2012-10-15T13:51:06-05:00 2011-12-31 861065772 Deloitte Tax LLP 111 South Wacker Drive Chicago IL 60606 990 2011-01-01 800710751 Alexian Brothers Specialty Group ALEX 8473857100 3040 West Salt Creek Lane Arlington Heights IL 600051069 Mark Frey 8473857100 2012-10-15 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z X Mark Frey 3040 West Salt Creek Lane Arlington Heights IL 600051069 1756828 0 0928 X www.alexianbrothershealth.org X 2011 IL ABSG carries out the healing mission of the Catholic Church (See Schedule O)as an Alexian Brothers ministry by identifying and developing effective responses to the health needs of those we are called to serve. 3 0 0 0 0 0 0 1756828 0 0 1756828 0 0 2119039 0 0 698242 2817281 -1060453 4033211 5093664 -1060453 Alexian Brothers Specialty Group ("ABSG") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health needs of those we are called to serve. 0 0 2585971 1756828 Alexian Brothers Health System employs 17 physicians and 4 other providers through the Alexian Brothers Specialty Group (ABSG). ABSG was formed in late 2011 and is comprised of a large cardiovascular physician group. ABSG physicians practice in the heart and vascular service line at multiple office locations and at both acute care hospitals. In 2011, these physicians had 4,218 office visits and 3,611 hospital visits. 2585971 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 IL X Daniel Isacksen 8473857160 3040 West Salt Creek Lane Arlington Heights IL 600051069 X Mark Frey 40.00 X X 0 867276 184992 Tracy Rogers 40.00 X X 0 497648 78096 Brother Thomas Keusenkothen 40.00 X X 0 0 0 James Sances 40.00 X X 0 642540 143948 Virginia Golembiewski 40.00 X 0 69801 16144 Daniel Isacksen 40.00 X 0 231986 25573 Jim Lewandowski 40.00 X 0 372210 66995 0 2681461 515748 0 0 1 0 Cardiovascular Management of Illinois 900 S Frontage Road Suite 325 Woodridge IL 60517 Management & billing services 158944 1 Net Patient Svcs Rev. 621111 1756828 1756828 1756828 1756828 1756828 0 0 1665284 1665284 280500 280500 72246 72246 101009 101009 2779 2779 850 850 287745 128028 159717 22954 439 22515 31397 30244 1153 2217 2217 99353 99006 347 5743 5743 1739 1566 173 24088 24088 106704 106227 477 Management Fees 43299 0 43299 0 Bad Debt 41001 41001 0 0 Medical Supplies 16931 16931 0 0 11442 11442 2817281 2585971 231310 0 258003 1440105 112760 809431 24088 0 785343 1437000 0 4033211 834938 0 4258726 0 5093664 X 0 0 0 0 0 -1060453 0 -1060453 0 4033211 -1060453 0 X 0 1 1 X 0 X 304888 7219 297669 504543 16869 487674 785343 Due to Affiliates 4258726 4258726 Description of Uncertain Tax Positions Under FIN 48: Part X: Alexian Brothers Specialty Group does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. There were no uncertain tax positions, and as a result there was no disclosure related to FIN 48 (ASC740) in the December 31, 2011 audit report. 0 1 0 0 0 0 0 0 0 Mark Frey 0 617468 0 172499 0 77309 0 145072 0 39920 0 1052268 0 0 Tracy Rogers 0 367650 0 105531 0 24467 0 34778 0 43318 0 575744 0 0 James Sances 0 477155 0 136544 0 28841 0 115746 0 28202 0 786488 0 0 Daniel Isacksen 0 196845 0 35141 0 0 0 3060 0 22513 0 257559 0 0 Jim Lewandowski 0 280338 0 56701 0 35171 0 35309 0 31686 0 439205 0 0 Part I, Line 3 ABSG follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation of the CEO and other officers and executives of the Corporation. This function is performed by the Compensation Committee of the Board of Governors of ABHS, which is composed of independent board members. 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. All of the items in Schedule J, Part I, Line 3 are used by the Committee to establish compensation for the CEO of the organization. Part I, Line 4b Alexian Brothers Health System offers a Supplemental Employee Retirement Plan to all employees who participate in the executive benefits program and whose compensation exceeds the IRS allowable limit for a qualified pension plan. The amount accrued in 2011 was included in income in Schedule J for the following individuals: Mark Frey - $77,808 James Sances - $52,060 Tracy Rogers - $5,914 Jim Lewandowski - $5,297 Form 990, Part VI, Section A, line 2 Mark Frey, Tracy Rogers, and James Sances have a business relationship due to joint employement at a common health sytem entity. Form 990, Part VI, Section A, line 6 Alexian Brothers Specialty Group has two classes of members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Hospital Network (the "Area Member"). Form 990, Part