2014-02-15T14:06:05-06:00 2013-06-30 420714325 MCGLADREY LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2012-07-01 363616314 GENESIS HEALTH SYSTEM GENE 5634216508 801 ILLINI DRIVE SILVIS IL 61282 MARK G ROGERS 5634216508 2014-02-17 1 JOHN J ROMANO P00227323 5638884000 2012 2015-11-30 17:44:51Z MARK G ROGERS 801 ILLINI DRIVE SILVIS IL 61282 87084356 0 X GENESISHEALTH.COM X 1988 IL GENESIS HEALTH SYSTEM (GHS ILLINOIS) EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 18 8 888 212 268137 35032 1714995 2606710 88021750 81456912 481458 318326 2385001 2563707 92603204 86945655 169854 315210 0 0 35615517 33765893 0 0 0 52439096 48501568 88224467 82582671 4378737 4362984 79704790 84731764 18733242 19453206 60971548 65278558 GENESIS HEALTH SYSTEM (GHS ILLINOIS) EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 0 0 56383604 315210 74667859 GENESIS MEDICAL CENTER - ILLINI: HEALTH CARE DELIVERY AND MANAGEMENT, GENERAL/OTHER: GENESIS MEDICAL CENTER - ILLINI, A NOT-FOR-PROFIT ORGANIZATION, IS LICENSED AS A 149-BED ACUTE CARE HOSPITAL AND PROVIDES RELATED HEALTHCARE INPATIENT, EMERGENCY, AND OUTPATIENT ANCILLARY SERVICES. (14,103 PATIENT DAYS; 113,906 OUTPATIENT VISITS) 7677004 9044524 ILLINI HOSPITAL NURSING HOME: HEALTH CARE FOR A 75-BED LICENSED NURSING FACILITY AND REHABILITATIVE AND PERSONAL CARE FOR A 45-BED FACILITY (35,988 PATIENT DAYS) WITH ASSISTED LIVING SERVICES CONSISTING OF 76 APARTMENTS AND 2 GUESTROOMS FOR THE ELDERLY (494 RESIDENT MONTHS). 64060608 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 X 68 0 1 888 1 1 1 0 0 0 0 0 0 0 0 0 X 18 8 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 X STEVEN C BAHLS 4.00 X 0 0 0 MARK D BAWDEN 10.00 X X 0 0 0 GREGORY J BUSH 4.00 X X 0 0 0 CHRISTOPHER J COX 4.00 X 0 0 0 EDMUND P COYNE JR MD 4.00 X 0 0 0 DOUGLAS P CROPPER 44.00 X X 0 1289580 121303 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 GEORGE J KONTOS JR MD 40.00 X 0 528797 28544 CHARLENE E MAASKE 4.00 X 0 0 0 EDWIN V MOTTO MD 10.00 X 0 0 0 EDWARD J ROGALSKI PHD 10.00 X X 0 0 0 G CHRISTOPHER WAHLIG 8.00 X X 0 0 0 C DANA WATERMAN III 4.00 X 0 0 0 CAROL A WATSON PHD RN CENP FAAN 4.00 X 0 0 0 DALE D ZUDE 4.00 X 0 0 0 MARK G ROGERS 40.00 X 0 567106 63788 WAYNE DIEWALD 40.00 X 0 414419 128153 ROBERT W FRIEDEN 40.00 X 0 383474 30701 FLORENCE L SPYROW 40.00 X 137045 243634 93976 KENNETH R CROKEN 40.00 X 0 443049 52299 JAMES A LEHMAN MD 40.00 X 0 480883 60423 JUDITH A MONDELLO 40.00 X 0 330369 45324 ROBERT M NELSON MD 40.00 X 0 357543 20958 JUDITH K PRANGER 40.00 X 0 239206 41724 HEIDI S KAHLY-MCMAHON 40.00 X 0 211704 64094 MIKE L SHARP 40.00 X 0 207803 54679 137045 5697567 805966 30 1 1 0 EMERGENCY CARE AND HEALTH ORGANIZATION 1S443 SUMMIT AVE SUITE 302 OAKBROOKE IL 60181 PHYSICIAN FEES- MED SERVICES 2753717 COGENT HEALTHCARE OF IOWA PC PO BOX 645037 CINCINNATI OH 45264 PHYSICIAN FEES- MED SERVICES 810358 QUEST DIAGNOSTICS LLC IL 1355 MITTEL BLVD WOOD DALE IL 60191 OUTSIDE SERVICES 297716 PHILIPS HEALTHCARE PO BOX 100355 ATLANTA GA 30384 OUTSIDE MAINTENANCE CONTRACTS 294729 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 OUTSIDE SERVICES 258147 17 2606710 2606710 PROFESSIONAL SERVICES 900099 157731942 157731942 I/P ANCILLARY SERVICES 621500 26177506 25909369 268137 NURSING SERVICES 900099 23250814 23250814 RESIDENT REVENUE 623000 864741 864741 RENTAL INCOME (HEALTHCARE RELATED 900099 704857 704857 -127272948 -127272948 81456912 310723 310723 15983 8380 7603 7603 7603 170420 130321 40099 40099 AMBULANCE 621910 1084296 1084296 OTHER SERVICES 900099 837263 837263 NON OPERATING IH, INV INCOME, LAR 900099 448544 448544 153505 153505 2523608 86945655 83712383 268137 358425 315210 315210 176234 176234 27730735 26986515 744220 703671 684786 18885 3116764 3034022 82742 2038489 1987827 50662 5233410 4850938 382472 32767 32767 2163057 2028540 134517 24130 22827 1303 8319917 8238690 81227 4085398 101242 3984156 3808602 3678616 129986 406060 379877 26183 37916 33011 4905 174112 174112 4267542 4267542 1075514 539001 536513 CORPORATE OVERHEAD ALLO 9964909 9964909 PATIENT CHARGEABLE SUPP 5356101 5356101 MISCELLANEOUS EXPENSE 3552133 1381751 2170382 82582671 64060608 18522063 0 4141 4535 17868586 17782302 17555234 18508776 2258554 2189345 659801 534037 108529551 67477245 39091697 41052306 1767043 1908909 499734 2751554 79704790 84731764 6402493 9352853 7750000 7070000 4580749 3030353 18733242 19453206 X 60668171 65017141 303377 261417 0 0 60971548 65278558 79704790 84731764 X 4362984 -14014 -41960 X X 0 1 X 1 0 X 0 1 0 1 0 0 1 2000 1 2285 0 1 30767 35052 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PART II-B, LINE 1B, PAID STAFF OR MANAGEMENT: GENESIS HEALTH SYSTEM (GHS ILLINOIS) HAD ONE STAFF MEMBER INVOLVED IN LOBBYING ACTIVITIES ON A PART TIME BASIS. HIS LOBBYING ACTIVITIES WERE FOCUSED ON SENDING LETTERS OR PUBLICATIONS TO GOVERNMENT OFFICIALS OR LEGISLATORS AND MEETING WITH OR CALLING GOVERNMENT OFFICIALS OR LEGISLATORS ON HEALTHCARE RELATED MATTERS. PART II-B, LINE 1D, MAILINGS TO MEMBERS, LEGISLATORS, OR THE PUBLIC: EMPLOYEES OF GENESIS HEALTH SYSTEM (GHS ILLINOIS) ARE ENCOURAGED TO PARTICIPATE IN THE ILLINOIS HOSPITAL ASSOCIATION'S "IHA ACTION ALERTS." THE EMPLOYEES PARTICIPATE BY RESPONDING TO E-MAIL ALERTS WHICH ALLOWS THEM TO VOICE THEIR OPINIONS TO THEIR STATE REPRESENTATIVES ON HEALTHCARE RELATED MATTERS (NOT CANDIDATE-SPECIFIC). THERE IS NO DIRECT COST TO GHS ILLINOIS REGARDING THIS ACTIVITY. PART II-B, LINE 1F, GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES: GENESIS HEALTH SYSTEM (GHS ILLINOIS) CONTRIBUTED TO ONE ORGANIZATION: 1.) QUAD CITIES CHAMBER - ILLINOIS LEGISLATIVE FORUM, 2013, $2,000. PART II-B, LINE 1G, DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: GENESIS HEALTH SYSTEM (GHS ILLINOIS) HAD ONE STAFF MEMBER INVOLVED IN LOBBYING ACTIVITIES ON A PART TIME BASIS. HIS LOBBYING ACTIVITIES WERE FOCUSED ON SENDING LETTERS OR PUBLICATIONS TO GOVERNMENT OFFICIALS OR LEGISLATORS AND MEETING WITH OR CALLING GOVERNMENT OFFICIALS OR LEGISLATORS ON HEALTHCARE RELATED MATTERS. THE DIRECT COSTS INCLUDED: SALARIES - $2,229, AND MILEAGE/TRAVEL EXPENSES - $56. PART II-B, LINE 1I, OTHER LOBBYING ACTIVITIES: LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED: 34% OF MEMBERSHIP DUES TO THE ILLINOIS HOSPITAL ASSOCIATION, OR $24,893, 24% OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OR $5,786, AND 8% OF MEMBERSHIP DUES TO THE AMERICAN ACADEMY OF SLEEP MEDICINE, OR $88. 7633243 2101 561816 359136 7838024 5519844 2014051 99448 100 7633243 5040857 16614 465988 3616 5519844 5010740 28352 297861 296096 5040857 5224450 30636 -243446 900 5010740 0.49880 0.50120 0 1 1 2374122 2374122 56588212 32316333 24271879 16771 10029 6742 43348686 33541956 9806730 6201760 1608927 4592833 41052306 THIRD PARTY PAYOR SETTLEMENTS 2713455 ACCRUED INS TRUST LOSSES 316898 3030353 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: GENESIS HEALTH SERVICES FOUNDATION, A RELATED ORGANIZATION, HOLDS THE ENDOWMENT FUNDS. THE INTENDED USE OF THE FOUNDATION'S ENDOWMENT FUNDS ARE AS FOLLOWS: SCHOLARSHIPS FOR EDUCATION IN THE MEDICAL FIELD, CHARITY CARE FOR THE INDIGENT AND VISITING NURSE, HOSPICE HOUSE, DIABETIC CARE, EMPLOYEE ASSISTANCE, AND PEDIATRIC HOSPICE SERVICES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: GENESIS HEALTH SYSTEM (GHS IOWA), GENESIS HEALTH SYSTEM (GHS ILLINOIS), GENESIS SENIOR LIVING, ALEDO (GSL, ALEDO), GENESIS HEALTH SERVICES FOUNDATION (GENESIS FOUNDATION), ILLINI HOSPITAL FOUNDATION (ILLINI FOUNDATION) AND GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST (WORKERS' COMPENSATION TRUST) ALL FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. UNRELATED BUSINESS TAXABLE INCOME IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, GSL, ALEDO, GENESIS FOUNDATION, ILLINI FOUNDATION AND WORKERS' COMPENSATION 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, GSL, ALEDO, GENESIS FOUNDATION, ILLINI FOUNDATION AND WORKERS' COMPENSATION TRUST ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED JUNE 30, 2009 AND PRIOR. GENVENTURES, INC. (GENVENTURES) IS A TAXABLE ORGANIZATION AND CURRENTLY FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND VARIOUS STATE JURISDICTIONS. GENVENTURES IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS JUNE 30, 2009 AND PRIOR. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2013 AND 2012. 1 1 X 1 X 1 X 1 1 0 1 1 2503218 0 2503218 0.03030 14204686 12349391 1855295 0.02250 0 0 16707904 12349391 4358513 0.05280 11692 0 11692 0.00010 0 0 0 0 0 0 39732 0 39732 0.00050 51424 51424 0.00060 16759328 12349391 4409937 0.05340 304 304 0.00000 6774 6774 0.00010 7078 7078 0.00010 1 6960624 0 23190823 23865735 -674912 X 1 1 1 LARSON CENTER PARTNERSHIP PROPERTY MANAGEMENT 0.75600 0.00000 0.22730 1 1 GENESIS MEDICAL CENTER - ILLINI

