Form990
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 07-01-2017 , and ending 06-30-2018
BCheck if applicable:
CName of organization
Alexian Brothers Behavioral Health Hospital
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1650 Moon Lake Blvd
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Hoffman Estates, IL60169
D Employer identification number

36-4251848
E Telephone number

G Gross receipts $ 84,707,321
F Name and address of principal officer:
Clayton Ciha
1650 Moon Lake Blvd
Hoffman Estates,IL60169
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
https://www.amitahealth.org/locations/hospitals/behavioral
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:  
L Year of formation: 1998
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: To improve the health and well-being of all people in the communities we serve.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 10
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 6
5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) ...... 5 858
6 Total number of volunteers (estimate if necessary) ............. 6 26
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 317,977 607,194
9 Program service revenue (Part VIII, line 2g) ......... 80,701,236 83,634,748
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 14,049 25,686
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 414,394 439,693
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 81,447,656 84,707,321
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   0
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 47,667,953 50,458,159
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 32,062,547 35,683,992
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 79,730,500 86,142,151
19 Revenue less expenses. Subtract line 18 from line 12....... 1,717,156 -1,434,830
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 35,941,744 40,590,024
21 Total liabilities (Part X, line 26)............. 17,544,403 20,112,862
22 Net assets or fund balances. Subtract line 21 from line 20..... 18,397,341 20,477,162
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2019)
Form 990 (2019)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: Alexian Brothers Behavioral Health Hospital ("ABBHH") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health needs of those we are called to serve.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 70,478,739 including grants of $ 0 ) (Revenue $ 83,727,116 )
Alexian Brothers Behavioral Health Hospital is a 141-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, Alexian Brothers Behavioral Health Hospital treated 5,398 adults and children for a total of 46,525 patient days of service. The hospital also provided services for 178,402 outpatient visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.
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 expensesMediumBullet70,478,739
Form 990 (2019)
Form 990 (2019)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
Form 990 (2019)
Form 990 (2019)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
64
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
858
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
Yes
 
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
 
Form 990 (2019)
Form 990 (2019)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
10
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJeannie Justie2601 Navistar Dr Bld 4 FL 2-Finance   Lisle,IL60532 (224) 273-0515
Form 990 (2019)
Form 990 (2019)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) BRUCE WOLFE
 
CHAIRPERSON
 1.0
.................
2.0 		X   X       0 0 0
(2) KATHLEEN GILMER
 
VICE CHAIRPERSON
 1.0
.................
2.0 		X   X       0 0 0
(3) CLAYTON CIHA
 
CEO, ABBHH
 47.0
.................
3.0 		X   X       0 393,089 51,398
(4) CHRISTOPHER D'AGOSTINO DO
 
DIRECTOR; CHIEF MEDICAL OFFICER
 50.0
.................
0 		X           413,724 0 56,236
(5) KUMUDINI GINDE MD
 
DIRECTOR; PSYCHIATRIST
 50.0
.................
0 		X           243,420 0 28,495
(6) JOANNE LESKI EDD RN CNE
 
DIRECTOR
 1.0
.................
2.0 		X           0 0 0
(7) MARIJO LETIZIA PHD
 
DIRECTOR
 1.0
.................
2.0 		X           0 0 0
(8) THOMAS R PALMER JD
 
DIRECTOR
 1.0
.................
2.0 		X           0 0 0
(9) GREGORY A TEAS MD
 
DIRECTOR; CHIEF MEDICAL OFFICER
 50.0
.................
0 		X           339,134 0 50,065
(10) JUDGE JOHN D TOURTELOT
 
DIRECTOR
 1.0
.................
2.0 		X           0 0 0
(11) MARK FREY
 
CEO, AMITA HEALTH
 0.0
.................
0.0 		    X       0 1,730,719 47,458
(12) DONNA GAUTHIER
 
ASSISTANT SECRETARY
 1.0
.................
39.0 		    X       0 90,398 24,526
(13) DAVID JONES
 
TREASURER; CFO, ABBHH
 17.0
.................
33.0 		    X       0 208,936 45,912
(14) DIANA WOYTKO
 
SECRETARY; CQO, AMITA HEALTH
 1.0
.................
49.0 		    X       0 383,399 58,496
(15) CHRISTOPHER R NOVAK
 
CHIEF OPERATING OFFICER
 50.0
.................
0.0 		      X     0 225,398 36,483
(16) CLIFTON J SAPER
 
EXECUTIVE DIRECTOR, O/P SERVICES (END 2/2017)
 0.0
.................
0 		      X     177,304 0 40,532
(17) SACHIN J BHALERAO DO
 
PSYCHIATRIST
 50.0
.................
0 		        X   456,193 0 21,306
Form 990 (2019)
Form 990 (2019)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) MICHAEL BRILLIANT MD
 
PSYCHIATRIST
 50.0
.......................0 		        X   523,190 0 47,217
(19) MUMTAZ F RAZA MD
 
PSYCHIATRIST
 50.0
.......................0 		        X   530,332 0 52,221
(20) SALAHUDDIN I SYED MD
 
PSYCHIATRIST
 50.0
.......................0 		        X   540,068 0 25,120
(21) SHUBHRAJAN S WADYAL MD
 
PSYCHIATRIST
 50.0
.......................0 		        X   525,615 0 1,333


















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 3,748,979 3,031,939 586,797
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet47
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
COMPREHENSIVE PHARMACY SERVICES LLC

DEPT 903
MEMPHIS,TN38148 		PHARMACY SERVICES 719,474
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 0
b Membership dues..1b 0
c Fundraising events..1c 0
d Related organizations1d 499,379
e Government grants (contributions)1e 107,815
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 607,194
Program Service RevenueAmt Business Code
2a Net Patient Revenue 621990 81,666,826 81,666,826    
b Services to Affiliates 561000 855,849 855,849    
c School/Aftercare Program 900099 1,112,073 1,112,073    
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 83,634,748
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 25,686     25,686
4 Income from investment of tax-exempt bond proceedsMediumBullet 0     0
5 Royalties...........MediumBullet 0     0
(ii) Personal (i) Real
6a Gross rents 0 0 6a
b Less: rental expenses   0 6b
c Rental income or (loss) 0 0 6c
d Net rental income or (loss).......MediumBullet 0     0
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 0 0 7a
b Less: cost or other basis and sales expenses 0   7b
c Gain or (loss) 0 0 7c
d Net gain or (loss).........MediumBullet 0     0
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet 0   0
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet 0     0
10a Gross sales of inventory, less
returns and allowances ..
10a 0
b Less: cost of goods sold .. 10b 0
c Net income or (loss) from sales of inventory..MediumBullet 0     0
Business Code Miscellaneous Revenue
11a Cafeteria/Vending Revenue 722514 204,704     204,704
b Research Revenue 900099 92,368 92,368    
c Escheatment Revenue 900099 9,043     9,043
d All other revenue .... 133,578 0 0 133,578
e Total. Add lines 11a–11d ...... MediumBullet 439,693
12 Total revenue. See instructions.....MediumBullet 84,707,321 83,727,116 0 373,011
Form 990 (2019)
Form 990 (2019)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....    
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 1,458,270 1,069,072 389,198  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........ 40,204,212 34,940,298 5,263,914  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,011,448 879,020 132,428  
9 Other employee benefits ....... 4,984,320 4,331,726 652,594  
10 Payroll taxes ........... 2,799,909 2,421,709 378,200  
11 Fees for services (non-employees):        
a Management ...... 97,369   97,369  
b Legal ......... 6,496   6,496  
c Accounting ........... -5,400   -5,400  
d Lobbying ........... 408   408  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 705,071 532,912 172,159 0
12 Advertising and promotion .... 47,904 518 47,386  
13 Office expenses ....... 297,265 73,472 223,793  
14 Information technology ...... 447   447  
15 Royalties ..        
16 Occupancy ........... 823,303 619,325 203,978  
17 Travel ............ 151,346 60,163 91,183  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 32,290 28,181 4,109  
20 Interest ........... 813,096   813,096  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 1,101,103 99,045 1,002,058  
23 Insurance ... 1,095,230   1,095,230  
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 Purchased Services 7,532,203 2,810,028 4,722,175  
b Professional Fees to Affiliate 15,153,065 15,153,065    
c Provider Tax 6,383,761 6,383,761    
d Medical Supplies 749,717 749,492 225  
e All other expenses 699,318 326,952 372,366 0
25 Total functional expenses. Add lines 1 through 24e 86,142,151 70,478,739 15,663,412 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2019)
Form 990 (2019)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ -206,795 1 3,089
2 Savings and temporary cash investments ......... 0 2 95,360
3 Pledges and grants receivable, net ...... 0 3  
4 Accounts receivable, net ............. 10,467,832 4 10,696,037
5 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ........... 0 7 0
8 Inventories for sale or use ............ 118,030 8 133,428
9 Prepaid expenses and deferred charges ...... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 30,111,444
b Less: accumulated depreciation 10b 6,405,077 23,135,660 10c 23,706,367
11 Investments—publicly traded securities . 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ............... 47,144 14 30,980
15 Other assets. See Part IV, line 11 ........... 2,379,873 15 5,924,763
16 Total assets. Add lines 1 through 15 (must equal line 33)... 35,941,744 16 40,590,024
Liabilities 17 Accounts payable and accrued expenses ..... 5,574,266 17 6,657,713
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 140,464 19 0
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
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 11,829,673 25 13,455,149
26 Total liabilities. Add lines 17 through 25.. 17,544,403 26 20,112,862
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions ..........   27  
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 18,397,341 32 20,477,162
33 Total liabilities and net assets/fund balances ........ 35,941,744 33 40,590,024
Form 990 (2019)
Form 990 (2019)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
84,707,321
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
86,142,151
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-1,434,830
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
18,397,341
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
542,285
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
2,972,366
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
20,477,162
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2019)
Form 990 (2019)
Additional Data


Software ID: 17005876
Software Version: 2017v2.2
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
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 2019 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-2019 		(iii)
Distributable
Amount for 2019
1 Distributable amount for 2019 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2019:
a From 2014.......  
b From 2015.......  
c From 2016.......  
d From 2017.......  
e From 2018.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2019 distributable amount  
i Carryover from 2014 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2019 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2019 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2019, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2019. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2020. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2015.....  
b Excess from 2016.....  
c Excess from 2017.....  
d Excess from 2018.....  
e Excess from 2019.....  
Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019
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) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2
Name of organization
Alexian Brothers Behavioral Health Hospital
  		Employer identification number
36-4251848
Part I
Contributors
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
 
 
 
 

$  


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

$  


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 3
Name of organization
Alexian Brothers Behavioral Health Hospital
  		Employer identification number

36-4251848
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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 4
Name of organization
Alexian Brothers Behavioral Health Hospital
  		Employer identification number

36-4251848
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data


Software ID: 17005876
Software Version: 2017v2.2
SCHEDULE C
(Form 990 or 990-EZ)

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2019

Schedule C (Form 990 or 990-EZ) 2019
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2019


Schedule C (Form 990 or 990-EZ) 2019
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
408
j
Total. Add lines 1c through 1i ....................................................................................................
408
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Alexian Brothers Behavioral Health Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Alexian Brothers Behavioral Health Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C (Form 990 or 990EZ) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   1,540,000 1,540,000
b Buildings ....   24,327,013 4,800,655 19,526,358
c Leasehold improvements   50,696 31,545 19,151
d Equipment ....   2,506,795 1,467,557 1,039,238
e Other .....   1,686,940 105,320 1,581,620
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 23,706,367
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 3
Part VII
Investments—Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)Other Assets 42,965
(2)Due from Affiliates 5,413,947
(3)Other Receivables 467,851
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 5,924,763
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  
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 13,455,149
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) 2019

Schedule D (Form 990) 2019
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2018.
Schedule D (Form 990) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    607,694 0 607,694 0.71 %
b Medicaid (from Worksheet 3, column a) . . . . .     11,361,112 5,971,715 5,389,397 6.26 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 11,968,806 5,971,715 5,997,091 6.96 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   8,506 459,906 199,142 260,764 0.30 %
f Health professions education (from Worksheet 5) . . .   841 702,881   702,881 0.82 %
g Subsidized health services (from Worksheet 6) . . . .     0 0 0 0 %
h Research (from Worksheet 7) .     0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     0 0 0 0 %
j Total. Other Benefits . . 0 9,347 1,162,787 199,142 963,645 1.12 %
k Total. Add lines 7d and 7j . 0 9,347 13,131,593 6,170,857 6,960,736 8.08 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support         0 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other   184 67,526 29,008 38,518 0.04 %
10 Total 0 184 67,526 29,008 38,518 0.04 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
974,920
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
97,492
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
21,071,397
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
22,490,299
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-1,418,902
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Alexian Brothers Behavioral Health Hospital
1650 Moon Lake Boulevard
Hoffman Estates,IL601691010
https://www.amitahealth.org/locations/hospitals/behavioral
0005009 		X               Behavioral Health Hospital  
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Alexian Brothers Behavioral Health 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): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.amitahealth.org/about-us/community-benefit/alexian-brothers-behavioral-health
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Alexian Brothers Behavioral Health Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
https://www.amitahealth.org/patient-resources/pay-your-bill/financial-assistance
b
https://www.amitahealth.org/patient-resources/pay-your-bill/financial-assistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 6
Part VFacility Information (continued)

Billing and Collections
Alexian Brothers Behavioral Health Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Alexian Brothers Behavioral Health Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 3E To better target community resources on the service area's most pressing health needs, the hospital participated in a group discussion with organizational decision makers and community leaders to prioritize the significant community health needs while considering several criteria: alignment with Ascension Health strategies of healthcare that leaves no one behind; care for the poor and vulnerable; opportunities for partnership; availability of existing programs and resources; addressing disparities of subgroups; availability of evidence-based practices; and community input. The significant health needs are a prioritized description of the significant health needs of the community as identified through the CHNA. See Schedule H, Part V, Line 7 for the link to the CHNA and Schedule H, Part V, Line 11 for how those needs are being addressed.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Alexian Brothers Behavioral Health Hospital. A LIST OF RECOMMENDED PARTICIPANTS WAS PROVIDED BY HOSPITALS PARTICIPATING IN THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL (MCHC) LED HOSPITAL COALITION; AND INCLUDED NAMES AND CONTACT INFORMATION FOR PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, SOCIAL SERVICE PROVIDERS AND A VARIETY OF OTHER COMMUNITY LEADERS. PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK AS WELL AS THE COMMUNITY OVERALL. TWENTY-NINE AGENCIES/INDIVIDUALS PROVIDED COMMENT. INPUT FROM THE FOLLOWING ORGANIZATIONS WAS GATHERED during the period August to October 2016: A SAFE HAVEN FOUNDATION ANTOICH AREA HEALTHCARE ACCESSIBILITY ALLIANCE AUSTIN CHILDCARE PROVIDERS NETWORK CHICAGO DEPARTMENT OF PUBLIC HEALTH DUPAGE COUNTY HEALTH DEPARTMENT DUPAGE FEDERATION ON HUMAN SERVICES REFORM ELMHURST CUSD 205 ENLACE CHICAGO ERIE FAMILY HEALTH CENTER/ERIE HEALTHREACH WAUKEGAN HEALTHCARE FOUNDATION OF NORTHERN LAKE COUNTY ILLINOIS DEPARTMENT OF PUBLIC HEALTH, BELLWOOD REG OFFICE LAKE COUNTY FOREST PRESERVES LAKE COUNTY HEALTH DEPARTMENT LAKE COUNTY COMMUNITY HEALTH CENTER LORETTO HOSPITAL METROPOLITAN CHICAGO HEALTHCARE COUNCIL NAPERVILLE SCHOOL DISTRICT 203 NEW MOMS, INC. NORTHWEST COMMUNITY HEALTHCARE NORTHWEST COMPASS, INC. NORTHWESTERN LAKE FOREST HOSPITAL PCC COMMUNITY WELLNESS CENTER PEOPLE'S RESOURCE CENTER ST. JOSEPH SERVICES UNITED WAY OF METROPOLITAN CHICAGO VILLAGE OF ADDISON VILLAGE OF ARLINGTON HEIGHTS WEST HUMBOLDT PARK DEVELOPMENT COUNCIL WHEELING TOWNSHIP GENERAL ASSISTANCE OFFICE THROUGH THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY POPULATIONS (INCLUDING AFRICAN-AMERICAN, ARABIC, ASIAN, AUTISTIC CHILDREN, THE DISABLED, EASTERN EUROPEAN, ELDERLY, ETHNIC MINORITIES, HISPANIC, THE HOMELESS, IMMIGRANTS, INDIAN, JAPANESE, LGBT POPULATION, LOW-INCOME RESIDENTS, MULTILINGUAL, MULTIRACIAL, NON-ENGLISH SPEAKING, POLISH, RUSSIAN, SOUTH AMERICAN, UNDOCUMENTED, UNINSURED/UNDERINSURED, WOMEN, YOUTH), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (INCLUDING AFRICAN-AMERICAN, THE DISABLED, ELDERLY, EX-OFFENDERS, FREE CARE, HISPANIC, THE HOMELESS, IMMIGRANTS, LGBT COMMUNITY, LOW-INCOME, MEDICAID/MEDICARE, THE MENTALLY ILL, NON-ENGLISH SPEAKING ADULTS, PREGNANT TEENS, SUBSTANCE ABUSERS, UNDOCUMENTED, UNINSURED/UNDERINSURED, VETERANS, YOUNG ADULTS, YOUTH).
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Alexian Brothers Behavioral Health Hospital. The other hospital facilities with which the reporting hospital conducted its CHNA include: Adventist LaGrange Memorial Hospital St. Alexius Medical Center Alexian Brothers Medical Center Franciscan St. James Health Ingalls Memorial Hospital Little Company of Mary Hospital and Health Care Centers Loretto Hospital Northwest Community Healthcare Northwestern memorial Hospital Palos Community Hospital Rush Oak Park Hospital Rush University Medical Center Saint Anthony Hospital St. Bernard Hospital and Health Care Center Swedish Covenant Hospital The University of Chicago Medicine Thorek Memorial Hospital Adventist Glen Oaks Hospital Adventist Hinsdale Hospital Edward Hospital & Health Services Elmhurst Memorial Healthcare Central Dupage Hospital Northwestern Lake Forest Hospital Adventist Bolingbrook Hospital
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Alexian Brothers Behavioral Health Hospital. Because ABBHH is a specialty hospital focusing on behavioral health and substance abuse, it is addressing only that prioritized need through its community benefit programs. The other prioritized needs are being addressed by ABBHH's sister organizations, Alexian Brothers Medical Center and St. Alexius Medical Center ISSUES: INJURY AND VIOLENCE/ MENTAL HEALTH/ SUBSTANCE ABUSE THERE IS A HIGHER RATE OF HOMICIDE AND VIOLENT CRIME IN THE ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL (ABBHH) AREA THAN IN THE MCHC REGION OR IN ILLINOIS. THIS MAY BE RELATED TO A RELATIVELY HIGH PERCENTAGE OF HOUSEHOLDS WITH FIREARMS. THIS MAY ALSO BE RELATED TO A LACK OF MENTAL HEALTH SERVICES FOR SOME RESIDENTS. IN THE ABBHH COMMUNITY MORE THAN HALF OF VERY LOW INCOME RESIDENTS EXPERIENCE SYMPTOMS OF CHRONIC DEPRESSION AND YET HAVE THE LEAST ACCESS TO SERVICES. 82% OF KEY STAKEHOLDERS HAVE RATED ACCESS TO MENTAL HEALTH SERVICES AS THEIR NUMBER ONE CONCERN IN THE ABBHH AREA. THE PERCENTAGE OF RESIDENTS SELF-REPORTING "FAIR" OR "POOR" MENTAL HEALTH HAS RISEN FROM 7.6% IN 2009, TO 10.2% IN 2012 AND 12.0% IN 2015. THE VERY LOW INCOME AND HISPANIC COMMUNITY ARE MOST AFFECTED. CLOSELY RELATED TO MENTAL HEALTH ACCESS, THIS ISSUE REMAINS A TOP CONCERN DUE TO LOW INCOME RESIDENTS' INABILITY TO ACCESS SERVICES, ESPECIALLY AS STATE FUNDING FOR SOCIAL SERVICE AGENCIES HAS BEEN WITHHELD. SO WHILE THE COMMUNITY STATISTICS MAY BE AVERAGE, KEY STAKEHOLDERS NOTE A LACK OF SERVICES FOR THIS POPULATION. ACTIONS TAKEN THE CRISIS INTERVENTION LED BY ABBHH IS A SERVICE AVAILABLE TO THE COMMUNITY 24 HOURS A DAY, 7 DAYS A WEEK AND 365 DAYS A YEAR AT NO CHARGE. THESE SERVICES ASSIST CLIENTS AND FAMILY MEMBERS IN ACUTE CRISIS SITUATIONS. WHEN NECESSARY, THEY ARE REFERRED TO THE CORRECT PROFESSIONAL TO HANDLE THEIR CASES. ABBHH OFFERED CLINICAL ACCESS ASSESSMENTS FOR MENTAL HEALTH, FREE OF CHARGE TO THE COMMUNITY. ABBHH HOUSES SEVERAL SUPPORT GROUPS IN REGARDS TO DEALING AND MANAGING MENTAL ISSUES. THESE INCLUDE EATING DISORDER GROUP, ANXIETY AND OCD GROUP, AND YOUNG ADULTS GROUP. YOUNG ADULTS GROUP IS DESIGNED FOR INDIVIDUALS AGED 18 TO 30 WHO ARE STRUGGLING TO MANAGE SYMPTOMS OF THEIR MENTAL HEALTH DURING THIS TRANSITION PHASE OF LIFE. ABBHH LICENSED CLINICAL SOCIAL WORKER OFFERED SCHOOL STAFF, PARISH STAFF, COACHES, SCOUT LEADERS AN OPPORTUNITY TO LEARN ABOUT SUICIDE AWARENESS, PREVENTION AND INTERVENTION UPON REQUEST. ABBHH PROVIDES ONGOING EDUCATIONAL SEMINARS ON AUTISM SPECTRUM DISORDER (ASD). THEY ALSO OFFERED FREE ASD SCREENING TO MEET THE NEEDS OF THE COMMUNITY IN ORDER TO CONNECT THEM TO RESOURCES. THE ASD SCREENING HAS SERVED OVER 390 PEOPLE IN THE COMMUNITY. THE ASD LIFE TRANSITIONS GROUP IS INTENDED TO HELP TEENS AND YOUNG ADULTS WITH AUTISM SPECTRUM DISORDERS AND THEIR FAMILIES BY PROVIDING EDUCATION AND NETWORKING AS WELL AS OPPORTUNITIES TO MEET AND CONNECT. EACH MONTH, A DIFFERENT SPEAKER TALKS TO THE GROUP AND ADDRESSES A VARIETY OF ISSUES SPECIFIC TO THIS POPULATION, INCLUDING COLLEGE TRANSITION AND ACCOMMODATIONS, JOB SKILLS, INDEPENDENT LIVING, VOLUNTEER OPPORTUNITIES, GOVERNMENT BENEFITS, DRIVING, EXERCISE AND MORE TOPICS OF INTEREST. ABBHH OFFERED SCHOOL REFUSAL/SCHOOL ANXIETY PROGRAM TO THE COMMUNITY. FOR SOME, SCHOOL ANXIETY WILL MANIFEST INTO SCHOOL AVOIDANCE WHICH MAY IMPACT ATTENDANCE, ACADEMIC PERFORMANCE, SOCIAL INTERACTIONS, FAMILY RELATIONSHIPS, AND PHYSICAL HEALTH. WITHOUT PROPER INTERVENTION, THESE PROBLEMS CAN HAVE A PROFOUND EFFECT ON BOTH THE FAMILY AND A STUDENT'S CHANCE FOR SUCCESS. PROGRAM DIRECTORS ALSO REACH OUT TO SCHOOL PROFESSIONALS AND PARENTS ON IDENTIFYING THE STUDENTS IN NEED AND RAISE AWARENESS. THE SEMINAR SERIES PROVIDED PROFESSIONALS IN THE COMMUNITY EDUCATIONAL INFORMATION ABOUT ALL NEURODEVELOPMENTAL DISORDERS AS WELL AS OPPORTUNITIES TO MEET AND CONNECT. EACH MONTH ABBHH INVITED A DIFFERENT SPEAKER TO ADDRESS A VARIETY OF ISSUES SPECIFIC TO THIS POPULATION, INCLUDING DIAGNOSIS AND TREATMENT, FUTURE PLANNING, BEHAVIORAL THERAPY, GOVERNMENT BENEFITS, AND MORE TOPICS OF INTEREST. ABBHH IS A CHARTER MEMBER OF THE KENNEDY FORUM, A CONSORTIUM OF PROVIDERS AND AGENCIES WHICH ADVOCATE AT THE STATE AND FEDERAL LEVEL FOR IMPROVED ACCESS TO MENTAL HEALTH SERVICES. THE KENNEDY FORUM OF ILLINOIS FOCUSES ON INCREASING ACCESS TO MENTAL HEALTH PROVIDERS, ADVANCING THE POLICIES AND PROGRAMMING OF BEHAVIORAL HEALTH AND IMPROVING THE LIVES OF INDIVIDUALS LIVING WITH MENTAL ILLNESS AND ADDICTION. STAND AGAINST VIOLENCE EVERYONE/EVERYWHERE (SAVE-2) INITIATIVE PROVIDES SCHOOLS WITH PROGRAMS FOR FAMILIES ON BULLYING, BULLYING PREVENTION, SUICIDE PREVENTION AND DEVELOPING OF A CULTURE OF COMPASSION AT BOTH MIDDLE AND HIGH SCHOOL LEVELS. ONE EXAMPLE IS THE EPIDEMIC PROGRAM IS EVIDENCE BASED 4-DAY BULLYING PREVENTION PROGRAM FOR 8TH GRADERS. THE PROGRAM HELPS DEVELOP INTERNAL AND EXTERNAL RESOURCES A CHILD CAN USE WHEN CONFRONTED WITH POTENTIALLY DANGEROUS INTERPERSONAL ENCOUNTERS. NOT ONLY DOES IT OFFER SUPPORT FOR THE STUDENTS, BUT IT ALSO PROVIDES CRUCIAL SUPPORT TO PARENTS AND SCHOOL PROFESSIONALS. IN THE ABBHH SERVICE AREA, THE POPULATION IS SLIGHTLY OLDER WITH 15.4% OF RESIDENTS OVER AGE 65 AS COMPARED TO 13.9% IN ILLINOIS. 19.2% OF THE POPULATION IS HISPANIC, A HIGHER PERCENTAGE AS COMPARED TO 16.7% IN ILLINOIS AND 17.4% IN THE US. THE COMMUNITY'S SOCIAL DETERMINANTS ARE FAIRLY AVERAGE, EXCEPT THAT THERE ARE 7.6% OF RESIDENTS THAT ARE CONSIDERED "LINGUISTICALLY ISOLATED" I.E. DO NOT SPEAK ENGLISH. NEARLY 15% OF THE POPULATION LIVES AT OR BELOW 100% OF THE POVERTY LEVEL AND 32.3% ARE AT OR BELOW THE 200% OF THE POVERTY LEVEL, REPRESENTING 2,174,865 INDIVIDUALS. IN THE ASSESSMENT, IT IS MOST OFTEN THESE INDIVIDUALS THAT HAVE DIFFICULTY ACCESSING SERVICES AND HAVE POORER OVERALL HEALTH, AND SO OUR EFFORTS TO PROVIDE THE COMMUNITY WITH NEEDED SERVICES SHOULD BE DIRECTED IN MOST CASES TOWARDS THIS POPULATION.
Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL. ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY. THE FRONT OF OUR STATEMENT INCLUDES THIS MESSAGE: "IF YOU ARE AN UNINSURED ILLINOIS RESIDENT AND MEET CERTAIN INCOME REQUIREMENTS, YOU MAY QUALIFY FOR A DISCOUNT THROUGH OUR ALEXIAN ASSISTANCE PROGRAM IN ACCORDANCE WITH THE STATE OF ILLINOIS, HOSPITAL UNINSURED PATIENT DISCOUNT ACT (EFFECTIVE APRIL 1, 2009). FOR ADDITIONAL INFORMATION, PLEASE CONTACT US AT 866-690-3370 OR ALEXIANASSISTANCE@ALEXIAN.NET". THE BACK OF OUR STATEMENT INCLUDES THIS MESSAGE: "IF PAYING THIS BILL PRESENTS A FINANCIAL HARDSHIP, YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ALEXIAN BROTHERS HOSPITAL NETWORK PROVIDES ASSISTANCE TO PATIENTS IN NEED OF FINANCIAL AID TO HELP PAY FOR HIS/HER HOSPITAL BILLS. YOU MAY OBTAIN AN APPLICATION BY CALLING OUR STAFF AT THE NUMBER BELOW OR YOU MAY DOWNLOAD THE FORMS FROM THE INTERNET AT WWW.ALEXIANBROTHERSHEALTH.ORG". IN ADDITION, ALL UNINSURED PATIENTS RECEIVE A LETTER FROM OUR PATIENT FINANCIAL SERVICES DEPARTMENT ONCE WE COMPLETE A PROCESS OF ATTEMPTING TO IDENTIFY ALTERNATIVE COVERAGE FOR UNINSURED PATIENTS. THIS LETTER IS SENT AT THE BEGINNING OF OUR STATEMENT CYCLE FOR EACH UNINSURED PATIENT. THE TEXT OF THE LETTER IS: "THANK YOU FOR CHOOSING ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL AS YOUR HEALTHCARE PROVIDER. YOUR ACCOUNT CURRENTLY HAS A BALANCE OF $XX; ADDITIONAL CHARGES MAY BE PENDING. WE HAVE NO RECORD THAT YOU HAVE HEALTH INSURANCE TO HELP IN PAYING YOUR BILL. IF YOU HAVE INSURANCE, PLEASE PROVIDE THE NECESSARY INFORMATION BY FILLING OUT THE STUB ABOVE AND FAXING A COPY OF YOUR INSURANCE CARD TO 847-483-7058, ATTN: CORRESPONDENCE TEAM. IF YOU HAD INSURANCE THAT ENDED WITHIN THE LAST 60 DAYS, YOU MAY BE ELIGIBLE FOR COBRA COVERAGE FROM A FORMER EMPLOYER. PLEASE CONTACT YOUR FORMER EMPLOYER TO DETERMINE IF YOU ARE ELIGIBLE." ABBHH USES MULTIPLE METHODS OF COMMUNICATING ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. ALEXIAN BROTHERS HEALTH SYSTEM'S (ABHS) WEBSITE, THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS, INCLUDING ABBHH FEATURES INFORMATION ON HOW TO APPLY FOR CHARITY CARE ONLINE. IN THE HOSPITAL SETTING, WE EMPLOY FINANCIAL COUNSELORS WHO ARE AVAILABLE TO WORK WITH PATIENTS AND WE ALSO HAVE MEDICAID APPLICATION SPECIALISTS TO ASSIST PATIENTS THAT MAY QUALIFY. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 9
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?0
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part I, Line 6a Community Benefit Report Filing Alexian Brothers Hospital Network (ABHN), EIN# 36-3276552, prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for Alexian Brothers Medical Center (ABMC), St. Alexius Medical Center (St. Alexius) and Alexian Brothers Behavioral Health Hospital (ABBHH).
Schedule H, Part VI, Line 7 STATE OF FILING FOR COMMUNITY BENEFIT ALEXIAN BROTHERS HOSPITAL NETWORK ("ABHN") PREPARES AND FILES THE ANNUAL NON-PROFIT HOSPITAL COMMUNITY BENEFIT PLAN REPORT WITH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. THIS REPORT IS PREPARED ON A CONSOLIDATED BASIS AND INCLUDES DATA FOR ALEXIAN BROTHERS MEDICAL CENTER ("ABMC"), ST. ALEXIUS MEDICAL CENTER ("SAMC") AND ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL ("ABBHH").
Schedule H, Part I, Line 3c FAP ELIGIBILITY PATIENTS WITH INCOME LESS THAN OR EQUAL TO 250% OF THE FEDERAL POVERTY LEVEL ("FPL") WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF ON THAT PORTION OF THE CHARGES FOR SERVICES FOR WHICH THE PATIENT IS RESPONSIBLE FOLLOWING PAYMENT BY AN INSURER, IF ANY. AT A MINIMUM, PATIENTS WITH INCOMES ABOVE 250% OF THE FPL BUT NOT EXCEEDING 400% OF THE FPL WILL RECEIVE A SLIDING SCALE DISCOUNT ON THAT PORTION OF THE CHARGES FOR SERVICES PROVIDED FOR WHICH THE PATIENT IS RESPONSIBLE FOLLOWING PAYMENT BY AN INSURER, IF ANY. A PATIENT ELIGIBLE FOR THE SLIDING SCALE DISCOUNT WILL NOT BE CHARGED MORE THAN THE CALCULATED AGB CHARGES. PATIENTS WITH DEMONSTRATED FINANCIAL NEEDS WITH INCOME GREATER THAN 400% OF THE FPL (INSURED) AND GREATER THAN 600% FPL (UNINSURED) MAY BE ELIGIBLE FOR CONSIDERATION UNDER A "MEANS TEST" FOR SOME DISCOUNT OF THEIR CHARGES FOR SERVICES FROM THE ORGANIZATION BASED ON A SUBSTANTIVE ASSESSMENT OF THEIR ABILITY TO PAY. CATASTROPHIC LOSS - YEARLY MAXIMUM FAMILY RESPONSIBILITY ON BALANCES WILL NOT EXCEED 25% OF THE ANNUAL GROSS FAMILY INCOME. A PATIENT ELIGIBLE FOR THE "MEANS TEST" DISCOUNT WILL NOT BE CHARGED MORE THAN THE CALCULATED AGB CHARGES.
Schedule H, Part V, Section B, Line 17 BILLING AND COLLECTION POLICY DURING TAX YEAR 2017, THE ORGANIZATION LEARNED VIA VERBAL COMMENTS OF IRS AGENTS AT PUBLIC EVENTS THAT THE IRS INTENDS THAT THE "READILY OBTAINABLE" STANDARD IN THE 501(R) REGULATIONS FOR THE AGB CALCULATION AND BILLING AND COLLECTION POLICY IS ONLY MET IF THOSE ITEMS ARE POSTED TO THE ORGANIZATION'S WEB SITE. THE ORGANIZATION HAD INTERPRETED THAT WEB POSTING STANDARD TO BE A SAFE HARBOR AFTER CONSULTING WITH EXTERNAL COUNSEL AND TAX ADVISORS, AND TIMELY TOOK OTHER STEPS TO MAKE THE INFORMATION READILY OBTAINABLE. CONSEQUENTLY, THE ORGANIZATION DOES NOT BELIEVE ITS DECISION TO NOT POST THESE DOCUMENTS TO ITS WEB SITE RISES TO THE LEVEL OF A FAILURE, NOR DOES IT BELIEVE THE CIRCUMSTANCES WERE EITHER WILLFUL OR EGREGIOUS, HAVING OTHERWISE TIMELY TAKEN THE STEPS NECESSARY TO ATTAIN AND CONTINUE TO MAINTAIN COMPLIANCE WITH THE OTHER REQUIREMENTS RELATED TO THE BILLING AND COLLECTION POLICY AND THE AGB, AS PART OF ITS POLICIES AND PROCEDURES FOR ENSURING COMPLIANCE WITH ALL ASPECTS OF 501(R). HOWEVER, THE ORGANIZATION IS MAKING THIS VOLUNTARY DISCLOSURE IN ORDER TO COMMUNICATE TO THE IRS THE CHANGES IT IS UNDERTAKING IN RESPONSE TO THE RECENT IRS INFORMAL GUIDANCE ON THIS SPECIFIC POINT CONCERNING THE "READILY OBTAINABLE" STANDARD, AND THE FACT THAT THE ORGANIZATION HAS STARTED THE WORK NECESSARY TO POST ITS AGB INFORMATION AND BILLING AND COLLECTION POLICY TO ITS WEB SITE AND WILL COMPLETE THOSE ADDITIONAL POSTINGS AS SOON AS REASONABLY POSSIBLE. THE OTHER WEB POSTINGS REQUIRED UNDER 501(R) (I.E., THOSE RELATED TO THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE FINANCIAL ASSISTANCE POLICY) WERE TIMELY COMPLETED AND CONTINUE TO REMAIN IN PLACE AS REQUIRED. THE ORGANIZATION BELIEVES ITS SAFEGUARDS WORKED AS INTENDED IN THIS CASE (I.E., THE ORGANIZATION HAS REGULAR COMMUNICATIONS WITH A NUMBER OF EXTERNAL LAW FIRMS AND TAX CONSULTANTS AND THE TIMELY ATTENTION TO THE RECENT GUIDANCE WAS SUPPORTED BY THE FRAMEWORK OF REGULAR ACCESS TO SUBJECT MATTER EXPERTS). THESE CHANGES ARE IN THE PROCESS OF BEING INCORPORATED INTO CORPORATE POLICIES AND PROCEDURES THAT APPLY TO THE ORGANIZATION.
Schedule H, Part I, Line 7g Subsidized Health Services ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL HAS NOT INCLUDED COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE FOLLOWING COSTING METHODOLOGIES WERE USED: -CHARITY AT COST - A COST TO CHARGE METHODOLOGY BASED ON THE FILED 2018 MEDICARE COST REPORT WAS USED TO CALCULATE COSTS. -UNREIMBURSED MEDICAID - COSTS ARE CALCULATED USING THE 2018 FILED MEDICAID COST REPORT. --OTHER BENEFITS - COSTS ARE DETERMINED BY ACTIVITY REPORTED IN ACCORDANCE WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION; COSTS COULD INCLUDE THE VALUE OF HOURLY WAGES, COSTS OF MATERIALS, VALUE OF SPACE LOANED TO COMMUNITY GROUPS FOR MEETINGS, AND INDIRECT COSTS WHERE APPLICABLE.
Schedule H, Part II Community Building Activities THE COMMUNITY BUILDING EFFORTS ARE LED BY THE MEMBER HOSPITALS, ALEXIAN BROTHERS MEDICALCENTER AND ST. ALEXIUS MEDICAL CENTER, WHICH INCLUDE ECONOMIC DEVELOPMENT OPPORTUNITIES WITH CHAMBERS; PROVIDING INTERSHIPS AND SCHOLARSHIPS TO LOCAL COLLEGES; SPONSORING FUNDRAISERS FOR COMMUNITY ORGANIZATIONS.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE ALEXIAN BROTHERS HOSPITAL NETWORK HOSPITALS PROACTIVELY WORK TO PRESUMPTIVELY ASSESS AND GRANT CHARITY TO ALL UNINSURED PATIENTS PRIOR TO SENDING THESE PATIENTS THEIR FIRST STATEMENT. WE SCREEN ALL UNINSURED PATIENTS AGAINST CREDIT SCORE DATA IN ORDER TO PRESUMPTIVELY APPLY OUR CHARITY POLICY. BASED ON THIS PROCESS, APPROXIMATELY 96% OF OUR UNINSURED PATIENT POPULATION IS DEFINED AS ELIGIBLE AND WE PROCESS A PARTIAL CHARITY ADJUSTMENT ON THEIR ACCOUNTS. THE AVERAGE DISCOUNT GIVEN TO THE UNINSURED PATIENT POPULATION IS 81%. IN PRIOR YEARS, WE LIMITED OUR PROACTIVE EFFORTS TO ONLY THOSE ACCOUNTS WITH BALANCES > $5,000. UNDER THAT SCENARIO, WE ESTIMATED THAT 1/3 OF OUR BAD DEBT PLACEMENTS MAY HAVE BEEN ELIGIBLE FOR CHARITY CARE DISCOUNTS. NOW THAT WE HAVE A MORE COMPREHENSIVE PRESUMPTIVE CHARITY PROGRAM, MANY MORE ACCOUNTS ARE GRANTED CHARITY EARLIER IN THE PROCESS AND PRIOR TO BAD DEBT PLACEMENT. THEREFORE, WE ESTIMATE THAT APPROXIMATELY 10% OF OUR CURRENT BAD DEBT PLACEMENTS WOULD BE ELIGIBLE FOR ADDITIONAL CHARITY IF WE HAD A FULL PRESUMPTIVE CHARITY PROCESS ACROSS 100% OF OUR SELFPAY AFTER INSURANCE ACCOUNTS. DISCOUNTS AND PAYMENTS ARE NOT INCLUDED IN BAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS FOR ABBHH UNLESS THE PAYMENT IS A RECOVERY OF AMOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT. RECOVERIES ARE CLASSIFIED AS A DECREASE TO BAD DEBT EXPENSE.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE (WHICH INCLUDE THE ACTIVITY OF ABBHH): THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING ECONOMIC CONDITIONS, HISTORICAL EXPERIENCE, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED THE HEALTH MINISTRY FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HEALTH MINISTRY'S POLICIES.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IT IS THE POLICY OF ABHS, INCLUDING ABBHH, TO OFFER PATIENTS A PAYMENT PLAN AND/OR CHARITY ASSISTANCE WHEN IT BECOMES KNOWN OR EVEN SUSPECTED THAT A PATIENT NEEDS FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS ARE NOTIFIED AND EVERY ATTEMPT IS MADE TO CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP THEM COMPLETE AN APPLICATION WITH COMPASSION AND DIGNITY. FINANCIAL COUNSELORS WORK WITH PATIENTS TO HELP DETERMINE IF THERE ARE ANY THIRD PARTY PAYERS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET HIS/HER OBLIGATIONS. WE WORK WITH THE PATIENT TO DETERMINE IF HE/SHE IS ELIGIBLE FOR FEDERAL PROGRAMS INCLUDING MEDICAID, STATE FUNDED PROGRAMS INCLUDING CRIME VICTIMS, ALTERNATIVE INSURANCE INCLUDING COBRA, WORKER'S COMPENSATION AND OR OTHER SPECIALIZED GRANT PROGRAMS. IN THE EVENT NO THIRD PARTY PROGRAMS ARE IDENTIFIED, WE THEN WORK WITH THE PATIENT TO HELP THEM APPLY FOR CHARITY DISCOUNTS AND PAYMENT PLANS IN ADDITION; ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY.
Schedule H, Part V, Section B, Line 16a FAP website - Alexian Brothers Behavioral Health Hospital: Line 16a URL: https://www.amitahealth.org/patient-resources/pay-your-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website - Alexian Brothers Behavioral Health Hospital: Line 16b URL: https://www.amitahealth.org/patient-resources/pay-your-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Alexian Brothers Behavioral Health Hospital: Line 16c URL: https://www.amitahealth.org/patient-resources/pay-your-bill/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessment ABBHH USES EXISTING SECONDARY DATA SOURCES TO COMPLEMENT THE RESEARCH QUALITY OF THIS COMMUNITY HEALTH NEEDS ASSESSMENT. DATA WERE OBTAINED FROM THE FOLLOWING SOURCES: CENTER FOR APPLIED RESEARCH AND ENVIRONMENTAL SYSTEMS (CARES) *CENTERS FOR DISEASE CONTROL & PREVENTION, OFFICE OF INFECTIOUS DISEASE, NATIONAL CENTER FOR HIV/AIDS, VIRAL HEPATITIS, STD, AND TB PREVENTION *CENTERS FOR DISEASE CONTROL & PREVENTION, OFFICE OF PUBLIC HEALTH SCIENCE SERVICES, CENTER FOR SURVEILLANCE, EPIDEMIOLOGY AND LABORATORY SERVICES, DIVISION OF HEALTH INFORMATICS AND SURVEILLANCE (DHIS) *CENTERS FOR DISEASE CONTROL & PREVENTION, OFFICE OF PUBLIC HEALTH SCIENCE SERVICES, NATIONAL CENTER FOR HEALTH STATISTICS *COMMUNITY COMMONS *CONNECTICUT DEPARTMENT OF PUBLIC HEALTH *ESRI ARCGIS MAP GALLERY *NATIONAL CANCER INSTITUTE, STATE CANCER PROFILES *OPENSTREETMAP (OSM) *US CENSUS BUREAU, AMERICAN COMMUNITY SURVEY *US CENSUS BUREAU, COUNTY BUSINESS PATTERNS *US CENSUS BUREAU, DECENNIAL CENSUS *US DEPARTMENT OF AGRICULTURE, ECONOMIC RESEARCH SERVICE *US DEPARTMENT OF HEALTH & HUMAN SERVICES *US DEPARTMENT OF HEALTH & HUMAN SERVICES, HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) *US DEPARTMENT OF JUSTICE, FEDERAL BUREAU OF INVESTIGATION *US DEPARTMENT OF LABOR, BUREAU OF LABOR STATISTICS SECONDARY DATA INDICATORS REFLECT COUNTY-LEVEL DATA FOR COOK, LAKE, AND DUPAGE COUNTIES. WHILE THIS ASSESSMENT IS QUITE COMPREHENSIVE, IT CANNOT MEASURE ALL POSSIBLE ASPECTS OF HEALTH IN THE COMMUNITY, NOR CAN IT ADEQUATELY REPRESENT ALL POSSIBLE POPULATIONS OF INTEREST. IT MUST BE RECOGNIZED THAT THESE INFORMATION GAPS MIGHT IN SOME WAYS LIMIT THE ABILITY TO ASSESS ALL OF THE COMMUNITY'S HEALTH NEEDS. FOR EXAMPLE, CERTAIN POPULATION GROUPS - SUCH AS THE HOMELESS, INSTITUTIONALIZED PERSONS, OR THOSE WHO ONLY SPEAK A LANGUAGE OTHER THAN ENGLISH OR SPANISH - ARE NOT REPRESENTED IN THE SURVEY DATA. OTHER POPULATION GROUPS - FOR EXAMPLE, PREGNANT WOMEN, LESBIAN/GAY/BISEXUAL/TRANSGENDER RESIDENTS, UNDOCUMENTED RESIDENTS, AND MEMBERS OF CERTAIN RACIAL/ETHNIC OR IMMIGRANT GROUPS - MIGHT NOT BE IDENTIFIABLE OR MIGHT NOT BE REPRESENTED IN NUMBERS SUFFICIENT FOR INDEPENDENT ANALYSES. IN TERMS OF CONTENT, THIS ASSESSMENT WAS DESIGNED TO PROVIDE A COMPREHENSIVE AND BROAD PICTURE OF THE HEALTH OF THE OVERALL COMMUNITY.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance MULTIPLE METHODS ARE USED AT ABBHH TO COMMUNICATE ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. ALEXIAN BROTHERS HEALTH SYSTEM'S (ABHS) WEBSITE, THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS, INCLUDING ABBHH, FEATURES INFORMATION ON HOW TO APPLY FOR CHARITY CARE ON-LINE. IN THE HOSPITAL SETTING, WE EMPLOY INDIVIDUALS WHO ARE AVAILABLE TO WORK WITH PATIENTS TO HELP THEM APPLY FOR CHARITY WITH DIGNITY. IN ADDITION, ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH ("ABCMH") AN AFFILIATED COMMUNITY MENTAL HEALTH CENTER EMPLOYS AN INDIVIDUAL WHO WORKS FOR BOTH ABCMH AND ABBHH WHO HELPS THE FAMILIES OF OUR CHILD AND ADOLESCENT PATIENTS APPLY FOR MEDICAID WHEN APPROPRIATE. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY CARE OPTIONS.
Schedule H, Part VI, Line 4 Community information IN THE ABBHH SERVICE AREA, THE POPULATION IS SLIGHTLY OLDER WITH 15.4% OF RESIDENTS OVER AGE 65 AS COMPARED TO 13.9% IN ILLINOIS. 19.2% OF THE POPULATION IS HISPANIC, A HIGHER PERCENTAGE AS COMPARED TO 16.7% IN ILLINOIS AND 17.4% IN THE US. THE COMMUNITY'S SOCIAL DETERMINANTS ARE FAIRLY AVERAGE, EXCEPT THAT THERE ARE 7.6% OF RESIDENTS THAT IS CONSIDERED LINGUISTICALLY ISOLATED" I.E. DO NOT SPEAK ENGLISH. NEARLY 15% OF THE POPULATION LIVES AT OR BELOW 100% OF THE POVERTY LEVEL AND 32.3% ARE AT OR BELOW THE 200% OF THE POVERTY LEVEL, REPRESENTING 2,174,865 INDIVIDUALS. IN THE ASSESSMENT, IT IS MOST OFTEN THESE INDIVIDUALS THAT HAVE DIFFICULTY ACCESSING SERVICES AND HAVE POORER OVERALL HEALTH, AND SO OUR EFFORTS TO PROVIDE THE COMMUNITY WITH NEEDED SERVICES SHOULD BE DIRECTED IN MOST CASES TOWARDS THIS POPULATION.
Schedule H, Part VI, Line 5 Promotion of community health ABBHH'S GOVERNING BODY IS THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS REPORTS UP THROUGH THE ALEXIAN BROTHERS HEALTH SYSTEM BOARD OF GOVERNERS. THE MAJORITY OF THE BOARD OF DIRECTORS LIVE AND WORK IN THE COMMUNITY AND SERVE TO SUPPORT THE MISSION AND VALUES OF THE ALEXIAN BROTHERS. ABBHH EXTENDS MEDICAL STAFF PRIVILEGES TO INTERESTED AND QUALIFIED PSYCHIATRISTS IN OUR COMMUNITY AND ENDEAVORS TO PROVIDE THEM WITH THE SAFEST AND MOST ADVANCED PSYCHIATRIC INTERVENTIONS AVAILABLE. ABBHH STRIVES TO FULLY SERVE THE COMMUNITY THROUGH PARTICIPATION IN GOVERNMENT SPONSORED HEALTHCARE PROGRAMS SUCH AS MEDICARE, MEDICAID, AND TRICARE AND BY PARTICIPATION IN RESEARCH AND EDUCATION. PHARMACEUTICAL BASED RESEARCH INCLUDES THE PERSISTENT DISORDERS OF SCHIZOPHRENIA, BIPOLAR DISORDER AND MAJOR DEPRESSIVE DISORDERS AS WELL AS RESEARCH IN THE DISORDERS OF ADOLESCENTS AND CHILDHOOD. ABBHH ALSO OPERATES A CENTER FOR EVIDENCE BASED PRACTICE AND RESEARCHES THE EFFICACY OF TREATMENT THROUGH OUTCOMES BASED MEASUREMENT. ON AVERAGE, ABBHH HAS MORE THAN 20 ACTIVE RESEARCH TRIALS AT ANY GIVEN TIME.
Schedule H, Part VI, Line 6 Affiliated health care system ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL D/B/A AMITA HEALTH ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL, HOFFMAN ESTATES, IS A MEMBER HOSPITAL OF ALEXIAN BROTHERS HEALTH SYSTEM (ABHS), A COMPREHENSIVE AND DIVERSIFIED HEALTHCARE ORGANIZATION LOCATED IN ARLINGTON HEIGHTS, ILLINOIS, A COMMUNITY IN CHICAGO'S NORTHWESTERN SUBURBS. A MINISTRY ORGANIZATION OF ASCENSION, THE LARGEST CATHOLIC HEALTH SYSTEM IN THE NATION, ABHS CONSISTS OF TWO ACUTE-CARE HOSPITALS, THREE SPECIALTY HOSPITALS, A COMMUNITY MENTAL HEALTH CENTER, CLINICAL INSTITUTES, DIAGNOSTIC IMAGING FACILITIES AND THE ALEXIAN BROTHERS AMBULATORY GROUP, D/B/A ALEXIAN BROTHERS MEDICAL GROUP, WHICH IS PART OF THE AMITA HEALTH MEDICAL GROUP. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ORGANIZATIONS/ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. ASCENSION (WWW.ASCENSION.ORG) IS A FAITH-BASED HEALTHCARE ORGANIZATION DEDICATED TO TRANSFORMATION THROUGH INNOVATION ACROSS THE CONTINUUM OF CARE. AS THE LARGEST NON-PROFIT HEALTH SYSTEM IN THE U.S. AND THE WORLD'S LARGEST CATHOLIC HEALTH SYSTEM, ASCENSION IS COMMITTED TO DELIVERING COMPASSIONATE, PERSONALIZED CARE TO ALL, WITH SPECIAL ATTENTION TO PERSONS LIVING IN POVERTY AND THOSE MOST VULNERABLE. IN FY2018, ASCENSION PROVIDED MORE THAN $2.0 BILLION IN CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. ASCENSION INCLUDES APPROXIMATELY 156,000 ASSOCIATES AND 34,000 ALIGNED PROVIDERS. ASCENSION'S HEALTHCARE DIVISION OPERATES MORE THAN 2,600 SITES OF CARE - INCLUDING 151 HOSPITALS AND MORE THAN 50 SENIOR LIVING FACILITIES - IN 21 STATES AND THE DISTRICT OF COLUMBIA, WHILE ITS SOLUTIONS DIVISION PROVIDES A VARIETY OF SERVICES AND SOLUTIONS INCLUDING PHYSICIAN PRACTICE MANAGEMENT, VENTURE CAPITAL INVESTING, INVESTMENT MANAGEMENT, BIOMEDICAL ENGINEERING, FACILITIES MANAGEMENT, CLINICAL CARE MANAGEMENT, INFORMATION SERVICES, RISK MANAGEMENT, AND CONTRACTING THROUGH ASCENSION'S OWN GROUP PURCHASING ORGANIZATION. AMITA HEALTH (WWW.AMITAHEALTH.ORG) IS A JOINT OPERATING COMPANY FORMED BY ASCENSION HEALTH AND ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION OF WHICH ADVENTIST MIDWEST HEALTH, AND ALEXIAN BROTHERS HEALTH SYSTEM, ARE THE MEMBERS. AMITA HEALTH WELCOMED PRESENCE HEALTH TO THE ORGANIZATION IN MARCH 2018, MAKING AMITA HEALTH THE LARGEST HEALTH SYSTEM IN ILLINIOS. THROUGH ITS MEMBERS, AMITA HEALTH HAS OVER 25,000 ASSOCIATES COMMITTED TO DELIVERING THE MOST EFFICIENT, HIGHEST QUALITY, FAITH-BASED CARE AT NINETEEN ACUTE AND SPECIALTY CARE HOSPITALS AND AT MORE THAN 200 AMBULATORY/CLINIC LOCATIONS. AMITA HEALTH HAS AN EXTENSIVE PROVIDER NETWORK OF OVER 7,000 HOSPITAL-AFFILIATED PHYSICIANS, AND THE AMITA HEALTH MEDICAL GROUP CONSISTS OF OVER 800 MULTI-SPECIALTY EMPLOYED PHYSICIANS AND ASSOCIATE PRACTITIONERS, RANKING IT AMONG THE LARGEST REGIONAL MEDICAL GROUPS. AMITA HEALTH'S MISSION IS TO EXTEND THE HEALING MINISTRY OF JESUS BY RESPECTING THE FAITH TRADITIONS OF THE MANY INDIVIDUALS AND FAMILIES IT SERVES ACROSS SUBURBAN CHICAGO. WITH A SACRED MISSION OF EXTENDING THE HEALING MINISTRY OF CHRIST, ADVENTHEALTH (WWW.ADVENTHEALTH.COM) IS A CONNECTED SYSTEM OF CARE FOR EVERY STAGE OF LIFE AND HEALTH. MORE THAN 80,000 SKILLED AND COMPASSIONATE CAREGIVERS IN PHYSICIAN PRACTICES, HOSPITALS, OUTPATIENT CLINICS, SKILLED NURSING FACILITIES, HOME HEALTH AGENCIES AND HOSPICE CENTERS PROVIDE INDIVIDUALIZED, WHOLISTIC CARE. A CHRISTIAN MISSION, SHARED VISION, COMMON VALUES, FOCUS ON WHOLE-PERSON HEALTH AND COMMITMENT TO MAKING COMMUNITIES HEALTHIER UNIFY THE SYSTEM'S 45 HOSPITAL CAMPUSES AND HUNDREDS OF CARE SITES IN DIVERSE MARKETS THROUGHOUT NINE STATES. THE COVERED AFFILIATES WITHIN AMITA HEALTH PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE SERVICES AND ACCESS TO THE MOST ADVANCED MEDICAL TECHNOLOGY. THEIR HEALTHCARE PROFESSIONALS ARE PASSIONATE ABOUT DELIVERING EXCEPTIONAL HEALTHCARE AND ARE PROUD OF THE POWERFUL, CUTTING-EDGE TECHNOLOGY OFFERED BY THE SYSTEM. THE COVERED AFFILIATES WITHIN AMITA HEALTH ALSO OFFER A WIDE RANGE OF COMMUNITY HEALTH SERVICES, CORPORATE WELLNESS PROGRAMS, PREVENTIVE CARE AND EDUCATION. AS CHARITABLE ORGANIZATIONS, THEY RECOGNIZE THAT NOT EVERYONE CAN AFFORD ESSENTIAL MEDICAL SERVICES AND THAT THEIR MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH AMITA HEALTH'S COMMITMENT TO SERVING ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT OR BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY ARE CONSIDERED AND PROVIDED WHEN APPROPRIATE. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY AND MEDICALLY UNDERSERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES INCLUDING, BUT NOT LIMITED TO, EDUCATIONAL AFFILIATIONS, HEALTH SCREENINGS, COUNSELING PROGRAMS, CONTINUING MEDICAL EDUCATION (CME) PROGRAMS AND DONATIONS TO COMMUNITY GROUPS.
Schedule H, Part VI, Line 7 State filing of community benefit report IL
Schedule H (Form 990) 2019
Additional Data


