2016-01-29T20:48:32-06:00 2015-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2014-05-01 237087041 KISHWAUKEE COMMUNITY HOSPITAL KISH 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 LOREN FOELSKE VICE-PRESIDENT - FINANCE, KHS 8157561521 2016-01-20 1 KELLY JACKSON HARDY P00747242 8152859300 2014 2016-04-25 22:37:26Z KISHWAUKEE HOSPITAL KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 224610829 0 X WWW.KISHHEALTH.ORG X 1970 IL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE AREA OF DEKALB COUNTY. 3 2 1201 235 123083 14039 387794 1112612 168636360 173901890 8476451 9697347 2681773 1693306 180182378 186405155 408449 23611228 0 0 60369123 58116480 0 0 13217 100450596 102912854 161228168 184640562 18954210 1764593 328924975 328357441 103167547 104853366 225757428 223504075 X TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREA OF DEKALB COUNTY. KISHWAUKEE HOSPITAL (KH) SERVES ALL PEOPLE WITH SKILL AND COMPASSION WHILE RESPECTING THEIR DIGNITY, RIGHTS, AND CHOICES BY OFFERING ACCESS TO HIGH-QUALITY PREVENTIVE, CURATIVE, AND REHABILITATIVE CARE DELIVERED IN A COST EFFECTIVE MANNER. KISHWAUKEE HOSPITAL RECOGNIZES THE NEED TO EFFECTIVELY MANAGE RESOURCES FOR PRESENT AND FUTURE GENERATIONS. 0 0 152993052 23611228 173802321 KISHWAUKEE HOSPITAL (KH), LOCATED IN DEKALB, ILLINOIS, SERVES THE RESIDENTS OF DEKALB COUNTY AND THE SURROUNDING AREAS BY OFFERING A NUMBER OF PROGRAMS AND SERVICES FOR COMMUNITY BENEFIT, INCLUDING CHARITY CARE.KISHWAUKEE HOSPITAL BELIEVES THAT IN ORDER TO BE A TRUE COMMUNITY HOSPITAL, WE MUST BE A RESOURCE FOR PREVENTATIVE AND CURATIVE HEALTH INFORMATION, EDUCATION AND SERVICES AND THAT WE MUST SUPPORT THE EFFORTS OF OTHERS WHO ALSO ARE DOING WORK FOR THE COMMUNITY GOOD. DOING SO HELPS BUILD TRUST, RESPECT AND LOYALTY FOR OUR HOSPITAL AND STRENGTHENS OUR ROLE AS A PARTNER IN IMPROVING THE HEALTH OUR CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE.THE COMMUNITY BENEFIT OBJECTIVES OF KISHWAUKEE HOSPITAL INCLUDE PROGRAMS TO IMPROVE ACCESS TO HEALTH SERVICES BY REDUCING GEOGRAPHIC, FINANCIAL, LANGUAGE, AND CULTURAL BARRIERS IMPROVE AND ENHANCE PUBLIC HEALTH, ADVANCE GENERAL HEALTH KNOWLEDGE, AND RELIEVE THE GOVERNMENT BURDEN OF PROVIDING HEALTH SERVICES FOR THE COMMUNITY, AND FOR THE UNINSURED AND UNDERINSURED. COMMUNITY HEALTH NEEDS ARE IDENTIFIED AND ADDRESSED THROUGH COMMUNITY OUTREACH PROGRAMS, BY ADDING NEW SERVICES AND BY EXPANDING OTHERS. NEEDS ALSO ARE MET THROUGH OPERATIONAL PROGRAMS SUCH AS CHARITY CARE, SUBSIDIZED SERVICES AND PROVIDING CASH AND IN-KIND DONATIONS TO SUPPORT ORGANIZATIONS THAT ALSO STRIVE TO MEET COMMUNITY HEALTH AND QUALITY OF LIFE NEEDS. THE HOSPITAL IDENTIFIES COMMUNITY HEALTH NEEDS IN SEVERAL WAYS.*AMERICAN DIABETES ASSOCIATION*AMERICAN MEDICAL ASSOCIATION*AMERICAN UNIVERSITY SURVEY*CENTERS FOR DISEASE CONTROL AND PREVENTION*COMMUNITY NEEDS INDEX*ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY*ILLINOIS DEPARTMENT OF PUBLIC HEALTH*ILLINOIS DEPARTMENT OF PUBLIC HEALTH ANNUAL HOSPITAL QUESTIONNAIRE*ILLINOIS DEPARTMENT OF PUBLIC HEALTH, BEHAVIORAL RISK FACTORS SURVEY*ILLINOIS DEPARTMENT OF PUBLIC HEALTH, ILLINOIS COUNTY CANCER STATISTICS REVIEW INCIDENCE*ILLINOIS DEPARTMENT OF PUBLIC HEALTH: BIRTH DEFECTS AND OTHER ADVERSE PREGNANCY OUTCOMES IN ILLINOIS, 2004-2008*ILLINOIS HOSPITAL ASSOCIATION*ILLINOIS HOSPITAL ASSOCIATION, COMP DATA*ILLINOIS PUBLIC HEALTH COMMUNITY MAP*NATIONAL CANCER INSTITUTE*NATIONAL CANCER FOR HEALTH STATISTICS*NATIONAL HEART LUNG AND BLOOD INSTITUTE*NORTHERN ILLINOIS UNIVERSITY ENROLLMENT DATA*PIONEERING HEALTHIER COMMUNITIES*STATE OF ILLINOIS DATA BY ZIP CODE*US CENSUS BUREAU 2010 DATA*INTERNAL REVIEW OF OUTPATIENT AND INPATIENT TRENDS, ESPECIALLY EMERGENCY DEPARTMENT USAGE*INPUT FROM OTHER COMMUNITY PROVIDERS. THIS INCLUDES PROVIDING HOSPITAL LEADERS TO SERVE ON BOARDS AND COMMITTEES THAT DIRECTLY OR INDIRECTLY IMPACT THE COMMUNITY HEALTH OR HELP THE HOSPITAL CONNECT TO UNDERSERVED OR VULNERABLE POPULATIONS.USING ALL THESE RESOURCES, THE HOSPITAL FOCUSED ON THE FOLLOWING COMMUNITY HEALTH NEEDS IN FISCAL YEAR 2015.EXPAND KISH PHYSICIAN GROUP (KPG) PRIMARY CARE PROVIDERS IN IDENTIFIED SERVICE AREAS.GOAL: PROVIDE GREATER ACCESS TO CARE IN THE COMMUNITIES WE SERVE, WHILE UTILIZING THE LATEST TECHNOLOGY, EQUIPMENT AND EDUCATION TO PROVIDE THE HIGHEST LEVEL OF CARE.- DURING THE COURSE OF THE FISCAL YEAR, KISH PHYSICIAN GROUP EXPANDED SERVICES TO TWO ADDITIONAL LOCATIONS INCLUDING AURORA AND DEKALB AND ADDED THIRTY NEW PROVIDERS. THE ADDITION OF PROVIDERS INCLUDES THE ACQUISITION OF THE DEKALB CLINIC PROVIDERS WHICH TOOK PLACE ON MARCH 2, 2015. THROUGHOUT THE FISCAL YEAR THERE WAS APPROXIMATELY A 70% INCREASE IN THE NUMBER OF PATIENT VISITS.DEFINE AND IDENTIFY OPPORTUNITIES FOR CARE COORDINATION, DISEASE MANAGEMENT, CHRONIC CARE PROGRAMS, GROUP MEDICAL VISITS AND OTHER INNOVATIVE HEALTHCARE DELIVERY OPTIONS.GOAL: PROVIDE PATIENT-CENTERED APPROACH TO HEALTH CARE DELIVERY.- DURING THE PAST YEAR MUCH WORK HAS TAKEN PLACE TO DEFINE AND IDENTIFY OPPORTUNITIES FOR CARE COORDINATION, AS KISH HEALTH SYSTEM EMPLOYEES WORK TO DEVELOP A MODEL WHICH PLACES THE FOCUS ON THE PATIENT. ADDITIONALLY, THE TEAMS WORKING ON THIS ACTION ITEM ARE FOCUSED ON REDUCING READMISSIONS FOR PATIENTS DIAGNOSED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), CONGESTIVE HEART FAILURE (CHF) AND OTHER RESPIRATORY DISEASE. AS THE TEAM DEVELOPS THE MODEL, IT IS ANTICIPATED THAT DISEASE AND CHRONIC CARE MANAGEMENT PROGRAMS AND GROUP MEDICAL VISITS WILL BE COMPONENTS OF THE OVERALL PLAN TO ADDRESS THE HEALTH ISSUES IDENTIFIED.- REGIONAL NURSE CARE COORDINATOR PROVIDED CARE FOR 129 UNIQUE INDIVIDUALS ENROLLED IN ACE THROUGH ILLINOIS PARTNERSHIP FOR HEALTH- COMPLEX CASE MANAGEMENT OF 75 REFERRED NON-ACE PATIENTS THROUGH KISHHEALTH SYSTEM ENTITIES- CARE COORDINATION PARTNERSHIP WITH CARDIAC REHAB TO MORE EFFECTIVELY MANAGE CHRONIC CHF PATIENTS IN THE COMMUNITY- UTILIZATION OF DATA TO IDENTIFY PATIENTS FOR DISEASE MANAGEMENT PROGRAMS SUCH AS DIABETES EDUCATIONSUPPORT THE DEKALB COUNTY MENTAL HEALTH BOARD WORK ON THE MENTAL HEALTH COMMUNITY NEEDS ASSESSMENT.GOAL: PARTICIPATE IN THE COMMUNITY MENTAL HEALTH NEEDS ASSESSMENT FOR DEKALB COUNTY.- THE DEKALB COUNTY MENTAL HEALTH BOARD IDENTIFIED AN AREA OF NEED AROUND TRAINING FOR PARTNER AGENCIES ON ISSUES FOCUSED ON OR AROUND MENTAL HEALTH ISSUES. KISHHEALTH SYSTEM, BEHAVIORAL HEALTH SERVICES, IS WORKING WITH THE BOARD ON A SERIES OF WORKSHOPS AND TRAINING TO BE OFFERED. THERE WAS ONE EVENT HELD TITLED MENTAL HEALTH AND THE LAW AND THERE WERE 40 PARTICIPANTS IN ATTENDANCE.FACILITATE COMMUNICATION BETWEEN HEALTH CARE ORGANIZATIONS THROUGH THE USE OF ELECTRONIC MEDICAL RECORD (EMR) TECHNOLOGY.GOAL: IMPLEMENT TECHNOLOGY TO FOSTER SHARED INFORMATION AMONG EMR USERS.- WORK TOWARD THIS OBJECTIVE WAS ACHIEVED BY THE DEPLOYMENT OF THE MEDICITY PLATFORM WHICH WILL ALLOW THE SHARING OF INFORMATION BETWEEN EMR SYSTEMS. KISHHEALTH SYSTEM IS CONNECTED TO SEVERAL PHYSICIAN OFFICES AND WE ARE RAPIDLY EXPANDING THIS REACH. ADDITIONALLY, KISHHEALTH SYSTEM BEGINNING THE TESTING OF THE MEDITECH DIRECT FUNCTIONALITY THAT ALLOWS US TO SEND INFORMATION TO PROVIDERS THAT COMPLY WITH FEDERAL COMMUNICATION AND ENCRYPTION STANDARDS ON THEIR EMR SOLUTIONS. THIS WILL ALLOW ADDITIONAL CONNECTIONS THAT CURRENTLY DO NOT EXIST. KISHHEALTH SYSTEM EVALUATES THE CONNECTIVITY TO REGIONAL OR STATE LEVEL HEALTH INFORMATION EXCHANGES (HIES) THAT WILL ALLOWS COMMUNICATION TO OCCUR ACROSS REGIONAL OR STATE PROVIDERS OF CARE. EXPAND COORDINATED APPROACH TO CHILD HEALTH (CATCH) IN DEKALB COUNTY SCHOOL AGE CHILDREN.GOAL: PROMOTE POLICY A CHANGE IN SCHOOLS TO IMPLEMENT CATCH CURRICULUM OR AFTERSCHOOL PROGRAMS.- DURING THIS LAST YEAR, CATCH CURRICULUM WAS OFFERED TO DEKALB, SYCAMORE AND GENOA SCHOOL DISTRICTS WITH 844CLASSROOM VISITS TOOK PLACE AND 22,374 STUDENTS RECEIVED EDUCATION ON HEALTHY EATING, INCREASING PHYSICAL ACTIVITY AND DECREASING SCREEN TIME. - GENOA PARK DISTRICT ALSO IMPLEMENTED CATCH IN ITS AFTER SCHOOL PROGRAM AND SUMMER PROGRAM, WITH AN ESTIMATED 16 SESSIONS AND 800 STUDENTS RECEIVING THIS PROGRAM.- KISHWAUKEE FAMILY YMCA SUMMER PROGRAM ADDED CATCH AS A COMPONENT OF THE PROGRAM, AND IN ATTENDANCE AT THE SIX SESSIONS WERE 3,200 CHILDREN.- THERE ARE ROUGHLY 90 NIU STUDENTS THAT SERVE AS CATCH INSTRUCTORS WHICH HELP TO MAKE THIS PROGRAM SUSTAINABLE IN THE COMMUNITY.IDENTIFY AND DEVELOP PROGRAMS FOR CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND DIABETES CONSIDERED TO BE HIGH RISK FOR READMISSION.GOAL: REDUCE READMISSIONS FOR CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND DIABETES THROUGH A COORDINATED APPROACH.- DURING THE PAST YEAR WORK HAS TAKEN PLACE ON THIS ACTION ITEM FOCUSING ON PROGRAM DEVELOPMENT FOR CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND DIABETES, AS IT RELATES TO HIGH RISK FOR READMISSION. - THIS PAST YEAR A PILOT PROGRAM ON CONGESTIVE HEART FAILURE WAS IMPLEMENTED WITH 56 PARTICIPANTSSUPPORT LIVE HEALTHY DEKALB COUNTY (FORMERLY PIONEERING HEALTHIER COMMUNITIES) IN ITS POLICY AND SYSTEMS CHANGES.GOAL: SUPPORT THE WORK OF LIVE HEALTHY DEKALB COUNTY THROUGH ITS POLICY AND ENVIRONMENTAL CHANGES TO MOTIVATE PEOPLE TO EAT HEALTHY AND BE PHYSICALLY ACTIVE EVERY DAY.- ON-GOING SUPPORT TO LIVE HEALTHY DEKALB COUNTY IS PROVIDED THROUGH IN-KIND STAFF TIME, AS WELL AS FINANCIAL SUPPORT. - ENVIRONMENTAL CHANGES INCLUDE AN INCREASE IN COMMUNITY GARDENS FROM 200 - 230 TO SUPPORT BARB FOOD MART (SCHOOL BASED FOOD PANTRY) AND HEALTHIER FOOD CHOICES IN SCHOOLS.- IMPLEMENTED STEPS TO ACHIEVE BIKE FRIENDLY DESIGNATION ASSESSMENT OF CRITERIA TO GATHER NEEDED RESOURCES TO BEGIN THE WORK- ENHANCED CONNECTIVITY OF BIKE TRAIL ON BETHANY ROAD BY ADDING A 300 FOOT ADDITION- EXTRA FREE FOOD DROP ADDED FOR COUNTY PANTRIES FACILITATED BY THE FOOD SECURITY COUNCILPROVIDE FREE OR LOW COST DIABETES EDUCATION CLASSES TO IDENTIFIED POPULATIONS.GOAL: EMPOWER PEOPLE TO APPROPRIATELY SELF-MANAGE DIABETES.- THROUGHOUT THE YEAR, DIABETES EDUCATION CLASSES ARE OFFERED AT REDUCED PRICE TO INDIVIDUALS AND THERE WERE 75 INDIVIDUALS THAT PARTICIPATED IN THIS VALUABLE PROGRAMMING.- WORLD DIABETES DAY EVENT WAS HELD IN NOVEMBER WITH OVER 150 PARTICIPANTS.PROVIDE FREE OR REDUCED COST CANCER SCREENINGS FOR TARGETED POPULAT 152993052 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 110 0 1 1201 1 1 1 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X LOREN FOELSKE VP OF FINANCE 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 THOMAS MATYA CHAIR 2.00 3.00 X X 0 0 0 MICHAEL CULLEN VICE CHAIR 2.00 9.00 X X 0 0 0 KEVIN POORTEN PRESIDENT & CEO, KISHHEALTH SYSTEM 9.00 46.00 X X 0 872800 129696 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 22.00 30.00 X 0 328625 87932 BRAD COPPLE PRESIDENT - KH & VWH 23.00 30.00 X 0 377347 59520 PAM DUFFY CNO & VP PATIENT CARE SVCS 10.00 35.00 X 0 276999 31324 JOESPH DANT VP BUSINESS DEVELOPMENT 0.00 47.00 X 0 289274 42457 MICHAEL KOKOTT ASST VP MKTG & PLANNING 10.00 35.00 X 0 200015 28844 ROGER HEATH BELL VP AND CIO 10.00 37.00 X 0 292428 44585 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 15.00 37.00 X 0 467070 73919 DAVID PROULX ASSISTANT VP OPERATIONS 8.00 45.00 X 0 184897 55158 MICHELE MCCLELLAND VP OF HUMAN RESOURCES 20.00 30.00 X 0 237252 40669 ANJU VOHRA TECHNICAL DIRECTOR - ECHO 45.00 X 139584 0 32971 THOMAS WARZECHA DIRECTOR OF PHARMACY 45.00 X 152380 0 33754 LISA ACKLAND DIRECTOR OF NURSING 45.00 X 155391 0 41012 CYNTHIA TUCKER DIRECTOR OF REHAB SERVICES 45.00 X 135736 0 31946 CHESTER SIMMONS PHARMACIST 45.00 X 134048 0 32649 717139 3526707 766436 42 0 1 0 KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 MANAGEMENT SERVICES 13246643 DOCTORS OF EMERGENCY MEDICINE 5N327 SWITCHGRAS LANE ST CHARLES IL 60175 MEDICAL SERVICES 9120107 SIDDIQUI SABET MD PC 13 VENNARD CT LOMBARD IL 60148 MEDICAL SERVICES 1700001 SODEXO INC & AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD SERVICES 1466117 MAYO MEDICAL LABORATORIES 200 1ST STREET SW ROCHESTER MN 55905 LABORATORY SERVICES 813458 31 1280 1051057 18982 41293 240 1112612 NET PATIENT SERVICE REVENUE 621110 173901890 173802321 99569 173901890 7079040 7079040 695190 727583 -32393 -32393 -32393 39707781 329189 37308752 109911 2399029 219278 2618307 2618307 119104 59428 59676 59676 CAFETERIA SALES 621110 731387 0 731387 INCOME PASSTHROUGH - MIDLAND SURG 621110 379389 379389 OTHER SERVICES 621110 347854 23514 324340 207393 207393 1666023 186405155 173802321 123083 11367139 X 23590189 23590189 21039 21039 44012654 42245932 1766722 2238358 2148507 89851 1523024 1461888 61136 10342444 9927286 415158 18253073 18253073 115709 115709 5817 5817 564542 564542 18807022 17458096 1348926 379948 46751 330735 2462 4048239 3362866 678315 7058 1634993 642001 992992 3566818 3417178 149640 134123 129697 4426 3435371 3435371 10278053 10278053 4004989 829288 3175701 UNRELATED BUSINESS INCO 3359 3359 MEDICAL SUPPLIES 25054356 25043851 10505 BAD DEBT EXPENSE 8209875 8209875 FEDERAL AND STATE ASSES 3403628 3403628 1012939 776927 232315 3697 184640562 152993052 31634293 13217 15006542 11539399 721854 122759 25581608 26643574 3803727 3745229 2855211 2444675 181017805 94648710 92124980 86369095 171588222 182412996 6515154 7496478 890392 848849 9837285 6734387 328924975 328357441 12614254 12002612 48203 72556 62065000 59775000 1245038 1070121 27195052 31933077 103167547 104853366 X 221656823 219234259 4100605 4269816 225757428 223504075 328924975 328357441 X 1764593 -2958212 -1059734 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 32846 32846 0 PART II-B, LINE 1: LOBBYING EXPENSES ARE ALLOCATED THROUGH MEMBERSHIP DUES WITH ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. NO OTHER LOBBYING ACTIVITIES WERE CONDUCTED. 6060255 6060255 114947337 46228212 68719125 657467 368752 288715 56442193 48051746 8390447 2910553 2910553 86369095 THIRD PARTY PAYABLES 24646469 DUE TO AFFILIATES 4078911 ACCRUED INTEREST PAYABLE 280280 OTHER PAYABLES - LONG TERM 2927417 31933077 X 168805720 787011 787011 168018709 18386446 18386446 186405155 154126412 787011 787011 153339401 31301161 31301161 184640562 PART X, LINE 2: KISHWAUKEE HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. KISHWAUKEE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AT APRIL 30, 2015 AND 2014, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 59,428. RENTAL EXPENSES 727,583. PART XI, LINE 4B - OTHER ADJUSTMENTS: BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - KISH AREA PHO 6,261. CONTRIBUTION REVENUE FROM KISHHEALTH FOUNDATION 1,051,057. BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - MIDLAND SURGICAL 21,673. NONOPERATING INCOME 9,097,580. BAD DEBT EXPENSE 8,209,875. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 59,428. RENTAL EXPENSES 727,583. PART XII, LINE 4B - OTHER ADJUSTMENTS: EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM 23,091,286. BAD DEBT EXPENSE 8,209,875. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 3524258 0 3524258 0.02000 18744739 12970891 5773848 0.03270 22268997 12970891 9298106 0.05270 4184137 25690 4158447 0.02360 1114028 12310 1101718 0.00620 2440836 651788 1789048 0.01010 584437 0 584437 0.00330 8323438 689788 7633650 0.04320 30592435 13660679 16931756 0.09590 1 8209875 0 31228443 47016841 -15788398 X 1 1 1 1 KISHWAUKEE HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 WWW.KISHHEALTH.ORG 0005470 X X X KISHWAUKEE HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 1 1 1 X WWW.KISHHEALTH.ORG X 1 12 1 WWW.KISHHEALTH.ORG 0 0 1 X 200.000000000000 600.000000000000 X X X X 1 1 X X 1 X WWW.KISHHEALTH.ORG X WWW.KISHHEALTH.ORG X X X X 1 X 0 X X X X X 1 X 0 0 KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 5: INDIVIDUALS REPRESENTING KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, DEKALB COUNTY HEALTH DEPARTMENT AND LIVE HEALTHY DEKALB COUNTY (FORMERLY KNOWN AS PIONEERING HEALTHIER COMMUNITIES), SERVED AS STEERING COMMITTEE MEMBERS. STEERING COMMITTEE MEMBERS MET MONTHLY FROM MAY 2012 TO NOVEMBER 2012 AND REVIEWED POPULATION DEMOGRAPHICS, BIRTH AND DEATH DATA AND SOCIAL AND HEALTH INDICATORS IN ORDER TO PRIORITIZE HEALTH PROBLEMS FOR THE DEKALB COUNTY COMMUNITY HEALTH PLAN AND KISHWAUKEE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT. THE STEERING COMMITTEE WAS CHARGED WITH FURTHER PRIORITIZING THESE ISSUES BASED ON A MORE IN-DEPTH EXPLORATION AND A STANDARDIZED PROCESS. IN SEPTEMBER OF 2012, THE STEERING COMMITTEE PRESENTED HEALTH PRIORITIES TO THE EXTERNAL COMMITTEE MEMBERS, WHO INCLUDED A VARIETY OF INDIVIDUALS FROM LOCAL AND STATE GOVERNMENTAL AGENCIES, LEADERS FROM COMMUNITY BASED ORGANIZATIONS, FOUNDATIONS, SCHOOL DISTRICTS, COLLEGES, AND LOCAL NON-PROFIT ORGANIZATIONS. THESE PARTICIPANTS ARE EXPERTS IN HEALTH CARE, SOCIAL DETERMINANTS OF HEALTH AND HEALTH AND SOCIAL SERVICES. THE INPUT FROM THE EXTERNAL GROUP HELPED TO ENSURE THAT NEEDS WERE IDENTIFIED AND WILL BE RESPONDED TO. AFTER THOROUGH REVIEW OF THE DATA, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS WERE GIVEN THE OPPORTUNITY TO DISCUSS THE INFORMATION AND FURTHER REVIEW HEALTH PROBLEMS FACING THE COUNTY. FOLLOWING A LENGTHY DISCUSSION, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS IDENTIFIED PRIORITIES FOR CONSIDERATION FOR THE COMMUNITY BENEFIT IMPLEMENTATION PLAN. THE FULL LIST OF PARTICIPANTS IN THE ASSESSMENT PROCESS INCLUDES:STEERING COMMITTEE MEMBERS (PARTICIPANTS LISTED ALPHABETICALLY)* BETH BUSCHING, MANAGER, COMMUNITY WELLNESS, KISHWAUKEE HOSPITAL* BETTE CHILTON, DEAN OF HEALTH AND EDUCATION, KISHWAUKEE COMMUNITY COLLEGE* DAWN ROZNOWSKI, COMMUNITY ENGAGEMENT ADVISOR, KISHHEALTH SYSTEM* JANE LUX, DIRECTOR, DEKALB COUNTY HEALTH DEPARTMENT* KIM JASS-RAMIREZ, SENIOR DIRECTOR OF HEALTHY LIVING, KISHWAUKEE YMCA* LISA CUMINGS, COMMUNITY HEALTH LIAISON, KISHWAUKEE HOSPITAL* MARCY ZANELLATO, HEALTH EDUCATION DIVISION, DEKALB COUNTY HEALTH DEPARTMENT* SHELLY JOHNSON, DIRECTOR, COMMUNITY CARES CLINIC AND CENTER FOR FAMILY HEALTH, EMPLOYEE HEALTH, COMMUNITY WELLNESS, KISHHEALTH SYSTEMEXTERNAL COMMITTEE MEMBERS* ERICA BARNES, LCPC, COUNSELOR/OUTREACH COORDINATOR, NORTHERN ILLINOIS UNIVERSITY COUNSELING AND STUDENT DEVELOPMENT* JAMES BRISCOE, SUPERINTENDENT, DEKALB SCHOOL DISTRICT #428* CINDY CAPEK, EXECUTIVE DIRECTOR, DEKALB PARK DISTRICT* BETTE CHILTON, DEAN OF HEALTH & EDUCATION, KISHWAUKEE COMMUNITY COLLEGE* BRENDA COURTNEY, DIRECTOR OF ADMINISTRATIVE SERVICES, DEKALB COUNTY HEALTH DEPARTMENT* KATHY COUNTRYMAN, SUPERINTENDENT, SYCAMORE SCHOOL DISTRICT #427* MICHAEL KOKOTT, ASSISTANT VICE PRESIDENT, MARKETING & PLANNING, KISHHEALTH SYSTEM* DAWN LITLEFIELD, EXECUTIVE DIRECTOR, KISHWAUKEE YMCA* CRISTY MEYER, PRINCIPAL, JEFFERSON ELEMENTARY SCHOOL* DONNA MOULTON, EXECUTIVE DIRECTOR, COMMUNITY MENTAL HEALTH BOARD & COMMUNITY SERVICES, DEKALB COUNTY* GABRIELA ORTIZ, PUBLIC HEALTH NURSE, DEKALB COUNTY HEALTH DEPARTMENT* MARY PRITCHARD, PHD., ASSOCIATE DEAN, NORTHERN ILLINOIS UNIVERSITY, COLLEGE OF HEALTH & HUMAN SCIENCES* TED STRACK, PRESIDENT, SYCAMORE PARK DISTRICT* DAN TEMPLIN, EXECUTIVE DIRECTOR, DEKALB COUNTY COMMUNITY FOUNDATION * ROB WILKINSON, CEO, KISHWAUKEE YMCAKISHHEALTH SYSTEM COMMITTEE MEMBERS* KEVIN POORTEN, PRESIDENT & CEO, KISHHEALTH SYSTEM* ALLISON BRYAN, COMMUNITY RELATIONS, VALLEY WEST HOSPITAL* BECKIE FRIEDERS, EMPLOYEE WELLNESS COORDINATOR, KISHHEALTH SYSTEM* BETH BUSCHING, MANAGER, COMMUNITY WELLNESS, KISHWAUKEE HOSPITAL* BETH GALE, DIRECTOR, CONTINUITY OF CARE* CINDY JOHNSTON, DIRECTOR, COMMUNITY WELLNESS, VALLEY WEST HOSPITAL* DAVID WESTER, PHYSICIAN ASSISTANT, CENTER FOR FAMILY HEALTH* DAWN ROZNOWSKI, COMMUNITY ENGAGEMENT ADVISOR, KISHHEALTH SYSTEM* DR. MICHAEL KULISZ, PHYSICIAN, CHIEF MEDICAL OFFICER, KISHHEALTH SYSTEM* JENNIFER RENFER, READMISSION NURSE* KAREN ROUSE, DIRECTOR, OUTPATIENT CLINICS* MICHAEL KOKOTT, ASSISTANT VICE PRESIDENT OF MARKETING AND PLANNING, KISHHEALTH SYSTEM* PAMELA DUFFY, VICE PRESIDENT, PATIENT CARE SERVICES AND CHIEF NURSING OFFICER* SHELLY JOHNSON, DIRECTOR, COMMUNITY CARES CLINIC AND CENTER FOR FAMILY HEALTH, EMPLOYEE HEALTH, COMMUNITY WELLNESS, KISHHEALTH SYSTEM* THERESA KOMITAS, COMMUNITY RELATIONS, KISHWAUKEE HOSPITAL KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDE VALLEY WEST HOSPITAL. KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 11: SEE FORM 990, PART III, LINE 4A FOR A DETAILED DESCRIPTION OF THE ACTIONS TAKEN BY KISHWAUKEE COMMUNITY HOSPITAL DURING THE FISCAL YEAR TO ADDRESS COMMUNITY HEALTH NEEDS.NINE OTHER TOPIC AREAS (ACCIDENTS, ALCOHOL/DRUG USE, ALLERGIES, CRIME, JOB AVAILABILITY, ORAL HEALTH, SUICIDE AND UNEMPLOYMENT) WERE IDENTIFIED FOR DATA COLLECTION, REVIEW AND PRIORITY SETTING. BELOW ARE THE AREAS IDENTIFIED AND A BRIEF DESCRIPTION WHY THE HOSPITAL DID NOT SELECT TO ADDRESS.PRIORITY IDENTIFIED: ACCIDENTSEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED.PRIORITY IDENTIFIED: ALCOHOL/DRUG USE EXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS BEN GORDON CENTER YOUTH SERVICES BUREAU, DCPSAFE AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: ALLERGIES EXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DID NOT CHOOSE THIS AS A PRIORITY TO ADDRESS, HOWEVER, IT MAY BE INDIRECTLY ADDRESSED AS A RESULT OF WORK ON OTHER IDENTIFIED HEALTH PRIORITIES LIKE ACCESS TO CARE, CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND OVERWEIGHT/OBESITY IN ADULTS/CHILDREN.PRIORITY IDENTIFIED: CRIMEEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED.PRIORITY IDENTIFIED: JOB AVAILABILITYEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS ILLINOIS EMPLOYMENT TRAINING CENTER, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: ORAL HEALTHEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. PRIORITY IDENTIFIED: SUICIDEEPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS BEN GORDON CENTER YOUTH SERVICES BUREAU, DCPSAFE AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: UNEMPLOYMENTEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS ILLINOIS EMPLOYMENT TRAINING CENTER, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM. KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 13B: IN ADDITION TO FEDERAL POVERTY GUIDELINES, A PERSON MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON THEIR FAMILY INCOME RELATIVE TO FAMILY SIZE AND OTHER FACTORS SUCH AS CURRENT FINANCIAL OBLIGATIONS AND LIVING EXPENSES. KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 20E: POSTING OF FINANCIAL ASSISTANCE POLICY TO SYSTEM'S WEBSITE. KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 22D: BASED ON COMPLIANCE WITH LAWS OF STATE OF ILLINOIS, SPECIFICALLY THE UNINSURED PATIENT DISCOUNT ACT. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.KISHHEALTH.ORG KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.KISHHEALTH.ORG PART I, LINE 3C: IN ADDITION TO FPG GUIDELINES, KISHWAUKEE HOSPITAL UTILIZES OTHER FACTORS TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PER THE ORGANIZATION'S CHARITY CARE POLICY, THESE FACTORS INCLUDE:* FAMILY INCOME RELATIVE TO FAMILY SIZE AND OTHER RELATED FACTORS SUCH AS CURRENT FINANCIAL OBLIGATIONS* EMPLOYMENT STATUS, INCLUDING, BUT NOT LIMITED TO, FUTURE EARNING CAPACITY WITH CONSIDERATION OF THE LIKELIHOOD OF A FINANCIAL CAPACITY SUFFICIENT TO MEET THE PATIENT'S FINANCIAL OBLIGATIONS IN AN ACCEPTABLE PERIOD OF TIME* FUTURE AND CURRENT ABILITY TO PAY* MEDICAL EXPENSES, INCLUDING PHARMACEUTICAL EXPENSES, AS A PERCENTAGE OF A PATIENT'S ANNUAL GROSS INCOME, THE AMOUNT OF TOTAL MEDICAL BILLS OUTSTANDING, AND THE FREQUENCY OF PAYMENTS TO BE MADE IN RELATION TO THE FACTORS ABOVE* CREDIT REPORT INFORMATION* ACTUAL COST OF CARE PROVIDED* OTHER FACTORS DEEMED APPROPRIATE BY THE HEALTH SYSTEMKISHWAUKEE HOSPITAL DOES NOT CONSIDER THE PATIENT'S ASSETS IN DETERMINING ABILITY TO PAY OR ELIGIBILTY FOR CHARITY CARE. PART I, LINE 7: THE RESPECTIVE IRS WORKSHEET, AS PROVIDED IN THE INSTRUCTIONS FOR SCHEDULE H, WERE USED TO CALCULATE THE COSTS OF ITEMS WITHIN THE TABLE ABOVE. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE HOSPITALIST SERVICES, DIABETES TREATMENT, EMS SERVICES, ANESTHESIA SERVICES AND CHILD DEVELOPMENT PROGRAMS PART I, LN 7 COL(F): SEE FOOTNOTE 4 AND FOOTNOTE 5 (BEGINNING ON PAGE 17) IN THE ATTACHED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 2: SEE FOOTNOTE 4 AND FOOTNOTE 5 (BEGINNING ON PAGE 17) IN THE ATTACHED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE. PART III, LINE 3: INTERNAL REVENUE SERVICE WORKSHEET 2 (PER SCHEDULE H INSTRUCTIONS) WAS UTILIZED TO DETERMINE THE COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS AND THE RELATED COMMUNITY BENEFIT. PART III, LINE 8: FOR THE 4/30/15 FISCAL YEAR, KH PROVIDED BILLED CHARGES TO MEDICARE PATIENTS TOTALING $51,600,000. HOWEVER, DUE TO THE MEDICARE INPATIENT AND OUTPATIENT PAYMENT METHODOLOGIES, THE ACTUAL CASH PAYMENTS RECEIVED FROM PROVIDING CARE TO THOSE PATIENTS WAS JUST $12,800,000, OR 24.7% OF BILLED CHARGES. THE COST OF PROVIDING THIS CARE, PER THE MEDICARE COST REPORT, WAS $18,700,000. THUS, THE PAYMENTS RECEIVED FROM MEDICARE WERE $5,900,000 LESS THAN COST, OR 68% OF COST. TRULY THIS $5,900,000 SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. AS APPROXIMATELY 46% OF ALL KISHWAUKEE HOSPITAL CHARGES GENERATED ARE FROM MEDICARE PATIENTS, THIS SHORTFALL PLACES A TREMENDOUS FINANCIAL BURDEN ON OUR HOSPITAL.KISHWAUKEE HOSPITAL, LIKE OTHER NOT-FOR-PROFIT HOSPITALS, MUST ACCEPT MEDICARE PAYMENTS AS PAYMENT IN FULL FOR SERVICES PROVIDED, WITH THE EXCEPTION OF COLLECTING ON DEDUCTIBLES AND CO-INSURANCE AMOUNTS. HOSPITALS CANNOT BILL MEDICARE PATIENTS FOR THE DIFFERENCE BETWEEN THE BILLED CHARGES AND MEDICARE PAYMENTS.KISHWAUKEE HOSPITAL PROVIDES SERVICES TO ALL PATIENTS WHO NEED CARE, ABIDING BY THE FEDERAL EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) REGULATION. IT REQUIRES HOSPITALS AND AMBULANCE SERVICES TO PROVIDE CARE TO ANYONE NEEDING EMERGENCY HEALTHCARE TREATMENT REGARDLESS OF CITIZENSHIP, LEGAL STATUS OR ABILITY TO PAY.KH UTILIZED THE CALCULATION OF MEDICARE COST FROM THE ANNUAL MEDICARE COST REPORT. THIS APPROACH ALLOCATES COST FROM NON REVENUE PRODUCING DEPARTMENTS TO THE REVENUE GENERATING DEPARTMENTS, BASED ON STEP DOWN STATISTICAL COST FINDING. WHILE NOT AS COMPREHENSIVE AS A TRUE COST ACCOUNTING SYSTEM, THIS PROCESS RESULTS IN AN ACCEPTABLE BASIS OF THE DEPARTMENTAL COST FOR PROVIDING SERVICES. RECALL THAT PRIOR TO MEDICARE PROSPECTIVE PAYMENT SYSTEM (PPS), THIS METHODOLOGY WAS THE BASIS FOR THE REIMBURSEMENT TO HOSPITALS. PART III, LINE 9B: COLLECTION ACTIONS INVOLVING UNINSURED PATIENTS. KHS (KISHHEALTH SYSTEM, PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL) SHALL NOT PURSUE A COLLECTION ACTION AGAINST AN UNINSURED PATIENT, UNLESS THE PATIENT HAS BEEN GIVEN THE OPPORTUNITY TO ASSESS THE ACCURACY OF THE BILL APPLY FOR FINANCIAL ASSISTANCE UNDER THE KHS FINANCIAL ASSISTANCE POLICY AND PROCEDURE AND AVAIL HIMSELF OR HERSELF OF A REASONABLE PAYMENT PLAN. NOTWITHSTANDING THIS, KHS MAY NOT PURSUE THE COLLECTION ACTION UNDER THE FOLLOWING CIRCUMSTANCES: (A) IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT, UNTIL KHS HAS OFFERED THE PATIENT A PAYMENT PLAN. KHS MAY REQUIRE THE PATIENT TO PROVIDE REASONABLE VERIFICATION OF HIS OR HER INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT.(B) IF KHS HAS REASON TO BELIEVE THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, UNTIL KHS HAS GIVEN THE PATIENT AT LEAST 60 DAYS FOLLOWING THE DATE OF DISCHARGE OR RECEIPT OF OUTPATIENT CARE TO SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. (C) IF THE PATIENT HAS AGREED TO A PAYMENT PLAN, UNTIL THE PATIENT HAS FAILED TO MAKE PAYMENTS IN ACCORDANCE WITH THAT PAYMENT PLAN. (D) IF THE PATIENT INFORMS KHS THAT HE OR SHE HAS APPLIED FOR HEALTH CARE COVERAGE UNDER MEDICAID, KIDCARE, OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAM (AND THERE IS A REASONABLE BASIS TO BELIEVE THAT THE PATIENT WILL QUALIFY FOR SUCH PROGRAM), BUT THE PATIENT'S APPLICATION IS DENIED. PART VI, LINE 2: IN 2012, KISHWAUKEE HOSPITAL PARTNERED WITH DEKALB COUNTY HEALTH DEPARTMENT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A PRIMARY TOOL USED BY THE HOSPITAL TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW THE HOSPITAL WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, KISHHEALTH SYSTEM SPONSORED AN ONLINE SURVEY WHICH WAS A QUESTIONNAIRE STYLE, SELF-ADMINISTERED SURVEY, AVAILABLE ONLINE, IN BOTH ENGLISH AND SPANISH. THE PROCESS FOLLOWED A CROSS SECTIONAL RESEARCH DESIGN, TAKING A SNAPSHOT OF DEKALB COUNTY RESIDENTS AT A SINGLE MOMENT IN TIME. LASTLY, THE COMMUNITY NEEDS INDEX IDENTIFIES THE SEVERITY OF HEALTH DISPARITIES FOR EVERY ZIP CODE IN THE UNITED STATES AND DEMONSTRATES THE LINK BETWEEN COMMUNITY NEED, ACCESS TO CARE, AND PREVENTABLE HOSPITALIZATIONS. REVIEW OF THE COMMUNITY NEEDS INDEX WAS USED TO IDENTIFY COMMUNITIES OF HIGHEST NEED AND PLAN FOR DIRECT A RANGE OF POTENTIAL COMMUNITY HEALTH OUTREACH EFFORTS. INDIVIDUALS REPRESENTING KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, DEKALB COUNTY HEALTH DEPARTMENT AND PIONEERING HEALTHIER COMMUNITIES, SERVED AS STEERING COMMITTEE MEMBERS. STEERING COMMITTEE MEMBERS MET MONTHLY FROM MAY 2012 TO AUGUST 2012 AND REVIEWED POPULATION DEMOGRAPHICS, BIRTH AND DEATH DATA AND SOCIAL AND HEALTH INDICATORS IN ORDER TO PRIORITIZE HEALTH PROBLEMS FOR THE DEKALB COUNTY COMMUNITY HEALTH PLAN AND KISHWAUKEE HOSPITAL BENEFIT PLAN. THE STEERING COMMITTEE AND KISHHEALTH SYSTEM BENEFIT TEAM MEMBERS WERE CHARGED WITH FURTHER PRIORITIZING THESE ISSUES BASED ON A MORE IN-DEPTH EXPLORATION AND A STANDARDIZED PROCESS. AFTER THOROUGH REVIEW OF THE DATA, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS WERE GIVEN THE OPPORTUNITY TO DISCUSS THE INFORMATION AND IDENTIFY HEALTH PROBLEMS FACING THE COUNTY. FOLLOWING A LENGTHY DISCUSSION, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS IDENTIFIED THE FOLLOWING PRIORITIES FOR CONSIDERATION. AFTER THOROUGH REVIEW OF THE DATA AND FURTHER ANALYSIS, THE PRIORITIES OF FOCUS ARE HIGHLIGHTED.DATA COLLECTION AND COMMUNITY HEALTH NEEDS ASSESSMENT:ADMINISTRATION OF THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY WAS NOT RANDOMIZED, BUT ANALYSIS OF RESPONDENT CHARACTERISTICS INDICATED THAT PARTICIPANTS RESPONDING TO THE SURVEY WERE REPRESENTATIVE OF THE COUNTY'S POPULATION.THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY WAS A QUESTIONNAIRE STYLE, SELF-ADMINISTERED SURVEY, AVAILABLE ONLINE, IN BOTH ENGLISH AND SPANISH. THE PROCESS FOLLOWED A CROSS SECTIONAL RESEARCH DESIGN, TAKING A SNAPSHOT OF DEKALB COUNTY RESIDENTS AT A SINGLE MOMENT IN TIME. THE ONLINE SURVEY WAS SPONSORED AND HOSTED BY KISHHEALTH SYSTEM. THE RESULTS OF THE ONLINE SURVEY, IS AVAILABLE ON THE KISH HEALTH SYSTEM'S WEBSITE.SECONDARY DATA COLLECTION:DATA NECESSARY FOR THE DECISION-MAKING PROCESS WAS PROVIDED BY JOEL COWEN, RETIRED FACULTY MEMBER OF HEALTH SYSTEMS RESEARCH OF THE UNIVERSITY OF ILLINOIS - COLLEGE OF MEDICINE, AT ROCKFORD. LOCAL, COUNTY, STATE AND FEDERAL SOURCES WERE COLLECTED TO PRESENT A COMMUNITY PROFILE, BIRTH AND DEATH CHARACTERISTICS, ACCESS TO HEALTH CARE,CHRONIC DISEASE, SOCIAL ISSUES AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN PERTINENT, THESE DATA SETS ARE PRESENTED IN THE CONTEXT OF DEKALB COUNTY AND THE STATE OF ILLINOIS. ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR VALLEY WEST HOSPITAL PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. RESOURCES UTILIZED INCLUDE:*AMERICAN DIABETES ASSOCIATION*AMERICAN MEDICAL ASSOCIATION*AMERICAN UNIVERSITY SURVEY*CENTERS FOR DISEASE CONTROL AND PREVENTION*COMMUNITY NEEDS INDEX*ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY*ILLINOIS DEPARTMENT OF PUBLIC HEALTH*ILLINOIS DEPARTMENT OF PUBLIC HEALTH ANNUAL HOSPITAL QUESTIONNAIRE*ILLINOIS DEPARTMENT OF PUBLIC HEALTH, BEHAVIORAL RISK FACTOR SURVEY*ILLINOIS DEPARTMENT OF PUBLIC HEALTH, ILLINOIS COUNTY CANCER STATISTICS REVIEW INCIDENCE*ILLINOIS DEPARTMENT OF PUBLIC HEALTH: BIRTH DEFECTS AND OTHER ADVERSE PREGNANCY OUTCOMES IN ILLINOIS, 2004-2008*ILLINOIS HOSPITAL ASSOCIATION*ILLINOIS HOSPITAL ASSOCIATION, COMPDATA*ILLINOIS PUBLIC HEALTH COMMUNITY MAP*NATIONAL CANCER INSTITUTE*NATIONAL CENTER FOR HEALTH STATISTICS*NATIONAL HEART LUNG AND BLOOD INSTITUTE*NORTHERN ILLINOIS UNIVERSITY ENROLLMENT DATA*PIONEERING HEALTHIER COMMUNITIES*STATE OF ILLINOIS DATA BY ZIP CODE*U.S. CENSUS BUREAU 2010 DATATHE FULL REPORT OF PRIMARY AND SECONDARY DATA SOURCES AND DATES UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR KISHWAUKEE HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL AND DEKALB COUNTY HEALTH DEPARTMENT AND IS AVAILABLE ON KISH HEALTH SYSTEM WEBSITE.COMMUNITY NEEDS INDEX:THE COMMUNITY NEEDS INDEX IDENTIFIES THE SEVERITY OF HEALTH DISPARITIES FOR EVERY ZIP CODE IN THE UNITED STATES AND DEMONSTRATES THE LINK BETWEEN COMMUNITY NEED, ACCESS TO CARE, AND PREVENTABLE HOSPITALIZATIONS. FOR EACH ZIP CODE IN THE US, THE COMMUNITY NEEDS INDEX AGGREGATES FIVE SOCIOECONOMIC INDICATORS/BARRIERS TO HEALTH CARE ACCESS THAT ARE KNOWN TO CONTRIBUTE TO HEALTH DISPARITIES RELATED TO INCOME, EDUCATION,CULTURE/LANGUAGE, INSURANCE AND HOUSING. REVIEW OF THE COMMUNITY NEEDS INDEX WAS USED TO IDENTIFY COMMUNITIES OF HIGHEST NEED AND PLAN FOR DIRECT A RANGE OF POTENTIAL COMMUNITY HEALTH OUTREACH EFFORTS. DATA ANALYSIS:AFTER THOROUGH REVIEW OF THE DATA, AND DETAILED ANALYSIS IT WAS DECIDED THAT COMPONENTS OF THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS BE UTILIZED TO HELP FURTHER DETERMINE THE PRIORITIES TO ESTABLISH FOR KISHHEALTH SYSTEM AS A WHOLE AND VALLEY WEST HOSPITAL. MAPP IS A STRATEGIC APPROACH TO COMMUNITY HEALTH IMPROVEMENT.FURTHER VETTING OF PRIMARY AND SECONDARY DATA INCLUDED STATISTICAL ANALYSIS OF TRENDS AND COMPARISONS, HEALTH INDICATORS, ISSUES THAT ARE OCCURRING THAT AFFECT THE HEALTH OF THE COMMUNITY, AND EXISTING PROGRAMS/SERVICES THAT CONTRIBUTE TO/OR IMPROVE THE QUALITY OF LIFE AND/OR OVERALL HEALTH OF THE COMMUNITY.USING PRIMARY AND SECONDARY DATA COLLECTION, PARTICIPANTS WERE ASKED TO REVIEW AND IDENTIFY THE HEALTH PRIORITIES FOR THE COMMUNITY THAT THEY BELIEVED TO BE THE MOST SIGNIFICANT TO THE OVERALL HEALTH OF THE COMMUNITY. USING A NOMINAL GROUP PROCESS, PRIORITIES WERE DISCUSSED AND RECOMMENDATIONS MADE. PART VI, LINE 3: INFORMATION IS PROVIDED AT REGISTRATION, VIA THE HOSPITAL WEBSITE, THROUGH CONSULTATIONS WITH FINANCIAL COUNSELORS FOR SOME OUTPATIENTS AS WELL AS INPATIENTS, DURING THE BILLING PROCESS ON STATEMENTS AND VIA PHONE CONVERSATIONS. PART VI, LINE 4: KISHWAUKEE HOSPITAL SERVES THE LARGEST PORTION OF DEKALB COUNTY RESIDENTS, WITH ROUGHLY 58.4% OF THE COUNTY'S ENTIRE POPULATION FOUND IN THE CITIES OF DEKALB AND SYCAMORE. UTILIZING ILLINOIS HOSPITAL ASSOCIATION COMP DATA, WHICH MEASURES HOSPITAL ADMISSIONS KISHWAUKEE HOSPITAL, HAD 5,775 ADMISSIONS, 156,418 OUTPATIENT VISITS AND 31,399 EMERGENCY DEPARTMENT VISITS IN FISCAL YEAR 2015. IN THE HOSPITAL SERVICE AREA, ESTIMATED AT 105,000 PEOPLE, THE INPATIENT MARKET SHARE IS ROUGHLY 59.95%. PART VI, LINE 5: KISHWAUKEE HOSPITAL IN DEKALB, IL, IS PART OF KISHHEALTH SYSTEM. THE HEALTH SYSTEM IS GOVERNED BY AN APPOINTED VOLUNTEER BOARD OF DIRECTORS, INDEPENDENT COMMUNITY LEADERS WHO RESIDE IN THE PRIMARY MARKETS SERVED BY THE HEALTH SYSTEM'S TWO HOSPITALS. THESE INDIVIDUALS ARE SELECTED FOR THE BOARD DUE TO THEIR INTEREST AND EXPERTISE IN VARIOUS AREAS THAT CAN HELP MANAGEMENT CARRY OUT THE MISSION OF THE HEALTH SYSTEM. MEMBERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR TIME. THE MEDICAL STAFF IS OPEN TO PHYSICIANS THAT MEET CRITERIA ESTABLISHED BY MEDICAL STAFF BY-LAWS. PHYSICIANS ARE GIVEN THE OPPORTUNITY TO VOLUNTEER TO DO FREE COMMUNITY WELLNESS PROGRAMS ON HEALTH TOPICS. SURPLUS FUNDS GO BACK INTO THE ORGANIZATION TO SUPPORT OPERATIONS, CAPITAL IMPROVEMENTS, THE HEALTH SYSTEM'S COMMITMENT TO EDUCATION AND INNOVATION, AND TO PROVIDE MEDICAL CARE TO ALL REGARDLESS OF ABILITY TO PAY. EFFORTS TO PROMOTE HEALTH WITHIN THE COMMUNITY ARE OFTEN FACILITATED BY THE COMMUNITY WELLNESS DEPARTMENT. THERE ARE FOUR HEALTH PROMOTION SPECIALISTS AND A HEALTHY CULINARY INSTRUCTOR THAT ARE EMPLOYED TO COLLABORATE WITH COMMUNITY PARTNERS, SCHOOLS, AND BUSINESSES TO PROMOTE HEALTHY LIFESTYLES THROUGH INDIVIDUAL AND ENVIRONMENTAL CHANGE. THERE ARE OTHER DEPARTMENTS AND PROGRAMS WITHIN THE HOSPITAL, SUCH AS BEHAVIORAL HEALTH SERVICES, THE ONCOLOGY DEPARTMENT, AND DIABETES EDUCATION THAT ALSO SPEND TIME ENGAGED IN PROMOTING COMMUNITY HEALTH. THE PRIMARY GOALS OF THESE ACTIVITIES WERE TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY, IMPROVE ACCESS TO CARE, AND REACH OUT TO SPECIAL POPULATIONS.SEE FORM 990, PART III, LINE 4A FOR SOME OF THE ACTIVITIES OR SERVICES THAT WERE PROVIDED TO WORK TOWARD A HEALTHY COMMUNITY DURING THE FISCAL YEAR. PART VI, LINE 6: KISH HEALTH SYSTEM AND ITS NON PROFIT AFFILIATES, KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, KISH HEALTH SYSTEM HOSPICE, KISH HEALTH SYSTEM HOMECARE, CENTER FOR FAMILY HEALTH MALTA, COMMUNITY CARES CLINIC, KISH HEALTH SYSTEM PHYSICIANS GROUP, AND KISH HEALTH SYSTEM FOUNDATION, ALL PROMOTE THE HEALTH OF COMMUNITIES IN OUR REGION THROUGH DIRECT SERVICES, DONATIONS OF LEADERSHIP TIME ON VARIOUS COMMITTEES AND BOARDS, AND THROUGH CASH CONTRIBUTIONS. KISH HEALTH SYSTEM UNDERWROTE $20,750,000 FOR KISH HEALTH SYSTEM PHYSICAN GROUP FOR OPERATIONAL LOSSES (APPROXIMATELY $6,775,000) AND FUNDING FOR THE PURCHASE OF DEKALB CLINIC. IN ADDITION, KISH HEALTH SYSTEM UNDERWROTE $300,000 FOR THE CENTER FOR FAMILY HEALTH-MALTA AND $250,000 FOR KISH HEALTH SYSTEM HOMECARE FOR OPERATIONAL LOSSES IN FISCAL YEAR 2015, ALL VITAL SERVICES FOR THE HEALTH OF THE COMMUNITY. IN ADDITION TO CONTRIBUTIONS MADE BY KISHWAUKEE HOSPITAL AND VALLEY WEST HOSPITAL TO OTHER ORGANIZATIONS WITHIN THEIR COMMUNITIES, KISH HEALTH SYSTEM CONTRIBUTED $25,800 TO OTHER ORGANIZATIONS WITHIN THE COMMUNITY. KISH HEALTH SYSTEM EMPLOYEES CONTRIBUTED MORE THAN 1,423 HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH, EDUCATION, AND QUALITY OF LIFE. VALLEY WEST HOSPITAL IS A CRITICAL ACCESS HOSPITAL IN SANDWICH, IL. KISH HEALTH SYSTEM HOSPICE IN DEKALB, IL PROVIDES FREE CARE AND SUPPORT FOR THE TERMINALLY ILL AS WELL AS GRIEF SUPPORT TO THE PUBLIC. CENTER FOR FAMILY HEALTH CLINIC IN MALTA IS A PRIMARY CLINIC FOR MEDICAID AND UNINSURED KISH HEALTH SYSTEM PHYSICIAN GROUP PROVIDES ACCESS TO MEDICAL SERIVCES, ESPECIALLY THE RURAL AREAS AND ACCEPTS MEDICAID AND UNINSURED PATIENTS, AND KISH HEALTH FOUNDATION IN DEKALB, IL RAISES MONEY FOR KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, KISH HEALTH SYSTEM HOSPICE, AND THE CENTER FOR FAMILY HEALTH AND FUNDS EQUIPMENT PURCHASES AND PATIENT SERVICES PARTICULARLY IN THE AREA OF CANCER CARE FOR THOSE WHO CANNOT AFFORD IT. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 AMERICAN CANCER SOCIETY 143 FIRST STREET BATAVIA IL 60510 131788491 501(C)(3) 12500 TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO CANCER RESEARCH AND EDUCATION AMERICAN HEART ASSOCIATION PO BOX 4002902 DES MOINES IA 50340 135613797 501(C)(3) 15000 TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO HEART HEALTH RESEARCH AND EDUCATION BEN GORDON CENTER FOUNDATION 12 HEALTH SERVICES DRIVE DEKALB IL 60115 362771343 501(C)(3) 50000 TO PROVIDE FINANCIAL ASSISTANCE FOR MENTAL HEALTH SERVICES FOR UNDER OR UNINSURED DEKALB COUNTY YOUTH SERVICES BUREAU 330 GROVE STREET DEKALB IL 60115 363034427 501(C)(3) 7500 TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO YOUTH SERVICES GENOA CHAMBER OF COMMERCE 111 N SYCAMORE ST GENOA IL 60135 362355846 501(C)(6) 6300 TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO PROMOTION OF GENOA AREA ECONOMIC DEVELOPMENT KISHWAUKEE FAMILY YMCA 2500 BETHANY ROAD SYCAMORE IL 60178 362379643 501(C)(3) 25930 TO PROVIDE FINANCIAL ASSISTANCE RELATED TO HEALTH AND FITNESS ACTIVITES FOR LOW INCOME CHILDREN AND FAMILIES SYCAMORE CHAMBER OF COMMERCE 407 W STATE STREET STE 10 SYCAMORE IL 60178 361848940 501(C)(6) 7000 TO PROVIDE FINANCIAL ASSISTANCE TO PROMOTE BUSINESSES AND ORGANIZATIONS IMPACTING THE COMMUNITY HEALTH AND SAFETY. CASA DEKALB COUNTY INC 407 W STATE STREET STE 6 SYCAMORE IL 60178 363903898 501(C)(3) 10000 SUPPORT PROGRAMS OFFERED TO CHILDREN IN DEKALB COUNTY THAT ARE ABUSED OR NEGLECTED. FAMILY SERVICE AGENCY 14 HEALTH SERVICES DRIVE DEKALB IL 60115 362360012 501(C)(3) 25000 TO SUPPORT A COMPREHENSIVE, CHILD APPROPRIATE AND MULTIDISCIPLINARY RESPONSE TO REPORTS OF CHILD SEXUAL AND SEVERE PHYSICAL ABUSE IN DEKALB COUNTY. SAFE PASSAGE PO BOX 621 DEKALB IL 60115 363108372 501(C)(3) 10000 FUNDING TO SUPPORT EMERGENCY SHELTER, TRANSITIONAL HOUSING, CRISIS INTERVENTION, TO WOMEN AND CHILDREN WHO ARE VICTIMS OF DOMESTIC VIOLENCE. FAMILIES FOR HOPE HAVEN 1145 RUSHMORE DRIVE DEKALB IL 60115 363537762 501(C)(3) 10000 FUNDING FOR FOOD, SHELTER, SUPPORTIVE SERVICES TO HOMELESS INDIVIDUALS AND FAMILIES OF DEKALB COUNTY. SYCAMORE PARK DISTRICT 940 EAST STATE STREET SYCAMORE IL 60178 366006122 GOVERNMENT ENTITY 5300 FUNDING SUPPORT EVENTS AND PURCHASE SUPPLIES/EQUIPMENT FOR PROGRAMS OFFERED. DEKALB COUNTY CHAMBER OF COMMERCE 164 E LINCOLN HIGHWAY DEKALB IL 60115 360981630 501(C)(6) 7000 TO PROVIDE FINANCIAL ASSISTANCE TO PROMOTE BUSINESSES AND ORGANIZATIONS IMPACTING THE COMMUNITY HEALTH AND SAFETY. DEKALB COUNTY EDC 421 N CALIFORNIA STREET BUILDING 1B SUITE 200 SYCAMORE IL 60178 363524353 501(C)(3) 12500 FUNDING TO SUPPORT WORKFORCE DEVELOPMENT FOR DEKALB COUNTY RESIDENTS. KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649080 501(C)(3) 23091286 TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF COMMUNITY SOCIAL SERVICES KISHWAUKEE COLLEGE FOUNDATION 21193 MALTA ROAD MALTA IL 60150 237433940 501(C)(3) 22500 FUNDING FOR EDUCATION SCHOLARSHIPS, SPECIFIC TO HEALTH CARE EDUCATION FOR STUDENTS ATTENDING THE COLLEGE. NORTHERN PUBLIC RADIO 801 N FIRST STREET DEKALB IL 60115 366086819 501(C)(3) 10078 THE MISSION OF NORTHERN PUBLIC RADIO IS TO ENRICH, INSPIRE, AND INFORM ADULTS IN NORTHERN ILLINOIS THROUGH PROGRAMS AND SERVICES THAT SHARE IDEAS, ENCOURAGE THOUGHT, GIVE PLEASURE, AND CREATE COMMUNITY. OSF SAINT ANTHONY FOUNDATION 5666 E STATE ST ROCKFORD IL 61108 371259284 501(C)(3) 7500 FUNDING TO SUPPORTS THE ANIMAL ASSISTED PRGRAMS AND LEVEL 3 TRAUMA BURN PROGRAM. DEKALB PUBLIC LIBRARY 309 OAK STREET DEKALB IL 60115 366005846 GOVERNMENT ENTITY 100000 FUNDING TO SUPPORT THE PROGRAM EXPANSION OF DEKALB LIBRARY'S COMPUTER LAB THAT IS AVAIALBALBE TO THE GENERAL PUBLIC USE. 16 3 KISHWAUKEE HOSPITAL AUXILIARY SCHOLARSHIP PROGRAM 20 21039 PART I, LINE 2: THE ORGANIZATION MAINTAINS SPECIFIC POLICIES AND QUALIFICATIONS FOR ALL GRANTS AVAILABLE. APPLICANTS MUST APPLY FOR THE RESPECTIVE GRANT AND BE APPROVED BY THE FUNDS GOVERNING BOARD. THE USE OF THE FUNDS IS MONITORED BY THE GOVERNING BOARD OF KISHWAUKEE HOSPITAL. REQUESTS FOR FINANCIAL ASSISTANCE FROM OTHER CHARITABLE ORGANIZATIONS ARE REVIEWED AND APPROVED BY THE VP - FINANCE OF KISHHEALTH SYSTEM. IF NECESSARY DUE TO THE DOLLAR AMOUNT OF THE REQUEST, THESE ITEMS MAY ALSO BE PRESENTED TO THE BOARD OF DIRECTORS. A BUDGET IS SET ANNUALLY FOR CHARITABLE ASSISTANCE TO OTHER ORGANIZATIONS. 0 1 0 0 0 0 0 0 0 KEVIN POORTEN PRESIDENT & CEO, KISHHEALTH SYSTEM 0 616000 0 196800 0 60000 0 108400 0 21296 0 1002496 0 0 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 0 277525 0 51100 0 0 0 69300 0 18632 0 416557 0 0 BRAD COPPLE PRESIDENT - KH & VWH 0 318347 0 59000 0 0 0 38900 0 20620 0 436867 0 0 PAM DUFFY CNO & VP PATIENT CARE SVCS 0 225599 0 51400 0 0 0 23808 0 7516 0 308323 0 0 JOESPH DANT VP BUSINESS DEVELOPMENT 0 234774 0 54500 0 0 0 22538 0 19919 0 331731 0 0 MICHAEL KOKOTT ASST VP MKTG & PLANNING 0 175715 0 24300 0 0 0 16075 0 12769 0 228859 0 0 ROGER HEATH BELL VP AND CIO 0 246628 0 45800 0 0 0 19416 0 25169 0 337013 0 0 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 0 366770 0 100300 0 0 0 54000 0 19919 0 540989 0 0 DAVID PROULX ASSISTANT VP OPERATIONS 0 162297 0 22600 0 0 0 35475 0 19683 0 240055 0 0 MICHELE MCCLELLAND VP OF HUMAN RESOURCES 0 199252 0 38000 0 0 0 20942 0 19727 0 277921 0 0 ANJU VOHRA TECHNICAL DIRECTOR - ECHO 139584 0 0 0 0 0 8594 0 24377 0 172555 0 0 0 THOMAS WARZECHA DIRECTOR OF PHARMACY 152380 0 0 0 0 0 9359 0 24395 0 186134 0 0 0 LISA ACKLAND DIRECTOR OF NURSING 139393 0 8078 0 7920 0 8871 0 32141 0 196403 0 0 0 CYNTHIA TUCKER DIRECTOR OF REHAB SERVICES 121611 0 14125 0 0 0 7064 0 24882 0 167682 0 0 0 CHESTER SIMMONS PHARMACIST 134048 0 0 0 0 0 8262 0 24387 0 166697 0 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE METHODS DESCRIBED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. PART I, LINE 4B THE ORGANIZATION'S EXECUTIVES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2014 RELATED TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF KISHHEALTH FOUNDATION WERE $273,900. THIS CONTRIBUTION REFLECTS AMOUNTS DUE FOR THE FISCAL YEAR ENDING APRIL 30, 2015. THE ORGANIZATION'S CEO PARTICIPATES IN TWO ADDITIONAL NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2014 WERE $60,000. DURING FY15, THE CEO TOOK A DISTRIBUTION FROM THE DEFERRED COMPENSATION PLAN IN THE AMOUNT OF $60,000. THIS DISTRIBUTION IS INCLUDED AS W-2 WAGES, HOWEVER THE ACCRUAL OF THE DEFERRED COMPENSATION PAYMENTS HAS ALSO BEEN INCLUDED AS OTHER COMPENSATION ON PRIOR YEAR FORM 990S. A ILLINOIS FINANCE AUTHORITY 861091967 452032AJ4 2008-08-22 63685000 CURRENT REFUNDING OF 2005 BONDS FOR CONSTRUCTION OF NEW FACILITY FOR KCH 0 1 0 A 3910000 63371994 328434 63043560 2008 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/31/2013 FORM 990, PART VI, SECTION A, LINE 6 KISHHEALTH SYSTEM IS THE SOLE MEMBER OF KISHWAUKEE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER AND PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL, KISHHEALTH SYSTEM HAS THE RIGHT TO APPROVE THE ELECTION OF MEMBERS OF THE HOSPITAL'S GOVERNING BOARD, PER THE HOSPITAL'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL (KH). PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF KH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER. PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF KH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER: A. ELECTING THE MEMBERS OF THE KH BOARD B. APPROVING, EVALUATING AND/OR REMOVING THE PRESIDENT AND CEO AND REVIEWING AND APPROVING THE EMPLOYMENT CONTRACT OF THE PRESIDENT AND CEO AND ESTABLISHING COMPENSATION FOR SUCH OFFICE C. APPROVING THE STRATEGIC PLAN FOR KH D. APPROVING THE DISPOSITION OF ANY ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS FOR KH E. APPROVING ANY CHANGE IN MEMBERSHIP OF KH F. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION AND BYLAWS OF KH G. APPROVING A PLAN OF MERGER OR A PLAN OF CONSOLIDATION OF KH OR ESTABLISHING A NEW SUBSIDIARY OR SISTER ENTITY H. APPROVING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF KH I. INITIATING, TAKING ANY AND ALL ACTIONS, AND EXERCISING ALL APPROVAL RIGHTS OF THE DIRECTORS PURSUANT TO THE APPLICABLE MEDICAL STAFF BYLAWS J. IMPLEMENTING AND MONITORING KH OPERATIONAL QUALITY IMPROVEMENT POLICIES AND PROGRAMS K. ACCEPTING GIFTS, GRANTS, BEQUESTS AND DONATIONS ON BEHALF OF KH L. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR KH M. EXERCISING ANY RIGHTS THAT KH HAS AS A SHAREHOLDER OR MEMBER OF ANY SUBSIDIARY ENTITY N. APPROVING ANY AFFILIATIONS OF KH O. APPROVING AND/OR DETERMINING (I) THE CREATION OF NEW HEALTH SERVICES TO BE PROVIDED AND THE LOCATION OF SUCH HEALTH SERVICES AND (II) THE DISCONTINUANCE OF ANY HEALTH SERVICE P. AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF KH Q. AUTHORIZING THE VOLUNTARY DISSOLUTION OF KH, OR REVOKING THE PROCEEDINGS THEREOF R. REQUIRING MINUTES OF MEETINGS, FINANCIAL RECORDS, AND SUCH OTHER INFORMATION AS MAY BE NECESSARY TO PROPERLY EVALUATE THE PERFORMANCE OF KH S. INITIATING ACTION TO REMOVE OR REINSTATE A DIRECTOR WHEN, IN THE OPINION OF THE KHS BOARD, IT IS IN THE BEST INTERESTS OF KHS OR KH. ANY ACTION TO REMOVE OR REINSTATE SHALL REQUIRE A MAJORITY VOTE OF THOSE KHS DIRECTORS THEN IN OFFICE PRESENT AND VOTING AT A MEETING OF THE KHS BOARD AT WHICH A QUORUM IS PRESENT. IN ANY ACTION(S) TO REMOVE TAKEN BY THE KHS BOARD, THE DIRECTOR IN QUESTION SHALL BE ADVISED AT LEAST TWENTY (20) DAYS PRIOR TO THE MEETING THAT THE ACTION WILL BE CONSIDERED AND SHALL BE GIVEN THE OPPORTUNITY TO MAKE A STATEMENT, PRESENT WITNESSES ON HIS/HER BEHALF AND QUESTION THOSE PRESENTING REASONS FOR HIS/HER REMOVAL. ALL ACTIONS TO REMOVE SHALL BE TAKEN IN CLOSED SESSIONS OF THE KHS BOARD AND T. TRANSFERRING MONEY OR PROPERTY AMONG KH, KHS AND/OR ONE OR MORE SUBSIDIARY CORPORATIONS AND TRANSFERRING MONEY OR PROPERTY FROM A SUBSIDIARY CORPORATION, INCLUDING REQUIRING THE DIRECTORS, OFFICERS, OR TRUSTEES OF ANY SUBSIDIARY CORPORATION TO TRANSFER MONEY OR OTHER PROPERTY TO KHS. SUBJECT TO THE POWERS OF THE BOARD OF DIRECTORS OF EACH SUBSIDIARY CORPORATION, THE KHS BOARD MAY INITIATE AND TAKE THE FOREGOING ACTIONS ON BEHALF OF KHS AND THE SUBSIDIARY CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ARE ALSO PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW. THE CHAIR OF THE AUDIT COMMITTEE AND THE AUDIT COMMITTEE MEMBERS ARE ALSO PROVIDED DRAFT COPIES AND REVIEW. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS COVERED BY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND CONSIDERED INTERESTED PERSONS, INCLUDE MEMBERS OF THE BOARD OF DIRECTORS OF ANY ENTITY WITHIN THE HEALTH SYSTEM, KISHHEALTH SYSTEM OFFICERS, ANY COMMITTEE MEMBER, ANY INDIVIDUAL WITH ULTIMATE RESPONSIBILITY FOR IMPLEMENTING BOARD DECISIONS OR SUPERVISING THE MANAGEMENT, ADMINISTRATION, OR OPERATION OF THE ORGANIZATION, AND IMMEDIATE FAMILY MEMBERS OF THOSE LISTED. IT IS THE DUTY OF THESE INTERESTED PERSONS TO SELF-DISCLOSE ANY CONFLICTS OF INTEREST. CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE KISHHEALTH SYSTEM GOVERNANCE COMMITTEE ON AN ONGOING BASIS. IF IT IS DETERMINED THAT AN INDIVIDUAL FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE INDIVIDUAL OF SUCH A BELIEF AND AFFORD HIM AN OPPORTUNITY TO EXPLAIN. AFTER SAID EXPLANATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION AS DEEMED NECESSARY. AN INTERESTED PERSON DEEMED TO HAVE A CONFLICT MUST NOT BE PRESENT DURING DISCUSSION OR VOTES RELATED TO THE TRANSACTION. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 KISHWAUKEE HOSPITAL IS NOT DIRECTLY INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT, AS THE INDIVIDUALS ARE EMPLOYED THROUGH KISHHEALTH SYSTEM. KISHHEALTH SYSTEM DOES COMPLY WITH THE REQUIREMENTS NOTED ABOVE. THROUGH THE OVERSIGHT OF THE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE, THE KISHHEALTH SYSTEM EXECUTIVE TOTAL COMPENSATION PROGRAM WILL BE COMPETITIVELY POSITIONED IN THE MARKET PLACE OF RELEVANT ORGANIZATIONS AND FALL WITHIN THE SAFE HARBOR GUIDELINES ESTABLISHED BY THE INTERMEDIATE SANCTIONS RULES. THE EXECUTIVE COMPENSATION COMMITTEE IS MADE UP OF THREE MEMBERS OF THE BOARD OF DIRECTORS WHO MEET THE BOARD APPROVED DEFINITION OF INDEPENDENT DIRECTORS. ANNUALLY THE EXECUTIVE COMPENSATION COMMITTEE CONTRACTS WITH SULLIVAN, COTTER AND ASSOCIATES, AN INDEPENDENT HUMAN RESOURCES CONSULTING FIRM TO PROVIDE THE COMMITTEE ANALYSIS AND COMPARABILITY DATA. USING THE SUPPLIED DATA THE COMPENSATION COMMITTEE APPROVES EACH EXECUTIVE'S TOTAL CASH COMPENSATION AND PROVIDES CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. TOTAL CASH COMPENSATION IS DEFINED AS THE SUM OF BASE SALARIES PLUS INCENTIVE AWARDS. BASED ON THE COMPARABILITY DATA AND THE PERFORMANCE OF EACH EXECUTIVE IN MEETING GOALS AND STRATEGIC OBJECTIVES, THE EXECUTIVE COMPENSATION COMMITTEE APPROVES INCREASES AND INCENTIVE AWARDS FOR EACH EXECUTIVE WITHIN THE GUIDELINES ESTABLISHED. THE EXECUTIVE COMPENSATION COMMITTEE REPORTS ON ALL COMPENSATION MATTERS TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED PERSONNEL: PROGRAM SERVICE EXPENSES 322,431. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,431. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,803,026. MANAGEMENT AND GENERAL EXPENSES 246,743. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,049,769. OTHER CONSULTING: PROGRAM SERVICE EXPENSES 16,496. MANAGEMENT AND GENERAL EXPENSES 286,173. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 302,669. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 695,448. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 695,448. LAB FEES: PROGRAM SERVICE EXPENSES 943,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 943,340. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,611,630. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,611,630. PHYSICIAN RECRUITMENT: PROGRAM SERVICE EXPENSES 974,898. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 974,898. COLLECTION FEES: PROGRAM SERVICE EXPENSES 25,758. MANAGEMENT AND GENERAL EXPENSES 816,010. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 841,768. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 1,065,069. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,065,069. FORM 990, PART XI, LINE 9: CHANGE OF INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION -548,057. BOOK/TAX DIFFERENCES IN K-1 PASSTHROUGH ENTITIES -27,934. OTHER ADJUSTMENTS -116,832. LIABILITIES GROUPED WITH EXPENSES ON FINANCIAL STATEMENT -34,372. EQUITY ADJUSTMENT -332,539. FORM 990, PART XI, LINE 3C: RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STMTS NO CHANGES IN THIS PROCESS WERE MADE DURING THE TAX YEAR. THE ORGANIZATION MAINTAINS AN INDEPENDENT AUDIT COMMITTEE WHICH IS RESPONSIBLE FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS. THIS COMMITTEE IS ALSO RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR. MEMBERS OF THE AUDIT COMMITTEE ARE ALSO MEMBERS OF THE KISHHEALTH SYSTEM BOARD OF DIRECTORS. KISHEALTH SYSTEM IS THE PARENT CORPORATION OF KISHWAUKEE HOSPITAL. KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649080 PARENT ORGANIZATION OF 501(C)(3) HEALTH SYSTEM IL 501(C)(3) 11B N/A 0 VALLEY WEST COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 364244337 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 DEKALB COUNTY HOSPICE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363164329 HEALTHCARE SERVICES, HOSPICE SERVICES IL 501(C)(3) 7 KISHHEALTH SYSTEM 0 KISHHEALTH FOUNDATION ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649077 SUPPORT OF KISHWAUKEE HEALTH SYSTEM NOT FOR PROFIT ENTITIES IL 501(C)(3) 7 KISHHEALTH SYSTEM 0 COMMUNITY CARES CLINIC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 800424001 HEALTHCARE SERVICES, PRIMARY CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 KISHWAUKEE PHYSICIANS GROUP INC 2240 GATEWAY DRIVE SYCAMORE IL 60178 651293967 HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 CENTER FOR FAMILY HEALTH - MALTA ONE KISH HOSPITAL DRIVE DEKALB IL 60115 800869393 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 KISHHEALTH SYSTEM HOME CARE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 371703513 HEALTHCARE SERVICES, HOME CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 KISHWAUKEE AREA PHO ONE KISH HOSPITAL DRIVE DEKALB IL 60115 364205273 MEDICARE SERVICES IL KISHWAUKEE COMMUNITY HOSPITAL INVESTMENT -20055 3091 0 0 0.50000 THE MIDLAND SURGICAL CENTER LLC 3085 WOLF COURT DEKALB IL 60115 352194610 SURGICAL SERVICES IL KISHWAUKEE COMMUNITY HOSPITAL INVESTMENT 716167 691999 0 0 0.74500 HEALTH VENTURES LLC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 753255958 RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES IL N/A ILLINOIS REGIONAL CANCER CENTER 10 HEALTH SERVICES DRIVE DEKALB IL 60115 363847273 CANCER TREATMENT SERVICES IL N/A HEALTH PROGRESS INC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363824138 INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESS IL N/A C 0 0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1