2011-02-14T14:37:06-06:00 2010-06-30 RSM MCGLADREY INC 201 N HARRISON ST STE 300 DAVENPORT IA 52801 990 2009-07-01 363616314 Genesis Health System GENE 5634216508 801 Illini Drive Silvis IL 61282 MARK G ROGERS 5634216508 2011-02-14 1 John J Romano 5638884000 2009 2016-02-24 21:20:13Z MARK G ROGERS 801 Illini Drive Silvis IL 61282 97795255 0 X genesishealth.com X 1988 IL GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 17 10 941 140 256039 97219 9055 21372 86630430 94598507 105815 118526 2617168 2375500 89362468 97113905 405284 398187 0 31394306 34531947 0 0 54434596 53943945 86234186 88874079 3128282 8239826 72326303 70228519 29706053 19464215 42620250 50764304 GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 0 0 68692344 398187 88341681 ILLINI HOSPITAL-HEALTH CARE DELIVERY AND MANAGEMENT, GENERAL/OTHER: ILLINI HOSPITAL, A NOT-FOR-PROFIT ORGANIZATION, IS LICENSED AS A 149-BED ACUTE CARE HOSPITAL AND PROVIDES RELATED HEALTHCARE INPATIENT, EMERGENCY, AND OUTPATIENT ANCILLARY SERVICES. (16,325 TOTAL PATIENT DAYS; 99,382 OUTPATIENT VISITS) 7375124 8349312 ILLINI HOSPITAL NURSING HOME: HEALTH CARE FOR A 75-BED LICENSED NURSING FACILITY AND REHABILITATIVE AND PERSONAL CARE FOR A 45-BED FACILITY (38,624 PATIENT DAYS) WITH INDEPENDENT LIVING SERVICES CONSISTING OF 76 APARTMENTS AND 2 GUESTROOMS FOR THE ELDERLY (708 RESIDENT MONTHS) 76067468 1 1 0 1 0 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 74 0 1 941 1 1 1 0 0 0 0 0 0 0 0 17 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 IL X MARK G ROGERS 5634216508 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 STEVEN C BAHLS 4.00 X 0 0 0 MARK D BAWDEN 4.00 X X 0 0 0 DR JAMES A BULL 44.00 X 0 201482 24595 GREGORY J BUSH 4.00 X X 0 0 0 DR EDMUND P COYNE JR 4.00 X 0 0 0 DOUGLAS P CROPPER 44.00 X X 0 582439 241529 THOMAS A GILDEHAUS 4.00 X 0 0 0 ROGER J HILL 4.00 X X 0 0 0 MARK C KILMER 4.00 X 0 0 0 JAMES W KOEHLER 4.00 X 0 0 0 CHARLENE E MAASKE 4.00 X 0 0 0 DR EDWIN V MOTTO 4.00 X 0 0 0 DR EDWARD J ROGALSKI 10.00 X X 0 0 0 G CHRISTOPHER WAHLIG 4.00 X 0 0 0 C DANA WATERMAN III 4.00 X 0 0 0 DR CAROL A WATSON 4.00 X 0 0 0 DALE D ZUDE 4.00 X 0 0 0 MARK G ROGERS 40.00 X 0 335170 103311 CHARLES E BRUHN 40.00 X 199007 278801 39899 ROBERT W FRIEDEN 40.00 X 0 298209 31570 FLORENCE SPYROW 40.00 X 0 276918 79962 DR FRANK R CLAUDY 40.00 X 0 393594 43730 KENNETH CROKEN 40.00 X 0 272895 87317 DR JAMES A LEHMAN 40.00 X 0 401920 71829 JULIE MANAS 40.00 X 0 308159 100852 ROBERT C TRAVIS 40.00 X 0 363525 48744 DR MICHAEL GIMBEL 40.00 X 0 140316 20756 HEIDI S KAHLY-MCMAHON 40.00 X 0 145899 40562 DR ROBERT NELSON 40.00 X 0 255357 76191 JUDITH PRANGER 40.00 X 0 182290 91312 MIKE SHARP 40.00 X 0 196108 77560 199007 4633082 1179719 36 1 1 0 EMERGENCY CARE AND HEALTH ORGANIZATION 555 WEST COURT STREET STE 410 KANKAKEE IL 60901 CONTRACTED MEDICAL STAFF 2648376 COGENT HEALTHCARE INC PO BOX 974451 DALLAS TX 75397 CONTRACTED MEDICAL STAFF 765538 CHG MEDICAL STAFFING INC PO BOX 972670 DALLAS TX 75397 CONTRACTED MEDICAL STAFF 739509 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 LAB DIAGNOSTICS 422028 RANDY'S LAWNCARE 5710 230TH STREET NORTH PORT BYRON IL 61275 OUTSIDE SERVICES 297584 16 9372 12000 9372 21372 Professional Services 900099 152963865 152963865 Nursing Services 900099 26293969 26293969 Ancillary REVENUE 621500 23330886 23074847 256039 RESIDENT REVENUE 623000 1203532 1203532 Contracts W/Affiliates 900099 384347 384347 -109578092 -109578092 94598507 118687 118687 564080 587977 -23897 -23897 -23897 161 -161 -161 -161 144084 93212 50872 50872 Ambulance 621910 899080 899080 OTHER SERVICES 900099 779163 779163 AFFILIATE LARSON CENTE 900099 325997 325997 344285 344285 2348525 97113905 96690993 256039 145501 398187 398187 227644 227644 27770324 27264252 506072 1290634 1267119 23515 3228295 3228131 164 2015050 1962244 52806 5381299 5307727 73572 1976 1976 31975 31975 24022 24022 1764243 1610986 153257 17164 8724 8440 9185697 9145576 40121 2866788 2866788 3437063 3372941 64122 134361 131237 3124 58806 55680 3126 1171670 1171670 3647575 3647575 1349667 1349667 PROVISION FOR BAD DEBT 7990850 7990850 CORPORATE OVERHEAD ALLO 7299762 7299762 PATIENT CHARGEABLE SUPP 5536991 5536991 MISCELLANEOUS EXPENSE 4044036 2617911 1426125 88874079 76067468 12806611 0 26824 37587 14958023 10816085 14942335 17232281 1905248 2089969 375832 673203 94979527 58518034 37462002 36461493 663098 663166 1858627 2135990 134314 118745 72326303 70228519 4258731 5379927 20803725 8821879 4643597 5262409 29706053 19464215 X 41925864 50019999 672386 711000 22000 33305 42620250 50764304 72326303 70228519 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 0 0 0 1 4285 0 1 27690 31975 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 31% OF MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $21,210, 26% OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OR $5,980, 20% OF MEMBERSHIP DUES TO THE ILLINOIS CHAMBER OF COMMERCE, OR $500. Part IV, Supplemental Information: PART II-B, LINE 1(D), MAILINGS TO MEMBERS, LEGISLATORS, OR THE PUBLIC: EXECUTIVES OF GENESIS HEALTH SYSTEM - ILLINOIS ARE ENCOURAGED TO PARTICIPATE IN THE ILLINOIS HOSPITAL ASSOCIATION'S "IHA ACTION ALERTS". THE EXECUTIVES PARTICIPATE BY RESPONDING TO E-MAIL ALERTS, WHICH ALLOWS THEM TO VOICE THEIR OPINIONS TO THEIR STATE REPRESENTATIVES ON HEALTHCARE RELATED MATTERS THROUGH AN E-MAIL FORMAT. THERE IS NO DIRECT COST TO GENESIS HEALTH SYSTEM - ILLINOIS REGARDING THIS ACTIVITY. 5010740 28352 297861 296096 5040857 5224450 30636 -243446 900 5010740 0.63000 0.37000 0.00000 0 1 1 494992 494992 52705189 26778915 25926274 16771 4889 11882 38775893 30292620 8483273 2986682 1441610 1545072 36461493 DUE TO AFFILIATES 2568184 THIRD PARTY PAYOR SETTLEMENTS 2103440 ACCRUED INS TRUST LOSSES 590785 5262409 Part V, Line 4: Description of Intended Use of Endowment Funds: GENESIS HEALTH SERVICES FOUNDATION AND ILLINI HOSPITAL FOUNDATION, BOTH RELATED ORGANIZATIONS, HOLD THE ENDOWMENT FUNDS. THE INTENDED USE OF THE FOUNDATIONS' ENDOWMENT FUNDS IS AS FOLLOWS: SCHOLARSHIPS FOR EDUCATION IN THE MEDICAL FIELD, CHARITY CARE FOR THE INDIGENT AND VNA, HOSPICE HOUSE, DIABETES CARE, EMPLOYEE ASSISTANCE, AND PEDIATRIC HOSPICE. Part X: Description of Uncertain Tax Positions Under FIN 48: GHS Iowa, GHS Illinois, the Genesis HEALTH SERVICES Foundation, the Illini HOSPITAL Foundation and the GENESIS HEALTH SYSTEM Workers' Compensation PLAN AND Trust all file a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax exempt status of each entity, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income. Unrelated business taxable income is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the combined financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for uncertain tax benefits in the accompanying combined balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Forms 990 and 990T filed by GHS Iowa, GHS Illinois, the Genesis HEALTH SERVICES Foundation, the Illini HOSPITAL Foundation and the GENESIS HEALTH SYSTEM Workers' Compensation PLAN AND Trust are subject to examination by the Internal Revenue Service (IRS) up to three years from the extended due date of each return. Forms 990 and 990T filed by GHS Iowa, GHS Illinois, the Genesis HEALTH SERVICES Foundation, the Illini HOSPITAL Foundation and the GENESIS HEALTH SYSTEM Workers' Compensation PLAN AND Trust are no longer subject to examination for the fiscal years ended June 30, 2006 and prior. GenVentures, INC. is a taxable organization and currently files income tax returns in the U.S. federal jurisdiction and various state jurisdictions. GenVentures, INC. is no longer subject to income tax examinations for years June 30, 2006 and prior. As of June 30, 2010 and 2009, the total amount of uncertain tax positions have reduced income tax expense and have increased excess of revenue over expenses by $40,000 and $5,000, respectively. Interest expense associated with uncertain tax positions from the years ended June 30, 2010 and 2009 is approximately $7,000 and $9,000, respectively. No amount has been accrued for penalties. During the years ended June 30, 2010 and 2009, $265,000 and none, respectively, in federal and state income taxes were paid for uncertain tax positions existing as of June 30, 2009 and 2008, as amended or past due income tax returns were filed. Management believes that it is reasonably possible the liability for uncertain tax positions associated with unrelated business income will decrease in the next twelve months as a result of the expiration of statutes of limitations in major jurisdictions. THE CURRENT YEAR GROUP LIABILITY IS $45,000. GENESIS HEALTH SYSTEM - ILLINOIS'S SHARE OF THIS LIABILITY IS $45,000. CENTRAL AMERICA AND THE CARIBBEAN INVESTMENTS 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 1423522 0 1423522 0.01760 8948329 5158194 3790135 0.04690 0 0 10371851 5158194 5213657 0.06450 14341 511 13830 0.00020 4286 0 4286 0.00010 136007 0 136007 0.00170 0 0 38091 0 38091 0.00050 192725 511 192214 0.00250 10564576 5158705 5405871 0.06700 0 0 0 0 0 0 0 0 0 0 697 0 697 0.00000 0 0 10220 0 10220 0.00010 0 0 10917 10917 0.00010 1 2906176 48661 25984274 28807699 -2823425 X 1 1 LARSON CENTER PARTNERSHIP LLC PROPERTY MANAGEMENT 0.75620 0.00000 0.16370 GENESIS MEDICAL CENTER - ILLINI

801 ILLINI DRIVE SILVIS IL 61282

X X X ILLINI RESTORATIVE CARE

1455 ILLINI DRIVE SILVIS IL 61282

L-T INTERMEDIATE, NSG, & SHELTERED CARE CROSSTOWN SQUARE

900 CROSSTOWN SQUARE SILVIS IL 61282

INDEPENDENT LIVING FACILITY ILLINI - BUILDING #3

1414 10TH STREET SILVIS IL 61282

OUTPATIENT DIAGNOSTIC CLINIC PHYSICAL THERAPY CLINIC KING PLAZA

3620 AVENUE OF THE CITIES MOLINE IL 61265

OUTPATIENT PHYSICAL THERAPY CLINIC ILLINI LARSON CENTER

855 ILLINI DRIVE SILVIS IL 61282

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

730 AVENUE OF THE CITIES EAST MOLINE IL 61244

AMBULANCE SERVICES Part I, Line 3c: NOT APPLICABLE Part I, Line 6a: NOT APPLICABLE Part I, Line 7: Genesis Health System utilized Worksheet 2 to calculate its cost-to-charge ratio. The calculated cost-to-charge ratio was used to calculate the cost of Charity Care and Unreimbursed Medicaid. The cost of subsidized health services was obtained from Genesis Health System's cost accounting system (i.e., Decision Support System) that calculates the per unit reimbursement and cost for each type of service and supply that the non-Medicare and non-Medicaid patients consumed in the departments reported. Costs of the "Other Benefits" (excluding subsidized health services) reported in 7e -7i were compiled throughout the year in the community benefit database (i.e., CBISA) that Genesis Health System utilizes. Part I, Line 7g: No costs associated with a physician clinic were reported in subsidized health services. Part I, Line 7f: $7,990,850 OF BAD DEBT EXPENSE IS SUBTRACTED FOR PURPOSES OF COMPUTING THE PERCENTAGE IN PART I, LINE 7K, COLUMN F. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES, LESS BAD DEBT, IS 13.06%, AND THE PERCENTAGE INCREASES TO 48.68% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. Part III, Line 4: i. The text from the footnote to Genesis Health System's financial statement is as follows: Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by third-party payErs and less an estimated allowance for doubtful receivables based on a review of all outstanding amounts on a monthly basis. Management determines the allowance for doubtful accounts by identifying troubled accounts, by historical experience applied to an aging of accounts, and by considering the patient's financial history, credit history and current economic conditions. Receivables are written off as bad debts when deemed uncollectible. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received. ii. The rationale and costing methodology used to calculate bad debt expense at cost (line 2) consisted of multiplying the total bad debt expense per the income statement by the ratio of patient care cost to charges to arrive at estimated cost of bad debt. Payments received after an account had been written off to bad debt were credited to a bad debt recovery account. Discounts on patient accounts provided by third-party payers were written off to a contractual allowance account. iii. Shared Business Services uses a separate transaction code to identify accounts written off to bad debt that have no financial documentation and may have qualified for charity care had paperwork been submitted. The estimated amount of Genesis Health System's bad debt expense attributable to patients eligible under the organization's charity care policy (line 3) was calculated by taking the total of these accounts and multiplying them by the ratio of patient care cost to charges. iv. No bad debt amounts were included in community benefit. Part III, Line 8: i. For the hospitals and the home health division, the Medicare cost report was used to compute the total revenue received from Medicare, including the disproportionate share adjustment and indirect medical education adjustment. The Medicare cost report was also used to compute the Medicare allowable costs of care. The Provider Statistical and Reimbursement System (PS&R) Provider Summary Reports were also used to determine charges, costs and reimbursement. ii. No Medicare shortfalls were included in community benefit. The Medicare shortfall represents the difference between the total revenue received from Medicare based on Medicare reimbursement rates and the costs incurred by Genesis Health System in providing healthcare services to the elderly. In 2009, the percent of persons 65 years and over was 16.0% in Rock County, Illinois and 12.7% in Scott County, Iowa. In accordance with Genesis Health System's mission statement, "To Provide Compassionate, Quality Health Services to All Those in Need," the elderly were served despite the Medicare loss of $2,823,425. For the third straight year, Genesis Health System was recognized by SDI as one of the nation's Top 100 health systems for integrating services to improve quality and improve efficiency. Accordingly, the loss was not attributable to poor operating practices but from inadequate reimbursements. Genesis Health System has a clear mission to serve all those in need and to improve the health of the community including the elderly. Furthermore, there are no for-profit hospitals in the community, and therefore Genesis Health System is one of two tax-exempt healthcare organizations in the community who provide access to healthcare for Medicare patients. Accordingly, it is Genesis Health System's position for the reasons stated above that the Medicare shortfall of $2,823,425 represents a Community Benefit. Pursuant to the instructions to the Form 990, Schedule H, the Medicare shortfall is not included in Part I, Line 7. If the Medicare shortfall was included in Part I, Line 7, then Part I, Line 7k, Column f would be 10.19%. Part III, Line 9b: Every effort is made to determine a patient's eligibility for financial assistance. If eligible, payment plans are made available based on their resources and income. All balances owing after financial assistance allowances have been taken are payable in monthly payments in accordance with the organization's financial assistance policy. Part V: All health care facilities were reported in Part V. Part VI, Line 2: Genesis Health System utilizes the community health assessments created by the Quad City Health Initiative (QCHI) and the Community Vitality Task Force of United Way. QCHI was formed by Genesis Health System, which is headquartered in Scott County, Iowa, and Trinity Regional Health System, which is headquartered in Rock Island County, Illinois. QCHI is now a community partnership of over 100 organizations consisting of 500 active individuals pursuing initiatives to create a healthier community, serving as a catalyst for improving the health and overall quality of life within the Quad Cities. A community health assessment was conducted by QCHI in 2003, and then re-assessed in 2007. Each year, the Community Vitality Task Force of United Way produces an annual Snapshot of Community Indicators, including information on the health status of the communities that Genesis Health System serves. Part VI, Line 3: Information on the availability of financial assistance is posted in visible locations in the admission departments of the hospitals. In addition, the hospital registration staff make available informative brochures for patients in the Emergency Room registration area explaining their eligibility for assistance. Genesis Health System provides patient financial counselors on each hospital campus to discuss options with the patients. Shared business services prepares and provides a letter to each patient, explaining their current balance and advising them of their options. A phone number is provided with the letter encouraging the patient to call if needed. In addition, the Genesis Health System website also lists the options for payment, and on a monthly basis a Power Point presentation is given to incoming cancer patients informing them of their payment options. The outpatient physician clinics and the home health division make available their financial policy brochures along with directing patients to government programs such as SCHIP. Part VI, Line 4: Genesis Health System's mission is "to provide compassionate, quality health services to all those in need." Genesis lives its mission each and every day by serving a 10-county region of Eastern Iowa and Western Illinois, including both urban and rural areas. The region served by Genesis Health System has a population of 378,163.The median age of the population in 2009 was 38.9 in Rock Island County, Illinois and 36.7 in Scott County, Iowa. The percent of persons 65 years and over was 16.5% in Rock Island County, Illinois and 12.7% in Scott County, Iowa.The percent of families living in poverty in 2009 was 5.8% in Rock Island County, Illinois and 9.8% in Scott County, Iowa. The homeless population in Genesis Health System's service area was 1,510 in January 2010. The average unemployment rate in 2009 was 9.2% for Rock Island County, Illinois and 6.6% in Scott County, Iowa.The percentage of people ages 18-64 who did not have any health insurance in 2009 was 12.0% in Rock Island County, Illinois and 8.2% in Scott County, Iowa. The percentage of adults who currently smoked in 2009 was 20.0% in Rock Island County, Illinois and 17.0% in Scott County, Iowa. The percentage of adults who were obese in 2009 was 27.7% in Rock island County, Illinois and 21.9% in Scott County, Iowa. Part VI, Line 5: Coalition Building: Genesis Health System supports employee involvement with not-for-profit organizations which advocate on behalf of persons with disabilities by donating staff time for special projects. Workforce Development: Genesis Health System and United Township High School co-operate a program that teaches life and job skills to the mentally challenged. Part VI, Line 6: Genesis Health System'S Board of Directors is a diverse representation of persons who reside in the primary service area that Genesis Health System serves. A MAJORITY OF THEM are neither employees or contractors of the organization, nor family members thereof. Genesis Health System extends medical staff privileges to all qualified physicians in its communities. Genesis Health System has endeavored to improve access to health care for the communities it serves by participating in appropriate joint ventures that offer needed health care services to under-served areas.Surplus funds resulting from efficient operations and cost-containment measures are re-invested in the healthcare operations of Genesis Health System to improve the healthcare services that Genesis provides. Advances in medical equipment and technology, staff education, and new medical services are examples of operational investments that ultimately improve the health of the communities that Genesis serves. Part VI, Line 7: Genesis Health System (tax ID #42-1418847), an Iowa nonprofit corporation, and Genesis Health System (tax ID #36-3616314), an Illinois not-for-profit corporation, have identical governing boards, management and bylaws and can act jointly.Genesis Health System (tax ID #42-1418847) is also the sole member of Genesis Health Services Foundation and Genesis Health System Workers' Compensation Plan and Trust, the sole stockholder of GenVentures, Inc., a member of Misericordia Assurance Company, Ltd. and a partner in Davenport SRS Leasing, LLC. Genesis Health System (tax ID #36-3616314) is the sole member of Illini Hospital Foundation and a partner in The Larson Center Partnership.Genesis Health System (tax ID #36-3616314) operates the following business units to promote the health of the communities it serves:Genesis Medical Center - Illini (GMC - Illini) is licensed as a 149-bed acute care hospital which provides services from its facility in Silvis, Illinois. Illini Hospital Nursing Home (INH) operates Illini Restorative Care Center and Crosstown Square. Illini Restorative Care Center operates a 75-bed licensed nursing facility which provides skilled and intermediate health care and related services to patients. Twenty-two of Illini Restorative Care Center's beds are designated as Hospital-based Medicare certified beds. Illini Restorative Care's Sheltered Care unit is a 45-bed facility which provides rehabilitative and personal care in a family-oriented setting. Crosstown Square is an independent living facility containing 76 rentable apartments and two guestrooms that offers services designed to meet the needs of our senior adults.Genesis Health System (tax ID #36-3616314) has a controlling ownership interest or membership in the following organizations: Illini Hospital Foundation (Illini Foundation) supports Genesis Medical Center - Illini by providing financial and fundraising assistance. The mission of the Illini Foundation is to assist GMC - Illini in providing quality, compassionate care for all those in need by raising, managing and granting charitable funds. The Larson Center Partnership (LCP) is a for-profit real estate partnership which owns a medical office building adjacent to GMC- Illini and leases space for clinics, laboratory, pharmacy and offices to GMC - Illini and other third-party organizations. GHS Illinois is a general partner and owns approximately 76% of LCP.Genesis Health System (tax ID #42-1418847) operates the following business units to promote the health of the communities it serves:Genesis Health System provides administrative, management, information technology and other support services to its affiliates.Genesis Clinical Services: Genesis Health System owns and operates physician medical practices, convenient care practices, operates an occupational medicine clinic and provides behavioral health services to the residents of eastern Iowa and western Illinois. Genesis Medical Center - Davenport (GMC- Davenport) is licensed as a 502-bed acute care hospital which provides services from two hospital facilities located in Davenport, Iowa. Genesis Family Medical Center (GFMC) is a family practice residency training program that operates clinics in Davenport and Blue Grass, Iowa to provide a clinical setting for the residents to treat patients.Genesis Medical Center - DeWitt (GMC - DeWitt) is certified as a critical access hospital, which has 13-acute care and swing beds, and has a 77-bed long-term care facility, which provides services from its facility in DeWitt, Iowa. Genesis Illinois Properties (GIP) was formed in October 1999 and shall continue perpetually. Genesis Illinois Properties owns land located in Moline, Illinois. Genesis Visiting Nurse Association and Hospice (VNA) provides home health care, community nursing services and hospice services to patients in eastern Iowa and western Illinois.Genesis Health System (tax ID #42-1418847) has a controlling ownership interest oR membership in the following organizations: Genesis Health Services Foundation (Genesis Foundation) is an organization whose mission is to develop, manage and grant charitable support to meet the health-related needs of the communities served by Genesis Health System.GenVentures, Inc. (GenVentures) is a wholly-owned for-profit corporation which operates the following divisions, primarily in the Quad Cities: Genesis at Home, Continuing Care sells and leases home medical equipment; provides intravenous therapy services, including sales of related solutions and supplies to patients; and provides retail pharmaceutical and over the counter products to patients and employees of the System.GenProperties owns, leases and/or manages office space in fourteen medical office buildings located in Davenport, Eldridge, LeClaire, Muscatine and Bettendorf, Iowa. Crescent Laundry provides commercial laundry services to health care facilities in eastern Iowa and north-central Illinois. Genesis Health System Workers' Compensation Plan and Trust (Workers' Compensation Trust) provides a fund which can be used to pay workers' compensation claims and costs for the benefit of Genesis Health System. Misericordia Assurance Company, Ltd. (Misericordia) is a wholly owned Cayman based captive insurance company which underwrites the general and professional liability risks of Genesis Health System and affiliates.Davenport SRS Leasing, LLC (SRS) is a limited liability company, which was formed in 2008, which leases medical equipment. Genesis Health System is a general partner and owned 55% of SRS as of June 30, 2009. On September 30, 2009, Genesis Health System acquired an additional 38.75% interest in SRS to obtain a 93.75% ownership interest as of June 30, 2010. IL 1 BIRDIES FOR CHARITY 15623 COALTOWN ROAD EAST MOLINE IL 61244 931332421 501(C)(3) 5000 GENERAL SUPPORT TO BE DISTRIBUTED LOCALLY GLOBUS RELIEF 1775 WEST 1500 SOUTH SALT LAKE CITY UT 84104 841369453 501(C)(3) 16018 FAIR MARKET VALUE MEDICAL SUPPLIES GENERAL SUPPORT GENESIS HEALTH SERVICES FOUNDATION 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421421670 501(C)(3) 5000 GHS FOUNDATION ANNUAL APPEAL GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 391905171 501(C)(3) 339557 CLAIM PAYMENTS CITY OF MOLINE 619 19TH STREET MOLINE IL 61265 366005999 CITY OF MOLINE 20862 DONATION TO PURCHASE EXERCISE EQUIPMENT FOR CITY PARK GENESIS HEALTH SYSTEM - IOWA 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421418847 501(C)(3) 7025 DONATION FOR PERLMUTTER LIBRARY 6 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE GENESIS HEALTH SYSTEM - ILLINOIS STAFF REQUIRES RECEIPTS AND OTHER DOCUMENTATION PRIOR TO RELEASING FUNDS FOR PROJECTS AND SERVICES WITHIN THE SCOPE OF THE ORGANIZATION'S MISSION. PROPER AUTHORIZATION OF GRANT REQUESTS IS ALSO REQUIRED. STAFF FOLLOWS THE ORGANIZATION'S FUNDING ADMINISTRATIVE POLICY TO ENSURE THAT GRANTS ARE BEING APPROVED AND UTILIZED CORRECTLY. X X 1 1 0 1 0 0 0 0 0 0 0 DR JAMES A BULL 0 160847 0 0 0 40635 0 12113 0 12482 0 226077 0 0 DOUGLAS P CROPPER 0 541243 0 0 0 41196 0 219726 0 21803 0 823968 0 0 MARK G ROGERS 0 221503 0 0 0 113667 0 91064 0 12247 0 438481 0 0 CHARLES E BRUHN 86606 121331 0 0 112401 157470 8928 12508 7690 10773 215625 302082 0 0 ROBERT W FRIEDEN 0 223267 0 0 0 74942 0 13005 0 18565 0 329779 0 0 FLORENCE SPYROW 0 229918 0 25000 0 22000 0 78778 0 1184 0 356880 0 0 DR FRANK R CLAUDY 0 260181 0 0 0 133413 0 27083 0 16647 0 437324 0 0 KENNETH CROKEN 0 188097 0 0 0 84798 0 69579 0 17738 0 360212 0 0 DR JAMES A LEHMAN 0 252408 0 0 0 149512 0 58042 0 13787 0 473749 0 0 JULIE MANAS 0 282411 0 0 0 25748 0 87230 0 13622 0 409011 0 0 ROBERT C TRAVIS 0 221519 0 0 0 142006 0 33985 0 14759 0 412269 0 0 DR MICHAEL GIMBEL 0 114358 0 6197 0 19761 0 9508 0 11248 0 161072 0 0 HEIDI S KAHLY-MCMAHON 0 137980 0 0 0 7919 0 24024 0 16538 0 186461 0 0 DR ROBERT NELSON 0 172488 0 0 0 82869 0 61266 0 14925 0 331548 0 0 JUDITH PRANGER 0 158828 0 0 0 23462 0 79808 0 11504 0 273602 0 0 MIKE SHARP 0 133540 0 0 0 62568 0 64020 0 13540 0 273668 0 0 Part I, Line 1a Genesis Health System provides the following to individuals reported in Part VII, Section A, line 1a: Travel for companions: This benefit is offered to all employees. The organization requires reimbursement of these expenses directly to the organization. Gross-up payments: This benefit is offered to qualifying executives who had contributions made on their behalf in the Supplemental Executive Retirement Plan. Contributions to the plan are included with reportable compensation for individuals with vested contributions. Part I, Line 4a THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2009 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA, A RELATED ORGANIZATION: CHARLES E. BRUHN - $228,929, DR. FRANK R. CLAUDY - $107,059, ROBERT W. FRIEDEN - $63,954, DR. JAMES A. LEHMAN - $100,898, AND ROBERT C. TRAVIS - $102,259. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009 AND THE GROSS-UP PAYMENT TO COVER TAX. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2009 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: KENNETH CROKEN - $53,843, DOUGLAS P. CROPPER - $209,926, HEIDI KAHLY-MCMAHON - $16,867, JULIE MANAS - $87,230, DR. ROBERT NELSON - $49,453, JUDITH PRANGER - $28,800, MARK G. ROGERS - $78,661, MIKE SHARP - $35,694, AND FLORENCE L. SPYROW - $76,328. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. Supplemental Information Part III PART I, LINE 3: GENESIS HEALTH SYSTEM - ILLINOIS RELIES ON GENESIS HEALTH SYSTEM - IOWA TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS, AND KEY EMPLOYEES. GENESIS HEALTH SYSTEM - IOWA UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE SUCH COMPENSATION. GENVENTURES INC SEE BELOW ON SCH O 202881 GENVENTURES, INC. PAID GENESIS HEALTH SYSTEM FOR FACILITY MAINTENANCE AND MEDICAL SUPPLIES. 0 GenvenTURES INC SEE BELOW ON SCH O 291573 GENESIS HEALTH SYSTEM PAID GENVENTURES, INC. FOR LAUNDRY SERVICES. 0 Form 990, Part VI, Section B, line 11 INTERNAL MANAGEMENT REVIEW IS COMPLETED OF THE COMPILED INFORMATION PRIOR TO PREPARATION AND REVIEW BY RSM MCGLADREY, INC. FOLLOWING RSM MCGLADREY, INC.'S PREPARATION AND REVIEW OF THE FORM 990, IT IS REVIEWED WITH THE ORGANIZATION'S PRESIDENT/CEO; VICE PRESIDENT, FINANCE/CFO; VICE PRESIDENT, LEGAL AFFAIRS; AND VICE PRESIDENT, HUMAN RESOURCES. THE FORM 990 IS THEN REVIEWED AT A JOINT MEETING OF THE ORGANIZATION'S FINANCE COMMITTEE AND AUDIT & COMPLIANCE COMMITTEE. PRIOR TO SUBMITTING THE FORM 990 TO THE IRS, IT IS E-MAILED TO THE ORGANIZATION'S BOARD OF DIRECTORS ONE WEEK IN ADVANCE OF A SCHEDULED MEETING. AT THE BOARD OF DIRECTORS MEETING, INTERNAL MANAGEMENT REVIEWS THE FORM 990 WITH THE BOARD OF DIRECTORS. SUGGESTED CHANGES FROM ALL OF THESE REVIEWS ARE CONSIDERED FOR INCLUSION IN THE FINAL FORM 990 SUBMITTED TO THE IRS. Form 990, Part VI, Section B, line 12c ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, OR MEMBER OF A BOARD OR BOARD COMMITTEE OF GENESIS HEALTH SYSTEM (GHS) OR AN AFFILIATE, SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT WILL BE CONSIDERED BY MANAGEMENT, THE BOARD, OR A COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING GHS, OR AN AFFILIATE, OR WITH RESPECT TO DESIGNATED FACILITIES AND ACTIVITIES, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH PERSON ADVOCATE HIS OR HER POSITION INFORMALLY THROUGH PRIVATE CONTACT, COMMUNICATION AND DISCUSSION WITH ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE APPLICABLE TRANSACTION OR ARRANGEMENT. Form 990, Part VI, Section B, line 15 EACH EXECUTIVE POSITION IS EVALUATED USING A FORMAL EVALUATION PLAN THAT IS ESTABLISHED BY AN OUTSIDE CONSULTANT. AT THE PRESENT TIME, THE CONSULTANT USES A POINT SYSTEM FOR JOB EVALUATION. THE POINT VALUES ARE BASED ON "KNOW HOW", "PROBLEM SOLVING", "ACCOUNTABILITY", AND OTHER JOB ATTRIBUTES SPECIFIC TO THE POSITION. ONCE THE POINT VALUE IS SET FOR A POSITION, MARKET COMPARISONS FOR JOBS WITH THE SAME ORGANIZATIONAL IMPACT CAN BE COMPARED FOR SALARY PURPOSES AND ESTABLISH PAY RANGES. THE DESIGN OF THE PAY RANGES FOR EXECUTIVES IS BASED ON MARKET DATA. THE MIDPOINT OF EACH PAY RANGE IS ESTABLISHED AT THE 50TH PERCENTILE OF THE MARKET COMPARISONS. A MINIMUM GUIDELINE IS ESTABLISHED AT THE 25TH PERCENTILE, AND A MAXIMUM GUIDELINE IS SET AT THE 75TH PERCENTILE. SPECIFIC PAY RATES FOR EXECUTIVES ARE SUBJECT TO CEO AND COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS APPROVAL. PAY RANGES ARE REVIEWED EACH YEAR TO DETERMINE THE NEED FOR REVISION. WHEN MARKET CONDITIONS SUGGEST AN ADJUSTMENT TO PAY RANGES, DATA WILL BE PRESENTED TO THE COMPENSATION COMMITTEE FOR ITS REVIEW. THE SPECIFIC PAY RANGES ARE SUBJECT TO CEO, COMPENSATION COMMITTEE, AND GENESIS HEALTH SYSTEM (GHS) BOARD OF DIRECTOR APPROVAL. THE PRESIDENT AND CEO HAS THE AUTHORITY AND RESPONSIBILITY TO ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS, THE BASE COMPENSATION OF EACH EXECUTIVE EMPLOYED BY GHS, AT APPROPRIATE TIMES. THE GHS BOARD OF DIRECTORS SHALL ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE, THE BASE COMPENSATION FOR THE CEO OF GHS, AT APPROPRIATE TIMES. THE LAST TIME THIS PROCESS WAS UNDERTAKEN WAS JANUARY 2009. IN 2009 THE GHS COMPENSATION COMMITTEE MET, AND THE CEO AND EXECUTIVE MANAGEMENT OPTED TO VOLUNTARILY FOREGO THE ANNUAL SALARY INCREASE IN 2009. 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. FORM 990, PART XI, LINE 2C THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - GENVENTURES, INC. MARK G. ROGERS IS AN OFFICER, CHARLES E. BRUHN AND FLORENCE L. SPYROW ARE KEY EMPLOYEES, AND MIKE SHARP IS A FORMER KEY EMPLOYEE OF GENESIS HEALTH SYSTEM AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, MARK G. ROGERS WAS AN OFFICER OF GENVENTURES, INC., AND CHARLES E. BRUHN, FLORENCE L. SPYROW, AND MIKE SHARP WERE DIRECTORS OF GENVENTURES, INC. FORM 990, PART VII, LINE 1A Genesis Health System, EIN 42-1418847, and Genesis Health System, EIN 36-3616314 have identical governing boards and an identical executive management team. The hours reported on Form 990, Part VII, Section A, column (B) represents the number of hours these individuals devote to both organizations. Furthermore, the amounts reported as reportable compensation for the officers, key employees, and highly compensated employees, unless otherwise noted elsewhere in PART VII, are for services rendered on behalf of both organizations. It would be administratively impracticable for members of the governing board and the executive team to breakout their hours devoted as well as their reportable compensation between each organization. All reportable compensation, unless otherwise noted in PART VII, is paid by Genesis Health System, EIN 42-1418847. FORM 990, PART I, LINES 9 & 17, PRIOR YEAR THE FORM 990, PART I, LINE 9, PRIOR YEAR COLUMN WAS UPDATED TO REFLECT PROGRAM SERVICE REVENUE NET OF CONTRACTUAL ADJUSTMENTS AND CHARITY CARE. THE FORM 990, PART I, LINE 17, PRIOR YEAR COLUMN WAS UPDATED TO REFLECT THE REDUCTION OF EXPENSES RELATED TO THE RECLASSIFICATION OF CONTRACTUAL ADJUSTMENTS AND CHARITY CARE. THE AMOUNTS REPORTED IN THE PRIOR YEAR COLUMN DIFFER FROM THE 2008 (FISCAL YEAR 2009) FILED FORM 990, BUT ARE REFLECTED AS SUCH ON THE CURRENT FISCAL YEAR RETURN FOR COMPARABILITY PURPOSES. GENESIS HEALTH SYSTEM - IOWA 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421418847 HEALTHCARE IA 501(C)(3) 3 N/A GENESIS HEALTH SERVICES FOUNDATION 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421421670 CHARITY IA 501(C)(3) 7 GENESIS HEALTH SYSTEM 42-1418847 ILLINI HOSPITAL FOUNDATION 801 ILLINI DRIVE SILVIS IL 61282 366208583 CHARITY IL 501(C)(3) 11/TYPE1 N/A GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 391905171 EMPLOYEE/BENEFIT/TRUST IA 501(C)(3) 11/TYPE1 GENESIS HEALTH SYSTEM 42-1418847 DAVENPORT HOSPITAL AMBULANCE CORP 1204 EAST HIGH STREET DAVENPORT IA 52803 421186903 AMBULANCE TRANSFERS IA 501(C)(3) 11/TYPE1 gENESIS HEALTH SYSTEM 42-1418847 GENGASTRO LLC 2222 53RD AVENUE BETTENDORF IA 52722 562315623 AMBULATORY SURGERY CENTER IA GENESIS HEALTH SYSTEM 42-1418847 RELATED 2440830 140124 0 0 SPRING PARK SURGERY CENTER LLC 3319 SPRING STREET STE 202A DAVENPORT IA 52807 421483989 OUTPATIENT SURGICAL CENTER IA GENESIS HEALTH SYSTEM 42-1418847 RELATED 1134953 2840380 0 0 LARSON CENTER PARTNERSHIP LLC 801 ILLINI DRIVE SILVIS IL 61282 363738454 PROPERTY MANAGEMENT IL N/A RELATED 280478 2217273 0 1 DAVENPORT SRS LEASING LLC 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 261655144 LEASING IA GENESIS HEALTH SYSTEM 42-1418847 RELATED -664938 7165439 0 0 INTEGRATED HEALTH PARTNERS LLC 2550 MIDDLE ROAD STE 601 BETTENDORF IA 52722 421513293 MEDICAL SERVICES IA GENESIS HEALTH SYSTEM 42-1418847 RELATED -125787 0 -95922 0 GENVENTURES INC 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421269171 SUPPORT SERVICES/PROPERTY MANAGEMENT IA N/A C -293371 47241728 1.00000 GENESIS HEART INSTITUTE 1236 EAST RUSHOLME STREET DAVENPORT IA 52803 421504979 HEALTHCARE MANAGEMENT IA N/A C 1.00000 MISERICORDIA ASSURANCE COMPANY LTD PO BOX 1051 GRAND CAYMAN CJ 980457943 OTHER FINANCIAL VEHICLE CJ N/A C 26685808 1.00000 MOB 1 OWNERS' ASSOCIATION 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 270865075 PROPERTY MANAGEMENT IA GENVENTURES INC C 0.81700 0 1 1 0 0 0 0 0 1 1 0 1 0 0 1 1 1 1 GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST B 339557 GENESIS HEALTH SYSTEM - IOWA I 228523 GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST L 95458 LARSON CENTER PARTNERSHIP LLC J 369712 GENESIS HEALTH SYSTEM - IOWA O 80177241 MISERICORDIA ASSURANCE COMPANY LTD O 683212 GENESIS HEALTH SYSTEM - IOWA P 15103854 GENVENTURES INC R 202881 ILLINI HOSPITAL FOUNDATION R 80871 GENVENTURES INC Q 291573 LARSON CENTER PARTNERSHIP LLC O 534971 GENESIS HEALTH SYSTEM - IOWA Q 8938329 larSON CENTER PARTNERSHIP LLC R 226873