TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) THOMAS MATYA........................................................................ CHAIR	2.00 .......................3.00	X	X			0	0	0
(2) MICHAEL CULLEN........................................................................ VICE CHAIR	2.00 .......................9.00	X	X			0	0	0
(3) KEVIN POORTEN........................................................................ PRESIDENT & CEO, KISHHEALTH SYSTEM	9.00 .......................46.00	X	X			0	872,800	129,696
(4) LOREN FOELSKE........................................................................ VP FINANCE - KISHHEALTH SYSTEM	22.00 .......................30.00		X			0	328,625	87,932
(5) BRAD COPPLE........................................................................ PRESIDENT - KH & VWH	23.00 .......................30.00		X			0	377,347	59,520
(6) PAM DUFFY........................................................................ CNO & VP PATIENT CARE SVCS	10.00 .......................35.00			X		0	276,999	31,324
(7) JOESPH DANT........................................................................ VP BUSINESS DEVELOPMENT	0.00 .......................47.00			X		0	289,274	42,457
(8) MICHAEL KOKOTT........................................................................ ASST VP MKTG & PLANNING	10.00 .......................35.00			X		0	200,015	28,844
(9) ROGER HEATH BELL........................................................................ VP AND CIO	10.00 .......................37.00			X		0	292,428	44,585
(10) DR MICHAEL KULISZ........................................................................ CHIEF MEDICAL OFFICER	15.00 .......................37.00			X		0	467,070	73,919
(11) DAVID PROULX........................................................................ ASSISTANT VP OPERATIONS	8.00 .......................45.00			X		0	184,897	55,158
(12) MICHELE MCCLELLAND........................................................................ VP OF HUMAN RESOURCES	20.00 .......................30.00			X		0	237,252	40,669
(13) ANJU VOHRA........................................................................ TECHNICAL DIRECTOR - ECHO	45.00 .......................				X	139,584	0	32,971
(14) THOMAS WARZECHA........................................................................ DIRECTOR OF PHARMACY	45.00 .......................				X	152,380	0	33,754
(15) LISA ACKLAND........................................................................ DIRECTOR OF NURSING	45.00 .......................				X	155,391	0	41,012
(16) CYNTHIA TUCKER........................................................................ DIRECTOR OF REHAB SERVICES	45.00 .......................				X	135,736	0	31,946
(17) CHESTER SIMMONS........................................................................ PHARMACIST	45.00 .......................				X	134,048	0	32,649

(A) Name and business address	(B) Description of services	(C) Compensation
KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB,IL60115	MANAGEMENT SERVICES	13,246,643
DOCTORS OF EMERGENCY MEDICINE 5N327 SWITCHGRAS LANE ST CHARLES,IL60175	MEDICAL SERVICES	9,120,107
SIDDIQUI SABET MD PC 13 VENNARD CT LOMBARD,IL60148	MEDICAL SERVICES	1,700,001
SODEXO INC & AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO,IL60674	FOOD SERVICES	1,466,117
MAYO MEDICAL LABORATORIES 200 1ST STREET SW ROCHESTER,MN55905	LABORATORY SERVICES	813,458
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 31

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	23,590,189	23,590,189
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....	21,039	21,039
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	44,012,654	42,245,932	1,766,722
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,238,358	2,148,507	89,851
9	Other employee benefits .......	1,523,024	1,461,888	61,136
10	Payroll taxes ...........	10,342,444	9,927,286	415,158
11	Fees for services (non-employees):
a	Management ......	18,253,073		18,253,073
b	Legal .........	115,709		115,709
c	Accounting ...........	5,817		5,817
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	564,542		564,542
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	18,807,022	17,458,096	1,348,926
12	Advertising and promotion ....	379,948	46,751	330,735	2,462
13	Office expenses .......	4,048,239	3,362,866	678,315	7,058
14	Information technology ......	1,634,993	642,001	992,992
15	Royalties ..
16	Occupancy ...........	3,566,818	3,417,178	149,640
17	Travel ............	134,123	129,697	4,426
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	3,435,371		3,435,371
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	10,278,053	10,278,053
23	Insurance ..............	4,004,989	829,288	3,175,701
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	UNRELATED BUSINESS INCO	3,359		3,359
b	MEDICAL SUPPLIES	25,054,356	25,043,851	10,505
c	BAD DEBT EXPENSE	8,209,875	8,209,875
d	FEDERAL AND STATE ASSES	3,403,628	3,403,628
e	All other expenses	1,012,939	776,927	232,315	3,697
25	Total functional expenses. Add lines 1 through 24e	184,640,562	152,993,052	31,634,293	13,217
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	15,006,542	1	11,539,399
2	Savings and temporary cash investments .........	721,854	2	122,759
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	25,581,608	4	26,643,574
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	3,803,727	8	3,745,229
9	Prepaid expenses and deferred charges ..........	2,855,211	9	2,444,675
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	181,017,805
b	Less: accumulated depreciation .....	10b	94,648,710	92,124,980	10c	86,369,095
11	Investments—publicly traded securities ..........	171,588,222	11	182,412,996
12	Investments—other securities. See Part IV, line 11 .....	6,515,154	12	7,496,478
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............	890,392	14	848,849
15	Other assets. See Part IV, line 11 ...........	9,837,285	15	6,734,387
16	Total assets. Add lines 1 through 15 (must equal line 34)......	328,924,975	16	328,357,441
	17	Accounts payable and accrued expenses .........	12,614,254	17	12,002,612
18	Grants payable .................	48,203	18	72,556
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	62,065,000	20	59,775,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,245,038	23	1,070,121
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	27,195,052	25	31,933,077
26	Total liabilities. Add lines 17 through 25.........	103,167,547	26	104,853,366
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	221,656,823	27	219,234,259
28	Temporarily restricted net assets ...........	4,100,605	28	4,269,816
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	225,757,428	33	223,504,075
34	Total liabilities and net assets/fund balances ........	328,924,975	34	328,357,441

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization KISHWAUKEE COMMUNITY HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization KISHWAUKEE COMMUNITY HOSPITAL

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

32,846

Total. Add lines 1c through 1i ...............................

32,846

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	LOBBYING EXPENSES ARE ALLOCATED THROUGH MEMBERSHIP DUES WITH ILLINOIS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. NO OTHER LOBBYING ACTIVITIES WERE CONDUCTED.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	6,060,255		6,060,255
b	Buildings ................	114,947,337	46,228,212	68,719,125
c	Leasehold improvements ............	657,467	368,752	288,715
d	Equipment ................	56,442,193	48,051,746	8,390,447
e	Other .................	2,910,553		2,910,553
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				86,369,095

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
THIRD PARTY PAYABLES		24,646,469
DUE TO AFFILIATES		4,078,911
ACCRUED INTEREST PAYABLE		280,280
OTHER PAYABLES - LONG TERM		2,927,417





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		31,933,077
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	168,805,720
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	787,011
e	Add lines 2a through 2d .....................			2e	787,011
3	Subtract line 2e from line 1.....................			3	168,018,709
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	18,386,446
c	Add lines 4a and 4b.......................			4c	18,386,446
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	186,405,155

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	154,126,412
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	787,011
e	Add lines 2a through 2d......................			2e	787,011
3	Subtract line 2e from line 1.....................			3	153,339,401
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	31,301,161
c	Add lines 4a and 4b.......................			4c	31,301,161
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	184,640,562

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	KISHWAUKEE HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. KISHWAUKEE HOSPITAL FILES 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 INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE 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 PERCENT 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 UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AT APRIL 30, 2015 AND 2014, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	COST OF GOODS SOLD 59,428. RENTAL EXPENSES 727,583.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - KISH AREA PHO 6,261. CONTRIBUTION REVENUE FROM KISHHEALTH FOUNDATION 1,051,057. BOOK/TAX DIFFERENCE ON INCOME FROM PASSTHROUGH ENTITIES - MIDLAND SURGICAL 21,673. NONOPERATING INCOME 9,097,580. BAD DEBT EXPENSE 8,209,875.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	COST OF GOODS SOLD 59,428. RENTAL EXPENSES 727,583.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	EQUITY DISTRIBUTION TO KISHHEALTH SYSTEM 23,091,286. BAD DEBT EXPENSE 8,209,875.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other 60000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	3,524,258	0	3,524,258	2.000 %
b	Medicaid (from Worksheet 3, column a) ....	18,744,739	12,970,891	5,773,848	3.270 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	22,268,997	12,970,891	9,298,106	5.270 %
Other Benefits		4,184,137	25,690	4,158,447	2.360 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	4,184,137	25,690	4,158,447	2.360 %
f	Health professions education (from Worksheet 5) ..	1,114,028	12,310	1,101,718	0.620 %
g	Subsidized health services (from Worksheet 6) ..	2,440,836	651,788	1,789,048	1.010 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	584,437	0	584,437	0.330 %
j	Total. Other Benefits ..	8,323,438	689,788	7,633,650	4.320 %
k	Total. Add lines 7d and 7j .	30,592,435	13,660,679	16,931,756	9.590 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

8,209,875

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

31,228,443

Enter Medicare allowable costs of care relating to payments on line 5.....

47,016,841

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-15,788,398

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	KISHWAUKEE HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB,IL60115 WWW.KISHHEALTH.ORG 0005470	X	X	X

