Form990
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 07-01-2015 , and ending 06-30-2016
BCheck if applicable:
CName of organization
Alexian Brothers Medical Center
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
800 Biesterfield Road
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Elk Grove Village, IL600073397
D Employer identification number

36-2596381
E Telephone number

G Gross receipts $ 474,072,842
F Name and address of principal officer:
John Werrbach
800 Biesterfield Road
Elk Grove Village,IL600073397
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.AlexianBrothersHealth.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:  
L Year of formation: 1971
M State of legal domicile: IL
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: Acute Care Hospital.
2 Check this box MediumBullet
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 1,036
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 3,556,050
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -2,175,352
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 506,658 487,339
9 Program service revenue (Part VIII, line 2g) ......... 459,800,913 469,826,329
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 6,000 11,387
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,580,142 1,973,213
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 461,893,713 472,298,268
Expenses; 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) 172,338,784 173,372,928
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 241,561,322 239,992,804
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 413,900,106 413,365,732
19 Revenue less expenses. Subtract line 18 from line 12....... 47,993,607 58,932,536
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 287,167,427 281,806,543
21 Total liabilities (Part X, line 26)............. 112,701,995 120,611,537
22 Net assets or fund balances. Subtract line 21 from line 20..... 174,465,432 161,195,006
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: Alexian Brothers Medical Center ("ABMC") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health needs of those we are called to serve.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 225,572,542 including grants of $   ) (Revenue $ 208,991,134 )
Ranked 11th in the Chicago metropolitan area and 12th in Illinois by U.S. News & World Report, AMITA Health Alexian Brothers Medical Center (ABMC), is a 387 bed acute care hospital in Elk Grove Village, Illinois, that has provided outstanding healthcare to the residents of Chicago's northwest suburbs for more than 40 years. Located at 800 Biesterfield Road, ABMC is a full service hospital with a Cancer Institute, Heart & Vascular Institute and Neurosciences Institute. ABMC has additional specialties in Older Adult (including an emergency room designed for seniors, a geropsychiatric unit, home health services and a hospice residence), Pediatrics, Bariatric Surgery, Orthopedics and Obstetrics. It also includes a 72 bed rehabilitation hospital. ABMC is a Certified Comprehensive Stroke Center and has received Disease Specific Care Certification from The Joint Commission in stroke, heart failure, acute myocardial infarction and joint replacement. The American Heart Association/American Stroke Association recognized ABMC for providing high quality stroke care, presenting ABMC 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. The American College of Radiology's Commission on Quality and Safety and the Commission on Breast Imaging have designated ABMC's breast care center as a Breast Imaging Center of Excellence. ABMC is rated as high performing in five adult specialties and five common adult procedures and conditions by U.S. News & World Report. The Blue Cross and Blue Shield Association's Blue Distinction Centers program also has recognized ABMC for delivering safe, high quality and cost efficient specialty care in bariatric surgery, cardiac care, maternity care and knee replacement/hip replacement/spine surgery. ABMC is among the first healthcare facilities in the nation to receive a Blue Distinction Center+ designation for bariatric surgery. BlueCross BlueShield of Illinois selected the hospital for the honor as part of the BlueCross BlueShield Association's Blue Distinction Centers for Specialty Care program. The hospital earned the designation by meeting patient safety and quality measures for gastric stapling and gastric banding procedures, and by demonstrating better cost efficiency relative to their peers. In 2016, ABMC treated more than 18,134 inpatients, performed 4,376 inpatient surgeries and delivered 1,985 babies. ABMC's medical staff includes about 900 physicians representing more than 80 medical and surgical specialties. ABMC provides care for all, including the financially disadvantaged, uninsured, underinsured, homeless and those who receive public aid. See Schedule H for a summary of benefit provided to the community by ABMC. About Alexian Brothers Health System ABMC 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.
4b (Code:   ) (Expenses $ 145,997,333 including grants of $   ) (Revenue $ 222,466,254 )
OUTPATIENT SERVICES PERFORMED IN 2016: - 7,157 OUTPATIENT SURGERIES - 128,869 DIAGNOSTIC IMAGES INCLUDING GENERAL X-RAY, CT, MRI, PET, ULTRASOUND, NUCLEAR MEDICINE & OTHERS - 1,180,421 LABORATORY TESTS - 51,152 EMERGENCY ROOM VISITS. THE COMPLETE DESCRIPTION OF ALEXIAN BROTHERS MEDICAL CENTER OUTPATIENT PROGRAMS IS INCLUDED WITH THE INPATIENT PROGRAMS IN LINE 4A.
4c (Code:   ) (Expenses $ 28,995,856 including grants of $   ) (Revenue $ 35,392,702 )
INPATIENT REHABILITATION SERVICES PERFORMED IN 2016: - 1,604 INPATIENTS WERE TREATED THE COMPLETE DESCRIPTION OF ALEXIAN BROTHERS MEDICAL CENTER INPATIENT REHABILITATION PROGRAMS IS INCLUDED WITH THE INPATIENT PROGRAMS IN LINE 4A.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet400,565,731
Form 990 (2015)
Form 990 (2015)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III .............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II ................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV
........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
Yes
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
8
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletDeborah Mau3040 West Salt Creek Lane   Arlington Heights,IL600051069 (847) 818-5100
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) KATHLEEN GILMER
 
DIRECTOR AND VICE CHAIRPERSON
1.0
.................
2.0
X   X       0 0 0
(2) JOHN WERRBACH
 
EX-OFFICIO DIRECTOR & PRESIDENT CEO
50.0
.................
2.0
X   X       0 605,719 69,789
(3) BRUCE WOLFE
 
DIRECTOR & CHAIRPERSON
1.0
.................
2.0
X   X       0 0 0
(4) DENNIS ABELLA MD
 
DIRECTOR
1.0
.................
0
X           0 0 0
(5) BARRY GLICK DO
 
DIRECTOR
30.0
.................
0.0
X           0 127,885 1,447
(6) JOANNE LESKI EDD RN CNE
 
DIRECTOR
1.0
.................
2.0
X           0 0 0
(7) THOMAS R PALMER JD
 
DIRECTOR
1.0
.................
2.0
X           0 0 0
(8) MARIJO LETIZIA PHD
 
DIRECTOR
1.0
.................
2.0
X           0 0 0
(9) DONNA GAUTHIER
 
ASSISTANT SECRETARY
1.0
.................
50.0
    X       0 74,341 17,743
(10) SHERRI VINCENT
 
TREASURER (THROUGH 1/4/16)
25.0
.................
25.0
    X       0 471,075 40,359
(11) DIANA WOYTKO
 
SECRETARY
1.0
.................
52.0
    X       0 279,053 55,450
(12) HENRY ZEISEL
 
TREASURER (EFFECTIVE 6/16/16)
25.0
.................
25.0
    X       0 0 0
(13) LAURENCE R DRY III
 
CHIEF OPERATING OFFICER
25.0
.................
25.0
      X     0 311,953 50,504
(14) TIMOTHY MALISCH MD
 
INTERVENTIONAL NEURORADIOLOGIST
50.0
.................
0.0
        X   0 896,273 26,034
(15) FRANKLIN A MARDEN MD
 
INTERVENTIONAL NEURORADIOLOGIST
50.0
.................
0.0
        X   0 704,969 34,237
(16) LAVERNA MENSAH MD
 
GYNECOLOGIST & ONCOLOGIST
50.0
.................
0.0
        X   0 386,329 27,470
(17) SZYMON S ROSENBLATT MD
 
NEUROSURGEON
50.0
.................
0.0
        X   0 984,535 35,151
Form 990 (2015)
Form 990 (2015)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) SANJAY YADLA PHD
 
