other community members will meet to ensure the viability of SmileHealthy. General anesthesia will also be provided to 3 children a month in the operatories at PCMC for severe dental treatment for children through a partnership with SmileHealthy. Faith in Action The Faith in Action program is an interfaith volunteer care giving ministry that provides practical assistance to adults 55 and over who are chronically ill, frail, or have long term health needs. The types of services provided by the trained volunteers includes escorted transportation to medical appointments and shopping, friendly home and phone visits, indoor/outdoor chores, and small home repairs. Crisis Nursery Support Crisis Nursery is located on the grounds of PCMC. Since inception, Crisis Nursery has provided a safe haven for children from birth to age five, working to prevent child abuse and neglect. Immediate response is needed in extreme situations where children are at risk of harm and assistance cannot wait. 85% of these children lived in a single, separated, divorced or widowed household. Crisis Nursery operates with no income eligibility or wait list. Over 46% of admissions are due to parental stress. 3% report domestic violence or substance abuse as the reason the Crisis Nursery was utilized. Bucher Farm Project The Bucher Farm project is designed to help the poor and vulnerable gain access to healthy food choices. Thanks to a generous land donation, PCMC can provide fresh corn to persons living in poverty. The farm consists of 88 acres located in southwest Champaign. 1.8 acres are planted with sweet corn. Diabetes Coalition In Champaign, 7% of all adults have diabetes. The prevalence of diabetes in the 65+ age group is 16.3% in Champaign County. It is especially prevalent among the African American population. They have twice the mortality rate as Caucasians. The Community Diabetes Coalition was established in March, 2011 to focus on the widespread problem of diabetes. The purpose of the coalition is to develop diabetes prevention and management activities through a unified community effort of hospitals, clinics, social service agencies, and other interested community partners. The coalition is co-led by Presence Center for Healthy Living (PCHL) and the Champaign-Urbana Public Health District. Presence Home Care is an active member of this coalition. PCHL receives a grant to implement the Diabetes Self-Management Program from the Illinois Department of Public Health. This is an evidenced-based program developed and researched by Stanford University. PartiCipants attend six 2.5 hour sessions. Classes are held at PCHL to teach techniques to deal with symptoms of diabetes, appropriate exercises, healthy eating, use of medication, and working effectively with health care providers. Faith2 The purpose of Faith2: "Fund to Accelerate Innovation towards Healing and Hope," is to serve as a catalyst for innovation and acceleration of community partnership and programs to improve the health of the communities we serve consistent with the Mission, Vision, and Values of our Ministry. The guiding philosophy of Faith2 is to extend the mission of our ministry beyond our facilities and into the communities and neighborhoods we serve. Through the program of Faith2 we help achieve this by providing grants to non-profit organizations in the Champaign/Urbana community to fund programs that will contribute to the identified needs as defined by the PCMC Implementation Strategy. Access to Care Obesity Domestic Violence/ Abuse The Foundation's Faith2 grants provided more than $65,000 to six local agencies for programs that impact identified and demonstrated community health needs. Transitions Presence Transitions is a service made available through the Home Care and Hospice programs to members of the community at no cost. Presence Transitions is a program that offers assistance, encouragement and support to individuals and families coping with a life-limiting illness. It is for those who either pursue a curative treatment or comfort care for their illness but are not pursuing hospice or home care. Services available include, but are not limited to, advanced care planning, advocacy, respite and volunteer support. Presence United Samaritans Medical Center (PUSMC), Danville, IL 2012 Community Benefit Highlights: The HALO Project The mission of the HALO Project is to focus on building a community culture that supports healthy life choices and a high quality of life. HALO Project serves as a catalyst to mobilize individuals, organizations, local government, neighborhood groups, social service agencies and healthcare providers to become partners in reclaiming responsibility for individual and community health. HALO Project has many committees and coalitions manned by community volunteers, community partners, and community stakeholders who come together to plan, develop, and implement programs and events. HALO Project's target population is all areas, ages, and members of the broader community in Vermilion County with an emphaSis on the disproportionate unmet health needs (DUHN) populations. Faith in Action (FIA) Faith in Action is a volunteer care giving ministry in the Danville area. The program uses faith and community volunteers to provide assistance to the senior adult population 60+ years. We provide transportation to medical appointments, banking, shopping and other necessary errands. Other services include home and phone visits, chores, and respite care. We have limited donated funds available for home repairs (paid contractors) and emergency needs such as RX, utilities assistance, medical equipment. Faith in Action South (FIAS) Faith in Action South is a volunteer care giving ministry (South County) The program uses faithand community v
PART VI, 6 (cont.)   As a not-for-profit health system, Presence Health invests its net gains from operations into the community through programs to serve vulnerable populations, such as the poor and uninsured, manage chronic conditions, and promote health education and promotion outreach and initiatives. In Fiscal Year 2012, this included $168 million in community benefit activities. Presence Health thus takes a systems approach to its community benefit efforts, and therefore ensures its member hospitals and other entities and affiliates are helping to promote and address the health needs of the communities they serve. For more information on Presence Health, visit www.presencehealth.org. PART VI, 7 Presence Health files its annual community benefit report in Illinois.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number
36-4195126
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) scholarships 60 76,040      












