2022-04-25T08:44:10-07:00 2021-06-30 990 2020-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325000 1125 Madison Street Jefferson City MO 65101 Tom Luebbering Vice President of Finance 5736325101 2022-04-25 1 11 1 AAL2 2020 2022-09-23 18:48:47Z Tom Luebbering 1432 Southwest Blvd Jefferson City MO 65109 245307061 0 X crmc.org X 1945 MO Capital Region Medical Center embraces its mission: To improve health and promote wellness in the communities we serve. 12 10 1846 50 1445290 0 175787 299637 215561987 233252025 418235 11755399 0 0 216156009 245307061 0 0 0 0 103993755 109635091 0 0 156006 114243280 127077923 218237035 236713014 -2081026 8594047 219577401 246856940 75722609 93457632 143854792 153399308 Capital Region Medical Center embraces its mission; To imporove the health and promote wellness in the communities we serve. 0 0 10347014 0 0 Inpatient and Outpatient Charity Care: Capital Region Medical Center serves the community by providing medical care to all patients regardless of their ability to pay. Patients who qualify for charity care will be identified as soon as possible, either before the services are provided or after an individual has received services to stabilize their medical condition. If it is difficult to determine a patient's eligibility for charity care prior to providing the service, the determination should be made as soon as possible after the provision of the service. Upon registration, patients without Medicare/Medicaid, adequate health insurance or other local health care financial assistance will receive either a packet of information that addresses the financial assistance policy and procedures or immediate financial counseling assistance from staff within established business hours. The packet of information will clearly indicate that CRMC provides care without regard to ability to pay, to individuals with limited financial resources and explain how patients apply for financial assistance. CRMC provides a variety of services ranging from emergency services to inpatient and outpatient elective surgery, diagnostic testing and education programs. Charity care policies and procedures are in place to address any instances in which patients may access services. 1793752 0 831045 Support of Medical Education - In 1952 CRMC entered into the teaching and training of physicians with programs to teach medical students and interns. Today CRMC serves as the primary clinical training site for one of the two Family Medicine Residency Programs sponsored by the University of Missouri-Columbia School of Medicine. CRMC also serves as a clinical training site for other specialty Residency Programs sponsored by the University of Missouri-Columbia School of Medicine. In addition medical students from the Kirksville College of Osteopathic Medicine and University of Health Sciences located in Kansas City schools of Medicine complete clinical rotations at CRMC. Capital Region Medical Center supports Lincoln University School of Nursing program, Columbia College Nursing Program, Missouri State University and Drury University; RN, BSN and MSN from Central Missouri State, Central Methodist, LPN and RN at State Tech; Social Work and Case Management students from MU and Lincoln; MSN students from St. Louis University, UMKC, Maryville, Chamberlain College, Frontier Nursing; Graceland, Herzing, Vanderbilt, University of Southern Alabama, New York International University. and Walden University in Family Nurse Practitioner clinicals for which we provide the preceptors/clinical supervisors as well as the facilities. CRMC assists Stephens College, Bell-Brown College, and State Fair College with Registered Medical Assistants; Stephens College and the University of North Dakota Physician's Assistant programs and local schools for Paramedic and EMT training. CRMC also assists State Tech for Radiology. Dietary students from Herzing University, Keiser University, UMC and UMSL, as well as assistance to the University of Missouri dietetics program. In addition to the direct financial support that Capital Region provides, we also provide support to Columbia College MSN students and Lincoln University School of Nursing BSN program in leadership training. We assist students from Rolla Technical College and Columbia Technical College in the surgical tech program. CRMC provides training to phlebotomist/tech students from Moberly Community College to assist them with fulfilling their clinical requirements. CRMC provides oversight and mentoring to the St. Louis College of Pharmacy, University of Missouri-Columbia and Kansas City Pharmacy Programs. We provide support to St. Louis University and University of Missouri-Columbia PT and Kansas City and State Tech PTA, OTA and Speech Therapy programs. Our support for these programs in not only through the provision of training facilities but also adjunct faculty and resources. 265613 75000 Community Health Resident Clinic: CRMC provides Residents and Physician Supervisors to staff the Community Health Center clinic. In addition to providing a valuable training tool for the medical students, the resident clinic serves a unique community benefit by providing over 2160 patient visits from the eight county service area. The charge for service is based on the individual's ability to pay, which in many cases is free. 202948100 0 0 All other inpatient and outpatient services provided to patients. 202948100 0 0 215354479 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 185 0 1 1846 1 1 1 0 0 0 0 0 0 0 X 12 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Tom Luebbering 5736325101 1432 Southwest Blvd Jefferson City MO 65109 Mitchell Godbee Physician 40 0 X 1405034 0 72703 Sharmilla Suri-Mohanram Physician 40 0 X 850683 0 27863 Scott Anderson Physician 40 0 X 634668 0 60771 Dennis Luetkemeyer Physician 40 0 X 615691 0 58260 Adam Patterson physician 40 0 X 601653 0 59509 Gaspare Calvaruso President 40 0 X 446110 0 56272 Diane Light Board Member/Physician 40 0 X 391187 0 46467 Randall Haight Vice President/Physician 40 0 X 346522 0 55419 Janet Weckenborg Vice President 40 0 X 277582 0 42925 Thomas Luebbering Vice President 40 0 X 265997 0 48788 Michelle Barg Vice President/Physician 40 0 X 280088 0 20611 Lisa Kolb Waggoner Board Member/Physician 40 0 X 235988 0 53959 Sarah Morrow Vice President 40 0 X 216877 0 32249 Glenda Dahlstrom Vice President 40 0 X 198614 0 39239 Ted Brandt - Paid by Univ of MO Vice President 40 0 X 204023 0 26155 Belynda Imhoff - Paid by Cerner Vice President 40 0 X 177064 0 13200 Ted Brandt - CRMC Vice President 40 0 X 11992 0 0 Beylnda Imhoff - CRMC Vice President 40 0 X 7978 0 0 Carlos Graham Vice Chair 2.50 0 X 0 0 0 Lorilei Schwartz Board Member 2.50 0 X 0 0 0 Stevan Whitt Board member 2.50 0 X 0 0 0 Marc Ellinger Chairman 2.50 0 X 0 0 0 Mary Beck Board Member 2.50 0 X 0 0 0 David Minton Treasurer 2.50 0 X 0 0 0 Jonathan Curtright Board member 2.50 0 X 0 0 0 Phillip Burger Secretary 2.50 0 X 0 0 0 Kristina Naught Board member 2.50 0 X 0 0 0 Frank Burkhead Board member 2.50 0 X 0 0 0 7167751 0 714390 132 0 1 1 Cerner Corporation 2800 Rockcreek Parkway Kansas City MO 641172551 Computer Management and Support 7538770 University of Missouri One Hospital Drive Columbia MO 65201 Physician and Professional Services 3539894 Quest Diagnostics PO Box 772976 Chicago IL 606770276 lab testing 3272059 Inpatient Consultants of MO Inc PO Box 844929 Los Angeles CA 900844929 Physician Service 2211434 Aya Healthcare PO Box 123519 Dept 3519 Dallas TX 753123519 Contract Nursing Services 1904369 84 0 0 0 299637 0 0 0 299637 Net Patient Service Revenue 622110 220092239 218708817 1383422 0 Other Revenue 900099 13159786 13159786 0 0 0 0 0 0 233252025 11744068 11682200 61868 0 3974 0 0 3974 0 0 0 0 0 0 0 7357 0 0 0 7357 7357 0 0 7357 0 0 245307061 243550803 1445290 11331 X 0 0 0 0 0 0 0 0 3054893 2749404 305489 0 0 0 0 0 90742207 81131539 9518225 92443 1586669 1452278 134391 0 8634086 7744743 872016 17327 5617236 5141456 475780 0 0 0 0 0 181145 141004 40141 0 151551 117968 33583 0 0 0 0 0 0 0 0 0 0 0 27412581 21337953 6066560 8068 260830 203014 57816 0 233900 214090 19810 0 8214469 7101570 1112899 0 0 0 0 0 674214 617111 57103 0 0 0 0 0 0 0 0 0 215138 196917 18221 0 1103682 959706 141632 2344 0 0 0 0 11153764 9946446 1187665 19653 1610213 1473836 136377 0 Supplies and Medical Supplies 61605633 61362458 227004 16171 Repairs/Maintenance and Utilities 5973618 5467681 505937 0 FRA Tax 4841079 4841079 0 0 Rent Expense 904123 827548 76575 0 2541983 2326678 215305 0 236713014 215354479 21202529 156006 0 0 24497370 23587724 0 0 25093101 29687875 0 0 0 0 0 0 4927152 5621592 4149594 4197690 277530277 199905564 83019650 77624713 67357877 78162095 0 0 0 10532657 27975251 219577401 246856940 33545274 35208417 0 0 0 0 33981367 47632303 0 0 0 0 0 0 0 0 8195968 10616912 75722609 93457632 X 139697029 147844252 4157763 5555056 143854792 153399308 219577401 246856940 X 8594047 -302720 0 0 0 1253189 X 1 X 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 46603 46603 0 Schedule C, Part II-B, Line 1 CRMC is a member of Missouri Hospital Association. Just one of the benefits of membership is that MHA communicates with government on issues that are important to Missouri hospitals. A portion of the annual dues (32.4% - $46,602.69) is attributable to lobbying. 