2011-02-14T14:37:06-06:00 2010-06-30 RSM McGladrey Inc 201 N Harrison Ste 300 Davenport IA 528011999 990 2009-07-01 421418847 Genesis Health System GENE 5634216508 1227 E Rusholme Davenport IA 528032498 MARK G ROGERS 5634216508 2011-02-14 1 John J Romano 5638884000 2009 2016-02-24 21:20:13Z Mark G Rogers 1227 E Rusholme Davenport IA 528032498 550973472 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 4917 1133 881515 -28803 2072965 1511240 442659914 444894265 4772963 8282065 8046967 7228434 457552809 461916004 1505952 3509212 0 213880145 225867420 0 0 227376640 216334185 442762737 445710817 14790072 16205187 483818744 520487697 157310176 177765873 326508568 342721824 GENESIS HEALTH SYSTEM EXISTS TO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES TO ALL THOSE IN NEED. 0 0 290293472 3404799 275821240 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 89,592 Patient Days, 22,056 Patient Discharges and 176,383 Out-patient Visits; Genesis Medical Center-DeWitt, containing licensed 13 Acute Beds and 77 Skilled Beds. Statistics inCLude 1,670 Patient Days, 297 Patient Discharges, and 19,223 Outpatient Visits. Genesis Health System also includes a Family Medicine Residency Program that continues to educate residents in the hospital setting. 100886646 149840723 Genesis Health Group, a physician group within Genesis Health System, consists of 42 clinics and 124 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 194,873 and RVU's (Relative Value Units) 744,997. 23535361 104413 24458340 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 121,378 and Hospice/ Hospice House Days 46,510. 75033 Genesis Illinois Properties, an entity within Genesis Health System, owns land in Illinois for future expansion purposes. 75033 414790512 1 1 0 1 0 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 345 0 1 4917 1 1 1 1 CJ 0 0 0 0 0 0 0 17 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 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 DR JAMES A BULL 44.00 X 201482 0 24595 GREGORY J BUSH 4.00 X X 0 0 0 DR EDMUND P COYNE JR 4.00 X 0 0 0 DOUGLAS P CROPPER 44.00 X X 582439 0 241529 THOMAS A GILDEHAUS 4.00 X 0 0 0 ROGER J HILL 4.00 X X 0 0 0 MARK C KILMER 4.00 X 0 0 0 JAMES W KOEHLER 4.00 X 0 0 0 CHARLENE E MAASKE 4.00 X 0 0 0 DR EDWIN V MOTTO 4.00 X 0 0 0 DR EDWARD J ROGALSKI 10.00 X X 0 0 0 G CHRISTOPHER WAHLIG 4.00 X 0 0 0 C DANA WATERMAN III 4.00 X 0 0 0 DR CAROL A WATSON 4.00 X 0 0 0 DALE D ZUDE 4.00 X 0 0 0 MARK G ROGERS 40.00 X 335170 0 103311 ROBERT W FRIEDEN 40.00 X 298209 0 31570 DR WILLIAM LANGLEY 40.00 X 287355 0 140449 JULIE MANAS 40.00 X 308159 0 100852 JUDITH PRANGER 40.00 X 182290 0 91312 FLORENCE L SPYROW 40.00 X 276918 0 79962 DR NICHOLAS AUGELLI 40.00 X 489776 0 26687 DR TERRILL BANER 40.00 X 521231 0 22691 DR ROBERT FIETSAM 40.00 X 545559 0 25495 DR DARRYL JOHNSON 40.00 X 546699 0 30916 DR GEORGE KONTOS JR 40.00 X 507064 0 26709 DR ANDREW ANDRESEN 40.00 X 231734 0 27987 DR DEAN BUNTING 40.00 X 192306 0 37023 JEFFREY M COOPER 40.00 X 172610 0 27987 DR ALEXANDER JONES 40.00 X 139112 0 11330 HEIDI KAHLY-MCMAHON 40.00 X 145899 0 40562 DR ROBERT NELSON 40.00 X 255357 0 76191 MIKE SHARP 40.00 X 196108 0 77560 CRAIG SOMMERS 40.00 X 136366 0 22551 6551843 0 1267269 237 1 1 0 Metropolitan Medical Lab 1814 EAST LOCUST STREET DAVENPORT IA 52803 Laboratory DIAGNOSTICS 8936230 DAVENPORT EMERGENCY ROOM PHYSICIANS 2116 MAIN STREET DAVENPORT IA 52803 EMERGENCY PHYSICIAN CARE 5387464 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 COMPUTER SOFTWARE SUPPORT & MAINTENANCE 4877270 COGENT HEALTHCARE PO BOX 974451 DALLAS TX 75397 CONTRACTED MEDICAL STAFF 1872687 the MIDLAND GROUP PO BOX 29161 SHAWNEE MISSION KS 66201 COLLECTION SERVICES 1313849 64 522136 115527 873577 9237 1511240 INPATIENT REVENUE 900099 486862207 486862207 OUTPATIENT REVENUE 621400 396134509 396134509 CLINIC REVENUE 621400 88157799 88157799 HOME HEALTH & HOSPICE 621610 24808836 24808836 OTHER OPERATING REVENU 624100 7923504 6946067 977437 -558992590 -558896668 -95922 444894265 5157635 5157635 1164415 43902 1120513 1120513 1120513 91661673 16272 88017697 535818 3643976 -519546 3124430 3124430 777759 460051 317708 317708 OTHER REVENUE 900099 3191867 3191867 DIETARY 900099 2141896 2141896 HOUSEKEEPING 900099 456450 456450 5790213 461916004 450120671 881515 9402578 3204390 3204390 304822 304822 2710833 529673 2181160 417082 268847 148235 181151190 173831146 7320044 9081426 8670675 410751 20131424 19896906 234518 12375465 12048321 327144 11986812 11505149 481663 1210704 1210704 287255 287255 118330 118330 24187190 22097785 2089405 1151886 147060 1004826 45002409 41669261 3333148 3316609 1114160 2202449 17402462 14155161 3247301 1900949 1348283 552666 52859 30130 22729 4372326 4206621 165705 28953192 28636136 317056 3772158 125920 3646238 PATIENT SUPPLY COST OF 42560161 42560161 PROVISION FOR BAD DEBTS 27401892 27401892 MISCELLANEOUS 2656991 1038013 1618978 445710817 414790512 30920305 0 2768090 3437343 46294703 40029286 60995977 62527236 11035056 20351406 8728963 9392564 3458205 3768127 470838940 300586556 175456064 170252384 112552269 129055977 32585992 35662465 20000 20000 29923425 45990909 483818744 520487697 43087279 46005476 78220000 94794486 34187 2506 35968710 36963405 157310176 177765873 X 316233314 331777982 10275254 10943842 326508568 342721824 483818744 520487697 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 0 0 0 1 37172 1 887 1 80271 118330 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: IN MARCH OF 2010, 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: 23% OF MEMBERSHIP DUES TO THE IOWA HOSPITAL ASSOCIATION, OR $28,320, 26.3% OF MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, OR $12,923, 50% OF MEMBERSHIP DUES TO THE SCOTT COUNTY MEDICAL SOCIETY, OR $5,225, AND VARIOUS OTHER ASSOCIATIONS - $8,803. 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. 5010740 28352 297861 296096 5040857 5224450 30636 -243446 900 5010740 0.63000 0.37000 0.00000 0 1 1 8878425 8878425 185689804 97798418 87891386 18228078 12999895 5228183 229791121 177096974 52694147 28251512 12691269 15560243 170252384 OTHER INVESTMENTS - GMC 54109 F INVESTMENT IN GENVENTURES, INC 26181121 C INVESTMENT IN MISERICORDIA 120000 C INVESTMENT IN MRIOWA, LLC 187655 C INVESTMENT IN HEI COOP 1707372 C INVESTMENT IN HEI VENTURES 101483 C INVESTMENT IN HEI IOWA ECHO/ULTRASOUND 93538 C INVESTMENT IN HEI BREAST BIOPS 3163 C INVESTMENT IN HEI DIGITAL MAMMOGRAPHY 14860 C INVESTMENT IN DAVENPORT SRS LEASING 1323168 C INVESTMENT IN SPRING PARK SURGERY CENTER 4110921 C INVESTMENT IN GENGASTRO LLC 875863 C INVESTMENT IN GENORTHO 634084 C OTHER INVESTMENTS - DEWITT 231811 C INVESTMENT IN HEI 10372 C INVESTMENT IN HEI BONE DENSITY 12945 C 35662465 OTHER ASSETS 738927 INTEREST IN NET ASSETS OF FOUNDATION 6855025 UNAMORTIZED BOND COSTS 641318 GOODWILL & COVENANT NOT TO COMPETE 866777 DEFERRED COMPENSATION ANNUITY 5021911 CERTIFICATES OF DEPOSIT 12343444 INTEREST RECEIVABLE 169020 DUE FROM RELATED PARTY 6161793 DEBT SERVICE RESERVE FUND 13192694 45990909 ACCRUED PENSION LIABILITY 33826093 ACCRUED INS TRUST LOSSES 3132868 RETIREMENT SAVINGS 4444 36963405 Part V, Line 4: Description of Intended Use of Endowment Funds: GENESIS HEALTH SERVICES FOUNDATION AND ILLINI HOSPITAL FOUNDATION, BOTH RELATED ORGANIZATIONS, HOLD THE ENDOWMENT FUNDS. THE INTENDED USE OF THE FOUNDATIONS' ENDOWMENT FUNDS IS AS FOLLOWS: SCHOLARSHIPS FOR EDUCATION IN THE MEDICAL FIELD, CHARITY CARE FOR THE INDIGENT AND VNA, HOSPICE HOUSE, DIABETES CARE, EMPLOYEE ASSISTANCE, AND PEDIATRIC HOSPICE. Part X: Description of Uncertain Tax Positions Under FIN 48: GHS Iowa, GHS Illinois, the Genesis HEALTH SERVICES Foundation, the Illini HOSPITAL Foundation and the GENESIS HEALTH SYSTEM Workers' Compensation PLAN AND Trust all file a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax exempt status of each entity, the nature, characterization and taxability of joint venture income and various positions relative to potential sources of unrelated business taxable income. Unrelated business taxable income is reported on Form 990T, as appropriate. The benefit of a tax position is recognized in the combined financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for uncertain tax benefits in the accompanying combined balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. Forms 990 and 990T filed by GHS Iowa, GHS Illinois, the Genesis HEALTH SERVICES Foundation, the Illini HOSPITAL Foundation and the GENESIS HEALTH SYSTEM Workers' Compensation PLAN AND Trust are subject to examination by the Internal Revenue Service (IRS) up to three years from the extended due date of each return. Forms 990 and 990T filed by GHS Iowa, GHS Illinois, the Genesis HEALTH SERVICES Foundation, the Illini HOSPITAL Foundation and the GENESIS HEALTH SYSTEM Workers' Compensation PLAN AND Trust are no longer subject to examination for the fiscal years ended June 30, 2006 and prior. GenVentures, INC. is a taxable organization and currently files income tax returns in the U.S. federal jurisdiction and various state jurisdictions. GenVentures, INC. is no longer subject to income tax examinations for years June 30, 2006 and prior. As of June 30, 2010 and 2009, the total amount of uncertain tax positions have reduced income tax expense and have increased excess of revenue over expenses by $40,000 and $5,000, respectively. Interest expense associated with uncertain tax positions from the years ended June 30, 2010 and 2009 is approximately $7,000 and $9,000, respectively. No amount has been accrued for penalties. During the years ended June 30, 2010 and 2009, $265,000 and none, respectively, in federal and state income taxes were paid for uncertain tax positions existing as of June 30, 2009 and 2008, as amended or past due income tax returns were filed. Management believes that it is reasonably possible the liability for uncertain tax positions associated with unrelated business income will decrease in the next twelve months as a result of the expiration of statutes of limitations in major jurisdictions. THE CURRENT YEAR GROUP LIABILITY IS $45,000. GENESIS HEALTH SYSTEM - IOWA'S SHARE OF THIS LIABILITY IS APPROXIMATELY $0. CENTRAL AMERICAN AND THE CARIBBEAN INVESTMENTS 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 6036502 0 6036502 0.01440 42076642 29020557 13056085 0.03120 0 0 48113144 29020557 19092587 0.04560 327724 159353 168371 0.00040 2773578 1064967 1708611 0.00410 2309473 0 2309473 0.00550 97744 0 97744 0.00020 2031098 0 2031098 0.00490 7539617 1224320 6315297 0.01510 55652761 30244877 25407884 0.06070 8523 0 8523 0.00000 11926 0 11926 0.00000 5108 0 5108 0.00000 71 0 71 0.00000 480 0 480 0.00000 476 0 476 0.00000 23674 0 23674 0.00010 2412 0 2412 0.00000 0 0 52670 52670 0.00010 1 9993313 69701 130397684 152975862 -22578178 X 1 1 MOB 1 OWNERS' ASSOCIATION PROPERTY MANAGMENT 0.81700 0.18300 GENESIS MEDICAL CENTER EAST - DAVENPORT

1227 EAST RUSHOLME STREET DAVENPORT IA 52803

X X X GENESIS MEDICAL CENTER - DEWITT

1118 11TH STREET DEWITT IA 52742

X X X GENESIS MEDICAL CENTER WEST - DAVENPORT

1401 WEST CENTRAL PARK DAVENPORT IA 52804

X X X X SCOTT COUNTY YMCA

3800 TANGLEFOOT LANE BETTENDORF IA 52722

OUTPATIENT REHABILITATION CLINIC GENESIS PHYSICAL REHAB - VALLEY FAIR

2720 WEST LOCUST STREET UNIT 2B DAVENPORT IA 52804

O/P PHYSICAL THERAPY CLINIC GENESIS PHYSICAL REHAB - CROW VALLEY

2300 53RD AVENUE STE LL02 BETTENDORF IA 52722

O/P PHYSICAL THERAPY CLINIC RICK'S HOUSE OF HOPE

4867 FOREST GROVE ROAD BETTENDORF IA 52722

COUNSELING SERVICES ELDRIDGE PHYSICAL THERAPY

170 SOUTH 4TH AVENUE ELDRIDGE IA 52748

OUTPATIENT PHYSICAL THERAPY CLINIC GENESIS PHYSICAL THERAPY AT LECLAIRE

1003 CANAL SHORE DRIVE LECLAIRE IA 52751

OUTPATIENT PHYSICAL THERAPY CLINIC DEWITT WEST WING PLACE

1118 11TH STREET DEWITT IA 52742

L-T NURSING CARE FACILITY DEWITT FAMILY PRACTICE

1008 11TH STREET DAVENPORT IA 52742

HOME HEALTH, COUNSELING SERVICES, & O/P DR. CLINIC CENTRAL PARK MEDICAL PAVILIONS 1 & 2

1351 WEST CENTRAL PARK AVENUE DAVENPORT IA 52804

O/P CANCER, REHAB, WOUND & DR. MEDICAL OFFICE BUILDING #1

1228 EAST RUSHOLME STREET DAVENPORT IA 52803

O/P MAMMOGRAPHY & DIALYSIS SERVICES GENESIS CENTER FOR BARIATRIC SURGERY

1230 EAST RUSHOLME STREET DAVENPORT IA 52803

O/P COMPREHENSIVE BARIATRIC PRGM GENESIS HEART INSTITUTE

1236 EAST RUSHOLME STREET DAVENPORT IA 52803

O/P CARDIAC DIAGNOSTICS & REHAB CARE GENESIS MEDICAL PLAZA

2535 MAPLECREST ROAD BETTENDORF IA 52722

O/P REHAB, PAIN, PHYS THERAPY & DR. BETTENDORF IMAGING CENTER

4017 DEVILS GLEN ROAD STE 205 BETTENDORF IA 52722

OUTPATIENT RADIOLOGY SERVICES ELDRIDGE FAMILY PRACTICE

301 NORTH 4TH AVENUE ELDRIDGE IA 52748

OUTPATIENT LAB & PHYSICIAN CLINIC DIVISION STREET CLINIC

3618 NORTH DIVISION STREET DAVENPORT IA 52804

OUTPATIENT LAB & PHYSICIAN CLINIC LECLAIRE FAMILY PRACTICE

532 NORTH CODY ROAD LECLAIRE IA 52751

OUTPATIENT PHYSICIAN CLINIC CONVENIENT CARE - DAVENPORT

1520 WEST 53RD STREET DAVENPORT IA 52806

OUTPATIENT URGENT CARE CLINIC NORTH FAMILY PRACTICE

210 WEST 53RD STREET DAVENPORT IA 52806

OUTPATIENT LAB & PHYSICIAN CLINIC LECLAIRE FAMILY PRACTICE - RIVERVIEW

200 SOUTH CODY LECLAIRE IA 52751

OUTPATIENT PHYSICIAN CLINIC GENESIS HEALTH GROUP

864-866 LINCOLN ROAD BETTENDORF IA 52722

OUTPATIENT PHYSICIAN CLINIC GENESIS PSYCHOLOGY ASSOCIATES

4455 EAST 56TH STREET DAVENPORT IA 52807

OUTPATIENT COUNSELING CLINIC DURANT FAMILY PRACTICE

619 5TH STREET DURANT IA 52747

OUTPATIENT PHYSICIAN CLINIC FAMILY PRACTICE AT WEST CAMPUS

1345 WEST CENTRAL PARK AVENUE DAVENPORT IA 52804

OUTPATIENT PHYSICIAN CLINIC BLUE GRASS FAMILY MEDICAL

413 SOUTH MISSISSIPPI BLUE GRASS IA 52726

OUTPATIENT PHYSICIAN CLINIC VISITING NURSE ASSOCIATION & HOSPICE

611 NORTH 2ND AVENUE CLINTON IA 52732

HOME HEALTH & HOSPICE VISITING NURSE ASSOCIATION & HOSPICE

2535 MAPLECREST ROAD DAVENPORT IA 52807

HOME HEALTH & HOSPICE CLARISSA C COOK HOSPICE HOUSE

2546 TECH DRIVE BETTENDORF IA 52722

HOSPICE HOUSE 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 HEDBERG BUILDING - MOLINE FAMILY PRACTIC

2526 41ST STREET MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC ALPHA FAMILY PRACTICE

202 PICARD STREET ALPHA IL 61413

OUTPATIENT PHYSICIAN CLINIC ERIE FAMILY PRACTICE

530 12TH STREET ERIE IL 61205

OUTPATIENT PHYSICIAN CLINIC MOLINE FAMILY PRACTICE - 7TH STREET

1410 7TH STREET MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC MOLINE VALLEY VIEW

615 VALLEY VIEW DRIVE MOLINE IL 61265

OUTPATIENT PHYSICIAN CLINIC ROCK ISLAND ARSENAL FAMILY PRACTICE

1634 WHITTERMORE STE 101 ROCK ISLAND IL 61201

OUTPATIENT PHYSICIAN CLINIC ROCK ISLAND INTERNAL MEDICINE

2560 24TH STREET ROCK ISLAND IL 61201

OUTPATIENT PHYSICIAN CLINIC ILLINI LARSON CENTER

855 ILLINI DRIVE SILVIS IL 61282

OUTPATIENT LAB & PHYSICIAN CLINIC CONVENIENT CARE - ILLINOIS

2350 41ST STREET MOLINE IL 61265

OUTPATIENT URGENT CARE CLINIC DEWITT AMBULANCE

1220 11TH STREET DEWITT IA 52742

AMBULANCE SERVICES SILVIS ANESTHESIOLOGY

801 ILLINI DRIVE SILVIS IL 61282

OUTPATIENT PHYSICIAN CLINIC MEDICAL OFFICE BUILDING #2

1230 EAST RUSHOLME STREET DAVENPORT IA 52803

OUTPATIENT PHYSICIAN CLINIC GENESIS MEDICAL PARK

4017 DEVILS GLEN ROAD BETTENDORF IA 52722

OUTPATIENT PHYSICIAN CLINIC CONVENIENT CARE - BETTENDORF

4017 DEVILS GLEN ROAD BETTENDORF IA 52722

OUTPATIENT URGENT CARE CLINIC EAP - CLINTON

1127 NORTH 2ND STREET CLINTON IA 52732

COUNSELING SERVICES EAP - MUSCATINE

1605 PLAZA PLACE MUSCATINE IA 52761

COUNSELING SERVICES EAP - ROCK ISLAND

2100 18TH AVENUE ROCK ISLAND IL 61201

COUNSELING SERVICES EAP - DAVENPORT

4455 EAST 56TH STREET DAVENPORT IA 52807

COUNSELING SERVICES GENESIS OCCUPATIONAL HEALTH

3319 SPRING STREET DAVENPORT IA 52807

OUTPATIENT OCCUPATIONAL HEALTH PRGM GENESIS OCCUPATIONAL HEALTH

2350 41ST STREET MOLINE IL 61265

OUTPATIENT OCCUPATIONAL HEALTH PRGM GENESIS PLASTIC SURGERY SPECIALISTS

5335 EASTERN AVENUE DAVENPORT IA 52807

OUTPATIENT PHYSICIAN CLINIC MUSCATINE FAMILY PRACTICE

2104 CEDARWOOD STREET MUSCATINE IA 52761

OUTPATIENT PHYSICIAN CLINIC DEWITT PAVILION 1

1118 11TH STREET DEWITT IA 52742

OUTPATIENT PHYSICAL THERAPY CLINIC Part I, Line 3c: NOT APPLICABLE Part I, Line 6a: NOT APPLICABLE Part I, Line 7: Genesis Health System utilized Worksheet 2 to calculate its cost-to-charge ratio. The calculated cost-to-charge ratio was used to calculate the cost of Charity Care and Unreimbursed Medicaid. The cost of subsidized health services was obtained from Genesis Health System's cost accounting system (i.e., Decision Support System) that calculates the per unit reimbursement and cost for each type of service and supply that the non-Medicare and non-Medicaid patients consumed in the departments reported. Costs of the "Other Benefits" (excluding subsidized health services) reported in 7e -7i were compiled throughout the year in the community benefit database (i.e., CBISA) that Genesis Health System utilizes. Part I, Line 7g: No costs associated with a physician clinic were reported in subsidized health services. Part I, Line 7f: $27,401,892 OF BAD DEBT EXPENSE IS SUBTRACTED FOR PURPOSES OF COMPUTING THE PERCENTAGE IN PART I, LINE 7K, COLUMN F. THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSES, LESS BAD DEBT, IS 13.30%, AND THE PERCENTAGE INCREASES TO 49.87% IF MEDICARE ALLOWABLE COSTS ARE INCLUDED IN TOTAL COMMUNTY BENEFIT EXPENSE. Part III, Line 4: i. The text from the footnote to Genesis Health System's financial statement is as follows: Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by third-party payErs and less an estimated allowance for doubtful receivables based on a review of all outstanding amounts on a monthly basis. Management determines the allowance for doubtful accounts by identifying troubled accounts, by historical experience applied to an aging of accounts, and by considering the patient's financial history, credit history and current economic conditions. Receivables are written off as bad debts when deemed uncollectible. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received. ii. The rationale and costing methodology used to calculate bad debt expense at cost (line 2) consisted of multiplying the total bad debt expense per the income statement by the ratio of patient care cost to charges to arrive at estimated cost of bad debt. Payments received after an account had been written off to bad debt were credited to a bad debt recovery account. Discounts on patient accounts provided by third-party payers were written off to a contractual allowance account. iii. Shared Business Services uses a separate transaction code to identify accounts written off to bad debt that have no financial documentation and may have qualified for charity care had paperwork been submitted. The estimated amount of Genesis Health System's bad debt expense attributable to patients eligible under the organization's charity care policy (line 3) was calculated by taking the total of these accounts and multiplying them by the ratio of patient care cost to charges. iv. No bad debt amounts were included in community benefit. Part III, Line 8: i. For the hospitals and the home health division, the Medicare cost report was used to compute the total revenue received from Medicare, including the disproportionate share adjustment and indirect medical education adjustment. The Medicare cost report was also used to compute the Medicare allowable costs of care. The Provider Statistical and Reimbursement System (PS&R) Provider Summary Reports were also used to determine charges, costs and reimbursement. ii. No Medicare shortfalls were included in community benefit. The Medicare shortfall represents the difference between the total revenue received from Medicare based on Medicare reimbursement rates and the costs incurred by Genesis Health System in providing healthcare services to the elderly. In 2009, the percent of persons 65 years and over was 16.0% in Rock County, Illinois and 12.7% in Scott County, Iowa. In accordance with Genesis Health System's mission statement, "To Provide Compassionate, Quality Health Services to All Those in Need," the elderly were served despite the Medicare loss of $22,578,178. For the third straight year, Genesis Health System was recognized by SDI as one of the nation's Top 100 health systems for integrating services to improve quality and improve efficiency. Accordingly, the loss was not attributable to poor operating practices but from inadequate reimbursements. Genesis Health System has a clear mission to serve all those in need and to improve the health of the community including the elderly. Furthermore, there are no for-profit hospitals in the community, and therefore Genesis Health System is one of two tax-exempt healthcare organizations in the community who provide access to healthcare for Medicare patients. Accordingly, it is Genesis Health System's position for the reasons stated above that the Medicare shortfall of $22,578,178 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 11.48%. Part III, Line 9b: Every effort is made to determine a patient's eligibility for financial assistance. If eligible, payment plans are made available based on their resources and income. All balances owing after financial assistance allowances have been taken are payable in monthly payments in accordance with the organization's financial assistance policy. Part V: All health care facilities were reported in Part V. Part VI, Line 2: Genesis Health System utilizes the community health assessments created by the Quad City Health Initiative (QCHI) and the Community Vitality Task Force of United Way. QCHI was formed by Genesis Health System, which is headquartered in Scott County, Iowa, and Trinity Regional Health System, which is headquartered in Rock Island County, Illinois. QCHI is now a community partnership of over 100 organizations consisting of 500 active individuals pursuing initiatives to create a healthier community, serving as a catalyst for improving the health and overall quality of life within the Quad Cities. A community health assessment was conducted by QCHI in 2003, and then re-assessed in 2007. Each year, the Community Vitality Task Force of United Way produces an annual Snapshot of Community Indicators, including information on the health status of the communities that Genesis Health System serves. Part VI, Line 3: Information on the availability of financial assistance is posted in visible locations in the admission departments of the hospitals. In addition, the hospital registration staff make available informative brochures for patients in the Emergency Room registration area explaining their eligibility for assistance. Genesis Health System provides patient financial counselors on each hospital campus to discuss options with the patients. Shared business services prepares and provides a letter to each patient, explaining their current balance and advising them of their options. A phone number is provided with the letter encouraging the patient to call if needed. In addition, the Genesis Health System website also lists the options for payment, and on a monthly basis a Power Point presentation is given to incoming cancer patients informing them of their payment options.The outpatient physician clinics and the home health division make available their financial policy brochures along with directing patients to government programs such as SCHIP 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 5: 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. A new employee effort in the spring of 2010 helped a food pantry restock its shelves at a time when the need was increasing.2. Economic Development: Genesis Health System executives and employees serve on dozens of volunteer boards throughout the region on important projects and initiatives, such as new library construction, 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. Planning of this event started in early 2010. 5. Leadership development and training for community members: Genesis Health System works with local community colleges to educate its staff on cultural considerations and skills. 6. Coalition Building: Genesis Health System was a key community partner in developing "Let's Move Davenport", a group formed in 2010 to promote health, fitness and good nutrition for children in Davenport. The program includes a number of events in the spring, summer and fall to get school children active. The program was patterned after "Let's Move", the national initiative of First Lady Michelle Obama. Genesis Health System is a participant in "Tobacco Free Quad Cities". "Tobacco Free Quad Cities" is a coalition of interested persons from both Illinois and Iowa who work to eliminate tobacco use in the Quad Cities. The Health Departments of both Scott and Rock Island Counties have dedicated employees to guide the implementation of various projects and activities of the coalition. 7. 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.8. 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 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) was formed in October 1999 and shall continue perpetually. Genesis Illinois Properties owns land located in Moline, Illinois. Genesis Visiting Nurse Association and Hospice (VNA) provides home health care, community nursing services and hospice services to patients in eastern Iowa and western Illinois.Genesis Health System 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 fourteen medical office buildings located in Davenport, Eldridge, LeClaire, Muscatine and Bettendorf, Iowa. Crescent Laundry provides commercial laundry services to health care facilities in eastern Iowa and north-central Illinois. Genesis Health System Workers' Compensation Plan and Trust (Workers' Compensation Trust) provides a fund which can be used to pay workers' compensation claims and costs for the benefit of Genesis Health System. Misericordia Assurance Company, Ltd. (Misericordia) is a wholly owned Cayman based captive insurance company which underwrites the general and professional liability risks of Genesis Health System and affiliates. Davenport SRS Leasing, LLC (SRS) is a limited liability company, which was formed in 2008, which leases medical equipment. Genesis Health System is a general partner and owned 55% of SRS as of June 30, 2009. On September 30, 2009, Genesis Health System acquired an additional 38.75% interest in SRS to obtain a 93.75% ownership interest as of June 30, 2010.Genesis Health System (tax ID #36-3616314) operates the following business units to promote the health of the communities it serves:Genesis Medical Center - Illini (GMC - Illini) is licensed as a 149-bed acute care hospital which provides services from its facility in Silvis, Illinois. Illini Hospital Nursing Home (INH) operates Illini Restorative Care Center and Crosstown Square. Illini Restorative Care Center operates a 75-bed licensed nursing facility which provides skilled and intermediate health care and related services to patients. Twenty-two of Illini Restorative Care Center's beds are designated as Hospital-based Medicare certified beds. Illini Restorative Care's Sheltered Care unit is a 45-bed facility which provides rehabilitative and personal care in a family-oriented setting. Crosstown Square is an independent living facility containing 76 rentable apartments and two guestrooms that offers services designed to meet the needs of our senior adults.Genesis Health System (tax ID #36-3616314) has a controlling ownership interest oR membership in the following organizations: Illini Hospital Foundation (Illini Foundation) supports Genesis Medical Center - Illini by providing financial and fundraising assistance. The mission of the Illini Foundation is to assist GMC - Illini in providing quality, compassionate care for all those in need by raising, managing and granting charitable funds. The Larson Center Partnership (LCP) is a for-profit real estate partnership which owns a medical office building adjacent to GMC- Illini and leases space for clinics, laboratory, pharmacy and offices to GMC - Illini and other third-party organizations. GHS Illinois is a general partner and owns approximately 76% of LCP. IL IA 1 FIGGE ART MUSEUM 225 WEST 2ND STREET DAVENPORT IA 52801 426090398 501(C)(3) 5000 ART OF LIVING EXHIBITION SPONSORSHIP AMERICAN HEART ASSOCIATION 1111 NINTH STREET DES MOINES IA 50314 135613797 501(C)(3) 5000 HEART WALK SPONSORSHIP MARCH OF DIMES 2117 STATE STREET BETTENDORF IA 52722 131846366 501(C)(3) 5000 CHEF'S AUCTION SPONSORSHIP NIABI ZOOLOGICAL SOCIETY NIABI ZOO ROAD COAL VALLEY IL 61240 363293641 501(C)(3) 5000 NIABI ZOO FAMILY FUN RUN/WALK SPONSORSHIP GENESIS HEALTH SYSTEM WORKERS' COMPENSATION PLAN & TRUST 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 391905171 501(C)(3) 1147679 CLAIM PAYMENTS GENESIS HEALTH SERVICES FOUNDATION 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 421421670 501(C)(3) 263217 ONCOLOGY FUNDING; FLU FREE; GOLF CHALLENGE; HEALTHCARE RELATED CONTRIBUTIONS BALLET QUAD CITIES 613 17TH STREET ROCK ISLAND IL 61201 421366753 501(C)(3) 10000 SPONSORSHIP OF FOUR PERFORMANCES CENTER FOR ACTIVE SENIORS INC 1035 WEST KIMBERLY ROAD DAVENPORT IA 52806 421011267 501(C)(3) 7717 RENT AND UTILITIES COVERAGE DAVENPORT ONE 130 WEST SECOND STREET DAVENPORT IA 52801 421500610 501(C)(3) 72500 PLEDGE/SPONSORSHIP - ARTIST IN RESIDENCE; RED, WHITE, & BOOM; QC FAMILY FESTIVAL; TRANS, EXPENSE WITH MERGERS, D1 INITIATIVE II QUAD CITY ARTS 1715 2ND AVENUE ROCK ISLAND IL 61201 363122824 501(C)(3) 17000 SPONSORSHIP - FESTIVAL OF TREES QUAD CITY SYMPHONY ASSOCIATION 327 BRADY STREET DAVENPORT IA 52801 426017663 501(C)(3) 23000 SPONSORSHIP - TICKET PROGRAMS, RUNOUTS, BROADCASTS SCOTT COUNTY FAMILY Y 606 WEST 2ND STREET DAVENPORT IA 52801 420703278 501(C)(3) 25500 SPONSORSHIP FOR CLA CAMPAIGN, GOLF CHALLENGE, PARTNER WITH YOUTH ST AMBROSE UNIVERSITY 518 WEST LOCUST STREET DAVENPORT IA 52804 420703280 501(C)(3) 437200 610000 FAIR MARKET VALUE SITE DEVELOPMENT & IMPROVEMENTS CONTRIBUTION TO HEALTH SCIENCE BUILDING; SITE DEVELOPMENT & IMPROVEMENTS FOR HEALTH SCIENCE BUILDING VERA FRENCH COMMUNITY MENTAL HEALTH CENTER 1441 WEST CENTRAL PARK DAVENPORT IA 52804 420716337 501(C)(3) 25000 FIRST AID MENTAL HEALTH COMMUNITY SPONSORSHIP AMERICAN RED CROSS PO BOX 73563 CHICAGO IL 60673 366000114 501(C)(3) 20000 HAITI RELIEF EFFORTS DEWITT PARK & RECREATION 900 14TH STREET DEWITT IA 52742 426004584 23187 EXERCISE EQUIPMENT FOR PARK; LITTLE TREES PARK BASKETBALL COURT DONATION ROAD RUNNERS CLUB OF AMERICA 315 EAST GEORGE WASHINGTON BLVD DAVENPORT IA 52803 930708918 501(C)(3) 50000 BIX 7 PLATINUM SPONSORSHIP COMMUNITY FOUNDATION OF THE GREAT RIVER BEND 852 MIDDLE ROAD BETTENDORF IA 52722 426122716 501(C)(3) 25000 PARTNERS IN NURSING PLEDGE IOWA HEALTHCARE COLLABORATIVE 100 EAST GRAND AVENUE STE 100 DES MOINES IA 50309 203869767 501(C)(3) 35000 PLEDGE TO SUPPORT IHC CONFERENCES, RESEARCH, AND EDUCATION THE BALLGAME CLASSIC PO BOX 5267 DAVENPORT IA 52808 412279129 150000 PSP BALLGAME CLASSIC SPONSORSHIP ALEDO PARK DISTRICT PO BOX 221 ALEDO IL 61231 362715313 22187 EXERCISE EQUIPMENT FOR PARK IOWA-ILLINOIS HIGH SCHOOL BASKETBALL SHOOTOUT LTD 516 EAST DOVER COURT DAVENPORT IA 52803 830413194 501(C)(3) 6000 PSP SHOOT OUT SPONSORSHIP DEWITT AREA FOUNDATION PO BOX 260 DEWITT IA 52742 421296691 501(C)(3) 50000 2010 STAR PLEDGE MEDICAL MINISTRY USA PO BOX 1339 ALLEN TX 75013 752601647 501(C)(3) 13428 FAIR MARKET VALUE MEDICAL SUPPLIES DONATED MEDICAL SUPPLIES FOR MISSION TRIP 21 3 MEDICAL SUPPLIES DONATED TO VARIOUS PATIENTS 356 39855 FAIR MARKET VALUE MEDICAL SUPPLIES MEDICAL/DENTAL COVERAGE FOR INDIVIDUALS WHO CANNOT ACCESS PRIMARY CARE ELSEWHERE 35 50000 MEDICAL SUPPLIES TO INDIVIDUALS 46 12139 FAIR MARKET VALUE MEDICAL SUPPLIES GRANTS FOR RESEARCH STUDIES 205 202828 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 X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 DR JAMES A BULL 160847 0 0 0 40635 0 12113 0 12482 0 226077 0 0 0 DOUGLAS P CROPPER 541243 0 0 0 41196 0 219726 0 21803 0 823968 0 0 0 MARK G ROGERS 221503 0 0 0 113667 0 91064 0 12247 0 438481 0 0 0 ROBERT W FRIEDEN 223267 0 0 0 74942 0 13005 0 18565 0 329779 0 0 0 DR WILLIAM LANGLEY 238071 0 0 0 49284 0 125406 0 15043 0 427804 0 0 0 JULIE MANAS 282411 0 0 0 25748 0 87230 0 13622 0 409011 0 0 0 JUDITH PRANGER 158828 0 0 0 23462 0 79808 0 11504 0 273602 0 0 0 FLORENCE L SPYROW 229918 0 25000 0 22000 0 78778 0 1184 0 356880 0 0 0 DR NICHOLAS AUGELLI 402743 0 46485 0 40548 0 9800 0 16887 0 516463 0 0 0 DR TERRILL BANER 495667 0 0 0 25564 0 9800 0 12891 0 543922 0 0 0 DR ROBERT FIETSAM 443172 0 78767 0 23620 0 9800 0 15695 0 571054 0 0 0 DR DARRYL JOHNSON 545379 0 0 0 1320 0 12250 0 18666 0 577615 0 0 0 DR GEORGE KONTOS JR 466578 0 0 0 40486 0 9800 0 16909 0 533773 0 0 0 DR ANDREW ANDRESEN 198672 0 0 0 33062 0 16211 0 11776 0 259721 0 0 0 DR DEAN BUNTING 178053 0 0 0 14253 0 18478 0 18545 0 229329 0 0 0 JEFFREY M COOPER 132407 0 0 0 40203 0 9059 0 18928 0 200597 0 0 0 DR ALEXANDER JONES 122874 0 0 0 16238 0 5607 0 5723 0 150442 0 0 0 HEIDI KAHLY-MCMAHON 137980 0 0 0 7919 0 24024 0 16538 0 186461 0 0 0 DR ROBERT NELSON 172488 0 0 0 82869 0 61266 0 14925 0 331548 0 0 0 MIKE SHARP 133540 0 0 0 62568 0 64020 0 13540 0 273668 0 0 0 CRAIG SOMMERS 120270 0 0 0 16096 0 5629 0 16922 0 158917 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. HOUSING ALLOWANCE: Genesis Health System provided a housing allowance in fiscal year 2010 to one newly-hired individual as a result of relocation. Health club dues: This benefit is offered to the presidents of the individual departments within the organization. The dues are included in the reportable compensation for the participating individuals. Part I, Line 4a THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2009 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: JEFFREY M. COOPER - $23,171 AND ROBERT W. FRIEDEN - $63,954. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009 AND THE GROSS-UP PAYMENT TO COVER TAX. THIS INFORMATION IS INCLUDED IN REPORTABLE COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. THE FOLLOWING INDIVIDUALS ALSO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IN 2009 SPONSORED BY GENESIS HEALTH SYSTEM - IOWA: DOUGLAS P. CROPPER - $209,926, HEIDI KAHLY-MCMAHON - $16,867, DR. WILLIAM LANGLEY - $79,283, JULIE MANAS - $87,230, DR. ROBERT NELSON - $49,453, JUDITH PRANGER - $28,800, MARK G. ROGERS - $78,661, MIKE SHARP - $35,694, AND FLORENCE L. SPYROW - $76,328. THE DOLLAR AMOUNT REPRESENTS THE CURRENT YEAR CONTRIBUTION MADE BY GENESIS HEALTH SYSTEM - IOWA ON BEHALF OF THE INDIVIDUALS TO THE PLAN IN 2009. THIS INFORMATION IS INCLUDED IN DEFERRED COMPENSATION ON THE FORM 990, PART VII AND SCHEDULE J, PART II. 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 95545195 70477896 1367299 11947778 2010 1 0 0 1 0 0 1 1 1 0.00910 0.00000 0.00910 1 0 0 0 0 0 1 KOEHLER ELECTRIC JIM KOEHLER, A DIRECTOR OF GHS-IOWA, OWNS KOEHLER ELECTRIC. 65431 GENESIS HEALTH SYSTEM - IOWA USES SERVICES PROVIDED BY KOEHLER ELECTRIC. 0 LANE & WATERMAN C. DANA WATERMAN, III, DIRECTOR OF GHS-IA, IS MNG PTR OF LANE & WATERMAN. 583517 GENESIS HEALTH SYSTEM - IOWA USES LANE & WATERMAN FOR LEGAL SERVICES. 0 EDWARD TED J ROGALSKI EDWARD J. ROGALSKI IS THE SON OF DR. EDWARD ROGALSKI, CHAIRMAN OF GHS. 140505 EDWARD J. ROGALSKI RECEIVES COMPENSATION FROM GENESIS HEALTH SYSTEM - IOWA AS THE DIRECTOR OF NEUROSCIENCE. 0 LISA ROGALSKI LISA ROGALSKI IS DAUGHTER-IN-LAW OF DR. EDWARD ROGALSKI, CHAIRMAN OF GHS. 97382 LISA ROGALSKI RECEIVES COMPENSATION FROM GENESIS HEALTH SYSTEM - IOWA AS THE DIRECTOR OF MATERIALS MANAGEMENT. 0 DR W DAVID MCECHRON DR. MCECHRON IS THE SPOUSE OF RITA WATTS, FORMER VICE CHAIRMAN OF GHS. 161578 DR. MCECHRON RECEIVES COMPENSATION FROM GENESIS HEALTH SYSTEM - IOWA FOR SERVICES PROVIDED AS A PHYSICIAN. 0 S & D REAL ESTATE SEE BELOW ON SCH O 186528 DR. MCECHRON HAS AN OWNERSHIP INTEREST IN S & D REAL ESTATE, LLC. GENESIS HEALTH SYSTEM - IOWA RENTS SPACE IN A BUILDING OWNED BY S & D REAL ESTATE. 0 GENVENTURES INC SEE BELOW ON SCH O 24561859 GENVENTURES, INC. PAID GENESIS HEALTH SYSTEM AS A COMMON PAYMASTER AND REIMBURSEMENT OF INTEREST. 0 GENVENTURES INC SEE BELOW ON SCH O 20029121 GENESIS HEALTH SYSTEM PAID GENVENTURES, INC. FOR LEASE PAYMENTS AND MEDICAL SUPPLIES. 0 Form 990, Part VI, Section B, line 11 INTERNAL MANAGEMENT REVIEW IS COMPLETED OF THE COMPILED INFORMATION PRIOR TO PREPARATION AND REVIEW BY RSM MCGLADREY, INC. FOLLOWING RSM MCGLADREY, INC.'S PREPARATION AND REVIEW OF THE FORM 990, IT IS REVIEWED WITH THE ORGANIZATION'S PRESIDENT/CEO; VICE PRESIDENT, FINANCE/CFO; VICE PRESIDENT, LEGAL AFFAIRS; AND VICE PRESIDENT, HUMAN RESOURCES. THE FORM 990 IS THEN REVIEWED AT A JOINT MEETING OF THE ORGANIZATION'S FINANCE COMMITTEE AND AUDIT & COMPLIANCE COMMITTEE. PRIOR TO SUBMITTING THE FORM 990 TO THE IRS, IT IS E-MAILED TO THE ORGANIZATION'S BOARD OF DIRECTORS ONE WEEK IN ADVANCE OF A SCHEDULED MEETING. AT THE BOARD OF DIRECTORS MEETING, INTERNAL MANAGEMENT REVIEWS THE FORM 990 WITH THE BOARD OF DIRECTORS. SUGGESTED CHANGES FROM ALL OF THESE REVIEWS ARE CONSIDERED FOR INCLUSION IN THE FINAL FORM 990 SUBMITTED TO THE IRS. Form 990, Part VI, Section B, line 12c ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, OR MEMBER OF A BOARD OR BOARD COMMITTEE OF GENESIS HEALTH SYSTEM (GHS) OR AN AFFILIATE, SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT WILL BE CONSIDERED BY MANAGEMENT, THE BOARD, OR A COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING GHS, OR AN AFFILIATE, OR WITH RESPECT TO DESIGNATED FACILITIES AND ACTIVITIES, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH PERSON ADVOCATE HIS OR HER POSITION INFORMALLY THROUGH PRIVATE CONTACT, COMMUNICATION AND DISCUSSION WITH ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE APPLICABLE TRANSACTION OR ARRANGEMENT. Form 990, Part VI, Section B, line 15 EACH EXECUTIVE POSITION IS EVALUATED USING A FORMAL EVALUATION PLAN THAT IS ESTABLISHED BY AN OUTSIDE CONSULTANT. AT THE PRESENT TIME, THE CONSULTANT USES A POINT SYSTEM FOR JOB EVALUATION. THE POINT VALUES ARE BASED ON "KNOW HOW", "PROBLEM SOLVING", "ACCOUNTABILITY", AND OTHER JOB ATTRIBUTES SPECIFIC TO THE POSITION. ONCE THE POINT VALUE IS SET FOR A POSITION, MARKET COMPARISONS FOR JOBS WITH THE SAME ORGANIZATIONAL IMPACT CAN BE COMPARED FOR SALARY PURPOSES AND ESTABLISH PAY RANGES. THE DESIGN OF THE PAY RANGES FOR EXECUTIVES IS BASED ON MARKET DATA. THE MIDPOINT OF EACH PAY RANGE IS ESTABLISHED AT THE 50TH PERCENTILE OF THE MARKET COMPARISONS. A MINIMUM GUIDELINE IS ESTABLISHED AT THE 25TH PERCENTILE, AND A MAXIMUM GUIDELINE IS SET AT THE 75TH PERCENTILE. SPECIFIC PAY RATES FOR EXECUTIVES ARE SUBJECT TO CEO AND COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS APPROVAL. PAY RANGES ARE REVIEWED EACH YEAR TO DETERMINE THE NEED FOR REVISION. WHEN MARKET CONDITIONS SUGGEST AN ADJUSTMENT TO PAY RANGES, DATA WILL BE PRESENTED TO THE COMPENSATION COMMITTEE FOR ITS REVIEW. THE SPECIFIC PAY RANGES ARE SUBJECT TO CEO, COMPENSATION COMMITTEE, AND GENESIS HEALTH SYSTEM (GHS) BOARD OF DIRECTOR APPROVAL. THE PRESIDENT AND CEO HAS THE AUTHORITY AND RESPONSIBILITY TO ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE AND THE GHS BOARD OF DIRECTORS, THE BASE COMPENSATION OF EACH EXECUTIVE EMPLOYED BY GHS, AT APPROPRIATE TIMES. THE GHS BOARD OF DIRECTORS SHALL ESTABLISH AND ADJUST, WITHIN THE RANGE APPROVED BY THE COMPENSATION COMMITTEE, THE BASE COMPENSATION FOR THE CEO OF GHS, AT APPROPRIATE TIMES. THE LAST TIME THIS PROCESS WAS UNDERTAKEN WAS JANUARY 2009. IN 2009 THE GHS COMPENSATION COMMITTEE MET, AND THE CEO AND EXECUTIVE MANAGEMENT OPTED TO VOLUNTARILY FOREGO THE ANNUAL SALARY INCREASE IN 2009. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR. Schedule K Supplental Information A formal Bond Compliance Policy has been developed, with plans for adoption by the Board of Directors of Genesis Health System prior to June 30, 2011. Prior to that date and during the reporting year, management ENSUred post-issuance compliance by assigning responsibility to appropriate personnel based on the covenants contained in the System's Tax Exemption Agreements and related Bond documents for each issue, including regular consultation during the reporting year with the System's Bond Counsel and a compliance seminar presented by, and related compliance guidelines prepared by, Bond Counsel, all as now reflected in the Bond Compliance Policy. FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - DR. W. DAVID MCECHRON DR. W. DAVID MCECHRON IS THE SPOUSE OF FORMER VICE CHAIRMAN, RITA WATTS. DR. MCEHRON HAS AN OWNERSHIP INTEREST IN S & D REAL ESTATE. FORM 990, SCHEDULE L, PART IV, COLUMN B DESCRIPTION OF RELATIONSHIP - GENVENTURES, INC. MARK G. ROGERS IS AN OFFICER, FLORENCE L. SPYROW IS A KEY EMPLOYEE, AND MIKE SHARP IS A FORMER KEY EMPLOYEE OF GENESIS HEALTH SYSTEM AND ARE REPORTED ON THE FORM 990, PART VII. DURING THE TAX YEAR, MARK G. ROGERS WAS AN OFFICER OF GENVENTURES, INC., AND FLORENCE L. SPYROW AND MIKE SHARP WERE DIRECTORS OF GENVENTURES, INC. FORM 990, PART VII, LINE 1A Genesis Health System, EIN 42-1418847, and Genesis Health System, EIN 36-3616314 have identical governing boards and an identical executive management team. The hours reported on Form 990, Part VII, Section A, column (B) represents the number of hours these individuals devote to both organizations. Furthermore, the amounts reported as reportable compensation for the officers, key employees, and highly compensated employees, unless otherwise noted elsewhere in PART VII, are for services rendered on behalf of both organizations. It would be administratively impracticable for members of the governing board and the executive team to breakout their hours devoted as well as their reportable compensation between each organization. All reportable compensation, unless otherwise noted in PART VII, is paid by Genesis Health System, EIN 42-1418847. FORM 990, PART I, LINES 9 & 17, PRIOR YEAR THE FORM 990, PART I, LINE 9, PRIOR YEAR COLUMN WAS UPDATED TO REFLECT PROGRAM SERVICE REVENUE NET OF CONTRACTUAL ADJUSTMENTS AND CHARITY CARE. THE FORM 990, PART I, LINE 17, PRIOR YEAR COLUMN WAS UPDATED TO REFLECT THE REDUCTION OF EXPENSES RELATED TO THE RECLASSIFICATION OF CONTRACTUAL ADJUSTMENTS AND CHARITY CARE. THE AMOUNTS REPORTED IN THE PRIOR YEAR COLUMN DIFFER FROM THE 2008 (FISCAL YEAR 2009) FILED FORM 990, BUT ARE REFLECTED AS SUCH ON THE CURRENT FISCAL YEAR RETURN FOR COMPARABILITY PURPOSES. 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