Form990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

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 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
CDH-DELNOR HEALTH SYSTEM
 
Doing Business As
CADENCE HEALTH
 
Number and street (or P.O. box if mail is not delivered to street address)
27W353 Jewell Rd
 
Room/suite
City or town, state or country, and ZIP + 4
Winfield, IL60190
D Employer identification number

36-3099698
E Telephone number

G Gross receipts $ 514,590,584
F Name and address of principal officer:
MICHAEL VIVODA
25 N Winfield Rd
Winfield,IL60190
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CDH.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: 1980
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CDH-DELNOR HEALTH SYSTEM (DBA CADENCE HEALTH) IS A SUPPORTING ORGANIZATION PROVIDING MANAGEMENT SERVICES TO A SYSTEM OF RELATED NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 17
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 682
6 Total number of volunteers (estimate if necessary) ............. 6 17
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,117,264
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 2,450,259
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 86,154,944 223,315
9 Program service revenue (Part VIII, line 2g) ......... 67,232,830 143,177,577
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 12,160,222 32,643,762
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,384,730 6,099,242
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 168,932,726 182,143,896
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 45,188,574 3,801,730
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) 34,775,634 54,280,217
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 88,774,055 118,464,468
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 168,738,263 176,546,415
19 Revenue less expenses. Subtract line 18 from line 12....... 194,463 5,597,481
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 968,848,461 1,048,370,382
21 Total liabilities (Part X, line 26)............. 633,375,759 615,255,077
22 Net assets or fund balances. Subtract line 21 from line 20..... 335,472,702 433,115,305
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: CDH-DELNOR HEALTH SYSTEM'S MISSION AND OBJECTIVE IS TO ESTABLISH AND MAINTAIN ORGANIZATIONS FOR THE PROVISION OF HEALTHCARE TO THE COMMUNITY ON A NOT-FOR-PROFIT BASIS.
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 $ 151,943,961 including grants of $ 3,801,730 ) (Revenue $ 143,364,810 )
CDH-DELNOR HEALTH SYSTEM (D/B/A CADENCE HEALTH) ACCOMPLISHES ITS MISSION OF PROVIDING HEALTHCARE TO THE COMMUNITY THROUGH MANAGEMENT OF A SYSTEM OF RELATED NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS. DURING THE TAX YEAR, CDH-DELNOR HEALTH SYSTEM SERVED AS THE PARENT AND MANAGING ENTITY FOR HEALTHCARE ORGANIZATIONS INCLUDING: CENTRAL DUPAGE HOSPITAL ASSOCIATION (COMMUNITY HOSPITAL), DELNOR-COMMUNITY HOSPITAL (COMMUNITY HOSPITAL), COMMUNITY NURSING SERVICE OF DUPAGE COUNTY (HOME HEALTH AND HOSPICE), CENTRAL DUPAGE PHYSICIAN GROUP (PRIMARY AND SPECIALTY PHYSICIANS), DELNOR-COMMUNITY RESIDENTIAL LIVING (SENIOR RESIDENCES), PAHCS II (OCCUPATIONAL HEALTH SERVICES), CENTRAL DUPAGE SPECIAL HEALTH ASSOCIATION (COORDINATED PHARMACY SERVICES WITHIN THE SYSTEM), LIVING WELL CANCER RESOURCE CENTER (SUPPORT FOR CANCER PATIENTS), CADENCE HEALTH FOUNDATION (FUNDRAISING) AND DELNOR-COMMUNITY HEALTH CARE FOUNDATION (WELLNESS). CDH-DELNOR HEALTH SYSTEM SUPPORTS THESE ORGANIZATIONS BY PROVIDING MANAGEMENT OVERSIGHT, LONG-RANGE PLANNING, MARKETING, FINANCE, ACCOUNTING, INTERNAL AUDIT, COMPLIANCE, PRIVACY, LEGAL, INFORMATION SYSTEMS, BUSINESS DEVELOPMENT, TREASURY, AND OTHER ADMINISTRATIVE SERVICES.
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 expensesMediumBullet151,943,961
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 IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21 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 IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, 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
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
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 .................
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......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the 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)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
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
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, 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................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
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
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
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.............
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 VI
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
634
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
682
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
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible 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
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
No
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
22
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
17
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
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
 
 
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
CA , 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:
MediumBulletJohn Orsini EVP & CFO25 N WINFIELD RDWinfieldIL60190 (630) 933-1600
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) CATHERINE E KOZIK........................................................................
Secretary
 1.00
.......................2.00 		X   X       0 0 0
(2) DAVID C BROWN........................................................................
Treasurer
 1.00
.......................2.00 		X   X       0 0 0
(3) MICHAEL VIVODA........................................................................
CEO
 40.00
.......................10.00 		X   X       912,060 0 36,090
(4) RICHARD A MARK........................................................................
Chair
 1.00
.......................2.00 		X   X       0 0 0
(5) WILLIAM P FLESCH........................................................................
Vice Chair
 1.00
.......................2.00 		X   X       0 0 0
(6) BRADLEY J KINSEY........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(7) C WILLIAM POLLARD........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(8) DONALD VAN PELT........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(9) JAMES E COMERFORD........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(10) JAMES G GIBLIN MD........................................................................
Director
 1.00
.......................2.00 		X           0 85,250 0
(11) JOSEPH G CACCHIONE MD........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(12) KAY CLANCY........................................................................
Director
 1.00
.......................3.00 		X           0 0 0
(13) MANNY FAVELA........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(14) MATTHEW J ROSS MD........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(15) MICHAEL J KACHMER........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(16) PATRICK J FLINN........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(17) PHILIP A BRANSHAW........................................................................
Director
 1.00
.......................2.00 		X           909 0 0
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) ROGER T HARRIS........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(19) SCOTT E FORE........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(20) STEPHEN R HOLTSFORD MD........................................................................
Director
 1.00
.......................2.00 		X           0 47,084 0
(21) TIMOTHY P MOEN........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(22) WILLIAM A WOLFORD........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(23) JOANNE C STREZO........................................................................
Asst Secy to BOD (partial year)
 40.00
.......................8.00 		    X       66,607 0 18,112
(24) JOHN ORSINI........................................................................
CFO
 40.00
.......................10.00 		    X       0 0 0
(25) KAREN DIERSEN........................................................................
Asst Secretary to the BOD (partial year)
 40.00
.......................10.00 		    X       98,203 0 14,923
(26) MAUREEN TAUS........................................................................
VP-Finance/Controller & Asst Treas
 40.00
.......................9.00 		    X       496,816 0 19,729
(27) MICHAEL HOLZHUETER........................................................................
VP-Legal & Asst Secy. to the BOD
 40.00
.......................10.00 		    X       556,476 0 47,124
(28) ROBERT FRIEDBERG........................................................................
System EVP, President, Delnor Hospital
 1.00
.......................44.00 		    X       0 829,822 44,576
(29) DANIEL F KINSELLA........................................................................
Exec VP / CIO
 40.00
.......................0 		      X     206,815 0 5,516
(30) ELIZABETH ROSENBERG........................................................................
EVP-Strategy & Admin
 40.00
.......................0 		      X     663,629 0 43,827
(31) ANDREW PALUMBO........................................................................
Vice President
 1.00
.......................41.00 		        X   500,145 0 37,692
(32) DAVID COOKE MD........................................................................
VP - Quality & Safety
 40.00
.......................0 		        X   544,780 0 38,784
(33) DAVID L PRINTZ........................................................................
Vice President
 40.00
.......................0 		        X   446,007 0 30,113
(34) LAWRENCE D BELL........................................................................
Vice President
 40.00
.......................0 		        X   423,631 0 23,780
(35) RICHARD DAVIS........................................................................
Vice President
 40.00
.......................0 		        X   576,468 0 45,852
(36) JAMES T SPEAR........................................................................
Former CFO
 0.00
.......................0.00 		          X 1,248,934 0 38,996
(37) LUKE MCGUINNESS........................................................................
Former CEO
 0
.......................0.00 		          X 3,517,593 0 33,471
(38) THOMAS WRIGHT........................................................................
Former EVP (System) & Delnor Hospital President
 0.00
.......................0.00 		          X 1,166,667 326,185 48,685
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 11,425,739 1,288,341 527,270
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet79
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
Yes
 
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
THE CHARTIS GROUP LLCDEPT 5925CAROL STREAMIL60122 CONSULTING 3,887,118
LAUGLIN CONSTABLEBOX 1451MILWAUKEEWI53201 MARKETING SERVICES 3,187,687
MCGUFFIN CREATIVE GROUP INC566 W ADAMS 440CHICAGOIL60661 MARKETING SERVICES 1,982,310
JOHN DRAKE & ASSOCIATES903 COMMERCE DR SUITE 302OAK BROOKIL60523 IT CONSULTING 1,904,765
PAR-ROD DEVELOPMENT LLC478 PENNSYLVANIA AVE 103GLEN ELLYNIL60137 CONSTRUCTION 1,840,082
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet71
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 101,125
e Government grants (contributions)1e 122,190
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 223,315
Program Service Revenue Business Code
2a MANAGEMENT SERVICES 900099 129,130,928 129,130,928    
b NET PATIENT CARE REVENUE 621110 3,818,103 3,818,103    
c RENTAL INCOME FROM RELATED ORGANIZATIONS 531120 10,228,546 10,228,546    
d     0      
e     0      
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 143,177,577
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 19,628,569     19,628,569
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 9,780,667  
b Less: rental expenses 9,795,753  
c Rental income or (loss) -15,086 0
d Net rental income or (loss).......MediumBullet -15,086     -15,086
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 334,910,411 755,717
b Less: cost or other basis and sales expenses 322,650,935 0
c Gain or (loss) 12,259,476 755,717
d Net gain or (loss)..........MediumBullet 13,015,193     13,015,193
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a INVESTMENTS IN JOINT VENTURES 900099 2,137,114   1,305,154 831,960
b PATHOLOGY SERVICES, NET 900099 2,812,110   2,812,110  
c ANSWERING SERVICE REVENUE 900099 590,333     590,333
d All other revenue .... 574,771 187,233 0 387,538
e Total. Add lines 11a–11d ...... MediumBullet 6,114,328
12 Total revenue. See Instructions......MediumBullet 182,143,896 143,364,810 4,117,264 34,438,507
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 3,801,730 3,801,730
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 9,126,207 9,126,207    
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 37,306,786 31,710,768 5,596,018  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,719,943 1,461,952 257,991  
9 Other employee benefits ....... 3,326,878 2,827,846 499,032  
10 Payroll taxes ........... 2,800,403 2,380,343 420,060  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,486,990   1,486,990  
c Accounting ........... 28,702   28,702  
d Lobbying ........... 119,746   119,746  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 648,588   648,588  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 23,307,071 13,946,622 9,360,449 0
12 Advertising and promotion .... 15,652,724 15,652,724    
13 Office expenses ....... 3,947,296 3,552,566 394,730  
14 Information technology ...... 20,366,327 18,329,694 2,036,633  
15 Royalties .. 0      
16 Occupancy ........... 10,744,353 9,669,918 1,074,435  
17 Travel ............ 497,532 422,902 74,630  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 823,237 699,751 123,486  
20 Interest ........... 22,860,376 22,860,376    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 14,126,474 12,713,827 1,412,647  
23 Insurance .............. 60,000 60,000    
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 PATIENT CARE EXPENSE 906,344 906,344    
b TAX EXPENSE 1,245,206 1,245,206    
c BAD DEBT EXPENSE 102,912 102,912    
d MEMBERSHIP DUES 359,907   359,907  
e All other expenses 1,180,683 472,273 708,410 0
25 Total functional expenses. Add lines 1 through 24e 176,546,415 151,943,961 24,602,454 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
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 .............   1  
2 Savings and temporary cash investments ......... 22,735 2 743,850
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 1,170,052 4 4,440,824
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  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
  6 0
7 Notes and loans receivable, net ............. 67,190,254 7 24,497,782
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 13,148,150 9 13,355,521
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 313,621,085
b Less: accumulated depreciation ..... 10b 111,814,349 143,980,586 10c 201,806,736
11 Investments—publicly traded securities .......... 676,169,769 11 547,818,726
12 Investments—other securities. See Part IV, line 11 ..... 52,236,028 12 162,130,772
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 14,930,887 15 93,576,171
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 968,848,461 16 1,048,370,382
Liabilities 17 Accounts payable and accrued expenses ......... 168,200,584 17 153,351,620
18 Grants payable ................. 3,000,000 18  
19 Deferred revenue ................ 432,200 19 408,250
20 Tax-exempt bond liabilities ............. 455,057,428 20 453,502,335
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
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..........   22 0
23 Secured mortgages and notes payable to unrelated third parties ..   23 1,781,888
24 Unsecured notes and loans payable to unrelated third parties ....   24  
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.................... 6,685,547 25 6,210,984
26 Total liabilities. Add lines 17 through 25......... 633,375,759 26 615,255,077
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 .............. 335,472,702 27 433,075,419
28 Temporarily restricted net assets ...........   28 39,886
29 Permanently restricted net assets ...........   29  
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 ........... 335,472,702 33 433,115,305
34 Total liabilities and net assets/fund balances ........ 968,848,461 34 1,048,370,382
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
182,143,896
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
176,546,415
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
5,597,481
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
335,472,702
5
Net unrealized gains (losses) on investments ...............
5
-54,130,582
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
146,175,704
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
433,115,305
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
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
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)
 
