2016-01-29T14:05:20-06:00 2015-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2014-05-01 364244337 VALLEY WEST COMMUNITY HOSPITAL VALL 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 VALLEY WEST HOSPITAL KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 60273452 0 X WWW.KISHHEALTH.ORG X 1998 IL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES IN THE AREAS OF DEKALB, KENDALL, AND LASALLE COUNTIES. 3 2 307 54 3072 2072 1510551 147721 45139967 47433837 2138634 1779051 88216 131021 48877368 49491630 77943 3333019 0 0 16167422 15300589 0 0 0 26254345 26778764 42499710 45412372 6377658 4079258 68161198 72419927 8966698 10038584 59194500 62381343 X TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREAS OF DEKALB, KENDALL, AND LASALLE COUNTIES. VALLEY WEST HOSPITAL WILL STRIVE TO PROVIDE HIGH QUALITY PRIMARY CARE AND COMMUNITY HEALTH EDUCATION, WHILE PROMOTING COMMUNITY HEALTH SERVICES IN A FRIENDLY, CARING ENVIRONMENT. VALLEY WEST HOSPITAL IS COMMITED TO PROVIDING HEALTH CARE IN ACCORDANCE WITH THE HIGHEST MEDICAL AND ETHICAL STANDARDS WITH CARE, COMPASSION, AND RESPECT FOR ALL, PROTECTING THE DIGNITY, AUTONOMY AND INTEGRITY OF ALL OUR PATIENTS, WHILE MANAGING THE MEDICAL RESOURCES AT OUR DISPOSAL WITH WISDOM AND FAIRNESS. 0 0 37443515 3333019 47433837 VALLEY WEST HOSPITAL (VALLEY WEST), LOCATED IN SANDWICH, ILLINOIS, SERVES THE RESIDENTS OF SOUTHERN DEKALB, NORTHERN LASALLE AND WESTERN KENDALL COUNTIES BY OFFERING A NUMBER OF PROGRAMS AND SERVICES THAT GO BEYOND BASIC HEALTH CARE. VALLEY WEST 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 OF OUR CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE.THE COMMUNITY BENEFIT OBJECTIVES OF VALLEY WEST 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. ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR VALLEY WEST HOSPITAL'S 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, BEHAVORIAL 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, 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* 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 COMMUNITY HEALTH OR HELP THE HOSPITAL CONNECT TO UNDERSERVED OR VULNERABLE POPULATIONS.THE HOSPITAL FOCUSED ON THE FOLLOWING COMMUNITY HEALTH NEEDS IN FY15: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.O DURING THE COURSE OF THE FISCAL YEAR, KISH PHYSICIAN GROUP EXPANDED SERVICES TO TWO ADDITIONAL LOCATIONS INCLUDING AURORA AND DEKALB AND 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. SUPPORT 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.O DURING THIS LAST YEAR VALLEY WEST HOSPITAL HAS SUPPORTED STAFF PARTICIPATION ON THE LIVE HEALTHY DEKALB COUNTY LEADERSHIP BOARD AND SEVERAL OF THE SUB-COMMITTEES INCLUDING: ACTIVE TRANSPORTATION AND THE FOOD SECURITY COUNCIL.O WORKSITE WELLNESS COMMITTEE WAS FORMED AND PLANNED 3 WORKSHOPS FOR THE BUSINESS COMMUNITY INCLUDING SESSIONS ON SMOKING CESSATION, PHYSICAL ACTIVITY AND HEALTHY FOOD AND BEVERAGE.CONDUCT INDIVIDUAL KNOW YOUR NUMBERS APPOINTMENTS WITH EXPANDED WELL COACH SESSION TO IDENTIFIED INDIVIDUALS.GOAL: PROVIDE SCREENING ON CHOLESTEROL AND BLOOD SUGAR LEVEL, BLOOD PRESSURE AND WAIST MEASUREMENT AND BODY MASS INDEX (BM/) TO ASSESS RISK FACTOR LEADING TO ADVERSE HEALTH CONDITIONS.O DURING THE YEAR THERE WERE 19 SESSIONS OFFERED FOR THE COMMUNITY TO PARTICIPATE IN BIOMETRIC SCREENINGS, WITH A TOTAL OF 66 PARTICIPANTS.ACQUIRE BABY FRIENDLY HOSPITAL ACCREDITATIONGOAL: INCREASE THE NUMBER OF MOTHERS BREASTFEEDING THROUGH EDUCATION AND POLICY CHANGES WITHIN THE HOSPITAL TO LOWER RISK FOR CERTAIN DISEASE AND IMPROVE HEALTH OUTCOMES FOR BOTH MOTHER AND BABY.O KISHWAUKEE HOSPITAL'S INTERNAL TEAM IS WORKING ON A PLAN TO IMPLEMENT NECESSARY STEPS TO ACQUIRE BABY FRIENDLY DESIGNATION.O THIS PAST YEAR STAFF HAS COMPLETED THE DEVELOPMENT PHASE WHICH INCLUDED THE FOLLOWING:O CONVENE A BABY FRIENDLY COMMITTEE/TASK FORCEO DEVELOP A BABY FRIENDLY HOSPITAL INITIATIVE WORK PLANO DEVELOP A COMPREHENSIVE HOSPITAL INFANT FEEDING POLICYO DEVELOP STAFF STRAINING PLAN/CURRICULUMO THE DISSEMINATION PHASE IS IN PROCESS AND INCLUDES:O ROLL OUT OF POLICY AND PLANSO STAFF TRAINING AND PATIENT EDUCATION ON BABY FRIENDLY HOSPITAL DESIGNATIONO DATA COLLECTIONEXPAND PARTNERSHIP WITH FOX VALLEY OLDER ADULT SERVICES TO PROMOTE FITNESS, B/P SCREENING, FALL PREVENTION PROGRAM, COPD, DIABETES SCREENINGS OR MENTAL HEALTH EDUCATION.GOAL: EXPAND SERVICES TARGETED AT OLDER ADULTS THROUGH NEW PARTNERSHIPS WITH FOX VALLEY OLDER ADULT SERVICES.O THROUGHOUT THE YEAR, MONTHLY EDUCATIONAL AND WELLNESS TOPICS AND SENIOR FITNESS PROGRAMS WERE PROVIDED. THERE 17 SESSIONS WITH 85 PARTICIPANTS.TARGET INGREDIENTS FOR HEALTHY LIVING SESSIONS TO IDENTIFIED HIGH RISK POPULATIONS.GOAL: PROMOTE HEALTHIER DIET CHOICES AND FOOD PREPARATION THROUGH EDUCATION AND INSTRUCTION.O DURING THE YEAR THERE WERE 4 SESSIONS OFFERED FOR THE COMMUNITY TO PARTICIPATE IN INGREDIENTS FOR HEALTHY LIVING SESSIONS WITH A TOTAL OF 11 PARTICIPANTS. A NOTED DECREASE IN PROGRAM SESSIONS AND ATTENDANCE IS ATTRIBUTED TO THE CONSTRUCTION OF THE NEW CULINARY KITCHEN.O KIDS CAN COOK, A PROGRAM OFFERED TO AGES 8 -11, TEACHES KITCHEN SKILLS TO MAKE HEALTHY RECIPES, HOW TO DEVELOP MYPLATE EATING HABITS, AND HOW TO INCORPORATE PHYSICAL ACTIVITY INTO DAILY LIVES. THERE WERE 6 HANDS ON SESSIONS OFFERED AND A TOTAL OF 67 PARTICIPANTS.IDENTIFY AND CREATE NEW PARTNERSHIPS WITH ORGANIZATIONS AND/OR BUSINESSES TO WORK WITH TO PROMOTE HEALTHIER LIFESTYLE CHOICES.GOAL: PROMOTE HEALTHIER LIFESTYLES THROUGH EDUCATIONO DURING THE YEAR THERE WERE SEVERAL NEW PARTNERSHIPS DEVELOPED, INCLUDING BUT NOT LIMITED TO; CORNERSTONE CHURCH, SHABBONA UNITED CHURCH OF CHRIST, OUR SAVIOR'S LUTHERAN CHURCH, CORNERSTONE FOOD PANTRY, THE STORE AT HARVEST CHAPEL, IGLESIAS LUTHERANA CROSS PLANO MISSION, N.L.C.E. CENTER, ST. JOHN'S LUTHERAN CHURCH, AND THE UNITED NEIGHBORHOOD CENTER, TO PROMOTE A HEALTHIER LIFESTYLE.FACILITATE AND PROVIDE SUPPORT FOR ALLIANCE FOR HEALTHIER GENERATION HEALTHY SCHOOLS PROGRAM IN PLANO, SANDWICH OR SOMONAUK.GOAL: THE HEALTHY SCHOOLS PROGRAM FOCUSES ON STUDENTS, PARENTS AND SCHOOL STAFF TO DETERMINE WHAT CAN BE DONE TO ACHIEVE THE COMMON GOAL OF A HEALTHY SCHOOL.O CURRENTLY RECEIVING DIRECT SUPPORT FROM THE ALLIANCE FOR A HEALTHIER GENERATION FOR THE THREE LARGEST DISTRICTS IN OUR SERVICE AREA. SCHOOL POLICIES DETERMINE THE SCHOOL ENVIRONMENT. THE HEALTHY SCHOOLS PROGRAM WORKS TO CREATE HEALTHY CHANGE WITHIN THE SCHOOL ENVIRONMENT. THE HEALTHY SCHOOLS PROGRAM ENCOURAGES SCHOOLS TO FOLLOW THE SIX STEPS TO A HEALTHIER SCHOOL- THE "ROADMAP" FOR MAKING SCHOOL HEALTH CHANGES. IT IS A CIRCULAR JOURNEY WHERE SCHOOLS CONTINUOUSLY TAKE A STATUS CHECK, WORK ON MAKING IMPROVEMENTS, LEARN FROM SUCCESSES AND CHALLENGES AND KEEP PUSHING THE NEEDLE FORWARD. WHEN SCHOOLS REPEAT THE CYCLE EACH YEAR, IT BECOMES EMBEDDED IN THE CULTURE OF THE SCHOOL AND EFFORTS TO BECOME A HEALTHY SCHOOL ARE SUSTAINED.O HOSTED 2 PROFESSIONAL LEADERSHIP DEVELOPMENT PROGRAMS FOR OVER 50 STAFF MEMBERS FROM THE THREE SCHOOL DISTRICTSO ALL FOURTEEN SCHOOLS INVOLVED IN THE PROGRAM COHORT COMPLETED THEIR SCHOOL HEALTH INDEX ASSESSMENT AND ACTIVATED ACTION PLANSO ACCOMPLISHED 5 KYN EVENTS WITHIN PLANO SCHOOL DISTRICT WITH 90 PARTICIPANTSO FACILITATED 5, 10-K-A-DAY WALKING CHALLENGES AMONGST THE DISTRICTS WITH A TOTAL PARTICIPATION OF 589 STAFF MEMBERS THROUGHOUT THE SERVICE AREA.FACILITATE AND PROVIDE SUPPORT TO THE COMMUNITY HEALTH NETWORK.GOAL: IMPLEMENT THE COMMUNITY HEALTH NETWORK IN THE VALLEY WEST SERVICE AREA. THIS INITIATIVE HELPS TO CONNECT PEOPLE TO NEEDED RESOURCES AND EMPOWER ORGANIZATIONS TO HELP THEIR MEMBERS LEAD HEALTHIER LIV 37443515 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 46 0 1 307 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 FINANCE 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 JAGDISH PATEL CHAIR 1.00 2.00 X X 0 0 0 TERRENCE DUFFY VICE-CHAIR 1.00 2.00 X X 0 0 0 KEVIN POORTEN PRESIDENT & CEO - KISHHEALTH SYSTEM 4.00 51.00 X X 0 872800 129696 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 5.00 47.00 X 0 328625 87932 BRAD COPPLE PRESIDENT - KH & VWH 23.00 30.00 X 0 377347 59520 PAM DUFFY CNO & VP PATIENT CARE SVCS 5.00 40.00 X 0 276999 31324 MICHAEL KOKOTT ASST. VP MKTG & PLANNING 5.00 40.00 X 0 200015 28844 ROGER HEATH BELL VP AND CIO 10.00 37.00 X 0 292428 44585 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 10.00 42.00 X 0 467070 73919 DAVID PROULX ASSISTANT VP OPERATIONS 42.00 11.00 X 0 184897 55158 JOSEPH DANT VP BUSINESS DEVELOPMENT 0.00 47.00 X 0 289274 42457 MICHELE MCCLELLAND VP OF HUMAN RESOURCES 5.00 45.00 X 0 237252 40669 SUE HOHENBERGER DIRECTOR OF PHARMACY 45.00 0.00 X 152784 0 24531 ALTHEA R RUSSELL RN 45.00 0.00 X 143915 0 28507 ALEX P LOMAHAN PHARMACIST 45.00 0.00 X 134545 0 18917 MUHAMMAD QASIM CARDIAC SONOGRAPHER 45.00 0.00 X 154923 0 34493 BARBARA DOBSON HOUSE SUPERVISOR 45.00 0.00 X 119072 0 34262 705239 3526707 734814 9 0 1 0 ERDMAN COMPANY PO BOX 88670 MILWAUKEE WI 53288 CONSTRUCTION SERVICES 3660610 KISH HEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 MANAGEMENT SERVICES 3419227 DOCTORS OF EMERGENCY MEDICINE 5 N 327 SWITCH GRASS LANE ST CHARLES IL 60175 MEDICAL SERVICES 1031960 MRI ASSOCIATES LLC 800 ROOSEVELT ROAD GLEN ELLYN IL 60137 MEDICAL SERVICES 549197 MIDWEST ORTHOPAEDIC INSTITUTE PC 1952 ABERDEEN COURT SYCAMORE IL 60178 MEDICAL SERVICES 451016 12 54512 14281 78928 147721 NET PATIENT SERVICE REVENUE 621110 47433837 47433837 47433837 1136720 1136720 151016 9672 180057 6600 -29041 3072 -25969 3072 -29041 11238055 868 10596592 0 641463 868 642331 642331 6058 -1427 7485 7485 DIETARY/CAFETERIA SALES 621110 102751 102751 OTHER INCOME 621110 32185 32185 DISCOUNTS AND REBATES 621110 14569 14569 149505 49491630 47433837 3072 1907000 X 3333019 3333019 11657815 10937273 720542 581093 545177 35916 2220940 2083669 137271 840741 788777 51964 3693314 3693314 40287 40287 2856 2856 86942 86942 7810602 7408705 401897 203089 81633 121456 1307872 671198 636674 303116 33936 269180 1172969 1160187 12782 77370 48201 29169 77120 77120 3000615 2998521 2094 1796956 233307 1563649 UNRELATED BUSINESS INCO 496 496 MEDICAL SUPPLIES 3276284 3273139 3145 BAD DEBT EXPENSE 2717648 2717648 FEDERAL AND STATE ASSES 941848 941848 269380 187277 82103 45412372 37443515 7968857 0 1185612 2087029 6448778 7756105 4979958 5644506 1608511 1598983 796707 901203 52550928 26049303 27555389 26501625 23008977 25789625 395683 196339 2181583 1944512 68161198 72419927 4762468 3670580 1473432 1188025 2730798 5179979 8966698 10038584 X 58960586 62134622 233914 246721 59194500 62381343 68161198 72419927 X 4079258 -900959 8544 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 17517 17517 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. 1279463 1279463 25467351 8628119 16839232 420249 188130 232119 22361653 17233054 5128599 3022212 3022212 26501625 IBNR RESERVE 198887 LEASE OBLIGATION PAYABLE 273627 DUE TO AFFILIATES 3567653 ESTIMATED SETTLEMENTS DUE 1116822 OTHER LONG TERM LIABILITIES 22990 5179979 X 45033034 186657 186657 44846377 4645253 4645253 49491630 39656517 186657 186657 39469860 5942512 5942512 45412372 PART X, LINE 2: VALLEY WEST HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. VALLEY WEST 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: RENTAL EXPENSES 186,657. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION REVENUE FROM KISHHEALTH FOUNDATION 54,512. COST OF GOODS SOLD 1,427. NONOPERATING INCOME 1,871,666. BAD DEBT EXPENSE 2,717,648. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE FOR 990 PURPOSES 186,657. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED WITH REVENUE FOR FINANCIAL STATEMENT PURPOSES 2,717,648. EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM, INC 3,223,437. COST OF GOODS SOLD 1,427. 1 1 X 1 X 1 X 1 1 1 0 1 1 949848 0 949848 0.02220 7550615 5863911 1686704 0.03950 8500463 5863911 2636552 0.06170 1699172 11156 1688016 0.03950 25063 0 25063 0.00060 1231322 277881 953441 0.02230 153895 0 153895 0.00360 3109452 289037 2820415 0.06600 11609915 6152948 5456967 0.12770 1 2717648 0 5782584 7722787 -1940203 X 1 1 1 1 VALLEY WEST HOSPITAL 11 EAST PLEASANT AVE SANDWICH IL 60548 WWW.KISHHEALTH.ORG 0004690 X X X X VALLEY WEST 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 300.000000000000 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 VALLEY WEST 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 VALLEY WEST 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 COMMUNITY 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* KEVIN POORTEN, PRESIDENT & CEO, KISHHEALTH SYSTEM* 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* 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 VALLEY WEST HOSPITAL PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDE KISHWAUKEE HOSPITAL. VALLEY WEST HOSPITAL PART V, SECTION B, LINE 11: SEE FORM 990, PART III, LINE 4A FOR A DETAILED DESCRIPTION OF THE ACTIONS TAKEN BY VALLEY WEST 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 TOPIC AREAS IDENTIFIED AND A BRIEF DESCRIPTION WHY THE HOSPITAL DID NOT SELECT TO ADDRESS.PRIORITY IDENTIFIED: ACCIDENTSEXPLANATION FOR NOT ADDRESSING: VALLEY WEST 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: VALLEY WEST HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST 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: VALLEY WEST 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: VALLEY WEST 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: VALLEY WEST HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST 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: VALLEY WEST HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. PRIORITY IDENTIFIED: SUICIDEEXPLANATION FOR NOT ADDRESSING: VALLEY WEST HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST 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: VALLEY WEST HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST 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. VALLEY WEST 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. VALLEY WEST HOSPITAL PART V, SECTION B, LINE 20E: POSTING OF FINANCIAL ASSISTANCE POLICY TO SYSTEM'S WEBSITE. VALLEY WEST 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 VALLEY WEST HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.KISHHEALTH.ORG VALLEY WEST HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.KISHHEALTH.ORG PART I, LINE 3C: IN ADDITION TO FPG GUIDELINES, VALLEY WEST 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 SYSTEMVALLEY WEST 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, EMS SERVICES AND ANESTHESIA SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,717,648. 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. PART III, LINE 4: 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 8: THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT IS UTILIZED IN DETERMINING THE ORGANIZATION'S COMMUNITY BENEFIT. PART III, LINE 9B: COLLECTION ACTIONS INVOLVING UNINSURED PATIENTS. KHS (KISHHEALTH SYSTEM, PARENT ORGANIZATION OF VALLEY WEST 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, VALLEY WEST 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 PREGNANCYOUTCOMES 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, DURING THE BILLING PROCESS ON STATEMENTS, AND VIA PHONE CONVERSATIONS. PART VI, LINE 4: VALLEY WEST HOSPITAL SERVES A PORTION OF DEKALB, KANE, KENDALL AND LASALLE COUNTIES RESIDENTS. UTILIZING ILLINOIS HOSPITAL ASSOCIATION COMP DATA, WHICH MEASURES HOSPITAL ADMISSIONS VALLEY WEST HOSPITAL, HAD 1,172 ADMISSIONS AND 9,003 EMERGENCY DEPARTMENT VISITS IN FISCAL YEAR 2015. IN THE HOSPITAL SERVICE AREA, ESTIMATED AT 71,000 PEOPLE, THE INPATIENT MARKET SHARE IS ROUGHLY 24.12%. PART VI, LINE 5: VALLEY WEST HOSPITAL, A CRITICAL ACCESS HOSPITAL IN SANDWICH, 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 BECAUSE OF THEIR INTEREST AND EXPERTISE IN VARIOUS AREAS THAT CAN HELP MANAGEMENT CARRY OUT THE HEALTH SYSTEM'S MISSION. MEMBERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR TIME. THE MEDICAL STAFF IS OPEN TO PHYSICIANS WHO MEET CRITERIA ESTABLISHED BY THE MEDICAL STAFF BYLAWS. PHYSICIANS ARE GIVEN AND TAKE 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 EXCELLENCE, 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 THREE 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, THE ONCOLOGY DEPARTMENT, AND DIABETES EDUCATION THAT ALSO SPEND TIME ENGAGED IN PROMOTING COMMUNITY HEALTH.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 FOX VALLEY FAMILY YMCA 3875 ELDAMAIN ROAD PLANO IL 60545 363028169 501(C)(3) 26000 UNDERWRITE COST OF HEALTH AND FITNESS PROGRAMS, INCLUDING DISCOUNT FOR EMPLOYEE MEMBERSHIPS AMERICAN CANCER SOCIETY 143 FIRST STREET BATAVIA IL 60510 131788491 501(C)(3) 12500 SUPPORT FOR RELAY FOR LIFE PROGRAM WHICH RAISES FUNDS FOR CANCER RESEARCH AND EDUCATION SANDWICH PARK DISTRICT PO BOX 405 SANDWICH IL 60548 362646087 GOVERNMENT ENTITY 13000 PROMOTE VARIOUS SPORTS AND FITNESS PROGRAMS FOX VALLEY OLDER ADULT SERVICES 1406 SUYDAM ROAD SANDWICH IL 60548 362738669 501(C)(3) 13000 SUPPORT PROGRAMS TO THE SENIOR POPULATION KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649080 501(C)(3) 3223437 TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF COMMUNITY SOCIAL SERVICES. 5 0 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 VALLEY WEST 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 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 JOSEPH DANT VP BUSINESS DEVELOPMENT 0 234774 0 54500 0 0 0 22538 0 19919 0 331731 0 0 MICHELE MCCLELLAND VP OF HUMAN RESOURCES 0 199252 0 38000 0 0 0 20942 0 19727 0 277921 0 0 SUE HOHENBERGER DIRECTOR OF PHARMACY 152784 0 0 0 0 0 8957 0 15574 0 177315 0 0 0 ALTHEA R RUSSELL RN 143915 0 0 0 0 0 4185 0 24322 0 172422 0 0 0 ALEX P LOMAHAN PHARMACIST 134545 0 0 0 0 0 8213 0 10704 0 153462 0 0 0 MUHAMMAD QASIM CARDIAC SONOGRAPHER 154923 0 0 0 0 0 7647 0 26846 0 189416 0 0 0 BARBARA DOBSON HOUSE SUPERVISOR 119072 0 0 0 0 0 7450 0 26812 0 153334 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 VALLEY WEST COMMUNITY HOPSITAL 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 PLANS. 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. THE DISTRIBUTIONS 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. FORM 990, PART VI, SECTION A, LINE 6 KISHHEALTH SYSTEM IS THE SOLE MEMBER OF VALLEY WEST HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER AND PARENT ORGANIZATION OF VALLEY WEST 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 VALLEY WEST HOSPITAL (VWH). PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF VWH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER: A. ELECTING THE MEMBERS OF THE VWH 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 VWH; D. APPROVING THE DISPOSITION OF ANY ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS FOR VWH; E. APPROVING ANY CHANGE IN MEMBERSHIP OF VWH; F. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION AND BYLAWS OF VWH; G. APPROVING A PLAN OF MERGER OR A PLAN OF CONSOLIDATION OF VWH OR ESTABLISHING A NEW SUBSIDIARY OR SISTER ENTITY; H. APPROVING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF VWH; 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 VWH OPERATIONAL QUALITY IMPROVEMENT POLICIES AND PROGRAMS; K. ACCEPTING GIFTS, GRANTS, BEQUESTS AND DONATIONS ON BEHALF OF VWH; L. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR VWH; M. EXERCISING ANY RIGHTS THAT VWH HAS AS A SHAREHOLDER OR MEMBER OF ANY SUBSIDIARY ENTITY; N. APPROVING ANY AFFILIATIONS OF VWH; 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 VWH; Q. AUTHORIZING THE VOLUNTARY DISSOLUTION OF VWH, 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 VWH; 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 VWH. 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 VWH, 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 CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE GOVERANCE 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. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 VALLEY WEST 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 124,228. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 124,228. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,684,285. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,684,285. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 606,219. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 606,219. OTHER CONSULTING: PROGRAM SERVICE EXPENSES 28,554. MANAGEMENT AND GENERAL EXPENSES 110,821. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 139,375. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 2,243,374. MANAGEMENT AND GENERAL EXPENSES 26,080. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,269,454. BROKER FEES: PROGRAM SERVICE EXPENSES 940. MANAGEMENT AND GENERAL EXPENSES 35,605. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,545. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 285,448. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 285,448. PHYSICIAN RECRUITMENT FEES: PROGRAM SERVICE EXPENSES 372,786. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 372,786. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 229,391. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 229,391. LAB PROCESSING FEES: PROGRAM SERVICE EXPENSES 62,871. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,871. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS OF KISHHEALTH FOUNDATION 8,544. 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 VALLEY WEST HOSPITAL. KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649080 PARENT CORPORATION OF 501(C)(3) HEALTH SYSTEM IL 501(C)(3) 11B N/A 0 KISHHEALTH FOUNDATION ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649077 SUPPORT OF CHARITABLE HEALTH ORGANIZATIONS IL 501(C)(3) 7 KISHHEALTH SYSTEM 0 KISHWAUKEE COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 237087041 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 DEKALB COUNTY HOSPICE 2727 SYCAMORE ROAD DEKALB IL 60115 363164329 HOSPICE SERVICES 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 HEALTH VENTURES LLC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 753255958 RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES IL N/A KISHWAUKEE AREA PHO ONE KISH HOSPITAL DRIVE DEKALB IL 60115 364205273 MEDICARE SERVICES IL N/A ILLINOIS REGIONAL CANCER CENTER 10 HEALTH SERVICES DRIVE DEKALB IL 60115 363847273 CANCER TREATMENT SERVICES IL N/A MIDLAND SURGICAL CENTER LLC 3085 WOLF COURT DEKALB IL 60115 352194610 SURGICAL SERVICES IL N/A HEALTH PROGRESS INC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363824138 INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESSES IL N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1