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
form 990 schedule I, PART I LINE 2   THE FOLLOWING THREE HOSPITALS AWARDED GRANTS AND ASSISTANCE AND USED THE FOLLOWYNG PROCEDURES FOR MONITORING THE USE OF THE FUNDS DISTRIBUTED: Presence Covenant Medical Center Checks for authorized students are sent directly to their respective universitIES (and made payable to the universitIES) for disbursement to the studentS for appropriate expenses such as tuition. In the case of Parkland College where a good number of nursing scholarships are given, Parkland bills THE MEDICAL CENTER at the conclusion of each semester. THE MEDICAL CENTER IS billed for only the dollars used and if a student does not utilize all of the funds made available for HIS OR HER scholarship award, the Auxiliary is not billed and does not incur the expense. They also notify THE MEDICAL CENTER if A student drops out or changes curriculums therefore no longer being eligible for the funds given in their healthcare studies. Most of the universities have auditing practices which requires them to oversee the distribution of scholarship funds to their students. THE MEDICAL CENTER placeS ITS confidence in their practices to ensure that monies given to the students are monitored appropriately. Presence Mercy Medical Center Scholarships are handled through THE MEDICAL CENTER'S Foundation. The Foundation office receives the applications and distributes the applications to a committee. The committee reviews the applications, determines which candidates to interview in person, conducts the interviews, and selects the recipients. The Foundation receives the tuition bills and makes the tuition payments directly to the schools (up to the amount of the scholarship award). Some grants are handled through THE Foundation. When grant funds are to be expended, a "Disbursement of Foundation Funds" form is completed by the clinical director responsible for handling the grant. The Foundation reviews and approves the form, and the funds are expended. The Foundation notifies Finance that the funds can be released from restriction. The clinical director and Foundation office work together to submit the necessary grant reports to the grantor. Federal grants are not handled through the Foundation. The clinical director responsible for the grant works with Finance to track the expenses for the grant. The clinical director prepares and submits the necessary reports to the grantor. PRESENCE UNITED SAMARITANS MEDICAL CENTER THE MEDICAL CENTER insureS that the young man or young woman awarded a scholarship through Young Men Aware or Young Women Aware actually enroll in an institution of higher learning and pay the scholarship (generally only $500 or $1,000) directly to the institution. Thus, eliminating any chance that the SCHOLARSHIP will not actually go towards education.
Schedule I (Form 990) 2012


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
2012
Open to Public Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
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 of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
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
Yes
 
3
Indicate which, if any, of the following the filing organization used 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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
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
 
No
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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)SANDRA BRUCEPRESIDENT/CEO & DIRECTOR (i)
(ii)		  
1,102,304 		 
235,527 		 
0 		 
1,377,541 		 
27,210 		 
2,742,582 		 
0
(2)AMY STEVENSCOO (i)
(ii)		 268,298
  		 
  		43,072
  		22,800
  		10,601
  		344,771
  		 
 
(3)ELIZABETH GARROWVP FOUNDATION (i)
(ii)		 92,558
  		 
  		208,356
  		 
  		11,669
  		312,583
  		72,307
 
(4)JARED ROGERSCMO (i)
(ii)		 235,191
  		14,588
  		29,304
  		20,800
  		20,022
  		319,905
  		 
 
(5)SUZETTE MAHNEKEVP PATIENT CARE SRVS (i)
(ii)		 148,040
  		 
  		126,428
  		11,604
  		19,223
  		305,295
  		 
 
(6)LAURENCE DRYVP STRATEGY & OPS (i)
(ii)		 183,985
  		41,768
  		42,710
  		11,343
  		26,347
  		306,153
  		 
 
(7)JACQUELINE MEDLANDVP PATIENT CARE SRVS (i)
(ii)		 196,350
  		 
  		48,106
  		19,201
  		27,673
  		291,330
  		 
 
(8)JANICE NEMRICAO (i)
(ii)		 184,190
  		 
  		62,907
  		18,001
  		18,972
  		284,070
  		20,009
 
(9)CATHERINE EMANUELREG VP STRATEGIC PLG & BUS DEV (i)
(ii)		 211,716
  		 
  		28,538
  		 
  		1,080
  		241,334
  		 
 
(10)LISA DIMARCOVP PATIENT CARE SRVS (i)
(ii)		 186,285
  		16,000
  		15,051
  		15,076
  		16,244
  		248,656
  		 
 
(11)DAVID MCNARYVP AMBULATORY SRVS (i)
(ii)		 70,880
  		 
  		126,360
  		 
  		1,864
  		199,104
  		36,239
 
(12)LISA LAGGERCRO (i)
(ii)		 178,350
  		 
  		18,607
  		16,046
  		16,973
  		229,976
  		 
 
(13)GARY PLUNDOCMO (i)
(ii)		 147,801
  		 
  		48,372
  		276
  		618
  		197,067
  		33,539
 
(14)MOLLY NICHOLSONVP PATIENT CARE SRVS (i)
(ii)		 137,983
  		8,232
  		46,875
  		12,001
  		14,479
  		219,570
  		 
 
(15)JENNIFER CORDVP OPERATIONS (i)
(ii)		 126,591
  		7,434
  		24,171
  		10,833
  		23,360
  		192,389
  		 
 
(16)FRANK MCHUGHVP FINANCE / CFO (i)
(ii)		 123,313
  		 
  		28,867
  		 
  		10,612
  		162,792
  		 
 
(17)JOMEL LABAYOGPHYSICIAN (i)
(ii)		 595,381
  		 
  		34,000
  		 
  		18,265
  		647,646
  		 
 
(18)SURENDRA GULATIPHYSICIAN (i)
(ii)		 451,615
  		 
  		1,584
  		 
  		19,320
  		472,519
  		 
 
(19)VICTOR ROSTAPSHOVPHYSICIAN (i)
(ii)		 322,618
  		 
  		24,084
  		 
  		9,522
  		356,224
  		 
 
(20)MICHAEL PANUSKAMEDICAL DIRECTOR (i)
(ii)		 229,843
  		28,000
  		13,910
  		 
  		13,195
  		284,948
  		 
 
(21)JINJENG ZHUPHYSICIST (i)
(ii)		 217,703
  		 
  		29,802
  		 
  		17,610
  		265,115
  		 
 
(22)Anthony FilerSYS CFO, TREASURER (i)
(ii)		  
633,416 		 
0 		 
136,386 		 
78,612 		 
46,124 		 
894,538 		 
0
(23)Connie March-CurtisPRES & CEO PSS (i)
(ii)		 318,406
  		0
  		136,912
  		0
  		22,596
  		477,914
  		19,138
 