No
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
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
(A) CENTRAL DUPAGE HOSPITAL ASSOCIATION
  		362513909 3 Yes           0
(B) DELNOR-COMMUNITY HOSPITAL
  		363484281 3 Yes           0
Total                 0

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: 12000266
Software Version: v2012.1.0
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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
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
CDH-DELNOR HEALTH SYSTEM
  		Employer identification number

36-3099698
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
CDH-DELNOR HEALTH SYSTEM
  		Employer identification number

36-3099698
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
CDH-DELNOR HEALTH SYSTEM
  		Employer identification number

36-3099698
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: 12000266
Software Version: v2012.1.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
119,746
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
119,746
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THE ORGANIZATION'S DIRECTOR OF COMMUNITY, GOVERNMENT, AND PUBLIC AFFAIRS SPENDS A PORTION OF HER TIME TRAVELING TO VARIOUS LOCATIONS TO MEET WITH KEY OFFICIALS RELATED TO LEGISLATION IMPACTING THE HEALTHCARE INDUSTRY. IN ADDITION, THE ORGANIZATION WORKS WITH AN OUTSIDE CONSULTING FIRM FOR LOBBYING SUPPORT. THE AMOUNTS REPORTED HERE INCLUDE AN ESTIMATION OF THE COMPENSATION FOR TIME SPENT ON LOBBYING ACTIVITY, AS WELL AS RELATED TRAVEL COSTS, CONSULTING FEES AND STATE LOBBYIST REGISTRATION FEES
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0

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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
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 ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
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)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
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 ................. 19,145,999 13,138,338 32,284,337
b Buildings ................ 97,838,819 49,111,474 48,143,026 98,807,267
c Leasehold improvements ............ 5,555,128 1,794,969 5,291,715 2,058,382
d Equipment ................ 9,982,049 81,982,774 51,985,780 39,979,043
e Other ................. 13,090,520 21,981,015 6,393,828 28,677,707
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 201,806,736
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 131,353,006  
(2)Closely-held equity interests 30,777,766  
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 162,130,772
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
(1) DUE FROM RELATED ORGANIZATIONS 40,642,476
(2) RETIREMENT FUND ASSETS 5,288,833
(3) ESCROW ACCOUNT 3,975,017
(4) INTEREST IN NET ASSETS OF CADENCE HEALTH FOUNDATION 39,886
(5) GOODWILL 42,055,000
(6) UNAMORTIZED PRACTICE ACQUISITION COSTS 1,574,959



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 93,576,171
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 920,665
DUE TO RELATED ORGANIZATIONS 1,486
RETIREMENT PLAN LIABILITY 5,288,833







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 6,210,984
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
FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 THE CORPORATIONS APPLY 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, THE CORPORATIONS MUST 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. AS OF JUNE 30, 2013, THE CORPORATIONS DO NOT HAVE ANY LIABILITIES FOR UNRECOGNIZED TAX BENEFITS.
Schedule D (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES INSURANCE 12,613,349
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....      
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 12,613,349
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
Method used to account for expenditures on organization's financial statements Schedule F, Part I, Line 3 CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL
Method used to account for expenditures on organization's financial statements Schedule F, Part I, Line 3 CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


