2012-03-28T17:05:48-05:00 2011-06-30 MCGLADREY & PULLEN LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2010-07-01 363616314 GENESIS HEALTH SYSTEM GENE 5634216508 801 ILLINI DRIVE SILVIS IL 61282 MARK G ROGERS 5634216508 2012-03-28 1 JOHN J ROMANO 5638884000 2010 2016-02-24 21:20:13Z MARK G ROGERS 801 ILLINI DRIVE SILVIS IL 61282 93625822 0 X GENESISHEALTH.COM X 1988 IL GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 17 10 929 123 236443 93011 21372 481284 94598507 89584278 118526 432239 2375500 2442666 97113905 92940467 398187 358481 0 0 34531947 34828113 0 0 0 53943945 51473355 88874079 86659949 8239826 6280518 70228519 75846041 19464215 19154268 50764304 56691773 GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 0 0 65996442 358481 83454539 ILLINI HOSPITAL-HEALTH CARE DELIVERY AND MANAGEMENT, GENERAL/OTHER: ILLINI HOSPITAL, A NOT-FOR-PROFIT ORGANIZATION, IS LICENSED AS A 149-BED ACUTE CARE HOSPITAL AND PROVIDES RELATED HEALTHCARE INPATIENT, EMERGENCY, AND OUTPATIENT ANCILLARY SERVICES. (15,903 PATIENT DAYS; 101,408 OUTPATIENT VISITS) 7120281 8231871 ILLINI HOSPITAL NURSING HOME: HEALTH CARE FOR A 75-BED LICENSED NURSING FACILITY AND REHABILITATIVE AND PERSONAL CARE FOR A 45-BED FACILITY (38,359 PATIENT DAYS) WITH ASSISTED LIVING SERVICES CONSISTING OF 76 APARTMENTS AND 2 GUESTROOMS FOR THE ELDERLY (579 RESIDENT MONTHS). 73116723 1 1 0 1 0 0 0 0 1 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 1 0 0 0 0 1 1 1 0 0 1 67 0 1 929 1 1 1 0 0 0 0 0 0 0 0 0 X 17 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 IL X MARK G ROGERS 5634216508 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 STEVEN C BAHLS 4.00 X 0 0 0 MARK D BAWDEN 4.00 X X 0 0 0 JAMES A BULL MD 40.00 X 0 191694 23426 GREGORY J BUSH 4.00 X X 0 0 0 EDMUND P COYNE JR MD 4.00 X 0 0 0 DOUGLAS P CROPPER 44.00 X X 0 739313 291003 THOMAS A GILDEHAUS 4.00 X X 0 0 0 ROGER J HILL 4.00 X X 0 0 0 MARK C KILMER 4.00 X 0 0 0 JAMES A KOEHLER 4.00 X 0 0 0 GEORGE KONTOS MD 40.00 X 0 538454 26179 CHARLENE E MAASKE 4.00 X 0 0 0 EDWIN V MOTTO MD 4.00 X 0 0 0 EDWARD J ROGALSKI PHD 10.00 X X 0 0 0 G CHRISTOPHER WAHLIG 4.00 X X 0 0 0 C DANA WATERMAN III 4.00 X 0 0 0 CAROL A WATSON PHD RN CENP FAAN 4.00 X 0 0 0 DALE D ZUDE 4.00 X 0 0 0 MARK G ROGERS 40.00 X 0 326941 123452 ROBERT W FRIEDEN 40.00 X 0 442228 31866 FLORENCE L SPYROW 40.00 X 271576 53665 109367 FRANK R CLAUDY MD 40.00 X 0 412778 43707 KENNETH CROKEN 40.00 X 0 323163 66340 JAMES A LEHMAN MD 40.00 X 0 417206 80277 JULIE MANAS 40.00 X 0 375185 137154 ROBERT C TRAVIS 40.00 X 0 384837 50545 CHARLES E BRUHN 40.00 X 0 291042 27046 HEIDI S KAHLY-MCMAHON 40.00 X 0 194797 78577 ROBERT NELSON MD 40.00 X 0 297906 57082 JUDITH PRANGER 40.00 X 0 224436 138891 MIKE SHARP 40.00 X 0 173413 95195 271576 5387058 1380107 28 1 1 0 EMERGENCY CARE AND HEALTH ORGANIZATION 555 WEST COURT STREET STE 410 KANKAKEE IL 60901 CONTRACTED MEDICAL STAFF 2682203 COGENT HEALTHCARE INC PO BOX 974451 DALLAS TX 75397 CONTRACTED MEDICAL STAFF 767095 CHG MEDICAL STAFFING INC PO BOX 972670 DALLAS TX 75397 CONTRACTED MEDICAL STAFF 744601 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 LAB DIAGNOSTICS 429122 CASSLING 13808 F STREET OMAHA NE 68137 OUTSIDE MAINTENANCE CONTRACTS 357375 15 417512 37604 26168 31651 481284 PROFESSIONAL SERVICES 900099 161808615 161808615 NURSING SERVICES 900099 26624986 26624986 I/P ANCILLARY SERVICES 621500 22344052 22107609 236443 RESIDENT REVENUE 623000 989704 989704 CONTRACTS W/AFFILIATES 900099 28882 28882 -122211961 -122211961 89584278 419062 419062 633687 589399 44288 44288 44288 23500 10323 13177 13177 13177 146086 85633 60453 60453 AMBULANCE 621910 975228 975228 OTHER SERVICES 900099 751308 751308 NON OPERATING IH, INV 900099 385570 385570 225819 225819 2337925 92940467 91685760 236443 536980 358481 358481 372422 372422 27916643 27791245 125398 1249483 1249483 3240275 3239661 614 2049290 2025149 24141 5712028 5560598 151430 27855 27855 29523 489 29034 2167888 1950116 217772 18466 13081 5385 8421088 8365160 55928 3483743 3483743 3511730 3467976 43754 206173 190993 15180 55236 47017 8219 445255 445255 3850479 3850479 1032607 1032607 CORPORATE OVERHEAD ALLO 6951626 6951626 PATIENT CHARGEABLE SUPP 6058360 6058360 PROVISION FOR BAD DEBT 6006164 6006164 MISCELLANEOUS EXPENSE 3495134 1464409 2030725 86659949 73116723 13543226 0 37587 4620 10816085 18659621 17232281 