KISHWAUKEE PHYSICIAN GROUP INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- KISHWAUKEE PHYSICIAN GROUP INC (EIN 65-1293967)
- Tax period
- 2013-05-01 to 2014-04-30
- Filed
- 2015-01-12
- IRS object ID
- 201540129349300934
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-01-12T09:14:18-06:00 | ReturnTs |
| Tax Period End | 2014-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 114 E EVERETT | AddressLine1 |
| City | DIXON | City |
| State | IL | State |
| ZIP Code | 61021 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 651293967 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KISHWAUKEE PHYSICIAN GROUP INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KISH | BusinessNameControlTxt |
| Phone | 8157561521 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LOREN FOELSKE | PersonNm |
| Person Title | VICE PRESIDENT - FINANCE, KHS | PersonTitleTxt |
| Phone | 8157561521 | PhoneNum |
| Signature | 2014-12-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KELLY JACKSON HARDY | PreparerPersonNm |
| PTIN | P00747242 | PTIN |
| Phone | 8152859300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KISH HEALTHSYSTEM PHYSICIAN GROUP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEVIN POORTEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,175,653 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KISHHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | KISHWUAKEE PHYSICIAN GROUP, INC. (KPG) EXISTS AS ONE OF THE AREA'S LEADING PHYSICIAN GROUPS PROVIDING HEALTHCARE TO ALL AREA RESIDENTS. ALL CARE GIVEN IS CHARACTERIZED BY EXCELLENCE AND INNOVATION WITH THE GOAL OF KEEPING OUR COMMUNITIES HEALTHY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 46 | TotalEmployeeCnt |
| Total Volunteers | 1 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,426,029 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,068,118 | CYProgramServiceRevenueAmt |
| PY Investment Income | $628 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $94,383 | PYOtherRevenueAmt |
| CY Other Revenue | $107,535 | CYOtherRevenueAmt |
| PY Total Revenue | $1,521,040 | PYTotalRevenueAmt |
| CY Total Revenue | $2,175,653 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,886,164 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,601,050 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,137,674 | PYOtherExpensesAmt |
| CY Other Expenses | $2,197,468 | CYOtherExpensesAmt |
| PY Total Expenses | $4,023,838 | PYTotalExpensesAmt |
| CY Total Expenses | $5,798,518 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,502,798 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,622,865 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,970,705 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,546,815 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $663,608 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $737,273 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,307,097 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,809,542 | NetAssetsOrFundBalancesEOYAmt |
| Mission | NONE | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,928,631 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,068,118 | RevenueAmt |
| Desc | KISHWAUKEE PHYSICIAN'S GROUP (KPG) WAS ESTABLISHED TO PROVIDE HIGH QUALITY HEALTH CARE TO PATIENTS AT A REASONABLE COST. KPG ALSO PROVIDES THE COMMUNITY WITH EDUCATION ACTIVITIES RELATED TO THE PROMOTION OF HEALTH AND PARTICIPATES IN ACTIVITIES SUCH AS PREVENTATIVE SCREENINGS AND HEALTH CLINICS INTENDED TO PROMOTE THE GENERAL HEALTH OF THE MEMBERS OF THE COMMUNITY. MEDICAL SERVICES ARE PROVIDED IN AN NONDISCRIMINATORY MANNER, INCLUDING MEDICARE AND MEDICAID PATIENTS, AND TO LOW-INCOME PATIENTS PURSUANT TO THE ORGANIZATION'S CHARITY CARE POLICY. ALL OF THESE ACTIVITES ARE INTENDED TO SERVE AND IMPROVE THE COMMUNITY VIA REDUCED HEALTH CARE COSTS, IMPOVED ACCESS TO PHYSICIANS AND EXPANDED HEALTHCARE RESOURCES. | Desc |
| Total Program Service Expenses | $4,928,631 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 46 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LOREN FOELSKE VP FINANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8157561521 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| KEVIN POORTEN | ||||||||
| PRESIDENT & CEO, KISHHEALTH SYSTEM | 5.00 | 50.00 | Yes (X) | Yes (X) | $0 | $849,820 | $223,339 | |
| MICHAEL CULLEN | ||||||||
| CHAIR | 5.00 | 6.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ERIC ENGLEHART MD | ||||||||
| VICE-CHAIR,PHYSICIAN FAMILY, MEDICINE | 45.00 | 0.00 | Yes (X) | Yes (X) | $231,857 | $0 | $32,381 | |
| AZEEM HALEEM MD | ||||||||
| DIRECTOR, PHYSICIAN, UROLOGY | 45.00 | 0.00 | Yes (X) | $461,975 | $0 | $20,759 | ||
| MICHAEL KULISZ DO | ||||||||
| DIRECTOR, CHIEF MEDICAL OFFICER | 2.00 | 50.00 | Yes (X) | $0 | $418,350 | $72,044 | ||
| ABE CHACKO | ||||||||
| PRACTICE ADMINISTRATOR, EXOFFICIO | 45.00 | 0.00 | Yes (X) | $133,581 | $0 | $23,856 | ||
| LOREN FOELSKE | ||||||||
| VP AND CFO, KISHHEALTH SYSTEM | 3.00 | 49.00 | Yes (X) | $0 | $322,928 | $86,194 | ||
| CHRISTINE WEIS | ||||||||
| PHYSICIAN, FAMILY MEDICINE | 40.00 | 0.00 | $201,050 | $0 | $30,842 | Yes (X) | ||
| ASIHENE WILLIAM | ||||||||
| PHYSICIAN, GENERAL SURGEON | 40.00 | 0.00 | $377,940 | $0 | $30,673 | Yes (X) | ||
| JAMIE BROEKHUIZEN | ||||||||
| PHYSICIAN, FAMILY MEDICINE | 40.00 | 0.00 | $175,296 | $0 | $9,938 | Yes (X) | ||
| MAUREEN DELA CRUZ | ||||||||
| PHYSICIAN, FAMILY MEDICINE | 40.00 | 0.00 | $172,557 | $0 | $18,739 | Yes (X) | ||
| SYEDA ALI | ||||||||
| PHYSICIAN, FAMILY MEDICINE | 40.00 | 0.00 | $164,990 | $0 | $15,054 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,919,246 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,591,098 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $563,819 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ABERGELDIE DEVELOPMENT INC | |||||
| 15770 D GRISWOLD SPRINGS ROAD | PLANO | IL | 60545 | CONSTRUCTION | $433,753 |
| KISH HEALTHSYSTEM | |||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | MANAGEMENT SERVICES | $198,344 |
| CHMB | |||||
| 901 WARRENVILLE ROAD | LISLE | IL | 60532 | A/R SERVICES | $107,550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT FEES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $2,068,118 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,068,118 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,068,118 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $107,535 | TotalRevenueColumnAmt |
| Exclusion | $107,535 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $107,535 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,175,653 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,068,118 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $107,535 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $950,055 | TotalAmt |
| Program Services | $950,055 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,349,899 | TotalAmt |
| Program Services | $2,092,873 | ProgramServicesAmt |
| Management And General | $257,026 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,662 | TotalAmt |
| Program Services | $98,577 | ProgramServicesAmt |
| Management And General | $11,085 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,076 | TotalAmt |
| Program Services | $6,031 | ProgramServicesAmt |
| Management And General | $3,045 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,358 | TotalAmt |
| Program Services | $167,894 | ProgramServicesAmt |
| Management And General | $14,464 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,791 | TotalAmt |
| Management And General | $141,791 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,137 | TotalAmt |
| Management And General | $118,137 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,450 | TotalAmt |
| Management And General | $4,450 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,265 | TotalAmt |
| Program Services | $193,645 | ProgramServicesAmt |
| Management And General | $155,620 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,207 | TotalAmt |
| Management And General | $82,207 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,220 | TotalAmt |
| Program Services | $287,289 | ProgramServicesAmt |
| Management And General | $12,931 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,888 | TotalAmt |
| Program Services | $14,832 | ProgramServicesAmt |
| Management And General | $24,056 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,057 | TotalAmt |
| Program Services | $399,476 | ProgramServicesAmt |
| Management And General | $12,581 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,643 | TotalAmt |
| Management And General | $19,643 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,861 | TotalAmt |
| Program Services | $15,861 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $482,622 | TotalAmt |
| Program Services | $479,203 | ProgramServicesAmt |
| Management And General | $3,419 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,257 | TotalAmt |
| Program Services | $131,103 | ProgramServicesAmt |
| Management And General | $1,154 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $79,832 | $79,832 | |
| LICENSES AND DUES | $20,238 | $11,960 | $8,278 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,798,518 | TotalAmt |
| Program Services | $4,928,631 | ProgramServicesAmt |
| Management And General | $869,887 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $528,628 | BOYAmt |
| EOY | $502,035 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,865 | BOYAmt |
| EOY | $501,116 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,942 | BOYAmt |
| EOY | $26,268 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,868,706 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $383,954 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $995,154 | BOYAmt |
| EOY | $1,484,752 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,116 | BOYAmt |
| EOY | $32,644 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,970,705 | BOYAmt |
| EOY | $2,546,815 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,095 | BOYAmt |
| EOY | $505,570 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $204,513 | BOYAmt |
| EOY | $231,703 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $663,608 | BOYAmt |
| EOY | $737,273 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,307,097 | BOYAmt |
| EOY | $1,809,542 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,307,097 | BOYAmt |
| EOY | $1,809,542 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,970,705 | BOYAmt |
| EOY | $2,546,815 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,622,865 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $4,125,310 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $115,965 | OtherCostOrOtherBasisAmt |
| Book Value | $115,965 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $405,709 | OtherCostOrOtherBasisAmt |
| Depreciation | $75,748 | DepreciationAmt |
| Book Value | $329,961 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $661,548 | OtherCostOrOtherBasisAmt |
| Depreciation | $128,263 | DepreciationAmt |
| Book Value | $533,285 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $633,910 | OtherCostOrOtherBasisAmt |
| Depreciation | $179,943 | DepreciationAmt |
| Book Value | $453,967 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $51,574 | OtherCostOrOtherBasisAmt |
| Book Value | $51,574 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,484,752 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $231,703 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $231,703 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,095,821 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,095,821 | RevenueSubtotalAmt |
| Other Revenues Not Included | $79,832 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $79,832 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,175,653 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $5,693,375 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $5,693,375 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $105,143 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $105,143 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $5,798,518 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE SYSTEM, KH, VWH, KHF, KPG, KHH, CFHP (CCC), CFHM, AND KHC ARE TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HPI IS A TAXABLE ORGANIZATION AND FILES A CORPORATE INCOME TAX RETURN, WHICH INCLUDES OPT, IRCC, AND HVL. THE SYSTEM FILES VARIOUS FORM 990'S (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AT APRIL 30, 2014 AND 2013, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RECLASSIFICATION OF BAD DEBT EXPENSE 79,832. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | TAX AMORTIZATION OF GOODWILL 25,311. RECLASSIFICATION OF BAD DEBT EXPENSE 79,832. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN POORTEN | ||||||||||||||
| PRESIDENT & CEO, KISHHEALTH SYSTEM | $0 | $575,560 | $0 | $185,669 | $0 | $88,591 | $0 | $202,577 | $0 | $20,762 | $0 | $1,073,159 | $0 | $88,591 |
| ERIC ENGLEHART MD | ||||||||||||||
| VICE-CHAIR,PHYSICIAN FAMILY, MEDICI | $162,691 | $0 | $69,166 | $0 | $0 | $0 | $8,111 | $0 | $24,270 | $0 | $264,238 | $0 | $0 | $0 |
| AZEEM HALEEM MD | ||||||||||||||
| DIRECTOR, PHYSICIAN, UROLOGY | $384,237 | $0 | $77,738 | $0 | $0 | $0 | $20,474 | $0 | $285 | $0 | $482,734 | $0 | $0 | $0 |
| MICHAEL KULISZ DO | ||||||||||||||
| DIRECTOR, CHIEF MEDICAL OFFICER | $0 | $322,866 | $0 | $95,484 | $0 | $0 | $0 | $51,900 | $0 | $20,144 | $0 | $490,394 | $0 | $0 |
| ABE CHACKO | ||||||||||||||
| PRACTICE ADMINISTRATOR, EXOFFICIO | $126,956 | $0 | $6,625 | $0 | $0 | $0 | $6,228 | $0 | $17,628 | $0 | $157,437 | $0 | $0 | $0 |
| LOREN FOELSKE | ||||||||||||||
| VP AND CFO, KISHHEALTH SYSTEM | $0 | $260,902 | $0 | $0 | $0 | $62,026 | $0 | $66,193 | $0 | $20,001 | $0 | $409,122 | $0 | $0 |
| CHRISTINE WEIS | ||||||||||||||
| PHYSICIAN, FAMILY MEDICINE | $186,050 | $0 | $15,000 | $0 | $0 | $0 | $9,723 | $0 | $21,119 | $0 | $231,892 | $0 | $0 | $0 |
| ASIHENE WILLIAM | ||||||||||||||
| PHYSICIAN, GENERAL SURGEON | $351,540 | $0 | $26,400 | $0 | $0 | $0 | $18,374 | $0 | $12,299 | $0 | $408,613 | $0 | $0 | $0 |
| JAMIE BROEKHUIZEN | ||||||||||||||
| PHYSICIAN, FAMILY MEDICINE | $175,296 | $0 | $0 | $0 | $0 | $0 | $9,785 | $0 | $153 | $0 | $185,234 | $0 | $0 | $0 |
| MAUREEN DELA CRUZ | ||||||||||||||
| PHYSICIAN, FAMILY MEDICINE | $150,263 | $0 | $22,294 | $0 | $0 | $0 | $10,140 | $0 | $8,599 | $0 | $191,296 | $0 | $0 | $0 |
| SYEDA ALI | ||||||||||||||
| PHYSICIAN, FAMILY MEDICINE | $147,867 | $0 | $17,123 | $0 | $0 | $0 | $9,845 | $0 | $5,209 | $0 | $180,044 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 KISHWAUKEE PHYSICIANS GROUP WERE $176,200. 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 CALENDAR YEAR 2013, 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. |
| SCHEUDLE 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTINE ENGLEHART | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | MS. ENGLEHART IS A FAMILY MEMBER OF BOARD MEMBER DR. ERIK ENGLEHART | RelationshipDescriptionTxt |
| Transaction | $62,459 | TransactionAmt |
| Transaction | COMPENSATION IN HER POSITION AS KPG AREA ADMINISTRATIVE COORDINATOR. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | KEVIN POORTEN, LOREN FOELSKE, AND MICHAEL KULISZ ARE BOTH EMPLOYEES OF KISHEALTH SYSTEM, THE PARENT ORGANIZATION OF KISHWAUKEE PHYSICIAN GROUP, INC. MR. POORTEN IS PRESIDENT AND CEO OF KISHHEALTH SYSTEM AND SERVES AS AN EX-OFFICIO DIRECTOR FOR ALL ORGANIZATIONS RELATED TO KISHHEALTH SYSTEM. MR. FOELSKE SERVES AS THE VICE-PRESIDENT - FINANCE OF KISHHEALTH SYSTEM. DR. KULISZ SERVES AS THE CHIEF MEDICAL OFFICER FOR THE HEALTH SYSTEM. IN ADDITION, OTHER BOARD MEMBERS ARE EMPLOYED BY KISHWAUKEE PHYSICIAN GROUP (KPG) AS PHYSICIANS. AS KEVIN POORTEN IS THE CEO OF THE CONTROLLED GROUP AND ON THE KPG BOARD, THIS CREATES A BUSINESS RELATIONSHIP WITH THESE EMPLOYEES. DR. ERIK ENGLEHART AND AZEEM HALEEM ARE EMPLOYED BY KPG AND SERVE ON ITS BOARD. |
| FORM 990, PART VI, SECTION A, LINE 6 | KISHHEALTH SYSTEM IS THE SOLE MEMBER OF KISHWAUKEE PHYSICIANS GROUP, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | PER THE ORGANIZATION'S BY-LAWS, KISHHEALTH SYSTEM, AS SOLE MEMBER, RESERVES THE POWER TO ELECT OR REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBERS OF THE BOARD AND APPROVE, EVALUATE OR REMOVE, WITH OUR WITHOUT CAUSE, THE PRACTICE ADMINISTRATOR AND ANY KPG OFFICERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF KISHWAUKEE PHYSICIANS GROUP (KPG). THE BYLAWS OF KPG STATE THAT KPG'S BOARD MAY NOT TAKE ACTION PERTAINING TO THE FOLLOWING WITHOUT APPROVAL FROM THE KHS BOARD: A. ADOPTING, AMENDING, ALTERING OR REPEALING KPG'S ORGANIZATIONAL DOCUMENTS B. FILING A VOLUNTARY PETITION OF BANKRUPTCY ON BEHALF OF KPG OR AUTHORIZING A VOLUNTARY DISSOLUTION OF KPG C. ELECTING OR REMOVING, WITH OR WITHOUT CAUSE, ANY MEMBERS OF THE BOARD AND APPROVING, EVALUATING OR REMOVING, WITH OR WITHOUT CAUSE, THE PRACTICE ADMINISTRATOR AND ANY KPG OFFICERS AND ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS, IF ANY. D. APPROVING THE STRATEGIC PLAN, ANNUAL OPERATING AND CAPITAL BUDGETS OF KPG AND MATERIAL DEVIATIONS FROM SUCH PLANS OR BUDGETS E. APPROVING ANY CHANGE IN CORPORATE MEMBERSHIP OF KPG OR ANY PLAN OF CONSOLIDATION OF KPG F. ESTABLISHING AN AFFILIATE OF KPG G. PURCHASING, SELLING, LEASING, PLEDGING OR HYPOTHECATING ANY KPG PROPERTY OR ENTERING INTO ANY CONTRACT FOR SUCH PURPOSE OTHER THAN IN THE ORDINARY COURSE OF KPG'S BUSINESS. H. ENTERING INTO ANY CONTRACT OR AGREEMENT THAT CONTEMPLATES KPG SPENDING IN EXCESS OF $100,000 IN ANY 12-MONTH PERIOD AND APPROVING ANY MANAGEMENT CONTRACT FOR THE FULL OPERATING OF KPG. I. APPROVING ALL COMPENSATION PAID TO PHYSICIAN EMPLOYEES AND/OR PHYSICIANS CONTRACTING WITH KPG, INCLUDING COMPENSATION FOR BOTH CLINICAL AND ADMINISTRATIVE DUTIES,THROUGH COMPENSATION PARAMETERS ESTABLISHED BY THE KHS BOARD'S COMPENSATION COMMITTEE; THE COMPENSATION COMMITTEE SHALL REVIEW SUCH PARAMETERS ANNUALLY TO ENSURE THAT PHYSICIAN COMPENSATION REPRESENTS FAIR MARKET VALUE FOR SERVICES RENDERED. J. EXERCISING ANY RIGHTS THAT KPG HAS AS A SHAREHOLDER OR MEMBER OF ANY SUBSIDIARY ENTITY, INCLUDING AN AFFILIATE. K. APPROVING AND/OR DETERMINING (1) THE CREATION OF NEW HEALTH SERVICES TO BE PROVIDED BY KPG AND THE LOCATION OF SUCH HEALTH SERVICES; (2) THE DISCONTINUANCE OF ANY HEALTH SERVICES PROVIDED BY KPG AND (3) THE THIRD-PARTY PAYOR ARRANGEMENTS (INCLUDING WITHOUT LIMITATION, MANAGED CARE PLANS) THAT KPG PARTICIPATES IN AND THE NEGOTIATION AND APPROVAL OF SUCH ARRANGEMENTS. L. APPROVING THE CREATION AND IMPLEMENTATION OF ARRANGEMENTS AMONG KPG, KHS, AND/OR ONE OR MORE AFFILIATES, INCLUDING TRANSFERRING MONEY OR PROPERTY AMONG SUCH ENTITIES. M. OVERSEEING THE QUALITY OF CARE PROVIDED TO PATIENTS OF KPG. N. APPROVING FINANCIAL, ACCOUNTING, HUMAN RESOURCES, EMPLOYEE BENEFIT, AND OTHER POLICIES AND PROCEDURES (EXCEPT PATIENT CARE POLICIES AND PROCEDURES) AND THE APPOINTMENT OF AUDITORS, LEGAL COUNSEL, VENDORS, CONTRACTORS AND CONSULTANTS FOR KPG. O. APPROVING PERSONNEL DECISIONS, INCLUDING, WITHOUT LIMITATION, DECISIONS TO HIRE OR TERMINATE THE EMPLOYMENT OF KPG PERSONNEL. |
| 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 PHYSICIAN GROUP, INC. 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 XI, LINE 9: | CAPITAL CONTRIBUTION FROM KISHWAUKEE HEALTH SYSTEM 4,100,000. BOOK/TAX DIFFERENCE IN AMORTIZATION OF INTANGIBLES 25,311. ROUNDING ADJUSTMENT -1. |
| FORM 990, PART XI, LINE 2C, RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STMTS | RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STATEMENTS: 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 PHYSICIANS GROUP, INC. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| KISHWAUKEE COMMUNITY HOSPITAL | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 237087041 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | KISHHEALTH SYSTEM | 0 | |
| KISHHEALTH SYSTEM | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 363649080 | PARENT CORPORATION OF 501(C)(3) HEALTH SYSTEM | IL | 501(C)(3) | 11B | 0 | N/A | |
| KISHHEALTH FOUNDATION | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 363649077 | SUPPORT OF CHARITABLE HEALTH ORGANIZATIONS | IL | 501(C)(3) | 7 | KISHHEALTH SYSTEM | 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 | |
| COMMUNITY CARES CLINIC | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 800424001 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | KISHHEALTH SYSTEM | 0 | |
| CENTER FOR FAMILY HEALTH MALTA | |||||||||||
| ONE KISH HOSPITAL DRIVE | MALTA | IL | 60150 | 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| HEALTH VENTURES LLC | |||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 753255958 | RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES | IL | N/A |
| KISHWAUKEE AREA PHO | |||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 364205273 | MEDICARE SERVICES | IL | N/A |
| ILLINOIS REGIONAL CANCER CENTER | |||||||
| 10 HEALTH SERVICES DRIVE | DEKALB | IL | 60115 | 363847273 | CANCER TREATMENT SERVICES | IL | N/A |
| MIDLAND SURGICAL CENTER LLC | |||||||
| 3085 WOLF COURT | DEKALB | IL | 60115 | 352194610 | SURGICAL SERVICES | IL | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTH PROGRESS INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363824138 | EIN |
| Primary Activities | INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESSES | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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