2012-08-07T15:59:35-05:00 2011-09-30 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2010-10-01 362167767 KEWANEE HOSPITAL KEWA 3098527500 1051 WEST SOUTH STREET KEWANEE IL 61443 PRESTON BECKER 3098527525 2012-08-07 1 TERRI REXRODE CPA MST 9206620016 2012-08-07 2010 2016-02-24 21:20:13Z PRESTON BECKER 1051 WEST SOUTH STREET KEWANEE IL 61443 28312253 0 X WWW.KEWANEEHOSPITAL.COM X 1902 IL OPERATES A 25 BED CRITICAL ACCESS HOSPITAL PLUS RELATED HEALTH CARE SERVICES. 11 11 317 109 2020 0 129521 121248 29661283 27118267 745997 565006 140120 174608 30676921 27979129 14571 4300 0 0 13520381 11163389 0 0 0 17906601 16852485 31441553 28020174 -764632 -41045 61234580 58950000 34353976 32626606 26880604 26323394 X TO IMPROVE THE HEALTH AND CARE OF THOSE WE SERVE FOCUSING ON QUALITY OF CARE REGARDLESS OF ABILITY TO PAY. 0 0 17641128 25359131 KEWANEE HOSPITAL IS A 501(C)(3) NOT-FOR-PROFIT CORPORATION LICENSED AS A 25-BED CRITICAL ACCESS HOSPITAL (CAH) LOCATED IN A RURAL COMMUNITY IN ILLINOIS. KEWANEE HOSPITAL STRIVES TO PROVIDE QUALITY HEALTH CARE TO ALL PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. MANY OF THE COMMUNITY MEMBERS WOULD HAVE NO ACCESS TO HEALTH CARE WITHOUT KEWANEE HOSPITAL. THE PATIENTS AND THEIR FAMILIES ABILITY TO TRAVEL 50+ MILES TO A LARGER TERTIARY CENTER IS COMPROMISED BY A LACK OF MOBILITY, A LACK OF INCOME, AND A LACK OF TRANSPORTATION. MANY OF THE SERVICES PROVIDED BY KEWANEE HOSPITAL ARE REIMBURSED AT OR BELOW THE COST TO PROVIDE CARE. KEWANEE HOSPITAL OFFERS A WIDE VARIETY OF SERVICES INCLUDING INPATIENT ACUTE AND CRITICAL CARE, SKILLED LEVEL CARE THROUGH SWING BEDS, DIAGNOSTIC CAPABILITIES INCLUDING RADIOLOGY, LABORATORY AND CARDIOPULMONARY, INPATIENT AND OUTPATIENT REHABILITATION AND TREATMENT, INPATIENT AND OUTPATIENT SURGICAL SERVICES, AND PRIMARY CARE SERVICES THROUGH THE FAMILY HEALTH CLINIC (FHC). DURING FY 2011 KEWANEE HOSPITAL PROVIDED 2,147 DAYS OF INPATIENT CARE AND 384 DAYS OF SWING BED CARE IN 2011. KEWANEE HOSPITAL PROVIDED A WIDE SCOPE OF OUTPATIENT SERVICES WHICH PROVIDED CARE TO 33,061 OUTPATIENTS. THE EMERGENCY DEPARTMENT (ED) IS A SAFETY NET TO THE RURAL COMMUNITY OF KEWANEE AND THE SURROUNDING AREA. THE ED IS STAFFED 24/7 BY DEDICATED EMERGENCY DEPARTMENT PHYSICIANS; DURING FY 2011 THE ED TREATED 9,643 PATIENTS, WITH OVER 50% OF THEM PAYING LESS THAN THE COST OF THE CARE RECEIVED. THE HOSPITAL OFFERS A VARIETY OF SURGICAL SERVICES INCLUDING GENERAL, ORTHOPEDIC, UROLOGY, OPHTHALMOLOGIC, ENDOSCOPY AND GASTROENTEROLOGY. IN FY 2011 THE HOSPITAL PROVIDED A TOTAL OF 971 SURGICAL PROCEDURES. 1183310 1926850 KEWANEE HOSPITAL STAFFS A MULTI-DISCIPLINARY OUTPATIENT FAMILY HEALTH CLINIC (FHC) WITH A COMPLIMENT OF BOTH PHYSICIAN AND MID-LEVEL PROVIDERS EMPLOYED BY THE HOSPITAL. THE FHC PROVIDES AN ARRAY OF SERVICES INCLUDING PRIMARY CARE (ADULTS AND PEDIATRICS) AND SURGICAL SERVICES. THE FHC IS A LICENSED RURAL HEALTH CLINIC AND PROVIDES MANY NEEDED SERVICES TO THE COMMUNITY. THE FHC IS ONE OF THE ONLY CLINICS IN THE AREA TO ACCEPT THE TREATMENT AND CARE OF CHILDREN WITH ATTENTION DEFICIT DISORDER. THE PROVIDERS IN THE FHC HAVE PARTICIPATED IN SEVERAL OUTREACH EFFORTS INCLUDING DIABETIC HEALTH, SMOKING CESSATION, MEDICATION MANAGEMENT, AND HEALTH AND NUTRITION. IN FY 2011 THE FHC PROVIDERS BROUGHT THEIR SERVICES TO THE AREA HIGH SCHOOL TO PROVIDE FREE SPORTS PHYSICALS. BECAUSE OF THE HIGH POVERTY LEVEL IN THE KEWANEE DISTRICT, MANY STUDENTS HAVE DIFFICULTY TRAVELING TO PROVIDER OFFICES FOR THEIR PHYSICALS AND MOST CANNOT PAY THE COST. KEWANEE HOSPITAL MADE THE DECISION TO OUTREACH TO THESE STUDENTS IN ORDER TO ENSURE THEY CAN TAKE PART IN SPORT ACTIVITIES AND RECEIVE THEIR NEEDED PHYSICAL EXAM.THE FHC PRACTICES THE MEDICAL HOME MODEL THROUGH THE ILLINOIS HEALTH CONNECT PROGRAM. THE NURSE PRACTITIONERS PROVIDE AFTER-HOURS CALL IN ORDER TO ENSURE PATIENTS HAVE THE ABILITY TO ACCESS A PROVIDER AFTER-HOURS AND ON WEEKENDS WHEN NEEDED. THE FHC PRACTITIONERS CONTINUALLY COLLABORATE WITH THE AREA SCHOOLS AND PROVIDERS OF OTHER HEALTH SERVICES IN ORDER TO PROVIDE THE BEST CARE POSSIBLE TO THE AREA COMMUNITY. 