801 ILLINI DRIVE SILVIS IL 61282

WWW.GENESISHEALTH.COM X X X GENESIS MEDICAL CENTER - ILLINI 1 1 X X X X X X X X 11 1 1 1 X X X X X X X X X X 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 8 ILLINI LARSON CENTER

855 ILLINI DRIVE SILVIS IL 61282

I/P PHARMACY & O/P LAB ILLINI RESTORATIVE CARE

1455 ILLINI DRIVE SILVIS IL 61282

L-T INTERMEDIATE, NSG, & SHELTERED CARE ILLINI AMBULANCE SERVICE

730 AVENUE OF THE CITIES EAST MOLINE IL 61244

AMBULANCE SERVICES GENESIS SENIOR LIVING ALEDO

409 NW NINTH AVENUE ALEDO IL 61231

LONG-TERM CARE FACILITY ILLINI - BUILDING #3

1414 10TH STREET SILVIS IL 61282

OUTPATIENT DIAGNOSTIC CLINIC CROSSTOWN SQUARE

900 CROSSTOWN SQUARE SILVIS IL 61282

INDEPENDENT LIVING FACILITY PHYSICAL THERAPY CLINIC KING PLAZA

3650 AVENUE OF THE CITIES MOLINE IL 61265

OUTPATIENT PHYSICAL THERAPY CLINIC ILLINI - BUILDING #4 - WOUND CENTER

1314 10TH STREET SILVIS IL 61282

OUTPATIENT WOUND CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE PART I, LINE 7: GENESIS HEALTH SYSTEM (GHS ILLINOIS) 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. COSTS OF THE "OTHER BENEFITS" REPORTED IN 7E -7I WERE COMPILED THROUGHOUT THE YEAR IN THE COMMUNITY BENEFIT DATABASE (I.E., CBISA) THAT GHS ILLINOIS UTILIZES. PART I, LINE 7G: NO COSTS ASSOCIATED WITH A PHYSICIAN CLINIC WERE REPORTED IN SUBSIDIZED HEALTH SERVICES. PART I, L7 COL(F): NO BAD DEBT EXPENSE WAS INCLUDED IN THE DENOMINATOR BECAUSE BAD DEBT WAS REPORTED IN LINE 2F OF PART VIII, STATEMENT OF REVENUE. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES IS 20.29%, AND THE PERCENTAGE INCREASES TO 49.19% IF MEDICARE COST REPORT ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE. PART II: COMMUNITY SUPPORT (F3): GENESIS HEALTH SYSTEM (GHS ILLINOIS) PARTICIPATES IN COMMUNITY WIDE DISASTER READINESS DRILLS THROUGHOUT THE YEAR TO ENSURE ITS PREPAREDNESS FOR AN ARRAY OF DISASTERS. WORKFORCE DEVELOPMENT (F8): GHS ILLINOIS AND UNITED TOWNSHIP HIGH SCHOOL CO-OPERATE A PROGRAM THAT TEACHES LIFE AND JOB SKILLS TO THE MENTALLY DISABLED. PART III, LINE 2: IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15, BAD DEBT IS REPORTED AT THE FULL-ESTABLISHED CHARGE FROM THE MOST RECENT AUDITED FINANCIAL REPORT. 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. PART III, LINE 3: GENESIS HEALTH SYSTEM (GHS ILLINOIS) USES AVADYNE HEALTH TO PROCESS AGING PATIENT ACCOUNTS. AVADYNE HEALTH'S COLLECTION PROCESS UTILIZES PUBLICLY AVAILABLE INFORMATION TO ENSURE ALL AGING PATIENT ACCOUNTS RECEIVE FINANCIAL ASSISTANCE IN ACCORDANCE TO GHS ILLINOIS POLICY BEFORE BEING DEEMED BAD DEBT. GHS ILLINOIS REPORTED ZERO DOLLARS FOR THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. RECEIVABLES DUE FROM MEDICAL OFFICE BUILDING TENANTS AND FROM COMMERCIAL LAUNDRY CUSTOMERS ARE CARRIED AT THE ORIGINAL INVOICE AMOUNT LESS AN ESTIMATE MADE FOR DOUBTFUL ACCOUNTS. 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. GENESIS HEALTH SYSTEM (GHS ILLINOIS) DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. 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. PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNT REPORTED IN PART III, LINES 5, 6, AND 7 FOR THE HOSPITAL. IN ADDITION, GENESIS HEALTH SYSTEM (GHS ILLINOIS) CALCULATED ITS MEDICARE SHORTFALL ANOTHER WAY FOR SUPPLEMENTAL INFORMATIONAL PURPOSES. THIS CALCULATION WAS COMPUTED USING THE GROSS PATIENT REVENUE BY PAYOR MIX AND CONVERTED TO COST USING THE COST-TO-CHARGE RATIO FROM PART I, WORKSHEET 2. USING A ZERO BALANCE REPORT FROM JULY 1, 2012 JUNE 30, 2013, THE PAYMENT RATE WAS CALCULATED BY TAKING THE SUM OF THE CONTRACTUALS AND CHARITY CARE AND DIVIDING BY MEDICARE CHARGES, THEN TAKING THE INVERSE. THE SHORTFALL IS THE DIFFERENCE BETWEEN THE PAYMENTS AND THE COSTS. A. UTILIZING THE PAYOR MIX AND ZERO BALANCE REPORT FOR GENESIS MEDICAL CENTER - ILLINI (GMC - ILLINI), COMBINED WITH ITS COST TO CHARGE RATIO OF 37.30%, CALCULATED USING WORKSHEET 2, GMC - ILLINI'S MEDICARE SHORTFALL IS $4,514,888. -SECTION B. MEDICARE - GMC - ILLINI USING COST TO CHARGE RATIO5. TOTAL REVENUE RECEIVED FROM MEDICARE $29,368,237 6. ALLOWABLE COSTS OF CARE $33,883,1257. SURPLUS (SHORTFALL) ($4,514,888)B. UTILIZING THE PAYOR MIX AND ZERO BALANCE REPORT FOR GMC - ILLINI AND ILLINOIS HOSPITAL NURSING HOME (INH), ALONG WITH EACH BUSINESS UNIT'S RESPECTIVE COST TO CHARGE RATIO OF 37.30% AND 75.29%, CALCULATED USING WORKSHEET 2, THE GHS ILLINOIS MEDICARE SHORTFALL IS $5,982,111. -SECTION B. MEDICARE - INDIVIDUAL ADDED - GMC - ILLINI & INH5. TOTAL REVENUE RECEIVED FROM MEDICARE $32,759,347 6. ALLOWABLE COSTS OF CARE $38,741,4587. SURPLUS (SHORTFALL) ($5,982,111)NO MEDICARE SHORTFALLS WERE INCLUDED IN COMMUNITY BENEFIT. THE MEDICARE COST REPORT SHORTFALL REPRESENTS THE DIFFERENCE BETWEEN THE TOTAL REVENUE RECEIVED FROM MEDICARE BASED ON MEDICARE COST REPORT REIMBURSEMENT RATES AND THE COSTS INCURRED BY GHS ILLINOIS IN PROVIDING HEALTHCARE SERVICES TO THE ELDERLY. THE TOTAL MEDICARE SHORTFALL, WHICH INCLUDES FEE SCREEN SERVICES, WAS $1,659,072. IN 2010, THE PERCENT OF PERSONS 65 YEARS AND OVER IN ROCK ISLAND AND SCOTT COUNTIES WAS 18.6%. IN ACCORDANCE WITH GHS ILLINOIS' MISSION STATEMENT, "TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED," THE ELDERLY WERE SERVED DESPITE THE TOTAL MEDICARE LOSS OF $1,659,072. GHS ILLINOIS 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 GHS ILLINOIS IS ONE OF TWO TAX-EXEMPT HEALTHCARE ORGANIZATIONS IN THE COMMUNITY WHO PROVIDE ACCESS TO HEALTHCARE FOR MEDICARE PATIENTS. ACCORDINGLY, IT IS GHS ILLINOIS' POSITION FOR THE REASONS STATED ABOVE THAT THE TOTAL MEDICARE SHORTFALL OF $1,659,072 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 TOTAL MEDICARE SHORTFALL WAS INCLUDED IN PART I, LINE 7, THEN PART I, LINE 7K, COLUMN F WOULD BE 7.35%. 