2014-02-04T09:25:44-06:00 2013-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2012-05-01 364244337 VALLEY WEST COMMUNITY HOSPITAL VALL 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 LOREN FOELSKE 8157561521 2014-01-27 1 KELLY JACKSON HARDY P00747242 8152842285 2012 2015-11-30 17:44:51Z KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 69311036 0 X WWW.VWCH.ORG X 1998 IL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREAS OF DEKALB, KENDALL, AND LASALLE COUNTIES. 3 1 301 65 0 0 380934 1155025 48706320 50534693 729322 1936464 857178 898880 50673754 54525062 19500 30931 0 0 14703466 16010765 0 0 0 31329533 30708765 46052499 46750461 4621255 7774601 61625713 67392153 10500036 10744093 51125677 56648060 X TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREAS OF DEKALB, KENDALL, AND LASALLE COUNTIES. VALLEY WEST COMMUNITY HOSPITAL WILL STRIVE TO PROVIDE HIGH QUALITY PRIMARY CARE AND COMMUNITY HEALTH EDUCATION, WHILE PROMOTING COMMUNITY HEALTH SERVICES IN A FRIENDLY, CARING ENVIRONMENT. VALLEY WEST COMMUNITY HOSPITAL IS COMMITED TO PROVIDING HEALTH CARE IN ACCORDANCE WITH THE HIGHEST MEDICAL AND ETHICAL STANDARDS WITH CARE, COMPASSION, AND RESPECT FOR ALL, PROTECTING THE DIGNITY, AUTONOMY AND INTEGRITY OF ALL OUR PATIENTS, WHILE MANAGING THE MEDICAL RESOURCES AT OUR DISPOSAL WITH WISDOM AND FAIRNESS. 0 0 38951353 30931 50534693 VALLEY WEST COMMUNITY HOSPITAL (VALLEY WEST), LOCATED IN SANDWICH, ILLINOIS, SERVES THE RESIDENTS OF SOUTHERN DEKALB, NORTHERN LASALLE AND WESTERN KENDALL COUNTIES BY OFFERING A NUMBER OF PROGRAMS AND SERVICES THAT GO BEYOND BASIC HEALTH CARE. VALLEY WEST BELIEVES THAT IN ORDER TO BE A TRUE "COMMUNITY" HOSPITAL, WE MUST BE A RESOURCE FOR PREVENTATIVE AND CURATIVE HEALTH INFORMATION, EDUCATION AND SERVICES AND THAT WE MUST SUPPORT THE EFFORTS OF OTHERS WHO ALSO ARE DOING WORK FOR THE COMMUNITY GOOD. DOING SO HELPS BUILD TRUST, RESPECT AND LOYALTY FOR OUR HOSPITAL AND STRENGTHENS OUR ROLE AS A PARTNER IN IMPROVING THE HEALTH OF OUR CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE.THE COMMUNITY BENEFIT OBJECTIVES OF VALLEY WEST INCLUDE PROGRAMS TO IMPROVE ACCESS TO HEALTH SERVICES BY REDUCING GEOGRAPHIC, FINANCIAL, LANGUAGE AND CULTURAL BARRIERS; IMPROVE AND ENHANCE PUBLIC HEALTH, ADVANCE GENERAL HEALTH KNOWLEDGE, AND RELIEVE THE GOVERNMENT BURDEN OF PROVIDING HEALTH SERVICES FOR THE COMMUNITY, AND FOR THE UNINSURED AND UNDERINSURED. COMMUNITY HEALTH NEEDS ARE IDENTIFIED AND ADDRESSED THROUGH COMMUNITY OUTREACH PROGRAMS, BY ADDING NEW SERVICES AND BY EXPANDING OTHERS. NEEDS ALSO ARE MET THROUGH OPERATIONAL PROGRAMS SUCH AS CHARITY CARE, SUBSIDIZED SERVICES AND PROVIDING CASH AND IN-KIND DONATIONS TO SUPPORT ORGANIZATIONS THAT ALSO STRIVE TO MEET COMMUNITY HEALTH AND QUALITY OF LIFE NEEDS. THE HOSPITAL IDENTIFIES COMMUNITY HEALTH NEEDS IN SEVERAL WAYS. ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR VALLEY WEST COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. RESOURCES UTILIZED INCLUDE:* AMERICAN DIABETES ASSOCIATION* AMERICAN MEDICAL ASSOCIATION* AMERICAN UNIVERSITY SURVEY* CENTERS FOR DISEASE CONTROL AND PREVENTION* COMMUNITY NEEDS INDEX* ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY* ILLINOIS DEPARTMENT OF PUBLIC HEALTH* ILLINOIS DEPARTMENT OF PUBLIC HEALTH ANNUAL HOSPITAL QUESTIONNAIRE* ILLINOIS DEPARTMENT OF PUBLIC HEALTH, BEHAVORIAL RISK FACTORS SURVEY* ILLINOIS DEPARTMENT OF PUBLIC HEALTH, ILLINOIS COUNTY CANCER STATISTICS REVIEW INCIDENCE* ILLINOIS DEPARTMENT OF PUBLIC HEALTH: BIRTH DEFECTS AND OTHER ADVERSE PREGNANCY OUTCOMES IN ILLINOIS, 2004-2008* ILLINOIS HOSPITAL ASSOCIATION* ILLINOIS HOSPITAL ASSOCIATION, COMPDATA* ILLINOIS PUBLIC HEALTH COMMUNITY MAP* NATIONAL CANCER INSTITUTE* NATIONAL CENTER FOR HEALTH STATISTICS* NATIONAL HEART LUNG AND BLOOD INSTITUTE* NORTHERN ILLINOIS UNIVERSITY ENROLLMENT DATA* PIONEERING HEALTHIER COMMUNITIES* STATE OF ILLINOIS DATA BY ZIP CODE* US CENSUS BUREAU 2010 DATA* INTERNAL REVIEW OF OUTPATIENT AND INPATIENT TRENDS, ESPECIALLY EMERGENCY DEPARTMENT USAGE * INPUT FROM OTHER COMMUNITY PROVIDERS. THIS INCLUDES PROVIDING HOSPITAL LEADERS TO SERVE ON BOARDS AND COMMITTEES THAT DIRECTLY OR INDIRECTLY IMPACT COMMUNITY HEALTH OR HELP THE HOSPITAL CONNECT TO UNDERSERVED OR VULNERABLE POPULATIONS.USING ALL THESE RESOURCES, THE HOSPITAL FOCUSED ON THE FOLLOWING COMMUNITY HEALTH NEEDS IN FY13: * THE PREVALENCE OF OBESITY IN CHILDREN AND ADULTS* ACCESS TO AFFORDABLE PRIMARY HEALTH CARE IN THE DEKALB/SYCAMORE AREA AND OUTLYING RURAL AREAS* TYPE II DIABETES* CARDIOVASCULAR DISEASE AND ADEQUATE HOSPITAL BASED AND COMMUNITY OUTREACH SERVICES* CANCER CARE SERVICES, EDUCATION AND PREVENTION* AFFORDABLE ACCESS TO CHILDBIRTH EDUCATION AND OB HOSPITAL SERVICES* OTHER COMMUNITY OUTREACH AND WELLNESS SERVICESACTIVITIES IN THESE AREAS ARE DETAILED IN SCHEDULE H OF THIS REPORT. ADDITIONAL ACTIVITIES ARE LISTED BELOW.*COMMUNITY COLLABORATION / OUTREACH / SCHOOL & WELLNESS PROGRAMS THE HOSPITAL'S COMMUNITY WELLNESS DEPARTMENT PROVIDES A VARIETY OF EDUCATIONAL ACTIVITIES AND PROGRAMS IN THE COMMUNITY. DEKALB COUNTY SCHOOLS ARE VISITED THROUGHOUT THE ACADEMIC YEAR, WITH HEALTH EDUCATORS PROVIDING EDUCATION ON NUTRITION, FITNESS ACTIVITIES, SCREEN TIME REDUCTION, HAND WASHING, DENTAL CARE, POISON PREVENTION, AND IN GENERAL LIVING A HEALTHY LIFESTYLE. COMMUNITY WELLNESS HEALTH EDUCATORS VISITED 600 CLASSROOMS WORKING WITH 13,100 STUDENTS.STAFF FROM COMMUNITY WELLNESS COLLABORATE WITH OR SERVE ON COMMITTEES AND PROMOTED HEALTH AND WELLNESS THOUGH THESE PARTNERSHIPS: PLANO CHAMBER OF COMMERCE BOARD OF DIRECTORS, KENDALL COUNTY HEALTH INITIATIVES COUNCIL, KENDALL COUNTY I-PLAN STEERING COMMITTEE, SANDWICH PROJECT SUCCESS COMMITTEE, AND FOX VALLEY YMCA.*OPERATIONAL COMMUNITY BENEFITTHE HOSPITAL ALSO PROVIDED COMMUNITY BENEFIT THROUGH CHARITY CARE, GOVERNMENT-SPONSORED INDIGENT HEALTH CARE, BAD DEBT, SUBSIDIZED HEALTH SERVICES, LANGUAGE ASSISTANCE, VOLUNTEER SERVICES, EDUCATION AND WORKFORCE DEVELOPMENT, CASH AND IN-KIND DONATIONS, AND OTHER. *CHARITY CARE AS PART OF ITS CHARITABLE MISSION, THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE, INCLUDING ACCESS TO PHARMACEUTICAL ASSISTANCE FOR PATIENTS WHO MET THE ELIGIBILITY CRITERIA ESTABLISHED IN ITS FINANCIAL ASSISTANCE POLICY. THE POLICY IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY. THE HOSPITAL ALSO COORDINATED WITH THE ILLINOIS BREAST AND CERVICAL CANCER PROGRAM FOR ASSISTANCE WITH BREAST AND CERVICAL CANCER SCREENINGS AND TREATMENT. MORE PATIENTS QUALIFIED FOR CHARITY CARE IN FY 2013 THAN IN PREVIOUS YEARS DUE TO THE POOR ECONOMY AND ALSO TO REDUCE THE HOSPITALS BAD DEBT. THE HOSPITAL ALSO UNDERWROTE UNREIMBURSED COSTS OF TREATING MEDICAID AND MEDICARE PATIENTS. *SUBSIDIZED HEALTH SERVICES A NUMBER OF PROGRAMS AND SERVICES WERE OPERATED AT A LOSS, BUT WERE SUBSIDIZED BECAUSE THEY IMPROVE THE HEALTH AND SAFETY OF THE COMMUNITY. *LANGUAGE ASSISTANCE THE HOSPITAL EMPLOYS SPANISH INTERPRETERS AVAILABLE OR ON CALL 24/7 AND USED VIDEOCONFERENCING EQUIPMENT, VIA LAPTOP, TO COMMUNICATE WITH THE HEARING IMPAIRED AND DUAL HANDSET PHONE SYSTEM THAT PROVIDED INSTANT INTERPRETATION FOR PATIENTS WHO DO NOT SPEAK ENGLISH.*VOLUNTEER SERVICES VOLUNTEER OPPORTUNITIES ARE PROVIDED TO EMPLOYEES TO SERVE IN THE COMMUNITY AND FOR COMMUNITY MEMBERS TO SERVE THE HOSPITAL. THERE WERE ROUGHLY 305 OF VOLUNTEER HOURS RECORDED BY EMPLOYEES. A VOLUNTEER SERVICES DEPARTMENT SCHEDULED MEMBERS OF THE VOLUNTEER S IN THE HOSPITAL. *EDUCATION & WORKFORCE DEVELOPMENT A MEDICAL LIBRARY WAS MAINTAINED FOR PHYSICIAN, STAFF AND PATIENT USE. HOSPITAL EMPLOYEES PROVIDED CLINICAL TRAINING, JOB SHADOWING AND MENTORING OF COLLEGE AND HIGH SCHOOL STUDENTS. THE AUXILIARY AND KISHHEALTH FOUNDATION AWARDED ANNUAL SCHOLARSHIPS FOR HEALTH CAREERS. HOSPITAL TOURS WERE GIVEN TO LOCAL SCHOOLS AND YOUTH GROUPS TO EDUCATE YOUTH ON HEALTHCARE CAREERS. CASH CONTRIBUTIONS WERE GIVEN TO LOCAL LIBRARIES, PUBLIC AND POST-SECONDARY EDUCATION FOUNDATIONS TO UNDERWRITE SCHOLARSHIPS, AND PURCHASE OR PROVIDE HEALTH-RELATED MATERIALS, EQUIPMENT AND ACTIVITIES.*CASH AND IN-KIND DONATIONSAN ALLOCATION WAS MADE IN THE OPERATING BUDGET FOR DONATIONS TO COMMUNITY EVENTS AND ORGANIZATIONS THAT IMPROVE THE HEALTH, WELFARE AND QUALITY OF LIFE IN THE COMMUNITIES SERVED BY THE HOSPITAL. THE HOSPITAL SUPPORTED COMMUNITY ACTIVITIES THAT ENCOURAGE CHILD AND ADULT PHYSICAL ACTIVITY; EFFORTS THAT REACH UNDERSERVED AND VULNERABLE POPULATIONS; YOUTH MENTORING, EDUCATION; DISEASE PREVENTION, AWARENESS, RESEARCH; MENTAL HEALTH; ECONOMIC DEVELOPMENT AND OTHER COMMUNITY BUILDING ACTIVITIES. IN-KIND DONATIONS AND SERVICES SUCH AS PERSONNEL TIME, SURPLUS SUPPLIES, FOOD, AND BOTTLED WATER WERE ALSO TRACKED.*DONATION HIGHLIGHTS THE HOSPITAL PROVIDED SUBSTANTIAL CASH CONTRIBUTIONS TO FOX VALLEY OLDER ADULT SERVICES TO CONTINUE ITS TRAINING FOR SENIORS; FOX VALLEY YMCA TO SUPPORT COMMUNITY FITNESS PROGRAMS; AMERICAN CANCER SOCIETY'S LOWER FOX VALLEY RELAY FOR LIFE. *IN-KIND DONATIONS INCLUDED ITEMS LIKE FIRST AID KITS, WATER AND OTHER EDUCATIONAL MATERIALS TO COMMUNITY ORGANIZATIONS. 38951353 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 58 0 1 301 1 0 0 0 0 0 0 0 0 0 0 X 3 1 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X LOREN FOELSKE VP FINANCE 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 X TERRENCE DUFFY 1.00 2.00 X X 0 0 0 KEVIN POORTEN 5.00 50.00 X X 0 966472 220153 JAGDISH PATEL 1.00 2.00 X X 0 36975 0 LOREN FOELSKE 5.00 42.00 X 0 284734 117504 BRAD COPPLE 21.00 25.00 X 0 359637 72184 PAM DUFFY 5.00 40.00 X 0 249153 30870 MIKE MUZZILLO THRU 62912 30.00 20.00 X 0 229519 12427 MIKE KOKOTT 15.00 30.00 X 0 194828 34842 ROGER HEATH BELL 10.00 37.00 X 0 273572 51107 DR MICHAEL KULISZ 10.00 42.00 X 0 402706 99258 MARK THATE 6.00 39.00 X 0 273139 26286 JOE DANT 2.00 43.00 X 0 255673 45841 SUE HOHENBERGER 40.00 X 141455 0 22759 ALTHEA R RUSSELL 40.00 X 104517 0 27644 ALEX P LOMAHAN 40.00 X 130706 0 29868 KATHRYN VALENZUELA 40.00 X 102792 0 27579 BARBARA DOBSON 40.00 X 113153 0 28869 592623 3526408 847191 5 0 1 0 KISH HEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 MANAGEMENT FEES 4872875 ERDMAN COMPANY PO BOX 88670 MILWAUKEE WI 53288 CONSTRUCTION SERVICES 1121810 COMPREHENSIVE THERAPEUTICS LTD 3703 WEST LAKE STREET GLENVIEW IL 60025 PHYSICAL THERAPY SERVICES 1094104 DOCTORS OF EMERGENCY MEDICINE 2807 BRITTANY COURT ST CHARLES IL 60175 HEALTH SERVICES 958886 ANESTHESIA ASSOCIATES LLC PO BOX 809096 CHICAGO IL 60680 MEDICAL SERVICES 933976 12 407333 397452 350240 1155025 NET PATIENT SERVICE REVENUE 621110 50534693 50534693 50534693 1230869 1230869 127714 22666 105048 105048 105048 15465403 3500 14763308 0 702095 3500 705595 705595 OTHER INCOME 621110 688010 688010 DIETARY/CAFETERIA SALES 621110 74923 74923 DISCOUNTS AND REBATES 621110 30899 30899 793832 54525062 50534693 0 2835344 X 30931 30931 11226561 10547613 678948 538447 505782 32665 3436560 3228081 208479 809197 760107 49090 3893917 3893917 49398 49398 432 432 103371 103371 8994080 8627338 366742 557294 8933 548361 5480132 4830770 649362 286951 2991 283960 1318985 1306218 12767 116286 79131 37155 116056 116056 2382007 2382007 662056 242411 419645 BAD DEBT EXPENSE 5511536 5511536 FEDERAL AND STATE ASSES 456192 456192 RECRUITMENT COSTS 383190 380608 2582 COLLECTION FEES 271189 271189 125693 50704 74989 46750461 38951353 7799108 0 219812 191951 3745816 10835184 6321278 5682230 1428631 1681009 1092870 936143 42930900 20798853 18256600 22132047 28884626 23459907 238078 738425 1438002 1735257 61625713 67392153 4758606 6048382 228869 193845 2009958 1747330 3502603 2754536 10500036 10744093 X 51076129 56543257 49548 104803 51125677 56648060 61625713 67392153 X 7774601 1123710 -3375928 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 17626 17626 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING EXPENSES ARE ALLOCATED THROUGH MEMBERSHIP DUES WITH ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. NO OTHER LOBBYING ACTIVITIES WERE CONDUCTED. 1279462 1279462 15159443 6337298 8822145 420249 139718 280531 20165551 14321837 5843714 5906195 5906195 22132047 IBNR RESERVE 184929 LEASE OBLIGATION PAYABLE 307700 DUE TO AFFILIATES 863958 ESTIMATED SETTLEMENTS DUE 1391221 OTHER LONG TERM LIABILITIES 6728 2754536 X 49752569 1123710 22666 1146376 48606193 5918869 5918869 54525062 41261591 22666 22666 41238925 5511536 5511536 46750461 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE SYSTEM, KCH, VWCH, KHF, KPG, DCH, 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, 2013 AND 2012, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE FOR FORM 990 PURPOSES 22,666. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION REVENUE FROM KISHHEALTH FOUNDATION 407,333. BAD DEBT EXPENSE NETTED WITH REVENUE FOR FINANCIAL STATEMENT PURPOSES 5,511,536. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH REVENUE FOR 990 PURPOSES 22,666. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED WITH REVENUE FOR FINANCIAL STATEMENT PURPOSES 5,511,536. 1 1 X 1 X 1 X 1 1 1 0 1 1 1487956 456192 1031764 0.02210 6972757 4675482 2297275 0.04910 8460713 5131674 3329039 0.07120 1876046 35226 1840820 0.03940 193703 0 193703 0.00410 1687655 738344 949311 0.02030 0 0 84139 0 84139 0.00180 3841543 773570 3067973 0.06560 12302256 5905244 6397012 0.13680 1 5511536 823660 11829324 11712202 117122 X 1 1 1 1 VALLEY WEST COMMUNITY HOSPITAL

11 EAST PLEASANT AVE SANDWICH IL 60548

X X X X VALLEY WEST COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 0 X X X X X 1 X 0 0 PART I, LINE 7: THE RESPECTIVE IRS WORKSHEET, AS PROVIDED IN THE INSTRUCTIONS FOR SCHEDULE H, WERE USED TO CALCULATE THE COSTS OF ITEMS WITHIN THE TABLE ABOVE. PART II: NO COMMUNITY BUILDING ACTIVITIES ARE REPORTED IN PART II. PART III, LINE 4: SEE FOOTNOTE 3 (PAGE 15) IN THE ATTACHED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE.INTERNAL REVENUE SERVICE WORKSHEET 2 (PER SCHEDULE H INSTRUCTIONS) WAS UTILIZED TO DETERMINE THE COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS. PART III, LINE 8: NONE PART III, LINE 9B: COLLECTION ACTIONS INVOLVING UNINSURED PATIENTS. KHS (KISHHEALTH SYSTEM, PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL) SHALL NOT PURSUE A COLLECTION ACTION AGAINST AN UNINSURED PATIENT, UNLESS THE PATIENT HAS BEEN GIVEN THE OPPORTUNITY TO ASSESS THE ACCURACY OF THE BILL; APPLY FOR FINANCIAL ASSISTANCE UNDER THE KHS FINANCIAL ASSISTANCE POLICY AND PROCEDURE; AND AVAIL HIMSELF OR HERSELF OF A REASONABLE PAYMENT PLAN. NOTWITHSTANDING THIS, KHS MAY NOT PURSUE THE COLLECTION ACTION UNDER THE FOLLOWING CIRCUMSTANCES: (A) IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT, UNTIL KHS HAS OFFERED THE PATIENT A PAYMENT PLAN. KHS MAY REQUIRE THE PATIENT TO PROVIDE REASONABLE VERIFICATION OF HIS OR HER INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT.(B) IF KHS HAS REASON TO BELIEVE THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, UNTIL KHS HAS GIVEN THE PATIENT AT LEAST 60 DAYS FOLLOWING THE DATE OF DISCHARGE OR RECEIPT OF OUTPATIENT CARE TO SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. (C) IF THE PATIENT HAS AGREED TO A PAYMENT PLAN, UNTIL THE PATIENT HAS FAILED TO MAKE PAYMENTS IN ACCORDANCE WITH THAT PAYMENT PLAN. (D) IF THE PATIENT INFORMS KHS THAT HE OR SHE HAS APPLIED FOR HEALTH CARE COVERAGE UNDER MEDICAID, KIDCARE, OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAM (AND THERE IS A REASONABLE BASIS TO BELIEVE THAT THE PATIENT WILL QUALIFY FOR SUCH PROGRAM), BUT THE PATIENT'S APPLICATION IS DENIED. VALLEY WEST COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: INDIVIDUALS REPRESENTING KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HEALTH DEPARTMENT AND LIVE HEALTHY DEKALB COUNTY (FORMERLY KNOWN AS PIONEERING HEALTHIER COMMUNITIES), SERVED AS STEERING COMMITTEE MEMBERS. STEERING COMMITTEE MEMBERS MET MONTHLY FROM MAY 2012 TO NOVEMBER 2012 AND REVIEWED POPULATION DEMOGRAPHICS, BIRTH AND DEATH DATA AND SOCIAL AND HEALTH INDICATORS IN ORDER TO PRIORITIZE HEALTH PROBLEMS FOR THE DEKALB COUNTY COMMUNITY HEALTH PLAN AND VALLEY WEST COMMUNITY HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT. THE STEERING COMMITTEE WAS CHARGED WITH FURTHER PRIORITIZING THESE ISSUES BASED ON A MORE IN-DEPTH EXPLORATION AND A STANDARDIZED PROCESS. IN SEPTEMBER OF 2012, THE STEERING COMMITTEE PRESENTED HEALTH PRIORITIES TO THE EXTERNAL COMMITTEE MEMBERS, WHO INCLUDED A VARIETY OF INDIVIDUALS FROM LOCAL AND STATE GOVERNMENTAL AGENCIES, LEADERS FROM COMMUNITY BASED ORGANIZATIONS, FOUNDATIONS, SCHOOL DISTRICTS, COLLEGES, AND LOCAL NON-PROFIT ORGANIZATIONS. THESE PARTICIPANTS ARE EXPERTS IN HEALTH CARE, SOCIAL DETERMINANTS OF HEALTH AND HEALTH AND SOCIAL SERVICES. THE INPUT FROM THE EXTERNAL GROUP HELPED TO ENSURE THAT NEEDS WERE IDENTIFIED AND WILL BE RESPONDED TO. AFTER THOROUGH REVIEW OF THE DATA, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS WERE GIVEN THE OPPORTUNITY TO DISCUSS THE INFORMATION AND FURTHER REVIEW HEALTH PROBLEMS FACING THE COUNTY. FOLLOWING A LENGTHY DISCUSSION, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS IDENTIFIED PRIORITIES FOR CONSIDERATION FOR THE COMMUNITY BENEFIT IMPLEMENTATION PLAN. THE FULL LIST OF PARTICIPANTS IN THE ASSESSMENT PROCESS INCLUDES:STEERING COMMITTEE MEMBERS (PARTICIPANTS LISTED ALPHABETICALLY)* BETH BUSCHING, MANAGER, COMMUNITY WELLNESS, KISHWAUKEE COMMUNITY HOSPITAL* BETTE CHILTON, DEAN OF HEALTH AND EDUCATION, KISHWAUKEE COMMUNITY COLLEGE* DAWN ROZNOWSKI, COMMUNITY ENGAGEMENT ADVISOR, KISHHEALTH SYSTEM* JANE LUX, DIRECTOR, DEKALB COUNTY HEALTH DEPARTMENT* KIM JASS-RAMIREZ, SENIOR DIRECTOR OF HEALTHY LIVING, KISHWAUKEE YMCA* LISA CUMINGS, COMMUNITY HEALTH LIAISON, KISHWAUKEE COMMUNITY HOSPITAL* MARCY ZANELLATO, HEALTH EDUCATION DIVISION, DEKALB COUNTY HEALTH DEPARTMENT* SHELLY JOHNSON, DIRECTOR, COMMUNITY CARES CLINIC AND CENTER FOR FAMILY HEALTH, EMPLOYEE HEALTH, COMMUNITY WELLNESS, KISHHEALTH SYSTEMEXTERNAL COMMITTEE MEMBERS* ERICA BARNES, LCPC, COUNSELOR/OUTREACH COORDINATOR, NORTHERN ILLINOIS UNIVERSITY COUNSELING AND STUDENT DEVELOPMENT* JAMES BRISCOE, SUPERINTENDENT, DEKALB SCHOOL DISTRICT #428* CINDY CAPEK, EXECUTIVE DIRECTOR, DEKALB PARK DISTRICT* BETTE CHILTON, DEAN OF HEALTH & EDUCATION, KISHWAUKEE COMMUNITY COLLEGE* BRENDA COURTNEY, DIRECTOR OF ADMINISTRATIVE SERVICES, DEKALB COUNTY HEALTH DEPARTMENT* KATHY COUNTRYMAN, SUPERINTENDENT, SYCAMORE SCHOOL DISTRICT #427* MICHAEL KOKOTT, ASSISTANT VICE PRESIDENT, MARKETING & PLANNING, KISHHEALTH SYSTEM* DAWN LITLEFIELD, EXECUTIVE DIRECTOR, KISHWAUKEE YMCA* CRISTY MEYER, PRINCIPAL, JEFFERSON ELEMENTARY SCHOOL* DONNA MOULTON, EXECUTIVE DIRECTOR, COMMUNITY MENTAL HEALTH BOARD & COMMUNITY SERVICES, DEKALB COUNTY* GABRIELA ORTIZ, PUBLIC HEALTH NURSE, DEKALB COUNTY HEALTH DEPARTMENT* KEVIN POORTEN, PRESIDENT & CEO, KISHHEALTH SYSTEM* MARY PRITCHARD, PHD., ASSOCIATE DEAN, NORTHERN ILLINOIS UNIVERSITY, COLLEGE OF HEALTH & HUMAN SCIENCES* TED STRACK, PRESIDENT, SYCAMORE PARK DISTRICT* DAN TEMPLIN, EXECUTIVE DIRECTOR, DEKALB COUNTY COMMUNITY FOUNDATION * ROB WILKINSON, CEO, KISHWAUKEE YMCAKISHHEALTH SYSTEM COMMITTEE MEMBERS* ALLISON BRYAN, COMMUNITY RELATIONS, VALLEY WEST COMMUNITY HOSPITAL* BECKIE FRIEDERS, EMPLOYEE WELLNESS COORDINATOR, KISHHEALTH SYSTEM* BETH BUSCHING, MANAGER, COMMUNITY WELLNESS, KISHWAUKEE COMMUNITY HOSPITAL* BETH GALE, DIRECTOR, CONTINUITY OF CARE* CINDY JOHNSTON, DIRECTOR, COMMUNITY WELLNESS, VALLEY WEST COMMUNITY HOSPITAL* DAVID WESTER, PHYSICIAN ASSISTANT, CENTER FOR FAMILY HEALTH* DAWN ROZNOWSKI, COMMUNITY ENGAGEMENT ADVISOR, KISHHEALTH SYSTEM* DR. MICHAEL KULISZ, PHYSICIAN, CHIEF MEDICAL OFFICER, KISHHEALTH SYSTEM* JENNIFER RENFER, READMISSION NURSE* KAREN ROUSE, DIRECTOR, OUTPATIENT CLINICS* MICHAEL KOKOTT, ASSISTANT VICE PRESIDENT OF MARKETING AND PLANNING, KISHHEALTH SYSTEM* PAMELA DUFFY, VICE PRESIDENT, PATIENT CARE SERVICES AND CHIEF NURSING OFFICER* SHELLY JOHNSON, DIRECTOR, COMMUNITY CARES CLINIC AND CENTER FOR FAMILY HEALTH, EMPLOYEE HEALTH, COMMUNITY WELLNESS, KISHHEALTH SYSTEM* THERESA KOMITAS, COMMUNITY RELATIONS, KISHWAUKEE COMMUNITY HOSPITAL VALLEY WEST COMMUNITY HOSPITAL PART V, SECTION B, LINE 4: KISHWAUKEE COMMUNITY HOSPITAL VALLEY WEST COMMUNITY HOSPITAL PART V, SECTION B, LINE 7: NINE OTHER TOPIC AREAS (ACCIDENTS, ALCOHOL/DRUG USE, ALLERGIES, CRIME, JOB AVAILABILITY, ORAL HEALTH, SUICIDE AND UNEMPLOYMENT) WERE IDENTIFIED FOR DATA COLLECTION, REVIEW AND PRIORITY SETTING. BELOW ARE THE TOPIC AREAS IDENTIFIED AND A BRIEF DESCRIPTION WHY THE HOSPITAL DID NOT SELECT TO ADDRESS.PRIORITY IDENTIFIED: ACCIDENTSSUPPORTING DATA: 2007-2009 CENTERS FOR DISEASE CONTROL AND PREVENTION, LISTS ACCIDENTS (MOTOR VEHICLE, FALLS AND POISONING) AS THE THIRD LEADING CAUSE OF DEATH FOR DEKALB COUNTY RESIDENTS. EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED.PRIORITY IDENTIFIED: ALCOHOL/DRUG USE SUPPORTING DATA: *ILLINOIS DEPARTMENT OF PUBLIC HEALTH BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY INDICATED 22.4% OF THE POPULATION REPORT RISK FOR ACUTE/BINGE DRINKING.* PER ILLINOIS SECRETARY OF STATE, THERE WERE 585 ARRESTS FOR DRIVING UNDER THE INFLUENCE IN 2010.* IN 2009, ILLINOIS STATE POLICE REPORTS INDICATE THERE WERE 571 ARRESTS FOR DRUG OFFENSES.* BASED ON ILLINOIS DEPARTMENT OF HUMAN SERVICES, DIVISION OF ALCOHOLISM AND SUBSTANCE ABUSE REPORT, AS ESTIMATED 13,155 (15.6%) OF DEKALB COUNTY RESIDENTS AGED 16 AND OLDER WERE IN NEED OF ALCOHOL TREATMENT, AS WELL AS 2,024 PERSONS IN NEED OF DRUG ABUSE TREATMENT. EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST COMMUNITY HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS BEN GORDON CENTER YOUTH SERVICES BUREAU, DCPSAFE AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: ALLERGIES SUPPORTING DATA: 62% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED ALLERGIES AS A MODERATE TO SEVERE PROBLEM IN DEKALB COUNTY. EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DID NOT CHOOSE THIS AS A PRIORITY TO ADDRESS, HOWEVER, IT MAY BE INDIRECTLY ADDRESSED AS A RESULT OF WORK ON OTHER IDENTIFIED HEALTH PRIORITIES LIKE ACCESS TO CARE, CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND OVERWEIGHT/OBESITY IN ADULTS/CHILDREN.PRIORITY IDENTIFIED: CRIMESUPPORTING DATA: 71% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED THAT CRIME IS A MODERATE TO SERIOUS CONCERN IN DEKALB COUNTY. ALSO, ILLINOIS STATE POLICE REPORT THAT FOR 2009, CITY OF DEKALB WAS HIGHEST AT 3,573.8 PER 100,000 POPULATION, FOLLOWED BY SOMONAUK (2093.9) AND SYCAMORE (1763.5).EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED.PRIORITY IDENTIFIED: JOB AVAILABILITYSUPPORTING DATA: 75% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED THAT JOB AVAILABILITY IS A MODERATE TO SERIOUS CONCERN IN DEKALB COUNTY.EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST COMMUNITY HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS ILLINOIS EMPLOYMENT TRAINING CENTER, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: ORAL HEALTHSUPPORTING DATA: 71.6% OF DEKALB COUNTY RESIDENTS HAVE DENTAL INSURANCE, HIGHER THAN THE STATE AVERAGE AT 61.9%. HOWEVER, 25.3% OF DEKALB COUNTY RESIDENTS CANNOT AFFORD DENTAL CARE WITHIN THE PAST YEAR.EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. PRIORITY IDENTIFIED: SUICIDESUPPORTING DATA: FOR THE PERIOD OF 2007-2009, SUICIDE RANKED AS THE 10TH LEADING CAUSE OF DEATH FOR DEKALB COUNTY RESIDENTS, AND THE SECOND LEADING CAUSE OF DEATH AMONG RESIDENTS AGED 15-44 YEARS OF AGE, PER THE CENTERS FOR DISEASE CONTROL AND PREVENTION. EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST COMMUNITY HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS BEN GORDON CENTER YOUTH SERVICES BUREAU, DCPSAFE AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: UNEMPLOYMENTSUPPORTING DATA: 74% OF RESPONDENTS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY INDICATED THAT UNEMPLOYMENT IS A MODERATE TO SERIOUS CONCERN IN DEKALB COUNTY. ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY REPORTS 9.2% OF DEKALB COUNTY RESIDENTS AS BEING UNEMPLOYED, LOWER THAN BOTH THE STATE AND U.S. RATES. EXPLANATION FOR NOT ADDRESSING: VALLEY WEST COMMUNITY HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. VALLEY WEST COMMUNITY HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS ILLINOIS EMPLOYMENT TRAINING CENTER, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM. VALLEY WEST COMMUNITY HOSPITAL PART V, SECTION B, LINE 18E: POSTING OF FINANCIAL ASSISTANCE POLICY TO SYSTEM'S WEBSITE. VALLEY WEST COMMUNITY HOSPITAL PART V, SECTION B, LINE 20D: BASED ON COMPLIANCE WITH LAWS OF STATE OF ILLINOIS, SPECIFICALLY THE UNINSURED PATIENT DISCOUNT ACT. PART VI, LINE 2: VALLEY WEST COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL, IDENTIFIES COMMUNITY HEALTH NEEDS IN SEVERAL WAYS. ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR VALLEY WEST COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. RESOURCES UTILIZED INCLUDE:* AMERICAN DIABETES ASSOCIATION* AMERICAN MEDICAL ASSOCIATION* AMERICAN UNIVERSITY SURVEY* CENTERS FOR DISEASE CONTROL AND PREVENTION* COMMUNITY NEEDS INDEX* ILLINOIS DEPARTMENT OF EMPLOYMENT SECURITY* ILLINOIS DEPARTMENT OF PUBLIC HEALTH* ILLINOIS DEPARTMENT OF PUBLIC HEALTH ANNUAL HOSPITAL QUESTIONNAIRE* ILLINOIS DEPARTMENT OF PUBLIC HEALTH, BEHAVORIAL RISK FACTORS SURVEY* ILLINOIS DEPARTMENT OF PUBLIC HEALTH, ILLINOIS COUNTY CANCER STATISTICS REVIEW INCIDENCE* ILLINOIS DEPARTMENT OF PUBLIC HEALTH: BIRTH DEFECTS AND OTHER ADVERSE PREGNANCY OUTCOMES IN ILLINOIS, 2004-2008* ILLINOIS HOSPITAL ASSOCIATION* ILLINOIS HOSPITAL ASSOCIATION, COMPDATA* ILLINOIS PUBLIC HEALTH COMMUNITY MAP* NATIONAL CANCER INSTITUTE* NATIONAL CENTER FOR HEALTH STATISTICS* NATIONAL HEART LUNG AND BLOOD INSTITUTE* NORTHERN ILLINOIS UNIVERSITY ENROLLMENT DATA* PIONEERING HEALTHIER COMMUNITIES* STATE OF ILLINOIS DATA BY ZIP CODE* US CENSUS BUREAU 2010 DATA* INPUT FROM OTHER COMMUNITY PROVIDERS. THIS INCLUDES PROVIDING HOSPITAL LEADERS SERVING ON BOARDS AND COMMITTEES THAT DIRECTLY OR INDIRECTLY IMPACT COMMUNITY HEALTH OR HELP THE HOSPITAL CONNECT TO UNDERSERVED OR VULNERABLE POPULATIONS. PART VI, LINE 3: INFORMATION IS PROVIDED AT REGISTRATION, VIA THE HOSPITAL WEBSITE, THROUGH CONSULTATIONS WITH FINANCIAL COUNSELORS, DURING THE BILLING PROCESS ON STATEMENTS, AND VIA PHONE CONVERSATIONS. PART VI, LINE 4: VALLEY WEST COMMUNITY HOSPITAL SERVES ALL OF DEKALB COUNTY, IL, AND BORDER COMMUNITIES IN KENDALL AND LASALLE COUNTIES. THE POPULATION OF THE VALLEY WEST SERVICE AREA, BASED ON THE 2010 CENSUS, WAS 72,043 THIS GEOGRAPHIC AREA INCLUDES A GROWING HISPANIC POPULATION. THE HISPANIC POPULATION IS EXPECTED TO GROW BY 1.84% BY 2017. POVERTY LEVELS FOR VALLEY WEST'S PRIMARY MARKET AT SANDWICH, 4.4%; SOMONAUK, 3.8%; LELAND, 7.9%; AND PLANO, 5.3%. PART VI, LINE 5: VALLEY WEST COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL IN SANDWICH, IL, IS PART OF KISHHEALTH SYSTEM. THE HEALTH SYSTEM IS GOVERNED BY AN APPOINTED VOLUNTEER BOARD OF DIRECTORS, INDEPENDENT COMMUNITY LEADERS WHO RESIDE IN THE PRIMARY MARKETS SERVED BY THE HEALTH SYSTEM'S TWO HOSPITALS. THESE INDIVIDUALS ARE SELECTED FOR THE BOARD BECAUSE OF THEIR INTEREST AND EXPERTISE IN VARIOUS AREAS THAT CAN HELP MANAGEMENT CARRY OUT THE HEALTH SYSTEM'S MISSION. MEMBERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR TIME. THE MEDICAL STAFF IS OPEN TO PHYSICIANS WHO MEET CRITERIA ESTABLISHED BY THE MEDICAL STAFF BYLAWS. PHYSICIANS ARE GIVEN AND TAKE THE OPPORTUNITY TO VOLUNTEER TO DO FREE COMMUNITY WELLNESS PROGRAMS ON HEALTH TOPICS. SURPLUS FUNDS GO BACK INTO THE ORGANIZATION TO SUPPORT OPERATIONS, CAPITAL IMPROVEMENTS, THE HEALTH SYSTEM'S COMMITMENT TO EXCELLENCE, EDUCATION AND INNOVATION, AND TO PROVIDE MEDICAL CARE TO ALL REGARDLESS OF ABILITY TO PAY. A COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED IN THE FALL OF 2009, VIA A RANDOM TELEPHONE SURVEY. RESULTS ARE ONE COMPONENT USED FOR FY 13 ACTION PLANNING. A COMMUNITY NEEDS ASSESSMENT ALSO WAS COMPLETED DURING THIS CURRENT FISCAL YEAR. BELOW ARE SPECIFIC EXAMPLES OF THE HOSPITAL'S EFFORTS TO PROMOTE HEALTH WITHIN THE COMMUNITY.COMMUNITY HEALTH NEEDS ASSESSMENT: IN COLLABORATION WITH DEKALB COUNTY HEALTH DEPARTMENT, VALLEY WEST COMMUNITY HOSPITAL UNDEWROTE THE COST OF THE DATA COLLECTION PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE PREVALENCE OF OBESITY IN CHILDREN AND ADULTS: COMMUNITY WELLNESS INITIATIVE IS TO DECREASE OBESITY AND THE CHRONIC DISEASES ASSOCIATED WITH IT BY OFFERING TARGETED WELLNESS PROGRAMS AND PREVENTATIVE SCREENINGS TO HELP OUR COMMUNITY GET WELL AND STAY WELL. THREE HEALTH PROMOTION SPECIALISTS AND A HEALTHY CULINARY INSTRUCTOR ARE EMPLOYED TO COLLABORATE WITH COMMUNITY ORGANIZATION, SCHOOLS AND TO WORK WITH THE COMMUNITY TO PROMOTE HEALTHY FOOD CHOICES, INCREASE FITNESS, AND DECREASE CHRONIC DISEASE. PROGRAMS INCLUDE FREE KNOW YOUR NUMBERS EVENTS, FREE BLOOD PRESSURE CLINICS, TIME TO QUIT TOBACCO CLASSES, WELLNESS FOR KIDS PROGRAM IN THE SCHOOLS, WE CAN PROGRAM IN THE SCHOOLS TO HELP PARENTS ADDRESS THE ISSUE OF OVERWEIGHT CHILDREN, KIDS IN THE KITCHEN, LIVE FIT CHALLENGE WITH THE FOX VALLEY FAMILY YMCA, AM I HUNGRY MINDFUL EATING WORKSHOPS, AND EMPOWERME4LIFE PROGRAM. SCHOOL PROGRAMS TOUCHED IN EXCESS OF 6,000 STUDENTS.ACCESS TO AFFORDABLE PRIMARY CARE: NEW PHYSICIANS WHO RECEIVE RECRUITMENT ASSISTANCE FROM KISHHEALTH SYSTEM OR WHO ARE EMPLOYED BY KISHHEALTH SYSTEM ARE REQUIRED TO ACCEPT MEDICAID AND UNINSURED PATIENTS. DURING FY 13, KISHWAUKEE PHYSICIAN GROUP EMPLOYED SEVEN PHYSICIANS WITH PRACTICES IN SANDWICH, DEKALB AND GENOA . A PEDIATRICIAN AND AN INTERNIST ARE UNDER CONTRACT WITH THE HEALTH SYSTEM TO PROVIDE PART-TIME OFFICE HOURS AT KISHHEALTH FAMILY & SPECIALTY CARE IN WATERMAN, PROVIDING THE RURAL AREAS OF WATERMAN, SHABBONA AND HINCKLEY ACCESS TO CONVENIENT PRIMARY CARE. THE WATERMAN OFFICE ALSO PROVIDES SERVICES FOR THE RURAL MEDICAID POPULATION. DURING FY13, THERE WERE OVER 14,500 PATIENT ENCOUNTERS WITH KPG PHYSICIANS.MENTAL HEALTH- DURING FY 13, THE CHILD DEVELOPMENT CLINIC NOW PROVIDES ASSESSMENT AND INTERVENTION OF CHILDHOOD DISORDERS INCLUDING AUTISM SPECTRUM DISORDERS, DEVELOPMENTAL DELAYS, SLEEP PROBLEMS, ANXIETY, DEPRESSION, AND OTHER MOOD DISORDERS, AS WELL AS COMMON SCHOOL, FAMILY, AND SOCIAL STRESSORS TYPICAL IN CHILDHOOD. THERE WERE 1525 VISITS TO THE CHILD DEVELOPMENT CLINIC IN FY 13. IN ADDITION, PSYCHIATRY, COUNSELING AND EMPLOYEE ASSISTANCE PROGRAM SERVICES ARE PROVIDED AT THE BEHAVIORAL HEALTH CENTER IN SYCAMORE AND AT THE VALLEY WEST COMMUNITY HOSPITAL MEDICAL OFFICE BUILDING. THERE WERE OVER 6,200 BEHAVIORAL HEALTH PATIENT VISITS IN FY13. TYPE II DIABETES: TO ADDRESS THE PREVALENCE OF DIABETES IN THE ADULT POPULATION, THE SYSTEM CONTINUED TO OPERATE DIABETES EDUCATION CENTERS AT KISH HOSPITAL AND VALLEY WEST WITH SATELLITE SERVICES AT KISHHEALTH FAMILY & SPECIALTY CARE IN GENOA. THE VALLEY WEST COMMUNITY HOSPITAL DIABETES EDUCATION CENTER HAD 2,757 CONSULTATIONS, A 10% INCREASE FROM THE PREVIOUS YEAR. ON AVERAGE, 18 INPATIENTS A MONTH AT VWCH WERE DIAGNOSED WITH DIABETES. IN FY13, KISH HOSPITAL HELD "THE ABCS OF DIABETES" IN CONJUNCTION WITH DEKALB CLINIC PROVIDING RESOURCES FOR PEOPLE WITH DIABETES. ABOUT 150 PEOPLE ATTENDED. THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY CONSISTED OF THREE SEPARATE SECTIONS: INDIVIDUAL INFORMATION, FAMILY/HOUSEHOLD INFORMATION, AND COMMUNITY INFORMATION. THE SURVEY WAS DESIGNED TO COLLECT DATA ON HEALTH ATTITUDES AND BELIEFS; HEALTH BEHAVIORS AND HEALTH CARE SEEKING PATTERNS; ACCESS TO AND UTILIZATION OF HEALTH SERVICES AND RELATED SOCIAL SERVICES; AND CONCERNS ABOUT COMMUNITY HEALTH ISSUES. IN ADDITION, RESPONDENTS COMPLETED A SERIES OF QUESTIONS RELATED TO RESIDENCY, LENGTH AT THEIR CURRENT LOCATION, GENDER, AGE, RACE, EDUCATION, EMPLOYMENT, INCOME AND HOUSEHOLD SIZE. A LIST OF 58 HEALTH, SAFETY AND ENVIRONMENTAL ISSUES THAT MIGHT BE FOND IN THE COMMUNITY WAS PROVIDED AND RESPONDENTS WERE ASKED TO INDICATE WHETHER THEY FELT THE ISSUE WAS A SERIOUS PROBLEM, MODERATE PROBLEM, NOT A PROBLEM, OR NOT SURE. 53% OF THE PARTICIPANTS INDICATED THAT DIABETES IS A CONCERN IN DEKALB COUNTY.CARDIOVASCULAR DISEASE AND HOSPITAL-BASED AND COMMUNITY OUTREACH SERVICES: COMMUNITY BENEFIT ACTIVITIES IN FY 13 THAT PROMOTED CARDIOVASCULAR HEALTH INCLUDED A WOMEN'S HEALTH EVENT AT VALLEY WEST IN FEBRUARY WHICH HAD 250 ATTENDEES AND KNOW YOUR NUMBERS EVENTS RESULTED IN 240 FREE SCREENINGS. BLOOD PRESSURE CLINICS: TOTAL FREE BLOOD PRESSURE CHECKS FOR VALLEY WEST WAS 1,086.CANCER CARE SERVICES: PROVIDED FREE SKIN CANCER SCREENINGS AT WOMEN'S HEALTH EVENT RESULTING IN 36 SCREENINGS AT VALLEY WEST. PROVIDED FINANCIAL SUPPORT OF AMERICAN CANCER SOCIETY RELAYS FOR LIFE LOWER FOX VALLEY (KENDALL COUNTY). OTHER: ENTERED INTO AGREEMENTS WITH THE FOX VALLEY YMCA (PLANO) AND THE SANDWICH PARK DISTRICT TO HELP UNDERWRITE THE COST OF FITNESS AND RECREATIONAL ACTIVITIES FOR COMMUNITY MEMBERS. IN ADDITION, COMMUNITY WELLNESS EDUCATORS VISITED 600 CLASSROOMS AND WORKED WITH 13,100 STUDENTS.FARMERS MARKET VOUCHERS: DURING THE SUMMER OF FY13, KISHWAUKEE COMMUNITY HOSPITAL WORKING WITH THE DEKALB COUNTY HEALTH DEPARTMENT'S WIC PROGRAM AND THE FAMILY SERVICE AGENCYS SENIOR SERVICES, VOUCHERS WERE PROVIDED TO LOW INCOME INDIVIDUALS. THE VOUCHERS WERE USED TO PURCHASE FRUITS, VEGETABLES, AND HERBS FROM PARTICIPATING VENDORS. THE VENDORS TURNED THE VOUCHERS IN TO THE HOSPITAL, WHICH ISSUED PAYMENT. MORE THAN $6,000 IN FRUITS AND VEGETABLES WERE PURCHASED.CASH AND IN-KIND DONATIONS: EACH YEAR AN ALLOCATION IS MADE IN THE OPERATING BUDGET FOR DONATIONS TO COMMUNITY EVENTS AND ORGANIZATIONS THAT IMPROVE THE HEALTH, WELFARE, AND QUALITY OF LIFE IN THE COMMUNITIES SERVED BY KISHHEALTH SYSTEM. THE SYSTEM ESPECIALLY WANTS TO SUPPORT COMMUNITY ACTIVITIES THAT ENCOURAGE CHILD AND ADULT PHYSICAL ACTIVITY; EFFORTS THAT REACH UNDERSERVED AND VULNERABLE POPULATIONS; YOUTH MENTORING AND EDUCATION; DISEASE PREVENTION, AWARENESS, AND RESEARCH; MENTAL HEALTH; ECONOMIC DEVELOPMENT, AND OTHER COMMUNITY BUILDING ACTIVITIES. IN-KIND DONATIONS AND SERVICES SUCH AS PERSONNEL TIME, SURPLUS SUPPLIES, FOOD, AND BOTTLED WATER ALSO ARE TRACKED. PART VI, LINE 6: KISHHEALTH SYSTEM AND ITS NON-PROFIT AFFILIATES, KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HOSPICE, COMMUNITY CARES CLINIC, CENTER FOR FAMILY HEALTH-MALTA, KISHHEALTH HOME CARE, KISHHEALTH PHYSICIAN GROUP AND THE KISHHEALTH FOUNDATION, ALL PROMOTE THE HEALTH OF COMMUNITIES IN OUR REGION THROUGH DIRECT SERVICES, DONATIONS OF LEADERSHIP TIME ON VARIOUS COMMITTEES AND BOARDS, AND THROUGH CASH CONTRIBUTIONS.KISHHEALTH SYSTEM UNDERWROTE $1,100,000 IN OPERATIONAL LOSSES IN FY 13 FOR THE TWO CENTERS FOR FAMILY HEALTH, AND $3,000,000 FOR KISHWAUKEE PHYSICIANS GROUP, BOTH VITAL SERVICES FOR THE HEALTH OF THE COMMUNITY. IT ALSO MADE $70,548 IN CONTRIBUTIONS TO SEVERAL ORGANIZATIONS IN FY13, NOTABLY $10,000 TO SANDWICH PARK DISTRICT, $10,000 TO FOX VALLEY YMCA AND $5,000 TO THE AMERICAN CANCER SOCIETY. IN ADDITION, HEALTH SYSTEM EMPLOYEES CONTRIBUTED MORE THAN 1,144 HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH, EDUCATION AND QUALITY OF LIFE. VALLEY WEST COMMUNITY HOSPITAL IS A CRITICAL ACCESS HOSPITAL IN SANDWICH. DEKALB COUNTY HOSPICE, DEKALB, IL, PROVIDES FREE CARE AND SUPPORT FOR THE TERMINALLY ILL AS WELL AS GRIEF SUPPORT TO THE PUBLIC. COMMUNITY CARES CLINIC, DEKALB, IL IS A PRIMARY CARE CLINIC FOR MEDICAID AND UNINSURED; KISHHEALTH PHYSICIAN GROUP PROVIDES ACCESS TO MEDICAL SERVICES, ESPECIALLY THE RURAL AREAS AND ACCEPTS MEDICAID AND UNINSURED PATIENTS, AND KISHHEALTH FOUNDATION IN DEKALB, IL RAISES MONEY FOR KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HOSPICE AND THE CENTERS FOR FAMILY HEALTH AND FUNDS EQUIPMENT PURCHASES AND PATIENT SERVICES PARTICULARLY IN THE AREA OF CANCER CARE FOR THOSE WHO CANNOT AFFORD IT. REPORTS FILED WITH STATES PART VI, LINE 7 IL 1 FOX VALLEY FAMILY YMCA 3875 ELDAMAIN ROAD PLANO IL 60545 363028169 501(C)(3) 10000 UNDERWRITE COST OF HEALTH AND FITNESS PROGRAMS, INCLUDING DISCOUNT FOR EMPLOYEE MEMBERSHIPS AMERICAN CANCER SOCIETY 143 FIRST STREET BATAVIA IL 60510 131788491 501(C)(3) 5000 SUPPORT FOR RELAY FOR LIFE PROGRAM WHICH RAISES FUNDS FOR CANCER RESEARCH AND EDUCATION SANDWICH PARK DISTRICT PO BOX 405 SANDWICH IL 60548 362646087 501(C)(3) 10000 PROMOTE VARIOUS SPORTS AND FITNESS PROGRAMS IHREF 24676 NETWORK PLACE CHICAGO IL 60673 237421930 501(C)(3) 5931 TO PROVIDE RELIEF FOR HOPSITALS NEGATIVELY AFFECTED BY ASSESSMENTS 4 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MAINTAINS SPECIFIC POLICIES AND QUALIFICATIONS FOR ALL GRANTS AVAILABLE. APPLICANTS MUST APPLY FOR THE RESPECTIVE GRANT AND BE APPROVED BY THE FUNDS GOVERNING BOARD. THE USE OF THE FUNDS IS MONITORED BY THE GOVERNING BOARD OF VALLEY WEST COMMUNITY HOSPITAL. REQUESTS FOR FINANCIAL ASSISTANCE FROM OTHER CHARITABLE ORGANIZATIONS ARE REVIEWED AND APPROVED BY THE VP - FINANCE OF KISHHEALTH SYSTEM. IF NECESSARY DUE TO THE DOLLAR AMOUNT OF THE REQUEST, THESE ITEMS MAY ALSO BE PRESENTED TO THE BOARD OF DIRECTORS. A BUDGET IS SET ANNUALLY FOR CHARITABLE ASSISTANCE TO OTHER ORGANIZATIONS 0 1 0 0 0 0 0 0 0 KEVIN POORTEN 0 548333 0 168139 0 250000 0 196100 0 24053 0 1186625 0 0 LOREN FOELSKE 0 256230 0 28504 0 0 0 94286 0 23218 0 402238 0 0 BRAD COPPLE 0 290654 0 68983 0 0 0 48700 0 23484 0 431821 0 0 PAM DUFFY 0 205275 0 43878 0 0 0 21863 0 9007 0 280023 0 0 MIKE MUZZILLO THRU 62912 0 107905 0 31214 0 90400 0 11876 0 551 0 241946 0 0 MIKE KOKOTT 0 164639 0 30189 0 0 0 19424 0 15418 0 229670 0 0 ROGER HEATH BELL 0 216114 0 57458 0 0 0 22712 0 28395 0 324679 0 0 DR MICHAEL KULISZ 0 310004 0 92702 0 0 0 75900 0 23358 0 501964 0 0 MARK THATE 0 175149 0 40790 0 57200 0 10707 0 15579 0 299425 0 0 JOE DANT 0 215055 0 40618 0 0 0 22696 0 23145 0 301514 0 0 SUE HOHENBERGER 134989 0 6466 0 0 0 8245 0 14514 0 164214 0 0 0 ALEX P LOMAHAN 129706 0 1000 0 0 0 7984 0 21884 0 160574 0 0 0 PART I, LINE 4B THE ORGANIZATION'S EXECUTIVES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2012 RELATED TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF VALLEY WEST COMMUNITY HOPSITAL WERE $334,200. THIS CONTRIBUTION REFLECTS AMOUNTS DUE FOR BOTH THE FISCAL YEARS ENDING APRIL 30, 2011 AND APRIL 30, 2012, WITH 50% OF THE CONTRIBUTION BEING ALLOCATED TO EACH YEAR. THE ORGANIZATION'S CEO PARTICIPATES IN AN ADDITIONAL NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2012 WERE $60,000. DURING FY13, THE CEO TOOK A DISTRIBUTION FROM THE DEFERRED COMPENSATION PLAN IN THE AMOUNT OF $250,000. 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. HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE 81072 HEALTH PROGRESS, INC. IS AN AFFILIATE OF VALLEY WEST COMMUNITY HOSPITAL. HEALTH PROGRESS SUBLEASES OFFICE SPACE FROM VALLEY WEST COMMUNITY HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 2 KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHHEALTH SYSTEM, THE PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL. 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, WHICH IS THE PARENT ORGANIZATION FOR ALL RELATED ENTITIES. BRAD COPPLE, AS THE PRESIDENT OF VWCH, IS CONSIDERED AN OFFICER. HE IS ALSO PRESIDENT OF KISHWAUKEE COMMUNITY HOSPITAL, A RELATED ENTITY, AND IS COMPENSATED BY KISHHEALTH SYSTEM. MR. POORTEN AND MR. FOELSKE ARE ALSO CONSIDERED OFFICERS OF KISHWAUKEE COMMUNITY HOSPITAL AND KISHHEALTH SYSTEM, AS DESCRIBED ABOVE. TERRENCE DUFFY IS A MEMBER OF THE VALLEY WEST COMMUNITY HOSPITAL BOARD OF DIRECTORS. HE ALSO SERVES ON THE BOARD OF DIRECTORS OF KISHHEALTH SYSTEM, THE PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL. JAGDISH PATEL SERVES ON THE BOARD OF VALLEY WEST COMMUNITY HOSPITAL. HE IS COMPENSATED FOR MEDICAL SERVICES HE PROVIDES TO THE HOSPITAL. HE IS NOT COMPENSATED FOR HIS SERVICES AS A BOARD DIRECTOR. THE FOLLOWING INDIVIDUALS ARE OFFICERS OR KEY EMPLOYEES OF KISHHEALTH SYSTEM AND ARE ALSO CONSIDERED OFFICERS OR KEY EMPLOYEES OF VALLEY WEST COMMUNITY HOSPITAL. THEY ARE ALL COMPENSATED BY KISHHEALTH SYSTEM: BRAD COPPLE, PRESIDENT KCH & VWCH PAM DUFFY, CNO AND VP PATIENT CARE JOE DANT, VP DEVELOPMENT MIKE KOKOTT, ASST. VP MARKETING ROGER HEATH BELL, VP AND CHIEF INFORMATION OFFICER MARK THATE, VP HUMAN RESOURCES DR. MICHAEL KULISZ, CHIEF MEDICAL OFFICER MIKE MUZZILLO, VP OPERATIONS - VWCH (TERMINATED EMPLOYMENT IN 2012) FORM 990, PART VI, SECTION A, LINE 6 KISHHEALTH SYSTEM IS THE SOLE MEMBER OF VALLEY WEST COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER AND PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL, KISHHEALTH SYSTEM HAS THE RIGHT TO APPROVE THE ELECTION OF MEMBERS OF THE HOSPITAL'S GOVERNING BOARD, PER THE HOSPITAL'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL (VWCH). PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF VWCH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER: A. ELECTING THE MEMBERS OF THE VWCH BOARD; B. APPROVING, EVALUATING AND/OR REMOVING THE PRESIDENT AND CEO AND REVIEWING AND APPROVING THE EMPLOYMENT CONTRACT OF THE PRESIDENT AND CEO AND ESTABLISHING COMPENSATION FOR SUCH OFFICE; C. APPROVING THE STRATEGIC PLAN FOR VWCH; D. APPROVING THE DISPOSITION OF ANY ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS FOR VWCH; E. APPROVING ANY CHANGE IN MEMBERSHIP OF VWCH; F. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION AND BYLAWS OF VWCH; G. APPROVING A PLAN OF MERGER OR A PLAN OF CONSOLIDATION OF VWCH OR ESTABLISHING A NEW SUBSIDIARY OR SISTER ENTITY; H. APPROVING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF VWCH; I. INITIATING, TAKING ANY AND ALL ACTIONS, AND EXERCISING ALL APPROVAL RIGHTS OF THE DIRECTORS PURSUANT TO THE APPLICABLE MEDICAL STAFF BYLAWS; J. IMPLEMENTING AND MONITORING VWCH OPERATIONAL QUALITY IMPROVEMENT POLICIES AND PROGRAMS; K. ACCEPTING GIFTS, GRANTS, BEQUESTS AND DONATIONS ON BEHALF OF VWCH; L. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR VWCH; M. EXERCISING ANY RIGHTS THAT VWCH HAS AS A SHAREHOLDER OR MEMBER OF ANY SUBSIDIARY ENTITY; N. APPROVING ANY AFFILIATIONS OF VWCH; O. APPROVING AND/OR DETERMINING (I) THE CREATION OF NEW HEALTH SERVICES TO BE PROVIDED AND THE LOCATION OF SUCH HEALTH SERVICES AND (II) THE DISCONTINUANCE OF ANY HEALTH SERVICE; P. AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF VWCH; Q. AUTHORIZING THE VOLUNTARY DISSOLUTION OF VWCH, OR REVOKING THE PROCEEDINGS THEREOF; R. REQUIRING MINUTES OF MEETINGS, FINANCIAL RECORDS, AND SUCH OTHER INFORMATION AS MAY BE NECESSARY TO PROPERLY EVALUATE THE PERFORMANCE OF VWCH; S. INITIATING ACTION TO REMOVE OR REINSTATE A DIRECTOR WHEN, IN THE OPINION OF THE KHS BOARD, IT IS IN THE BEST INTERESTS OF KHS OR VWCH. ANY ACTION TO REMOVE OR REINSTATE SHALL REQUIRE A MAJORITY VOTE OF THOSE KHS DIRECTORS THEN IN OFFICE PRESENT AND VOTING AT A MEETING OF THE KHS BOARD AT WHICH A QUORUM IS PRESENT. IN ANY ACTION(S) TO REMOVE TAKEN BY THE KHS BOARD, THE DIRECTOR IN QUESTION SHALL BE ADVISED AT LEAST TWENTY (20) DAYS PRIOR TO THE MEETING THAT THE ACTION WILL BE CONSIDERED AND SHALL BE GIVEN THE OPPORTUNITY TO MAKE A STATEMENT, PRESENT WITNESSES ON HIS/HER BEHALF AND QUESTION THOSE PRESENTING REASONS FOR HIS/HER REMOVAL. ALL ACTIONS TO REMOVE SHALL BE TAKEN IN CLOSED SESSIONS OF THE KHS BOARD; AND T. TRANSFERRING MONEY OR PROPERTY AMONG VWCH, KHS AND/OR ONE OR MORE SUBSIDIARY CORPORATIONS AND TRANSFERRING MONEY OR PROPERTY FROM A SUBSIDIARY CORPORATION, INCLUDING REQUIRING THE DIRECTORS, OFFICERS, OR TRUSTEES OF ANY SUBSIDIARY CORPORATION TO TRANSFER MONEY OR OTHER PROPERTY TO KHS. SUBJECT TO THE POWERS OF THE BOARD OF DIRECTORS OF EACH SUBSIDIARY CORPORATION, THE KHS BOARD MAY INITIATE AND TAKE THE FOREGOING ACTIONS ON BEHALF OF KHS AND THE SUBSIDIARY CORPORATIONS. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ARE ALSO PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW. THE CHAIR OF THE AUDIT COMMITTEE AND THE AUDIT COMMITTEE MEMBERS ARE ALSO PROVIDED DRAFT COPIES AND REVIEW. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE GOVERANCE 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. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED. VALLEY WEST COMMUNITY HOSPITAL IS NOT DIRECTLY INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT, AS THE INDIVIDUALS ARE EMPLOYED THROUGH KISHHEALTH SYSTEM. KISHHEALTH SYSTEM DOES COMPLY WITH THE REQUIREMENTS NOTED ABOVE. THROUGH THE OVERSIGHT OF THE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE, THE KISHHEALTH SYSTEM EXECUTIVE TOTAL COMPENSATION PROGRAM WILL BE COMPETITIVELY POSITIONED IN THE MARKET PLACE OF RELEVANT ORGANIZATIONS AND FALL WITHIN THE SAFE HARBOR GUIDELINES ESTABLISHED BY THE INTERMEDIATE SANCTIONS RULES. THE EXECUTIVE COMPENSATION COMMITTEE IS MADE UP OF THREE MEMBERS OF THE BOARD OF DIRECTORS WHO MEET THE BOARD APPROVED DEFINITION OF "INDEPENDENT DIRECTORS". ANNUALLY THE EXECUTIVE COMPENSATION COMMITTEE CONTRACTS WITH SULLIVAN, COTTER AND ASSOCIATES, AN INDEPENDENT HUMAN RESOURCES CONSULTING FIRM TO PROVIDE THE COMMITTEE ANALYSIS AND COMPARABILITY DATA. USING THE SUPPLIED DATA THE COMPENSATION COMMITTEE APPROVES EACH EXECUTIVE'S TOTAL CASH COMPENSATION AND PROVIDES CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. TOTAL CASH COMPENSATION IS DEFINED AS THE SUM OF BASE SALARIES PLUS INCENTIVE AWARDS. BASED ON THE COMPARABILITY DATA AND THE PERFORMANCE OF EACH EXECUTIVE IN MEETING GOALS AND STRATEGIC OBJECTIVES, THE EXECUTIVE COMPENSATION COMMITTEE APPROVES INCREASES AND INCENTIVE AWARDS FOR EACH EXECUTIVE WITHIN THE GUIDELINES ESTABLISHED. THE EXECUTIVE COMPENSATION COMMITTEE REPORTS ON ALL COMPENSATION MATTERS TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINISTRATION. DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS FORM 990, PART VII, COLUMN (B) AVERAGE HOURS PER WEEK FOR THE INDIVIDUALS IDENTIFIED AS OFFICER'S ARE ESTIMATES OF THE INDIVIDUALS TOTAL TIME PER WEEK UTILIZED FOR WORK RELATED TO VALLEY WEST COMMUNITY HOSPITAL. OTHER FEES FORM 990, PART IX, LINE 11G PURCHASED PERSONNEL : PROGRAM SERVICE EXPENSES 1,215,253. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,215,253. PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 3,750,841. MANAGEMENT AND GENERAL EXPENSES 241,440. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,992,281. SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 600,804. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 600,804. OTHER CONSULTING : PROGRAM SERVICE EXPENSES 61,897. MANAGEMENT AND GENERAL EXPENSES 54,294. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,191. OTHER CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 2,941,725. MANAGEMENT AND GENERAL EXPENSES 35,563. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,977,288. BROKER FEES : PROGRAM SERVICE EXPENSES 563. MANAGEMENT AND GENERAL EXPENSES 35,445. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,008. MEDICAL DIRECTOR FEES : PROGRAM SERVICE EXPENSES 56,255. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,255. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM, INC. -3,352,000. OTHER -19,675. CHANGE IN NET ASSETS OF KISHHEALTH FOUNDATION -4,253. RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STATEMENTS FORM 990, PART XI, LINE 3C 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 VALLEY WEST COMMUNITY HOSPITAL. KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649080 PARENT CORPORATION OF 501(C)(3) HEALTH SYSTEM IL 501(C)(3) 11B N/A 0 KISHHEALTH FOUNDATION ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649077 SUPPORT OF CHARITABLE HEALTH ORGANIZATIONS IL 501(C)(3) 7 KISHHEALTH SYSTEM 0 KISHWAUKEE COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 237087041 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 DEKALB COUNTY HOSPICE 2727 SYCAMORE ROAD DEKALB IL 60115 363164329 HOSPICE SERVICES IL 501(C)(3) 7 KISHHEALTH SYSTEM 0 COMMUNITY CARES CLINIC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 800424001 HEALTHCARE SERVICES, PRIMARY CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 KISHWAUKEE PHYSICIANS GROUP INC 2240 GATEWAY DRIVE SYCAMORE IL 60178 651293967 HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 CENTER FOR FAMILY HEALTH - MALTA ONE KISH HOSPITAL DRIVE DEKALB IL 60115 800869393 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 KISHHEALTH SYSTEM HOME CARE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 371703513 HEALTHCARE SERVICES, HOME CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 0 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 HEALTH PROGRESS INC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363824138 INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESSES IL N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1