15899596 2089969 2261478 673203 388788 98002938 62193357 36461493 35809581 663166 663832 2135990 1962113 118745 196412 70228519 75846041 5379927 5297435 8821879 8477977 5262409 5378856 19464215 19154268 X 50019999 56288451 711000 359030 33305 44292 50764304 56691773 70228519 75846041 X 6280518 -353049 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 0 0 0 1 27855 27855 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED; 32% OF MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $22,191, AND 24% OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OR $5,664. PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1(D), MAILINGS TO MEMBERS, LEGISLATORS, OR THE PUBLIC: EXECUTIVES OF GENESIS HEALTH SYSTEM - ILLINOIS ARE ENCOURAGED TO PARTICIPATE IN THE ILLINOIS HOSPITAL ASSOCIATION'S "IHA ACTION ALERTS". THE EXECUTIVES PARTICIPATE BY RESPONDING TO E-MAIL ALERTS, WHICH ALLOWS THEM TO VOICE THEIR OPINIONS TO THEIR STATE REPRESENTATIVES ON HEALTHCARE RELATED MATTERS THROUGH AN E-MAIL FORMAT. THERE IS NO DIRECT COST TO GENESIS HEALTH SYSTEM - ILLINOIS REGARDING THIS ACTIVITY. 5040857 16615 465988 3616 5519844 5010740 28352 297861 296096 5040857 5224450 30636 -243446 900 5010740 0.67000 0.33000 0 1 1 494992 494992 53880354 28625785 25254569 16771 8058 8713 40719072 32056929 8662143 2891749 1502585 1389164 35809581 DUE TO AFFILIATES 2759455 THIRD PARTY PAYOR SETTLEMENTS 1946193 ACCRUED INS TRUST LOSSES 671063 ACCRUED BENEFITS 2145 5378856 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: GENESIS HEALTH SERVICES FOUNDATION AND ILLINI HOSPITAL FOUNDATION, BOTH RELATED ORGANIZATIONS, HOLD THE ENDOWMENT FUNDS. THE INTENDED USE OF THE FOUNDATIONS' ENDOWMENT FUNDS IS AS FOLLOWS: SCHOLARSHIPS FOR EDUCATION IN THE MEDICAL FIELD, CHARITY CARE FOR THE INDIGENT AND VNA, HOSPICE HOUSE, DIABETES CARE, EMPLOYEE ASSISTANCE, AND PEDIATRIC HOSPICE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: GHS IOWA, GHS ILLINOIS, THE GENESIS HEALTH SERVICES FOUNDATION, THE ILLINI HOSPITAL FOUNDATION AND THE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ALL FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. UNRELATED BUSINESS TAXABLE INCOME IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, THE GENESIS HEALTH SERVICES FOUNDATION, THE ILLINI HOSPITAL FOUNDATION AND THE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, THE GENESIS HEALTH SERVICES FOUNDATION, THE ILLINI HOSPITAL FOUNDATION AND THE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED JUNE 30, 2006 AND PRIOR. GENVENTURES, INC. IS A TAXABLE ORGANIZATION AND CURRENTLY FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND VARIOUS STATE JURISDICTIONS. GENVENTURES, INC. IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS JUNE 30, 2006 AND PRIOR. AS OF JUNE 30, 2011 AND 2010, THE TOTAL AMOUNT OF UNCERTAIN TAX POSITIONS HAVE REDUCED INCOME TAX EXPENSE AND HAVE INCREASED EXCESS OF REVENUE OVER EXPENSES BY $45,000 AND $40,000, RESPECTIVELY. INTEREST EXPENSE ASSOCIATED WITH UNCERTAIN TAX POSITIONS FROM THE YEARS ENDED JUNE 30, 2011 AND 2010 IS APPROXIMATELY NONE AND $7,000, RESPECTIVELY. NO AMOUNT HAS BEEN ACCRUED FOR PENALTIES. DURING THE YEARS ENDED JUNE 30, 2011 AND 2010, NONE AND $265,000, RESPECTIVELY, IN FEDERAL AND STATE INCOME TAXES WERE PAID FOR UNCERTAIN TAX POSITIONS EXISTING AS OF JUNE 30, 2009 AND 2008, AS AMENDED OR PAST DUE INCOME TAX RETURNS WERE FILED. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 2493594 0 2493594 0.03090 13773139 11263110 2510029 0.03110 0 0 16266733 11263110 5003623 0.06200 14217 0 14217 0.00020 2756 0 2756 0.00000 134330 61346 72984 0.00090 0 0 62701 0 62701 0.00080 214004 61346 152658 0.00190 16480737 11324456 5156281 0.06390 0 0 0 0 14 0 14 0.00000 0 0 0 0 0 0 0 0 13980 0 13980 0.00020 13994 13994 0.00020 1 2203114 89089 29443803 33740952 -4297149 X 1 1 1 LARSON CENTER PARTNERSHIP LLC PROPERTY MANAGEMENT 0.75600 0.00000 0.22730 1 1 GENESIS MEDICAL CENTER - ILLINI

801 ILLINI DRIVE SILVIS IL 61282

X X X NA 1 6 ILLINI RESTORATIVE CARE

1455 ILLINI DRIVE SILVIS IL 61282

L-T INTERMEDIATE, NSG, & SHELTERED CARE ILLINI LARSON CENTER

855 ILLINI DRIVE SILVIS IL 61284

I/P PHARMACY & O/P LAB ILLINI AMBULANCE SERVICE

730 AVENUE OF THE CITIES EAST MOLINE IL 61244

AMBULANCE SERVICES ILLINI - BUILDING #3

1414 10TH STREET SILVIS IL 61282

OUTPATIENT DIAGNOSTIC CLINIC CROSSTOWN SQUARE

900 CROSSTOWN SQUARE SILVIS IL 61282

INDEPENDENT LIVING FACILITY PHYSICAL THERAPY CLINIC KING PLAZA

3650 AVENUE OF THE CITIES MOLINE IL 61265

OUTPATIENT PHYSICAL THERAPY CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: GENESIS HEALTH SYSTEM UTILIZED WORKSHEET 2 TO CALCULATE ITS COST-TO-CHARGE RATIO. THE CALCULATED COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE COST OF CHARITY CARE AND UNREIMBURSED MEDICAID. THE COST OF SUBSIDIZED HEALTH SERVICES WAS OBTAINED FROM GENESIS HEALTH SYSTEM'S COST ACCOUNTING SYSTEM (I.E., DECISION SUPPORT SYSTEM) THAT CALCULATES THE PER UNIT REIMBURSEMENT AND COST FOR EACH TYPE OF SERVICE AND SUPPLY THAT THE NON-MEDICARE AND NON-MEDICAID PATIENTS CONSUMED IN THE DEPARTMENTS REPORTED. COSTS OF THE "OTHER BENEFITS" (EXCLUDING SUBSIDIZED HEALTH SERVICES) REPORTED IN 7E -7I WERE COMPILED THROUGHOUT THE YEAR IN THE COMMUNITY BENEFIT DATABASE (I.E., CBISA) THAT GENESIS HEALTH SYSTEM UTILIZES. PART I, LINE 7G: NO COSTS ASSOCIATED WITH A PHYSICIAN CLINIC WERE REPORTED IN SUBSIDIZED HEALTH SERVICES. PART I, L7 COL(F): $6,006,164 OF BAD DEBT EXPENSE IS SUBTRACTED FOR PURPOSES OF COMPUTING THE PERCENTAGE IN PART I, LINE 7K, COLUMN F. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES, LESS BAD DEBT, IS 20.43%, AND THE PERCENTAGE INCREASES TO 62.27% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. PART II: COMMUNITY SUPPORT: GENESIS HEALTH SYSTEM CONDUCTS DISASTER AND DECONTAMINATION DRILLS THROUGHOUT THE YEAR. WORKFORCE DEVELOPMENT: GENESIS HEALTH SYSTEM AND UNITED TOWNSHIP HIGH SCHOOL CO-OPERATE A PROGRAM THAT TEACHES LIFE AND JOB SKILLS TO THE MENTALLY DISABLED. PART III, LINE 4: THE TEXT FROM THE FOOTNOTE TO GENESIS HEALTH SYSTEM'S FINANCIAL STATEMENT IS AS FOLLOWS: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. RECEIVABLES ARE WRITTEN OFF AS BAD DEBTS WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. THE RATIONALE AND COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSE AT COST (LINE 2) CONSISTED OF MULTIPLYING THE TOTAL BAD DEBT EXPENSE PER THE INCOME STATEMENT BY THE RATIO OF PATIENT CARE COST TO CHARGES TO ARRIVE AT ESTIMATED COST OF BAD DEBT. PAYMENTS RECEIVED AFTER AN ACCOUNT HAD BEEN WRITTEN OFF TO BAD DEBT WERE CREDITED TO A BAD DEBT RECOVERY ACCOUNT. DISCOUNTS ON PATIENT ACCOUNTS PROVIDED BY THIRD-PARTY PAYERS WERE WRITTEN OFF TO A CONTRACTUAL ALLOWANCE ACCOUNT. SHARED BUSINESS SERVICES USES A SEPARATE TRANSACTION CODE TO IDENTIFY ACCOUNTS WRITTEN OFF TO BAD DEBT THAT HAVE NO FINANCIAL DOCUMENTATION AND MAY HAVE QUALIFIED FOR CHARITY CARE HAD PAPERWORK BEEN SUBMITTED. THE ESTIMATED AMOUNT OF GENESIS HEALTH SYSTEM'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY (LINE 3) WAS CALCULATED BY TAKING THE TOTAL OF THESE ACCOUNTS AND MULTIPLYING THEM BY THE RATIO OF PATIENT CARE COST TO CHARGES. NO BAD DEBT AMOUNTS WERE INCLUDED IN COMMUNITY BENEFIT. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINE 6, FOR THE HOSPITALS AND THE HOME HEALTH DIVISION, WAS COMPUTED USING THE GROSS PATIENT REVENUE BY PAYER MIX AND CONVERTED TO COST USING THE COST TO CHARGE RATIO FROM PART I, WORKSHEET 2. THE PAYMENT RATE WAS CALCULATED BY DIVIDING THE MEDICARE PAYMENTS BY MEDICARE CHARGES USING A 12-MONTH ZERO BALANCE REPORT. THE SHORTFALL IS THE DIFFERENCE BETWEEN THE PAYMENTS AND THE COSTS. GENESIS CLINICAL SERVICES AND GENESIS FAMILY MEDICAL CENTER WERE CALCULATED USING A PAYER ANALYSIS REPORT, CONVERTING CHARGES TO COST USING THE COST TO CHARGE RATIO FROM PART I, WORKSHEET 2 AND SUBTRACTING THE PAYMENTS TO OBTAIN THE SHORTFALL. NO MEDICARE SHORTFALLS WERE INCLUDED IN COMMUNITY BENEFIT. THE MEDICARE SHORTFALL REPRESENTS THE DIFFERENCE BETWEEN THE TOTAL REVENUE RECEIVED FROM MEDICARE BASED ON MEDICARE REIMBURSEMENT RATES AND THE COSTS INCURRED BY GENESIS HEALTH SYSTEM IN PROVIDING HEALTHCARE SERVICES TO THE ELDERLY. IN 2009, THE PERCENT OF PERSONS 65 YEARS AND OVER WAS 16.0% IN ROCK COUNTY, ILLINOIS AND 12.7% IN SCOTT COUNTY, IOWA. IN ACCORDANCE WITH GENESIS HEALTH SYSTEM'S MISSION STATEMENT, "TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED," THE ELDERLY WERE SERVED DESPITE THE MEDICARE LOSS OF $4,297,149. GENESIS HEALTH SYSTEM HAS A CLEAR MISSION TO SERVE ALL THOSE IN NEED AND TO IMPROVE THE HEALTH OF THE COMMUNITY INCLUDING THE ELDERLY. FURTHERMORE, THERE ARE NO FOR-PROFIT HOSPITALS IN THE COMMUNITY, AND THEREFORE GENESIS HEALTH SYSTEM IS ONE OF TWO TAX-EXEMPT HEALTHCARE ORGANIZATIONS IN THE COMMUNITY WHO PROVIDE ACCESS TO HEALTHCARE FOR MEDICARE PATIENTS. ACCORDINGLY, IT IS GENESIS HEALTH SYSTEM'S POSITION FOR THE REASONS STATED ABOVE THAT THE MEDICARE SHORTFALL OF $4,297,149 REPRESENTS A COMMUNITY BENEFIT. PURSUANT TO THE INSTRUCTIONS TO THE FORM 990, SCHEDULE H, THE MEDICARE SHORTFALL IS NOT INCLUDED IN PART I, LINE 7. IF THE MEDICARE SHORTFALL WAS INCLUDED IN PART I, LINE 7, THEN PART I, LINE 7K, COLUMN F WOULD BE 11.72%. PART III, LINE 9B: EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF ELIGIBLE, PAYMENT PLANS ARE MADE AVAILABLE BASED ON THEIR RESOURCES AND INCOME. ALL BALANCES OWING AFTER FINANCIAL ASSISTANCE ALLOWANCES HAVE BEEN TAKEN ARE PAYABLE IN MONTHLY PAYMENTS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: GENESIS HEALTH SYSTEM UTILIZES THE COMMUNITY HEALTH ASSESSMENTS CREATED BY THE QUAD CITY HEALTH INITIATIVE (QCHI) AND THE COMMUNITY VITALITY TASK FORCE OF UNITED WAY. QCHI WAS FORMED BY GENESIS HEALTH SYSTEM, WHICH IS HEADQUARTERED IN SCOTT COUNTY, IOWA, AND TRINITY REGIONAL HEALTH SYSTEM, WHICH IS HEADQUARTERED IN ROCK ISLAND COUNTY, ILLINOIS. QCHI IS NOW A COMMUNITY PARTNERSHIP OF OVER 100 ORGANIZATIONS CONSISTING OF 500 ACTIVE INDIVIDUALS PURSUING INITIATIVES TO CREATE A HEALTHIER COMMUNITY, SERVING AS A CATALYST FOR IMPROVING THE HEALTH AND OVERALL QUALITY OF LIFE WITHIN THE QUAD CITIES. A COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY QCHI IN 2003, AND THEN RE-ASSESSED IN 2007. IN 2010, THE COMMUNITY VITALITY TASK FORCE OF UNITED WAY PRODUCED A SNAPSHOT OF COMMUNITY INDICATORS, INCLUDING INFORMATION ON THE HEALTH STATUS OF THE COMMUNITIES THAT GENESIS HEALTH SYSTEM SERVES. PART VI, LINE 3: INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN VISIBLE LOCATIONS IN THE ADMISSION DEPARTMENTS OF THE HOSPITALS. IN ADDITION, THE HOSPITAL REGISTRATION STAFF MAKE AVAILABLE INFORMATIVE BROCHURES FOR PATIENTS IN THE EMERGENCY ROOM REGISTRATION AREA EXPLAINING THEIR ELIGIBILITY FOR ASSISTANCE. GENESIS HEALTH SYSTEM PROVIDES PATIENT FINANCIAL COUNSELORS ON EACH HOSPITAL CAMPUS TO DISCUSS OPTIONS WITH THE PATIENTS. SHARED BUSINESS SERVICES PREPARES AND PROVIDES A LETTER TO EACH PATIENT, EXPLAINING THEIR CURRENT BALANCE AND ADVISING THEM OF THEIR OPTIONS. A PHONE NUMBER IS PROVIDED WITH THE LETTER ENCOURAGING THE PATIENT TO CALL IF NEEDED. IN ADDITION, THE GENESIS HEALTH SYSTEM WEBSITE ALSO LISTS THE OPTIONS FOR PAYMENT, AND ON A MONTHLY BASIS A POWER POINT PRESENTATION IS GIVEN TO INCOMING CANCER PATIENTS INFORMING THEM OF THEIR PAYMENT OPTIONS. THE OUTPATIENT PHYSICIAN CLINICS AND THE HOME HEALTH DIVISION MAKE AVAILABLE THEIR FINANCIAL POLICY BROCHURES ALONG WITH DIRECTING PATIENTS TO GOVERNMENT PROGRAMS SUCH AS SCHIP. PART VI, LINE 4: GENESIS HEALTH SYSTEM'S MISSION IS "TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED." GENESIS LIVES ITS MISSION EACH AND EVERY DAY BY SERVING A 10-COUNTY REGION OF EASTERN IOWA AND WESTERN ILLINOIS, INCLUDING BOTH URBAN AND RURAL AREAS. THE REGION SERVED BY GENESIS HEALTH SYSTEM HAS A POPULATION OF 378,163.THE MEDIAN AGE OF THE POPULATION IN 2009 WAS 38.9 IN ROCK ISLAND COUNTY, ILLINOIS AND 36.7 IN SCOTT COUNTY, IOWA. THE PERCENT OF PERSONS 65 YEARS AND OVER WAS 16.5% IN ROCK ISLAND COUNTY, ILLINOIS AND 12.7% IN SCOTT COUNTY, IOWA.THE PERCENT OF FAMILIES LIVING IN POVERTY IN 2009 WAS 5.8% IN ROCK ISLAND COUNTY, ILLINOIS AND 9.8% IN SCOTT COUNTY, IOWA. THE HOMELESS POPULATION IN GENESIS HEALTH SYSTEM'S SERVICE AREA WAS 1,510 IN JANUARY 2010. THE AVERAGE UNEMPLOYMENT RATE IN 2009 WAS 9.2% FOR ROCK ISLAND COUNTY, ILLINOIS AND 6.6% IN SCOTT COUNTY, IOWA.THE PERCENTAGE OF PEOPLE AGES 18-64 WHO DID NOT HAVE ANY HEALTH INSURANCE IN 2009 WAS 12.0% IN ROCK ISLAND COUNTY, ILLINOIS AND 8.2% IN SCOTT COUNTY, IOWA. THE PERCENTAGE OF ADULTS WHO CURRENTLY SMOKED IN 2009 WAS 20.0% IN ROCK ISLAND COUNTY, ILLINOIS AND 17.0% IN SCOTT COUNTY, IOWA. THE PERCENTAGE OF ADULTS WHO WERE OBESE IN 2009 WAS 27.7% IN ROCK ISLAND COUNTY, ILLINOIS AND 21.9% IN SCOTT COUNTY, IOWA. PART VI, LINE 6: GENESIS HEALTH SYSTEM'S BOARD OF DIRECTORS IS A DIVERSE REPRESENTATION OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA THAT GENESIS HEALTH SYSTEM SERVES. A MAJORITY OF THEM ARE NEITHER EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. GENESIS HEALTH SYSTEM EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. GENESIS HEALTH SYSTEM HAS ENDEAVORED TO IMPROVE ACCESS TO HEALTH CARE FOR THE COMMUNITIES IT SERVES BY PARTICIPATING IN APPROPRIATE JOINT VENTURES THAT OFFER NEEDED HEALTH CARE SERVICES TO UNDER-SERVED AREAS.SURPLUS FUNDS RESULTING FROM EFFICIENT OPERATIONS AND COST-CONTAINMENT MEASURES ARE RE-INVESTED IN THE HEALTHCARE OPERATIONS OF GENESIS HEALTH SYSTEM TO IMPROVE THE HEALTHCARE SERVICES THAT GENESIS PROVIDES. ADVANCES IN MEDICAL EQUIPMENT AND TECHNOLOGY, STAFF EDUCATION, AND NEW MEDICAL SERVICES ARE EXAMPLES OF OPERATIONAL INVESTMENTS THAT ULTIMATELY IMPROVE THE HEALTH OF THE COMMUNITIES THAT GENESIS SERVES. PART VI, LINE 7: GENESIS HEALTH SYSTEM (TAX ID #42-1418847), AN IOWA NONPROFIT CORPORATION, AND GENESIS HEALTH SYSTEM (TAX ID #36-3616314), AN ILLINOIS NOT-FOR-PROFIT CORPORATION, HAVE IDENTICAL GOVERNING BOARDS, MANAGEMENT AND BYLAWS AND CAN ACT JOINTLY.GENESIS HEALTH SYSTEM (TAX ID #42-1418847) IS ALSO THE SOLE MEMBER OF GENESIS HEALTH SERVICES FOUNDATION AND GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST, THE SOLE STOCKHOLDER OF GENVENTURES, INC., A MEMBER OF MISERICORDIA ASSURANCE COMPANY, LTD. AND A PARTNER IN DAVENPORT SRS LEASING, LLC. GENESIS HEALTH SYSTEM (TAX ID #36-3616314) IS THE SOLE MEMBER OF ILLINI HOSPITAL FOUNDATION AND A PARTNER IN THE LARSON CENTER PARTNERSHIP.GENESIS HEALTH SYSTEM (TAX ID #36-3616314) OPERATES THE FOLLOWING BUSINESS UNITS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES:GENESIS MEDICAL CENTER - ILLINI (GMC - ILLINI) IS LICENSED AS A 149-BED ACUTE CARE HOSPITAL WHICH PROVIDES SERVICES FROM ITS FACILITY IN SILVIS, ILLINOIS. ILLINI HOSPITAL NURSING HOME (INH) OPERATES ILLINI RESTORATIVE CARE CENTER AND CROSSTOWN SQUARE. ILLINI RESTORATIVE CARE CENTER OPERATES A 75-BED LICENSED NURSING FACILITY WHICH PROVIDES SKILLED AND INTERMEDIATE HEALTH CARE AND RELATED SERVICES TO PATIENTS. TWENTY-TWO OF ILLINI RESTORATIVE CARE CENTER'S BEDS ARE DESIGNATED AS HOSPITAL-BASED MEDICARE CERTIFIED BEDS. ILLINI RESTORATIVE CARE'S SHELTERED CARE UNIT IS A 45-BED FACILITY WHICH PROVIDES REHABILITATIVE AND PERSONAL CARE IN A FAMILY-ORIENTED SETTING. CROSSTOWN SQUARE IS AN INDEPENDENT LIVING FACILITY CONTAINING 76 RENTABLE APARTMENTS AND TWO GUESTROOMS THAT OFFERS SERVICES DESIGNED TO MEET THE NEEDS OF OUR SENIOR ADULTS.GENESIS HEALTH SYSTEM (TAX ID #36-3616314) HAS A CONTROLLING OWNERSHIP INTEREST OR MEMBERSHIP IN THE FOLLOWING ORGANIZATIONS: ILLINI HOSPITAL FOUNDATION (ILLINI FOUNDATION) SUPPORTS GENESIS MEDICAL CENTER - ILLINI BY PROVIDING FINANCIAL AND FUNDRAISING ASSISTANCE. THE MISSION OF THE ILLINI FOUNDATION IS TO ASSIST GMC - ILLINI IN PROVIDING QUALITY, COMPASSIONATE CARE FOR ALL THOSE IN NEED BY RAISING, MANAGING AND GRANTING CHARITABLE FUNDS. THE LARSON CENTER PARTNERSHIP (LCP) IS A FOR-PROFIT REAL ESTATE PARTNERSHIP WHICH OWNS A MEDICAL OFFICE BUILDING ADJACENT TO GMC- ILLINI AND LEASES SPACE FOR CLINICS, LABORATORY, PHARMACY AND OFFICES TO GMC - ILLINI AND OTHER THIRD-PARTY ORGANIZATIONS. GHS ILLINOIS IS A GENERAL PARTNER AND OWNS APPROXIMATELY 75.6% OF LCP.GENESIS HEALTH SYSTEM (TAX ID #42-1418847) OPERATES THE FOLLOWING BUSINESS UNITS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES:GENESIS HEALTH SYSTEM PROVIDES ADMINISTRATIVE, MANAGEMENT, INFORMATION TECHNOLOGY AND OTHER SUPPORT SERVICES TO ITS AFFILIATES.GENESIS CLINICAL SERVICES: GENESIS HEALTH SYSTEM OWNS AND OPERATES PHYSICIAN MEDICAL PRACTICES, CONVENIENT CARE PRACTICES, OPERATES AN OCCUPATIONAL MEDICINE CLINIC AND PROVIDES BEHAVIORAL HEALTH SERVICES TO THE RESIDENTS OF EASTERN IOWA AND WESTERN ILLINOIS. GENESIS MEDICAL CENTER - DAVENPORT (GMC- DAVENPORT) IS LICENSED AS A 502-BED ACUTE CARE HOSPITAL WHICH PROVIDES SERVICES FROM TWO HOSPITAL FACILITIES LOCATED IN DAVENPORT, IOWA. GENESIS FAMILY MEDICAL CENTER (GFMC) IS A FAMILY PRACTICE RESIDENCY TRAINING PROGRAM THAT OPERATES CLINICS IN DAVENPORT AND BLUE GRASS, IOWA TO PROVIDE A CLINICAL SETTING FOR THE RESIDENTS TO TREAT PATIENTS.GENESIS MEDICAL CENTER - DEWITT (GMC - DEWITT) IS CERTIFIED AS A CRITICAL ACCESS HOSPITAL, WHICH HAS 13-ACUTE CARE AND SWING BEDS, AND HAS A 77-BED LONG-TERM CARE FACILITY, WHICH PROVIDES SERVICES FROM ITS FACILITY IN DEWITT, IOWA. GENESIS ILLINOIS PROPERTIES (GIP) OWNS LAND LOCATED IN MOLINE, ILLINOIS. GENESIS VISITING NURSE ASSOCIATION AND HOSPICE (VNA) PROVIDES HOME HEALTH CARE, COMMUNITY NURSING SERVICES AND HOSPICE SERVICES TO PATIENTS IN EASTERN IOWA AND WESTERN ILLINOIS.GENESIS HEALTH SYSTEM (TAX ID #42-1418847) HAS A CONTROLLING OWNERSHIP INTEREST OR MEMBERSHIP IN THE FOLLOWING ORGANIZATIONS: GENESIS HEALTH SERVICES FOUNDATION (GENESIS FOUNDATION) IS AN ORGANIZATION WHOSE MISSION IS TO DEVELOP, MANAGE AND GRANT CHARITABLE SUPPORT TO MEET THE HEALTH-RELATED NEEDS OF THE COMMUNITIES SERVED BY GENESIS HEALTH SYSTEM.GENVENTURES, INC. (GENVENTURES) IS A WHOLLY-OWNED FOR-PROFIT CORPORATION WHICH OPERATES THE FOLLOWING DIVISIONS, PRIMARILY IN THE QUAD CITIES: GENESIS AT HOME, CONTINUING CARE SELLS AND LEASES HOME MEDICAL EQUIPMENT; PROVIDES INTRAVENOUS THERAPY SERVICES, INCLUDING SALES OF RELATED SOLUTIONS AND SUPPLIES TO PATIENTS; AND PROVIDES RETAIL PHARMACEUTICAL AND OVER THE COUNTER PRODUCTS TO PATIENTS AND EMPLOYEES OF THE SYSTEM.GENPROPERTIES OWNS, LEASES AND/OR MANAGES OFFICE SPACE IN THIRTEEN MEDICAL OFFICE BUILDINGS LOCATED IN DAVENPORT, ELDRIDGE, LECLAIRE, MUSCATINE AND BETTENDORF, IOWA. CRESCENT LAUNDRY PROVIDES COMMERCIAL LAUNDRY SERVICES TO HEALTH CARE FACILITIES IN EASTERN IOWA AND NORTH-CENTRAL ILLINOIS. GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST (WORKERS' COMPENSATION TRUST) PROVIDES A FUND WHICH CAN BE USED TO PAY WORKERS' COMPENSATION CLAIMS AND COSTS FOR THE BENEFIT OF GENESIS HEALTH SYSTEM. MISERICORDIA ASSURANCE COMPANY, LTD. (MISERICORDIA) IS A WHOLLY OWNED CAYMAN BASED CAPTIVE INSURANCE COMPANY WHICH UNDERWRITES THE GENERAL AND PROFESSIONAL LIABILITY RISKS OF GENESIS HEALTH SYSTEM AND AFFILIATES.DAVENPORT SRS LEASING, LLC (SRS) IS A LIMITED LIABILITY COMPANY, WHICH WAS FORMED IN 2008, WHICH LEASES MEDICAL EQUIPMENT. GENESIS HEALTH SYSTEM IS A GENERAL PARTNER AND OWNED 93.75% OF SRS AS OF JUNE 30, 2011. REPORTS FILED WITH STATES PART VI, LINE 7 IL 1 BIRDIES FOR CHARITY 15623 COALTOWN ROAD EAST MOLINE IL 61244 931332421 501(C)(3) 5000 GENERAL SUPPORT TO BE DISTRIBUTED TO LOCAL NON-PROFITS ILLINI HOSPITAL FOUNDATION 801 ILLINI DRIVE SILVIS IL 61282 366208583 501(C)(3) 5000 UNRESTRICTED DONATIONS BY THE MEDICAL STAFF TO SUPPORT THE MISSION OF ILLINI HOSPITAL FOUNDATION. GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 391905171 501(C)(3) 311101 CLAIM PAYMENTS VILLAGE OF CORDOVA 306 MAIN STREET CORDOVA IL 61244 322718781 VILLAGE OF CORDOVA 23905 DONATION RESTRICTED TO PURCHASE EXERCISE EQUIPMENT FOR CITY PARK GENESIS HEALTH SYSTEM - IOWA 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421418847 501(C)(3) 9555 PAYROLL DEDUCTIONS BY MEDICAL STAFF, DIRECTED TOWARDS MEDICAL EDUCATION PURPOSES AND THE PERLMUTTER LIBRARY AT THE GMC, ILLINOIS CAMPUS. 5 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GENESIS HEALTH SYSTEM - ILLINOIS STAFF REQUIRES RECEIPTS AND OTHER DOCUMENTATION PRIOR TO RELEASING FUNDS FOR PROJECTS AND SERVICES WITHIN THE SCOPE OF THE ORGANIZATION'S MISSION. PROPER AUTHORIZATION OF GRANT REQUESTS IS ALSO REQUIRED. STAFF FOLLOWS THE ORGANIZATION'S FUNDING ADMINISTRATIVE POLICY TO ENSURE THAT GRANTS ARE BEING APPROVED AND UTILIZED CORRECTLY. X X 1 1 1 1 0 0 0 0 0 0 0 JAMES A BULL MD 0 152602 0 0 0 39092 0 11544 0 11882 0 215120 0 0 DOUGLAS P CROPPER 0 567498 0 137967 0 33848 0 269566 0 21437 0 1030316 0 0 GEORGE KONTOS MD 0 497978 0 0 0 40476 0 10127 0 16052 0 564633 0 0 MARK G ROGERS 0 232637 0 56242 0 38062 0 111580 0 11872 0 450393 0 0 ROBERT W FRIEDEN 0 223268 0 43193 0 175767 0 13869 0 17997 0 474094 0 0 FLORENCE L SPYROW 212029 41898 41177 8137 18370 3630 89607 17707 1714 339 362897 71711 0 0 FRANK R CLAUDY MD 0 255051 0 36695 0 121032 0 27584 0 16123 0 456485 0 0 KENNETH CROKEN 0 189996 0 40982 0 92185 0 49562 0 16778 0 389503 0 26922 JAMES A LEHMAN MD 0 248591 0 48979 0 119636 0 67178 0 13099 0 497483 0 0 JULIE MANAS 0 310431 0 63590 0 1164 0 120713 0 16441 0 512339 0 0 ROBERT C TRAVIS 0 217260 0 38707 0 128870 0 36416 0 14129 0 435382 0 0 CHARLES E BRUHN 0 0 0 0 0 291042 0 13121 0 13925 0 318088 0 0 HEIDI S KAHLY-MCMAHON 0 157172 0 27892 0 9733 0 60087 0 18490 0 273374 0 0 ROBERT NELSON MD 0 171852 0 37837 0 88217 0 43643 0 13439 0 354988 0 24727 JUDITH PRANGER 0 172000 0 28501 0 23935 0 127582 0 11309 0 363327 0 0 MIKE SHARP 0 128152 0 31335 0 13926 0 81588 0 13607 0 268608 0 0 PART I, LINE 1A GENESIS HEALTH SYSTEM PROVIDES THE FOLLOWING TO INDIVIDUALS REPORTED IN PART VII, SECTION A, LINE 1A: TRAVEL FOR COMPANIONS: THIS BENEFIT IS OFFERED TO ALL EMPLOYEES. THE ORGANIZATION REQUIRES REIMBURSEMENT OF THESE EXPENSES DIRECTLY TO THE ORGANIZATION. GROSS-UP PAYMENTS: THIS BENEFIT IS OFFERED TO QUALIFYING EXECUTIVES WHO HAD CONTRIBUTIONS MADE ON THEIR BEHALF IN THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. CONTRIBUTIONS TO THE PLAN ARE INCLUDED WITH REPORTABLE COMPENSATION FOR INDIVIDUALS WITH VESTED CONTRIBUTIONS. PART I, LINES 4A-B GENESIS HEALTH SYSTEM'S EXECUTIVE EMPLOYMENT AGREEMENT PROVIDES SEPARATION PAY IN THE EVENT AN EXECUTIVE IS TERMINATED WITHOUT CAUSE. MR. CHARLES E. BRUHN WAS AN EXECUTIVE WITH GENESIS HEALTH SYSTEM WHO WAS TERMINATED WITHOUT CAUSE AND RECEIVED SEPARATION PAY IN ACCORDANCE WITH THE TERMS OF HIS EMPLOYMENT AGREEMENT. IN 2010, MR. CHARLES E. BRUHN RECEIVED $245,171, PAID BY GENESIS HEALTH SYSTEM-IOWA, A RELATED ORGANIZATION, AND IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA, A RELATED ORGANIZATION: ROBERT C. TRAVIS - $90,931, JAMES A. LEHMAN, M.D. - $75,022, AND FRANK CLAUDY, M.D. - $95,100. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010 AND THE GROSS-UP PAYMENT TO COVER TAX. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVING BENEFIT PLAN IN 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA, A RELATED ORGANIZATION: KENNETH CROKEN - $62,595, ROBERT W. FRIEDEN - $94,525, AND ROBERT NELSON, M.D. - $ 57,924. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA, A RELATED ORGANIZATION: KENNETH CROKEN - $33,082, DOUGLAS P. CROPPER - $260,072, HEIDI KAHLY-MCMAHON - $50,557, JULIE MANAS - $113,363, ROBERT NELSON, M.D. - $30,408, JUDITH PRANGER - $61,119, MARK G. ROGERS - $98,412, MIKE SHARP - $44,191, AND FLORENCE L. SPYROW - $97,572. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J PART II. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: GENESIS HEALTH SYSTEM - ILLINOIS RELIES ON GENESIS HEALTH SYSTEM - IOWA TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS, AND KEY EMPLOYEES. GENESIS HEALTH SYSTEM - IOWA UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE SUCH COMPENSATION. PART II, COLUMN F: THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2009 AND 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: WILLIAM LANGLEY, M.D. - $79,283 AND ROBERT NELSON, M.D. - $24,727. THE DOLLAR AMOUNT REPRESENTS THE PRIOR YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009. THIS INFORMATION WAS INCLUDED IN DEFERRED COMPENSATION ON THE PRIOR YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THESE INDIVIDUALS REACHED A SPECIFIED LEVEL OF VESTING IN 2010, SO THE DOLLAR AMOUNT IS NOW INCLUDED IN REPORTABLE COMPENSATION ON THE CURRENT YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THE DOLLAR AMOUNT IS ALSO LISTED AS COMPENSATION REPORTED IN PRIOR FORM 990 ON THE CURRENT YEAR FORM 990, SCHEDULE J, PART II. WELLMARK HEALTH PLAN OF IOWA INC SEE BELOW IN PART V 3222164 GENESIS HEALTH SYSTEM (GHS) OBTAINS EMPLOYEE HEALTH INSURANCE COVERAGE AND ISSUES REFUNDS FOR OVERPAYMENTS TO WELLMARK HEALTH PLAN OF IOWA, INC. 0 WELLMARK HEALTH PLAN OF IOWA INC SEE BELOW IN PART V 1574902 GHS HAS A PROVIDER SERVICE AGREEMENT FOR PATIENT MEDICAL SERVICES WITH WELLMARK HEALTH PLAN OF IOWA, INC. 0 GENVENTURES INC SEE BELOW IN PART V 310180 GHS PAID GENVENTURES, INC. FOR LAUNDRY SERVICES. 0 GENVENTURES INC SEE BELOW IN PART V 13351 GENVENTURES, INC. PAID GHS FOR FACILITY MAINTENANCE AND MEDICAL SUPPLIES. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - WELLMARK HEALTH PLAN OF IOWA, INC. DOUGLAS P. CROPPER IS THE BOARD PRESIDENT/CEO OF GHS AND A DIRECTOR ON THE BOARD OF WELLMARK HEALTH PLAN OF IOWA, INC. FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - GENVENTURES, INC. MARK G. ROGERS AND ROGER A. HILL ARE OFFICERS, FLORENCE L. SPYROW IS A KEY EMPLOYEE, JAMES A. KOEHLER IS A DIRECTOR, AND MIKE SHARP IS A FORMER KEY EMPLOYEE OF GHS AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, MARK G. ROGERS, ROGER A. HILL, JAMES A. KOEHLER, AND MIKE SHARP WERE OFFICERS OF GENVENTURES, INC., AND FLORENCE L. SPYROW WAS A DIRECTOR OF GENVENTURES, INC. X EXERCISE BIKE 1 3640 COST X TV, CAR SEAT 2 1205 COST X UHF RADIOS 4 26168 COST X MISC SUPPLIES 1025 638 COST 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 INTERNAL MANAGEMENT REVIEW IS COMPLETED OF THE COMPILED INFORMATION PRIOR TO PREPARATION AND REVIEW BY MCGLADREY & PULLEN, LLP. FOLLOWING MCGLADREY & PULLEN, LLP'S PREPARATION AND REVIEW OF THE FORM 990, IT IS REVIEWED WITH THE ORGANIZATION'S PRESIDENT/CEO; VICE PRESIDENT, FINANCE/CFO; VICE PRESIDENT, LEGAL AFFAIRS; AND VICE PRESIDENT, HUMAN RESOURCES. THE FORM 990 IS THEN REVIEWED AT A JOINT MEETING OF THE ORGANIZATION'S FINANCE COMMITTEE AND AUDIT & COMPLIANCE COMMITTEE. PRIOR TO SUBMITTING THE FORM 990 TO THE IRS, IT IS E-MAILED TO THE ORGANIZATION'S BOARD OF DIRECTORS ONE WEEK IN ADVANCE OF A SCHEDULED MEETING. AT THE BOARD OF DIRECTORS MEETING, INTERNAL MANAGEMENT REVIEWS THE FORM 990 WITH THE BOARD OF DIRECTORS. SUGGESTED CHANGES FROM ALL OF THESE REVIEWS ARE CONSIDERED FOR INCLUSION IN THE FINAL FORM 990 SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, OR MEMBER OF A BOARD OR BOARD COMMITTEE OF GENESIS HEALTH SYSTEM (GHS) OR AN AFFILIATE, SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT WILL BE CONSIDERED BY MANAGEMENT, THE BOARD, OR A COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING GHS, OR AN AFFILIATE, OR WITH RESPECT TO DESIGNATED FACILITIES AND ACTIVITIES, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH PERSON ADVOCATE HIS OR HER POSITION INFORMALLY THROUGH PRIVATE CONTACT, COMMUNICATION AND DISCUSSION WITH ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE APPLICABLE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EACH EXECUTIVE POSITION IS EVALUATED USING A FORMAL EVALUATION PLAN THAT IS ESTABLISHED BY AN OUTSIDE CONSULTANT. AT THE PRESENT TIME, THE CONSULTANT USES A POINT SYSTEM FOR JOB EVALUATION. THE POINT VALUES ARE BASED ON "KNOW HOW", "PROBLEM SOLVING", "ACCOUNTABILITY", AND OTHER JOB ATTRIBUTES SPECIFIC TO THE POSITION. ONCE THE POINT VALUE IS SET FOR A POSITION, MARKET COMPARISONS FOR JOBS WITH THE SAME ORGANIZATIONAL IMPACT CAN BE COMPARED FOR SALARY PURPOSES AND ESTABLISH PAY RANGES. THE DESIGN OF THE PAY RANGES FOR EXECUTIVES IS BASED ON MARKET DATA. THE MIDPOINT OF EACH PAY RANGE IS ESTABLISHED AT THE 50TH PERCENTILE OF THE MARKET COMPARISONS. A MINIMUM GUIDELINE IS ESTABLISHED AT THE 25TH PERCENTILE, AND A MAXIMUM GUIDELINE IS SET AT THE 75TH PERCENTILE. SPECIFIC PAY RATES FOR EXECUTIVES ARE SUBJECT TO CEO AND COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS APPROVAL. PAY RANGES ARE REVIEWED EACH YEAR TO DETERMINE THE NEED FOR REVISION. WHEN MARKET CONDITIONS SUGGEST AN ADJUSTMENT TO PAY RANGES, DATA WILL BE PRESENTED TO THE COMPENSATION COMMITTEE FOR ITS REVIEW. THE SPECIFIC PAY RANGES ARE SUBJECT TO CEO, COMPENSATION COMMITTEE, AND GENESIS HEALTH SYSTEM (GHS) BOARD OF DIRECTOR APPROVAL. THE PRESIDENT AND CEO HAS THE AUTHORITY AND RESPONSIBILITY TO ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS, THE BASE COMPENSATION OF EACH EXECUTIVE EMPLOYED BY GHS, AT APPROPRIATE TIMES. THE GHS BOARD OF DIRECTORS SHALL ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE, THE BASE COMPENSATION FOR THE CEO OF GHS, AT APPROPRIATE TIMES. THE LAST TIME THIS PROCESS WAS FORMALLY UNDERTAKEN WAS AUGUST 2010. HOWEVER, INTERNAL REEVALUATIONS ARE PERFORMED ANNUALLY TO ENSURE CONSISTENCY WITH INDUSTRY STATISTICS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -6,583. CHANGE IN NET ASSETS OF THE FOUNDATION -340,983. NON-CASH CONTRIBUTIONS NOT RECORDED ON BOOKS -5,483. TOTAL TO FORM 990, PART XI, LINE 5: -353,049. FORM 990, PART XII, LINE 2C THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. FORM 990, PART VII, LINE 1A GENESIS HEALTH SYSTEM, EIN 42-1418847, AND GENESIS HEALTH SYSTEM, EIN 36-3616314 HAVE IDENTICAL GOVERNING BOARDS AND AN IDENTICAL EXECUTIVE MANAGEMENT TEAM. THE HOURS REPORTED ON FORM 990, PART VII, SECTION A, COLUMN (B) REPRESENTS THE NUMBER OF HOURS THESE INDIVIDUALS DEVOTE TO BOTH ORGANIZATIONS. FURTHERMORE, THE AMOUNTS REPORTED AS REPORTABLE COMPENSATION FOR THE OFFICERS, KEY EMPLOYEES, AND HIGHLY COMPENSATED EMPLOYEES, UNLESS OTHERWISE NOTED ELSEWHERE IN PART VII, ARE FOR SERVICES RENDERED ON BEHALF OF BOTH ORGANIZATIONS. IT WOULD BE ADMINISTRATIVELY IMPRACTICABLE FOR MEMBERS OF THE GOVERNING BOARD AND THE EXECUTIVE TEAM TO BREAKOUT THEIR HOURS DEVOTED AS WELL AS THEIR REPORTABLE COMPENSATION BETWEEN EACH ORGANIZATION. ALL REPORTABLE COMPENSATION, UNLESS OTHERWISE NOTED IN PART VII, IS PAID BY GENESIS HEALTH SYSTEM, EIN 42-1418847. 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