11016621 0 11016621 161310484 0 121026197 40284287 2584238 0 1875270 708968 102618934 0 77004097 25614837 0 0 0 0 77624713 Interest in net assets of Capital Region Medical Foundation 5555056 Long-term receivable and other noncurrent assets 8580432 Intangible assets, net 13839763 27975251 0 Capital Leases Payable 773774 Other Long Term Debt 941104 457(b) Payable 5042572 Insurance Payable 1733169 Malpractice Liability 2126293 10616912 X 245007424 0 0 0 0 0 245007424 0 299637 299637 245307061 236849761 0 0 0 136747 136747 236713014 0 0 0 236713014 Schedule D, Part X, Line 2 Because CRMC did not have any tax liabilities, the wording is silent. Footnote 1 would have disclosed this if it was applicable. Income Taxes: The Medical Center has been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However, the Medical Center is subject to federal income tax on any unrelated business taxable income. Schedule D, Part XI, Line 4b Contributions for capital acquisitions 299627 Schedule D, Part XII, Line 2d Fundraising (Foundation Expenses) 144,104 - Gain on Sale of Assets 7357 1 1 X 1 X 1 X 1 1 1 0 0 0 0 3320178 0 3320178 0.014 18825049 13728581 5096468 0.0215 0 0 0 0 0 0 22145227 13728581 8416646 0.0355 4506209 432597 4073612 0.017 2059365 906045 1153320 0.0048 8049 0 8049 0.00003 182158 0 182158 0.0007 0 0 6755781 1338642 5417139 0.02253 0 0 28901008 15067223 13833785 0.05803 56500 56500 7928324 5473682 2454642 0 0 7984824 5473682 2511142 0 0 8748285 0 49871284 46748008 3123276 X 1 1 1 1 Capital Region Medical Center 1125 Madison Street Jefferson City MO 65101 crmc.org 419-19 X X X X Capital Region Medical Center 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X www.crmc.org X X 1 18 1 https://www.crmc.org/about-us/community-involvement/community-health-needs-assessment/ 0 0 1 X 200 200 X X X 1 1 X X X X 1 X https://www.crmc.org/patients-and-visitors/billing-insurance/financial-assistance/ X https://www.crmc.org//media/1268/2404-007.pdf X https://www.crmc.org/patients-and-visitors/billing-insurance/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Capital Region Medical Center The Central Missouri Community Health Assessment Partnership (CMCHAP) was created and embarked on a mission to improve the health of residents of the four counties of Cole, Miller, Moniteau and Osage. The partnership worked collaboratively to collect and analyze health data and gather input from community members to aid in assessing and prioritizing health needs. This unique partnership of health care and social service providers was financially funded by the two local hospitals - Capital Region Medical Center and SSM St. Mary's Health Center, and nine other community partners joined together to form the CMCHAP. Schedule H, Part V, Section B, Line 6a-Capital Region Medical Center Capital Region Medical Center and SSM St. Mary's Hospital Schedule H, Part V, Section B, Line 6b-Capital Region Medical Center The Health Departments of Cole, Callaway, Miller, Moniteau and Osage counties, Community Health Center of Central Missouri, Central Missouri United Way, Compass Health Network, and the Missouri Coalition for Community Behavioral healthcare. Schedule H, Part V, Section B, Line 7d-Capital Region Medical Center Capital Region Medical Center - Capital Region Medical Center made the CHNA available online at crmc.org. Additionally paper copies were made available through the public relations department. A review of the CHNA was provided to medical center managers, Board of Directors, the CRMC foundation, and also at the Community Outreach meeting held in several of the outlying clinics we serve. Schedule H, Part V, Section B, Line 11-Capital Region Medical Center CRMC has a dedicated department referenced as Community Benefit that works collectively with community partners to address such needs. There is also an internal team that reviews the CHNA and determines the strategic plan for implementing strategies to address such needs. This team meets regularly and provides an update to the Board of Directors in August each year. The top five needs determined in the August 2018 CHNA are as follows: 1. Improve access to health care and support services. 