18824438 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15 0 1 317 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 IL X PRESTON BECKER CFO 3098527525 1051 W SOUTH STREET KEWANEE IL 61443 MARGARET M GUSTAFSON 40.00 X X 213386 0 34506 MARY KAY NORTH 3.00 X X 0 0 0 GARY PHEIFFER 4.00 X X 0 0 0 MARK REWERTS 3.00 X X 0 0 0 TOM BURHOM 2.00 X 0 0 0 DANIEL CONGREVE MD 40.00 X 338411 0 30969 RITA HUNGATE MD 2.00 X 0 0 0 RUSSELL MEDLEY 2.00 X 0 0 0 WILLIAM OWENS 2.00 X 0 0 0 FRANK TOCHA 2.00 X 0 0 0 MIKE YAKLICH 2.00 X 0 0 0 JENNIFER COOMBES 40.00 X 80771 0 18528 LYNN A FULTON 40.00 X 116719 0 35463 JENNIFER JUNIS 40.00 X 100496 0 9020 ELOISE SKELTON MD 40.00 X 310300 0 13301 MICHAEL STEWART CRNA 40.00 X 165698 0 13468 ANGELA WALKER MD 40.00 X 235253 0 12646 1561034 0 167901 7 0 1 0 EPSS 12528 SR 78 HAVANA IL 62644 ED PHYSIAN STAFFING 1225839 SYCAMORE ANESTHESIA SERVICES 942 W STATE ST 500 SYCAMORE IL 601780474 ANESTHESIA SERVICES 259471 CPS INC PO BOX 116474 ATLANTA GA 303686474 PHARMACY MANAGEMENT SERVICES 251303 OSF SAINT FRANCIS INC 1420 W PIONEER PARKWAY PEORIA IL 61615 MRI SERVICES 214525 METHODIST REFERENCE LABRATORY 221 NE GLEN OAK PEORIA IL 61636 REFERENCE LAB SERVICES 201627 7 41200 41493 38555 16877 121248 PATIENT SERVICE REVENU 621400 27021910 27021910 CAFETERIA MEALS 621400 83154 83154 MASSAGE THERAPY 621400 12803 12803 MEDICAL RECORDS 621400 400 400 27118267 732279 732279 87950 1523 86427 86427 86427 79050 38493 66877 217939 12173 -179446 -167273 -167273 8665 41200 8665 0 42994 38120 4874 4874 MISC OPERATING REVENUE 900099 57459 57459 MEDICAL STAFF 900099 15700 15700 AUXILIARY REVENUE 900099 6644 6644 3504 1484 2020 83307 27979129 27285981 2020 569880 4300 4300 1728936 682765 1046171 7700919 5647287 2053632 234507 178815 55692 725330 551815 173515 773697 545295 228402 258986 258986 70845 70845 2696216 1532917 1163299 146792 146792 336552 191838 144714 383978 24311 359667 129330 69235 60095 23315 5070 18245 1568291 1568291 2791857 1103362 1688495 319238 60824 258414 MEDICAL PROFESSIONAL FE 2335304 2335304 BAD DEBT EXPENSE 2211834 2211834 MEDICAL SUPPLIES 1416555 1416555 2163392 694620 1468772 28020174 18824438 9195736 0 7814578 6383547 4741569 7277922 113325 56959 3132629 3322516 291706 387588 263168 397391 43999279 14719172 31576298 29280107 11751164 10508869 0 1550143 1335101 61234580 58950000 2963701 2689990 851973 786616 29935000 29100000 603302 50000 34353976 32626606 X 26154137 25594118 52958 55767 673509 673509 26880604 26323394 61234580 58950000 X -41045 -516165 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 10 0 0 1 1000 0 1 18042 19052 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE LOBBYING EFFORTS BY KEWANEE HOSPITAL FOR 2011 CONSISTED OF SEVERAL LETTERS AND E-MAILS TO AREA LEGISLATORS REGARDING PENDING LEGISLATION. ANNUALLY, A PORTION OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND ILLINOIS HOSPITAL ASSOCIATION (IHA) DUES ARE ALLOCATED TO LOBBYING EFFORTS BOTH ORGANIZATIONS EXERT ON BEHALF OF HOSPITALS AT THE NATIONAL AND STATE LEVEL. ACCORDING TO THE AHA AND IHA, 24% AND 32% RESPECTIVELY, OF OUR DUES WENT TOWARDS LOBBYING; THIS REPRESENTS $18,042 FOR THE YEAR. PART II-B 1 (G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENTAL OFFICIALS, OR A LEGISLATIVE BODY: LEADERSHIP TIME SPENT WITH LEGISLATORS CONCERNING ISSUES RELATING TO PROPERTY TAX LEGISLATION. 