(24)Jeannie FreySecretary (i)
(ii)		  
488,063 		 
34,579 		 
0 		 
56,393 		 
5,731 		 
584,766 		 
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
FORM 990 SCHEDULE J SUPPLEMENTAL INFORMATION   PART I, QUESTION 1A THE FOLLOWING RECEIVED HEALTH CLUB DUES, WHICH ARE TAXABLE TO THE RECIPIENTS: MOLLY NICHOLSON $5,292 JENNIFER CORD $4,779 PART I, QUESTION 4A THE FOLLOWING RECEIVED SEVERANCE PAYMENTS: Elizabeth Garrow $ 98,970 Suzette Mahneke $ 37,936 David McNary $109,384
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
Identifier Return Reference Explanation
FORM 990 PART VI SECTION A, QUESTION 6   THE SOLE MEMBER OF PRESENCE HOSPITALS PRV IS PRESENCE PRV HEALTH. FORM 990 PART VI SECTION A, QUESTIONS 7A & 7B PRESENCE PRV HEALTH AS THE SOLE MEMBER OF PRESENCE HOSPITALS PRV HAS THE POWER TO REMOVE AND APPOINT MEMBERS OF THE BOARD AND RESERVES THE RIGHT TO MAKE GOVERNANCE DECISIONS FOR PRESENCE HOSPITALS PRV.
FORM 990 PART VI SECTION B, QUESTION 11B   THE DATA AND INFORMATION NECESSARY TO PREPARE THE FORM 990 WAS COMPILED BY PROVENA HEALTH'S ACCOUNTING GROUP. KPMG, AS EXTERNAL TAX PREPARERS, USED THIS INFORMATION TO PREPARE THE FORM 990. THE FINAL FORM 990 IS PROVIDED TO THE CORPORATION'S BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING.
FORM 990 PART VI SECTION B, QUESTIONS 12A, 12B, & 12C   THE ORGANIZATION HAS ADOPTED A POLICY THAT REQUIRES BOARD MEMBERS TO COMPLETE A STATEMENT THAT DISCLOSES ALL ACTIVITIES AND PROHIBITS VOTING ON ANY MATTERS INVOLVING ANY CONFLICTS. EVERY AGENDA HAS A STATEMENT THAT PROHIBITS VOTING ON AGENDA ITEMS WHERE BOARD MEMBERS HAVE CONFLICTS. VENDOR FILES ARE MATCHED WITH COMPANIES BOARD MEMBERS THAT HAVE AFFILIATIONS WITH TO DETERMINE IF CONFLICTS EXIST. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CORPORATE COMPLIANCE DEPARTMENT.
FORM 990 PART VI SECTION B, QUESTIONS 15A & 15B   THE COMPENSATION COMMITTEE OR OTHER AUTHORIZED COMMITTEE OF THE BOARD, NONE OF WHICH HAVE A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT, WAS ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR THE CEO AND KEY EMPLOYEES. THE COMMITTEE DEVELOPED, CONSISTENT WITH PRESENCE HOSPITAL PRV'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR THE CEO AND KEY EMPLOYEES. THE COMMITTEE ALSO REVIEWED APPROPRIATE COMPARABILITY DATA PREPARED BY AN INDEPENDENT CONSULTANT THAT UTILIZED NATIONAL NONPROFIT COMPENSATION SURVEYS IN DETERMINING THE CEO'S AND KEY EMPLOYEES' COMPENSATIONS. THE COMMITTEE'S WRITTEN RECORDS INCLUDE THE (1) TERMS OF THE ARRANGEMENT WITH THE DISQUALIFIED PERSON (INCLUDING THE DATE THE ARRANGEMENT WAS APPROVED); AND (2) A DESCRIPTION OF THE COMPARABLE DATA RELIED ON BY THE COMMITTEE. KEY DELIBERATIONS OF THE COMMITTEE, INCLUDING: (A) THE TERMS OF THE TRANSACTION THAT WAS APPROVED AND THE DATE IT WAS APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DEBATE ON THE TRANSACTION THAT WAS APPROVED AND THOSE WHO VOTED ON IT; (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED; AND (D) ANY ACTIONS TAKEN WITH RESPECT TO CONSIDERATION OF THE TRANSACTION BY ANYONE WHO IS OTHERWISE A MEMBER OF THE COMMITTEE BUT WHO HAD A CONFLICT OF INTEREST WITH RESPECT TO THE TRANSACTION ARE ALSO DOCUMENTED IN MINUTES, WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING.
FORM 990 PART VI SECTION C, QUESTION 19   GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND ARE ON THE ORGANIZATION'S WEBSITE.
FORM 990 PART XI Line 9, Other Change in Net Asset or Fund Balance Transfers from Affiliates 11,121,123 Book/Tax Income Difference with Joint Ventures (854,509) ------------ Other Changes in Net Assets or Fund Balances(Ln 9) 10,266,614
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
Presence Hospitals PRV
 
Employer identification number

36-4195126
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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) Alverno Provena Laboratories Inc
2434 INTERSTATE PLAZA DR
hammond,IN46324
20-3238867 		Healthcare IN 134,349,891 150,000 Pres Hos PRV
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) RESURRECTION HEALTH CARE CORPORATION

7435 WEST TALCOTT AVENUE

CHICAGO,IL60631
36-2235165 		PARENT CORP IL 501(C)(3) 7 PH NETWORK
 
 
No
(2) PRESENCE RESURRECTION MEDICAL CENTER

7435 WEST TALCOTT AVENUE

CHICAGO,IL60631
36-3330926 		HEALTH CARE IL 501(C)(3) 3 RHCC
 
 
No
(3) PRESENCE LADY-RESURRECTION MED CTR

5645 WEST ADDISON STREET

CHICAGO,IL60634
36-2644178 		HEALTH CARE IL 501(C)(3) 3 RHCC
 
 
No
(4) Presence Health Network

7435 WEST TALCOTT AVENUE

CHICAGO,IL60631
36-1649520 		PARENT CORP IL 501(C)(3) 3 NA
 
 
No
(5) PRESENCE SAINT FRANCIS HOSPITAL

355 RIDGE AVENUE

EVANSTON,IL60202
36-2167800 		HEALTH CARE IL 501(C)(3) 3 RHCC
 
 
No
(6) PRESENCE SAINTS MARY & ELIZABETH MED CTR

2233 WEST DIVISION STREET

CHICAGO,IL60622
36-2171079 		HEALTH CARE IL 501(C)(3) 3 RHCC
 
 
No
(7) PRESENCE HOLY FAMILY MEDICAL CENTER

100 n RIVER ROAD

DES PLAINES,IL60016
36-2439318 		HEALTH CARE IL 501(C)(3) 3 RHCC
 
 
No
(8) Medicare Value Partners

100 N River Road

Des Plaines,IL60016
36-3495969 		health care IL 501(C)(3) 3 RHCC
 
 
No
(9) Presence Saint Joseph Hospital - Chicago

2900 North Lake Shore Drive

chicago,IL60657
36-3200170 		health care IL 501(C)(3) 3 RHCC
 
 
No
(10) Resurrection University

7435 West Talcott Avenue

chicago,IL60631
36-2182170 		health care IL 501(C)(3) 3 RHCC
 
 
No
(11) Presence Ambulatory Services

7435 West Talcott Avenue

Chicago,IL60631
36-4286236 		health care IL 501(C)(3) 3 RHCC
 
 
No
(12) Presence RHC Senior Services

7435 West Talcott Avenue

chicago,IL60631
23-7061646 		senior living IL 501(C)(3) 3 RHCC
 
 
No
(13) PRESENCE HEALTHCARE SERVICES

7447 West Talcott Avenue

chicago,IL60631
36-3330928 		health care IL 501(C)(3) 3 RHCC
 
 
No
(14) Proviso Family Services

1820 South 25th Avenue

broadview,IL60155
36-2709982 		health care IL 501(C)(3) 3 RES SERVICE
 
 
No
(15) Presence Home Care Services

5747 West Dempster

morton grove,IL60053
36-2893936 		home care IL 501(C)(3) 3 RHCC
 
 
No
(16) Resurrection Development Foundation

150 N River Road

des plaines,IL60016
36-3330929 		fundraising IL 501(C)(3) 7 RHCC
 
 
No
(17) Resurrection Ministries of New York

90 N Main Street

castelton,NY12033
14-1720818 		parent corp NY 501(C)(3) 7 RHCC
 
 
No
