TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) KATHLEEN GILMER DIRECTOR & VICE CHAIRPERSON	1.0 ................. 2.0	X	X			0	0
(2) LEN WILK EX-OFFICIO DIRECTOR & PRESIDENT CEO	50.0 ................. 2.0	X	X			519,797	59,449
(3) BRUCE WOLFE DIRECTOR & CHAIRPERSON	1.0 ................. 2.0	X	X			0	0
(4) CALVIN H FISCHER DO DIRECTOR	1.0 ................. 50.0	X				284,956	33,693
(5) THOMAS R PALMER JD DIRECTOR	1.0 ................. 2.0	X				0	0
(6) MARIJO LETIZIA PHD DIRECTOR	1.0 ................. 2.0	X				0	0
(7) RICHARD CARROLL MD DIRECTOR	1.0 ................. 0	X				0	0
(8) JOANNE LESKI EDD RN CNE DIRECTOR	1.0 ................. 2.0	X				0	0
(9) DONNA GAUTHIER ASSISTANT SECRETARY	1.0 ................. 50.0		X			74,341	17,743
(10) SHERRI VINCENT TREASURER (THROUGH 1/4/16)	25.0 ................. 25.0		X			471,075	40,359
(11) DIANA WOYTKO SECRETARY	1.0 ................. 52.0		X			279,053	55,450
(12) HENRY ZEISEL TREASURER (EFFECTIVE 6/16/16)	25.0 ................. 25.0		X			0	0
(13) LAURENCE R DRY III CHIEF OPERATING OFFICER	25.0 ................. 25.0			X		311,953	50,504
(14) ROBERT M ARENSMAN MD PEDIATRIC SURGEON	50.0 ................. 0.0				X	341,176	28,398
(15) BRYAN BERTOGLIO MD NEUROSURGEON	50.0 ................. 0.0				X	955,336	32,494
(16) KONSTANTIN I DENEV MD CRITICAL CARE PEDIATRICIAN	50.0 ................. 0.0				X	329,079	11,971
(17) JATEEN C PATEL MD PEDIATRIC SURGEON	50.0 ................. 0.0				X	681,570	16,552

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I

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

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

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization St Alexius Medical Center

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization St Alexius Medical Center		Employer identification number 36-4251846

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization St Alexius Medical Center			Employer identification number 36-4251846
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ..............................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

43,832

Total. Add lines 1c through 1i ....................................................................................................

43,832

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

Yes

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Alexius Medical Center does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Alexius Medical Center does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I

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

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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" on Form 990, Part IV, line 8.

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

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

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

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

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(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 ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. 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 ...	12,220,000		12,220,000
b	Buildings	245,988,577	34,653,090	211,335,487
c	Leasehold improvements	8,357,549	3,549,816	4,807,733
d	Equipment ...	44,599,041	22,753,004	21,846,037
e	Other ...	1,313,215	23,043	1,290,172
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				251,499,429

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Due to third party payors	49,576,237
Due to affiliates	16,501,866
Reserve for outstanding insurance losses	8,042,975
Other current liabilities	838,183
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	74,959,261
2. Liability for uncertain tax positions. 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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference	Explanation
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2016.

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 60000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		2,991	5,569,686		5,569,686	1.84 %
b	Medicaid (from Worksheet 3, column a) . . . . .		28,183	78,380,316	68,305,547	10,074,769	3.33 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	31,174	83,950,002	68,305,547	15,644,455	5.17 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).		6,743	406,451	36,954	369,497	0.12 %
f	Health professions education (from Worksheet 5) . . .		1,194	722,760	1,700	721,060	0.24 %
g	Subsidized health services (from Worksheet 6) . . . .		14,832	2,618,857		2,618,857	0.87 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .		1	126,801		126,801	0.04 %
j	Total. Other Benefits . .	0	22,770	3,874,869	38,654	3,836,215	1.27 %
k	Total. Add lines 7d and 7j .	0	53,944	87,824,871	68,344,201	19,480,670	6.44 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing					0
2	Economic development					0
3	Community support					0
4	Environmental improvements					0
5	Leadership development and training for community members					0
6	Coalition building					0
7	Community health improvement advocacy					0
8	Workforce development					0
9	Other		1,154	8,225		8,225
10	Total	0	1,154	8,225	0	8,225

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,148,561

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

314,856

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

91,119,856

Enter Medicare allowable costs of care relating to payments on line 5.....

110,901,107

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-19,781,251

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 HOFFMAN ESTATES SURGERY CENTER LLC	AMBULATORY SURGERY CENTER	40 %	60 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	St Alexius Medical Center 1555 Barrington Road Hoffman Estates,IL60169 www.alexianbrothershealth.org 0004994	X	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	St Alexius Medical Center
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.alexianbrothershealth.org/communityneeds

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.alexianbrothershealth.org/communityneeds

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	St Alexius Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0% and FPG family income limit for eligibility for discounted care of 600.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.alexianbrothershealth.org/pay-my-bill

The FAP application form was widely available on a website (list url):

www.alexianbrothershealth.org/pay-my-bill

A plain language summary of the FAP was widely available on a website (list url):
www.alexianbrothershealth.org/pay-my-bill