Software ID: 17005876
Software Version: 2017v2.2
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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1CLAYTON CIHA
 
CEO, ABBHH 		(i)

(ii)		 0
-------------
294,579 		0
-------------
44,565 		0
-------------
53,946 		0
-------------
29,447 		0
-------------
21,950 		0
-------------
444,487 		0
-------------
45,565
2CHRISTOPHER D'AGOSTINO DO
 
DIRECTOR; CHIEF MEDICAL OFFICER 		(i)

(ii)		 286,627
-------------
0 		121,763
-------------
0 		5,334
-------------
0 		34,265
-------------
0 		21,971
-------------
0 		469,960
-------------
0 		0
-------------
0
3KUMUDINI GINDE MD
 
DIRECTOR; PSYCHIATRIST 		(i)

(ii)		 224,725
-------------
0 		17,625
-------------
0 		1,070
-------------
0 		14,665
-------------
0 		13,830
-------------
0 		271,915
-------------
0 		0
-------------
0
4GREGORY A TEAS MD
 
DIRECTOR; CHIEF MEDICAL OFFICER 		(i)

(ii)		 322,351
-------------
0 		15,633
-------------
0 		1,150
-------------
0 		32,630
-------------
0 		17,434
-------------
0 		389,198
-------------
0 		0
-------------
0
5MARK FREY
 
CEO, AMITA HEALTH 		(i)

(ii)		 0
-------------
912,487 		0
-------------
678,307 		0
-------------
139,925 		0
-------------
25,948 		0
-------------
21,510 		0
-------------
1,778,177 		0
-------------
0
6DAVID JONES
 
TREASURER; CFO, ABBHH 		(i)

(ii)		 0
-------------
189,597 		0
-------------
9,192 		0
-------------
10,146 		0
-------------
30,108 		0
-------------
15,804 		0
-------------
254,848 		0
-------------
8,661
7DIANA WOYTKO
 
SECRETARY; CQO, AMITA HEALTH 		(i)

(ii)		 0
-------------
244,210 		0
-------------
104,096 		0
-------------
35,093 		0
-------------
42,582 		0
-------------
15,915 		0
-------------
441,895 		0
-------------
27,399
8CHRISTOPHER R NOVAK
 
CHIEF OPERATING OFFICER 		(i)

(ii)		 0
-------------
190,420 		0
-------------
9,047 		0
-------------
25,931 		0
-------------
13,264 		0
-------------
23,219 		0
-------------
261,881 		0
-------------
24,791
9CLIFTON J SAPER
 
EXECUTIVE DIRECTOR, O/P SERVICES (END 2/2017) 		(i)

(ii)		 170,300
-------------
0 		6,034
-------------
0 		970
-------------
0 		39,370
-------------
0 		1,162
-------------
0 		217,835
-------------
0 		0
-------------
0
10SACHIN J BHALERAO DO
 
PSYCHIATRIST 		(i)

(ii)		 327,892
-------------
0 		127,816
-------------
0 		485
-------------
0 		14,913
-------------
0 		6,393
-------------
0 		477,499
-------------
0 		0
-------------
0
11MICHAEL BRILLIANT MD
 
PSYCHIATRIST 		(i)

(ii)		 401,463
-------------
0 		121,252
-------------
0 		475
-------------
0 		33,199
-------------
0 		14,018
-------------
0 		570,407
-------------
0 		0
-------------
0
12MUMTAZ F RAZA MD
 
PSYCHIATRIST 		(i)

(ii)		 384,631
-------------
0 		144,931
-------------
0 		770
-------------
0 		33,328
-------------
0 		18,894
-------------
0 		582,553
-------------
0 		0
-------------
0
13SALAHUDDIN I SYED MD
 
PSYCHIATRIST 		(i)

(ii)		 373,041
-------------
0 		164,457
-------------
0 		2,570
-------------
0 		6,444
-------------
0 		18,677
-------------
0 		565,188
-------------
0 		0
-------------
0
14SHUBHRAJAN S WADYAL MD
 
PSYCHIATRIST 		(i)

(ii)		 381,056
-------------
0 		144,084
-------------
0 		475
-------------
0 		0
-------------
0 		1,333
-------------
0 		526,948
-------------
0 		0
-------------
0
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Alexian Brothers - AHS Midwest Region Health Co., a related organization of the filing organization, uses the following methods to establish the compensation of the organization's CEO: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Compensation survey or study - Approval by the Compensation Committee
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received payment(s) from the supplemental nonqualified retirement plan during the calendar year: CLAYTON CIHA - $45,565 DAVID JONES - $8,661 DIANA WOYTKO - $27,399 CHRISTOPHER R NOVAK - $24,791
Schedule J (Form 990) 2019

Additional Data


Software ID: 17005876
Software Version: 2017v2.2
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2019
Schedule L (Form 990 or 990-EZ) 2019
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) ANTHONY D'AGOSTINO
  		FATHER OF DIRECTOR 246,510 EMPLOYMENT   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2




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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Return Reference Explanation
Form 990, Part IV, Line 20b AUDITED FINANCIAL STATEMENTS The activity of Alexian Brothers Behavioral Health Hospital is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of Alexian Brothers Behavioral Health Hospital is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of Alexian Brothers Behavioral Health Hospital.
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER, THE PROCESS, PERFORMED BY ALEXIAN BROTHERS - AHS MIDWEST REGION HEALTH CO., A RELATED ORGANIZATION OF ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE ALEXIAN BROTHERS - AHS MIDWEST REGION HEALTH CO. COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS OR KEY EMPLOYEES, THE PROCESS PERFORMED BY ALEXIAN BROTHERS - AHS MIDWEST REGION HEALTH CO., A RELATED ORGANIZATION OF ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 4 Significant changes to organizational documents DIRECTORS SHALL BE APPOINTED BY THE ASCENSION CLASS DIRECTORS OF THE MINISTRY MARKET CORPORATION (THE CORPORATE MEMBER) AND SHALL SERVE FOR THREE (3) THREE-YEAR TERMS AND UNTIL SUCCESSORS ARE DULY APPOINTED AND QUALIFIED UNLESS THEY SHALL SOONER RESIGN OR BE REMOVED. EXCEPT AS OTHERWISE DETERMINED BY THE ASCENSION CLASS DIRECTORS OF THE MINISTRY MARKET CORPORATION, NO PERSON SHALL BE ELIGIBLE FOR APPOINTMENT FOR MORE THAN THREE SUCCESSIVE THREE-YEAR TERMS. FORMERLY, DIRECTORS WOULD SERVE FOR ONE YEAR AND WERE ELIGIBLE FOR EIGHT CONSECUTIVE APPOINTMENTS. THE CORPORATE MEMBER NAME CHANGED AND WORDING WAS EDITED TO READ AS FOLLOWS: THE CORPORATION SHALL HAVE ONE MEMBER: ALEXIAN BROTHERS HEALTH SYSTEM D/B/A PRESENCE ALEXIAN BROTHERS HEALTH SYSTEM, AN ILLINOIS NOT-FOR PROFIT CORPORATION. ADDITIONALLY, RIGHTS OF ASCENSION, ASCENSION HEALTH AND THE JOINT OPERATING COMPANY WERE ADDED TO THE BYLAWS AS FOLLOWS: DECISION MAKING RIGHTS OF ASCENSION SUBJECT TO THE AMITA AFFILIATION AGREEMENT, THE FOLLOWING MATTERS SHALL BE DECIDED BY ASCENSION: MAJOR TRANSACTIONS INVOLVING CORPORATION OR A CORPORATION SUBSIDIARY THAT IS A CREDIT GROUP MEMBER; AND THE INCURRENCE OF DEBT BY CORPORATION OR ANY CORPORATION SUBSIDIARY. DECISION MAKING RIGHTS OF ASCENSION HEALTH SUBJECT TO THE AMITA AFFILIATION AGREEMENT, THE FOLLOWING MATTERS SHALL BE DECIDED BY ASCENSION HEALTH: THE APPOINTMENT, REMOVAL AND PERFORMANCE EVALUATION OF THE PRESIDENT OF THE CORPORATION; CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION WHERE SUCH CHANGES ARE NOT CONSISTENT WITH SYSTEM POLICY; THE APPOINTMENT, REMOVAL, AND PERFORMANCE EVALUATION OF THE CORPORATION PRESIDENT; THE FORMATION OF A CORPORATION SUBSIDIARY; AND MAJOR TRANSACTIONS INVOLVING ANY CORPORATION SUBSIDIARY THAT IS NOT A CREDIT GROUP MEMBER. THE DISTRIBUTION OF ASSETS UPON DISSOLUTION WAS AMENDED WHERE FORMERLY ALL ASSETS REMAINING AFTER THE PAYMENT OF ALL LIABILITIES OF THE CORPORATION WOULD BE DISTRIBUTED TO THE CORPORATE MEMBER OR OTHER SUCH EXEMPT ORGANIZATION(S) UNDER SECTION 501(C)(3) OF THE CODE AS DETERMINED BY THE CORPORATE MEMBER, NOW THE BYLAWS STATE: UPON THE DISSOLUTION OF THE CORPORATION, THE DISPOSITION OF ALL THE ASSETS OF THE CORPORATION SHALL BE IN A MANNER AS PROVIDE BY THE BOARD (SUBJECT TO THE PRIOR APPROVAL OF ASCENSION HEALTH) AND IN ACCORDANCE WITH THE FOLLOWING: THE PAYING, OR THE MAKING PROVISION, OF THE PAYMENT OF ALL OF THE LIABILITIES, DIRECT OR INDIRECT, CONTINGENT OR OTHERWISE, INCLUDING WITHOUT LIMITATION, ALL LIABILITIES EVIDENCED IN ALL OUTSTANDING LOAN AGREEMENTS, CREDIT AGREEMENTS, MASTER INDENTURES AND OTHER SIMILAR DOCUMENTS. SUBJECT TO COMPLIANCE WITH THE DISSOLUTION PRINCIPLES OF ASCENSION HEALTH, ALL ASSETS REMAINING AFTER THE PAYMENT OF ALL OF THE LIABILITIES OF THE CORPORATION SHALL BE DISTRIBUTED TO ASCENSION HEALTH OR SUCH OTHER EXEMPT ORGANIZATION(S) UNDER SECTION 501(C)(3) OF THE CODE AS SHALL BE DETERMINED BY ASCENSION. ANY OTHER ASSETS NOT SO DISPOSED OF SHALL BE DISTRIBUTED FOR ONE OR MORE EXEMPT PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE CODE, OR SHALL BE DISTRIBUTED TO THE FEDERAL GOVERNMENT, OR TO A STATE OR LOCAL GOVERNMENT, FOR A PUBLIC PURPOSE. ANY SUCH ASSETS NOT SO DISPOSED OF SHALL BE DISPOSED OF BY A COURT OF COMPETENT JURISDICTION OF THE COUNTY IN WHICH THE PRINCIPAL OFFICE OF THE CORPORATION IS THEN LOCATED, EXCLUSIVELY FOR SUCH PURPOSES OR TO SUCH ORGANIZATION OR ORGANIZATIONS, AS SAID COURT SHALL DETERMINE, WHICH ARE ORGANIZED AND OPERATED EXCLUSIVELY FOR SUCH PURPOSES.
Form 990, Part VI, Line 6 Classes of members or stockholders EFFECTIVE AS OF 3/1/2018, ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL HAS ONE CORPORATE MEMBER - ALEXIAN BROTHERS HEALTH SYSTEM IS THE CORPORATE MEMBER OF EACH OF ITS SUBSIDIARIES. THE INSTITUTE MEMBER OF ALEXIAN BROTHERS HEALTH SYSTEM IS ASCENSION HEALTH.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Subject to the ratification of the Board of Alexian Brothers - AHS Midwest Region Health Co., Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Brothers Behavioral Health Hospital.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY THE CORPORATE MEMBER, ALEXIAN BROTHERS HEALTH SYSTEM, SUBJECT TO THE APPROVAL OF ALEXIAN BROTHERS - AHS MIDWEST REGION HEALTH CO.
Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD.
Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Line 19 Required documents available to the public The Organization will provide any documents open to public inspection upon request.
Form 990, Part VII, Section A Related Entities The organization utilizes an affiliate as the common pay agent. Employees reported in Part VII may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Medical Records Fees - Total Revenue: 397, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 397; Miscellaneous Revenue - Total Revenue: 133181, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 133181;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers with ALPHA - -49358075; Transfers with Affiliates - 52281950; Other - 48491;
Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Alexian Brothers Behavioral Health Hospital
 
Employer identification number

36-4251848
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Ascension Health Alliance
PO Box 45998

St Louis,MO631455998
45-3358926 		National Health System MO 501(c)(3) Type I NA
 
 
No
(2)Ascension Health
PO Box 45998

St Louis,MO63145
31-1662309 		National Health System MO 501(c)(3) Type I Ascension Health Alliance
 
 
No
(3)Alexian Brothers - AHS Midwest Region Health Co
2601 Navistar Drive

Lisle,IL60532
47-2360513 		Joint Operating Company IL 501(c)(3) Type II NA
 
 
No
(4)Alexian Brothers Health System
200 South Wacker Drive

Chicago,IL60606
36-3260495 		Supports the provision of healthcare services for related corporations for which it is a member IL 501(c)(3) Type III-FI Ascension Health
 
 
No
(5)Alexian Brothers Bonaventure House dba Alexian Brothers The Harbor and Alex
ian Brothers Housing and Health Alliance825 Wellington Avenue

Chicago,IL60657
36-3527899 		Housing and supportive care services for persons with HIV/AIDS IL 501(c)(3) 10 Alexian Brothers Health System
 
Yes
 
(6)Alexian Brothers of San Jose Inc
2601 Navistar Drive

Lisle,IL60532
94-1530037 		Acute care hospital (sold in 1998) TX 501(c)(3) Type I Alexian Brothers Health System
 
Yes
 
(7)Alexian Brothers Services Inc
2601 Navistar Drive

Lisle,IL60532
43-1295333 		HUD housing MO 501(c)(3) 10 Alexian Brothers Health System
 
Yes
 
(8)Alexian Brothers Hospital Network
2601 Navistar Drive

Lisle,IL60532
36-3276552 		Supports the provision of healthcare services for related corporations IL 501(c)(3) Type III-FI Alexian Brothers Health System
 
Yes
 
(9)Alexian Brothers Medical Center
800 Biesterfield Road

Elk Grove Village,IL60007
36-2596381 		Acute care hospital TX 501(c)(3) 3 Alexian Brothers Health System
 
Yes
 
(10)Savelli Properties Inc
2601 Navistar Drive

Lisle,IL60532
36-3308965 		Owns or leases properties where healthcare services are delivered IL 501(c)(2)   Alexian Brothers Health System
 
Yes
 
(11)St Alexius Medical Center
1555 Barrington Road

Hoffman Estates,IL60194
36-4251846 		Acute care hospital IL 501(c)(3) 3 Alexian Brothers Health System
 
Yes
 
(12)Alexian Brothers Ambulatory Group
2601 Navistar Drive

Lisle,IL60532
36-4336931 		Physician services IL 501(c)(3) 3 Alexian Brothers Health System
 
Yes
 
(13)Alexian Brothers Specialty Group
2601 Navistar Drive

Lisle,IL60532
80-0710751 		Specialty physician practice group IL 501(c)(3) 3 Alexian Brothers Health System
 
Yes
 
(14)Alexian Brothers Center for Mental Health
3436 N Kennicott Avenue

Arlington Heights,IL60004
36-3045007 		Outpatient community mental health services IL 501(c)(3) 10 Alexian Brothers Health System
 
Yes
 
(15)Alexian Brothers Medical Care Group NFP
2601 Navistar Drive

Lisle,IL60532
47-1930457 		Physician services IL 501(c)(3) 3 Alexian Brothers Health System
 
Yes
 
(16)Alexian Brothers Medical Group Specialty Care
2601 Navistar Drive

Lisle,IL60532
81-1110738 		SPECIALTY PHYSICIAN PRACTICE GROUP IL 501(c)(3) 3 ALEXIAN BROTHERS HEALTH SYSTEM
 
Yes
 
(17)PRESENCE CARE TRANSFORMATION CORPORATION
200 South Wacker Drive

Chicago,IL60606
36-3366652 		MGMT SUPPORT IL 501(c)(3) Type III-FI Alexian Brothers Health System
 
Yes
 
(18)PRESENCE HEALTH PARTNERS SERVICES
2380 E DEMPSTER AVE STE 236

DES PLAINES,IL60016
36-2644178 		HEALTH CARE IL 501(c)(3) Type II Alexian Brothers Health System
 
Yes
 
(19)PRESENCE HEALTH FOUNDATION BOARD OF TRUSTEES
200 SOUTH WACKER DRIVE

CHICAGO,IL60606
36-3330929 		FUNDRAISING IL 501(c)(3) 7 Alexian Brothers Health System
 
Yes
 
(20)PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
200 South Wacker Drive

Chicago,IL60606
36-4195126 		HEALTH CARE IL 501(c)(3) 3 Presence Care Transformation Corporation
 
Yes
 
(21)PRESENCE BEHAVIORAL HEALTH
1820 SOUTH 25TH AVENUE

BROADVIEW,IL60155
36-2709982 		HEALTH CARE IL 501(c)(3) 3 Presence Care Transformation Corporation
 
Yes
 
(22)PRESENCE AMBULATORY SERVICES
2380 E Dempster Street

DES PLAINES,IL60016
36-4286236 		HEALTH CARE IL 501(c)(3) 10 Presence Care Transformation Corporation
 
Yes
 
(23)PRESENCE CHICAGO HOSPITALS NETWORK
200 SOUTH WACKER DRIVE

CHICAGO,IL60606
36-2235165 		HEALTH CARE IL 501(c)(3) 3 Presence Care Transformation Corporation
 
Yes
 
(24)PRESENCE HEALTHCARE SERVICES
2380 E Dempster Street

DES PLAINES,IL60016
36-3330928 		HEALTH CARE IL 501(c)(3) 10 Presence Care Transformation Corporation
 
Yes
 
(25)RAINBOW HOSPICE AND PALLIATIVE CARE
1550 BISHOP COURT

MOUNT PROSPECT,IL60056
36-3296367 		HEALTH CARE IL 501(c)(3) 10 Presence Care Transformation Corporation
 
Yes
 
(26)MEDICARE VALUE PARTNERS
100 NORTH RIVER ROAD

DES PLAINES,IL60016
36-3495969 		HEALTH CARE IL 501(c)(3) 10 Presence Health Partners Services
 
Yes
 
(27)PRESENCE HOME CARE
18927 HICKORY CREEK DR 300

MOKENA,IL60448
46-0483581 		HEALTH CARE IL 501(c)(3) 10 PRESENCE CARE TRANSFORMATION CORPORATION
 
Yes
 
(28)PRESENCE CARE HOME
18927 HICKORY CREEK DR 300

MOKENA,IL60448
46-0483587 		HEALTH CARE IL 501(c)(3) 10 PRESENCE CARE TRANSFORMATION CORPORATION
 
Yes
 
(29)ALVERNO PROVENA HOSPITAL LABORATORIES INC
2434 Interstate Plaza Drive

Hammond,IN46234
20-3238867 		HEALTH CARE IN 501(c)(3) 3 Presence Central & Suburban Hospitals Network AND PRESENCE CHICAGO HOSPITAL
S NETWORK
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Alexian Rehabilitation Services LLC

935 Beisner
Elk Grove Village,IL60007
30-0221481 		Rehabilitation hospital IL NA
  		N/A                
(2) Bonaventure Medical Foundation LLC

2601 Navistar Drive
Lisle,IL60532
36-3978153 		Manages managed care contracts DE NA
  		N/A                
(3) St Alexius Center for Sleep Health LLC

1300 S Main Street
Lombard,IL60148
20-5876371 		Operation of sleep lab IL NA
  		N/A                
(4) BELMONTHARLEM SURGERY CENTER LLC

3101 NORTH HARLEM
CHICAGO,IL60634
41-2237162 		MEDICAL SERVICE IL NA
  		N/A                
(5) ALVERNO CLINICAL LABORATORIES LLC

2434 INTERSTATE PLAZA DRIVE
HAMMOND,IN46324
20-3240648 		MEDICAL SERVICE IN NA
  		N/A                
(6) Presence Lakeshore Gastroenterology LLC

150 N River Road
Suite 210
Des Plaines,IL60016
81-1750563 		Medical Service IL NA
  		N/A                
(7) PROFESSIONAL CLINICAL LABORATORIES LLC

113 E 4TH ST
MICHIGAN CITY,IN46360
30-0711211 		Medical Services IN NA
  		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?
Yes No
(1) Thelen Corporation

2601 Navistar Drive
Lisle,IL60532
36-3266316 		Owns/ leases property; joint venture partner IL NA
  		C Corporation       Yes  
(2) Alexian Brothers Health Providers Association Inc

2601 Navistar Drive
Lisle,IL60532
36-3853286 		Messenger model IPA IL NA
  		C Corporation       Yes  
(3) PRESENCE PROPERTIES INC

100 NORTH RIVER ROAD
DES PLAINES,IL60016
36-3520630 		MEDICAL IL NA
  		C Corporation       Yes  
(4) PRESENCE SERVICE CORPORATION

2380 E DEMPSTER STREET
DES PLAINES,IL60016
36-4314354 		MEDICAL IL NA
  		C Corporation       Yes  
(5) PRESENCE VENTURES INC

100 NORTH RIVER ROAD
DES PLAINES,IL60016
37-1168085 		MEDICAL IL NA
  		C Corporation       Yes  
(6) AMITA HEALTH CLINICALLY INTEGRATED NETWORK LLC

2601 NAVISTAR DRIVE
LISLE,IL60532
80-0967178 		MANAGED CARE IL NA
  		C Corporation       Yes  


Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) ALEXIAN BROTHERS MEDICAL CENTER

 L 2,047,402 FAIR MARKET VALUE
(2) ALEXIAN BROTHERS MEDICAL CENTER

 Q 2,667,175 FAIR MARKET VALUE
(3) ALEXIAN BROTHERS MEDICAL CENTER

 S 103,197 FAIR MARKET VALUE
(4) ST ALEXIUS MEDICAL CENTER

 L 583,162 FAIR MARKET VALUE
(5) ST ALEXIUS MEDICAL CENTER

 M 320,122 FAIR MARKET VALUE
(6) ST ALEXIUS MEDICAL CENTER

 Q 1,097,441 FAIR MARKET VALUE
(7) ALEXIAN BROTHERS SPECIALTY GROUP

 L 50,279 FAIR MARKET VALUE
(8) ALEXIAN BROTHERS SPECIALTY GROUP

 M 60,625 FAIR MARKET VALUE
(9) ALEXIAN BROTHERS MEDICAL CARE GROUP NFP

 M 62,773 FAIR MARKET VALUE
(10) ALEXIAN BROTHERS HOSPITAL NETWORK

 L 3,944,209 FAIR MARKET VALUE
(11) ALEXIAN BROTHERS HOSPITAL NETWORK

 M 320,121 FAIR MARKET VALUE
(12) ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH

 L 90,000 FAIR MARKET VALUE
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2019

Additional Data


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Software Version: 2017v2.2