NEUROSURGEON
50.0
.......................0.0
        X   0 594,076 28,838
(19) LINDA BAKER
 
FORMER KEY EMPLOYEE
0.0
.......................50.0
          X 0 234,838 64,069
(20) SCOTT PETERSON
 
FORMER KEY EMPLOYEE
0.0
.......................0.0
          X 0 110,504 0
(21) JON ROZENFELD
 
FORMER KEY EMPLOYEE
0.0
.......................0.0
          X 0 176,287 31,819


















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 5,957,838 482,911
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 484,140
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f 3,199
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 487,339
 Program Service RevenueAmt Business Code
2a General Hospital Svcs 621990 229,554,244 229,554,244    
b Medicare & Medicaid 621990 226,706,381 226,706,381    
c Meaningful Use 621990 1,448,047 1,448,047    
d Lab Services 621500 2,500,635   2,500,635  
e Outpatient Pharmacy 446110 3,922,333 3,446,729 475,604  
f All other program service revenue. 5,694,689 5,694,689 0 0
g Total.Add lines 2a–2f.....MediumBullet 469,826,329
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet        
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   1,301,640
b Less: rental expenses   1,774,574
c Rental income or (loss) 0 -472,934
d Net rental income or (loss)......MediumBullet -472,934     -472,934
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 11,387  
b Less: cost or other basis and sales expenses    
c Gain or (loss) 11,387 0
d Net gain or (loss).....MediumBullet 11,387     11,387
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a Cafeteria Sales 722514 1,866,336     1,866,336
b Answering Service 561000 579,811   579,811  
c            
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 2,446,147
12 Total revenue. See Instructions......MediumBullet 472,298,268 466,850,090 3,556,050 1,404,789
Form 990 (2015)
Form 990 (2015)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to 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 143,547,818 137,751,034 5,796,784  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,544,184 4,360,680 183,504  
9 Other employee benefits ....... 15,097,739 14,488,058 609,681  
10 Payroll taxes ........... 10,183,187 9,771,967 411,220  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 26,484 15,716 10,768  
c Accounting ........... 0 0 0  
d Lobbying ........... 49,970 0 49,970  
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) 34,968,691 34,036,350 932,341 0
12 Advertising and promotion .... 143,827 50,228 93,599  
13 Office expenses ....... 12,497,557 11,015,694 1,481,863  
14 Information technology ...... 63,919 57,527 6,392  
15 Royalties .. 0 0 0  
16 Occupancy ........... 8,754,422 7,878,980 875,442  
17 Travel ............ 587,086 515,684 71,402  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0 0 0  
19 Conferences, conventions, and meetings .... 49,771 42,219 7,552  
20 Interest ........... 7,337,352 6,603,617 733,735  
21 Payments to affiliates ....... 0 0 0  
22 Depreciation, depletion, and amortization .. 14,992,368 13,493,131 1,499,237  
23 Insurance ... -1,425,169 -1,282,652 -142,517  
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 79,389,794 79,389,794 0  
b ABHN & ABHS Mgt. Fee 63,266,885 63,266,885 0  
c Medicaid Tax 15,088,524 15,088,524 0  
d Minority Interest 3,368,959 3,368,959 0  
e All other expenses 832,364 653,336 179,028 0
25 Total functional expenses. Add lines 1 through 24e 413,365,732 400,565,731 12,800,001 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 13,989 1 11,266
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 72,774,867 4 66,269,441
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 ....   7  
8 Inventories for sale or use ........ 7,897,843 8 8,480,157
9 Prepaid expenses and deferred charges ...... 346,844 9 326,796
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 274,021,653
b Less: accumulated depreciation 10b 68,034,705 205,232,764 10c 205,986,948
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  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 901,120 15 731,935
16 Total assets. Add lines 1 through 15 (must equal line 34)... 287,167,427 16 281,806,543
Liabilities 17 Accounts payable and accrued expenses ..... 19,415,638 17 23,527,525
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 93,286,357 25 97,084,012
26 Total liabilities. Add lines 17 through 25.. 112,701,995 26 120,611,537
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 174,465,432 27 161,195,006
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund ...   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 174,465,432 33 161,195,006
34 Total liabilities and net assets/fund balances ........ 287,167,427 34 281,806,543
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
472,298,268
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
413,365,732
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
58,932,536
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
174,465,432
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-72,202,962
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
161,195,006
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID: 15000238
Software Version: 2015v3.0
Form 990, Special Condition Description:
Special Condition Description
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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (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      

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

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) right arrow (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) right arrow (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.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

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) right arrow (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) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015

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
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
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.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
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
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
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
No
1
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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
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.
2a
 
 
b
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.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
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.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

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
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet 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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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
Alexian Brothers Medical Center
 
Employer identification number
36-2596381
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


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No.from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data


Software ID: 15000238
Software Version: 2015v3.0
SCHEDULE C
(Form 990 or 990-EZ)

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletInformation 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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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

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

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the 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


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)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
49,970
j
Total. Add lines 1c through 1i ....................................................................................................
49,970
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
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. Alexian Brothers 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. Alexian Brothers 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

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
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 ....    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" 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 .... 207,527 207,527 678,892 928,892 928,892
b Contributions ...     0 0 0
c Net investment earnings, gains, and losses     0 0 0
d Grants or scholarships ...     0 0 0
e Other expenditures for facilities
and programs ...
    471,365 250,000 0
f Administrative expenses ....     0 0 0
g End of year balance ...... 207,527 207,527 207,527 678,892 928,892
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
No
(ii) related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
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 ...   10,100,000 10,100,000
b Buildings   194,657,131 33,119,221 161,537,910
c Leasehold improvements   1,979,449 496,468 1,482,981
d Equipment ...   62,249,204 34,099,676 28,149,528
e Other ...   5,035,869 319,340 4,716,529
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 205,986,948
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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.)Small Bullet  
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.)...........Small Bullet  
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 53,680,986
Due to affiliates 30,660,264
Other current liabilities 1,960,376
Other long term liabilities 3,230,830
Reserve for outstanding insurance losses 7,551,556
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 97,084,012
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

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 V, Line 4 Intended uses of endowment funds The endowment funds are used to support charitable efforts within the Alexian Brothers Health System.
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




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
  2,401 5,166,051   5,166,051 1.25 %
b Medicaid (from Worksheet 3, column a) . . . . .   25,112 55,659,538 34,402,861 21,256,677 5.14 %
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 27,513 60,825,589 34,402,861 26,422,728 6.39 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   5,594 389,054 13,526 375,528 0.09 %
f Health professions education (from Worksheet 5) . . .   884 1,042,788 300,700 742,088 0.18 %
g Subsidized health services (from Worksheet 6) . . . .   5,546 1,014,399   1,014,399 0.25 %
h Research (from Worksheet 7) .         0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .         0 0 %
j Total. Other Benefits . . 0 12,024 2,446,241 314,226 2,132,015 0.52 %
k Total. Add lines 7d and 7j . 0 39,537 63,271,830 34,717,087 28,554,743 6.91 %
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 (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members
        0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development   270 16,935   16,935 0 %
9 Other   59 473   473 0 %
10 Total 0 329 17,408 0 17,408 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,124,191
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
312,419
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
186,480,113
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
228,486,253
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-42,006,140
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Alexian Brothers Medical Center
800 Biesterfield Road
Elk Grove Village,IL600073397
www.alexianbrothershealth.org/abmc
0002238
X X       X X      
Schedule H (Form 990) 2015
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)
Alexian Brothers 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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.alexianbrothershealth.org/communityneeds
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Alexian Brothers Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.alexianbrothershealth.org/pay-my-bill
b
www.alexianbrothershealth.org/pay-my-bill
c
d
e
f
g
h
i
Billing and Collections
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

