2012-08-15T08:40:15-05:00 2011-09-30 Deloitte Tax LLP 111 S Wacker Dr Chicago IL 60606 990 2010-10-01 362179813 SWEDISH COVENANT HOSPITAL SWED 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 GARY M KRUGEL 7738788200 2012-08-15 1 3124861000 2010 2016-02-24 21:20:13Z GARY M KRUGEL 5145 N CALIFORNIA AVE CHICAGO IL 60625 245531279 0 X www.schosp.org X 1907 IL Providing excellent healthcare services for our culturally diverse communities for over 120 years. 23 16 2348 231 2342598 0 1294073 335333 227463408 233153424 5357224 1105301 10062486 10929211 244177191 245523269 54400 0 0 0 114830691 117999513 0 0 540798 121122563 126367993 236007654 244367506 8169537 1155763 376279526 404463278 238956766 282381313 137322760 122081965 X Our Mission is to provide a continuum of excellent healthcare services. Rooted in The Evangelical Covenant Church, the hospital is dedicated to serving the physical, spiritual and psychological needs of our culturally diverse communities. 0 0 216507308 241716674 Since 1886, Swedish Covenant Hospital (SCH) has been dedicated to providing community benefit healthcare services and healthcare education. As part of its mission as a not-for-profit, church-based community hospital, Swedish Covenant has served as an educational center, health rehabilitation center, illness prevention center, social support services center, and community center. Swedish Covenant Hospital serves as a solid community structure through employment of over 1,930 individuals.Recognizing its mission to the community, Swedish Covenant Hospital offers the following quality medical healthcare services regardless of race, creed, sex, national origin, handicap, age or ability to pay:General Medicine, Surgery, ICUSwedish Covenant Hospital continually offers the latest technology to meet the vast needs of the community. During the fiscal year, SCH serviced 14,064 inpatients and more than 249,247 outpatients for a total cost of $204,826,982.Physical Medicine/Rehab ServicesSCH is dedicated to providing a comprehensive Rehab Unit that combines the disciplines of physical therapy, speech therapy, occupational therapy and social work to help patients regain their strength and skills. The Rehab unit features a special room that simulates a home environment so patients can practice with home-like carpeting, furniture and fixtures while supervised by nurses. During the fiscal year, 220,338 inpatient and outpatient treatments for rehab, speech and occupational therapy were provided for a total cost of $4,040,869.Cardiac Care and RehabThe Cardiac Rehabilitation program offered by Swedish Covenant Hospital has improved the lives of many individuals with such innovative programs as Coronary Heart Disease Reversal. SCH also offers a state-of-the-art Cardiac Catheterization Lab, and other diagnostic and preventive programs. During the fiscal year, SCH provided 23,028 treatments and 1,586 procedures by the Cardiac Rehab program and Cardiac Catheterization Lab, respectively, for a total cost of $6,098,144.Family Practice CenterThe SCH Family Practice Center is a key component of its community benefit programs, especially for those who are uninsured or underinsured. The Center offers physician office visits and lab work, low-cost obstetric/prenatal care, health screenings and back-to-school physicals. During the fiscal year ended September 30, 2011, the Family Practice Center performed 15,227 procedures for a total cost of $562,743.In addition to the program services listed above, Swedish Covenant Hospital also offers the following services to the community:Health Screening, Health Promotions, Education, PreventionSCH offers year-round health screenings to members of the community. During the fiscal year, SCH offered 10 blood pressure screening events serving 280 participants. Each year free or reduced-cost cancer screenings are offered to the community. These include prostate, skin, oral,and breast screenings. An eight-week smoking cessation class was offered. The program has had a quit rate after one year of over 50%.During the fiscal year Swedish Covenant Hospital served a total of 19,430 persons through participation in health promotions, education, and prevention for a total cost of $299,779.Community Wellness and Prevention programs continue to serve the community with 251 events held at the Hospital or in the community through collaboration with community partners. These events include health fairs, screenings, daytime and evening lectures, seminars, classes, Speakers' Bureau presentations, children's events and other health related activities. Throughout the year the Hospital collaborated with dozens of community organizations to provide wellness and prevention programs.Swedish Covenant Hospital publishes periodic information letters which are distributed to 105,200 households throughout the surrounding community for a cost of $145,826.During the fiscal year, Swedish Covenant Hospital also offered transportation services to 3,682 members of the community at a cost of $148,917.Interpreter ServicesSwedish Covenant Hospital provides in-house interpreters for patients who speak Korean, Spanish, and Russian, the primary non-English languages in the community. In FY 2011, the interpreters participated in a total of 2,792 sessions. Additionally, SCH uses professional telephone interpretive assistance and had 5,595 calls. For deaf or hearing impaired patients who request sign language interpreters, the Hospital provides interpreters through CAIRS. SCH incurred a total cost of $384,048 for interpreter services serving a total of 37,807 persons.Medical Education ProgramSwedish Covenant Hospital is an independent teaching hospital, with residency programs in family medicine, osteopathic internal medicine, and osteopathic transitional year. As part of our affiliation with Midwestern University, Swedish Covenant Hospital is a training site for residents in Midwestern OB/GYNE, emergency medicine, and critical care residency programs. Our teaching affiliation is with Midwestern University's Chicago College of Osteopathic Medicine. 216507308 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 372 0 1 2348 1 1 1 0 0 0 0 1 1 0 0 0 0 X 23 16 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X GARY M KRUGEL 7738788200 5145 N CALIFORNIA AVE CHICAGO IL 60625 X CHARLES L ADAIR 1.00 X 0 0 0 KURT D ANDERSON 1.00 X 0 0 0 LYLE BANKS 1.00 X 750 0 0 JAMES F BOFFA MD 1.00 X 30000 0 0 RENEE BORKOWSKI 1.00 X 0 0 0 JUDITH E DABERTIN 1.00 X 0 0 0 H CLARK FEDERER MD 1.00 X 0 0 0 W J WESLEY KEE 1.00 X 0 0 0 DAVID J KOO 1.00 X 0 0 0 PATRICIA MERRYWEATHER 1.00 X 0 0 0 DONALD L MEYER 1.00 X 0 143411 23873 REV MARY C MILLER 1.00 X 0 0 0 JAMES B PETERSON 1.00 X 0 0 0 THOMAS M PYRA 1.00 X 0 0 0 SYDNEY P SCARBOROUGH 1.00 X 0 0 0 TONY R VANCAUWELAERT MD 1.00 X 49487 0 0 LAWRENCE P ANDERSON 1.00 X 0 470396 59466 DAVID A DWIGHT 1.00 X 0 571606 115344 MARTIN SZANTO MD 1.00 X 0 0 0 REV GARY B WALTER 1.00 X 0 148660 113514 PAUL A HAWKINSON 1.00 X X 0 0 0 JUDITH A PINS 1.00 X X 0 0 0 DAVID R PUTMAN 1.00 X X 0 0 0 MARK NEWTON 40.00 X X 0 693644 83708 JUDITH A BORENSTEIN 40.00 X 348673 0 32638 ANTHONY GUACCIO 40.00 X 367191 0 52803 DEREK J KELLY MD 40.00 X 349316 0 17542 GARY M KRUGEL 40.00 X 400178 0 53976 MARY SHEHAN RN 40.00 X 291855 0 24279 WALTEN BABA MD 40.00 X 324174 0 13425 JONATHAN YOUNAN 40.00 X 168714 112584 20587 KAREN M SHEEHAN 40.00 X 274474 0 32867 MICHAEL FEINZIMER 40.00 X 231214 0 1716 NICHOLAS PARISE 40.00 X 205009 0 19678 3041035 2140301 665416 119 0 1 0 BSA LIFE STRUCTURES 9365 COUNSELORS ROW INDIANAPOLIS IN 46240 ARCHITECTURE & ENGINEERING 2482061 MIDWESTERN UNIVERSITY 555 31ST STREET DOWNERS GROVE IL 60515 HEALTH CARE 1284617 NEPHRON DIALYSIS CENTER 5140 N CALIFORNIA AVE CHICAGO IL 60625 HEALTH CARE 773830 QUEST DIAGNOSTICS PO BOX 12989 CHICAGO IL 60693 HEALTH CARE 670060 PEDIATRIC FACULTY FOUNDATION 2300 CHILDRENS PLAZA CHICAGO IL 60614 HEALTH CARE 600291 45 82451 19500 80000 153382 335333 HEALTH CARE SERVICES 900099 231290898 231290898 LABORATORY SERVICES 621500 1862526 1862526 233153424 751997 751997 3514025 3514025 3514025 3514025 353304 353304 353304 353304 31373 82451 8010 23363 23363 PARKING GARAGE FEES 812930 1125640 1125640 CHILD CARE CENTER 624410 897814 417742 480072 CAFETERIA 900099 846332 846332 4522037 4522037 7391823 245523269 241716674 2342598 1128664 2126427 736159 1390268 102148 102148 95922248 89176528 6475741 269979 4113587 3768334 333941 11312 8667904 7965488 668453 33963 7067199 6436982 609564 20653 2572818 2572818 338020 338020 162223 162223 217500 217500 18320423 15814060 2349776 156587 851062 247024 595640 8398 545496 451139 86954 7403 4232313 3754186 478127 262941 198838 61588 2515 8792705 8792705 16720364 16261502 436089 22773 9665926 8881246 784680 OTHER OPERATING SUPPLIE 34677797 34597562 78452 1783 BAD DEBT EXPENSE 10341145 10341145 IDPA TAX 9796474 9796474 EQUIPMENT REPAIR & MAIN 6967997 6925153 41550 1294 PROPERTY & SALES TAX 785473 172748 612725 1117316 982740 130438 4138 244367506 216507308 27319400 540798 3469630 0 1093799 1083799 10404409 11454267 2932943 3074570 9322421 6463580 400302166 220258906 164373410 180043260 138280484 138787295 46402430 63556507 376279526 404463278 39779175 37129112 159421206 196111710 2500000 39756385 46640491 238956766 282381313 X 135702017 120575596 1620743 1506369 137322760 122081965 376279526 404463278 X 1155763 -16396558 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 128762 0 1 217500 346262 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: In the course of regular business activities, the hospital or its lobbyist perform some lobbying activities on matters of interest to itself and its patients. 18814654 1270179 20979 479599 19626213 18354856 1341311 -13043 868470 18814654 18234850 795551 675545 18354856 0.10700 0.89300 0 1 1 7960138 7960138 143419285 70399314 73019971 1680580 1680580 0 203644200 134453648 69190552 43597963 13725364 29872599 180043260 BANK OF AMERICA - FMV 35599662 F CMB BOND & EQUITY FUND - FMV 103144158 F MERRILL LYNCH - FMV 43475 F 138787295 OTHER INVESTMENTS 2055662 CAPTIVE RECOVERIES A/R 7004672 DUE FROM AFFILIATES 36305951 ASSETS WHOSE USE IS LIMITED 17888296 ALL OTHER CURRENT ASSETS 301926 63556507 ACCRUED LONG TERM MALPRACTICE LIABILITY 11041259 FAIR VALUE OF INTEREST RATE SWAPS 24403402 ASSET RETIREMENT OBLIGATION 1339895 DUE TO THIRD PARTY PAYERS 9855935 46640491 Description of Intended Use of Endowment Funds: Part V, Line 4: The earnings are to be used for education, charity care, the Healing Garden and other hospital programs. Swedish Covenant Hospital is the related beneficiary of the endowment funds held by Swedish Covenant Hospital Foundation. GALA 10 96398 71502 24896 GALA 11 7411 7411 1 10015 3538 6477 8010 113824 82451 31373 8010 8010 23363 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 6080200 6080200 0.02600 59934116 53457867 6476249 0.02770 66014316 53457867 12556449 0.05370 915907 915907 0.00390 3601425 2580858 1020567 0.00440 1161629 196994 964635 0.00410 5678961 2777852 2901109 0.01240 71693277 56235719 15457558 0.06610 18154 18154 0.00010 18154 18154 0.00010 1 2069012 85562264 87484287 -1922023 X 1 1 1 CARDIOVASCULAR PERFORMANCE GROUP LLC MANAGEMENT OF CARDIOVASCULAR SERVICES 0.74600 0.25400 3 1 SWEDISH COVENANT HOSPITAL

5145 N CALIFORNIA AVENUE CHICAGO IL 60625

X X X X 2 SCH GALTER MEDICAL PAVILION

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PHYSICAL REHABILITATION SERVICES SWEDISH COVENANT HOME HEALTH CARE

2965 W PETERSON AVENUE CHICAGO IL 60659

HOME HEALTH CARE SERVICES Part I, Line 7: Each net community benefit expense is divided by total hospital expenses to determine the percent of community benefits provided for fiscal year 2011.Costing Methodology - For all community benefits, we utilize the cost to charge ratio to calculate the benefit. The net operating costs are calculated by taking the total operating costs less the following: the PA tax and the non-patient care activity costs. The net gross charges are calculated as follows: gross charges less charges for community benefits. Net operating costs divided by net gross charges provides the cost to charge ratio.Part I - Line 7d - column dFor Schedule H, line 7b, column (c) the $59,934,116 in the Community Benefit Expense includes the provider assessment tax of $9,796,474 million. Had the provider tax been excluded, the total Community Benefit expense would have been $50,137,642. On Schedule H, line 7b, column (d), the direct offsetting revenue of $53,457,867 includes the provider tax revenue of $20,055,920 million. Had the public aid provider revenue been excluded from Schedule H, the direct offsetting revenue would have been $33,401,947. Using an adjusted total community benefit expense of $50,137,642 noted above, minus an adjusted direct offsetting revenue amount of $33,401,947, also noted above, the resulting community benefit dollar amount on Schedule H, line 7b, column (e) would have been $16,735,695. On Schedule H, line 7b, column (f) percentage of total expense would have increased from 2.78% to 7.17%.The PA tax benefit is not reimbursement for direct patient care and therefore we believe it should be excluded from the Schedule H calculations. Part I, Line 7g: Costs attributable to a physician clinic of $257,555 were included in subsidized health services. Part I, L7 Col(f): The amount of bad debt which was included on Form 990 Part IX Line 24 was $10,341,145. This was subtracted out for Schedule H calculations. Part II: Members of Swedish Covenant Hospital staff work with other organizations and participate in many activities to advocate for health improvement in our community. These include:Involvement with the Association for Community Safety Net Hospitals.Community meetings, education and seeking of resources with regard to the planning and development of an Urgent Care facility to expand health services to the community.Working with Easter Seals and the City of Chicago Workforce Investment Board to target programs for summer youth job training and job training and placement for veterans in our community.Meetings and planning with the City of Chicago Agency on Aging and with Catholic Charities on how to partner on a community coordinated care program. Patient discharge follow-up care improved as a result. Part III, Line 4: The audited financial statements do not contain a specific footnote related to the bad debt expense. The costing methodology is applying the cost-to-charge ratio of 20% to total bad debt expense.There are no bad debt amounts included in community benefits. Part III, Line 8: The hospital has used the standard single apportionment step down cost allocation methodology for the allocation of allowable costs (as defined by the Medicare principles of reimbursement) to the revenue cost centers. Allowable allocated costs are divided by the revenues in each ancillary department and by the days in each nursing unit to determine the appropriate ratios and cost per diems to be applied to the related Medicare ancillary charges and nursing unit days to determine the cost of Medicare services.None of the shortfall has been treated as a community benefit. The allowable costs of care for Medicare are higher than the reimbursement received from Medicare, which places a financial burden on Swedish Covenant Hospital of having to fund this loss from other areas of its operations. For the year, the hospital had losses from all operations and had to fund all losses from retained earnings. Therefore, we believe that the shortfall from Medicare represents a community benefit to our primary service area as we would never turn patients away.Every uninsured self-pay patient who utilizes any of Swedish Covenant Hospital services receives a 75% discount off the charges listed on their bill. Applying the cost to charge ratio methodology, the costs of giving this discount amounted to $4,110,778. These amounts are not included in the community benefit amounts listed on the tax return; however, we believe that this cost should be included as they are for the benefit of all uninsured patients from our primary service area. Part III, Line 9b: Charity Care Patients:If a patient has been determined to meet Hospital Charity Care Guidelines no collection agencies, lien attachments or attempts to possess real or personal property will be made.During the fiscal year 2012, the organization policy of using the Federal Poverty Guidelines to determine eligibility for providing free care to low income individuals was amended from 150% to 200% of the family income limit.During the fiscal year ending September 30, 2012, the organization implemented a policy of Presumptive Charity Care for health care services to uninsured patients that are not expected to result in payment and no financial assistance application is completed. Patients will qualify for Presumptive Charity assistance based on their individual life circumstances, homeowner status, living address and other measurable socio-economic factors.Financial Assistance:Patients with a self-pay balance and without the resources to pay their obligations will be assessed for financial assistance by the Credit Services Department. The assessment involves an evaluation for eligibility for all appropriate levels of assistance, including governmental or partial reductions or complete charity care. Part VI, Line 2: Needs AssessmentThe Community Benefit Plan must identify the populations and communitiesserved by the Hospital, health care needs that were considered in developingthe plan and the goals and objectives for providing community benefits includingcharity and government-sponsored indigent health care.As a ministry of The Evangelical Covenant Church, Swedish Covenant Hospital is dedicated to providing a continuum of care and to serving the physical, spiritual, and psychological needs of its culturally diverse community. The hospital has developed the Healthier Community Initiative, a strategic plan that addressed the priority health care needs of the hospital's service area. These priority needs were identified by analyzing and prioritizing the data collected during the community needs assessment.Based on this data, The Healthier Community Initiative was developed and consisted of four separate initiatives:Aging/Mature Market Initiative provided direction in meeting the needs of the aging/mature market by making the facility "user friendly," enhancing community programs for the senior community, providing affordable transportation to the hospital and increasing awareness within this group of community assets.Wellness/Prevention Initiative expanded the community outreach programs addressing the identified priority needs. Maternal/Child Initiative strengthened the community by developing and implementing a program to address high infant mortality rate and low birth weight babies; opening two school-based health care centers and enhancing the teen volunteer program at the hospital.Community Resources Awareness Initiative created a plan to heighten community awareness of the services and assets of both the hospital and the community at large. Significant progress has been made in achieving the priority goals set forth by these four initiatives. Part VI, Line 3: Patient Education of eligibility for AssistanceCharity or discounted care is available for medically necessary services as defined by Medicare, to patients who meet the financial and documentation criteria defined below. Each situation is reviewed on an individual case-by-case basis. While not absolutely essential, the need for potential charity or discounted care should be established in advance of admission or rendering of service, or shortly thereafter.The charity care policy is provided during admission procedures to all patients admitted through the Admitting Department and the Emergency Room. Signage informing patients about charity care and the availability of financial counseling is posted in the Emergency Room and the Admitting Department.In order to be eligible for charity or discounted care, the patient must be willing to provide verification of income, assets, etc. by filling out the Patient Financial Statement.During the registration and information gathering process, the financial counselors will first determine if the patient qualifies for medical assistance from other existing financial resources such as Medicare, Medicaid, Kid Care, Family Care or other state or federal programs. If the patient refuses to apply for existing financial resources or to provide information necessary to the application process, charity or discounted care cannot be granted. If the application for existing financial resources is denied, or has been previously denied, consideration for charity or discounted care will then be given.Once the information on the Patient Financial Statement is received, the financial counselors will determine the eligibility of the patient for charity or discounted care. In evaluating the data, considerations will be given to assets (saving accounts, ownership of home), income and current indebtedness. Documentation of income may be required in the form of paycheck stubs, income tax returns, social security, and unemployment benefits. Information used to apply for state or local assistance will also be used in the determination process.The insured patient with a large balance due to deductibles and/or co-payments may be eligible for charity or discounted care. In order to qualify, the patient must complete the Patient Financial Statement and return it to the financial counselors for evaluation and recommendation.If a patient has been determined to meet the Hospital Charity Care Guidelines, no collection agencies, lien attachments or attempts to possess real or personal property will be made.No legal action by the collection agency will be taken against uninsured patients for the first one hundred twenty (120) days after discharge.Illinois residents who have a family income that is no more than 600% of the Federal Poverty Guidelines (as determined each year), and who do not have any health insurance as documented through SCH's insurance verification procedures, will receive a discount in accordance with the Hospital Uninsured Patient Discount Act (210 ILCS 89/) (the Act). Part VI, Line 4: Community InformationThe geographic area assessed includes the following 12 Chicago communitiesserved by the hospital: Albany Park, Edgewater, Forest Glen, Irving Park, Jefferson Park, Lincoln Square, North Center, North Park, Portage Park, Rogers Park, Uptown, and West Ridge.Also included in the area served is Lincolnwood, a small village of approximately 12,000 residents. This community is in close proximity to the hospital, just north of the north boundary of Chicago.The hospital serves a very diverse multicultural community. Over the past eight years there have been changes in the ethnic mix in the community with the most significant being in the Hispanic community.Since September 11, 2001, immigration into the United States and the community served by the hospital has decreased significantly. Although the number of new, documented immigrants coming into the hospital's community was almost negligible during the first year after September 11th, the numbers of new documented immigrants