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	St Alexius Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - St Alexius Medical Center. To solicit input from key informants or those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was implemented as part of the Community Health Needs Assessment process. A list of recommended participants was provided by hospitals participating in the Metropolitan Chicago Healthcare Council (MCHC) led hospital coalition; and included names and contact information for physicians, public health representatives, social service providers and a variety of other community leaders. Participants were chosen because of their ability to identify primary concerns of the populations with whom they work as well as the community overall. Twenty-nine agencies/individuals provided comment.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - St Alexius Medical Center. The other hospital facilities with which the reporting hospital conducted its CHNA include: Adventist LaGrange Memorial Hospital Alexian Brothers Medical Center Alexian Brothers Behavioral Health Hospital Franciscan St. James Health Ingalls Memorial Hospital Little Company of Mary Hospital and Health Care Centers Loretto Hospital Northwest Community Healthcare Northwestern memorial Hospital Palos Community Hospital Rush Oak Park Hospital Rush University Medical Center Saint Anthony Hospital St. Bernard Hospital and Health Care Center Swedish Covenant Hospital The University of Chicago Medicine Thorek Memorial Hospital Adventist Glen Oaks Hospital Adventist Hinsdale Hospital Edward Hospital & Health Services Elmhurst Memorial Healthcare Central Dupage Hospital Northwestern Lake Forest Hospital Adventist Bolingbrook Hospital
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - St Alexius Medical Center. Disproportionate unmet community health needs identified: Cancer St. Alexius Medical Center (SAMC) provides a variety of community based education and screenings about the importance of preventing and treating cancer at its earliest possible stages. SAMC also provides cancer support groups for patients who have cancer as well as their families. Some examples of those support groups which routinely meet at SAMC are "Us Too", a prostate cancer support group, a Breast Cancer Support Group staffed by a SAMC Breast Cancer Nurse Navigator who encourages the group to share "stories" and also offers education; and a Brain Tumor Support Group staffed by a SAMC social worker who encourages participants to share their struggles, treatment and to network with others experiencing brain cancer. The Cancer Institute applied for and received a grant to assist cancer patients who have no other means of transportation to get to their medical appointments. A social worker screens each patient for need and if eligible is picked up from their home and transported to the treatment facility and back home again. SAMC provides mammography services to the underserved communities through a grant awarded by the Susan G Komen Foundation, Chicago. This includes any patient approved for Susan G Komen Grant funding (need based) of their breast imaging and/ or follow up care such as breast biopsy or cyst aspiration. It also involves communication with Access to Care and VNA both Federally Qualified Health Centers, for patients new to St. Alexius Medical Center referred in because of our grant as well as primary physicians to existing patients that qualified for grant funding. ABHS, the corporate member of SAMC, participated in the American Cancer Society's (ACS) Fundraiser "Black and White Ball" which nets the ACS hundreds of thousands of dollars for research, prevention and education of all types of cancer. ABHS, the corporate member of SAMC, participated in the American Cancer Society's "Relay for Life" raising thousands of dollars for ACS to provide education, research and public information about the prevention and treatment of cancer. SAMC provides Mammacare training and certification to professionals which enables them to teach community members advanced self-breast examination techniques proven to detect breast cancer earlier, therefore at more curable stages. There is a modest cost for professionals, but no cost for community members wishing to learn advanced breast self-exam techniques. SAMC's Cancer Center provides free classes in Yoga, Tai Chi, and fitness to its patients with cancer for stress management and to maintain physical wellness while undergoing cancer treatment. SAMC's Cancer Institute operates a boutique by appointment which offers sensitive, private consultations to discuss options for hair replacement. If a patient's insurance does not cover the cost of a wig, a voucher of up to $300.00 is given to use towards the cost. Chronic Kidney Disease The leading cause of chronic kidney disease is Type II Diabetes, also a top concern and unmet need for the SAMC service area. Our efforts at addressing Chronic Kidney Disease are included in all education, prevention, screening and treatment of Type II Diabetes. Type II Diabetes Type II Diabetes is a top concern for community stakeholders in the SAMC area. It is closely related to heart disease, stroke, and kidney disease and is linked to poor nutrition, weight and lack of exercise. ABHS, the corporate parent of SAMC, provides education and screening for diabetes routinely through health fairs, senior centers and park districts. ABHS, the corporate parent of SAMC provides the Schaumburg Park District with a Community Resource Nurse who provides health care prevention and referral services to any community member. Programming includes nutrition education, information on diabetes prevention and treatment, along with blood pressure screenings and body fat analysis. ABHS, the corporate parent of SAMC provided a diabetes educator for an educational session for anyone in the community on diabetes and neuropathy. ABHS, corporate member of SAMC, sent an endocrinologist to discuss the various new treatment options for diabetes. The audience had many questions, particularly regarding diet. One person who was recently diagnosed with diabetes was relieved to learn that with the proper care, it is definitely treatable. SAMC entered into an agreement with Golden Corridor YMCA to provide financial support for a new Diabetes Prevention Program. Vetted by the Federal Agencies Center for Disease Control and the National Institutes of Health, the program has been shown to reduce the incidence of Type II Diabetes in at-risk adults over 60 by 58% and by 71% in adults over age 70. The program is 16 sessions over a year. This partnership is designed to reduce the number of adults with Type II Diabetes through sustained education and support. SAMC provides a "Let's Talk Diabetes" support group open to anyone in the community. ABHS, corporate member for SAMC, sponsored an event featuring staff from the Pediatric Endocrinology Clinic that focused on education, support and activities for children and teens with diabetes. Heart Disease and Stroke ABHS, corporate member of SAMC, participated in the American Heart Association's (AHA) annual fundraising gala at which the AHA raised hundreds of thousands of dollars for research and education. SAMC is a certified primary stroke center. ABHS, the corporate member of SAMC funds Stroke Survivors Empowering Each Other (SSEEO) annually to assist their efforts at supporting those who have had a stroke as well as their families. Their annual report identifies over 1000 lives touched through their E-newsletter, peer visitation, support calls, and classes. Over 5000 brochures have been distributed. A message from their president: "There is life after stroke and SSEEO is helping to make this become a reality in the lives of many stroke survivors." ABHS, corporate member of SAMC, provided Registered Nurses to administer blood pressure screenings, cholesterol screenings, body fat analysis and education numerous times to the community at large. Participants are informed about the relationship of cholesterol, blood pressure and weight to heart disease, stroke and diabetes. ABHS, corporate member of SAMC, provided a Registered Dietitian to present on healthy eating during holidays. Information about which ingredients are good substitutes in recipes, as well as providing traditional holiday recipes that had less fat, sodium, etc. The audience also gave some of their suggestions that they use in their own recipes. ABHS, corporate member of SAMC, sponsored the "Retreat and Refresh Stroke Camp" which provides an opportunity for stroke survivors, caregivers, and family members to experience a camping weekend. Activities are designed specifically for campers, offering an informal and comfortable outlet for education, relaxation, socialization, and support. Volunteers from sponsoring organizations also have the opportunities to give back and reconnect with stroke survivors. ABHS, corporate member of SAMC, routinely provides an Advanced Practice Nurse to present to the community the various risk factors for stroke and the ways of reducing your chances of having one. She explained all aspects of stroke, including blood pressure, elevated cholesterol and diabetes. The attendees had many questions and appreciated the time the Nurse took to answer them.
Schedule H, Part V, Section B, Line 11 Facility , 2	Facility , 2 - St Alexius Medical Center. Continued HIV/AIDS ABHS, corporate member of SAMC, is a permanent, voting member of The Catholic Charities HIV/AIDS Task Force for the Chicago Archdiocese and is an HIV/AIDS Program Services Advisory Committee. This Task Force collaborates with agencies, institutions and individuals who provide HIV/AIDS services, education and ministry in the Chicago area to carry out the healing mission of the Catholic Church. This meeting focused on strategies to expand outreach through social media. ABHS, corporate member of SAMC, was asked to serve as a proposal reviewer to determine the funding of HIV specialty clinics in the Uptown community. The purpose of the "Expansion of Primary Care Services for Residents Living with HIV/AIDS RFP" was to determine whether or not the Chicago Department of Public Health should continue to provide direct HIV primary care services or if more residents would be served by reinvesting the same amount of funding in community partners. CDPH's ultimate goal is to leverage its limited resources to ensure that high-quality care is provided to as many residents as possible. ABHS reviewed two proposals and made funding recommendations at the request of CDPH. The Urban Coalition for HIV/AIDS Prevention Services (UCHAPS) is a national collaboration of community partners and health departments dedicated to preventing new HIV infections and reducing health disparities, morbidity, and mortality. UCHAPS member jurisdictions are among the epicenters of the urban HIV epidemic and are often at the forefront of piloting new intervention strategies. ABHS, corporate member of SAMC, was nominated by the Chicago Department of Public Health (CDPH) to represent the Chicago jurisdiction. Immunization and Infectious Disease SAMC provides every patient upon discharge the opportunity to receive a flu vaccine. SAMC requires every employee to have a flu vaccine for the protection of our patients unless they are medically excused. The employed physician group serving SAMC urges every patient to have a flu vaccination. ABHS, corporate member of SAMC, provides a free immunization clinic each quarter to any member of the community. Infant Health and Family Planning SAMC has adopted the March of Dimes "Healthy Babies are Worth the Wait" initiative to educate consumers and professionals about preventable preterm birth, which was adopted by all Obstetricians on the medical staff and communicated to all patients. Injury and Violence ABHS, corporate member of SAMC, has been a longtime supporter of Women in Need Growing Stronger, or WINGS. WINGS is a domestic violence shelter which provides women and their children with housing, occupational counseling, mental health counseling and support while they are attempting to flee from a violent partner. SAMC provides pro bono space to WINGS for the provision of counseling services to women affected by domestic violence. Mental Health Most mental health community programming is disseminated through Alexian Brothers Behavioral Health Hospital, a hospital affiliated with SAMC. SAMC provides financial support to the Ecker Center, a community mental health center based in Elgin,. Nutrition, Physical Activity and Weight ABHS, corporate member of SAMC provides free weight management and nutritional counseling to the community throughout the year. SAMC sponsors "Go Noodle", a suite of interactive on-line videos for use in elementary schools which provide brief breaks of moderate to vigorous physical activity throughout the school day. Teachers report better behavior from the students who are less restless and readier to learn as well as the benefits of frequent exercise. ABHS, corporate member of SAMC is a frequent participant in sponsoring exercise events such as a "Zombie 5K Event" on Halloween to attract runners/walkers for Boys and Girls Clubs. ABHS, corporate member of SAMC, encourages staff to sit on boards of various community agencies such as YMCA and Boys and Girls Clubs to assist in cooperative community efforts that promote exercise. ABHS, corporate member of SAMC, supports "Fittest Loser" a community event to promote safe, sustainable weight loss in a contest format. Potentially Disabling Conditions ABMC, affiliated with SAMC, provides an "Aphasia Conversation Group" weekly group facilitated by a speech language pathologist which offers a social setting where patients with cognitive impairments which include speech expression and comprehension can come together and practice their communication skills. Topics of conversation are generated from the group and encourage the practices of comprehension, expression, sequencing, practicing, socialization, and ultimately support. A Stroke Support group meets weekly with community members and current in-patients. Goal is to share recovery journey, community reintegration, provide support, build relationships, network, and inspire hope. Content of discussion varies from general discussion regarding rehabilitation, community reintegration, tips for mastering skills and advocacy. Occasional speakers are brought in at the request of members. Members rotate in/out throughout the year. For persons struggling with memory issues, non-invasive memory screenings are offered to interested community members. Participants were given the opportunity to answer questions and perform tasks that would give an assessment of their memory. Clients were referred to their primary care physician if they had concerns about their results. Verbal feedback from participants indicated that they found these screenings to be a valuable tool in recognizing changes in their memory. Respiratory Diseases At the time of this report, ABMC is in the planning stages of an Asthma program with other community stakeholders. Sexually Transmitted Diseases SAMC does not provide specific programming for this issue but provides referrals to primary care for any community member needing assistance. Substance Abuse Substance Abuse programming is disseminated through Alexian Brothers Behavioral Health Hospital, a hospital affiliated with ABMC.
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - St Alexius Medical Center. ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY. THE FRONT OF OUR STATEMENT INCLUDES THIS MESSAGE: "IF YOU ARE AN UNINSURED ILLINOIS RESIDENT AND MEET CERTAIN INCOME REQUIREMENTS, YOU MAY QUALIFY FOR A DISCOUNT THROUGH OUR ALEXIAN ASSISTANCE PROGRAM IN ACCORDANCE WITH THE STATE OF ILLINOIS, HOSPITAL UNINSURED PATIENT DISCOUNT ACT (EFFECTIVE APRIL 1, 2009). FOR ADDITIONAL INFORMATION, PLEASE CONTACT US AT 866-690-3370 OR ALEXIANASSISTANCE@ALEXIAN.NET". THE BACK OF OUR STATEMENT INCLUDES THIS MESSAGE: "IF PAYING THIS BILL PRESENTS A FINANCIAL HARDSHIP, YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ALEXIAN BROTHERS HOSPITAL NETWORK PROVIDES ASSISTANCE TO PATIENTS IN NEED OF FINANCIAL AID TO HELP PAY FOR HIS/HER HOSPITAL BILLS. YOU MAY OBTAIN AN APPLICATION BY CALLING OUR STAFF AT THE NUMBER BELOW OR YOU MAY DOWNLOAD THE FORMS FROM THE INTERNET AT WWW.ALEXIANBROTHERSHEALTH.ORG". IN ADDITION, ALL UNINSURED PATIENTS RECEIVE A LETTER FROM OUR PATIENT FINANCIAL SERVICES DEPARTMENT ONCE WE COMPLETE A PROCESS OF ATTEMPTING TO IDENTIFY ALTERNATIVE COVERAGE FOR UNINSURED PATIENTS. THIS LETTER IS SENT AT THE BEGINNING OF OUR STATEMENT CYCLE FOR EACH UNINSURED PATIENT. THE TEXT OF THE LETTER IS: "THANK YOU FOR CHOOSING ST. ALEXIUS MEDICAL CENTER AS YOUR HEALTHCARE PROVIDER. YOUR ACCOUNT CURRENTLY HAS A BALANCE OF $XX; ADDITIONAL CHARGES MAY BE PENDING. WE HAVE NO RECORD THAT YOU HAVE HEALTH INSURANCE TO HELP IN PAYING YOUR BILL. IF YOU HAVE INSURANCE, PLEASE PROVIDE THE NECESSARY INFORMATION BY FILLING OUT THE STUB ABOVE AND FAXING A COPY OF YOUR INSURANCE CARD TO 847-483-7058, ATTN: CORRESPONDENCE TEAM. IF YOU HAD INSURANCE THAT ENDED WITHIN THE LAST 60 DAYS, YOU MAY BE ELIGIBLE FOR COBRA COVERAGE FROM A FORMER EMPLOYER. PLEASE CONTACT YOUR FORMER EMPLOYER TO DETERMINE IF YOU ARE ELIGIBLE. ST. ALEXIUS USES MULTIPLE METHODS OF COMMUNICATING ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. ALEXIAN BROTHERS HEALTH SYSTEM'S (ABHS) WEBSITE, THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS, INCLUDING ST. ALEXIUS, FEATURES INFORMATION ON HOW TO APPLY FOR CHARITY CARE ON-LINE. IN THE HOSPITAL SETTING, WE EMPLOY TWO FINANCIAL COUNSELORS WHO ARE AVAILABLE TO WORK WITH PATIENTS AND WE ALSO HAVE MEDICAID APPLICATION SPECIALISTS TO ASSIST PATIENTS THAT MAY QUALIFY. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY.
Schedule H, Part V, Section B, Line 22 Facility , 1	Facility , 1 - St Alexius Medical Center. ST. ALEXIUS MEDICAL CENTER USES THE STATE OF ILLINOIS, HOSPITAL UNINSURED PATIENT DISCOUNT ACT GUIDELINES WHICH SPECIFY THAT ELIGIBLE PATIENTS SHOULD BE CHARGED 135% OF HOSPITAL COSTS WHICH FOR ST. ALEXIUS MEDICAL CENTER APPROXIMATES 32% OF CHARGES.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?2
Name and address		Type of Facility (describe)
1	St Alexius Outpatient Center 347 W Golf Road Schaumburg,IL60195	Diagnostic imaging services and physical therapy rehabilitation services.
2	St Alexius Breast Care Center 864 W Stearns Bartlett,IL60103	mammography and Dexa bone scan imaging services.
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I, Line 3c FAP Eligibility	Every uninsured person, regardless of income receives an automatic 15% discount off of charges. Persons who earn less than 600% of federal poverty guidelines are given more significant discounts, depending on their individual situations. Federal Poverty Level - 0-200% Patient Discount Uninsured - 100% Federal Poverty Level - 201-300% Patient Discount Uninsured - 75% Federal Poverty Level - 301-600% Patient Discount Uninsured - 75% Federal Poverty Level - >600% Patient Discount Uninsured - 15%
Schedule H, Part VI, Line 7 State of Filing Community Benefit	Alexian Brothers Hospital Network("ABHN") prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for Alexian Brothers Medical Center ("ABMC"), St. Alexius Medical Center ("SAMC") and Alexian Brothers Behavioral Health Hospital ("ABBHH").
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	Alexian Brothers Hospital (ABHN) prepares and files the annual non-profit hospital community benefit plan report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for Alexian Brothers Medical Center (ABMC), St. Alexius Medical Center (SAMC) and Alexian Brothers Behavioral Health Hospital (ABBHH).
Schedule H, Part I, Line 7g Subsidized Health Services	ST. ALEXIUS HAS NOT INCLUDED COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	The following costing methodologies were used: - Charity at cost - a cost to charge methodology based on the filed 2016 Medicare cost report was used to calculate costs. - Unreimbursed Medicaid - costs are calculated using the 2016 filed Medicaid cost report. - Other benefits - costs are determined by activity reported in accordance with guidelines published by the Catholic Health Association; costs could include the value of hourly wages, costs of materials, value of space loaned to community groups for meetings, and indirect costs where applicable
Schedule H, Part II Community Building Activities	In the twelve months ended June 30, 2016, SAMC concentrated most of its resources in other areas of community benefit that were not "community building" as described by the Catholic Health Association.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the St Alexius Medical Center follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The ABHN hospitals, including St. Alexius, proactively work to presumptively assess and grant charity to all uninsured patients prior to sending these patients their first statement. We screen all uninsured patients against credit score data in order to presumptively apply our charity policy. Based on this process, approximately 96% of our uninsured patient population is defined as eligible and we process a partial charity adjustment on their accounts. The average discount given to the uninsured patient population is 81%. In prior years, we limited our proactive efforts to only those accounts with balances > $5,000. Under that scenario, we estimated that 1/3 of our bad debt placements may have been eligible for charity care discounts. Now that we have a more comprehensive presumptive charity program, many more accounts are granted charity earlier in the process and prior to bad debt placement. Therefore, we estimate that approximately 10% of our current bad debt placements would be eligible for additional charity if we had a full presumptive charity process across 100% of our selfpay after insurance accounts. Discounts and payments are not included in bad debt expense in the financial statements for St. Alexius unless the payment is a recovery of amounts previously written off as bad debt. Recoveries are classified as a decrease to bad debt expense.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	St. Alexius is part of the Ascension Health Alliance consolidated audit. The footnote that references bad debt expense can be found on page 18 of the audited Financial Statements. St. Alexius' share of bad debt expense for ABHS for the twelve months ended June 30, 2016 was $17,364,890 at charges ($3,148,561 at cost). Cost is determined in the same manner as charity at cost.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	Medicare costs are allocated by cost center in accordance with Medicare regulations. Healthcare Reform has resulted in billions of dollars being removed from health provider payments, mostly hospital payments. This is a trend that will continue for at least another six years. The systematic degradation of reimbursement that is already less than the cost of providing the service for the vast majority of hospitals needs to be considered community benefit to accurately represent the enormous contributions that hospitals make toward easing government burden in caring for an enormous and growing number of its citizens.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	It is the policy of ABHS, including St. Alexius, to offer patients a payment plan and/or charity assistance when it becomes known or even suspected that a patient needs financial assistance. Financial counselors are notified and every attempt is made to contact and work with the patient or their family to help them complete an application with compassion and dignity. Financial counselors work with patients to help determine if there are any third party payers which may be available to help the patient meet their obligations. We work with the patient to determine if they are eligible for federal programs including Medicaid, state funded programs including crime victims, alternative insurance including COBRA, Worker's Compensation and or other specialized grant programs such as our mammography grant program for low income women. In the event no third party programs are identified, we then work with the patient to help them apply for charity discounts and payment plans. At St. Alexius, two full-time financial counselors each work with approximately 7,700 patients per year. Translators are used as needed for language assistance. In addition, all bills and statements include information regarding charity.
Schedule H, Part V, Section B, Line 16a FAP website	- St. Alexius Medical Center: Line 16a URL: www.alexianbrothershealth.org/pay-my-bill;
Schedule H, Part V, Section B, Line 16b FAP Application website	- St. Alexius Medical Center: Line 16b URL: www.alexianbrothershealth.org/pay-my-bill;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- St. Alexius Medical Center: Line 16c URL: www.alexianbrothershealth.org/pay-my-bill;
Schedule H, Part VI, Line 2 Needs assessment	Needs Assessment The 2015 Community Health Needs Assessment was conducted by the Professional Research Consultants, Inc. in cooperation with MCHC and other partnering hospitals, and incorporates data from both quantitative and qualitative sources. Qualitative data include primary research in the form of the PRC Community Health Survey which was a sample of 1,033 individuals age 18 and older in the total service area. For statistical purposes, the maximum error rate associated with a sample size of 1,033 is +/-3.1% at the 95 % confidence level. Quantitative research includes sources such as Vital Statistics and other existing data. Benchmarking with state and national data is provided as available and qualitative input includes primary research gathered from an online Key Informant Survey from various community stakeholders. There were a total of 29 online key informants who participated from various agencies such as health departments, school districts, social service agencies and municipalities. The service area for the hospital is comprised of 84 residential zip codes based on patient origin. It should be noted that this is a large increase in the number of zip codes surveyed in 2012 and in 2009. When a trend has indicated a significant difference from prior surveys, the data has been compared to the former 38 zip code sample and the discrepancy duly noted. The information in the Community Health Needs Analysis is not exhaustive or conclusive, rather an overview of the issues most prominent in a community. There may be discreet but very important issues in a community that are not able to be detected by this instrument. For example, we know that community members have many questions about how to locate services in our health system, other agencies or may have general questions about insurance, pharmaceuticals, or other kinds of care givers. To assist, we have created the St. Alexius Senior & Community Resource Center. This center is open to anyone in the community and there is never a charge for any of the services. We help people review insurance coverage options within Medicare or Medicaid or help them apply for marketplace insurance coverage. We also help them locate in home caregivers, home health, hospice or palliative care services. We can assist in providing or locating transportation services, locating legal services or housing options such as assisted living or skilled nursing. These services can be offered as walk in or by appointment and are very appreciated by the community. SAMC also offers Post-partum depression support groups, outpatient consultations and phone consultations for women experiencing depression after the birth of a child. This issue is not found in the CHNA, but is a very serious condition that needs to be identified and treated at its earliest possible stage. SAMC informs new parents of the signs and symptoms of post -partum depression and offers counseling to anyone without charge in several settings.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Multiple methods are used at St. Alexius to communicate its mission of providing care to all who need it regardless of ability to pay. Signs posted at registration clearly point out that charity care or financial assistance is available. Alexian Brothers Health System's (ABHS) website, the main website for all System hospitals, including St. Alexius, features information on how to apply for charity care on-line. In the hospital setting, we employ four financial counselors who are available to work with patients and we also have Medicaid application specialists to assist patients that may qualify. In addition, all bills and statements include information regarding charity
Schedule H, Part VI, Line 4 Community information	Community Information A description of the geography served by zip code and mapping is available for each hospital on our website, www.alexianbrothershealth.org under the Community Benefit Section, choose the desired hospital, page 6. The demographics of the population served is available for each hospital on our website, www.alexianbrothershealth.org under the Community Benefit Section, choose desired hospital, page 10.
Schedule H, Part VI, Line 5 Promotion of community health	SAMC's governing body is the Board of Directors. The Board of Directors report up through the Alexian Brothers Health System Board of Governors. The majority of the Board of Directors members live and work in the community and serve to support the mission and values of the Alexian Brothers. SAMC extends medical staff privileges to all qualified physicians in our community and endeavors to provide them with the safest and most technologically advanced environment possible through the effective use of surplus funds. Some of our surplus funds have been used to purchase technology for non-invasive brain mapping and non-invasive technology for treating brain tumors in prior years. As necessary, SAMC recruits medical specialists and subspecialists who provide the expertise for emerging technologies that advance patient care. SAMC strives to fully serve the community through participation in government sponsored healthcare programs such as Medicare, Medicaid, Champus and Tricare. SAMC also participates in research and education. Community members also use SAMC as a conduit for volunteering as evidenced by over 600 volunteers (comprising almost 71,000 hours of service) who assist with non- medical patient services, administration and the Gift Shop.
Schedule H, Part VI, Line 6 Affiliated health care system	St. Alexius is an affiliate of ABHS. ABHS is the national member and ultimate parent of St. Alexius. ABHS, with its corporate offices located in Arlington Heights, Illinois, is sponsored by Ascension Health, a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Ministries, throughout the United States and the District of Columbia. ABHS carries out its exempt purposes by coordinating and managing the activities of the regional corporations for which it is the National Member. Through these regional corporations, ABHS provides healthcare and other services to communities in suburban Chicago, Illinois. As a charitable organization, it is recognized that not all individuals possess the ability to purchase essential medical services and further that our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping with ABHS' commitment to serve all members of its community, free care and/or subsidized care, care to persons covered by government programs at or below cost, and health activities and programs to support the community are considered and provided when appropriate. These activities include wellness programs, community education programs, special programs for the elderly and medically underserved, and a variety of broad community support activities including but not limited to educational affiliations, health screenings, counseling programs, continuing medical education (CME) programs and donations to community groups. Net community benefits expense for ABHS in 2016 is as follows: Charity Care at Cost - $11,382,000 Excess of Government Sponsored Health Care Cost Over Reimbursement - Medicaid - $36,763,000 Donations - $295,000 Education - $2,744,000 Subsidized Health Services - $3,637,000 Other Community Benefit Programs - $3,438,000 Total Charity Care and Community Benefits - $58,260,000 Information has been included for all exempt entities in ABHS. The information for the hospitals included has been calculated on a basis consistent with the requirements for the Illinois Attorney General Community Benefit report. In addition, ABHS reported bad debt expense (at cost) of $7,100,000 in the twelve months ended June 30, 2016 and excess of Medicare costs over reimbursement of $62,600,000 in 2016. Certain affiliated entities within ABHS and the services they provide, are described below: Alexian Brothers Medical Center - An acute care hospital located in Elk Grove Village, Illinois that provides inpatient, outpatient and emergency services, including specialties in the areas of cardiology, neurosciences/stroke, orthopedics, oncology, bariatrics, hospice and home health. Alexian Brothers Behavioral Health Hospital - A behavioral health hospital located in Hoffman Estates, Illinois that provides inpatient and outpatient psychiatric services, including specialties in chemical dependency, eating disorders and self-injury programs. Alexian Brothers Center for Mental Health - Provides community mental health services in northwest suburban Chicago, including vocational training programs, transitional living programs, partial hospital programs and nursing home programs. Alexian Brothers Bonaventure House and Alexian Brothers Bettendorf Place, LLC - Provides supportive services, transitional and permanent supportive housing for persons with HIV/AIDS. Alexian Brothers Hospital Network - The area member for Illinois hospitals and related entities, ABHN provides community education classes, health screenings and counseling and other services on a sliding fee scale to surrounding communities and performs research activities geared towards improving the health of those we serve. Alexian Brothers Ambulatory Group - Provides a multitude of ambulatory services to suburban Chicago, including primary care physician services; pediatric physician services; older adult physician services; other specialty physician services; occupational health services; and immediate care services; also provides wellness services through its various locations and practices. Alexian Brothers Specialty Group - Provides cardiology services through employment of cardiologists to suburban Chicago residents. Alexian Brothers Medical Care Group - Provides a multitude of ambulatory services to suburban Chicago, including primary care physician services and pediatric physician services

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1LEN WILK EX-OFFICIO DIRECTOR & PRESIDENT CEO	(i) (ii)	0 ------------- 391,764	0 ------------- 110,586	0 ------------- 17,447	0 ------------- 24,140	0 ------------- 35,309	0 ------------- 579,246	0 ------------- 17,447
2CALVIN H FISCHER DO DIRECTOR	(i) (ii)	0 ------------- 227,216	0 ------------- 57,740	0 ------------- 0	0 ------------- 11,800	0 ------------- 21,893	0 ------------- 318,649	0 ------------- 0
3SHERRI VINCENT TREASURER (THROUGH 1/4/16)	(i) (ii)	0 ------------- 379,176	0 ------------- 71,178	0 ------------- 20,720	0 ------------- 33,239	0 ------------- 7,120	0 ------------- 511,434	0 ------------- 20,720
4DIANA WOYTKO SECRETARY	(i) (ii)	0 ------------- 228,584	0 ------------- 38,646	0 ------------- 11,822	0 ------------- 37,206	0 ------------- 18,244	0 ------------- 334,503	0 ------------- 11,822
5LINDA BAKER FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 192,429	0 ------------- 38,696	0 ------------- 3,713	0 ------------- 35,053	0 ------------- 29,016	0 ------------- 298,907	0 ------------- 3,713
6EDWARD GOLDBERG FORMER OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 420,959	0 ------------- 29,202	0 ------------- 18,392	0 ------------- 468,554	0 ------------- 420,959
7SCOTT PETERSON FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 110,504	0 ------------- 0	0 ------------- 0	0 ------------- 110,504	0 ------------- 0
8JON ROZENFELD FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 159,094	0 ------------- 0	0 ------------- 17,194	0 ------------- 18,187	0 ------------- 13,632	0 ------------- 208,106	0 ------------- 17,194
9LAURENCE R DRY III CHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 260,706	0 ------------- 51,247	0 ------------- 0	0 ------------- 20,069	0 ------------- 30,435	0 ------------- 362,457	0 ------------- 0
10ROBERT M ARENSMAN MD PEDIATRIC SURGEON	(i) (ii)	0 ------------- 341,176	0 ------------- 0	0 ------------- 0	0 ------------- 11,800	0 ------------- 16,598	0 ------------- 369,574	0 ------------- 0
11BRYAN BERTOGLIO MD NEUROSURGEON	(i) (ii)	0 ------------- 877,336	0 ------------- 60,000	0 ------------- 18,000	0 ------------- 10,080	0 ------------- 22,414	0 ------------- 987,830	0 ------------- 0
12KONSTANTIN I DENEV MD CRITICAL CARE PEDIATRICIAN	(i) (ii)	0 ------------- 329,079	0 ------------- 0	0 ------------- 0	0 ------------- 10,379	0 ------------- 1,592	0 ------------- 341,050	0 ------------- 0
13JATEEN C PATEL MD PEDIATRIC SURGEON	(i) (ii)	0 ------------- 506,581	0 ------------- 156,989	0 ------------- 18,000	0 ------------- 5,300	0 ------------- 11,252	0 ------------- 698,122	0 ------------- 0
14ROBERT O MAGANINI BREAST SURGEON	(i) (ii)	0 ------------- 471,358	0 ------------- 36,785	0 ------------- 0	0 ------------- 11,051	0 ------------- 10,080	0 ------------- 529,274	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
Schedule J, Part II FORM 990, PART VII, SECTION A, LINE 5	The following individual(s) was compensated by Adventist Health System Sunbelt Healthcare Corporation "AHSSHC" in 2015 for services provided to the filing organization. Please see our response to Form 990, Part III, Line 4A for a discussion concerning the filing organization's affiliation with AHSSHC. Individuals that are considered Officers have been reported in Part VII. Individuals that are considered Key Employees have not been reported in Part VII since they did not receive reportable compensation in excess of $150,000 from this organization and/or related organizations. Name of Employer: Adventist Health System Sunbelt Healthcare Corporation Name of Employee: Donald J. Russell, Key Employee Type and Amount of Compensation Paid/Accrued from AHSSHC for services rendered to the filing organization: Base Compensation: $312,868 Bonus & Incentive Compensation: $40,291 Other Reportable Compensation: $31,149 Retirement & Other Deferred Compensation: $20,149 Nontaxable benefits: $40,754
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	Alexian Brothers Health System, a related organization of St. Alexius Medical Center, uses the following methods to establish the compensation of the organization's CEO: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Compensation survey or study - Approval by the Board or Compensation Committee
Schedule J, Part I, Line 4a Severance or change-of-control payment	The following individuals listed in Schedule J were paid the referenced amount of severance in calendar 2015: Edward Goldberg-$420,959 Scott Peterson-$110,504
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	Alexian Brothers Health System offers a Supplemental Employee Retirement Plan to all employees who participate in the executive benefits program and whose compensation exceeds the IRS allowable limit for a qualified pension plan. The purpose of the plan is to restore retirement benefits that are restricted because of compensation limits for the executives. No distributions from the supplemental nonqualified retirement plan were made in the current year.

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) LESLEY POTTER	SISTER OF FORMER KEY EMPLOYEE	58,294	EMPLOYMENT		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Return Reference	Explanation
Form 990, Part III, Line 4a Statement of Program Service Accomplishments-Part I	SAMC has received Disease Specific Care Certification from The Joint Commission in stroke, heart failure, and knee and hip joint replacement. The Blue Cross and Blue Shield Association's Blue Distinction Centers program also has recognized SAMC for delivering safe, high quality and cost efficient specialty care in bariatric surgery, maternity care and knee replacement/hip replacement/spine surgery. The American Heart Association/American Stroke Association recognized AMITA Health St. Alexius for providing high quality stroke care, presenting them with the 2016 Get With The Guidelines Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite. The award recognizes the medical centers' commitment to providing the most appropriate stroke treatment in accordance with nationally recognized guidelines based on the latest scientific evidence. In 2015, Alexian Brothers Women & Children's Hospital added a Neonatal Transport Team that specializes in emergency transport of critically ill babies from outside hospitals. The program operates to provide facilities with a unique, safe and efficient transport system. The Neonatal Transport Team has the expertise and specialized equipment to care for critically ill newborns as they are transported to the hospital by ambulance. Complex care is initiated by the transport team upon arrival at the referring hospital and continued throughout the transport until the infant is received at the hospital. In fiscal 2016, SAMC treated 17,482 inpatients, performed 3,622 inpatient surgeries, performed 7,170 outpatient surgeries and delivered 3,852 babies. There were 138,995 diagnostic images, including general X ray, CT, MRI, mammography, ultrasound and nuclear medicine. There were 525,027 laboratory tests performed and 62,533 emergency room visits. SAMC's medical staff includes about 1,000 physicians, representing 60 medical and surgical specialties. SAMC provides care for all, including the financially disadvantaged, uninsured, underinsured, homeless and those who receive public aid. See Schedule H for a summary of community benefit provided by SAMC.
Form 990, Part III, Line 4a Statement of Program Service Accomplishments-Part II	About Alexian Brothers Health System SAMC is a member hospital of Alexian Brothers Health System (ABHS), a comprehensive and diversified healthcare organization headquartered in Arlington Heights, Illinois, a community in Chicago's northwestern suburbs. ABHS, which serves more than 2 million people, is a ministry organization of Ascension, the largest Catholic health system in the nation. ABHS provides the community with a full range of healthcare services and access to the most advanced medical technology. Its people are passionate about delivering exceptional healthcare and are proud of the system's powerful, cutting edge technology. In addition, ABHS offers a wide range of community health services, corporate wellness programs, preventive care and education. Its ministries exist to continue the Alexian Brothers' mission of caring for the sick, the poor and the dying and promoting the physical, mental, spiritual and social health and well being of all individuals they serve. Adventist Health System Sunbelt Healthcare Corporation and Ascension Health, the sponsors of Adventist Midwest Health (AMH) and Alexian Brothers Health System (ABHS), respectively, entered into an Affiliation Agreement that established the Joint Operating Company, Alexian Brothers-AHS Midwest Region Health Co. which became operational on February 1, 2015. The purpose of the Joint Operating Company is to provide a financially and operationally integrated organization for the common management and operation of the health care facilities and operations of AMH and ABHS while preserving the Adventist and Catholic identities and mission priorities that define AMH and ABHS, respectively. In April 2015, AMITA Health was announced as the d/b/a for Alexian Brothers-AHS Midwest Region Health Co. The word AMITA is inspired by words from several languages: friendship in Italian, honesty and truth in Hebrew, and spiritual light and boundlessness in Hindi. These words reflect our core values of friendship, truth, and mutual respect for all, as well as our faith-based call to healing. Although the name is new, the values of our two great organizations will continue to be the foundation of who we are and how we care for our communities into the future. The dedication and promise our caregivers show every day to our patients, their families and each other is deeply rooted in the new name - AMITA Health. Clinical Institutes Cancer Institute at Alexian Brothers Health System The Cancer Institute at Alexian Brothers Health System provides comprehensive oncology services across ABHS. The Cancer Institute's treatment center at SAMC earned a three year full accreditation with commendations as a comprehensive community hospital cancer program from the Commission on Cancer of the American College of Surgeons. Only 25 percent of cancer care programs in the United States receive this recognition. The accreditation recognizes the quality of comprehensive cancer care available at a facility and means that patients have access to the full scope of care required to diagnose, treat, and rehabilitate cancer patients and to provide support to them and their families. The Cancer Institute boasts five year survival rates that exceed the American Cancer Society's national statistics for breast, ovarian, lung and colon cancers. SAMC's treatment center uses cutting edge diagnostic technologies, including a 64 slice computed tomography (CT) scanner and breast magnetic resonance imaging (MRI). Radiation therapy can be delivered at SAMC through the following techniques: cone beam CT, intensity modulated radiation therapy, image guided radiotherapy, RapidArc radiotherapy, advanced high dose rate brachytherapy, and MammoSite radiation therapy for breast cancer. The National Accreditation Program for Breast Centers (NAPBC), which is administered by the American College of Surgeons, has accredited SAMC's breast center program. This recognition is given only to those breast centers that provide the highest quality breast care and that undergo a rigorous evaluation process and review of their performance. The NAPBC review includes such areas as leadership, clinical management, research, community outreach, professional education and quality improvement. The American College of Radiology's Commission on Quality and Safety and the Commission on Breast Imaging have designated SAMC's breast care center as a Breast Imaging Center of Excellence. Heart & Vascular Institute The Heart & Vascular Institute offers high level cardiovascular care. Starting with a community based screening program, the institute's continuum of care includes a full range of non invasive testing for the rapid detection of heart and vascular disease. Services include diagnostic and interventional cardiology, electrocardiograms (EKGs), echocardiography, stress tests, Holter monitoring of arrhythmias, angiograms, angioplasty and stent placement, tilt table tests, cardioversion and pacemaker insertion. Neurosciences Institute The Neurosciences Institute offers the latest medical advances and technology to help patients with neurological conditions. Its spectrum of care includes advanced diagnostic procedures, treatment strategies and proven approaches to help patients achieve a high quality of life. In addition, the institute works to provide scientific insight into how to lower the risk of developing certain neurological diseases. Services include acute stroke care, the Epilepsy Center, neurosurgery, pediatric neuropsychology, and stroke prevention. SAMC is a primary stroke center.
Form 990, Part III, Line 4a Statement Program Service Accomplishments-Part III	Services Diagnostic Services SAMC'S diagnostic services include the latest technology and practices, which are accredited by nationally recognized agencies and associations, such as the American Diabetes Association, the American College of Radiology, the College of American Pathologists and The Joint Commission. Diagnostic services offered include: Diagnostic imaging (general X ray, CT, MRI, ultrasound, nuclear medicine) Breast care services (screening and 3 D diagnostic mammography, breast biopsy ultrasound, stereotactic breast biopsy, bone densitometry, genetic counseling, MammaCare breast self examination instructions) Cardiology (cardiac catheterization, electrophysiology, electrocardiograms (EKGs), stress testing, echocardiology, Holter monitoring of arrhythmias) Pulmonary diagnostics (arterial blood gas analysis, pulse oximetry, bedside spirometry, peak flow monitoring, ventilator care) Gastroenterology (gastroscopy, colonoscopy, bronchoscopy) Laboratory/pathology (chemistry, microbiology, hematology, histology, cytology, phlebotomy, transfusion services) Emergency Services Emergency medical care is provided 24/7 for all ages and types of patients, regardless of the ability to pay for such services. The SAMC emergency department is designated a Level II trauma center. In addition, a helipad allows for rapid transport of critical cases to a Level I facility. SAMC's physicians voluntarily participate on the emergency department call roster. It is the belief of the medical staff that physicians who want to serve patients voluntarily will perform to a higher standard than those physicians mandated to do so. SAMC also operates a program called "CN Emergikids," in which board certified pediatric emergency physicians are available to treat pediatric patients in the emergency department. The specialized pediatric treatment area includes child sized equipment, colorful decorations and toys to provide children with a comforting environment. Alexian Brothers Women & Children's Hospital ABWCH features an expanded, 16 bed, Level III neonatal intensive care unit, labor/delivery units, mother/baby units, eight pediatric intensive care beds, four step down beds and 20 pediatric beds. Obstetrics SAMC's caring obstetrical team has the experience and expertise to address the needs of the families the medical center serves. Its highly trained staff includes a multilingual group of board certified obstetricians and obstetricians/gynecologists who offer expert prenatal and post delivery care, and lactation educators who are specialists in breastfeeding. As a state designated children's hospital Alexian Brothers Women and Childrens Hospital, on the campus of SAMC, offers 24 hour coverage by board certified neonatologists, pediatricians with special training in the care of healthy newborns, as well as those with special needs. Pediatrics SAMC's pediatric services offer care by physicians, nurses and staff with expertise in pediatric medical care. The medical center's staff of pediatricians includes more than 60 sub specialists covering a wide range of medicine, including many who are board certified and fellowship trained in their specialties. Child life specialists are available to help children and their families adjust to the hospital setting. The pediatric intensive care unit (PICU) is ready and equipped for critical situations. Hospital intensivists, who are board certified pediatricians with additional training in the care of severely ill children, work with each child's pediatrician or family practitioner to provide care for the patient while he or she is in the PICU. Older Adult SAMC's older adult services are designed to provide an innovative, seamless continuum of care for older adults from wellness, to early detection of disease, through inpatient and post acute care. The medical center's overall goal is to optimize older adults' quality of life by addressing their physical, emotional, social and spiritual needs. Orthopedics Recognized as one of the leading centers for orthopedics in the Midwest, SAMC takes a comprehensive, leading edge approach to the prevention, assessment, treatment and rehabilitation of musculoskeletal injuries, including aching backs, arthritis pain, sports injuries, and work injuries. SAMC's orthopedic treatments and services encompass care of the wrist, foot and ankle, hands and upper extremities, and shoulder and elbow; partial joint replacements with alternative options; total joint replacement and reconstruction; emergency treatment of fractures; sports medicine; surgical spine procedures; and pediatric care. Special Outpatient Services Cancer program: diagnostics, chemotherapy and surgery Community outreach: health education classes/programs and health screenings Diabetes program: treatment and education Outpatient rehabilitation: physical, occupational and speech therapy Hospice services Asthma education program Procedure clinic for patients undergoing procedures requiring a short hospital stay (no more than 12 hours). Procedures include blood transfusions, arteriograms, outpatient chemotherapy, antibiotic therapy and pain management. Physician referral Volunteer program Surgical Services Surgical procedures are performed in SAMC's state of the art facility. The medical center offers a wide range of procedures in orthopedics, gynecology, urology, general surgery, podiatry, ear, nose and throat, pain management, neurosurgery, cosmetic surgery, oral/maxillofacial, and ophthalmology.
Form 990, Part IV, Line 20b EXPLANATION OF FINANCIAL STATEMENTS	The activity of St. Alexius Medical Center is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Alexius Medical Center is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Alexius Medical Center.
Form 990, Part V, Line 1a IRS FILINGS AND TAX COMPLIANCE	ALEXIAN BROTHERS HEALTH SYSTEM, A RELATED ORGANIZATION OF ST. ALEXIUS MEDICAL CENTER, 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 CEO, OTHER OFFICERS OR KEY EMPLOYEES	IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY Alexian Brothers - AHS Midwest Region Health Co., A RELATED ORGANIZATION OFthe filing organization, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE Alexian Brothers - AHS Midwest Region Health Co. 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/HER COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY Alexian Brothers - AHS Midwest Region Health Co., A RELATED ORGANIZATION OF the filing organization INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. 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.
Form 990, Part VI, Line 6 Classes of members or stockholders	St. Alexius Medical Center has two classes of corporate members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Hospital Network (the "Area 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 St. Alexius Medical Center.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	All decisions that have a material impact to St. Alexius Medical Center'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 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 St Alexius Medical Center are available through the Office of the Illinois Attorney General. Conflicts of Interest statements and the governing documents of St Alexius Medical Center are not made available to the public.
Form 990, Part VIII, Line 2f Other Program Service Revenue	Miscellaneous - Total Revenue: 2256151, Related or Exempt Function Revenue: 2256151, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees	Other-Consulting - Total Expense: 19626428, Program Service Expense: 18853130, Management and General Expenses: 773298, Fundraising Expenses: ; Medical Purchased Services - Total Expense: 12439381, Program Service Expense: 12439381, Management and General Expenses: , Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Transfers to Alexian Brothers Health System - -75164376;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

St Alexius Medical Center

Employer identification number

36-4251846

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Alexian Brothers - AHS Midwest Region Health Co 3040 W Salt Creek Lane Arlington Heights,IL60005 47-2360513	Joint Operating Company	IL	501(c)(3	Type II	NA		No
(2)Ascension Health Alliance PO Box 45998 St Louis,MO631455998 45-3358926	National Health System	MO	501(c)(3	Type I	NA		No
(3)Ascension Health PO Box 45998 St Louis,MO63145 31-1662309	National Health System	MO	501(c)(3	Type I	Ascension Health Alliance		No
(4)Alexian Brothers Bonaventure House 825 Wellington Avenue Chicago,IL60657 36-3527899	Housing and supportive care services for persons with HIV/AIDS	IL	501(c)(3	9	Alexian Brothers Health System	Yes
(5)Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights,IL60005 36-3260495	Supports the provision of healthcare services for related corporations for which it is a member	IL	501(c)(3	Type III-FI	Ascension Health		No
(6)Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights,IL60005 94-1530037	Acute care hospital (sold in 1998)	TX	501(c)(3	Type I	Alexian Brothers Health System	Yes
(7)Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights,IL60005 43-1295333	HUD housing	MO	501(c)(3	9	Alexian Brothers Health System	Yes
(8)Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights,IL60005 36-4484290	Supports the provision of healthcare for related corporations	IL	501(c)(3	Type III-FI	Alexian Brothers Health System	Yes
(9)Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights,IL60005 36-3276552	Supports the provision of healthcare services for related corporations	IL	501(c)(3	Type III-FI	Alexian Brothers Health System	Yes
(10)Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village,IL60007 36-2596381	Acute care hospital	TX	501(c)(3	3	Alexian Brothers Health System	Yes
(11)Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights,IL60005 36-3308965	Owns or leases properties where healthcare services are delivered	IL	501(c)(2		Alexian Brothers Health System	Yes
(12)Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates,IL60169 36-4251848	Behavioral health hospital	IL	501(c)(3	3	Alexian Brothers Health System	Yes
(13)Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights,IL60005 36-4336931	Physician services	IL	501(c)(3	3	Alexian Brothers Health System	Yes
(14)Alexian Brothers Specialty Group 3040 W Salt Creek Lane Arlington Heights,IL60005 80-0710751	Specialty physician practice group	IL	501(c)(3	3	Alexian Brothers Health System	Yes
(15)Alexian Brothers Center for Mental Health 3436 N Kennicott Avenue Arlington Heights,IL60004 36-3045007	Outpatient community mental health services	IL	501(c)(3	9	Alexian Brothers Health System	Yes
(16)Alexian Brothers Medical Care Group NFP 3040 W Salt Creek Lane Arlington Heights,IL60005 47-1930457	Physician services	IL	501(c)(3	3	Alexian Brothers Health System	Yes
(17)ALEXIAN BROTHERS MEDICAL GROUP SPECIALITY CARE 3040 W SALT CREEK LANE ARLINGTON HEIGHTS,IL60005 81-1110738	SPECIALITY PHYSICIAN PRACTICE GROUP	IL	501(c)(3	3	ALEXIAN BROTHERS HEALTH SYSTEM	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Alexian Rehabilitation Services LLC 935 Beisner Elk Grove Village,IL60007 30-0221481	Rehabilitation hospital	IL	NA	N/A								0 %
(2) Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights,IL60005 87-0783164	Provision of NeuroMeg services	IL	NA	N/A								0 %
(3) Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights,IL60005 36-3853289	Medical office building	IL	NA	N/A								0 %
(4) Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights,IL60005 36-3978153	Manages managed care contracts	DE	NA	N/A								0 %
(5) Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights,IL60005 86-1115516	Ownership of Gamma Knife	IL	NA	N/A								0 %
(6) St Alexius Center for Sleep Health LLC 1300 S Main Street Lombard,IL60148 20-5876371	Operation of sleep lab	IL	St Alexius Medical Center CLASS A SHARES	Related	-588	-6,886		No			No	65.62 %
(7) St Alexius Center for Sleep Health LLC 1300 S Main Street Lombard,IL60148 20-5876371	OPERATION OF SLEEP LAB	IL	ST ALEXIUS MEDICAL CENTER CLASS B SHARES	Related	-588	-6,886		No			No	52.5 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) Thelen Corporation 3040 W Salt Creek Arlington Heights,IL60005 36-3266316	Owns/ leases property; joint venture partner	IL	NA	C Corporation				No
(2) Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Arlington Heights,IL60005 36-3853286	Messenger model IPA	IL	NA	C Corporation				No
(3) Alexian Village of Elk Grove 3040 W Salt Creek Arlington Heights,IL60005 35-2211303	Tax credit financed housing	IL	NA	C Corporation				No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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