6435546 -984217 424700 5026629 5191411 2790 1420588 179243 6435546 5597772 20 -406381 5191411 0.86400 0.13400 0.00200 0 0 1040521 1040521 20519741 3730079 16789662 25127 25127 0 22372868 10963966 11408902 41022 41022 29280107 DUE TO THIRD PARTY PAYORS 50000 50000 27979129 28020174 -41045 -506699 -12275 2809 -516165 -557210 28006497 -12275 -12275 28018772 -39643 -39643 27979129 28059817 39643 39643 28020174 0 28020174 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2011 OR 2010. FEDERAL AND STATE INCOME TAX RETURNS FOR THE YEARS ENDED SEPTEMBER 30, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRIBUTIONS AND UNREALIZED GAIN LOSS 9,293. RELEASED FROM RESTRICTION -6,484. PART XII, LINE 4B - OTHER ADJUSTMENTS: COGS ON INVENTORY SALES -38,120. RENTAL EXPENSES -1,523. PART XIII, LINE 2D - OTHER ADJUSTMENTS: COGS ON INVENTORY SALES 38,120. RENTAL EXPENSE 1,523. LININGER GOLF OUTING 49865 41200 8665 4729 1205 2731 49865 41200 8665 4729 1205 2731 8665 0 1 1 1 X 1 X 1 1 0 1 1 833100 833100 0.03230 5233906 3388051 1845855 0.07150 6067006 3388051 2678955 0.10380 212349 212349 0.00820 4300 4300 0.00020 32837 32837 0.00130 249486 249486 0.00970 6316492 3388051 2928441 0.11350 1 1212291 0 7974044 10337920 -2363876 X 1 1 1 1 KEWANEE HOSPITAL

1051 WEST SOUTH STREET KEWANEE IL 61443

X X X X RURAL HEALTH KEWANEE HOSPITAL 1 1 KEWANEE HOSPITAL FAMILY HEALTH CLINIC

1051 WEST SOUTH STREET KEWANEE IL 61443

RURAL HEALTH CLINIC PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,211,834. PART II: KEWANEE HOSPITAL PROVIDES A GREAT DEAL OF FREE COMMUNITY SERVICES AND COMMUNITY OUTREACH. THE HOSPITAL RECOGNIZES THE DIFFICULTY IN REACHING THE AT-RISK POPULATION AND HAS MADE A PRACTICE TO USE A VARIETY OF NOTIFICATION MECHANISMS TO MAKE THE COMMUNITY AWARE OF OUTREACH AND EDUCATIONAL OPPORTUNITIES. DEPENDING ON THE TARGET AUDIENCE, THE HOSPITAL UTILIZES LOCAL MEDIA (NEWSPAPER AND RADIO), COMMUNITY BULLETIN BOARDS (GROCERY STORE, CHURCHES, SENIOR CITIZENS CENTER, COMMUNITY CENTER AT THE LOCAL HOUSING AUTHORITY, ETC.), WEB-SITE, E-MAIL NOTIFICATIONS, POSTINGS AT THE HOSPITAL AND IN THE FAMILY HEALTH CLINIC (FHC), AND DIRECT MAIL. THE HOSPITAL PROVIDES FREE SPORTS PHYSICALS FOR THE AREA ATHLETES AT THE SCHOOL TO ASSIST THEM IN MEETING THE ILLINOIS HIGH SCHOOL ASSOCIATION REQUIREMENTS. MANY OF THE KEWANEE ATHLETES WOULD NOT BE ABLE TO MAKE IT TO THE HOSPITAL OR AREA PHYSICIAN OFFICES. KEWANEE HOSPITAL REHABILITATION SERVICES PROVIDES FREE ATHLETIC TRAINING SERVICES TO THE KEWANEE SPORTS PROGRAMS. THE ATHLETIC TRAINER WORKS COLLABORATIVELY WITH THE COACHES TO ENSURE A SAFE ENVIRONMENT FOR THE ATHLETES. THE REHABILITATION DEPARTMENT HAS ALSO STARTED A COMPETITIVE EDGE, SPORTS STRENGTHENING PROGRAM. UNDERSTANDING THAT MANY OF THE ATHLETES IN THE KEWANEE AREA DO NOT HAVE THE FINANCIAL MEANS TO PARTICIPATE IN THE PROGRAM, THE HOSPITAL HAS OFFERED SCHOLARSHIPS TO ASSIST ATHLETES INTO THE PROGRAM. THE PROGRAM NOT ONLY HELPS THE ATHLETES' PHYSICAL ABILITIES, BUT ALSO GIVES SOME OF THESE KIDS ADDED CONFIDENCE.THE HOSPITAL HAS PROVIDED A VARIETY OF FREE SCREENING OPPORTUNITIESINCLUDING CHOLESTEROL, BLOOD PRESSURE, BLOOD GLUCOSE, ETC. SO THATCOMMUNITY MEMBERS CAN TAKE AN ACTIVE ROLE IN THEIR HEALTH WITHOUT FEELING THE FISCAL CONSTRAINTS. RECENTLY KEWANEE HOSPITAL HOSTED A LADIES' NIGHT OUT AND OFFERED DISCOUNTED MAMMOGRAMS, FREE FOOD, AND FREE MINI MANICURES AND MASSAGES TO PROMOTE EARLY DETECTION AND PREVENTION. THE HOSPITAL HAS ALSO PROVIDED A VARIETY OF FREE EDUCATIONAL DINNER PROGRAMS TO AREA CITIZENS ON TOPICS SUCH AS HEALTHY EATING, DIABETES, AND CANCER AWARENESS (COLORECTAL, SKIN, AND BREAST). THE HOSPITAL REGULARLY OFFERS FREE SMOKING CESSATION PROGRAMS ALONG WITH DISCOUNTED SMOKING CESSATION AIDS TO THE COMMUNITY. THE PROGRAM IS ONGOING AND SEVERAL PARTICIPANTS CONTINUE TO BE SMOKE-FREE. SUPPORT OF LOCAL SERVICE AGENCIES:KEWANEE HOSPITAL SUPPORTS SEVERAL AREA SERVICE AGENCIES AND OTHER NOT-FOR-PROFITS BOTH THROUGH VOLUNTEER HOURS AND MONETARY SUPPORT. MANY HOSPITAL STAFF MEMBERS ACTIVELY PARTICIPATE IN LOCAL KIWANIS, ROTARY, AND LION'S SERVICE CLUBS. THE HOSPITAL PROVIDES SPACE FREE OF CHARGE TO FREEDOM HOUSE, A SERVICE AGENCY SUPPORTING BATTERED WOMEN AND CHILDREN. KEWANEE HOSPITAL HAS SUPPORTED THE GOOD FELLOWS BASKETS THROUGH HOSPITAL SPONSORED LABOR HOURS. IN 2011 THE GOOD FELLOWS DELIVERED OVER 1000 BASKETS OF FOOD TO NEEDY AREA FAMILIES. THE HOSPITAL REGULARLY SUPPORTS THE SALVATION ARMY, FOOD PANTRY, BIG BROTHERS/BIG SISTERS, AMERICAN CANCER SOCIETY AND RELAY FOR LIFE, SENIOR CITIZENS CENTER AND JUNIOR ACHIEVEMENT. KEWANEE HOSPITAL HAS PROVIDED FREE MEETING SPACE TO AREA SUPPORT GROUPS. THE LOCAL FOOD PANTRY IS ALWAYS IN NEED OF DONATIONS AS MORE AND MORE LOCAL FAMILIES ARE RELIANT ON THEIR SERVICES. THE HOSPITAL HAD A CONTEST WITH OTHER REGIONAL HOSPITALS FOR THEIR RESPECTIVE FOOD PANTRY ORGANIZATIONS ON WHO COULD DONATE THE MOST FOOD AND KEWANEE HOSPITAL WON WITH OVER 1,500 POUNDS OF FOOD DONATED TO THE KEWANEE FOOD PANTRY. THE HOSPITAL SUPPORTS LOCAL ECONOMIC DEVELOPMENT AND IS AN ACTIVE PARTICIPANT IN THE COMMUNITY WIDE PLANNING EFFORT; COMMITTING MEETING SPACE, A/V EQUIPMENT, FOOD, AND LEADERSHIP HOURS TO THE EFFORT IN ORDER TO SUPPORT POSITIVE GROWTH IN THE COMMUNITY.DISASTER PREPAREDNESS:A COMPREHENSIVE DISASTER PREPAREDNESS PROGRAM WAS STARTED BY THE HOSPITAL A FEW YEARS AGO WITH ONGOING EFFORTS TO WORK COLLABORATIVELY WITH THE COUNTY HEALTH DEPARTMENT, LOCAL CITY AGENCIES, AND THE REGION TO BUILD ON THAT PROGRAM. THE LEADERSHIP TEAM HAS BEEN THROUGH THE INCIDENT COMMAND SYSTEM (ICS) EDUCATION AND HAS USED THE ICS STRUCTURE FOR SEVERAL AREA EMERGENCIES INCLUDING A CHEMICAL SPILL AND H1N1 PANDEMIC. THE TEAM HAS PRACTICED THE STRUCTURE, PARTICIPATING IN DRILLS AT THE LOCAL AND REGIONAL LEVEL. DURING THE PLANNING OF THE NEW HOSPITAL, IT WAS IDENTIFIED THAT A FIXED INDOOR DECONTAMINATION UNIT WOULD BE BENEFICIAL. KEWANEE IS SURROUNDED BY AGRICULTURE WITH THE ONGOING RISK OF CHEMICAL EXPOSURE AS WELL AS EXPERIENCING AN INCREASE IN THE NUMBER OF LOCAL METH LABS. THE HOSPITAL HAS IDENTIFIED AND TRAINED A "DECON TEAM" THAT HAS USED THE UNIT SEVERAL TIMES IN THE FEW YEARS THE NEW HOSPITAL HAS BEEN OPEN. KEWANEE HOSPITAL KNOWS THAT THE COMMUNITY WILL RELY ON THEM IN THE FACE OF A DISASTER OR LOCAL EMERGENCY AND WANTS TO HAVE PLANS IN PLACE TO ENSURE CONTINUED OPERATIONS TO THE BEST OF THEIR ABILITY. ENVIRONMENTAL AWARENESS: KEWANEE HOSPITAL BELIEVES IN BEING A GOOD STEWARD TO THE COMMUNITY AND SETTING THE STANDARD FOR ENVIRONMENTAL AWARENESS IN THEIR AREA. IN FY 2010 A GOAL WAS SET TO ELIMINATE STYROFOAM USAGE IN THE CAFE AND TO REPLACE THOSE PRODUCTS WITH BIODEGRADABLE OPTIONS. OVERALL PAPER USAGE IN THE CAFE WAS DECREASED THROUGH A "GREEN" TAX ON TO-GO ORDERS. THE ENVIRONMENTAL SERVICES DEPARTMENT CONTINUES TO FURTHER THE HOSPITAL'S RECYCLING AND "GREEN" INITIATIVES. OVERALL ENERGY USE WAS DECREASED BY SCALING BACK HEATING/COOLING IN NON-PATIENT AREAS AFTER HOURS. MANY LIGHT BULBS HAVE BEEN CHANGED TO GREENER OPTIONS UTILIZING LESS ENERGY. THE HOSPITAL CONTINUES TO TRANSITION CHEMICALS TO GREENER ALTERNATIVES AS THEY BECOME AVAILABLE. BIKE RACKS WERE INSTALLED SO EMPLOYEES AND VISITORS CAN BIKE TO THE HOSPITAL AND SAVE FUEL. TILING WAS INSTALLED ON THE ADJOINING FARM GROUND TO PREVENT RUNOFF OF PRECIOUS TOPSOIL. THE HOSPITAL HAS CHALLENGED OTHER ORGANIZATIONS IN KEWANEE TO JOIN THEM IN LOWERING THEIR CARBON FOOTPRINT. HEALTH AND WELLNESS:AS ONE OF THE LARGEST EMPLOYERS, KEWANEE HOSPITAL BELIEVES THAT IN ORDER TO BETTER CARE FOR PATIENTS AND THE COMMUNITY, THE HOSPITAL NEEDS TO BE A LEADER IN HEALTH AND WELLNESS. THE HOSPITAL HAS FOCUSED ON HEALTH AND WELLNESS FOR THEIR EMPLOYEES WITH PLANS TO ROLL OUT A PROGRAM TO THE COMMUNITY. IN FY 2011 THE WELLNESS ENDEAVOR CONTINUED THE "KNOW YOUR NUMBERS" CAMPAIGN. EMPLOYEES WERE OFFERED FREE SCREENINGS FOR CHOLESTEROL, BLOOD GLUCOSE, BLOOD PRESSURE, BMI AND WAIST MEASUREMENT. EMPLOYEES IN WARNING CATEGORIES WERE PROVIDED FREE FOLLOW-UP VISITS IN THE HOSPITAL'S FAMILY HEALTH CLINIC. EMPLOYEES RETESTED SIX MONTHS LATER AND SHOWED MARKED IMPROVEMENT IN ALL AREAS. THE HOSPITAL CONDUCTED THEIR FIRST ANNUAL 5K RUN FOR EMPLOYEES, FAMILY MEMBERS, AND WELLNESS PROGRAM CORPORATE PARTNERS. THE EVENT WAS A SUCCESS WITH 58 PARTICIPANTS AND THE HOSPITAL PLANS ON CONTINUING THE EVENT FOR YEARS TO COME. THE WELLNESS TEAM HAS ROLLED OUT A NUMBER OF FREE SERVICES TO EMPLOYEES TO ASSIST THEM IN THEIR WELLNESS ENDEAVOR INCLUDING: PERSONAL TRAINING SESSIONS, OFF-HOURS ACCESS TO THE FITNESS CENTER, CONSULTATIONS WITH THE FHC PROVIDERS, ONGOING TESTING, SMOKING CESSATION, EAP PROGRAM, AND A PROGRAM ON BUDGETING AND FINANCE. THE HOSPITAL HAS STARTED LINKING THIS INFORMATION TO OTHER COMMUNITY EDUCATION TO INFORM THE COMMUNITY OF THE WELLNESS INITIATIVE AND TO ENTICE COMMUNITY MEMBERS TO TAKE AN ACTIVE ROLE IN THEIR OWN HEALTH, AND IN FY 2011 THE WELLNESS TEAM TOOK ON THEIR SECOND CORPORATE PARTNER, PROVIDING SOME OF THESE SERVICES TO OTHER COMMUNITY MEMBERS. PART III, LINE 4: BAD DEBTS WERE REPORTED ON THE FINANCIAL STATEMENTS AT GROSS CHARGES. THEN THE COST TO CHARGE RATIO WAS USED TO CONVERT THE BAD DEBT AMOUNT FROM A CHARGE BASED NUMBER TO A COST BASED NUMBER. PART III, LINE 8: THE MEDICARE PROGRAM DOES NOT COVER ALL SERVICES PROVIDED TO THEIR PARTICIPANTS AND THE HOSPITAL IS NOT ALLOWED TO COLLECT FROM THE PARTICIPANTS FOR SOME SERVICES BASED ON THE HOSPITAL'S AGREEMENT WITH THE PROGRAM. THEREFORE, NOT ALL REVENUES ARE COVERED BY MEDICARE. IN ADDITION, MEDICARE DOES NOT ALLOW ALL BUSINESS COSTS OF THE HOSPITAL TO BE INCLUDED IN THE COST REPORT, SO THERE ARE ADDITIONAL UNCOVERED COSTS. THE SHORTFALL BY THE MEDICARE PROGRAM COULD BE AVOIDED BY NOT PROVIDING CARE TO MEDICARE PATIENTS; THEREFORE, THIS SHORTFALL SHOULD BE INCLUDED AS A BENEFIT PROVIDED BY THE HOSPITAL.PART I, LINE 7: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORT IS BASED ON THE AUDITED FINANCIAL STATEMENTS OF KEWANEE HOSPITAL AND THE HOSPITAL'S EXPENSING OF COSTS TO THE APPROPRIATE COST CENTER THROUGH THE HOSPITAL'S INTERNAL COMPUTER SYSTEM. PART III, LINE 9B: IT IS THE POLICY OF KEWANEE HOSPITAL TO EXTEND A FULL OR PARTIAL DISCOUNT FROM CHARGES TO QUALIFYING PATIENTS WHOSE CARE IS NOT COVERED BY OTHER FINANCIAL AID OR GOVERNMENT HEALTHCARE PROGRAMS. KEWANEE HOSPITAL UTILIZES A NUMBER OF METHODS FOR COMMUNICATING FINANCIAL ASSISTANCE, INCLUDING CHARITY CARE, TO PATIENTS AND THE COMMUNITY INCLUDING:A. SIGNS STATING THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED INTHE EMERGENCY DEPARTMENT, REGISTRATION AND ADMITTING AREAS AND THECASHIERS OFFICE. BROCHURES WITH INFORMATION REGARDING CHARITY CARE ARE ALSO AVAILABLE.B. NOTICE OF THE AVAILABILITY OF CHARITY CARE IS INCLUDED ON THEHOSPITALS WEB SITE.C. PATIENT FINANCIAL SERVICES STAFF IS KNOWLEDGEABLE ABOUT THE POLICY AND PROCESS.D. THE STAFFS OF THE OUTSOURCED SELF PAY BILLING SERVICE AND BAD DEBTCOLLECTION AGENCY ARE ALSO KNOWLEDGEABLE ABOUT THE POLICY AND PROCESS.E. NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON ORWITH HOSPITAL BILLING STATEMENTS TO GUARANTORS.KEWANEE HOSPITAL ATTEMPTS TO IDENTIFY UNINSURED PATIENTS ELIGIBLE FORCHARITY CARE PRIOR TO OR AT TIME OF SERVICE. FINANCIAL ASSISTANCEINFORMATION AND APPLICATIONS MAY BE OBTAINED FROM THE FINANCIALCOUNSELORS. COMPLETED APPLICATIONS AND DOCUMENTATION WILL BE REVIEWED AND PROCESSED. APPLICANTS WILL THEN RECEIVE A WRITTEN DETERMINATION OF ELIGIBILITY. PART VI, LINE 2: KEWANEE HOSPITAL CONTINUALLY STRIVES TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED AND PERFORMS ONGOING ASSESSMENTS IN ORDER TO BEST ALLOCATE THE HOSPITALS SCARCE RESOURCES. THE HOSPITAL EVALUATES THE NEEDS OF THE KEWANEE COMMUNITY THROUGH INTERNAL EVALUATIONOF MARKET DATA, COMMUNITY DEMOGRAPHICS, CDC AND OTHER HEALTH RELATED DATA, ANALYSIS OF PATIENTS SERVED THROUGH THE HOSPITALS FAMILY HEALTH CLINIC, REVIEW OF EMERGENCY DEPARTMENT VISITS, AND COLLABORATIVE MEETINGS WITH THE AREA SCHOOL DISTRICTS AND THE COUNTY HEALTH DEPARTMENT.KEWANEE HOSPITAL WORKS WITH A NUMBER OF COMMUNITY VOLUNTEERS THROUGH THE HOSPITALS DEVELOPMENT COUNCIL. THE COMMUNITY RELATIONS COMMITTEE IS CHARGED WITH NEEDED EDUCATION FOR THE COMMUNITY AND UTILIZES THE INFORMATION GAINED AS TOPICS FOR EDUCATION. THROUGH THE ONGOING ASSESSMENT PROCESS THE HOSPITAL HAS IDENTIFIED AND PROVIDED OUTREACH FOR DIABETIC EDUCATION, SUICIDE PREVENTION EDUCATIONAL SERIES FOR TEACHERS AND PARENTS, HEALTH AND NUTRITION FOR AT-RISK POPULATIONS, IMPORTANCE OF PREVENTATIVE SCREENING, SKIN-CANCER PREVENTION, AND A POSITIVE PARENTING SERIES.THROUGH COLLABORATION WITH KEWANEE HOSPITALS REGIONAL PARTNERS, INCLUDING THE HENRY COUNTY HEALTH DEPARTMENT, THE HOSPITAL IDENTIFIED DISASTER PREPAREDNESS AS A COMMUNITY NEED. AS A RURAL COMMUNITY, KEWANEE HAS FEW CITY RESOURCES. CITIZENS VIEW THE HOSPITAL AS THE MAINSTAY OR COMMUNITY CORNERSTONE AND THUS WOULD LOOK TO KEWANEE HOSPITAL IN AN EMERGENCY. THE HOSPITAL LEADERSHIP TEAM, STAFF AND PROVIDERS HAVE GONE THROUGH EDUCATION AND TRAINING ON INCIDENT COMMAND. PART VI, LINE 3: KEWANEE HOSPITAL PROVIDED OVER $1,500,000 IN CHARITY CARE TO NEEDY COMMUNITY MEMBERS IN FY 2011. KEWANEE HOSPITAL COMMUNICATES TO PATIENTS ABOUT THEIR FINANCIAL OBLIGATIONS THROUGHOUT THE HEALTH CARE EXPERIENCE. IT IS THE HOSPITAL'S GOAL TO ASSESS FINANCIAL NEED AS SOON AS POSSIBLE IN THE CARE PROCESS. PATIENTS SETTING UP DIAGNOSTIC TESTING THROUGH CENTRALIZED SCHEDULING DISCUSS THE PAYMENT OBLIGATIONS PRIOR TO VISITING THE HOSPITAL, ALLOWING FOR PATIENTS NEEDING ASSISTANCE TO START THE PROCESS RIGHT THEN. THE FAMILY HEALTH CLINIC (FHC) PATIENTS BENEFIT FROM HAVING FHC STAFF TALK WITH THEM ABOUT OBLIGATIONS RELATED TO PROCEDURES, DIAGNOSTICS, ETC. AND ARE OFTEN ABLE TO ACCESS FINANCIAL ASSISTANCE PRIOR TO THE PROCEDURE. KEWANEE HOSPITAL STAFF IS TRAINED TO RECOGNIZE POTENTIAL NEED AND TO PROACTIVELY DISCUSS PAYMENT ARRANGEMENTS. THE HOSPITAL PROMOTES FINANCIAL ASSISTANCE THROUGHOUT THE ORGANIZATION AND THROUGH VARIOUS PUBLICATIONS. INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS IS POSTED THROUGH:-SIGNAGE (ADMISSIONS/REGISTRATION AT MAIN ENTRANCE, EMERGENCY DEPARTMENT ADMISSIONS, ADMISSION BOOTHS).-KEWANEE HOSPITALS WEBSITE, WWW.KEWANEEHOSPITAL.COM DIRECT MAIL PIECES INCLUDING QUARTERLY NEWSLETTERS AND COMMUNITY BENEFIT REPORT-HENRY COUNTY TOURISM VIDEO/WEB-SITE LINK-RADIO PROGRAM, MONDAY MORNING TUNED-IN, WKEI-PATIENT EDUCATION THROUGHOUT THE CARE PROCESS-FINANCIAL ASSISTANCE BROCHURES AT CASHIERS WINDOW-PATIENT BILL FOR SERVICE.-IDENTIFICATION OF NEED AND EDUCATION THROUGH CENTRALIZED SCHEDULING, ADMISSIONS STAFF, FHC STAFF, CASHIERS OFFICE, FINANCIAL COUNSELORS, PROVIDERS OF SERVICES, AND OTHER STAFF AS THEY BECOME AWARE OF THE PATIENTS NEED.-ANNOUNCEMENTS AND BOOTHS AT FREE COMMUNITY EDUCATION AND OUTREACH CONDUCTED BY KEWANEE HOSPITAL. PART VI, LINE 4: KEWANEE HOSPITAL IS LOCATED IN A RURAL AREA OF NORTHERN WEST-CENTRAL ILLINOIS, ABOUT 10 MILES SOUTH OF INTERSTATE 80 AND BETWEEN THE LARGER URBAN AREAS OF PEORIA, ILLINOIS AND THE QUAD CITIES (LOCATED ABOUT 50-55 MILES FROM EACH). THE HOSPITAL SERVES THE PRIMARY MARKET AREA (POPULATION APPROXIMATELY 19,700) OF KEWANEE AND THE SURROUNDING RURAL COMMUNITIES INCLUDING GALVA AND TOULON. THE OVERALL MARKET (POPULATION APPROXIMATELY 29,000) INCLUDES THE THREE COUNTY PORTIONS OF HENRY, BUREAU, AND STARK IN RURAL ILLINOIS. THE LARGEST PERCENTAGES OF KEWANEE HOSPITALS PATIENTS ARE DERIVED FROM THE KEWANEE ZIP CODE OF 61443. THE POPULATION OF KEWANEE IS AGING AND POOR WITH THE GREATEST NUMBERS IN THE OVER 65 AND UNDER 18. IN 2000, 12.8% OF THE POPULATION WAS BELOW THE POVERTY LEVEL. THE KEWANEE SCHOOL DISTRICT REPORTED OVER 85% OF CHILDREN ATTENDING SCHOOL ON THE FREE AND REDUCED LUNCH PROGRAM. SUBSEQUENTLY THAT LEAVES FEW CITIZENS IN THE MIDDLE WHERE A COMMUNITY TYPICALLY SEES THE WORKING CLASS. AS A RESULT OF THE DEMOGRAPHICS, KEWANEE HOSPITAL SEES A HIGH PROPORTION OF PATIENTS RELIANT ON MEDICAID AND UNINSURED. FOLLOWING THE NATIONAL TREND, THE HIGHEST CONCENTRATION IS IN THE EMERGENCY DEPARTMENT AND THE HOSPITALS FAMILY HEALTH CLINIC (FHC). FY 2011 REPORTED 28% OF PATIENTS IN THE EMERGENCY DEPARTMENT WERE RELIANT ON MEDICAID WHILE 14% WERE UNINSURED. THE FAMILY HEALTH CLINIC REPORTED 44% OF PATIENTS WERE RELIANT ON MEDICAID AND 9% WERE UNINSURED. THE OVERALL HOSPITAL REPORTED 20% RELIANT ON MEDICAID AND 8% UNINSURED. PART VI, LINE 6: KEWANEE HOSPITAL HAS AN OPEN MEDICAL STAFF AND WELCOMES PHYSICIANS AND MID-LEVEL PROVIDERS TO PRACTICE AND PROVIDE CARE IN THE KEWANEE COMMUNITY. THE BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS FROM THE LOCAL SERVICE AREA WHO ARE COMMITTED TO THEIR ROLE IN KEEPING QUALITY HEALTH CARE LOCAL. THE HOSPITAL PROVIDES MANY SERVICES THAT WOULD OTHERWISE BE UNAVAILABLE, PARTICULARLY TO THOSE COMMUNITY MEMBERS UNABLE TO TRAVEL FOR SERVICES OR UNABLE TO PAY. THE HOSPITAL CONTINUALLY WORKS WITH AREA STUDENTS PURSUING MEDICAL RELATED CAREERS AND PARTNERS WITH THE AREA COMMUNITY COLLEGE AND REGIONAL COLLEGES AND UNIVERSITIES TO OFFER CLINICAL AND ADMINISTRATIVE EXPERIENCES. THIS INCLUDES PRE-MED, NURSING, LAB, RADIOLOGY, CARDIOPULMONARY, FINANCE, AND ADMINISTRATION.IN ORDER TO RECRUIT AND RETAIN PHYSICIANS AND MID-LEVEL PROVIDERS TO THE RURAL COMMUNITY, KEWANEE HOSPITAL MUST OFFER COMPETITIVE EMPLOYMENT OPPORTUNITIES. EMPLOYING PHYSICIANS IS AN EXPENSIVE UNDERTAKING WHICH INCLUDES TAKING THE RISK OF PRACTICE DEVELOPMENT AND ASSUMING THE EXPENSE AND RISK FOR LIABILITY INSURANCE. CURRENTLY THE FHC PROVIDERS STRUGGLE TO ACCESS SPECIALISTS FOR THEIR PATIENTS WHEN NEEDED. THERE IS A RELUCTANCE OF OUT-OF-TOWN SPECIALISTS TO ACCEPT PATIENTS RELIANT ON MEDICAID. ILLINOIS' CURRENT MEDICAID CRISISHAS CAUSED THOSE SPECIALISTS ONCE WILLING TO TAKE NEW MEDICAID PATIENTS TO CEASE BECAUSE THEY CANNOT DETERMINE WHEN THEY WILL RECEIVE PAYMENT. THE CHILDREN UNDER THE CARE OF THE FHC ARE TURNED DOWN BY ENT'S, PSYCHIATRIST, AND OTHER NEEDED SPECIALIST BECAUSE OF THEIR RELIANCE ON MEDICAID. BECAUSE OF THE SIZE OF THE COMMUNITY, THE DEMOGRAPHICS AND THE CURRENT PHYSICIAN SHORTAGE, KEWANEE HOSPITAL IS UNABLE TO RECRUIT SPECIALISTS SUCH AS ENT, PSYCHIATRISTS, ORTHOPEDICS, ETC. TO THE AREA. THE FHC PROVIDERS THEREFOR HAVE TO RELY ON OUT-OF-TOWN SPECIALISTS FOR REFERRAL. THE FHC HAS STARTED A PATIENT ASSISTANCE PROGRAM THAT REACHES OUT TO ORGANIZATIONS, PROGRAMS, FOUNDATIONS, ETC. TO MATCH PATIENTS SO THEY CAN ACCESS SPECIALTY CARE, TREATMENT, OR MEDICATIONS THAT ARE NEEDED.KEWANEE HOSPITAL CONTINUES THE COMMITMENT TO THEIR MISSION OF IMPROVING THE HEALTH AND CARE OF THOSE THEY SERVE WITHIN THEIR COMMUNITIES. FY 2011 CONTINUES A FOCUS ON HEALTH EDUCATION, DISEASE MANAGEMENT, PREVENTION, AND WELLNESS. DESPITE GROWING ECONOMIC HARDSHIPS DUE TO CONTINUED DECREASE IN THE NUMBER OF COMMERCIALLY INSURED INDIVIDUALS, THE GROWTH IN PATIENTS RELIANT ON MEDICAID, AND THE INCREASE IN UNINSURED PATIENTS, THE HOSPITAL WILL CONTINUE TO PROVIDE COMMUNITY OUTREACH TO ASSIST THOSE IN NEED. THE HOSPITAL'S VALUE TO THE COMMUNITY WELL EXCEEDS THE NEARLY $3 MILLION CONTRIBUTED IN FY 2011. THE HOSPITAL IS THERE 24 HOURS A DAY, 7 DAYS A WEEK, FOR COMMUNITY MEMBERS IN THEIR TIME OF NEED-WHETHER FOR A CHILD WHO IS SICK THROUGHOUT THE NIGHT, A PARENT EXPERIENCING CHEST PAINS, A GRANDMOTHER WITH THE WARNING SIGNS OF A STROKE, OR THE VICTIMS OF A TRAUMATIC CAR ACCIDENT. KEWANEE HOSPITAL STANDS READY TO TAKE CARE OF THOSE COMMUNITY MEMBERS IN NEED AND CONTINUES TO WORK TOWARDS THEIR VISION OF SETTING THE STANDARD FOR LOCAL HEALTH CARE WITH A TEAM OF COMPASSIONATE PROFESSIONALS WHO ARE FOCUSED ON CLINICAL EXCELLENCE AND CUSTOMER SERVICE. X X X X X 0 0 0 0 0 0 0 0 0 MARGARET M GUSTAFSON 213386 0 0 0 0 0 10414 0 24092 0 247892 0 0 0 DANIEL CONGREVE MD 338411 0 0 0 0 0 6637 0 24332 0 369380 0 0 0 LYNN A FULTON 116719 0 0 0 0 0 6467 0 28996 0 152182 0 0 0 ELOISE SKELTON MD 310300 0 0 0 0 0 1568 0 11733 0 323601 0 0 0 MICHAEL STEWART CRNA 165698 0 0 0 0 0 0 0 13468 0 179166 0 0 0 ANGELA WALKER MD 235253 0 0 0 0 0 7165 0 5481 0 247899 0 0 0 ILLINOIS FINANCE AUTHORITY 861091967 45200BH27 2006-08-31 32114451 0 0 0 33978645 2352650 642289 33336356 2008 0 0 1 1 0 0 1 0 1 0.00590 0.00590 1 1 0 0 1 SEE SCHEDULE O 1 0 0 FORM 990, SCHEDULE K, PART I, LINE A DESCRIPTION OF PURPOSE IN RESPONSE TO PART I, LINE A (F), THE PURPOSE OF THE $32,205,000 ILLINOIS FINANCE AUTHORITY REVENUE BONDS, SERIES 2006 (KEWANEE HOSPITAL PROJECT) (THE "BONDS") WAS, TOGETHER WITH CERTAIN OTHER AMOUNTS AVAILABLE TO KEWANEE HOSPITAL, TO (A) PAY OR REIMBURSE KEWANEE HOSPITAL FOR THE PAYMENT OF THE COST OF ACQUIRING, CONSTRUCTING, RENOVATING, REMODELING AND EQUIPPING CERTAIN OF ITS HEALTH FACILITIES, (B) PROVIDE FUNDED INTEREST FOR THE BONDS, AND (C) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS. FORM 990, SCHEDULE K, PART IV, LINE 4B & 4C NAME OF GIC PROVIDER AND TERM OF GIC FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE STRATEGIC PLANNING AND FINANCE COMMITTEE (SPF) IS THE BOARD OF TRUSTEE LEVEL COMMITTEE CHARGED WITH REVIEWING THE FINAL FORM 990 PRIOR TO ITS FILING. THE ENTIRE BOARD IS INVITED TO THE SPF COMMITTEE MEETING WHERE THE 990 WILL BE PRESENTED TO PARTICIPATE IN THE REVIEW. THE TAX RETURN PREPARER CONDUCTS THE OVERVIEW OF THE FORM 990, PROJECTING THE 990 ON THE SCREEN AND EXPLAINING THE PERTINENT SCHEDULES. EACH BOARD MEMBER IS PROVIDED A COPY OF THE 990 FOR THEIR REVIEW. THE BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. THE 990 IS NOT FILED UNTIL AFTER THE BOARD OF TRUSTEES MEETING WHERE THE 990 WILL BE APPROVED AND ACCEPTED. FORM 990, PART VI, SECTION B, LINE 12C ANY INTERESTED PERSON WHO HAS A PERSONAL OR PRIVATE INTEREST IN A MEASURE, CONTRACT, RESOLUTION, OR OTHER TRANSACTION PRESENTED TO THE BOARD OR A COMMITTEE THEREOF FOR DELIBERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION, OR ANY INTERESTED PERSON WHO REASONABLY BELIEVES SUCH AN INTEREST EXISTS IN ANOTHER PERSON, SHALL MAKE A PROMPT, FULL, AND FRANK DISCLOSURE IN WRITING OF THE PERSONAL OR PRIVATE INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. THE INTERESTED PERSON SHALL DISCLOSE THE EXISTENCE OF HIS OR HER PERSONAL OR PRIVATE INTEREST AND ALL MATERIAL FACTS, KNOWN TO HIM OR HER ABOUT THE PERSONAL OR PRIVATE INTEREST AND POTENTIAL CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF TRUSTEES ACTS AS THE COMPENSATION COMMITTEE FOR KEWANEE HOSPITAL. ANNUALLY THE EXECUTIVE COMMITTEE OF THE BOARD MEETS TO REVIEW AND APPROVE COMPENSATION FOR THE EXECUTIVE TEAM WHICH INCLUDES THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER AND CHIEF NURSING OFFICER. RESOURCE DATA FOR THIS REVIEW COMES FROM SALARY SURVEYS FROM A NUMBER OF SOURCES INCLUDING SULLIVAN COTTER, CENTRAL ILLINOIS SOCIETY FOR HEALTHCARE HUMAN RESOURCE ADMINISTRATION (CISHRA), IHA EXECUTIVE AND MANAGEMENT SALARY SURVEY, AND A 990 REVIEW THROUGH GUIDESTAR.ORG OF LOCAL AND REGIONAL ORGANIZATIONS. THE SURVEYS ARE ANALYZED BY REVIEWING APPLICABLE CUTS OF THE SURVEY INCLUDING CRITICAL ACCESS HOSPITALS, HOSPITALS WITH LIKE REVENUE, AND SIMILARLY STAFFED ORGANIZATIONS. SURVEYS ARE ALSO REVIEWED AT REGIONAL AND NATIONAL LEVELS. COMPENSATION IS PROPOSED TO THE COMMITTEE TAKING INTO CONSIDERATION THE MEDIAN RANGE OF ALL SALARY SOURCES, EDUCATION/DEGREE, TRAINING, CERTIFICATION, AND EXPERIENCE. THE COMMITTEE REVIEWS THE SALARY PROPOSAL FOR REASONABLENESS BASED ON THE DATA SOURCES. THE CHIEF EXECUTIVE OFFICER MAKES RECOMMENDATIONS FOR THE SALARIES OF THE OTHER EXECUTIVES (COO, CFO AND CNO). 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: -506,699. DONATED SERVICES AND USE OF FACILITIES: -12,275. CONTRIBUTIONS AND UNREALIZED GAIN LOSS 9,293. RELEASED FROM RESTRICTION -6,484. TOTAL TO FORM 990, PART XI, LINE 5: -516,165. AUDITED FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2C THE ORGANIZATION'S BOARD OF TRUSTEES ENGAGES THE INDEPENDENT ACCOUNTANTS TO PERFORM THE AUDIT. THE BOARD MEETS WITH THE AUDITORS TO GO OVER THE AUDIT REPORT. NAME OF GIC PROVIDER AND TERM OF GIC FORM 990, SCHEDULE K, PART IV, LINES 4B & 4C TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY- GIC PROVIDER FOR PROCEEDS DEPOSITED IN A PROJECT FUND - 1.61 YEARS. CITIGROUP FINANCIAL PRODUCTS, INC. - GIC PROVIDER FOR GROSS PROCEEDS DEPOSITED IN A DEBT SERVICE FUND - 4.90 YEARS - TERMINATED ON JANUARY 9, 2009.