has increased slightly. The World Relief office in Albany Park reports that in 2003 they assisted less than 34% of the number of immigrants they helped relocate prior to the tragedy in 2001.The Spanish, Korean and Russian languages represent the majority of interpretative assistance requested at the hospital. To meet this need on an inpatient and outpatient basis, the hospital employs a full time Spanish and Korean interpreter and two full time Russian interpreters. In addition, the hospital uses an "over the phone" interpretative service to meet interpretative needs in other languages and also for Korean, Russian and Spanish interpretation when the interpreters are not present.Several initiatives are in place to meet the needs of the Spanish, Korean and Russian speaking residents in our community. To better serve the Korean community, the hospital partners each year with Korean American Community Services, the Korean Medical Society and the Korean Nurses Association to host an annual Korean Health Fair at the hospital. This is an annual event, targeting the uninsured working population. Attendance is over 400 Koreans who reside in the greater Chicago area. The hospital also collaborates with several local Korean organizations and participates in their annual health fairs.The Spanish speaking community represents the largest segment of non-English speaking community residents. The hospital employs a full time Hispanic Liaison who is a Registered Nurse and coordinates many classes and events both at the hospital and in the community to better serve these individuals.While better off than Chicago as a whole, the Swedish Covenant Hospital area lags substantially behind the total US averages for the following: High School Graduates, Unemployment, Are below the poverty level, and the number of seniors living alone. Part VI, Line 6: In keeping with the Hospital's mission to provide a continuum of excellent healthcare services, any surplus funds are invested in capital improvements related to patient care or in community benefit programs.The hospital extends medical staff privileges to all qualified physicians in the communities it serves, in accordance with our medical staff development process. The hospital has an active Board of Directors who meet every two months. In addition to reviewing the hospital's financial results, they discuss the hospital's plans and programs in support of our efforts to enhance the health care environment for the entire community we service. Twenty percent of the Board of Directors live in the community and are not employees of the organization. The hospital operates the "HouseCalls" program to provide medical care to the homebound.The Hospital helps community members gain access to health care services by assisting low income families in applying for the Illinois Department of Public Aid's KidCare and FamilyCare programs. Reports Filed With States Part VI, Line 7 IL X 1 1 X X X X 0 1 0 0 0 0 0 0 0 DONALD L MEYER 0 125341 0 0 0 18070 0 3637 0 20236 0 167284 0 0 LAWRENCE P ANDERSON 0 346296 0 66800 0 57300 0 43653 0 24843 0 538892 0 0 DAVID A DWIGHT 0 510979 0 0 0 60627 0 85776 0 29568 0 686950 0 0 REV GARY B WALTER 0 148660 0 0 0 0 0 27082 0 86432 0 262174 0 0 MARK NEWTON 0 461177 0 160991 0 71476 0 70741 0 12967 0 777352 0 17169 JUDITH A BORENSTEIN 233478 0 34461 0 80734 0 24586 0 8052 0 381311 0 0 0 ANTHONY GUACCIO 292644 0 49358 0 25189 0 31725 0 21078 0 419994 0 0 0 DEREK J KELLY MD 299624 0 40715 0 8977 0 0 0 17542 0 366858 0 0 0 GARY M KRUGEL 264799 0 52219 0 83160 0 31068 0 22908 0 454154 0 0 0 MARY SHEHAN RN 217431 0 39078 0 35346 0 23473 0 806 0 316134 0 0 0 WALTEN BABA MD 260829 0 0 0 63345 0 0 0 13425 0 337599 0 0 0 JONATHAN YOUNAN 93684 77046 61491 0 13539 35538 0 0 12643 7944 181357 120528 0 0 KAREN M SHEEHAN 186385 0 26917 0 61172 0 19183 0 13684 0 307341 0 0 0 MICHAEL FEINZIMER 218810 0 0 0 12404 0 0 0 1716 0 232930 0 0 0 NICHOLAS PARISE 194240 0 0 0 10769 0 0 0 19678 0 224687 0 0 0 Part I, Line 1a As part of their compensation package, vice presidents of the organization are offered a $900 reimbursement for membership dues to the health club of their choice. This benefit is treated as taxable compensation. Part I, Line 4b Executive Benefit Plan Covenant Ministries of Benevolence (CMB) provides certain supplemental retirement benefits to its officers and key employees. These benefits are provided through a nonqualified deferred compensation plan, under which a portion of the benefits being earned are subject to a substantial risk of forfeiture. The supplemental retirement benefits are structured to provide a retention incentive that has been determined by the Compensation Committee of CMB's Board to be of substantial value to the organization. The Committee approves all retirement benefits, together with all other forms of compensation and benefits for these and other executives, in a manner intended to qualify for the rebuttable presumption of reasonableness under the intermediate sanctions rules of federal income tax law. The following individuals participated in the Executive Benefit Plan: David Dwight: - $47,992 Lawrence Anderson - $48,077 Mark Newton - $43,796 Judith Borenstein - $24,586 Anthony Guaccio - $31,725 Gary Krugel - $31,068 Mary Shehan - $23,473 Karen Sheehan - $19,183 Pension Restoration Plan As certain individuals' pension benefits may be limited by tax code maximums on both eligible compensation and benefits, Covenant Ministries of Benevolence (CMB) provides a Pension Restoration Plan which entitles the individuals listed below to a pension benefit based on total cash compensation. David Dwight - $8,596 Lawrence Anderson - $2,920 Mark Newton - $9,950 Supplemental Information Part III The Hospital and Covenant Ministries of Benevolence (listed on Schedule R) follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. This function is performed by the governance committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Illinois Finance Authority 861091967 45200FEW5 2008-04-08 60000000 2008A IFA Revenue Bonds - Cap Adds & Ref of 01/16/98 & 07/22/99 issues. 0 0 0 Illinois Finance Authority 861091967 45200FR35 2010-02-02 99390260 2010A IFA Revenue Bonds - Ref of 11/17/03 & 06/17/08 issues. 0 0 0 Illinois Finance Authority 861091967 2010-11-03 20000000 2010C IFA Revenue Bonds - Cap Adds 0 0 0 Illinois Finance Authority 861091967 2011-06-28 20000000 2011A IFA Revenue Bonds - Cap Adds & Construction 0 0 0 1560000 60046518 135850 837840 7508444 52500000 2009 1 0 1 1 1340000 99967235 9871979 1982568 88150000 1 0 1 1 20001226 318305 13581364 6419862 0 0 0 1 20012399 39167 20012399 0 0 0 1 0 0 1 0 1 0.00000 0.00000 1 0 0 1 0 1 0.01500 0.01500 1 0 0 0 0 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 1 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 Schedule K Supplental Information Form 990 - Schedule K - Part I - Line B - Column f The original 8038 filing for the 2010A bonds listed the issue date of the 2008B refunded bond incorrectly as April 8, 2008. The correct issue date of the 2008B refunded bond is June 17, 2008. Form 990 - Schedule K - Part II - Line 3 Difference between Issue Price and Total Proceeds of issue: The total amount of proceeds of the bond issues entered on Part II Line 3 include the investment earnings. Form 990 - Schedule K - Part II - Line 4 Gross Proceeds in Reserve Funds The amounts shown here consist of debt service reserve fund and sinking fund deposits. Brooke Newton Family member of Mark Newton (CEO of Swedish Covenant Hospital) 58947 Wages paid as an employee of Swedish Covenant Hospital 0 Kathryn Shehan Family member of Mary Shehan (VP of Swedish Covenant Hospital) 24150 Wages paid as an employee of Swedish Covenant Hospital 0 Samantha Shehan Family member of Mary Shehan (VP of Swedish Covenant Hospital) 10247 Wages paid as an employee of Swedish Covenant Hospital 0 James F Boffa MD Member of the Board of Directors 101369 Office Rent - The hospital leases office space in its medical office building to its physician board members at the same rate as is charged to all other occupants of the building. The hospital also leases billing software and telephone services at the same rate as is charged to other physicians. 0 Form 990, Part VI, Section A, line 2 Kurt D. Anderson, Director, and Lawrence P. Anderson, Director, have a family relationship. Form 990, Part VI, Section A, line 4 Effective 01/29/11, the bylaws of Swedish Covenant Hospital were amended to add a Physicians Relations Committee. Form 990, Part VI, Section A, line 6 The sole member is Covenant Ministries of Benevolence (CMB). Form 990, Part VI, Section A, line 7a The member elects the Board of Directors. Form 990, Part VI, Section A, line 7b S 3.1 of the Bylaws grant reserved powers to the member, such as approval of amendments to the Bylaws of the corporation, approval of certain acquisitions, dispositions and financing, and the power to elect or remove the members of the Board of Directors of the Corporation. Form 990, Part VI, Section B, line 11 Management Review: The draft Form 990 was reviewed by multiple levels of management and by the CFO of Swedish Covenant Hospital. Board Review: The Finance Committee of the Board of Directors reviewed the final Form 990 prior to filing. The final Form 990 was provided to each member of the Board of Directors prior to filing. The key provisions of the form will be discussed at a subsequent board meeting. Form 990, Part VI, Section B, line 12c Swedish Covenant Hospital has an Administrative Policy on conflict of interest, identifying the parameters of a conflict of interest and the requirement to disclose any such conflict of interest. Each September, the policy is distributed to the board members, key employees, directors and officers. They are asked to sign acknowledging receipt of policy and to disclose if they have any conflicts of interest. If someone is absent from the meeting or fails to return the acknowledgement, there is a follow-up with the individual until the signed acknowledgement is provided. Form 990, Part VI, Section B, line 15 The Hospital and Covenant Ministries of Benevolence (listed on Schedule R) follow the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of the corporation. This function is performed by the governance committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the compensation committee and full board meetings where executive compensation is considered. Form 990, Part VI, Section C, line 18 A copy of the organization's Form 990 is available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon request by contacting the Swedish Covenant Hospital administration department at 773/878-8200. HOURS WORKED AT RELATED ORGANIZATIONS FORM 990 - PART VII - SECTION A Lawrence P. Anderson worked 40 hours per week at Covenant Ministries of Benevolence. David A. Dwight worked 40 hours per week at Covenant Ministries of Benevolence. Gary Walter worked 40 hours per week at Evangelical Covenant Church. Donald L. Meyer worked 40 hours per week at Evangelical Covenant Church. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -12,027,702. Equity transfer from Swedish Covenant Hospital Foundation 105,000. Net assets released from restriction - Capital 235,402. Equity transfer to SC Insurance Company -4,100,000. Equity transfer to Covenant Ministries of Benevolence -867,342. Net restricted funds transfers from Swedish Covenant Hospital Foundation 258,084. Total to Form 990, Part XI, Line 5: -16,396,558. Evangelical Covenant Church (ECC) 5101 N Francisco Avenue Chicago IL 60625 362167730 Church IL 501(c)(3) Line 1 N/A 0 Swedish Covenant Faculty Group (SCFG) 5145 N California Avenue Chicago IL 60625 363686216 Patient Treatment/Education IL 501(c)(3) Line 11a, I Swedish Covenant Hospital (SCH) 1 Swedish Covenant Hospital Foundation (SCHF) 5145 N California Avenue Chicago IL 60625 205055155 Supporting Organization of Swedish Covenant Hospital IL 501(c)(3) Line 7 Swedish Covenant Hospital (SCH) 1 SC Insurance Company 6970 E Chauncey Lane Suite 100 Phoenix AZ 85054 273312053 Insurance AZ 501(c)(3) Line 11a, I Swedish Covenant Hospital (SCH) 1 Cardiovascular Performance Group LLC 5145 N California Avenue Chicago IL 60625 203587272 Management Services IL N/A N/A 0 0 Covenant Village of PortlandLP 420 NE Mason St Portland OR 97211 364356838 Assisted Living Community OR N/A N/A 0 0 Coast Asset Management LLC 2450 Colorado Avenue Suite 100 E To Santa Monica CA 90404 954763400 Hedge Fund Investment CA N/A N/A 0 0 LifeConnect LLC 5700 Old Orchard Road Skokie IL 60077 272827919 Wellness Software Development IL N/A N/A 0 0 Management Services Organiztion LLC 5700 Old Orchard Road Skokie IL 60077 272827998 Management & Consulting Services IL N/A N/A 0 0 Swedish Covenant Surgery Center LLC 5215 N California Avenue Chicago IL 60625 272485300 Outpatient Medical Services IL N/A N/A 0 0 Covenant International Insurance Company Ltd Crawford House 50 Cedar Avenue Hamilton BD Insurance BD N/A Covenant Trust Company 5215 Old Orchard Road Suite 725 Skokie IL 60077 363583163 Financial Services IL N/A C Swedish Covenant Management Services Inc (SCMS) 5145 N California Avenue Chicago IL 60625 364073303 Physician Practice Management IL N/A C Swedish Covenant Managed Health Care Alliance (SCMCA) 2740 W Foster Suite 409 Chicago IL 60625 364118659 Physician - Hospital Organization IL N/A C 0 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 Swedish Covenant Hospital Foundation Q 82288 Cash Value Swedish Covenant Hospital Foundation K 317365 Intercompany Contract Swedish Covenant Hospital Foundation L 317365 Intercompany Contract Swedish Covenant Hospital Foundation C 459873 Cash Value Swedish Covenant Hospital Foundation R 445372 Cash Value Swedish Covenant Management Services Inc Q 6119748 Cash Value Cardiovascular Performance Group LLC J 651114 Intercompany Contract Cardiovascular Performance Group LLC L 114334 Intercompany Contract SC Insurance Company Q 4100000 Cash Value