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	KISHWAUKEE HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.KISHHEALTH.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): WWW.KISHHEALTH.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	KISHWAUKEE HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 600.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url): WWW.KISHHEALTH.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.KISHHEALTH.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	KISHWAUKEE HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
KISHWAUKEE HOSPITAL	PART V, SECTION B, LINE 5: INDIVIDUALS REPRESENTING KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, DEKALB COUNTY HEALTH DEPARTMENT AND LIVE HEALTHY DEKALB COUNTY (FORMERLY KNOWN AS PIONEERING HEALTHIER COMMUNITIES), SERVED AS STEERING COMMITTEE MEMBERS. STEERING COMMITTEE MEMBERS MET MONTHLY FROM MAY 2012 TO NOVEMBER 2012 AND REVIEWED POPULATION DEMOGRAPHICS, BIRTH AND DEATH DATA AND SOCIAL AND HEALTH INDICATORS IN ORDER TO PRIORITIZE HEALTH PROBLEMS FOR THE DEKALB COUNTY COMMUNITY HEALTH PLAN AND KISHWAUKEE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT. THE STEERING COMMITTEE WAS CHARGED WITH FURTHER PRIORITIZING THESE ISSUES BASED ON A MORE IN-DEPTH EXPLORATION AND A STANDARDIZED PROCESS. IN SEPTEMBER OF 2012, THE STEERING COMMITTEE PRESENTED HEALTH PRIORITIES TO THE EXTERNAL COMMITTEE MEMBERS, WHO INCLUDED A VARIETY OF INDIVIDUALS FROM LOCAL AND STATE GOVERNMENTAL AGENCIES, LEADERS FROM COMMUNITY BASED ORGANIZATIONS, FOUNDATIONS, SCHOOL DISTRICTS, COLLEGES, AND LOCAL NON-PROFIT ORGANIZATIONS. THESE PARTICIPANTS ARE EXPERTS IN HEALTH CARE, SOCIAL DETERMINANTS OF HEALTH AND HEALTH AND SOCIAL SERVICES. THE INPUT FROM THE EXTERNAL GROUP HELPED TO ENSURE THAT NEEDS WERE IDENTIFIED AND WILL BE RESPONDED TO. AFTER THOROUGH REVIEW OF THE DATA, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS WERE GIVEN THE OPPORTUNITY TO DISCUSS THE INFORMATION AND FURTHER REVIEW HEALTH PROBLEMS FACING THE COUNTY. FOLLOWING A LENGTHY DISCUSSION, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS IDENTIFIED PRIORITIES FOR CONSIDERATION FOR THE COMMUNITY BENEFIT IMPLEMENTATION PLAN. THE FULL LIST OF PARTICIPANTS IN THE ASSESSMENT PROCESS INCLUDES:STEERING COMMITTEE MEMBERS (PARTICIPANTS LISTED ALPHABETICALLY)* BETH BUSCHING, MANAGER, COMMUNITY WELLNESS, KISHWAUKEE HOSPITAL* BETTE CHILTON, DEAN OF HEALTH AND EDUCATION, KISHWAUKEE COMMUNITY COLLEGE* DAWN ROZNOWSKI, COMMUNITY ENGAGEMENT ADVISOR, KISHHEALTH SYSTEM* JANE LUX, DIRECTOR, DEKALB COUNTY HEALTH DEPARTMENT* KIM JASS-RAMIREZ, SENIOR DIRECTOR OF HEALTHY LIVING, KISHWAUKEE YMCA* LISA CUMINGS, COMMUNITY HEALTH LIAISON, KISHWAUKEE HOSPITAL* MARCY ZANELLATO, HEALTH EDUCATION DIVISION, DEKALB COUNTY HEALTH DEPARTMENT* SHELLY JOHNSON, DIRECTOR, COMMUNITY CARES CLINIC AND CENTER FOR FAMILY HEALTH, EMPLOYEE HEALTH, COMMUNITY WELLNESS, KISHHEALTH SYSTEMEXTERNAL COMMITTEE MEMBERS* ERICA BARNES, LCPC, COUNSELOR/OUTREACH COORDINATOR, NORTHERN ILLINOIS UNIVERSITY COUNSELING AND STUDENT DEVELOPMENT* JAMES BRISCOE, SUPERINTENDENT, DEKALB SCHOOL DISTRICT #428* CINDY CAPEK, EXECUTIVE DIRECTOR, DEKALB PARK DISTRICT* BETTE CHILTON, DEAN OF HEALTH & EDUCATION, KISHWAUKEE COMMUNITY COLLEGE* BRENDA COURTNEY, DIRECTOR OF ADMINISTRATIVE SERVICES, DEKALB COUNTY HEALTH DEPARTMENT* KATHY COUNTRYMAN, SUPERINTENDENT, SYCAMORE SCHOOL DISTRICT #427* MICHAEL KOKOTT, ASSISTANT VICE PRESIDENT, MARKETING & PLANNING, KISHHEALTH SYSTEM* DAWN LITLEFIELD, EXECUTIVE DIRECTOR, KISHWAUKEE YMCA* CRISTY MEYER, PRINCIPAL, JEFFERSON ELEMENTARY SCHOOL* DONNA MOULTON, EXECUTIVE DIRECTOR, COMMUNITY MENTAL HEALTH BOARD & COMMUNITY SERVICES, DEKALB COUNTY* GABRIELA ORTIZ, PUBLIC HEALTH NURSE, DEKALB COUNTY HEALTH DEPARTMENT* MARY PRITCHARD, PHD., ASSOCIATE DEAN, NORTHERN ILLINOIS UNIVERSITY, COLLEGE OF HEALTH & HUMAN SCIENCES* TED STRACK, PRESIDENT, SYCAMORE PARK DISTRICT* DAN TEMPLIN, EXECUTIVE DIRECTOR, DEKALB COUNTY COMMUNITY FOUNDATION * ROB WILKINSON, CEO, KISHWAUKEE YMCAKISHHEALTH SYSTEM COMMITTEE MEMBERS* KEVIN POORTEN, PRESIDENT & CEO, KISHHEALTH SYSTEM* ALLISON BRYAN, COMMUNITY RELATIONS, VALLEY WEST HOSPITAL* BECKIE FRIEDERS, EMPLOYEE WELLNESS COORDINATOR, KISHHEALTH SYSTEM* BETH BUSCHING, MANAGER, COMMUNITY WELLNESS, KISHWAUKEE HOSPITAL* BETH GALE, DIRECTOR, CONTINUITY OF CARE* CINDY JOHNSTON, DIRECTOR, COMMUNITY WELLNESS, VALLEY WEST HOSPITAL* DAVID WESTER, PHYSICIAN ASSISTANT, CENTER FOR FAMILY HEALTH* DAWN ROZNOWSKI, COMMUNITY ENGAGEMENT ADVISOR, KISHHEALTH SYSTEM* DR. MICHAEL KULISZ, PHYSICIAN, CHIEF MEDICAL OFFICER, KISHHEALTH SYSTEM* JENNIFER RENFER, READMISSION NURSE* KAREN ROUSE, DIRECTOR, OUTPATIENT CLINICS* MICHAEL KOKOTT, ASSISTANT VICE PRESIDENT OF MARKETING AND PLANNING, KISHHEALTH SYSTEM* PAMELA DUFFY, VICE PRESIDENT, PATIENT CARE SERVICES AND CHIEF NURSING OFFICER* SHELLY JOHNSON, DIRECTOR, COMMUNITY CARES CLINIC AND CENTER FOR FAMILY HEALTH, EMPLOYEE HEALTH, COMMUNITY WELLNESS, KISHHEALTH SYSTEM* THERESA KOMITAS, COMMUNITY RELATIONS, KISHWAUKEE HOSPITAL
KISHWAUKEE HOSPITAL	PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDE VALLEY WEST HOSPITAL.
KISHWAUKEE HOSPITAL	PART V, SECTION B, LINE 11: SEE FORM 990, PART III, LINE 4A FOR A DETAILED DESCRIPTION OF THE ACTIONS TAKEN BY KISHWAUKEE COMMUNITY HOSPITAL DURING THE FISCAL YEAR TO ADDRESS COMMUNITY HEALTH NEEDS.NINE OTHER TOPIC AREAS (ACCIDENTS, ALCOHOL/DRUG USE, ALLERGIES, CRIME, JOB AVAILABILITY, ORAL HEALTH, SUICIDE AND UNEMPLOYMENT) WERE IDENTIFIED FOR DATA COLLECTION, REVIEW AND PRIORITY SETTING. BELOW ARE THE AREAS IDENTIFIED AND A BRIEF DESCRIPTION WHY THE HOSPITAL DID NOT SELECT TO ADDRESS.PRIORITY IDENTIFIED: ACCIDENTSEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED.PRIORITY IDENTIFIED: ALCOHOL/DRUG USE EXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS BEN GORDON CENTER YOUTH SERVICES BUREAU, DCPSAFE AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: ALLERGIES EXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DID NOT CHOOSE THIS AS A PRIORITY TO ADDRESS, HOWEVER, IT MAY BE INDIRECTLY ADDRESSED AS A RESULT OF WORK ON OTHER IDENTIFIED HEALTH PRIORITIES LIKE ACCESS TO CARE, CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND OVERWEIGHT/OBESITY IN ADULTS/CHILDREN.PRIORITY IDENTIFIED: CRIMEEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED.PRIORITY IDENTIFIED: JOB AVAILABILITYEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS ILLINOIS EMPLOYMENT TRAINING CENTER, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: ORAL HEALTHEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. PRIORITY IDENTIFIED: SUICIDEEPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS BEN GORDON CENTER YOUTH SERVICES BUREAU, DCPSAFE AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.PRIORITY IDENTIFIED: UNEMPLOYMENTEXPLANATION FOR NOT ADDRESSING: KISHWAUKEE HOSPITAL DOES NOT HAVE THE EXPERTISE OR INFRASTRUCTURE TO SERVE AS A LEAD AROUND THIS AREA OF NEED. KISHWAUKEE HOSPITAL WILL SUPPORT COMMUNITY AGENCIES SUCH AS ILLINOIS EMPLOYMENT TRAINING CENTER, DEKALB COUNTY ECONOMIC DEVELOPMENT CORPORATION AND OTHER COMMUNITY PROGRAMS TO ADDRESS ISSUES NOT DIRECTLY ADDRESSED BY THE HEALTH SYSTEM.
KISHWAUKEE HOSPITAL	PART V, SECTION B, LINE 13B: IN ADDITION TO FEDERAL POVERTY GUIDELINES, A PERSON MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON THEIR FAMILY INCOME RELATIVE TO FAMILY SIZE AND OTHER FACTORS SUCH AS CURRENT FINANCIAL OBLIGATIONS AND LIVING EXPENSES.
KISHWAUKEE HOSPITAL	PART V, SECTION B, LINE 20E: POSTING OF FINANCIAL ASSISTANCE POLICY TO SYSTEM'S WEBSITE.
KISHWAUKEE HOSPITAL	PART V, SECTION B, LINE 22D: BASED ON COMPLIANCE WITH LAWS OF STATE OF ILLINOIS, SPECIFICALLY THE UNINSURED PATIENT DISCOUNT ACT.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	WWW.KISHHEALTH.ORG
KISHWAUKEE HOSPITAL PART V, SECTION B, LINE 16C WEBSITE:	WWW.KISHHEALTH.ORG

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	IN ADDITION TO FPG GUIDELINES, KISHWAUKEE HOSPITAL UTILIZES OTHER FACTORS TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PER THE ORGANIZATION'S CHARITY CARE POLICY, THESE FACTORS INCLUDE:* FAMILY INCOME RELATIVE TO FAMILY SIZE AND OTHER RELATED FACTORS SUCH AS CURRENT FINANCIAL OBLIGATIONS* EMPLOYMENT STATUS, INCLUDING, BUT NOT LIMITED TO, FUTURE EARNING CAPACITY WITH CONSIDERATION OF THE LIKELIHOOD OF A FINANCIAL CAPACITY SUFFICIENT TO MEET THE PATIENT'S FINANCIAL OBLIGATIONS IN AN ACCEPTABLE PERIOD OF TIME* FUTURE AND CURRENT ABILITY TO PAY* MEDICAL EXPENSES, INCLUDING PHARMACEUTICAL EXPENSES, AS A PERCENTAGE OF A PATIENT'S ANNUAL GROSS INCOME, THE AMOUNT OF TOTAL MEDICAL BILLS OUTSTANDING, AND THE FREQUENCY OF PAYMENTS TO BE MADE IN RELATION TO THE FACTORS ABOVE* CREDIT REPORT INFORMATION* ACTUAL COST OF CARE PROVIDED* OTHER FACTORS DEEMED APPROPRIATE BY THE HEALTH SYSTEMKISHWAUKEE HOSPITAL DOES NOT CONSIDER THE PATIENT'S ASSETS IN DETERMINING ABILITY TO PAY OR ELIGIBILTY FOR CHARITY CARE.
PART I, LINE 7:	THE RESPECTIVE IRS WORKSHEET, AS PROVIDED IN THE INSTRUCTIONS FOR SCHEDULE H, WERE USED TO CALCULATE THE COSTS OF ITEMS WITHIN THE TABLE ABOVE.
PART I, LINE 7G:	SUBSIDIZED HEALTH SERVICES INCLUDE HOSPITALIST SERVICES, DIABETES TREATMENT, EMS SERVICES, ANESTHESIA SERVICES AND CHILD DEVELOPMENT PROGRAMS
PART I, LN 7 COL(F):	SEE FOOTNOTE 4 AND FOOTNOTE 5 (BEGINNING ON PAGE 17) IN THE ATTACHED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE.
PART III, LINE 2:	SEE FOOTNOTE 4 AND FOOTNOTE 5 (BEGINNING ON PAGE 17) IN THE ATTACHED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE.
PART III, LINE 3:	INTERNAL REVENUE SERVICE WORKSHEET 2 (PER SCHEDULE H INSTRUCTIONS) WAS UTILIZED TO DETERMINE THE COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS AND THE RELATED COMMUNITY BENEFIT.
PART III, LINE 8:	FOR THE 4/30/15 FISCAL YEAR, KH PROVIDED BILLED CHARGES TO MEDICARE PATIENTS TOTALING $51,600,000. HOWEVER, DUE TO THE MEDICARE INPATIENT AND OUTPATIENT PAYMENT METHODOLOGIES, THE ACTUAL CASH PAYMENTS RECEIVED FROM PROVIDING CARE TO THOSE PATIENTS WAS JUST $12,800,000, OR 24.7% OF BILLED CHARGES. THE COST OF PROVIDING THIS CARE, PER THE MEDICARE COST REPORT, WAS $18,700,000. THUS, THE PAYMENTS RECEIVED FROM MEDICARE WERE $5,900,000 LESS THAN COST, OR 68% OF COST. TRULY THIS $5,900,000 SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. AS APPROXIMATELY 46% OF ALL KISHWAUKEE HOSPITAL CHARGES GENERATED ARE FROM MEDICARE PATIENTS, THIS SHORTFALL PLACES A TREMENDOUS FINANCIAL BURDEN ON OUR HOSPITAL.KISHWAUKEE HOSPITAL, LIKE OTHER NOT-FOR-PROFIT HOSPITALS, MUST ACCEPT MEDICARE PAYMENTS AS PAYMENT IN FULL FOR SERVICES PROVIDED, WITH THE EXCEPTION OF COLLECTING ON DEDUCTIBLES AND CO-INSURANCE AMOUNTS. HOSPITALS CANNOT BILL MEDICARE PATIENTS FOR THE DIFFERENCE BETWEEN THE BILLED CHARGES AND MEDICARE PAYMENTS.KISHWAUKEE HOSPITAL PROVIDES SERVICES TO ALL PATIENTS WHO NEED CARE, ABIDING BY THE FEDERAL EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) REGULATION. IT REQUIRES HOSPITALS AND AMBULANCE SERVICES TO PROVIDE CARE TO ANYONE NEEDING EMERGENCY HEALTHCARE TREATMENT REGARDLESS OF CITIZENSHIP, LEGAL STATUS OR ABILITY TO PAY.KH UTILIZED THE CALCULATION OF MEDICARE COST FROM THE ANNUAL MEDICARE COST REPORT. THIS APPROACH ALLOCATES COST FROM NON REVENUE PRODUCING DEPARTMENTS TO THE REVENUE GENERATING DEPARTMENTS, BASED ON STEP DOWN STATISTICAL COST FINDING. WHILE NOT AS COMPREHENSIVE AS A TRUE COST ACCOUNTING SYSTEM, THIS PROCESS RESULTS IN AN ACCEPTABLE BASIS OF THE DEPARTMENTAL COST FOR PROVIDING SERVICES. RECALL THAT PRIOR TO MEDICARE PROSPECTIVE PAYMENT SYSTEM (PPS), THIS METHODOLOGY WAS THE BASIS FOR THE REIMBURSEMENT TO HOSPITALS.
PART III, LINE 9B:	COLLECTION ACTIONS INVOLVING UNINSURED PATIENTS. KHS (KISHHEALTH SYSTEM, PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL) SHALL NOT PURSUE A COLLECTION ACTION AGAINST AN UNINSURED PATIENT, UNLESS THE PATIENT HAS BEEN GIVEN THE OPPORTUNITY TO ASSESS THE ACCURACY OF THE BILL APPLY FOR FINANCIAL ASSISTANCE UNDER THE KHS FINANCIAL ASSISTANCE POLICY AND PROCEDURE AND AVAIL HIMSELF OR HERSELF OF A REASONABLE PAYMENT PLAN. NOTWITHSTANDING THIS, KHS MAY NOT PURSUE THE COLLECTION ACTION UNDER THE FOLLOWING CIRCUMSTANCES: (A) IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT, UNTIL KHS HAS OFFERED THE PATIENT A PAYMENT PLAN. KHS MAY REQUIRE THE PATIENT TO PROVIDE REASONABLE VERIFICATION OF HIS OR HER INABILITY TO PAY THE FULL AMOUNT OF THE DEBT IN ONE PAYMENT.(B) IF KHS HAS REASON TO BELIEVE THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, UNTIL KHS HAS GIVEN THE PATIENT AT LEAST 60 DAYS FOLLOWING THE DATE OF DISCHARGE OR RECEIPT OF OUTPATIENT CARE TO SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. (C) IF THE PATIENT HAS AGREED TO A PAYMENT PLAN, UNTIL THE PATIENT HAS FAILED TO MAKE PAYMENTS IN ACCORDANCE WITH THAT PAYMENT PLAN. (D) IF THE PATIENT INFORMS KHS THAT HE OR SHE HAS APPLIED FOR HEALTH CARE COVERAGE UNDER MEDICAID, KIDCARE, OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAM (AND THERE IS A REASONABLE BASIS TO BELIEVE THAT THE PATIENT WILL QUALIFY FOR SUCH PROGRAM), BUT THE PATIENT'S APPLICATION IS DENIED.
PART VI, LINE 2:	IN 2012, KISHWAUKEE HOSPITAL PARTNERED WITH DEKALB COUNTY HEALTH DEPARTMENT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A PRIMARY TOOL USED BY THE HOSPITAL TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW THE HOSPITAL WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, KISHHEALTH SYSTEM SPONSORED AN ONLINE SURVEY WHICH WAS A QUESTIONNAIRE STYLE, SELF-ADMINISTERED SURVEY, AVAILABLE ONLINE, IN BOTH ENGLISH AND SPANISH. THE PROCESS FOLLOWED A CROSS SECTIONAL RESEARCH DESIGN, TAKING A SNAPSHOT OF DEKALB COUNTY RESIDENTS AT A SINGLE MOMENT IN TIME. LASTLY, THE COMMUNITY NEEDS INDEX IDENTIFIES THE SEVERITY OF HEALTH DISPARITIES FOR EVERY ZIP CODE IN THE UNITED STATES AND DEMONSTRATES THE LINK BETWEEN COMMUNITY NEED, ACCESS TO CARE, AND PREVENTABLE HOSPITALIZATIONS. REVIEW OF THE COMMUNITY NEEDS INDEX WAS USED TO IDENTIFY COMMUNITIES OF HIGHEST NEED AND PLAN FOR DIRECT A RANGE OF POTENTIAL COMMUNITY HEALTH OUTREACH EFFORTS. INDIVIDUALS REPRESENTING KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, DEKALB COUNTY HEALTH DEPARTMENT AND PIONEERING HEALTHIER COMMUNITIES, SERVED AS STEERING COMMITTEE MEMBERS. STEERING COMMITTEE MEMBERS MET MONTHLY FROM MAY 2012 TO AUGUST 2012 AND REVIEWED POPULATION DEMOGRAPHICS, BIRTH AND DEATH DATA AND SOCIAL AND HEALTH INDICATORS IN ORDER TO PRIORITIZE HEALTH PROBLEMS FOR THE DEKALB COUNTY COMMUNITY HEALTH PLAN AND KISHWAUKEE HOSPITAL BENEFIT PLAN. THE STEERING COMMITTEE AND KISHHEALTH SYSTEM BENEFIT TEAM MEMBERS WERE CHARGED WITH FURTHER PRIORITIZING THESE ISSUES BASED ON A MORE IN-DEPTH EXPLORATION AND A STANDARDIZED PROCESS. AFTER THOROUGH REVIEW OF THE DATA, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS WERE GIVEN THE OPPORTUNITY TO DISCUSS THE INFORMATION AND IDENTIFY HEALTH PROBLEMS FACING THE COUNTY. FOLLOWING A LENGTHY DISCUSSION, KISHHEALTH SYSTEM COMMUNITY BENEFIT TEAM MEMBERS IDENTIFIED THE FOLLOWING PRIORITIES FOR CONSIDERATION. AFTER THOROUGH REVIEW OF THE DATA AND FURTHER ANALYSIS, THE PRIORITIES OF FOCUS ARE HIGHLIGHTED.DATA COLLECTION AND COMMUNITY HEALTH NEEDS ASSESSMENT:ADMINISTRATION OF THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY WAS NOT RANDOMIZED, BUT ANALYSIS OF RESPONDENT CHARACTERISTICS INDICATED THAT PARTICIPANTS RESPONDING TO THE SURVEY WERE REPRESENTATIVE OF THE COUNTY'S POPULATION.THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE SURVEY WAS A QUESTIONNAIRE STYLE, SELF-ADMINISTERED SURVEY, AVAILABLE ONLINE, IN BOTH ENGLISH AND SPANISH. THE PROCESS FOLLOWED A CROSS SECTIONAL RESEARCH DESIGN, TAKING A SNAPSHOT OF DEKALB COUNTY RESIDENTS AT A SINGLE MOMENT IN TIME. THE ONLINE SURVEY WAS SPONSORED AND HOSTED BY KISHHEALTH SYSTEM. THE RESULTS OF THE ONLINE SURVEY, IS AVAILABLE ON THE KISH HEALTH SYSTEM'S WEBSITE.SECONDARY DATA COLLECTION:DATA NECESSARY FOR THE DECISION-MAKING PROCESS WAS PROVIDED BY JOEL COWEN, RETIRED FACULTY MEMBER OF HEALTH SYSTEMS RESEARCH OF THE UNIVERSITY OF ILLINOIS - COLLEGE OF MEDICINE, AT ROCKFORD. LOCAL, COUNTY, STATE AND FEDERAL SOURCES WERE COLLECTED TO PRESENT A COMMUNITY PROFILE, BIRTH AND DEATH CHARACTERISTICS, ACCESS TO HEALTH CARE,CHRONIC DISEASE, SOCIAL ISSUES AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN PERTINENT, THESE DATA SETS ARE PRESENTED IN THE CONTEXT OF DEKALB COUNTY AND THE STATE OF ILLINOIS. ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR VALLEY WEST HOSPITAL PRIMARY SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. RESOURCES UTILIZED INCLUDE:AMERICAN DIABETES ASSOCIATIONAMERICAN MEDICAL ASSOCIATIONAMERICAN UNIVERSITY SURVEYCENTERS FOR DISEASE CONTROL AND PREVENTIONCOMMUNITY NEEDS INDEXILLINOIS DEPARTMENT OF EMPLOYMENT SECURITYILLINOIS DEPARTMENT OF PUBLIC HEALTHILLINOIS DEPARTMENT OF PUBLIC HEALTH ANNUAL HOSPITAL QUESTIONNAIREILLINOIS DEPARTMENT OF PUBLIC HEALTH, BEHAVIORAL RISK FACTOR SURVEYILLINOIS DEPARTMENT OF PUBLIC HEALTH, ILLINOIS COUNTY CANCER STATISTICS REVIEW INCIDENCEILLINOIS DEPARTMENT OF PUBLIC HEALTH: BIRTH DEFECTS AND OTHER ADVERSE PREGNANCY OUTCOMES IN ILLINOIS, 2004-2008ILLINOIS HOSPITAL ASSOCIATIONILLINOIS HOSPITAL ASSOCIATION, COMPDATAILLINOIS PUBLIC HEALTH COMMUNITY MAPNATIONAL CANCER INSTITUTENATIONAL CENTER FOR HEALTH STATISTICSNATIONAL HEART LUNG AND BLOOD INSTITUTENORTHERN ILLINOIS UNIVERSITY ENROLLMENT DATAPIONEERING HEALTHIER COMMUNITIESSTATE OF ILLINOIS DATA BY ZIP CODE*U.S. CENSUS BUREAU 2010 DATATHE FULL REPORT OF PRIMARY AND SECONDARY DATA SOURCES AND DATES UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR KISHWAUKEE HOSPITAL, VALLEY WEST COMMUNITY HOSPITAL AND DEKALB COUNTY HEALTH DEPARTMENT AND IS AVAILABLE ON KISH HEALTH SYSTEM WEBSITE.COMMUNITY NEEDS INDEX:THE COMMUNITY NEEDS INDEX IDENTIFIES THE SEVERITY OF HEALTH DISPARITIES FOR EVERY ZIP CODE IN THE UNITED STATES AND DEMONSTRATES THE LINK BETWEEN COMMUNITY NEED, ACCESS TO CARE, AND PREVENTABLE HOSPITALIZATIONS. FOR EACH ZIP CODE IN THE US, THE COMMUNITY NEEDS INDEX AGGREGATES FIVE SOCIOECONOMIC INDICATORS/BARRIERS TO HEALTH CARE ACCESS THAT ARE KNOWN TO CONTRIBUTE TO HEALTH DISPARITIES RELATED TO INCOME, EDUCATION,CULTURE/LANGUAGE, INSURANCE AND HOUSING. REVIEW OF THE COMMUNITY NEEDS INDEX WAS USED TO IDENTIFY COMMUNITIES OF HIGHEST NEED AND PLAN FOR DIRECT A RANGE OF POTENTIAL COMMUNITY HEALTH OUTREACH EFFORTS. DATA ANALYSIS:AFTER THOROUGH REVIEW OF THE DATA, AND DETAILED ANALYSIS IT WAS DECIDED THAT COMPONENTS OF THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS BE UTILIZED TO HELP FURTHER DETERMINE THE PRIORITIES TO ESTABLISH FOR KISHHEALTH SYSTEM AS A WHOLE AND VALLEY WEST HOSPITAL. MAPP IS A STRATEGIC APPROACH TO COMMUNITY HEALTH IMPROVEMENT.FURTHER VETTING OF PRIMARY AND SECONDARY DATA INCLUDED STATISTICAL ANALYSIS OF TRENDS AND COMPARISONS, HEALTH INDICATORS, ISSUES THAT ARE OCCURRING THAT AFFECT THE HEALTH OF THE COMMUNITY, AND EXISTING PROGRAMS/SERVICES THAT CONTRIBUTE TO/OR IMPROVE THE QUALITY OF LIFE AND/OR OVERALL HEALTH OF THE COMMUNITY.USING PRIMARY AND SECONDARY DATA COLLECTION, PARTICIPANTS WERE ASKED TO REVIEW AND IDENTIFY THE HEALTH PRIORITIES FOR THE COMMUNITY THAT THEY BELIEVED TO BE THE MOST SIGNIFICANT TO THE OVERALL HEALTH OF THE COMMUNITY. USING A NOMINAL GROUP PROCESS, PRIORITIES WERE DISCUSSED AND RECOMMENDATIONS MADE.
PART VI, LINE 3:	INFORMATION IS PROVIDED AT REGISTRATION, VIA THE HOSPITAL WEBSITE, THROUGH CONSULTATIONS WITH FINANCIAL COUNSELORS FOR SOME OUTPATIENTS AS WELL AS INPATIENTS, DURING THE BILLING PROCESS ON STATEMENTS AND VIA PHONE CONVERSATIONS.
PART VI, LINE 4:	KISHWAUKEE HOSPITAL SERVES THE LARGEST PORTION OF DEKALB COUNTY RESIDENTS, WITH ROUGHLY 58.4% OF THE COUNTY'S ENTIRE POPULATION FOUND IN THE CITIES OF DEKALB AND SYCAMORE. UTILIZING ILLINOIS HOSPITAL ASSOCIATION COMP DATA, WHICH MEASURES HOSPITAL ADMISSIONS KISHWAUKEE HOSPITAL, HAD 5,775 ADMISSIONS, 156,418 OUTPATIENT VISITS AND 31,399 EMERGENCY DEPARTMENT VISITS IN FISCAL YEAR 2015. IN THE HOSPITAL SERVICE AREA, ESTIMATED AT 105,000 PEOPLE, THE INPATIENT MARKET SHARE IS ROUGHLY 59.95%.
PART VI, LINE 5:	KISHWAUKEE HOSPITAL IN DEKALB, IL, IS PART OF KISHHEALTH SYSTEM. THE HEALTH SYSTEM IS GOVERNED BY AN APPOINTED VOLUNTEER BOARD OF DIRECTORS, INDEPENDENT COMMUNITY LEADERS WHO RESIDE IN THE PRIMARY MARKETS SERVED BY THE HEALTH SYSTEM'S TWO HOSPITALS. THESE INDIVIDUALS ARE SELECTED FOR THE BOARD DUE TO THEIR INTEREST AND EXPERTISE IN VARIOUS AREAS THAT CAN HELP MANAGEMENT CARRY OUT THE MISSION OF THE HEALTH SYSTEM. MEMBERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR TIME. THE MEDICAL STAFF IS OPEN TO PHYSICIANS THAT MEET CRITERIA ESTABLISHED BY MEDICAL STAFF BY-LAWS. PHYSICIANS ARE GIVEN THE OPPORTUNITY TO VOLUNTEER TO DO FREE COMMUNITY WELLNESS PROGRAMS ON HEALTH TOPICS. SURPLUS FUNDS GO BACK INTO THE ORGANIZATION TO SUPPORT OPERATIONS, CAPITAL IMPROVEMENTS, THE HEALTH SYSTEM'S COMMITMENT TO EDUCATION AND INNOVATION, AND TO PROVIDE MEDICAL CARE TO ALL REGARDLESS OF ABILITY TO PAY. EFFORTS TO PROMOTE HEALTH WITHIN THE COMMUNITY ARE OFTEN FACILITATED BY THE COMMUNITY WELLNESS DEPARTMENT. THERE ARE FOUR HEALTH PROMOTION SPECIALISTS AND A HEALTHY CULINARY INSTRUCTOR THAT ARE EMPLOYED TO COLLABORATE WITH COMMUNITY PARTNERS, SCHOOLS, AND BUSINESSES TO PROMOTE HEALTHY LIFESTYLES THROUGH INDIVIDUAL AND ENVIRONMENTAL CHANGE. THERE ARE OTHER DEPARTMENTS AND PROGRAMS WITHIN THE HOSPITAL, SUCH AS BEHAVIORAL HEALTH SERVICES, THE ONCOLOGY DEPARTMENT, AND DIABETES EDUCATION THAT ALSO SPEND TIME ENGAGED IN PROMOTING COMMUNITY HEALTH. THE PRIMARY GOALS OF THESE ACTIVITIES WERE TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY, IMPROVE ACCESS TO CARE, AND REACH OUT TO SPECIAL POPULATIONS.SEE FORM 990, PART III, LINE 4A FOR SOME OF THE ACTIVITIES OR SERVICES THAT WERE PROVIDED TO WORK TOWARD A HEALTHY COMMUNITY DURING THE FISCAL YEAR.
PART VI, LINE 6:	KISH HEALTH SYSTEM AND ITS NON PROFIT AFFILIATES, KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, KISH HEALTH SYSTEM HOSPICE, KISH HEALTH SYSTEM HOMECARE, CENTER FOR FAMILY HEALTH MALTA, COMMUNITY CARES CLINIC, KISH HEALTH SYSTEM PHYSICIANS GROUP, AND KISH HEALTH SYSTEM FOUNDATION, ALL PROMOTE THE HEALTH OF COMMUNITIES IN OUR REGION THROUGH DIRECT SERVICES, DONATIONS OF LEADERSHIP TIME ON VARIOUS COMMITTEES AND BOARDS, AND THROUGH CASH CONTRIBUTIONS. KISH HEALTH SYSTEM UNDERWROTE $20,750,000 FOR KISH HEALTH SYSTEM PHYSICAN GROUP FOR OPERATIONAL LOSSES (APPROXIMATELY $6,775,000) AND FUNDING FOR THE PURCHASE OF DEKALB CLINIC. IN ADDITION, KISH HEALTH SYSTEM UNDERWROTE $300,000 FOR THE CENTER FOR FAMILY HEALTH-MALTA AND $250,000 FOR KISH HEALTH SYSTEM HOMECARE FOR OPERATIONAL LOSSES IN FISCAL YEAR 2015, ALL VITAL SERVICES FOR THE HEALTH OF THE COMMUNITY. IN ADDITION TO CONTRIBUTIONS MADE BY KISHWAUKEE HOSPITAL AND VALLEY WEST HOSPITAL TO OTHER ORGANIZATIONS WITHIN THEIR COMMUNITIES, KISH HEALTH SYSTEM CONTRIBUTED $25,800 TO OTHER ORGANIZATIONS WITHIN THE COMMUNITY. KISH HEALTH SYSTEM EMPLOYEES CONTRIBUTED MORE THAN 1,423 HOURS OF IN-KIND SERVICE TO COMMUNITY ORGANIZATIONS, EDUCATIONAL INSTITUTIONS AND OTHER ACTIVITIES THAT PROMOTE HEALTH, EDUCATION, AND QUALITY OF LIFE. VALLEY WEST HOSPITAL IS A CRITICAL ACCESS HOSPITAL IN SANDWICH, IL. KISH HEALTH SYSTEM HOSPICE IN DEKALB, IL PROVIDES FREE CARE AND SUPPORT FOR THE TERMINALLY ILL AS WELL AS GRIEF SUPPORT TO THE PUBLIC. CENTER FOR FAMILY HEALTH CLINIC IN MALTA IS A PRIMARY CLINIC FOR MEDICAID AND UNINSURED KISH HEALTH SYSTEM PHYSICIAN GROUP PROVIDES ACCESS TO MEDICAL SERIVCES, ESPECIALLY THE RURAL AREAS AND ACCEPTS MEDICAID AND UNINSURED PATIENTS, AND KISH HEALTH FOUNDATION IN DEKALB, IL RAISES MONEY FOR KISHWAUKEE HOSPITAL, VALLEY WEST HOSPITAL, KISH HEALTH SYSTEM HOSPICE, AND THE CENTER FOR FAMILY HEALTH AND FUNDS EQUIPMENT PURCHASES AND PATIENT SERVICES PARTICULARLY IN THE AREA OF CANCER CARE FOR THOSE WHO CANNOT AFFORD IT.
PART VI, LINE 7, REPORTS FILED WITH STATES	IL

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number
23-7087041

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) AMERICAN CANCER SOCIETY 143 FIRST STREET BATAVIA,IL60510	13-1788491	501(C)(3)	12,500	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO CANCER RESEARCH AND EDUCATION
(2) AMERICAN HEART ASSOCIATION PO BOX 4002902 DES MOINES,IA50340	13-5613797	501(C)(3)	15,000	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO HEART HEALTH RESEARCH AND EDUCATION
(3) BEN GORDON CENTER FOUNDATION 12 HEALTH SERVICES DRIVE DEKALB,IL60115	36-2771343	501(C)(3)	50,000	TO PROVIDE FINANCIAL ASSISTANCE FOR MENTAL HEALTH SERVICES FOR UNDER OR UNINSURED
(4) DEKALB COUNTY YOUTH SERVICES BUREAU 330 GROVE STREET DEKALB,IL60115	36-3034427	501(C)(3)	7,500	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO YOUTH SERVICES
(5) GENOA CHAMBER OF COMMERCE 111 N SYCAMORE ST GENOA,IL60135	36-2355846	501(C)(6)	6,300	TO PROVIDE FINANCIAL ASSISTANCE FOR ACTIVITIES RELATED TO PROMOTION OF GENOA AREA ECONOMIC DEVELOPMENT
(6) KISHWAUKEE FAMILY YMCA 2500 BETHANY ROAD SYCAMORE,IL60178	36-2379643	501(C)(3)	25,930	TO PROVIDE FINANCIAL ASSISTANCE RELATED TO HEALTH AND FITNESS ACTIVITES FOR LOW INCOME CHILDREN AND FAMILIES
(7) SYCAMORE CHAMBER OF COMMERCE 407 W STATE STREET STE 10 SYCAMORE,IL60178	36-1848940	501(C)(6)	7,000	TO PROVIDE FINANCIAL ASSISTANCE TO PROMOTE BUSINESSES AND ORGANIZATIONS IMPACTING THE COMMUNITY HEALTH AND SAFETY.
(8) CASA DEKALB COUNTY INC 407 W STATE STREET STE 6 SYCAMORE,IL60178	36-3903898	501(C)(3)	10,000	SUPPORT PROGRAMS OFFERED TO CHILDREN IN DEKALB COUNTY THAT ARE ABUSED OR NEGLECTED.
(9) FAMILY SERVICE AGENCY 14 HEALTH SERVICES DRIVE DEKALB,IL60115	36-2360012	501(C)(3)	25,000	TO SUPPORT A COMPREHENSIVE, CHILD APPROPRIATE AND MULTIDISCIPLINARY RESPONSE TO REPORTS OF CHILD SEXUAL AND SEVERE PHYSICAL ABUSE IN DEKALB COUNTY.
(10) SAFE PASSAGE PO BOX 621 DEKALB,IL60115	36-3108372	501(C)(3)	10,000	FUNDING TO SUPPORT EMERGENCY SHELTER, TRANSITIONAL HOUSING, CRISIS INTERVENTION, TO WOMEN AND CHILDREN WHO ARE VICTIMS OF DOMESTIC VIOLENCE.
(11) FAMILIES FOR HOPE HAVEN 1145 RUSHMORE DRIVE DEKALB,IL60115	36-3537762	501(C)(3)	10,000	FUNDING FOR FOOD, SHELTER, SUPPORTIVE SERVICES TO HOMELESS INDIVIDUALS AND FAMILIES OF DEKALB COUNTY.
(12) SYCAMORE PARK DISTRICT 940 EAST STATE STREET SYCAMORE,IL60178	36-6006122	GOVERNMENT ENTITY	5,300	FUNDING SUPPORT EVENTS AND PURCHASE SUPPLIES/EQUIPMENT FOR PROGRAMS OFFERED.
(13) DEKALB COUNTY CHAMBER OF COMMERCE 164 E LINCOLN HIGHWAY DEKALB,IL60115	36-0981630	501(C)(6)	7,000	TO PROVIDE FINANCIAL ASSISTANCE TO PROMOTE BUSINESSES AND ORGANIZATIONS IMPACTING THE COMMUNITY HEALTH AND SAFETY.
(14) DEKALB COUNTY EDC 421 N CALIFORNIA STREET BUILDING 1B SUITE 200 SYCAMORE,IL60178	36-3524353	501(C)(3)	12,500	FUNDING TO SUPPORT WORKFORCE DEVELOPMENT FOR DEKALB COUNTY RESIDENTS.
(15) KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB,IL60115	36-3649080	501(C)(3)	23,091,286	TO PROVIDE FINANCIAL ASSISTANCE IN SUPPORT OF COMMUNITY SOCIAL SERVICES
(16) KISHWAUKEE COLLEGE FOUNDATION 21193 MALTA ROAD MALTA,IL60150	23-7433940	501(C)(3)	22,500	FUNDING FOR EDUCATION SCHOLARSHIPS, SPECIFIC TO HEALTH CARE EDUCATION FOR STUDENTS ATTENDING THE COLLEGE.
(17) NORTHERN PUBLIC RADIO 801 N FIRST STREET DEKALB,IL60115	36-6086819	501(C)(3)	10,078	THE MISSION OF NORTHERN PUBLIC RADIO IS TO ENRICH, INSPIRE, AND INFORM ADULTS IN NORTHERN ILLINOIS THROUGH PROGRAMS AND SERVICES THAT SHARE IDEAS, ENCOURAGE THOUGHT, GIVE PLEASURE, AND CREATE COMMUNITY.
(18) OSF SAINT ANTHONY FOUNDATION 5666 E STATE ST ROCKFORD,IL61108	37-1259284	501(C)(3)	7,500	FUNDING TO SUPPORTS THE ANIMAL ASSISTED PRGRAMS AND LEVEL 3 TRAUMA BURN PROGRAM.
(19) DEKALB PUBLIC LIBRARY 309 OAK STREET DEKALB,IL60115	36-6005846	GOVERNMENT ENTITY	100,000	FUNDING TO SUPPORT THE PROGRAM EXPANSION OF DEKALB LIBRARY'S COMPUTER LAB THAT IS AVAIALBALBE TO THE GENERAL PUBLIC USE.

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2014

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) KISHWAUKEE HOSPITAL AUXILIARY SCHOLARSHIP PROGRAM	20	21,039

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

THE ORGANIZATION MAINTAINS SPECIFIC POLICIES AND QUALIFICATIONS FOR ALL GRANTS AVAILABLE. APPLICANTS MUST APPLY FOR THE RESPECTIVE GRANT AND BE APPROVED BY THE FUNDS GOVERNING BOARD. THE USE OF THE FUNDS IS MONITORED BY THE GOVERNING BOARD OF KISHWAUKEE HOSPITAL. REQUESTS FOR FINANCIAL ASSISTANCE FROM OTHER CHARITABLE ORGANIZATIONS ARE REVIEWED AND APPROVED BY THE VP - FINANCE OF KISHHEALTH SYSTEM. IF NECESSARY DUE TO THE DOLLAR AMOUNT OF THE REQUEST, THESE ITEMS MAY ALSO BE PRESENTED TO THE BOARD OF DIRECTORS. A BUDGET IS SET ANNUALLY FOR CHARITABLE ASSISTANCE TO OTHER ORGANIZATIONS.

Schedule I (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1KEVIN POORTENPRESIDENT & CEO, KISHHEALTH SYSTEM	(i) (ii)	0 ............................... 616,000	0 ............................... 196,800	0 ............................... 60,000	0 ............................... 108,400	0 ............................... 21,296	0 ............................... 1,002,496	0 ............................... 0
2LOREN FOELSKEVP FINANCE - KISHHEALTH SYSTEM	(i) (ii)	0 ............................... 277,525	0 ............................... 51,100	0 ............................... 0	0 ............................... 69,300	0 ............................... 18,632	0 ............................... 416,557	0 ............................... 0
3BRAD COPPLEPRESIDENT - KH & VWH	(i) (ii)	0 ............................... 318,347	0 ............................... 59,000	0 ............................... 0	0 ............................... 38,900	0 ............................... 20,620	0 ............................... 436,867	0 ............................... 0
4PAM DUFFYCNO & VP PATIENT CARE SVCS	(i) (ii)	0 ............................... 225,599	0 ............................... 51,400	0 ............................... 0	0 ............................... 23,808	0 ............................... 7,516	0 ............................... 308,323	0 ............................... 0
5JOESPH DANTVP BUSINESS DEVELOPMENT	(i) (ii)	0 ............................... 234,774	0 ............................... 54,500	0 ............................... 0	0 ............................... 22,538	0 ............................... 19,919	0 ............................... 331,731	0 ............................... 0
6MICHAEL KOKOTTASST VP MKTG & PLANNING	(i) (ii)	0 ............................... 175,715	0 ............................... 24,300	0 ............................... 0	0 ............................... 16,075	0 ............................... 12,769	0 ............................... 228,859	0 ............................... 0
7ROGER HEATH BELLVP AND CIO	(i) (ii)	0 ............................... 246,628	0 ............................... 45,800	0 ............................... 0	0 ............................... 19,416	0 ............................... 25,169	0 ............................... 337,013	0 ............................... 0
8DR MICHAEL KULISZCHIEF MEDICAL OFFICER	(i) (ii)	0 ............................... 366,770	0 ............................... 100,300	0 ............................... 0	0 ............................... 54,000	0 ............................... 19,919	0 ............................... 540,989	0 ............................... 0
9DAVID PROULXASSISTANT VP OPERATIONS	(i) (ii)	0 ............................... 162,297	0 ............................... 22,600	0 ............................... 0	0 ............................... 35,475	0 ............................... 19,683	0 ............................... 240,055	0 ............................... 0
10MICHELE MCCLELLANDVP OF HUMAN RESOURCES	(i) (ii)	0 ............................... 199,252	0 ............................... 38,000	0 ............................... 0	0 ............................... 20,942	0 ............................... 19,727	0 ............................... 277,921	0 ............................... 0
11ANJU VOHRATECHNICAL DIRECTOR - ECHO	(i) (ii)	139,584 ............................... 0	0 ............................... 0	0 ............................... 0	8,594 ............................... 0	24,377 ............................... 0	172,555 ............................... 0	0 ............................... 0
12THOMAS WARZECHADIRECTOR OF PHARMACY	(i) (ii)	152,380 ............................... 0	0 ............................... 0	0 ............................... 0	9,359 ............................... 0	24,395 ............................... 0	186,134 ............................... 0	0 ............................... 0
13LISA ACKLANDDIRECTOR OF NURSING	(i) (ii)	139,393 ............................... 0	8,078 ............................... 0	7,920 ............................... 0	8,871 ............................... 0	32,141 ............................... 0	196,403 ............................... 0	0 ............................... 0
14CYNTHIA TUCKERDIRECTOR OF REHAB SERVICES	(i) (ii)	121,611 ............................... 0	14,125 ............................... 0	0 ............................... 0	7,064 ............................... 0	24,882 ............................... 0	167,682 ............................... 0	0 ............................... 0
15CHESTER SIMMONSPHARMACIST	(i) (ii)	134,048 ............................... 0	0 ............................... 0	0 ............................... 0	8,262 ............................... 0	24,387 ............................... 0	166,697 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 3

THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE METHODS DESCRIBED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION.

PART I, LINE 4B

THE ORGANIZATION'S EXECUTIVES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2014 RELATED TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF KISHHEALTH FOUNDATION WERE $273,900. THIS CONTRIBUTION REFLECTS AMOUNTS DUE FOR THE FISCAL YEAR ENDING APRIL 30, 2015. THE ORGANIZATION'S CEO PARTICIPATES IN TWO ADDITIONAL NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2014 WERE $60,000. DURING FY15, THE CEO TOOK A DISTRIBUTION FROM THE DEFERRED COMPENSATION PLAN IN THE AMOUNT OF $60,000. THIS DISTRIBUTION IS INCLUDED AS W-2 WAGES, HOWEVER THE ACCRUAL OF THE DEFERRED COMPENSATION PAYMENTS HAS ALSO BEEN INCLUDED AS OTHER COMPENSATION ON PRIOR YEAR FORM 990S.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number
23-7087041

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	ILLINOIS FINANCE AUTHORITY	86-1091967	452032AJ4	08-22-2008	63,685,000	CURRENT REFUNDING OF 2005 BONDS FOR CONSTRUCTION OF NEW FACILITY FOR KCH		X	X			X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	3,910,000
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	63,371,994
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	328,434
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .
11 Other spent proceeds . . . . . . . . . . . . . .	63,043,560
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2014

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .
6 Total of lines 4 and 5 . . . . . . . . . . . . .
7 Does the bond issue meet the private security or payment test? . . . . .		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X
b Exception to rebate? . . . . . . . .		X
c No rebate due? . . . . . . . .	X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2014

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/31/2013

Schedule K (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	KISHHEALTH SYSTEM IS THE SOLE MEMBER OF KISHWAUKEE HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	AS THE SOLE MEMBER AND PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL, KISHHEALTH SYSTEM HAS THE RIGHT TO APPROVE THE ELECTION OF MEMBERS OF THE HOSPITAL'S GOVERNING BOARD, PER THE HOSPITAL'S BYLAWS.
FORM 990, PART VI, SECTION A, LINE 7B	KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF KISHWAUKEE HOSPITAL (KH). PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF KH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER. PER THE BYLAWS, WITH RESPECT TO THE GOVERNANCE OF KH, THE FOLLOWING POWERS SHALL BE RESERVED TO THE SOLE CORPORATE MEMBER: A. ELECTING THE MEMBERS OF THE KH BOARD B. APPROVING, EVALUATING AND/OR REMOVING THE PRESIDENT AND CEO AND REVIEWING AND APPROVING THE EMPLOYMENT CONTRACT OF THE PRESIDENT AND CEO AND ESTABLISHING COMPENSATION FOR SUCH OFFICE C. APPROVING THE STRATEGIC PLAN FOR KH D. APPROVING THE DISPOSITION OF ANY ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS FOR KH E. APPROVING ANY CHANGE IN MEMBERSHIP OF KH F. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION AND BYLAWS OF KH G. APPROVING A PLAN OF MERGER OR A PLAN OF CONSOLIDATION OF KH OR ESTABLISHING A NEW SUBSIDIARY OR SISTER ENTITY H. APPROVING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF KH I. INITIATING, TAKING ANY AND ALL ACTIONS, AND EXERCISING ALL APPROVAL RIGHTS OF THE DIRECTORS PURSUANT TO THE APPLICABLE MEDICAL STAFF BYLAWS J. IMPLEMENTING AND MONITORING KH OPERATIONAL QUALITY IMPROVEMENT POLICIES AND PROGRAMS K. ACCEPTING GIFTS, GRANTS, BEQUESTS AND DONATIONS ON BEHALF OF KH L. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR KH M. EXERCISING ANY RIGHTS THAT KH HAS AS A SHAREHOLDER OR MEMBER OF ANY SUBSIDIARY ENTITY N. APPROVING ANY AFFILIATIONS OF KH O. APPROVING AND/OR DETERMINING (I) THE CREATION OF NEW HEALTH SERVICES TO BE PROVIDED AND THE LOCATION OF SUCH HEALTH SERVICES AND (II) THE DISCONTINUANCE OF ANY HEALTH SERVICE P. AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF KH Q. AUTHORIZING THE VOLUNTARY DISSOLUTION OF KH, OR REVOKING THE PROCEEDINGS THEREOF R. REQUIRING MINUTES OF MEETINGS, FINANCIAL RECORDS, AND SUCH OTHER INFORMATION AS MAY BE NECESSARY TO PROPERLY EVALUATE THE PERFORMANCE OF KH S. INITIATING ACTION TO REMOVE OR REINSTATE A DIRECTOR WHEN, IN THE OPINION OF THE KHS BOARD, IT IS IN THE BEST INTERESTS OF KHS OR KH. ANY ACTION TO REMOVE OR REINSTATE SHALL REQUIRE A MAJORITY VOTE OF THOSE KHS DIRECTORS THEN IN OFFICE PRESENT AND VOTING AT A MEETING OF THE KHS BOARD AT WHICH A QUORUM IS PRESENT. IN ANY ACTION(S) TO REMOVE TAKEN BY THE KHS BOARD, THE DIRECTOR IN QUESTION SHALL BE ADVISED AT LEAST TWENTY (20) DAYS PRIOR TO THE MEETING THAT THE ACTION WILL BE CONSIDERED AND SHALL BE GIVEN THE OPPORTUNITY TO MAKE A STATEMENT, PRESENT WITNESSES ON HIS/HER BEHALF AND QUESTION THOSE PRESENTING REASONS FOR HIS/HER REMOVAL. ALL ACTIONS TO REMOVE SHALL BE TAKEN IN CLOSED SESSIONS OF THE KHS BOARD AND T. TRANSFERRING MONEY OR PROPERTY AMONG KH, KHS AND/OR ONE OR MORE SUBSIDIARY CORPORATIONS AND TRANSFERRING MONEY OR PROPERTY FROM A SUBSIDIARY CORPORATION, INCLUDING REQUIRING THE DIRECTORS, OFFICERS, OR TRUSTEES OF ANY SUBSIDIARY CORPORATION TO TRANSFER MONEY OR OTHER PROPERTY TO KHS. SUBJECT TO THE POWERS OF THE BOARD OF DIRECTORS OF EACH SUBSIDIARY CORPORATION, THE KHS BOARD MAY INITIATE AND TAKE THE FOREGOING ACTIONS ON BEHALF OF KHS AND THE SUBSIDIARY CORPORATIONS.
FORM 990, PART VI, SECTION B, LINE 11	A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ARE ALSO PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW. THE CHAIR OF THE AUDIT COMMITTEE AND THE AUDIT COMMITTEE MEMBERS ARE ALSO PROVIDED DRAFT COPIES AND REVIEW. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN.
FORM 990, PART VI, SECTION B, LINE 12C	INDIVIDUALS COVERED BY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND CONSIDERED INTERESTED PERSONS, INCLUDE MEMBERS OF THE BOARD OF DIRECTORS OF ANY ENTITY WITHIN THE HEALTH SYSTEM, KISHHEALTH SYSTEM OFFICERS, ANY COMMITTEE MEMBER, ANY INDIVIDUAL WITH ULTIMATE RESPONSIBILITY FOR IMPLEMENTING BOARD DECISIONS OR SUPERVISING THE MANAGEMENT, ADMINISTRATION, OR OPERATION OF THE ORGANIZATION, AND IMMEDIATE FAMILY MEMBERS OF THOSE LISTED. IT IS THE DUTY OF THESE INTERESTED PERSONS TO SELF-DISCLOSE ANY CONFLICTS OF INTEREST. CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE KISHHEALTH SYSTEM GOVERNANCE COMMITTEE ON AN ONGOING BASIS. IF IT IS DETERMINED THAT AN INDIVIDUAL FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE INDIVIDUAL OF SUCH A BELIEF AND AFFORD HIM AN OPPORTUNITY TO EXPLAIN. AFTER SAID EXPLANATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION AS DEEMED NECESSARY. AN INTERESTED PERSON DEEMED TO HAVE A CONFLICT MUST NOT BE PRESENT DURING DISCUSSION OR VOTES RELATED TO THE TRANSACTION. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED.
FORM 990, PART VI, SECTION B, LINE 15	KISHWAUKEE HOSPITAL IS NOT DIRECTLY INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT, AS THE INDIVIDUALS ARE EMPLOYED THROUGH KISHHEALTH SYSTEM. KISHHEALTH SYSTEM DOES COMPLY WITH THE REQUIREMENTS NOTED ABOVE. THROUGH THE OVERSIGHT OF THE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE, THE KISHHEALTH SYSTEM EXECUTIVE TOTAL COMPENSATION PROGRAM WILL BE COMPETITIVELY POSITIONED IN THE MARKET PLACE OF RELEVANT ORGANIZATIONS AND FALL WITHIN THE SAFE HARBOR GUIDELINES ESTABLISHED BY THE INTERMEDIATE SANCTIONS RULES. THE EXECUTIVE COMPENSATION COMMITTEE IS MADE UP OF THREE MEMBERS OF THE BOARD OF DIRECTORS WHO MEET THE BOARD APPROVED DEFINITION OF INDEPENDENT DIRECTORS. ANNUALLY THE EXECUTIVE COMPENSATION COMMITTEE CONTRACTS WITH SULLIVAN, COTTER AND ASSOCIATES, AN INDEPENDENT HUMAN RESOURCES CONSULTING FIRM TO PROVIDE THE COMMITTEE ANALYSIS AND COMPARABILITY DATA. USING THE SUPPLIED DATA THE COMPENSATION COMMITTEE APPROVES EACH EXECUTIVE'S TOTAL CASH COMPENSATION AND PROVIDES CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. TOTAL CASH COMPENSATION IS DEFINED AS THE SUM OF BASE SALARIES PLUS INCENTIVE AWARDS. BASED ON THE COMPARABILITY DATA AND THE PERFORMANCE OF EACH EXECUTIVE IN MEETING GOALS AND STRATEGIC OBJECTIVES, THE EXECUTIVE COMPENSATION COMMITTEE APPROVES INCREASES AND INCENTIVE AWARDS FOR EACH EXECUTIVE WITHIN THE GUIDELINES ESTABLISHED. THE EXECUTIVE COMPENSATION COMMITTEE REPORTS ON ALL COMPENSATION MATTERS TO THE FULL BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	PURCHASED PERSONNEL: PROGRAM SERVICE EXPENSES 322,431. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,431. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,803,026. MANAGEMENT AND GENERAL EXPENSES 246,743. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,049,769. OTHER CONSULTING: PROGRAM SERVICE EXPENSES 16,496. MANAGEMENT AND GENERAL EXPENSES 286,173. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 302,669. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 695,448. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 695,448. LAB FEES: PROGRAM SERVICE EXPENSES 943,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 943,340. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,611,630. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,611,630. PHYSICIAN RECRUITMENT: PROGRAM SERVICE EXPENSES 974,898. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 974,898. COLLECTION FEES: PROGRAM SERVICE EXPENSES 25,758. MANAGEMENT AND GENERAL EXPENSES 816,010. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 841,768. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 1,065,069. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,065,069.
FORM 990, PART XI, LINE 9:	CHANGE OF INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION -548,057. BOOK/TAX DIFFERENCES IN K-1 PASSTHROUGH ENTITIES -27,934. OTHER ADJUSTMENTS -116,832. LIABILITIES GROUPED WITH EXPENSES ON FINANCIAL STATEMENT -34,372. EQUITY ADJUSTMENT -332,539.
FORM 990, PART XI, LINE 3C: RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STMTS	NO CHANGES IN THIS PROCESS WERE MADE DURING THE TAX YEAR. THE ORGANIZATION MAINTAINS AN INDEPENDENT AUDIT COMMITTEE WHICH IS RESPONSIBLE FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS. THIS COMMITTEE IS ALSO RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR. MEMBERS OF THE AUDIT COMMITTEE ARE ALSO MEMBERS OF THE KISHHEALTH SYSTEM BOARD OF DIRECTORS. KISHEALTH SYSTEM IS THE PARENT CORPORATION OF KISHWAUKEE HOSPITAL.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

KISHWAUKEE COMMUNITY HOSPITAL

Employer identification number

23-7087041

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) KISHHEALTH SYSTEM ONE KISH HOSPITAL DRIVE DEKALB,IL60115 36-3649080	PARENT ORGANIZATION OF 501(C)(3) HEALTH SYSTEM	IL	501(C)(3)	11B	N/A		No
(2) VALLEY WEST COMMUNITY HOSPITAL ONE KISH HOSPITAL DRIVE DEKALB,IL60115 36-4244337	HEALTHCARE SERVICES, PRIMARILY ACUTE CARE	IL	501(C)(3)	3	KISHHEALTH SYSTEM		No
(3) DEKALB COUNTY HOSPICE ONE KISH HOSPITAL DRIVE DEKALB,IL60115 36-3164329	HEALTHCARE SERVICES, HOSPICE SERVICES	IL	501(C)(3)	7	KISHHEALTH SYSTEM		No
(4) KISHHEALTH FOUNDATION ONE KISH HOSPITAL DRIVE DEKALB,IL60115 36-3649077	SUPPORT OF KISHWAUKEE HEALTH SYSTEM NOT FOR PROFIT ENTITIES	IL	501(C)(3)	7	KISHHEALTH SYSTEM		No
(5) COMMUNITY CARES CLINIC ONE KISH HOSPITAL DRIVE DEKALB,IL60115 80-0424001	HEALTHCARE SERVICES, PRIMARY CARE	IL	501(C)(3)	3	KISHHEALTH SYSTEM		No
(6) KISHWAUKEE PHYSICIANS GROUP INC 2240 GATEWAY DRIVE SYCAMORE,IL60178 65-1293967	HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE	IL	501(C)(3)	3	KISHHEALTH SYSTEM		No
(7) CENTER FOR FAMILY HEALTH - MALTA ONE KISH HOSPITAL DRIVE DEKALB,IL60115 80-0869393	HEALTHCARE SERVICES, PRIMARILY ACUTE CARE	IL	501(C)(3)	3	KISHHEALTH SYSTEM		No
(8) KISHHEALTH SYSTEM HOME CARE ONE KISH HOSPITAL DRIVE DEKALB,IL60115 37-1703513	HEALTHCARE SERVICES, HOME CARE	IL	501(C)(3)	3	KISHHEALTH SYSTEM		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) KISHWAUKEE AREA PHO ONE KISH HOSPITAL DRIVE DEKALB,IL60115 36-4205273	MEDICARE SERVICES	IL	KISHWAUKEE COMMUNITY HOSPITAL	INVESTMENT	-20,055	3,091		No			No	50.000 %
(2) THE MIDLAND SURGICAL CENTER LLC 3085 WOLF COURT DEKALB,IL60115 35-2194610	SURGICAL SERVICES	IL	KISHWAUKEE COMMUNITY HOSPITAL	INVESTMENT	716,167	691,999		No			No	74.500 %
(3) HEALTH VENTURES LLC ONE KISH HOSPITAL DRIVE DEKALB,IL60115 75-3255958	RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES	IL	N/A
(4) ILLINOIS REGIONAL CANCER CENTER 10 HEALTH SERVICES DRIVE DEKALB,IL60115 36-3847273	CANCER TREATMENT SERVICES	IL	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) HEALTH PROGRESS INC ONE KISH HOSPITAL DRIVE DEKALB,IL60115 36-3824138	INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESS	IL	N/A	C				No

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE AREA OF DEKALB COUNTY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	3
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	2
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	1,201
6	Total number of volunteers (estimate if necessary) .............	6	235
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	123,083
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	14,039

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	387,794	1,112,612
9	Program service revenue (Part VIII, line 2g) .........	168,636,360	173,901,890
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,476,451	9,697,347
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,681,773	1,693,306
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	180,182,378	186,405,155
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	408,449	23,611,228
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	60,369,123	58,116,480
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 13,217
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	100,450,596	102,912,854
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	161,228,168	184,640,562
19	Revenue less expenses. Subtract line 18 from line 12.......	18,954,210	1,764,593
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	328,924,975	328,357,441
21	Total liabilities (Part X, line 26).............	103,167,547	104,853,366
22	Net assets or fund balances. Subtract line 21 from line 20.....	225,757,428	223,504,075

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 152,993,052 including grants of $ 23,611,228 ) (Revenue $ 173,802,321 )
	KISHWAUKEE HOSPITAL (KH), LOCATED IN DEKALB, ILLINOIS, SERVES THE RESIDENTS OF DEKALB COUNTY AND THE SURROUNDING AREAS BY OFFERING A NUMBER OF PROGRAMS AND SERVICES FOR COMMUNITY BENEFIT, INCLUDING CHARITY CARE.KISHWAUKEE HOSPITAL BELIEVES THAT IN ORDER TO BE A TRUE COMMUNITY HOSPITAL, WE MUST BE A RESOURCE FOR PREVENTATIVE AND CURATIVE HEALTH INFORMATION, EDUCATION AND SERVICES AND THAT WE MUST SUPPORT THE EFFORTS OF OTHERS WHO ALSO ARE DOING WORK FOR THE COMMUNITY GOOD. DOING SO HELPS BUILD TRUST, RESPECT AND LOYALTY FOR OUR HOSPITAL AND STRENGTHENS OUR ROLE AS A PARTNER IN IMPROVING THE HEALTH OUR CITIZENS AND THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE.THE COMMUNITY BENEFIT OBJECTIVES OF KISHWAUKEE HOSPITAL INCLUDE PROGRAMS TO IMPROVE ACCESS TO HEALTH SERVICES BY REDUCING GEOGRAPHIC, FINANCIAL, LANGUAGE, AND CULTURAL BARRIERS IMPROVE AND ENHANCE PUBLIC HEALTH, ADVANCE GENERAL HEALTH KNOWLEDGE, AND RELIEVE THE GOVERNMENT BURDEN OF PROVIDING HEALTH SERVICES FOR THE COMMUNITY, AND FOR THE UNINSURED AND UNDERINSURED. COMMUNITY HEALTH NEEDS ARE IDENTIFIED AND ADDRESSED THROUGH COMMUNITY OUTREACH PROGRAMS, BY ADDING NEW SERVICES AND BY EXPANDING OTHERS. NEEDS ALSO ARE MET THROUGH OPERATIONAL PROGRAMS SUCH AS CHARITY CARE, SUBSIDIZED SERVICES AND PROVIDING CASH AND IN-KIND DONATIONS TO SUPPORT ORGANIZATIONS THAT ALSO STRIVE TO MEET COMMUNITY HEALTH AND QUALITY OF LIFE NEEDS. THE HOSPITAL IDENTIFIES COMMUNITY HEALTH NEEDS IN SEVERAL WAYS.AMERICAN DIABETES ASSOCIATIONAMERICAN MEDICAL ASSOCIATIONAMERICAN UNIVERSITY SURVEYCENTERS FOR DISEASE CONTROL AND PREVENTIONCOMMUNITY NEEDS INDEXILLINOIS DEPARTMENT OF EMPLOYMENT SECURITYILLINOIS DEPARTMENT OF PUBLIC HEALTHILLINOIS DEPARTMENT OF PUBLIC HEALTH ANNUAL HOSPITAL QUESTIONNAIREILLINOIS DEPARTMENT OF PUBLIC HEALTH, BEHAVIORAL RISK FACTORS SURVEYILLINOIS DEPARTMENT OF PUBLIC HEALTH, ILLINOIS COUNTY CANCER STATISTICS REVIEW INCIDENCEILLINOIS DEPARTMENT OF PUBLIC HEALTH: BIRTH DEFECTS AND OTHER ADVERSE PREGNANCY OUTCOMES IN ILLINOIS, 2004-2008ILLINOIS HOSPITAL ASSOCIATIONILLINOIS HOSPITAL ASSOCIATION, COMP DATAILLINOIS PUBLIC HEALTH COMMUNITY MAPNATIONAL CANCER INSTITUTENATIONAL CANCER FOR HEALTH STATISTICSNATIONAL HEART LUNG AND BLOOD INSTITUTENORTHERN ILLINOIS UNIVERSITY ENROLLMENT DATAPIONEERING HEALTHIER COMMUNITIESSTATE OF ILLINOIS DATA BY ZIP CODEUS CENSUS BUREAU 2010 DATAINTERNAL REVIEW OF OUTPATIENT AND INPATIENT TRENDS, ESPECIALLY EMERGENCY DEPARTMENT USAGE*INPUT FROM OTHER COMMUNITY PROVIDERS. THIS INCLUDES PROVIDING HOSPITAL LEADERS TO SERVE ON BOARDS AND COMMITTEES THAT DIRECTLY OR INDIRECTLY IMPACT THE COMMUNITY HEALTH OR HELP THE HOSPITAL CONNECT TO UNDERSERVED OR VULNERABLE POPULATIONS.USING ALL THESE RESOURCES, THE HOSPITAL FOCUSED ON THE FOLLOWING COMMUNITY HEALTH NEEDS IN FISCAL YEAR 2015.EXPAND KISH PHYSICIAN GROUP (KPG) PRIMARY CARE PROVIDERS IN IDENTIFIED SERVICE AREAS.GOAL: PROVIDE GREATER ACCESS TO CARE IN THE COMMUNITIES WE SERVE, WHILE UTILIZING THE LATEST TECHNOLOGY, EQUIPMENT AND EDUCATION TO PROVIDE THE HIGHEST LEVEL OF CARE.- DURING THE COURSE OF THE FISCAL YEAR, KISH PHYSICIAN GROUP EXPANDED SERVICES TO TWO ADDITIONAL LOCATIONS INCLUDING AURORA AND DEKALB AND ADDED THIRTY NEW PROVIDERS. THE ADDITION OF PROVIDERS INCLUDES THE ACQUISITION OF THE DEKALB CLINIC PROVIDERS WHICH TOOK PLACE ON MARCH 2, 2015. THROUGHOUT THE FISCAL YEAR THERE WAS APPROXIMATELY A 70% INCREASE IN THE NUMBER OF PATIENT VISITS.DEFINE AND IDENTIFY OPPORTUNITIES FOR CARE COORDINATION, DISEASE MANAGEMENT, CHRONIC CARE PROGRAMS, GROUP MEDICAL VISITS AND OTHER INNOVATIVE HEALTHCARE DELIVERY OPTIONS.GOAL: PROVIDE PATIENT-CENTERED APPROACH TO HEALTH CARE DELIVERY.- DURING THE PAST YEAR MUCH WORK HAS TAKEN PLACE TO DEFINE AND IDENTIFY OPPORTUNITIES FOR CARE COORDINATION, AS KISH HEALTH SYSTEM EMPLOYEES WORK TO DEVELOP A MODEL WHICH PLACES THE FOCUS ON THE PATIENT. ADDITIONALLY, THE TEAMS WORKING ON THIS ACTION ITEM ARE FOCUSED ON REDUCING READMISSIONS FOR PATIENTS DIAGNOSED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), CONGESTIVE HEART FAILURE (CHF) AND OTHER RESPIRATORY DISEASE. AS THE TEAM DEVELOPS THE MODEL, IT IS ANTICIPATED THAT DISEASE AND CHRONIC CARE MANAGEMENT PROGRAMS AND GROUP MEDICAL VISITS WILL BE COMPONENTS OF THE OVERALL PLAN TO ADDRESS THE HEALTH ISSUES IDENTIFIED.- REGIONAL NURSE CARE COORDINATOR PROVIDED CARE FOR 129 UNIQUE INDIVIDUALS ENROLLED IN ACE THROUGH ILLINOIS PARTNERSHIP FOR HEALTH- COMPLEX CASE MANAGEMENT OF 75 REFERRED NON-ACE PATIENTS THROUGH KISHHEALTH SYSTEM ENTITIES- CARE COORDINATION PARTNERSHIP WITH CARDIAC REHAB TO MORE EFFECTIVELY MANAGE CHRONIC CHF PATIENTS IN THE COMMUNITY- UTILIZATION OF DATA TO IDENTIFY PATIENTS FOR DISEASE MANAGEMENT PROGRAMS SUCH AS DIABETES EDUCATIONSUPPORT THE DEKALB COUNTY MENTAL HEALTH BOARD WORK ON THE MENTAL HEALTH COMMUNITY NEEDS ASSESSMENT.GOAL: PARTICIPATE IN THE COMMUNITY MENTAL HEALTH NEEDS ASSESSMENT FOR DEKALB COUNTY.- THE DEKALB COUNTY MENTAL HEALTH BOARD IDENTIFIED AN AREA OF NEED AROUND TRAINING FOR PARTNER AGENCIES ON ISSUES FOCUSED ON OR AROUND MENTAL HEALTH ISSUES. KISHHEALTH SYSTEM, BEHAVIORAL HEALTH SERVICES, IS WORKING WITH THE BOARD ON A SERIES OF WORKSHOPS AND TRAINING TO BE OFFERED. THERE WAS ONE EVENT HELD TITLED MENTAL HEALTH AND THE LAW AND THERE WERE 40 PARTICIPANTS IN ATTENDANCE.FACILITATE COMMUNICATION BETWEEN HEALTH CARE ORGANIZATIONS THROUGH THE USE OF ELECTRONIC MEDICAL RECORD (EMR) TECHNOLOGY.GOAL: IMPLEMENT TECHNOLOGY TO FOSTER SHARED INFORMATION AMONG EMR USERS.- WORK TOWARD THIS OBJECTIVE WAS ACHIEVED BY THE DEPLOYMENT OF THE MEDICITY PLATFORM WHICH WILL ALLOW THE SHARING OF INFORMATION BETWEEN EMR SYSTEMS. KISHHEALTH SYSTEM IS CONNECTED TO SEVERAL PHYSICIAN OFFICES AND WE ARE RAPIDLY EXPANDING THIS REACH. ADDITIONALLY, KISHHEALTH SYSTEM BEGINNING THE TESTING OF THE MEDITECH DIRECT FUNCTIONALITY THAT ALLOWS US TO SEND INFORMATION TO PROVIDERS THAT COMPLY WITH FEDERAL COMMUNICATION AND ENCRYPTION STANDARDS ON THEIR EMR SOLUTIONS. THIS WILL ALLOW ADDITIONAL CONNECTIONS THAT CURRENTLY DO NOT EXIST. KISHHEALTH SYSTEM EVALUATES THE CONNECTIVITY TO REGIONAL OR STATE LEVEL HEALTH INFORMATION EXCHANGES (HIES) THAT WILL ALLOWS COMMUNICATION TO OCCUR ACROSS REGIONAL OR STATE PROVIDERS OF CARE. EXPAND COORDINATED APPROACH TO CHILD HEALTH (CATCH) IN DEKALB COUNTY SCHOOL AGE CHILDREN.GOAL: PROMOTE POLICY A CHANGE IN SCHOOLS TO IMPLEMENT CATCH CURRICULUM OR AFTERSCHOOL PROGRAMS.- DURING THIS LAST YEAR, CATCH CURRICULUM WAS OFFERED TO DEKALB, SYCAMORE AND GENOA SCHOOL DISTRICTS WITH 844CLASSROOM VISITS TOOK PLACE AND 22,374 STUDENTS RECEIVED EDUCATION ON HEALTHY EATING, INCREASING PHYSICAL ACTIVITY AND DECREASING SCREEN TIME. - GENOA PARK DISTRICT ALSO IMPLEMENTED CATCH IN ITS AFTER SCHOOL PROGRAM AND SUMMER PROGRAM, WITH AN ESTIMATED 16 SESSIONS AND 800 STUDENTS RECEIVING THIS PROGRAM.- KISHWAUKEE FAMILY YMCA SUMMER PROGRAM ADDED CATCH AS A COMPONENT OF THE PROGRAM, AND IN ATTENDANCE AT THE SIX SESSIONS WERE 3,200 CHILDREN.- THERE ARE ROUGHLY 90 NIU STUDENTS THAT SERVE AS CATCH INSTRUCTORS WHICH HELP TO MAKE THIS PROGRAM SUSTAINABLE IN THE COMMUNITY.IDENTIFY AND DEVELOP PROGRAMS FOR CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND DIABETES CONSIDERED TO BE HIGH RISK FOR READMISSION.GOAL: REDUCE READMISSIONS FOR CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND DIABETES THROUGH A COORDINATED APPROACH.- DURING THE PAST YEAR WORK HAS TAKEN PLACE ON THIS ACTION ITEM FOCUSING ON PROGRAM DEVELOPMENT FOR CARDIOVASCULAR DISEASE, RESPIRATORY DISEASE AND DIABETES, AS IT RELATES TO HIGH RISK FOR READMISSION. - THIS PAST YEAR A PILOT PROGRAM ON CONGESTIVE HEART FAILURE WAS IMPLEMENTED WITH 56 PARTICIPANTSSUPPORT LIVE HEALTHY DEKALB COUNTY (FORMERLY PIONEERING HEALTHIER COMMUNITIES) IN ITS POLICY AND SYSTEMS CHANGES.GOAL: SUPPORT THE WORK OF LIVE HEALTHY DEKALB COUNTY THROUGH ITS POLICY AND ENVIRONMENTAL CHANGES TO MOTIVATE PEOPLE TO EAT HEALTHY AND BE PHYSICALLY ACTIVE EVERY DAY.- ON-GOING SUPPORT TO LIVE HEALTHY DEKALB COUNTY IS PROVIDED THROUGH IN-KIND STAFF TIME, AS WELL AS FINANCIAL SUPPORT. - ENVIRONMENTAL CHANGES INCLUDE AN INCREASE IN COMMUNITY GARDENS FROM 200 - 230 TO SUPPORT BARB FOOD MART (SCHOOL BASED FOOD PANTRY) AND HEALTHIER FOOD CHOICES IN SCHOOLS.- IMPLEMENTED STEPS TO ACHIEVE BIKE FRIENDLY DESIGNATION ASSESSMENT OF CRITERIA TO GATHER NEEDED RESOURCES TO BEGIN THE WORK- ENHANCED CONNECTIVITY OF BIKE TRAIL ON BETHANY ROAD BY ADDING A 300 FOOT ADDITION- EXTRA FREE FOOD DROP ADDED FOR COUNTY PANTRIES FACILITATED BY THE FOOD SECURITY COUNCILPROVIDE FREE OR LOW COST DIABETES EDUCATION CLASSES TO IDENTIFIED POPULATIONS.GOAL: EMPOWER PEOPLE TO APPROPRIATELY SELF-MANAGE DIABETES.- THROUGHOUT THE YEAR, DIABETES EDUCATION CLASSES ARE OFFERED AT REDUCED PRICE TO INDIVIDUALS AND THERE WERE 75 INDIVIDUALS THAT PARTICIPATED IN THIS VALUABLE PROGRAMMING.- WORLD DIABETES DAY EVENT WAS HELD IN NOVEMBER WITH OVER 150 PARTICIPANTS.PROVIDE FREE OR REDUCED COST CANCER SCREENINGS FOR TARGETED POPULAT

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses152,993,052

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	717,139	3,526,707	766,436

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b		1,280
c	Fundraising events....1c
d	Related organizations...1d		1,051,057
e	Government grants (contributions)1e		18,982

f	All other contributions, gifts, grants, and similar amounts not included above1f		41,293

g	Noncash contributions included in lines 1a-1f:$		240
h	Total. Add lines 1a-1f.......			1,112,612
			Business Code
2a	NET PATIENT SERVICE REVENUE		621110	173,901,890	173,802,321	99,569
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			173,901,890
3	Investment income (including dividends, interest, and other similar amounts).......			7,079,040			7,079,040
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	695,190
b	Less: rental expenses	727,583
c	Rental income or (loss)	-32,393
d	Net rental income or (loss).......			-32,393			-32,393
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	39,707,781	329,189
b	Less: cost or other basis and sales expenses	37,308,752	109,911
c	Gain or (loss)	2,399,029	219,278
d	Net gain or (loss)..........			2,618,307			2,618,307
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		119,104
b	Less: cost of goods sold ..b		59,428
c	Net income or (loss) from sales of inventory..			59,676			59,676
Miscellaneous Revenue			Business Code
11a	CAFETERIA SALES		621110	731,387		0	731,387
b	INCOME PASSTHROUGH - MIDLAND SURG		621110	379,389			379,389
c	OTHER SERVICES		621110	347,854		23,514	324,340
d	All other revenue ....			207,393			207,393
e	Total. Add lines 11a–11d ......			1,666,023
12	Total revenue. See Instructions......			186,405,155	173,802,321	123,083	11,367,139


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			15,006,542	1	11,539,399
2	Savings and temporary cash investments .........			721,854	2	122,759
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			25,581,608	4	26,643,574
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			3,803,727	8	3,745,229
9	Prepaid expenses and deferred charges ..........			2,855,211	9	2,444,675
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	181,017,805
b	Less: accumulated depreciation .....	10b	94,648,710	92,124,980	10c	86,369,095
11	Investments—publicly traded securities ..........			171,588,222	11	182,412,996
12	Investments—other securities. See Part IV, line 11 .....			6,515,154	12	7,496,478
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............			890,392	14	848,849
15	Other assets. See Part IV, line 11 ...........			9,837,285	15	6,734,387
16	Total assets. Add lines 1 through 15 (must equal line 34)......			328,924,975	16	328,357,441
17	Accounts payable and accrued expenses .........			12,614,254	17	12,002,612
18	Grants payable .................			48,203	18	72,556
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			62,065,000	20	59,775,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,245,038	23	1,070,121
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			27,195,052	25	31,933,077
26	Total liabilities. Add lines 17 through 25.........			103,167,547	26	104,853,366
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			221,656,823	27	219,234,259
28	Temporarily restricted net assets ...........			4,100,605	28	4,269,816
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			225,757,428	33	223,504,075
34	Total liabilities and net assets/fund balances ........			328,924,975	34	328,357,441