2013-05-13T14:38:21-05:00 2012-06-30 990 2011-07-01 364015560 LOYOLA UNIVERSITY MEDICAL CENTER LOYO 7082169000 2160 SOUTH FIRST AVENUE MAYWOOD IL 601533328 AJAY SIAL 7082169000 2013-05-13 2011 2016-02-24 21:20:13Z LARRY GOLDBERG 2160 SOUTH FIRST AVENUE MAYWOOD IL 601533328 982328120 0 X WWW.LUHS.ORG X 1995 IL TO EDUCATE STUDENTS, CARE FOR PATIENTS AND CONDUCT RESEARCH 13 6 7580 230 90740 0 6512166 11262114 909667494 943047625 14717942 5141066 7750323 22426245 938647925 981877050 18007722 23025422 0 0 516215561 519201313 0 0 0 389558915 423902064 923782198 966128799 14865727 15748251 829649535 861493651 613285363 672730020 216364172 188763631 X TO EDUCATE STUDENTS, CARE FOR PATIENTS AND CONDUCT RESEARCH - SEE SCHEDULE H FOR MORE INFORMATION 0 0 841206236 23025422 957642486 BASED IN THE WESTERN SUBURBS OF CHICAGO, LOYOLA UNIVERSITY MEDICAL CENTER (LUMC) IS A QUARTERNARY CARE SYSTEM WITH A 61-ACRE MAIN MEDICAL CENTER CAMPUS AND 18 PRIMARY AND SPECIALTY CARE FACILITIES IN COOK, WILL AND DUPAGE COUNTIES. THE MEDICAL CENTER IS CONVENIENTLY LOCATED IN MAYWOOD, 13 MILES WEST OF THE CHICAGO LOOP AND 8 MILES EAST OF OAK BROOK, ILLINOIS. THE HEART OF THE MEDICAL CENTER CAMPUS, LUMC'S HOSPITAL, IS A 569 LICENSED BED FACILITY. BESIDES THE HOSPITAL, THE FOLLOWING CLINICAL FACILITIES ARE LOCATED ON CAMPUS: A LEVEL 1 TRAUMA CENTER, A BURN CENTER, THE RONALD MCDONALD CHILDREN'S HOSPITAL OF LOYOLA UNIVERSITY MEDICAL CENTER, THE CARDINAL BERNARDIN CANCER CENTER, LOYOLA OUTPATIENT CENTER, LOYOLA CENTER FOR HEART & VASCULAR MEDICINE AND LOYOLA ORAL HEALTH CENTER. DURING FISCAL YEAR 2012, LUMC PROVIDED OVER 125,000 DAYS OF HEALTHCARE SERVICES AND OVER 860,000 OUTPATIENT VISITS TO THE COMMUNITY. THE MISSION STATEMENT OF LOYOLA UNIVERSITY MEDICAL CENTER IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTH IN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US 841206236 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 0 0 1 530 0 1 7580 1 1 1 0 0 0 0 1 1 0 0 0 0 X 13 6 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL AK AL AR AZ CA CO CT DC FL GA HI ID KS KY LA MA MD ME MI MN MO MS NC ND NH NJ NM NY OH OK OR PA RI SC TN UT VA WA WI WV X AJAY SIAL 7082164252 2160 SOUTH FIRST AVENUE MAYWOOD IL 601533328 X DANIEL HALE 2.00 X X 0 925954 106225 PATRICIA CASSIDY 10.00 X X 1885874 0 173667 LARRY GOLDBERG 30.00 X X 0 196650 12915 ROBERT FLANIGAN MD 40.00 X 408994 0 25796 RICHARD GAMELLI MD 40.00 X 890026 0 29194 P TERRENCE O'ROURKE 2.00 X 0 863581 50709 ROBERT SULO MD 40.00 X 333392 0 42076 DAVID WILBER 40.00 X 640268 0 26131 NANCY KNOWLES 2.00 X 0 0 0 HENRY LANG 2.00 X 0 0 0 WILLIAM REICHERT 2.00 X 0 0 0 MARC SCHWARTZ 2.00 X 0 0 0 SR JOAN MARIE STEADMAN CSC 2.00 X 0 0 0 JACK WEINBERG 2.00 X 0 0 0 AJAY SIAL 40.00 X 0 0 0 BENJAMIN CARTER 2.00 X 0 755014 102689 SILIA MIGLIO 2.00 X 0 157638 17486 CHARLES REITER III 40.00 X 1588987 0 113850 JILL RAPPIS 40.00 X 288502 0 58102 DONNA HALINSKI 40.00 X 309741 0 48973 TOM HONAN NAVIGANT 30.00 X 1556520 0 0 MELISSA COVERDALE 40.00 X 313996 0 14372 KAREN ALEXANDER 40.00 X 506191 0 610904 THOMAS ANDERSON 40.00 X 0 550337 46196 DANIEL POST 40.00 X 920602 0 64924 JOSEPH SWEDISH 2.00 X 0 5186660 576202 KEDRICK ADKINS 2.00 X 0 1405226 117120 J RICHARD O'CONNELL 2.00 X 0 943237 118221 MICHAEL MURPHY 2.00 X 0 474370 75538 MAMDOUH BAKHOS 40.00 X 992863 0 25778 GUIDO MARRA 40.00 X 885844 0 31619 ALEXANDER GHANAYEM 40.00 X 835007 0 32230 RONALD POTKUL 40.00 X 817470 0 33730 BRUCE LEWIS 40.00 X 784979 0 31757 JOHN MORDACH 0.00 X 151087 0 10570 SHARON O'KEEFE 0.00 X 134302 0 11039 MICHAEL SCHEER 0.00 X 150726 0 4477 PAUL WHELTON 0.00 X 3693100 0 1453069 WILLIAM CANNON MD 45.00 X 426610 0 46972 PAULA HINDLE 45.00 X 506703 0 68187 ARTHUR KRUMREY 45.00 X 448192 0 101285 19469976 11458667 4282003 704 1 1 1 SODEXO INC AND AFFILIATES PO BOX 70060 CHICAGO IL 60673 MANAGEMENT SERVICES 11666395 WALSH CONSTRUCTION 929 W ADAMS CHICAGO IL 60607 CONSTRUCTION SERVICES 2719738 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 INFO TECHNOLOGY 2704820 BVK 250 W COVENTRY COURT MILWAUKEE WI 53217 ADVERTISING SERVICES 2232979 THH ACQUISITION LLC 780 MCLEAN BLVD ELGIN IL 60123 HOME HEALTH SERVICES 2202520 203 205402 5000 1252643 9799069 311927 11262114 NET PATIENT SVC REV 621110 939323882 939233142 90740 HOSPITAL PHARMACY 446110 3723743 3723743 943047625 2703699 2703699 2484924 10200 0 57757 2484924 -47557 2437367 2437367 36660 205402 269236 -232576 -232576 230452 124077 106375 106375 PARKING REVENUE 812930 4003792 4003792 CAFETERIA REVENUE 722210 3863053 3863053 MEDICAID/MEDICARE HIT 900099 3792094 3792094 10893507 10893507 22552446 981877050 957642486 90740 12881710 23025422 23025422 8684151 8684151 4176202 430583 3745619 416358795 377351269 39007526 20099556 18771796 1327760 41063276 36589887 4473389 28819333 25523593 3295740 1763855 1763855 29529028 18962214 10566814 2424739 68285 2356454 16757472 10404559 6352913 5186014 598531 4587483 20661253 18890923 1770330 3051162 2529393 521769 171230 115324 55906 12965887 12965887 39356181 31760769 7595412 37697165 20883000 16814165 MEDICAL SUPPLIES 149958323 149374069 584254 BAD DEBT 45033590 45033590 CONTRACT LABOR 20467505 16520168 3947337 HOSPITAL PROVIDER TAX 19097112 19097112 19781548 12309862 7471686 966128799 841206236 124922563 0 64989724 18450951 957809 427771 4625797 1258457 145761428 154000902 12860353 15969238 5858730 3714990 498839662 39350099 383475733 459489563 129618775 61429440 13393469 82221837 36230000 68107717 28300502 829649535 861493651 93340550 225354099 6813000 339300204 180644609 440562921 613285363 672730020 X 189405029 165232322 20287967 16339868 6671176 7191441 216364172 188763631 829649535 861493651 X 15748251 -43348792 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 203895 1 40291 0 0 244186 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE MAJORITY OF LOBBYING ACTIVITIES CONDUCTED BY LOYOLA UNIVERSITY MEDICAL CENTER INVOLVED EDUCATING LEGISLATORS REGARDING APPROPRIATE HEALTH CARE PUBLIC POLICIES IN THE AREAS OF ILLINOIS MEDICAID REIMBURSEMENTS AND ISSUES RELATING TO THE PROVISION OF HEALTH CARE IN AN ACADEMIC TEACHING HOSPITAL ENVIRONMENT. LOYOLA UNIVERSITY MEDICAL CENTER ALSO MADE GRANTS TO OTHER ORGANIZATIONS IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. LOYOLA UNIVERSITY MEDICAL CENTER MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 8933970 520265 2262794 7191441 8751883 31505 348552 197970 8933970 8810000 30600 126692 215409 8751883 9728929 26525 -697789 247665 8810000 1.00000 0 0 7400000 5670000 13070000 331319571 13939371 317380200 95543690 21998713 73544977 58906401 3412015 55494386 459489563 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 46415553 F EQUITY METHOD INVESTMENTS 35806284 C 82221837 CAPITAL LEASE OBLIGATION 37984872 ASSET RETIREMENT OBLIGATION 645085 OTHER CURRENT LIABILITIES 917864 INTERCOMPANY PAYABLES 14988591 DEFERRED COMPENSATION 5850492 LONG TERM ANNUITY PAYABLE 323358 INTERCOMPANY NOTES PAYABLE 322289746 OTHER LONG TERM LIABILITIES 7876881 INTERCOMPANY OTHER LT LIABILITIES 49686032 440562921 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR HEALTHCARE, HOSPITAL SERVICES, RESEARCH, CAPITAL PROJECTS AND INDIGENT CARE. GALA 123175 116825 6350 234304 MCDONALD WALK 118887 88577 30310 34932 242062 205402 36660 269236 269236 -232576 1 1 X 1 X 1 X 1 1 1 0 1 1 1 1444 15836145 15836145 0.01720 87572 135743890 104858607 30885283 0.03350 1 89016 151580035 104858607 46721428 0.05070 21 86711 655147 655147 0.00070 3 2888 46437859 22643827 23794032 0.02580 5 808 4113481 1895775 2217706 0.00240 1 1 534 534 0.00000 5 983 22739654 2040 22737614 0.02470 35 91391 73946675 24541642 49405033 0.05360 36 180407 225526710 129400249 96126461 0.10430 1 1 2745 2745 0.00000 1 9 291842 291842 0.00030 1 10000 1065940 1065940 0.00120 1 1 5856 5856 0.00000 1 68 5779 5779 0.00000 5 10079 1372162 1372162 0.00150 0 14301634 4290490 227277582 202818220 24459362 X 1 1 1 1 FOSTER G MCGAW HOSPITAL

LOYOLA UNIVERSITY MEDICAL CENTER S FIRST AVE MA IL 60153

X X X X X X OUTPATIENT SURGERY FOSTER G MCGAW HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X 1 0 1 X 0 0 2 AMBULATORY SURGERY CENTER

2160 S FIRST AVENUE MAYWOOD IL 60153

OUTPATIENT SURGERY CENTER LOYOLA AMBULATORY SURGERY CENTER

15224 SUMMIT AVE SUITE 201 OAKBROOK TERRACE IL 60181

AMBULATORY SURGERY CENTER PART I, LINE 6A: LOYOLA UNIVERSITY MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF ILLINOIS. AS OF JULY 1, 2011, LOYOLA UNIVERSITY MEDICAL CENTER ALSO REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, LOYOLA UNIVERSITY MEDICAL CENTER WILL INCLUDE A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, L7 COL(F): THE FOLLOWING NUMBER, $45,033,590, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II: COMMUNITY BUILDING ACTIVITIES - LOYOLA UNIVERSITY MEDICAL CENTER (LUMC) PROVIDED A NUMBER OF COMMUNITY-BUILDING ACTIVITIES IN FISCAL YEAR 2012 TO SUPPORT AND PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. THE PROVISION OF EMERGENCY MEDICAL SERVICES (EMS) MEANS PROVIDING LIFESAVING EARLY INTERVENTIONS FOR ILLNESSES AND INJURIES INCLUDING PATIENT ASSESSMENT, URGENT TREATMENT AND TRANSPORT TO THE NEAREST APPROPRIATE HOSPITAL. AS AN EMS RESOURCE HOSPITAL FOR REGION 8 (ONE OF ONLY 11 REGIONS IN ILLINOIS) PREDOMINATELY COVERING CHICAGO'S WESTERN SUBURBS, LUMC ALSO IS A KEY CONTRIBUTOR TO ILLINOIS' EMS SYSTEM. AS A RESOURCE HOSPITAL, LUMC MAKES A SUBSTANTIAL COMMUNITY COMMITMENT. IN THIS CAPACITY, LUMC SERVES AS A MEDICAL COMMUNICATION HUB IN THE EVENT OF DISASTER, IS RESPONSIBLE FOR THE EDUCATION AND TRAINING OF EMERGENCY MEDICAL PERSONNEL AND PROVIDES EQUIPMENT AND INSPECTION SERVICES OF AREA AMBULANCES. IN ADDITION, DURING FISCAL YEAR 2012, LUMC EMS PHYSICIANS AND STAFF PARTICIPATED IN A MASS CASUALTY EXERCISE WITH MULTIPLE HOSPITALS, FIRE AND POLICE DEPARTMENTS, AND OTHER AGENCIES TO TEST SYSTEMS IN PLACE TO HANDLE A MAJOR MEDICAL CRISIS. FURTHERMORE, LUMC EMS STAFF PARTICIPATED IN MONTHS OF PREPARATION WITH THE CITY OF CHICAGO AND OTHER COMMUNITIES TO GET READY FOR THE NATO SUMMIT HELD IN MAY 2012 IN CHICAGO. LUMC REPRESENTATIVES ALSO SERVED ON EXTERNAL TASK FORCES TO HELP DISABLED STUDENTS AND IMPROVE HEALTH INFORMATION TECHNOLOGY IN THE PUBLIC HEALTH SECTOR, PARTICIPATED IN A LOCAL COLLEGE'S COMMUNITY FAIR TO INTRODUCE STUDENTS TO HEALTHCARE CAREERS, AND PRESENTED HEALTHCARE TOPICS TO LAW ENFORCEMENT OFFICIALS. IN ADDITION, STAFF COORDINATED PLACEMENT OF DISADVANTAGED HIGH SCHOOL STUDENTS IN A WORK/STUDY PROGRAM AT LUMC IN VARIOUS CLINICAL AND SUPPORT DEPARTMENTS. FURTHERMORE, NEARLY 3,000 INDIVIDUALS PARTICIPATED IN LUMC'S MANY SUPPORT GROUPS ON GRIEF AND SERIOUS HEALTH CONDITIONS RELATED TO HEART DISEASE, CANCER, STROKE, TRANSPLANT, BURN, AND TRAUMA. PART III, LINE 4: AS OF JULY 1, 2011, LOYOLA UNIVERSITY MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM THOSE STATEMENTS: "SUBSTANTIALLY ALL OF THE CORPORATION'S RECEIVABLES ARE RELATED TO PROVIDING HEALTHCARE SERVICES TO PATIENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. THE CORPORATION'S ESTIMATE FOR ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS BY PAYOR."COSTING METHODOLOGY FOR LINES 2 AND 3: AMOUNTS ARE CALCULATED ON LINE 2 USING A COST TO CHARGE RATIO METHODOLOGY.ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.THE AMOUNT ON LINE 3 IS BASED ON THE ACCOUNTS WRITTEN OFF TO BAD DEBT AFTER THEY WENT TO COLLECTION AGENCY THAT HAD A CREDIT SCORE OF LESS THAN 500. BASED ON THE EXPERTISE OF THE COLLECTION AGENCY, THESE PATIENTS ARE UNABLE TO PAY AND MOST LIKELY WOULD HAVE QUALIFIED FOR CHARITY IF THEY HAD COMPLETED ALL PAPERWORK. PART III, LINE 8: LOYOLA UNIVERSITY MEDICAL CENTER DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE LUMC WEBSITE EXPLAINS ALL OF THE VARIOUS FINANCIAL ASSISTANCE PROGRAMS, AND EVEN HAS THE FULL CHARITY POLICY AND APPLICATION ONLINE FOR PRINT OUT. ALL BILLING AND COLLECTION STATEMENTS TO PATIENTS MENTION AVAILABLE FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE. WHEN PATIENTS CALL TO SCHEDULE CARE, THEY ARE INFORMED OF THE SELF PAY POLICY, WHICH INCLUDES A 40% DISCOUNT. THE SCHEDULING STAFF IS ALSO TRAINED TO DISCUSS THE VARIOUS FINANCIAL ASSISTANCE PROGRAMS WHEN A PATIENT INDICATES AN INABILITY TO PAY. PATIENTS ARE OFFERED THE OPPORTUNITY TO MEET WITH AN LUMC FINANCIAL COUNSELOR TO ASSESS THEIR ELIGIBILITY FOR A PAYMENT PLAN, MEDICAID APPLICATION OR CHARITY APPLICATION. ONCE A PATIENT IS DEEMED ELIGIBLE FOR A FINANCIAL ASSISTANCE PROGRAM, THEY WILL BE RESPONSIBLE FOR PAYING ONLY THE BALANCE (IF ANY) AS COMPUTED PER THE LUMC PROGRAM GUIDELINES. FINANCIAL ASSISTANCE TO PATIENTS WITH A BALANCE WILL FOLLOW THE SELF PAY ACCOUNT BILLING CYCLE PER LUMC POLICY, WHICH INCLUDES THREE STATEMENTS, A FINAL NOTICE AND POSSIBLE REFERRAL TO A COLLECTION AGENCY IF THE ACCOUNT REMAINS UNPAID. FOSTER G MCGAW HOSPITAL PART V, SECTION B, LINE 19D: IN DETERMINING THE AMOUNTS BILLED TO INDIVIDUALS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, LOYOLA UNIVERSITY MEDICAL CENTER USED MEDICARE RECEIVED PER THE ILLINOIS UNINSURED PATIENT ACT. PART VI, LINE 2: NEEDS ASSESSMENT - LOYOLA UNIVERSITY MEDICAL CENTER PERFORMS COMMUNITY HEALTH NEEDS EVALUATIONS, WHICH ARE A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL-BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR LOYOLA UNIVERSITY MEDICAL CENTER'S STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.THE LOYOLA UNIVERSITY MEDICAL CENTER COMMUNITY HEALTH NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE LOYOLA UNIVERSITY MEDICAL CENTER COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES. LOYOLA UNIVERSITY MEDICAL CENTER PLANS TO COMPLETE A MORE FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT BY JUNE 30, 2013. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - LUMC IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THOSE WHO ARE POOR AND UNDERSERVED IN OUR COMMUNITIES; - CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES;- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE; AND - BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITY.LUMC HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS;- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS;- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS;- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER; AND- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONS. LUMC PROVIDES EFFECTIVE COMMUNICATION WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.LUMC OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH FACE-TO-FACE FINANCIAL COUNSELING FOR PATIENTS AND FAMILY MEMBERS. ADMITTED PATIENTS WHO ARE UNINSURED ARE VISITED BY A FINANCIAL COUNSELOR WHO WILL WORK WITH THE PATIENT AND FAMILY TO SCREEN THEM FOR EVERY-AND ALL-GOVERNMENTAL PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE. THE COUNSELORS COMPLETE THE APPLICATION(S) AND FOLLOW UP WITH THE APPROPRIATE AGENCY. ALSO, FINANCIAL COUNSELORS ARE LOCATED IN THE AMBULATORY SITES FOR THOSE PATIENTS SEEKING OUTPATIENT CARE. SIGNAGE ON OUR PROGRAMS IS POSTED THROUGHOUT THE HOSPITAL, AND OUR PATIENT BILLING STATEMENTS ALSO INFORM THE PATIENT ABOUT THE AVAILABILITY OF FREE OR DISCOUNTED CARE. INFORMATION ABOUT FINANCIAL ASSISTANCE ALSO IS AVAILABLE ON THE HOSPITAL WEBSITE, ALONG WITH AN APPLICATION THAT CAN BE PRINTED OUT. INFORMATION IS GIVEN OUT DURING INTAKE, AND IS ALSO INCLUDED IN THE ADMISSION PACKET. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH AND POLISH REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. LUMC HAS ESTABLISHED A WRITTEN POLICY FOR BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. LUMC MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. LUMC EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. FINANCIAL COUNSELORS AND REGISTRARS RECEIVE TRAINING ON THE ELIGIBILITY CRITERIA FOR GOVERNMENTAL PROGRAMS, ALONG WITH OUR FINANCIAL ASSISTANCE ELIGIBILITY GUIDELINES. THEY ALSO RECEIVE CUSTOMER SERVICE TRAINING. PART VI, LINE 4: COMMUNITY INFORMATION - BASED IN THE WESTERN SUBURBS OF CHICAGO, LUMC IS A QUATERNARY CARE SYSTEM WITH A MAIN MEDICAL CENTER CAMPUS IN A DIVERSE COMMUNITY AND OPERATES PRIMARY- AND SPECIALTY-CARE FACILITIES ACROSS COOK, DUPAGE AND WILL COUNTIES. THE HEART OF THE MEDICAL CENTER CAMPUS, LUMC'S FOSTER G. MCGAW HOSPITAL, IS A 569-LICENSED-BED FACILITY. IN ADDITION TO THE HOSPITAL, THE FOLLOWING CLINICAL SERVICES ARE LOCATED ON CAMPUS: LEVEL 1 TRAUMA CENTER, RONALD MCDONALD CHILDREN'S HOSPITAL OF LOYOLA UNIVERSITY MEDICAL CENTER, CARDINAL BERNARDIN CANCER CENTER, LOYOLA OUTPATIENT CENTER, LOYOLA CENTER FOR HEART & VASCULAR MEDICINE AND LOYOLA ORAL HEALTH CENTER. THE CAMPUS ALSO IS THE HOME OF LOYOLA UNIVERSITY OF CHICAGO'S STRITCH SCHOOL OF MEDICINE, MARCELLA NIEHOFF SCHOOL OF NURSING, GRADUATE SCHOOL'S HEALTH SCIENCES DIVISION, AND LOYOLA CENTER FOR FITNESS. BECAUSE OF ITS CONVENIENT LOCATION, LUMC IS ACCESSIBLE TO THE MAJORITY OF CHICAGO'S (SIX-COUNTY) METROPOLITAN AREA OF 8.4 MILLION PEOPLE. LUMC'S PRIMARY SERVICE AREA, WHICH ACCOUNTS FOR 58 PERCENT OF PATIENTS SERVED AT LUMC, HAS AN ETHNICALLY AND ECONOMICALLY DIVERSE POPULATION OF ALMOST 2 MILLION AND IS MADE UP OF THE FOLLOWING CHARACTERISTICS:- 50 PERCENT OF THE POPULATION IS UNDER THE AGE OF 35. - AVERAGE HOUSEHOLD INCOME IS $69,701 WITH 19 PERCENT OF HOUSEHOLDS OVER $100,000 AND 21 PERCENT UNDER $25,000.- HISPANICS ARE AMONG THE FASTEST-GROWING GROUP MAKING UP 38 PERCENT OF THE POPULATION.LUMC SERVED 6.2 PERCENT (HIGHEST AMONG THE AREA'S HOSPITALS) OF THE 223,300 DISCHARGED INPATIENTS FROM THIS PRIMARY SERVICE AREA IN FISCAL YEAR 2012. NEARLY 130 HOSPITALS TRANSFERRED MORE THAN 3,700 INPATIENTS TO LUMC LAST YEAR FOR SPECIALIZED CARE AND TREATMENT, IN PARTICULAR, FOR HEART DISEASE, CANCER, BURN/TRAUMA, ORGAN TRANSPLANTATION AND NEUROLOGICAL DISORDERS. LUMC ALSO PROVIDES CRITICAL CARE TO PATIENTS FROM AS FAR AS 300 MILES AWAY WHO ARE TRANSPORTED TO THE HOSPITAL VIA AN AIR-TRANSPORT SERVICE. THESE CRITICALLY INJURED OR SEVERELY ILL PATIENTS TYPICALLY RECEIVE LUMC'S LEVEL I TRAUMA SERVICES. PART VI, LINE 5: OTHER INFORMATION - LUHS IS COMMITTED TO THE JESUIT TRADITION OF ACADEMIC DISTINCTION AND THE VALUES OF CARE, CONCERN AND RESPECT FOR STUDENTS AND FOR EACH OTHER. THROUGH AGREEMENTS WITH LOYOLA UNIVERSITY CHICAGO, LUMC PROVIDES CLINICAL EDUCATION SUPPORT AND TEACHING FACILITIES FOR THE UNIVERSITY'S HEALTH SCIENCES EDUCATION PROGRAMS AT THE LOYOLA UNIVERSITY STRITCH SCHOOL OF MEDICINE TO TRAIN FUTURE DOCTORS AND AT LOYOLA'S MARCELLA NIEHOFF SCHOOL OF NURSING TO PREPARE NURSING STUDENTS. LUMC DEMONSTRATED ITS COMMITMENT TO MEDICAL EDUCATION BY CONTRIBUTING $22.5 MILLION TO LOYOLA UNIVERSITY'S HEALTH SCIENCES DIVISION IN SUPPORT OF FUTURE PHYSICIAN AND NURSING EDUCATION. THESE FUNDS ARE USED TO ASSIST THE STRITCH SCHOOL OF MEDICINE AND MARCELLA SCHOOL OF NURSING IN PROVIDING ITS MEDICAL AND NURSING EDUCATION ACTIVITIES, WHICH COST FAR MORE TO PROVIDE THAN THE REVENUE AFFORDED BY TUITION AND OTHER GRANTS RECEIVED BY THE SCHOOLS. IN ADDITION, LUMC HAS AGREEMENTS WITH 23 OTHER SCHOOLS OF NURSING. FURTHERMORE, LUMC PROVIDES EDUCATION AND INSTRUCTION FOR PRE-HOSPITAL RESPONDERS (E.G. PARAMEDICS, DISPATCHERS), AND STUDENTS IN SOCIAL WORK, MEDICAL TECHNOLOGY, NUTRITION, PATHOLOGY AND PASTORAL CARE PROGRAMS. LUMC TRAINED NEARLY 600 MEDICAL RESIDENTS AND FELLOWS INVOLVED IN ITS VARIOUS GRADUATE MEDICAL EDUCATION PROGRAMS, 1,100 NURSES, 6,800 PRE-HOSPITAL RESPONDERS AND DOZENS OF OTHER STUDENTS IN HEALTH PROFESSION PROGRAMS.LUMC ALSO PROVIDES SUBSIDIZED HEALTH PROGRAMS, IN RESPONSE TO A COMMUNITY NEED, THAT OPERATE AT A FINANCIAL LOSS. THESE INCLUDE CLINICAL SERVICES, AS WELL AS COMMUNITY HEALTH AND EDUCATION PROGRAMS. THE CLINICAL SERVICES INCLUDE LUMC'S OUTPATIENT BURN CLINIC TREATING MORE THAN 3,400 CHILDREN AND ADULTS WITH ELECTRIC, CHEMICAL AND OTHER BURNS; THE COLEMAN CENTER OF THE CARDINAL BERNARDIN CANCER CENTER, OFFERING SPIRIT-LIFTING SUPPORT SERVICES FOR HUNDREDS OF CANCER PATIENTS; THE ORAL HEALTH CENTER PROVIDING DENTAL SERVICES TO NEARLY 11,000 INDIVIDUALS AND FAMILIES; THE CHILD LIFE PROGRAM HELPING 9,300 PEDIATRIC PATIENTS ADJUST TO HOSPITALIZATIONS AND TREATMENT THROUGH VARIOUS SUPPORT PROGRAMS; AND THE HOSPICE PROGRAM OFFERING COMFORT SERVICES TO MORE THAN 200 END-OF-LIFE PATIENTS AND THEIR FAMILIES. IF LUMC DID NOT PROVIDE THESE SERVICES TO THE COMMUNITY, THESE SERVICES MAY NOT BE AVAILABLE, THE COMMUNITY'S CAPACITY TO PROVIDE THE SERVICE MAY BE LESS THAN THE COMMUNITY'S NEED, OR THE SERVICE MAY BECOME THE RESPONSIBILITY OF GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION.FURTHERMORE, LUMC PHYSICIANS PROVIDED NEARLY 2,500 HOURS OF VOLUNTEER TIME TO PROVIDE FREE CARE FOR PATIENTS ENROLLED IN THE ACCESS TO CARE PROGRAM (A SEPARATE ORGANIZATION THAT CONNECTS UNINSURED/UNDERINSURED PATIENTS WITH HEALTHCARE PROVIDERS). LUMC ALSO PROVIDED FREE INPATIENT AND OUTPATIENT HOSPITAL SERVICES, AND LABORATORY AND RADIOLOGY SERVICES. THESE ACTIVITIES INCLUDED LECTURES ON SPECIFIC WOMEN'S, MEN'S AND CHILDREN'S HEALTH ISSUES; AND LABORATORY TESTS FOR DISADVANTAGED HIGH SCHOOL STUDENTS. ADDITIONALLY, LUMC CONTRIBUTED FINANCIAL SUPPORT TO THE ILLINOIS POISON CENTER (IPC), WHICH PROVIDES EXPERT POISON-PREVENTION AND TREATMENT SERVICES THROUGHOUT ILLINOIS VIA A TOLL-FREE HOTLINE THAT OPERATES AROUND THE CLOCK. METROPOLITAN CHICAGO HOSPITALS CONTRIBUTE TO THE IPC'S ANNUAL OPERATING BUDGET, ENSURING THAT THE PUBLIC AND PHYSICIANS ALIKE HAVE ACCESS TO TRAINED SPECIALISTS IN TOXICOLOGY IN TIMES OF AN EMERGENCY. LUMC'S DONATIONS ALSO INCLUDED MEDICAL MISSION SUPPLIES, FREE LEGAL SERVICES FOR INDIGENT PATIENTS WHO NEED GUARDIANSHIP SERVICES, AND INFLUENZA VACCINATION DONATIONS. PART VI, LINE 6: LUMC IS A MEMBER ORGANIZATION OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE SYSTEMS IN THE COUNTRY. BASED IN LIVONIA, MICHIGAN, TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEVELOP, AND ARE HELD ACCOUNTABLE FOR ACHIEVING, COMMUNITY BENEFIT GOALS THAT INCLUDE DEVELOPING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS TO SERVE THE POOR AND UNINSURED, MANAGE CHRONIC CONDITIONS LIKE DIABETES, HEALTH EDUCATION AND PROMOTION INITIATIVES, AND OUTREACH TO THE ELDERLY. IN FISCAL YEAR 2012, THIS INCLUDED OVER $615 MILLION IN SUCH COMMUNITY BENEFITS. THEREFORE, TRINITY HEALTH TAKES A SYSTEM APPROACH IN ITS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION, AND IS CONSEQUENTLY ABLE TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ARE HELPING PROMOTE AND ADDRESS THE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. REPORTS FILED WITH STATES PART VI, LINE 7 IL 1 LOYOLA UNIVERSITY OF CHICAGO 820 N MICHIGAN AVENUE CHICAGO IL 60611 361408475 501(C)(3) 22500000 ACADEMIC OPERATIONS SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AS PART OF THE LOYOLA UNIVERSITY ACADEMIC AFFILIATION AGREEMENT, LOYOLA UNIVERSITY MEDICAL CENTER AGREED TO PROVIDE ECONOMIC SUPPORT TO LOYOLA UNIVERSITY CHICAGO FOR THE STRITCH SCHOOL OF MEDICINE AND OTHER ACADEMIC OPERATIONS OF THE UNIVERSITY. PART II, LINE 1: LOYOLA UNIVERSITY MEDICAL CENTER PROVIDES CLINICAL EDUCATION SUPPORT AND TEACHING FACILITIES FOR THE UNIVERSITY'S HEALTH SCIENCES EDUCATION PROGRAMS AT THE LOYOLA UNIVERSITY STRITCH SCHOOL OF MEDICINE AND THE MARCELLA NIEHOFF SCHOOL OF NURSING. 1 1 0 0 0 0 0 0 0 DANIEL HALE 0 479340 0 186340 0 260274 0 87640 0 18585 0 1032179 0 155414 PATRICIA CASSIDY 490629 0 217040 0 1178205 0 158843 0 14824 0 2059541 0 0 0 LARRY GOLDBERG 0 126243 0 50000 0 20407 0 12003 0 912 0 209565 0 0 ROBERT FLANIGAN MD 321449 0 40579 0 46966 0 20982 0 4814 0 434790 0 0 0 RICHARD GAMELLI MD 308813 0 383422 0 197791 0 20982 0 8212 0 919220 0 0 0 P TERRENCE O'ROURKE 0 500415 0 209835 0 153331 0 22851 0 27858 0 914290 0 0 ROBERT SULO MD 331070 0 0 0 2322 0 20982 0 21094 0 375468 0 0 0 DAVID WILBER 567184 0 67500 0 5584 0 20982 0 5149 0 666399 0 0 0 BENJAMIN CARTER 0 509505 0 174420 0 71089 0 73824 0 28865 0 857703 0 0 SILIA MIGLIO 0 137314 0 4919 0 15405 0 14043 0 3443 0 175124 0 0 CHARLES REITER III 262219 0 130098 0 1196670 0 98740 0 15110 0 1702837 0 0 0 JILL RAPPIS 237141 0 50152 0 1209 0 49455 0 8647 0 346604 0 0 0 DONNA HALINSKI 227291 0 72792 0 9658 0 33582 0 15391 0 358714 0 0 0 TOM HONAN NAVIGANT 1556520 0 0 0 0 0 0 0 0 0 1556520 0 0 0 MELISSA COVERDALE 241989 0 71435 0 572 0 2173 0 12199 0 328368 0 0 0 KAREN ALEXANDER 178734 0 92125 0 235332 0 586412 0 24492 0 1117095 0 0 0 THOMAS ANDERSON 0 405358 0 86609 0 58370 0 25340 0 20856 0 596533 0 0 DANIEL POST 373019 0 301111 0 246472 0 37870 0 27054 0 985526 0 0 0 JOSEPH SWEDISH 0 1279458 0 677642 0 3229560 0 548602 0 27600 0 5762862 0 2698342 KEDRICK ADKINS 0 743978 0 316652 0 344596 0 103857 0 13263 0 1522346 0 143708 J RICHARD O'CONNELL 0 571942 0 230946 0 140349 0 85919 0 32302 0 1061458 0 0 MICHAEL MURPHY 0 402598 0 0 0 71772 0 48365 0 27173 0 549908 0 0 MAMDOUH BAKHOS 847433 0 100500 0 44930 0 20982 0 4796 0 1018641 0 0 0 GUIDO MARRA 547510 0 337236 0 1098 0 20982 0 10637 0 917463 0 0 0 ALEXANDER GHANAYEM 589638 0 244230 0 1139 0 20982 0 11248 0 867237 0 0 0 RONALD POTKUL 679334 0 134555 0 3581 0 20982 0 12748 0 851200 0 0 0 BRUCE LEWIS 464367 0 317444 0 3168 0 20982 0 10775 0 816736 0 0 0 JOHN MORDACH 116305 0 0 0 34782 0 4317 0 6253 0 161657 0 0 0 SHARON O'KEEFE 94919 0 0 0 39383 0 5830 0 5209 0 145341 0 0 0 MICHAEL SCHEER 0 0 0 0 150726 0 0 0 4477 0 155203 0 0 0 PAUL WHELTON 485635 0 251100 0 2956365 0 1438402 0 14667 0 5146169 0 0 0 WILLIAM CANNON MD 338127 0 46373 0 42110 0 25176 0 21796 0 473582 0 0 0 PAULA HINDLE 237675 0 22053 0 246975 0 58307 0 9880 0 574890 0 0 0 ARTHUR KRUMREY 313291 0 92993 0 41908 0 73542 0 27743 0 549477 0 0 0 PART I, LINE 3 AS OF JULY 1, 2011, LOYOLA UNIVERSITY MEDICAL CENTER IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. LOYOLA UNIVERSITY MEDICAL CENTER'S PRESIDENT IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF LOYOLA UNIVERSITY MEDICAL CENTER'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2011. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): KAREN ALEXANDER - $148,175 PATRICIA CASSIDY - $1,031,555 CHARLES REITER, III - $960,000 MICHAEL SCHEER - $150,726 PAUL WHELTON - $432,802 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNTS WHICH WERE UNPAID AS OF 12/31/11: KAREN ALEXANDER - $570,845 ($359,505 PAID IN 2012 AND $211,340 TO BE PAID IN 2013) PATRICIA CASSIDY - $121,005 ($60,503 PAID IN 2012 AND $60,502 TO BE PAID IN 2013) CHARLES REITER, III - $49,021 ($24,511 PAID IN 2012 AND $24,510 TO BE PAID IN 2013) MICHAEL SCHEER - $0 PAUL WHELTON - $1,427,198 ($930,012 PAID IN 2012 AND $497,186 TO BE PAID IN 2013) PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2011). THE FOLLOWING ACCRUALS FOR 2011 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS- $91,607 BENJAMIN CARTER - $54,011 LARRY GOLDBERG - $5,686 DANIEL HALE - $42,034 MICHAEL MURPHY - $27,513 J. RICHARD O'CONNELL - $66,279 JOSEPH SWEDISH - $255,902 THE FOLLOWING ARE PARTICIPANTS IN THE LOYOLA UNIVERSITY MEDICAL CENTER RETIREMENT RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2011). THE FOLLOWING TAXABLE AMOUNTS FOR 2011 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: PATRICIA CASSIDY - $145,408 CHARLES REITER, III - $152,173 THE FOLLOWING IS A PARTICIPANT IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUAL FOR 2011 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: JOSEPH SWEDISH - $265,000 PART II: THE FOLLOWING INDIVIDUALS BECAME VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) DURING CALENDAR 2011. AS A RESULT, THE VESTED AMOUNTS WERE INCLUDED IN THEIR 2011 TAXABLE INCOMES. THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $220,648 KAREN ALEXANDER - $52,681 DANIEL POST - $207,043 CHARLES REITER, III - $42,488 JOSEPH SWEDISH - $2,740,000 PAUL WHELTON - $2,362,626 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. SUPPLEMENTAL INFORMATION PART III PART II: TOM HONAN - THE AMOUNT LISTED IN COLUMN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY LOYOLA UNIVERSITY MEDICAL CENTER IN CALENDAR 2011 TO NAVIGANT FOR MR. HONAN'S SERVICES AS INTERIM CFO. LOYOLA UNIVERSITY MEDICAL CENTER DOES NOT KNOW HOW MUCH MR. HONAN RECEIVED AS WAGES FROM NAVIGANT IN CALENDAR 2011. DAWN MACK FAMILY MEMBER OF DANIEL POST, KEY EMPLOYEE 92999 EMPLOYMENT ARRANGEMENT 0 THERESA HINDLE FAMILY MEMBER OF PAULA HINDLE, FORMER KEY EMPLOYEE 55356 EMPLOYMENT ARRANGEMENT 0 DENISE OLIVIERI-SULO FAMILY MEMBER OF ROBERT SULO, MD, BOARD DIRECTOR 115454 EMPLOYMENT ARRANGEMENT 0 BRIAN CASSIN FAMILY MEMBER OF DONNA HALINSKI, BOARD ASSISTANT SECRETARY 132491 EMPLOYMENT ARRANGEMENT 0 ANNA BERRY-KRUMREY FAMILY MEMBER OF ARTHUR KRUMREY, FORMER KEY EMPLOYEE 34284 EMPLOYMENT ARRANGEMENT 0 MEDLINE INDUSTRIES PAULA HINDLE, FORMER KEY EMPLOYEE IS ON AN ADVISORY COUNCIL FOR MEDLINE 218446 LOYOLA UNIVERSITY MEDICAL CENTER PURCHASED MEDICAL SURGICAL SUPPLIES FROM MEDLINE INDUSTRIES 0 X 1 200 FMV X 2000 FMV X 6835 FMV X 2 249778 MARKET VALUE X 2 200 FMV X 1 1200 FMV X GIFT CARDS 24 948 COST X TRAVEL/ENTERTAINMENT 118 33827 FMV X GIFT BASKETS 22 1900 FMV X MISCELLANEOUS 58 15039 FMV 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE AMOUNTS IN PART I, COLUMN (B) FOR "NUMBER OF CONTRIBUTIONS OR ITEMS CONTRIBUTED" REPRESENTS THE TOTAL NUMBER OF ITEMS CONTRIBUTED, EXCEPT FOR SECURITIES, WHICH REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 3 LOYOLA UNIVERSITY MEDICAL CENTER HAS CONTRACTED WITH NAVIGANT FOR THE PROVISION OF INTERIM CFO SERVICES. SEE SCHEDULE J, PART III FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE JULY 1, 2011, LOYOLA UNIVERSITY MEDICAL CENTER AND ITS SOLE MEMBER, LOYOLA UNIVERSITY HEALTH SYSTEM, BECAME PART OF THE TRINITY HEALTH SYSTEM. LOYOLA UNIVERSITY MEDICAL CENTER'S ARTICLES AND BYLAWS WERE AMENDED TO REFLECT THIS OWNERSHIP CHANGE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF LOYOLA UNIVERSITY MEDICAL CENTER IS LOYOLA UNIVERSITY HEALTH SYSTEM. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A LOYOLA UNIVERSITY HEALTH SYSTEM IS THE SOLE MEMBER OF LOYOLA UNIVERSITY MEDICAL CENTER. LOYOLA UNIVERSITY HEALTH SYSTEM HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF LOYOLA UNIVERSITY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, LOYOLA UNIVERSITY HEALTH SYSTEM MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. LOYOLA UNIVERSITY HEALTH SYSTEM MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE TRINITY HOME OFFICE TAX DEPARTMENT, BASED ON INFORMATION PROVIDED BY A MULTI-DISCIPLINARY TEAM OF LOYOLA STAFF. A DETAILED SUMMARY OF THE DRAFT FORM 990 IS PRESENTED TO THE ORGANIZATION'S BOARD FINANCE & PLANNING COMMITTEE AND THE ORGANIZATION'S OFFICERS ARE PROVIDED A COPY OF THE ORGANIZATION'S DRAFT FORM 990 (INCLUDING ALL KEY REQUIRED SCHEDULES). THE COMPLETE FORM 990 IS PROVIDED TO THE LOYOLA UNIVERSITY MEDICAL CENTER BOARD IN ELECTRONIC FORM, PRIOR TO FINALIZING AND FILING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C LOYOLA UNIVERSITY MEDICAL CENTER HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF LOYOLA UNIVERSITY MEDICAL CENTER, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH LOYOLA UNIVERSITY MEDICAL CENTER'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO LOYOLA UNIVERSITY MEDICAL CENTER OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF LOYOLA UNIVERSITY MEDICAL CENTER IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO LOYOLA UNIVERSITY MEDICAL CENTER. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF DIRECTORS OF LOYOLA UNIVERSITY MEDICAL CENTER ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF LOYOLA UNIVERSITY MEDICAL CENTER ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 EFFECTIVE JULY 1, 2011, LOYOLA UNIVERSITY MEDICAL CENTER IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, LOYOLA UNIVERSITY MEDICAL CENTER WILL BE INCLUDING A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: KEDRICK ADKINS - 53 HOURS KAREN ALEXANDER - 2 HOURS THOMAS ANDERSON - 2 HOURS BENJAMIN CARTER - 48 HOURS PATRICIA CASSIDY - 30 HOURS MELISSA COVERDALE - 3 HOURS ROBERT FLANIGAN, MD - 5 HOURS RICHARD GAMELLI, MD - 5 HOURS LARRY GOLDBERG - 15 HOURS DANIEL HALE - 48 HOURS DONNA HALINSKI - 5 HOURS TOM HONAN - 12 HOURS SILIA MIGLIO - 40 HOURS MICHAEL MURPHY - 53 HOURS J. RICHARD O'CONNELL - 53 HOURS P. TERRENCE O'ROURKE - 48 HOURS DANIEL POST - 2 HOURS JILL RAPPIS - 7 HOURS CHARLES REITER, III - 5 HOURS AJAY SIAL - 5 HOURS ROBERT SULO, MD - 5 HOURS JOSEPH SWEDISH - 53 HOURS DAVID WILBER - 5 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -13,026,702. EQUITY TRANSFER FROM AFFILIATE: 217,237,078. CHANGE IN DEFERRED RETIREMENT COST: -54,998,928. EQUITY GAIN/LOSS IN UNCONSOLIDATED AFFILIATES: 1,799,309. LOSS FROM EXTINGUISHMENT OF DEBT: -3,239,578. PURCHASE ACCOUNTING ADJUSTMENTS DUE TO ACQUISITION BY TRINITY HEALTH CORP. -216,364,172. OTHER TRANSACTIONS: 25,244,201. TOTAL TO FORM 990, PART XI, LINE 5: -43,348,792. FORM 990, PART XII, LINE 2: LOYOLA UNIVERSITY MEDICAL CENTER'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY12 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. 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