2. Mental health disorders and substance abuse. 3. Chronic disease and health risks prevention - overweight/obesity & physical inactivity, smoking & tobacco use. 4. Improve health literacy. 5. Address social determinants of health. Strategies have included support groups, smoking cessation and lifestyle programs. Implemented tracking and education of depression and body mass index screenings at all primary care visits. We have increased the number of participating providers including primary and psychiatrists. We work with the Council for Drug Free Youth on many projects and also created the Behavioral Health Resource Partnership. CRMC has been actively engaging the medical team in policies to decrease usage of controlled substances with emphasis on reducing risk of opioid abuse. To help combat environmental and abuse issues, CRMC also places a bin in the pharmacy for people to safely dispose of unused prescription medications. Our implementation strategies also encourage improved nutrition and increased physical activity. We sponsor farmer's markets, buddy packs at local schools, participated in the Local Foods Local Places coalition, and partnered with several schools and recreation centers to develop health concession policies. CRMC has worked with multiple city governments on bike/pedestrian plans, complete street policies, as well as trails, including the Rock Island Trail. With the pandemic we implemented virtual support groups and call-chains to stay connected and continue to provide services when not able to meet in person Schedule H, Part V, Section B, Line 15e-Capital Region Medical Center Use of Human Arc to assist in Medicaid application. 19 Capital Region Physicians 1125 Madison Street Jefferson City MO 65101 Medical Center Expansion - Physician clinics and outpatient services Capital Region Southwest 1432 Southwest Blvd Jefferson City MO 65109 Outpatient and Wellness Services CRMC Healthplex West 3308 West Edgewood Jefferson City MO 65109 Urgent Care and Outpatient Therapy Capital Region Central Missouri Cardiology 3501 West Truman Blvd Jefferson City MO 65109 Cardiology Physician Office Primary Care 1014 Madison Street Jefferson City MO 65101 Primary Care - Family Practice Clinic CRMC-SW Clinic 1500 Southwest Blvd Jefferson City MO 65109 Family Practice Clinic CRMC- Versailles 901 Kidwell Drive Versailles MO 65084 Family Practice Clinic CRMC - Eldon 103 Business Hwy 54 North Eldon MO 65026 Family Practice Clinic CRMC Surgicare 1705 Christy Drive Jefferson City MO 65101 Surgeon CRMC-Owensville 3536 Kuhne Road Owensville MO 65066 Family Practice Clinic West Truman Clinic 3527 W Truman Blvd Jefferson City MO 65109 Physician Clinic Eastland Urgent Care 915 A Eastland Drive Jefferson City MO 65101 Urgent Care Clinic CRMC-Linn 916 East Main Street Linn MO 65051 Family Practice Capital Region Family Medical Center 420 East High Street Jefferson City MO 65101 Family Practice Clinic CRMC-California 704 Buchanan California MO 65018 Family Practice Clinic CRMC-Holts Summit 180 North Star Holts Summit MO 65043 Family Practice Clinic St Elizabeth Clinic 631 S Walnut Street St Elizabeth MO 65075 Physician Clinic Vienna Family Practice 111 Parkway Vienna MO 65582 Family Practice Clinic CRMC Quick Care 3721 W Truman Blvd Jefferson City MO 65109 Quick Care Clinic Schedule H, Part I, Line 3c Average Medicare and Commercial/Managed Care Adjustments were used to calculate 65% auto self pay. Schedule H, Part I, Line 7 Cost to Charge ratios from Worksheet 2 Schedule H, Part II Schedule H, Part II, Line 3 - CRMC provides a building for use to the St. Nicholas Academy. It is a not-for-profit organization which is creating a group home for at-risk youth. This is the normal rental amount for this square footage. St. Nicholas Academy pays $1 per year in rent. Schedule H, Part III, Section A, Line 4 Footnote #2 in Audit Report Schedule H, Part III, Section B, Line 8 Line 2 is determined using the cost to charge ratio from Worksheet 2. Schedule H, Part III, Section C, Line 9b All Self Pay patients automatically receive a 65% Self Pay discount. For collections practices, we run presumptive charity using Paro Presumptive Charity software to identify all patients under the presumptive score of 279% which equals 200% of FPL. We write off to charity all patients under the threshold and do not send to collections. All patients over 279% of presumptive score must complete the financial application to prove need of charity assistance. In addition patients are screened for Medicaid eligibility using a company called Human Arc. Schedule H, Part VI, Line 2 The CMCHAP conducted a comprehensive community health assessment using both secondary and primary analysis, which allowed us to measure perception, health risks, health factors, health outcomes and characteristics specific to the communities in these five central counties. This is the third comprehensive regional health assessment completed in this collaborative fashion by the CMCHAP. The objectives were to identify factors influencing health status, determine and prioritize issues of greatest concern, identify unmet health needs and project a source of reliable information that will support the development of solutions. The needs assessment was conducted using three methods: secondary data analysis, discussions with community groups, and provide clients with surveys completed by community members, community leaders and local physicians. Existing data previously collected for other purposes, called secondary data was compiled from a variety of credible local state and federal sources to provide a context for analysis and interpretation. Community discussion groups, much like town hall meetings were organized by the steering team identified the most serious health issues and then ranked then using a priority matrix. The results were: 1. Access to Health Care 2. Mental Health and Substance Abuse 3. Chronic Disease and Health Risks Prevention. 4. Health Literacy and 5. Social Determinants of Health. Schedule H, Part VI, Line 3 At every location, registration staff have financial assistance packets available to hand out. All self pay patients are referred to one of the three financial counselors in the area. Patient financial counselors visit all self pay in-house patients. Also Human Arc helps patients apply for Medicaid and an Accountable Care representative is on site one day per week. Signs are posted in rooms and at registration sites. For every statement sent, there is a number printed to call for assistance. All first letters indicate who to call for assistance. All clinics are aware of the policy- so is the medical staff. It is posted on our website and on our online bill pay. Schedule H, Part VI, Line 4 The five county region included both urban and rural areas. The local area economy is heavily dependent on state government. The total population for the region is based on the 2010 census which was 175,851. The region is expecting an increase of 5.5% from 2010-2020. Cole County which has the largest population of the region, shows a projected growth in population of 6.11% which is a a slight increase of the actual growth experienced of 6.04% growth between the 2000-2010 censuses. The age distribution continues to shift toward a larger population of older adults. Understanding the older population generally have more chronic disease and face more barriers in accessing care, it was notified that the concentration of the aging population in the rural counties where there are fewer services is of growing concern. Community discussion groups noted an increase in minority and diverse groups. X 1 1 X X 0 1 0 1 0 1 0 1 0 Mitchell Godbee Physician 837976 0 566148 0 910 0 11400 0 61303 0 1477737 0 0 0 Sharmilla Suri-Mohanram Physician 586483 0 263429 0 771 0 5624 0 22239 0 878546 0 0 0 Scott Anderson Physician 597929 0 33075 0 3664 0 11400 0 49371 0 695439 0 0 0 Dennis Luetkemeyer Physician 566812 0 47539 0 1340 0 8550 0 49710 0 673951 0 0 0 Diane Light Board Member/Physician 365387 0 24306 0 1494 0 8504 0 37963 0 437654 0 0 0 Gaspare Calvaruso President 386442 0 52642 0 7027 0 8878 0 47394 0 502383 0 0 0 Randall Haight Vice President/Physician 297430 0 48200 0 892 0 7050 0 48369 0 401941 0 0 0 Michelle Barg Vice President/Physician 244088 0 35545 0 455 0 5595 0 15017 0 300700 0 0 0 Lisa Kolb Waggoner Board Member/Physician 191452 0 43213 0 1323 0 4782 0 49177 0 289947 0 0 0 Janet Weckenborg Vice President 243910 0 31901 0 1771 0 5748 0 37177 0 320507 0 0 0 Thomas Luebbering Vice President 239502 0 25372 0 1123 0 5642 0 43146 0 314785 0 0 0 Glenda Dahlstrom Vice President 175990 0 21445 0 1179 0 4178 0 35061 0 237853 0 0 0 Ted Brandt - Paid by Univ of MO Vice President 196079 0 0 0 7944 0 10344 0 11311 0 225678 0 0 0 Sarah Morrow Vice President 200014 0 16428 0 434 0 4717 0 27532 0 249125 0 0 0 Belynda Imhoff - Paid by Cerner Vice President 139997 0 21466 0 15601 0 0 0 13200 0 190264 0 0 0 Ted Brandt - CRMC Vice President 0 0 11992 0 0 0 0 0 0 0 11992 0 0 0 Beylnda Imhoff - CRMC Vice President 0 0 7978 0 0 0 0 0 0 0 7978 0 0 0 Adam Patterson physician 569711 0 31303 0 640 0 10002 0 49507 0 661163 0 0 0 Schedule J, Part I, Line 1a Capital Region pays for the President's membership with the Jefferson City County Club. This is used for many business reasons. Any personal expenses incurred are reimbursed by the President to the Medical Center Schedule J, Part I, Line 3 Annually, all board members complete an evaluation of the CEO and individually present the results to the board chair who presents them to the compensation committee, consisting of 3 board members, including the Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri or the region. The compensation committee members do not have conflict of interest with respect to the compensation arrangements. The committee documents their review and decisions. Schedule J, Part I, Line 4 Contributions to 457(B) plan: Janet Weckenborg 19500, Randall Haight 6251 Mitchell Godbee 18018, Michelle Barg 19500, Adam Patterson 17500.08, Thomas Luebbering 5944, Sharmilla Suri-Mohanram 19500, Gaspare Calvaruso 8250, Sarah Morrow 18017, Glenda Dahlstrom, 5324 Schedule J, Part I, Line 5 For all employees, an annual bonus is partially based on the achievement of certain organizational goals. These goals pertain to quality, service, and financial indicators. Schedule J, Part I, Line 6 For all employees, an annual bonus is partially based on the achievement of certain organizational goals. These goals pertain to quality, service, and financial indicators. Schedule J, Part I, Line 7 The President, Vice President, Directors, and Managers, participate in the Management Incentive Compensation Program. They receive additional bonus compensation if certain stated goals are met. Most Physicians receive a base salary, but also have the ability to earn an additional amount based on production. A Health & Educational Facilities State of MO 431178966 000000000 2017-03-09 20000000 Acquire, construct, and equipment for health facilities 0 0 0 B Health & Educational Facilities of State of MO 431178966 60637ASU7 2020-11-10 33254282 Refund Series 2011 bonds (issued 11/22/2011) 0 0 0 A 4761137 0 20000000 0 0 0 0 0 0 0 20000000 0 2016 0 0 1 1 B 0 0 33254803 0 0 0 429728 0 0 1251707 12809637 18763481 1 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 Schedule K, Part II, Line 3-11/10/2020 33,254,282 Health & Educational Facilities of State of MO difference in issue price listed in Part I, column is investment earnings. Schedule K, Part II, Line 11-11/10/2020 33,254,282 Health & Educational Facilities of State of MO Series 2011 Bonds pay off Schedule K, Part II, Line 12-11/10/2020 33,254,282 Health & Educational Facilities of State of MO Note for Line 13 - Project is still underway at 6/30/2021 Lori Luebbering Wife of Tom Luebbering, Vice President 8936 salary as nurse for CRMC 0 Kathleen Weckenborg daughter in Law of Janet Weckenborg, Vice President 8932 Salary as occupational therapist at CRMC 0 Jessica Luebbering daughter in law of Tom Luebbering, Vice President 104729 Salary as physician at CRMC 0 Nathan Luebbering son of Tom Luebbering, Vice President 9583 Salary as lab employee at CRMC 0 Form 990, Part VI, Section A, Line 2 Frank Burkhead, board member is a brother in law to Tom Luebbering, Vice President. Form 990, Part VI, Section A, Line 6 The organization has 2 members - The University of Missouri- Columbia Medical Alliance and CRMC Healthcare Form 990, Part VI, Section A, Line 7a All elections for appointments to the Governing Body are subject to approval of the member, the University of Missouri Medical Alliance. Form 990, Part VI, Section A, Line 7b The bylaws provide a number of instances requiring approval by the University of Missouri Medical Alliance (e.g. amendment of the bylaws, dissolution of the organization, sale of substantial assets, and discontinuance of a major service). Form 990, Part VI, Section B, Line 11b The 990 is reviewed by the Director of Accounting, legal counsel, the Vice President of Finance, and the President. The 990 is presented to the Board of Directors and copies are available to all members. Form 990, Part VI, Section B, Line 12c The hospital legal counsel attends board meetings. He is continually monitoring if any transaction would be a conflict of interest. The Vice President of Finance reviews all payments to physician and identifies any potential conflicts. The Director of Accounting reviews payments and identifies any potential conflicts. Form 990, Part VI, Section B, Line 15 All board members complete an evaluation of the CEO and individually present the results to the board chair, who presents to the compensation committee, consisting of three board members, including Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri and the region. the compensation committee members do not have a conflict of interest with respect to the compensation agreements. The committee documents their review and decision and meets at least annually. The CEO sets the recommended salaries for key employees using comparable date from three salary surveys. The Vice President of Human Resources participates in determining the appropriate salary. Form 990, Part VI, Section C, Line 19 The Capital Region website (crmc.org) provides important information about the medical center to the community. The "Fraud and Wrongdoing" policy, "Privacy" policy, "Affiliation and Accreditations" policy, leader profiles, site location and contact information are all disclosed on the website. Capital Region includes financial statements in the annual report provided to the Board of Governors (approximately 500 members). Financial information is reviewed at the Medical Executive and Medical Staff meetings monthly. The information is then shared at the monthly managers' meeting and then communicated to all staff at department meetings. Form 990, Part IX, Line 11g Purchased Services for physicians, nurses, and other healthcare providers. Also, consultants, biomedical, maintenance and other companies providing services. Form 990, Part XI, Line 9 Increase in Foundation Net Assets +1397293, Paid Foundation Expenses - 144104 = 1241287 Capital Region Medical Foundation PO Box 1128 Jefferson City MO 651021128 431506900 Raise Money and manage funds to be used by Capital Region Medical Center MO 501(c)(3) Supporting Org Typ I N/A Still Osteopathic Medical Foundation PO Box 1128 Jefferson City MO 651021128 431720296 Support Capital Region Medical Center MO 501(c)(3) Support Org Typ III N/A Capital Region Medical Center Partners 1125 Madison Street Jefferson City MO 65101 446014361 Support Capital Region Medical Center MO 501(c)(3) Support Org Typ I N/A CRMC Healthcare Inc 1125 Madison Street Jefferson City MO 65101 461699021 Support Capital Region Medical Center MO 501 (c)(3) Type II Support Org N/A University of Missouri - Columbia Medical Alliance 1000 West Nifong Building 7 Suite 300 Columbia MO 65211 311574931 Support and encourage health care delivery and medical education MO 501 (c)(3) Type I Support Org N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 Capital Region Medical Center Partners m 150977 In the fiscal year ending June 30, 2021, the Partners donated 14,658 hours valued at $10.30 per hour = $150,977 Capital Region Medical Foundation o 108166 Capital Region pays for the salary, benefits, and other expenses of the CRMC Foundation. Capital Region Medical Foundation c 299637 Cash value of donations from the Foundation. Capital Region Medical Center Partners c 4110 Cash value of items donated to Capital Region Medical Center Capital Region Medical Center Partners q 25613 Partners reimburse the Medical Center for the salary and FICA tax expense for the gift shop manager. A 6 month extension was approved. Extended due date is May 15, 2022