(18) Resurrection Nursing Home Inc

90 N Main Street

castelton,NY12033
14-1348691 		senior living NY 501(C)(3) 3 Resur Min NY
 
 
No
(19) Mount Loretto Nursing Home Inc

302 Swart Hill Road

amsterdam,NY12010
14-1363014 		senior living NY 501(C)(3) 3 Resur Min NY
 
 
No
(20) Resurrection Medical Center Auxiliary

7435 West Talcott Avenue

chicago,IL60631
36-6109825 		fundraising IL 501(C)(3) 7 Resur MedCtr
 
 
No
(21) Saint Francis Hospital Auxiliary

355 Ridge Avenue

evanston,IL60202
36-6143349 		fundraising IL 501(C)(3) 7 St Fran Hosp
 
 
No
(22) PRESENCE PRV HEALTH

9223 w st francis road

frankfort,IL60423
36-3366652 		healthcare IL 501(C)(3) 11 PH NETWORK
 
 
No
(23) Presence Life Connections

19065 hickory creek drive

mokena,IL60448
37-1127787 		healthcare IL 501(C)(3) 9 PRS PRV HEAL
 
 
No
(24) presence care home

19065 hickory creek drive

mokena,IL60448
46-0483587 		healthcare IL 501(C)(3) 9 PLC
 
 
No
(25) Presence Home Care

19065 hickory creek drive

mokena,IL60448
46-0483581 		healthcare IL 501(C)(3) 9 plc
 
 
No
(26) presence self-insurance trust

9223 west st st francis road

frankfort,IL60423
36-2987310 		insurance IL 501(C)(3) 9 prs prv heal
 
 
No
(27) presence laverna terrace

19065 hickory creek drive

mokena,IL60448
36-3438977 		healthcare IL 501(C)(3) 9 PRS PRV HEAL
 
 
No
(28) Holy Family Health Care System Inc

100 N River Road

Des Plaines,IL60016
36-3495969 		health care IL 501(C)(3) 3 rhcc
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) PRESENCE SERVICES CORPORATION

9223 W ST FRANCIS ROAD
FRANKFORT,IL60423
36-4314354 		medical IL Pres Hosp PRV
  		c corp     100.000 % Yes  
(2) PRESENCE VENTURES

9223 west st francis road
frankfort,IL60423
37-1168085 		medical IL Pres Prv Health
  		c corp         No
(3) PRESENCE properties

9223 west st francis road
frankfort,IL60423
36-3520630 		medical IL Pres Ventures
  		c corp         No
(4) Provena Health Assurance SPC

 
 
98-0420054 		SELF-INSUR CJ PRES PRV HEALTH
  		c corp         No
(5) L Gilbraith Insurance SPC Ltd

9223 West St Francis Road
Frankfort,IL60423
98-0420054 		medical IL na
  		c corp         No
(6) resurrection health care preferred

100 N River Road
Des Plaines,IL60016
36-3974620 		Mgd Care Cont IL RHCC
  		C Corp         No
(7) Presence Health Partners

200 S WACKER DRIVE
CHICAGO,IL60606
46-3111349 		INSURANCE HOLD CO IL PH NETWORK
  		c corp         No
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) PRESENCE SERVICE CORPORATION

 p 1,234,953 cost of service





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID:  
Software Version: