2015-02-13T15:40:59-06:00 2014-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-10-01 362167767 KEWANEE HOSPITAL KEWA 3098527500 1051 W SOUTH ST PO BOX 747 KEWANEE IL 61443 JOHN M BOWSER CFO 3098527522 2015-02-13 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-02-13 2013 2016-02-25 16:41:14Z X JOHN M BOWSER 1051 W SOUTH ST PO BOX 747 KEWANEE IL 61443 15634186 0 X WWW.OSFSAINTLUKE.ORG X 1902 IL OPERATES A 25 BED CRITICAL ACCESS HOSPITAL PLUS RELATED HEALTH CARE SERVICES. 11 8 252 75 0 0 89145 33182 28550846 14786927 1007997 676346 1506472 77044 31154460 15573499 18721 216250 0 0 11860642 6192810 0 0 0 17945504 8941092 29824867 15350152 1329593 223347 63172289 0 32135070 0 31037219 0 X TO IMPROVE THE HEALTH AND CARE OF THOSE WE SERVE FOCUSING ON QUALITY OF CARE REGARDLESS OF ABILITY TO PAY. 1 0 10408965 216250 13814777 KEWANEE HOSPITAL IS A 501(C)(3) NOT-FOR-PROFIT CORPORATION LICENSED ASA 25-BED CRITICAL ACCESS HOSPITAL (CAH) LOCATED IN A RURAL COMMUNITY INILLINOIS. KEWANEE HOSPITAL STRIVES TO PROVIDE QUALITY HEALTH CARE TOALL PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP,AGE, OR ABILITY TO PAY. MANY OF THE COMMUNITY MEMBERS WOULD HAVE NOACCESS TO HEALTH CARE WITHOUT KEWANEE HOSPITAL. THE PATIENTS AND THEIRFAMILIES ABILITY TO TRAVEL 50+ MILES TO A LARGER TERTIARY CENTER ISCOMPROMISED BY A LACK OF MOBILITY, A LACK OF INCOME, AND A LACK OFTRANSPORTATION. MANY OF THE SERVICES PROVIDED BY KEWANEE HOSPITAL ARE REIMBURSED AT OR BELOW THE COST TO PROVIDE CARE. KEWANEE HOSPITAL OFFERS A WIDE VARIETY OF SERVICES INCLUDING INPATIENT ACUTE AND CRITICAL CARE, SKILLED LEVEL CARE THROUGH SWING BEDS, DIAGNOSTIC CAPABILITIES INCLUDING RADIOLOGY,LABORATORY AND CARDIOPULMONARY, INPATIENT AND OUTPATIENT REHABILITATION AND TREATMENT, INPATIENT AND OUTPATIENT SURGICAL SERVICES, AND PRIMARY CARE SERVICES THROUGH THE FAMILY HEALTH CLINIC (FHC). DURING THE SIX-MONTH REPORTING PERIOD ENDING MARCH 31, 2014, KEWANEE HOSPITAL PROVIDED 606 DAYS OF INPATIENT CARE AND 212 DAYS OF SWING BED CARE IN THE SIX-MONTH REPORTING PERIOD ENDING MARCH 31, 2014. KEWANEE HOSPITAL PROVIDED A WIDE SCOPE OF OUTPATIENT SERVICES WHICH PROVIDED CARE TO 17,249 OUTPATIENTS. THE EMERGENCY DEPARTMENT (ED) IS A SAFETY NET TO THE RURAL COMMUNITY OF KEWANEE AND THE SURROUNDING AREA. THE ED IS STAFFED 24/7 BY DEDICATED EMERGENCY DEPARTMENT PHYSICIANS; DURING THE SIX-MONTH REPORTING PERIOD ENDING MARCH 31, 2014 THE ED HAD 5,099 VISITS. THE HOSPITAL OFFERS A VARIETY OF SURGICAL SERVICES INCLUDING GENERAL, ORTHOPEDIC, OPHTHALMOLOGIC, ENDOSCOPY AND GASTROENTEROLOGY. IN THE SIX-MONTH PERIOD ENDING MARCH 31, 2014 THE HOSPITAL PROVIDED A TOTAL OF 361 SURGICAL PROCEDURES. 682314 986087 KEWANEE HOSPITAL STAFFS A MULTI-DISCIPLINARY OUTPATIENT FAMILY HEALTHCLINIC (FHC) WITH A COMPLIMENT OF BOTH PHYSICIAN AND MID-LEVELPROVIDERS EMPLOYED BY THE HOSPITAL. THE FHC PROVIDES AN ARRAY OFSERVICES INCLUDING PRIMARY CARE (ADULTS AND PEDIATRICS) AND SURGICALSERVICES. THE FHC IS A LICENSED RURAL HEALTH CLINIC AND PROVIDES MANYNEEDED SERVICES TO THE COMMUNITY. THE FHC IS ONE OF THE ONLY CLINICSIN THE AREA TO ACCEPT THE TREATMENT AND CARE OF CHILDREN WITH ATTENTIONDEFICIT DISORDER. THE PROVIDERS IN THE FHC HAVE PARTICIPATED INSEVERAL OUTREACH EFFORTS INCLUDING DIABETIC HEALTH, SMOKING CESSATION,MEDICATION MANAGEMENT, AND HEALTH AND NUTRITION. IN FY 2014, THE FHCPROVIDERS BROUGHT THEIR SERVICES TO THE AREA HIGH SCHOOL TO PROVIDEFREE SPORTS PHYSICALS. BECAUSE OF THE HIGH POVERTY LEVEL IN THE KEWANEE DISTRICT, MANY STUDENTS HAVE DIFFICULTY TRAVELING TO PROVIDEROFFICES FOR THEIR PHYSICALS AND MOST CANNOT PAY THE COST. KEWANEEHOSPITAL MADE THE DECISION TO OUTREACH TO THESE STUDENTS IN ORDER TOENSURE THEY CAN TAKE PART IN SPORT ACTIVITIES AND RECEIVE THEIR NEEDEDPHYSICAL EXAM.THE FHC PRACTICES THE MEDICAL HOME MODEL THROUGH THE ILLINOIS HEALTHCONNECT PROGRAM. THE NURSE PRACTITIONERS PROVIDE AFTER-HOURS CALL INORDER TO ENSURE PATIENTS HAVE THE ABILITY TO ACCESS A PROVIDERAFTER-HOURS AND ON WEEKENDS WHEN NEEDED. IN FY 2014, THE FHC PRACTITIONERSCONTINUALLY COLLABORATE WITH THE AREA SCHOOLS AND PROVIDERS OF OTHERHEALTH SERVICES IN ORDER TO PROVIDE THE BEST CARE POSSIBLE TO THE AREACOMMUNITY. 11091279 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 31 0 252 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 0 IL X JOHN M BOWSER CFO 3098527522 1051 W SOUTH STREET KEWANEE IL 61443 PRESTON BECKER FORMER CFO/TREASURER 40.00 X X 112410 0 23014 LYNN A FULTON CEO 40.00 X X 191677 0 34765 MARY KAY NORTH SECRETARY 2.00 X X 0 0 0 GARY PHEIFFER CHAIRPERSON 2.00 X X 0 0 0 MARK REWERTS VICE CHAIRPERSON 2.00 X X 0 0 0 TOM BURHORN TRUSTEE 2.00 X 0 0 0 DANIEL CONGREVE MD TRUSTEE 40.00 X 411637 0 35299 RITA HUNGATE MD TRUSTEE 2.00 X 0 0 0 RUSSELL MEDLEY TRUSTEE 2.00 X 0 0 0 FRANK TOCHA TRUSTEE 2.00 X 0 0 0 MIKE YAKLICH TRUSTEE 2.00 X 0 0 0 JENNIFER JUNIS CNO 40.00 X 136779 0 11695 DEBRA EWING DO PHYSICIAN 40.00 X 140469 0 6078 AIMEE SHANE CRNA CRNA 40.00 X 168628 0 19654 PRIYANKA PATEL PHARMACY DIRECTOR 40.00 X 113616 0 6712 TAMARA HARKER NURSE PRACTITIONER 40.00 X 106587 0 5377 NEIL TEX CRNA 40.00 X 151752 0 6751 1533555 0 149345 9 0 1 0 EPPS 12528 SR 78 HAVANA IL 62644 ED PHYSIAN STAFFING 1635598 HOSPITAL CARE CONSULTANTS 17304 PRESTON RD DALLAS TX 75252 HOSPITALIST STAFFING 577365 OSF SAINT FRANCIS INC 1420 W PIONEER PARKWAY PEORIA IL 61615 MRI SERVICES 560889 DRINKER BIDDLE & REATH LLP ONE LOGAN SQUARE SUITE 2000 PHILADELPHIA PA 19103 LEGAL 474245 METHODIST REFERENCE LABORATORY 221 NE GLEN OAK PEORIA IL 61636 REFERENCE LAB 221977 5 12000 21182 33182 PATIENT SERVICE REVENUE 621400 14709740 14709740 CAFETERIA MEALS 621400 62866 62866 MASSAGE THERAPY 621400 11540 11540 MEDICAL RECORDS 621400 2781 2781 14786927 672346 672346 33475 43062 -9587 -9587 -9587 4000 0 4000 4000 4000 24672 17625 7047 7047 EHR REVENUE 900099 38944 38944 MISC OPERATING REVENUE 900099 37565 37565 MEDICAL STAFF 900099 3075 3075 79584 15573499 14800864 0 739453 X 216250 216250 787456 626211 161245 4215843 3120233 1095610 173512 129925 43587 576624 431773 144851 439375 329002 110373 142206 142206 84922 84922 1696677 997316 699361 51665 51665 188658 123185 65473 189884 27423 162461 38862 29611 9251 14201 3200 11001 703069 703069 1293087 464595 828492 123801 45434 78367 BAD DEBT EXPENSE 1850538 1850538 MEDICAL PROFESSIONAL FE 1086539 1086539 MEDICAL SUPPLIES 718812 717426 1386 758171 189549 568622 15350152 11091279 4258873 0 2300342 0 14251461 0 9937 0 4449879 0 0 0 0 356286 0 554777 0 0 26163332 0 12129533 0 0 0 0 2956742 0 63172289 0 2781825 322163 27305000 1726082 0 32135070 0 X 30306051 0 54062 0 677106 0 31037219 0 63172289 0 X 223347 697464 -31958030 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 1000 0 1 11200 12200 0 PART II-B, LINE 1: THE LOBBYING EFFORTS BY KEWANEE HOSPITAL FOR THE FISCAL YEAR ENDED 3-31-14 CONSISTED OF SEVERAL LETTERS AND E-MAILS TO AREA LEGISLATORS REGARDING PENDING LEGISLATION. ANNUALLY, A PORTION OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND ILLINOIS HOSPITAL ASSOCIATION (IHA) DUES ARE ALLOCATED TO LOBBYING EFFORTS BOTH ORGANIZATIONS EXERT ON BEHALF OF HOSPITALS AT THE NATIONAL AND STATE LEVEL. ACCORDING TO THE AHA AND IHA, 23.65% AND 39% RESPECTIVELY, OF OUR DUES WENT TOWARDS LOBBYING; THIS REPRESENTS $11,200 FOR THE YEAR. PART II-B 1 (G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENTAL OFFICIALS, OR A LEGISLATIVE BODY: LEADERSHIP TIME SPENT WITH LEGISLATORS CONCERNING ISSUES RELATING TO PROPERTY TAX LEGISLATION. ESTIMATED COST EQUALS $1,000. 9771264 6182 493327 10270773 9372410 3596 1084245 688987 9771264 8148017 1280567 56174 9372410 9131640 -552439 431184 8148017 7210168 892005 1241101 211634 9131640 1 0 0 X 13777466 0 13777466 1796033 1796033 15573499 13360301 60687 60687 13299614 2050538 2050538 15350152 PART V, LINE 4: ENDOWMENTS INCLUDED ON FORM 990 INCLUDE ASSETS SET ASIDE BY THE BOARD OF TRUSTEES FOR FUTURE CAPITAL IMPROVEMENTS, OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSES. ENDOWMENTS ALSO INCLUDE DONOR-RESTRICTED FUNDS WHICH WILL BE USED FOR PROPERTY AND EQUIPMENT ADDITIONS, REIMBURSEMENT OF OPERATING EXPENSES, AND TO SUPPORT HEALTH CARE SERVICES. THE ENTIRE AMOUNT WAS TRANSFERRED IN THE MERGER WITH OSF HEALTHCARE SYSTEM. PART X, LINE 2: IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITIES HAVE FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF THE SIX-MONTH PERIOD ENDED MARCH 31, 2014 AND THE YEAR ENDED SEPTEMBER 30, 2013. THE HOSPITAL'S INCOME TAX RETURNS FOR TAX YEARS 2011 AND BEYOND ARE NO LONGER SUBJECT TO EXAMINATION BY TAX AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: COGS ON INVENTORY SALES -17,625. NONOPERATING REVENUE INCLUDED IN FINANCIAL STATEMENT EXPENSE 6,182. BAD DEBT EXPENSE INCLUDED IN FINANCIAL STATEMENT REVENUE 1,850,538. RENT EXPENSE INCLUDED IN FORM 990 REVENUE -43,062. PART XII, LINE 2D - OTHER ADJUSTMENTS: COGS ON INVENTORY SALES 17,625. RENT EXPENSE INCLUDED IN FORM 990 REVENUE 43,062. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE INCLUDED IN FINANCIAL STATEMENT REVENUE 1,850,538. GRANT EXPENSE NOT INCLUDED IN FINANCIAL STATEMENT EXPESNE 200,000. 1 1 1 X 125.000000000000 1 X 1 1 0 1 1 338489 338489 0.02510 3376409 2426830 949579 0.07030 3714898 2426830 1288068 0.09540 70501 70501 0.00520 3000 3000 0.00020 16250 16250 0.00120 89751 89751 0.00660 3804649 2426830 1377819 0.10200 1 1850538 4395116 4435582 -40466 X 1 1 1 1 KEWANEE HOSPITAL 1051 WEST SOUTH STREET KEWANEE IL 61443 X X X X RURAL HEALTH KEWANEE HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X SEE PART V, SECTION B, LINE 5D X X X X X 1 0 1 1 125.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X 1 0 1 X X 0 0 KEWANEE HOSPITAL PART V, SECTION B, LINE 3: A FOCUS GROUP COMPRISED OF HEALTHCARE PROFESSIONALS AND PARTNERS MET ON OCTOBER 18, 2012. THE GROUP INCLUDED REPRESENTATIVES OF NURSING AND REHABILITATION FACILITIES, CLINICS, AND OTHERS. THIS GROUP DISCUSSED POSITIVE DEVELOPMENTS IN THE KEWANEE HOSPITAL SERVICE AREA IN THE RECENT PAST AND A WIDE VARIETY OF HEALTH NEEDS AND HEALTH-RELATED CONCERNS IN GENERAL.A FOCUS GROUP COMPRISED OF COMMUNITY LEADERS AND GROUP REPRESENTATIVES ALSO MET ON OCTOBER 18, 2012. THE GROUP INCLUDED REPRESENTATIVES OF LOCAL EMPLOYERS, CITY DEPARTMENTS, COMMUNITY GROUPS, AND OTHERS. THIS FOCUS GROUP SESSION OPENED WITH THE IDENTIFICATION OF SEVERAL POSITIVE EVENTS THAT TOOK PLACE WITHIN THE KEWANEE HOSPITAL SERVICE AREA DURING THE PAST FIVE YEARS. THROUGH A FACILITATED IDENTIFICATION PROCESS, THE GROUP NEXT DEVELOPED A LIST OF OBSERVED OR PERCEIVED WEAKNESSES, BOTH CURRENT AND THREATENED FOR THE FUTURE, IN DELIVERY OF HEALTH CARE IN THE KEWANEE HOSPITAL SERVICE AREA. KEWANEE HOSPITAL PART V, SECTION B, LINE 5D: THE CHNA REPORT WAS PROVIDED TO THE PARTICIPANTS, MADE AVAILABLE ON THE WEBSITE (WWW.KEWANEEHOSPITAL.COM, AFTER THE MERGER, THE WEBSITE IS NOW WWW.OSFSAINTLUKE.ORG), A PORTION POSTED ON THE FACILITY BULLETIN BOARD, AND DISTRIBUTED AT LOCAL SERVICE CLUB MEETINGS. WEBSITE LOCATION OF CHNA: HTTP://WWW.OSFHEALTHCARE.ORG/ABOUT/COMMUNITY-HEALTH/. KEWANEE HOSPITAL PART V, SECTION B, LINE 10: KEWANEE HOSPITAL REVIEWS THE FOLLOWING CRITERIA TO DETERMINE FREE AND/OR DISCOUNTED CARE: INCOME LEVEL, ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNINSURED DISCOUNT, MEDICARE/MEDICAID AND STATE REGULATION. KEWANEE HOSPITAL PART V, SECTION B, LINE 11: KEWANEE HOSPITAL REVIEWS THE FOLLOWING CRITERIA TO DETERMINE FREE AND/OR DISCOUNTED CARE: INCOME LEVEL, ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNINSURED DISCOUNT, MEDICARE/MEDICAID AND STATE REGULATION. KEWANEE HOSPITAL PART V, SECTION B, LINE 20D: FOR UNINSURED, THE MAXIMUM CHARGED AMOUNT CANNOT EXCEED 25% OF ANNUAL INCOME. 1 KEWANEE HOSPITAL FAMILY HEALTH CLINIC 1051 WEST SOUTH STREET KEWANEE IL 61443 RURAL HEALTH CLINIC PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,850,538. PART II, COMMUNITY BUILDING ACTIVITIES: KEWANEE HOSPITAL HAS AN OPEN MEDICAL STAFF AND WELCOMES PHYSICIANS AND MID-LEVEL PROVIDERS TO PRACTICE AND PROVIDE CARE IN THE KEWANEE COMMUNITY. THE BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS FROM THE LOCAL SERVICE AREA WHO ARE COMMITTED TO THEIR ROLE IN KEEPING QUALITY HEALTH CARE LOCAL. THE HOSPITAL PROVIDES MANY SERVICES THAT WOULD OTHERWISE BE UNAVAILABLE, PARTICULARLY TO THOSE COMMUNITY MEMBERS UNABLE TO TRAVEL FOR SERVICES OR UNABLE TO PAY. THE HOSPITAL CONTINUALLY WORKS WITH AREA STUDENTS PURSUING MEDICAL RELATED CAREERS AND PARTNERS WITH THE AREA COMMUNITY COLLEGE AND REGIONAL COLLEGES AND UNIVERSITIES TO OFFER CLINICAL AND ADMINISTRATIVE EXPERIENCES. THIS INCLUDES PRE-MED, NURSING, LAB, RADIOLOGY, CARDIOPULMONARY, FINANCE, AND ADMINISTRATION.IN ORDER TO RECRUIT AND RETAIN PHYSICIANS AND MID-LEVEL PROVIDERS TO THE RURAL COMMUNITY, KEWANEE HOSPITAL MUST OFFER COMPETITIVE EMPLOYMENT OPPORTUNITIES. EMPLOYING PHYSICIANS IS AN EXPENSIVE UNDERTAKING WHICH INCLUDES TAKING THE RISK OF PRACTICE DEVELOPMENT AND ASSUMING THE EXPENSE AND RISK FOR LIABILITY INSURANCE. CURRENTLY THE FHC PROVIDERS STRUGGLE TO ACCESS SPECIALISTS FOR THEIR PATIENTS WHEN NEEDED. THERE IS A RELUCTANCE OF OUT-OF-TOWN SPECIALISTS TO ACCEPT PATIENTS RELIANT ON MEDICAID. ILLINOIS' CURRENT MEDICAID CRISISHAS CAUSED THOSE SPECIALISTS ONCE WILLING TO TAKE NEW MEDICAID PATIENTS TO CEASE BECAUSE THEY CANNOT DETERMINE WHEN THEY WILL RECEIVE PAYMENT. THE CHILDREN UNDER THE CARE OF THE FHC ARE TURNED DOWN BY ENT'S, PSYCHIATRIST, AND OTHER NEEDED SPECIALIST BECAUSE OF THEIR RELIANCE ON MEDICAID. BECAUSE OF THE SIZE OF THE COMMUNITY, THE DEMOGRAPHICS AND THE CURRENT PHYSICIAN SHORTAGE, KEWANEE HOSPITAL IS UNABLE TO RECRUIT SPECIALISTS SUCH AS ENT, PSYCHIATRISTS, UROLOGISTS, CARDIOLOGISTS,ETC. TO THE AREA. THE FHC PROVIDERS THEREFORE HAVE TO RELY ON OUT-OF-TOWN SPECIALISTS FOR REFERRAL. THE FHC HAS STARTED A PATIENT ASSISTANCE PROGRAM THAT REACHES OUT TO ORGANIZATIONS, PROGRAMS, FOUNDATIONS, ETC. TO MATCH PATIENTS SO THEY CAN ACCESS SPECIALTY CARE, TREATMENT, OR MEDICATIONS THAT ARE NEEDED.KEWANEE HOSPITAL CONTINUES THE COMMITMENT TO THEIR MISSION OF IMPROVING THE HEALTH AND CARE OF THOSE THEY SERVE WITHIN THEIR COMMUNITIES. FY 2014 CONTINUES A FOCUS ON HEALTH EDUCATION, DISEASE MANAGEMENT, PREVENTION, AND WELLNESS. DESPITE GROWING ECONOMIC HARDSHIPS DUE TO CONTINUED DECREASE IN THE NUMBER OF COMMERCIALLY INSURED INDIVIDUALS, THE GROWTH IN PATIENTS RELIANT ON MEDICAID, AND THE INCREASE IN UNINSURED PATIENTS, THE HOSPITAL WILL CONTINUE TO PROVIDE COMMUNITY OUTREACH TO ASSIST THOSE IN NEED. THE HOSPITAL'S VALUE TO THE COMMUNITY FOR THE SIX-MONTH PERIOD ENDED MARCH 31, 2014, WAS APPROXIMATELY $1 MILLION. THE HOSPITAL IS THERE 24 HOURS A DAY, 7 DAYS A WEEK, FOR COMMUNITY MEMBERS IN THEIR TIME OF NEED-WHETHER FOR A CHILD WHO IS SICK THROUGHOUT THE NIGHT, A PARENT EXPERIENCING CHEST PAINS, A GRANDMOTHER WITH THE WARNING SIGNS OF A STROKE, OR THE VICTIMS OF A TRAUMATIC CAR ACCIDENT. KEWANEE HOSPITAL STANDS READY TO TAKE CARE OF THOSE COMMUNITY MEMBERS IN NEED AND CONTINUES TO WORK TOWARDS THEIR VISION OF SETTING THE STANDARD FOR LOCAL HEALTH CARE WITH A TEAM OF COMPASSIONATE PROFESSIONALS WHO ARE FOCUSED ON CLINICAL EXCELLENCE AND CUSTOMER SERVICE. PART III, LINE 4: BAD DEBTS WERE REPORTED ON THE FINANCIAL STATEMENTS AT GROSS CHARGES. THEN THE COST TO CHARGE RATIO WAS USED TO CONVERT THE BAD DEBT AMOUNT FROM A CHARGE BASED NUMBER TO A COST BASED NUMBER. PART III, LINE 8: 100% OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. KEWANEE HOSPITAL IS COMMITTED TO SERVING PATIENTS, REGARDLESS OF ABILITY TO PAY OR IF THE PAYMENTS TO BE RECEIVED WILL BE LESS THAN THE COST TO PROVIDE THE SERVICE, WHICH IS THE CASE FOR MEDICARE AND MEDICAID PATIENTS. THE MEDICARE ALLOWABLE COSTS ON LINE 6 PART III HAVE BEEN CALCULATED BY MULTIPLYING MEDICARE CHARGES BY THE PATIENT CARE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. THE AMOUNT IS COMPARED TO TOTAL MEDICARE PAYMENTS RECEIVED INCLUDING DSH AND IME PAYMENTS. THIS SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE IT REFLECTS UNREIMBURSED COSTS TO THE HEALTH SYSTEM FOR PROVIDING MEDICAL SERVICES TO THE MEDICARE RESIDENTS OF THE COMMUNITY. PART III, LINE 9B: IT IS THE POLICY OF KEWANEE HOSPITAL TO EXTEND A FULL OR PARTIAL DISCOUNT FROM CHARGES TO QUALIFYING PATIENTS WHOSE CARE IS NOT COVERED BY OTHER FINANCIAL AID OR GOVERNMENT HEALTHCARE PROGRAMS. KEWANEE HOSPITAL UTILIZES A NUMBER OF METHODS FOR COMMUNICATING FINANCIAL ASSISTANCE, INCLUDING CHARITY CARE, TO PATIENTS AND THE COMMUNITY INCLUDING:A. SIGNS STATING THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED INTHE EMERGENCY DEPARTMENT, REGISTRATION AND ADMITTING AREAS AND THECASHIERS OFFICE. BROCHURES WITH INFORMATION REGARDING CHARITY CARE ARE ALSO AVAILABLE.B. NOTICE OF THE AVAILABILITY OF CHARITY CARE IS INCLUDED ON THEHOSPITALS WEB SITE.C. PATIENT FINANCIAL SERVICES STAFF IS KNOWLEDGEABLE ABOUT THE POLICY AND PROCESS.D. THE STAFFS OF THE OUTSOURCED SELF PAY BILLING SERVICE AND BAD DEBTCOLLECTION AGENCY ARE ALSO KNOWLEDGEABLE ABOUT THE POLICY AND PROCESS.E. NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON ORWITH HOSPITAL BILLING STATEMENTS TO GUARANTORS.KEWANEE HOSPITAL ATTEMPTS TO IDENTIFY UNINSURED PATIENTS ELIGIBLE FORCHARITY CARE PRIOR TO OR AT TIME OF SERVICE. FINANCIAL ASSISTANCEINFORMATION AND APPLICATIONS MAY BE OBTAINED FROM THE FINANCIALCOUNSELORS. COMPLETED APPLICATIONS AND DOCUMENTATION WILL BE REVIEWED AND PROCESSED. APPLICANTS WILL THEN RECEIVE A WRITTEN DETERMINATION OF ELIGIBILITY. PART VI, LINE 2: KEWANEE HOSPITAL CONTINUALLY STRIVES TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED AND PERFORMS ONGOING ASSESSMENTS IN ORDER TO BEST ALLOCATE THE HOSPITAL'S SCARCE RESOURCES, THE HOSPITAL EVALUATES THE NEEDS OF THE KEWANEE COMMUNITY THROUGH INTERNAL EVALUATION OF MARKET DATA, COMMUNITY DEMOGRAPHICS, CDC AND OTHER HEALTH RELATED DATA, ANALYSIS OF PATIENTS SERVED THROUGH THE HOSPITALS FAMILY HEALTH CLINIC, REVIEW OF EMERGENCY DEPARTMENT VISITS, AND COLLABORATIVE MEETINGS WITH THE AREA SCHOOL DISTRICTS AND THE COUNTY HEALTH DEPARTMENT.KEWANEE HOSPITAL WORKS WITH A NUMBER OF COMMUNITY VOLUNTEERS THROUGH THE HOSPITALS DEVELOPMENT COUNCIL. THE COMMUNITY RELATIONS COMMITTEE IS CHARGED WITH NEEDED EDUCATION FOR THE COMMUNITY AND UTILIZES THE INFORMATION GAINED AS TOPICS FOR EDUCATION. THROUGH THE ONGOING ASSESSMENT PROCESS THE HOSPITAL HAS IDENTIFIED AND PROVIDED OUTREACH INCLUDING A SUICIDE PREVENTION EDUCATIONAL SERIES FOR TEACHERS AND PARENTS, FINANCIAL WELLNESS FOR WOMEN, AND SKIN-CANCER PREVENTION.THROUGH COLLABORATION WITH KEWANEE HOSPITAL'S REGIONAL PARTNERS, INCLUDING THE HENRY COUNTY HEALTH DEPARTMENT, THE HOSPITAL IDENTIFIED DISASTER PREPAREDNESS AS A COMMUNITY NEED. AS A RURAL COMMUNITY, KEWANEE HAS FEW CITY RESOURCES. CITIZENS VIEW THE HOSPITAL AS THE MAINSTAY OR COMMUNITY CORNERSTONE AND THUS WOULD LOOK TO KEWANEE HOSPITAL IN AN EMERGENCY. THE HOSPITAL LEADERSHIP TEAM, STAFF AND PROVIDERS HAVE GONE THROUGH EDUCATION AND TRAINING ON INCIDENT COMMAND. PART VI, LINE 3: KEWANEE HOSPITAL PROVIDED NEARLY $800,000 IN CHARITY CARE TO NEEDY COMMUNITY MEMBERS IN THE SIX-MONTH REPORTING PERIOD ENDING MARCH 31, 2014. KEWANEE HOSPITAL COMMUNICATES TO PATIENTS ABOUT THEIR FINANCIAL OBLIGATIONS THROUGHOUT THE HEALTH CARE EXPERIENCE. IT IS THE HOSPITAL'S GOAL TO ASSESS FINANCIAL NEED AS SOON AS POSSIBLE IN THE CARE PROCESS. PATIENTS SETTING UP DIAGNOSTIC TESTING THROUGH CENTRALIZED SCHEDULING DISCUSS THE PAYMENT OBLIGATIONS PRIOR TO VISITING THE HOSPITAL, ALLOWING FOR PATIENTS NEEDING ASSISTANCE TO START THE PROCESS RIGHT THEN. THE FAMILY HEALTH CLINIC (FHC) PATIENTS BENEFIT FROM HAVING FHC STAFF TALK WITH THEM ABOUT OBLIGATIONS RELATED TO PROCEDURES, DIAGNOSTICS, ETC. AND ARE OFTEN ABLE TO ACCESS FINANCIAL ASSISTANCE PRIOR TO THE PROCEDURE. KEWANEE HOSPITAL STAFF IS TRAINED TO RECOGNIZE POTENTIAL NEED AND TO PROACTIVELY DISCUSS PAYMENT ARRANGEMENTS. THE HOSPITAL PROMOTES FINANCIAL ASSISTANCE THROUGHOUT THE ORGANIZATION AND THROUGH VARIOUS PUBLICATIONS. INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS IS POSTED THROUGH:-SIGNAGE (ADMISSIONS/REGISTRATION AT MAIN ENTRANCE, EMERGENCY DEPARTMENT ADMISSIONS, ADMISSION BOOTHS).-KEWANEE HOSPITAL'S WEBSITE, WWW.KEWANEEHOSPITAL.COM (AFTER THE MERGER, THE WEBSITE IS WWW.OSFSAINTLUKE.ORG) DIRECT MAIL PIECES INCLUDING BIANNUAL NEWSLETTERS AND COMMUNITY BENEFIT REPORT-HENRY COUNTY TOURISM VIDEO/WEB-SITE LINK-RADIO PROGRAM, MONDAY MORNING TUNED-IN, WKEI-PATIENT EDUCATION THROUGHOUT THE CARE PROCESS-FINANCIAL ASSISTANCE BROCHURES AT CASHIERS WINDOW-PATIENT BILL FOR SERVICE.-IDENTIFICATION OF NEED AND EDUCATION THROUGH CENTRALIZED SCHEDULING, ADMISSIONS STAFF, FHC STAFF, CASHIERS OFFICE, FINANCIAL COUNSELORS, PROVIDERS OF SERVICES, AND OTHER STAFF AS THEY BECOME AWARE OF THE PATIENTS NEED.-ANNOUNCEMENTS AND POSTINGS AT BOOTHS AT FREE COMMUNITY EDUCATION AND OUTREACH CONDUCTED BY KEWANEE HOSPITAL. PART VI, LINE 4: KEWANEE HOSPITAL IS LOCATED IN A RURAL AREA OF NORTHERN WEST-CENTRAL ILLINOIS, ABOUT 10 MILES SOUTH OF INTERSTATE 80 AND BETWEEN THE LARGER URBAN AREAS OF PEORIA, ILLINOIS AND THE QUAD CITIES (LOCATED ABOUT 50-55 MILES FROM EACH). THE HOSPITAL SERVES THE PRIMARY MARKET AREA (POPULATION APPROXIMATELY 19,700) OF KEWANEE AND THE SURROUNDING RURAL COMMUNITIES INCLUDING GALVA AND TOULON. THE OVERALL MARKET (POPULATION APPROXIMATELY 29,000) INCLUDES THE THREE COUNTY PORTIONS OF HENRY, BUREAU, AND STARK IN RURAL ILLINOIS. THE LARGEST PERCENTAGES OF KEWANEE HOSPITALS PATIENTS ARE DERIVED FROM THE KEWANEE ZIP CODE OF 61443. THE POPULATION OF KEWANEE IS AGING AND POOR WITH THE GREATEST NUMBERS IN THE OVER 65 AND UNDER 18. IN 2012, 18% OF THE POPULATION WAS BELOW THE POVERTY LEVEL. THE KEWANEE SCHOOL DISTRICT REPORTED OVER 79% OF CHILDREN ATTENDING SCHOOL ON THE FREE AND REDUCED LUNCH PROGRAM. SUBSEQUENTLY THAT LEAVES FEW CITIZENS IN THE MIDDLE WHERE A COMMUNITY TYPICALLY SEES THE WORKING CLASS. AS A RESULT OF THE DEMOGRAPHICS, KEWANEE HOSPITAL SEES A HIGH PROPORTION OF PATIENTS RELIANT ON MEDICAID AND UNINSURED. FOLLOWING THE NATIONAL TREND, THE HIGHEST CONCENTRATION IS IN THE EMERGENCY DEPARTMENT AND THE HOSPITAL'S FAMILY HEALTH CLINIC (FHC). FOR THE SIX-MONTH REPORTING PERIOD ENDING MARCH 31, 2014, 30% OF PATIENTS IN THE EMERGENCY DEPARTMENT WERE RELIANT ON MEDICAID WHILE 15% WERE UNINSURED. THE FAMILY HEALTH CLINIC REPORTED 37% OF PATIENTS WERE RELIANT ON MEDICAID AND 8% UNINSURED. 1 IL HOSPITAL RESEARCH & EDUCATION FOUNDATION 1151 E WARRENVILLE NAPERVILLE IL 60566 237421930 501(C)(3) 16250 TO ADDRESS THE DISPARATE AND NEGATIVE EFFECTS OF THE ILLINOIS MEDICAID PROGRAM. KEWANEE AREA HEALTHCARE TRUST 1051 WEST SOUTH ST KEWANEE IL 61443 806264344 501(C)(3) 200000 TO SUPPORT THE DELIVERY AND AVAILABILITY OF HIGH-QUALITY HEALTHCARE SERVICES WITHIN KEWANEE HOSPITAL'S SERVICE AREA PER THE AFFILIATION AGREEMENT. 2 0 PART I, LINE 2: FOR GRANTS GIVEN TO ORGANIZATIONS, SUBSTANTIATION IS REQUIRED PRIOR TO DISBURSEMENT OF ALL FUNDS FOR SCHOLARSHIPS, ALL INDIVIDUALS MUST SIGN A SUPPORT AGREEMENT VERIFYING THEIR OBLIGATIONS AS AWARD RECIPIENTS AND THE RAMIFICATIONS IF THE AGREEMENT IS NOT MET. X X X X X 0 0 0 0 0 0 0 0 0 LYNN A FULTON CEO 191677 0 0 0 0 0 10061 0 24704 0 226442 0 0 0 DANIEL CONGREVE MD TRUSTEE 411637 0 0 0 0 0 11100 0 24199 0 446936 0 0 0 AIMEE SHANE CRNA CRNA 168628 0 0 0 0 0 8651 0 11003 0 188282 0 0 0 NEIL TEX CRNA 151752 0 0 0 0 0 0 0 6751 0 158503 0 0 0 ALL ASSETS AND LIABILITIES WERE TRANSFERRED AS PART OF A MERGER DUE TO AFFILIATION. 2014-04-01 31958030 BOOK VALUE 370813229 OSF HEALTHCARE SYSTEM NORTHEAST GLEN OAK AVE PEORIA IL 61603 501(C)(3) 0 1 0 0 0 0 0 0 0 PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: THE TRANSFER, DUE TO AFFILIATION, WAS A STATUTORY MERGER. ALL OF THE OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES CONTINUED EMPLOYMENT (OR SERVICE TO THE BOARD) AFTER AFFILIATION. THE MERGER WILL ALLOW BOTH PARTIES TO UNIFY THEIR HEALTH CARE MISSIONS AND BETTER SERVE THE COMMUNITIES SERVED BY OSF AND KEWANEE. FORM 990, PART III, LINE 2 UROLOGY FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FOR THE SIX-MONTH PERIOD ENDED MARCH 31, 2014 WILL BE REVIEWED AND APPROVED BY THE CFO AND CEO AND THEN IT WILL BE SENT TO OSF (WHOM THIS ORGANIZATION MERGED WITH EFFECTIVE ON APRIL 1, 2014) FOR THEIR FINAL REVIEW AND APPROVAL. AT THIS TIME, THE FORMER BOD IS NO LONGER FIDUCIALLY RESPONSIBLE FOR THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ANY INTERESTED PERSON WHO HAS A PERSONAL OR PRIVATE INTEREST IN A MEASURE, CONTRACT, RESOLUTION, OR OTHER TRANSACTION PRESENTED TO THE BOARD OR A COMMITTEE THEREOF FOR DELIBERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION, OR ANY INTERESTED PERSON WHO REASONABLY BELIEVES SUCH AN INTEREST EXISTS IN ANOTHER PERSON, SHALL MAKE A PROMPT, FULL, AND FRANK DISCLOSURE IN WRITING OF THE PERSONAL OR PRIVATE INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. THE INTERESTED PERSON SHALL DISCLOSE THE EXISTENCE OF HIS OR HER PERSONAL OR PRIVATE INTEREST AND ALL MATERIAL FACTS, KNOWN TO HIM OR HER ABOUT THE PERSONAL OR PRIVATE INTEREST AND POTENTIAL CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF TRUSTEES ACTS AS THE COMPENSATION COMMITTEE FOR KEWANEE HOSPITAL. ANNUALLY THE EXECUTIVE COMMITTEE OF THE BOARD MEETS TO REVIEW AND APPROVE COMPENSATION FOR THE EXECUTIVE TEAM WHICH INCLUDES THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND CHIEF NURSING OFFICER. RESOURCE DATA FOR THIS REVIEW COMES FROM SALARY SURVEYS FROM A NUMBER OF SOURCES INCLUDING SULLIVAN COTTER, CENTRAL ILLINOIS SOCIETY FOR HEALTHCARE HUMAN RESOURCE ADMINISTRATION (CISHRA), IHA EXECUTIVE AND MANAGEMENT SALARY SURVEY, AND A 990 REVIEW THROUGH GUIDESTAR.ORG OF LOCAL AND REGIONAL ORGANIZATIONS. THE SURVEYS ARE ANALYZED BY REVIEWING APPLICABLE CUTS OF THE SURVEY INCLUDING CRITICAL ACCESS HOSPITALS, HOSPITALS WITH LIKE REVENUE, AND SIMILARLY STAFFED ORGANIZATIONS. SURVEYS ARE ALSO REVIEWED AT REGIONAL AND NATIONAL LEVELS. COMPENSATION IS PROPOSED TO THE COMMITTEE TAKING INTO CONSIDERATION THE MEDIAN RANGE OF ALL SALARY SOURCES, EDUCATION/DEGREE, TRAINING, CERTIFICATION, AND EXPERIENCE. THE COMMITTEE REVIEWS THE SALARY PROPOSAL FOR REASONABLENESS BASED ON THE DATA SOURCES. THE CHIEF EXECUTIVE OFFICER MAKES RECOMMENDATIONS FOR THE SALARIES OF THE OTHER EXECUTIVES (CFO AND CNO). FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED MEDICAL STAFF SERVICES: PROGRAM SERVICE EXPENSES 997,316. MANAGEMENT AND GENERAL EXPENSES 699,361. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,696,677. FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS DUE TO STATUTORY MERGER -31,958,030. FORM 990, PART XII, LINE 2C, AUDITED FINANCIAL STATEMENTS THE PROCESS HAS CHANGED FROM THE PRIOR YEAR. EFFECTIVE APRIL 1, 2014, THE HOSPITAL WAS MERGED INTO OSF HEALTHCARE SYSTEM (OSF), AN ILLINOIS NOT-FOR-PROFIT CORPORATION. DUE TO THE STATUTORY MERGER WITH OSF, THE COMMUNITY BOARD OF DIRECTORS NO LONGER HAD A FIDUCIARY RESPONSIBILITY, AND WAS NO LONGER A PART OF THE FINAL AUDIT PROCESS. FORM 990, PART XI, LINE 9, OTHER CHANGES IN NET ASSETS EFFECTIVE APRIL 1, 2014, THE HOSPITAL WAS MERGED INTO OSF HEALTHCARE SYSTEM (OSF), AN ILLINOIS NOT-FOR-PROFIT CORPORATION. AFTER THE MERGER, THE HOSPITAL AND OSF BECAME A SINGLE NOT-FOR-PROFIT CORPORATION WITH OSF BEING THE SURVIVING ENTITY AND THE HOSPITAL BECOMING AN OPERATING DIVISION OF OSF KNOWN AS OSF SAINT LUKE MEDICAL CENTER. THE HOSPITAL AS A SEPARATE CORPORATION CEASED TO EXIST AS OF APRIL 1, 2014, WITH ITS LAST DAY OF OPERATIONS BEING MARCH 31, 2014. AFTER THE MERGER, THE DEFINED CONTRIBUTION PLAN FOR HOSPITAL EMPLOYEES WAS FROZEN AND CONTRIBUTIONS TO THE PLAN CAN NO LONGER BE MADE. AS A RESULT OF THE MERGER, ALL ASSETS AND LIABILITIES OF THE HOSPITAL AS OF MARCH 31, 2014, WERE TRANSFERRED AND ASSUMED BY OSF. THE ILLINOIS FINANCE AUTHORITY REVENUE BONDS, SERIES 2006 ASSUMED BY OSF AND REFINANCED IN AUGUST 2014. DURING MARCH 2014, THE HOSPITAL TRANSFERRED $200,000 TO KEWANEE AREA HEALTHCARE TRUST, A NEWLY CREATED CHARITABLE TRUST AS REQUIRED BY THE MERGER OF THE HOSPITAL AND OSF. KEWANEE AREA HEALTHCARE TRUST IS A NOT-FOR-PROFIT PRIVATE FOUNDATION ESTABLISHED TO SUPPORT THE DELIVERY AND AVAILABILITY OF HIGH-QUALITY HEALTH CARE SERVICES TO THE RESIDENTS WITHIN OSF SAINT LUKE MEDICAL CENTER'S SERVICE AREA.