2015-01-12T09:14:18-06:00 2014-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2013-05-01 237087041 KISHWAUKEE COMMUNITY HOSPITAL KISH 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 LOREN FOELSKE VICE-PRESIDENT - FINANCE, KHS 8157561521 2014-12-16 1 KELLY JACKSON HARDY P00747242 8152859300 2013 2016-02-25 16:41:14Z KISHWAUKEE HOSPITAL KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 238194778 0 X WWW.KISHHEALTH.ORG X 1970 IL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREA OF DEKALB COUNTY. 3 2 1252 300 108997 13443 498254 387794 183790492 168636360 8160848 8476451 2013451 2681773 194463045 180182378 326958 408449 0 0 63821467 60369123 0 0 9491 109778090 100450596 173926515 161228168 20536530 18954210 319597870 328924975 107654934 103167547 211942936 225757428 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 132120378 408449 168636360 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 2014.*THE PREVALENCE OF OBESITY IN CHILDREN AND ADULTS*ACCESS TO AFFORDABLE PRIMARY HEALTH CARE IN THE DEKALB/SYCAMORE AREA AND OUTLYING RURAL AREAS*TYPE II DIABETES*CARDIOVASCULAR DISEASE AND ADEQUATE HOSPITAL BASED AND COMMUNITY OUTREACH SERVICES*CANCER CARE SERVICES, EDUCATION AND PREVENTION*AFFORDABLE ACCESS TO CHILDBIRTH EDUCATION AND OB HOSPITAL SERVICES*OTHER COMMUNITY OUTREACH AND WELLNESS SERVICESACTIVITIES IN THESE AREAS ARE DETAILED IN SCHEDULE H OF THIS REPORT. ADDITIONAL ACTIVITIES ARE LISTED BELOW.COMMUNITY COLLABORATION / OUTREACH / SCHOOL & WELLNESS PROGRAMS. THE HOSPITAL'S COMMUNITY WELLNESS DEPARTMENT PROVIDES A VARIETY OF EDUCATIONAL ACTIVITIES AND PROGRAMS IN THE COMMUNITY. DEKALB COUNTY SCHOOLS ARE VISITED THROUGHOUT THE ACADEMIC YEAR, WITH HEALTH EDUCATORS PROVIDING EDUCATION ON NUTRITION, FITNESS ACTIVITIES, SCREEN TIME REDUCTION, HAND WASHING, DENTAL CARE, AND POISON PREVENTION AND IN GENERAL LIVING A HEALTHY LIFE STYLE. COMMUNITY WELLNESS HEALTH EDUCATORS VISITED 600 CLASS ROOMS WORKING WITH 13,100 STUDENTS.STAFF FROM COMMUNITY WELLNESS COLLABORATES WITH OR SERVE ON COMMITTEES AND PROMOTED HEALTH AND WELLNESS THROUGH THESE PARTNERSHIP: PLANO CHAMBER OF COMMERCE BOARD OF DIRECTORS, KENDALL COUNTY HEALTH INITIATIVES COUNCIL, KENDALL COUNTY I-PLAN STEERING COMMITTEE, SANDWICH PROJECT SUCCESS COMMITTEE, AND FOX VALLEY YMCA.OPERATIONAL COMMUNITY BENEFITTHE HOSPITAL ALSO PROVIDED COMMUNITY BENEFIT THROUGH CHARITY CARE, GOVERNMENT-SPONSORED INDIGENT HEALTH CARE, BAD DEBT, SUBSIDIZED HEALTH SERVICES, LANGUAGE ASSISTANCE, VOLUNTEER SERVICES, EDUCATION AND WORKFORCE DEVELOPMENT, CASH AND IN-KIND DONATIONS, AND OTHER.CHARITY CAREAS PART OF ITS CHARITABLE MISSION, THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE, INCLUDING ACCESS TO PHARMACEUTICAL ASSISTANCE FOR PATIENTS WHO MET THE ELIGIBILITY CRITERIA ESTABLISHED IN ITS FINANCIAL ASSISTANCE POLICY. THE POLICY IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY. THE HOSPITAL ALSO COORDINATED WITH THE ILLINOIS BREAST AND CERVICAL CANCER PROGRAM FOR ASSISTANCE WITH BREAST AND CERVICAL CANCER SCREENINGS AND TREATMENT.THE HOSPITAL ALSO UNDERWROTE UNREIMBURSED COSTS OF TREATING MEDICAID AND MEDICARE PATIENTS.SUBSIDIZED HEALTH SERVICESA NUMBER OF PROGRAM AND SERVICES WERE OPERATED AT A LOSS, BUT WERE SUBSIDIZED BECAUSE THEY IMPROVE THE HEALTH AND SAFETY OF THE COMMUNITY.LANGUAGE ASSISTANCETHE HOSPITAL EMPLOYS SPANISH INTERPRETERS AVAILABLE OR ON CALL 24/7 AND USED VIDEOCONFERENCING EQUIPMENT, VIA LAPTOP, TO COMMUNICATE WITH THE HEARING IMPAIRED AND DUAL HANDSET PHONE SYSTEM THAT PROVIDED INSTANT INTERPRETATION FOR PATIENTS WHO DO NOT SPEAK ENGLISH.VOLUNTEER SERVICESVOLUNTEER OPPORTUNITIES ARE PROVIDED TO EMPLOYEE'S TOP SERVE IN THE COMMUNITY AND FOR COMMUNITY MEMBERS TO SERVE THE HOSPITAL. THERE WERE ROUGHLY 305 VOLUNTEER HOURS RECORDED BY EMPLOYEES. A VOLUNTEER SERVICES DEPARTMENT SCHEDULED DEPARTMENT SCHEDULED MEMBERS OF THE VOLUNTEERS IN THE HOSPITAL.EDUCATION & WORKFORCE DEVELOPMENTA MEDICAL LIBRARY WAS MAINTAINED FOR PHYSICIAN, STAFF AND PATIENT USE. HOSPITAL EMPLOYEES PROVIDED CLINICAL TRAINING, JOB SHADOWING AND MENTORING OF COLLEGE AND HIGH SCHOOL STUDENTS. THE AUXILIARY AND KISH HEALTH FOUNDATION AWARDED ANNUAL SCHOLARSHIPS FOR HEALTH CAREERS. HOSPITAL TOURS WERE GIVEN TO LOCAL SCHOOLS AND YOUTH GROUPS TO EDUCATE YOUTH ON HEALTHCARE CAREERS. CASH CONTRIBUTIONS WERE GIVEN TO LOCAL LIBRARIES, PUBLIC AND POST-SECONDARY EDUCATION FOUNDATIONS TO UNDERWRITE SCHOLARSHIPS, AND PURCHASE OR PROVIDE HEALTH-RELATED MATERIALS, EQUIPMENT, AND ACTIVITIES.CASH AND IN KIND DONATIONSAN ALLOCATION WAS MADE IN THE OPERATING BUDGET FOR DONATION TO COMMUNITY EVENTS AND ORGANIZATIONS THAT IMPROVE THE HEALTH, WELFARE, AND QUALITY OF LIFE IN THE COMMUNITIES SERVED BY THE HOSPITAL. THE HOSPITAL SUPPORTED COMMUNITY ACTIVITIES THAT ENCOURAGE CHILD AND ADULT PHYSICAL ACTIVITY, EFFORTS THAT REACH UNDERSERVED AND VULNERABLE POPULATIONS; YOUTH MENTORING; EDUCATION; DISEASE PREVENTION, AWARENESS, RESEARCH, MENTAL HEALTH, ECONOMIC DEVELOPMENT, AND OTHER COMMUNITY BUILDING ACTIVITIES. IN-KIND DONATIONS AND SERVICES SUCH AS PERSONNEL TIME, SURPLUS SUPPLIES, AND FOOD AND BOTTLE WARE WERE ALSO TRACKED.DONATION HIGHLIGHTSTHE HOSPITAL PROVIDED SUBSTANTIAL CASH CONTRIBUTIONS TO FOX VALLEY OLDER ADULT SERVICES TO CONTINUE ITS TRAINING FOR SENIORS, FOX VALLEY YMCA TO SUPPORT COMMUNITY FITNESS PROGRAMS; AMERICAN CANCER SOCIETY'S LOWER FOX VALLEY RELAY FOR LIFE.IN-KIND DONATIONSINCLUDED ITEMS LIKE FIRST AID KITS, WATER, AND OTHER EDUCATIONAL MATERIALS TO COMMUNITY ORGANIZATIONS 132120378 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 0 0 0 1 107 0 1 1252 1 1 1 0 0 0 0 0 0 0 0 0 X 3 2 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X LOREN FOELSKE VP OF FINANCE 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 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 849820 223339 THOMAS MATYA CHAIR 2.00 3.00 X X 0 0 0 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 22.00 30.00 X 0 322928 86194 BRAD COPPLE PRESIDENT - KH & VWH 23.00 30.00 X 0 295129 58014 PAM DUFFY CNO & VP PATIENT CARE 10.00 35.00 X 0 262869 31539 JOE DANT VP BUSINESS DEVELOPMENT 0.00 47.00 X 0 280047 42152 MIKE KOKOTT ASST VP - MARKETING 10.00 35.00 X 0 204285 28155 ROGER HEATH BELL VP - CIO 10.00 37.00 X 0 270954 45501 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 15.00 37.00 X 0 418350 72044 MARK THATE VP - HUMAN RESOURCES 12.00 33.00 X 0 262257 23704 DAVID PROULX VP OPERATIONS - VWH 8.00 45.00 X 0 185981 55134 ANJU VOHRA TECHNICAL DIRECTOR - ECHO 45.00 0.00 X 136545 0 34693 THOMAS WARZECHA DIRECTOR OF PHARMACY 45.00 0.00 X 143115 0 35177 DARYL BURTZOS PHARMACIST 45.00 0.00 X 133486 0 17683 KENNETH O'BRIEN CHARGE REGISTERED NURSE 45.00 0.00 X 126792 0 36256 LISA ACKLAND DIRECTOR OF NURSING 45.00 0.00 X 144632 0 43362 684570 3352620 832947 41 0 1 0 KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 MANAGEMENT SERVICES 13227378 DOCTORS OF EMERGENCY MEDICINE N327 SWITCHGRAS LANE ST CHARLES IL 60175 EMERGENCY MEDICINE SERVICES 9283598 SIDDIQUI SABET MD PC 13 VENNARD CT LOMBARD IL 60148 MEDICAL SERVICES 1700000 MIDWEST ORTHOPAEDIC INSTITUTE PC 2111 MIDLANDS COURT SYCAMORE IL 60178 MEDICAL SERVICES 1027250 MAYO MEDICAL LABORATORIES 201 1ST ST SW ROCHESTER MN 55905 MANAGEMENT SERVICES 754520 34 854 325487 40360 21093 220 387794 NET PATIENT SERVICE REVENUE 621110 168636360 168556699 79661 168636360 7307876 7307876 585978 668357 -82379 -82379 -82379 58289536 140126 57261087 0 1028449 140126 1168575 1168575 110210 82956 27254 27254 INCOME PASSTHROUGH - MIDLAND SURG 621110 1137271 1137271 OTHER SERVICES 621110 750218 29086 721132 CAFETERIA SALES 621110 731859 250 731609 117550 117550 2736898 180182378 168556699 108997 11128888 X 388201 388201 20248 20248 43765195 41955439 1809756 2235404 2142967 92437 1715730 1644782 70948 12652794 12129582 523212 16518149 16518149 231324 231324 10042 10042 528850 528850 19678877 18260419 1418458 639471 89103 550368 31218727 30006011 1207704 5012 1608735 551162 1057573 3142540 3100244 42296 156754 149234 7520 2000 2000 3580390 3580390 10871854 10871854 2111373 801960 1309413 UNRELATED BUSINESS INCO 8750 8750 BAD DEBT EXPENSE 5418378 5418378 FEDERAL AND STATE ASSES 4512656 4512656 DUES, SUBSCRIPTIONS, AN 177977 49262 127994 721 33749 26876 3115 3758 161228168 132120378 29098299 9491 11234100 15006542 80478 721854 32318217 25581608 3873075 3803727 3292374 2855211 177253579 85128599 100209331 92124980 150226426 171588222 10222071 6515154 931936 890392 7209862 9837285 319597870 328924975 29692939 12614254 727790 48203 63685000 62065000 1204610 1245038 12344595 27195052 107654934 103167547 X 207748100 221656823 4194836 4100605 211942936 225757428 319597870 328924975 X 18954210 921494 -6061212 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 35011 35011 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. 5255089 5255089 115227643 40209974 75017669 657466 315972 341494 54974054 44602653 10371401 1139327 1139327 92124980 THIRD PARTY PAYABLES 19406727 DUE TO AFFILIATES 4148313 ACCRUED INTEREST PAYABLE 293303 OTHER PAYABLES - LONG TERM 3346709 27195052 X 175602196 921494 200 751312 1673006 173929190 6253188 6253188 180182378 156592149 200 751312 751512 155840637 5387531 5387531 161228168 PART X, LINE 2: THE SYSTEM, KH, VWH, KHF, KPG, KHH, CFHP, 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: RECLASSIFICATION OF COST OF GOODS SOLD 82,956. RECLASSIFICATION OF RENTAL EXPENSES 668,356. PART XI, LINE 4B - OTHER ADJUSTMENTS: BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - KISH AREA PHO 439. CONTRIBUTION REVENUE FROM KISHHEALTH FOUNDATION 325,687. BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - MIDLAND SURGICAL 539,531. RECLASSIFICATION OF BAD DEBT EXPENSE (NETTED WITH REVENUE ON F/S) 5,387,531. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF COST OF GOODS SOLD 82,956. RECLASSIFICATION OF RENTAL EXPENSES 668,356. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF BAD DEBT EXPENSE (NETTED WITH REVENUE ON F/S) 5,387,531. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 5091747 0 5091747 0.03160 19799068 14181465 5617603 0.03480 24890815 14181465 10709350 0.06640 4923375 406578 4516797 0.02800 957307 12940 944367 0.00590 2608453 519163 2089290 0.01300 482988 0 482988 0.00300 8972123 938681 8033442 0.04990 33862938 15120146 18742792 0.11630 1 5418378 0 33246030 52453894 -19207864 X 1 1 1 1 KISHWAUKEE HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 WWW.KISHHEALTH.ORG 0005470 X X X KISHWAUKEE HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X WWW.KISHHEALTH.ORG X X X X X X X X 0 0 1 1 200.000000000000 1 600.000000000000 1 X X X X X 1 1 X X X 1 0 X X X X X 1 X 0 0 KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 3: 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 TEH 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 4: OTHER HOSPITAL FACILITIES INCLUDE VALLEY WEST HOSPITAL KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 7: 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: ACCIDENTSSUPPORTING DATA: 2007-2009 CENTERS FOR DISEASE CONTROL AND PREVENTION, LISTS ACCIDENTS (MOTOR VEHICLE, FALLS AND POISONING) AS THE THIRD LEADING CAUSE OF DEATH FOR DEKALB COUNTY RESIDENTS. EXPLANATION 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 SUPPORTING DATA: *ILLINOIS DEPARTMENT OF PUBLIC HEALTH BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY INDICATED 22.4% OF THE POPULATION REPORT RISK FOR ACUTE/BINGE DRINKING.* PER ILLINOIS SECRETARY OF STATE, THERE WERE 585 ARRESTS FOR DRIVING UNDER THE INFLUENCE IN 2010.* IN 2009, ILLINOIS STATE POLICE REPORTS INDICATE THERE WERE 571 ARRESTS FOR DRUG OFFENSES.* BASED ON ILLINOIS DEPARTMENT OF HUMAN SERVICES, DIVISION OF ALCOHOLISM AND SUBSTANCE ABUSE REPORT, AS ESTIMATED 13,155 (15.6%) OF DEKALB COUNTY RESIDENTS AGED 16 AND OLDER WERE IN NEED OF ALCOHOL TREATMENT, AS WELL AS 2,024 PERSONS IN NEED OF DRUG ABUSE TREATMENT. 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 SUPPORTING DATA: 62% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED ALLERGIES AS A MODERATE TO SEVERE PROBLEM IN DEKALB COUNTY. 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: CRIMESUPPORTING DATA: 71% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED THAT CRIME IS A MODERATE TO SERIOUS CONCERN IN DEKALB COUNTY. ALSO, ILLINOIS STATE POLICE REPORT THAT FOR 2009, CITY OF DEKALB WAS HIGHEST AT 3,573.8 PER 100,000 POPULATION, FOLLOWED BY SOMONAUK (2093.9) AND SYCAMORE (1763.5).EXPLANATION 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 AVAILABILITYSUPPORTING DATA: 75% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED THAT JOB AVAILABILITY IS A MODERATE TO SERIOUS CONCERN IN DEKALB COUNTY.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 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 HEALTHSUPPORTING DATA: 71.6% OF DEKALB COUNTY RESIDENTS HAVE DENTAL INSURANCE, HIGHER THAN THE STATE AVERAGE AT 61.9%. HOWEVER, 25.3% OF DEKALB COUNTY RESIDENTS CANNOT AFFORD DENTAL CARE WITHIN THE PAST YEAR.EXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. PRIORITY IDENTIFIED: SUICIDESUPPORTING DATA: FOR THE PERIOD OF 2007-2009, SUICIDE RANKED AS THE 10TH LEADING CAUSE OF DEATH FOR DEKALB COUNTY RESIDENTS, AND THE SECOND LEADING CAUSE OF DEATH AMONG RESIDENTS AGED 15-44 YEARS OF AGE, PER THE CENTERS FOR DISEASE CONTROL AND PREVENTION. 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: UNEMPLOYMENTSUPPORTING DATA: 74% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED THAT UNEMPLOYMENT IS A MODERATE TO SERIOUS CONCERN IN DEKALB COUNTY. ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY REPORTS 9.2% OF DEKALB COUNTY RESIDENTS AS BEING UNEMPLOYED, LOWER THAN BOTH THE STATE AND U.S. RATES. 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 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 18E: POSTING OF FINANCIAL ASSISTANCE POLICY TO SYSTEM'S WEBSITE. KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 20D: BASED ON COMPLIANCE WITH LAWS OF STATE OF ILLINOIS, SPECIFICALLY THE UNINSURED PATIENT DISCOUNT ACT. 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 III, LINE 4: SEE FOOTNOTE 3 AND FOOTNOTE 4 (BEGINNING ON PAGE 15) IN THE ATTACHED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE.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 4/30/14 FISCAL YEAR, KH PROVIDED BILLED CHARGES TO MEDICARE PATIENTS TOTALING $180,500,000. HOWEVER, DUE TO THE MEDICARE INPATIENT AND OUTPATIENT PAYMENT METHODOLOGIES, THE ACTUAL CASH PAYMENTS RECEIVED FROM PROVIDING CARE TO THOSE PATIENTS WAS JUST $33,400,000, OR 18.48% OF BILLED CHARGES. THE COST OF PROVIDING THIS CARE, PER THE MEDICARE COST REPORT, WAS $53,200,000. THUS, THE PAYMENTS RECEIVED FROM MEDICARE WERE $19,800,000 LESS THAN COST, OR 63% OF COST. TRULY THIS $19,800,000 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 APPROXIMATELY 8,300 ADMISSIONS, 224,000 OUTPATIENT VISITS AND 38,900 EMERGENCY DEPARTMENT VISITS IN FISCAL YEAR 2011. IN THE HOSPITAL SERVICE AREA, ESTIMATED AT 105,000 PEOPLE, THE INPATIENT MARKET SHARE IS ROUGHLY 45.7%. 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.BELOW IS A LISTING OF SOME OF THE ACTIVITIES OR SERVICES WERE PROVIDED TO WORK TOWARD A HEALTHY COMMUNITY.**EXPAND BEHAVIORAL HEALTH SERVICES, WITH EMPHASIS ON FAMILIES WITH CHILDREN AGED 0-8.GOAL: INCREASE THE NUMBER OF CHILDREN AGED 0-8 RECEIVING BEHAVIORAL HEALTH SERVICES BY 20%.RESULT: WORK TOWARDS THIS OBJECTIVE WAS ACHIEVED THROUGH A PARTNERSHIP WITH AREA SCHOOL DISTRICTS TO PROVIDE EDUCATION AND TRAINING FOR STAFF ON MENTAL HEALTH ISSUESTHIS GOAL IS COMPLETE UNDER THE COMMUNITY BENEFIT PLAN. THERE WAS A 50% INCREASE IN UTILIZATION OF SERVICES FOR CHILDREN AGED 0-8 AS A RESULT OF THE WORK UNDER THIS ACTION ITEM.**SUPPORT 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.RESULT: 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. THIS GOAL IS COMPLETE UNDER THE COMMUNITY BENEFIT PLAN.**DEVELOP NEW COLLABORATIONS WITH DEKALB COUNTY SCHOOLS AND BEHAVIORAL HEALTH SERVICES TO ADDRESS STUDENT NEEDS.GOAL: IDENTIFY AND COLLABORATE WITH SCHOOL PERSONNEL TO ASSIST STUDENTS IN SUCCEEDING IN THE SCHOOL SETTING.RESULT: BEHAVIORAL HEALTH SERVICES PARTNERED WITH DEKALB SCHOOL DISTRICT TO PROVIDE SUPPORT FOR PHD PROVIDERS IN THE SCHOOLS. AS A RESULT OF THIS PARTNERSHIP EDUCATION AND TRAINING OCCURRED ON MENTAL HEALTH ISSUES TO THE STUDENT POPULATION. THERE WERE TWO TOPICS: GENERAL MENTAL HEALTH AND BULLYING/SELF-INJURY/SUICIDAL IDEATIONS AND ALCOHOL USE. THERE WERE 5 SESSIONS FOR 300 MIDDLE SCHOOL CHILDREN. THIS GOAL IS COMPLETE UNDER THE COMMUNITY BENEFIT PLAN.**INCORPORATE DIABETES MANAGEMENT PROGRAM, TARGETED AT UNDERSERVED POPULATIONS, THROUGH GROUP VISITS IN IDENTIFIED KISH PHYSICIAN GROUP (KPG) OFFICES.GOAL: INCREASE EDUCATION AND SELF-MANAGEMENT OF DIABETES.RESULT: THIS PAST YEAR, THERE WERE SEVERAL PROGRAMS TARGETED TO DIABETIC PATIENTS. AT THESE KISHHEALTH SYSTEM SPONSORED EVENTS, INFORMATION AND EDUCATION WAS PROVIDED TO THE POPULATION. THIS GOAL IS COMPLETE UNDER THE COMMUNITY BENEFIT PLAN.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.RESULT: DURING THIS LAST YEAR, CATCH BECAME A POLICY CHANGE TO THE CURRICULUM OF ALL DEKALB SCHOOL DISTRICT CLASSROOMS. THE POLICY INCORPORATED A MINIMUM OF SIX LESSONS INTO EVERY CLASSROOM. WITH THIS CHANGE, 792 CLASSROOM VISITS TOOK PLACE AND 21,533 STUDENTS RECEIVED EDUCATION ON HEALTHY EATING, INCREASING PHYSICAL ACTIVITY AND DECREASING SCREEN TIME. CATCH WAS OFFERED TO GENOA MIDDLE SCHOOL STUDENTS AND THIS YEAR, WITH 99 CLASSROOM VISITS WITH 3,875 STUDENTS PARTICIPATING IN THE PROGRAM. GENOA PARK DISTRICT ALSO IMPLEMENTED CATCH IN ITS AFTER SCHOOL PROGRAM, WITH AN ESTIMATED 6 SESSIONS AND 180 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 2,400 CHILDREN. THERE ARE ROUGHLY 90 NIU STUDENTS THAT SERVE AS CATCH INSTRUCTORS WHICH HELP TO MAKE THIS PROGRAM SUSTAINABLE IN THE COMMUNITY. THIS GOAL IN ON-GOING UNDER THE COMMUNITY BENEFIT PLAN.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.RESULT: 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 40 TO 200 TO SUPPORT BARB FOOD MART (SCHOOL BASED FOOD PANTRY) AND HEALTHIER FOOD CHOICES IN SCHOOLS. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM. **PROVIDE FREE OR LOW COST DIABETES EDUCATION CLASSES TO IDENTIFIED POPULATIONS.GOAL: EMPOWER PEOPLE TO APPROPRIATELY SELF-MANAGE DIABETES.RESULT: THROUGHOUT THE YEAR, DIABETES EDUCATION CLASSES ARE OFFERED AT REDUCED PRICE TO INDIVIDUALS AND THERE WERE 33 INDIVIDUALS THAT PARTICIPATED IN THIS VALUABLE PROGRAMMING. WORLD DIABETES DAY EVENT WAS HELD IN NOVEMBER WITH OVER 150 PARTICIPANTS. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM. PROVIDE FREE OR REDUCED COST CANCER SCREENINGS FOR TARGETED POPULATIONS.GOAL: PROVIDE OUTPATIENT CANCER SERVICES TO FACILITATE QUALITY CARE AND EASE FOR THE PATIENT.RESULT: DURING THE YEAR THERE WERE EVENTS THAT PROVIDED EDUCATION ON SELF-BREAST EXAMS, WAYS TO REDUCE RISK OF CANCER, SUCH AS SUN PROTECTION, REGULAR SCREENINGS AND MAINTAINING A HEALTHY LIFESTYLE. AT THESE EVENTS, THERE WERE 154 PARTICIPANTS, WITH 13 IDENTIFIED FOR FOLLOW UP TREATMENT. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM. 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 (BMI) TO ASSESS RISK FACTOR LEADING TO ADVERSE HEALTH CONDITIONS.RESULT: DURING THE YEAR THERE WERE 23 SESSIONS OFFERED FOR THE COMMUNITY TO PARTICIPATE IN BIOMETRIC SCREENINGS, WITH A TOTAL OF 338 PARTICIPANTS. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM. **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.RESULT: KISHWAUKEE HOSPITAL'S INTERNAL TEAM IS WORKING ON A PLAN TO IMPLEMENT NECESSARY STEPS TO ACQUIRE BABY FRIENDLY DESIGNATION. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM.**PARTICIPATE IN THE YMCA DIABETES PREVENTION PROGRAM (YDPP)GOAL: INCREASE HEALTHY EATING AND PHYSICAL ACTIVITY TO REDUCE THE RISK OF DEVELOPING TYPE II DIABETES FOR PARTICIPANTS.RESULT: DURING THE YEAR THERE WERE 16 SESSIONS OFFERED FOR THE COMMUNITY TO PARTICIPATE IN YDPP WITH A TOTAL 5 PARTICIPANTS. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM.**PROMOTE LIVE HEALTHY TEAM CHALLENGEGOAL: DECREASE WEIGHT, INCREASE PHYSICAL ACTIVITY AND DECREASE STRESS.RESULT: THE LIVE HEALTHY TEAM CHALLENGE FOR THIS YEAR HAD 126 ENROLLED PARTICIPANTS. OF THOSE PARTICIPANTS THE FOLLOWING ARE THE RESULTS OF THOSE PARTICIPATING IN THE CHALLENGE THERE WERE 66 THAT COMPLETED THE EIGHT WEEK PROGRAM. GROUP A WAS MADE UP OF COMMUNITY MEMBERS AND COLLECTIVELY THE GROUP LOST OVER 187.8 LBS. AND 149 INCHES. GROUP B WAS MADE UP OF EMPLOYEES FROM JOHNSON CONTROLS, A PILOT PROGRAM FOR BUSINESSES, AND THIS GROUP LOST 234.3 LBS. AND 149 A PILOT PROGRAM FOR BUSINESSES, AND THIS GROUP LOST 234.3 LBS. AND 149 INCHES. THIS GOAL IS ON-GOING AND WILL CARRY OVER INTO THE 2015 COMMUNITY BENEFIT PLANS AS AN ACTION ITEM. 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, 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 $3,598,000 FOR KISH HEALTH SYSTEM PHYSICAN GROUP, $504,000 FOR THE TWO CENTERS FOR FAMILY HEALTH, $446,000 FOR KISH HEALTH SYSTEM HOMECARE, AND $454,000 FOR KISH HEALTH SYSTEM 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 $28,400 TO OTHER ORGANIZATIONS WITHIN THE COMMUNITY. KISH HEALTH SYSTEM EMPLOYEES CONTRIBUTED MORE THAN 1,797 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) 20077 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 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 327 W MAIN STREET GENOA IL 60135 362355846 501(C)(6) 6300 TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO PROMOTION OF GENOA AREA ECONOMIC DEVELOPMENT IHREF 24676 NETWORK PLACE CHICAGO IL 60673 237421930 501(C)(3) 28589 TO PROVIDE RELIEF FOR HOPSITALS NEGATIVELY AFFECTED BY ASSESSMENTS KISHWAUKEE FAMILY YMCA 2500 BETHANY ROAD SYCAMORE IL 60178 362379643 501(C)(3) 31500 TO PROVIDE FINANCIAL ASSISTANCE RELATED TO HEALTH AND FITNESS ACTIVITES FOR LOW INCOME CHILDREN AND FAMILIES KISHWAUKEE UNITED WAY PO BOX 311 115 N FIRST STREET DEKALB IL 60115 366158489 501(C)(3) 5000 TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF COMMUNITY SOCIAL SERVICES VOLUNTARY ACTION CENTER 1606 BETHANY ROAD SYCAMORE IL 60178 362798257 501(C)(3) 8500 TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF MEALS ON WHEELS AND TRANSPORTATION SERVICES FOR LOW INCOME AND ELDERLY OPPORTUNITY HOUSE 202 LUCAS STREET PO BOX 9 SYCAMORE IL 60178 362476231 501(C)(3) 10000 TO PROVIDE ASSISTANCE IN SUPPORT OF SPECIAL OLYMPICS SYCAMORE CHAMBER OF COMMERCE 407 W STATE STREET STE 10 SYCAMORE IL 60178 361848940 501(C)(6) 6200 TO PROVIDE FINANCIAL ASSISTANCE TO PROMOTE SYCAMORE ECONOMIC VITALITY AND DEVELOPMENT CASA DEKALB COUNTY INC 407 W STATE STREET STE 6 SYCAMORE IL 60178 363903898 501(C)(3) 10000 TO PROVIDE FINANCIAL ASSISTANCE FOR PROGRAMS OFFERED TO CHILDREN OF DEKALB COUNTY THAT ARE ABUSED OR NEGLECTED. FAMILY SERVICE AGENCY 14 HEALTH SERVICES DRIVE DEKALB IL 60115 362360012 501(C)(3) 40000 TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF 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 TO PROVIDE FINANCIAL ASSISTANCE TO SUPPORT EMERGENCY SHELTER, TRANSITIONAL HOUSE, AND 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 TO PROVIDE FINANCIAL ASSITANCE TO FUND FOOD, SHELTER, AND SUPPORTIVE SERVICES TO HOMELESS INDIVIDUALS AND THEIR FAMILITIES IN DEKALB COUNTY. SYCAMORE PARK DISTRICT 138 N FAIR STREET SYCAMORE IL 60178 366006122 GOVERNMENT ENTITY 5800 TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF EVENTS AND FOR THE PURCHASE OF SUPPLIES/EQUIPMENT FOR PROGRAMS OFFERED BY THE PARK DISTRICT WHICH ENCOURAGE PHYSICAL FITNESS EGYPTIAN THEATRE 135 N 2ND STREET DEKALB IL 60115 363011960 501(C)(3) 5000 TO PROVIDE FINANCIAL ASSITANCE TO SUPPORT EDUCATIONAL PROGRAM OFFERINGS TO DEKALB COUNTY YOUTH INTERESTED IN THEATER ARTS DEKALB COUNTY CHAMBER OF COMMERCE 164 E LINCOLN HIGHWAY DEKALB IL 60115 360981630 501(C)(6) 10733 TO PROVIDE FINANCIAL ASSISTANCE TO PROMOTE BUSINESSES AND ORGANIZATIONS IMPACTING THE COMMUNITY HEALTH AND SAFETY. DEKALB COUNTY ECONOMIC 421 N CALIFORNIA STREET BUILDING 1B SUITE 200 SYCAMORE IL 60178 363524353 501(C)(3) 6000 TO PROVIDE FINANCIAL ASSISTANCE NECESSARY TO SUPPORT WORKFORCE DEVELOPMENT FOR DEKALB COUNTY RESIDENTS. 16 3 KISHWAUKEE HOSPITAL AUXILIARY SCHOLARSHIP PROGRAM 19 20248 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 575560 0 185669 0 88591 0 202577 0 20762 0 1073159 0 88591 LOREN FOELSKE VP FINANCE - KISHHEALTH SYSTEM 0 260902 0 62026 0 0 0 66193 0 20001 0 409122 0 0 BRAD COPPLE PRESIDENT - KH & VWH 0 295129 0 0 0 0 0 37780 0 20234 0 353143 0 0 PAM DUFFY CNO & VP PATIENT CARE 0 213438 0 49431 0 0 0 23947 0 7592 0 294408 0 0 JOE DANT VP BUSINESS DEVELOPMENT 0 216567 0 63480 0 0 0 22222 0 19930 0 322199 0 0 MIKE KOKOTT ASST VP - MARKETING 0 165020 0 39265 0 0 0 15470 0 12685 0 232440 0 0 ROGER HEATH BELL VP - CIO 0 217987 0 52967 0 0 0 20300 0 25201 0 316455 0 0 DR MICHAEL KULISZ CHIEF MEDICAL OFFICER 0 322866 0 95484 0 0 0 51900 0 20144 0 490394 0 0 MARK THATE VP - HUMAN RESOURCES 0 163242 0 44815 0 54200 0 6375 0 17329 0 285961 0 0 DAVID PROULX VP OPERATIONS - VWH 0 149727 0 36254 0 0 0 35583 0 19551 0 241115 0 0 ANJU VOHRA TECHNICAL DIRECTOR - ECHO 136545 0 0 0 0 0 8372 0 26321 0 171238 0 0 0 THOMAS WARZECHA DIRECTOR OF PHARMACY 143115 0 0 0 0 0 8189 0 26988 0 178292 0 0 0 DARYL BURTZOS PHARMACIST 133486 0 0 0 0 0 8066 0 9617 0 151169 0 0 0 KENNETH O'BRIEN CHARGE REGISTERED NURSE 126792 0 0 0 0 0 6806 0 29450 0 163048 0 0 0 LISA ACKLAND DIRECTOR OF NURSING 131108 0 8078 0 5446 0 8628 0 34734 0 187994 0 0 0 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 FOUNDATION 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 PLAN. 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. 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. SCHEDULE J, 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. A ILLINOIS FINANCE AUTHORITY 861091967 452032AJ4 2008-08-22 63685000 CONSTRUCTION OF NEW FACILITY FOR KISHWAUKEE HOSPITAL 0 1 0 A 1620000 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 0 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 2 KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHHEALTH SYSTEM, THE PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL. MR. POORTEN IS PRESIDENT AND CEO OF KISHWHEALTH 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, WHICH IS THE PARENT ORGANIZATION FOR ALL RELATED ENTITIES. BRAD COPPLE, AS THE PRESIDENT OF KISHWAUKEE HOSPITAL, IS CONSIDERED AN OFFICER. HE IS ALSO PRESIDENT OF VALLEY WEST COMMUNITY HOSPITAL, A RELATED ENTITY, AND IS COMPENSATED BY KISHHEALTH SYSTEM. MR. POORTEN AND MR. FOELSKE ARE ALSO CONSIDERED OFFICERS OF KISHWAUKEE HOSPITAL AND KISHHEALTH SYSTEM, AS DESCRIBED ABOVE. TOM MATYA AND MICHAEL CULLEN ARE MEMBERS OF THE KISHWAUKEE HOSPITAL BOARD OF DIRECTORS. THEY ALSO SERVE ON THE BOARD OF DIRECTORS OF KISHHEALTH SYSTEM, THE PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL. THE FOLLOWING INDIVIDUALS ARE OFFICERS OR KEY EMPLOYEES OF KISHHEALTH SYSTEM AND ARE ALSO CONSIDERED OFFICERS OR KEY EMPLOYEES OF KISHWAUKEE HOSPITAL. THEY ARE ALL COMPENSATED BY KISHHEALTH SYSTEM: BRAD COPPLE, PRESIDENT KH & VWC PAM DUFFY, VP PATIENT CARE JOE DANT, VP DEVELOPMENT MIKE KOKOTT, ASST. VP MARKETING HEATH BELL, VP AND CHIEF INFORMATION OFFICER MARK THATE, VP HUMAN RESOURCES (RETIRED 12/2013) DR. MICHAEL KULISZ, CHIEF MEDICAL OFFICER DAVE PROULX, VP OPERATIONS VWCH 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 ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINISTRATION. FORM 990, PART IX, LINE 11G PURCHASED PERSONNEL : PROGRAM SERVICE EXPENSES 463,014. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 463,014. OTHER CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 4,235,140. MANAGEMENT AND GENERAL EXPENSES 236,186. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,471,326. OTHER CONSULTING : PROGRAM SERVICE EXPENSES 17,812. MANAGEMENT AND GENERAL EXPENSES 313,087. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 330,899. MEDICAL DIRECTOR FEES : PROGRAM SERVICE EXPENSES 350,019. MANAGEMENT AND GENERAL EXPENSES 6,250. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 356,269. BROKER FEES : PROGRAM SERVICE EXPENSES 7,533. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,533. SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 639,057. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 639,057. LAB FEES : PROGRAM SERVICE EXPENSES 948,189. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 948,189. PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 10,351,957. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,351,957. PHYSICIAN RECRUITMENT : PROGRAM SERVICE EXPENSES 1,209,787. MANAGEMENT AND GENERAL EXPENSES -8,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,201,141. COLLECTION FEES: PROGRAM SERVICE EXPENSES 37,911. MANAGEMENT AND GENERAL EXPENSES 871,581. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 909,492. FORM 990, PART XI, LINE 9: EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM -5,382,800. CHANGE OF INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION -183,796. BOOK/TAX DIFFERENCES IN K-1 PASSTHROUGH ENTITIES -539,970. OTHER EQUITY ADJUSTMENT 100,066. OTHER ADJUSTMENT -54,712. 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 -21068 1074 0 0 0.50000 THE MIDLAND SURGICAL CENTER LLC 3085 WOLF COURT DEKALB IL 60115 352194610 SURGICAL SERVICES IL KISHWAUKEE COMMUNITY HOSPITAL INVESTMENT 1137271 1351528 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 0 1 1 1 1 1