2015-05-14T14:33:57-05:00 2014-06-30 420714325 MCGLADREY LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2013-07-01 454475683 GENESIS MEDICAL CENTER ALEDO GENE 5634216508 409 NW 9TH AVENUE ALEDO IL 61231 MARK G ROGERS VP FINANCE/CFO GHS & ASST TREAS 5634216508 2015-05-12 1 JOHN J ROMANO P00227323 5638884000 2013 2016-02-25 16:41:14Z MARK G ROGERS 409 NW 9TH AVENUE ALEDO IL 61231 13398208 0 X WWW.GENESISHEALTH.COM X 2012 IL GENESIS HEALTH SYSTEM (GHS ILLINOIS), SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 18 8 123 16 0 0 11463 828470 5016182 12040547 3451 7485 2758665 521706 7789761 13398208 1138 5711 0 0 2660120 6447049 0 0 0 2576927 6429442 5238185 12882202 2551576 516006 6066705 12600882 3461985 9480156 2604720 3120726 GENESIS HEALTH SYSTEM (GHS ILLINOIS), SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 0 0 7649223 5711 10722601 GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) IS A 22-BED CRITICAL ACCESS HOSPITAL LOCATED IN ALEDO, IL AND SERVES THE HEALTH CARE NEEDS OF MERCER COUNTY RESIDENTS. GMC, ALEDO OFFERS A WIDE RANGE OF INPATIENT, OUTPATIENT, EMERGENCY, AND COMMUNITY HEALTH SERVICES DELIVERED BY HIGHLY-QUALIFIED HEALTH CARE PROFESSIONALS. 2004900 1822790 THE GENESIS HEALTH GROUP, ALEDO EMPLOYS FIVE PHYSICIANS AND TWO NURSE PRACTITIONERS OFFERING SERVICES IN FAMILY PRACTICE, INTERNAL MEDICINE, PODIATRY, OCCUPATIONAL MEDICINE AND WOMEN'S HEALTH. THIS TEAM OF MEDICAL PROFESSIONALS PROVIDES COMPREHENSIVE GENERAL HEALTH CARE, INCLUDING PHYSICAL EXAMINATION, TREATMENT AND MONITORING OF CHRONIC AND ACUTE HEALTH PROBLEMS, AS WELL AS INJURY THREATMENT, FOR BOTH ADULTS AND CHILDREN. 9654123 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 30 0 1 123 1 0 0 0 0 0 0 0 0 0 0 X 18 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X MARK G ROGERS 5634216508 1227 E RUSHOLME STREET DAVENPORT IA 52803 X STEVEN C BAHLS DIRECTOR 4.00 X 0 0 0 MARK D BAWDEN CHAIRPERSON 10.00 X X 0 0 0 GREGORY J BUSH TREASURER 4.00 X X 0 0 0 CHRISTOPHER J COX DIRECTOR 4.00 X 0 0 0 EDMUND P COYNE JR MD DIRECTOR 4.00 X 0 0 0 DOUGLAS P CROPPER PRESIDENT/CEO GHS 44.00 X X 0 969272 149873 THOMAS A GILDEHAUS FORMER DIRECTOR 4.00 X 0 0 0 ROGER J HILL SECRETARY 4.00 X X 0 0 0 MARK C KILMER DIRECTOR 4.00 X 0 0 0 JAMES W KOEHLER DIRECTOR 4.00 X 0 0 0 GEORGE J KONTOS JR MD DIRECTOR 40.00 X 0 530019 29764 DAVID C LARSON DIRECTOR 4.00 X 0 0 0 CHARLENE E MAASKE DIRECTOR 4.00 X 0 0 0 EDWIN V MOTTO MD DIRECTOR 10.00 X 0 0 0 EDWARD J ROGALSKI PHD DIRECTOR 10.00 X 0 0 0 G CHRISTOPHER WAHLIG VICE CHAIRPERSON 8.00 X X 0 0 0 C DANA WATERMAN III DIRECTOR 4.00 X 0 0 0 CAROL A WATSON PHD RN CENP DIRECTOR 4.00 X 0 0 0 DALE D ZUDE DIRECTOR 4.00 X 0 0 0 EDWARD TED J ROGALSKI GMC, ALEDO ADMINISTRATOR 40.00 X 164837 0 25686 MARK G ROGERS V.P. FINANCE/CFO GHS/ASST. TREASURER 40.00 X 0 516595 76548 JACQUELINE K ANHALT V.P. PATIENT SERVICES 40.00 X 0 212125 78177 WAYNE A DIEWALD CHIEF OPERATING OFFICER 40.00 X 0 522062 155674 ROBERT W FRIEDEN V.P. INFORMATION SERVICES 40.00 X 0 402514 30291 JOSEPH L LOHMULLER MD CHIEF MEDICAL OFFICER 40.00 X 0 289026 93236 FLORENCE L SPYROW SENIOR VICE PRESIDENT 40.00 X 0 671002 61440 KEVIN L YOUMANS V.P. OUTPATIENT SERVICES 40.00 X 0 158647 45612 KENNETH R CROKEN V.P. CORPORATE COMMUNICATIONS 40.00 X 0 363136 29115 HEIDI S KAHLY-MCMAHON V.P. HUMAN RESOURCES 40.00 X 0 357277 49300 JAMES A LEHMAN V.P. QUALITY 40.00 X 0 335162 51071 ROBERT D PADGETT MD PHYSICIAN 40.00 X 239237 49000 17930 MIKE L SHARP V.P. SUPPORT SERVICES 40.00 X 0 251653 61712 404074 5627490 955429 22 0 1 0 EMERGENCY DEPARTMENT ASSOCIATES 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ER PHYSICIAN SERVICES 781144 RIVERBEND ANESTHESIA 1710 COBBLESTONE DRIVE MUSCATINE IA 52761 ANESTHETHIC SERVICES 151980 2 28470 800000 828470 PROFESSIONAL SERVICES 622110 18104151 18104151 CLINIC REVENUE 622110 4081613 4081613 NURSING SERVICES 622110 1261316 1261316 PATIENT ANCILLARY SERVICES 622110 100879 100879 LESS: PROV TAX ASSESSEMNT 622110 -172376 -172376 -11335036 -11335036 12040547 7485 7485 16862 0 16862 16862 16862 OTHER INCOME 900099 444432 444432 VENDING/CAFETERIA SALES 722212 35120 35120 OUTSIDE SERVICE REVENUES 900099 25292 25292 504844 13398208 12545391 0 24347 5711 5711 180856 180856 5188076 5089038 99038 696344 696264 80 381773 362583 19190 972888 972403 485 7691 7691 859816 829263 30553 3117 2609 508 1156751 1052890 103861 908151 531 907620 435134 425384 9750 23233 18570 4663 23489 11929 11560 54902 54902 101014 47038 53976 CORPORATE OVERHEAD 1763341 1763341 MISCELLANEOUS 77691 42784 34907 COGS - PATIENT SUPPLY 42224 42224 12882202 9654123 3228079 0 607867 1097987 414682 55543 2897189 1994208 246797 281276 155439 63170 9184657 75959 1744731 9108698 6066705 12600882 2152130 3815869 121103 102707 1188752 5561580 3461985 9480156 X 2551576 3067582 53144 53144 2604720 3120726 6066705 12600882 516006 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 53144 53144 53144 53144 0.81000 0.19000 0.00000 0 0 65000 65000 229770 30235 199535 374362 45724 328638 8515525 8515525 9108698 MEDICARE SETTLEMENTS/BLUE CROSS UPP 549527 DUE TO GENESIS HEALTH SYSTEM (GHS ILLINOIS) 5012053 5561580 X PART V, LINE 4: INTENDED USE FOR PERMANENT RESTRICTED EDOWMENT TO USE TOWARDS THE HOSPITAL'S CAPITAL PROJECTS. PART X, LINE 2: GENESIS HEALTH SYSTEM (GHS IOWA), GENESIS HEALTH SYSTEM (GHS ILLINOIS), GENESIS SENIOR LIVING, ALEDO (GSL, ALEDO), GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO), GENESIS HEALTH SERVICES FOUNDATION (GENESIS FOUNDATION), GENESIS PHILANTHROPY (PHILANTHROPY) AND GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST (WORKERS' COMPENSATION TRUST) ALL FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. UNRELATED BUSINESS TAXABLE INCOME IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED 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% 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 UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, GSL, ALEDO, GMC, ALEDO, GENESIS FOUNDATION, PHILANTHROPY AND WORKERS' COMPENSATION TRUST ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, GENESIS FOUNDATION AND WORKERS' COMPENSATION TRUST ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED JUNE 30, 2010 AND PRIOR. GENVENTURES, INC. (GENVENTURES) IS A TAXABLE ORGANIZATION AND CURRENTLY FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND VARIOUS STATE JURISDICTIONS. GENVENTURES IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS JUNE 30, 2010 AND PRIOR. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2014 AND 2013. 1 1 X 1 X 1 X 1 1 0 1 1 299682 299682 0.02330 2191410 1618926 572484 0.04440 2491092 1618926 872166 0.06770 5073 5073 0.00040 4269 4269 0.00030 6301 6301 0.00050 15643 15643 0.00120 2506735 1618926 887809 0.06890 1215 1215 0.00010 220 220 0.00000 1325 1325 0.00010 2760 2760 0.00020 1 606972 0 4775059 4868311 -93252 X 1 1 1 1 GENESIS MEDICAL CENTER ALEDO 409 NW NINTH AVENUE ALEDO IL 61231 WWW.GENESISHEALTH.COM 5868 X X X X GENESIS MEDICAL CENTER ALEDO 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 1 GENESIS HEALTH GROUP ALEDO 1007 NW 3RD STREET ALEDO IL 61231 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO. THE CALCULATED COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE COST OF CHARITY CARE AND UNREIMBURSED MEDICAID. COSTS OF THE "OTHER BENEFITS" REPORTED IN 7E -7I WERE COMPILED THROUGHOUT THE YEAR IN THE COMMUNITY BENEFIT DATABASE (I.E., CBISA) THAT GMC, ALEDO UTILIZES. PART I, LINE 7G: NO COSTS ASSOCIATED WITH A PHYSICIAN CLINIC WERE REPORTED IN SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): NO BAD DEBT EXPENSE WAS INCLUDED IN THE DENOMINATOR BECAUSE BAD DEBT WAS REPORTED IN LINE 2F OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 19.46%, AND THE PERCENTAGE INCREASES TO 57.25% IF MEDICARE COST REPORT ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT (F2): GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) SUPPORTS EMPLOYEE COUNCIL/CHAMBER INVOLVEMENT BY PARTICIPATING AS A BOARD MEMBER OF "ALEDO MAIN STREET." COMMUNITY SUPPORT (F3): GMC, ALEDO SUPPORTS EMPLOYEE INVOLVEMENT WITH JUNIOR ACHIEVEMENT. WORKFORCE DEVELOPMENT (F8): GMC, ALEDO SUPPORTS ITS EMPLOYEE INVOLVEMENT ON THE ROCK ISLAND, HENRY AND MERCER COUNTIES WORKFORCE DEVELOPMENT BOARD. PART III, LINE 2: IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15, BAD DEBT IS REPORTED AT THE FULL-ESTABLISHED CHARGE FROM THE MOST RECENT AUDITED FINANCIAL REPORT. PAYMENTS RECEIVED AFTER AN ACCOUNT HAD BEEN WRITTEN OFF TO BAD DEBT WERE CREDITED TO A BAD DEBT RECOVERY ACCOUNT. DISCOUNTS ON PATIENT ACCOUNTS PROVIDED BY THIRD-PARTY PAYERS WERE WRITTEN OFF TO A CONTRACTUAL ALLOWANCE ACCOUNT. PART III, LINE 3: GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) UTILIZES AVADYNE HEALTH TO PROCESS AGING PATIENT ACCOUNTS. AVADYNE HEALTH'S COLLECTION PROCESS UTILIZES PUBLICLY AVAILABLE INFORMATION TO ENSURE ALL AGING PATIENT ACCOUNTS RECEIVE FINANCIAL ASSISTANCE IN ACCORDANCE TO GMC, ALEDO POLICY BEFORE BEING DEEMED BAD DEBT. GMC, ALEDO REPORTED ZERO DOLLARS FOR THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. RECEIVABLES DUE FROM MEDICAL OFFICE BUILDING TENANTS AND FROM COMMERCIAL LAUNDRY CUSTOMERS ARE CARRIED AT THE ORIGINAL INVOICE AMOUNT LESS AN ESTIMATE MADE FOR DOUBTFUL ACCOUNTS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. GENESIS MEDICAL CENTER, ALEDO DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. RECEIVABLES ARE WRITTEN OFF AS BAD DEBTS WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNT REPORTED IN PART III, LINES 5, 6, AND 7 FOR THE HOSPITAL. NO MEDICARE SHORTFALLS WERE INCLUDED IN COMMUNITY BENEFIT. THE MEDICARE COST REPORT SHORTFALL REPRESENTS THE DIFFERENCE BETWEEN THE TOTAL REVENUE RECEIVED FROM MEDICARE BASED ON MEDICARE COST REPORT REIMBURSEMENT RATES AND THE COSTS INCURRED BY GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) IN PROVIDING HEALTHCARE SERVICES TO THE ELDERLY. THE TOTAL MEDICARE SHORTFALL, WHICH INCLUDES FEE SCREEN SERVICES, WAS $93,252. IN ACCORDANCE WITH GMC, ALEDO'S MISSION STATEMENT, "TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED," THE ELDERLY WERE SERVED DESPITE THE TOTAL MEDICARE LOSS OF $93,252. GMC, ALEDO HAS A CLEAR MISSION TO SERVE ALL THOSE IN NEED AND TO IMPROVE THE HEALTH OF THE COMMUNITY INCLUDING THE ELDERLY. FURTHERMORE, THERE ARE NO FOR-PROFIT HOSPITALS IN THE COMMUNITY, AND THEREFORE GMC, ALEDO IS THE ONLY HEALTHCARE ORGANIZATION IN THE COMMUNITY WHO PROVIDES ACCESS TO HEALTHCARE FOR MEDICARE PATIENTS. ACCORDINGLY, IT IS GMC, ALEDO'S POSITION FOR THE REASONS STATED ABOVE THAT THE TOTAL MEDICARE SHORTFALL OF $93,252 REPRESENTS A COMMUNITY BENEFIT. PURSUANT TO THE INSTRUCTIONS TO THE FORM 990, SCHEDULE H, THE MEDICARE SHORTFALL IS NOT INCLUDED IN PART I, LINE 7. IF THE TOTAL MEDICARE SHORTFALL WAS INCLUDED IN PART I, LINE 7, THEN PART I, LINE 7K, COLUMN F WOULD BE 7.62%. PART III, LINE 9B: EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF ELIGIBLE, PAYMENT PLANS ARE MADE AVAILABLE BASED ON THEIR RESOURCES AND INCOME. ALL BALANCES OWING AFTER FINANCIAL ASSISTANCE ALLOWANCES HAVE BEEN TAKEN ARE PAYABLE IN MONTHLY PAYMENTS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) WAS INCORPORATED IN FEBRUARY 2012 AND REQUESTED EXEMPTION FROM THE INTERNAL REVENUE SERVICE BUT WAS NOT OPERATING AS A HOSPITAL. IN MARCH 2013, GMC, ALEDO ACQUIRED THE ASSETS OF MERCER COUNTY HOSPITAL AND BEGAN OPERATING AS A HOSPITAL FACILITY. AS A NEWLY AQUIRED HOSPITAL FACILITY, GMC, ALEDO IS REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE IDENTIFIED COMMUNITY NEEDS BY THE LAST DAY OF THE SECOND TAXABLE YEAR BEGINNING AFTER THE DATE THE HOSPITAL FACILITY WAS ACQUIRED. SINCE THE YEAR-ENDED JUNE 30, 2014 REPRESENTS THE FIRST TAXABLE YEAR AFTER ACQUISITION, GMC, ALEDO DID NOT CONDUCT A CHNA. PART VI, LINE 3: INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN VISIBLE LOCATIONS IN THE ADMISSION DEPARTMENT OF THE HOSPITAL. IN ADDITION, THE HOSPITAL REGISTRATION STAFF MAKE AVAILABLE INFORMATIVE BROCHURES FOR PATIENTS IN THE EMERGENCY ROOM REGISTRATION AREA EXPLAINING THEIR ELIGIBILITY FOR ASSISTANCE. GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) PROVIDES A PATIENT FINANCIAL COUNSELOR TO DISCUSS OPTIONS WITH THE PATIENTS. SHARED BUSINESS SERVICES PREPARES AND PROVIDES A LETTER TO EACH PATIENT, EXPLAINING THEIR CURRENT BALANCE AND ADVISING THEM OF THEIR OPTIONS. A PHONE NUMBER IS PROVIDED WITH THE LETTER ENCOURAGING THE PATIENT TO CALL IF NEEDED. IN ADDITION, THE GMC, ALEDO WEBSITE WWW.GENESISHEALTH.COM ALSO LISTS THE OPTIONS FOR PAYMENT. PART VI, LINE 4: THE MISSION OF GENESIS HEALTH SYSTEM (GHS ILLINOIS), SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO, (GMC, ALEDO) IS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. GMC, ALEDO AND ITS RELATED ORGANIZATIONS LIVE ITS MISSION EACH AND EVERY DAY BY SERVING A 10-COUNTY REGION OF EASTERN IOWA AND WESTERN ILLINOIS, INCLUDING BOTH URBAN AND RURAL AREAS. MERCER COUNTY IS A COUNTY LOCATED IN THE STATE OF ILLINOIS. ACCORDING TO THE 2010 CENSUS, IT HAS A POPULATION OF 16,434, WHICH IS A DECREASE OF 3.1% FROM 16,957 IN 2000. ITS COUNTY SEAT IS ALEDO. IT IS ONE OF THE FOUR COUNTIES THAT MAKE UP THE DAVENPORT - MOLINE - ROCK ISLAND METROPOLITAN STATISTICAL AREA. AS OF THE CENSUS OF 2000, THERE WERE 16,957 PEOPLE, 6,624 HOUSEHOLDS, AND 4,915 FAMILIES RESIDING IN THE COUNTY. OUT OF THE 6,624 HOUSEHOLDS, 32.10% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 63.5% WERE MARRIED COUPLES LIVING TOGETHER, 7.2% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 25.8% WERE NON-FAMILIES. 22.8% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 11.6% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.53 AND THE AVERAGE FAMILY SIZE WAS 2.96.IN THE COUNTY THE POPULATION WAS SPREAD OUT WITH 24.80% UNDER THE AGE OF 18, 7.3% FROM 18 TO 24, 26.6% FROM 25 TO 44, 25.4% FROM 45 TO 64, AND 15.90% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 40 YEARS. FOR EVERY 100 FEMALES THERE WERE 96.90 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER, THERE WERE 94.20 MALES.THE RACIAL MAKEUP OF THE COUNTY WAS 98.37% WHITE, 0.29% BLACK OR AFRICAN AMERICAN, 0.12% NATIVE AMERICAN, 0.17% ASIAN, 0.01% PACIFIC ISLANDER, 0.35% FROM OTHER RACES, AND 0.68% FROM TWO OR MORE RACES. 1.27% OF THE POPULATION WERE HISPANIC OR LATINO OF ANY RACE. 25.4% WERE GERMAN, 14.1% AMERICAN, 13.0% SWEDISH, 12.3% ENGLISH AND 11.3% IRISH ANCESTRY.THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $40,893, AND THE MEDIAN INCOME FOR A FAMILY WAS $47,192. MALES HAD A MEDIAN INCOME OF $35,138 VERSUS $22,227 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $18,645. 7.8% OF THE POPULATION AND 5.8% OF FAMILIES WERE BELOW THE POVERTY LINE. 10% OF THOSE UNDER THE AGE OF 18 AND 8.4% OF THOSE 65 AND OLDER WERE LIVING BELOW THE POVERTY LINE. PART VI, LINE 5: GMC, ALEDO'S BOARD OF DIRECTORS IS A DIVERSE REPRESENTATION OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA THAT GMC, ALEDO AND ITS RELATED ORGANIZATIONS SERVE. GMC, ALEDO AND ITS RELATED ORGANIZATIONS' EXECUTIVES AND EMPLOYEES SERVE ON DOZENS OF VOLUNTEER BOARDS THROUGHOUT THE REGION ON IMPORTANT PROJECTS AND INITIATIVES, SUCH AS HOMELESS SHELTERS, MENTAL HEALTH, DOWNTOWN REDEVELOPMENT, BIG BROTHERS AND BIG SISTERS, JUNIOR ACHIEVEMENT, EVENTS AND FESTIVALS. GMC, ALEDO EMPLOYEES SERVE THE COMMUNITIES WHERE THEY LIVE BY SERVING IN ELECTED OFFICES IN CITY AND COUNTY GOVERNMENT.GMC, ALEDO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE EMPLOYEES OF GMC, ALEDO AND ITS RELATED ORGANIZATIONS SUPPORT COMMUNITY OUTREACH PROGRAMS THROUGH A PROGRAM CALLED "TAKIN IT TO THE STREETS". PROJECTS HAVE INCLUDED PRIMARY SPONSORSHIP OF A HABITAT FOR HUMANITY HOUSE (292 VOLUNTEERS); COLLECTION OF ITEMS FOR DOMESTIC VIOLENCE SHELTERS AND HUMILITY OF MARY HOMELESS SHELTER; X-STREAM CLEANUP (94 VOLUNTEERS), A CLEANUP PROJECT OF RIVERS AND STREAMS, AND ADOPT A HIGHWAY. EMPLOYEES HAVE USED THEIR COLLECTIVE IMPACT AND GENEROSITY TO SECURE DONATIONS FOR FOOD PANTRIES. GMC, ALEDO PROVIDES THE COMMUNITY WITH CLASSES AND EVENTS PROMOTING HEALTH AND HEALTH EDUCATION. RESIDENTS IN THE REGION SERVED BY GMC, ALEDO LEARN CPR, FIRST AID, PARENTING SKILLS AND NEWBORN CARE BY ENROLLING IN CLASSES.GENESIS HEALTH SYSTEM HAS LAUNCHED GENESIS DINEWELL, A HEALTHY EATING PLAN FOR ITS OWN CAFETERIAS AND FOR RESTAURANTS IN THE REGION. GENESIS DINEWELL WILL WORK WITH LOCAL RESTAURANTS TO MAKE INFORMATION PUBLIC ABOUT HEALTHY RECIPES AND MENU ITEMS. THE IDEA IS THAT THE PUBLIC WILL BE BETTER ABLE TO MAKE INFORMED DECISIONS ABOUT THEIR FOOD CHOICES. GENESIS HEALTH SYSTEM DIETITIANS WILL COMPILE HEALTH RECIPES TO PROVIDE TO THE PUBLIC. THERE WILL ALSO BE AN "ASK THE DIETITIAN" FEATURE AVAILABLE AT WWW.GENESISHEALTH.COM.GMC, ALEDO AND ITS RELATED ORGANIZATIONS HAVE REDUCED ITS ENVIRONMENTAL FOOTPRINT ON THE COMMUNITIES IT SERVES BY IMPLEMENTING BULK WASTE RECYCLING, POLYSTYRENE RECYCLING, REDUCING SHARPS DISPOSAL, IMPLEMENTING WATER RUNOFF MEASURES, AND REDUCING WATER AND CHEMICAL USAGE IN THE MEDICAL LAUNDRY.GMC, ALEDO AND ITS RELATED ORGANIZATIONS MAINTAINS AN ACTIVE EFFORT TO ADVOCATE FOR ACCESS TO HEALTH CARE IN IOWA AND ILLINOIS STATE GOVERNMENT AND IN WASHINGTON D.C. EMPLOYEES ALSO PARTICIPATE IN A VOTER VOICE INITIATIVE TO ADVOCATE ON IMPORTANT HEALTH ISSUES WITH CITY, COUNTY, STATE AND NATIONAL ELECTED OFFICIALS. SURPLUS FUNDS RESULTING FROM EFFICIENT OPERATIONS AND COST-CONTAINMENT MEASURES ARE RE-INVESTED IN THE HEALTHCARE OPERATIONS OF GMC, ALEDO TO IMPROVE THE HEALTHCARE SERVICES THAT GMC, ALEDO PROVIDES. ADVANCES IN MEDICAL EQUIPMENT AND TECHNOLOGY, STAFF EDUCATION, AND NEW MEDICAL SERVICES ARE EXAMPLES OF OPERATIONAL INVESTMENTS THAT ULTIMATELY IMPROVE THE HEALTH OF THE COMMUNITIES THAT GMC, ALEDO SERVES. PART VI, LINE 6: GENESIS HEALTH SYSTEM (GHS IOWA), AN IOWA NONPROFIT CORPORATION, AND GENESIS HEALTH SYSTEM (GHS ILLINOIS), AN ILLINOIS NOT-FOR-PROFIT CORPORATION, HAVE IDENTICAL GOVERNING BOARDS, MANAGEMENT AND BYLAWS AND CAN ACT JOINTLY. GHS IOWA IS ALSO THE SOLE MEMBER OF GENESIS HEALTH SERVICES FOUNDATION, GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST AND GENESIS PHILANTHROPY, THE SOLE STOCKHOLDER OF GENVENTURES, INC., A MEMBER OF MISERICORDIA ASSURANCE COMPANY, LTD. AND A PARTNER IN GENGASTRO, LLC. GHS ILLINOIS IS THE SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO AND GENESIS SENIOR LIVING, ALEDO AND IS A PARTNER IN THE LARSON CENTER PARTNERSHIP.GHS IOWA, GHS ILLINOIS, GMC, ALEDO, AND GSL, ALEDO COLLECTIVELY REPRESENT THE OBLIGATED GROUP ON CERTAIN COMPONENTS OF THE OBLIGATED GROUP'S LONG-TERM DEBT. GHS IOWA AND GHS ILLINOIS OPERATE THE FOLLOWING BUSINESS UNITS: GENESIS HEALTH SYSTEM PROVIDES ADMINISTRATIVE, MANAGEMENT, INFORMATION TECHNOLOGY AND OTHER SUPPORT SERVICES TO ITS AFFILIATES. GENESIS CLINICAL SERVICES OPERATES PHYSICIAN MEDICAL PRACTICES, CONVENIENT CARE PRACTICES AND AN OCCUPATIONAL MEDICINE CLINIC AND PROVIDES BEHAVIORAL HEALTH SERVICES TO THE RESIDENTS OF EASTERN IOWA AND WESTERN ILLINOIS. GENESIS MEDICAL CENTER - DAVENPORT (GMC - DAVENPORT) IS LICENSED AS A 502-BED ACUTE CARE HOSPITAL WHICH PROVIDES SERVICES FROM TWO HOSPITAL FACILITIES LOCATED IN DAVENPORT, IOWA. GENESIS FAMILY MEDICAL CENTER (GFMC) IS A FAMILY PRACTICE RESIDENCY TRAINING PROGRAM THAT OPERATES CLINICS IN DAVENPORT AND BLUE GRASS, IOWA TO PROVIDE A CLINICAL SETTING FOR THE RESIDENTS TO TREAT PATIENTS. GENESIS MEDICAL CENTER - DEWITT (GMC - DEWITT) IS CERTIFIED AS A CRITICAL ACCESS HOSPITAL, WHICH HAS 13-ACUTE CARE AND SWING BEDS, AND HAS A 77-BED LONG-TERM CARE FACILITY, WHICH PROVIDES SERVICES FROM ITS FACILITY IN DEWITT, IOWA.GENESIS VISITING NURSE ASSOCIATION AND HOSPICE (VNA) PROVIDES HOME HEALTH CARE, COMMUNITY NURSING SERVICES AND HOSPICE SERVICES TO PATIENTS IN EASTERN IOWA AND WESTERN ILLINOIS. GENESIS MEDICAL CENTER - SILVIS (GMC - SILVIS) IS LICENSED AS A 149-BED ACUTE CARE HOSPITAL WHICH PROVIDES SERVICES FROM ITS FACILITY IN SILVIS, ILLINOIS. ILLINI HOSPITAL NURSING HOME (INH) OPERATES ILLINI RESTORATIVE CARE CENTER AND CROSSTOWN SQUARE. ILLINI RESTORATIVE CARE CENTER IS A 120-BED LICENSED NURSING FACILITY, CONSISTING OF 75 SKILLED CARE BEDS AND 45 SHELTERED CARE BEDS. TWENTY-TWO OF THE SKILLED CARE BEDS ARE DESIGNATED AS HOSPITAL-BASED MEDICARE CERTIFIED BEDS. THE SHELTERED CARE UNIT PROVIDES REHABILITATIVE AND PERSONAL CARE IN A FAMILY-ORIENTED SETTING. CROSSTOWN SQUARE IS AN INDEPENDENT LIVING FACILITY CONTAINING 76 RENTABLE APARTMENTS AND TWO GUEST ROOMS THAT OFFERS SERVICES DESIGNED TO MEET THE NEEDS OF SENIOR ADULTS. GHS IOWA AND GHS ILLINOIS HAVE A CONTROLLING OWNERSHIP INTEREST OR MEMBERSHIP IN THE FOLLOWING ORGANIZATIONS: GENESIS MEDICAL CENTER - ALEDO (GMC - ALEDO) IS CERTIFIED AS A CRITICAL ACCESS HOSPITAL, WHICH HAS 22-ACUTE CARE AND SWING BEDS, AS WELL AS A PHYSICAN CLINIC, WHICH PROVIDES SERVICES FROM ITS FACILITY IN ALEDO, ILLINOIS.GENESIS SENIOR LIVING - ALEDO (GSL - ALEDO) IS CERTIFIED AS A NURSING FACILITY, WHICH HAS A 92-BED LONG-TERM CARE FACILITY, WHICH PROVIDES SERVICES FROM ITS FACILITY IN ALEDO, ILLINOIS.GENESIS HEALTH SERVICES FOUNDATION (GENESIS FOUNDATION) IS AN ORGANIZATION WHOSE MISSION IS TO DEVELOP, MANAGE AND GRANT CHARITABLE SUPPORT TO MEET THE HEALTH-RELATED NEEDS OF THE COMMUNITIES SERVED BY GENESIS HEALTH SYSTEM. THE GENESIS FOUNDATION IS REFERRED TO AS THE FOUNDATION. GENGASTRO, LLC (D/B/A THE CENTER FOR DIGESTIVE HEALTH) IS A LIMITED LIABILITY COMPANY, WHICH OPERATES A SINGLE-SPECIALTY GASTROENTEROLOGY AMBULATORY SURGERY CENTER LOCATED IN BETTENDORF, IOWA. UPON OBTAINING A CONTROLLING INTEREST, THE SYSTEM CONSOLIDATED THE ACCOUNTS OF GENGASTRO, LLC IN ITS CONSOLIDATED FINANCIAL STATEMENTS IN JANUARY 2011. GENESIS HEALTH SYSTEM (GHS IOWA) MAINTAINS A 75% OWNERSHIP INTEREST AS OF JUNE 30, 2014 AND 2013. THE LARSON CENTER PARTNERSHIP (LCP) IS A FOR-PROFIT REAL ESTATE PARTNERSHIP WHICH OWNS A MEDICAL OFFICE BUILDING ADJACENT TO GMC ILLINI AND LEASES SPACE FOR CLINICS, LABORATORY, PHARMACY AND OFFICES TO GMC ILLINI AND OTHER THIRD-PARTY ORGANIZATIONS. GHS ILLINOIS IS A GENERAL PARTNER AND OWNS APPROXIMATELY 75.6% OF LCP.GENVENTURES, INC. (GENVENTURES) IS A WHOLLY-OWNED FOR-PROFIT CORPORATION WHICH OPERATES THE FOLLOWING DIVISIONS, PRIMARILY IN THE QUAD CITIES: GENESIS AT HOME, CONTINUING CARE SELLS AND LEASES HOME MEDICAL EQUIPMENT; PROVIDES INTRAVENOUS THERAPY SERVICES, INCLUDING SALES OF RELATED SOLUTIONS AND SUPPLIES TO PATIENTS; AND PROVIDES RETAIL PHARMACEUTICAL AND OVER-THE-COUNTER PRODUCTS TO PATIENTS AND EMPLOYEES OF THE SYSTEM. GENPROPERTIES OWNS, LEASES AND/OR MANAGES OFFICE SPACE IN 15 MEDICAL OFFICE BUILDINGS LOCATED IN BETTENDORF, CLINTON, DAVENPORT, ELDRIDGE, LE CLAIRE AND MUSCATINE, IOWA. CRESCENT LAUNDRY PROVIDES COMMERCIAL LAUNDRY SERVICES TO HEALTH CARE FACILITIES IN EASTERN IOWA AND IN NORTH-CENTRAL ILLINOIS. GENESIS ACCOUNTABLE CARE ORGANIZATION, LLC (GENESIS ACO) IS AN IOWA LIMITED LIABILITY COMPANY FORMED IN DECEMBER 2011. ITS PURPOSE IS TO ENGAGE IN ANY LAWFUL BUSINESS AND ANY BUSINESS RELATED TO CREATION AND ORGANIZATION OF A "PHYSICIAN-DRIVEN" NETWORK TO ACT AS, AND/OR PARTICIPATE IN, AN ACCOUNTABLE CARE ORGANIZATION WITHIN THE MEANING OF THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE COMPANY IS ALSO ORGANIZED TO DEVELOP A CLINICALLY INTEGRATED NETWORK OF PROVIDERS INCLUDING PHYSICIANS, HEALTH PROFESSIONALS, HOSPITALS AND ANCILLARY PROVIDERS WORKING TOGETHER TO PROMOTE HIGH QUALITY, COORDINATED AND EFFICIENT CARE TO PATIENTS INCLUDING MEMBERS OF VARIOUS MANAGED CARE PAYORS AND THE COMMUNITY AT LARGE. GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST (WORKERS' COMPENSATION TRUST) PROVIDES A FUND WHICH CAN BE USED TO PAY WORKERS' COMPENSATION CLAIMS AND COSTS FOR THE BENEFIT OF GENESIS HEALTH SYSTEM. MISERICORDIA ASSURANCE COMPANY, LTD. (MISERICORDIA) IS A WHOLLY-OWNED CAYMAN BASED CAPTIVE INSURANCE COMPANY WHICH UNDERWRITES THE GENERAL AND PROFESSIONAL LIABILITY RISKS OF GHS IOWA AND AFFILIATES. GENESIS PHILANTHROPY IS A WHOLLY-OWNED TAX-EXEMPT ENTITY FORMED IN 2013, WHICH PARTNERS WITH OTHER HOSPITAL FOUNDATIONS TO FORM A REGIONAL NETWORK TO ATTRACT DONORS TO HELP FUND SPECIFIC HEALTH-RELATED CAUSES AND PROMOTE WELLNESS IN THE REGION. PART VI, LINE 7, REPORTS FILED WITH STATES IL,IA 0 1 0 0 0 0 0 0 0 DOUGLAS P CROPPER PRESIDENT/CEO GHS 0 643736 0 188962 0 136574 0 128504 0 21369 0 1119145 0 0 GEORGE J KONTOS JR MD DIRECTOR 0 451523 0 5836 0 72660 0 11250 0 18514 0 559783 0 0 EDWARD TED J ROGALSKI GMC, ALEDO ADMINISTRATOR 128516 0 15555 0 20766 0 8178 0 17508 0 190523 0 0 0 MARK G ROGERS V.P. FINANCE/CFO GHS/ASST. TREASURER 0 310175 0 97204 0 109216 0 62436 0 14112 0 593143 0 0 JACQUELINE K ANHALT V.P. PATIENT SERVICES 0 182757 0 19689 0 9679 0 60316 0 17861 0 290302 0 0 WAYNE A DIEWALD CHIEF OPERATING OFFICER 0 425137 0 92235 0 4690 0 140500 0 15174 0 677736 0 0 ROBERT W FRIEDEN V.P. INFORMATION SERVICES 0 248278 0 39267 0 114969 0 11389 0 18902 0 432805 0 0 JOSEPH L LOHMULLER MD CHIEF MEDICAL OFFICER 0 233270 0 39236 0 16520 0 76516 0 16720 0 382262 0 0 FLORENCE L SPYROW SENIOR VICE PRESIDENT 0 317200 0 54519 0 299283 0 59080 0 2360 0 732442 0 172872 KEVIN L YOUMANS V.P. OUTPATIENT SERVICES 0 123425 0 20000 0 15222 0 33800 0 11812 0 204259 0 0 KENNETH R CROKEN V.P. CORPORATE COMMUNICATIONS 0 239314 0 33966 0 89856 0 15323 0 13792 0 392251 0 0 HEIDI S KAHLY-MCMAHON V.P. HUMAN RESOURCES 0 193403 0 27422 0 136452 0 30806 0 18494 0 406577 0 75129 JAMES A LEHMAN V.P. QUALITY 0 130852 0 52377 0 151933 0 43675 0 7396 0 386233 0 0 ROBERT D PADGETT MD PHYSICIAN 224246 45930 0 0 14991 3070 1173 241 13708 2808 254118 52049 0 0 MIKE L SHARP V.P. SUPPORT SERVICES 0 174080 0 25871 0 51702 0 47620 0 14092 0 313365 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2013 SPONSORED BY GENESIS HEALTH SYSTEM (GHS IOWA), A RELATED ORGANIZATION: JAMES A. LEHMAN - $72,451. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUAL TO THE PLAN IN 2013 AND THE GROSS-UP PAYMENT TO COVER TAX. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2013 SPONSORED BY GENESIS HEALTH SYSTEM (GHS IOWA), A RELATED ORGANIZATION: KENNETH R. CROKEN - $81,075, DOUGLAS P. CROPPER - $117,004, ROBERT W. FRIEDEN - $82,574, HEIDI S. KAHLY-MCMAHON - $131,627, MARK G. ROGERS - $49,636, MIKE L. SHARP - $22,303 AND FLORENCE L. SPYROW - $281,826. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2013. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2013 SPONSORED BY GHS IOWA, A RELATED ORGANIZATION: JACQUELINE K. ANHALT - $47,008, DOUGLAS P. CROPPER - $117,004, WAYNE A. DIEWALD - $129,000, HEIDI S. KAHLY-MCMAHON - $24,929, JOSEPH L. LOHMULLER, M.D. - $66,502, MARK G. ROGERS - $49,636, MIKE L. SHARP - $22,303, FLORENCE L. SPYROW - $47,580 AND KEVIN L. YOUMANS - $33,800. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2013. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. FORM 990, SCHEDULE J, PART I, LINE 3: GENESIS MEDICAL CENTER, ALEDO RELIES ON GENESIS HEALTH SYSTEM (GHS IOWA) TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS, AND KEY EMPLOYEES. GHS IOWA UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE SUCH COMPENSATION. FORM 990, SCHEDULE J, PART II, COLUMN F: THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2009, 2010, 2011, 2012 AND 2013 SPONSORED BY GENESIS HEALTH SYSTEM (GHS IOWA), A RELATED ENTITY: HEIDI S. KAHLY-MCMAHON - $75,129 AND FLORENCE L. SPYROW - $172,872. THE DOLLAR AMOUNT REPRESENTS PRIOR YEAR CONTRIBUTIONS MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009, 2010, 2011 AND 2012. THIS INFORMATION WAS INCLUDED IN DEFERRED COMPENSATION ON THE PRIOR YEARS' FORM 990, PART VII AND SCHEDULE J, PART II. THESE INDIVIDUALS REACHED A SPECIFIED LEVEL OF VESTING IN 2013, SO THE DOLLAR AMOUNT IS NOW INCLUDED IN REPORTABLE COMPENSATION ON THE CURRENT YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THE DOLLAR AMOUNT IS ALSO LISTED AS COMPENSATION REPORTED IN A PRIOR YEAR FORM 990 ON THE CURRENT YEAR FORM 990, SCHEDULE J, PART II. EDWARD TED J ROGALSKI SEE BELOW IN PART V 180856 EDWARD (TED) J. ROGALSKI RECEIVES COMPENSATION FROM GENESIS MEDICAL CENTER, ALEDO AS AN ADMINISTRATOR OF THE ORGANIZATION. 0 GENVENTURES INC SEE BELOW IN PART V 17494 GENESIS MEDICAL CENTER, ALEDO PAID GENVENTURES, INC. FOR MEDICAL SUPPLIES AND LAUNDRY SERVICES. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - EDWARD (TED) J. ROGALSKIEDWARD (TED) J. ROGALSKI IS THE SON OF EDWARD J. ROGALSKI, PH.D., DIRECTOR OF GENESIS MEDICAL CENTER, ALEDO. FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - GENVENTURES, INC.MARK G. ROGERS AND ROGER J. HILL ARE OFFICERS, JAMES W. KOEHLER IS A DIRECTOR, FLORENCE L. SPYROW IS A KEY EMPLOYEE AND MIKE L. SHARP IS A HIGHEST COMPENSATED EMPLOYEE OF GENESIS MEDICAL CENTER, ALEDO AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, MARK G. ROGERS, ROGER J. HILL, JAMES W. KOEHLER, AND MIKE L. SHARP WERE OFFICERS AND FLORENCE L. SPYROW WAS A DIRECTOR OF GENVENTURES, INC. FORM 990, PART I, LINE 4 & PART VI, SECTION A, LINE 1B: THE FOLLOWING GENESIS MEDICAL CENTER, ALEDO DIRECTORS ARE NOT INDEPENDENT DUE TO TRANSACTIONS DISCLOSED ON FORM 990, SCHEDULE L OF GENESIS HEALTH SYSTEM (GHS IOWA), A RELATED TAX-EXEMPT ORGANIZATION: GREGORY J. BUSH, EDMUND P. COYNE, JR., M.D., ROGER J. HILL, MARK C. KILMER, JAMES W. KOEHLER, EDWIN V. MOTTO, M.D., EDWARD J. ROGALSKI, PH.D., AND C. DANA WATERMAN III. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO IS GENESIS HEALTH SYSTEM (GHS ILLINOIS), AN ILLINOIS NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO (CORPORATION), GENESIS HEALTH SYSTEM (GHS ILLINOIS) HAS THE POWER: 1) TO DETERMINE THE NUMBER OF DIRECTORS OF THE CORPORATION AND TO ELECT, APPOINT, REMOVE OR FILL THE VACANCIES OF THE BOARD MEMBERS; 2) TO PRESENT AT ANY REGULAR OR SPECIAL BOARD MEETING I) AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS, II) A PLAN OF MERGER OR CONSOLIDATION BY THE CORPORATION INTO OR WITH ANY OTHER CORPORATION, III) A PROPOSAL FOR ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE CORPORATION'S ASSETS, AND III) A PROPOSAL FOR DISSOLUTION OF THE CORPORATION AND PLAN OF DISTRIBUTION; 3) TO ESTABLISH SYSTEM WIDE POLICIES AND PROCEDURES REGARDING QUALITY OF CARE, FINANCE, UTILIZATION OF RESOURCES, MANAGED CARE CONTRACTING, STRATEGIC PLANNING, AND EMPLOYEE BENEFITS; 4) TO ASSESS THE CORPORATION EXPENSES OF THE MEMBER ATTRIBUTABLE TO THE CORPORATION AND AFFILIATES AND TO ASSESS TO THE CORPORATION ITS SHARE OF GENERAL OVERHEAD OF THE MEMBER; AND 5) TO DIRECT THE CORPORATION TO TRANSFER FUNDS TO THE MEMBER FOR THE DEVELOPMENT OF SYSTEM WIDE PROJECTS. FORM 990, PART VI, SECTION B, LINE 11 INTERNAL MANAGEMENT REVIEW IS COMPLETED OF THE COMPILED INFORMATION PRIOR TO PREPARATION AND REVIEW BY MCGLADREY LLP. FOLLOWING MCGLADREY LLP'S PREPARATION AND REVIEW OF THE FORM 990, IT IS REVIEWED WITH THE ORGANIZATION'S VICE PRESIDENT, FINANCE/CFO; VICE PRESIDENT, LEGAL AFFAIRS; VICE PRESIDENT, HUMAN RESOURCES; AND CHIEF COMPLIANCE RISK OFFICER. THE FORM 990 IS THEN REVIEWED AT A JOINT MEETING OF THE ORGANIZATION'S FINANCE COMMITTEE AND AUDIT & COMPLIANCE COMMITTEE. PRIOR TO SUBMITTING THE FORM 990 TO THE IRS, IT IS E-MAILED TO THE ORGANIZATION'S BOARD OF DIRECTORS ONE WEEK IN ADVANCE OF A SCHEDULED MEETING. AT THE BOARD OF DIRECTORS MEETING, INTERNAL MANAGEMENT REVIEWS THE FORM 990 WITH THE BOARD OF DIRECTORS. SUGGESTED CHANGES FROM ALL OF THESE REVIEWS ARE CONSIDERED FOR INCLUSION IN THE FINAL FORM 990 SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, OR MEMBER OF A BOARD OR BOARD COMMITTEE OF GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) OR AN AFFILIATE, SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT WILL BE CONSIDERED BY MANAGEMENT, THE BOARD, OR A COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING GMC, ALEDO, OR AN AFFILIATE, OR WITH RESPECT TO DESIGNATED FACILITIES AND ACTIVITIES, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH PERSON ADVOCATE HIS OR HER POSITION INFORMALLY THROUGH PRIVATE CONTACT, COMMUNICATION AND DISCUSSION WITH ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE APPLICABLE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EACH EXECUTIVE POSITION IS EVALUATED USING A FORMAL EVALUATION PLAN THAT IS ESTABLISHED BY AN OUTSIDE CONSULTANT. AT THE PRESENT TIME, THE CONSULTANT USES A POINT SYSTEM FOR JOB EVALUATION. THE POINT VALUES ARE BASED ON "KNOW HOW", "PROBLEM SOLVING", "ACCOUNTABILITY", AND OTHER JOB ATTRIBUTES SPECIFIC TO THE POSITION. ONCE THE POINT VALUE IS SET FOR A POSITION, MARKET COMPARISONS FOR JOBS WITH THE SAME ORGANIZATIONAL IMPACT CAN BE COMPARED FOR SALARY PURPOSES AND ESTABLISH PAY RANGES. THE DESIGN OF THE PAY RANGES FOR EXECUTIVES IS BASED ON MARKET DATA. THE MIDPOINT OF EACH PAY RANGE IS ESTABLISHED AT THE 50TH PERCENTILE OF THE MARKET COMPARISONS. A MINIMUM AND MAXIMUM ARE ESTABLISHED OFF OF THE MIDPOINT. SPECIFIC PAY RATES FOR EXECUTIVES ARE SUBJECT TO CEO AND COMPENSATION COMMITTEE AND THE GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) BOARD OF DIRECTORS APPROVAL. PAY RANGES ARE REVIEWED EACH YEAR TO DETERMINE THE NEED FOR REVISION. WHEN MARKET CONDITIONS SUGGEST AN ADJUSTMENT TO PAY RANGES, DATA WILL BE PRESENTED TO THE COMPENSATION COMMITTEE FOR ITS REVIEW. THE SPECIFIC PAY RANGES ARE SUBJECT TO CEO, COMPENSATION COMMITTEE, AND GHS BOARD OF DIRECTOR APPROVAL. THE PRESIDENT AND CEO HAVE THE AUTHORITY AND RESPONSIBILITY TO ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE AND THE GMC, ALEDO BOARD OF DIRECTORS, THE BASE COMPENSATION OF EACH EXECUTIVE EMPLOYED BY GMC, ALEDO, AT APPROPRAITE TIMES. THE GMC, ALEDO BOARD OF DIRECTORS SHALL ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE, THE BASE COMPENSATION FOR THE CEO OF GMC, ALEDO, AT APPROPRIATE TIMES. THE LAST TIME THIS PROCESS WAS FORMALLY UNDERTAKEN WAS NOVEMBER 2012. 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 VII, LINE 1A: GENESIS HEALTH SYSTEM (GHS IOWA), GENESIS HEALTH SYSTEM (GHS ILLINOIS), GENESIS SENIOR LIVING, ALEDO, GENESIS HEALTH SERVICES FOUNDATION, GENESIS PHILANTHROPY AND GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ARE RELATED ORGANIZATIONS OF GENESIS MEDICAL CENTER, ALEDO. THE AMOUNTS REPORTED AS REPORTABLE COMPENSATION FOR THE OFFICERS, KEY EMPLOYEES, AND HIGHLY COMPENSATED EMPLOYEES, UNLESS OTHERWISE NOTED ELSEWHERE IN PART VII, ARE FOR SERVICES RENDERED ON BEHALF OF ALL ORGANIZATIONS. IT WOULD BE ADMINISTRATIVELY IMPRACTICABLE FOR MEMBERS OF THE GOVERNING BOARD AND THE EXECUTIVE TEAM TO BREAKOUT THEIR REPORTABLE COMPENSATION AMONG EACH ORGANIZATION. ALL REPORTABLE COMPENSATION, UNLESS OTHERWISE NOTED IN PART VII, IS PAID BY GHS IOWA. FORM 990, PART XII, LINE 2C: THE OVERISGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. GENESIS ACCOUNTABLE CARE ORGANIZATION LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 454168932 ACCOUNTABLE CARE SERVICES IA -450504 1970087 GENESIS HEALTH SYSTEM (GHS IOWA) SPIN ECHO LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 421491373 PROPERTY MANAGEMENT IA 138232 1603464 GENVENTURES INC GENESIS HEALTH SYSTEM (GHS ILLINOIS) 801 ILLINI DRIVE SILVIS IL 61282 363616314 HEALTHCARE IL 501(C)(3) LINE 3 GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENESIS HEALTH SYSTEM (GHS IOWA) 1227 E RUSHOLME STREET DAVENPORT IA 52803 421418847 HEALTHCARE IA 501(C)(3) LINE 3 GENESIS HEALTH SYSTEM (GHS ILLINOIS) 1 GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 E RUSHOLME STREET DAVENPORT IA 52803 391905171 EMPLOYEE/BENEFIT/TRUST IA 501(C)(3) LINE 11A, I GENESIS HEALTH SYSTEM (GHS IOWA) 1 DAVENPORT HOSPITAL AMBULANCE CORPORATION 1204 E HIGH STREET DAVENPORT IA 52803 421186903 AMBULANCE TRANSFERS IA 501(C)(3) LINE 11A, I GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENESIS SENIOR LIVING ALEDO 309 NW NINTH AVENUE ALEDO IL 61231 454475803 SENIOR LIVING SERVICES IL 501(C)(3) LINE 3 GENESIS HEALTH SYSTEM (GHS ILLINOIS) 1 GENESIS HEALTH SERVICES FOUNDATION 1227 E RUSHOLME STREET DAVENPORT IA 52803 421421670 CHARITY IA 501(C)(3) LINE 7 GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENESIS PHILANTHROPY 1227 E RUSHOLME STREET DAVENPORT IA 52803 462452851 CHARITY IA 501(C)(3) LINE 11A, I GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENGASTRO LLC 2222 53RD AVENUE BETTENDORF IA 52722 562315623 AMBULATORY SURGERY CENTER IA N/A SPRING PARK SURGERY CENTER LLC 3319 SPRING STREET STE 202A DAVENPORT IA 52807 421483989 OUTPATIENT SURGICAL CENTER IA N/A LARSON CENTER PARTNERSHIP LLC 801 ILLINI DRIVE SILVIS IL 61282 363738454 PROPERTY MANAGEMENT IL N/A GENORTHO LLC 2300 53RD AVENUE BETTENDORF IA 52722 203406994 ORTHOPAEDIC SURGERY CENTER IA N/A GENRAD IMAGING LLC 1970 E 53RD STREET DAVENPORT IA 52807 453571628 DIAGNOSTIC IMAGING CENTER IA N/A GENESIS ONCOLOGY CO - MANAGEMENT LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 454456824 ONCOLOGY PROGRAM MANAGEMENT IA N/A GENVENTURES INC 1227 E RUSHOLME STREET DAVENPORT IA 52803 421269171 SUPPORT SERVICES/PROPERTY MANAGEMENT IA N/A C 0 GENESIS HEART INSTITUTE 1236 E RUSHOLME STREET DAVENPORT IA 52803 421504979 HEALTHCARE MANAGEMENT IA N/A C 0 MISERICORDIA ASSURANCE COMPANY LTD PO BOX 1051 GRAND CAYMAN CJ 980457943 OTHER FINANCIAL VEHICLE CJ N/A C 0 MOB 1 OWNERS' ASSOCIATION 1227 E RUSHOLME STREET DAVENPORT IA 52803 270865075 PROPERTY MANAGEMENT IA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 GENESIS HEALTH SYSTEM (GHS IOWA) L 3395039 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) P 23389921 FAIR MARKET VALUE GENESIS SENIOR LIVING ALEDO P 587899 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS ILLINOIS) P 182558 FAIR MARKET VALUE GENESIS SENIOR LIVING ALEDO Q 587899 FAIR MARKET VALUE