Software ID: 12000266
Software Version: v2012.1.0



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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number
36-3099698
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
(1) CADENCE HEALTH FOUNDATION
27W353 JEWELL RD
WINFIELD,IL60190 		36-4401289 501C3 3,122,769       HEALTHCARE/EDUCATION
(2) NORTHERN ILLINOIS FOOD BANK
273 DEARBORN
GENEVA,IL60134 		36-3203648 501C3 55,000       HEALTHY FOOD FOR LOW INCOME
(3) KANE COUNTY HEALTH DEPARTMENT
1240 N HIGHLAND AVE
AURORA,IL60506 		36-6006585 GOVERNMENT 50,000       COMMUNITY HEALTH
(4) DUPAGE EDUCATION FOUNDATION
503 N COUNTY FARM RD
WHEATON,IL60187 		20-3314577 501C3 50,000       CHILDHOOD OBESITY INITIATIVE
(5) GENEVA CHAMBER OF COMMERCE
8 S THIRD ST
GENEVA,IL60134 		36-2043217 501C6 45,000       SUPPORT FOR COMMUNITY EVENT
(6) WHEATON PARK DISTRICT
102 E WESLEY
WHEATON,IL60187 		36-6006155 GOVERNMENT 35,500       RECREATION SCHOLARSHIPS FOR LOW INCOME
(7) SAMARITAN INTERFAITH COUNSELING CENTER
SUITE 109
NAPERVILLE,IL60540 		36-2846570 501C3 30,000       MENTAL HEALTH/COUNSELING
(8) TRICITY FAMILY SERVICES
1120 RANDALL CT
GENEVA,IL60134 		23-7310008 501C3 25,000       MENTAL HEALTH/COUNSELING
(9) AMERICAN ACADEMY FOR HOME CARE PHYSICIANS
PO BOX 1037
EDGEWOOD,MD21040 		52-1891671 501C3 50,000       HOME CARE PHYSICIAN SUPPORT
(10) MORTON ARBORETUM
4100 IL ROUTE 53
GLEN ELLYN,IL60137 		36-1505770 501C3 25,000       CONSERVATION
(11) PROACTIVE KIDS FOUNDATION
1101 BELTER DR
WHEATON,IL60189 		37-1556796 501C3 23,053       CHILD HEALTH/OBESITY EDUCATION
(12) WINFIELD HISTORICAL SOCIETY
PO BOX 315
WINFIELD,IL60190 		36-2985509 501C3 20,904       COMMUNITY FUNDRAISER SUPPORT
(13) MARCH OF DIMES
111 W JACKSON BLVD
SUITE 2200
CHICAGO,IL60604 		13-1846366 501C3 20,000       INFANT HEALTH
(14) WEST CHICAGO PARK DISTRICT
157 W WASHINGTON ST
WEST CHICAGO,IL60185 		36-2762236 GOVERNMENT 20,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(15) WINFIELD SCHOOL DISTRICT 34
0S150 WINFIELD RD
WINFIELD,IL60190 		36-6004497 GOVERNMENT 19,500       CHILD SAFETY / NUTRITION
(16) CAROL STREAM PARK DISTRICT
849 W LIES RD
CAROL STREAM,IL60188 		36-2590167 GOVERNMENT 17,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(17) WINFIELD EDUCATION FOUNDATION
0S150 PARK ST
WINFIELD,IL60190 		01-0692701 501C3 15,500       CHILD SAFETY / NUTRITION
(18) EPILEPSY FOUNDATION OF GREATER CHICAGO
17 N STATE ST
SUITE 1300
CHICAGO,IL60602 		36-2317619 501C3 15,500       EDUCATION/RESEARCH
(19) AMERICAN CANCER SOCIETY
225 N MICHIGAN AVE
CHICAGO,IL60601 		13-1788491 501C3 15,000       EDUCATION/RESEARCH
(20) NAMI OF DUPAGE
2100 MANCHESTER
BLDG B SUITE 925
WHEATON,IL60187 		36-3412057 501C3 15,000       MENTAL HEALTH/COUNSELING
(21) DUPAGE PADS
601 W LIBERTY
WHEATON,IL60187 		36-3675494 501C3 10,000       HOMELESSNESS
(22) FOX VALLEY FOOD FOR HEALTH
38W286 FERSON WOODS
ST CHARLES,IL60174 		46-0961627 501C3 10,000       HEALTHY FOOD FOR LOW INCOME
(23) MARKLUND CHARITIES
15450 WYATT DR
GENEVA,IL60134 		36-4074849 501C3 10,000       SPECIAL NEEDS CHILDREN/ADULTS
(24) GLEN ELLYN PARK DISTRICT
185 SPRING AVE
GLEN ELLYN,IL60137 		36-6005896 GOVERNMENT 10,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(25) WARRENVILLE PARK DISTRICT
3S260 WARREN AVE
WARRENVILLE,IL60555 		36-4342909 GOVERNMENT 10,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(26) WESTERN DUPAGE SPECIAL RECREATION ASSOC
116 N SCHMALE RD
CAROL STREAM,IL60188 		36-3932924 501C3 10,000       RECREATIONAL SCHOLARSHIPS FOR DISABLED
(27) WINFIELD IN ACTION
PO BOX 225
WINFIELD,IL60190 		23-7359257 501C3 10,000       RECREATION PROGRAM SUPPORT
(28) GIRL SCOUTS OF NORTHERN ILLINOIS
12N124 COOMBS RD
ELGIN,IL60124 		36-2358083 501C3 5,898       NUTRITION/EXERCISE/HEATLHY CHOICES
(29) ADVOCATES FOR THE WINFIELD BIKEWAY
VILLAGE OF WINFIELD
27W465 JEWELL RD
WINFIELD,IL60190 		36-6009519 GOVERNMENT 5,000       COMMUNITY EVENT SUPPORT
(30) BARTLETT PARK DISTRICT
700 S BARTLETT RD
BARTLETT,IL60103 		36-2532333 GOVERNMENT 5,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(31) DISTRICT 33 FOUNDATION FOR EDUCATIONAL EXCELLENCE
312 E FOREST AVE
WEST CHICAGO,IL60185 		36-3652226 501C3 5,000       MENTAL HEALTH/COUNSELING
(32) GENEVA PARK DISTRICT
710 WESTERN AVE
GENEVA,IL60134 		36-6008378 GOVERNMENT 5,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(33) ST CHARLES PARK DISTRICT
213 WALNUT ST
ST CHARLES,IL60174 		36-6006441 GOVERNMENT 5,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
(34) PEOPLE'S RESOURCE CENTER
201 S NAPERVILLE RD
WHEATON,IL60187 		36-3157600 501C3 5,000       HEALTHY FOOD FOR LOW INCOME
(35) WINFIELD PARK DISTRICT
0N020 COUNTY FARM RD
WINFIELD,IL60190 		36-3303703 GOVERNMENT 5,000       RECREATION SCHOLARSHIPS FOR LOW INCOME
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
34
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
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












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
Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE GUIDING PHILOSOPHY OF CDH-DELNOR HEALTH SYSTEM'S CHARITABLE GRANT ACTIVITY IS TO NOT ONLY CONTRIBUTE OUR OWN RESOURCES, BUT TO ACTIVELY ENGAGE PARTNERS TO ASSESS, PLAN FOR AND MEET COMMUNITY HEALTH AND MEDICAL NEEDS. CDH-DELNOR HEALTH SYSTEM WORKS VERY CLOSELY WITH ITS PARTNERS IN THE PROGRAMS THAT ARE SUPPORTED, IN PART, BY CDH-DELNOR HEALTH SYSTEM. MONITORING THE USE OF GRANT FUNDS IS ACHIEVED THROUGH VARIOUS MEANS, INCLUDING ACTIVE PARTICIPATION IN PROGRAM IMPLEMENTATION, WRITTEN CONTRIBUTION AGREEMENTS, PERFORMANCE REPORTS AND BOARD PARTICIPATION IN SOME INSTANCES.
Schedule I (Form 990) 2012


Additional Data


Software ID: 12000266
Software Version: v2012.1.0


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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
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
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
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)ANDREW PALUMBOVICE PRESIDENT (i)
(ii)		 277,722
0 		221,613
0 		810
0 		8,490
0 		29,201
0 		537,837
0 		0
0
(2)DANIEL F KINSELLAEXEC VP / CIO (i)
(ii)		 106,226
0 		100,000
0 		590
0 		0
0 		5,516
0 		212,331
0 		0
0
(3)DAVID COOKE MDVP - QUALITY & SAFETY (i)
(ii)		 327,913
0 		211,935
0 		4,931
0 		17,538
0 		21,245
0 		583,563
0 		0
0
(4)DAVID L PRINTZVICE PRESIDENT (i)
(ii)		 321,340
0 		120,494
0 		4,173
0 		14,002
0 		16,112
0 		476,120
0 		0
0
(5)ELIZABETH ROSENBERGEVP-STRATEGY & ADMIN (i)
(ii)		 414,263
0 		247,800
0 		1,566
0 		15,577
0 		28,250
0 		707,456
0 		0
0
(6)JAMES T SPEARFORMER CFO (i)
(ii)		 418,976
0 		452,059
0 		377,899
0 		16,235
0 		22,761
0 		1,287,930
0 		0
0
(7)LAWRENCE D BELLVICE PRESIDENT (i)
(ii)		 233,665
0 		185,724
0 		4,242
0 		13,034
0 		10,746
0 		447,411
0 		0
0
(8)LUKE MCGUINNESSFORMER CEO (i)
(ii)		 992,240
0 		2,250,000
0 		275,353
0 		14,708
0 		18,763
0 		3,551,064
0 		0
0
(9)MAUREEN TAUSVP-FINANCE/CONTROLLER & ASST TREAS (i)
(ii)		 252,178
0 		243,373
0 		1,265
0 		17,910
0 		1,819
0 		516,545
0 		0
0
(10)MICHAEL HOLZHUETERVP-LEGAL & ASST SECY. TO THE BOD (i)
(ii)		 335,582
0 		219,325
0 		1,569
0 		15,192
0 		31,932
0 		603,600
0 		0
0
(11)MICHAEL VIVODACEO (i)
(ii)		 616,830
0 		293,988
0 		1,242
0 		16,096
0 		19,994
0 		948,150
0 		0
0
(12)RICHARD DAVISVICE PRESIDENT (i)
(ii)		 283,201
0 		287,155
0 		6,111
0 		16,539
0 		29,312
0 		622,319
0 		0
0
(13)ROBERT FRIEDBERGSYSTEM EVP, PRESIDENT, DELNOR HOSPITAL (i)
(ii)		 0
388,982 		0
438,563 		0
2,277 		0
15,385 		0
29,191 		0
874,398 		0
0
(14)THOMAS WRIGHTFORMER EVP (SYSTEM) & DELNOR HOSPITAL PRESIDENT (i)
(ii)		 116,667
325,336 		0
0 		1,050,000
848 		0
30,384 		0
18,301 		1,166,667
374,870 		0
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
First-class or charter travel Schedule J, Part I, Line 1a THE ORGANIZATION'S TRAVEL POLICY GENERALLY REQUIRES TRAVELING IN ECONOMY CLASS, BUT ALLOWS FOR UPGRADED CABIN CLASS FOR FLIGHTS IN EXCESS OF FOUR HOURS. TWO INSTANCES OF FIRST CLASS TRAVEL, CONSISTENT WITH THE TERMS OF THE POLICY, OCCURRED DURING CY 2012 AND INVOLVED THE CHIEF EXECUTIVE OFFICER (LUKE MCGUINNESS) AND THE CHIEF FINANCIAL OFFICER (JAMES SPEAR). THE EXPENSE WAS DETERMINED TO HAVE A VALID BUSINESS PURPOSE AND THEREFORE WAS NOT INCLUDED AS TAXABLE INCOME ON THE EMPLOYEES' W-2.
Travel for companions Schedule J, Part I, Line 1a THERE WAS ONE INSTANCE OF SPOUSAL TRAVEL IN CY2012. THE ORGANIZATION REIMBURSED THE THEN CEO (LUKE MCGUINNESS) FOR THE AIRFARE PAID FOR THIS SPOUSE TO ACCOMPANY HIM ON A BUSINESS TRIP. THE COST OF THE AIRFARE WAS INCLUDED AS TAXABLE COMPENSATION IN MR. MCGUINNESS' 2012 FORM W-2.
Health or social club dues or initiation fees Schedule J, Part I, Line 1a CDH-DELNOR HEALTH SYSTEM REIMBURSES HEALTH CLUB DUES FOR SOME EXECUTIVES AND SOME KEY EMPLOYEES. ALL OTHER EMPLOYEES ARE ELIGIBLE TO RECEIVE A HEALTH CLUB SUBSIDY IF THEY MEET OR EXCEED THE REQUIRED NUMBER OF VISITS TO THEIR HEALTH CLUB IN A GIVEN MONTH. ALL SUCH REIMBURSEMENTS OR SUBSIDIES ARE INCLUDED AS TAXABLE INCOME IN THE EMPLOYEES' W-2. EMPLOYEES LISTED IN FORM 990, PART VII, SECTION A, LINE 1A WHO RECEIVED A HEALTH CLUB DUES REIMBURSEMENT WERE: DAVID COOKE AND RICHARD DAVIS. THE REIMBURSEMENT AMOUNT WAS INCLUDED AS TAXABLE INCOME IN THE EMPLOYEES' W-2.
Severance or change-of-control payment Schedule J, Part I, Line 4a TWO FORMER OFFICERS RECEIVED SEVERANCE PAYMENTS DURING CY2012 FROM THE FILING ORGANIZATION. JAMES SPEAR $375,577 THOMAS WRIGHT $ 1,050,000
Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b THE FORMER CHIEF EXECUTIVE OFFICER (MCGUINNESS) PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. PURSUANT TO THIS PLAN, DURING CY 2012, $268,845 WAS CONTRIBUTED, IMMEDIATELY VESTED, AND DISTRIBUTED. ALL ASPECTS OF THE FORMER CHIEF EXECUTIVE OFFICER'S COMPENSATION, INCLUDING CONTRIBUTIONS TO THE SUPPLEMENTAL RETIREMENT PLAN, ARE REVIEWED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AND SUPPORTED BY CONSULTANTS ENGAGED BY SUCH COMMITTEE.
COMPENSATION CONTINGENT ON NET EARNINGS SCHEDULE J, PART I, LINE 6A CDH-DELNOR HEALTH SYSTEM MAINTAINS AN INCENTIVE PLAN (MYSTEP) AS A COMPONENT OF COMPENSATION FOR ITS EMPLOYEES, INCLUDING EMPLOYED INTERESTED PERSONS. THE INCENTIVE PORTION OF COMPENSATION IS INCLUDED IN THE COMPENSATION REVIEW CONDUCTED BY THE COMPENSATION COMMITTEE OF THE CDH-DELNOR HEALTH SYSTEM BOARD OF DIRECTORS, AS DESCRIBED IN SCHEDULE O FOR FORM 990 CORE, PART VI, LINE 15. THE PURPOSE OF MYSTEP IS TO ALIGN EMPLOYEES' INTERESTS WITH THE GOALS AND OBJECTIVES OF CDH-DELNOR HEALTH SYSTEM AND ALL RELATED ORGANIZATIONS BY PROVIDING FINANCIAL INCENTIVES LINKED TO THE CONTINUING AND SUSTAINABLE SUCCESS OF THE ORGANIZATIONS. FINANCIAL INCENTIVES ARE PAID BASED ON A SERIES OF MEASURES THAT INCLUDE: (I) PATIENT SATISFACTION; (II) FINANCIAL PERFORMANCE; AND (III) DEPARTMENTAL/TEAM-SPECIFIC GOALS. OVERALL ADMINISTRATION OF MYSTEP IS THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THIS INCENTIVE PROGRAM DOES NOT MEET THE STANDARDS AS SET OUT IN SCHEDULE J, PART I FOR LINES 5, 6 OR 7.
Schedule J (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number
36-3099698
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A ILLINOIS FINANCE AUTHORITY
  		86-1091967 45200FXQ7 05-06-2009 88,395,058 PROJECT FUNDS FOR CANCER CENTER AND BED PAVILION AND OTHER ROUTINE CAPITAL   X   X   X
B ILLINOIS FINANCE AUTHORITY
  		86-1091967 45200FE21 11-18-2009 241,070,419 CAPITAL FUNDS FOR BED PAVILION, ROUTINE & WORKING CAPITAL & REFUND SERIES 2004 B&C BONDS   X   X   X
C ILLINOIS FINANCE AUTHORITY
  		86-1091967   08-05-2011 127,150,000 REFUND SERIES 2004A BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 3,300,000  
2 Amount of bonds legally defeased . . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 88,615,254 241,745,576 127,150,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 9,065,459 21,188,809 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . . 0 0 0  
8 Credit enhancement from proceeds . . . . . . . . . . . 0 0 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 5,527,050 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 79,549,794 112,884,717 0  
11 Other spent proceeds . . . . . . . . . . . . . . 0 102,145,000 127,150,000  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2010 2012 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .   X   X   X    
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X    
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.0000% 0.0000% 0%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.0000% 0.0000% 0%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.0000% 0.0000% 0%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.0000% 0% 0%   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X   X    
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X   X   X    
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X   X     X    
b Exception to rebate? . . . . . . . .   X   X   X    
c No rebate due? . . . . . . . . . .
  X   X X      
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X   X X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X X      
b Name of provider . . . . . . . . . MORGAN STANLEY
  		 