VI, Section A, line 7a Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Brothers Specialty Group. Form 990, Part VI, Section A, line 7b Alexian Brothers Health System has principal authority with respect to the following matters: Adoption or amendment of the Articles of Incorporation: Amendment of the Bylaws as provided by Statute; Appointment and removal of Directors and Executive Officers; Adoption, amendment and repeal of fundamental statements of mission, philosophy, spirit, vision, values and charity policy, and the sponsorship of apostolic activities. Form 990, Part VI, Section B, line 11 ABSG is an affiliate of Alexian Brothers Health System ("ABHS" or "the System"), which is a Catholic healthcare system. ABHS is the National Member and ultimate parent for each entity within the System. ABSG's Form 990 goes through an intensive review process at the System's Corporate level prior to being filed with the IRS. The entire Form 990 is reviewed by ABSG's financial officer and the CEO. The Form 990 is also reviewed at the System Corporate level by the Chief Accounting Officer for the System. The Vice President and General Counsel for the System reviews all sections of the Form 990 with the exception of the compensation section. The Vice President of Human Resources for ABHS reviews all compensation disclosures for each entity in ABHS. These reviews were conducted before the Form 990 was signed and filed with the IRS. In addition, there is also a Compensation Committee that reports to the ABHS Board of Governors. This Committee reviews the Compensation disclosures for all entities in the System. The ABSG board reports to the ABHS Board of Governors, which has ultimate oversight of the activities of all entities within the System. The Audit Committee of the ABHS Board of Governors has responsibility for and oversight of the Tax Compliance process. The Audit Committee provides oversight for the Form 990 process for the entire System and reviews detailed Forms 990 for the System as requested. It then reports back to the ABHS Board of Governors on the results of these activities. The Forms 990 not reviewed by the Audit Committee are available to the Audit Committee members upon request. The Audit Committee did not review the 2011 Form 990 for ABSG. Form 990, Part VI, Section B, line 12c ABSG collects annual attestations from board members, officers, directors and key employees. The attestations are reviewed by the ABSG compliance officer and any conflicts are shared with the ABSG Chief Executive Officer. The conflicts are also reviewed by the System's Vice President, Corporate Responsibility Officer. The Audit Committee of the ABHS Board of Governors monitors and receives reports on the completion of this process. Form 990, Part VI, Section B, line 15 ABSG follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation of the CEO and other officers and executives of the Corporation. This function is performed by the Compensation Committee of the Board of Governors of ABHS, which is composed of independent board members. 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. Form 990, Part VI, Section C, line 19 Alexian Brothers Specialty Group was incorporated in April 2011. Therefore no previous financial information is available. Conflicts of Interest statements and the governing documents of Alexian Brothers Specialty Group are not made available to the public. Column E and F Disclosure Disclosure for estimated hours per week devoted to related organizations for which compensation was reported: Mark Frey, Jim Sances, Tracy Rogers, Virginia Golembiewski, and Jim Lewandowski all worked 40 hours per week for Alexian Brothers Health System. Reasonable efforts made to obtain compensation from related organizations: Form 990, Part VII: Payroll records are kept that identify which officers/key employees are paid by a related entity. These documents also show the organization being charged for the officer's/key employee's services. Alexian Brothers of America Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 362606768 Religious order of Roman Catholic men TX Section 501(c)(3) 1 N/A 0 Brothers of St Alexius Health and Welfare Fund Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 362976617 Provides for health & welfare payments for religious sponsor TX Section 501(c)(3) 1 Alexian Brothers of America Inc 1 Alexian Brothers Bonaventure House 825 Wellington Avenue Chicago IL 606570000 363527899 Housing and supportive care services for persons with HIV/AIDS IL Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 600051069 363260495 Supports provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Health System Inc Inv Trust 3040 W Salt Creek Lane Arlington Heights IL 600051069 363801585 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Alexian Brothers of America Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 600051069 364390471 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers of Chicago 3040 W Salt Creek Lane Arlington Heights IL 600051069 Inactive Corporation IL Section 501(c)(3) 9 Alexian Brothers of America Inc 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 941530037 Acute care hospital (sold in 1998) TX Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 431295333 HUD housing MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Village of Milwaukee Inc 9301 N 76th Street Milwaukee WI 532230000 391351584 Continuing care retirement community WI Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Suite 110 Chattanooga TN 374040000 364344423 Provides comprehensive & coordinated community based services IL Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 374020000 620646376 Supports the provision of community services for senior citizens TN Section 501(c)(3) 7 Alexian Brothers Health System 1 Alexian Village of Tennessee 437 Alexian Way Signal Mountain TN 373770000 621136742 Continuing care retirement community TN Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 600051069 364484290 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 392039667 Community outreach WI Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 631160000 431470362 Skilled nursing facility MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Sherbrooke Village 4005 Ripa Avenue St Louis MO 631250000 431592502 Skilled nursing facility MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 430653236 Acute care hospital (sponsorship transferred in 1997) MO Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 600051069 363276552 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363308965 Owns or leases properties where healthcare services are delivered IL Section 501(c)(2) N/A Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3350 W Salt Creek Lane Arlington Heights IL 600051069 363045007 Outpatient community mental health services IL Section 501(c)(3) 7 Alexian Brothers Health System 1 Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates IL 601940000 364251848 Behavioral health hospital IL Section 501(c)(3) 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 601940000 364251846 Acute care hospital IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 600051069 364336931 Physician services IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX Section 501(c)(3) 3 Alexian Brothers Hospital Network 1 Alexian Rehabilitation Services LLC 935 Beisner Road Elk Grove Village IL 600070000 300221481 Rehabilitation hospital IL N/A Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 870783164 Provision of NeuroMeg services IL N/A Elk Grove MOB Ltd Partnership 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853289 Medical office building IL N/A Workplace Solutions LLC 1100 E Woodfield Road Schaumburg IL 60173 364095007 Provision of EAP services IL N/A Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 363978153 Manages managed care contracts DE N/A Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 861115516 Ownership of Gamma Knife IL N/A St Alexius Center for Sleep Health LLC 665 W North Avenue Lombard IL 601480000 205876371 Operation of sleep lab IL N/A Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 600051069 363266316 Owns/leases property; joint venture partner IL N/A C Edessa Insurance Company Ltd 3040 W Salt Creek Lane Arlington Heights IL 600051069 Captive insurer located in Bermuda BD Alexian Brothers Medical Center C Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853286 Messenger model IPA IL N/A C Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 943465394 Tax credit financed housing IL N/A C Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 600051069 352211303 Tax credit financed housing IL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 Alexian Brothers Health System O 4258725 Schedule R, Part V, Line 2: ABSG tracks all transactions with related organizations in the general ledger or subsidiary schedules to the general ledger. Amounts are valued based on the fair market value of the transaction.