2019-05-15T14:44:30-05:00 2018-06-30 420714325 RSM US LLP 1 S Wacker Drive STE 800 Chicago IL 60606 990 2017-07-01 362246719 Little Company of Mary Hospital Inc LITT 7082295111 2800 West 95th Street Evergreen Park IL 60805 Timothy Kelleher CFO 7082295111 2019-05-15 1 Zack Fortsch P00052725 3126343400 66.98.98.9 2019-05-15 12:13:00 CD P F6217F2D6ED5C2D75B43E0AF4E216B671259B073 8C7237D2AFEDFB09D88626A2D3FB2BC60A40D8C2 2017 2019-02-21 02:37:17Z Timothy Kelleher 2800 West 95th Street Evergreen Park IL 60805 260186656 0 X www.lcmh.org X 1893 IL In solidarity with the Sisters of the Little Company of Mary, we are entrusted to serve the community through our ministry of Catholic Health Care. We are the empowered laity - the Greater Company of Mary. Rooted in a deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity. 14 12 2198 600 0 0 1981778 1067863 201678731 197921640 35168253 56036827 2292817 5160326 241121579 260186656 93775 40000 0 0 113148936 110667357 0 0 0 107112835 112940929 220355546 223648286 20766033 36538370 1013934438 1032155567 334036844 333662757 679897594 698492810 X In solidarity with the Sisters of the Little Company of Mary, we are entrusted to serve the community through our ministry of Catholic Health Care. We are the empowered laity - the Greater Company of Mary. Rooted in deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity. 0 0 183710170 40000 197921640 Little Company of Mary Hospital operates 278 staffed beds in its hospital facilities. During fiscal year ended June 30, 2018, the Hospital admitted 10,738 patients and also had 4,505 observation cases. These admissions drove the 51,109 inpatient days the hospital had during the fiscal year. Furthermore, the Hospital provided its outpatients with 56,044 of equivalent patient days worth of care. Included in that 56,044 are emergency room visits of 45,504 along with various other outpatient visits. Some of the major service lines the Hospital offers are in the fields of cardiology, dermatology, endocrinology, GI medicine, hematology, infectious disease, medical trauma, neurology, oncology, pulmonary medicine, renal care, rheumatology, gynecology and obstetrics, behavioral health, cardiac surgery, cancer surgery, dental surgery, general surgery, GI surgery, neuro surgery, orthopedic surgery, trauma surgery, urology surgery, and vascular surgery.Little Company of Mary Hospital strives to offer excellent quality care. This can be seen in the many accreditations that it currently holds. Some of the accreditations are: -American College of Radiology Commission on Radiation Quality and Safety;-Baby Friendly Status from Baby Friendly USA;-Stroke Center Accredited by the Joint Commission on Accreditation of Healthcare Organizations;-Breast Health Center Accredited by the American College of Surgeons;-Gold Seal of Approval by the Joint Commission;-2014 Women's Choice award winner by America's Best Breast Centers;-Seal of Approval by the National Accreditation Program for Breast Centers;-Breast Imaging Center of Excellence by American College of Radiology;-American Diabetes Association recognizes the Hospital's diabetes center as meeting the national standards for diabetes self-management education;-Cancer Center has been recognized by the Commission on Cancer of the American College of Surgeons as offering the very best in cancer care;-Sleep Disorder Center accredited by American Academy of Sleep Medicine. 183710170 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 227 0 1 2198 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 X Walter Furtner 7082295100 2800 West 95th Street Evergreen Park IL 60805 Sister Sharon Ann Walsh Chairperson 1.00 1.00 X X 0 0 0 Thomas Fahey Vice Chairperson 1.00 1.00 X X 0 0 0 Dennis Reilly President & CEO 40.00 1.00 X X 942799 0 25946 Dennis Kelly Treasurer 1.00 X X 0 0 0 Joseph Pedota Secretary 1.00 X X 0 0 0 Randy Ruther Assistant Treasurer & CFO 40.00 2.00 X X 527816 0 23629 Nancy Barett Director 1.00 X 0 0 0 Sister Renee Cunningham Director 1.00 X 0 0 0 Patrick Folliard CPA Director 1.00 X 0 0 0 Grace Gorka Director 1.00 X 0 0 0 Lawrence Kelly Director 1.00 X 0 0 0 Jayanthi Ramadurai MD Director (Until 12/31/17) 1.00 X 0 0 0 Daniel Rowan DO Director 1.00 1.00 X 0 0 0 Jay B Sterns Director 1.00 X 0 0 0 William Walsh MD Director (Until 12/31/17) 1.00 X 0 0 0 Michael D'Astice MD Ex. Officio Member 1.00 X 0 0 0 Christopher Vandenberg Ex. Officio Member 1.00 X 0 0 0 Steven Domiano MD Ex. Officio Member (as of 1/1/18) 1.00 X 0 0 0 Lisa DiMarco CNO & VP of Patient Care Services 40.00 X 272339 0 23633 Ann Haskins VP of Business Development 40.00 1.00 X 310110 0 14236 Kevin Rehder VP Clinical Svcs. & Facilities 40.00 1.00 X 232030 0 32060 Cynthia Deuser VP of Quality Improvement 40.00 X 166606 0 25301 Mary Jo Quick VP Mission 40.00 X 145359 0 23763 John Hanlon VP Medical Affairs/CMO 40.00 1.00 X 358867 0 35808 Kent Armbruster MD Physician Advisor 40.00 1.00 X 190819 0 21583 Emuata Bassey OB Hospitalist 40.00 X 239200 0 14884 Mary Fugett Physician 40.00 X 228520 0 33571 Gina Knox General Counsel 40.00 X 191177 0 21913 Richard Lopez Physician 40.00 X 197359 0 14126 Mary Freyer Former COO 0.00 X 261147 0 12674 4264148 0 323127 83 1 1 0 Inpatient Consultants of IL PC PO Box 844929 Los Angeles CA 90084 Hospitalist Services 3217022 University of Chicago PED 5721 S Maryland Ave K160 Chicago IL 60637 Pediatrics Hospitalists 2134256 Cain Brothers & Company LLC 277 Park Ave 40th Floor New York NY 10172 Financial Consultants 741651 Anderson Rasor & Partners LLP 150 S Wacker Dr Suite 350 Chicago IL 60606 Legal Services 587078 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 Diagnostic Imaging Services 567075 26 1067863 1067863 Patient Services 621400 194418766 194418766 Related Support Services 900099 3502874 3502874 197921640 24041312 24041312 363362 0 363362 363362 363362 31995515 0 31995515 31995515 31995515 Food Service Revenue 900099 650151 650151 Revenue from Affiliates 900099 624579 624579 Vending 900099 14767 14767 3507467 3507467 4796964 260186656 197921640 0 61197153 40000 40000 3066815 3066815 84481362 65780329 18701033 1499036 1127275 371761 14149584 10640487 3509097 7470560 5617861 1852699 132279 132279 98100 98100 16071577 13503532 2568045 771777 771777 7831761 5090645 2741116 2875305 2300244 575061 3170408 2694847 475561 48926 47876 1050 132445 78974 53471 3716412 3344734 371678 14151006 9905704 4245302 7350753 7080652 270101 Medical Supplies 31704934 31704934 IL Medicaid Assessment 12498754 12498754 Provision for Bad Debts 7787793 7787793 Consolidation Costs 1714679 1714679 2884020 1398714 1485306 223648286 183710170 39938116 0 8732064 6245225 24958919 21442545 79559 39559 1623986 1717830 9433363 9039647 408233117 176083118 232405767 232149999 731504179 757236213 5196601 4284549 1013934438 1032155567 27014183 29566137 200645320 195885313 106377341 108211307 334036844 333662757 X 677018436 694799523 2879158 3693287 679897594 698492810 1013934438 1032155567 X 36538370 -1252976 -16690178 X 0 1 X 1 0 X 1650000 141086 141086 1650000 1650000 164274 164274 1650000 1650000 170959 170959 1650000 1650000 54014 54014 1650000 1650000 68188 68188 1650000 1.00000 0 1 1 9018035 9018035 290820782 168887833 121932949 103160524 7195285 95965239 5233776 5233776 232149999 Self-Insurance Reserve 74354640 Settlements Due to Third Party 33856667 108211307 X Part V, Line 4: The endowment funds are intended to be used for nursing scholarship opportunities for future employed nurses, palliative and end of life care, outreach and education programs for the under-served people in the community, subsidies for services and programs for underinsured and uninsured people in the community, and financial support for services, programs, facility renovation and new construction to meet the future needs of the people served by Little Company of Mary Hospital and Health Care Centers. Part X, Line 2: The Hospital has received a determination letter from the Internal Revenue Service stating that it is exempt from the payment of income taxes under Section 501(c)(3) of the Internal Revenue Code. The Hospital adopted the FASB-issued guidance for accounting for uncertainty in income taxes. The Hospital files a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax-exempt status of each entity, the continued tax-exempt status of bonds issued by the obligated group, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business income (UBI). The benfits of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregate with other positions. Tax positions that meet the "more-likely-than-not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above would be reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Upon the adoption of the FASB-issued guidance on July 1, 2007, and since that date through June 30, 2018, there were no unrecognized tax benefits identified and recorded as a liability. Form 990 filed by the Hospital is subject to examination by the Internal Revenue Service (IRS) up to three years from the extended due date of each return. Forms 990 filed by the Hospital are no longer subject to examination for fiscal years 2014 and prior. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 4813306 4813306 0.02150 32702427 20999432 11702995 0.05230 37515733 20999432 16516301 0.07380 2180277 2180277 0.00970 2180277 2180277 0.00970 39696010 20999432 18696578 0.08350 1 7787793 72246525 97865311 -25618786 X 1 1 1 1 Little Company of Mary Hospital Inc 2800 West 95th Street Evergreen Park IL 60805 www.lcmh.org X X X Little Company of Mary Hospital Inc 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X http://www.lcmh.org/_data/mediaCenter/files/288.pdf___ X lcmh.healthforecast.net X 1 15 1 http://www.lcmh.org/_data/mediaCenter/files/288.pdf 0 1 X 200.000000000000 600.000000000000 X X X X 1 1 X X X X 1 X http://www.lcmh.org/home/find-a-career/apply-for-financial-assistance/ X http://www.lcmh.org/home/find-a-career/apply-for-financial-assistance/ X http://www.lcmh.org/home/find-a-career/apply-for-financial-assistance/ X X X X X X 1 X 0 X X X X 1 X 0 0 Little Company of Mary Hospital, Inc. Part V, Section B, Line 5: As part of the community health needs assessment, there were five key informant focus groups held in the region. These key informant focus groups allowed for input from persons with special knowledge of or expertise in public health, as well as others who represent the broad interests of the community served by the Hospital. Participants included 38 key informants in the region, including physicians, other health professionals, social service representatives, public health experts, and business and other community leaders. Little Company of Mary Hospital, Inc. Part V, Section B, Line 6a: Alexian Brothers Health System/Amita Health (Alexian Brothers Behavioral Health Hospital, Alexian Brothers Medical Center, St. Alexius Medical Center); Amita Health (Adventist Bolingbrook Hospital, Adventist GlenOaks Hospital, Adventist Hinsdale Hospital, Adventist LaGrange Memorial Hospital); Edward Elmhurst Healthcare (Edward Hospital & Health Services, Elmhurst Memorial Hospital); Franciscan Alliance (Franciscan St. James Health); Ingalls Health System (Ingalls Memorial Hospital); Little Company of Mary Hospital and Health Care Centers; Loretto Hospital; Northwest Community Healthcare (Northwest Community Hospital, Northwestern Memorial Hospital); Northwestern Medicine (Central DuPage Hospital, Northwestern Lake Forest Hospital); Palos Community Hospital; Rush System for Health (Rush Oak Park Hospital, Rush University Medical Center); Saint Anthony Hospital; St. Bernard Hospital and Health Care Center; Swedish Covenant Hospital; Thorek Memorial Hospital; and the University of Chicago Medicine. Little Company of Mary Hospital, Inc. Part V, Section B, Line 11: In acknowledging the wide range of priority health issues that emerged from the CHNA process - and taking into account hospital resources and overall alignment with the hospital's mission, goals, and strategic priorities - it was determined that LCMH would focus on developing and/or supporting strategies and initiatives to improve: Heart Disease & Stroke, Cancer, Diabetes, Nutrition, Physical Activity & Weight, and Access to Healthcare Services. Please see the following action plan summaries used to address these health needs.Heart Disease & Stroke - LCMH will increase opportunities for blood pressure screening and education through the following initiatives: 1) Health Ed Center will provide free BP screening twice per week at the hospital 2) LCMH will incorporate blood pressure screening into all lab screening programs and 3) the Health Ed Center will reach out to new community groups (churches, senior groups, etc.).Cancer - LCMH will increase community awareness of and access to screenings for colorectal cancer through the following initiatives: 1) LCMH will implement colon cancer risk stratification survey to be administered to all particiants in HEC screening programs 2) LCMH will provide three physician led prgrams for colorectal cancer awareness and screening updates and 3) LCMH will develop a self-referral colonoscopy screening program.Diabetes - LCMH will increase the number of people who have their blood sugar tested by creating a free blood sugar check program and adding information about this program to the already established Diabetes Toolkit program.Nutrition, Physical Activity, & Weight - LCMH will encourage employees to lose weight and make healthier nutrition choices by developing programs that encourage weight loss and healthy eating opportunities. These programs include a weight loss challenge, team walking challenge, healthy lifestyle choices for lunch and dinner in the Hospital Cafeteria, offering hypnosis for weight loss, and bariatric patient success dinner and celebration event.Access to Healthcare Services - LCMH will enhance access to services on campus by assisting patients with public transportation vouchers, determining the feasibility of adding a bus stop on campus, and joining Healthy Chicago Hospital Collaborative Access to Care Workgroup to identify what is working well for other hospital partners. In addition, LCMH will partner with area programs/businesses/townships to bring health programs and screenings to the community and pursue a location in the service area for a neighborhood health center.In acknowledging the wide range of priority health issues that emerged from the CHNA process, Little Company of Mary Hospital determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. Other health needs identified by the CHNA and not focused on by LCMH are primarily a result of other community organizations having infrastructure and programs in place to better meet these needs and limited resources. 11 1 - Carestation West 6700 West 95th Street Oak Lawn IL 60453 Other Outpatient Center 2 - The Cancer Center 2800 W 95th Street Evergreen IL 60805 Healthcare 3 - Carestation East 5660 West 95th Street Oak Lawn IL 60453 Other Outpatient Center 4 - Mary Potter Physicians Pavillion 2850 West 95th Street Evergreen IL 60805 Other Outpatient Center 5 - Homecare and Hospice Building 9800 S Southwest Highway Oak Lawn IL 60453 Home Care and Hospice 6 - Burbank Building 4901 West 79th Street Burbank IL 60459 Healthcare 7 - Halsted Building 736 West 95th Street Chicago IL 60628 Healthcare 8 - Heritage Building 2800 West 87th Street Chicago IL 60652 Healthcare 9 - Palos Medical Office Center 12450 S Harlem Palos Heights IL 60463 Physician Offices 10 - Little Company of Mary Diagnostic Center 12432 S Harlem Palos Heights IL 60463 Diagnostic Center 11 - LCM Medical Group Mt Greenwood Location 10961 S Kedzie Avenue Chicago IL 60655 Physician Offices Part I, Line 3c: The Hospital uses Federal Poverty Guidelines to determine eligibility for free or discounted care. Part I, Line 6a: The Hospital's community benefit report is prepared in a separate report presented by the organization. Part I, Line 7: The Hospital used the cost to charge ratio from the Medicare cost report (Worksheet C, Part 1). Part I, Ln 7 Col(f): Bad debt expense of $7,787,793 was included on Form 990, Part IX, Line 25, Column (A) but subtracted for purposes of calculating the community benefit percentage on Schedule H, Part I, Line 7, Column (f). Part III, Line 2: Please refer to the explanation for Schedule H, Part III, line 4 below for more information about evaluating the length of time receivables are outstanding, the payor source, historical collection experience, and trends in healthcare. Part III, Line 3: Not applicable. Part III, Line 4: Patient accounts receivable are stated at net realizable value. The Hospital evaluates the collectibility of its accounts receivable based on the length of time the receivable is outstanding, major payor sources of revenue, historical collection experience, and trends in health care insurance programs to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. For receivables associated with services provided to patients who have third-party payor coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts. For receivables from self-pay patients, the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. These allowance are recorded on an estimated basis and are adjusted as needed in future periods. Accounts receivable are charges to the allowance for uncollectible accounts when they are deemed uncollectible. Part III, Line 8: The Hospital used the cost to charge ratio from the Medicare cost report (Worksheet C, Part 1). Part III, Line 9b: For patients who are classified as uninsured, the financial counselor will complete a financial evaluation worksheet to determine if the patient qualifies for a government assistance program. If not, the counselor will ascertain whether the patient is eligible under the Hospital's charity care policy. Also, for insured patients there will be no collection agency referral if the patient has requested a reasonable payment plan or requested financial assistance and is eligible under the Hospital's charity policy. Part VI, Line 2: Needs Assessment:The Hospital gathers information on the community's health needs from many sources including the following: 1) Community Health Needs Assessment - We provide health care access to the community by offering programs for specifically identified health improvement needs to populations at risk 2) Internal records - These records provide a reliable source of timely information about what services are used by our community. Information is compiled and analyzed on many levels, including by major diagnostic category and diagnostic related group, to track changes in the community's utilization of health services. 3) Patient surveys - Results are reviewed and program, screening, and health lectures are added and modified based on this feedback from the community. 4) Internal/External data - The Hospital engages outside studies of services used by the community. 5) Physician input - Physicians are periodically surveyed to assess the healthcare services needed by their patients. In addition to surveys, physician input is gathered through the Medical Executive Committee and departmental meetings. Physicians also serve on the Hospital's Board of Directors, Strategic Planning Committee, Mission Committee and Performance Improvement Council. Part VI, Line 3: Patient Education of Eligibility for Assistance: At registration, patient's employment status or lack of basic insurance coverage will prompt the staff to offer a charity application. Notice of this charity assistance policy is posted in locations visible to the public including the emergency department, admission areas and the business office. Notices are available in general patient brochures, on the Hospital's website and on patient billing statements explaining how to apply for charity consideration. Part VI, Line 4: Community Information:The Hospital is located in Evergreen Park, Illinois and is just 20 minutes from downtown Chicago. The Hospital's primary service area includes many Chicago neighborhoods as well as the suburban communities of Oak Lawn and Hometown. Data was compiled by analysis of inpatient and outpatient discharges by ZIP code.The general demographics of the LCMH Service Area are as follows:Sex and Age:Total Population (18+) Age 18-39 - 39.5% Age 40-64 - 43.4% 65 years and over - 17.1%Male Population (18+) Age 18-39 - 41.6% Age 40-64 - 43.8% 65 years and over - 14.6%Female Population (18+) Age 18-39 - 37.8% Age 40-64 - 42.8% 65 years and over - 19.4%Race: Non-Hispanic White - 37.8% Non-Hispanic Black - 38.2% Hispanic - 21.4% Other - 2.6%Three other hospitals are located within the primary service area. Part VI, Line 5: Promotion of Community Health:The hospital currently has well over 60 separate programs to provide ongoing care to its target population, including:- Wellness events- Health screenings- Physician-led community programs- Senior billing assistance- Mobile medical home visits by our staff physicians and nurses- Diabetes center and diabetes education and awareness community-led forums- Weight management programs for the community, hypnosis, and multiple physician presentations on nutrition- Smoking cessation classes and participation in the Great American Smokeout- Weekly healthy heart screenings throughout the year- Wakeup call screening (for strokes)- Monthly blood pressure screenings - Sponsorships/partnering or support services to local elementary and high schools, church parishes and local community service organizations.The Hospital furthers relationships with local townships, villages and schools by holding quarterly meetings with health service coordinators and by participating in collaborative health and wellness initiatives in its community through the Healthier Evergreen Committee by holding multiple meetings throughout the year.The majority of the Hospital's governing body is comprised of persons residing in and around the primary service area who are not employees or independent contractors (nor family members thereof) of the Hospital.The Hospital extends medical staff priveleges to all qualified physicians in its community. Part VI, Line 6: The Hospital communicates with the community to provide ongoing care to its target population by providing physician-led community programs, health fairs, and health events. Little Company of Mary Affiliated Services promotes the health of the community by providing ambulatory services and employing physicians in a variety of specialties. The employed physicians see and treat patients from the community and are part of the health programs offered by the Hospital.Little Company of Mary Foundation promotes the health of the community by supporting the Hospital. The Foundation collects donations which are used to fund the programs of the Hospital. Part VI, Line 7, Reports Filed With States IL 1 Student Nursing Tuition 8 40000 Part I, Line 2: The hospital monitors use of grants in scholarships by following its policy. The director of human resoures makes sure that each scholarship recipient adheres to the policy and the agreement that each recipient signed. Any deviation results in the recipient having to repay the grant to the hospital. X X X X 0 0 0 0 0 0 0 1 0 Dennis Reilly President & CEO 637255 0 300000 0 5544 0 5400 0 20546 0 968745 0 0 0 Randy Ruther Assistant Treasurer & CFO 433873 0 90000 0 3943 0 5400 0 18229 0 551445 0 0 0 Lisa DiMarco CNO & VP of Patient Care Services 249727 0 19000 0 3612 0 5087 0 18546 0 295972 0 0 0 Ann Haskins VP of Business Development 286566 0 18000 0 5544 0 5400 0 8836 0 324346 0 0 0 Kevin Rehder VP Clinical Svcs. & Facilities 205437 0 25000 0 1593 0 4244 0 27816 0 264090 0 0 0 Cynthia Deuser VP of Quality Improvement 144601 0 20000 0 2005 0 4220 0 21081 0 191907 0 0 0 Mary Jo Quick VP Mission 123612 0 20000 0 1747 0 2617 0 21146 0 169122 0 0 0 John Hanlon VP Medical Affairs/CMO 328323 0 25000 0 5544 0 5400 0 30408 0 394675 0 0 0 Kent Armbruster MD Physician Advisor 185178 0 2500 0 3141 0 3436 0 18147 0 212402 0 0 0 Emuata Bassey OB Hospitalist 218893 0 20000 0 307 0 4428 0 10456 0 254084 0 0 0 Mary Fugett Physician 225061 0 3000 0 459 0 4636 0 28935 0 262091 0 0 0 Gina Knox General Counsel 183779 0 6507 0 891 0 3141 0 18772 0 213090 0 0 0 Richard Lopez Physician 192991 0 4000 0 368 0 3920 0 10206 0 211485 0 0 0 Mary Freyer Former COO 213162 0 45000 0 2985 0 3251 0 9423 0 273821 0 0 0 Part I, Line 7 The Board of Directors exercises discretion over executive bonus payments. A Illinois Finance Authority 861091967 45200FFV6 2008-04-29 134340000 See Part VI 0 0 0 B Illinois Finance Authority 861091967 000000000 2015-08-18 102000000 See Part VI 0 0 0 A 39665000 134483633 704492 25000 13730097 120024044 2008 1 0 1 1 B 102000000 335431 27825707 73838862 1 0 1 1 A 0 0 1 1 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: Illinois Finance Authority Date the Rebate Computation was Performed: 03/07/2011 Schedule K, Part I, Line 1, 2008 Bond Issuance: The issuance was composed of two bonds. Below are the two CUSIP numbers: 2008A - 45200FFV6 2008B - 45200FFW4 Schedule K, Part I, Line A, Column F Bond A: The 4/29/2008 bonds were used to (I) refinance a bank loan; (II) pay expenses incurred with the issuance of the bonds and credit enhancements. On March 13, 2008 the Hospital entered into a revolving credit agreement with JP Morgan Chase Bank and applied proceeds of the term loan advanced thereunder to currently refund the series 1997B bonds, issued 11/20/1997, on March 13, 2008 and the series 2007 bonds, issued 8/16/2007 on April 1, 2008. Proceeds of $120,024,044 from the bonds were used to refund the bank loan. Schedule K, Part I, Line B, Column F Bond B: The 8/18/15 bond was used to refund the outstanding Illinois Finance Authority Revenue Bonds Series 2010 and to modernize and equip operating rooms and patient care areas in the hospital's 1984 building. Schedule K, Part II, Line 3: The difference between the issuance price and the total proceeds of issue represents investment earnings. Mary Coners Family Member of Dennis Reilly 65203 Employment 0 Thomas Freyer Family Member of Mary Freyer 54600 Employment 0 Timothy Ruther Family Member of Randy Ruther 35754 Employment 0 Form 990, Part VI, Section A, line 6 American Province of The Little Company of Mary Sisters, Inc. is the sole corporate member and is an Illinois not-for-profit corporation whose purpose is to represent the interest of the congregation of Little Company of Mary Sisters. Form 990, Part VI, Section A, line 7a American Province of The Little Company of Mary has the power to appoint members of the governing body. Form 990, Part VI, Section A, line 7b The sole corporate members retain reserved powers to approve, among other things, the Hospital's annual budget, election of directors, and the incurrence of debt or transfer of property in excess of certain limits. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the accounting manager and CFO prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Each director, principal officer, key employee, and member of a committee with Board delegated powers shall annually sign a conflict of interest statement which affirms that such person has received, read, understood and agreed to comply with the directive. All conflict of interest statements are reviewed annually by the CEO and the Corporate Compliance Officer and the results presented to the Corporate Compliance Committee. The results and any recommendations are reported at the next Board of Directors' meeting. If a conflict is deemed to exist, such person shall not vote on, nor use his or her personal influence on, nor participate (other than to present factual information or to respond to questions) in the discussions of deliberations with respect to such contract or transaction. Such person may not be counted in determining the existence of a quorum at any meeting where the contract of transaction is under discussion or is being voted upon. The minutes of the meeting shall reflect the disclosure made, the vote thereon and, where applicable, the abstention from voting and participation, and whether a quorum was present. Form 990, Part VI, Section B, line 15a The Board Executive Committee annually reviews external benchmark compensation drafts and determines compensation adjustments based on market data and internal performance results for the CEO, CFO, and COO positions. The organization uses an outside consultant and outside surveys to determine appropriateness of executive pay. The process of determining executive compensation is documented and retained by the CEO. For other top management positions, the compensation committee is comprised of the CEO, CFO, and COO. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available to the public upon request, for the same period of time as set forth in Internal Revenue Code section 6104(d). Form 990, Part XI, line 9: Net Asset Transfers -14,582,300. Pension-Related Changes 1,093,987. Net Assets Released from Restriction -3,201,865. Little Company of Mary Health Systems 2800 West 95th Street Evergreen Park IL 60805 363823627 Health Services IL 501(c)(3) Line 1 American Pronvince 0 Little Company of Mary Affiliated Services 2800 West 95th Street Evergreen Park IL 60805 363383867 Health Services IL 501(c)(3) Line 7 Little Company of Mary 0 Little Company of Mary Foundation 2800 West 95th Street Evergreen Park IL 60805 363993337 Support Organization IL 501(c)(3) Line 11 Little Company of Mary Hopsital 0 American Province of the Little Company of Mary Sisters 2800 West 95th Street Evergreen Park IL 60805 237294648 Religious IL 501(c)(3) Line 1 N/A 0 Southwest Health Systems Inc 2800 West 95th Street Evergreen Park IL 60805 363425870 Managed Care IL Little Company of Mary Hospital C 0 Mary Cap Insurance Inc 76 St Paul Street Ste 500 Burlington VA 05401 030304812 Captive Insurance VA Little Company of Mary Hospital C 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 Little Company of Mary Foundation C 1067863 FMV