NORTHWESTERN MEMORIAL HEALTHCARE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: NORTHWESTERN MEMORIAL HEALTHCARE (EIN 23-7087041)
Tax period: 2010-05-01 to 2011-04-30
Filed: 2011-12-14
IRS object ID: 201113489349300041
Schema version: 2010v3.4
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-12-14T14:42:06-06:00	Timestamp
Tax Period End Date	2011-04-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CLIFTON GUNDERSON LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	114 E EVERETT	AddressLine1
City	DIXON	City
State	IL	State
ZIP Code	61021	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-05-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	237087041	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	KISHWAUKEE COMMUNITY HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	KISH	NameControl
Phone	8157561521	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	ONE KISH HOSPITAL DRIVE	AddressLine1
City	DEKALB	City
State	IL	State
ZIP Code	60115	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LOREN FOELSKE	Name
Title	VICE-PRESIDENT - FINANCE, KHS	Title
Phone	8157561521	Phone
Date Signed	2011-12-13	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	KELLY JACKSON HARDY	Name
Phone	8152842285	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	KEVIN P POORTEN	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	ONE KISH HOSPITAL DRIVE	AddressLine1
City	DEKALB	City
State	IL	State
ZIP Code	60115	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	193633562	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.KISHHOSPITAL.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1970	YearFormation
State Legal Domicile	IL	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREA OF DEKALB COUNTY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	3	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	2	NbrIndependentVotingMembers
Total Nbr Employees	1136	TotalNbrEmployees
Total Nbr Volunteers	282	TotalNbrVolunteers
Total Gross UBI	141780	TotalGrossUBI
Net Unrelated Business Txbl Income	43953	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	439308	ContributionsGrantsPriorYear
Contributions Grants Current Year	1113923	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	154699731	ProgramServiceRevenuePriorYear
Program Service Revenue CY	163834645	ProgramServiceRevenueCY
Investment Income Prior Year	2817426	InvestmentIncomePriorYear
Investment Income Current Year	2966348	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1341487	OtherRevenuePriorYear
Other Revenue Current Year	1803798	OtherRevenueCurrentYear
Total Revenue Prior Year	159297952	TotalRevenuePriorYear
Total Revenue Current Year	169718714	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	581784	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	999268	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	52062278	SalariesEtcPriorYear
Salaries Etc Current Year	56726719	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	5578	TotalFundrsngExpCurrentYear
Other Expense Prior Year	93398918	OtherExpensePriorYear
Other Expenses Current Year	95690873	OtherExpensesCurrentYear
Total Expenses Prior Year	146042980	TotalExpensesPriorYear
Total Expenses Current Year	153416860	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	13254972	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	16301854	RevenuesLessExpensesCY
Total Assets BOY	248596359	TotalAssetsBOY
Total Assets EOY	278068882	TotalAssetsEOY
Total Liabilities BOY	93032057	TotalLiabilitiesBOY
Total Liabilities EOY	101229299	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	155564302	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	176839583	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING INPATIENT ACUTE AND NONACUTE CARE, AND VARIOUS OUTPATIENT SERVICES IN THE AREA OF DEKALB COUNTY. KISHWAUKEE COMMUNITY HOSPITAL (KCH) SERVES ALL PEOPLE WITH SKILL AND COMPASSION WHILE RESPECTING THEIR DIGNITY, RIGHTS, AND CHOICES BY OFFERING ACCESS TO HIGH-QUALITY PREVENTIVE, CURATIVE, AND REHABILITATIVE CARE DELIVERED IN A COST EFFECTIVE MANNER. KISHWAUKEE COMMUNITY HOSPITAL RECOGNIZES THE NEED TO EFFECTIVELY MANAGE RESOURCES FOR PRESENT AND FUTURE GENERATIONS.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	128532470	Expense
Grants	999268	Grants
Revenue	165465868	Revenue
Description	KISHWAUKEE COMMUNITY HOSPITAL (KCH), LOCATED IN DEKALB, ILLINOIS, SERVES THE RESIDENTS OF DEKALB COUNTY AND THE SURROUNDING AREAS BY OFFERING A NUMBER OF PROGRAMS AND SERVICES FOR COMMUNITY BENEFIT, INCLUDING CHARITY CARE. KISHWAUKEE COMMUNITY HOSPITAL BELIEVES THAT IN ORDER TO BE A TRUE "COMMUNITY" HOSPITAL, WE MUST BE A RESOURCE FOR PREVENTATIVE AND CURATIVE HEALTH INFORMATION, EDUCATION AND SERVICES AND THAT WE MUST SUPPORT THE EFFORTS OF OTHERS WHO ALSO ARE DOING WORK FOR THE COMMUNITY GOOD. DOING SO HELPS BUILD TRUST, RESPECT AND LOYALTY FOR OUR HOSPITAL AND STRENGTHENS OUR ROLE AS A PARTNER IN IMPROVING THE HEALTH OF OUR CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE.THE COMMUNITY BENEFIT OBJECTIVES OF KCH INCLUDE PROGRAMS TO REDUCE GEOGRAPHIC, FINANCIAL, LANGUAGE AND CULTURAL BARRIERS; IMPROVE AND ENHANCE PUBLIC HEALTH; ADVANCE GENERALIZEABLE KNOWLEDGE, AND RELIEVE THE GOVERNMENT BURDEN OF PROVIDING HEALTH SERVICES FOR THE COMMUNITY, UNINSURED AND UNDERINSURED. THIS SECTION ELABORATES ON SEVERAL AREAS: COMMUNITY BENEFIT PATIENT SERVICES, EMERGENCY/DISASTER RESPONSE, CLINICAL EDUCATION, COMMUNITY WELLNESS ACTIVITIES, OTHER COMMUNITY EDUCATION AND OUTREACH, CASH CONTRIBUTIONS AND IN-KIND CONTRIBUTIONS.KISHWAUKEE COMMUNITY HOSPITAL SERVES ALL OF DEKALB COUNTY, IL, AND BORDER COMMUNITIES IN KANE AND OGLE COUNTIES. POPULATION OF THE HOSPITAL'S SERVICE AREA, BASED ON 2010 CENSUS, IS 131,782. THIS GEOGRAPHIC AREA INCLUDES A GROWING HISPANIC POPULATION. A UNIQUE POPULATION IN OUR SERVICE AREA IS NORTHERN ILLINOIS UNIVERSITY STUDENTS (23,850 FALL 2010 ENROLLMENT), INCLUDING FOREIGN STUDENTS AND VISITORS. THE HISPANIC POPULATION IS EXPECTED TO GROW BY 22.62% BY 2016. ACCORDING TO THE AMERICAN COMMUNITY SURVEY, 29.5% OF FAMILIES AND 42.7% OF INDIVIDUALS ARE BELOW THE POVERY LEVEL BASED ON POPULATION ADN HOUSING DATA FROM 2005-2009.COMMUNITY BENEFIT PATIENT SERVICESTHE HOSPITAL OPERATES A NUMBER OF HEALTH SERVICES AT A LOSS FOR THE GOOD OF THE HEALTH, SAFETY AND WELFARE OF OUR PATIENTS AND COMMUNITY. KCH FOCUSED ON THE FOLLOWING COMMUNITY HEALTH NEEDS FOR THE FISCAL YEAR ENDED APRIL 30, 2011:* THE PREVALENCE OF OBESITY IN CHILDREN AND ADULTS* ACCESS TO AFFORDABLE PRIMARY HELTH CARE IN THE DEKALB/SYCAMORE AREA AND OUTLYING RURAL AREA* OUTPATIENT BEHAVIORLA HEALTH SERVICES AT BOTH HOSPITALS* TYPE II DIABETES * CARDIOVASCULAR DISEASE AND ADEQUATE HOSPITAL-BASED AND COMMUNITY OUTREACH SERVICES * CANCER CARE SERVICES, EDUCATION AND PREVENTION * AFFORDABLE ACCESS TO CHILDBIRTH EDUCATION AND OB HOSPITAL SERVICES* OTHER COMMUNITY OUTREACH AND WELLNESS SERVICES.EACH OF THESE INITIATIVES IS SUMMARIZED BELOW:FY 2011 COMMUNITY WELLNESS OBESITY INITIATIVECOMMUNITY WELLNESS INITIATIVE IS TO DECREASE OBESITY AND THE CHRONIC DISEASES ASSOCIATED WITH IT BY OFFERING TARGETED WELLNESS PROGRAMS AND PREVENTATIVE SCREENINGS TO HELP OUR COMMUNITY GET WELL AND STAY WELL. CURRENT PROGRAMS INCLUDE:* KNOW YOUR NUMBERS EVENTS * ONGOING WELLNESS PROGRAMS: MANAGING YOUR CHOLESTEROL WITH TLC. FREE BLOOD PRESSURE CLINICS. TIME TO QUIT TOBACCO.* WELLNESS FOR KIDS PROGRAMS* "WE CAN" PROGRAM: DEVELOPED BY THE NATIONAL INSTITUTES OF HEALTH TO HELP PARENTS / FAMILIES ADDRESS THE ISSUE OF OVERWEIGHT CHILDREN (AGES 8 - 13) THROUGH NUTRITION, FITNESS AND REDUCED SCREEN TIME* CATCH (COORDINATED APPROACH TO CHILD HEALTH): TO CREATE BEHAVIORAL AND ENVIRONMENTAL CHANGE TO IMPROVE NUTRITION, PHYSICAL ACTIVITY AND REDUCE SCREEN TIME TO DECREASE OBESITY RATES; DEVELOPED BY THE CENTERS FOR DISEASE CONTROL.* WEIGHT NO MORE WITH THE YMCA: WELLNESS PRESENTATIONS AND FITNESS CLASSES OFFERED TWICE A YEARACCESS TO AFFORDABLE PRIMARY CARE. NEW PHYSICIANS WHO RECEIVE RECRUITMENT ASSISTANCE ARE REQUIRED TO ACCEPT MEDICAID PATIENTS. OUTPATIENT BEHAVIORAL HEALTHDURING FY 11, OUTPATIENT BEHAVIORAL HEALTH SERVICES WERE EXPANDED TO SISTER HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL IN SANDWICH. FOR KISH HOSPITAL PRIMARY MARKET, A LARGER OFFICE SUITE OPENED IN SYCAMORE. THERE WERE MORE THAN 3,700 BEHAVIORAL HEALTH PATIENT VISITS, A 44% INCREASE OVER THE PREVIOUS YEAR. AT THE SYCAMORE LOCATION, ONE OF THE CENTER'S TWO PSYCHIATRISTS EXPANDED OFFICE HOURS, BILINGUAL EMPLOYEE ASSISTANCE PROGRAM SERVICES WERE ADDED, AND SPECIALIZED SERVICES FOR CHILDREN WERE EXPANDED. THE MOVE TO NEW OFFICE SPACE ALSO FACILITATED A COLLABORATIVE RELATIONSHIP WITH ANOTHER TENANT, ALEXIAN BROTHERS BEHAVIORAL HEALTH FROM HOFFMAN ESTATES, WHICH IS PROVIDING INTENSIVE OUTPATIENT TREATMENT FOR ADULTS IN THE AREA OF EATING DISORDERS AND OBSESSIVE COMPULSIVE DISORDER.TYPE II DIABETESTO ADDRESS THE PREVALENCE OF DIABETES IN THE ADULT POPULATION, THE HOSPITAL CONTINUED TO OPERATE A DIABETES EDUCATION CENTERS AND RURAL SATELLITE SERVICES AT KISHHEALTH FAMILY & SPECIALTY CARE IN GENOA AND WATERMAN. THE KISH DIABETES EDUCATION CENTER HAD 6,777 CONSULTATIONS, A 5.3% DECREASE FROM THE PREVIOUS YEAR.CARDIOVASCULAR DISEASE AND HOSPITAL-BASED AND COMMUNITY OUTREACH SERVICES ACCORDING TO THE SYSTEM'S 2009 COMMUNITY HEALTH STATUS TELEPHONE SURVEY, MORE THAN 80% OF THE ADULT POPULATION IN THE KCH MARKET AND HAVE ONE OR MORE CARDIOVASCULAR RISK FACTORS OR BEHAVIORS, SUCH AS HIGH BLOOD PRESSURE, HIGH CHOLESTEROL OR SMOKE. COMMUNITY BENEFIT ACTIVITIES IN FY 11 THAT PROMOTED CARDIOVASCULAR HEALTH WERE: * GO RED FOR WOMEN CAMPAIGN IN PARTNERSHIP WITH THE AMERICAN HEART ASSOCIATION: LUNCHEON IN MAY ATTENDED BY 150 PEOPLE. BUSINESS LEADER BREAKFAST IN APRIL, ATTENDED BY 50.* WOMEN'S HEALTH EVENT IN FEBRUARY ATTENDED BY 750* KNOW YOUR NUMBERS CAMPAIGN DURING THE SUMMER/FALL OF 2010* NUMEROUS COMMUNITY WELLNESS PROGRAMS AND CLASSESCANCER CARE SERVICES, EDUCATION AND PREVENTION * OPEN HOUSE FOR THE NEW CANCER CENTER AT KISHWAUKEE COMMUNITY HOSPITAL ATTENDED BY SEVERAL HUNDRED* SPACE PROVIDED FOR AMERICAN CANCER SOCIETY RESOURCE LIBRARY AT THE NEW CANCER CENTER OPEN TO THE PUBLIC* FINANCIAL SUPPORT OF AMERICAN CANCER SOCIETY RELAYS FOR LIFE FOR DEKALB COUNTY AND LOWER FOX VALLEY (KENDALL COUNTY)* FREE SUPPORT GROUPS INCLUDING GARDEN THERAPY, MEN AND WOMEN NETWORKING, CAREGIVER SUPPORT* PROVIDED FREE SKIN CANCER SCREENING AT WOMEN'S HEALTH EVENT* PROVIDED BREAST CANCER AWARENESS BOOTH AT SYCAMORE'S LADIES NIGHT OUTAFFORDABLE ACCESS TO CHILDBIRTH EDUCATION AND OB HOSPITAL SERVICES* 672 TUITION WAIVERS FOR INFANT AND CHILDBIRTH CLASSES FOR CLIENTS OF THE DEKALB COUNTY HEALTH DEPARTMENT IN THE WIC PROGRAM AND HEALTHY MOMS/HEALTHY KIDS PROGRAM.* FREE PREPARED CHILDBIRTH CLASSES FOR YOUNG MOMS* MONTHLY MOMS BREASTFEEDING SUPPORT GROUP LED BY A LACTATION COUNSELOR * FREE POST PARTUM VISITS FOR NEW MOMS* BEGAN PLANNING FOR LACTATION CENTEROTHER COMMUNITY OUTREACH AND WELLNESS EFFORTS* FREE SAFE SITTER PROGRAM FOR 24 STUDENTS IN THE SYCAMORE SPARTAN REACH, A PROGRAM FOR CHILDREN WHO RECEIVE EITHER REDUCED OR FREE LUNCHES.* COMMUNITY WELLNESS EDUCATORS TAUGHT HEALTH TOPICS IN AREA SCHOOLS: 477 CLASSROOMS TOUCHING 12,048 STUDENTS.* COMMUNITY WELLNESS EDUCATORS SERVED ON THE FOLLOWING COMMITTEES TO PROMOTE HEALTH AND WELLNESS: DEKALB LEADERSHIP ACADEMY, CO-COACH / PIONEERING HEALTHY COMMUNITIES, SYCAMORE SCHOOL DISTRICT WELLNESS COMMITTEE, DEKALB SCHOOL DISTRICT WELLNESS COMMITTEE AND SCHOOL LUNCH AND COMMUNITY OUTREACH SUB-COMMITTEES, LATINO ACTION GROUP, GO RED LUNCHEON COMMITTEE,CANCER COMMITTEE, * FREE AND LOW COST FITNESS AND INJURY PREVENTION CLASSES THROUGH UNLIMITED PERFORMANCE REHABILITATION AND SPORTS MEDICINE.* SPONSORED ANNUAL FITFEST, A WALKING EVENT WITH THE KISHWAUKEE FAMILY YMCA TO PROMOTE EMPLOYEE HEALTH AND FITNESS DAY TO AREA EMPLOYERS. ATTENDED BY 400.* PUBLISHED A COMMUNITY WELLNESS MAGAZINE THREE TIMES A YEAR PROVIDING INFORMATION ABOUT PROGRAMS, FREE SCREENINGS, AND GENERAL HEALTH TIPS.OPERATIONAL COMMUNITY BENEFITCHARITY CARE* AS PART OF ITS CHARITABLE MISSION, FREE AND DISCOUNTED CARE PROVIDED, INCLUDING ACCESS TO PHARMACEUTICAL ASSISTANCE FOR PATIENTS WHO MET THE ELIGIBILITY CRITERIA ESTABLISHED IN ITS FINANCIAL ASSISTANCE POLICY. THE POLICY IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY. THE LAST REVIEW WAS APRIL 2011.* ADHERED TO THE REQUIREMENTS OF THE HOSPITAL UNINSURED PATIENT DISCOUNT ACT OF 2009, PROVIDING UNINSURED PATIENTS DISCOUNTS WHEN FAMILY INCOME IS AT OR BELOW 600% OF THE FEDERAL POVERTY LEVEL FOR KISHWAUKEE COMMUNITY HOSPITAL, 300% OF THE FEDERAL POVERTY LEVEL FOR VALLEY WEST COMMUNITY HOSPITAL.* COORDINATED WITH THE ILLINOIS BREAST AND CERVICAL CANCER PROGRAM FOR ASSISTANCE WITH BREAST AND CERVICAL CANCER SCREENINGS AND TREATMENT.SUBSIDIZED HEALTH SERVICESA NUMBER OF PROGRAMS AND SERVICES WERE OPERATED AT A LOSS, BUT WERE SUBSIDIZED BECAUSE THEY IMPROVE THE HEALTH AND SAFETY OF THE COMMUNITY. MANY ORGANIZATIONS ALSO RECEIVED CASH AND IN KIND DONATIONS.	Description
Total Program Service Expense	128532470	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	1	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	1	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	1	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	136	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	1136	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	1	QuidProQuoContributions
Quid Pro Quo Disclosure	0	QuidProQuoDisclosure
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	3	NbrVotingGoverningBodyMembers
Number Independent Voting Members	2	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	1	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	IL	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	PHILLIP JOHNSON DIR OF ACCTG	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	8157561521	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	ONE KISH HOSPITAL DRIVE	AddressLine1
City	DEKALB	City
State	IL	State
ZIP Code	60115	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
MICHAEL MOONEY
CHAIR	2.00	X	X	0	0	0
MICHAEL CULLEN
VICE CHAIR	2.00	X	X	0	0	0
KEVIN POORTEN
PRESIDENT & CEO, KHS	30.00	X	X	0	918469	100377
LOREN FOELSKE
VP FINANCE	10.00		X	0	303588	39563
BRAD COPPLE
PRESIDENT - KCH & VWCH	20.00			0	341357	39811	X
PAM DUFFY
VP PATIENT CARE	20.00			0	234689	26496	X
JOE DANT
VP DEVELOPMENT	20.00			0	258586	39499	X
MIKE KOKOTT
ASST VP - MARKETING	10.00			0	193903	22972	X
ROGER HEATH BELL
VP - CHIEF INFORMATION OFF	15.00			0	216841	37445	X
DR MICHAEL KULISZ
CHIEF MEDICAL OFFICER	20.00			0	204758	20414	X
MARK THATE
VP - HUMAN RESOURCES	20.00			0	179403	27847	X
CHERYL FISHER
ASST VP - PATIENT CARE	20.00			0	136108	30631	X
THOMAS W TILTON DO
OPTHAMOLOGIST	45.00			457022	0	39793		X
RON C LUBCKE
DIRECTOR OF PHARMACY	40.00			134714	0	18342		X
KENYA M WILLIAMS MD
OPTHAMOLOGIST	40.00			242011	0	23954		X
JASMEET DHALIWAL
OPTHAMOLOGIST	40.00			477103	0	20326		X
ANJU VOHRA
LEAD CARDIAC SONOGRAPHER	40.00			158138	0	20053		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1468988	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	2851594	TotalReportableCompFrmRltdOrgs
Total Other Compensation	476892	TotalOtherCompensation
Number Individuals GT100 K	29	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
POWER CONSTRUCTION COMPANY LLC
2360 NORTH PALMER DRIVE	SCHAUMBURG	IL	60173	CONSTRUCTION SERVICES	11652165
KISHHEALTH SYSTEM
ONE KISH HOSPITAL DRIVE	DEKALB	IL	60115	MANAGEMENT SERVICES	11135722
DOCTORS OF EMERGENCY MEDICINE
2807 BRITTANY COURT	ST CHARLES	IL	60175	ER	6557328
SABET SIDDIQUI MDPC
6925 ERROL COURT	CHERRY VALLEY	IL	61016	PHYSICAN - CANCER CARE CENTER	1700000
SODEXO INC & AFFILIATES
4880 PAYSPHERE CIRCLE	CHICAGO	IL	60674	FOOD SERVICES	1370122

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	30	NumberOfContractorsGT100K
Membership Dues	950	MembershipDues
Fundraising Events	40771	FundraisingEvents
Related Organizations	1030699	RelatedOrganizations
Government Grants	34267	GovernmentGrants
All Other Contributions	7236	AllOtherContributions
Noncash Contributions	15758	NoncashContributions
Total Contributions	1113923	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE RE	621110	163782199	163678774	103425
AFFILIATED RENTAL INCO	621610	52446	52446

Field	Value	IRS element (for citing)
Total Program Service Revenue	163834645	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	4563748	TotalRevenueColumn
Exclusion	$4,563,748	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	179278	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	207570	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	-28292	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	-28292	TotalRevenueColumn
Exclusion	-$28,292	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	21996108	Securities
Other	20283	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	23596108	Securities
Other	17683	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	-1600000	Securities
Other	2600	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-1597400	TotalRevenueColumn
Exclusion	-$1,597,400	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	40727	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	40771	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	22871	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	17856	TotalRevenueColumn
Exclusion	$17,856	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	111847	GrossSalesOfInventory
Cost Of Goods Sold	70616	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	41231	TotalRevenueColumn
Exclusion	$41,231	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA SALES	621110	671700	657365	14335
INCOME PASSTHROUGH - K	621110	618461	618461
DISCOUNTS AND REBATES	621110	260678	260678

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	222164	TotalRevenueColumn
Related Or Exempt Function Income	198144	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	24020	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Other Revenue	1773003	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	169718714	TotalRevenueColumn
Related Or Exempt Function Income	165465868	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	141780	UnrelatedBusinessRevenue
Exclusion	$2,997,143	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	975868	Total
Program Services	975868	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	23400	Total
Program Services	23400	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	40758604	Total
Program Services	39183853	ProgramServices
Management And General	1574751	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	2324647	Total
Program Services	2234832	ProgramServices
Management And General	89815	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	10668658	Total
Program Services	10256757	ProgramServices
Management And General	411901	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	2974810	Total
Program Services	2859875	ProgramServices
Management And General	114935	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	11135722	Total
Management And General	11135722	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	202275	Total
Management And General	202275	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	4512	Total
Management And General	4512	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	431158	Total
Management And General	431158	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	17727299	Total
Program Services	16211821	ProgramServices
Management And General	1515478	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	902557	Total
Program Services	82150	ProgramServices
Management And General	820407	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	22672615	Total
Program Services	21891120	ProgramServices
Management And General	777338	ManagementAndGeneral
Fundraising	4157	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	1747972	Total
Program Services	481037	ProgramServices
Management And General	1266935	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	3356192	Total
Program Services	3316678	ProgramServices
Management And General	39514	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	171777	Total
Program Services	152827	ProgramServices
Management And General	18950	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	7490	Total
Program Services	7490	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	3591700	Total
Management And General	3591700	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	9934236	Total
Program Services	9934236	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	3028235	Total
Program Services	1073019	ProgramServices
Management And General	1955216	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral	Program ServicesProgramServices
UNRELATED BUSINESS INCO	7045	7045
BAD DEBT EXPENSE	11210035		11210035
PHYSICAN FEES	3347646		3347646
PHYSICIAN RECRUITMENT	3127261		3127261
FEDERAL AND STATE ASSES	2063616		2063616

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1021530	Total
Program Services	98949	ProgramServices
Management And General	921160	ManagementAndGeneral
Fundraising	1421	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	153416860	Total
Program Services	128532470	ProgramServices
Management And General	24878812	ManagementAndGeneral
Fundraising	5578	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	7816993	BOY
EOY	6499149	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	653378	BOY
EOY	279934	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	22393791	BOY
EOY	25341679	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	3088963	BOY
EOY	3529110	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	2271599	BOY
EOY	2061173	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	159479787	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	54658407	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	95545088	BOY
EOY	104821380	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	85746795	BOY
EOY	104528505	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	22067417	BOY
EOY	22243230	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	9012335	BOY
EOY	8764722	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	248596359	BOY
EOY	278068882	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	11813777	BOY
EOY	13418274	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	156389	BOY
EOY	945417	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	63685000	BOY
EOY	63685000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	230016	BOY
EOY	1245941	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	17146875	BOY
EOY	21934667	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	93032057	BOY
EOY	101229299	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	150907951	BOY
EOY	172416577	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	4656351	BOY
EOY	4423006	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	155564302	BOY
EOY	176839583	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	248596359	BOY
EOY	278068882	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	16301854	ReconcilationRevenueExpenses
Reconcilation Other Changes	4973427	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	1	DirectContactLegislators
Direct Contact Legislators	$0	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$22,624	OtherActivitiesAmount
Total Lobbying Expenditures IIB	22624	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	EXPLANATION OF OTHER LOBBYING ACTIVITIES:	Identifier
Return Reference	PART II-B, LINE 1I:	ReturnReference
Explanation	LOBBYING EXPENSES ARE ALLOCATED THROUGH MEMBERSHIP DUES WITH ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. NO OTHER LOBBYING ACTIVITIES WERE CONDUCTED.	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4110685	OtherCostOrOtherBasis
Book Value	4110685	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	93721369	OtherCostOrOtherBasis
Depreciation	18945921	Depreciation
Book Value	74775448	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	554682	OtherCostOrOtherBasis
Depreciation	85302	Depreciation
Book Value	469380	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	46120556	OtherCostOrOtherBasis
Depreciation	33167524	Depreciation
Book Value	12953032	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	14972495	OtherCostOrOtherBasis
Depreciation	2459660	Depreciation
Book Value	12512835	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	104821380	TotalOfBookValueLandBuildings

Closely Held Equity Interests CloselyHeldEquityInterests

Field	Value	IRS element (for citing)
Book Value	2107306	BookValue
Method Of Valuation	C	MethodOfValuation

Other Securities OtherSecurities (3 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
CASH EQUIVALENTS	7471986	F
ACCRUED INTEREST	413670	F
CERTIFICATES OF DEPOSIT	12250268	F

Field	Value	IRS element (for citing)
Total Of Book Value Securities	22243230	TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescription	AmountAmount
THIRD PARTY PAYABLES	$14,538,082
DUE TO AFFILIATES	$1,695,903
ACCRUED INTEREST PAYABLE	$310,133
OTHER PAYABLES - LONG TERM	$5,390,549

Field	Value	IRS element (for citing)
Total Of Amounts	21934667	TotalOfAmounts
Total Revenue	169718714	TotalRevenue
Total Expenses	153416860	TotalExpenses
Excess Or Deficit For Year	16301854	ExcessOrDeficitForYear
Net Unrealized GL On Investments	7085798	NetUnrealizedGLOnInvestments
Other	-$2,112,371	OtherAmount
Total Adjustments	4973427	TotalAdjustments
Excess Or Deficit Per FS	21275281	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	179400022	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	7085798	NetUnrealizedGainsInvestments
Other Revenues	3758067	OtherRevenues
Revenue Not Rptd F990	10843865	RevenueNotRptdF990
Revenue Subtotal	168556157	RevenueSubtotal
Other Revenues Not Included	1162557	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	1162557	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	169718714	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	156319098	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	3758077	OtherExpensesIncluded
Expenses Not Rptd F990	3758077	ExpensesNotRptdF990
Expenses Subtotal	152561021	ExpensesSubtotal
Other Expenses Not Included	855839	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	855839	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	153416860	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifier	ExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:	EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM -1,880,000. CHANGE OF INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION -100,514. BOOK/TAX DIFFERENCES IN K-1 PASSTHROUGH ENTITIES -101,198. GRANT REVENUE INCLUDED IN FIXED ASSETS FOR FINANCIAL STATEMENT PURPOSES -30,659.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RECLASSIFICATION TO EXPENSES 3,758,067.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - KISH AREA PHO 67. CONTRIBUTION REVENUE FROM KISHHEALTH FOUNDATION 1,030,699. BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - MIDLAND SURGICAL 101,132. GRANT REVENUE INCLUDED IN FIXED ASSETS FOR FINANCIAL STATEMENT PURPOSES 30,659.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:	RECLASSIFICATION FROM REVENUE 3,758,067. ROUNDING 10.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:	CONTRIBUTION TO KISHHEALTH FOUNDATION 855,839.
	PART XI, LINE 10, EXCESS OR (DEFICIT) FOR THE YEAR PER FINANCIAL STATEMENTS: LINE 10 IDENTIFIES FINANCIAL STATEMENT INCOME AS EQUALING $21,275,281. FINANCIAL STATEMENT INCOME IS ACTUALLY $23,080,924. THE DIFFERENCE RELATES TO THE FOLLOWING ITEMS: 1. KISHWAUKEE COMMUNITY HOSPITAL MADE A CAPITAL DISTRIBUTION OF $1,880,000 TO ITS PARENT ORGANIZATION, KISHHEALTH SYSTEM. 2. KISHHEALTH FOUNDATION (KHF), AN AFFILIATED ENTITY, RECEIVES CONTRIBUTIONS DESIGNATED FOR USE BY KISHWAUKEE COMMUNITY HOSPITAL. THIS IS ALLOCATED TO KISHWAUKEE COMMUNITY HOSPITAL, VIA AN ENTRY TO INCREASE KISHWAUKEE COMMUNITY HOSPITAL'S INTEREST IN THE ASSETS OF KHF. A CORRESPONDING EQUITY ENTRY IS MADE ON KISHWAUKEE COMMUNITY HOSPITAL'S GENERAL LEDGER. THE CURRENT YEAR DECREASE WAS $96,459. 3. KCH RECEIVED CONTRIBUTIONS FROM AFFILIATES (KHF) IN THE AMOUNT OF $1,026,644 AND MADE CONTRIBUTIONS TO AFFILIATES IN THE AMOUNT OF $855,839. THESE ADJUSTMENTS WERE REFLECTED AS EQUITY TRANSACTIONS FOR FINANCIAL STATEMENT PURPOSES. 6. THERE IS A ROUNDING ADJUSTMENT OF $11

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	ANNUAL SCHOLARSHIP BALL	NameOfEvent1
Gross Receipts Event1	81498	GrossReceiptsEvent1
Charitable Contributions Event1	40771	CharitableContributionsEvent1
Gross Revenue Event1	40727	GrossRevenueEvent1
Food And Beverage Event1	15963	FoodAndBeverageEvent1
Entertainment Event1	2500	EntertainmentEvent1
Other Direct Expenses Event1	4408	OtherDirectExpensesEvent1
Gross Receipts Total	81498	GrossReceiptsTotal
Charitable Contributions Total	40771	CharitableContributionsTotal
Gross Revenue Total Events	40727	GrossRevenueTotalEvents
Food And Beverage Total Events	15963	FoodAndBeverageTotalEvents
Entertainment Total Events	2500	EntertainmentTotalEvents
Other Direct Expenses Total Events	4408	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	22871	DirectExpenseSummaryEvents
Net Income Summary	17856	NetIncomeSummary

