2012-03-28T17:05:48-05:00 2011-06-30 MCGLADREY & PULLEN LLP 201 N HARRISON STREET SUITE 300 DAVENPORT IA 528011999 990 2010-07-01 421418847 GENESIS HEALTH SYSTEM GENE 5634216508 1227 E RUSHOLME DAVENPORT IA 528032498 MARK G ROGERS 5634216508 2012-03-28 1 JOHN J ROMANO 5638884000 2010 2016-02-24 21:20:13Z MARK G ROGERS 1227 E RUSHOLME DAVENPORT IA 528032498 541989530 0 X WWW.GENESISHEALTH.COM X 1994 IA GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 17 10 4695 745 1759891 0 1511240 3964542 444894265 429053689 8282065 7986368 7228434 5725735 461916004 446730334 3509212 2535350 0 0 225867420 224745550 0 0 0 216334185 207906251 445710817 435187151 16205187 11543183 520487697 566049515 177765873 154288577 342721824 411760938 X GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 0 0 267683027 2438567 337456388 GENESIS HEALTH SYSTEM IS A HEALTH SYSTEM LOCATED IN EASTERN IOWA, CONSISTING OF THREE HOSPITALS, TWO BASED IN IOWA: GENESIS MEDICAL CENTER-DAVENPORT, CONTAINING 502 LICENSED ACUTE BEDS. STATISTICS INCLUDE 84,759 PATIENT DAYS, 21,094 PATIENT DISCHARGES AND 179,279 OUT-PATIENT VISITS; GENESIS MEDICAL CENTER-DEWITT, CONTAINING LICENSED 13 ACUTE BEDS AND 77 SKILLED BEDS. STATISTICS INCLUDE 1,490 PATIENT DAYS, 291 PATIENT DISCHARGES, AND 18,240 OUTPATIENT VISITS. GENESIS HEALTH SYSTEM ALSO INCLUDES A FAMILY MEDICINE RESIDENCY PROGRAM THAT CONTINUES TO EDUCATE RESIDENTS IN THE HOSPITAL SETTING. 81122115 0 71581430 GENESIS HEALTH GROUP, A PHYSICIAN GROUP WITHIN GENESIS HEALTH SYSTEM, CONSISTS OF 44 CLINICS AND 134 PHYSICIANS ENCOMPASSING A WIDE VARIETY OF SPECIALTIES AND FAMILY PRACTICE GROUPS SERVING IOWA, ILLINOIS AND SURROUNDING COMMUNITIES IN EASTERN IOWA AND WESTERN ILLINOIS. STATISTICS INCLUDE TOTAL PRACTITIONER HOURS 213,721 AND RVU'S (RELATIVE VALUE UNITS) 766,359. 20770883 96782 23568820 GENESIS AT HOME VNA & HOSPICE, A VISITING NURSE AND HOSPICE CARE PROGRAM WITHIN GENESIS HEALTH SYSTEM, ENCOMPASSES HOME HEALTH SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL/SPEECH THERAPY, SKILLED NURSING AND MEDICAL SOCIAL WORKER VISITS, AND THE HOSPICE HOUSE, WHICH CARES FOR TERMINALLY ILL PATIENTS. STATISTICS INCLUDE HOME HEALTH VISITS 122,788 AND HOSPICE/ HOSPICE HOUSE DAYS 44,200. 444002 0 0 GENESIS ILLINOIS PROPERTIES, A BUSINESS UNIT WITHIN GENESIS HEALTH SYSTEM, OWNS LAND IN ILLINOIS FOR FUTURE EXPANSION PURPOSES. 444002 370020027 1 1 0 1 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 378 0 1 4695 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 17 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 IA IL X MARK G ROGERS 5634216508 1227 E RUSHOLME DAVENPORT IA 528032498 STEVEN C BAHLS 4.00 X 0 0 0 MARK D BAWDEN 4.00 X X 0 0 0 JAMES A BULL MD 40.00 X 191694 0 23426 GREGORY J BUSH 4.00 X X 0 0 0 EDMUND P COYNE JR MD 4.00 X 0 0 0 DOUGLAS P CROPPER 44.00 X X 739313 0 291003 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 A KOEHLER 4.00 X 0 0 0 GEORGE KONTOS JR MD 40.00 X 538454 0 26179 CHARLENE E MAASKE 4.00 X 0 0 0 EDWIN V MOTTO MD 10.00 X 0 0 0 EDWARD J ROGALSKI PHD 4.00 X X 0 0 0 G CHRISTOPHER WAHLIG 4.00 X X 0 0 0 C DANA WATERMAN III 4.00 X 0 0 0 CAROL A WATSON PHD RN CENP FAAN 4.00 X 0 0 0 DALE D ZUDE 4.00 X 0 0 0 MARK G ROGERS 40.00 X 326941 0 123452 ROBERT W FRIEDEN 40.00 X 442228 0 31866 WILLIAM LANGLEY MD 40.00 X 507583 0 69290 JULIE MANAS 40.00 X 375185 0 137154 JUDITH PRANGER 40.00 X 224436 0 138891 FLORENCE L SPYROW 40.00 X 53665 271576 109367 NICHOLAS AUGELLI MD 40.00 X 459598 0 27772 MARK HULL MD 40.00 X 521637 0 31672 DARRYL JOHNSON MD 40.00 X 464485 0 30417 TODD RIDENOUR MD 40.00 X 847339 0 33990 WILLIAM SYBESMA MD 40.00 X 449086 0 18386 ANDREW ANDRESEN MD 40.00 X 268383 0 28216 DEAN BUNTING MD 40.00 X 187706 0 39013 JEFFREY M COOPER 40.00 X 262079 0 28989 ALEXANDER JONES MD 40.00 X 140600 0 11519 HEIDI KAHLY-MCMAHON 40.00 X 194797 0 78577 ROBERT NELSON MD 40.00 X 297906 0 57082 MIKE SHARP 40.00 X 173413 0 95195 CRAIG SOMMERS 40.00 X 145574 0 20916 7812102 271576 1452372 197 1 1 0 METROPOLITAN MEDICAL LAB 1814 EAST LOCUST STREET DAVENPORT IA 52803 LABORATORY DIAGNOSTICS 8835595 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 COMPUTER SOFTWARE SUPPORT & MAINTENANCE 5187208 DAVENPORT EMERGENCY ROOM PHYSICIANS 2116 MAIN STREET DAVENPORT IA 52803 EMERGENCY PHYSICIAN CARE 3326969 COGENT HEALTHCARE PO BOX 974451 DALLAS TX 75397 CONTRACTED MEDICAL STAFF 1960503 EXECUTIVE HEALTH RESOURCES PO BOX 822688 PHILADELPHIA PA 19182 CONTRACTED SERVICES 1052458 72 2770974 143112 1050456 134502 3964542 INPATIENT REVENUE 900099 454792531 454792531 OUTPATIENT REVENUE 621400 379718222 379718222 CLINIC REVENUE 621400 121838992 121838992 HOME HEALTH & HOSPICE 621610 26325306 26325306 OTHER OPERATING REVENU 624100 6840921 5081030 1759891 -560462283 -560462283 429053689 5592504 5592504 510986 98091 412895 412895 412895 97038114 28160 94667850 4560 2370264 23600 2393864 2393864 794074 488695 305379 305379 OTHER REVENUE 900099 2697432 2697432 DIETARY 900099 2133414 2133414 HOUSEKEEPING 900099 176615 176615 5007461 446730334 432606638 1759891 8399263 2209685 2209685 325665 325665 4188931 1617559 2571372 457886 281615 176271 176396317 154091540 22304777 10634626 9912884 721742 20439340 16917824 3521516 12628450 10594684 2033766 11834672 10333977 1500695 1010945 1010945 269044 269044 119034 119034 563644 563644 25014855 19369967 5644888 1410370 1351252 59118 45552619 42158906 3393713 7083509 787820 6295689 18251876 17364842 887034 1414861 1329927 84934 358834 327886 30948 4263233 4261109 2124 25217693 16178497 9039196 3332296 354830 2977466 PATIENT SUPPLY COST OF 38563600 38563600 PROVISION FOR BAD DEBTS 21627108 21627108 MISCELLANEOUS 2018058 58850 1959208 435187151 370020027 65167124 0 3437343 4559542 40029286 49269864 62527236 60717960 20351406 26667288 9392564 10437231 3768127 5121663 493687071 327493859 170252384 166193212 129055977 154265413 35662465 55946811 20000 0 45990909 32870531 520487697 566049515 46005476 49521584 94794486 89172645 2506 125466 36963405 15468882 177765873 154288577 X 331777982 397635264 10943842 14125674 342721824 411760938 520487697 566049515 X 11543183 57495931 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 0 1 43775 1 775 1 74485 119035 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: IN FISCAL YEAR 2011, GENESIS HEALTH SYSTEM- IOWA RECEIVED PROFESSIONAL LOBBYING AND GOVERNMENTAL RELATIONS CONSULTING SERVICES FROM EIDE & HEISINGER, LLC AT A COST OF $25,000. LOBBYING EXPENDITURES RELATED TO MEMBERSHIP DUES INCLUDED; 21% OF MEMBERSHIP DUES TO THE IOWA HOSPITAL ASSOCIATION, OR $26,932, 24% OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OR $12,239, 50% OF MEMBERSHIP DUES TO THE AMERICAN MEDICAL ASSOCIATION, OR $3,045, AND VARIOUS OTHER ASSOCIATIONS- $7,269. PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1(D), MAILINGS TO MEMBERS, LEGISLATORS, OR THE PUBLIC: EMPLOYEES OF GENESIS HEALTH SYSTEM - IOWA ARE ENCOURAGED TO PARTICIPATE IN THE IOWA 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 IN AN E-MAIL FORMAT. THERE IS NO DIRECT COST TO GENESIS HEALTH SYSTEM - IOWA REGARDING THIS ACTIVITY. 5040858 16614 465988 3616 5519844 5010740 28352 297861 296096 5040857 5224450 30636 -243446 900 5010740 0.67000 0.33000 0.00000 0 1 1 8878425 8878425 189967263 104464894 85502369 19048024 14366546 4681478 245937167 195077555 50859612 29856192 13584864 16271328 166193212 OTHER INVESTMENTS - GMC 50576 F INVESTMENT IN GENVENTURES, INC 25620357 C INVESTMENT IN MISERICORDIA 120000 C INVESTMENT IN MRIOWA, LLC 221767 C INVESTMENT IN HEI COOP 1652162 C INVESTMENT IN HEI VENTURES 105800 C INVESTMENT IN HEI IOWA ECHO/ULTRASOUND 118806 C INVESTMENT IN HEI BREAST BIOPS 3264 C INVESTMENT IN HEI DIGITAL MAMMOGRAPHY 10366 C INVESTMENT IN DAVENPORT SRS LEASING 1045651 C INVESTMENT IN SPRING PARK SURGERY CENTER 4254491 C INVESTMENT IN GENGASTRO LLC 20769194 C INVESTMENT IN GENORTHO 1646250 C OTHER INVESTMENTS - DEWITT 321147 C INVESTMENT IN HEI -9258 C INVESTMENT IN HEI BONE DENSITY 16238 C 55946811 OTHER ASSETS 822978 INTEREST IN NET ASSETS OF FOUNDATION 9991929 UNAMORTIZED BOND COSTS 579508 GOODWILL & COVENANT NOT TO COMPETE 820444 DEFERRED COMPENSATION ANNUITY 6716559 CERTIFICATES OF DEPOSIT 8691616 INTEREST RECEIVABLE 12154 DEBT SERVICE RESERVE FUND 5235343 32870531 ACCRUED PENSION LIABILITY 12340314 ACCRUED INS TRUST LOSSES 3123806 RETIREMENT SAVINGS 4762 15468882 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: GENESIS HEALTH SERVICES FOUNDATION AND ILLINI HOSPITAL FOUNDATION, BOTH RELATED ORGANIZATIONS, HOLD THE ENDOWMENT FUNDS. THE INTENDED USE OF THE FOUNDATIONS' ENDOWMENT FUNDS IS AS FOLLOWS: SCHOLARSHIPS FOR EDUCATION IN THE MEDICAL FIELD, CHARITY CARE FOR THE INDIGENT AND VNA, HOSPICE HOUSE, DIABETES CARE, EMPLOYEE ASSISTANCE, AND PEDIATRIC HOSPICE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: GHS IOWA, GHS ILLINOIS, THE GENESIS HEALTH SERVICES FOUNDATION, THE ILLINI HOSPITAL FOUNDATION AND THE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ALL FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF EACH ENTITY, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. UNRELATED BUSINESS TAXABLE INCOME IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX BENEFITS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, THE GENESIS HEALTH SERVICES FOUNDATION, THE ILLINI HOSPITAL FOUNDATION AND THE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY GHS IOWA, GHS ILLINOIS, THE GENESIS HEALTH SERVICES FOUNDATION, THE ILLINI HOSPITAL FOUNDATION AND THE GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST ARE NO LONGER SUBJECT TO EXAMINATION FOR THE FISCAL YEARS ENDED JUNE 30, 2006 AND PRIOR. GENVENTURES, INC. IS A TAXABLE ORGANIZATION AND CURRENTLY FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND VARIOUS STATE JURISDICTIONS. GENVENTURES, INC. IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS JUNE 30, 2006 AND PRIOR. AS OF JUNE 30, 2011 AND 2010, THE TOTAL AMOUNT OF UNCERTAIN TAX POSITIONS HAVE REDUCED INCOME TAX EXPENSE AND HAVE INCREASED EXCESS OF REVENUE OVER EXPENSES BY $45,000 AND $40,000, RESPECTIVELY. INTEREST EXPENSE ASSOCIATED WITH UNCERTAIN TAX POSITIONS FROM THE YEARS ENDED JUNE 30, 2011 AND 2010 IS APPROXIMATELY NONE AND $7,000, RESPECTIVELY. NO AMOUNT HAS BEEN ACCRUED FOR PENALTIES. DURING THE YEARS ENDED JUNE 30, 2011 AND 2010, NONE AND $265,000, RESPECTIVELY, IN FEDERAL AND STATE INCOME TAXES WERE PAID FOR UNCERTAIN TAX POSITIONS EXISTING AS OF JUNE 30, 2009 AND 2008, AS AMENDED OR PAST DUE INCOME TAX RETURNS WERE FILED. CENTRAL AMERICAN AND THE CARIBBEAN 0 0 INVESTMENTS 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 8940885 0 8940885 0.02160 49151343 35560103 13591240 0.03290 269989 79960 190029 0.00050 58362217 35640063 22722154 0.05500 385711 0 385711 0.00090 2644076 2137416 506660 0.00120 13658899 10505807 3153092 0.00760 190374 0 190374 0.00050 795103 795103 0.00190 17674163 12643223 5030940 0.01210 76036380 48283286 27753094 0.06710 1478 0 1478 0.00000 44569 0 44569 0.00010 16523 0 16523 0.00000 200 0 200 0.00000 0 0 144 0 144 0.00000 21171 0 21171 0.00010 20699 0 20699 0.00010 0 0 104784 104784 0.00030 1 8284277 95282 154141148 176695713 -22554565 X 1 1 1 MOB 1 OWNERS' ASSOCIATION PROPERTY MANAGMENT 0.82200 0.17800 3 1 GENESIS MEDICAL CENTER EAST - DAVENPORT

1227 EAST RUSHOLME STREET DAVENPORT IA 52803

X X X 2 GENESIS MEDICAL CENTER WEST - DAVENPORT

1401 WEST CENTRAL PARK DAVENPORT IA 52804

X X X X 3 GENESIS MEDICAL CENTER - DEWITT

1118 11TH STREET DEWITT IA 52742

X X X NA 1 60 VISITING NURSE ASSOCIATION & HOSPICE

2535 MAPLECREST ROAD DAVENPORT IA 52807

HOME HEALTH & HOSPICE MEDICAL OFFICE BUILDING #1

1228 EAST RUSHOLME STREET DAVENPORT IA 52803

O/P MAMMOGRAPHY & DIALYSIS SERVICES GENESIS HEALTH GROUP

864-866 LINCOLN ROAD BETTENDORF IA 52722

OUTPATIENT PHYSICIAN CLINIC CENTRAL PARK MEDICAL PAVILIONS 1 & 2

1351 WEST CENTRAL PARK AVENUE DAVENPORT IA 52804

O/P CANCER, REHAB, WOUND & DR. BETTENDORF IMAGING CENTER

4017 DEVILS GLEN ROAD STE 205 BETTENDORF IA 52722

OUTPATIENT RADIOLOGY SERVICES GENESIS MEDICAL PLAZA

2535 MAPLECREST ROAD BETTENDORF IA 52722

O/P REHAB, PAIN, PHYS THERAPY & DR ILLINI LARSON CENTER

855 ILLINI DRIVE SILVIS IL 61282

OUTPATIENT LAB & PHYSICIAN CLINIC HEDBERG BUILDING - MOLINE FAMILY PRACTIC

2526 4TH STREET MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC DIVISION STREET CLINIC

3618 NORTH DIVISION STREET DAVENPORT IA 52804

OUTPATIENT PHYSICIAN CLINIC DEWITT WEST WING PLACE

1118 11TH STREET DEWITT IA 52742

L-T NURSING CARE FACILITY GENESIS MEDICAL PARK

4017 DEVILS GLEN ROAD BETTENDORF IA 52722

OUTPATIENT PHYSICIAN CLINIC SCOTT COUNTY YMCA

3800 TANGLEFOOT LANE BETTENDORF IA 52722

OUTPATIENT REHABILITATION CLINIC FAMILY PRACTICE AT WEST CAMPUS

1345 WEST CENTRAL PARK AVENUE DAVENPORT IA 52804

OUTPATIENT PHYSICIAN CLINIC NORTH FAMILY PRACTICE

210 WEST 53RD STREET DAVENPORT IA 52806

OUTPATIENT LAB & PHYSICIAN CLINIC NORTHWEST FAMILY PRACTICE

1520 SOUTH 53RD STREET DAVENPORT IA 52806

OUTPATIENT PHYSICIAN CLINIC ELDRIDGE FAMILY PRACTICE

301 NORTH 4TH AVENUE ELDRIDGE IA 52748

OUTPATIENT LAB & PHYSICIAN CLINIC GENESIS PHYSICAL REHAB - VALLEY FAIR

2720 WEST LOCUST STREET UNIT 2B DAVENPORT IA 52804

O/P PHYSICAL THERAPY CLINIC CONVENIENT CARE - DAVENPORT

1520 WEST 53RD STREET DAVENPORT IA 52806

OUTPATIENT URGENT CARE CLINIC GENESIS PSYCHOLOGY ASSOCIATES

4455 EAST 56TH STREET DAVENPORT IA 52807

OUTPATIENT COUNSELING CLINIC ILLINI BUILDING #1

903-05 ILLINI DRIVE SILVIS IL 61282

HOME HEALTH & O/P PHYSICIAN CLINIC ILLINI BUILDING #2

1504 10TH STREET SILVIS IL 61282

OUTPATIENT PHYSICIAN CLINIC GENESIS PHYSICAL REHAB - CROW VALLEY

2300 53RD AVENUE STE LL02 BETTENDORF IA 52722

O/P PHYSICAL THERAPY CLINIC DAV OBGYN

3319 SPRING STREET DAVENPORT IA 52807

OUTPATIENT PHYSICIAN CLINIC MOLINE FAMILY PRATICE - 7TH STREET

1410 7TH STREET MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC VISITING NURSE ASSOCIATION & HOSPICE

611 NORTH 2ND AVE CLINTON IA 52732

HOME HEALTH & HOSPICE MUSCATINE FAMILY PRACTICE

2104 CEDARWOOD STREET MUSCATINE IA 52761

OUTPATIENT PHYSICIAN CLINIC CONVENIENT CARE - BETTENDORF

4017 DEVILS GLEN ROAD BETTENDORF IA 52722

OUTPATIENT URGENT CARE CLINIC GENESIS OCCUPATIONAL HEALTH

3319 SPRING STREET DAVENPORT IA 52807

OUTPATIENT OCCUPATIONAL HEALTH PROGRAM DEWITT FAMILY PRACTICE

1008 11TH STREET DEWITT IA 52742

HOME HEALTH, COUNSELING SERVICES, & O/P GENESIS PLASTIC SURGERY SPECIALISTS

5335 EASTERN AVE DAVENPORT IA 52807

OUTPATIENT PHYSICIAN CLINIC SILVIS ANESTHESIOLOGY

801 ILLINI DRIVE SILVIS IL 61282

OUTPATIENT PHYSICIAN CLINIC CLARISSA C COOK HOSPICE HOUSE

2546 TECH DRIVE BETTENDORF IA 52722

HOSPICE HOUSE GENESIS CENTER FOR BARIATRIC SURGERY

1230 EAST RUSHOLME STREET DAVENPORT IA 52803

O/P COMPREHENSIVE BARIATRIC PRGM MEDICAL OFFICE BUILDING #2

1230 EAST RUSHOLME STREET DAVENPORT IA 52803

OUTPATIENT PHYSICIAN CLINIC CONVENIENT CARE - ILLINOIS

2350 41ST STREET MOLINE IL 61265

OUTPATIENT URGENT CARE CLINIC DEWITT PAVILION 1

1118 11TH STREET DEWITT IA 52742

OUTPATIENT PHYSICAL THERAPY CLINIC ELDRIDGE PHYSICAL THERAPY

170 SOUTH 4TH AVENUE ELDRIDGE IA 52748

OUTPATIENT PHYSICAL THERAPY CLINIC GENESIS OCCUPATIONAL HEALTH

2350 41ST STREET MOLINE IL 61265

OUTPATIENT OCCUPATIONAL HEALTH PROGRAM LECLAIRE FAMILY PRACTICE - RIVERVIEW

200 SOUTH CODY LECLAIRE IA 52751

OUTPATIENT PHYSICIAN CLINIC ROCK ISLAND INTERNAL MEDICINE

2560 24TH STREET ROCK ISLAND IL 61201

OUTPATIENT PHYSICIAN CLINIC MOLINE VALLEY VIEW

615 VALLEY VIEW DRIVE MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC DEWITT AMBULANCE

1220 11TH STREET DEWITT IA 52742

AMBULANCE SERVICES DAVENPORT CLINIC

1820 WEST 3RD ST DAVENPORT IA 52803

OUTPATIENT PHYSICIAN CLINIC DURANT FAMILY PRACTICE

619 5TH STREET DURANT IA 52747

OUTPATIENT PHYSICIAN CLINIC BLUE GRASS FAMILY MEDICAL

413 SOUTH MISSISSIPPI BLUE GRASS IA 52726

OUTPATIENT PHYSICIAN CLINIC LOMBARD PHYSICAL THERAPY

1414 WEST LOMBARD STREET DAVENPORT IA 52804

OUTPATIENT PHYSICIAN CLINIC GENESIS PHYSICAL THERAPY AT LECLAIRE

1003 CANAL SHORE DRIVE LECLAIRE IA 52751

OUTPATIENT PHYSICAL THERAPY CLINIC ERIE FAMILY PRACTICE

530 12TH STREET ERIE IL 61205

OUTPATIENT PHYSICIAN CLINIC ROCK ISLAND ARSENAL FAMILY PRACTICE

1634 WHITTERMORE STE 101 ROCK ISLAND IL 61201

OUTPATIENT PHYSICIAN CLINIC ALPHA FAMILY PRACTICE

202 PICARD STREET ALPHA IL 61413

OUTPATIENT PHYSICIAN CLINIC IA CITY PEDIATRIC PT CLINIC

2451 CORAL CT CORALVILLE IA 52241

OUTPATIENT PHYSICAL THERAPY CLINIC GHS-U OF IA PEDIATRIC GASTRO

2222 53RD AVE BETTENDORF IA 52722

OUTPATIENT PHYSICIAN CLINIC EAP - DAVENPORT

4455 EAST 56TH STREET DAVENPORT IA 52807

COUNSELING SERVICES MOLINE VALLEY VIEW WEST FAMILY PRACTICE

515 VALLEY VIEW DRIVE MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC SILVIS SURGICAL ASSOCIATES

1801 EAST 54TH STREET DAVENPORT IA 52807

OUTPATIENT PHYSICIAN CLINIC VISITING NURSE ASSOCIATION KID'S NEST

606 WEST 2ND STREET DAVENPORT IA 52803

HOME HEALTH (MOM/ BABE PROGRAM) GENESIS HEART INSTITUTE

1236 EAST RUSHOLME STREET DAVENPORT IA 52803

O/P CARDIAC DIAGNOSTICS & REHAB CARE EAP - MUSCATINE

1605 PLAZA PLACE MUSCATINE IA 52761

COUNSELING SERVICES EAP - ROCK ISLAND

2100 18TH AVENUE ROCK ISLAND IL 61201

COUNSELING SERVICES EAP - CLINTON

1127 NORTH 2ND STREET CLINTON IA 52732

COUNSELING 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, L7 COL(F): $21,627,108 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 18.39%, AND THE PERCENTAGE INCREASES TO 61.11% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. PART II: 1. PHYSICAL IMPROVEMENTS AND HOUSING: GENESIS HEALTH SYSTEM EMPLOYEES PROMOTE THE HEALTH OF THE COMMUNITY BY SUPPORTING COMMUNITY OUTREACH PROGRAMS, INCLUDING HABITAT FOR HUMANITY, AREA SHELTERS FOR THE HOMELESS, SHELTERS FOR ABUSED WOMEN AND DEPENDENT CHILDREN, AND FOOD PANTRIES.2. ECONOMIC DEVELOPMENT: GENESIS HEALTH SYSTEM EXECUTIVES AND EMPLOYEES SERVE ON VOLUNTEER BOARDS THROUGHOUT THE REGION SUPPORTING IMPORTANT PROJECTS AND INITIATIVES, HOMELESS SHELTERS, MENTAL HEALTH, DOWNTOWN REDEVELOPMENT AND EVENTS AND FESTIVALS.3. COMMUNITY SUPPORT: GENESIS HEALTH SYSTEM PARTICIPATES IN A VOLUNTEER PARTNERSHIP WITH JUNIOR ACHIEVEMENT. SEVERAL GENESIS HEALTH SYSTEM EMPLOYEES TRAVEL TO LOCAL COMMUNITY SCHOOLS TO TEACH THE IMPORTANCE OF WORKFORCE READINESS, ENTREPRENEURSHIP, AND FINANCIAL LITERACY. GENESIS HEALTH SYSTEM CONDUCTS MULTIPLE DISASTER AND DECONTAMINATION DRILLS THROUGHOUT THE YEAR.4. ENVIRONMENTAL IMPROVEMENTS: GENESIS HEALTH SYSTEM'S "TAKIN' IT TO THE STREETS" COMMITTEE ORGANIZED A CREW OF EMPLOYEES AND THEIR FAMILIES TO CLEAN UP THE WATERWAYS OF THE COMMUNITIES IT SERVES.5. COALITION BUILDING: GENESIS HEALTH SYSTEM WAS A LEAD COMMUNITY PARTNER IN THE FLU-FREE QUAD CITIES INITIATIVE WHICH VACCINATED 9,300 ELEMENTARY SCHOOL CHILDREN IN THE REGION FOR SEASONAL INFLUENZA AT NO COST TO THE CHILDREN. FUNDS WERE RAISED THROUGH VARIOUS BUSINESS PARTNERS, GRANTS AND A FLU-FREE TELETHON ON WQAD-TV. 6. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: GENESIS HEALTH SYSTEM MAINTAINS AN ACTIVE EFFORT TO ADVOCATE FOR ACCESS TO HEALTH CARE WITH THE IOWA AND ILLINOIS STATE GOVERNMENTS AND IN WASHINGTON D.C. GENESIS EMPLOYEES PARTICIPATE IN A VOTER VOICE INITIATIVE TO ALSO ADVOCATE ON IMPORTANT HEALTH ISSUES.7. WORKFORCE DEVELOPMENT: GENESIS HEALTH SYSTEM PARTNERS WITH THE LOCAL COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE. GENESIS HEALTH SYSTEM WORKS WITH THE LOCAL COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS COMMUNITY-WIDE WORKFORCE ISSUES BY SUPPORTING JOB CREATION AND TRAINING PROGRAMS. PART III, LINE 4: THE TEXT FROM THE FOOTNOTE TO GENESIS HEALTH SYSTEM'S FINANCIAL STATEMENT IS AS FOLLOWS: PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYERS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. RECEIVABLES ARE WRITTEN OFF AS BAD DEBTS WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. THE RATIONALE AND COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSE AT COST (LINE 2) CONSISTED OF MULTIPLYING THE TOTAL BAD DEBT EXPENSE PER THE INCOME STATEMENT BY THE RATIO OF PATIENT CARE COST TO CHARGES TO ARRIVE AT ESTIMATED COST OF BAD DEBT. PAYMENTS RECEIVED AFTER AN ACCOUNT HAD BEEN WRITTEN OFF TO BAD DEBT WERE CREDITED TO A BAD DEBT RECOVERY ACCOUNT. DISCOUNTS ON PATIENT ACCOUNTS PROVIDED BY THIRD-PARTY PAYERS WERE WRITTEN OFF TO A CONTRACTUAL ALLOWANCE ACCOUNT. SHARED BUSINESS SERVICES USES A SEPARATE TRANSACTION CODE TO IDENTIFY ACCOUNTS WRITTEN OFF TO BAD DEBT THAT HAVE NO FINANCIAL DOCUMENTATION AND MAY HAVE QUALIFIED FOR CHARITY CARE HAD PAPERWORK BEEN SUBMITTED. THE ESTIMATED AMOUNT OF GENESIS HEALTH SYSTEM'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY (LINE 3) WAS CALCULATED BY TAKING THE TOTAL OF THESE ACCOUNTS AND MULTIPLYING THEM BY THE RATIO OF PATIENT CARE COST TO CHARGES. NO BAD DEBT AMOUNTS WERE INCLUDED IN COMMUNITY BENEFIT. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINE 6, FOR THE HOSPITALS AND THE HOME HEALTH DIVISION, WAS COMPUTED USING THE GROSS PATIENT REVENUE BY PAYOR MIX AND CONVERTED TO COST USING THE COST TO CHARGE RATIO FROM PART I, WORKSHEET 2. THE PAYMENT RATE WAS CALCULATED BY DIVIDING THE MEDICARE PAYMENTS BY MEDICARE CHARGES USING A 12-MONTH ZERO BALANCE REPORT. THE SHORTFALL IS THE DIFFERENCE BETWEEN THE PAYMENTS AND THE COSTS. GENESIS CLINICAL SERVICES AND GENESIS FAMILY MEDICAL CENTER WERE CALCULATED USING A PAYER ANALYSIS REPORT, CONVERTING CHARGES TO COST USING THE COST TO CHARGE RATIO FROM PART I, WORKSHEET 2 AND SUBTRACTING THE PAYMENTS TO OBTAIN THE SHORTFALL. NO MEDICARE SHORTFALLS WERE INCLUDED IN COMMUNITY BENEFIT. THE MEDICARE SHORTFALL REPRESENTS THE DIFFERENCE BETWEEN THE TOTAL REVENUE RECEIVED FROM MEDICARE BASED ON MEDICARE REIMBURSEMENT RATES AND THE COSTS INCURRED BY GENESIS HEALTH SYSTEM IN PROVIDING HEALTHCARE SERVICES TO THE ELDERLY. IN 2009, THE PERCENT OF PERSONS 65 YEARS AND OVER WAS 16.0% IN ROCK COUNTY, ILLINOIS AND 12.7% IN SCOTT COUNTY, IOWA. IN ACCORDANCE WITH GENESIS HEALTH SYSTEM'S MISSION STATEMENT, "TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED," THE ELDERLY WERE SERVED DESPITE THE MEDICARE LOSS OF $22,554,565. 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 $22,554,565 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 12.16%. PART III, LINE 9B: EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF ELIGIBLE, PAYMENT PLANS ARE MADE AVAILABLE BASED ON THEIR RESOURCES AND INCOME. ALL BALANCES OWING AFTER FINANCIAL ASSISTANCE ALLOWANCES HAVE BEEN TAKEN ARE PAYABLE IN MONTHLY PAYMENTS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: GENESIS HEALTH SYSTEM UTILIZES THE COMMUNITY HEALTH ASSESSMENTS CREATED BY THE QUAD CITY HEALTH INITIATIVE (QCHI) AND THE COMMUNITY VITALITY TASK FORCE OF UNITED WAY. QCHI WAS FORMED BY GENESIS HEALTH SYSTEM, WHICH IS HEADQUARTERED IN SCOTT COUNTY, IOWA, AND TRINITY REGIONAL HEALTH SYSTEM, WHICH IS HEADQUARTERED IN ROCK ISLAND COUNTY, ILLINOIS. QCHI IS NOW A COMMUNITY PARTNERSHIP OF OVER 100 ORGANIZATIONS CONSISTING OF 500 ACTIVE INDIVIDUALS PURSUING INITIATIVES TO CREATE A HEALTHIER COMMUNITY, SERVING AS A CATALYST FOR IMPROVING THE HEALTH AND OVERALL QUALITY OF LIFE WITHIN THE QUAD CITIES. A COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY QCHI IN 2003, AND THEN RE-ASSESSED IN 2007. IN 2010, THE COMMUNITY VITALITY TASK FORCE OF UNITED WAY 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 AND HAWKEYE. 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 16.0% IN ROCK ISLAND COUNTY, ILLINOIS AND 12.7% IN SCOTT COUNTY, IOWA.THE PERCENT OF FAMILIES LIVING IN POVERTY IN 2009 WAS 5.8% IN ROCK ISLAND COUNTY, ILLINOIS AND 9.8% IN SCOTT COUNTY, IOWA. THE HOMELESS POPULATION IN GENESIS HEALTH SYSTEM'S SERVICE AREA WAS 1,510 IN JANUARY 2010. THE AVERAGE UNEMPLOYMENT RATE IN 2009 WAS 9.2% FOR ROCK ISLAND COUNTY, ILLINOIS AND 6.6% IN SCOTT COUNTY, IOWA.THE PERCENTAGE OF PEOPLE AGES 18-64 WHO DID NOT HAVE ANY HEALTH INSURANCE IN 2009 WAS 12.0% IN ROCK ISLAND COUNTY, ILLINOIS AND 8.2% IN SCOTT COUNTY, IOWA. THE PERCENTAGE OF ADULTS WHO CURRENTLY SMOKED IN 2009 WAS 20.0% IN ROCK ISLAND COUNTY, ILLINOIS AND 17.0% IN SCOTT COUNTY, IOWA. THE PERCENTAGE OF ADULTS WHO WERE OBESE IN 2009 WAS 27.7% IN ROCK ISLAND COUNTY, ILLINOIS AND 21.9% IN SCOTT COUNTY, IOWA. PART VI, LINE 6: GENESIS HEALTH SYSTEM'S BOARD OF DIRECTORS IS A DIVERSE REPRESENTATION OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA THAT GENESIS HEALTH SYSTEM SERVES. A MAJORITY OF THEM ARE NEITHER EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. GENESIS HEALTH SYSTEM EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. GENESIS HEALTH SYSTEM HAS ENDEAVORED TO IMPROVE ACCESS TO HEALTH CARE FOR THE COMMUNITIES IT SERVES BY PARTICIPATING IN APPROPRIATE JOINT VENTURES THAT OFFER NEEDED HEALTH CARE SERVICES TO UNDER-SERVED AREAS.SURPLUS FUNDS RESULTING FROM EFFICIENT OPERATIONS AND COST-CONTAINMENT MEASURES ARE RE-INVESTED IN THE HEALTHCARE OPERATIONS OF GENESIS HEALTH SYSTEM TO IMPROVE THE HEALTHCARE SERVICES THAT GENESIS PROVIDES. ADVANCES IN MEDICAL EQUIPMENT AND TECHNOLOGY, STAFF EDUCATION, AND NEW MEDICAL SERVICES ARE EXAMPLES OF OPERATIONAL INVESTMENTS THAT ULTIMATELY IMPROVE THE HEALTH OF THE COMMUNITIES THAT GENESIS SERVES. PART VI, LINE 7: GENESIS HEALTH SYSTEM (TAX ID #42-1418847), AN IOWA NONPROFIT CORPORATION, AND GENESIS HEALTH SYSTEM (TAX ID #36-3616314), AN ILLINOIS NOT-FOR-PROFIT CORPORATION, HAVE IDENTICAL GOVERNING BOARDS, MANAGEMENT AND BYLAWS AND CAN ACT JOINTLY.GENESIS HEALTH SYSTEM (TAX ID #42-1418847) IS ALSO THE SOLE MEMBER OF GENESIS HEALTH SERVICES FOUNDATION AND GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST, THE SOLE STOCKHOLDER OF GENVENTURES, INC., A MEMBER OF MISERICORDIA ASSURANCE COMPANY, LTD. AND A PARTNER IN DAVENPORT SRS LEASING, LLC. GENESIS HEALTH SYSTEM (TAX ID #36-3616314) IS THE SOLE MEMBER OF ILLINI HOSPITAL FOUNDATION AND A PARTNER IN THE LARSON CENTER PARTNERSHIP.GENESIS HEALTH SYSTEM (TAX ID #42-1418847) OPERATES THE FOLLOWING BUSINESS UNITS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES:GENESIS HEALTH SYSTEM PROVIDES ADMINISTRATIVE, MANAGEMENT, INFORMATION TECHNOLOGY AND OTHER SUPPORT SERVICES TO ITS AFFILIATES.GENESIS CLINICAL SERVICES: GENESIS HEALTH SYSTEM OWNS AND OPERATES PHYSICIAN MEDICAL PRACTICES, CONVENIENT CARE PRACTICES, OPERATES AN OCCUPATIONAL MEDICINE CLINIC AND PROVIDES BEHAVIORAL HEALTH SERVICES TO THE RESIDENTS OF EASTERN IOWA AND WESTERN ILLINOIS. GENESIS MEDICAL CENTER - DAVENPORT (GMC - DAVENPORT) IS LICENSED AS A 502-BED ACUTE CARE HOSPITAL WHICH PROVIDES SERVICES FROM TWO HOSPITAL FACILITIES LOCATED IN DAVENPORT, IOWA. GENESIS FAMILY MEDICAL CENTER (GFMC) IS A FAMILY PRACTICE RESIDENCY TRAINING PROGRAM THAT OPERATES CLINICS IN DAVENPORT AND BLUE GRASS, IOWA TO PROVIDE A CLINICAL SETTING FOR THE RESIDENTS TO TREAT PATIENTS.GENESIS MEDICAL CENTER - DEWITT (GMC - DEWITT) IS CERTIFIED AS A CRITICAL ACCESS HOSPITAL, WHICH HAS 13-ACUTE CARE AND SWING BEDS, AND HAS A 77-BED LONG-TERM CARE FACILITY, WHICH PROVIDES SERVICES FROM ITS FACILITY IN DEWITT, IOWA. GENESIS ILLINOIS PROPERTIES (GIP) OWNS LAND LOCATED IN MOLINE, ILLINOIS. GENESIS VISITING NURSE ASSOCIATION AND HOSPICE (VNA) PROVIDES HOME HEALTH CARE, COMMUNITY NURSING SERVICES AND HOSPICE SERVICES TO PATIENTS IN EASTERN IOWA AND WESTERN ILLINOIS.GENESIS HEALTH SYSTEM IOWA HAS A CONTROLLING OWNERSHIP INTEREST OR MEMBERSHIP IN THE FOLLOWING ORGANIZATIONS: GENESIS HEALTH SERVICES FOUNDATION (GENESIS FOUNDATION) IS AN ORGANIZATION WHOSE MISSION IS TO DEVELOP, MANAGE AND GRANT CHARITABLE SUPPORT TO MEET THE HEALTH-RELATED NEEDS OF THE COMMUNITIES SERVED BY GENESIS HEALTH SYSTEM.GENVENTURES, INC. (GENVENTURES) IS A WHOLLY-OWNED FOR-PROFIT CORPORATION WHICH OPERATES THE FOLLOWING DIVISIONS, PRIMARILY IN THE QUAD CITIES: GENESIS AT HOME, CONTINUING CARE SELLS AND LEASES HOME MEDICAL EQUIPMENT; PROVIDES INTRAVENOUS THERAPY SERVICES, INCLUDING SALES OF RELATED SOLUTIONS AND SUPPLIES TO PATIENTS; AND PROVIDES RETAIL PHARMACEUTICAL AND OVER THE COUNTER PRODUCTS TO PATIENTS AND EMPLOYEES OF THE SYSTEM.GENPROPERTIES OWNS, LEASES AND/OR MANAGES OFFICE SPACE IN THIRTEEN MEDICAL OFFICE BUILDINGS LOCATED IN DAVENPORT, ELDRIDGE, LECLAIRE, MUSCATINE AND BETTENDORF, IOWA. CRESCENT LAUNDRY PROVIDES COMMERCIAL LAUNDRY SERVICES TO HEALTH CARE FACILITIES IN EASTERN IOWA AND NORTH-CENTRAL ILLINOIS. GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN AND TRUST (WORKERS' COMPENSATION TRUST) PROVIDES A FUND WHICH CAN BE USED TO PAY WORKERS' COMPENSATION CLAIMS AND COSTS FOR THE BENEFIT OF GENESIS HEALTH SYSTEM. MISERICORDIA ASSURANCE COMPANY, LTD. (MISERICORDIA) IS A WHOLLY OWNED CAYMAN BASED CAPTIVE INSURANCE COMPANY WHICH UNDERWRITES THE GENERAL AND PROFESSIONAL LIABILITY RISKS OF GENESIS HEALTH SYSTEM AND AFFILIATES. DAVENPORT SRS LEASING, LLC (SRS) IS A LIMITED LIABILITY COMPANY, WHICH WAS FORMED IN 2008, WHICH LEASES MEDICAL EQUIPMENT. GENESIS HEALTH SYSTEM IS A GENERAL PARTNER AND OWNS 93.75% AS OF JUNE 30, 2011.GENESIS HEALTH SYSTEM (TAX ID #36-3616314) OPERATES THE FOLLOWING BUSINESS UNITS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES:GENESIS MEDICAL CENTER - ILLINI (GMC - ILLINI) IS LICENSED AS A 149-BED ACUTE CARE HOSPITAL WHICH PROVIDES SERVICES FROM ITS FACILITY IN SILVIS, ILLINOIS. ILLINI HOSPITAL NURSING HOME (INH) OPERATES ILLINI RESTORATIVE CARE CENTER AND CROSSTOWN SQUARE. ILLINI RESTORATIVE CARE CENTER OPERATES A 75-BED LICENSED NURSING FACILITY WHICH PROVIDES SKILLED AND INTERMEDIATE HEALTH CARE AND RELATED SERVICES TO PATIENTS. TWENTY-TWO OF ILLINI RESTORATIVE CARE CENTER'S BEDS ARE DESIGNATED AS HOSPITAL-BASED MEDICARE CERTIFIED BEDS. ILLINI RESTORATIVE CARE'S SHELTERED CARE UNIT IS A 45-BED FACILITY WHICH PROVIDES REHABILITATIVE AND PERSONAL CARE IN A FAMILY-ORIENTED SETTING. CROSSTOWN SQUARE IS AN INDEPENDENT LIVING FACILITY CONTAINING 76 RENTABLE APARTMENTS AND TWO GUESTROOMS THAT OFFERS SERVICES DESIGNED TO MEET THE NEEDS OF OUR SENIOR ADULTS.GENESIS HEALTH SYSTEM (TAX ID #36-3616314) HAS A CONTROLLING OWNERSHIP INTEREST OR MEMBERSHIP IN THE FOLLOWING ORGANIZATIONS: ILLINI HOSPITAL FOUNDATION (ILLINI FOUNDATION) SUPPORTS GENESIS MEDICAL CENTER - ILLINI BY PROVIDING FINANCIAL AND FUNDRAISING ASSISTANCE. THE MISSION OF THE ILLINI FOUNDATION IS TO ASSIST GMC - ILLINI IN PROVIDING QUALITY, COMPASSIONATE CARE FOR ALL THOSE IN NEED BY RAISING, MANAGING AND GRANTING CHARITABLE FUNDS. THE LARSON CENTER PARTNERSHIP (LCP) IS A FOR-PROFIT REAL ESTATE PARTNERSHIP WHICH OWNS A MEDICAL OFFICE BUILDING ADJACENT TO GMC- ILLINI AND LEASES SPACE FOR CLINICS, LABORATORY, PHARMACY AND OFFICES TO GMC - ILLINI AND OTHER THIRD-PARTY ORGANIZATIONS. GHS ILLINOIS IS A GENERAL PARTNER AND OWNS APPROXIMATELY 75.6% OF LCP. REPORTS FILED WITH STATES PART VI, LINE 7 IL,IA 1 GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 391905171 501(C)(3) 1234339 CLAIM PAYMENTS GENESIS HEALTH SERVICES FOUNDATION 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421421670 501(C)(3) 267547 7900 FMV ADVERTISING SPACE IN THE QC TIMES & DISPATCH/ARGUS NEWPAPERS. HEALTHCARE RELATED CONTRIBUTIONS; PLEDGE TOWARDS ROOFSCAPE PROJECT; GOLF CHALLENGE SPONSORSHIP BALLET QUAD CITIES 613 17TH STREET ROCK ISLAND IL 61201 421366753 501(C)(3) 7500 SPONSORSHIP OF FOUR PERFORMANCES BIX-7 - QUAD CITY TIMES 2685 E KIMBERLY ROAD BETTENDORF IA 52722 420823980 40000 SPONSORSHIP FOR BIX RACE DAVENPORT ONE 130 WEST SECOND STREET DAVENPORT IA 52801 421500610 501(C)(6) 46333 SPONSORSHIP - RED, WHITE, & BOOM; RIVER ROOTS QUAD CITY ARTS 1715 2ND AVENUE ROCK ISLAND IL 61201 363122824 501(C)(3) 11500 SPONSORSHIP - YOUTH EMPLOYMENT & FESTIVAL OF TREES HABITAT FOR HUMANITY QUAD CITIES 2235 GRANT ST BETTENDORF IA 52722 421404937 501(C)(3) 5000 SPONSORSHIP OF HOME PROJECT SCOTT COUNTY FAMILY Y 606 WEST 2ND STREET DAVENPORT IA 52801 420703278 501(C)(3) 66000 SPONSORSHIP FOR VARIOUS PROGRAMS LIKE CAMP GENESIS AND PARTNER WITH YOUTHS ST AMBROSE UNIVERSITY 518 WEST LOCUST STREET DAVENPORT IA 52804 420703280 501(C)(3) 219000 CONTRIBUTION TO HEALTH SCIENCE BUILDING AND WINE FESTIVAL SPONSORSHIP MIDWEST CARDIOVASCULAR RESEARCH FOUNDATION 1622 E LOMBARD STREET DAVENPORT IA 52803 050529623 501(C)(3) 5000 RESEARCH STUDY PROGRAM TAPE2TAPE SPORTS & ENTERTAINMENT - QC MALLARDS RIVER DRIVE MOLINE IL 61265 421772437 21900 QUAD CITY MALLARDS SPONSORSHIP COMMUNITY HEALTH CARE 500 W RIVER DRIVE DAVENPORT IA 52801 421060724 501(C)(3) 50500 DONATION TO ORGANIZATION THAT AIDES INDIVIDUALS WHO DO NOT HAVE MEDICAL OR DENTAL COVERERAGE. DEWITT AREA FOUNDATION PO BOX 260 DEWITT IA 52742 421296691 501(C)(3) 50000 CONTRIBUTION PLEDGE, 2011 STAR COMMUNITY FOUNDATION OF THE GREAT RIVER BEND 852 MIDDLE ROAD BETTENDORF IA 52722 426122716 501(C)(3) 25000 SPONSORSHIP OF HEALTHCARE EXPO RICK'S HOUSE OF HOPE 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 241914034 501(C)(3) 30000 YEARLY SPONSORSHIP TO SUPPORT SERVICES AT RICK'S HOUSE OF HOPE. GILDA'S CLUB QUAD CITIES 1234 E RIVER DRIVE DAVENPORT IA 52803 421446989 501(C)(3) 30000 SPONSORSHIP FOR HELEN HUNT EVENT FOR CANCER AWARENESS PUTNAM MUSEUM & IMAX THEATRE 1717 WEST 12TH STREET DAVENPORT IA 52804 420680474 501(C)(3) 8400 SPONSORSHIP FOR MEMBERSHIP PROGRAMS IOWA-ILLINOIS HIGH SCHOOL BASKETBALL SHOOTOUT LTD 516 EAST DOVER COURT DAVENPORT IA 52803 830413194 501(C)(3) 6000 POWER SPORTS PERFORMANCE SHOOT OUT EVENT SPONSORSHIP I WIRELESS CENTER 1201 RIVER DRIVE MOLINE IL 61265 363482673 20000 EVENT SPONSORSHIP: TEMPTATIONS AND TOPS, THOMAS & FRIENDS THE ADVISORY BOARD COMPANY PO BOX 79461 BALTIMORE MD 21279 521468699 20375 ONCOLOGY ROUNDTABLE IOWA HEALTHCARE COLLABORATIVE 100 EAST GRAND AVE STE 100 DES MOINES IA 50309 203869767 501(C)(3) 35000 CONTRIBUTION PLEDGE FOR SUPPORT TOWARDS IHC CONFERENCES, RESEARCH, AND EDUCATION ILLINI HOSPITAL FOUNDATION 801 ILLINI DRIVE SILVIS IL 61282 366208583 501(C)(3) 11808 SPONSORSHIP FOR HELEN HUNT EVENT FOR CANCER AWARENESS 17 21 MEDICAL SUPPLIES TO INDIVIDUALS 413 145330 FAIR MARKET VALUE MEDICAL SUPPLIES GRANTS FOR RESEARCH STUDIES 173 180334 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GENESIS HEALTH SYSTEM - IOWA 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 X X X X X 0 1 0 0 0 0 0 0 0 JAMES A BULL MD 152602 0 0 0 39092 0 11544 0 11882 0 215120 0 0 0 DOUGLAS P CROPPER 567498 0 137967 0 33848 0 269566 0 21437 0 1030316 0 0 0 GEORGE KONTOS JR MD 497978 0 0 0 40476 0 10127 0 16052 0 564633 0 0 0 MARK G ROGERS 232637 0 56242 0 38062 0 111580 0 11872 0 450393 0 0 0 ROBERT W FRIEDEN 223268 0 43193 0 175767 0 13869 0 17997 0 474094 0 0 0 WILLIAM LANGLEY MD 222088 0 37218 0 248277 0 54738 0 14552 0 576873 0 79283 0 JULIE MANAS 310431 0 63590 0 1164 0 120713 0 16441 0 512339 0 0 0 JUDITH PRANGER 172000 0 28501 0 23935 0 127582 0 11309 0 363327 0 0 0 FLORENCE L SPYROW 41898 212029 8137 41177 3630 18370 17707 89607 339 1714 71711 362897 0 0 NICHOLAS AUGELLI MD 420618 0 0 0 38980 0 11921 0 15851 0 487370 0 0 0 MARK HULL MD 480286 0 0 0 41351 0 14415 0 17257 0 553309 0 0 0 DARRYL JOHNSON MD 451942 0 11158 0 1385 0 12250 0 18167 0 494902 0 0 0 TODD RIDENOUR MD 806991 0 0 0 40348 0 17573 0 16417 0 881329 0 0 0 WILLIAM SYBESMA MD 428506 0 0 0 20580 0 2767 0 15619 0 467472 0 0 0 ANDREW ANDRESEN MD 191237 0 34587 0 42559 0 16948 0 11268 0 296599 0 0 0 DEAN BUNTING MD 170507 0 0 0 17199 0 19167 0 19846 0 226719 0 0 0 JEFFREY M COOPER 127531 0 35003 0 99545 0 10771 0 18218 0 291068 0 0 0 ALEXANDER JONES MD 118508 0 0 0 22092 0 6127 0 5392 0 152119 0 0 0 HEIDI KAHLY-MCMAHON 157172 0 27892 0 9733 0 60087 0 18490 0 273374 0 0 0 ROBERT NELSON MD 171852 0 37837 0 88217 0 43643 0 13439 0 354988 0 24727 0 MIKE SHARP 128152 0 31335 0 13926 0 81588 0 13607 0 268608 0 0 0 CRAIG SOMMERS 117370 0 12704 0 15500 0 5818 0 15098 0 166490 0 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 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: JEFFREY M. COOPER - $28,336, ROBERT W. FRIEDEN- $67,420. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010 AND THE GROSS-UP PAYMENT TO COVER TAX. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVING BENEFIT PLAN IN 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: JEFFREY M. COOPER- $55,499, ROBERT W. FRIEDEN - $94,525, WILLIAM LANGLEY, M.D. - $184,284, AND ROBERT NELSON, M.D. - $ 57,924. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: DOUGLAS P. CROPPER - $260,072, HEIDI KAHLY-MCMAHON - $50,557, JULIE MANAS - $113,363, ROBERT NELSON, M.D. - $30,408, JUDITH PRANGER - $61,119, MARK G. ROGERS - $98,412, MIKE SHARP - $44,191, AND FLORENCE L. SPYROW - $97,572. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2010. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. SUPPLEMENTAL INFORMATION PART III PART II, COLUMN F: THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT SAVINGS BENEFIT PLAN IN 2009 AND 2010 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: WILLIAM LANGLEY, M.D. - $79,283 AND ROBERT NELSON, M.D. - $24,727. THE DOLLAR AMOUNT REPRESENTS THE PRIOR YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009. THIS INFORMATION WAS INCLUDED IN DEFERRED COMPENSATION ON THE PRIOR YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THESE INDIVIDUALS REACHED A SPECIFIED LEVEL OF VESTING IN 2010, SO THE DOLLAR AMOUNT IS NOW INCLUDED IN REPORTABLE COMPENSATION ON THE CURRENT YEAR FORM 990, PART VII AND SCHEDULE J, PART II. THE DOLLAR AMOUNT IS ALSO LISTED AS COMPENSATION REPORTED IN PRIOR FORM 990 ON THE CURRENT YEAR FORM 990, SCHEDULE J, PART II. IOWA FINANCE AUTHORITY 521699886 46246PLP4 2010-06-24 95545195 REFUND 12-23-97 AND 08-02-00 BOND ISSUE; RENOVATE AND EQUIP FACILITY 0 0 0 95545195 1367299 18162589 2010 1 0 1 1 0 0 1 1 1 0.00910 0.00000 0.00910 1 0 0 0 0 0 1 WELLMARK HEALTH PLAN OF IOWA INC SEE BELOW IN PART V 83630286 GENESIS HEALTH SYSTEM (GHS) HAS A PROVIDER SERVICE AGREEMENT FOR PATIENT MEDICAL SERVICES AND RECEIVES ADDITIONAL INCOME FOR QUALITY HEALTHCARE SERVICES FROM WELLMARK HEALTH PLAN OF IOWA, INC. 0 GENVENTURES INC SEE BELOW IN PART V 26843891 GENVENTURES, INC. PAID GHS AS A COMMON PAYMASTER AND REIMBURSEMENT OF INTEREST. 0 GENVENTURES INC SEE BELOW IN PART V 20908785 GHS PAID GENVENTURES, INC. FOR LEASE PAYMENTS, MEDICAL SUPPLIES, AND LAUNDRY SERVICES. 0 WELLMARK HEALTH PLAN OF IOWA INC SEE BELOW IN PART V 19246939 GHS OBTAINS EMPLOYEE HEALTH INSURANCE COVERAGE AND ISSUES REFUNDS FOR OVERPAYMENTS TO WELLMARK HEALTH PLAN OF IOWA, INC. 0 JW KOEHLER ELECTRIC INC JAMES A. KOEHLER, A DIRECTOR OF GHS, OWNS KOEHLER ELECTRIC. 191210 GHS USES SERVICES PROVIDED BY KOEHLER ELECTRIC. 0 EDWARD TED J ROGALSKI EDWARD J. ROGALSKI IS THE SON OF DR. EDWARD ROGALSKI, DIRECTOR OF GHS. 176271 EDWARD J. ROGALSKI RECEIVES COMPENSATION FROM GHS AS THE DIRECTOR OF NEUROSCIENCE AND MERCER COUNTY ADMINISTRATOR. 0 S & D REAL ESTATE SEE BELOW IN PART V 158444 DR. MCECHRON HAS AN OWNERSHIP INTEREST IN S & D REAL ESTATE, LLC. GHS RENTS SPACE IN A BUILDING OWNED BY S & D REAL ESTATE. 0 BUSH CONTRUCTION COMPANY INC SEE BELOW IN PART V 144202 GHS USES SERVICES PROVIDED BY BUSH CONSTRUCTION COMPANY, INC. 0 DR W DAVID MCECHRON DR. MCECHRON IS THE SPOUSE OF RITA WATTS, FORMER VICE CHAIRMAN OF GHS. 108441 DR. MCECHRON RECEIVES COMPENSATION FROM GHS FOR SERVICES PROVIDED AS A PHYSICIAN. 0 LISA ROGALSKI LISA ROGALSKI IS DAUGHTER-IN-LAW OF DR. EDWARD ROGALSKI, CHAIRMAN OF GHS. 105617 LISA ROGALSKI RECEIVES COMPENSATION FROM GHS AS THE DIRECTOR OF MATERIALS MANAGEMENT. 0 QUAD CITY BANK & TRUST MARK KILMER IS THE CHAIRMAN OF QCB&T, AND A DIRECTOR OF GHS. 104583 GHS RECEIVED INTEREST INCOME FROM QUAD CITY BANK & TRUST. 0 BARBARA P PARK BARBARA P. PARK IS THE DAUGHTER OF JUDITH PRANGER, KEY EMPLOYEE OF GHS. 56588 BARBARA P. PARK RECEIVES COMPENSATION FROM GHS AS A PHYSICAL THERAPIST. 0 QUAD CITY BANK & TRUST MARK KILMER IS THE CHAIRMAN OF QCB&T, AND A DIRECTOR OF GHS. 56021 GHS INCURRED INTEREST EXPENSE AND OTHER FEES WITH QUAD CITY BANK & TRUST. 0 ERIN E MOORE-WATERMAN SEE BELOW IN PART V 10968 ERIN MOORE-WATERMAN RECIEVES COMPENSATION FROM GHS AS A MEDICAL LIBRARIAN. 0 FORM 990, SCHEDULE L , PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - WELLMARK HEALTH PLAN OF IOWA, INC. DOUGLAS P. CROPPER IS THE BOARD PRESIDENT/CEO OF GHS AND A DIRECTOR ON THE BOARD OF WELLMARK HEALTH PLAN OF IOWA, INC. FORM 990, SCHEDULE L , PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - GENVENTURES, INC. MARK G. ROGERS AND ROGER A. HILL ARE OFFICERS, FLORENCE L. SPYROW IS A KEY EMPLOYEE, JAMES A. KOEHLER IS A DIRECTOR, AND MIKE SHARP IS A FORMER KEY EMPLOYEE OF GHS AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, MARK G. ROGERS, ROGER A. HILL, JAMES A. KOEHLER, AND MIKE SHARP WERE OFFICERS OF GENVENTURES, INC., AND FLORENCE L. SPYROW WAS A DIRECTOR OF GENVENTURES, INC. FORM 990, SCHEDULE L , PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - S AND D REAL ESTATE DR. W. DAVID MCECHRON IS THE SPOUSE OF FORMER VICE CHAIRMAN OF THE BOARD, RITA WATTS. DR. MCEHRON HAS AN OWNERSHIP INTEREST IN S & D REAL ESTATE. FORM 990, SCHEDULE L , PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - GREGORY J. BUSH GREGORY J. BUSH, THE TREASURER OF GHS, IS CHAIRMAN OF BUSH CONTRUCTION COMPANY INC. FORM 990, SCHEDULE L , PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - ERIN E. MOORE-WATERMAN ERIN E. MOORE-WATERMAN IS THE DAUGHTER-IN-LAW OF C. DANA WATERMAN, DIRECTOR OF GHS. X 1 134502 VENDOR LIST PRICE/ FMV 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): ON APRIL 15, 2011 GENESIS HEALTH SYSTEM RECEIVED A NON-CASH CONTRIBUTION FROM STRYKER ENDOSCOPY CONSISTING OF: 1.) 5.0 MMX 10 FT CLEAR SASE FIBEROPTIC LIGHT CABLE: $591 EACH, QTY 5 2.) CROSSFIRE CONSOLE: $19,000 EACH, QTY 3 3.) CROSSFIRE FOOTSWITCH: $2,000 EACH, QTY 4 4.) FORMULA SHAVER HANDPIECE (WITH BUTTONS): $10,428 EACH, QTY 5 5.) DICOM ACTIVATION FOR SDC ULTRA: $7,204 EACH, QTY 2 FORM 990, PART VI, SECTION B, LINE 11 INTERNAL MANAGEMENT REVIEW IS COMPLETED OF THE COMPILED INFORMATION PRIOR TO PREPARATION AND REVIEW BY MCGLADREY & PULLEN, LLP. FOLLOWING MCGLADREY & PULLEN, LLP'S PREPARATION AND REVIEW OF THE FORM 990, IT IS REVIEWED WITH THE ORGANIZATION'S PRESIDENT/CEO; VICE PRESIDENT, FINANCE/CFO; VICE PRESIDENT, LEGAL AFFAIRS; AND VICE PRESIDENT, HUMAN RESOURCES. THE FORM 990 IS THEN REVIEWED AT A JOINT MEETING OF THE ORGANIZATION'S FINANCE COMMITTEE AND AUDIT & COMPLIANCE COMMITTEE. PRIOR TO SUBMITTING THE FORM 990 TO THE IRS, IT IS E-MAILED TO THE ORGANIZATION'S BOARD OF DIRECTORS ONE WEEK IN ADVANCE OF A SCHEDULED MEETING. AT THE BOARD OF DIRECTORS MEETING, INTERNAL MANAGEMENT REVIEWS THE FORM 990 WITH THE BOARD OF DIRECTORS. SUGGESTED CHANGES FROM ALL OF THESE REVIEWS ARE CONSIDERED FOR INCLUSION IN THE FINAL FORM 990 SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, OR MEMBER OF A BOARD OR BOARD COMMITTEE OF GENESIS HEALTH SYSTEM (GHS) OR AN AFFILIATE, SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT WILL BE CONSIDERED BY MANAGEMENT, THE BOARD, OR A COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING GHS, OR AN AFFILIATE, OR WITH RESPECT TO DESIGNATED FACILITIES AND ACTIVITIES, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH PERSON ADVOCATE HIS OR HER POSITION INFORMALLY THROUGH PRIVATE CONTACT, COMMUNICATION AND DISCUSSION WITH ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE APPLICABLE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 EACH EXECUTIVE POSITION IS EVALUATED USING A FORMAL EVALUATION PLAN THAT IS ESTABLISHED BY AN OUTSIDE CONSULTANT. AT THE PRESENT TIME, THE CONSULTANT USES A POINT SYSTEM FOR JOB EVALUATION. THE POINT VALUES ARE BASED ON "KNOW HOW", "PROBLEM SOLVING", "ACCOUNTABILITY", AND OTHER JOB ATTRIBUTES SPECIFIC TO THE POSITION. ONCE THE POINT VALUE IS SET FOR A POSITION, MARKET COMPARISONS FOR JOBS WITH THE SAME ORGANIZATIONAL IMPACT CAN BE COMPARED FOR SALARY PURPOSES AND ESTABLISH PAY RANGES. THE DESIGN OF THE PAY RANGES FOR EXECUTIVES IS BASED ON MARKET DATA. THE MIDPOINT OF EACH PAY RANGE IS ESTABLISHED AT THE 50TH PERCENTILE OF THE MARKET COMPARISONS. A MINIMUM GUIDELINE IS ESTABLISHED AT THE 25TH PERCENTILE, AND A MAXIMUM GUIDELINE IS SET AT THE 75TH PERCENTILE. SPECIFIC PAY RATES FOR EXECUTIVES ARE SUBJECT TO CEO AND COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS APPROVAL. PAY RANGES ARE REVIEWED EACH YEAR TO DETERMINE THE NEED FOR REVISION. WHEN MARKET CONDITIONS SUGGEST AN ADJUSTMENT TO PAY RANGES, DATA WILL BE PRESENTED TO THE COMPENSATION COMMITTEE FOR ITS REVIEW. THE SPECIFIC PAY RANGES ARE SUBJECT TO CEO, COMPENSATION COMMITTEE, AND GENESIS HEALTH SYSTEM (GHS) BOARD OF DIRECTOR APPROVAL. THE PRESIDENT AND CEO HAS THE AUTHORITY AND RESPONSIBILITY TO ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS, THE BASE COMPENSATION OF EACH EXECUTIVE EMPLOYED BY GHS, AT APPROPRIATE TIMES. THE GHS BOARD OF DIRECTORS SHALL ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE, THE BASE COMPENSATION FOR THE CEO OF GHS, AT APPROPRIATE TIMES. THE LAST TIME THIS PROCESS WAS FORMALLY UNDERTAKEN WAS AUGUST 2010. HOWEVER, INTERNAL REEVALUATIONS ARE PERFORMED ANNUALLY TO ENSURE CONSISTENCY WITH INDUSTRY STATISTICS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 18,474,375. CHANGE IN FUNDED STATUS OF RETIREMENT 20,918,020. CHANGE IN NET ASSETS OF FOUNDATION 3,136,904. NON-CASH GRANT NOT RECORDED ON BOOKS 7,900. EXCESS OF FAIR VALUE OVER EQUITY ACQUIRED FOR GENGASTRO, LLC 14,958,732. TOTAL TO FORM 990, PART XI, LINE 5: 57,495,931. FORM 990, PART XII, LINE 2C THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. FORM 990, PART VII, LINE 1A GENESIS HEALTH SYSTEM, EIN 42-1418847, AND GENESIS HEALTH SYSTEM, EIN 36-3616314 HAVE IDENTICAL GOVERNING BOARDS AND AN IDENTICAL EXECUTIVE MANAGEMENT TEAM. THE HOURS REPORTED ON FORM 990, PART VII, SECTION A, COLUMN (B) REPRESENTS THE NUMBER OF HOURS THESE INDIVIDUALS DEVOTE TO BOTH ORGANIZATIONS. FURTHERMORE, THE AMOUNTS REPORTED AS REPORTABLE COMPENSATION FOR THE OFFICERS, KEY EMPLOYEES, AND HIGHLY COMPENSATED EMPLOYEES, UNLESS OTHERWISE NOTED ELSEWHERE IN PART VII, ARE FOR SERVICES RENDERED ON BEHALF OF BOTH ORGANIZATIONS. IT WOULD BE ADMINISTRATIVELY IMPRACTICABLE FOR MEMBERS OF THE GOVERNING BOARD AND THE EXECUTIVE TEAM TO BREAKOUT THEIR HOURS DEVOTED AS WELL AS THEIR REPORTABLE COMPENSATION BETWEEN EACH ORGANIZATION. ALL REPORTABLE COMPENSATION, UNLESS OTHERWISE NOTED IN PART VII, IS PAID BY GENESIS HEALTH SYSTEM, EIN 42-1418847. 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