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

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

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

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

f Dividends from related organization(s) ............................

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

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

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

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

Yes

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

Yes

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

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

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

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

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

Yes

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

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

Yes

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

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Alexian Brothers Specialty Group	J	427,550	Fair Market Value
(2) Savelli Properties Inc	K	217,512	Fair Market Value
(3) Alexian Brothers Ambulatory Group	J	197,823	Fair Market Value

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

1	Briefly describe the organization’s mission or most significant activities: Acute care hospital
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	639
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	486,491
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	320,500

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	367,972	462,698
9	Program service revenue (Part VIII, line 2g) .........	349,425,272	356,445,315
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	20,000	17,364
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,775,403	1,679,645
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	351,588,647	358,605,022
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	123,721,461	119,274,199
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	185,239,974	183,244,448
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	308,961,435	302,518,647
19	Revenue less expenses. Subtract line 18 from line 12.......	42,627,212	56,086,375
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	313,830,468	306,621,657
21	Total liabilities (Part X, line 26).............	79,530,565	91,399,755
22	Net assets or fund balances. Subtract line 21 from line 20.....	234,299,903	215,221,902

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 191,386,313 including grants of $ ) (Revenue $ 190,764,425 )
	Ranked 14th in the Chicago metropolitan area and 16th in Illinois by U.S. News & World Report, AMITA Health St. Alexius Medical Center (SAMC) is a 318 bed acute care hospital in Hoffman Estates, Illinois, that has provided outstanding healthcare to the residents of Chicago's northwest suburbs for more than 30 years. Located at 1555 Barrington Road, SAMC is rated as high performing in six adult specialties and two common adult procedures and conditions by U.S. News & World Report. SAMC is a full service hospital with a Cancer Institute, Heart & Vascular Institute and Neurosciences Institute. The medical center has additional specialties in Older Adult, Pediatrics, Bariatric Surgery and Orthopedics. Alexian Brothers Women & Children's Hospital (ABWCH) opened on SAMC's campus in April 2013. ABWCH specializes in obstetrics, pediatrics and the treatment of premature infants in a Level III neonatal intensive care unit.

4b	(Code: ) (Expenses $ 102,593,545 including grants of $ ) (Revenue $ 165,194,399 )
	OUTPATIENT SERVICES PERFORMED FOR THE YEAR ENDING JUNE 30, 2016: 7,170 OUTPATIENT SURGERIES 138,995 DIAGNOSTIC IMAGES INCLUDING GENERAL X-RAY, CT, MRI, MAMMOGRAPHY, ULTRASOUND, AND NUCLEAR MEDICINE 525,027 LABORATORY TESTS 62,533 EMERGENCY ROOM VISITS THE COMPLETE DESCRIPTION OF ST. ALEXIUS MEDICAL CENTER OUTPATIENT PROGRAMS IS INCLUDED WITH THE INPATIENT PROGRAMS IN LINE 4A.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses293,979,858

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) ROBERT O MAGANINI BREAST SURGEON	50.0 .......................0.0	X		0	508,143	21,131
(19) LINDA BAKER FORMER KEY EMPLOYEE	0.0 .......................50.0		X	0	234,838	64,069
(20) EDWARD GOLDBERG FORMER OFFICER	0.0 .......................0.0		X	0	420,959	47,594
(21) SCOTT PETERSON FORMER KEY EMPLOYEE	0.0 .......................0.0		X	0	110,504	0
(22) JON ROZENFELD FORMER KEY EMPLOYEE	0.0 .......................0.0		X	0	176,287	31,819

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	5,699,068	511,227

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	462,698
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		462,698

		Business Code
2a	General Hosp Svcs	622110	193,486,563	193,486,563
b	Medicare & Medicaid	622110	159,218,679	159,218,679
c	Meaningful Use	622110	954,248	954,248
d	Capitation	900099	43,183	43,183
e	Laboratory Services	621500	486,491		486,491
f	All other program service revenue.			2,256,151	2,256,151	0	0
g Total.Add lines 2a–2f.....			356,445,315

3 Investment income (including dividends, interest, and othersimilar amounts) ..........
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,610,093
b	Less: rental expenses		1,452,547
c	Rental income or (loss)	0	157,546
d	Net rental income or (loss)......			157,546			157,546
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	17,364
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	17,364	0
d	Net gain or (loss).....			17,364			17,364
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..
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..
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..
Business Code			Miscellaneous Revenue
11a	Cafeteria Sales		722514	1,522,099			1,522,099
b
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			1,522,099
12	Total revenue. See Instructions......			358,605,022	355,958,824	486,491	1,697,009

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	99,962,550	97,662,928	2,299,622
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,876,363	2,810,193	66,170
9	Other employee benefits .......	9,325,118	9,110,596	214,522
10	Payroll taxes ...........	7,110,168	6,946,599	163,569
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	7,286		7,286
c	Accounting ...........
d	Lobbying ...........	43,832		43,832
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	32,065,809	31,292,511	773,298	0
12	Advertising and promotion ....	82,466	2,257	80,209
13	Office expenses .......	6,816,235	5,570,562	1,245,673
14	Information technology ......	141,377	127,239	14,138
15	Royalties ..
16	Occupancy ...........	9,383,884	8,445,496	938,388
17	Travel ............	156,513	84,571	71,942
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	34,864	25,383	9,481
20	Interest ...........	9,170,796	8,253,716	917,080
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	14,942,203	13,447,983	1,494,220
23	Insurance ...	494,359	444,923	49,436
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	Medical Supplies	51,094,027	51,094,027
b	ABHS/ABHN Mgmt. Fees	45,029,841	45,029,841
c	Medicaid Tax	12,913,767	12,913,767
d	Food	299,790	299,790
e	All other expenses	567,399	417,476	149,923	0
25	Total functional expenses. Add lines 1 through 24e	302,518,647	293,979,858	8,538,789	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			12,845	1	11,170
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			50,639,790	4	47,646,519
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 ....			283,277	7
8	Inventories for sale or use ........			4,106,153	8	4,554,117
9	Prepaid expenses and deferred charges ......			216,955	9	283,049
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	312,478,382
b	Less: accumulated depreciation	10b	60,978,953	257,170,979	10c	251,499,429
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13	1,296,595
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,400,469	15	1,330,778
16	Total assets. Add lines 1 through 15 (must equal line 34)...			313,830,468	16	306,621,657

17	Accounts payable and accrued expenses .....	14,752,937	17	16,440,494
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	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
23	Secured mortgages and notes payable to unrelated third parties ..		23
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	64,777,628	25	74,959,261
26	Total liabilities. Add lines 17 through 25..	79,530,565	26	91,399,755

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	234,299,903	27	215,221,902
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	234,299,903	33	215,221,902
34	Total liabilities and net assets/fund balances ........	313,830,468	34	306,621,657