  		MORGAN STANLEY
  		 
 
c Term of hedge . . . . . . . . . . 0.0 0.0 32.0  
d Was the hedge superintegrated? . . . . . .   X   X   X    
e Was a hedge terminated? . . . . . . .   X   X   X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X    
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 0.0 0.0 0.0  
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .   X   X   X    
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
TAX EXEMPT BONDS SCHEDULE K, PART I, COLUMN (B) THE 2009B BONDS (11/8/09) REPORTED ON PART I, COL. B REFUNDED THE 2004B AND C BONDS AND NO ESCROW REMAINS OUTSTANDING.
TOTAL PROCEEDS OF SERIES 2009 BONDS SCHEDULE K, PART II, LINE 3 INCLUDES INVESTMENT EARNINGS OF $209,992. SERIES 2009 (5/6/09)
TOTAL PROCEEDS OF SERIES 2009B BONDS SCHEDULE K, PART II, LINE 3 INCLUDES INVESTMENT EARNINGS OF $675,387. SERIES 2009B (11/18/09)
ISSUER NAME: Illinois Finance Authority: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 6/22/05.
Schedule K (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0

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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
Identifier Return Reference Explanation
NUMBER OF INDEPENDENT BOARD MEMBERS FORM 990, PART VI, LINE 1B FIVE OF THE TWENTY-TWO BOARD MEMBERS ARE NOT CONSIDERED TO BE INDEPENDENT UNDER THE IRS DEFINITION OF INDEPENDENCE. THOSE MEMBERS ARE: THE ORGANIZATION'S CEO; TWO BOARD MEMBERS WHO SERVE AS MEDICAL STAFF PRESIDENT FOR CENTRAL DUPAGE HOSPITAL OR DELNOR-COMMUNITY HOSPITAL (RELATED ORGANIZATIONS); AND, TWO BOARD MEMBERS WHOSE MEDICAL PRACTICES ARE COMPENSATED FOR PHYSICIAN SERVICES PROVIDED TO CENTRAL DUPAGE HOSPITAL OR DELNOR-COMMUNITY HOSPITAL (RELATED ORGANIZATIONS).
Family/business relationships amongst interested persons Form 990, Part VI, Section A, Line 2 PATRICK FLINN AND WILLIAM WOLFORD - BUSINESS RELATIONSHIP
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b PRIOR TO FILING, A DRAFT OF THE COMPLETED FORM 990 IS REVIEWED BY OUTSIDE TAX ADVISERS AND INTERNAL MANAGEMENT. AFTER THAT REVIEW IS COMPLETE, THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR ADDITIONAL REVIEW AND COMMENT.
Conflict of interest policy Form 990, Part VI, Section B, Line 12c EACH YEAR, CDH-DELNOR HEALTH SYSTEM (CDHS) ASKS EACH BOARD MEMBER TO REVIEW THE CONFLICT OF INTEREST POLICY AND TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. IN ADDITION, THE POLICY REQUIRES THAT BOARD MEMBERS DISCLOSE POTENTIAL CONFLICTS THAT MAY ARISE BETWEEN ANNUAL STATEMENTS THROUGH SUPPLEMENTARY DISCLOSURES. BOTH THE ANNUAL STATEMENTS AND SUPPLEMENTARY DISCLOSURES ARE REVIEWED AND EVALUATED BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE GOVERNANCE COMMITTEE IS DELEGATED THE RESPONSIBILITY TO DETERMINE WHETHER A POTENTIAL CONFLICT IS AN ACTUAL CONFLICT, AND FURTHER TO RECOMMEND CONFLICT MITIGATION STRATEGIES TO THE BOARD (WHICH MAY INCLUDE LIMITING A BOARD MEMBER'S PARTICIPATION IN MATTERS WHERE AN ACTUAL CONFLICT EXISTS, TO BOARD MEMBER REMOVAL IF THE CONFLICT IS INCOMPATIBLE WITH ONGOING BOARD SERVICE). SIMILARLY, EACH YEAR CDHS ASKS EACH EMPLOYEE TO REVIEW THE CONFLICT OF INTEREST POLICY AND TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. IN ADDITION, THE POLICY REQUIRES THAT EMPLOYEES DISCLOSE POTENTIAL CONFLICTS THAT MAY ARISE BETWEEN ANNUAL STATEMENTS THROUGH SUPPLEMENTARY DISCLOSURES. BOTH THE ANNUAL STATEMENTS AND SUPPLEMENTARY DISCLOSURES ARE REVIEWED AND EVALUATION BY THE DIRECTOR OF INTERNAL AUDIT AND COMPLIANCE. THAT DIRECTOR IS DELEGATED THE RESPONSIBILITY TO DETERMINE WHETHER A POTENTIAL CONFLICT IS AN ACTUAL CONFLICT, AND FURTHER TO RECOMMEND AND IMPLEMENT, WHERE APPROPRIATE, CONFLICT MITIGATION STRATEGIES. COMPLETION RESULTS ARE PROVIDED TO THE AUDIT & FINANCE COMMITTEE OF THE BOARD OF DIRECTORS.
Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS AND IS DELEGATED THE RESPONSIBILITY FOR REVIEWING THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVES (INCLUDING THE CHIEF EXECUTIVE OFFICER) AND OTHER KEY EMPLOYEES AND CERTAIN PHYSICIANS. THE PROCESS INCLUDES ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ASSIST IN DETERMINING THE APPROPRIATENESS OF COMPENSATION, WHICH INCLUDES REVIEWING COMPARABLE COMPENSATION STUDIES FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. THE COMPENSATION COMMITTEE ROUTINELY REPORTS TO THE FULL BOARD OF DIRECTORS ITS COMPENSATION-RELATED ACTIVITIES, AND MAY FROM TIME TO TIME RECOMMEND MATTERS FOR THE FULL BOARD OF DIRECTORS CONSIDERATION (E.G., THE ESTABLISHMENT OF ANY NEW COMPENSATION OR BENEFIT PLAN). THE COMPENSATION COMMITTEE CONDUCTS A FORMAL REVIEW FOR THE ORGANIZATION'S EXECUTIVES ON AN ANNUAL BASIS, AND MAY MAKE DECISIONS RELATED TO COMPENSATION AND BENEFITS THROUGHOUT THE YEAR. THE COMPENSATION COMMITTEE RECEIVED AN INDEPENDENT CONSULTANT'S REPORT SUPPORTING THE REASONABLENESS OF THE ORGANIZATION'S EXECUTIVES' COMPENSATION FOR THE REPORTING PERIOD IN JULY, 2013.
Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b SEE THE NARRATIVE FOR FORM 990, PART VI, LINE 15A.
Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 VARIOUS PUBLIC AND PRIVATE ENTITIES MAY REQUIRE THE FILING OF SUCH DOCUMENTS AS PART OF A REGULATORY OR CONTRACTUAL COMMITMENT, AND AS A RESULT OF SUCH OBLIGATIONS, CERTAIN OF THESE MATERIALS MAY, IN FACT, BE AVAILABLE TO THE PUBLIC. OUTSIDE OF SUCH DISCLOSURES, THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT ROUTINELY MADE AVAILABLE BY THE ORGANIZATION TO THE PUBLIC. NOTABLY, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED TO BE DISCLOSED TO THE PUBLIC PURSUANT TO IRC SECTION 6104.
REPORTABLE COMPENSATION FROM THE ORGANIZATION FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (D) CDH-DELNOR HEALTH SYSTEM PROVIDES BOARD MEMBERS WITH AN IPAD FOR USE AT BOARD MEETINGS AND TO RECEIVE BOARD-RELATED MATERIALS SENT ELECTRONICALLY. MOST BOARD MEMBERS RECEIVED THEIR IPAD IN CY11 AND THIS WAS REFLECTED ON THE FY12 FORM 990. ONE BOARD MEMBER RECEIVED AN IPAD DURING CY12, WHICH IS REPORTED IN THIS FY13 FORM 990, PART VII-A. BOARD MEMBERS RECEIVE A FORM 1099 REFLECTING THE COST OF THE IPAD RECEIVED.
REPORTABLE COMPENSATION FROM THE ORGANIZATION FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (D) JOHN ORSINI, AN OFFICER LISTED IN PART VII-A S JOINED THE ORGANIZATION IN 2013. THEREFORE THERE IS NO CALENDAR YEAR 2012 W-2 COMPENSATION TO REPORT FOR MR. ORSINI.
GAIN ON SALE OF ASSETS OTHER THAN INVENTORY FORM 990, PART VIII, LINE 7A ON MARCH 12, 2010, CDH-DELNOR HEALTH SYSTEM SOLD SUBSTANTIALLY ALL THE ASSETS AND THE BUSINESS OPERATIONS OF ITS SENIOR CARE AND LIVING FACILITIES. IN ADDITION, THE BUYER ASSUMED LONG-TERM DEBT AND OTHER OBLIGATIONS. CDH-DELNOR HEALTH SYSTEM AGREED TO PROVIDE CERTAIN LIQUIDITY AND GUARANTEES SUBSEQUENT TO THE DATE OF THE SALE. A GAIN ON THE SALE WAS RECOGNIZED DURING FY2010, WITH A PORTION OF THE GAIN, RELATED TO THE GUARANTEES, DEFERRED. THE DEFERRED GAIN IS BEING AMORTIZED TO REVENUE OVER THE TERM OF THE GUARANTEE. DURING FY2013, $743,604 OF THE DEFERRED GAIN WAS RECOGNIZED AS REVENUE AND IS REPORTED ON FORM 990, PART VIII, LINE 7(II).
Other Expenses Form 990, Part IX, Line 11g MEDICAL PROFESSIONAL FEES - TOTAL EXPENSE: 2493959, PROGRAM SERVICE EXPENSE: 2493959, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONSULTING SERVICES - TOTAL EXPENSE: 7523418, PROGRAM SERVICE EXPENSE: 4137880, MANAGEMENT AND GENERAL EXPENSES: 3385538, FUNDRAISING EXPENSES: ; PATIENT FINANCIAL SERVICES - TOTAL EXPENSE: 6146447, PROGRAM SERVICE EXPENSE: 4609835, MANAGEMENT AND GENERAL EXPENSES: 1536612, FUNDRAISING EXPENSES: ; HUMAN RESOURCES - TOTAL EXPENSE: 3743868, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 3743868, FUNDRAISING EXPENSES: ; TEMPORARY PERSONNEL - TOTAL EXPENSE: 1554135, PROGRAM SERVICE EXPENSE: 1321015, MANAGEMENT AND GENERAL EXPENSES: 233120, FUNDRAISING EXPENSES: ; ALL OTHER - TOTAL EXPENSE: 1845244, PROGRAM SERVICE EXPENSE: 1383933, MANAGEMENT AND GENERAL EXPENSES: 461311, FUNDRAISING EXPENSES: ;
Other changes in net assets or fund balances Form 990 , Part XI, Line 9 NET ASSETS RELEASED FROM RESTRICTION FOR LAND, BUILDING AND EQUIPMENT - 3399812; CHANGE IN RESTRICTED FUND BALANCE - 39886; TRANSFER OF NET ASSETS FROM DELNOR-COMMUNITY HEALTH CARE FOUNDATION - 907000; INTEREST RATE SWAP VALUATION ADJUSTMENT - 14222006; FUND BALANCE TRANSFER TO CENTRAL DUPAGE PHYSICIAN GROUP - -43233000; FUND BALANCE TRANSFER TO PAHCS II - -160000; FUND BALANCE TRANSFER FROM CENTRAL DUPAGE HOSPITAL ASSOCIATION - 171000000;
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: 12000266
Software Version: v2012.1.0
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
CDH-DELNOR HEALTH SYSTEM
 
Employer identification number

36-3099698
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) SOUTH ELGIN HOLDINGS LLC
300 RANDALL RD
GENEVA,IL60134
27-1141151 		HOLDINGS CO IL -9,973 2,263,184 DELNOR-COMMUNITY HEALTH CARE FOUNDATION
 
(2) CADENCE AMBULATORY SURGERY CENTER LLC
25 N WINFIELD RD
WINFIELD,IL60190
80-0838376 		HEALTHCARE SERVICES IL 2,403,172 45,527,162 CDH-DELNOR HEALTH SYSTEM
 
(3) CADENCE MEDICAL PARTNERS LLC
25 N WINFIELD RD
WINFIELD,IL60190
90-0917479 		HEALTHCARE SERVICES IL -334,095 0 CDH-DELNOR HEALTH SYSTEM
 






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) CENTRAL DUPAGE HOSPITAL ASSOCIATION

25 N WINFIELD RD

WINFIELD,IL60190
 HOSPITAL IL 501(C)(3) 3 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(2) CADENCE HEALTH FOUNDATION

27W353 JEWELL RD

WINFIELD,IL60190
 FUNDRAISING IL 501(C)(3) 7 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(3) CENTRAL DUPAGE PHYSICIAN GROUP

27W353 JEWELL RD

WINFIELD,IL60190
 PRIMARY CARE IL 501(C)(3) 9 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(4) COMMUNITY NURSING SERVICE OF DUPAGE

COUNTY 690 E NORTH AVE

CAROL STREAM,IL60188
 HOME HEALTH IL 501(C)(3) 9 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(5) PAHCS II

27W353 JEWELL RD

WINFIELD,IL60190
 OCCUP. HEALTH IL 501(C)(3) 9 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(6) CENTRAL DUPAGE SPECIAL HEALTH ASSOC

27W353 JEWELL RD

WINFIELD,IL60190
 PHARMACY IL 501(C)(3) 9 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(7) DELNOR-COMMUNITY HEALTHCARE FOUNDATION

300 RANDALL ROAD

GENEVA,IL60134
 HEALTH/FITNESS IL 501(C)(3) 7 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(8) DELNOR-COMMUNITY RESIDENTIAL LIVING INC

300 RANDALL ROAD

GENEVA,IL60134
 RESIDENTIAL SERVICES IL 501(C)(3) 9 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(9) LIVING WELL CANCER RESOURCE CENTER

300 RANDALL ROAD

GENEVA,IL60134
 WELLNESS IL 501(C)(3) 7 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
(10) DELNOR-COMMUNITY HOSPITAL

300 RANDALL ROAD

GENEVA,IL60134
 HOSPITAL IL 501(C)(3) 3 CDH-DELNOR HEALTH SYSTEM
 
Yes
 
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
(1) TRI-CITIES IMCARE

300 RANDALL ROAD
GENEVA,IL60134
27-1942888 		HEALTH CARE IL DELCOM
  		RELATED             No  
(2) TRI-CITIES DIALYSIS

1300 WATERFORD DR LOWER LEVEL
AURORA,IL60504
36-4272042 		HEALTH CARE IL DELCOM
  		RELATED             No  
(3) TRI-CITIES SURGERY

345 DELNOR DRIVE
GENEVA,IL60134
51-0551673 		HEALTH CARE IL DELCOM
  		RELATED             No  
(4) TRI-CITIES CANCER

300 RANDALL ROAD
GENEVA,IL60134
36-4009336 		HEALTH CARE IL DELCOM
  		RELATED             No  
(5) FVFPDELNOR PROPERTIES

300 RANDALL ROAD
GENEVA,IL60134
45-1147062 		PROPERTY MANAGEMENT IL DELCOM
  		EXCLUDED             No  
(6) CADENCE ALTERNATIVE INVESTMENTS LP

900 NORTH MICHIGAN AVE SUITE 1100
CHICAGO,IL60611
80-0833919 		INVESTMENTS DE CDH-DELNOR HEALTH SYSTEM
  		EXCLUDED 0 125,236,947   No 0   No 99.992 %


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) DUPAGE HEALTH SERVICES INC

27W353 JEWELL RD
WINFIELD,IL60190
36-3270521 		HEALTHCARE DE CDH-DELNOR HEALTH SYSTEM
  		C CORPORATION -590,403 1,040,516 100 % Yes  
(2) DELCOM CORPORATION AND SUBSIDIARY

300 RANDALL ROAD
GENEVA,IL60134
36-3334711 		HEALTH MGMT IL CDH-DELNOR HEALTH SYSTEM
  		C CORPORATION 981,846 9,110,141 100 % Yes  
(3) UNITED PROFESSIONALS INSURANCE COMPANY LTD

PO BOX 30600
GRAND CAYMAN   KY1-1203
CJ
INSURANCE CJ CDH-DELNOR HEALTH SYSTEM
  		C CORPORATION 0 48,224,953 100 % Yes  
(4) CORNERSTONE MEDICAL GROUP

27W353 JEWELL RD
WINFIELD,IL60190
36-4345453 		PRIMARY HEALTHCARE IL CENTRAL DUPAGE PHYSICIAN GROUP
  		C CORPORATION          






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
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
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
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
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
Yes
 
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) DUPAGE HEALTH SERVICES INC

 Q 625,594  
(2) DELCOM CORPORATION AND SUBSIDIARY

 Q 7,818,564  
(3) UNITED PROFESSIONALS INSURANCE COMPANY LTD

 P 12,613,349  



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: 12000266
Software Version: v2012.1.0