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	600.000000000000	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4930972	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2041416	DirectOffsettingRevenue
Net Community Benefit Expense	2889556	NetCommunityBenefitExpense
Percent Of Total Expense	0.02030	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	15454005	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9931068	DirectOffsettingRevenue
Net Community Benefit Expense	5522937	NetCommunityBenefitExpense
Percent Of Total Expense	0.03880	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	20384977	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11972484	DirectOffsettingRevenue
Net Community Benefit Expense	8412493	NetCommunityBenefitExpense
Percent Of Total Expense	0.05910	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	6665130	TotalCommunityBenefitExpense
Direct Offsetting Revenue	540568	DirectOffsettingRevenue
Net Community Benefit Expense	6124562	NetCommunityBenefitExpense
Percent Of Total Expense	0.04310	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1376232	TotalCommunityBenefitExpense
Direct Offsetting Revenue	20348	DirectOffsettingRevenue
Net Community Benefit Expense	1355884	NetCommunityBenefitExpense
Percent Of Total Expense	0.00950	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	875853	TotalCommunityBenefitExpense
Direct Offsetting Revenue	218863	DirectOffsettingRevenue
Net Community Benefit Expense	656990	NetCommunityBenefitExpense
Percent Of Total Expense	0.00460	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	376091	TotalCommunityBenefitExpense
Net Community Benefit Expense	376091	NetCommunityBenefitExpense
Percent Of Total Expense	0.00260	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	9293306	TotalCommunityBenefitExpense
Direct Offsetting Revenue	779779	DirectOffsettingRevenue
Net Community Benefit Expense	8513527	NetCommunityBenefitExpense
Percent Of Total Expense	0.05980	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	29678283	TotalCommunityBenefitExpense
Direct Offsetting Revenue	12752263	DirectOffsettingRevenue
Net Community Benefit Expense	16926020	NetCommunityBenefitExpense
Percent Of Total Expense	0.11890	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$4,016,221	BadDebtExpenseAmount
Amount Attributable To	682758	AmountAttributableTo
Amount Reimbursed By Medicare	33036390	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	51759695	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-18723305	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	1 MIDLAND SURGICAL CENTER (MSC)	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	AMBULATORY SURGERY	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.77500	OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership	0.00000	OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership	0.00000	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	KISHWAUKEE COMMUNITY HOSPITAL	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	ONE KISH HOSPITAL DRIVE	AddressLine1
City	DEKALB	City
State	IL	State
ZIP Code	60115	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	NOT REQUIRED	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
PART I, LINE 7, COLUMN (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 $ 11210035.
PART II: NO COMMUNITY BUILDING ACTIVITIES ARE REPORTED IN PART II.
PART III, LINE 4: NET PATIENT SERVICE REVENUETHE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYORS WHICH PROVIDE FOR REIMBURSEMENT TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. CONTRACTUAL ADJUSTMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS REPRESENT THE DIFFERENCE BETWEEN THE HOSPITAL'S BILLINGS AT LIST PRICE AND THE AMOUNTS REIMBURSED BY MEDICARE, MEDICAID, BLUE CROSS, AND CERTAIN OTHER THIRD-PARTY PAYORS; AND ANY DIFFERENCES BETWEEN ESTIMATED THIRD-PARTY REIMBURSEMENT SETTLEMENTS FOR PRIOR YEARS AND SUBSEQUENT FINAL SETTLEMENTS. CONTRACTUAL ADJUSTMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. A SUMMARY OF THE BASIS OF REIMBURSEMENT WITH MAJOR THIRD-PARTY PAYORS FOLLOWS:MEDICARE: KISHWAUKEE COMMUNITY HOSPITAL (KCH) IS PAID FOR INPATIENT ACUTE CARE AND OUTPATIENT CARE SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARY UNDER PROSPECTIVELY DETERMINED RATES PER DISCHARGE (PROSPECTIVE PAYMENT SYSTEMS). THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. THE HOSPITAL'S CLASSIFICATION OF PATIENTS UNDER PROSPECTIVE PAYMENT SYSTEMS AND THE APPROPRIATENESS OF THE PATIENT'S ADMISSIONS ARE SUBJECT TO VALIDATION REVIEWS. THE HOSPITAL IS REIMBURSED FOR COST REIMBURSABLE ITEMS AT TENTATIVE RATES WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL REIMBURSEMENT REPORTS BY THE HOSPITAL AND AUDITS BY THE MEDICARE FISCAL INTERMEDIARY. THE HOSPITAL'S CLASSIFICATION OF PATIENTS UNDER THE MEDICARE PROGRAM AND THE APPROPRIATENESS OF THEIR ADMISSION ARE SUBJECT TO AN INDEPENDENT REVIEW BY A PEER REVIEW ORGANIZATION. CHANGES AS A RESULT OF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES IMPLEMENTATION OF THE PROVISIONS OF THE FUTURE MEDICARE LEGISLATION MAY HAVE AN ADVERSE EFFECT ON THE HOSPITAL'S NET PATIENT SERVICE REVENUE.LAWS AND REGULATIONS GOVERNING THE MEDICARE PROGRAM ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION. AS A RESULT,THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR-TERM.MEDICAID: THE HOSPITAL IS REIMBURSED AT PROSPECTIVELY DETERMINED RATES FOR EACH MEDICAID INPATIENT DISCHARGE. OUTPATIENT SERVICES ARE REIMBURSED BASED ON ESTABLISHED FEE SCREENS. FOR INPATIENT ACUTE CARE SERVICES, PAYMENT RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. THE PROSPECTIVELY DETERMINED RATES ARE NOT SUBJECT TO RETROACTIVE ADJUSTMENT. THE HOSPITAL ALSO RECEIVES INCREMENTAL MEDICAID REIMBURSEMENT FOR SPECIFIC PROGRAMS AND SERVICES AT THE DISCRETION OF THE STATE OF ILLINOIS MEDICAID PROGRAM. MEDICAID REIMBURSEMENT MAY BE SUBJECT TO PERIODIC ADJUSTMENT, AS WELL AS TO CHANGES IN EXISTING PAYMENT LEVELS AND RATES, BASED ON THE AMOUNT OF FUNDING AVAILABLE TO THE MEDICAID PROGRAM.LAWS AND REGULATIONS GOVERNING THE MEDICAID PROGRAM ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR-TERM.IN DECEMBER 2004, THE FEDERAL CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) APPROVED STATEOF ILLINOIS (STATE) LEGISLATION FOR A MEDICAID HOSPITAL ASSESSMENT PROGRAM (PROGRAM). UNDER THE PROGRAM, THE HOSPITAL RECEIVES ADDITIONAL MEDICAID REIMBURSEMENT FROM THE STATE AND PAYS ARELATED ASSESSMENT TAX. THE PROGRAM HAS BEEN EXTENDED THROUGH JUNE 30, 2013. BLUE CROSS: THE HOSPITAL ALSO PARTICIPATES AS A PROVIDER OF HEALTH CARE SERVICES UNDER A REIMBURSEMENT AGREEMENT WITH BLUE CROSS. THE PROVISIONS OF THIS AGREEMENT STIPULATE THAT INPATIENT SERVICES WILL BE REIMBURSED AT A TENTATIVE REIMBURSEMENT RATE AND THAT FINAL REIMBURSEMENT FOR THESE SERVICES IS DETERMINED AFTER THE SUBMISSION OF AN ANNUAL COST REPORT BY THE HOSPITAL AND A REVIEW BY BLUE CROSS. MANAGED CARE ORGANIZATIONS: THE HOSPITAL HAS ALSO ENTERED INTO REIMBURSEMENT AGREEMENTS WITH CERTAIN COMMERCIAL INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS, AND PREFERRED PROVIDER ORGANIZATIONS. THE BASIS FOR PAYMENT UNDER THESE AGREEMENTS INCLUDES DISCOUNTS FROMESTABLISHED CHARGES AND PROSPECTIVELY DETERMINED PER DIEM RATES.INTERNAL REVENUE SERVICE WORKSHEET 2 (PER SCHEDULE H INSTRUCTIONS) WAS UTILIZED TO DETERMINE THE COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS. 20% OF THE ORGANIZATION'S BAD DEBT EXPENSE WAS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY.
