Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
ALEXIAN BROTHERS MEDICAL CENTER |
362596381 | No | 0 | 0 | ||
| (B)
ST ALEXIUS MEDICAL CENTER |
364251846 | No | 0 | 0 | ||
| (C)
ALEXIAN BROTHERS BEHAVIORAL HEALTH Hospital |
364251848 | No | 0 | 0 | ||
| (D)
ALEXIAN BROTHERS CENTER FOR MENTAL Health |
363045007 | No | 0 | 0 | ||
| (E)
Alexian Brothers Medical Care Group NFP |
471930457 | No | 0 | 0 | ||
| (F)
Alexian Brothers Ambulatory Group |
364336931 | No | 0 | 0 | ||
| (G)
Alexian Brothers Specialty Group |
800710751 | No | 0 | 0 | ||
Total 7
|
0 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part I, Line 1 SUPPORT | ABHN SUPPORTS THE PROVISION OF HEALTHCARE SERVICES AT THE CORPORATIONS TO WHICH IT IS A MEMBER BY THE PROVISION OF CENTRALIZED ADMINISTRATIVE SUPPORT, INCLUDING BILLING AND COLLECTIONS; MANAGED CARE CONTRACTING; PROPERTY MANAGEMENT; CLINICAL RESEARCH (INCLUDING ONCOLOGY, NEUROSCIENCES, AND GENERAL RESEARCH); MARKETING; LOGISTICS; EXTERNAL AFFAIRS; PUBLIC RELATIONS; AND CONSTRUCTION. COSTS OF CERTAIN OF THESE DEPARTMENTS ARE CHARGED TO THE CORPORATIONS THROUGH A MANAGEMENT FEE. TRANSACTIONS WITH EACH CORPORATION IS DELINEATED ON SCHEDULE R. |
| Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name | Alexian Brothers Hospital Network "ABHN" does not list the supported entities-each supported entity lists "ABHN". There is a historic and continuing relationship between ABHN and its supported organizations. Currently and historically, ABHN has provided support services such as billing and collections, managed care contracting, marketing, and other administrative services. |
| Schedule A, Part IV, Section A, Line 5a Added, Substituted, or Removed Sup. Org. | (i) Alexian Brothers Medical Care Group, NFP EIN: 47-1930457. (ii) for the acquisition of physician practice. (iii) Alexian Brothers Health System, as the National Member of Alexian Brothers Hospital Network, has the authority to approve the acquisition of legal entities and (iv) the action was accomplished by a Resolution of the Board of Governors of Alexian Brothers Health System. |
| Schedule A, Part IV, Section D, Line 3 Supp. Org. Have Significant Voice In Investment Policies | BY VIRTUE OF OVERLAPPING BOARD MEMBERS, THE SUPPORTED ORGANIZATIONS HAVE A SIGNIFICANT VOICE IN THE SUPPORTING ORGANIZATION'S DAILY OPERATIONS. THE ASCENSION SPONSOR, THROUGH ITS CONTROL OF THE ASCENSION BOARD, CONTROLS THE SYSTEM INTEGRATED STRATEGIC OPERATIONAL FINANCIAL PLAN, ANNUAL TARGETS AND INITIATIVES. WITHIN THIS OPERATIONAL FRAMEWORK, CERTAIN EXPENDITURES OF FUNDS, CAPITAL INVESTMENTS, ISSUANCE OF DEBT, ETC. ARE SUBJECT TO ASCENSION-LEVEL APPROVAL. |
| Schedule A, Part IV, Section E, Line 2a Org. Activities Directly Further The Exempt Purposes | Alexian Brothers Hospital Network, as a supporting organization, provided services to its supported organizations such as managed care contracting, billing and collections, research support, supply chain support, and managing the use of assets and other resources to enable the supported organizations to carry out their mission, as part of a clinically integrated system of care in furtherance of the exempt purpose of the supported organizations. |
| Schedule A, Part IV, Section E, Line 2b Activities That One Or More Supp. Org. Engaged In | Alexian Brothers Hospital Network engaged in activities which included managing facilities and other exempt function assets and coordinating the activities of personnel who support the charitable purposes of the supported organizations. Such activities are integral to the mission of the supported organizations and would have been performed by the supported organizations had they not been performed by Alexian Brothers Hospital Network. |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part V, Line 1a IRS FILINGS AND TAX COMPLIANCE | ALEXIAN BROTHERS HEALTH SYSTEM, A RELATED ORGANIZATION AND SOLE CORPORATE MEMBER OF ALEXIAN BROTHERS HOSPITAL NETWORK, USES A COMMON BANK ACCOUNT TO COMPENSATE ALL INDEPENDENT CONTRACTORS WITHIN THE HEALTH SYSTEM. THE NUMBER ATTRIBUTABLE TO EACH ORGANIZATION IS NOT EASILY DISTINGUISHED. THE TOTAL NUMBER OF FORMS 1099 FILED FOR THE ENTIRE HEALTH SYSTEM APPEARS ON PART V, LINE 1A OF THE ALEXIAN BROTHERS HEALTH SYSTEM FORM 990. |
| Form 990, Part VI, Line 15 COMPENSATION | IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ALEXIAN BROTHERS HOSPITAL NETWORK, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY ALEXIAN BROTHERS HEALTH SYSTEM, A RELATED ORGANIZATION OF ALEXIAN BROTHERS HOSPITAL NETWORK, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO OTHER SIMILARLY SITUATED ORGANIZATIONS' EMPLOYEES THAT HOLD THE SAME OR SIMILAR TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION BY THE COMPENSATION COMMITTEE, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. |
| Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIP AMONGST INTERESTED PARTIES | Tracy Rogers, Len Wilk, Clay Ciha, John Werrbach, Paul Belter, Mark Frey, Donna Gauthier have a business relationship due to a joint employment by a common health system entity. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | *Note A: To identify that the Alexian Brothers Health System is part of an affiliation comprising a regional comprehensive health care delivery network operated and managed by Alexian Brother-AHS Midwest Region Health Co. (the "Joint Operating Company"). With respect to the Corporation, the authority granted to the Corporation's Board of Directors or otherwise reserved to Alexian Brothers Health System ("ABHS") under the Corporation's Bylaws is subject to the authority granted to the Joint Operating Company and its members and sponsors under the Affiliation Agreement and the Joint Operating Company Bylaws. Note B: Operating Agreement amended to clarify the initial appointment of the Class A and Class B Directors shall be for a term of two years. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | Alexian Brothers Hospital Network has one member, Alexian Brothers Health System (the "National Member"). |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Subject to the ratification of the Board of Alexian Brothers AHS Midwest Region Health Co., Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Brothers Hospital Network. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | All decisions that have a material impact to Alexian Brothers Hospital Network's financial information or corporation as a whole are subject to approval by the National Member, Alexian Brothers Health System, subject to the approval of Alexian Brothers AHS Midwest Region Health Co. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board members are provided the Form 990 and management team members are available to answer any Board Members' questions. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. |
| Form 990, Part VI, Line 19 Required documents available to the public | The financial statements of Alexian Brothers Hospital Network are available through the Office of the Illinois Attorney General. Conflict of Interest statements and the governing documents of Alexian Brothers Hospital Network are not made available to the public. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | All Other - Total Revenue: 21767489, Related or Exempt Function Revenue: 21767489, Unrelated Business Revenue: 0, Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; |
| Form 990, Part IX, Line 11g Other Fees | Other Fees for Service - Total Expense: 15177256, Program Service Expense: 4944738, Management and General Expenses: 10232518, Fundraising Expenses: 0; Patient Financial Services Expense - Total Expense: 4061661, Program Service Expense: 4061661, Management and General Expenses: , Fundraising Expenses: ; System office supply chain fee - Total Expense: 1219352, Program Service Expense: 1219352, Management and General Expenses: , Fundraising Expenses: ; Consulting - Total Expense: 1702495, Program Service Expense: 1702495, Management and General Expenses: , Fundraising Expenses: ; Advertising - Total Expense: 2949159, Program Service Expense: 2949159, Management and General Expenses: , Fundraising Expenses: ; Management Fees - Total Expense: 1046977, Program Service Expense: 1046977, Management and General Expenses: , Fundraising Expenses: ; PS Trimedx Other - Total Expense: 4982124, Program Service Expense: 4982124, Management and General Expenses: , Fundraising Expenses: ; |
| Form 990, Part IX, Line 11g Other Expenses | All Other Expenses - Total Expense: 6303520, Program Service Expense: 6203520, Management and General Expenses: 100000, Fundraising Expenses: 0; Management fees - Total Expense: 681775, Program Service Expense: 681775, Management and General Expenses: , Fundraising Expenses: ; Purchase Services - Total Expense: 1579540, Program Service Expense: 1579540, Management and General Expenses: , Fundraising Expenses: ; Other fees and services - Total Expense: 7171097, Program Service Expense: 7171097, Management and General Expenses: , Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Transfers to and from Affiliates - -3883603; |
| Form 990, Part XII, Line 2b AUDIT DISCLOSURE | The activity of Alexian Brothers Hospital Network is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of Alexian Brothers Hospital Network is completed. Ascension Health Alliance's audit committee assumes responsibility for oversight of the audit of the financial statements. The audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of Alexian Brothers Hospital Network. |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |