2015-01-12T09:14:18-06:00 2014-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2013-05-01 363649080 KISHHEALTH SYSTEM KISH 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 LOREN FOELSKE VICE PRESIDENT - FINANCE, KHS 8157561521 2014-12-18 1 KELLY JACKSON HARDY P00747242 8152859300 2013 2016-03-07 17:11:31Z KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 24555864 0 X WWW.KISHHEALTH.ORG X 1988 IL MANAGEMENT AND PARENT ORGANIZATION PROVIDING SERVICES TO 501(C)(3) HEALTH SYSTEM 13 10 115 14 0 0 0 0 17928735 20492028 232584 424505 -129031 -148808 18032288 20767725 39269 18207 0 0 11664059 12451561 0 0 0 6147351 8043649 17850679 20513417 181609 254308 27826655 30814855 12659013 15171240 15167642 15643615 X MANAGEMENT AND PARENT ORGANIZATION PROVIDING SERVICES TO 501 (C) (3) HEALTH SYSTEM. WE ARE THE CORNERSTONE OF HEALTH CARE FOR THE COMMUNITIES WE SERVE-THE FIRST CHOICE FOR SERVICE, COMFORT AND SAFETY. AS A COMMUNITY-OWNED HEALTH SYSTEM, THE KISH FAMILY UNSELFISHLY COMMITS TO EXCELLENCE, EDUCATION AND INNOVATION. 0 0 1724643 18207 20492028 KISHHEALTH SYSTEM (KHS) IS THE NON-PROFIT CORPORATE UMBRELLA FOR TWO HOSPITALS, A HOSPICE, CLINIC, HOME HEALTH CARE SERVICE, AND A HEALTH FOUNDATION PREDOMINATELY SERVING RESIDENTS OF DEKALB, KENDALL AND LASALLE COUNTIES IN ILLINOIS. THE MISSION OF THE HEALTH SYSTEM IS TO BE "THE CORNERSTONE OF HEALTH CARE FOR THE COMMUNITIES WE SERVE-THE FIRST CHOICE FOR SERVICE, COMFORT AND SAFETY. AS A COMMUNITY-OWNED HEALTH SYSTEM, THE KISH FAMILY UNSELFISHLY COMMITS TO EXCELLENCE, EDUCATION AND INNOVATION." IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HOSPICE, CENTER FOR FAMILY HEALTH CLINIC, KISHHEALTH HOME CARE, AND KISHHEALTH FOUNDATION, THE HEALTH SYSTEM'S CORPORATE OFFICE PROVIDES COMMUNITY BENEFIT IN THE FOLLOWING AREAS:* KISH HEALTH SYSTEM UNDERWROTE $3,598,000 FOR KISH HEALTH SYSTEM PHYSICIAN GROUP, $504,000 FOR THE TWO CENTERS FOR FAMILY HEALTH CLINICS, $446,000 FOR KISHHEALTH SYSTEM HOMECARE, AND $299,000 FOR KISHHEALTH SYSTEM HOSPICE (DEKALB COUNTY HOSPICE) FOR OPERATIONAL LOSSES IN FISCAL YEAR 2014, 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 IN EXCESS OF $18,000 TO OTHER ORGANIZATIONS WITHIN THE COMMUNITY.KISHHEALTH SYSTEM EMPLOYEES CONTRIBUTED 772 HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH AND EDUCATION. KISH HEALTH SYSTEM LEADERS SERVE ON THE BOARDS OF DIRECTORS FOR LIVE HEALTHY DEKALB COUNTY, FORMERLY KNOWN AS PIONEERING HEALTHY COMMUNITIES, KISHWAUKEE FAMILY YMCA, KISHWAUKEE COLLEGE FOUNDATION, OPPORTUNITY HOUSE, VOLUNTARY ACTION CENTER, DEKALB COUNTY YOUTH SERVICES BOARD, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION; DEKALB, SYCAMORE, GENOA, SANDWICH, AND PLANO CHAMBERS OF COMMERCE; THE CENTER FOR FAMILY HEALTH, FOX VALLEY OLDER ADULT SERVICES, NORTHERN ILLINOIS UNIVERSITY, WABAUNSEE COMMUNITY COLLEGE, AND ST. ANTHONY SCHOOL OF NURSING ADVISORY BOARDS.THE HEALTH SYSTEM'S NON-PROFIT ENTITIES ARE KISHWAUKEE HOSPITAL, A 98-BED HOSPITAL IN DEKALB, IL, SERVING ALL OF DEKALB COUNTY AND BEYOND, VALLEY WEST HOSPITAL, A 25-BED CRITICAL ACCESS HOSPITAL IN SANDWICH; KISH HEALTH SYSTEM HOSPICE, DEKALB, IL, WHICH PROVIDES FREE CARE AND SUPPORT FOR THE TERMINALLY ILL AS WELL AS GRIEF SUPPORT TO THE PUBLIC; CENTER FOR FAMILY HEALTH MALTA, IL, PRIMARY CARE CLINIC FOR MEDICAID AND UNINSURED; KISH HEALTH SYSTEM PHYSICIAN GROUP, WHICH PROVIDES ACCESS TO MEDICAL SERVICES, ESPECIALLY THE RURAL AREAS AND ACCEPTS MEDICAID AND UNINSURED PATIENTS, KISH HEALTH SYSTEM HOMECARE, DEKALB, IL, WHICH PROVIDES HOME HEALTH SERVICES PREVIOUSLY OFFERED THROUGH THE COUNTY HEALTH DEPARTMENT, AND KISH HEALTH FOUNDATION IN DEKALB, IL, WHICH RAISES MONEY FOR THE HEALTH SYSTEM AND FUNDS EQUIPMENT PURCHASES AND PATIENT SERVICES PARTICULARLY IN THE AREA OF CANCER CARE FOR THOSE WHO CANNOT AFFORD. 1724643 1 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 16 0 1 115 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X LOREN FOELSKE VP - FINANCE 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 MICHAEL CULLEN DIRECTOR 2.00 9.00 X 0 0 0 TERRENCE DUFFY DIRECTOR 2.00 1.00 X 0 0 0 MICHAEL LARSON PAST CHAIR 2.00 0.00 X X 0 0 0 JOHN MOULTON VICE CHAIR 2.00 0.00 X X 0 0 0 THOMAS MATYA CHAIR 2.00 3.00 X X 0 0 0 MARY LYNN MCARTOR DIRECTOR 2.00 0.00 X 0 0 0 KEVIN POORTEN DIRECTOR/PRESIDENT & CEO - KISHHEALTH SYSTEM 30.00 25.00 X X 849820 0 223339 JAGDISH PATEL MD DIRECTOR 2.00 1.00 X 0 34425 0 PROMOD VOHRA DIRECTOR 2.00 0.00 X 0 0 0 THOMAS CHOICE 2ND VICE CHAIR 2.00 0.00 X X 0 0 0 PHOTINE LIAKOS MD DIRECTOR 2.00 0.00 X 0 0 0 LEONETTA RIZZI DIRECTOR 2.00 0.00 X 0 0 0 MARC STRAUSS DIRECTOR 2.00 0.00 X 0 0 0 ANN WEST MD DIRECTOR 2.00 1.00 X 0 1250 0 TIMOTHY RUETTEN MD DIRECTOR 2.00 0.00 X 0 22616 0 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 15.00 37.00 X 322928 0 86194 BRAD COPPLE PRESIDENT - KH & VWH 7.00 46.00 X 295129 0 58014 JOSEPH DANT VP BUSINESS DEVELOPMENT 37.00 10.00 X 280047 0 43152 MICHAEL KOKOTT ASST. VP MKTG & PLANNING 25.00 20.00 X 204285 0 28155 ROGER HEATH BELL VP AND CIO 12.00 35.00 X 270954 0 45501 PAM DUFFY VP PATIENT CARE SVCS 20.00 25.00 X 262869 0 31539 MARK THATE VP - HUMAN RESOURCES (RETIRED 12/2013) 25.00 20.00 X 262257 0 23704 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 20.00 32.00 X 418350 0 72044 DAVID PROULX VP OPERATIONS - VWH 3.00 50.00 X 185981 0 55134 CHERYL FISHER DIRECTOR OF RISK MANAGEMENT 45.00 0.00 X 144386 0 36608 CRAIG VILLACORTA DIRECTOR OF INFORMATION SYSTEMS 45.00 0.00 X 120906 0 33789 JEFFERY REIFSTECK TECHNICAL OPERATIONS MANAGEMENT 45.00 0.00 X 111271 0 37860 TODD BARROWCLIFT SENIOR DIRECTOR OF PHYSICIAN OPERATIONS 45.00 0.00 X 165443 0 35877 RICHARD LOVITT DIRECTOR OF ACCOUNTING 45.00 0.00 X 101859 0 11871 3996485 58291 822781 15 0 1 0 REINHART BOERNER VANDEUREN PO BOX 2965 MILWAUKEE IL 532012965 LEGAL SERVICES 1067030 PLUNKETT RAYSICH ARCHITECTS LLP 11000 WEST PARK PLACE MILWAUKEE WI 53224 ARCHITECTURAL SERVICES 697388 AURORA RADIOLOGY 1870 WEST GALENA BLVD AURORA IL 60506 MEDICAL SERVICES 348540 KAUFMAN HALL & ASSOCIATES 5202 OLD ORCHARD ROAD SKOKIE IL 60077 CONSULTING SERVICES 230841 BE SMITH ASSOCIATES INC DEPARTMENT 300 KANSAS CITY MO 64121 STAFFING SERVICES 199974 8 KHS ADMINISTRATION HEALTH SYSTEM 551112 20492028 20492028 20492028 244992 244992 290809 439724 -148915 -148915 -148915 3190548 337380 3182491 165924 8057 171456 179513 179513 MISCELLANEOUS INCOME 551112 107 107 107 20767725 20492028 0 275697 18207 18207 4019398 4019398 5304489 57024 5247465 308540 2775 305765 2300484 15720 2284764 518650 3282 515368 780462 780462 108484 108484 10000 10000 1974000 1974000 239598 239598 512923 512923 1756403 1756403 538177 538177 361656 361656 22723 22723 1627635 1627635 476 476 DUES AND SUBSCRIPTIONS 101953 101953 MISCELLANEOUS EXPENSE 9159 9159 20513417 1724643 18788774 0 2231333 1583852 103892 79841 697 0 522939 729653 12097812 3852587 5962753 8245225 8767925 7968396 9049472 7146680 1187644 5061208 27826655 30814855 11515671 10937009 257962 756321 885380 3477910 12659013 15171240 X 15167642 15643615 15167642 15643615 27826655 30814855 X 254308 -254309 475974 X X 0 1 X 1 0 X X X X 0 0 0 KISHWAUKEE COMMUNITY HOSPITAL 237087041 03 1 1 1 0 VALLEY WEST COMMUNITY HOSPITAL 364244337 03 1 1 1 0 DEKALB COUNTY HOSPICE 363164329 07 1 1 1 825000 KISHHEALTH FOUNDATION 363649077 07 1 1 1 500000 CENTER FOR FAMILY HEALTH 800424001 03 1 1 1 40000 KISHWAUKEE PHYSICIANS GROUP INC 651293967 03 1 1 1 4100000 CENTER FOR FAMILY HEALTH - MALTA 800869393 03 1 1 1 250000 KISHHEALTH HOME CARE 371703513 03 1 1 1 420000 8 6135000 0 0 0 0 0 1 10000 0 0 0 10000 0 PART II-B, LINE 1: KISHHEALTH SYSTEM MADE A $10,000 CONTRIBUTION TO COALITION TO PROTECT AMERICAS HEATH CARE. THE ORGANIZATION INDICATED THAT THIS CONTRIBUTION WAS FOR LOBBYING ACTIVITIES. 1713988 1713988 1527804 189281 1338523 1235983 423685 812298 5531758 3239621 2292137 2088279 2088279 8245225 5928149 C CASH EQUIVALENTS 319603 F CERTIFICATES OF DEPOSIT 850484 F ACCRUED INTEREST 48444 F 7146680 DUE FROM SUBSIDIARY ORGANIZATIONS 5061208 5061208 DUE TO SUBSIDIARY ORGANIZATIONS 3477910 3477910 X 37678 -254309 439724 185415 -147737 20915462 20915462 20767725 461113 439724 439724 21389 20492028 20492028 20513417 PART X, LINE 2: THE SYSTEM, KH, VWH, KHF, KPG, KHH, CFHP (CCC), CFHM, AND KHC ARE TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HPI IS A TAXABLE ORGANIZATION AND FILES A CORPORATE INCOME TAX RETURN, WHICH INCLUDES OPT, IRCC, AND HVL. THE SYSTEM FILES VARIOUS FORM 990'S (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, 2014 AND 2013, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH INCOME FOR FORM 990 439,724. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON SUBSIDIARY, HPI, REPORTED ON SEPARATE COMPANY RETURN 423,432. MANAGEMENT FEES PAID TO KHS, REPORTED AS EXPENSES ON FINANCIAL STATEMENTS 20,492,028. ROUNDING 2. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH INCOME FOR FORM 990 439,724. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES PAID TO KHS, REPORTED AS EXPENSES ON FINANCIAL STATEMENTS 20,492,028. 1 OSF SAINT ANTHONY MEDICAL CENTER FOUNDATION 5666 E STATE STREET ROCKFORD IL 61108 371259284 501(C)(3) 7500 TO PROVIDE FINANCIAL ASSISTANCE IN CONNECTION WITH SUPPORT OF PHILANTHROPIC EFFORTS THAT IMPACT THE CARE OF PATIENTS FROM OUR COMMUNITY. COALITION TO PROTECT AMERICAS HEALTH CARE 800 10TH STREET NW TWO CITYCENTER 400 WASHINGTON DC 20001 522253225 501(C)(4) 10000 TO PROVIDE SUPPORT TO ORGANIZATION WHICH PROVIDES EDUCTION AND INFORMATION TO THE PUBLIC AND POLICY MAKERS REGARDING HEALTHCARE ISSUES. 1 1 PART I, LINE 2: REQUESTS FOR FINANCIAL ASSISTANCE FROM OTHER CHARITABLE ORGANIZATIONS ARE REVIEWED AND APPROVED BY THE CEO 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. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 KEVIN POORTEN DIRECTOR/PRESIDENT & CEO - KISHHEALT 575560 0 185669 0 88591 0 202577 0 20762 0 1073159 0 88591 0 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 260902 0 62026 0 0 0 66193 0 20001 0 409122 0 0 0 BRAD COPPLE PRESIDENT - KH & VWH 295129 0 0 0 0 0 37780 0 20234 0 353143 0 0 0 JOSEPH DANT VP BUSINESS DEVELOPMENT 216567 0 63480 0 0 0 23222 0 19930 0 323199 0 0 0 MICHAEL KOKOTT ASST. VP MKTG & PLANNING 165020 0 39265 0 0 0 15470 0 12685 0 232440 0 0 0 ROGER HEATH BELL VP AND CIO 217987 0 52967 0 0 0 20300 0 25201 0 316455 0 0 0 PAM DUFFY VP PATIENT CARE SVCS 213438 0 49431 0 0 0 23947 0 7592 0 294408 0 0 0 MARK THATE VP - HUMAN RESOURCES (RETIRED 12/201 163242 0 44815 0 54200 0 6375 0 17329 0 285961 0 0 0 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 322866 0 95484 0 0 0 51900 0 20144 0 490394 0 0 0 DAVID PROULX VP OPERATIONS - VWH 149727 0 36254 0 0 0 35583 0 19551 0 241115 0 0 0 CHERYL FISHER DIRECTOR OF RISK MANAGEMENT 135172 0 9214 0 0 0 8124 0 28484 0 180994 0 0 0 CRAIG VILLACORTA DIRECTOR OF INFORMATION SYSTEMS 116346 0 4560 0 0 0 6812 0 26977 0 154695 0 0 0 TODD BARROWCLIFT SENIOR DIRECTOR OF PHYSICIAN OPERATI 165443 0 0 0 0 0 8885 0 26992 0 201320 0 0 0 PART I, LINE 1A KISHHEALTH SYSTEM PROVIDES PAYMENT FOR SOCIAL CLUB DUES FOR THE CEO AND PRESIDENT - KH & VWH OF THE ORGANIZATION. KISHHEALTH SYSTEM ALSO PROVIDES PAYMENT FOR AUTOMOBILE ALLOWANCE FOR THE CEO, PRESIDENT - KH & VWH, VP BUSINESS DEVELOPMENT, AND THE AVP PLANNING & MARKETING OF THE ORGANIZATION. SUCH PAYMENTS ARE REPORTED AS TAXABLE COMPENSATION ON THE INDIVIDUAL'S FORM W-2. PART I, LINE 4B THE ORGANIZATION'S EXECUTIVES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2013 RELATED TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF KISHHEALTH SYSTEM WERE $253,600. THIS CONTRIBUTION REFLECTS AMOUNTS DUE FOR THE FISCAL YEAR ENDING APRIL 30, 2013. THE ORGANIZATION'S CEO PARTICIPATES IN TWO ADDITIONAL NONQUALIFIED DEFERRED COMPENSATION PLANS. CONTRIBUTIONS FOR CALENDAR YEAR 2013 WERE $99,777. DURING FY14, THE CEO TOOK A DISTRIBUTION FROM THE DEFERRED COMPENSATION PLAN IN THE AMOUNT OF $88,591. THE 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. HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 91976 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF HEALTH PROGRESS, INC. THE PURPOSE OF KHS IS TO PROVIDE MANAGEMENT AND SUPPORT SERVICES TO ITS RELATED ORGANIZATIONS, ALL OF WHICH PROVIDE HEALTHCARE SERVICES. FEES PAID TO KHS ARE IN EXCHANGE FOR THESE SERVICES, INCLUDING THE ORGANIZATIONS SHARE OF COMPENSATION OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES. 0 HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 496800 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF HEALTH PROGRESS, INC. KHS LEASES BUILDING SPACE FROM HEALTH PROGRESS, INC. 0 ANJU VOHRA SPOUSE OF MEMBER OF THE BOARD OF DIRECTORS 144455 MRS. VOHRA IS THE SPOUSE OF PROMOD VOHRA, WHO IS A MEMBER OF THE BOARD OF DIRECTORS OF KISHHEALTH SYSTEM. SHE IS PAID FOR PROFESSIONAL SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 2 KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHHEALTH SYSTEM. HOWEVER, THEY ALSO SERVE ON THE BOARD OF DIRECTORS OR AS OFFICERS OF THE RELATED TAX-EXEMPT SUBSIDIARY ORGANIZATIONS, INCLUDING KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, KISHHEALTH SYSTEM HOSPICE, KISHWAUKEE PHYSICIAN GROUP, CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, KISHHEALTH HOME CARE, AND KISHHEALTH FOUNDATION. MR. POORTEN IS PRESIDENT AND CEO OF KISHHEALTH SYSTEM AND SERVES AS AN EX-OFFICIO DIRECTOR FOR ALL ORGANIZATIONS RELATED TO KISHHEALTH SYSTEM. MR. FOELSKE SERVES AS THE VICE-PRESIDENT - FINANCE OF KISHHEALTH SYSTEM, AND SERVES AS THE TOP FINANCIAL OFFICIAL FOR ALL RELATED ENTITIES. THE FOLLOWING INDIVIDUALS ARE OFFICERS OR KEY EMPLOYEES OF KISHHEALTH SYSTEM AND ARE ALSO CONSIDERED KEY EMPLOYEES OF VALLEY WEST COMMUNITY HOSPITAL AND KISHWAUKEE COMMUNITY HOSPITAL. THEY ARE ALL COMPENSATED BY KISHHEALTH SYSTEM: BRAD COPPLE, PRESIDENT KH & VWH PAM DUFFY, VP PATIENT CARE JOE DANT, VP DEVELOPMENT MIKE KOKOTT, ASST. VP MARKETING ROGER HEALTH BELL, VP AND CHIEF INFORMATION OFFICER MARK THATE, VP HUMAN RESOURCES (RETIRED DECEMBER 2013) DR. MICHAEL KULISZ, CHIEF MEDICAL OFFICER DAVID PROULX, VP OPERATIONS, VWH SEVERAL MEMBERS OF THE KISHHEALTH SYSTEM BOARD OF DIRECTORS ALSO SERVE ON THE BOARD OF DIRECTORS FOR A RELATED ENTITY. ALL ENTITIES ARE WHOLLY OWNED SUBSIDIARIES OF KISHHEALTH SYSTEM. THESE MEMBERS INCLUDE: MICHAEL CULLEN, ALSO SERVES ON KISHWAUKEE HOSPITAL, CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, AND KISHWAUKEE PHYSICIANS GROUP BOARDS. TERRENCE DUFFY, ALSO SERVES ON VALLEY WEST COMMUNITY HOSPITAL BOARD JOE DANT, ALSO SERVES ON CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, KISH HEALTH HOME CARE AND HEALTH PROGRESS, INC BOARDS. ANN WEST, ALSO SERVES ON KISHHEALTH FOUNDATION BOARD DR. MICHAEL KULISZ, ALSO SERVES ON BOARDS OF KISHWAUKEE PHYSICIANS GROUP AND KISH HEALTH HOME CARE PAM DUFFY ALSO SERVES ON THE BOARD OF KISH HEALTH HOME CARE JAGDISH PATEL ALSO SERVES ON THE VALLEY WEST HOSPITAL BOARD. TOM MATYA, ALSO SERVES ON KISHHEALTH FOUNDATION BOARD AND KISHWAUKEE HOSPITAL BOARD JOHN MOULTON, ALSO SERVES ON HEALTH PROGRESS, INC. BOARD IN ADDITION, PROMOD VOHRA SERVES AS A DIRECTOR OF KHS. HIS WIFE IS AN EMPLOYEE OF KHS. DR. PHOTINE LIAKOS, ALSO SERVES AS A BOARD DIRECTOR OWNS AN INTEREST IN MIDLAND SUGICAL CENTER. KISHWAUKEE HOSPITAL, A SUBSIDIARY OF KHS, OWNS A 74.5% INTEREST IN THIS ENTITY. FORM 990, PART VI, SECTION A, LINE 6 KISHHEALTH SYSTEM MAINTAINS SEVERAL CLASSES OF MEMBERS. THEY ARE AS FOLLOWS: KHS SHALL HAVE HONORARY MEMBERS WHO SHALL NOT HAVE VOTING RIGHTS IN THE CORPORATION. HONORARY MEMBERS SHALL CONTINUE AS HONORARY MEMBERS PROVIDED THEY HAVE SATISFIED THE REQUIREMENTS OF MEMBERSHIP. HONORARY MEMBERS SHALL NOT HAVE MEETINGS EXCEPT THAT (I) HONORARY MEMBERS SHALL BE INVITED TO ATTEND INFORMATIONAL MEETINGS AS CALLED BY THE BOARD OF DIRECTORS FROM TIME TO TIME; AND (II) HONORARY MEMBERS SHALL BE INVITED TO ATTEND A SPECIAL INFORMATIONAL MEETING PRIOR TO THE ADOPTION BY THE KHS BOARD OF ANY OF THE ACTIONS THAT ARE DESCRIBED IN SECTION 4.1.D, G, H OR Q BELOW (WITH RESPECT TO KHS, KH OR VWH). ANY PERSON (WHICH TERM SHALL INCLUDE, FOR PURPOSES OF THIS SECTION 3.1, INDIVIDUALS AND FIRMS, CORPORATIONS, ASSOCIATIONS, CLUBS, OR SOCIETIES FOR THE DURATION OF THEIR EXISTENCE) MAY BECOME AN HONORARY MEMBER OF KHS PERMANENTLY OR FROM TIME TO TIME, AS THE CASE MAY BE, BY MEETING THE QUALIFICATIONS FOR ONE OF THE FOLLOWING CATEGORIES OF MEMBERS: A. PARTICIPATING MEMBER. ANY PERSON WHO HAS CONTRIBUTED PROPERTY OR CASH OR BOTH AGGREGATING $100 OR MORE BUT LESS THAN $500 IN VALUE TO KHS, KH, VWH OR THE HEALTH FOUNDATION SHALL BE A PARTICIPATING MEMBER OF KHS. ANY PERSON DESIGNATED A PARTICIPATING MEMBER SHALL RETAIN SUCH DESIGNATION FOR ONE YEAR FOLLOWING THE DATE OF HIS, HER OR ITS QUALIFYING CONTRIBUTION. B. CONTRIBUTING MEMBER. ANY PERSON WHO HAS CONTRIBUTED PROPERTY OR CASH OR BOTH AGGREGATING $500 OR MORE BUT LESS THAN $5,000 IN VALUE TO KHS, KH, VWH OR THE HEALTH FOUNDATION SHALL BE A CONTRIBUTING MEMBER OF KHS. ANY PERSON DESIGNATED A CONTRIBUTING MEMBER SHALL RETAIN SUCH DESIGNATION FOR ONE YEAR FOLLOWING THE DATE OF HIS, HER OR ITS QUALIFYING CONTRIBUTION. C. LIFE MEMBER. ANY PERSON WHO HAS CONTRIBUTED PROPERTY OR CASH OR BOTH AGGREGATING AT ANY TIME $5,000 OR MORE BUT LESS THAN $10,000 IN VALUE TO KHS, KH, VWH OR THE HEALTH FOUNDATION SHALL BE A LIFE MEMBER OF KHS. ANY PERSON DESIGNATED A LIFE MEMBER SHALL RETAIN SUCH DESIGNATION. D. FOUNDER. ANY PERSON WHO HAS CONTRIBUTED OR PLEDGED PROPERTY OR CASH OR BOTH AGGREGATING AT ANY TIME $10,000 OR MORE IN VALUE TO KHS, KH, VWH OR THE HEALTH FOUNDATION SHALL BE A FOUNDER OF KHS. ANY PERSON DESIGNATED A FOUNDER SHALL RETAIN SUCH DESIGNATION. E. SERVICE MEMBER. (1) ANY PERSON WHO HAS CONTRIBUTED AT LEAST 60 HOURS ON A FISCAL YEAR BASIS OF UNPAID VOLUNTARY SERVICE TO KH OR VWH SHALL BECOME A SERVICE MEMBER OF KHS. (2) ANY PERSON WHO SERVES ON THE KHS BOARD OR ON ANY GOVERNING BOARD OF ANY SUBSIDIARY CORPORATION OF KHS SHALL BE A SERVICE MEMBER OF KHS WHILE SERVING ON THE KHS BOARD OR SUCH SUBSIDIARY CORPORATION BOARD. 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 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 ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINSTRATION. FORM 990, PART XI, LINE 9: LOSS ON EQUITY METHOD SUBSIDIARY REPORTED ON SEPARATE COMPANY RETURN - HPI -423,434. EQUITY CONTRIBUTION TO SUBSIDIARIES -1,325,000. EQUITY DISTRIBUTION FROM SUBSIDIARIES 9,361,000. LOSS ON EQUITY METHOD SUBSIDIARY REPORTED ON SEPARATE COMPANY RETURNS -4,286,095. ADJUSTMENT TO ADJUST SUBSIDIARY BALANCES TO ACTUAL -3,010,497. EQUITY DISTRIBUTION FROM LIQUIDATED SUBSIDIARY 160,000. 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. KISHWAUKEE COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 237087041 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 VALLEY WEST COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 364244337 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 DEKALB COUNTY HOSPICE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363164329 HEALTHCARE SERVICES, PRIMARILY HOSPICE SERVICES IL 501(C)(3) 7 KISHHEALTH SYSTEM 1 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 1 COMMUNITY CARES CLINIC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 800424001 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 7 KISHHEALTH SYSTEM 1 KISHWAUKEE PHYSICIAN GROUP INC ONE KISH HOSPITAL DRIVE SYCAMORE IL 60178 651293967 HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 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 1 KISHHEALTH SYSTEM HOME CARE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 371703513 HEALTHCARE SERVICES, HOME CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 HEALTH VENTURES LLC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 753255958 RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES IL HEALTH PROGRESS INC RELATED 14735 316694 0 1 0.51000 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 HEALTH PROGRESS INC RELATED 435769 1358701 0 0 0.51000 MIDLAND SURGICAL CENTER LLC 3085 WOLF COURT DEKALB IL 60115 352194610 SURGICAL SERVICES IL KISHWAUKEE COMMUNITY HOSPITAL RELATED 1137271 1351528 0 0 0.74500 HEALTH PROGRESS INC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363824138 INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESS IL KISHHEALTH SYSTEM C -344650 3803532 1.00000 1 1 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 KISHWAUKEE COMMUNITY HOSPITAL C 5382800 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL C 3978200 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL O 16518149 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL O 3557321 FAIR MARKET VALUE DEKALB COUNTY HOSPICE O 77212 FAIR MARKET VALUE KISHHEALTH FOUNDATION O 40138 FAIR MARKET VALUE HEALTH PROGRESS INC O 91976 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL Q 1800915 FAIR MARKET VALUE HEALTH PROGRESS INC Q 568832 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL Q 12425306 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL J 117911 FAIR MARKET VALUE HEALTH PROGRESS INC P 6398 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL P 35072922 FAIR MARKET VALUE KISHHEALTH FOUNDATION P 3496 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL P 8223021 FAIR MARKET VALUE COMMUNITY CARES CLINIC INC Q 5177 FAIR MARKET VALUE DEKALB COUNTY HOSPICE P 672629 FAIR MARKET VALUE CENTER FOR FAMILY HEALTH - MALTA B 250000 FAIR MARKET VALUE CENTER FOR FAMILY HEALTH B 40000 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP B 4100000 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP P 2205322 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP Q 15536 FAIR MARKET VALUE KISHHEALTH FOUNDATION B 500000 FAIR MARKET VALUE KISHHEALTH HOME CARE B 420000 FAIR MARKET VALUE KISHHEALTH HOME CARE O 65810 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP O 141791 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL K 625824 FAIR MARKET VALUE COMMUNITY CARES CLINIC INC P 8576 FAIR MARKET VALUE CENTER FOR FAMILY HEATLH - MALTA P 2345 FAIR MARKET VALUE KISHHEALTH SYSTEM HOME CARE P 484532 FAIR MARKET VALUE DEKALB COUNTY HOSPICE B 825000 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP J 40571 FAIR MARKET VALUE HEALTH PROGRESS INC A 496800 FAIR MARKET VALUE