2013-12-12T15:11:20-06:00 2013-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2012-05-01 363649080 KISHHEALTH SYSTEM KISH 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 LOREN FOELSKE 8157561521 2013-12-10 1 KELLY JACKSON HARDY P00747242 8152842285 2012 2015-11-30 17:44:51Z KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 21043173 0 X WWW.KISHHEALTH.ORG X 1988 IL MANAGEMENT AND PARENT ORGANIZATION PROVIDING SERVICES TO 501(C)(3) HEALTH SYSTEM 14 10 108 14 0 0 0 0 17094568 17928735 251703 232584 -90650 -129031 17255621 18032288 167500 39269 0 0 11328378 11664059 0 0 0 5542178 6147351 17038056 17850679 217565 181609 22577087 27826655 13116831 12659013 9460256 15167642 X MANAGEMENT AND PARENT ORGANIZATION PROVIDING SERVICES TO 501 (C) (3) HEALTH SYSTEM. WE ARE THE CORNERSTONE OF HEALTH CARE FOR THE COMMUNITIES WE SERVE-THE FIRST CHOICE FOR SERVICE, COMFORT AND SAFETY. AS A COMMUNITY-OWNED HEALTH SYSTEM, THE KISH FAMILY UNSELFISHLY COMMITS TO EXCELLENCE, EDUCATION AND INNOVATION. 0 0 1675999 39269 17928735 KISHHEALTH SYSTEM (KHS) IS THE NON-PROFIT CORPORATE UMBRELLA FOR TWO HOSPITALS, A HOSPICE, CLINIC, HOME HEALTH CARE SERVICE, AND A HEALTH FOUNDATION PREDOMINATELY SERVING RESIDENTS OF DEKALB, KENDALL AND LASALLE COUNTIES IN ILLINOIS. THE MISSION OF THE HEALTH SYSTEM IS TO BE "THE CORNERSTONE OF HEALTH CARE FOR THE COMMUNITIES WE SERVE-THE FIRST CHOICE FOR SERVICE, COMFORT AND SAFETY. AS A COMMUNITY-OWNED HEALTH SYSTEM, THE KISH FAMILY UNSELFISHLY COMMITS TO EXCELLENCE, EDUCATION AND INNOVATION." IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HOSPICE, CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, KISHHEALTH HOME CARE, AND KISHHEALTH FOUNDATION, THE HEALTH SYSTEM'S CORPORATE OFFICE PROVIDES COMMUNITY BENEFIT IN THE FOLLOWING AREAS:* KISHHEALTH SYSTEM UNDERWROTE MORE THAN $900,000 IN OPERATIONAL LOSSES IN FY 13 FOR THE CENTER FOR FAMILY HEALTH, $215,100 FOR CENTER FOR FAMILY HEALTH-MALTA, $863,100 FOR KISHHEALTH HOME CARE, AND MORE THAN $3,000,000 FOR KISHWAUKEE PHYSICIAN'S GROUP, ALL VITAL SERVICES FOR THE HEALTH OF THE COMMUNITY. IT ALSO MADE OVER $30,000 IN CONTRIBUTIONS TO SEVERAL ORGANIZATIONS IN FY13. NOTABLE CONTRIBUTIONS INCLUDE THOSE MADE TO HELP THE DEKALB CHAMBER OF COMMERCE, AND RENEW DEKALB.KISHHEALTH SYSTEM EMPLOYEE CONTRIBUTED 1,144 OF HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH AND EDUCATION. KISHHEALTH SYSTEM LEADERS SERVE ON THE BOARDS OF DIRECTORS FOR LIVE HEALTHY DEKALB COUNTY, FORMERLY KNOWN AS PIONEERING HEALTHY COMMUNITIES, KISHWAUKEE FAMILY YMCA, KISHWAUKEE COLLEGE FOUNDATION, OPPORTUNITY HOUSE, VOLUNTARY ACTION CENTER, DEKALB COUNTY YOUTH SERVICES BOARD, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION; DEKALB, SYCAMORE GENOA, SANDWICH AND PLANO CHAMBERS OF COMMERCE; THE CENTER FOR FAMILY HEALTH, FOX VALLEY OLDER ADULT SERVICES, NORTHERN ILLINOIS UNIVERSITY, WABAUNSEE COMMUNITY COLLEGE AND ST. ANTHONY SCHOOL OF NURSING ADVISORY BOARDS.* THE HEALTH SYSTEM'S NON-PROFIT ENTITIES ARE KISHWAUKEE COMMUNITY HOSPITAL, A 98-BED HOSPITAL IN DEKALB IL, SERVING ALL OF DEKALB COUNTY AND BEYOND; VALLEY WEST COMMUNITY HOSPITAL, A 25-BED CRITICAL ACCESS HOSPITAL IN SANDWICH; DEKALB COUNTY HOSPICE, DEKALB, IL, WHICH PROVIDES FREE CARE AND SUPPORT FOR THE TERMINALLY ILL AS WELL AS GRIEF SUPPORT TO THE PUBLIC; CENTER FOR FAMILY HEALTH, DEKALB AND MALTA, IL, PRIMARY CARE CLINICS FOR MEDICAID AND UNINSURED; KISHHEALTH PHYSICIAN GROUP, WHICH PROVIDES ACCESS TO MEDICAL SERVICES, ESPECIALLY THE RURAL AREAS AND ACCEPTS MEDICAID AND UNINSURED PATIENTS; KISHHEALTH HOME CARE, DEKALB, IL, WHICH PROVIDES HOME HEALTH SERVICES PREVIOUSLY OFFERED THROUGH THE COUNTY HEALTH DEPARTMENT, AND KISHHEALTH FOUNDATION IN DEKALB, IL, WHICH RAISES MONEY FOR THE HEALTH SYSTEM AND FUNDS EQUIPMENT PURCHASES AND PATIENT SERVICES PARTICULARLY IN THE AREA OF CANCER CARE FOR THOSE WHO CANNOT AFFORD. 1675999 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 28 0 1 108 1 0 0 0 0 0 0 0 0 0 0 0 X 14 10 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X LOREN FOELSKE VP - FINANCE 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 X MICHAEL CULLEN 2.00 9.00 X X 0 0 0 TERRENCE DUFFY 2.00 1.00 X 0 0 0 MICHAEL LARSON 2.00 X X 0 0 0 JOHN MOULTON 2.00 1.00 X X 0 0 0 THOMAS MATYA 2.00 3.00 X X 0 0 0 MARY LYNN MCARTOR 2.00 X 0 0 0 KEVIN POORTEN 30.00 25.00 X X 966472 0 220153 BRADLEY WALLER 2.00 X 0 0 0 JAGDISH PATEL MD 2.00 1.00 X 0 36975 0 PROMOD VOHRA 2.00 X 0 0 0 THOMAS CHOICE 2.00 X 0 0 0 UMESH GOSWAMI MD 2.00 X 0 0 0 PHOTINE LIAKOS MD 2.00 X 0 0 0 LEONETTA RIZZI 2.00 X 0 0 0 ANN WEST MD 2.00 1.00 X 0 0 0 TIMOTHY RUETTEN MD 2.00 X 0 0 0 LOREN FOELSKE 9.00 37.00 X 284734 0 117504 BRAD COPPLE 4.00 43.00 X 359637 0 72184 JOSEPH DANT 30.00 15.00 X 255673 0 45841 MICHAEL KOKOTT 15.00 30.00 X 194828 0 34842 ROGER HEATH BELL 20.00 27.00 X 273572 0 51107 PAM DUFFY 20.00 25.00 X 249153 0 30870 MARK THATE 25.00 20.00 X 273139 0 26286 MICHAEL MUZZILLO THRU 62912 4.00 47.00 X 229519 0 12427 DR MICHAEL KULISZ 20.00 32.00 X 402706 0 99258 CHERYL FISHER 45.00 X 156287 0 30649 CRAIG VILLACORTA 45.00 X 114534 0 30568 JEFFERY REIFSTECK 45.00 X 110215 0 31791 SHELLY JOHNSON 4.00 37.00 X 100621 0 28073 PHILIP JOHNSON THRU 7612 45.00 X 105606 0 11511 4076696 36975 843064 16 0 1 0 REINHART BOERNER VANDEUREN PO BOX 2965 MILWAUKEE IL 532012965 LEGAL SERVICES 1192485 AURORA RADIOLOGY 1870 WEST GALENA BLVD AURORA IL 60506 MEDICAL SERVICES 440185 MICROSOFT PO BOX 842467 DALLAS TX 75284 INFORMATION TECHNOLOGY SERVICES 343543 CLIFTONLARSONALLEN 114 E EVERETT DIXON IL 61021 ACCOUNTING SERVICES 161450 POWER CONSTRUCTION COMPANY LLC 2360 NORTH PALMER DRIVE SCHAUMBURG IL 60173 CONSTRUCTION SERVICES 130999 6 KHS ADMINISTRATION HEALTH SYSTEM 551112 17928735 17928735 17928735 237568 237568 120421 250115 -129694 -129694 -129694 2755786 2760770 -4984 -4984 -4984 MISCELLANEOUS INCOME 551112 663 663 663 18032288 17928735 0 103553 39269 39269 4114925 4114925 5137392 134587 5002805 337059 7481 329578 1514174 27906 1486268 560509 8580 551929 772529 772529 120000 120000 822611 822611 161600 161600 491708 491708 1392371 1392371 591120 87648 503472 255771 255771 23001 23001 1364407 1364407 6651 6121 530 DUES AND SUBSCRIPTIONS 90350 90350 RECRUITMENT FEES 53963 53963 MISCELLANEOUS EXPENSE 1269 1269 17850679 1675999 16174680 0 2304447 2231333 82832 103892 185 697 598705 522939 8847014 2884261 5533547 5962753 7909893 8767925 4412256 9049472 1735222 1187644 22577087 27826655 10255691 11515671 440206 257962 2420934 885380 13116831 12659013 X 9460256 15167642 9460256 15167642 22577087 27826655 X 181609 -48241 5574018 X X 0 1 X 1 0 X X X X 0 0 0 KISHWAUKEE COMMUNITY HOSPITAL 237087041 03 1 1 1 0 VALLEY WEST COMMUNITY HOSPITAL 364244337 03 1 1 1 0 DEKALB COUNTY HOSPICE 363164329 07 1 1 1 0 KISHHEALTH FOUNDATION 363649077 07 1 1 1 550000 CENTER FOR FAMILY HEALTH 800424001 03 1 1 1 900000 KISHWAUKEE PHYSICIANS GROUP INC 651293967 04 1 1 1 3000000 CENTER FOR FAMILY HEALTH - MALTA 800869393 03 1 1 1 215100 KISHHEALTH HOME CARE 371703513 03 1 1 1 863100 8 5528200 1713988 1713988 1496912 109339 1387573 1126618 310801 815817 3662118 2464121 1197997 847378 847378 5962753 8533209 C CASH EQUIVALENTS 5469 F CERTIFICATES OF DEPOSIT 455255 F ACCRUED INTEREST 55539 F 9049472 DUE TO SUBSIDIARY ORGANIZATIONS 885380 885380 X -495555 -48241 -48241 -447314 18479602 18479602 18032288 172059 250115 250115 -78056 17928735 17928735 17850679 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 4B - OTHER ADJUSTMENTS: LOSS ON SUBSIDIARY, HPI, REPORTED ON SEPARATE COMPANY RETURN 800,982. MANAGEMENT FEES PAID TO KHS, REPORTED AS EXPENSES ON FINANCIAL STATEMENTS 17,928,735. RENTAL EXPENSES NETTED WITH INCOME FOR FORM 990 -250,115. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH INCOME FOR FORM 990 250,115. PART XII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES PAID TO KHS, REPORTED AS EXPENSES ON FINANCIAL STATEMENTS 17,928,735. ROUNDING 1 RENEW DEKALB 111 S SECOND STREET 201 DEKALB IL 60115 760834191 501(C)(3) 5000 TO PROVIDE FINANCIAL ASSISTANCE FOR ECONOMIC DEVELOPMENT PROGRAMS AND ACTIVITIES RELATED TO DOWNTOWN DEKALB RENEWAL OSF SAINT ANTHONY MEDICAL CENTER FOUNDATION 5666 E STATE STREET ROCKFORD IL 61108 371259284 501(C)(3) 7500 TO PROVIDE FINANCIAL ASSISTANCE IN CONNECTION WITH SUPPORT OF PHILANTHROPIC EFFORTS THAT IMPACT THE CARE OF PATIENTS FROM OUR COMMUNITY. DEKALB COUNTY CHAMBER OF COMMERCE 164 E LINCOLNWAY DEKALB IL 60115 360961630 501(C)(6) 7000 TO PROVIDE FINANCIAL ASSISTANCE FOR SERVING AND ADVANCING BUSINESS INTERESTS IN THE DEKALB REGION. DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION 421 N CALIFORNIA STREET STE 200 SYCAMORE IL 60178 363524353 501(C)(3) 14375 TO PROVIDE FINANCIAL ASSISTANCE FOR PROMOTING THE VALUE OF THE DEKALB COUNTY ECONOMY. 3 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: REQUESTS FOR FINANCIAL ASSISTANCE FROM OTHER CHARITABLE ORGANIZATIONS ARE REVIEWED AND APPROVED BY THE CEO 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. X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 KEVIN POORTEN 548333 0 168139 0 250000 0 196100 0 24053 0 1186625 0 0 0 LOREN FOELSKE 256230 0 28504 0 0 0 94286 0 23218 0 402238 0 0 0 BRAD COPPLE 290654 0 68983 0 0 0 48700 0 23484 0 431821 0 0 0 JOSEPH DANT 215055 0 40618 0 0 0 22696 0 23145 0 301514 0 0 0 MICHAEL KOKOTT 164639 0 30189 0 0 0 19424 0 15418 0 229670 0 0 0 ROGER HEATH BELL 216114 0 57458 0 0 0 22712 0 28395 0 324679 0 0 0 PAM DUFFY 205275 0 43878 0 0 0 21863 0 9007 0 280023 0 0 0 MARK THATE 175149 0 40790 0 57200 0 10707 0 15579 0 299425 0 0 0 MICHAEL MUZZILLO THRU 62912 107905 0 31214 0 90400 0 11876 0 551 0 241946 0 0 0 DR MICHAEL KULISZ 310004 0 92702 0 0 0 75900 0 23358 0 501964 0 0 0 CHERYL FISHER 131456 0 24831 0 0 0 8764 0 21885 0 186936 0 0 0 PART I, LINE 1A KISHHEALTH SYSTEM PROVIDES PAYMENT FOR SOCIAL CLUB DUES FOR THE CEO AND PRESIDENT - KCH & VWCH OF THE ORGANIZATION. KISHHEALTH SYSTEM ALSO PROVIDES PAYMENT FOR AUTOMOBILE ALLOWANCE FOR THE CEO, PRESIDENT - KCH & VWCH, VP BUSINESS DEVELOPMENT, AND THE AVP PLANNING & MARKETING OF THE ORGANIZATION. SUCH PAYMENTS ARE REPORTED AS TAXABLE COMPENSATION ON THE INDIVIDUAL'S FORM W-2. PART I, LINES 4A-B PHILLIP JOHNSON, DIRECTOR OF ACCOUNTING, RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $54,070 DURING FY13. HE TERMINATED EMPLOYMENT WITH KISHWAUKEE HEALTH SYSTEM ON 7/6/2012. THE ORGANIZATION'S EXECUTIVES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2012 RELATED TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF KISHHEALTH SYSTEM 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, SUBSIDIARY ORGANIZATION 319327 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF HEALTH PROGRESS, INC. THE PURPOSE OF KHS IS TO PROVIDE MANAGEMENT AND SUPPORT SERVICES TO ITS RELATED ORGANIZATIONS, ALL OF WHICH PROVIDE HEALTHCARE SERVICES. FEES PAID TO KHS ARE IN EXCHANGE FOR THESE SERVICES, INCLUDING THE ORGANIZATIONS SHARE OF COMPENSATION OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES. 0 HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 486096 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF HEALTH PROGRESS, INC. KHS LEASES BUILDING SPACE FROM HEALTH PROGRESS, INC. 0 HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 1025000 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF HEALTH PROGRESS, INC. DURING THE FISCAL YEAR, KHS MADE AN EQUITY CONTRIBUTION TO HEALTH PROGRESS, INC. 0 ANJUL VOHRA SPOUSE OF MEMBER OF THE BOARD OF DIRECTORS 155402 MRS. VOHRA IS THE SPOUSE OF PROMOD VOHRA, WHO IS A MEMBER OF THE BOARD OF DIRECTORS OF KISHHEALTH SYSTEM. 0 FORM 990, PART VI, SECTION A, LINE 2 KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHHEALTH SYSTEM. HOWEVER, THEY ALSO SERVE ON THE BOARD OF DIRECTORS OR AS OFFICERS OF THE RELATED TAX-EXEMPT SUBSIDIARY ORGANIZATIONS, INCLUDING KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HOSPICE, CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, KISHHEALTH HOME CARE, AND KISHHEALTH FOUNDATION. 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, AND SERVES AS THE TOP FINANCIAL OFFICIAL FOR ALL RELATED ENTITIES. THE FOLLOWING INDIVIDUALS ARE OFFICERS OR KEY EMPLOYEES OF KISHHEALTH SYSTEM AND ARE ALSO CONSIDERED KEY EMPLOYEES OF VALLEY WEST COMMUNITY HOSPITAL AND KISHWAUKEE COMMUNITY HOSPITAL. THEY ARE ALL COMPENSATED BY KISHHEALTH SYSTEM: BRAD COPPLE, PRESIDENT KCH & VWCH PAM DUFFY, VP PATIENT CARE JOE DANT, VP DEVELOPMENT MIKE KOKOTT, ASST. VP MARKETING ROGER HEALTH BELL, VP AND CHIEF INFORMATION OFFICER MARK THATE, VP HUMAN RESOURCES DR. MICHAEL KULISZ, CHIEF MEDICAL OFFICER MICHAEL MUZZILLO, VP OPERATIONS, VWCH (TERMINATED DURING FY13) SEVERAL MEMBERS OF THE KISHHEALTH SYSTEM BOARD OF DIRECTORS ALSO SERVE ON THE BOARD OF DIRECTORS FOR A RELATED ENTITY. ALL ENTITIES ARE WHOLLY OWNED SUBSIDIARIES OF KISHHEALTH SYSTEM. THESE MEMBERS INCLUDE: MICHAEL CULLEN, ALSO SERVES ON KISHWAUKEE COMMUNITY HOSPITAL, CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, AND KISHWAUKEE PHYSICIANS GROUP BOARDS. TERRENCE DUFFY, ALSO SERVES ON VALLEY WEST COMMUNITY HOSPITAL BOARD JOE DANT, ALSO SERVES ON CENTER FOR FAMILY HEALTH, CENTER FOR FAMILY HEALTH MALTA, KISH HEALTH HOME CARE AND HEALTH PROGRESS, INC BOARDS. ANN WEST, ALSO SERVES ON KISHHEALTH FOUNDATION BOARD DR. MICHAEL KULISZ, ALSO SERVES ON BOARDS OF KISHWAUKEE PHYSICIANS GROUP AND KISH HEALTH HOME CARE PAM DUFFY ALSO SERVES ON THE BOARD OF KISH HEALTH HOME CARE JAGDISH PATEL ALSO SERVES ON THE VALLEY WEST COMMUNITY HOSPITAL BOARD. TOM MATYA, ALSO SERVES ON KISHHEALTH FOUNDATION BOARD AND KISHWAUKEE COMMUNITY HOSPITAL BOARD JOHN MOULTON, ALSO SERVES ON HEALTH PROGRESS, INC. BOARD IN ADDITION, PROMOD VOHRA SERVES AS A DIRECTOR OF KHS. HIS WIFE IS AN EMPLOYEE OF KHS. DR. PHOTINE LIAKOS, ALSO SERVES AS A BOARD DIRECTOR OWNS AN INTEREST IN MIDLAND SUGICAL CENTER. KISHWAUKEE COMMUNITY HOSPITAL, A SUBSIDIARY OF KHS, OWNS A 74.5% INTEREST IN THIS ENTITY. FORM 990, PART VI, SECTION A, LINE 6 KISHHEALTH SYSTEM MAINTAINS SEVERAL CLASSES OF MEMBERS. THEY ARE AS FOLLOWS: KHS SHALL HAVE HONORARY MEMBERS WHO SHALL NOT HAVE VOTING RIGHTS IN THE CORPORATION. HONORARY MEMBERS SHALL CONTINUE AS HONORARY MEMBERS PROVIDED THEY HAVE SATISFIED THE REQUIREMENTS OF MEMBERSHIP. HONORARY MEMBERS SHALL NOT HAVE MEETINGS EXCEPT THAT (I) HONORARY MEMBERS SHALL BE INVITED TO ATTEND INFORMATIONAL MEETINGS AS CALLED BY THE BOARD OF DIRECTORS FROM TIME TO TIME; AND (II) HONORARY MEMBERS SHALL BE INVITED TO ATTEND A SPECIAL INFORMATIONAL MEETING PRIOR TO THE ADOPTION BY THE KHS BOARD OF ANY OF THE ACTIONS THAT ARE DESCRIBED IN SECTION 4.1.D, G, H OR Q BELOW (WITH RESPECT TO KHS, KCH OR VWCH). ANY PERSON (WHICH TERM SHALL INCLUDE, FOR PURPOSES OF THIS SECTION 3.1, INDIVIDUALS AND FIRMS, CORPORATIONS, ASSOCIATIONS, CLUBS, OR SOCIETIES FOR THE DURATION OF THEIR EXISTENCE) MAY BECOME AN HONORARY MEMBER OF KHS PERMANENTLY OR FROM TIME TO TIME, AS THE CASE MAY BE, BY MEETING THE QUALIFICATIONS FOR ONE OF THE FOLLOWING CATEGORIES OF MEMBERS: A. PARTICIPATING MEMBER. ANY PERSON WHO HAS CONTRIBUTED PROPERTY OR CASH OR BOTH AGGREGATING $100 OR MORE BUT LESS THAN $500 IN VALUE TO KHS, KCH, VWCH OR THE HEALTH FOUNDATION SHALL BE A PARTICIPATING MEMBER OF KHS. ANY PERSON DESIGNATED A PARTICIPATING MEMBER SHALL RETAIN SUCH DESIGNATION FOR ONE YEAR FOLLOWING THE DATE OF HIS, HER OR ITS QUALIFYING CONTRIBUTION. B. CONTRIBUTING MEMBER. ANY PERSON WHO HAS CONTRIBUTED PROPERTY OR CASH OR BOTH AGGREGATING $500 OR MORE BUT LESS THAN $5,000 IN VALUE TO KHS, KCH, VWCH OR THE HEALTH FOUNDATION SHALL BE A CONTRIBUTING MEMBER OF KHS. ANY PERSON DESIGNATED A CONTRIBUTING MEMBER SHALL RETAIN SUCH DESIGNATION FOR ONE YEAR FOLLOWING THE DATE OF HIS, HER OR ITS QUALIFYING CONTRIBUTION. C. LIFE MEMBER. ANY PERSON WHO HAS CONTRIBUTED PROPERTY OR CASH OR BOTH AGGREGATING AT ANY TIME $5,000 OR MORE BUT LESS THAN $10,000 IN VALUE TO KHS, KCH, VWCH OR THE HEALTH FOUNDATION SHALL BE A LIFE MEMBER OF KHS. ANY PERSON DESIGNATED A LIFE MEMBER SHALL RETAIN SUCH DESIGNATION. D. FOUNDER. ANY PERSON WHO HAS CONTRIBUTED OR PLEDGED PROPERTY OR CASH OR BOTH AGGREGATING AT ANY TIME $10,000 OR MORE IN VALUE TO KHS, KCH, VWCH OR THE HEALTH FOUNDATION SHALL BE A FOUNDER OF KHS. ANY PERSON DESIGNATED A FOUNDER SHALL RETAIN SUCH DESIGNATION. E. SERVICE MEMBER. (1) ANY PERSON WHO HAS CONTRIBUTED AT LEAST 60 HOURS ON A FISCAL YEAR BASIS OF UNPAID VOLUNTARY SERVICE TO KCH OR VWCH SHALL BECOME A SERVICE MEMBER OF KHS. (2) ANY PERSON WHO SERVES ON THE KHS BOARD OR ON ANY GOVERNING BOARD OF ANY SUBSIDIARY CORPORATION OF KHS SHALL BE A SERVICE MEMBER OF KHS WHILE SERVING ON THE KHS BOARD OR SUCH SUBSIDIARY CORPORATION BOARD. 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. FORM 990, PART VI, SECTION B, LINE 15 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 ADMINSTRATION. 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 KISHHEALTH SYSTEM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: LOSS ON EQUITY METHOD SUBSIDIARY REPORTED ON SEPARATE COMPANY RETURN - HPI -800,982. EQUITY CONTRIBUTION TO SUBSIDIARIES -550,000. EQUITY DISTRIBUTION FROM SUBSIDIARIES 6,925,000. 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. KISHWAUKEE COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 237087041 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 VALLEY WEST COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB IL 60115 364244337 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 DEKALB COUNTY HOSPICE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363164329 HEALTHCARE SERVICES, PRIMARILY HOSPICE SERVICES IL 501(C)(3) 7 KISHHEALTH SYSTEM 1 KISHHEALTH FOUNDATION ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363649077 SUPPORT OF KISHWAUKEE HEALTH SYSTEM NOT FOR PROFIT ENTITIES IL 501(C)(3) 7 KISHHEALTH SYSTEM 1 COMMUNITY CARES CLINIC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 800424001 HEALTHCARE SERVICES, PRIMARILY ACUTE CARE IL 501(C)(3) 7 KISHHEALTH SYSTEM 1 KISHWAUKEE PHYSICIAN GROUP INC ONE KISH HOSPITAL DRIVE SYCAMORE IL 60178 651293967 HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 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 1 KISHHEALTH SYSTEM HOME CARE ONE KISH HOSPITAL DRIVE DEKALB IL 60115 371703513 HEALTHCARE SERVICES, HOME CARE IL 501(C)(3) 3 KISHHEALTH SYSTEM 1 HEALTH VENTURES LLC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 753255958 RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES IL HEALTH PROGRESS INC RELATED 15187 305083 0 1 0.51000 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 HEALTH PROGRESS INC RELATED 373793 1309751 0 0 0.51000 MIDLAND SURGICAL CENTER LLC 3085 WOLF COURT DEKALB IL 60115 352194610 SURGICAL SERVICES IL KISHWAUKEE COMMUNITY HOSPITAL RELATED 233354 291962 0 0 0.74500 N/A HEALTH PROGRESS INC ONE KISH HOSPITAL DRIVE DEKALB IL 60115 363824138 INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESS IL KISHHEALTH SYSTEM C -800982 4236564 1.00000 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 KISHWAUKEE COMMUNITY HOSPITAL S 3573000 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL S 3352000 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL O 13362767 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL O 3893917 FAIR MARKET VALUE DEKALB COUNTY HOSPICE O 90713 FAIR MARKET VALUE KISHHEALTH FOUNDATION O 47716 FAIR MARKET VALUE HEALTH PROGRESS INC O 319327 FAIR MARKET VALUE DEKALB COUNTY HOSPICE Q 90000 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL Q 1685338 FAIR MARKET VALUE HEALTH PROGRESS INC Q 533634 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL Q 9275343 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL J 87648 FAIR MARKET VALUE HEALTH PROGRESS INC P 104470 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL P 50390811 FAIR MARKET VALUE KISHHEALTH FOUNDATION P 6769 FAIR MARKET VALUE VALLEY WEST COMMUNITY HOSPITAL P 8780389 FAIR MARKET VALUE COMMUNITY CARES CLINIC INC Q 116491 FAIR MARKET VALUE DEKALB COUNTY HOSPICE P 725790 FAIR MARKET VALUE HEALTH PROGRESS INC K 486086 FAIR MARKET VALUE CENTER FOR FAMILY HEALTH - MALTA B 215100 FAIR MARKET VALUE CENTER FOR FAMILY HEALTH B 900000 FAIR MARKET VALUE HEALTH PROGRESS INC B 1025000 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP B 3000000 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP P 1862313 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP Q 150000 FAIR MARKET VALUE KISHHEALTH FOUNDATION B 550000 FAIR MARKET VALUE KISHHEALTH HOME CARE B 863100 FAIR MARKET VALUE KISHHEALTH HOME CARE O 42727 FAIR MARKET VALUE KISHWAUKEE PHYSICIANS GROUP O 171569 FAIR MARKET VALUE KISHWAUKEE COMMUNITY HOSPITAL K 17375 FAIR MARKET VALUE CENTER FOR FAMILY HEALTH - MALTA S 96686 FAIR MARKET VALUE COMMUNITY CARES CLINIC INC P 3953 FAIR MARKET VALUE CENTER FOR FAMILY HEATLH - MALTA P 93070 FAIR MARKET VALUE KISHHEALTH SYSTEM HOME CARE P 302025 FAIR MARKET VALUE KISHHEALTH SYSTEM HOME CARE Q 10048 FAIR MARKET VALUE