PART III, LINE 8: FOR THE 4/30/11 FISCAL YEAR, KCH PROVIDED BILLED CHARGES TO MEDICARE PATIENTS TOTALING $150,000,000. HOWEVER, DUE TO THE MEDICARE INPATIENT AND OUTPATIENT PAYMENT METHODOLOGIES, THE ACTUAL CASH PAYMENTS RECEIVED FROM PROVIDING CARE TO THOSE PATIENTS WAS JUST $33,036,390, OR 22% OF BILLED CHARGES. THE COST OF PROVIDING THIS CARE, PER THE MEDICARE COST REPORT, WAS $51,759,695. THUS, THE PAYMENTS RECEIVED FROM MEDICARE WERE $18,723,305 LESS THAN COST, OR 64% OF COST. TRULY THIS $18,723,305 SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. AS APPROXIMATELY 46% OF ALL KISHWAUKEE COMMUNITY HOSPITAL CHARGES GENERATED ARE FROM MEDICARE PATIENTS, THIS SHORTFALL PLACES A TREMENDOUS FINANCIAL BURDEN ON OUR HOSPITAL.KISHWAUKEE COMMUNITY HOSPITAL, LIKE OTHER NOT-FOR-PROFIT HOSPITALS, MUST ACCEPT MEDICARE PAYMENTS AS PAYMENT IN FULL FOR SERVICES PROVIDED, WITH THE EXCEPTION OF COLLECTING ON DEDUCTIBLES AND CO-INSURANCE AMOUNTS. HOSPITALS CANNOT BILL MEDICARE PATIENTS FOR THE DIFFERENCE BETWEEN THE BILLED CHARGES AND MEDICARE PAYMENTS.KISHWAUKEE COMMUNITY HOSPITAL PROVIDES SERVICES TO ALL PATIENTS WHO NEED CARE, ABIDING BY THE FEDERAL EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) REGULATION. IT REQUIRES HOSPITALS AND AMBULANCE SERVICES TO PROVIDE CARE TO ANYONE NEEDING EMERGENCY HEALTHCARE TREATMENT REGARDLESS OF CITIZENSHIP, LEGAL STATUS OR ABILITY TO PAY.KCH UTILIZED THE CALCULATION OF MEDICARE COST FROM THE ANNUAL MEDICARE COST REPORT. THIS APPROACH ALLOCATES COST FROM NON REVENUE PRODUCING DEPARTMENTS TO THE REVENUE GENERATING DEPARTMENTS, BASED ON STEP DOWN STATISTICAL COST FINDING. WHILE NOT AS COMPREHENSIVE AS A TRUE COST ACCOUNTING SYSTEM, THIS PROCESS RESULTS IN AN ACCEPTABLE BASIS OF THE DEPARTMENTAL COST FOR PROVIDING SERVICES. RECALL THAT PRIOR TO MEDICARE PROSPECTIVE PAYMENT SYSTEM (PPS), THIS METHODOLOGY WAS THE BASIS FOR THE REIMBURSEMENT TO HOSPITALS.
PART III, LINE 9B: COLLECTION ACTIONS INVOLVING UNINSURED PATIENTS. KHS (KISHHEALTH SYSTEM, PARENT ORGANIZATION OF KISHWAUKEE COMMUNITY HOSPITAL) SHALL NOT PURSUE A COLLECTION ACTION AGAINST AN UNINSURED PATIENT, UNLESS THE PATIENT HAS BEEN GIVEN THE OPPORTUNITY TO ASSESS THE ACCURACY OF THE BILL; APPLY FOR FINANCIAL ASSISTANCE UNDER THE KHS FINANCIAL ASSISTANCE POLICY AND PROCEDURE; AND AVAIL HIMSELF OR HERSELF OF A REASONABLE PAYMENT PLAN. NOTWITHSTANDING THIS, KHS MAY NOT PURSUE THE COLLECTION ACTION UNDER THE FOLLOWING CIRCUMSTANCES: (A) IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT, UNTIL KHS HAS OFFERED THE PATIENT A PAYMENT PLAN. KHS MAY REQUIRE THE PATIENT TO PROVIDE REASONABLE VERIFICATION OF HIS OR HER INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT.(B) IF KHS HAS REASON TO BELIEVE THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, UNTIL KHS HAS GIVEN THE PATIENT AT LEAST 60 DAYS FOLLOWING THE DATE OF DISCHARGE OR RECEIPT OF OUTPATIENT CARE TO SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. (C) IF THE PATIENT HAS AGREED TO A PAYMENT PLAN, UNTIL THE PATIENT HAS FAILED TO MAKE PAYMENTS IN ACCORDANCE WITH THAT PAYMENT PLAN. (D) IF THE PATIENT INFORMS KHS THAT HE OR SHE HAS APPLIED FOR HEALTH CARE COVERAGE UNDER MEDICAID, KIDCARE, OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAM (AND THERE IS A REASONABLE BASIS TO BELIEVE THAT THE PATIENT WILL QUALIFY FOR SUCH PROGRAM), BUT THE PATIENT'S APPLICATION IS DENIED.
PART VI, LINE 2: KISHWAUKEE COMMUNITY HOSPITAL IDENTIFIES COMMUNITY HEALTH NEEDS IN SEVERAL WAYS:* DEKALB COUNTY HEALTH DEPARTMENT I-PLAN* COMMUNITY HEALTH NEEDS SURVEY* U.S. GOVERNMENT HEALTHY PEOPLE 2010 AND 2010 GUIDELINES* INTERNAL REVIEW OF OUTPATIENT AND INPATIENT TRENDS, ESPECIALLY EMERGENCY DEPARTMENT USAGE * INPUT FROM OTHER COMMUNITY PROVIDERS. THIS INCLUDES PROVIDING HOSPITAL LEADERS TO SERVE ON BOARDS AND COMMITTEES THAT DIRECTLY OR INDIRECTLY IMPACT COMMUNITY HEALTH OR HELP THE HOSPITAL CONNECT TO UNDERSERVED OR VULNERABLE POPULATIONS.
PART VI, LINE 3: INFORMATION IS PROVIDED AT REGISTRATION, VIA THE HOSPITAL WEBSITE, THROUGH CONSULTATIONS WITH FINANCIAL COUNSELORS FOR SOME ED AND OUTPATIENTS AS WELL AS INPATIENTS, DURING THE BILLING PROCESS ON STATEMENTS AND VIA PHONE CONVERSATIONS.
PART VI, LINE 4: KISHWAUKEE COMMUNITY HOSPITAL SERVES ALL OF DEKALB COUNTY, IL, AND BORDER COMMUNITIES IN KANE AND OGLE COUNTIES. POPULATION OF THE HOSPITAL'S SERVICE AREA, BASED ON 2010 CENSUS, IS 131,782. THIS GEOGRAPHIC AREA INCLUDES A GROWING HISPANIC POPULATION. A UNIQUE POPULATION IN OUR SERVICE AREA IS NORTHERN ILLINOIS UNIVERSITY STUDENTS (23,850 FALL 2010 ENROLLMENT), INCLUDING FOREIGN STUDENTS AND VISITORS. THE HISPANIC POPULATION IS EXPECTED TO GROW BY 22.62% BY 2016. ACCORDING TO THE AMERICAN COMMUNITY SURVEY, 29.5% OF FAMILIES AND 42.7% OF INDIVIDUALS ARE BELOW THE POVERTY LEVEL BASED ON POPULATION AND HOUSING DATA FROM 2005-2009.
PART VI, LINE 6: KISHWAUKEE COMMUNITY HOSPITAL IN DEKALB, IL, IS PART OF KISHHEALTH SYSTEM. THE HEALTH SYSTEM IS GOVERNED BY AN APPOINTED VOLUNTEER BOARD OF DIRECTORS, INDEPENDENT COMMUNITY LEADERS WHO RESIDE IN THE PRIMARY MARKETS SERVED BY THE HEALTH SYSTEM'S TWO HOSPITALS. THESE INDIVIDUALS ARE SELECTED FOR THE BOARD BECAUSE OF THEIR INTEREST AND EXPERTISE IN VARIOUS AREAS THAT CAN HELP MANAGEMENT CARRY OUT THE HEALTH SYSTEM'S MISSION. MEMBERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR TIME. THE MEDICAL STAFF IS OPEN TO PHYSICIANS WHO MEET CRITERIA ESTABLISHED BY THE MEDICAL STAFF BYLAWS. PHYSICIANS ARE GIVEN AND TAKE THE OPPORTUNITY TO VOLUNTEER TO DO FREE COMMUNITY WELLNESS PROGRAMS ON HEALTH TOPICS. SURPLUS FUNDS GO BACK INTO THE ORGANIZATION TO SUPPORT OPERATIONS, CAPITAL IMPROVEMENTS, THE HEALTH SYSTEM'S COMMITMENT TO EXCELLENCE, EDUCATION AND INNOVATION, AND TO PROVIDE MEDICAL CARE TO ALL REGARDLESS OF ABILITY TO PAY. A COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED IN THE FALL OF 2009, VIA A RANDOM TELEPHONE SURVEY. OUR COMMUNITY WELLNESS DEPARTMENT USED THE FINDINGS AS ONE COMPONENT OF ITS DECISION TO EMBARK ON A MULTI-YEAR INITIATIVE TO ADDRESS THE PREVALENCE OF OBESITY AMONG CHILDREN AND ADULTS IN OUR COMMUNITIES. (SEE SCHEDULE O OF THIS REPORT FOR DETAILS ABOUT COMMUNITY WELLNESS ACTIVITIES FOR FY 11). DURING FY 11, KISHHEALTH SYSTEM'S OUTPATIENT BEHAVIORAL HEALTH SERVICES WERE EXPANDED BY ADDING SERVICES AT VALLEY WEST COMMUNITY HOSPITAL IN SANDWICH AND MOVING TO A LARGER OFFICE SUITE IN SYCAMORE. THERE WERE MORE THAN 3,700 BEHAVIORAL HEALTH PATIENT VISITS, A 44% INCREASE OVER THE PREVIOUS YEAR. AT THE SYCAMORE LOCATION, ONE OF THE CENTERS TWO PSYCHIATRISTS EXPANDED OFFICE HOURS, BILINGUAL EMPLOYEE ASSISTANCE PROGRAM SERVICES WERE ADDED, AND SPECIALIZED SERVICES FOR CHILDREN WERE EXPANDED.FOR THE SECOND YEAR, THE HOSPITAL ALSO MADE A $25,000 GRANT TO THE COMMUNITY MENTAL HEALTH CENTER (BEN GORDON CENTER) TO HELP THE AGENCY BETTER MEET THE NEEDS OF THE MEDICAID AND UNINSURED POPULATION.THE HEALTH SYSTEM PLAYS A CRITICAL ROLE IN FINANCING AND MANAGING THE COMMUNITY CARES CLINIC, WHICH PROVIDES PRIMARY CARE TO THE UNINSURED AND UNDERINSURED, BOTH CHILDREN AND ADULTS. IN 2009, THE HEALTH SYSTEM PLEDGED $650,000 OVER THREE YEARS FOR THE OPERATION AND MANAGEMENT OF THE CLINIC. THE CLINIC IS A PARTNERSHIP AMONG KISHHEALTH SYSTEM, NORTHERN ILLINOIS UNIVERSITY AND PRIVATE DONORS, OVER THE PAST TWO YEARS, THE CLINIC HAS SEEN 4,136 PATIENTS AND HAD 11,658 VISITS. IT HAS PROVIDED HEALTHCARE FOR 804 PATIENTS WITHOUT INSURANCE AND FOR 1,866 CHILDREN ON PUBLIC AID FOR WHOM ACCESS TO CARE WAS PREVIOUSLY VERY LIMITED. DUE TO STATE FUNDING CUTS, THE CLINIC TOOK OVER THE RESPONSIBILITY OF PUBLIC AID WELL-CHILD VISITS PREVIOUSLY HANDLED BY THE DEKALB COUNTY HEALTH DEPARTMENT.
PART VI, LINE 7: KISHHEALTH SYSTEM MADE $120,000 IN CONTRIBUTIONS TO SEVERAL ORGANIZATIONS IN FY11, 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. OTHER GRANTS WERE MADE TO THE KISHWAUKEE (COMMUNITY COLLEGE) COLLEGE FOUNDATION TO SUPPORT AN ENDOWMENT FOR SCHOLARSHIPS IN HEALTH-RELATED FIELDS. OTHER MONETARY GIFTS SUPPORTED THE ECONOMIC HEALTH OF COMMUNITIES SERVED, SUCH AS DOWNTOWN DEKALB RENEWAL AND OTHER DEKALB COUNTY ECONOMIC DEVELOPMENT EFFORTS. HEALTH SYSTEM LEADERS SERVED ON NUMEROUS COMMUNITY BOARDS AND COMMITTEES, MOST NOTABLY THE COMMUNITY CARES CLINIC, VOLUNTARY ACTION CENTER, FAMILY SERVICE AGENCY, FOX VALLEY OLDER ADULT SERVICES, KISHWAUKEE UNITED WAY, AND KISHWAUKEE FAMILY YMCA, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND THE PLANO ECONOMIC DEVELOPMENT. IN ADDITION, HEALTH SYSTEM EMPLOYEES CONTRIBUTED MORE THAN 1,300 HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH, EDUCATION AND QUALITY OF LIFE. OTHER NON-PROFIT HEALTH SYSTEM ENTITIES THAT PROMOTE THE HEALTH OF THE COMMUNITY ARE VALLEY WEST COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL IN SANDWICH, IL; COMMUNITY CARES CLINIC, DEKALB, IL, A PRIMARY CARE CLINIC FOR MEDICAID AND UNINSURED; DEKALB COUNTY HOSPICE, DEKALB, IL, WHICH PROVIDES FREE CARE AND SUPPORT FOR THE TERMINALLY ILL AS WELL AS GRIEF SUPPORT TO THE PUBLIC; 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.
IL	REPORTS FILED WITH STATES	PART VI, LINE 7

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (9 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
AMERICAN CANCER SOCIETY - FOX VALLEY REGION
143 FIRST STREET	BATAVIA	IL	60510	131788491	501(C)(3)	10000	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO CANCER RESEARCH AND TREATMENT
AMERICAN HEART ASSOCIATION MIDWEST AFFILIATE
PO BOX 4002902	DES MOINES	IA	50340	135613797	501(C)(3)	20000	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO HEART HEALTH RESEARCH AND TREATMENT
KISHWAUKEE COLLEGE FOUNDATION
21193 MALTA ROAD	MALTA	IL	60150	237433949	501(C)(3)	18200	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO HEALTH EDUCATION
NORTHERN PUBLIC RADIO
801 N FIRST STREET	DEKALB	IL	60115	366086819	501(C)(3)	8517	TO PROVIDE CORPORATE SUPPORT OF PUBLIC RADIO
FAMILY SERVICE AGENCY
14 HEALTH SERVICES DRIVE	DEKALB	IL	60115	362360012	501(C)(3)	24000	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO FAMILY HEALTH SERVICES
DEKALB CHAMBER OF COMMERCE
164 E LINCOLN HWY	DEKALB	IL	60115	360981630	501(C)(3)	7000	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO COMMUNITY SERVICES
DEKALB COUNTY YOUTH SERVICE BUREAU
330 GROVE STREET	DEKALB	IL	60115	363034427	501(C)(3)	5000	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO YOUTH SERVICES
KISHWAUKEE UNITED WAY
PO BOX 311 115 N FIRST ST	DEKALB	IL	60115	366158489	501(C)(3)	11976	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO COMMUNITY SERVICES
KISHHEALTH FOUNDATION
ONE KISH HOSPITAL DRIVE	DEKALB	IL	60115	363649077	501(C)(3)	855839	TO PROVIDE FOR HEALTH SYSTEM ENDOWMENT

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	KISHWAUKEE COMMUNITY HOSPITAL AUXILIARY SCHOLARSHIP PROGRAM	TypeOfGrant
Number Of Recipients	11	NumberOfRecipients
Amount Of Cash Grant	23400	AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	Identifier
Return Reference	PART I, LINE 2:	ReturnReference
Explanation	SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MAINTAINS SPECIFIC POLICIES AND QUALIFICATIONS FOR ALL GRANTS AVAILABLE. APPLICANTS MUST APPLY FOR THE RESPECTIVE GRANT AND BE APPROVED BY THE FUNDS GOVERNING BOARD. THE USE OF THE FUNDS IS MONITORED BY THE GOVERNING BOARD OF KISHWAUKEE COMMUNITY HOSPITAL. REQUESTS FOR FINANCIAL ASSISTANCE FROM OTHER CHARITABLE ORGANIZATIONS ARE REVIEWED AND APPROVED BY THE VP - FINANCE OF KISHHEALTH SYSTEM. IF NECESSARY DUE TO THE DOLLAR AMOUNT OF THE REQUEST, THESE ITEMS MAY ALSO BE PRESENTED TO THE BOARD OF DIRECTORS. A BUDGET IS SET ANNUALLY FOR CHARITABLE ASSISTANCE TO OTHER ORGANIZATIONS	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Substantiation Required	1	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KEVIN POORTEN
0	493308	0	175161	0	250000	0	79288	0	21089	0	1018846	0	250000
LOREN FOELSKE
0	248671	0	54917	0	0	0	19288	0	20275	0	343151	0	0
BRAD COPPLE
0	267332	0	74025	0	0	0	19288	0	20523	0	381168	0	0
PAM DUFFY
0	190811	0	43878	0	0	0	18566	0	7930	0	261185	0	0
JOE DANT
0	210725	0	47861	0	0	0	19288	0	20211	0	298085	0	0
MIKE KOKOTT
0	165989	0	27914	0	0	0	15303	0	7669	0	216875	0	0
ROGER HEATH BELL
0	168475	0	48366	0	0	0	17393	0	20052	0	254286	0	0
DR MICHAEL KULISZ
0	204758	0	0	0	0	0	0	0	20414	0	225172	0	0
MARK THATE
0	145067	0	34336	0	0	0	14318	0	13529	0	207250	0	0
THOMAS W TILTON DO
366224	0	90798	0	0	0	19288	0	20505	0	496815	0	0	0
RON C LUBCKE
124569	0	10145	0	0	0	10790	0	7552	0	153056	0	0	0
KENYA M WILLIAMS MD
214490	0	27521	0	0	0	19288	0	4666	0	265965	0	0	0
JASMEET DHALIWAL
253957	0	223146	0	0	0	0	0	20326	0	497429	0	0	0
ANJU VOHRA
158138	0	0	0	0	0	12452	0	7601	0	178191	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	PART I, LINE 4B	ReturnReference
Explanation	THE ORGANIZATION'S CEO PARTICIPATES IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2010 WERE $60,000. DURING 2010, THE CEO TOOK A DISTRIBUTION FROM THE DEFERRED COMPENSATION PLAN IN THE AMOUNT OF $250,000. THIS DISTRIBUTION IS INCLUDED IN W-2 WAGES, HOWEVER THE ACCRUAL OF THE DEFERRED COMPENSATION PAYMENTS HAS ALSO BEEN INCLUDED AS "OTHER COMPENSATION" ON PRIOR YEAR FORM 990S.	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	CITY OF SYCAMORE DEKALB COUNTY ILLINOIS HEALTH FACILITIES REVENUE BOND	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	861091967	IssuerEIN
CUSIP Number	452032AJ4	CUSIPNumber
Date Issued	2008-08-01	DateIssued
Issue Price	63685000	IssuePrice
Description Of Purpose	CONSTRUCTION OF NEW FACILITY FOR KISHWAUKEE COMMUNITY HOSPITAL	DescriptionOfPurpose
Defeased	1	Defeased
On Behalf Of Issuer	1	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Total Proceeds	63371994	TotalProceeds
Issuance Costs From Proceeds	328434	IssuanceCostsFromProceeds
Year Of Subst Completion	2007	YearOfSubstCompletion
Current Refunding	0	CurrentRefunding
Advance Refunding	1	AdvanceRefunding
Final Allocation Made	1	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	0	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Post Issuance Compliance Procdrs	0	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	0	Form8038TFiled
Variable Rate Issue	0	VariableRateIssue
Hedge Identified In Books And Recds	0	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGIC
Gross Proceeds Invested	0	GrossProceedsInvested
Exception To Rebate	0	ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part III Form990ScheduleLPartIII

Name Of Interested Business NameOfInterestedBusiness

Field	Value	IRS element (for citing)
Business Name Line1	KISHHEALTH FOUNDATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Relationship With Organization	BROTHER/SISTER ORGANIZATIONS	RelationshipWithOrganization
Amount Of Grant	855839	AmountOfGrant
Type Of Assistance	CASH ASSISTANCE TO SUPPORT HEALTH SERVICES AND BUILD ENDOWMENT	TypeOfAssistance

Form990 Schedule L Part IV Form990ScheduleLPartIV (9 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
KISHHEALTH SYSTEM
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, KHS IS PARENT ORGANIZATION OF KCH	11135722	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
KISHHEALTH SYSTEM
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, KHS IS PARENT ORGANIZATION OF KCH	1880000	DURING THE CURRENT YEAR, KISHWAUKEE COMMUNITY HOSPITAL ALSO MADE A AN EQUITY DISTRIBUTION BACK TO ITS PARENT ORGANIZATION.	0
KISHHEALTH FOUNDATION
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	1026644	KISHHEALTH FOUNDATION WAS ORGANIZED TO SUPPORT CHARITABLE HEALTHCARE ORGANIZATIONS. THE FOUNDATION ANNUALLY MAKES CONTRIBUTIONS TO KISHWAUKEE COMMUNITY HOSPITAL.	0
DEKALB COUNTY HOSPICE
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	302107	DEKALB COUNTY HOSPICE (DCH) IS AN AFFILIATE OF KISHWAUKEE COMMUNITY HOSPITAL (SAME PARENT CORPORATION). KCH IS UTILIZED BY DEKALB COUNTY HOSPICE FOR MEDICAL TREATMENTS AND SUPPLIES.	0
DEKALB COUNTY HOSPICE
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	47736	KISHWAUKEE COMMUNITY HOSPITAL (KCH) IS AN AFFILIATE OF DEKALB COUNTY HOSPICE (SAME PARENT CORPORATION). DEKALB COUNTY HOSPICE RENTS SPACE IN THE BUILDING OWNED BY KCH.	0
KISHHEALTH FOUNDATION
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	262472	KISHWHEALTH FOUNDATION UTILIZES EMPLOYEES OF KISHWAUKEE COMMUNITY HOSPITAL. EMPLOYEES ARE LEASED FROM KISHWAUKEE COMMUNITY HOSPTIAL.	0
HEALTH PROGRESS INC
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	8576	KISHWAUKEE COMMUNITY HOSPITAL PROVIDES FOR HOUSEKEEPING SERVICES UTILIZED BY HEALTH PROGRESS, INC.	0
VALLEY WEST COMMUNITY HOSPITAL
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	3917755	KISHWAUKEE COMMUNITY HOSPITAL ROUTINELY SELLS SUPPLIES AND SERVICES TO VALLEY WEST COMMUNITY HOSPITAL AS PART OF ITS DAY-TO-DAY BUSINESS.	0
COMMUNITY CARES CLINIC INC
COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER/SISTER AFFILIATE	276491	KISHWAUKEE COMMUNITY HOSPITAL PROVIDES MEDICAL SERVICES AND STAFF TO THE CLINIC. FEES PAID TO KCH ARE IN EXCHANGE FOR THESE SERVICES.	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2	KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHHEALTH SYSTEM, THE PARENT ORGANIZATION OF KISHWAUKEE COMMUNITY HOSPITAL. MR. POORTEN IS PRESIDENT AND CEO OF KISHWHEALTH SYSTEM AND SERVES AS AN EX-OFFICIO DIRECTOR FOR ALL ORGANIZATIONS RELATED TO KISHHEALTH SYSTEM. MR. FOELSKE SERVES AS THE VICE-PRESIDENT - FINANCE OF KISHHEALTH SYSTEM, WHICH IS THE PARENT ORGANIZATION FOR ALL RELATED ENTITIES. MICHAEL MOONEY AND MICHAEL CULLEN ARE MEMBERS OF THE KISHWAUKEE COMMUNITY HOSPITAL BOARD OF DIRECTORS. THEY ALSO SERVE ON THE BOARD OF DIRECTORS OF KISHHEALTH SYSTEM, THE PARENT ORGANIZATION OF KISHWAUKEE COMMUNITY HOSPITAL. THE FOLLOWING INDIVIDUALS ARE OFFICERS OR KEY EMPLOYEES OF KISHHEALTH SYSTEM AND ARE ALSO CONSIDERED OFFICERS OR KEY EMPLOYEES OF 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 HEATH BELL, VP AND CHIEF INFORMATION OFFICER MARK THATE, VP HUMAN RESOURCES DR. MICHAEL KULISZ, CHIEF MEDICAL OFFICER
FORM 990, PART VI, SECTION A, LINE 6	KISHHEALTH SYSTEM IS THE SOLE MEMBER OF KISHWAUKEE COMMUNITY HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	AS THE SOLE MEMBER AND PARENT ORGANIZATION OF KISHWAUKEE COMMUNITY HOSPITAL, KISHHEALTH SYSTEM HAS THE RIGHT TO APPROVE THE ELECTION OF MEMBERS OF THE HOSPITAL'S GOVERNING BOARD, PER THE HOSPITAL'S BYLAWS.
FORM 990, PART VI, SECTION A, LINE 7B	KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF VALLEY WEST COMMUNITY HOSPITAL (VWCH). PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF VWCH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER. PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF KCH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER: A. ELECTING THE MEMBERS OF THE KCH BOARD; B. APPROVING, EVALUATING AND/OR REMOVING THE PRESIDENT AND CEO AND REVIEWING AND APPROVING THE EMPLOYMENT CONTRACT OF THE PRESIDENT AND CEO AND ESTABLISHING COMPENSATION FOR SUCH OFFICE; C. APPROVING THE STRATEGIC PLAN FOR KCH; D. APPROVING THE DISPOSITION OF ANY ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS FOR KCH; E. APPROVING ANY CHANGE IN MEMBERSHIP OF KCH; F. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION AND BYLAWS OF KCH; G. APPROVING A PLAN OF MERGER OR A PLAN OF CONSOLIDATION OF KCH OR ESTABLISHING A NEW SUBSIDIARY OR SISTER ENTITY; H. APPROVING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF KCH; I. INITIATING, TAKING ANY AND ALL ACTIONS, AND EXERCISING ALL APPROVAL RIGHTS OF THE DIRECTORS PURSUANT TO THE APPLICABLE MEDICAL STAFF BYLAWS; J. IMPLEMENTING AND MONITORING KCH OPERATIONAL QUALITY IMPROVEMENT POLICIES AND PROGRAMS; K. ACCEPTING GIFTS, GRANTS, BEQUESTS AND DONATIONS ON BEHALF OF KCH; L. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR KCH; M. EXERCISING ANY RIGHTS THAT KCH HAS AS A SHAREHOLDER OR MEMBER OF ANY SUBSIDIARY ENTITY; N. APPROVING ANY AFFILIATIONS OF KCH; O. APPROVING AND/OR DETERMINING (I) THE CREATION OF NEW HEALTH SERVICES TO BE PROVIDED AND THE LOCATION OF SUCH HEALTH SERVICES AND (II) THE DISCONTINUANCE OF ANY HEALTH SERVICE; P. AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF KCH; Q. AUTHORIZING THE VOLUNTARY DISSOLUTION OF KCH, OR REVOKING THE PROCEEDINGS THEREOF; R. REQUIRING MINUTES OF MEETINGS, FINANCIAL RECORDS, AND SUCH OTHER INFORMATION AS MAY BE NECESSARY TO PROPERLY EVALUATE THE PERFORMANCE OF KCH; S. INITIATING ACTION TO REMOVE OR REINSTATE A DIRECTOR WHEN, IN THE OPINION OF THE KHS BOARD, IT IS IN THE BEST INTERESTS OF KHS OR KCH. ANY ACTION TO REMOVE OR REINSTATE SHALL REQUIRE A MAJORITY VOTE OF THOSE KHS DIRECTORS THEN IN OFFICE PRESENT AND VOTING AT A MEETING OF THE KHS BOARD AT WHICH A QUORUM IS PRESENT. IN ANY ACTION(S) TO REMOVE TAKEN BY THE KHS BOARD, THE DIRECTOR IN QUESTION SHALL BE ADVISED AT LEAST TWENTY (20) DAYS PRIOR TO THE MEETING THAT THE ACTION WILL BE CONSIDERED AND SHALL BE GIVEN THE OPPORTUNITY TO MAKE A STATEMENT, PRESENT WITNESSES ON HIS/HER BEHALF AND QUESTION THOSE PRESENTING REASONS FOR HIS/HER REMOVAL. ALL ACTIONS TO REMOVE SHALL BE TAKEN IN CLOSED SESSIONS OF THE KHS BOARD; AND T. TRANSFERRING MONEY OR PROPERTY AMONG KCH, KHS AND/OR ONE OR MORE SUBSIDIARY CORPORATIONS AND TRANSFERRING MONEY OR PROPERTY FROM A SUBSIDIARY CORPORATION, INCLUDING REQUIRING THE DIRECTORS, OFFICERS, OR TRUSTEES OF ANY SUBSIDIARY CORPORATION TO TRANSFER MONEY OR OTHER PROPERTY TO KHS. SUBJECT TO THE POWERS OF THE BOARD OF DIRECTORS OF EACH SUBSIDIARY CORPORATION, THE KHS BOARD MAY INITIATE AND TAKE THE FOREGOING ACTIONS ON BEHALF OF KHS AND THE SUBSIDIARY CORPORATIONS.
FORM 990, PART VI, SECTION B, LINE 11	A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ARE ALSO PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW. THE CHAIR OF THE AUDIT COMMITTEE AND THE AUDIT COMMITTEE MEMBERS ARE ALSO PROVIDED DRAFT COPIES AND REVIEW. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN.
	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 12C
	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 B, LINE 15
	THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINISTRATION.	FORM 990, PART VI, SECTION C, LINE 19
DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS	AVERAGE HOURS PER WEEK FOR THE INDIVIDUALS IDENTIFIED AS OFFICER'S ARE ESTIMATES OF THE INDIVIDUALS TOTAL TIME PER WEEK UTILIZED FOR WORK RELATED TO KISHWAUKEE COMMUNITY HOSPITAL.	FORM 990, PART VII, COLUMN (B)
CHANGES IN NET ASSETS OR FUND BALANCES:	NET UNREALIZED GAINS ON INVESTMENTS: 7,085,798. EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM -1,880,000. CHANGE OF INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION -100,514. BOOK/TAX DIFFERENCES IN K-1 PASSTHROUGH ENTITIES -101,198. GRANT REVENUE INCLUDED IN FIXED ASSETS FOR FINANCIAL STATEMENT PURPOSES -30,659. TOTAL TO FORM 990, PART XI, LINE 5: 4,973,427.	FORM 990, PART XI, LINE 5:
RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STATEMENTS	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.	FORM 990, PART XI, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg
KISHHEALTH SYSTEM
ONE KISH HOSPITAL DRIVE	DEKALB	IL	60115	363649080	PARENT ORGANIZATION OF 501(C)(3) HEALTH SYSTEM	IL	501(C)(3)	11B	N/A	0
VALLEY WEST COMMUNITY HOSPITAL
ONE KISH HOSPITAL DRIVE	DEKALB	IL	60115	364244337	HEALTHCARE SERVICES, PRIMARILY ACUTE CARE	IL	501(C)(3)	3	N/A	0
DEKALB COUNTY HOSPICE
2727 SYCAMORE ROAD 1B	DEKALB	IL	60115	363164329	HEALTHCARE SERVICES, HOSPICE SERVICES	IL	501(C)(3)	7	N/A	0
KISHHEALTH FOUNDATION
ONE KISH HOSPITAL DRIVE	DEKALB	IL	60115	363649077	SUPPORT OF KISHWAUKEE HEALTH SYSTEM NOT FOR PROFIT ENTITIES	IL	501(C)(3)	7	N/A	0
COMMUNITY CARES CLINIC
3100 SYCAMORE ROAD	DEKALB	IL	60115	800424001	HEALTHCARE SERVICES, PRIMARY CARE	IL	501(C)(3)	3		0
H-R EYE INSTITUTE
2240 GATEWAY DRIVE	SYCAMORE	IL	60178		HEALTHCARE SERVICES	IL	501(C)(3)	3	N/A	0

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership
KISHWAUKEE AREA PHO
ONE KISH HOSPITAL DRIVE	DEKALB	IL	60115	364205273	MEDICARE SERVICES	IL	RELATED	-24246	15399	0	0	0.50000
THE MIDLAND SURGICAL CENTER LLC
3085 WOLF COURT	DEKALB	IL	60115	352194610	SURGICAL SERVICES	IL	RELATED	618461	1242703	0	0	0.77500

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	HEALTH PROGRESS INC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	ONE KISH HOSPITAL DRIVE	AddressLine1
City	DEKALB	City
State	IL	State
ZIP Code	60115	ZIPCode

Field	Value	IRS element (for citing)
EIN	363824138	EIN
Primary Activity	INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESS	PrimaryActivity
Legal Domicile State	IL	LegalDomicileState
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Type Of Entity	C	TypeOfEntity

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg