2023-11-14T08:09:10-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2022-01-01 431279063 CH ALLIED SERVICES INC CHAL 5738158732 1600 E BROADWAY COLUMBIA MO 65201 EDWARD CLAYTON CHIEF FINANCIAL OFFICER 5738158732 2023-11-10 1 EDWARD CLAYTON XXX-XX-XXXX 0 AMBER ROGNAN-HAMILTON P01251012 3149254300 2023-11-10 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z BOONE HOSPITAL CENTER TROY GREER 1600 E BROADWAY COLUMBIA MO 65201 358564170 0 X WWW.BOONE.HEALTH X 1983 MO FULL SERVICE HOSPITAL STRIVING TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES SERVED. 11 11 2659 53 0 0 131336539 7353216 321993976 348393494 -32460 368686 2807368 2397260 456105423 358512656 531675 42470 0 0 168418442 189133311 0 0 0 213059889 231590186 382010006 420765967 74095417 -62253311 320950223 263339191 182889385 161194934 138060838 102144257 TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 274364692 36670 313158554 THE ORGANIZATION OPERATES A 392-BED FULL SERVICE HOSPITAL AND EMPLOYED PHYSICIAN PRACTICES LOCATED IN COLUMBIA, MO. AS A REGIONAL REFERRAL CENTER LOCATED IN THE CENTER OF THE STATE, THE ORGANIZATION PROVIDES PROGRESSIVE HEALTHCARE PROGRAMS, SERVICES, AND TECHNOLOGY TO PEOPLE IN 25 MID-MISSOURI COUNTIES. FOR THE YEAR ENDED DECEMBER 31, 2022, THE ORGANIZATION PROVIDED CARE TO ITS COMMUNITY THROUGH 29,638 EMERGENCY DEPARTMENT VISITS, 9,246 SURGERY CASES AND 12,270 ADMISSIONS. 76981792 5800 36941680 THE ORGANIZATION OPERATES TWO PHYSICIAN SERVICE UNITS, CHAS PHYSICIAN SERVICES, LLC AND BOONE PHYSICIAN SERVICES, LLC. THE EMPLOYED PHYSICIANS PROVIDE CARE TO PATIENTS OF THE ORGANIZATION'S HOSPITAL AND VARIOUS CLINICS. -1706740 THE HEALTH SYSTEM PROVIDES CARE WITHOUT CHARGE TO PATIENTS MEETING CERTAIN CRITERIA UNDERITS CHARITY CARE POLICY. BECAUSE THE HEALTH SYSTEM DOES NOT PURSUE COLLECTION OF AMOUNTSDETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICEREVENUE AND IS INSTEAD AN OFFSET TO PATIENT SERVICE REVENUE. 351346484 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 178 0 2659 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRIAN WINN 5738158732 1600 E BROADWAY COLUMBIA MO 65201 JERRY KENNETT CHAIR 1.00 1.00 X X 0 0 0 RANDY MORROW BOARD MEMBER 1.00 1.00 X 0 0 0 JAN BECKETT SECRETARY 1.00 1.00 X X 0 0 0 GREG STEINHOFF TREASURER 1.00 1.00 X X 0 0 0 BOB MCDAVID VICE CHAIR 1.00 1.00 X X 0 0 0 CHARLES BONDURANT BOARD MEMBER 1.00 1.00 X 0 0 0 DIANNE LYNCH BOARD MEMBER 1.00 1.00 X 0 0 0 JUDY STARR BOARD MEMBER 1.00 1.00 X 0 0 0 GARY THOMPSON BOARD MEMBER 1.00 1.00 X 0 0 0 STAYCE SMITH BOARD MEMBER 1.00 1.00 X 0 0 0 WILLIAM ORSCHELN BOARD MEMBER 1.00 1.00 X 0 0 0 TROY GREER PRESIDENT/CEO 20.00 20.00 X 614636 0 52697 LAURA THOMAS CFO (TERM ENDED AUGUST 2022) 20.00 20.00 X 318841 0 8483 KATE PITZER HOSPITAL ADMINISTRATION/SECRETARY 40.00 0.00 X 257626 0 41000 CHAD PEW VP PROVIDER SERVICES 20.00 20.00 X 329753 0 46166 ED CLAYTON CFO 20.00 20.00 X 172678 0 37502 MICHELLE ZVANUT VP - HUMAN RESOURCES 40.00 0.00 X 278295 0 55216 KENYON WOODWARD CIO 40.00 0.00 X 310351 0 34663 ROBIN BLOUNT CMO 20.00 20.00 X 485384 0 55710 MONICA SMITH COO 20.00 20.00 X 394907 0 64009 RICHARD MELLITT CARDIOTHORACIC SURGEON 40.00 0.00 X 1088035 0 48468 JOSS FERNANDEZ CARDIOTHORACIC SURGEON 40.00 0.00 X 1073248 0 21310 TAREQ ABU SALAH PULMONOLOGIST 40.00 0.00 X 660653 0 50151 ANNE PETERSEN GENERAL SURGEON 40.00 0.00 X 718480 0 38404 REGGIE VADEN COLORECTAL SURGEON 40.00 0.00 X 664549 0 39232 7367436 0 593011 216 0 1 0 MEDEFIS PO BOX 5068 NEW YORK NY 10087 STAFFING AGENCY 25082608 MISSOURI CARDIOVASCULAR SPECIALISTS 1605 E BROADWAY STE 300 COLUMBIA MO 65201 CARDIOVASCULAR PHYSICIAN SERVICES 22516957 ENSEMBLE RCM LLC 11511 REED HARTMAN HIGHWAY CINCINATTI OH 45241 REVENUE CYCLE MANAGEMENT 12647898 MID AMERICA ANESTHESIA CONSULTANTS 1316 OLD HIGHWAY 63 SUITE 102 COLUMBIA MO 65201 ANESTHESIA PHYSICIAN SERVICES 5207742 HUBER & ASSOCIATES INC 1400 CREEK TRAIL DRIVE JEFFERSON CITY MO 65109 INFORMATION TECHNOLOGY SERVICES 4515958 52 7353216 7353216 PATIENT SERVICE REVENUE 621110 343819839 343819839 PHARMACY 456110 4017180 4017180 SHARED SERVICES 621110 556475 556475 348393494 359582 359582 5174 0 5174 5174 5174 60618 51514 9104 9104 9104 FOOD SERVICES 722514 1774972 1774972 OTHER REVENUE 624100 607514 607514 MANAGEMENT SERVICES 541610 9600 9600 2392086 358512656 348393494 0 2765946 X 42470 42470 3557917 2970861 587056 151979082 126902533 25076549 7078576 5910611 1167965 17747959 14819546 2928413 8769777 7322764 1447013 5786918 4832077 954841 993715 829752 163963 26186 21865 4321 21730 18145 3585 64903063 54194059 10709004 801336 669116 132220 5060752 4225728 835024 9635436 8045589 1589847 10567090 8823520 1743570 196751 164287 32464 3145751 2626593 519158 23228387 19395703 3832684 3149903 2630169 519734 MEDICAL SUPPLIES AND EQ 74727111 62397138 12329973 PHARMACEUTICALS AND VAC 22881045 19105673 3775372 REPAIRS AND MAINTENANCE 2352586 1964409 388177 MISCELLANEOUS EXPENSES 1815582 1516011 299571 2296844 1917865 378979 420765967 351346484 69419483 0 44499431 11322877 28322530 26104911 51452705 48623219 295592 316279 12766453 11567314 6343495 4777723 111970849 38963126 83606540 73007723 1377384 1430419 92286093 86188726 320950223 263339191 42891539 51253041 42489 42489 89967715 89654175 49987642 20245229 182889385 161194934 X 109738308 74255550 28322530 27888707 138060838 102144257 320950223 263339191 X -62253311 1783792 24552938 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 21730 21730 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES IS USED BY THE ASSOCIATIONS FOR LOBBYING ACTIVITIES. 15847095 4618659 11228436 800428 153800 646628 88590272 34190667 54399605 6733054 6733054 73007723 DUE FROM AFFILIATES 418058 OPERATING RIGHT OF USE ASSETS 85770668 86188726 SECTION 457 PLAN PAYABLE 1456502 DUE TO THIRD PARTY PAYORS 18788727 20245229 1 1 X 1 X 1 X 1 1 0 1 1 1733634 1733634 0.00410 27069293 18182289 8887004 0.02110 28802927 18182289 10620638 0.02520 218752 218752 0.00050 92649 92649 0.00020 76981793 37089856 39891937 0.09480 76890 76890 0.00020 77370084 37089856 40280228 0.09570 106173011 55272145 50900866 0.12090 323717 323717 0.00080 323717 323717 0.00080 1 20877472 4833460 99671759 104516503 -4844744 X 1 1 1 1 BOONE HOSPITAL CENTER 1600 E BROADWAY COLUMBIA MO 65201 WWW.BOONE.HEALTH 361-14 X X X BOONE HOSPITAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V FOR URL X 1 22 1 SEE PART V FOR URL 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE PART V FOR URL X SEE PART V FOR URL X SEE PART V FOR URL X X X X X X 1 X 0 X X X 1 X 0 0 BOONE HOSPITAL CENTER PART V, SECTION B, LINE 5: THE ORGANIZATION HELD A FORUM WITH 16 KEY STATEKHOLDERS OF THE COMMUNITY, INCLUDING RELIGIOUS LEADERS, MEMBERS OF THE HEALTH DEPARTMENT AND VARIOUS OTHER GROUPS THAT REPRESENT THE COMMUNITY. THE FOCUS GROUP REVIEWED THE COMMUNITY HEALTH NEED FINDINGS FROM THE 2019 CHNA AND PRIMARY DATA ON KEY HEALTH INDICATORS AND DISCUSSED CHANGES THAT HAD OCCURRED SINCE 2019. ADDITIONALLY, THE FOCUS GROUP REVIEWED GAPS IN MEETING NEEDS, AS WELL AS IDENTIFIED POTENTIAL COMMUNITY ORGANIZATIONS FOR BOONE HOSPITAL TO COLLABORATE WITH IN ADDRESSING NEEDS. BOONE HOSPITAL CENTER PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THREE MAJOR NEEDS: DIABETES, HEART DISESASE AND SKIN CANCER.TO ADDRESS THE DIABETES NEED, THE ORGANIZATION DETERMINED THE FOLLOWING OBJECTIVES:SCREEN 350 ADULTS EACH YEAR FOR GLUCOSE USING BOONE HEALTH'S MOBILE HEALTH UNIT. WE WILL ALSO PARTNER WITH OTHER LOCAL ORGANIZATIONS: BOONE COUNTY HEALTH DEPT., COMPASS HEALTH NETWORK - FAMILY HEALTH CENTER, THE ARC, AND OTHER COMMUNITY ORGANIZATIONS; PROVIDE INDIVIDUALS WITH ON-SITE EDUCATION AND MATERIALS TO INCREASE THEIR KNOWLEDGE OF HEALTHY LIFESTYLE CHANGES TO HELP MANAGE THEIR CONDITION.TO ADDRESS THE HEART DISEASE NEED, THE ORGANIZATION DETERMINED THE FOLLOWING OBJECTIVES:SCREEN 350 ADULTS FOR HIGH BLOOD PRESSURE USING BOONE HEALTH'S MOBILE HEALTH UNIT. WE WILL ALSO PARTNER WITH OTHER LOCAL ORGANIZATIONS: BOONE COUNTY HEALTH DEPT., COMPASS HEALTH NETWORK - FAMILY HEALTH CENTER, THE ARC, AND OTHER COMMUNITY ORGANIZATIONS; PROVIDE INDIVIDUALS WITH ON-SITE EDUCATION AND MATERIALS TO INCREASE THEIR KNOWLEDGE OF HEALTHY LIFESTYLE CHANGES TO HELP MANAGE THEIR CONDITION.TO ADDRESS THE SKIN CANCER NEED, THE ORGANIZATION DETERMINED THE FOLLOWING OBJECTIVES:SCREEN 150 ADULTS EACH YEAR FOR SKIN CANCER USING BOONE HEALTH'S MOBILE HEALTH UNIT. WE WILL ALSO PARTNER WITH OTHER LOCAL ORGANIZATIONS: BOONE COUNTY HEALTH DEPT., COMPASS HEALTH NETWORK - FAMILY HEALTH CENTER, THE ARC, AND OTHER COMMUNITY ORGANIZATIONS; PROVIDE INDIVIDUALS WITH ON-SITE EDUCATION AND MATERIALS TO INCREASE THEIR KNOWLEDGE OF HEALTHY LIFESTYLE CHANGES TO HELP MANAGE THEIR CONDITION. PART V, LINE 16A FINANCIAL ASSISTANCE POLICY WEBSITE:HTTPS://BOONE.HEALTH/WP-CONTENT/UPLOADS/2021/03/BOONEHEALTH_FAP_2021_FINAL-APPROVED.PDF PART V, LINE 16B FINANCIAL ASSISTANCE APPLICATION WEBSITE:HTTPS://BOONE.HEALTH/WP-CONTENT/UPLOADS/2021/03/BOONE_FA_APPLICATION_2021.PDF PART B, LINE 16C PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://BOONE.HEALTH/PATIENTS-VISITORS/BEFORE-AFTER-YOUR-VISIT/BILLING-AND-INSURANCE/ SCHEDULE H, PART V, SECTION B, LINE 7A THE ORGANIZATION'S 2022 COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT:HTTPS://BOONE.HEALTH/WP-CONTENT/UPLOADS/2023/01/CHNA-REPORT-2022-FINAL.PDF SCHEDULE H, PART V, SECTION B, LINE 10A THE ORGANIZATION'S 2022 IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://BOONE.HEALTH/WP-CONTENT/UPLOADS/2023/01/CHNA-REPORT-2022-FINAL.PDF 30 1 - BHMG - ASHLAND 605 C DOUGLAS DRIVE ASHLAND MO 65010 MEDICAL CLINIC 2 - BHMG - BOONVILLE 606 EAST SPRING STREET BOONVILLE MO 65233 MEDICAL CLINIC 3 - BHMG - CENTRAL 1605 EAST BORADWAY SUITE 110 COLUMBIA MO 65201 MEDICAL CLINIC 4 - BHMG - CENTRALIA 1021 EAST HIGHWAY 22 CENTRALIA MO 65240 MEDICAL CLINIC 5 - BHMG - GLASGOW 108 MARKET STREET GLASGOW MO 65254 MEDICAL CLINIC 6 - BHMG - HALLSVILLE 501 NORTH BOUTE B HALLSVILLE MO 65255 MEDICAL CLINIC 7 - BHMG - MEXICO 1051 OLD FARM ROAD EAST MEXICO MO 65265 MEDICAL CLINIC 8 - BHMG - MEXICO MEDICAL PARK 600 MEDICAL PARK DRIVE MEXICO MO 65265 MEDICAL CLINIC 9 - BHMG - MOBERLY 300 N MORLEY STREET SUITE A-C MOBERLY MO 65270 MEDICAL CLINIC 10 - BHMG - OSAGE BEACH 931 D HIGHWAY OSAGE BEACH MO 65065 MEDICAL CLINIC 11 - BHMG - SOUTH 900 W NIFONG BLVD SUITE 101 COLUMBIA MO 65203 MEDICAL CLINIC 12 - BHMG - RHEMATOLOGY 900 W NIFONG BLVD SUITE 101 COLUMBIA MO 65203 MEDICAL CLINIC 13 - BHMG - CONVENIENT CARE - PARKADE 601 BUSINESS LOOP 70 WEST SUITE 275 COLUMBIA MO 65203 MEDICAL CLINIC 14 - BHMG - NIFONG CONVENIENT CARE 900 W NIFONG BLVD SUITE 100 COLUMBIA MO 65203 MEDICAL CLINIC 15 - BHMG - PULMONARY AND SLEEP MEDICINE 1705 E BROADWAY SUITE 280 COLUMBIA MO 65201 MEDICAL CLINIC 16 - BHMG - HEART SURGERY 1605 E BROADWAY SUITE 210 COLUMBIA MO 65201 MEDICAL CLINIC 17 - BHMG - MID MO NEUROSURGERY 1605 E BROADWAY SUITE 100 COLUMBIA MO 65201 MEDICAL CLINIC 18 - BHMG - HOSPITALISTINTENSIVIST 1605 E BROADWAY COLUMBIA MO 65201 HOSPITAL BASED PRACTICE 19 - BHMG - DIABETES AND ENDOCRINOLOGY 1701 E BROADWAY SUITE 302 COLUMBIA MO 65201 MEDICAL CLINIC 20 - BHMG - SURGERY 1601 E BROADWAY SUITE 240 COLUMBIA MO 65201 MEDICAL CLINIC 21 - BHMG - PODIATRY 1705 E BROADWAY SUITE 280 COLUMBIA MO 65201 MEDICAL CLINIC 22 - BHMG - INFECTIOUS DISEASE 1705 E BROADWAY SUITE 280 COLUMBIA MO 65201 MEDICAL CLINIC 23 - BHMG - PLASTIC SURGERY 1601 E BROADWAY SUITE 260 COLUMBIA MO 65201 MEDICAL CLINIC 24 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 1605 E BROADWAY SUITE 300 COLUMBIA MO 65201 MEDICAL CLINIC 25 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 606 E SPRING STREET BOONVILLE MO 65233 OUTREACH MEDICAL CLINIC 26 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 130 E LOCKLING AVE BROOKFIELD MO 64628 OUTREACH MEDICAL CLINIC 27 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 1241 W STADIUM BLVD 2ND FLOOR JEFFERSON CITY MO 65109 OUTREACH MEDICAL CLINIC 28 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 404 PROVIDENCE ROAD MACON MO 63552 OUTREACH MEDICAL CLINIC 29 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 2303 S HIGHWAY 65 MARSHALL MO 65340 OUTREACH MEDICAL CLINIC 30 - CHAS PHYSICIAN SERVICES LLC (MO HEART) 300 N MORLEY STREET MOBERLY MO 65270 OUTREACH MEDICAL CLINIC PART I, LINE 3C: FINANCIAL ASSISTANCE IS BASED ON THE PATIENT'S INCOME LEVEL, WHICH IS VERIFIED THROUGH PAY STUBS, SOCIAL SECURITY AWARDS LETTERS, SELF-EMPLOYMENT LEDGERS AND OTHER FINANCIAL RECORDS FOR THE PRECEDING THREE MONTHS. PART I, LINE 7: CHARITY CARE COST IS BASED ON THE TOTAL COST TO CHARGE RATIO DERIVED FROM THE MEDICARE COST REPORT FOR SERVICES PROVIDED TO PATIENTS. PART I, LINE 7G: COSTING METHODOLOGY:THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. COST COMPUTED ON IRS WORKSHEET 6 WAS COMPUTED FROM THE MEDICARE COST REPORT AND DEPARTMENT FINANCIAL STATEMENTS, USING SPECIFIC FINANCIAL DATA FOR EACH TYPE OF SUBSIDY. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION PARTICIPATES IN CAREER DAYS TO EDUCATE STUDENTS ABOUT THE MEDICAL FIELD AND GENERATE MEDICAL PROFESSIONALS FOR THE FUTURE IN THE COMMUNITY. THE ORGANIZATION ALSO SUPPORTS MARATHONS AND OTHER ACTIVITIES TO ENCOURAGE A HEALTHIER OVERALL LIFESTYLE FOR COMMUNITY MEMBERS, AND IT ALSO PROVIDES DISASTER PREPARED PROGRAMS AND AMBULANCES TO LOCAL EVENTS IN ORDER TO ENSURE AND ENHANCE THE COMMUNITY'S WELLBEING IN THE EVENT OF AN EMERGENCY. PART III, LINE 2: METHODOLOGY IS CALCULATED ON A/R BALANCE BY PAYOR AND BASED HISTORICAL RESULTS. SELF PAY PATIENTS RECEIVE A 40% DISCOUNT WHICH IS ADJUSTED TO CONTRACTUAL. IF THE ACCOUNT IS BAD DEBT, THE ORGANIZATION ONLY EXPENSES 60% TO BAD DEBT EXPENSE. PART III, LINE 3: THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING THE MEDICARE COST REPORT. PART III, LINE 4: FOOTNOTE #3 IS LOCATED ON PAGES 12-16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS AND BRIEFLY DESCRIBES THE PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS. BAD DEBT IS LISTED AS A DEDUCTION FROM REVENUE. THIS TREATEMENT IS CONSISTENT WITH THE HFMA PRINCIPLES AND PRACTICES BOARD STATEMENT NO. 15 AND WITH THE AICPA AUDIT AND ACCOUNTING GUIDE FOR HEALTHCARE ORGANIZATIONS. PART III, LINE 8: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6, WHICH ONLY REFLECTS HOSPITAL FACILITY ACTIVITY AND PAYMENTS FROM CMS AGENTS. WHEN SEQUESTRATION WITHHOLDINGS, COSTS AND PAYMENTS FOR MEDICARE ADVANTAGE PLAN PATIENTS, AND PHYSICIAN AND CLINIC SERVICES AND PAYMENTS ARE ALSO CONSIDERED, THE SHORTFALL BECOMES SIGNIFICANT. PART III, LINE 9B: IN THE EVENT OF NON-PAYMENT OF SERVICES (DISCOUNTED OR FULL RATE), THE ORGANIZATION MAY TAKE EXTRAORDINARY ACTIONS TO PURSUE COLLECTIONS, INCLUDING BUT NOT LIMITED TO; REFERRING THE ACCOUNT TO OUTSIDE COLLECTIONS AGENCIES, ADVERSE CREDIT REPORTING, AND/OR LEGAL ACTION, PURSUANT TO BOONE'S BILLING AND COLLECTIONS POLICY. A FREE COPY OF THE BILLING AND COLLECTIONS POLICY IS AVAILABLE BY REQUEST FROM PATIENT BUSINESS SERVICES 888-538-1535. PART VI, LINE 2: IN ADDITION TO ITS COMMUNITY INVOLVEMENT EFFORTS RELATED TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION'S BOARD OF DIRECTORS CONSISTS OF FIVE PUBLICLY ELECTED OFFICIALS AND SIX STRATEGICALLY SELECTED MEMBERS TO REPRESENT THE VARYING INTERESTS OF THE COMMUNITY, AND MULTIPLE HOSPITAL LEADERS SERVE ON VARIOUS BOARDS FOR OTHER ORGANIZATIONS ADDRESSING COMMUNITY NEEDS. PART VI, LINE 3: WHEN A PATIENT INQUIRES ABOUT FINANCIAL ASSISTANCE, THEY ARE GIVEN ALL INFORMATION REGARDING THE ORGANIZATION'S FAP. PART VI, LINE 4: THE ORGANIZATION IS LOCATED IN BOONE COUNTY IN THE CITY OF COLUMBIA, MISSOURI, THE COUNTY SEAT AND LARGEST CITY IN BOONE COUNTY. BOONE COUNTY HAS A POPULATION OF 179,704 (2020 CENSUS). THE POPULATION EXPERIENCED A 12.89 PERCENT INCREASE FROM 2010 TO 2020, A SIGNIFICANT GROWTH FOR THE COUNTY.AT THE TIME OF THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSEMENT, BOONE COUNTY HAD THE FOLLOWING DEMOGRAPHIC INFORMATION:51.5 PERCENT FEMALE48.5 PERCENT MALE80.4 PERCENT WHITE8.9 PERCENT AFRICAN AMERICAN4.4 PERCENT ASIAN3.5 PERCENT HISPANIC OR LATINO4.8 PERCENT TWO OR MORE RACES0.4 PERCENT AM. INDIAN & ALASKA NAT.0.1 PERCENT NATIVE HAW. & OTHER P.I. PERSONS 65 YEARS AND OVER IN THE COUNTY TOTALED 12.3 PERCENT COMPARED TO 16.9 PERCENT IN THE STATE. 94.6 PERCENT OF THE POPULATION 25 AND OLDER HAD A HIGH SCHOOL DIPLOMA COMPARED TO 90.6 PERCENT THE STATE. 47.7 PERCENT OF THE POPULATION 25 AND OLDER HAD A BACHELOR'S DEGREE WHEN COMPARED TO 29.9 PERCENT IN THE STATE. THE MEDIAN INCOME OF HOUSEHOLDS IN THE COUNTY AT $58,000 WAS SLIGHTLY HIGHER THAN THE STATE MEDIAN AVERAGE OF $57,400. WITH AN ESTIMATED POVERTY RATE OF 16.7 PERCENT, BOONE COUNTY HAD A HIGHER PERCENTAGE OF PERSONS LIVING IN POVERTY THAN MISSOURI (13.0 PERCENT). WHILE THIS HIGHER POVERTY RATE MIGHT BE ATTRIBUTABLE TO THE SUB-POPULATION OF COLLEGE STUDENTS WHO EARN LESS INCOME, IT IS IMPORTANT NOT TO OVERLOOK FAMILIES WHO LIVE BELOW THE POVERTY LEVEL. PART VI, LINE 5: THE ORGANIZATION PROVIDES VARIOUS HEALTH SCREENINGS TO MEMBERS OF THE COMMUNITY AT REDUCED COST OR NO COST. PRESENTATIONS AND EDUCATIONAL MATERIALS ARE ALSO MADE TO IMPROVE THE GENERAL HEALTH KNOWLEDGE OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES MO 1 COLUMBIA PUBLIC SCHOOLS 1818 WEST WORLEY COLUMBIA MO 65203 436000318 GOVERNMENT 20000 0 ATHLETICS AND ACTIVITIES INITIATIVE AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 10000 0 OPERATING SUPPORT 2 PART I, LINE 2: SPONSORSHIPS ARE EVALUATED BY THE DIRECTOR OF MARKETING AND COMMUNITY WELLNESS AND THE CEO OF BOONE HEALTH. WE LOOK TO PARTNER WITH ESTABLISHED, REPUTABLE ORGANIZATIONS THAT SUPPORT OUR MISSION OF IMPROVING THE HEALTH OF PEOPLE AND COMMUNITIES WE SERVE. WE TYPICALLY PARTICIPATE IN THE EVENTS THAT WE SPONSOR TO CONFIRM THAT THE AUDIENCE AND BENEFIT PROVIDED MEETS THE ESTABLISHED GOALS. X X 0 1 0 0 0 0 0 0 0 RICHARD MELLITT CARDIOTHORACIC SURGEON 969184 0 118851 0 0 0 27000 0 21468 0 1136503 0 0 0 JOSS FERNANDEZ CARDIOTHORACIC SURGEON 914422 0 158826 0 0 0 20500 0 810 0 1094558 0 0 0 ANNE PETERSEN GENERAL SURGEON 681244 0 37236 0 0 0 20500 0 17904 0 756884 0 0 0 TAREQ ABU SALAH PULMONOLOGIST 411462 0 249191 0 0 0 20500 0 29651 0 710804 0 0 0 REGGIE VADEN COLORECTAL SURGEON 629116 0 35433 0 0 0 27000 0 12232 0 703781 0 0 0 TROY GREER PRESIDENT/CEO 613636 0 1000 0 0 0 24840 0 27857 0 667333 0 0 0 ROBIN BLOUNT CMO 355197 0 130187 0 0 0 46500 0 9210 0 541094 0 0 0 MONICA SMITH COO 303907 0 91000 0 0 0 36277 0 27732 0 458916 0 0 0 CHAD PEW VP PROVIDER SERVICES 272337 0 57416 0 0 0 20151 0 26015 0 375919 0 0 0 KENYON WOODWARD CIO 227228 0 83123 0 0 0 34220 0 443 0 345014 0 0 0 MICHELLE ZVANUT VP - HUMAN RESOURCES 201728 0 76567 0 0 0 37800 0 17416 0 333511 0 0 0 LAURA THOMAS CFO (TERM ENDED AUGUST 2022) 280941 0 37900 0 0 0 4496 0 3987 0 327324 0 0 0 KATE PITZER HOSPITAL ADMINISTRATION/SECRETARY 210765 0 46861 0 0 0 41000 0 0 0 298626 0 0 0 ED CLAYTON CFO 162678 0 10000 0 0 0 26794 0 10708 0 210180 0 0 0 PART I, LINE 4B CONTRIBUTIONS TO A 457(F) PLAN WERE MADE BY THE ORGANIZATION FOR THE FOLLOWING PERSONS: MICHELLE ZVANUT - $9,970 MONICA SMITH - $14,193 ROBIN BLOUNT - $16,552 TROY GREER - $20,500 KENYON WOODWARD - $11,076 CHAD PEW - $10,500 EDWARD CLAYTON - $3,308 DISTRIBUTIONS FROM A 457(F) PLAN WERE TAKEN FOR THE FOLLOWING PERSONS: TROY GREER - $18,174 MICHELLE ZVANUT - $10,767 MONICA SMITH - $15,381 ROBIN BLOUNT - $19,687 KENYON WOODWARD - $11,024 MISSOURI CARDIOVASCULAR SPECIALISTS PRACTICE OF BOARD MEMBER JERRY KENNETT 22516957 PSA PAYMENTS 0 MID MO NEURO SURGERY PRACTICE OF BOARD MEMBER CHARLES BONDURANT 1946073 PSA PAYMENTS 0 FORM 990, PART VI, SECTION A, LINE 1A THE ORGANIZATION HAS ESTABLISHED AN EXECUTIVE COMMITTEE, WHICH CONSISTS OF THE CHAIR, VICE CHAIR, SECRETARY, TREASURER AND UP TO ONE OTHER BOARD MEMBER. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO TRANSACT ROUTINE BUSINESS OF THE ORGANIZATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT SUCH ACTIONS TAKEN SHALL BE CONSISTENT WITH AND NOT CONFLICT WITH ANY ACTIONS OR POLICIES OF THE BOARD OF DIRECTORS, THE ORGANIZATION'S BYLAWS OR APPLICABLE LAW. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE ARE PROMPTLY REPORTED TO THE BOARD OF DIRECTORS AT THE NEXT MEETING, AND THE EXECUTIVE COMMITTEE KEEPS REGULAR MINUTES OF ITS PROCEEDINGS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS BOONE HEALTH, INC., A MISSOURI NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THIS ORGANIZATION'S BOARD OF DIRECTORS SHALL AT ALL TIMES BE THOSE PERSONS WHO SERVE FROM TIME TO TIME ON THE BOARD OF DIRECTORS OF THE SOLE MEMBER, AND ANY APPOINTMENT, TERM, ELECTION, RESIGNATION, REMOVAL, OR VACANCY ON THE SOLE MEMBER'S BOARD OF DIRECTORS SHALL AUTOMATICALLY AND SIMULTANEOUSLY HAVE AN IDENTICAL EFFECT ON THIS ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF TRUSTEES OF BOONE COUNTY HOSPITAL RESERVES THE AUTHORITY TO APPROVE OF THE FOLLOWING ACTIONS BEFORE THEY ARE UNDERTAKEN: ANY CHANGE OR MODIFICATION TO THE PURPOSE OF THE ORGANIZATION; ANY TERMINATION, AMENDMENT, OR MODIFICATION TO THE LEASE; THE INCURRENCE OF DEBT FOR THE CORPORATION OR THE HEALTH SYSTEM THAT IS COLLATERALIZED BY THE HOSPITAL, THE HEALTHCARE FACILITIES LOCATED ON THE CAMPUS OF THE HOSPITAL, OR IS OTHERWISE OWNED BY THE TRUSTEES OR THE COUNTY (COLLECTIVELY, THE "FACILITIES") AND/OR ANY REVENUE OF THE HOSPITAL OR THE FACILITIES (OTHER THAN ANY EXISTING BONDS ISSUED FOR THE BENEFIT OF THE HOSPITAL OR THE FACILITIES; ANY ACTION EXPECTED TO AFFECT THE TAX-EXEMPT STATUS OF THE CORPORATION OR ANY OTHER TAX-EXEMPT SUBSIDIARY OF THE CORPORATION WHILE THERE IS ANY TAX-EXEMPT DEBT OUTSTANDING, THE PROCEEDS OF WHICH FINANCED OR REFINANCED ALL OR ANY PORTION OF THE HOSPITAL OR THE FACILITIES, ANY ACTION THAT COULD AFFECT THE TAX-EXEMPT STATUS OF ANY ENTITY OWNING OR OPERATING THE HOSPITAL OR THE FACILITIES THAT ARE OBLIGATED ON SUCH DEBT, OR ANY ACTION THAT COULD ADVERSELY AFFECT THE TAX-EXEMPT STATUS OF SUCH DEBT; ANY ACTION SUBJECT TO ANY RIGHTS VESTED TO THE TRUSTEES UNDER CHAPTER 205 REVISED MISSOURI STATUTES, SECTION 160 ET SEQ., AS SUCH ACT MAY BE AMENDED, MODIFIED, SUPPLEMENTED, CONSOLIDATED, OR REPLACED FROM TIME TO TIME; OR ANY ACTION REQUIRED TO ENSURE THE TRUSTEES' COMPLIANCE WITH ANY OF ITS OBLIGATIONS UNDER ANY INDENTURE, LOAN AGREEMENT, COVENANT AGREEMENT, DISCLOSURE AGREEMENT, TAX AGREEMENT, OR SIMILAR AGREEMENT RELATING TO OUTSTANDING INDEBTEDNESS SECURED BY ALL OR ANY PORTION OF THE HOSPITAL OR THE FACILITIES OR REVENUE OF THE HOSPITAL OR THE FACILITIES. FORM 990, PART VI, SECTION B, LINE 11B A INTIAL, DETAILED REVIEW OF THE FORM 990 IS CONDUCTED BY THE EXECUTIVE DIRECTOR OF FINANCE. A CURSORY REVIEW WILL THEN BE COMPLETED BY THE CHIEF FINANCIAL OFFICER, LEGAL COUNSEL AND DIRECTOR OF FINANCE BEFORE IT IS PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ALL PERSONNEL OF THE ORGANIZATION AT THE DIRECTOR LEVEL OR ABOVE (INCLUDING KEY EMPLOYEES) COMPLETE AN ANNUAL SURVERY TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE ORGANIZATION'S RISK MANAGEMENT GROUP REVIEWS THE SURVEYS AND MONITORS ANY ITEMS THAT MAY LEAD TO A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION UTILIZES AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE STANDARD BASE RATES FOR THE CEO AND OTHER OFFICERS. AN INCENTIVE PLAN, WHICH IS BASED ON ORGANIZATIONAL PERFORMAION AS COMPARED TO KEY PERFORMANCE INDICATORS CHOSEN PRIOR TO THE FISCAL YEAR, IS ALSO DETERMINED BY THE INDEPENDENT COMPENSATION CONSULTANT. THE BOARD OF DIRECTORS MUST THEN APPROVE THE BASE RATE AND INCENTIVE PLAN FOR THE ORGANIZATION'S CEO. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION PROVIDES THESE FORMS UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART IX, LINE 11G PURCHASED PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 6,573,998. MANAGEMENT AND GENERAL EXPENSES 1,299,053. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,873,051. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 3,321,282. MANAGEMENT AND GENERAL EXPENSES 656,301. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,977,583. JANITORIAL AND HOUSKEEPING CONTRACTS: PROGRAM SERVICE EXPENSES 203,435. MANAGEMENT AND GENERAL EXPENSES 40,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 243,635. CONSULTING FEES: PROGRAM SERVICE EXPENSES 110,369. MANAGEMENT AND GENERAL EXPENSES 21,809. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,178. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 40,790,755. MANAGEMENT AND GENERAL EXPENSES 8,060,449. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,851,204. ANSWERING SERVICE: PROGRAM SERVICE EXPENSES 49,383. MANAGEMENT AND GENERAL EXPENSES 9,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,141. COLLECTIONS SERVICE: PROGRAM SERVICE EXPENSES 2,220. MANAGEMENT AND GENERAL EXPENSES 439. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,659. COURIER SERVICE: PROGRAM SERVICE EXPENSES 227,421. MANAGEMENT AND GENERAL EXPENSES 44,939. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 272,360. LAB FEES: PROGRAM SERVICE EXPENSES 11,020. MANAGEMENT AND GENERAL EXPENSES 2,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,198. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 2,434,739. MANAGEMENT AND GENERAL EXPENSES 481,116. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,915,855. SECURITY: PROGRAM SERVICE EXPENSES 406. MANAGEMENT AND GENERAL EXPENSES 80. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 486. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 371,360. MANAGEMENT AND GENERAL EXPENSES 73,382. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 444,742. FOOD SERVICES: PROGRAM SERVICE EXPENSES 97,671. MANAGEMENT AND GENERAL EXPENSES 19,300. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,971. FORM 990, PART XI, LINE 9: ASSET TRANSFERS FROM BOARD OF TRUSTEES 24,969,240. NET AMORTIZATION OF CONTRIBUTED RENT -433,823. TRANSFER OF NET ASSETS FROM AFFILIATE 17,521. FORM 990, PAGE 12, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CHAS PHYSICIAN SERVICES LLC 1600 E BROADWAY COLUMBIA MO 65201 320275207 PHYSICIAN SERVICES MO 10880421 2168156 CH ALLIED SERVICES INC BOONE PHYSICIAN SERVICES LLC 1600 E BROADWAY COLUMBIA MO 65201 460552280 PHYSICIAN SERVICES MO 26209435 5531480 CH ALLIED SERVICES INC BOONE HOSPITAL CENTER'S VISITING NURSES INC 1600 E BROADWAY COLUMBIA MO 65201 430998347 HOME HEALTH AND HOSPICE MO 501(C)(3) LINE 12A, I CH ALLIED SERVICES INC 1 BOONE HEALTH INC 1600 E BROADWAY COLUMBIA MO 65201 850769204 HOSPITAL GOVERNANCE MO 501(C)(3) LINE 12C, III-FI 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0