Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
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. | ||||||
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. | ||||||
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.) | ||||||
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.).. | ||||||
| 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 | ||||
| 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) |
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| 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) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a Statement of Program Service Accomplishments-Part I | Clinical Institutes Cancer Institute at Alexian Brothers Health System The Cancer Institute at Alexian Brothers Health System provides comprehensive oncology services across ABHS. Accredited by the Commission on Cancer of the American College of Surgeons as a comprehensive community hospital cancer program, the Cancer Institute's treatment center at ABMC provides state of the art cancer care and boasts five year survival rates that exceed the American Cancer Society's national statistics for breast, ovarian, lung and colon cancers. The center uses cutting edge diagnostic technologies, including a 64 slice computed tomography (CT) scanner, a positron emission tomography (PET) scanning system , and breast magnetic resonance imaging (MRI). At ABMC, radiation therapy can be delivered through the following techniques: intensity modulated radiation therapy, image guided radiotherapy, RapidArc radiotherapy, low dose rate and high dose rate brachytherapy, and SAVI and MammoSite radiation therapy for breast cancer. The National Accreditation Program for Breast Centers, which is administered by the American College of Surgeons, has accredited ABMC's breast center program. Heart & Vascular Institute The Heart & Vascular Institute offers high level cardiovascular care. Its cardiac team includes some of the most highly respected cardiologists and cardiovascular surgeons in the area, many of whom are known regionally and nationally. Open heart surgery procedures include coronary artery bypass grafts, valve repair and replacement, and repair of congenital heart defects. Minimally invasive surgical techniques are used when appropriate. Services include coronary angioplasty and stenting, coronary atherectomy and embolectomy, stenting for chronic total occlusions, implantation of pacemakers and internal defibrillators to regulate the heart's electrical impulses, and implantation of mechanized heart pumps. ABMC also offers ablation therapy, transmyocardial revascularization, endovascular stenting for abdominal aortic aneurysms, and carotid artery stenting. In addition, the medical center's interventional areas perform a full array of limb saving complex peripheral arterial and venous procedures. State of the art diagnostic procedures include electrophysiology mapping and intravascular ultrasound with fractional flow reserve. The latest technological advancements and minimally invasive procedures are contributing to shorter hospital stays, reduced risk of complications and faster recovery. A comprehensive cardiac rehabilitation program follows patients through their recovery, enabling them to resume their daily activities safely and confidently. 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 the Center for Brain Research, clinical research, the Epilepsy Center, the Illinois Gamma Knife Center, interventional neuroradiology, the Memory Disorders Center, the Movement Disorders Center, neuropsychological services, neurosurgery, pediatric neuropsychological services, stroke prevention, the Second Opinion Stroke Clinic, stroke rehabilitation, and vertebroplasty for spinal compression fractures. ABMC is a certified comprehensive stroke center. Services Diagnostic Services ABMC'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, PET, 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 (EKG's), stress testing, echocardiology, Holter monitoring of arrhythmias) Pulmonary diagnostics (arterial blood gas analysis) Gastroenterology (colonoscopy, bronchoscopy) Laboratory/pathology (chemistry, microbiology, hematology, histology, cytology, phlebotomy, transfusion services) Emergency department Emergency medical care is provided 24/7 for all ages and types of patients, regardless of the ability to pay for such services. Outpatient services performed in 2016: 7,157 outpatient surgeries 128,869 diagnostic images, including general X ray, CT, MRI, PET, ultrasound, nuclear medicine and others 1,180,421 laboratory tests 51,152 emergency room visits. The complete description of ABMC outpatient programs is included with the inpatient programs in line 4a. Inpatient rehabilitation services performed in 2016: 1,604 inpatients were treated The complete description of ABMC inpatient rehabilitation programs is included with the inpatient programs in line 4a. |
| Form 990, Part IV, Line 20b Explanation of Financial Statements | The activity of Alexian Brothers Medical Center is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of Alexian Brothers Medical Center is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of Alexian Brothers Medical Center. |
| Form 990, Part V, Line 1a IRS FILINGS AND TAX COMPLIANCE | ALEXIAN BROTHERS HEALTH SYSTEM, A RELATED ORGANIZATION OF ALEXIAN BROTHERS 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 PROCESS TO ESTABLISH COMPENSATION | 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 | Alexian Brothers 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 Alexian Brothers Medical Center. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | All decisions that have a material impact to Alexian Brothers 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 Region Health, Co. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board members are provided the Form 990 and management team members are available to answer any Board Members' questions. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. |
| Form 990, Part VI, Line 19 Required documents available to the public | The financial statements of Alexian Brothers Medical Center are available through the Office of the Illinois Attorney General. Conflicts of Interest statements and the governing documents of Alexian Brothers Medical Center are not made available to the public. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | - Total Revenue: 5694689, Related or Exempt Function Revenue: 5694689, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | TRANSFER TO ALEXIAN BROTHERS HEALTH SYSTEM - -72202962; |
| Form 990, Part XII, Line 2b Audit Disclosure | The activity of ALEXIAN BROTHERS MEDICAL CENTER is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit is completed of ALEXIAN BROTHERS MEDICAL CENTER. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of ALEXIAN BROTHERS MEDICAL CENTER . |
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |