TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) SANDRA BRUCE...................................................................... PRESIDENT/CEO/EX-OFFICIO-12/30	1.0 ................. 47.0	X	X	1,668,089	20,881
(2) HAVEN COCKERHAM...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(3) BRUCE HAMORY MD...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(4) MARK HANSON...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(5) THOMAS HUBERTY MD...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(6) SISTER PATRICIA ANN KOSCHALKE CSFN...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(7) SISTER CLARA FRANCES KUSEK CR...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(8) MARSHA LADENBURGER...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(9) LAURIE LAFONTAINE...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(10) SISTER TERRY MALTBY RSM...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(11) SUSAN MCDONOUGH...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(12) VICTOR ORLER...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(13) KENT RUSSELL...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(14) JOSE SANTIAGO MD...................................................................... DIRECTOR (TERM 9/15)	1.0 ................. 3.0	X		0	0
(15) THOMAS D SETTLES...................................................................... VICE CHAIR/DIRECTOR	1.0 ................. 4.0	X	X	0	0
(16) SISTER MARY SHINNICK OSF...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(17) SISTER EVELYN VARBONCOEUR-SSCM...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) GUY WIEBKING........................................................................ CHAIR /DIRECTOR	1.0 .......................3.0	X	X				0	0	0
(19) JAMES WINIKATES........................................................................ DIRECTOR	1.0 .......................3.0	X					0	0	0
(20) MICHAEL ENGLEHART........................................................................ PRESIDENT/CEO	1.0 .......................46.0		X				0	540,805	39,897
(21) JEANNIE C FREY........................................................................ SECRETARY	1.0 .......................63.0		X				0	577,236	125,759
(22) ANTHONY J FILER........................................................................ TREASURER	1.0 .......................62.0		X				0	1,401,909	1,209,330
(23) PATRICK QUINN........................................................................ ASSISTANT TREASURER	1.0 .......................61.0		X				0	328,224	71,480
(24) JULIE ROKNICH........................................................................ ASSISTANT SECRETARY	1.0 .......................60.0		X				0	217,095	30,640
(25) MICHAEL L BROWN........................................................................ REGIONAL PRESIDENT & CEO-FXV	40.0 .......................0.0			X			580,180	0	98,167
(26) JARED C ROGERS........................................................................ REGIONAL PRESIDENT & CEO-CES	40.0 .......................0.0			X			489,968	0	76,357
(27) DAVID R FRANZBLAU........................................................................ CONVERSION - Regional CMO	40.0 .......................0.0			X			447,595	0	67,025
(28) ANIL B GOPINATH........................................................................ REGIONAL CHIEF MEDICAL OFFFXV	40.0 .......................0.0			X			354,770	0	59,395
(29) JANICE M NEMRI........................................................................ RGN CHIEF AMB & ANCIL OFF-SSB	40.0 .......................0.0			X			372,260	0	52,516
(30) JACQUELINE J MEDLAND........................................................................ CHIEF NURSING OFFICER-SSB	40.0 .......................0.0			X			414,367	0	79,992
(31) DEBORAH A SCHIMEROWSKI........................................................................ REGIONAL FIN OFFICER- CES/SSB	40.0 .......................0.0			X			317,216	0	21,636
(32) KEVIN W LARKIN........................................................................ REGIONAL FINANCE OFFICER-FXV	40.0 .......................0.0			X			312,752	0	38,027
(33) CATHERINE EMANUEL........................................................................ REGN STRATEGY & GROWTH OFFCES	40.0 .......................0.0			X			285,540	0	13,250
(34) MOLLY A NICHOLSON........................................................................ REGIONAL CHIEF NURSING OFFICER	40.0 .......................0.0			X			266,365	0	38,060
(35) SYED SAEED P BOKHARI........................................................................ PSMH CHIEF MEDICAL OFFICER	40.0 .......................0.0			X			259,792	0	9,036
(36) GRACE L MCBRIDE........................................................................ REGIONAL CHIEF NURSING OFFICER	40.0 .......................0.0			X			248,073	0	24,533
(37) JENNIFER S CORD........................................................................ REGCHF AMB/ANC/SPT/MSN OFF-CES	40.0 .......................0.0			X			223,771	0	32,206
(38) ERIC M RHODES........................................................................ REG CHIEF AMB & ANC OFF-FXV	40.0 .......................0.0			X			209,742	0	25,161
(39) TIMOTHY J DAUGHERTY........................................................................ REGN STRATEGY & GROWTH OFFSSB	40.0 .......................0.0			X			200,251	0	27,806
(40) SURENDRA M GULATI........................................................................ PHYSICIAN	40.0 .......................0.0				X		474,087	0	28,308
(41) LESLIE A MASOOD........................................................................ PHYSICIAN	40.0 .......................0.0				X		332,297	0	32,456
(42) JOSEPH R DANNA........................................................................ MEDICAL DIRECTOR	40.0 .......................0.0				X		294,806	0	27,483
(43) MICHAEL PANUSKA........................................................................ MEDICAL DIRECTOR	40.0 .......................0.0				X		290,561	0	29,671
(44) SHOBHANA RAVIKUMAR........................................................................ PHYSICIAN	40.0 .......................0.0				X		259,007	0	32,939
(45) LISA M LAGGER........................................................................ FORMER REG CHIEF REL OFFICER	0.0 .......................40.0					X	0	332,865	37,869
(46) AMY D STEVENS........................................................................ FORMER COO	0.0 .......................40.0					X	0	513,905	639,390
(47) Connie J Noltemeyer........................................................................ FORMER REGIONAL QUALITY LEADER	0.0 .......................0.0					X	145,470	0	4,275

(A) Name and business address	(B) Description of services	(C) Compensation
OWENS AND MINOR DISTRIBUTION INC, 437 TOWER BLVD CAROL STREAM,IL60188	CONSULTING SERVICE	6,018,850
AMERICAN ANESTHESIA ASSOCIATES OF I, 19627 S LA GRANGE RD MOKENA,IL60448	ANESTHESIA SERVICES	6,310,206
REHABCARE GROUP MGMT SERVICES INC, 680 SOUTH FOURTH STREET LOUISVILLE,KY402022412	REHABILITATION SVCS	3,612,132
US BANK CORPORATE TRUSTSHIFTWISE, PO BOX 70870 ST PAUL,MN55170	CLINICAL STAFFING	3,269,772
CHRISTIE CLINIC LLC, 101 UNIVERSITY AVE CHAMPAIGN,IL61820	HOSPITALIST SERVICES	2,521,228
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 112

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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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

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

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

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

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

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

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

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

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

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

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2015

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

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

Name of organization PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

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

Page 3

Name of organization PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK		Employer identification number 36-4195126

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 PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK			Employer identification number 36-4195126
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Part I

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

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	2,899,207	2,848,100	2,744,115	1,885,241	1,823,675
b	Contributions ...	16,897,832	2,872	4,756	765,424	61,758
c	Net investment earnings, gains, and losses	-21,361	104,946	122,906	108,794	43,217
d	Grants or scholarships ...	29,359	55,109	21,530	13,844	26,673
e	Other expenditures for facilities and programs ...	5,154,860	1,602	2,147	1,500	16,425
f	Administrative expenses ....					311
g	End of year balance ......	14,591,459	2,899,207	2,848,100	2,744,115	1,885,241

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

10.000 %

Temporarily restricted endowment SchDMd Bullet

90.000 %

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

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

Yes

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

3a(i)

Yes

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

3a(ii)

Yes

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

Yes

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 ...	22,201,396		22,201,396
b	Buildings	696,401,085	367,125,645	329,275,440
c	Leasehold improvements	4,854,931	852,184	4,002,747
d	Equipment ...	337,105,630	258,144,261	78,961,369
e	Other ...	20,660,782	13,885,073	6,775,709
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				441,216,661

Schedule D (Form 990) 2015

Page 3

Part VII

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

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value
(1) THIRD PARTY RECEIVABLES				35,247,645
(2) DUE FROM AFFILIATES				11,407,997
(3) MANUAL RECEIVABLES				6,817,123
(4) LONG TERM RECEIVABLES				4,211,605
(5) DEFERRED COMPENSATION ASSET				271,625
(6) PHYSICIAN LOAN RECEIVABLE ST				207,136
(7) PHYSICIAN LOAN RECEIVABLE LT				199,428
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				58,362,559

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	0
DUE TO THIRD PARTY PAYORS	114,776,832
OTHER LONG TERM LIABILITIES	4,739,969
CAPITAL ACCUMULATION	277,370
OTHER LONG TERM LIABILITIES	270,693
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	120,064,864
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

SCHEDULE D, PART V, LINE 1B

CONTRIBUTIONS INCLUDES A $9,198,390 ADJUSTMENT FOR ENDOWMENT FUNDS THAT WERE NOT INCLUDED IN PRIOR YEARS. PRIOR YEAR BALANCE AND ACTIVITY INADVERTENTLY DID NOT INCLUDE ALL THE ENDOWMENT FUNDS. SCHEDULE D, PART V, LINE 4 ENDOWMENT FUND USES THE INTENDED USES OF THE ENDOWMENT FUND INCLUDE THE FOLLOWING: SUPPLEMENTAL HOSPITAL INCOME, EDUCATION, TECHNOLOGY, HEALTH AND HUMAN SERVICES FOR THE POOR, SCHOLARSHIPS, AND DIABETES WELLNESS CENTER.

SCHEDULE D, Part X, LINE 2

PRESENCE HEALTH AND AFFILIATES RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. AS OF DECEMBER 31, 2015 AND 2014, PRESENCE HEALTH AND AFFILIATES DOES NOT HAVE ANY LIABILITIES FOR UNRECOGNIZED TAX BENEFITS.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Information about Schedule G (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
PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?
			Yes	No
	CENTRAL IL BOOKS	BOOK FAIR	Yes
	MASQUERADE FUNDRAISING	$5 SALE	Yes
	GOLD COAST	JEWELRY	Yes
	DANVILLE GARDENS	FLOWER SALE		No






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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GALA (event type)	(b) Event #2 FEST. OF TREES (event type)	(c) Other events 10 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	263,727	254,386	766,878	1,284,991
2	Less: Contributions . . . .	83,532	77,750	348,280	509,562
3	Gross income (line 1 minus line 2) . . . . . .	180,195	176,636	418,598	775,429

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .			20,693	20,693
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	112,949	153,046	269,668	535,663
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				556,356
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				219,073

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	112,949	153,046	269,668	535,663

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

1400 W PARK
URBANA,IL61801

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

200% 250% 300% 350% 400% Other 600 %

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		29,341	26,140,884		26,140,884	3.920 %
b	Medicaid (from Worksheet 3, column a) . . . . .		122,408	232,561,177	183,084,930	49,476,247	7.420 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		151,749	258,702,061	183,084,930	75,617,131	11.340 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	110	56,554	2,416,651	153,336	2,263,315	0.340 %
f	Health professions education (from Worksheet 5) . . .	15	3,077	5,819,073	631,731	5,187,342	0.780 %
g	Subsidized health services (from Worksheet 6) . . . .	5	1,463	4,794,497	4,252,847	541,650	0.080 %
h	Research (from Worksheet 7) .	5		347,215		347,215	0.050 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	24	8,131	605,489	153,754	451,735	0.070 %
j	Total. Other Benefits . .	159	69,225	13,982,925	5,191,668	8,791,257	1.320 %
k	Total. Add lines 7d and 7j .	159	220,974	272,684,986	188,276,598	84,408,388	12.660 %

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	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	3	6,292	176,488	176,488
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1		951	951
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	4	6,292	177,439	177,439

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

63,150,366

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. ......

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

Section B. Medicare

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

435,898,545

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

484,278,435

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

-48,379,890

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1Alliance PHO	Physician Hospital Org.	50 %	50 %
2KANKAKEE VALLEY DLY	Dialysis Center	50 %	50 %
3Kendail PT Surgery	Surgery Center	15 %	50 %
4Dreyer Provena Amb	Ambulatory Care Center	40 %	60 %
5Ctr Digestive Dis	Digestive Health Center	10 %	80 %
6PSJH ORTHO CLINICAL	MGMT OF ORTHOPEDIC SERV LINE	20 %	80 %
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?6 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	PRESENCE ST JOSEPH MEDICAL CENTER 333 N MADISON STREET JOILET,IL60435 www.presencehealth.org 0004838	X	X	X
2	PRESENCE MERCY MEDICAL CENTER 1325 NORTH HIGHLAND AVENUE AURORA,IL60506 www.presencehealth.org 0004903	X	X	X
3	PRESENCE ST JOSEPH HOSPITAL 77 NORTH AIRLITE AVENUE ELGIN,IL60123 WWW.PRESENCEHEALTH.ORG 0004887	X	X	X
4	PRESENCE ST MARY'S HOSPITAL 500 WEST COURT STREET KANKAKEE,IL60901 WWW.PRESENCEHEALTH.ORG 0004879	X	X	X
5	PRESENCE COVENANT MEDICAL CENTER 1400 WEST PARK STREET URBANA,IL61801 WWW.PRESENCEHEALTH.ORG 0004861	X	X	X
6	PRESENCE UNITED SAMARITANS MED CNTR 812 NORTH LOGAN AVENUE DANVILLE,IL61832 WWW.PRESENCEHEALTH.ORG 0004853	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	PRESENCE ST JOSEPH MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): www.presencehealth.org/community-reports

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

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

Yes

If "Yes" (list url): www.presencehealth.org/community-reports

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PRESENCE ST JOSEPH MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

presencehealth.org

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

presencehealth.org

A plain language summary of the FAP was widely available on a website (list url):
presencehealth.org

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	PRESENCE ST JOSEPH MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 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)

	PRESENCE MERCY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): www.presencehealth.org/community-reports

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): www.presencehealth.org/community-reports

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PRESENCE MERCY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

presencehealth.org

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

presencehealth.org

A plain language summary of the FAP was widely available on a website (list url):
presencehealth.org

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	PRESENCE MERCY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 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)

	PRESENCE ST JOSEPH HOSPITAL
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): www.presencehealth.org/community-reports

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): www.presencehealth.org/community-reports

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PRESENCE ST JOSEPH HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

presencehealth.org

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

presencehealth.org

A plain language summary of the FAP was widely available on a website (list url):
presencehealth.org

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	PRESENCE ST JOSEPH HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 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)

	PRESENCE ST MARY'S HOSPITAL
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): www.presencehealth.org/community-reports

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): www.presencehealth.org/community-reports

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PRESENCE ST MARY'S HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

presencehealth.org

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

presencehealth.org

A plain language summary of the FAP was widely available on a website (list url):
presencehealth.org

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	PRESENCE ST MARY'S HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 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)

	PRESENCE COVENANT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): www.presencehealth.org/community-reports

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

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

Yes

If "Yes" (list url): www.presencehealth.org/community-reports

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PRESENCE COVENANT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

presencehealth.org

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

presencehealth.org

A plain language summary of the FAP was widely available on a website (list url):
presencehealth.org

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	PRESENCE COVENANT MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 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)

	PRESENCE UNITED SAMARITANS MED CNTR
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): www.presencehealth.org/community-reports

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

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

Yes

If "Yes" (list url): www.presencehealth.org/community-reports

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

10b

12a

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

12a

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	PRESENCE UNITED SAMARITANS MED CNTR
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 600.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

presencehealth.org

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

presencehealth.org

A plain language summary of the FAP was widely available on a website (list url):
presencehealth.org

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	PRESENCE UNITED SAMARITANS MED CNTR
Name of hospital facility or letter of facility reporting group

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PRESENCE SAINT JOSEPH MEDICAL CENTER (1)	Part V, Section B, Line 5 Presence Saint Joseph Medical Center (PSJMC) used the Mobilizing for Action through Planning and Partnerships (MAPP) process to conduct its CHNA. This process is a thorough, collaborative process which includes four separate assessments that engage representatives from all community sectors to obtain input and feedback on what the identified needs are in the community. The assessments are listed below, including the agencies who provided input: Community Health Status Assessment (CHSA): The CHSA committee was comprised of MAPP Executive Committee members, data and planning staff from the three local hospitals and the health departments epidemiologist. This team reviewed key health indicators and the health departments epidemiologist analyzed the data gathered to provide insight into the trends and top issues. Local Public Health System Assessment (LPHSA): Over 100 public health system partners were invited to participate in the Will County Public Health System forum held in December 2013 at New Life Church in New Lenox. Approximately 70 partners participated in assessing how well the Will County public health system provides the ten Essential Public Health Services (EPHS) in Will County. Community Themes and Strengths Assessment (CTSA): Three separate methods of data collection were used in conducting the CTSA: random and targeted community surveys and photovoice. Random Survey: In a county-wide random sample, 5,000 residents were mailed a community survey between September and November 2013. The survey was 10 pages in length and took about 20 minutes to complete. It asked questions about residents perceptions on the quality of life in Will County. There were 496 respondents. Targeted Survey: After survey results were collected, the MAPP Executive Committee realized that the survey respondents did not reflect the demographics of Will County. In order to obtain the perspective of residents underrepresented in the random survey, targeted surveys were distributed in January 2014 to gather additional information from vulnerable populations. Eighty-three participants gave their input on strengths and assets of their community and their perception about the quality of life in Will County through these targeted surveys. Photovoice: the third method used for data collection. Photovoice is a technique that enables community residents of all ages and languages to share information about their communities through pictures. Twenty-eight photos were received from a number of residents in Will County. Forces of Change Assessment (FOCA): The FOCA was completed in September 2013 with 41 participants, consisting of MAPP Executive Committee members and other community leaders. Factors and trends most impacting Will County includes the current economy with rising unemployment, loss of services and programs, and increased need for mental health services. PSJMC engaged the following agencies as part of its CHNA process: Adventist Bolingbrook Hospital American Cancer Society Aunt Marthas Youth Service/Center Bridges to a New Day, NFP Catholic Charities CASA of Will County Center for Economic Development (Three Rivers Educational Partnership TREP) Chestnut Health Systems Child Care Resource and Referral Agency Community Service Council of Will County, Inc. Crete Monee School District 201 Crisis Line of Will and Grundy County Easter Seals of Joliet Region, Inc. Edward Hospital Greater Joliet Area YMCA Governors State University Guardian Angel Community Services Harvey Brooks Foundation Housing Authority of Joliet Joliet Junior College Joliet Township Joliet Township High School/YESS (Youth Experiencing Success in School) Lewis University Linden Oaks at Edwards Hospital Lutheran Social Services of Illinois Marian Village Mount Zion Baptist Church MorningStar Mission National Association of Mental Illness (NAMI) Will County National Hook-up of Black Women, Inc. New Life Church Provena Home Care Presence Health System Presence Saint Joseph Medical Center Presence Villa Franciscan Presence Life Connections Senior Services Center of Will County Service INC., Child and Family Connections #15 Silver Cross Hospital Stepping Stones, Inc. Three Rivers Manufactures Association Trinity Services, Inc. U of I Extension Kankakee, Will Grundy Co. United Way of Will County University of St. Francis Warren-Sharpe Community Center Will County Community Concerns Will County Community Foundation Will County Community Health Center Will County EMA Will County Executives Office Will County Forest Preserve District Will County Health Department Will County Local Area Network (LAN) Will County Land Use Community Development Will County Regional Office of Education Will County Residents Will Grundy Center for Independent Living Will-Grundy Medical Clinic Part V, Section B, Line 6a PSJMC partnered with Silver Cross Hospital, Adventist Bolingbrook Hospital and Edward Hospital to complete their CHNA. Part V, Section B, Line 7d PSJMC has worked with its CHNA partners to develop a community-friendly document highlighting pertinent CHNA information. Copies will be mailed and/or e-mailed to community partners who participated in the CHNA process. Partners will also be provided links to the website for dissemination to their mailing lists and respective constituents. Part V, Section B, Line 11 After consolidating overlapping issues identified in the MAPP CHNA, the top identified needs in Will County are: Behavorial Health Chronic Care Primary Health Care PSJMC will continue to serve on the MAPP Executive Committee and MAPP Action Teams to address the identified needs in Will County within the next three to five years. Please see Part VI, Line 5 for the description of programs in place to address these identified needs along with 2015 objectives and 2015 measurable outcomes. Part VI, Line 5 also includes the system-wide mental health and enrollment strategies that are being used by each hospital in the system. Part V, Section B, Line 14 Federal Poverty Guidelines are also used in determining the basis of calculating amounts charged to patients.
PRESENCE MERCY MEDICAL CENTER (2)	Part V, Section B, Line 5 The CHNA process was initiated by Presence Mercy Medical Center (PMMC) and Presence Saint Joseph Hospital (PSJH) in collaboration with the community they serve, the Kane County Health Department, Delnor Hospital, Rush-Copley Medical Center, Sherman Hospital, Fox Valley United Way and the United Way of Elgin. Engagement of Public Health Expertise The Kane County Health Department facilitated the CHNA process by using the Mobilizing for Action through Planning and Partnerships (MAPP) tool. PMMC served as one of eight partners that participated in the Kane County Community Health Needs Assessment. This provided the opportunity for PMMC to actively provide expertise, input, and financial support. Partners also involved in this process included the four other hospitals in Kane County including Delnor Hospital, Presence Saint Joseph Hospital, Rush-Copley Medical Center, Sherman Hospital, as well as Fox Valley United Way and the United Way of Elgin. Community Health Improvement Plan (CHIP) Committee To provide community level oversight for the process, a diverse group of community stakeholders and PMMC representatives were invited to participate on the CHIP Steering Committee. To ensure representative engagement, personal invitations were sent to organizations representing cultural, linguistic, racial, ethnic, and other minority groups. In addition, individuals with specialized qualifications in dealing with special populations or clinical groups were solicited for their participation. Finally, efforts were made to include individuals on the CHIP Steering Committee with public health expertise. Those who committed to the assessment and planning process became the eight members of the CHNA Steering Committee, which continues to meet regularly to provide feedback and oversight, assess progress, and modify plans as needed. The Kane County CHIP Steering Committee members are listed below: Kane County Health Department United Way of Elgin Presence Mercy Medical Center Presence Saint Joseph Hospital Sherman Hospital Fox Valley United Way INC Board Cadence Health Rush-Copley Medical Center Approach: Kane County approached the 2011 Community Health Needs Assessment differently than in years past. In late 2010, the Kane County Health Department (KCHD) engaged the five hospitals in the county and the INC Board in a formal Community Health Assessment Committee to fund and lead the assessment effort. In early 2011, the Fox Valley United Way and the United Way of Elgin both formally agreed to fund and support the assessment process as well. This partnership allowed all agencies to meet their community assessment requirements and provided an efficient use of assessment and planning resources from all involved agencies. Methodology: The assessment partnership funded a comprehensive telephone survey of Kane County residents to collect health status information for over 1,500 adults and the caregivers of over 400 children. The survey questions were created based on the Behavioral Risk Factor Surveillance System survey, allowing the results to be compared with state and national figures. The Northern Illinois University Public Opinion Laboratory was contracted to conduct the phone survey between March and July of 2011. In addition to quantitative data, the department gathered qualitative information from residents about the health of the community through the Quality of Kane Public Meetings, Focus Groups, Community Cafs and Community Meetings. These events provided an opportunity to hear directly from residents about the factors most influencing health in their communities. This information was used to help planners understand the health data collected. Over 200 residents participated in at least one of these events. Community and Stakeholder Participation: Community and stakeholder input were obtained to determine the needs of the community. The Quality of Kane Public Meetings were held in April, May, and November 2011. These meetings provided community members an opportunity to hear about and provide their input on planning initiatives in Kane County from different planning disciplines: health, land use, and transportation. There were six meetings total, two from each of the three planning areas in the county. The planning areas are defined by the county and are used by all departments. Part V, Section B, Line 6 PMMC partnered with Sherman Hospital, Cadence Health, Presence Saint Joseph Hospital and Rush-Copley Medical Center to complete their CHNA. Part V, Section B, Line 7d PMMC worked with its CHNA partners to develop a community-friendly document highlighting pertinent CHNA information. Copies were mailed and/or e-mailed to community partners who participated in the CHNA process. Partners were also provided links to the website for dissemination to their mailing lists and respective constituents. Part V, Section B, Line 11 Based on the CHNA findings, internal resources, and internal expertise the areas of focus for the 2015 Implementation Strategy Plan that PMMC will help address include: Obesity Chronic Disease Poor Social and Emotional Wellness Please see Part VI, Line 5 for the description of programs in place to address these identified needs along with 2015 objectives and 2015 measurable outcomes. Part VI, Line 5 also includes the system-wide mental health and enrollment strategies that are being used by each hospital in the system. Part V, Section B, Line 14 Federal Poverty Guidelines are also used in determining the basis of calculating amounts charged to patients.
PRESENCE SAINT JOSEPH HOSPITAL (3)	Part V, Section B, Line 5 The CHNA process was initiated by Presence Saint Joseph Hospital (PSJH) and Presence Mercy Medical Center (PMMC) in collaboration with the community they serve, the Kane County Health Department, Delnor Hospital, Rush-Copley Medical Center, Sherman Hospital, Fox Valley United Way and the United Way of Elgin. Engagement of Public Health Expertise The Kane County Health Department facilitated the CHNA process by using the Mobilizing for Action through Planning and Partnerships (MAPP) tool. PSJH served as one of eight partners that participated in the Kane County Community Health Needs Assessment. This provided the opportunity for PSJH to actively provide expertise, input, and financial support. Partners also involved in this process included the four other hospitals in Kane County including Delnor Hospital, Presence Mercy Medical Center, Rush-Copley Medical Center, Sherman Hospital, as well as Fox Valley United Way and the United Way of Elgin. Community Health Improvement Plan (CHIP) Committee: To provide community level oversight for the process, a diverse group of community stakeholders and PSJH representatives were invited to participate on the CHIP Steering Committee. To ensure representative engagement, personal invitations were sent to organizations representing cultural, linguistic, racial, ethnic, and other minority groups. In addition, individuals with specialized qualifications in dealing with special populations or clinical groups were solicited for their participation. Finally, efforts were made to include individuals on the CHIP Steering Committee with public health expertise. Those who committed to the assessment and planning process became the eight members of the CHNA Steering Committee, which continues to meet regularly to provide feedback and oversight, assess progress, and modify plans as needed. The Kane County CHIP Steering Committee members are listed below: Kane County Health Department United Way of Elgin Presence Mercy Medical Center Presence Saint Joseph Hospital Sherman Hospital Fox Valley United Way INC Board Cadence Health Rush-Copley Medical Center Approach: Kane County approached the 2011 Community Health Needs Assessment differently than in years past. In late 2010, the Kane County Health Department (KCHD) engaged the five hospitals in the county and the INC Board in a formal Community Health Assessment Committee to fund and lead the assessment effort. In early 2011, the Fox Valley United Way and the United Way of Elgin both formally agreed to fund and support the assessment process as well. This partnership allowed all agencies to meet their community assessment requirements and provided an efficient use of assessment and planning resources from all involved agencies. Methodology: The assessment partnership funded a comprehensive telephone survey of Kane County residents to collect health status information for over 1,500 adults and the caregivers of over 400 children. The survey questions were created based on the Behavioral Risk Factor Surveillance System survey, allowing the results to be compared with state and national figures. The Northern Illinois University Public Opinion Laboratory was contracted to conduct the phone survey between March and July of 2011. In addition to quantitative data, the department gathered qualitative information from residents about the health of the community through the Quality of Kane Public Meetings, Focus Groups, Community Cafs and Community Meetings. These events provided an opportunity to hear directly from residents about the factors most influencing health in their communities. This information was used to help planners understand the health data collected. Over 200 residents participated in at least one of these events. Community and Stakeholder Participation: Community and stakeholder input were obtained to determine the needs of the community. The Quality of Kane Public Meetings were held in April, May, and November 2011. These meetings provided community members an opportunity to hear about and provide their input on planning initiatives in Kane County from different planning disciplines: health, land use, and transportation. There were six meetings total, two from each of the three planning areas in the county. The planning areas are defined by the county and are used by all departments. Part V, Section B, Line 6 PSJH partnered with Sherman Hospital, Presence Mercy Medical Center, Cadence Health and Rush-Copley Medical Center to complete their CHNA. Part V, Section B, Line 7d PSJH worked with its CHNA partners to develop a community-friendly document highlighting pertinent CHNA information. Copies were mailed and/or e-mailed to community partners who participated in the CHNA process. Partners were also provided links to the website for dissemination to their mailing lists and respective constituents. Part V, Section B, Line 11 Based on the CHNA findings, internal resources, and internal expertise the areas of focus for the 2015 Implementation Strategy Plan that PSJH will help address include: Obesity Chronic Disease *Poor Social and Emotional Wellness Please see Part VI, Line 5 for the description of programs in place to address these identified needs along with 2015 objectives and 2015 measurable outcomes. Part VI, Line 5 also includes the system-wide mental health and enrollment strategies that are being used by each hospital in the system. Part V, Section B, Line 14 Federal Poverty Guidelines are also used in determining the basis of calculating amounts charged to patients.
PRESENCE ST. MARY'S HOSPITAL (4)	Part V Line 5 During 2015, a Community Health Needs Assessment (CHNA) was facilitated by Presence St. Marys Hospital (PSMH), Riverside Medical Center and Kankakee County Health Department. This report summarizes the health profile and community input findings of the CHNA conducted for the population served by PSMH and identifies the top priority health issues for the community to focus on in developing its implementation strategies. Engagement of Public Health Expertise The Kankakee County Health Department and PSMH co-facilitated the CHNA process by using the Mobilizing for Action through Planning and Partnerships (MAPP) tool. The Partnership for a Healthy Community formally engaged the Illinois Public Health Institute (IPHI) for assistance in planning and executing the CHNA process. IPHI served as an expert public health consultant throughout the CHNA timeline. CHNA Steering Committee To provide community level oversight for the process, a diverse group of community stakeholders and PSMH representatives were invited to participate on the CHNA Steering Committee. To ensure representative engagement, personal invitations were sent to organizations representing cultural, linguistic, racial, ethnic, and other minority groups. In addition, individuals with specialized qualifications in dealing with special populations or clinical groups were solicited for their participation. Finally, efforts were made to include individuals on the CHNA Steering Committee with public health expertise. Those who committed to the assessment and planning process became the 11 members of the CHNA Steering Committee, which continues to meet regularly to provide feedback and oversight, assess progress, and modify plans as needed. The agencies represented on the CHNA Steering Committee are listed below: Kankakee Community College United Way of Kankakee County Presence St. Marys Hospital I Kan Regional Office of Education & NAACP Riverside Medical Center New Life Pentecostal Church & Hispanic Partnership Presence Home Health Care The Helen Wheeler Center for Community Mental Health Riverside Medical Center Kankakee County Health Department Process Used to Identify Community Needs Every five years, local health departments in Illinois must complete a community health needs assessment (CHNA) and health plan as a requirement for recertification with the Illinois Department of Public Health (IDPH). This process is known as Illinois Project for Local Assessment of Need, (IPLAN). Hospitals are required by the IRS to complete a CHNA every three years. For the 2015 assessment and planning process, the Partnership for a Healthy Community used the Mobilizing for Action through Planning and Partnerships (MAPP) process as an equivalent for IPLAN. The Kankakee County Health Department and PSMH partnered to facilitate the MAPP process in 2012 and again in 2015. From June 2014 through July 2015 four separate assessments were conducted. MAPP is a process that provides a comprehensive framework for assessing community needs, and developing and addressing strategic issues. The purpose of the Kankakee County MAPP process is to provide a community plan that is developed by and for the community. The benefits of Kankakee County engaging in this process include: A healthier community that improves the quality of life for the people who live and work in it. Increased visibility of public health in the community. Increased awareness and knowledge about public health issues. Preparation of our local public health system to better anticipate, manage and respond to changes in the county. Greater collaboration and sharing of resources among partners. Reflection of priorities in hospital implementation strategies. MAPP has six phases. The first five phases were completed over twenty-two months. Phase six, the action cycle, is an ongoing process of planning, implementing and evaluating. Kankakee County is currently in phase six of the process. Part V, Section B, Line 6 PSMH partnered with Riverside Medical Center to complete their CHNA. Part V, Section B, Line 11 After consolidating overlapping issues identified in the MAPP CHNA, the top identified needs in Kankakee County are: Teen pregnancy & Infant Mortality Access to Care Chronic Disease Mental Health & Substance Abuse Violence & Safety Education Please see Part VI, Line 5 for the description of programs in place to address these identified needs along with 2015 objectives and 2015 measurable outcomes. Part VI, Line 5 also includes the system-wide mental health and enrollment strategies that are being used by each hospital in the system. Part V, Section B, Line 14 Federal Poverty Guidelines are also used in determining the basis of calculating amounts charged to patients.
PRESENCE COVENANT MEDICAL CENTER (5)	Part V, Section B, Line 5 The 2014-2016 Champaign County Illinois Planning for Local Assessment of Needs (IPLAN) was accomplished with direct contribution from over 60 individuals representing more than 30 different agencies from across the county. Presence Covenant Medical Center (PCMC) also incorporated the voice of more than 1,000 community residents through surveys, focus groups and community meetings. Engagement of Public Health Expertise PCMC was a participant and helped facilitate some aspects of the 2014-2016 Champaign County IPLAN. The Champaign Urbana Public Health Department (CUPHD) chose to utilize the Mobilizing for Action through Planning and Partnership (MAPP) model to help acquire input from community partners, planners, elected officials and residents of the community. This MAPP process assessed the current health status of the community, identified the needs, and created a comprehensive plan to make the community healthier. Four assessments were conducted as detailed below: Community Health Status Assessment (CHSA): evaluated the basic demographics and health-related statistics of residents in Champaign County. We used aggregated data accessed from countyhealthrankings.org and city and county agencies including the Champaign and Urbana Police Departments. Community Themes and Strengths Assessment (CTSA): we surveyed 975 community residents and held focus groups with 32 residents representing different community groups (undergraduate and graduate students, international student family housing residents, and homeless residents) to get a more in-depth picture of strengths and weaknesses. Local Public Health System Assessment (LPHSA): included almost 60 community leaders from over 30 different agencies, including local government, community planners, public health professionals, clinicians, police and fire, emergency preparedness, and the University of Illinois. This measured how the local public health system is addressing the 10 essential public health services. Forces of Change Assessment: identified the Affordable Care Act (ACA) as a force impacting many sectors; meeting the needs of increasing populations of undocumented immigrants, addressing widening health disparities and the lack of economic opportunities, and the increased use of technology in healthcare (e.g. telemedicine and electronic medical records) and using social media and technology to promote general health were identified as major forces of change. IPLAN Community Advisory Committee To provide community level oversight for the process, a diverse group of community stakeholders and PCMC representatives were invited to participate on the IPLAN Community Advisory Committee. To ensure representative engagement, personal invitations were sent to organizations representing cultural, linguistic, racial, ethnic, and other minority groups. In addition, individuals with specialized qualifications in dealing with special populations or clinical groups were solicited for their participation. Finally, efforts were made to include individuals on the IPLAN Community Advisory Committee with public health expertise. Those who committed to the assessment and planning process became the 65 members to include the CUPHD Staff of the IPLAN Community Advisory Committee. Agencies represented on this committee are listed below: Avicenna Community Health Center Carle Foundation Hospital Champaign County Administrator Champaign County Board Chair Champaign County Chamber of Commerce Champaign County Coroner Champaign County Healthcare Consumers Champaign County Regional Planning Commission Champaign Fire Department Champaign Park District Champaign Police Department Champaign Unit 4 School District Champaign Urbana Public Health District Christie Clinic City of Champaign Fire Department City of Urbana Community Development Services City or Urbana Community Elements CU Mass Transit District CUPHD-Infectious Disease Housing Authority of Champaign County Land of Lincoln Mckinley Health Center National Alliance on Mental Illness Parkland College Presence Covenant Center for Healthy Living Presence Covenant Medical Center Promise Healthcare Prosperity Gardens Inc. Soil and Water Conservation District United Way of Champaign County University of Illinois University of Illinois NCSA University of Illinois Police University of Illinois-CPRD Urbana Market at the Square Urbana Park District Urbana School District 116 Part V, Section B, Line 6 PCMC partnered with Carle Foundation Hospital to complete their CHNA. Part V, Section B, Line 7d PCMC has worked with its CHNA partners to develop a community-friendly document highlighting pertinent CHNA information. Copies will be mailed and/or e-mailed to community partners who participated in the CHNA process. Partners will also be provided links to the website for dissemination to their mailing lists and respective constituents. Part V, Section B, Line 11 Results of the 2014-2017 Community Health Needs Assessment Based on the four MAPP assessments, community leaders convened to identify priorities. After identifying over 30 health concerns, participants voted to narrow down the list to four priorities to address in 2014-2017. Based on the CDCs model, SMART objectives were used to identify goals and objectives within each priority that were feasible, actionable, and could be implemented in the upcoming years. Workgroups then formed and met separately to address each of the four priorities, and formulate goals and action plans to address them. Access to Care (medical, mental and dental health): resource mapping and forming a community resource center, increasing Medicaid enrollment for eligible patients, increasing capacity, and increasing communication and collaboration. Goal: Champaign County will develop opportunities to improve access to and affordability of medical, behavioral health (mental health and/or substance use), and dental services for those living below 200% of the federal poverty level. Behavioral Health: resource center, promoting education and training on mental and behavioral health for teachers and officers. Goal: Champaign County will improve behavioral health and wellness by increasing capacity and access to care, providing educational opportunities, increasing prevention activities and advocating that treatment works and recovery is possible. Violence (domestic violence, relationship between drug & alcohol abuse and violence): improving mental health services, linking parolees and those incarcerated to resources including housing, jobs, healthcare, counseling, taking medication; developing and maintaining specialty courts. Goal: Prevent violence in Champaign County by providing linkages to services and access to resources for individuals with behavioral health needs, and increasing options for youth to participate in healthy afterschool and summer activities. Obesity (nutrition, diet and exercise, risk factors & complications): improving nutrition and increasing physical activity by increasing street lighting and safety. Goal: Increase the proportion of adults who report being at a healthy weight by 5%. PCMCs review of current community benefit programs found that the hospital is meeting existing community needs through the following programs: the SmileHealthy Partnership, Faith in Action, Crisis Nursery, Diabetes Coalition, Faith2 and Transitions. Please see Part VI, Line 5 for the description of programs in place to address these identified needs along with 2015 objectives and 2015 measurable outcomes. Part VI, Line 5 also includes the system-wide mental health and enrollment strategies that are being used by each hospital in the system. Part V, Section B, Line 14 Federal Poverty Guidelines are also used in determining the basis of calculating amounts charged to patients.
PRESENCE UNITED SAMARITANS MEDICAL CENTER (6)	Part V, Section B, Line 5 A Community Health Needs Assessment (CHNA) is a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon significant unmet community health needs. This CHNA is conducted to meet the hospital partners IRS requirement every three years and the Health Departments Illinois Department of Public Health IPLAN (Illinois Plan for Local Assessment of Needs) requirement every five years. The initial planning meeting for the re-assessment process began on March 12, 2014. At this meeting Jenny Trimmell, VCHD Health Administrator, Dr. Krista Jones with the University of Illinois, Sheri Ervin, Regional Director Community Health Integration, and Jennifer Cord, Regional Mission & Ancillary Officer discussed the assessment process as well as forming the Vermilion County Executive Assessment Committee. Engagement of Public Health Expertise The Vermilion County Health Department, as a certified local health department for Vermilion County, Illinois is charged to assess the health and well-being of the community by retrieving and presenting relevant data, seeking community input, generating dialogue, and identifying existing and needed resources that lead to the development of strategies with measurable outcomes to address the identified priorities. The Vermilion County Health Department has a long standing relationship with area colleges of nursing. Danville Area Community College, Lakeview College of Nursing and the University of Illinois have collaborated with the health department to provide several prevention education and targeted knowledge awareness workshops to members of the community. In 2014, a reassessment was conducted in order to review information for updated and new data. Community and stakeholder surveys were collaboratively distributed by the University of Illinois College of Nursing, Danville Area Community College of Nursing, and Lakeview College of Nursing. Survey information was collected from September 2014 through November 2014. Age range of those surveyed was from 23-67 years of age. The top community health concerns identified in the 2012 IPLAN were Alcohol/Drug Use, Teen Pregnancy, and Obesity. The reassessment in 2014 again identified the same top three health issues. In the summer of 2014, student interns from DePaul University and the University of Illinois at Chicago collected and summarized data in the above categories. This data was compiled into a preliminary report and shared with the Vermilion County partners. Several meetings were held with the CHNA team to review the data in detail, identify gaps or other data sources needed and finalize the report. This report summarizes the community health profile findings conducted for the population served by Vermilion County. The report summarizes the key findings for the community to focus on in developing its community health improvement plan and implementation strategies. IPLAN Community Advisory Committee Presence United Samaritans Medical Centers (PUSMC) Implementation Strategy was developed based on the findings and priorities established by the Vermilion County CHNA and a review of the hospitals existing community benefit activities. PUSMC was one of over 40 stakeholder groups representing a variety of agencies and organizations from across the county. The members represented on the IPLAN Community Advisory Committee are listed below: 708 Mental Health Board Aunt Marthas Health Center (FQHC) Big Brothers/Big Sisters Board of Health Carle Clinic Danville Carle Hoopeston Regional Health Center Center for Children Services Central Christian Church Channel 3 News Crosspoint/YRFC Danville Area Community College Danville Area Community College, School of Nursing Danville Family YMCA Danville Mass Transit Danville School District 118 Faith in Action Fithian (Village of) Hoopeston (City of) - volunteer Hoopeston Multi-Agency I Sing the Body Electric (PUSMC Foundation) Illinois House of Representatives - Chad Hays Lakeview College of Nursing Lakeview College of Nursing New Life Church of Faith Oakwood (Village of) - Mayor Presence Regional EMS Project Success/CAPIT PUSMC - Community Benefit Coordinator PUSMC Foundation, HALO Salvation Army United Way University of Illinois University of Illinois - Chicago College of Nursing VA Illiana Healthcare Vermilion County Regional Office of Education Vermillion Advantage Vermillion County Board Vermillion County Board of Health - president and members Vermillion County Health Department - Administration Vermillion County Health Department - Community Health Services Vermillion County Health Department - Emergency Preparedness Part V, Section B, Line 6 PUSMC partnered with Hoopeston Hospital to complete their CHNA. Part V, Section B, Line 11 The top three community health priorities to be addressed in the 2014-2017 plan are: Teen pregnancy, Alcohol/substance abuse, and *Obesity. Please see Part VI, Line 5 for the description of programs in place to address these identified needs along with 2015 objectives and 2015 measurable outcomes. Part VI, Line 5 also includes the system-wide mental health and enrollment strategies that are being used by each hospital in the system. Part V, Section B, Line 14 Federal Poverty Guidelines are also used in determining the basis of calculating amounts charged to patients.

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?28
Name and address		Type of Facility (describe)
1	PRESENCE PHYSICAL THERAPY 3000 W JEFFERSON ST JOLIET,IL60435	PHYSICAL THERAPY
2	PRESENCE PHYSICAL THERAPY SERVICES 600 SOUTH WEBER ROAD ROMEOVILLE,IL60446	PHYSICAL THERAPY
3	PRESENCE CENTER FOR WOUND CARE 301 NORTH MADISON ST JOLIET,IL60435	WOUND CARE CENTER
4	PRESENCE PHYSICAL THERAPYINDUSTRIAL REH 852 SHARP AVENUE SHOREWOOD,IL60404	PHYSICAL THERAPY
5	MERCY PROFESSIONAL BUILDING PHARMACY 1315 N HIGHLAND Suite 201 AURORA,IL60506	OUTPATIENT PHARMACY
6	PRESENCE PHYSICAL REHAB & SPORT INJURY 2132 JEFFERSON STREET JOLIET,IL60435	PHYSICAL THERAPY
7	PRESENCE PHYSICAL THERAPY SERVICES 1812 LINCOLN HIGHWAY NEW LENOX,IL60451	PHYSICAL THERAPY
8	PRESENCE PHYSICAL THERAPY SERVICES 15120 WALLIN DRIVE PLAINFIELD,IL60544	PHYSICAL THERAPY
9	PRESENCE SLEEP DISORDER CENTER 2132 JEFFERSON STREET JOLIET,IL60435	SLEEP DISORDER CENTER
10	PRESENCE SLEEP LAB 412 SHERIDAN DANVILLE,IL61832	SLEEP DISORDER CENTER
11	PRESENCE UNITED SAMARITANS ONCOLOGY CTR 806 NORTH LOGAN AVENUE DANVILLE,IL61832	ONCOLOGY CENTER
12	PRESENCE MANTENO MEDCENTRE 501 S LOCUST STREET MANTENO,IL60950	MEDICAL OFFICE BUILDING
13	PRESENCE MEDCENTRE EAST 455 WEST COURT STREET KANKAKEE,IL60901	MEDICAL OFFICE BUILDING
14	PRESENCE MEDCENTRE WEST 555 WEST COURT STREET KANKAKEE,IL60901	MEDICAL OFFICE BUILDING
15	PRESENCE MOMENCE MEDCENTRE 739 NORTH DIXIE HIGHWAY MOMENCE,IL60954	MEDICAL OFFICE BUILDING
16	PRESENCE PEOTONE MEDCENTRE 117 SOUTH HARLEM AVENUE PEOTONE,IL60468	MEDICAL OFFICE BUILDING
17	PRESENCE ST MARY'S REGIONAL CANCER CTR 100 PROVENA WAY BOURBONNAIS,IL60914	REGIONAL ONCOLOGY CENTER
18	PRESENCE ST MARY'S IMAGING CENTER 100 PROVENA WAY BOURBONNAIS,IL60914	IMAGING CENTER
19	PRESENCE CENTER FOR HEALTHY AGING 401 EAST UNIVERSITY SUITE 102 CHAMPAIGN,IL61820	SENIOR HEALTH CENTER
20	PRESENCE REGIONAL EMS 408 S NEIL STREET CHAMPAIGN,IL61820	EMS PARAMEDIC SERVICES
21	PRO AMBULANCE SERVICES 408 S NEIL STREET CHAMPAIGN,IL61820	AMBULANCE SERVICES
22	PUSMC RETAIL Pharmacy 800 N LOGAN AVENUE DANVILLE,IL61832	RETAIL PHARMACY
23	PRESENCE SLEEP DISORDER 656 N CONVENT STREET BOURBONNAIS,IL60914	SLEEP DISORDER CENTER
24	PRESENCE ADVANCED IMAGING 410 EAST LINCOLN HIGHWAY NEW LENOX,IL60451	IMAGING CENTER
25	PRESENCE HEALING ARTS PAVILION 410 EAST LINCOLN HIGHWAY NEW LENOX,IL60451	MEDICAL OFFICE BUILDING
26	PRESENCE ADVANCED IMAGING 2000 GLENWOOD AVENUE JOLIET,IL60435	IMAGING CENTER
27	PRESENCE HEALING ARTS PAVILION 16615 SOUTH ROUTE 59 PLAINFIELD,IL60586	MEDICAL OFFICE BUILDING
28	PCMC MOB 1405 WEST PARK STREET URBANA,IL61801	MEDICAL OFFICE BUILDING

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
PART I, LINE 3C	THIS QUESTION IS NOT APPLICABLE BECAUSE PRESENCE HEALTH USES THE FEDERAL POVERTY GUIDELINES.
PART I, LINE 6A	Presence Health, the parent of Presence Central and Suburban Hospitals Network, published a Community Benefit Report with 2015 data, which details the combined charitable impact our ministries have within the communities we serve. Each ministry creates ministry-specific Implementation Strategies which outline the goals and objectives they have established to address the prioritized needs of their communities.
PART I, LINE 6B	The 2015 Presence Health Community Benefit Report was made publicly available through a variety of ways to share the information with the community at large: Print version of report The report will be mailed from the system office to community partners, elected officials, and local leaders. Website A robust community section has been developed and can be found online at www.presencehealth.org/community. This section includes an online, downloadable file of the 2015 Community Benefit Report. Each ministry has its own link on this page. Through this link, Community Health Needs Assessment (CHNA) documents specific to the hospital can be downloaded, including a community-friendly CHNA flipbook, the source documents of all data reviewed, an overall CHNA Report, and an Implementation Strategy. *PowerPoint presentation A standard PowerPoint of the entire 2015 Community Benefit Report has been made available. A customized version of this presentation has also been created for each ministry to share with the community, which shows the local community benefit contributions, persons served, and the 2015 prioritized community needs.
PART I, LINE 7, COLUMN G	Costs from physician clinics are not included in subsidized service totals. PART I, LINE 7, COLUMN F Per 2015 Instructions for Schedule H (Form 990), the Bad Debt Expense of $63,150,366 has been removed from the denominator in calculating the percentage of total expense in Line 7.
PART I, LINE 7 - EXPLANATION OF COSTING METHODOLOGY	THE COST-TO-CHARGE RATIO WAS USED TO DETERMINE SCHEDULE H, PART I, LINE 7A, FINANCIAL ASSISTANCE AT COST. SCHEDULE H, PART I, LINE 7B, UNREIMBURSED MEDICAID, WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. THE REMAINING AMOUNTS REPORTED ON LINE 7 ARE REPORTED AT COST.
PART II, COMMUNITY BUILDING ACTIVITIES	Community building activities include programs that improve the communitys health and safety by addressing the root causes of health problems, such as poverty, homelessness and environmental hazards. Participation in collaborative community efforts to promote public health initiatives is also included, such as engagement in coalitions and advocacy for health improvement. These activities strengthen the communitys capacity to promote the health and well-being of its residents by offering the expertise and resources of the health care organization. Presence Health hospital ministries engage in a variety of community-building activities which ultimately improve the health and well-being of the communities we are privileged to serve, even though they are not specific health activities. Examples of community building activities include: The work of all of our hospitals in support of disaster readiness and emergency preparedness. This work goes above and beyond any licensure requirements to proactively ensure that our communities are safe and prepared if a disaster should present itself. Community Support: Donations from our ministries to organizations addressing the root causes of health problems. Coalition Building: Presence Saint Joseph Medical Center leads a community coalition, Joliet Partners for Healthy Families (JPHF), with the goal of making Will County a healthier place to live. JPHF is working with local legislators on policy, systems and environmental changes. Workforce Development: Presence St. Marys Hospital partners with the Kankakee Regional Volunteer Services coalition. This coalition allows local teen participants the opportunity to use their time and talents for those in need, while providing themselves with excellent exposure to many health-related careers, as well as business communications and early childhood teaching.
PART III, BAD DEBT, MEDICARE, & COLLECTION PRACTICES	PART III, SECTION A, LINE 2 The bad debt reported on Part III, line 2 agrees to the financial statements account. This account reduces the revenue recognized related to the account that is deemed uncollectible to zero.
PART III, SECTION A, LINE 3	The Provision for Financial Assistance Policy allows for accounts in bad debt to be approved for Financial Assistance if the patient meets the criteria. There are possible financial assistance accounts in bad debt, although the exact percentage is unknown as we do not have the appropriate tools to determine this percentage accurately.
PART III, SECTION A, LINE 4	FOR TAX RETURN PURPOSES THE BAD DEBT EXPENSE IS SHOWN ON PART IX, STATEMENT OF FUNCTIONAL EXPENSE. FOR AUDIT PURPOSES THE ORGANIZATION FOLLOWS ASU 2011-07 PRESENTATION. PATIENTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENTS ACCOUNTS RECEIVABLE, PRESENCE HEALTH ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOUCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, PRESENCE HEALTH ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE PATIENTS ARE SCREENED AGAINST PRESENCE HEALTH CHARITY CARE POLICY AND UNINSURED DISCOUNT POLICY. FOR ANY REMAINING PATIENT RESPONSIBILITY BALANCE, PRESENCE HEALTH RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATE (OR DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.
PART III, SECTION B, LINE 8	Presence Health computes the Medicare shortfall based on a ratio of cost to charges. Presence Health believes it is important for the community and the IRS to be made aware of government shortfalls, specifically Medicare. However, we acknowledge that Medicare shortfalls may be experienced by other than non-profit healthcare organizations. As such, Presence Health does not believe that Medicare shortfall should be considered community benefit.
PART III, SECTION C, LINE 9B	Collection policies are the same for all Presence Health entities. Patients are notified of the financial assistance policy at the time of registration via posted notifications and on every account statement that is sent to them. This information is available in a number of languages. Patients may apply for financial assistance at any time during the revenue cycle. Per the Provision for Financial Assistance Policy, the collection process is as follows: 1. Pre-Litigation Review: Prior to an account being authorized for the filing of suit for non-payment of a patient bill, a final review of the account will be conducted and approved by the Financial Counseling Representative (or designee) to make sure that no application of financial assistance was ever received and that there exists objective evidence that the patient does have sufficient financial means to pay all or part of his/her bill. Prior to a collections suit being filed, the Self-pay Collections Director must review and approve. 2. Residential Liens: No hospital will place a lien on the primary residence of a patient who has been determined to be eligible for Financial Assistance/Charity Care, for payment of the patient's undiscounted balance due. Further, in no case will any hospital execute a lien by forcing the sale or foreclosure of the primary residence of any patient to pay for any outstanding medical bill. 3. No Use of Body Attachments: No hospital will use body attachment to require any person, whether receiving Financial Assistance/Charity Care discounts or not, to appear in court. 4. Collection Agency Referrals: Each hospital Finance accounting will ensure that all collection agencies used to collect patient bills promptly refer any patient who indicates financial need, or otherwise appears to qualify for Financial Assistance/Charity Care discounts, to a financial counselor to determine if the patient is eligible for such a charitable discount. For more information about Presence Healths Financial Assistance Program, visit http://presencehealth.org/patients-and-visitors/financial-assistance.
PART VI, LINE 2 NEEDS ASSESSMENT	Presence Health ministries join forces with local community organizations to assess the health needs of the community. Community health needs assessments (CHNAs) are completed for the individual counties we serve with community partners every 3 years as required. To supplement the CHNA, Presence hospitals also review and analyze Inpatient and Emergency Department utilization on an annual basis to uncover any new community health trends. In addition to assessing the health needs, Presence hospital ministries also complete medical staff development plans. The plans are conducted by external consultants, who provide an independent assessment of the need for physicians by specialty within the hospitals primary service area as defined by Stark regulations. Identifying community needs is just one step in the CHNA process. The most critical step is prioritizing and aligning expertise to make an impact on the identified needs. To facilitate this process, the Board of Directors of each hospital ministry has appointed a Community Leadership Board that is ultimately responsible for the oversight and direction of the community benefit initiatives. On a triennial basis this advisory board, which is made up of community members, approves the hospitals Implementation Strategy pursuant to authority delegated by the hospital ministrys board of directors. This plan identifies the priorities and actions that will take place to transform community health. Identifying community needs is just one step in the CHNA process. The most critical step is prioritizing and aligning expertise to make an impact on the identified needs. To facilitate this process, the Board of Directors of each hospital ministry has appointed a Community Leadership Board that is ultimately responsible for the oversight and direction of the community benefit initiatives. On a triennial basis this advisory board, which is made up of community members, approves the hospitals Implementation Strategy pursuant to authority delegated by the hospital ministrys board of directors. This plan identifies the priorities and actions that will take place to transform community health.
PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	Presence Health hospital ministries proactively communicate the availability of our financial assistance/charity care programs by using multiple types of appropriate media and in multiple appropriate languages. The mechanisms used by Presence Health hospitals to communicate the availability of Financial Assistance/Charity Care include, but are not limited to the following: 1. Signage: Signs are posted prominently throughout high traffic areas of our ministries, as well as within our inpatient and outpatient registration/patient admitting areas and emergency departments. Signs state that patients may be eligible for Financial Assistance/Charity Care discounts, and describe how to obtain more information, including identification of appropriate hospital representatives by title. Signs are in multiple languages. 2. Provision of Financial Assistance Materials to Uninsured Patients: Presence Health hospitals provide a summary of its Financial Assistance Programs and a Financial Assistance application to all persons receiving hospital care that it identifies as uninsured patients at the time of in-person registration, admission, or such later time that the patient is first identified as an uninsured patient. For patients presenting in the Emergency Department, all Presence Health hospitals provide such Financial Assistance materials at such time and in such manner as is consistent with their obligations under EMTALA to access and stabilize the patient before making inquiry of the patients ability to pay. 3. Brochures: Brochures, information sheets and similar forms of written communication regarding the hospitals Financial Assistance/Charity Care policy are maintained in appropriate areas of the hospital (e.g. Emergency Department, organized registration areas, the Business Office). These communications state in multiple languages that the hospital offers Financial Assistance/Charity Care discounts and describes how to obtain more information. 4. Website: Comprehensive information about our financial assistance programs including eligibility criteria, application details, and contact information is also available on our consumer Web site (http://presencehealth.org/patients-and-visitors/financial-assistance). 5. Billing Notices: Each Presence Health hospital includes a note on or with the hospital bill and/or statement regarding the hospitals Financial Assistance/Charity Care program and how the patient may apply for consideration under this program. 6. Financial Counselors: Each Presence Health hospital has one or more financial counselors whose contact information is listed or provided with other information concerning the Financial Assistance/Charity Care discount program. These counselors are available to discuss eligibility and other questions concerning the program, and provide assistance with applications. They are also available to meet with patients during their stay if they have questions about their ability to pay for services and our financial assistance programs. 7. Notification of Determination: When a Presence Health hospital makes a determination that a patients bill is discounted or adjusted based on a determination of financial need, the hospital notifies the patient of such eligibility determination and that there is no further collection action taken on the discounted portion of the patients bill.
PART VI, LINE 4 COMMUNITY INFORMATION	Presence Hospital ministries provide services at 150 sites, including eleven acute care hospitals with a total of 3,188 staffed beds and over 90 primary and specialty care clinics. These ministries offer a broad range of services from highly specialized tertiary services to an extended network of primary and ambulatory care. Presence Health hospital ministries have identified a separate service area for each of its acute care hospitals utilizing a consistent methodology and reflecting a combination of geographic location and market share criteria. The total service area of each ministry represents approximately 80% to 90% of the total inpatient discharges from that facility. The primary service area (the "Primary Service Area") of each facility represents approximately 65 to 75% of such discharges and the secondary service area (the "Secondary Service Area") of each facility represents approximately 15 to 25% of such discharges. The Primary Service Areas and Secondary Service Areas have been determined by utilizing a patient origin analysis to identify those zip codes that represent inpatient discharges. These zip codes are then mapped to identify geographic coverage of the Primary Service Areas and Secondary Service Areas. Many of the Presence Health hospital ministries facilities are located in population growth areas. Based upon population estimates and projections obtained from Claritas, Inc., the population of the our hospitals combined service area is expected to grow at a rate of 1.9% annually between 2012 and 2017, compared with a growth rate of 1.3% and 1.6% per year in the Chicago MSA and in Illinois, respectively. Of Presences total service area population, 10.7% is over the age of 65, compared to 11.1% and 12.3% in the Chicago MSA and in Illinois, respectively. Presence Covenant Medical Center, Champaign, IL (PCMC): Champaign County is the tenth largest county in the state of Illinois with a 2013 population of 203,276. In the primary service area, 11% of the population is over the age 65 and the median household income is $46,708. The primary demographic make-up of Champaign County is as follows: 74.1% white, 12.2% black or African American, 9.1% Asian, 5.1% Hispanic/Latino. Just under 22% of families in Champaign County live below the poverty level. The PCMC service area is defined by zip codes below: Service Area: Primary Market Zip Code City 61821 Champaign 61801 Urbana 61820 Champaign 61866 Rantoul 61802 Urbana 61953 Tuscola 61880 Tolono 61873 Saint Joseph 61956 Villa Grove 61874 Savoy 61849 Horner 61878 Thomasboro 61822 Champaign 61847 Gifford 61877 Sidney 61943 Oakland 61851 Ivesdale 61884 White Heath 61839 De Land 61931 Humboldt 61844 Fithian 61862 Penfield 61882 Weldon 61773 Sibley 61930 Hindsboro 61812 Armstrong 60933 Elliott 61932 Hume 61871 Royal 60926 Claytonville 61845 Foosland 61941 Murdock Service Area: Secondary Market Zip Code City 60948 Loda 60957 Paxton 61856 Monticello 61853 Mahomet 61938 Mattoon 61910 Arcola 60936 Gibson City 61920 Charleston 61942 Newman 61813 Bement Presence United Samaritans Medical Center (PUSMC), Danville, IL: PUSMCs primary and secondary service areas have an estimated population of 81,625 residents. In the primary service area, 16.7% of the population is over the age 65 and the average household income is $40,463. The primary demographic make-up of Vermillion County is as follows: 83.6% white, 13.3% black or African American, 4.5% Hispanic/Latino. 18.8% of families in Vermillion County live below the poverty level. The PUSMC service area is defined by zip codes below: Service Area: Primary Market Zip Code City 61832 Danville 61834 Danville 61846 Georgetown 61883 Westville 61833 Tilton Service Area: Secondary Market Zip Code City 47932 Covington, IN 60942 Hoopeston 61817 Catlin 61858 Oakwood 61870 Ridge Farm 61924 Chrisman 60963 Rossville 47987 Veedersburg, IN 61841 Fairmont 47974 Perrysville, IN 47993 Williamsport, IN 61814 Bismark 61865 Potomac 47928 Cayuga, IN 47952 Kingman, IN 61876 Sidell 61811 Alvin 61844 Fithian 61850 Indianola 47991 West Lebanon, IN 61848 Henning 47982 State Line, IN 60960 Rankin 47918 Attica, IN 61812 Armstrong 60973 Wellington 61940 Metcalf 61831 Collision Presence Saint Joseph Medical Center (PSJMC), Joliet, IL: PSJMCs primary service has an estimated population of 677,560 according to the 2010 census. In the primary service area, 9.3% of the population is over the age 65 and the median household income is $75,906. Approximately, 7.1% of the population in Joliet lives below the poverty level. The racial makeup of the city is 76.0% White, 11.2% African American, 4.6% Asian, and 7.9% Multi-racial/Other. The 2014 population also estimates that 22.5% are Hispanic or Latino. The Presence Saint Joseph Medical Center service area is defined by zip codes below: Service Area: Primary Market Zip Code City 60435 Joliet 60436 Joliet 60544 Plainfield 60433 Joliet 60431 Joliet 60432 Joliet 60434 Joliet 60585 Plainfield 60586 Plainfield 60403 Crest Hill 60404 Shorewood Service Area: Secondary Market Zip Code City 60451 New Lenox 60481 Wilmington 60450 Morris 60410 Channahon 60446 Romeoville 60447 Minooka 60416 Coal City 60408 Braidwood 60421 Elwood 60441 Lockport 60448 Mokena 60442 Manhattan 60423 Frankfort 60440 Bolingbrook 60424 Gardner 60439 Lemont 60407 Braceville 60474 South Wilmington 60491 Homer Glen Presence St. Marys Hospital (PSMH), Kankakee, IL: PSMHs primary service has an estimated population of 113,449, according to the 2010 census. In the primary service area 14.1% of the population is over the age 65 and the average household income is $49,266. 15% of the population in Kankakee lives below the poverty level. The racial makeup of the city is 81.3% White, 15.5% African American, 9.3% Hispanic. The PSMH service area is defined by zip codes below: Service Area: Primary Market Zip Code City 60901 Kankakee 60914 Bourbonnais 60915 Bradley 60954 Momence 60950 Manteno Service Area: Secondary Market Zip Code City 60964 Saint Anne 60927 Clifton 60922 Chebanse 60940 Grant Park 60970 Watseka 60941 Herscher 60913 Bonfield 60938 Gilman 60911 Ashkum 60955 Onarga 60944 Hopkins Park 60951 Martinton 60930 Danforth 60910 Aroma Park 60912 Beaverville 60919 Cabery 60961 Reddick 60917 Buckingham 60935 Essex 60928 Crescent City 60481 Wilmington 60468 Peotone 60420 Dwight 60958 Pembroke Township Presence Mercy Medical Center (PMMC), Aurora, IL: Aurora, where PMMC resides, is the second largest city in Illinois and accounts for most of the hospitals primary service area. Kane Countys population according to the 2010 census is 515,269. In the primary service area, 10.7% of the population is over the age 65 and the average household income is $69,496. Within the primary service area (Aurora), approximately 35,000 individuals (21.3%) reside in medically underserved areas (MUAs). Of that population, about 30% fall 200% below the federal poverty level. Within the MUA, 68% of the population is Hispanic and 11% is African American. Fifty-three per cent are underinsured and 47% are Medicaid recipients. 10.1% of residents in Kane County live below the poverty level. PMMCs service area is defined by zip codes below: Service Area: Primary Market Zip Code City 60506 Aurora 60505 Aurora 60542 North Aurora 60538 Montgomery 60504 Aurora 60507 Aurora 60502 Aurora Service Area: Secondary Market Zip Code City 60510 Batavia 60543 Oswego 60560 Yorkville 60548 Sandwich 60545 Plano 60174 Saint Charles 60554 Sugar Grove 60134 Geneva 60552 Somonauk 60503 Aurora 60511 Big Rock 60520 Hinckley 60119 Elburn 60115 DeKalb 60541 Newark 60512 Bristol 60531 Leland 60556 Waterman 60539 Mooseheart Presence Saint Joseph Hospital (PSJH), Elgin, IL: Kane Countys population according to the 2010 census is 515,269. In the primary service area, 8.6% of the population is over the age 65 and the average household income is $59,032. 12.3% of families in Elgin live below the poverty level. The racial makeup of the city is 65.9% White, 7.4% African American, 5.4% Asian, and 3.6% from two or more races. 43.6% of the population are Hispanic or Latino of any race. The PSJHs service area is defined by zip code below: Service Area: Primary Market Zip Code City 60123 Elgin 60120 Elgin 60124 Elgin 60121 Elgin 60110 Carpentersville 60177 South Elgin 60140 Hampshire 60118 Dundee Service Area: Secondary Market Zip Code City 60102 Algonquin 60103 Bartlett 60174 Saint Charles 60014 Crystal Lake 60107 Streamwood 60142 Huntley 60098 Woodstock 60050 McHenry 60051 McHenry 60156 Lake in the Hills 60175 Saint Charles 60136 Gilberts 60134 Geneva 60013 Cary 60152 Marengo 60135 Genoa 60109 Burlington 60012 Crystal Lake 60180 Union
PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH	Presence Health hospitals are faith-based ministries that provide services based upon the ethical and religious directives of the Catholic Church. Presence Health hospitals enhance the public health of our communities by: 1. Ensuring our medical staff is open to all qualified physician. 2. All of our hospitals are accredited and in good standing with the Joint Commission Accreditation of Healthcare Organizations. 3. Ensuring our board of directors is diverse and able to provide expertise, and made up of independent members of the communities we serve. Our board members must follow a conflict of interest policy. 4. Reinvesting surplus funds into the organization to improve patient care though new programs and technology. 5. Providing financial assistance, sliding scale discounts and has collection practices that are in compliance with state and federal guidelines. In addition, we follow the financial assistance and charity guidelines of the Catholic Health Association. 6. Participating in all government sponsored health care programs, Medicare, Medicaid, CHAMPUS, Tricare, SCHIP and others. 7. Providing emergency room services in all of our communities and providing training to local fire departments and ambulances. Our emergency room participates with local police and fire departments in disaster drills. 8. Staffing Board Certified Emergency Room Physicians in our emergency room and urgent care services. We treat patients according to EMTALA guidelines and serve all patients regardless of ability to pay. In addition, we are committed to determining the needs of our communities and creating ways to meet those needs. The obligation to reach out to those in need and improve health flows directly from our Catholic identity and the heritage of our founding congregations. In each of the communities we serve, we work with others including charitable organizations, community health providers, elected officials, business leaders, schools, churches, and residents to look at the overall health of the community and identify the greatest needs. We then make a plan and develop strategies together with our communities to address the highest priority health needs. The highest priority needs and the programs weve developed to meet these needs are identified below for each hospital. Presence Covenant Medical Center, Champaign, IL (PCMC) Community Resource Center Identified Need: Access to Care Presence Covenant Community Resource Center was developed to address unmet medical and social needs of those patients that were frequently utilizing the Emergency Room. It has recently expanded its services to serve any community member that seeks assistance. The center primarily provides community referral services to clients and helps them connect with an array of social service agencies based on a holistic approach to medical problems. The PCMC Community Resource Center is staffed by three PCMC Health Navigators and one PCMC social worker. In addition to the hospital staff, the center is made up of community partners that provide services at the center. These partners include: Catholic Charities, Champaign County Christian Health Clinic, Champaign County Health Care Consumers, Patient Innovation Center, and Promise Health. 2015 Objectives: Solidify process of case coordination for patients identified for our program. Develop a client registry and charting system. Expand services from solely working with Emergency Department patients to also working with any community member that seeks assistance. Develop standards and procedures for working with our target population. Increase outreach to community services to increase community partners and better serve our clients. 2015 Measurable Outcomes: In 2015, the navigators held a case load of approximately 160-200 SuperUsers at any time. As of 12/15/15, we have over 3,500 people entered into our database. The navigators averaged 30.4 contacts per week in a designated time in 2015. Standards and Procedures manual modified throughout 2015. We now have over 150 different referral sources. Smile Healthy SmileHealthy is a collection of dental programs that work to improve the oral health of the community through providing preventive care, treatment, and education. Mobile Dental Program - The mobile program sets up inside dozens of locations and provides exam, preventive services, and treatments such as fillings and extractions. Pediatric Restorative Outpatient Surgery (PROPS) - Once a month, a SmileHealthy dentist provides comprehensive treatment under general anesthesia in hospital setting. The program cares for three low-income children each month who have extensive treatment plans often needing 10-20 treatments at once. Dental Emergency Referral - SmileHealthy offers an education and referral program for patients that present to the Emergency Department with dental pain. The program provides oral health and nutrition education, counseling and case management to facilitate patients getting treatment from a dentist and works to reduce repeat visits to the Emergency Department for the same dental health issues. The program targets low-income uninsured adults who have difficulty finding dental care. 2015 Objectives Provide 200 People with 600 dental treatments to reduce repeat Emergency Department visits for dental conditions Provide care for 36 children with approximately 12 treatments per child Increase the number of patients who receive dental education through the Dental Emergency Referral Program (DEERP) 2015 Measurable Outcomes These results are from January-November 2015: Provided 714 treatments to 152 unduplicated patients. There were total of 244 patient visits in 14 mobile clinics. We anticipate an additional 20 visits and 40 treatments for the upcoming December mobile clinic. Provided 253 treatments to 17 children. We expect additional 5 children and 50 treatments for two December PROPS days. 30 people were seen at DEERP. Faith in Action (FIA) Faith in Action is a volunteer care giving ministry in Champaign-Urbana and the surrounding areas. The program uses faith and community volunteers to provide assistance to the senior population 55+ years. We provide transportation to medical appointments, banking, shopping and other necessary errands. Other services include home and phone visits, chores, and respite care. 2015 Objectives Seniors are directly assisted by the FIA ministry to remain safely in their home. Work with families to fill in gaps with what family is able to do. Increase the number of Faith in Action volunteers. Annual Survey of Volunteer Care Givers and Care Receivers. Conduct follow-up calls for Care Receivers after Chore Day. 2015 Measurable Outcomes Seniors are directly assisted by the FIA ministry to remain safely in their home, with access to care Promote health and wellness with seniors Increase the number of Faith in Action volunteers Center for Healthy Living The Center for Healthy Living (CHL) provides health and wellness programs that promote healthy living, reduce the risk of disease, and preserve independence. CHL offers a variety of educational programs, screenings, special events, and other services for adults that address the physical, social, mental, and spiritual dimensions of health. Most programs offered by CHL are free of charge. 2015 Objectives Promote healthy living, reduce the risk of disease, and preserve independence 2015 Measurable Outcomes The Center for Healthy Living was not included in the previous Implementation Strategy, so there are no previous baselines or outcomes. Faith2 The purpose of FAITH2: "Funds to Accelerate Innovation towards healing and hope", is to serve as a catalyst for innovation and acceleration of community partnership and programs to improve the health of the communities we serve consistent with the Mission, Vision, and Values of our Ministry. Promise Healthcare is dedicated to improving the health of the community through treatment, prevention and education, which aligns with our mission. In 2015, Presence Covenant Medical Centers Foundation funded Promise Healthcare through its FAITH2 program the amount of $103,824 a second year for their project: Promise Healthcare at the Community Resource Center (CRC), to move their startup nurse practitioner satellite at the CRC to an established clinic, to work on possible expansion and improvements, to begin to address population health, and to potentially create a pilot structure for care coordination through Medicaid managed care. Enrollment Strategy In response to a demonstrated community need of improving affordable access to health care, Presence Health and its community partners engaged in the development of a community-wide enrollment strategy so as to decrease the percentage of Illinois residents without health insurance. An over-arching strategy was created in partnership with community stakeholders to guide the 2014-2015 Open Enrollment period. The model boasts a four-
PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM	The Provena Health and Resurrection Health Care Systems combined on November 1, 2011 to form a new health system, Presence Health, creating a comprehensive family of not-for-profit health care services and the single largest Catholic health system based in Illinois. Presence Health embodies the act of being present in every moment we share with those we serve and is the cornerstone of a patient, resident and family-centered care environment. Presence Health embodies the way we choose to be present in our communities, as well as with one another and those we serve. Presence Health is sponsored by five congregations of Catholic religious women: the Franciscan Sisters of the Sacred Heart, the Servants of the Holy Heart of Mary, the Sisters of the Holy Family of Nazareth, Sisters of Mercy of the Americas and the Sisters of the Resurrection. As was the case from our very beginnings, Presence Health is called to be much more than just a provider of health services. Presence Health has instilled within all of its ministries that are committed to responding to the needs of those we are privileged to serve; delivering high quality care that is accessible to all. It is this culture of caring and giving that drives our diligent efforts to ensure we return the optimal value of our charitable assets to our local communities. As a not-for-profit health system, Presence Health invests a significant portion of its operating capital into the community through programs to serve vulnerable populations, such as the poor and uninsured, manage chronic conditions, and promote health education and promotion outreach and initiatives. In Fiscal Year 2015, this included $206 million in community benefit activities. Presence Health thus takes a systems approach to its community benefit efforts, and therefore ensures its member hospitals and other entities and affiliates are helping to promote and address the health needs of the communities they serve. For more information on Presence Health, visit www.presencehealth.org
PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT	Presence Health files its annual community benefit report in Illinois.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number
36-4195126

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) Champaign County Healthcare Consumers 44 E Main St Suite 208 Champaign,IL618203649	37-1073411	501(c)(3)	80,883	COMMUNITY ACCESS AND RESOURCES
(2) UNITED WAY OF WILL COUNTY 54 N OTTAWA STREET SUITE 300 JOLIET,IL60432	36-2515625	501(c)(3)	10,000	COMMUNITY HEALTH NEEDS
(3) WILL-GRUNDY MEDICAL CLINIC 213 EAST CASS STREET JOLIET,IL60432	36-3492306	501(C)(3)	35,000	FREE HEALTH CLINIC

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1) SCHOLARSHIPS	50	49,044
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
Form Schedule I, Part I, Line 2	ALL SCHOLARSHIPS ARE MONITORED BY THE APPROPRIATE GRANT ADMINISTRATORS TO ENSURE THAT ALL FUNDS ARE USED FOR QUALIFIED EDUCATION EXPENSES, AND THAT EDUCATION IS PURSUED AND COURSES ARE COMPLETED. ALL ORGANIZATIONS WHICH ARE RECIPIENTS OF GRANT FUNDS ARE TAX-EXEMPT ORGANIZATIONS DESCRIBED IN 501(C)(3) AND THEREFORE THE CORPORATION DOES NOT MONITOR THE USE OF THOSE FUNDS.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

Any related organization?

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

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

The organization?

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1SANDRA BRUCEPRESIDENT/CEO/EX-OFFICIO-12/30	(i) (ii)	0 ------------- 1,055,767	0 ------------- 329,629	0 ------------- 282,693	0 ------------- 5,300	0 ------------- 15,581	0 ------------- 1,688,970	0 ------------- 0
2MICHAEL ENGLEHARTPRESIDENT/CEO	(i) (ii)	0 ------------- 284,074	0 ------------- 250,000	0 ------------- 6,731	0 ------------- 36,674	0 ------------- 3,223	0 ------------- 580,702	0 ------------- 0
3JEANNIE C FREYSECRETARY	(i) (ii)	0 ------------- 446,640	0 ------------- 105,384	0 ------------- 25,212	0 ------------- 102,389	0 ------------- 23,370	0 ------------- 702,995	0 ------------- 0
4ANTHONY J FILERTREASURER	(i) (ii)	0 ------------- 658,477	0 ------------- 161,537	0 ------------- 581,895	0 ------------- 1,185,735	0 ------------- 23,595	0 ------------- 2,611,239	0 ------------- 377,532
5PATRICK QUINNASSISTANT TREASURER	(i) (ii)	0 ------------- 234,711	0 ------------- 62,409	0 ------------- 31,104	0 ------------- 49,265	0 ------------- 22,215	0 ------------- 399,704	0 ------------- 18,512
6JULIE ROKNICHASSISTANT SECRETARY	(i) (ii)	0 ------------- 189,526	0 ------------- 27,407	0 ------------- 162	0 ------------- 9,850	0 ------------- 20,790	0 ------------- 247,735	0 ------------- 0
7MICHAEL L BROWNREGIONAL PRESIDENT & CEO-FXV	(i) (ii)	404,868 ------------- 0	99,498 ------------- 0	75,814 ------------- 0	84,382 ------------- 0	13,785 ------------- 0	678,347 ------------- 0	43,575 ------------- 0
8JARED C ROGERSREGIONAL PRESIDENT & CEO-CES	(i) (ii)	371,917 ------------- 0	87,115 ------------- 0	30,936 ------------- 0	60,026 ------------- 0	16,331 ------------- 0	566,325 ------------- 0	20,800 ------------- 0
9DAVID R FRANZBLAUCONVERSION - Regional CMO	(i) (ii)	217,845 ------------- 0	43,995 ------------- 0	185,755 ------------- 0	58,183 ------------- 0	8,842 ------------- 0	514,620 ------------- 0	0 ------------- 0
10ANIL B GOPINATHREGIONAL CHIEF MEDICAL OFFFXV	(i) (ii)	310,246 ------------- 0	25,728 ------------- 0	18,796 ------------- 0	13,250 ------------- 0	46,145 ------------- 0	414,165 ------------- 0	0 ------------- 0
11JANICE M NEMRIRGN CHIEF AMB & ANCIL OFF-SSB	(i) (ii)	233,395 ------------- 0	71,436 ------------- 0	67,429 ------------- 0	38,882 ------------- 0	13,634 ------------- 0	424,776 ------------- 0	18,001 ------------- 0
12JACQUELINE J MEDLANDCHIEF NURSING OFFICER-SSB	(i) (ii)	199,945 ------------- 0	74,498 ------------- 0	139,924 ------------- 0	13,250 ------------- 0	66,742 ------------- 0	494,359 ------------- 0	0 ------------- 0
13DEBORAH A SCHIMEROWSKIREGIONAL FIN OFFICER- CES/SSB	(i) (ii)	230,431 ------------- 0	65,245 ------------- 0	21,540 ------------- 0	13,250 ------------- 0	8,386 ------------- 0	338,852 ------------- 0	16,046 ------------- 0
14KEVIN W LARKINREGIONAL FINANCE OFFICER-FXV	(i) (ii)	217,797 ------------- 0	77,077 ------------- 0	17,878 ------------- 0	16,253 ------------- 0	21,774 ------------- 0	350,779 ------------- 0	12,895 ------------- 0
15CATHERINE EMANUELREGN STRATEGY & GROWTH OFFCES	(i) (ii)	223,416 ------------- 0	53,396 ------------- 0	8,728 ------------- 0	13,250 ------------- 0	0 ------------- 0	298,790 ------------- 0	0 ------------- 0
16MOLLY A NICHOLSONREGIONAL CHIEF NURSING OFFICER	(i) (ii)	194,930 ------------- 0	56,357 ------------- 0	15,078 ------------- 0	17,948 ------------- 0	20,112 ------------- 0	304,425 ------------- 0	12,001 ------------- 0
17SYED SAEED P BOKHARIPSMH CHIEF MEDICAL OFFICER	(i) (ii)	218,244 ------------- 0	8,313 ------------- 0	33,235 ------------- 0	0 ------------- 0	9,036 ------------- 0	268,828 ------------- 0	0 ------------- 0
18GRACE L MCBRIDEREGIONAL CHIEF NURSING OFFICER	(i) (ii)	223,148 ------------- 0	23,485 ------------- 0	1,440 ------------- 0	10,969 ------------- 0	13,564 ------------- 0	272,606 ------------- 0	0 ------------- 0
19JENNIFER S CORDREGCHF AMB/ANC/SPT/MSN OFF-CES	(i) (ii)	157,789 ------------- 0	50,945 ------------- 0	15,037 ------------- 0	9,787 ------------- 0	22,419 ------------- 0	255,977 ------------- 0	10,833 ------------- 0
20ERIC M RHODESREG CHIEF AMB & ANC OFF-FXV	(i) (ii)	159,232 ------------- 0	38,794 ------------- 0	11,716 ------------- 0	5,697 ------------- 0	19,464 ------------- 0	234,903 ------------- 0	8,801 ------------- 0
21TIMOTHY J DAUGHERTYREGN STRATEGY & GROWTH OFFSSB	(i) (ii)	185,042 ------------- 0	14,427 ------------- 0	782 ------------- 0	6,192 ------------- 0	21,614 ------------- 0	228,057 ------------- 0	0 ------------- 0
22SURENDRA M GULATIPHYSICIAN	(i) (ii)	468,623 ------------- 0	0 ------------- 0	5,464 ------------- 0	13,250 ------------- 0	15,058 ------------- 0	502,395 ------------- 0	0 ------------- 0
23LESLIE A MASOODPHYSICIAN	(i) (ii)	331,983 ------------- 0	0 ------------- 0	314 ------------- 0	10,404 ------------- 0	22,052 ------------- 0	364,753 ------------- 0	0 ------------- 0
24JOSEPH R DANNAMEDICAL DIRECTOR	(i) (ii)	292,848 ------------- 0	0 ------------- 0	1,958 ------------- 0	7,515 ------------- 0	19,968 ------------- 0	322,289 ------------- 0	0 ------------- 0
25MICHAEL PANUSKAMEDICAL DIRECTOR	(i) (ii)	262,882 ------------- 0	0 ------------- 0	27,679 ------------- 0	18,550 ------------- 0	11,121 ------------- 0	320,232 ------------- 0	0 ------------- 0
26SHOBHANA RAVIKUMARPHYSICIAN	(i) (ii)	246,145 ------------- 0	12,500 ------------- 0	362 ------------- 0	13,201 ------------- 0	19,738 ------------- 0	291,946 ------------- 0	0 ------------- 0
27LISA M LAGGERFORMER REG CHIEF REL OFFICER	(i) (ii)	0 ------------- 198,932	0 ------------- 71,009	0 ------------- 62,924	0 ------------- 23,268	0 ------------- 14,601	0 ------------- 370,734	0 ------------- 16,046
28AMY D STEVENSFORMER COO	(i) (ii)	0 ------------- 323,777	0 ------------- 130,862	0 ------------- 59,266	0 ------------- 636,826	0 ------------- 2,564	0 ------------- 1,153,295	0 ------------- 0
29Connie J NoltemeyerFORMER REGIONAL QUALITY LEADER	(i) (ii)	143,121 ------------- 0	1,087 ------------- 0	1,262 ------------- 0	0 ------------- 0	4,275 ------------- 0	149,745 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
DETERMINATION OF COMPENSATION OF ORGANIZATION'S CEO/EXECUTIVE DIRECTOR	SCHEDULE J, PART I, LINE 3 COMPENSATION FOR THE CORPORATION'S CEO AND OTHER OFFICERS OR KEY EMPLOYEES IS DETERMINED IN ACCORDANCE WITH WRITTEN POLICIES AND PROCEDURES ADOPTED BY THE BOARD OF DIRECTORS OF THE CORPORATION AND THE CORPORATIONS ULTIMATE PARENT, PRESENCE HEALTH NETWORK. SUCH POLICIES AND PROCEDURES ARE APPLIED BY THE HUMAN RESOURCES COMMITTEE OF PRESENCE HEALTH NETWORK, WHICH CONSISTS WHOLLY OF INDEPENDENT DIRECTORS. PRESENCE HEALTH NETWORK USES MARKET DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH BASE SALARIES AND TOTAL CASH COMPENSATION OPPORTUNITIES. THE HUMAN RESOURCES COMMITTEE MONITORS EXECUTIVE TOTAL COMPENSATION, ANNUALLY REVIEWING AND APPROVING COMPENSATION CHANGES FOR EACH EXECUTIVE, AND REGULARLY REPORTING ITS ACTIVITIES TO THE BOARD.
SEVERANCE PAYMENTS	SCHEDULE J, PART I, LINE 4A PRESENCE HAS THREE SEVERANCE PLANS DEPENDING UPON LEVEL. THESE PLANS ALLOW INDIVIDUALS WHOSE JOBS HAVE BEEN ELIMINATED AND WHO HAVE NOT BEEN ABLE TO FIND A SIMILAR POSITION WITHIN THE SYSTEM TIME TO TRANSITION. THE NUMBER OF WEEKS OF WAGE CONTINUATION ARE BASED UPON LENGTH OF SERVICE. THE PLANS ARE NOT FUNDED. THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR YEAR 2015: ANTHONY J. FILER $ 1,169,835 DAVID R FRANZBLAU $ 152,132 SYED SAEED P BOKHARI $ 28,846 THE CORPORATION ALSO ACCRUED DEFERRED SEVERANCE FOR THE FOLLOWING INDIVIDUALS, WHICH WILL VEST IN A LATER YEAR: DAVID R FRANZBLAU $ 58,183 AMY D STEVENS $ 593,357
PAYMENTS FROM A SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN	SCHEDULE J, PART I, QUESTION 4B IN ORDER TO ENHANCE THE ABILITY OF PRESENCE HEALTH TO ATTRACT AND RETAIN QUALIFIED MANAGEMENT PERSONNEL BY PROVIDING ELIGIBLE EXECUTIVES WITH ADDITIONAL RETIREMENT BENEFITS ON A DEFERRED BASIS, PRESENCE HEALTH NETWORK MAINTAINS AN UNFUNDED SUPPLEMENTAL RETIREMENT PLAN (THE "PLAN") FOR A SELECT GROUP OF MANAGEMENT, WHICH IS INTENDED TO COMPLY WITH SECTION 457(F), AND SECTION 409A OF THE INTERNAL REVENUE CODE. THE PLAN, PRESENCE HEALTH NETWORK CREDITS TO SUCH ELIGIBLE EXECUTIVE'S RETIREMENT ACCOUNT AN AMOUNT BASED ON A PERCENTAGE OF SALARY. EARNINGS AND/OR LOSSES ON INVESTMENTS ARE CREDITED AT A RATE EQUAL TO THE RATE OF RETURN OVER THE SAME PERIOD ON INVESTMENT OPTIONS SELECTED BY THE ELIGIBLE EXECUTIVE. ELIGIBLE EXECUTIVES ARE ENTITLED TO RECEIVE BENEFITS ON THE EARLIEST OF (I) JANUARY 1 OF THE THIRD CALENDAR YEAR BEGINNING AFTER THE YEAR IN WHICH SUCH CONTRIBUTION IS CREDITED, (II) ATTAINING AGE 62, OR (III) ATTAINING THE AGE OF 60 IF THE ELIGIBLE EXECUTIVE HAS COMPLETED TEN (10) YEARS OF SERVICE. THE FOLLOWING LISTED INDIVIDUALS BECAME VESTED IN SUPPLEMENTAL RETIREMENT BENEFITS UNDER THE SERP, AND THEREFORE HAD BENEFITS INCLUDED IN THEIR TAXABLE INCOME: SANDRA BRUCE $ 265,646 ANTHONY J FILER $ 558,075 PATRICK QUINN $ 21,921 MICHAEL L BROWN $ 59,255 JARED C ROGERS $ 26,971 JANICE M NEMRI $ 18,941 DEBORAH A. SCHIMEROWSKI $ 20,596 KEVIN W LARKIN $ 17,036 MOLLY A NICHOLSON $ 14,662 JENNIFER S CORD $ 14,481 ERIC M RHODES $ 11,373 LISA M LAGGER $ 36,590 ALSO IN RESPONSE TO QUESTION 4B, THE FOLLOWING LISTED INDIVIDUALS PARTICIPATED IN THE ORGANIZATION'S SECTION 457(F) PLAN AND EARNED UNVESTED BENEFITS DURING 2015 WHICH ARE REPORTED IN COLUMN (C): MICHAEL ENGLEHART $ 36,673 JEANNIE FREY $ 86,489 PATRICK QUINN $ 24,076 MICHAEL L BROWN $ 69,580 JARED C ROGERS $ 46,776 AMY D STEVENS $ 43,469

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	1	1,000	cost
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( TRAILER )	X	1	10,400	COST
26 Other ( SPORTING EVENT TICKETS )	X	24	10,162	COST
27 Other ( DINNERS/LUNCHES )	X	10	5,945	COST
28 Other ( GALA RAFFLE/MISC )	X	142	35,117	COST

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that

it must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2015)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
Schedule M, Part II, Column B	The amounts reported in column (b) are the number of contributors.

Schedule M (Form 990) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

Return Reference	Explanation
FORM 990, BOX C	DOING BUSINESS AS/ASSUMED NAMES PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK ALSO OPERATES UNDER THE FOLLOWING ASSUMED NAMES: - PRESENCE COVENANT MEDICAL CENTER - PRESENCE MERCY MEDICAL CENTER - PRESENCE SAINT JOSEPH HOSPITAL ELGIN - PRESENCE SAINT JOSEPH MEDICAL CENTER - PRESENCE ST. MARYS HOSPITAL - PRESENCE UNITED SAMARITANS MEDICAL CENTER - COVENANT OUTPATIENT PHARMACY - HIGHLAND ANSWERING SERVICE - MERCY PROFESSIONAL BUILDING PHARMACY - PRESENCE IMAGING PLAINFIELD - PRESENCE IMMEDIATE CARE PLAINFIELD - PRESENCE SURGERY CENTER JOLIET - THE APOTHECARY DANVILLE - PRESENCE COVENANT MEDICAL CENTER FOUNDATION - PRESENCE MERCY MEDICAL CENTER FOUNDATION - PRESENCE SAINT JOSEPH HOSPITAL ELGIN FOUNDATION - PRESENCE SAINT JOSEPH MEDICAL CENTER FOUNDATION - PRESENCE ST. MARYS HOSPITAL FOUNDATION - PRESENCE UNITED SAMARITANS MEDICAL CENTER FOUNDATION
FORM 990, PART III, QUESTION 1	MISSION STATEMENT THE CORPORATION IS PART OF THE PRESENCE HEALTH SYSTEM AND ACTS IN ACCORDANCE WITH THE PRESENCE HEALTH MISSION, WHICH IS AS FOLLOWS: INSPIRED BY THE HEALING MINISTRY OF JESUS CHRIST AND AS PART OF PRESENCE HEALTH, A CATHOLIC HEALTH SYSTEM, PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK PROVIDES HEALTHCARE SERVICES IN A COMPASSIONATE, HOLISTIC MANNER IN THE SPIRIT OF HEALING AND HOPE.
FORM 990, PART I, QUESTION 5, AND PART V, QUESTION 2	COMPENSATION AND FORM W-3 TRANSMITTAL OF WAGES AND TAX STATEMENT PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK (THE "CORPORATION") REPORTS 0 EMPLOYEES ON FORM 990, PART I, QUESTION 5 AND FORM 990, PART V, QUESTION 2A AS IT IS NOT REQUIRED TO FILE FORM W-3, TRANSMITTAL OF WAGES AND TAX STATEMENT. THE CORPORATIONS COMPENSATION IS PAID BY PRESENCE CARE TRANSFORMATION CORPORATION ("PCTC"), WHICH ISSUES THE FORMS W-2 AND W-3, AND THE EXPENSE IS TRANSFERRED TO THE CORPORATION. THE COMPENSATION AMOUNTS REPORTED IN THIS 990 REFLECT THE AMOUNT TRANSFERRED TO THE CORPORATION FROM PCTC.
FORM 990, PART V, QUESTION 1A	FORM 1096 TRANSMITTAL OF U.S. INFORMATION RETURNS PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK (THE "CORPORATION") REPORTS 0 ON FORM 990, PART V, QUESTION 1A AS IT IS NOT REQUIRED TO FILE FORM 1096, TRANSMITTAL OF U.S. INFORMATION RETURNS. ALL OF THE CORPORATIONS ACCOUNTS PAYABLE REPORTABLE ON FORM 1096 ARE PAID BY PRESENCE CARE TRANSFORMATION CORPORATION ("PCTC"), WHICH ISSUES ALL FORMS 1099, AND THE EXPENSE IS TRANSFERRED TO THE CORPORATION. THE COMPENSATION AMOUNTS REPORTED IN THIS 990 REFLECT THE AMOUNT TRANSFERRED TO THE CORPORATION FROM PCTC.
FORM 990, PART VI, QUESTION 6	MEMBERS OR SHAREHOLDERS PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK HAS ONE MEMBER, PRESENCE CARE TRANSFORMATION CORPORATION.
FORM 990, PART VI, QUESTION 7A	PERSONS WITH AUTHORITY TO ELECT MEMBERS OF THE GOVERNING BODY THE CORPORATIONS SOLE MEMBER, PRESENCE CARE TRANSFORMATION CORPORATION, HAS THE POWER TO APPOINT MEMBERS OF THE GOVERNING BODY, OTHER THAN EX-OFFICIO DIRECTORS.
FORM 990, PART VI, QUESTION 7B	DECISIONS OF GOVERNING BODY APPROVAL BY MEMBERS OR SHAREHOLDERS PRESENCE CARE TRANSFORMATION CORPORATION (THE "MEMBER"), THROUGH ITS BOARD OF DIRECTORS, HAS CERTAIN GENERAL AND RESERVED POWERS WITH RESPECT TO THE FOLLOWING. GENERAL POWERS: THE MEMBER SHALL PROVIDE OVERSIGHT AND SUPPORT FOR THE ACTIVITIES OF THE CORPORATION, FOR THE PURPOSE OF ASSURING THAT ALL ACTIONS OF THE CORPORATION ARE CONSISTENT WITH THE MISSION AND VALUES OF THE SYSTEM; THE PURPOSES OF THE CORPORATION; THE ETHICAL AND RELIGIOUS DIRECTIVES; THE PRESENCE HEALTH SYSTEM STRATEGIC PLAN; AND BEST PRACTICES. EXCLUSIVE POWERS: IN FURTHERANCE OF THE EXERCISE OF ITS GENERAL POWERS AND RESPONSIBILITIES, THE MEMBER SHALL HAVE THE SOLE POWER TO TAKE THE ACTIONS SPECIFIED BELOW WITH RESPECT TO THE FOLLOWING MATTERS: A) AMEND OR REPEAL THE BYLAWS OF THE CORPORATION. B) APPOINT AND REMOVE ALL OFFICERS OF THE CORPORATION AND ALL DIRECTORS OF THE CORPORATION, OTHER THAN ANY EX-OFFICIO DIRECTORS. C) APPROVAL CAPITAL AND OPERATING BUDGETS, AND LONG-TERM CAPITAL EQUIPMENT PLANS FOR THE CORPORATION. D) APPROVE UNBUDGETED EXPENDITURES IN EXCESS OF THE LIMIT ESTABLISHED BY THE MEMBER FROM TIME TO TIME. E) APPROVE ANY BORROWING OR SIGNIFICANT INCURRENCE OF DEBT BY THE CORPORATION IN EXCESS OF THE LIMIT ESTABLISHED BY THE MEMBER FROM TIME TO TIME, OR ANY SALE, PURCHASE, ALIENATION, EXCHANGE, SIGNIFICANT LEASES (OTHER THAN IN THE ORDINARY COURSE) OR ENCUMBRANCES OF THE CORPORATIONS REAL PROPERTY, EXCEPT THOSE MADE PURSUANT TO APPROVED BUDGETS. F) APPROVE EXECUTION OF ANY DEEDS, MORTGAGES, BONDS, OR MAJOR EQUIPMENT LEASES, EXCEPT THOSE MADE PURSUANT TO APPROVED BUDGETS. G) APPROVE ANY OTHER SIGNIFICANT AND UNBUDGETED SALE, PURCHASE, EXCHANGE, LEASE (OTHER THAN IN THE ORDINARY COURSE) TRANSFER, LITIGATION OR LEGAL SETTLEMENT, BENEFITS PACKAGES, ENCUMBRANCE OR OTHER DISPOSITION OR OTHER SIGNIFICANT TRANSACTION INVOLVING THE NON-REAL-ESTATE ASSETS OF THE CORPORATION IN EXCESS OF THE LIMIT ESTABLISHED BY THE MEMBER FROM TIME TO TIME. H) APPROVE MATERIAL CHANGES IN THE KIND OF SERVICES RENDERED, SUCH AS THE ADDITION OR DISCONTINUATION OF ANY MAJOR SERVICE LINE (E.G., OBSTETRICS) OR CHANGE IN THE FUNDAMENTAL NATURE OF SERVICES PROVIDED BY THE CORPORATION (E.G., A CHANGE REQUIRING A DIFFERENT KIND OF LICENSE). I) APPROVE STRATEGIC PLANS FOR THE CORPORATION CONSISTENT WITH AN IN FURTHERANCE OF SYSTEM MISSION AND VALUES, AND RESPONSIVE TO THE NEEDS OF THE COMMUNITIES SERVED BY THE CORPORATION AND SUPPORT THE ABILITY OF THE CORPORATION AND ITS AFFILIATES TO PROVIDE HIGH-QUALITY CARE AND SERVICES. J) APPROVE ANY CONTRACT FOR THE MANAGEMENT OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION OR ANY HEALTH CARE FACILITIES OWNED BY THE CORPORATION. K) APPROVE ANY SELECTION OR MODIFICATION OF THE BUSINESS NAME OR LOGO OF THE CORPORATION OR ANY PROGRAM OR DIVISION OF THE CORPORATION, OR THE USE OF ANY CORPORATE OR BUSINESS NAME OF THE CORPORATION BY AN ENTITY OTHER THAN THE MEMBER OR AN AFFILIATE. L) PROVIDE OR ASSURE THE PROVISION OF APPROPRIATE INSURANCE COVERAGE, STANDARDIZED EMPLOYEE BENEFITS, INFORMATION SYSTEMS AND TECHNOLOGY, FINANCIAL MANAGEMENT SERVICES, LEGAL, MARKETING, RISK MANAGEMENT AND OTHER ADMINISTRATIVE SERVICES NECESSARY TO SUPPORT THE CORPORATIONS OPERATIONS. M) APPROVE THE ESTABLISHMENT, TERMINATION, OR SALE OF ANY SIGNIFICANT JOINT VENTURE RELATIONSHIP BY THE CORPORATION. N) APPROVE THE ACQUISITION OR DEVELOPMENT OF ANY BUSINESS OR ACTIVITY UNRELATED TO THE PROVISION OF HEALTH CARE SERVICES. O) APPROVE THE CREATION OF ANY NEW AFFILIATE TO BE OWNED OR CONTROLLED BY THE CORPORATION. P) DIRECT AND APPROVE ANY CONTRIBUTIONS, DONATIONS OR OTHER ASSET TRANSFERS WITHOUT CONSIDERATION TO THE MEMBER OR ANY AFFILIATE, IN FURTHERANCE OF THE MISSION AND VALUES. Q) APPROVE ACCEPTANCE OF A CONTRIBUTION THAT IMPOSES A MATERIAL OBLIGATION ON THE CORPORATION, IF APPROVED BY THE CORPORATIONS APPLICABLE FOUNDATION OR FUNDRAISING AFFILIATE AS CONSISTENT WITH THE CORPORATIONS AND SYSTEMS MISSION AND GOALS. R) DEFINE THE CRITERIA FOR THE SELECTION OF BANKS AND OTHER FINANCIAL DEPOSITORIES TO BE USED BY THE CORPORATION, AND AUTHORIZE THE PROCESS BY WHICH SIGNATORIES ON ALL BANK AND SIMILAR ACCOUNTS OF THE CORPORATION ARE APPROVED. S) SELECT INDEPENDENT AUDITORS FOR THE CORPORATION, IN CONNECTION WITH THE CONSOLIDATED AUDIT OF ALL SYSTEM ENTITIES. T) APPROVE OR CHANGE THE CORPORATIONS REGISTERED AGENT OR REGISTERED OFFICE, AS APPROPRIATE FROM TIME TO TIME. U) APPROVE ANY VOLUNTARY CHANGE TO THE CORPORATIONS STATUS OF AN ORGANIZATION EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS AMENDED FROM TIME TO TIME. APPROVAL AND RECOMMENDATION POWERS: TO BE EFFECTIVE, THE ACTIONS SET FORTH BELOW MUST BE APPROVED BY BOTH THE CORPORATIONS BOARD OF DIRECTORS AND THE MEMBER. SUCH ACTIONS MAY BE INITIATED EITHER BY THE MEMBER OR THE CORPORATIONS BOARD. A) ADOPTION, AMENDMENT OR REPEAL OF THE ARTICLES OF INCORPORATION OF THE CORPORATION B) ADOPTION OF ANY PLAN OF MERGER, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION.
FORM 990, PART VI, QUESTION 11B	FORM 990 REVIEW PROCESS THE CORPORATION PROVIDES A COMPLETE COPY OF ITS FORM 990 TO ALL MEMBERS OF THE GOVERNING BODY OF ITS ULTIMATE PARENT CORPORATION, PRESENCE HEALTH NETWORK, FOR REVIEW PRIOR TO FILING WITH THE IRS. THE BOARD OF DIRECTORS OF THE CORPORATION AND OTHER SUBSIDIARY ORGANIZATIONS WITHIN THE PRESENCE HEALTH SYSTEM ARE INTERNAL LIMITED FIDUCIARY BOARDS WHICH DO NOT RECEIVE A COMPLETED COPY OF THE FORM 990 PRIOR TO FILING. AS A RESULT, THE CORPORATION ANSWERS "NO", TO FORM 990, PART VI, LINE 11A.
FORM 990, PART VI, LINE 12C	PROCEDURES FOR ADDRESSING CONFLICTS OF INTEREST THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT THE INTERESTS OF PRESENCE HEALTH NETWORK AND ALL OF ITS AFFILIATED MINISTRIES (COLLECTIVELY "PRESENCE HEALTH") WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF ANY DIRECTOR, TRUSTEE, OFFICER, CORPORATE MEMBER APPOINTEE, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, SENIOR LEADERS, AND OTHERS IN A RECENT POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER PRESENCE HEALTH ("INTERESTED PERSONS"), AND CLARIFY THE STANDARDS OF CONDUCT, DUTIES AND OBLIGATIONS OF INTERESTED PERSONS IN THE CONTEXT OF POTENTIAL CONFLICTS OF INTEREST BY PROVIDING A METHOD FOR DISCLOSING AND RESOLVING SUCH POTENTIAL CONFLICTS. NO PRESENCE HEALTH ENTITY WILL ENGAGE IN ANY CONTRACT, TRANSACTION OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST UNLESS DISINTERESTED MEMBERS OF THE APPLICABLE BOARD OF DIRECTORS OR OTHER GOVERNING BODY DETERMINE BY A MAJORITY VOTE THAT APPROPRIATE SAFEGUARDS TO PROTECT THE CHARITABLE MISSION OF PRESENCE HEALTH HAVE BEEN IMPLEMENTED. TO FACILITATE THIS POLICY, ALL INTERESTED PERSONS HAVE A CONTINUING OBLIGATION TO PROMPTLY DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE. ALL DISCLOSURES MUST BE PROVIDED TO THE SYSTEM COMPLIANCE OFFICER AND GENERAL COUNSEL IN A WRITTEN DESCRIPTION OF THE MATERIAL FACTS. DISCLOSURE SHALL BE ON A CONFLICTS OF INTEREST QUESTIONNAIRE OR SIMILAR FORMAT AS DESCRIBED IN THE CONFLICTS OF INTEREST POLICY. ALL INTERESTED PERSONS SHALL ALSO COMPLETE A QUESTIONNAIRE BASED ON THE ASSUMPTION OF THE BOARD (OR OTHER RELEVANT) POSITION, AND THEREAFTER ON AT LEAST AN ANNUAL BASIS OR WHEN AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT ARISES. AT ANY TIME THAT AN ACTUAL, APPARENT OR A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED TO THE CORPORATIONS BOARD OF DIRECTORS, WHETHER THROUGH THE VOLUNTARY SUBMISSION OF A DISCLOSURE STATEMENT BY AN INTERESTED PERSON, OR BY A DISCLOSURE BY A PERSON OTHER THAN THE SUBJECT INTERESTED PERSON, THE CORPORATIONS BOARD OR APPLICABLE COMMITTEE SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, ONLY DISINTERESTED DIRECTORS/COMMITTEE MEMBERS VOTE TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF A CONFLICT IS FOUND TO EXIST THE INTERESTED PERSON WILL GENERALLY BE REQUIRED TO RECUSE HIM OR HERSELF DURING ANY MEETING IN WHICH THE BOARD OF DIRECTORS OR APPLICABLE COMMITTEE CONDUCTS THE EVALUATION OF THE SUBJECT TRANSACTION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. TO ENSURE THAT THE PRESENCE HEALTH OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS EXEMPT STATUS, TRANSACTIONS INVOLVING INTERESTED PERSONS ARE ONLY APPROVED IF, AFTER EXERCISING REASONABLE DUE DILIGENCE, THE BOARD DETERMINES THEY ARE FAIR AND REASONABLE, TAKING INTO ACCOUNT FACTORS SUCH AS WHETHER PRESENCE HEALTH COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION OR ARRANGEMENT. HOWEVER, LENDING MONEY OR GUARANTYING AN OBLIGATION OF A DIRECTOR, OFFICER, OR EMPLOYEE OF PRESENCE HEALTH (EXCLUSIVE OF CUSTOMARY INSURANCE COVERAGE FOR ACTS DONE IN CONNECTION WITH SUCH INDIVIDUALS SERVICE TO OR EMPLOYMENT BY PRESENCE HEALTH) IS STRICTLY PROHIBITED.
FORM 990 PART VI, QUESTIONS 15A AND 15B, AND PART V, QUESTION 2A	COMPENSATION AND APPROVAL PROCESS FOR OFFICERS AND KEY EMPLOYEES COMPENSATION FOR THE CORPORATIONS CEO AND OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED IN ACCORDANCE WITH WRITTEN POLICIES AND PROCEDURES ADOPTED BY THE BOARD OF DIRECTORS OF PRESENCE HEALTH NETWORK, THE SYSTEM PARENT CORPORATION WHICH SHARES A MIRROR BOARD WITH PRESENCE CARE TRANSFORMATION CORPORATION (PCTC) AND PRESENCE CHICAGO HOSPITALS NETWORK (PCHN). SUCH POLICIES AND PROCEDURES ARE APPLIED BY THE HUMAN RESOURCES COMMITTEE OF THE SYSTEM PARENT CORPORATION, WHICH CONSISTS WHOLLY OF INDEPENDENT DIRECTORS. THE SYSTEM PARENT CORPORATION USES MARKET DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH BASE SALARIES AND TOTAL CASH COMPENSATION OPPORTUNITIES. THE SYSTEM PARENTS HUMAN RESOURCES COMMITTEE MONITORS EXECUTIVE TOTAL COMPENSATION AND APPROVES ALL COMPONENTS OF EXECUTIVE TOTAL COMPENSATION, ANNUALLY REVIEWING AND APPROVING COMPENSATION CHANGES FOR EACH EXECUTIVE, AND REGULARLY REPORTING ITS ACTIVITIES TO THE SYSTEM PARENTS BOARD. THE CORPORATION ANSWERS "NO" TO FORM 990, PART VI, QUESTION 15A AND 15B PER THE FORM 990 INSTRUCTIONS AS ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION, PRESENCE CARE TRANSFORMATION CORPORATION, THE SYSTEMS STATUTORY EMPLOYER.
FORM 990, PART VI, LINE 19	DOCUMENT AVAILABILITY THE CORPORATIONS ARTICLES OF INCORPORATION ARE ON FILE WITH THE STATE OF ILLINOIS. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE CORPORATION, TOGETHER WITH ITS AFFILIATES, ARE AVAILABLE FROM THE NATIONAL DISSEMINATION AGENT AS REQUIRED BY PRESENCE HEALTH SYSTEMS BOND DOCUMENTS. CONFLICTS OF INTEREST POLICIES ARE NOT MADE AVAILABLE TO THE PUBLIC, HOWEVER A SUMMARY OF THE CURRENT POLICY IS ANNUALLY INCLUDED IN SCHEDULE O OF THE CORPORATIONS FORM 990.
FORM 990, PART VII, SECTIONS A & B	STATUTORY EMPLOYER PRESENCE CARE TRANSFORMATION CORPORATION ("PCTC") (FEIN 36-3366652) ACTS AS THE AGENT FOR THE CORPORATION. CASH IS SWEPT FROM THE CORPORATION ON A DAILY BASIS TO PCTC AND PCTC ISSUES ALL PAYROLL AND ACCOUNTS PAYABLE CHECKS ON BEHALF OF AND AS AGENT FOR THE CORPORATION AND THE APPROPRIATE ACCOUNTING ENTRIES ARE RECORDED. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES INTERCOMPANY TRANSFER FROM AFFILIATES $ 96,037,579 NET ASSETS RELEASED FOR CAPITAL $ 1,532,906 PRESENCE HEALTH PARTNERS $ (3,113,640) RESTRICTED FUND ACTIVITY $ 2,493,862 ____________ TOTAL $96,950,707
FORM 990, PART XII, LINE 2B	AUDITED FINANCIAL STATEMENTS AN INDEPENDENT ACCOUNTANT ANNUALLY AUDITS THE CONSOLIDATED FINANCIAL STATEMENTS OF PRESENCE HEALTH NETWORK AND ITS AFFILIATES. THE AUDIT OPINION IS ISSUED ON THE CONSOLIDATED FINANCIAL STATEMENTS AND EACH AFFILIATE IS NOT SEPARATELY AUDITED.
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:47424452
FORM 990 PART IX LINE 11G	DESCRIPTION:AGENCY FEES TOTAL FEES:7923445
FORM 990 PART IX LINE 11G	DESCRIPTION:LAB SERVICES TOTAL FEES:11690131
FORM 990 PART IX LINE 11G	DESCRIPTION:ANESTHESIOLOGY SERVICES TOTAL FEES:4489895
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER TOTAL FEES:67308651

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:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

PRESENCE CENTRAL AND SUBURBAN HOSPITALS
NETWORK

Employer identification number

36-4195126

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
(1) Presence Health Partners LLC 18927 HICKORY CREEK DRIVE Mokena,IL60448 46-3111349	MGD CARE CONT	IL	53,563,972	7,758,101	PCSHN
(2) Vermilion County Surgery Center LLC 26 W Newell Danville,IL61834 80-0811427	MEDICAL SRVC	IL	-1,580,882	4,473,859	PCSHN

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Presence Health Network 200 South Wacker Drive Chicago,IL60606 36-1649520	Parent Corp	IL	501(C)(3)	11c III FI	na		No
(2)Medicare Value Partners 100 North River Road Des Plaines,IL60016 36-3495969	Health Care	IL	501(C)(3)	3	PCHN	Yes
(3)Presence Holy Family Medical Center 100 North River Road Des Plaines,IL60016 36-2439318	Health Care	IL	501(C)(3)	3	PCHN	Yes
(4)Mount Loretto Nursing Home Inc 302 Swart Hill Road Amsterdam,NY12010 14-1363014	Health Care	NY	501(C)(3)	3	RM New York	Yes
(5)Presence Health Partners Services 2380 E Dempster Ave Ste 236 Des Plaines,IL60016 36-2644178	Health Care	IL	501(C)(3)	3	PCHN	Yes
(6)Presence Care Home 18927 Hickory Creek Drive 300 Mokena,IL60448 46-0483587	Health Care	IL	501(C)(3)	9	PLC	Yes
(7)Presence Care Transformation Corp 1000 Remington Blvd Ste 100 Bolingbrook,IL60440 36-3366652	Mgmt Support	IL	501(C)(3)	11c III FI	PHN		No
(8)Presence Home Care 18927 Hickory Creek Drive 300 Mokena,IL60448 46-0483581	Health Care	IL	501(C)(3)	9	PLC	Yes
(9)Laverna Terrace Housing Corporation 18927 Hickory Creek Drive 300 Mokena,IL60448 36-3438977	Senior Living	IL	501(C)(3)	9	PCTC	Yes
(10)Provena Self-Insurance Trust 1000 Remington Blvd Suite 100 Bolingbrook,IL60440 36-2987310	Insurance	IL	501(C)(3)	11c III FI	na		No
(11)Presence Life Connections 18927 Hickory Creek Drive 300 Mokena,IL60448 37-1127787	Health Care	IL	501(C)(3)	9	PCTC	Yes
(12)Presence Behavioral Health 1820 South 25th Avenue Broadview,IL60155 36-2709982	Health Care	IL	501(C)(3)	3	PHS	Yes
(13)Presence Ambulatory Services 100 North River Road Des Plaines,IL60016 36-4286236	Health Care	IL	501(C)(3)	9	PCHN	Yes
(14)Presence Health Fdn Board of Trustees 200 South Wacker Drive Chicago,IL60606 36-3330929	Fundraising	IL	501(C)(3)	7	PCHN	Yes
(15)Presence Chicago Hospitals Network 200 South Wacker Drive Chicago,IL60606 36-2235165	Mgmt Support	IL	501(C)(3)	11c III FI	PHN		No
(16)Presence Home Care Services 5747 West Dempster Morton Grove,IL60053 36-2893936	Home Care	IL	501(C)(3)	3	PCHN	Yes
(17)Presence Resurrection Medical Center 7435 West Talcott Avenue Chicago,IL60631 36-3330926	Health Care	IL	501(C)(3)	3	PCHN	Yes
(18)Resurrection Nursing Home Inc 90 North Main Street Castleton,NY12033 14-1348691	Health Care	NY	501(C)(3)	3	RM New York	Yes
(19)Presence Senior Srvcs - Chicagoland 100 North River Road Des Plaines,IL60016 23-7061646	Health Care	IL	501(C)(3)	3	PCHN	Yes
(20)Presence Healthcare Services 100 North River Road Des Plaines,IL60016 36-3330928	Health Care	IL	501(C)(3)	3	PCHN	Yes
(21)Presence Saint Francis Hospital 355 Ridge Avenue Evanston,IL60202 36-2167800	Health Care	IL	501(C)(3)	3	PCHN	Yes
(22)Presence St Mary and Elizabeth Med Cntr 2233 West Division Street Chicago,IL60622 36-2171079	Health Care	IL	501(C)(3)	3	PCHN	Yes
(23)Presence Saint Joseph Hospital Chicago 2900 North Lake Shore Drive Chicago,IL60657 36-3200170	Health Care	IL	501(C)(3)	3	PCHN	Yes
(24)Presence Nazarethville 300 North River Road Des Plaines,IL60016 36-2801392	Health Care	IL	501(C)(3)	9	PSSC	Yes
(25)Arthur Merkle - Clara Knipprath Nursing 1190 E 2900 N Road Clifton,IL60927 36-2841358	Health Care	IL	501(C)(3)	9	PLC	Yes
(26)Rainbow Hospice and Palliative Care 1550 Bishop Court Mount Prospect,IL60056 36-3296367	Health Care	IL	501(C)(3)	9	PHCS	Yes
(27)Resurrection University 1431 N Claremont Chicago,IL60622 36-2182170	Education	IL	501(C)(3)	2	PCHN	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Bel Harlem Surg Ctr 3101 North Harlem Chicago,IL60634 41-2237162	Medical Service	IL	N/A
(2) RH Sleep Ctr - NW 665 West North Ave 500 Lombard,IL60148 26-1519627	Medical Service	IL	N/A
(3) RH Sleep Ctr - Evan 665 West North Ave 500 Lombard,IL60148 26-1519556	Medical Service	IL	N/A
(4) RH Sleep Ctr - LP 665 West North Ave 500 Lombard,IL60148 26-1519667	Medical Service	IL	N/A
(5) RH Sleep Ctr - RF 665 West North Ave 500 Lombard,IL60148 26-2189763	Medical Service	IL	N/A
(6) Alverno Clinic Lab 2434 Interstate Plaza Drive Hammond,IN46324 20-3240648	Medical Service	IN	N/A
(7) Prof Clinic Lab LLC 113 E 4th St Michigan City,IN46360 30-0711211	Medical Service	IN	N/A

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) L Gilbraith Insurance SPC LTD 68 W Bay Road PO Box 1109 Grand Cayman CJ 000000000	Insurance	CJ	PCHN	Foreign Company				Yes
(2) Provena Health Assurance SPC 23 Lime Tree Bay Ave PO Box 1051 Grand Cayman CJ 98-0420054	Insurance	CJ	PCTC	Foreign Company				Yes
(3) Presence Properties Inc 100 North River Road Des Plaines,IL60016 36-3520630	Medical	IL	PV	C Corp				Yes
(4) Presence Service Corporation 2380 E Dempster Street Des Plaines,IL60016 36-4314354	Medical	IL	PCSHN	C Corp	31,999,042	22,782,493	100.000 %	Yes
(5) Presence Ventures Inc 100 North River Road Des Plaines,IL60016 37-1168085	Medical	IL	PCTC	C Corp				Yes
(6) Resurrection Medical Center Auxiliary 7435 West Talcott Avenue Chicago,IL60631 36-6109825	Fundraising	IL	PRMC	C Corp				Yes
(7) Resurrection Ministries of New York 90 North Main Street Castleton,NY12033 14-1720818	Parent Corp	NY	PCHN	C Corp				Yes
(8) Presence Health Care Preferred 100 North River Road Des Plaines,IL60016 36-3974620	MGD Care Contract	IL	PCHN	C Corp				Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

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

Yes

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

Yes

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

Yes

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

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) PRESENCE CARE TRANSFORMATION CORPORATION	P	134,426,035	COST
(2) PRESENCE LIFE CONNECTIONS	P	89,863	COST
(3) PRESENCE SERVICE CORPORATION	P	2,898,115	COST
(4) PRESENCE CHICAGO HOSPITALS NETWORK	P	11,692,544	COST
(5) PRESENCE HOME CARE	Q	253,803	COST
(6) PRESENCE LIFE CONNECTIONS	Q	100,847	COST

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

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

Return Reference

Explanation

REIMBURSEMENTS FOR SHARED SERVICES

PRESENCE CARE TRANSFORMATION CORPORATION (FKA PRESENCE PRV HEALTH) (FEIN: 36-3366652) PAYS ALL OF THE COMPENSATION AND ACCOUNTS PAYABLE FOR ALL ENTITIES UNDER THE PRESENCE HEALTH SYSTEM AS THE DESIGNATED PAYMENT AGENT FOR SUCH ENTITIES. CASH IS DEPOSITED INTO AN ACCOUNT BY PRESENCE HEALTH ENTITIES AND SWEPT ON A MONTHLY BASIS TO REIMBURSE PRESENCE CARE TRANSFORMATION CORPORATION FOR THESE EXPENSES AT COST. THE AMOUNTS REPORTED ON PART V OF SCHEDULE R REFLECT THE TOTAL CASH TRANSFERS TO/FROM PRESENCE CARE TRANSFORMATION CORPORATION.

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION STRIVES TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING SERVICES THAT AVOIDS ILLNESS USING PREVENTIVE CARE AND ADVANCED TECHNOLOGIES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	17
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	1,661
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	4,467,688
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	2,348,779

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,593,403	2,244,326
9	Program service revenue (Part VIII, line 2g) .........	1,049,160,317	1,125,420,820
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,097,577	3,114,452
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	14,639,842	14,322,191
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,071,491,139	1,145,101,789
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	148,930	174,927
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	412,539,891	405,214,427
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	25,231	0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,855,342
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	622,033,586	792,310,967
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,034,747,638	1,197,700,321
19	Revenue less expenses. Subtract line 18 from line 12.......	36,743,501	-52,598,532
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	790,635,498	757,839,362
21	Total liabilities (Part X, line 26).............	247,609,118	171,622,372
22	Net assets or fund balances. Subtract line 21 from line 20.....	543,026,380	586,216,990

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 822,613,339 including grants of $ 174,927 ) (Revenue $ 1,133,728,248 )
	PRESENCE SAINT JOSEPH MEDICAL CENTER (PSJMC) IS A 480 BED REGIONAL LEADER OF HEALTH SERVICES, PROVIDING EXCELLENCE IN HEALTH CARE TO A 23-COMMUNITY POPULATION OF CLOSE TO 700,000. PSJMC HAS A MEDICAL STAFF OF MORE THAN 570 PHYSICIANS REPRESENTING OVER 50 MEDICAL SPECIALTIES AND EMPLOYS 2,600 PROFESSIONAL, TECHNICAL AND SUPPORT PERSONNEL, MAKING IT ONE OF THE LARGEST EMPLOYERS IN WILL COUNTY. PSJMCS MISSION OF PROVIDING HEALING AND HOPE IS ENHANCED BY THE FACILITYS STATE-OF-THE-ART TECHNOLOGY AND THE BED TOWERS CENTERED APPROACH TO CARE. THE NEW FACILITY ALLOWS PSJMC TO PROVIDE THE HIGHEST LEVEL OF PATIENT CARE FOR THE BEST HEALTH OUTCOMES. WITH PSJMCS NEW FACILITY, WILL COUNTY RESIDENTS CAN ACCESS THE BEST DOCTORS AND HIGHEST QUALITY HEALTHCARE WITHOUT HAVING TO TRAVEL TO CHICAGO. PSJMC HAS BEEN PART OF THE JOLIET COMMUNITY FOR OVER 130 YEARS AND CONTINUES TO CARRY OUT THE MISSION OF ITS DEDICATED FOUNDING SISTERS, THE FRANCISCAN SISTERS OF THE SACRED HEART, AND SET THE HIGHEST STANDARDS OF MEDICAL CARE FOR THE COMMUNITY. PSJMCS ROOTS IN THE COMMUNITY ARE MATCHED ONLY BY OUR UNWAVERING COMMITMENT TO STAY IN WILL COUNTY AND GROW SO WE MAY CONTINUE TO PROVIDE THE BEST OF CARE TO RESIDENTS HERE IN THE FUTURE. FOR CALENDAR YEAR ENDED DECEMBER 2015 PRESENCE SAINT JOSEPH MEDICAL CENTER PROVIDED PATIENT CARE OF 102,027 PATIENT DAYS AND HAD 22,266 DISCHARGES. EMERGENCY ROOM VISITS TOTALED 65,181, SURGERIES TOTALED 14,049, AND OUTPATIENT REGISTRATIONS TOTALED 357,718. PRESENCE ST. MARYS HOSPITAL (PSMH) HAS BEEN MEETING THE HEALTH NEEDS OF KANKAKEE COUNTY RESIDENTS FOR OVER 115 YEARS. FOUNDED BY THE SERVANTS OF THE HOLY HEART OF MARY, PRESENCE ST. MARYS HOSPITAL CONTINUES TO CARRY OUT ITS MISSION OF PROVIDING "COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES" IT SERVES. PSMH IS A 189 BED ACUTE CARE FACILITY EMPLOYING 920 PEOPLE, WITH A LEVEL II EMERGENCY/TRAUMA CENTER. PSMH PROVIDES MANY HEALTHCARE SERVICES SUCH AS A REGIONAL CANCER CENTER, REHABILITATION SERVICES, FAMILY BIRTHING CENTER, PEDIATRIC UNIT, MENTAL HEALTH SERVICES, SLEEP DISORDER CENTER, RENAL DIALYSIS CENTER, WOUND CARE, INFUSION CENTER, OCCUPATIONAL HEALTH AND A TOTAL WELLNESS CENTER. LOCATED IN KANKAKEE, ILLINOIS, PSMH SERVES THE KANKAKEE COMMUNITY AND PARTNERS WITH OUR MINISTRIES IN KANKAKEE TO CONTINUE TO CARRY OUT OUR MISSION OF BRINGING HEALING AND HOPE TO OUR COMMUNITY. FOR CALENDAR YEAR ENDED DECEMBER 2015 PRESENCE SAINT MARY HOSPITAL PROVIDED PATIENT CARE OF 22,883 PATIENT DAYS AND HAD 5,461 DISCHARGES. EMERGENCY ROOM VISITS TOTALED 30,917, SURGERIES TOTALED 5,167, AND OUTPATIENT REGISTRATIONS TOTALED 67,291. PRESENCE SAINT JOSEPH HOSPITAL (PSJH) HAS BEEN MEETING THE HEALTH NEEDS OF KANE COUNTY RESIDENTS FOR OVER 110 YEARS. FOUNDED BY THE FRANCISCAN SISTERS, PSJH CONTINUES TO CARRY OUT ITS MISSION OF PROVIDING "COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES" IT SERVES. PSJH IS A 178-BED FACILITY LOCATED IN ELGIN, ILLINOIS, A GROWING SUBURB 40 MILES NORTHWEST OF CHICAGO, ILLINOIS ON THE FOX RIVER. CONSISTENT WITH THE MISSION AND VISION SET FORTH BY THE FOUNDING FRANCISCAN SISTERS, PSJH DILIGENTLY WORKS TO MEET THE NEEDS OF THE COMMUNITY. THIS IS ACHIEVED THROUGH A COMMITMENT TO PROVIDE HIGH QUALITY, STATE-OF-THE-ART, COST-EFFECTIVE CARE, WITHIN A CATHOLIC, CULTURALLY-SENSITIVE ENVIRONMENT, TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF RELIGIOUS PREFERENCE. WITH OVER 1,200 EMPLOYEES AND A MEDICAL STAFF OF OVER 340 PHYSICIANS ACROSS MULTIPLE SPECIALTIES, PSJH OFFERS A FULL RANGE OF INPATIENT AND OUTPATIENT MEDICAL SERVICES FOR THE GREATER ELGIN AREA. IN CONCERT WITH OTHER PRESENCE MINISTRIES, PSJH STRIVES TO LIVE OUT ITS MISSION OF PROVIDING COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES WE SERVE. FOR CALENDAR YEAR ENDED DECEMBER 2015 PRESENCE SAINT JOSEPH HOSPITAL ELGIN PROVIDED PATIENT CARE OF 40,647 PATIENT DAYS AND HAD 7,231 DISCHARGES. EMERGENCY ROOM VISITS TOTALED 26,684, SURGERIES TOTALED 4,518, AND OUTPATIENT REGISTRATIONS TOTALED 107,432. PRESENCE MERCY MEDICAL CENTER (PMMC) HAS BEEN MEETING THE HEALTH NEEDS OF KANE COUNTY RESIDENTS FOR OVER 100 YEARS. FOUNDED BY THE SISTERS OF MERCY, PMMC CONTINUES TO CARRY OUT ITS MISSION OF PROVIDING "COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES" IT SERVES. PMMC IS A 350-BED FACILITY LOCATED IN AURORA, ILLINOIS, A GROWING SUBURB 40 MILES WEST OF CHICAGO. CONSISTENT WITH THE MISSION AND VISION SET FORTH BY THE FOUNDING SISTERS OF MERCY, PMMC DILIGENTLY WORKS TO MEET THE NEEDS OF THE COMMUNITY. THIS IS ACHIEVED THROUGH A COMMITMENT TO PROVIDE HIGH QUALITY, STATE-OF-THE-ART, COST-EFFECTIVE CARE, WITHIN A CATHOLIC, CULTURALLY SENSITIVE ENVIRONMENT, TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF RELIGIOUS PREFERENCE. WITH OVER 1,200 EMPLOYEES AND A MEDICAL STAFF OF OVER 340 PHYSICIANS ACROSS MULTIPLE SPECIALTIES, PMMC OFFERS A FULL RANGE OF INPATIENT AND OUTPATIENT MEDICAL SERVICES FOR THE GREATER AURORA AREA. IN CONCERT WITH OTHER PRESENCE MINISTRIES, PMMC STRIVES TO LIVE OUT ITS MISSION OF PROVIDING COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES IT SERVES. FOR CALENDAR YEAR ENDED DECEMBER 2015 PRESENCE MERCY MEDICAL CENTER PROVIDED PATIENT CARE OF 40,245 PATIENT DAYS AND HAD 8,907 DISCHARGES. EMERGENCY ROOM VISITS TOTALED 36,778, SURGERIES TOTALED 3,265, AND OUTPATIENT REGISTRATIONS TOTALED 136,412. PRESENCE COVENANT MEDICAL CENTER (PCMC) HAS BEEN MEETING THE HEALTH NEEDS OF CHAMPAIGN COUNTY RESIDENTS FOR OVER 90 YEARS. FOUNDED BY THE SERVANTS OF THE HOLY HEART OF MARY, OUR HOSPITAL CONTINUES TO CARRY OUT ITS MISSION OF PROVIDING "COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES" IT SERVES. PRESENCE COVENANT MEDICAL CENTER IS A 210-BED COMPREHENSIVE MEDICAL FACILITY WITH A RICH HISTORY IN THE CHAMPAIGN-URBANA COMMUNITY. TODAY, PCMC IS ONE OF EAST CENTRAL ILLINOIS MOST ADVANCED MEDICAL FACILITIES, WITH A MEDICAL STAFF OF OVER 250 PHYSICIANS REPRESENTING VARIOUS AREAS OF SPECIALIZED CARE. PCMC MAINTAINS THE AREAS LARGEST INPATIENT REHABILITATION CENTER, FEATURING FACILITIES FOR PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY. PCMC ALSO HAS ORTHOPEDIC SERVICES, THE CENTER FOR HEALTHY LIVING, AND THE AREAS ONLY ADULT BEHAVIORAL HEALTH UNIT IN A HOSPITAL SETTING. FOR CALENDAR YEAR ENDED DECEMBER 2015 PRESENCE COVENANT MEDICAL CENTER PROVIDED PATIENT CARE OF 29,939 PATIENT DAYS AND HAD 7,504 DISCHARGES. EMERGENCY ROOM VISITS TOTALED 25,527, SURGERIES TOTALED 6,291, AND OUTPATIENT REGISTRATIONS TOTALED 109,696. PRESENCE UNITED SAMARITANS MEDICAL CENTER (PUSMC) HAS BEEN MEETING THE HEALTH NEEDS OF DANVILLE AND THE SURROUNDING EAST CENTRAL ILLINOIS AND WESTERN INDIANA RESIDENTS SINCE 1882. FOUNDED BY THE FRANCISCAN SISTERS OF THE SACRED HEART, PUSMC CONTINUES TO CARRY OUT ITS MISSION OF PROVIDING "COMPASSIONATE, HOLISTIC CARE WITH A SPIRIT OF HEALING AND HOPE IN THE COMMUNITIES IT SERVES." PUSMC IS A CATHOLIC, NON-PROFIT 174-LICENSED ACUTE BED HOSPITAL PROVIDING QUALITY HEALTH CARE LOCATED IN DANVILLE, ILLINOIS. PUSMCS PRIMARY SERVICE AREA CONSISTS OF VERMILLION COUNTY, ILLINOIS (NEARLY 82,000 RESIDENTS). COMMUNITIES IN RURAL SOUTHERN IROQUOIS AND NORTHERN EDGAR COUNTIES IN ILLINOIS AND VERMILLION, FOUNTAIN AND WARREN COUNTIES IN INDIANA COMPLETE THE 110,000 RESIDENT TOTAL SERVICE AREAS. FOR CALENDAR YEAR ENDED DECEMBER 2015 PRESENCE UNITED SAMARITANS MEDICAL CENTER PROVIDED PATIENT CARE OF 19,209 PATIENT DAYS AND HAD 5,584 DISCHARGES. EMERGENCY ROOM VISITS TOTALED 39,329, SURGERIES TOTALED 3,224, AND OUTPATIENT REGISTRATIONS TOTALED 136,412.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses822,613,339

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,778,870	5,580,128	2,993,545

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	509,562
d	Related organizations		1d
e	Government grants (contributions)		1e	122,796

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,611,968

g	Noncash contributions included in lines 1a-1f:$ 62,624
h Total.Add lines 1a-1f.......		2,244,326

		Business Code
2a	NET PATIENT REVENUE	622110	1,059,947,321	1,059,947,321
b	RETAIL/CONTRACT PHARMACY	446110	3,985,521	2,305,746	1,679,775
c	MEANINGFUL USE	622110	5,733,935	5,733,935
d	MEDICAL OFFICE BLDG RENT	561000	2,190,071	2,190,071
e	PHP CAPITATION REVENUE	622110	53,563,972	53,563,972
f	All other program service revenue.
g Total.Add lines 2a–2f.....			1,125,420,820

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			2,924,591		1,475,834	1,448,757
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		178,246
b	Less: rental expenses		130,966
c	Rental income or (loss)	0	47,280
d	Net rental income or (loss)......			47,280		47,280
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,324,809
b	Less: cost or other basis and sales expenses	54,764	1,080,184
c	Gain or (loss)	-54,764	244,625
d	Net gain or (loss).....			189,861	189,861
8a	Gross income from fundraising events (not including $ 509,562of contributions reported on line 1c). See Part IV, line 18 ....
	a		775,429
b	Less: direct expenses ...b		556,356
c	Net income or (loss) from fundraising events..			219,073			219,073
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..			0
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CAFETERIA SALES		722514	3,972,231			3,972,231
b	GIFT SHOP & AUXILIARY		453220	701,241			701,241
c	ADMINISTRATION SERVICES			5,859,694	5,859,694
d	All other revenue ....			3,522,672	2,257,873	1,264,799
e	Total. Add lines 11a–11d ......			14,055,838
12	Total revenue. See Instructions......			1,145,101,789	1,132,048,473	4,467,688	6,341,302

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	125,883	125,883
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	49,044	49,044
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	5,645,814		5,645,814
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	323,893,521	306,370,335	16,367,075	1,156,111
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	12,755,458	193,138	12,562,320
9	Other employee benefits .......	38,407,364	581,550	37,825,814
10	Payroll taxes ...........	24,512,270	27,592	24,484,678
11	Fees for services (non-employees):
a	Management ......	108,471,264		108,471,264
b	Legal .........	557,752		557,752
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	138,836,574	108,556,289	30,280,285
12	Advertising and promotion ....	352,235	125,077	175,855	51,303
13	Office expenses .......	4,348,368	4,244,041	100,439	3,888
14	Information technology ......	104,369	93,095	11,156	118
15	Royalties ..	0
16	Occupancy ...........	31,199,427	12,035,791	19,158,879	4,757
17	Travel ............	692,962	344,855	327,112	20,995
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	211,926	172,748	29,099	10,079
20	Interest ...........	24,597,917		24,597,917
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	52,275,679	2,748,157	49,527,368	154
23	Insurance ...	38,701,213	140,533	38,560,680
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	182,821,599	182,821,599
b	BAD DEBT EXPENSE	63,150,366	63,150,366
c	IL MEDICAID TAX	53,523,211	53,523,211
d	CAPITATION EXPENSE	51,841,132	51,841,132
e	All other expenses	40,624,973	35,468,903	4,548,133	607,937
25	Total functional expenses. Add lines 1 through 24e	1,197,700,321	822,613,339	373,231,640	1,855,342
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			37,736,241	2	35,929,304
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			223,684,989	4	165,237,905
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	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
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			28,182,384	8	25,803,971
9	Prepaid expenses and deferred charges ......			3,449,564	9	1,985,458
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,081,223,824
b	Less: accumulated depreciation	10b	640,007,163	456,003,351	10c	441,216,661
11	Investments—publicly traded securities .			0	11	26,026,731
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	3,276,773
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			41,578,969	15	58,362,559
16	Total assets. Add lines 1 through 15 (must equal line 34)...			790,635,498	16	757,839,362

17	Accounts payable and accrued expenses .....	80,724,559	17	48,110,201
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	241,698
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	3,205,609
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	166,884,559	25	120,064,864
26	Total liabilities. Add lines 17 through 25..	247,609,118	26	171,622,372

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	530,928,782	27	571,625,531
28	Temporarily restricted net assets ...........	10,562,188	28	13,070,811
29	Permanently restricted net assets	1,535,410	29	1,520,648
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	543,026,380	33	586,216,990
34	Total liabilities and net assets/fund balances ........	790,635,498	34	757,839,362