2012-12-17T09:40:13-06:00 2012-04-30 410746749 CLIFTONLARSONALLEN LLP 114 E EVERETT DIXON IL 61021 990 2011-05-01 363649080 KISHHEALTH SYSTEM KISH 8157561521 ONE KISH HOSPITAL DRIVE DEKALB IL 60115 LOREN FOELSKE 8157561521 2012-12-12 1 KELLY JACKSON HARDY P00747242 8152842285 2011 2016-02-24 21:20:13Z KEVIN P POORTEN ONE KISH HOSPITAL DRIVE DEKALB IL 60115 19287618 0 X WWW.KISHHEALTH.ORG X 1988 IL MANAGEMENT AND PARENT ORGANIZATION PROVIDING SERVICES TO 501(C)(3) HEALTH SYSTEM 15 14 99 14 0 0 0 0 15118192 17094568 271802 251703 -8813 -90650 15381181 17255621 119811 167500 0 0 10640071 11328378 0 0 0 4360853 5542178 15120735 17038056 260446 217565 16174525 22577087 11308718 13116831 4865807 9460256 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 2520400 167500 17104257 KISHHEALTH SYSTEM (KHS) IS THE NON-PROFIT CORPORATE UMBRELLA FOR TWO HOSPITALS, A HOSPICE, CLINIC, 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, COMMUNITY CARES CLINIC, AND KISHHEALTH FOUNDATION, THE HEALTH SYSTEM'S CORPORATE OFFICE PROVIDES COMMUNITY BENEFIT IN THE FOLLOWING AREAS:* KISHHEALTH SYSTEM UNDERWROTE MORE THAN $500,000 IN OPERATIONAL LOSSES IN FY 12 FOR THE COMMUNITY CARES CLINIC, AND MORE THAN $690,000 FOR DEKALB COUNTY HOSPICE, BOTH VITAL SERVICES FOR THE HEALTH OF THE COMMUNITY. IT ALSO MADE $167,500 IN CONTRIBUTIONS TO SEVERAL ORGANIZATIONS IN FY12, NOTABLY A $50,000 GRANT TO DEKALB COUNTY GOVERNMENT FOR A FIBER OPTIC PROJECT THAT IS ESTABLISHING BROADBAND CONNECTIVITY THROUGHOUT DEKALB COUNTY. THIS PROJECT IS ENABLING HIGH SPEED ELECTRONIC COMMUNICATION TO RURAL AREAS AND TO COMMUNITY INSTITUTIONS SUCH AS SCHOOLS, LOCAL GOVERNMENT, LIBRARIES AND THE TWO KISHHEALTH SYSTEM HOSPITALS IN THE COUNTY. ALSO, $75,000 WAS GIVEN TO DEKALB COUNTY COMMUNITY FOUNDATION TO REMODEL A HISTORIC LANDMARK FOR OFFICES; AND $25,000 WAS GIVEN TO THE NORTHERN ILLINOIS UNIVERSITY FOUNDATION TO SUPPORT CONSTRUCTION OF AN INDOOR ATHLETIC FACILITY. * KISHHEALTH SYSTEM LEADERS SERVE ON THE BOARDS OF PIONEERING HEALTHY COMMUNITIES, KISHWAUKEE YMCA, KISHWAUKEE COLLEGE FOUNDATION, VOLUNTARY ACTION CENTER, DEKALB COUNTY YOUTH SERVICES BUREAU, DEKALB COUNTY EDC; DEKALB, SYCAMORE, GENOA, SANDWICH AND PLANO CHAMBERS OF COMMERCE AND EDCS; THE COMMUNITY CARES CLINIC, VOLUNTARY ACTION CENTER, FAMILY SERVICE AGENCY, FOX VALLEY OLDER ADULT SERVICES, KISHWAUKEE UNITED WAY. IN ADDITION, HEALTH SYSTEM EMPLOYEES CONTRIBUTED MORE THAN 1,200 HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH, EDUCATION AND QUALITY OF LIFE. SIXTY HOURS OF SENIOR LEADER TIME WAS DEVOTED TO "PIONEERING HEALTHY COMMUNITIES", TRAVELING TO WASHINGTON DC FOR TRAINING ON THE PROGRAM, WHICH IS PART OF ACTIVATE AMERICA -THE YMCA'S RESPONSE TO THE NATION'S HEALTH CRISIS. THE LOCAL EFFORT, "LIVE HEALTHY DEKALB COUNTY" IS EXPANDING EFFORTS TO INCREASE COLLABORATIONS BETWEEN ORGANIZATIONS WITHIN COMMUNITIES TO ELIMINATE BARRIERS THAT ARE PREVENTING KIDS, INDIVIDUALS AND FAMILIES FROM LEADING HEALTHIER LIVES. KISHHEALTH SYSTEM IS A MAJOR PARTNER IN THE LOCAL EFFORT. * 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; COMMUNITY CARES CLINIC, DEKALB, IL, A PRIMARY CARE CLINIC FOR MEDICAID AND UNINSURED; KISHHEALTH PHYSICIAN GROUP, WHICH PROVIDES ACCESS TO MEDICAL SERVICES, ESPECIALLY THE RURAL AREAS AND ACCEPTS MEDICAID AND UNINSURED PATIENTS, AND KISHHEALTH FOUNDATION IN DEKALB, IL, WHICH RAISES MONEY FOR KISHWAUKEE COMMUNITY HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL, DEKALB COUNTY HOSPICE AND THE COMMUNITY CARES CLINIC AND FUNDS EQUIPMENT PURCHASES AND PATIENT SERVICES PARTICULARLY IN THE AREA OF CANCER CARE FOR THOSE WHO CANNOT AFFORD. 2520400 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 4 0 1 99 1 0 0 0 0 0 0 0 0 0 0 X 15 14 1 0 0 0 1 1 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 MICHAEL CULLEN 2.00 X X 0 0 0 TERRENCE DUFFY 2.00 X 0 0 0 ERIK ENGLEHART MD 2.00 X 0 0 0 MICHAEL LARSON 2.00 X X 0 0 0 JOHN MOULTON 2.00 X X 0 0 0 THOMAS MATYA 2.00 X 0 0 0 MARY LYNN MCARTOR 2.00 X 0 0 0 MICHAEL MOONEY 2.00 X 0 0 0 KEVIN POORTEN 45.00 X X 698961 0 102663 BRADLEY WALLER 2.00 X 0 0 0 ANITA ZURBRUGG 2.00 X 0 0 0 BRETT CASSIDY MD 2.00 X 0 0 0 JAGDISH PATEL MD 2.00 X 0 0 0 PROMOD VOHRA 2.00 X 0 0 0 JACK WAGONER 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 X 0 0 0 LOREN FOELSKE 45.00 X 316761 0 41819 BRAD COPPLE 45.00 X 365900 0 42075 JOSEPH DANT 2.00 X 263727 0 41741 MICHAEL KOKOTT 2.00 X 198097 0 23734 ROGER HEATH BELL 2.00 X 253756 0 39782 PAM DUFFY 45.00 X 241412 0 27266 MARK THATE 45.00 X 197280 0 29354 MICHAEL MUZZILLO 45.00 X 179349 0 27579 DR MICHAEL KULISZ 45.00 X 391391 0 22661 CHERYL FISHER 45.00 X 150191 0 32889 JENNIFER DIETRICH 45.00 X 116341 0 16616 GARY PAXSON 45.00 X 113318 0 33432 JEFFERY REIFSTECK 45.00 X 115223 0 9234 SHELLY JOHNSON 45.00 X 117543 0 48434 3719250 0 539279 17 0 1 0 REINHART BOERNER VANDEUREN PO BOX 2965 MILWAUKEE IL 532012965 LEGAL SERVICES 736951 AURORA RADIOLOGY 1870 WEST GALENA BLVD AURORA IL 60506 MEDICAL SERVICES 428770 MICROSOFT PO BOX 842467 DALLAS TX 75284 INFORMATION TECHNOLOGY SERVICES 312379 KAUFMAN HALL & ASSOCIATES INC 5202 OLD ORCHARD ROAD SKOKIE IL 60077 SOFTWARE SUPPORT SERVICES 248437 CLIFTONLARSONALLEN LLP 114 EAST EVERETT STREET DIXON IL 61021 ACCOUNTING SERVICES 115550 5 KHS ADMINISTRATION HEA 551112 17094568 17094568 17094568 260740 260740 116831 217170 -100339 -100339 -100339 1805790 1814827 -9037 -9037 -9037 MISCELLANEOUS INCOME 551112 9689 9689 9689 17255621 17104257 0 151364 167500 167500 3668519 3668519 4979974 1205468 3774506 228726 64902 163824 2011476 320692 1690784 439683 64247 375436 1044395 1044395 114996 8000 106996 940183 7879 932304 126960 126960 416477 42522 373955 1487346 1487346 490587 55523 435064 224749 19830 204919 30846 30846 555023 555023 11084 7403 3681 DUES AND SUBSCRIPTIONS 66103 1411 64692 RECRUITMENT FEES 32524 0 32524 MISCELLANEOUS EXPENSE 905 905 17038056 2520400 14517656 0 2543250 2304447 88477 82832 8690 185 354789 598705 7053401 1519854 1802458 5533547 7173923 7909893 2256680 4412256 1946258 1735222 16174525 22577087 9477311 10255691 627760 440206 1203647 2420934 11308718 13116831 X 4865807 9460256 4865807 9460256 16174525 22577087 X 217565 4376884 X X 0 1 1 X 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 690000 KISHHEALTH FOUNDATION 363649077 07 1 1 1 300000 COMMUNITY CARES CLINIC 800424001 07 1 1 1 0 KISHWAUKEE PHYSICIANS GROUP INC 651293967 04 1 1 1 0 6 990000 1713361 1713361 1197483 185975 1011508 608882 20383 588499 3083938 1313496 1770442 449737 449737 5533547 3330991 C CASH EQUIVALENTS 234131 F CERTIFICATES OF DEPOSIT 776963 F ACCRUED INTEREST 70171 F 4412256 DUE FROM SUBSIDIARY ORGANIZATIONS 1735222 1735222 DUE TO SUBSIDIARY ORGANIZATIONS 2420934 2420934 17255621 17038056 217565 185791 4191093 4376884 4594449 -404894 185790 185790 -590684 17846305 17846305 17255621 160657 217170 217170 -56513 17094569 17094569 17038056 PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS ON EQUITY METHOD SUBSIDIARY REPORTED ON SEPARATE COMPANY RETURN - HPI -968,907. EQUITY CONTRIBUTION TO SUBSIDIARIES -990,000. EQUITY DISTRIBUTION FROM SUBSIDIARIES 6,150,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: 4,191,093. PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS ON SUBSIDIARY, HPI, REPORTED ON SEPARATE COMPANY RETURN 968,907. MANAGEMENT FEES PAID TO KHS, REPORTED AS EXPENSES ON FINANCIAL STATEMENTS 17,094,568. RENTAL EXPENSES NETTED WITH INCOME FOR FORM 990 -217,170. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED WITH INCOME FOR FORM 990 217,170. PART XIII, LINE 4B - OTHER ADJUSTMENTS: MANAGEMENT FEES PAID TO KHS, REPORTED AS EXPENSES ON FINANCIAL STATEMENTS 17,094,568. ROUNDING 1. PART XI, LINE 10, EXCESS OR (DEFICIT) FOR THE YEAR PER FINANCIAL STATEMENTS: LINE 10 IDENTIFIES FINANCIAL STATEMENT INCOME AS EQUALING $4,594,449. FINANCIAL STATEMENT INCOME IS ACTUALLY $(565,551). THE DIFFERENCE RELATES TO THE FOLLOWING ITEMS: 1. KISHHEALTH SYSTEM RECEIVED A CAPITAL CONTRIBUTION OF $4,440,000 FROM A SUBSIDIARY ORGANIZATION, KISHWAUKEE COMMUNITY HOSPITAL. 2. KISHHEALTH SYSTEM RECEIVED A CAPITAL CONTRIBUTION OF $1,710,000 FROM A SUBSIDIARY ORGANIZATION, VALLEY WEST COMMUNITY HOSPITAL. 3. KISHHEALTH SYSTEM MADE A CAPITAL CONTRIBUTION OF $300,000 TO A SUBSIDIARY ORGANIZATION, KISHHEALTH FOUNDATION. 4. KISHHEALTH SYSTEM MADE A CAPITAL CONTRIBUTION OF $690,000 TO A SUBSIDIARY ORGANIZATION, DEKALB COUNTY HOSPICE. 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 GOVERNMENT 110 E SYCAMORE STREET SYCAMORE IL 60178 366006548 115 50000 TO PROVIDE FINANCIAL ASSISTANCE IN CONNECTION WITH ESTABLISHMENT OF BROADBAND CONNECTIVITY THROUGHOUT DEKALB COUNTY. DEKALB COUNTY COMMUNITY FOUNDATION 475 DEKALB AVE SYCAMORE IL 60178 363788167 501(C)(3) 75000 TO PROVIDE FINANCIAL ASSISTANCE TO COMMUNITY FOUNDATION BUILDING PROJECT. DEKALB COUNTY YOUTH SERVICE BUREAU 330 GROVE STREET DEKALB IL 60115 363034427 501(C)(3) 5000 TO PROVIDE FINANCIAL ASSISTANCE TO PROGRAMS FOR AT-RISK YOUTH NORTHERN ILLINOIS UNIVERSITY FOUNDATION ALTGELD HALL 135 DEKALB IL 60115 366086819 501(C)(3) 25000 TO PROVIDE FINANCIAL ASSISTANCE RELATED TO CONSTRUCTION OF NIU ATHLETIC FACIILTY 5 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 0 1 0 0 0 0 0 0 0 KEVIN POORTEN 515921 0 183040 0 0 0 79288 0 23375 0 801624 0 0 0 LOREN FOELSKE 249213 0 67548 0 0 0 19288 0 22531 0 358580 0 0 0 BRAD COPPLE 287064 0 78836 0 0 0 19288 0 22787 0 407975 0 0 0 JOSEPH DANT 204572 0 59155 0 0 0 19288 0 22453 0 305468 0 0 0 MICHAEL KOKOTT 161458 0 36639 0 0 0 15303 0 8431 0 221831 0 0 0 ROGER HEATH BELL 191687 0 62069 0 0 0 17393 0 22389 0 293538 0 0 0 PAM DUFFY 196437 0 44975 0 0 0 18566 0 8700 0 268678 0 0 0 MARK THATE 159512 0 37768 0 0 0 14318 0 15036 0 226634 0 0 0 MICHAEL MUZZILLO 145011 0 34338 0 0 0 12707 0 14872 0 206928 0 0 0 DR MICHAEL KULISZ 301391 0 90000 0 0 0 0 0 22661 0 414052 0 0 0 CHERYL FISHER 125884 0 24307 0 0 0 11004 0 21885 0 183080 0 0 0 SHELLY JOHNSON 108106 0 9437 0 0 0 7779 0 40655 0 165977 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, LINE 4B THE ORGANIZATION'S CEO PARTICIPATES IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2011 WERE $60,000. KISHWAUKEE COMMUNITY HOSPITAL COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 12642156 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF KISHWAUKEE COMMUNITY HOSPITAL. 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 VALLEY WEST COMMUNITY HOSPITAL COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 3924864 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL. 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 DEKALB COUNTY HOSPICE COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 95321 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. 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 KISHHEALTH FOUNDATION COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 43606 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF KISHHEALTH FOUNDATION. 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 KISHWAUKEE COMMUNITY HOSPITAL COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 4440000 KISHWAUKEE COMMUNITY HOSPITAL MADE AN EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM, ITS PARENT ORGANIZATION. 0 VALLEY WEST COMMUNITY HOSPITAL COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 1710000 VALLEY WEST COMMUNITY HOSPITAL MADE AN EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM, ITS PARENT ORGANIZATION. 0 KISHHEALTH FOUNDATION COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 300000 EQUITY TRANSFER MADE TO SUBSIDIARY ORGANIZATION. TRANSFER WAS INTENDED TO PROVIDE THE ORGANIZATION WITH ADDITIONAL ASSETS TO CARRY ON ITS CHARITABLE ACTIVITIES. 0 HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 388619 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 0 HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 55523 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF HEALTH PROGRESS, INC. KHS LEASES BUILDING SPACE FROM HEALTH PROGRESS, INC. 0 DEKALB COUNTY HOSPICE COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 690000 EQUITY TRANSFER MADE TO SUBSIDIARY ORGANIZATION. TRANSFER WAS INTENDED TO PROVIDE THE ORGANIZATION WITH ADDITIONAL ASSETS TO CARRY ON ITS CHARITABLE ACTIVITIES. 0 HEALTH PROGRESS INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 400000 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 COMMUNITY CARES CLINIC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 500000 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF COMMUNITY CARES CLINIC. DURING THE FISCAL YEAR, KHS MADE AN EQUITY CONTRIBUTION TO COMMUNITY CARES CLINIC. 0 KISHWAUKEE PHYSICIAN'S GROUP INC COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 2110484 KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF KISHWAUKEE PHYSICIAN'S GROUP, INC. DURING THE FISCAL YEAR, KHS MADE AN EQUITY CONTRIBUTION TO KISHWAUKEE PHYSICIAN'S GROUP, INC. 0 KISHWAUKEE COMMUNITY HOSPITAL COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, SUBSIDIARY ORGANIZATION 97091 KISHWAUKEE COMMUNITY HOPSITAL IS AN AFFILIATE OF KISHHEALTH SYSTEM (KHS). KCH RENTS SPACE FROM KHS AT ITS FOXPOINTE FACILITY 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, COMMUNITY CARES CLINIC, INC. 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 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 MOONEY, ALSO SERVED ON KISHWAUKEE COMMUNITY HOSPITAL BOARD MICHAEL CULLEN, ALSO SERVES ON KISHWAUKEE COMMUNITY HOSPITAL, COMMUNITY CARES CLINIC, AND KISHWAUKEE PHYSICIANS GROUP BOARDS ERIK ENGLEHART, ALSO SERVED ON THE VALLEY WEST COMMUNITY HOSPITAL BOARD, UNTIL BECOMING AN EMPLOYEE OF KISHWAUKEE PHYSICIANS GROUP AND ELECTED A DIRECTOR OF ITS BOARD TERRENCE DUFFY, ALSO SERVES ON VALLEY WEST COMMUNITY HOSPITAL BOARD JOE DANT, ALSO SERVES ON COMMUNITY CARES CLINIC AND HEALTH PROGRESS, INC BOARDS ANN WEST, ALSO SERVES ON KISHHEALTH FOUNDATION BOARD DR. MICHAEL KULISZ, ALSO SERVES ON BOARD OF KISHWAUKEE PHYSICIANS GROUP TOM MATYA, ALSO SERVES ON KISHHEALTH FOUNDATION BOARD AND KISHWAUKEE COMMUNITY HOSPITAL BOARD JOHN MOULTON, ALSO SERVES ON HEALTH PROGRESS, INC. BOARD 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 A, LINE 7A A NOMINATING COMMITTEE, COMPRISED OF MEMBERS OF THE KISHHEALTH SYSTEM (KHS) BOARD OF DIRECTORS, IS RESPONSIBLE FOR PREPARATION OF A SLATE OF NOMINEES OR ELECTION TO THE KHS BOARD. SOME MEMBERS OF THE NOMINATING COMMITTEE ARE ALSO CONSIDERED "MEMBERS" OF KISHHEALTH SYSTEM, BY VIRTUE OF THEIR SERVICE TO THE 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 185,791. LOSS ON EQUITY METHOD SUBSIDIARY REPORTED ON SEPARATE COMPANY RETURN - HPI -968,907. EQUITY CONTRIBUTION TO SUBSIDIARIES -990,000. EQUITY DISTRIBUTION FROM SUBSIDIARIES 6,150,000. TOTAL TO FORM 990, PART XI, LINE 5: 4,376,884. RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STATEMENTS FORM 990, PART XI, LINE 2C 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. 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