Alexian Brothers Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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 - Alexian Brothers 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 - Alexian Brothers Medical Center. The other hospital facilities with which the reporting hospital conducted its CHNA include: Adventist LaGrange Memorial Hospital St. Alexius 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 - Alexian Brothers Medical Center. Disproportionate unmet community health needs identified: Cancer Alexian Brothers Medical Center (ABMC) provides a variety of community based education and screenings about the importance of preventing and treating cancer at its earliest possible stages. For example, a staff oncologist provided a comprehensive presentation on skin cancer. He explained the many types of skin cancer, as well as the precautions to take to avoid contracting it. He explained the treatments and urged the attendees to always be proactive in protecting themselves from the harmful rays of the sun, which include sunscreens and protective hats and clothing. A professional chef from ABMC's staff provided a cooking demonstration and tasting as part of a seminar for Fighting Colon Cancer. A Gastro-Intestinal physician discussed colon screening methods, risk factors and gastrointestinal health regarding colon cancer. A Registered Dietitian spoke about the role nutrition can play in gastrointestinal cancer. The chef demonstrated 2 healthy recipes and attendees could taste the recipes. ABMC provide 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 Alexian Brothers Medical Center referred in because of our grant as well as primary physicians to existing patients that qualified for grant funding. A Registered Dietitian (Certified Specialist in Oncology) is available at no cost to meet with our patients, family/caregivers to provide a nutrition assessment, discuss specific dietary needs and provide follow up as needed. The consultation may include the suggestion of foods to eat and avoid while managing treatment side effects as well as ways to enhance the immune system. A discussion of healthy dietary choices post treatment and strategies to achieve and maintain appropriate weight may also be included. ABHS, the corporate member of ABMC, 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 ABMC, 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. ABMC 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. ABMC'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. ABMC provides a variety of free cancer support groups for patients dealing with cancer, including breast cancer, prostate cancer, a young women's group, brain tumor support group, lung cancer support group and all cancer support group and a caregiver's support group for families. Chronic Kidney Disease The leading cause of chronic kidney disease is Type II Diabetes, also a top concern and unmet need for the ABMC 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 ABMC area. It is closely related to heart disease, stroke, and kidney disease and is linked to poor nutrition, weight and lack of exercise. ABMC or ABHS, the corporate parent of ABMC, provides education and screening for diabetes routinely through health fairs, senior centers and park districts. ABHS, the corporate parent of ABMC 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 ABMC provided a diabetes educator for an educational session on diabetes and neuropathy. ABHS, corporate member of ABMC, 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. ABMC 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. Heart Disease and Stroke ABHS, corporate member of ABMC, 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. ABMC is a certified comprehensive stroke hospital. ABHS, the corporate member of ABMC 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 ABMC, 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 ABMC, 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 ABMC, 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 ABMC, 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 - Alexian Brothers Medical Center. Continued: HIV/AIDS ABHS, corporate member of ABMC, 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 ABMC, 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 ABMC, was nominated by the Chicago Department of Public Health (CDPH) to represent the Chicago jurisdiction. Immunization and Infectious Disease ABMC provides every patient upon discharge the opportunity to receive a flu vaccine. ABMC requires every employee to have a flu vaccine for the protection of our patients unless they are medically excused. The employed physician group serving ABMC urges every patient to have a flu vaccination. ABHS, corporate member of ABMC, provides a free immunization clinic each quarter to any member of the community. Infant Health and Family Planning ABMC 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 ABMC, 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. Mental Health Most mental health community programming is disseminated through Alexian Brothers Behavioral Health Hospital, a hospital affiliated with ABMC. ABMC does provide ongoing grief support counseling through its Hospice Center for families and friends who have lost a loved one. Nutrition, Physical Activity and Weight ABHS, corporate member of ABMC provides free weight management and nutritional counseling to the community throughout the year. ABMC 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 ABMC 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 staff is board members 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 ABMC, supports "Fittest Loser" a community event to promote safe, sustainable weight loss in a contest format. Potentially Disabling Conditions ABMC 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 practice of comprehension, expression, sequencing, practicing, socialization, and ultimately support. A Stroke Support group meets weekly with community members and current in-patient. 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. Typically for seniors, ABMC offers a driving class to the community to promote safe driving practices. This was a two-day class presented by an AARP-trained volunteer at the Senior and Community Resource Center. This class was offered in response to a high demand from community members. Participants of this class were provided information on the effects of aging on driving, how to use safe driving strategies to reduce the risk of being in a crash, and how new laws and regulations affect road users of all age's traffic. Verbal and written feedback from participants indicated that this course was very comprehensive in the information it provided and also helped participants to consider driving and safety concerns from new perspectives. 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 ABMC 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 - Alexian Brothers 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 ALEXIAN BROTHERS 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. ABMC 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 ABMC, FEATURES INFORMATION ON HOW TO APPLY FOR CHARITY CARE ONLINE. 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 V, Section B, Line 22 Facility , 1 Facility , 1 - Alexian Brothers Medical Center. ALEXIAN BROTHERS 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 ALEXIAN BROTHERS MEDICAL CENTER APPROXIMATES 32% OF CHARGES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
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?5
Name and address Type of Facility (describe)
1 Alexian Rehabilitation Hospital
955 Beisner Road
Elk Grove Village,IL600073397
Healthcare Services
2 Alexian Brothers Hospice Residence
1000 Martha Street
Elk Grove Village,IL60007
Healthcare Services
3 ABMC Diagnostic Imaging
1339 West Lake Street
Addison,IL60101
Diagnostic Imaging Services
4 ABMC Cardiovascular Imaging
1555 Barrington Road
Hoffman Estates,IL60169
Diagnostic Imaging Services
5 ABMC Diagnostic Imaging
1060 South Elmhurst Road
Mount Prospect,IL60056
Diagnostic Imaging Services
6
7
8
9
10
Schedule H (Form 990) 2015
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 for 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 NAME OF RELATED ORGANIZATION THAT PREPARED COMMUNITY BENEFIT REPORT 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 7g Subsidized Health Services Alexian Brothers Medical Center 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, ABMC 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 Alexian Brothers 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 ABHS hospitals, including ABMC, 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 ABMC 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 ABMC 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. ABMC's share of bad debt expense for ABHS for the twelve months ended June 30, 2016 was $16,088,751 at charges ($3,124,191 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 ABMC, 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 ABMC, four full-time financial counselors each work with approximately 7,700 patients per year. Two of four counselors are fluent in Spanish, and translators are used for other languages. In addition, all bills and statements include information regarding charity.
Schedule H, Part V, Section B, Line 16a FAP website - Alexian Brothers Medical Center: Line 16a URL: www.alexianbrothershealth.org/pay-my-bill;
Schedule H, Part V, Section B, Line 16b FAP Application website - Alexian Brothers Medical Center: Line 16b URL: www.alexianbrothershealth.org/pay-my-bill;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Alexian Brothers Medical Center: Line 16c URL: www.alexianbrothershealth.org/pay-my-bill;
Schedule H, Part VI, Line 2 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, the liaison from our ABMC Senior Resource Center identified that many seniors had questions about their pharmaceutical products. They wanted to know how their medicines worked, wondered about interaction with over the counter medications and how to manage their medicines safely and effectively from home. In response, ABMC offered one-on-one meetings with a staff Pharmacist. Participants were grateful to have the time necessary to understand their medications better and felt more knowledgeable and empowered to manage their own health at home. In another example, the Senior Center identified many community members struggling with grief over losing a spouse or other family member. A Grief Support Group was created to assist persons struggling with loss, depression, fear and anxiety through sharing with others and referrals to additional care if necessary. It is important to provide support during these transitions as depression can cause self- care to erode if not addressed early and the survivor's health will suffer.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Multiple methods are used at ABMC 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 ABMC, 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 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.
Schedule H, Part VI, Line 5 Promotion of community health ABMC'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. ABMC 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, ABMC recruits medical specialists and subspecialists who provide the expertise for emerging technologies that advance patient care. ABMC strives to fully serve the community through participation in government sponsored healthcare programs such as Medicare, Medicaid, Champus and Tricare. ABMC also participates in research and education. In 2016 we had affiliations with 30 schools of nursing for undergraduate placement and numerous graduate level programs for clinical rotations. Community members also use ABMC as a conduit for volunteering as evidenced by over 800 volunteers (comprising almost 80,000 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 ABMC is an affiliate of ABHS. ABHS is the national member and ultimate parent of ABMC. 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: St. Alexius Medical Center - An acute care hospital located in Hoffman Estates, Illinois that provides inpatient, outpatient and emergency services, including specialties in the areas of pediatrics, cardiology, neurosciences, orthopedics, oncology and bariatrics. 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 Medical Care Group - Provides a multitude of ambulatory services to suburban Chicago, including primary care physician services and pediatric physician services Alexian Brothers Specialty Group - Provides cardiology services through employment of cardiologists to suburban Chicago residents.
Schedule H (Form 990) 2015
Additional Data


Software ID: 15000238
Software Version: 2015v3.0
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" 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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
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? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization?
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization?
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1JOHN WERRBACH
  EX-OFFICIO DIRECTOR & PRESIDENT CEO
(i)

(ii)
0
-------------
456,058
0
-------------
122,137
0
-------------
27,525
0
-------------
44,845
0
-------------
24,944
0
-------------
675,509
0
-------------
27,525
2SHERRI 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
3DIANA 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
4LINDA 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
5SCOTT PETERSON
  FORMER KEY EMPLOYEE
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
110,504
0
-------------
0
0
-------------
0
0
-------------
110,504
0
-------------
0
6JON 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
7LAURENCE 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
8TIMOTHY MALISCH MD
  INTERVENTIONAL NEURORADIOLOGIST
(i)

(ii)
0
-------------
853,273
0
-------------
25,000
0
-------------
18,000
0
-------------
10,798
0
-------------
15,236
0
-------------
922,307
0
-------------
0
9FRANKLIN A MARDEN MD
  INTERVENTIONAL NEURORADIOLOGIST
(i)

(ii)
0
-------------
661,819
0
-------------
25,150
0
-------------
18,000
0
-------------
10,615
0
-------------
23,622
0
-------------
739,206
0
-------------
0
10LAVERNA MENSAH MD
  GYNECOLOGIST & ONCOLOGIST
(i)

(ii)
0
-------------
386,329
0
-------------
0
0
-------------
0
0
-------------
5,300
0
-------------
22,170
0
-------------
413,799
0
-------------
0
11SZYMON S ROSENBLATT MD
  NEUROSURGEON
(i)

(ii)
0
-------------
951,783
0
-------------
32,752
0
-------------
0
0
-------------
11,278
0
-------------
23,873
0
-------------
1,019,686
0
-------------
0
12SANJAY YADLA PHD
  NEUROSURGEON
(i)

(ii)
0
-------------
576,076
0
-------------
0
0
-------------
18,000
0
-------------
5,300
0
-------------
23,538
0
-------------
622,914
0
-------------
0
Schedule J (Form 990) 2015

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 - AHS Midwest Region Health Co., a related organization of the filing organization, 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 Compensation Committee
Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual listed in Schedule J was paid the referenced amount of severance in calendar 2015: 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 CERTAIN 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
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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
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 .
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
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach 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
Alexian Brothers Medical Center
 
Employer identification number

36-2596381
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?
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)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
 
(11)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
 
(12)St Alexius Medical Center
1555 Barrington Road

Hoffman Estates,IL60194
36-4251846
Acute care 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
SPECIALTY 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
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


Yes No Yes No
(1) Alexian Rehabilitation Services LLC

935 Beisner
Elk Grove Village,IL60007
30-0221481
Rehabilitation hospital IL NA
 
N/A       No     No 0 %
(2) Illinois NeuroMeg Center LLC

3040 W Salt Creek Lane
Arlington Heights,IL60005
87-0783164
Provision of NeuroMeg services IL Alexian Brothers Medical Center
 
Related -24,211 0   No   Yes   71.43 %
(3) Elk Grove MOB Limited Partnership

3040 W Salt Creek Lane
Arlington Heights,IL60005
36-3853289
Medical office building IL NA
 
N/A       No     No 0 %
(4) Bonaventure Medical Foundation LLC

3040 W Salt Creek Lane
Arlington Heights,IL60005
36-3978153
Manages managed care contracts DE NA
 
N/A       No     No 0 %
(5) Neurosciences Equipment LLC

3040 W Salt Creek Lane
Arlington Heights,IL60005
86-1115516
Ownership of Gamma Knife IL NA
 
N/A       No     No 0 %
(6) St Alexius Center for Sleep Health LLC

1300 S Main Street
Lombard,IL60148
20-5876371
Operation of sleep lab IL NA
 
N/A       No     No 0 %


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
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
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
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) ALEXIAN BROTHERS AMBULATORY GROUP

J 127,703 FMV
(2) ALEXIAN BROTHERS SPECIALTY GROUP

J 108,580 FMV
(3) ALEXIAN BROTHERS MEDICAL CARE GROUPNFP

J 144,485 FMV
(4) SAVELLI PROPERTIES INC

K 486,410 FMV
(5) THELEN CORPORATION

K 149,093 FMV

Schedule R (Form 990) 2015
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2015
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