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. GENESIS MEDICAL CENTER - ILLINI PART V, SECTION B, LINE 3: FOR OVER A DECADE, COMMUNITY HEALTH CARE, GENESIS HEALTH SYSTEM (GHS IOWA), GENESIS HEALTH SYSTEM (GHS ILLINOIS), QUAD CITY HEALTH INITIATIVE (QCHI), ROCK ISLAND COUNTY HEALTH DEPARTMENT, SCOTT COUNTY HEALTH DEPARTMENT, AND TRINITY REGIONAL HEALTH SYSTEM HAVE BEEN COLLABORATING ON IMPROVING HEALTH STATUS AND QUALITY OF LIFE IN THE QUAD CITIES REGION THROUGH THE QCHI. OUR COORDINATED ASSESSMENT APPROACH INCLUDED PRIMARY DATA COLLECTION, SECONDARY DATA ANALYSIS, AND QUALITATIVE INPUT FROM COMMUNITY LEADERS. EACH HEALTH DEPARTMENT CONVENED A COMMUNITY HEALTH TASK FORCE TO REVIEW AND PRIORITIZE SECONDARY DATA AND COLLECT QUALITATIVE INPUT FROM COMMUNITY LEADERS IN SCOTT AND ROCK ISLAND COUNTIES. IN ADDITION, THROUGH QCHI, THE HEALTH SYSTEMS FUNDED A SURVEY AND DATA COLLECTION FOR THE BI-STATE AREA AND HIRED PROFESSIONAL RESEARCH CONSULTANTS (PRC) TO CONDUCT THIS WORK. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INCORPORATES DATA FROM PRIMARY RESEARCH (THE PRC COMMUNITY HEALTH SURVEY) AND SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA); THESE COMPONENTS ALLOW FOR TRENDING AND COMPARISON TO BENCHMARK DATA AT THE STATE AND NATIONAL LEVELS.THE SURVEY INSTRUMENT USED FOR THIS STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. THE FINAL SURVEY INSTRUMENT WAS DEVELOPED BY THE SPONSORING ORGANIZATIONS AND PRC, AND IS SIMILAR TO THE PREVIOUS SURVEYS USED IN THE REGION, ALLOWING FOR DATA TRENDING.TO ENSURE THE BEST REPRESENTATION OF THE POPULATION SURVEYED, A TELEPHONE INTERVIEW METHODOLOGY - ONE THAT INCORPORATES BOTH LANDLINE AND CELL PHONE INTERVIEWS - WAS EMPLOYED. THE PRIMARY ADVANTAGES OF TELEPHONE INTERVIEWING ARE TIMELINESS, EFFICIENCY AND RANDOM-SELECTION CAPABILITIES. THE SAMPLE DESIGN USED FOR THIS EFFORT CONSISTED OF A STRATIFIED RANDOM SAMPLE OF 800 INDIVIDUALS AGE 18 AND OLDER IN THE QUAD CITIES AREA, INCLUDING 400 IN ROCK ISLAND COUNTY AND 400 IN SCOTT COUNTY. IN ADDITION, AN OVERSAMPLE OF 120 ADDITIONAL INTERVIEWS WAS IMPLEMENTED AMONG AFRICAN AMERICAN AND HISPANIC ADULTS TO ENSURE THAT THESE POPULATIONS WERE ADEQUATELY REPRESENTED IN THE SAMPLE AND COULD BE ANALYZED INDEPENDENTLY. THIS YIELDED A TOTAL OF 90 INTERVIEWS AMONG AFRICAN AMERICAN RESIDENTS AND 103 INTERVIEWS AMONG HISPANIC RESIDENTS (INCLUDING RESPONDENTS REACHED THROUGH BOTH THE RANDOM SAMPLE AND OVERSAMPLE INTERVIEWS). ONCE ALL SURVEYS WERE COMPLETED, THE TOTAL OF 920 INTERVIEWS WERE WEIGHTED IN PROPORTION TO THE ACTUAL POPULATION DISTRIBUTION SO AS TO APPROPRIATELY REPRESENT QUAD CITIES AREA AS A WHOLE. ALL ADMINISTRATION OF THE SURVEYS, DATA COLLECTION AND DATA ANALYSIS WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC).FOR STATISTICAL PURPOSES, THE MAXIMUM RATE OF ERROR ASSOCIATED WITH A SAMPLE SIZE OF 920 RESPONDENTS IS +/-3.3% AT THE 95 PERCENT LEVEL OF CONFIDENCE. [NOTE THAT ANALYSES OF SUBGROUPS CARRY LARGER ASSOCIATED ERROR; FOR EXAMPLE, THE SAMPLES OF AFRICAN AMERICAN AND HISPANIC RESIDENTS (INCLUDING THE "OVERSAMPLE" INTERVIEWS) CARRY MAXIMUM ERROR RATES OF +/-10.3% AND +/-9.7%, RESPECTIVELY.]IT IS A COMMON AND PREFERRED PRACTICE TO "WEIGHT" THE RAW DATA TO IMPROVE REPRESENTATIVENESS EVEN FURTHER. THIS IS ACCOMPLISHED BY ADJUSTING THE RESULTS OF A RANDOM SAMPLE TO MATCH THE GEOGRAPHIC DISTRIBUTION AND DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION SURVEYED (POSTSTRATIFICATION), SO AS TO ELIMINATE ANY NATURALLY OCCURRING BIAS. SPECIFICALLY, ONCE THE RAW DATA ARE GATHERED, RESPONDENTS ARE EXAMINED BY KEY DEMOGRAPHIC CHARACTERISTICS (NAMELY GENDER, AGE, RACE, ETHNICITY, AND POVERTY STATUS) AND A STATISTICAL APPLICATION PACKAGE APPLIES WEIGHTING VARIABLES THAT PRODUCE A SAMPLE WHICH MORE CLOSELY MATCHES THE POPULATION FOR THESE CHARACTERISTICS. THUS, WHILE THE INTEGRITY OF EACH INDIVIDUAL'S RESPONSES IS MAINTAINED, ONE RESPONDENT'S RESPONSES MAY CONTRIBUTE TO THE WHOLE THE SAME WEIGHT AS, FOR EXAMPLE, 1.1 RESPONDENTS. ANOTHER RESPONDENT, WHOSE DEMOGRAPHIC CHARACTERISTICS MAY HAVE BEEN SLIGHTLY OVERSAMPLED, MAY CONTRIBUTE THE SAME WEIGHT AS 0.9 RESPONDENTS.A VARIETY OF EXISTING (SECONDARY) DATA SOURCES WAS CONSULTED TO COMPLEMENT THE RESEARCH QUALITY OF THIS COMMUNITY HEALTH ASSESSMENT. DATA FOR ROCK ISLAND AND SCOTT COUNTIES WERE OBTAINED FROM THE FOLLOWING SOURCES: CENTERS FOR DISEASE CONTROL & PREVENTION GEOLYTICS DEMOGRAPHIC ESTIMATES & PROJECTIONS NATIONAL CENTER FOR HEALTH STATISTICS IOWA DEPARTMENT OF PUBLIC HEALTH / ILLINOIS DEPARTMENT OF PUBLIC HEALTH IOWA DEPARTMENT OF PUBLIC SAFETY / ILLINOIS STATE POLICE US CENSUS BUREAU US DEPARTMENT OF HEALTH AND HUMAN SERVICES US DEPARTMENT OF JUSTICE, FEDERAL BUREAU OF INVESTIGATION NOTE THAT SECONDARY DATA REFLECT COUNTY-LEVEL DATA. GENESIS MEDICAL CENTER - ILLINI PART V, SECTION B, LINE 4: TRINITY REGIONAL HEALTH SYSTEM PART V, LINE 5A: HTTPS://WWW.GENESISHEALTH.COM/NEWS/2012/QC-HEALTH-ASSESSMENT PART VI, LINE 2: GENESIS HEALTH SYSTEM (GHS ILLINOIS) UTILIZES THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC) IN 2012. THE CHNA WAS FUNDED BY GHS ILLINOIS AND TRINITY REGIONAL HEALTH SYSTEM AND SPONSORED BY COMMUNITY HEALTH CARE, GHS ILLINOIS, QUAD CITY HEALTH INITIATIVE (QCHI), ROCK ISLAND COUNTY HEALTH DEPARTMENT, SCOTT COUNTY HEALTH DEPARTMENT, AND TRINITY REGIONAL HEALTH SYSTEM. QCHI WAS FORMED BY GENESIS HEALTH SYSTEM (GHS IOWA) AND GHS ILLINOIS, WHICH HAS HEADQUARTERS IN BOTH SCOTT COUNTY, IOWA, AND ROCK ISLAND COUNTY, ILLINOIS, AND TRINITY 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. 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 (GHS ILLINOIS) 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. PART VI, LINE 4: GENESIS HEALTH SYSTEM'S (GHS ILLINOIS) MISSION IS TO PROVIDE QUALITY, COMPASSIONATE CARE FOR ALL THOSE IN NEED. GHS ILLINOIS LIVES ITS MISSION EACH DAY BY SERVING A 10-COUNTY REGION OF EASTERN IOWA AND WESTERN ILLINOIS, INCLUDING BOTH URBAN AND RURAL AREAS. THE REGION SERVED BY GHS ILLINOIS (DAVENPORT-MOLINE-ROCK ISLAND, IA.-IL. METROPOLITIAN STATISTICAL AREA HENRY COUNTY, IL., MERCER COUNTY, IL, ROCK ISLAND, IL., AND SCOTT COUNTY, IA.) HAS A POPULATION OF 379,690. ACCORDING TO THE 2010 CENSUS, WHITES MADE UP 88.4% OF THE MSA POPULATION WITH 8.3% BLACK OR AFRICAN-AMERICAN AND 7.6% HISPANIC OR LATINO ORIGIN.MEDIAN AGE OF THE POPULATION OF THE REGION IS 40.6 YEARS. MORE THAN 30% OF THE POPULATION OF THE REGION IS GREATER THAN 50 YEARS OLD, WHICH WILL CREATE A CONTINUED AND EXPANDED NEED FOR HEALTH CARE SERVICES IN THE NEXT 20 YEARS. THE PERCENT OF PERSONS 65 YEARS AND OVER WAS 18.6% IN ROCK ISLAND AND SCOTT COUNTIES.ACCORDING TO ESTIMATES FROM THE AMERICAN COMMUNITY SURVEY (ACS), 11.9% OF QUAD CITIES AREA RESIDENTS (SCOTT AND ROCK ISLAND COUNTIES) LIVE BELOW THE FEDERAL POVERTY. IN 2012, 2.0% OF QUAD CITIES AREA ADULTS REPORTED THAT THERE WAS A TIME IN THE PAST TWO YEARS WHEN THEY WERE LIVING ON THE STREET, IN A CAR, OR IN A TEMPORARY SHELTER. THE AVERAGE UNEMPLOYMENT RATE IN 2009 WAS 9.2% FOR ROCK ISLAND COUNTY, ILLINOIS AND 6.6% IN SCOTT COUNTY, IOWA.LACK OF HEALTH INSURANCE IS REPORTED BY 12% OF SCOTT COUNTY, IA RESIDENTS AND 13% OF ROCK ISLAND COUNTY, IL RESIDENTS. THE QUAD CITIES AREA PERCENTAGE OF ADULTS WHO CURRENTLY SMOKED IN 2012 WAS 19.4%. THE PERCENTAGE OF ADULTS WHO WERE OBESE IN 2012 WAS 33.4% IN ROCK ISLAND COUNTY, ILLINOIS AND 33.6% IN SCOTT COUNTY, IOWA. OBESITY RATES IN BOTH SCOTT COUNTY, IA AND ROCK ISLAND COUNTY, IL ARE HIGHER THAN NATIONAL BENCHMARKS. PART VI, LINE 5: GENESIS HEALTH SYSTEM'S (GHS ILLINOIS) BOARD OF DIRECTORS IS A DIVERSE REPRESENTATION OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA THAT GHS ILLINOIS SERVES. GHS ILLINOIS EXECUTIVES AND EMPLOYEES SERVE ON DOZENS OF VOLUNTEER BOARDS THROUGHOUT THE REGION ON IMPORTANT PROJECTS AND INITIATIVES, SUCH AS HOMELESS SHELTERS, MENTAL HEALTH, DOWNTOWN REDEVELOPMENT AND EVENTS AND FESTIVALS. GHS ILLINOIS EMPLOYEES SERVE THE COMMUNITIES WHERE THEY LIVE BY SERVING IN ELECTED OFFICES IN CITY AND COUNTY GOVERNMENT.GHS ILLINOIS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. GHS ILLINOIS 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. GHS ILLINOIS SCHEDULES DOZENS OF HEALTH SCREENINGS AND IMMUNIZATIONS THROUGHOUT THE YEAR AT A REDUCED COST. THESE INCLUDE SCREENINGS FOR DIABETES, STROKE AND HEART DISEASE AND PUBLIC FLU IMMUNIZATION CLINICS.GHS ILLINOIS SPONSORS GENESIS ADVENTURES IN NURSING (GAIN), A CAMP FOR CHILDREN INTERESTED IN HEALTH CARE CAREERS. GHS ILLINOIS EMPLOYEES SERVE AS MENTORS AND INSTRUCTORS DURING CAMP WEEK.GHS ILLINOIS EMPLOYEES MAKE MEDICAL MISSION TRIPS EACH YEAR TO AREAS OF NEED ALL OVER THE WORLD. GHS ILLINOIS EMPLOYEES HAVE PROVIDED RELIEF TO HAITI AFTER THE EARTHQUAKE AND DURING THE CHOLERA OUTBREAK AND TO TRADITIONALLY IMPOVERISHED COUNTRIES, INCLUDING PERU, ECUADOR, THE DOMINICAN REPUBLIC, HAITI AND TO AFRICAN NATIONS. GHS ILLINOIS EMPLOYEES SUPPORT COMMUNITY OUTREACH PROGRAMS THROUGH A PROGRAM CALLED "TAKIN IT TO THE STREETS." PROJECTS HAVE INCLUDED PRIMARY SPONSORSHIP OF A HABITAT FOR HUMANITY HOUSE (280 VOLUNTEERS); COLLECTION OF ITEMS FOR DOMESTIC VIOLENCE SHELTERS AND HUMILITY OF MARY HOMELESS SHELTER; X-STREAM CLEANUP (85 VOLUNTEERS), A CLEANUP PROJECT OF RIVERS AND STREAMS, AND ADOPT A HIGHWAY. EMPLOYEES HAVE USED THEIR COLLECTIVE IMPACT AND GENEROSITY TO SECURE DONATIONS FOR FOOD PANTRIES. EACH YEAR, GHS ILLINOIS PROVIDES THE COMMUNITY WITH DOZENS OF CLASSES AND EVENTS PROMOTING HEALTH AND HEALTH EDUCATION. HUNDREDS OF RESIDENTS IN THE REGION SERVED BY GHS ILLINOIS LEARN CPR, FIRST AID, PARENTING SKILLS AND NEWBORN CARE BY ENROLLING IN CLASSES.GHS ILLINOIS HAS LAUNCHED GENESIS DINEWELL, A HEALTHY EATING PLAN FOR ITS OWN CAFETERIAS AND FOR RESTAURANTS IN THE REGION. GENESIS DINEWELL WILL WORK WITH LOCAL RESTAURANTS TO MAKE INFORMATION PUBLIC ABOUT HEALTHY RECIPES AND MENU ITEMS. THE IDEA IS THAT THE PUBLIC WILL BE BETTER ABLE TO MAKE INFORMED DECISIONS ABOUT THEIR FOOD CHOICES. GHS ILLINOIS DIETITIANS WILL COMPILE HEALTH RECIPES TO PROVIDE TO THE PUBLIC. THERE WILL ALSO BE AN "ASK THE DIETITIAN" FEATURE AVAILABLE AT WWW.GENESISHEALTH.COM.GHS ILLINOIS LAUNCHED A TOBACCO-FREE PARKS PROJECT IN 2013. A PETITION DRIVE WILL ASK COMMUNITIES TO BAN SMOKING WITHIN A DEFINED DISTANCE FROM PLAYGROUNDS, YOUTH ATHLETIC FIELDS AND OTHER AREAS WHERE CHILDREN PLAY AND ENJOY SPORTS EVENTS. HUNDREDS OF PEOPLE HAVE SIGNED THE PETITION.GHS ILLINOIS HAS REDUCED ITS ENVIRONMENTAL FOOTPRINT ON THE COMMUNITIES IT SERVES BY IMPLEMENTING BULK WASTE RECYCLING, POLYSTYRENE RECYCLING, REDUCING SHARPS DISPOSAL, IMPLEMENTING WATER RUNOFF MEASURES, AND REDUCING WATER AND CHEMICAL USAGE IN THE MEDICAL LAUNDRY. IN 2013, GHS ILLINOIS COMPLETED CONSTRUCTION ON A MEDICAL OFFICE PARK IN MOLINE, IL. THE LAND WAS REMEDIATED BY GHS ILLINOIS FROM A LANDFILL SITE AND GREEN FEATURES WERE INTEGRATED INTO THE SITE AND DESIGN OF THE BUILDING.GHS ILLINOIS SPONSORS AND HOSTS AN ANNUAL BOY SCOUT MERIT BADGE DAY TO ASSIST SCOUTS IN WORKING TOWARD FIRST AID AND MEDICINE MERIT BADGES. PROFESSIONAL HEALTH CARE STAFF INSTRUCT THE SCOUTS FOR THE DAY.GHS ILLINOIS MAINTAINS AN ACTIVE EFFORT TO ADVOCATE FOR ACCESS TO HEALTH CARE IN IOWA AND ILLINOIS STATE GOVERNMENT AND IN WASHINGTON D.C. GHS ILLINOIS EMPLOYEES ALSO PARTICIPATE IN A VOTER VOICE INITIATIVE TO ADVOCATE ON IMPORTANT HEALTH ISSUES WITH CITY, COUNTY, STATE AND NATIONAL ELECTED OFFICIALS. IN 2013, GHS ILLINOIS RECEIVED A FEDERAL GRANT TO ASSIST UNINSURED INDIVIDUALS IN THE REGION TO SECURE HEALTH INSURANCE. GHS ILLINOIS PROJECTS IT WILL ASSIST AS MANY AS 11,000 INDIVIDUALS TO GAIN ACCESS TO HEALTH INSURANCE. SURPLUS FUNDS RESULTING FROM EFFICIENT OPERATIONS AND COST-CONTAINMENT MEASURES ARE RE-INVESTED IN THE HEALTHCARE OPERATIONS OF GHS ILLINOIS TO IMPROVE THE HEALTHCARE SERVICES THAT GHS ILLINOIS 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 GHS ILLINOIS SERVES. PART VI, LINE 6: GENESIS HEALTH SYSTEM (GHS IOWA) AN IOWA NONPROFIT CORPORATION, AND GENESIS HEALTH SYSTEM (GHS ILLINOIS), AN ILLINOIS NOT-FOR-PROFIT CORPORATION, HAVE IDENTICAL GOVERNING BOARDS, MANAGEMENT AND BYLAWS AND CAN ACT JOINTLY. GHS IOWA 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 GENGASTRO, LLC. GHS ILLINOIS IS THE SOLE MEMBER OF GENESIS MEDICAL CENTER, ALEDO AND GENESIS SENIOR LIVING, ALEDO AND IS A PARTNER IN THE LARSON CENTER PARTNERSHIP. THE FOLLOWING ENTITIES FORMED DURING THE YEAR ENDED JUNE 30, 2013: GENESIS MEDICAL CENTER, ALEDO (GMC, ALEDO) IS CERTIFIED AS A CRITICAL ACCESS HOSPITAL, WHICH HAS 22-ACUTE CARE AND SWING BEDS, AS WELL AS A PHYSICIAN CLINIC, WHICH PROVIDES SERVICES FROM ITS FACILITY IN ALEDO, ILLINOIS. ON FEBRUARY 1, 2013, GMC, ALEDO ACQUIRED ALL OF THE ASSETS AND ASSUMED ALL THE LIABILITIES OF THE HOSPITAL IN ALEDO, ILLINOIS FROM MERCER COUNTY, ILLINOIS, FOR NO CONSIDERATION. THE ASSETS ACQUIRED EXCEED THE LIABILITIES ASSUMED BY APPROXIMATELY $2,536,000, A CONTRIBUTION WHICH IS PRESENTED AS A COMPONENT OF OTHER NONOPERATING INCOME. GENESIS SENIOR LIVING, ALEDO (GSL, ALEDO) IS CERTIFIED AS A NURSING FACILITY, WHICH HAS A 92-BED LONG-TERM CARE FACILITY, WHICH PROVIDES SERVICES FROM ITS FACILITY IN ALEDO, ILLINOIS. ON FEBRUARY 1, 2013, GSL, ALEDO ACQUIRED ALL OF THE ASSETS AND ASSUMED ALL THE LIABILITIES OF THE NURSING HOME IN ALEDO, ILLINOIS FROM MERCER COUNTY, ILLINOIS FOR APPROXIMATELY $2,250,000. THE ASSETS ACQUIRED EXCEED THE LIABILITIES ASSUMED AND CONSIDERATION PAID BY APPROXIMATELY $725,000, A CONTRIBUTION WHICH IS PRESENTED AS A COMPONENT OF OTHER NONOPERATING INCOME. GHS IOWA, GHS ILLINOIS, GMC, ALEDO AND GSL, ALEDO COLLECTIVELY REPRESENT THE OBLIGATED GROUP ON CERTAIN COMPONENTS OF THE OBLIGATED GROUP'S LONG-TERM DEBT. GHS IOWA AND GHS ILLINOIS OPERATE THE FOLLOWING BUSINESS UNITS: GENESIS HEALTH SYSTEM PROVIDES ADMINISTRATIVE, MANAGEMENT, INFORMATION TECHNOLOGY AND OTHER SUPPORT SERVICES TO ITS AFFILIATES. GENESIS CLINICAL SERVICES OPERATES PHYSICIAN MEDICAL PRACTICES, CONVENIENT CARE PRACTICES AND 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) OWNED LAND LOCATED IN MOLINE, ILLINOIS. DURING THE YEAR ENDED JUNE 30, 2012, GIP SOLD ITS LAND TO GENESIS MEDICAL CENTER ILLINI AND GIP WAS DISCONTINUED AS A BUSINESS UNIT. 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 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 IS A 120-BED LICENSED NURSING FACILITY, CONSISTING OF 75 SKILLED CARE BEDS AND 45 SHELTERED CARE BEDS. TWENTY-TWO OF THE SKILLED CARE BEDS ARE DESIGNATED AS HOSPITAL-BASED MEDICARE CERTIFIED BEDS. THE SHELTERED CARE UNIT PROVIDES REHABILITATIVE AND PERSONAL CARE IN A FAMILY-ORIENTED SETTING. CROSSTOWN SQUARE IS AN INDEPENDENT LIVING FACILITY CONTAINING 76 RENTABLE APARTMENTS AND TWO GUEST ROOMS THAT OFFERS SERVICES DESIGNED TO MEET THE NEEDS OF SENIOR ADULTS. GHS IOWA AND GHS ILLINOIS HAVE 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. THE GENESIS FOUNDATION IS REFERRED TO AS THE FOUNDATION. ILLINI HOSPITAL FOUNDATION (ILLINI FOUNDATION) SUPPORTED GMC ILLINI BY PROVIDING FINANCIAL AND FUNDRAISING ASSISTANCE. THE MISSION OF THE ILLINI FOUNDATION WAS TO ASSIST GMC ILLINI IN PROVIDING QUALITY, COMPASSIONATE CARE FOR ALL THOSE IN NEED BY RAISING, MANAGING AND GRANTING CHARITABLE FUNDS. DURING THE YEAR ENDED JUNE 30, 2012, ILLINI FOUNDATION MERGED WITH GENESIS FOUNDATION AND ILLINI FOUNDATION WAS DISSOLVED. GENGASTRO, LLC (D/B/A THE CENTER FOR DIGESTIVE HEALTH) IS A LIMITED LIABILITY COMPANY, WHICH WAS FORMED IN 2003, A SINGLE-SPECIALTY GASTROENTEROLOGY AMBULATORY SURGERY CENTER LOCATED IN BETTENDORF, IOWA. UPON OBTAINING A CONTROLLING INTEREST, THE SYSTEM CONSOLIDATED THE ACCOUNTS OF GENGASTRO, LLC IN ITS CONSOLIDATED FINANCIAL STATEMENTS IN JANUARY 2011. DURING THE YEAR ENDED JUNE 30, 2012, GHS IOWA ACQUIRED AN ADDITIONAL 8.33% INTEREST IN GENGASTRO, LLC FROM NONCONTROLLING INTERESTS AND MAINTAINS A 75% OWNERSHIP INTEREST AS OF JUNE 30, 2013 AND 2012. THE LARSON CENTER PARTNERSHIP (LCP) IS A FOR-PROFIT REAL ESTATE PARTNERSHIP WHICH OWNS A MEDICAL OFFICE BUILDING ADJACENT TO GMC ILLINI AND LEASES SPACE FOR CLINICS, LABORATORY, PHARMACY AND OFFICES TO GMC ILLINI AND OTHER THIRD-PARTY ORGANIZATIONS. GHS ILLINOIS IS A GENERAL PARTNER AND OWNS APPROXIMATELY 75.6% OF LCP.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 15 MEDICAL OFFICE BUILDINGS LOCATED IN BETTENDORF, CLINTON, DAVENPORT, ELDRIDGE, LE CLAIRE AND MUSCATINE, IOWA. CRESCENT LAUNDRY PROVIDES COMMERCIAL LAUNDRY SERVICES TO HEALTH CARE FACILITIES IN EASTERN IOWA AND IN NORTH-CENTRAL ILLINOIS. GENESIS ACCOUNTABLE CARE ORGANIZATION, LLC (GENESIS ACO) IS AN IOWA LIMITED LIABILITY COMPANY FORMED IN DECEMBER 2011. ITS PURPOSE IS TO ENGAGE IN ANY LAWFUL BUSINESS AND ANY BUSINESS RELATED TO CREATION AND ORGANIZATION OF A "PHYSICIAN-DRIVEN" NETWORK TO ACT AS, AND/OR PARTICIPATE IN, AN ACCOUNTABLE CARE ORGANIZATION WITHIN THE MEANING OF THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE COMPANY IS ALSO ORGANIZED TO DEVELOP A CLINICALLY INTEGRATED NETWORK OF PROVIDERS INCLUDING PHYSICIANS, HEALTH PROFESSIONALS, HOSPITALS AND ANCILLARY PROVIDERS WORKING TOGETHER TO PROMOTE HIGH QUALITY, COORDINATED AND EFFICIENT CARE TO PATIENTS INCLUDING MEMBERS OF VARIOUS MANAGED CARE PAYORS AND THE COMMUNITY AT LARGE. 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 GHS ILLINOIS. MISERICORDIA ASSURANCE COMPANY, LTD. (MISERICORDIA) IS A WHOLLY-OWNED CAYMAN BASED CAPTIVE INSURANCE COMPANY WHICH UNDERWRITES THE GENERAL AND PROFESSIONAL LIABILITY RISKS OF GHS IOWA AND AFFILIATES. DAVENPORT SRS LEASING, LLC (SRS) IS A LIMITED LIABILITY COMPANY, WHICH WAS FORMED IN 2008, WHICH LEASES MEDICAL EQUIPMENT. GHS IOWA MAINTAINED A 93.75% OWNERSHIP INTEREST AS OF JUNE 30, 2011. DURING THE YEAR ENDED JUNE 30, 2012, GMC DAVENPORT ACQUIRED THE REMAINING INTEREST OF SRS, TO OBTAIN 100% OWNERSHIP. UPON OBTAINING 100% OWNERSHIP, THE ASSETS, LIABILITIES AND OPERATIONS OF SRS WERE TRANSFERRED TO GMC DAVENPORT AND SRS WAS DISSOLVED. GENESIS PHILANTHROPY IS A WHOLLY-OWNED TAX-EXEMPT ENTITY FORMED IN 2013, WHICH WILL PARTNER WITH OTHER HOSPITAL FOUNDATIONS TO FORM A REGIONAL NETWORK TO ATTRACT DONORS TO HELP FUND SPECIFIC HEALTH-RELATED CAUSES AND PROMOTE WELLNESS IN THE REGION. GENESIS PHILANTHROPY HAD NO FINANCIAL ACTIVITY FOR THE YEAR ENDED JUNE 30, 2013. REPORTS FILED WITH STATES PART VI, LINE 7 IL,IA 1 GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 E RUSHOLME STREET DAVENPORT IA 52803 391905171 501(C)(3) 270224 CLAIM PAYMENTS BIRDIES FOR CHARITY 15623 COALTOWN ROAD EAST MOLINE IL 61244 931332421 501(C)(3) 10000 GENERAL SUPPORT TO BE DISTRIBUTED TO LOCAL NON-PROFITS. GENESIS HEALTH SYSTEM (GHS IOWA) 1227 E RUSHOLME STREET DAVENPORT IA 52803 421418847 501(C)(3) 6240 DEDUCTIONS BY MEDICAL STAFF, DIRECTED TOWARDS MEDICAL EDUCATION PURPOSES AND THE PERLMUTTER LIBRARY AT THE GENESIS MEDICAL CENTER - ILLINI CAMPUS. GENESIS HEALTH SERVICES FOUNDATION 1227 E RUSHOLME STREET DAVENPORT IA 52803 421421670 501(C)(3) 6200 UNRESTRICTED DONATIONS BY THE MEDICAL STAFF TO SUPPORT THE MISSION OF THE GENESIS HEALTH SERVICES FOUNDATION. 4 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GENESIS HEALTH SYSTEM (GHS 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 DOUGLAS P CROPPER 0 610687 0 179153 0 499740 0 98378 0 22925 0 1410883 0 341127 GEORGE J KONTOS JR MD 0 498555 0 3819 0 26423 0 11250 0 17294 0 557341 0 0 MARK G ROGERS 0 292096 0 65263 0 209747 0 50775 0 13013 0 630894 0 132586 WAYNE DIEWALD 0 376755 0 35497 0 2167 0 113999 0 14154 0 542572 0 0 ROBERT W FRIEDEN 0 239030 0 47365 0 97079 0 11075 0 19626 0 414175 0 0 FLORENCE L SPYROW 114192 203008 17121 30436 5732 10190 32982 58634 850 1510 170877 303778 0 0 KENNETH R CROKEN 0 228879 0 35230 0 178940 0 36692 0 15607 0 495348 0 88911 JAMES A LEHMAN MD 0 279934 0 53026 0 147923 0 46191 0 14232 0 541306 0 0 JUDITH A MONDELLO 0 243522 0 43203 0 43644 0 38126 0 7198 0 375693 0 0 ROBERT M NELSON MD 0 154361 0 0 0 203182 0 9515 0 11443 0 378501 0 105947 JUDITH K PRANGER 0 78120 0 28518 0 132568 0 31939 0 9785 0 280930 0 0 HEIDI S KAHLY-MCMAHON 0 179762 0 22800 0 9142 0 44405 0 19689 0 275798 0 0 MIKE L SHARP 0 158345 0 24375 0 25083 0 40931 0 13748 0 262482 0 0 PART I, LINE 1A GENESIS HEALTH SYSTEM (GHS ILLINOIS) PROVIDES THE FOLLOWING TO INDIVIDUALS REPORTED IN PART VII, SECTION A, LINE 1A: TRAVEL FOR COMPANIONS: IN TAX YEAR 2012, THE FOLLOWING TYPES OF LISTED INDIVIDUALS REPORTED IN PART VII RECEIVED THE TRAVEL FOR COMPANIONS BENEFIT: 7 DIRECTORS, 4 OFFICERS, 2 KEY EMPLOYEES, 1 HIGHEST COMPENSATED EMPLOYEE, AND 2 FORMER KEY EMPLOYEES. ALL INDIVIDUALS REIMBURSED GHS ILLINOIS IN FULL AND NONE OF THE BENEFIT WAS LISTED AS TAXABLE COMPENSATION. 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. JAMES A. LEHMAN RECEIVED THIS BENEFIT IN 2012. SEE ADDITIONAL INFORMATION PROVIDED BELOW. PART I, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2012 SPONSORED BY GENESIS HEALTH SYSTEM (GHS IOWA), A RELATED ORGANIZATION: JAMES A. LEHMAN, M.D. - $116,175. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUAL TO THE PLAN IN 2012 AND THE GROSS-UP PAYMENT TO COVER TAX. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2012 SPONSORED BY GHS IOWA, A RELATED ORGANIZATION: KENNETH R. CROKEN - $153,019, DOUGLAS P. CROPPER - $480,670, ROBERT W. FRIEDEN - $72,765, JUDITH A. MONDELLO - $24,876, ROBERT M. NELSON, M.D. - $132,086, JUDITH K. PRANGER - $27,556, MARK G. ROGERS - $190,594, MIKE L. SHARP - $16,291. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2012. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2012 SPONSORED BY GHS IOWA, A RELATED ORGANIZATION: KENNETH R. CROKEN - $21,778, DOUGLAS P. CROPPER - $87,128, WAYNE DIEWALD - $113,999, HEIDI S. KAHLY-MCMAHON - $38,543, JUDITH A. MONDELLO - $26,876, MARK G. ROGERS - $38,307, MIKE L. SHARP - $16,291 AND FLORENCE L. SPYROW - $80,366. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2012. 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 (GHS ILLINOIS) RELIES ON GENESIS HEALTH SYSTEM (GHS IOWA) TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS, AND KEY EMPLOYEES. GHS IOWA UTILIZES A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE SUCH COMPENSATION. PART II, COLUMN F: THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2009, 2010, 2011, AND 2012 SPONSORED BY GENESIS HEALTH SYSTEM (GHS IOWA), A RELATED ORGANIZATION: KENNETH R. CROKEN - $88,911, DOUGLAS P. CROPPER - $341,127, ROBERT M. NELSON, M.D. - $105,947 AND MARK G. ROGERS - $132,586. THE DOLLAR AMOUNT REPRESENTS PRIOR YEAR CONTRIBUTIONS MADE BY GHS IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009, 2010 AND 2011. THIS INFORMATION WAS INCLUDED IN DEFERRED COMPENSATION ON THE PRIOR YEARS' FORM 990, PART VII AND SCHEDULE J, PART II. THESE INDIVIDUALS REACHED A SPECIFIED LEVEL OF VESTING IN 2012, SO THE DOLLAR AMOUNT IS NOW INCLUDED IN REPORTABLE COMPENSATION ON THE CURRENT YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THE DOLLAR AMOUNT IS ALSO LISTED AS COMPENSATION REPORTED IN A PRIOR FORM 990 ON THE CURRENT YEAR FORM 990, SCHEDULE J, PART II. GENVENTURES INC SEE BELOW IN PART V 1573916 GENESIS HEALTH SYSTEM (GHS ILLINOIS) PAID GENVENTURES, INC. FOR MEDICAL SUPPLIES AND LAUNDRY SERVICES. 0 LARSON CENTER PARTNERSHIP SEE BELOW IN PART V 502276 FACILITY LEASE PAYMENTS 0 GENVENTURES INC SEE BELOW IN PART V 147061 PAYMENT FROM GENVENTURES, INC. FOR MEDICAL SUPPLIES 0 CARDIOVASCULAR MEDICINE PC SEE BELOW IN PART V 114403 HEALTHCARE PROFESSIONAL SERVICES 0 FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - GENVENTURES, INC. MARK G. ROGERS AND ROGER J. HILL ARE OFFICERS, FLORENCE L. SPYROW IS A KEY EMPLOYEE, JAMES W. KOEHLER IS A DIRECTOR, AND MIKE L. SHARP IS A FORMER KEY EMPLOYEE OF GENESIS HEALTH SYSTEM (GHS ILLINOIS) AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, MARK G. ROGERS, ROGER J. HILL, JAMES W. KOEHLER, AND MIKE L. SHARP WERE OFFICERS OF GENVENTURES, INC., AND FLORENCE L. SPYROW WAS A DIRECTOR OF GENVENTURES, INC. FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - LARSON CENTER PARTNERSHIP FLORENCE L. SPYROW IS A KEY EMPLOYEE OF GENESIS HEALTH SYSTEM (GHS ILLINOIS), AND THE VOTING REPRESENTATIVE IN THE LARSON CENTER PARTNERSHIP FOR GHS ILLINOIS, A PARTNER IN THE LARSON CENTER PARTNERSHIP. FORM 990, SCHEDULE L, PART IV, COLUMN B: DESCRIPTION OF RELATIONSHIP - CARDIOVASCULAR MEDICINE, PC EDMUND P. COYNE, JR., M.D. IS A DIRECTOR OF GENESIS HEALTH SYSTEM (GHS ILLINOIS) AND IS ALSO A DIRECTOR OF CARDIOVASCULAR MEDICINE, PC. FORM 990, PART I, LINE 4 & PART VI, SECTION A, LINE 1B: THE FOLLOWING GENESIS HEALTH SYSTEM,(GHS ILLINOIS) DIRECTORS ARE NOT INDEPENDENT DUE TO TRANSACTIONS DISCLOSED ON FORM 990, SCHEDULE L OF GENESIS HEALTH SYSTEM (IOWA), A RELATED TAX-EXEMPT ORGANIZATION: THOMAS A. GILDEHAUS, MARK C. KILMER, EDWIN V. MOTTO, M.D., EDWARD J. ROGALSKI, PH.D., AND C. DANA WATERMAN III. FORM 990, PART VI, SECTION B, LINE 11 INTERNAL MANAGEMENT REVIEW IS COMPLETED OF THE COMPILED INFORMATION PRIOR TO PREPARATION AND REVIEW BY MCGLADREY LLP. FOLLOWING MCGLADREY LLP'S PREPARATION AND REVIEW OF THE FORM 990, IT IS REVIEWED WITH THE ORGANIZATION'S VICE PRESIDENT, FINANCE/CFO; VICE PRESIDENT, LEGAL AFFAIRS; VICE PRESIDENT, HUMAN RESOURCES; AND CHIEF COMPLIANCE RISK OFFICER. 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 ILLINOIS) 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 ILLINOIS, 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 AND MAXIMUM ARE ESTABLISHED OFF OF THE MIDPOINT. SPECIFIC PAY RATES FOR EXECUTIVES ARE SUBJECT TO CEO AND COMPENSATION COMMITTEE AND THE GENESIS HEALTH SYSTEM (GHS ILLINOIS) 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 GHS ILLINOIS 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 ILLINOIS BOARD OF DIRECTORS, THE BASE COMPENSATION OF EACH EXECUTIVE EMPLOYED BY GHS ILLINOIS, AT APPROPRIATE TIMES. THE GHS ILLINOIS BOARD OF DIRECTORS SHALL ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE, THE BASE COMPENSATION FOR THE CEO OF GHS ILLINOIS, AT APPROPRIATE TIMES. THE LAST TIME THIS PROCESS WAS FORMALLY UNDERTAKEN WAS NOVEMBER 2012. 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 VII, LINE 1A: GENESIS HEALTH SYSTEM (GHS IOWA), GENESIS HEALTH SYSTEM (GHS ILLINOIS), GENESIS MEDICAL CENTER, ALEDO, AND GENESIS SENIOR LIVING, ALEDO 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 ALL FOUR 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 ALL FOUR 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 AMONG EACH ORGANIZATION. ALL REPORTABLE COMPENSATION, UNLESS OTHERWISE NOTED IN PART VII, IS PAID BY GHS IOWA. PROVISION FOR DOUBTFUL ACCOUNTS FORM 990, PART VIII, LINE 2F: GENESIS HEALTH SYSTEM (GHS ILLINOIS) CHANGED ITS METHOD OF PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE AND THE PROVISION FOR DOUBTFUL ACCOUNTS AS A RESULT OF THE ADOPTION OF ACCOUNTING STANDARDS UPDATE NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES, DURING THE YEAR ENDED JUNE 30, 2013. THEREFORE, EFFECTIVE FOR THE CURRENT TAX YEAR, BAD DEBT EXPENSE IS NETTED WITH PROGRAM SERVICE REVENUES AND INCLUDED IN PART XIII, LINE 2F. FORM 990, PART X, COLUMN A, LINES 4 & 17: IN FISCAL YEAR 2013, GENESIS HEALTH SYSTEM'S (GHS ILLINOIS) AUDITED FINANCIAL REPORT MODIFIED THE PRESENTATION OF AFFILIATES' ACCOUNTS RECEIVABLE AND ACCOUNTS PAYABLE. AS A RESULT OF THIS CHANGE, FORM 990, PART X, COLUMN B (END OF YEAR), LINES 4 AND 17 REFLECT THIS NEW PRESENTATION. ALSO IN ACCORDANCE WITH THE AUDITED FINANCIAL REPORT PRESENTATION, FORM 990, PART X, COLUMN A (BEGINNING OF YEAR), LINES 4 AND 17 WERE NOT RESTATED TO REFLECT THE PRESENTATION CHANGE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS OF GENESIS HEALTH SERVICES FOUNDATION -41,960. FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. GENESIS OUTPATIENT PHYSICAL THERAPY LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 208389282 OUTPATIENT PHYSICAL THERAPY SERVICES IA 0 0 GENESIS HEALTH SYSTEM (GHS IOWA) GENESIS ACCOUNTABLE CARE ORGANIZATION LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 454168932 ACCOUNTABLE CARE SERVICES IA 1365482 1365482 GENESIS HEALTH SYSTEM (GHS IOWA) SPIN ECHO LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 421491373 PROPERTY MANAGEMENT IA 142927 1600877 GENVENTURES INC GENESIS HEALTH SYSTEM (GHS IOWA) 1227 E RUSHOLME STREET DAVENPORT IA 52803 421418847 HEALTHCARE IA 501(C)(3) LINE 3 GENESIS HEALTH SYSTEM (GHS ILLINOIS) 1 GENESIS HEALTH SERVICES FOUNDATION 1227 E RUSHOLME STREET DAVENPORT IA 52803 421421670 CHARITY IA 501(C)(3) LINE 7 GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 E RUSHOLME STREET DAVENPORT IA 52803 391905171 EMPLOYEE/BENEFIT/TRUST IA 501(C)(3) LINE 11A, I GENESIS HEALTH SYSTEM (GHS IOWA) 1 DAVENPORT HOSPITAL AMBULANCE CORP 1204 E HIGH STREET DAVENPORT IA 52803 421186903 AMBULANCE TRANSFERS IA 501(C)(3) LINE 11A, I GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENESIS SENIOR LIVING ALEDO 309 NW NINTH AVENUE ALEDO IL 61231 454475803 SENIOR LIVING SERVICES IL 501(C)(3) LINE 3 GENESIS HEALTH SYSTEM (GHS ILLINOIS) 1 GENESIS MEDICAL CENTER ALEDO 409 NW NINTH AVENUE ALEDO IL 61231 454475683 HEALTHCARE IL 501(C)(3) LINE 3 GENESIS HEALTH SYSTEM (GHS ILLINOIS) 1 GENESIS PHILANTHROPY 1227 E RUSHOLME STREET DAVENPORT IA 52803 462462851 CHARITY IA 501(C)(3) LINE 11A, I GENESIS HEALTH SYSTEM (GHS IOWA) 1 GENGASTRO LLC 2222 53RD AVENUE BETTENDORF IA 52722 562315623 AMBULATORY SURGERY CENTER IA N/A SPRING PARK SURGERY CENTER LLC 3319 SPRING STREET STE 202A DAVENPORT IA 52807 421483989 OUTPATIENT SURGICAL CENTER IA N/A LARSON CENTER PARTNERSHIP 801 ILLINI DRIVE SILVIS IL 61282 363738454 PROPERTY MANAGEMENT IL GENESIS HEALTH SYSTEM (GHS ILLINOIS) RELATED 430490 1847976 0 1 0.75600 GENORTHO LLC 2300 53RD AVENUE BETTENDORF IA 52722 203406994 ORTHOPAEDIC SURGERY CENTER IA N/A GENRAD IMAGING LLC 1970 E 53RD ST DAVENPORT IA 52807 453571628 DIAGNOSTIC IMAGING CENTER IA N/A GENESIS ONCOLOGY CO - MANAGEMENT LLC 1227 E RUSHOLME STREET DAVENPORT IA 52803 454456824 ONCOLOGY PROGRAM MANAGEMENT IA N/A GENVENTURES INC 1227 E RUSHOLME STREET DAVENPORT IA 52803 421269171 SUPPORT SERVICES/PROPERTY MANAGEMENT IA N/A C 0 GENESIS HEART INSTITUTE 1236 E RUSHOLME STREET DAVENPORT IA 52803 421504979 HEALTHCARE MANAGEMENT IA N/A C 0 MISERICORDIA ASSURANCE COMPANY LTD PO BOX 1051 GRAND CAYMAN CJ 980457943 OTHER FINANCIAL VEHICLE CJ N/A C 0 MOB 1 OWNERS' ASSOCIATION 1227 E RUSHOLME STREET DAVENPORT IA 52803 270865075 PROPERTY MANAGEMENT IA N/A C 0 1 1 0 0 0 0 0 1 0 1 1 1 1 0 0 1 1 1 1 GENESIS HEALTH SYSTEM (GHS IOWA) A 284811 FAIR MARKET VALUE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST B 270224 FAIR MARKET VALUE GENESIS SENIOR LIVING ALEDO B 2246380 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) J 284811 FAIR MARKET VALUE LARSON CENTER PARTNERSHIP K 502276 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) L 12294789 FAIR MARKET VALUE GENESIS HEALTH SERVICES FOUNDATION L 131752 FAIR MARKET VALUE DAVENPORT HOSPITAL AMBULANCE CORPORATION M 266200 FAIR MARKET VALUE MISERICORDIA ASSURANCE COMPANY LTD M 427256 FAIR MARKET VALUE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST M 80381 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) P 7652118 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) P 84417448 FAIR MARKET VALUE GENESIS HEALTH SERVICES FOUNDATION Q 247531 FAIR MARKET VALUE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST R 80381 FAIR MARKET VALUE GENVENTURES INC R 269686 FAIR MARKET VALUE GENVENTURES INC R 1304230 FAIR MARKET VALUE MISERICORDIA ASSURANCE COMPANY LTD R 427256 FAIR MARKET VALUE GENVENTURES INC R 147061 FAIR MARKET VALUE DAVENPORT HOSPITAL AMBULANCE CORPORATION R 266200 FAIR MARKET VALUE LARSON CENTER PARTNERSHIP R 502276 FAIR MARKET VALUE LARSON CENTER PARTNERSHIP R 302391 FAIR MARKET VALUE GENESIS HEALTH SERVICES FOUNDATION R 247531 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) S 12294789 FAIR MARKET VALUE GENVENTURES INC S 269686 FAIR MARKET VALUE GENVENTURES INC S 147061 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) S 84417448 FAIR MARKET VALUE GENESIS HEALTH SYSTEM (GHS IOWA) S 7652118 FAIR MARKET VALUE GENVENTURES INC S 1304230 FAIR MARKET VALUE