2022-12-08T15:48:10-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2021-01-01 431279063 CH ALLIED SERVICES INC CHAL 5738158732 1600 E BROADWAY COLUMBIA MO 65201 EDWARD CLAYTON CHIEF FINANCIAL OFFICER 5738158732 2022-12-07 1 EDWARD CLAYTON XXX-XX-XXXX JEFF PARKER P00970069 6182331200 2022-12-07 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z X X BOONE HOSPITAL CENTER TROY GREER 1600 E BROADWAY COLUMBIA MO 65201 456381294 0 X WWW.BOONE.HEALTH X 1983 MO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 11 11 2592 16 0 0 131336539 321993976 -32460 2807368 456105423 531675 0 168418442 0 0 213059889 382010006 74095417 320950223 182889385 138060838 OUR MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 263129678 526675 287826313 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, 2021, THE ORGANIZATION PROVIDED CARE TO ITS COMMUNITY THROUGH 26,170 EMERGENCY DEPARTMENT VISITS, 8,906 SURGERY CASES AND 11,943 ADMISSIONS. 55924942 5000 34167663 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. 319054620 1 1 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 1 1 1 0 0 0 1 1 1 0 0 0 1 158 0 2592 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X TAMMI SEELE 5738158732 1600 E BROADWAY COLUMBIA MO 65201 JERRY KENNETT CHAIR 1.00 1.00 X X 0 0 0 RANDY MORROW VICE CHAIR 1.00 1.00 X X 0 0 0 JAN BECKETT SECRETARY, PRIOR CHAIR 1.00 1.00 X X 0 0 0 GREG STEINHOFF TREASURER 1.00 1.00 X X 0 0 0 BOB MCDAVID BOARD MEMBER 1.00 1.00 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 DAVID APLINGTON BOARD MEMBER (TERM ENDED) 1.00 0.00 X 0 0 0 JOAN MAGRUDER BOARD MEMBER (TERM ENDED) 1.00 0.00 X 0 0 0 MONICA SMITH COO/VICE CHAIR (TERM ENDED) 20.00 20.00 X X 623770 0 59421 ROBIN BLOUNT CMO/SECRETARY (TERM ENDED) 40.00 0.00 X X 796058 0 35890 TROY GREER PRESIDENT/CEO 20.00 20.00 X 615354 0 76038 JIM SINEK PRIOR CEO 20.00 20.00 X 939250 0 0 BRIAN WINN INTERIM CFO 20.00 20.00 X 139784 0 36302 LAURA THOMAS CFO 20.00 20.00 X 121135 0 16923 BARRY CHAMBERS PRIOR CFO 20.00 20.00 X 499145 0 10411 KATE PITZER HOSPITAL ADMINISTRATION/SECRETARY 40.00 0.00 X 315867 0 12359 CHAD PEW VP PROVIDER SERVICES 20.00 20.00 X 207648 0 26010 MICHELLE ZVANUT VP - HUMAN RESOURCES 40.00 0.00 X 440728 0 30899 KENYON WOODWARD CIO 40.00 0.00 X 303670 0 38935 MARLENE LYON EXECUTIVE DIRECTOR - PATIENT CARE SERVICES 40.00 0.00 X 289229 0 29741 RICHARD MELLITT CARDIOTHORACIC SURGEON 40.00 0.00 X 1126403 0 39675 JOSS FERNANDEZ CARDIOTHORACIC SURGEON 40.00 0.00 X 1047923 0 16138 TAREQ ABU SALAH PULMONOLOGIST 40.00 0.00 X 600349 0 35922 ANNE PETERSEN GENERAL SURGEON 40.00 0.00 X 445991 0 22370 REGGIE VADEN COLORECTAL SURGEON 40.00 0.00 X 440122 0 21331 8952426 0 508365 127 0 1 0 MISSOURI CARDIOVASCULAR SPECIALISTS 1605 E BROADWAY STE 300 COLUMBIA MO 65201 CARDIOVASCULAR PHYSICIAN SERVICES 18908970 MEDEFIS PO BOX 5068 NEW YORK NY 10087 STAFFING AGENCY 16252307 ENSEMBLE RCM LLC 11511 REED HARTMAN HIGHWAY CINCINATTI OH 45241 REVENUE CYCLE MANAGEMENT 6165606 MID AMERICA ANESTHESIA CONSULTANTS 1316 OLD HIGHWAY 63 SUITE 102 COLUMBIA MO 65201 ANESTHESIA PHYSICIAN SERVICES 4563477 MEDICAL INFORMATION TECH INC PO BOX 74569 CHICAGO IL 60696 ELECTRONIC HEALTH RECORDS FEES 4252300 19 5359467 125977072 125977072 131336539 PATIENT SERVICE REVENUE 621110 319083596 319083596 PHARMACY 446110 2401665 2401665 SHARED SERVICES 621110 508715 508715 321993976 114111 114111 115640 0 115640 115640 115640 129300 275871 -146571 -146571 -146571 FOOD SERVICES 722514 1537100 1537100 OTHER REVENUE 624100 1102276 1102276 MANAGEMENT SERVICES 541610 52352 52352 2691728 456105423 321993976 0 2774908 X 531675 531675 5327934 4448665 879269 130315415 108809462 21505953 6816032 5691182 1124850 17695242 14774996 2920246 8263819 6900041 1363778 8516388 7110928 1405460 711811 594341 117470 136165 113694 22471 26107 21799 4308 59837537 49962547 9874990 599599 500647 98952 7927437 6619172 1308265 8156972 6810827 1346145 12843500 10723937 2119563 202018 168679 33339 3269436 2729866 539570 21193560 17695987 3497573 2852333 2381612 470721 MEDICAL SUPPLIES AND EQ 61301994 51185326 10116668 PHARMACEUTICALS AND VAC 19897376 16613712 3283664 DIETARY 2021896 1688223 333673 REPAIRS AND MAINTENANCE 1492751 1246402 246349 2073009 1730900 342109 382010006 319054620 62955386 0 44499431 28322530 51452705 295592 12766453 6343495 102196010 18589470 0 83606540 1377384 0 92286093 0 320950223 42891539 42489 89967715 0 49987642 0 182889385 X 109738308 28322530 0 138060838 0 320950223 X 74095417 1783792 62181629 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 26107 26107 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. 15467297 2255175 13212122 800428 71735 728693 83700801 16262560 67438241 2227484 2227484 83606540 DUE FROM AFFILIATES 4210470 OPERATING RIGHT OF USE ASSETS 21436087 FINANCING RIGHT OF USE ASSETS 66639361 DEFERRED CHARGES 175 92286093 SECTION 457 PLAN PAYABLE 1377384 DUE TO THIRD PARTY PAYORS 48610258 49987642 1 1 X 1 X 1 X 1 1 0 1 1 5129237 5129237 0.01340 20768828 14478882 6289946 0.01650 25898065 14478882 11419183 0.02990 61610 61610 0.00020 79484 79484 0.00020 66974991 34902468 32072523 0.08400 529070 529070 0.00140 67645155 34902468 32742687 0.08580 93543220 49381350 44161870 0.11570 2100272 2100272 0.00550 264785 264785 0.00070 2365057 2365057 0.00620 1 23564392 14554990 86199904 85742914 456990 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 19 1 0 0 1 X HTTPS://BOONE.HEALTH/ABOUT-US/COMMITMENT-TO-COMMUNITY/ X 1 19 1 HTTPS://BOONE.HEALTH/ABOUT-US/COMMITMENT-TO-COMMUNITY/ 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 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 1 X 0 X X X 1 X 0 0 BOONE HOSPITAL CENTER PART V, SECTION B, LINE 5: THE ORGANIZATION HOSTED A FOCUS GROUP WITH MEMBERS OF THE COMMUNITY, INCLUDING RELIGIOUS LEADERS, MEMBERS OF THE HEALTH DEPARTMENT AND VARIOUS OTHER GROUPS THAT REPRESENT THE COMMUNITY. THE FOCUS GROUP REVIEWED THE PRIMARY DATA AND COMMUNITY HEALTH NEED FINDINGS FROM 2016 AND DISCUSSED CHANGES THAT HAD OCCURRED SINCE 2016. 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 TWO MAJOR NEEDS: DIABETES AND HEART DISESASE.TO ADDRESS THE DIABETES NEED, THE ORGANIZATION DETERMINED THE FOLLOWING OBJECTIVES:SCREEN 500 ADULTS EACH YEAR FOR GLUCOSE AT BOONE HOSPITAL CENTER'S OUTPATIENT DIABETES AND NUTRITION CLINIC AS WELL AS UTILIZING THE BOONE HOSPITAL CENTER'S MOBILE HEALTH UNIT. WE WILL ALSO PARTNER WITH OTHER LOCAL ORGANIZATIONS: BOONE COUNTY HEALTH DEPT. LIVE WELL BY FAITH ETC.; FOLLOW-UP WITH 40% OF CLIENTS WHO OPT-IN AND ARE IDENTIFIED AS IN THE PRE-DIABETES OR DIABETES RANGE AT SCREENINGS; PROVIDE THE CLIENTS WITH REFERRAL SPECIALIST ACCESS AS WELL AS EDUCATIONAL 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:SET A BASELINE IN 2020 AND INCREASE THE NUMBER OF ADULTS WHO SCREEN FOR BLOOD PRESSURE, CHOLESTEROL AND BLOOD GLUCOSE IN BOONE COUNTY AND SURROUNDING COUNTIES BY 10% EACH YEAR; SUCCESSFUL CONTACT OF 40% OF AT-RISK PARTICIPANTS WHO OPT-IN FOR FOLLOW-UP EACH YEAR; WITHIN THE YEAR FOLLOWING THE INITIAL SCREENING, COMMUNITY EDUCATION STAFF WILL CONFIRM THAT FIVE (5) PERCENT OF THOSE CONTACTED WILL HAVE AN APPOINTMENT SCHEDULED FOR A FOLLOW-UP APPOINTMENT WITH THEIR PHYSICIAN.WHILE THE IMPLEMENTATION OF THE STRATEGY DEVELOPED IN THE 2019 CHNA WAS NOT ABLE TO BE FULLY ACCOMPLISHED DUE TO THE COVID PANDEMIC AND THE RESULTING RESTRICTIONS ON CERTAIN ACTIVITIES, THIS POTENTIAL OBSTACLE IS BEING FACTORED INTO THE STRATEGY BEING DEVELOPED FOR 2022. 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/ 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 THECALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. COST COMPUTED ON IRSWORKSHEET 6 WAS COMPUTED FROM THE MEDICARE COST REPORT AND DEPARTMENTFINANCIAL STATEMENTS, USING SPECIFIC FINANCIAL DATA FOR EACH TYPE OFSUBSIDY. 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 PAGE 14 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 178,271 (2017 CENSUS ESTIMATE). THE POPULATION EXPERIENCED A 9.6 PERCENT INCREASE FROM 2010 TO 2017, 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 FEMALE (91,810)48.5 PERCENT MALE (86,461)79.0 PERCENT WHITE (140,834)9.6 PERCENT AFRICAN AMERICAN (17,114)5.0 PERCENT ASIAN (8,914)3.4 PERCENT HISPANIC OR LATINO (6,061)3.1 PERCENT TWO OR MORE RACES (5,526)0.4 PERCENT AM. INDIAN & ALASKA NAT. (713)0.1 PERCENT NATIVE HAW. & OTHER P.I. (178)PERSONS 65 YEARS AND OVER IN THE COUNTY TOTALED 11.8 PERCENT COMPARED TO 16.5 PERCENT IN THE STATE. 93.5 PERCENT OF THE POPULATION 25 AND OLDER HAD A HIGH SCHOOL DIPLOMA COMPARED TO 88.8 PERCENT THE STATE. 45.9 PERCENT OF THE POPULATION 25 AND OLDER HAD A BACHELOR'S DEGREE WHEN COMPARED TO 27.6 PERCENT IN THE STATE. THE MEDIAN INCOME OF HOUSEHOLDS IN THE COUNTY AT $52,005 WAS SLIGHTLY HIGHER THAN THE STATE MEDIAN AVERAGE OF $51,542. HOME OWNERSHIP WAS LOWER IN BOONE COUNTY (50.4 PERCENT) THAN THE STATE (57.8 PERCENT). WITH AN ESTIMATED POVERTY RATE OF 18.7 PERCENT, BOONE COUNTY HAD A HIGHER PERCENTAGE OF PERSONS LIVING IN POVERTY THAN MISSOURI (14.6 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 TRACK CLUB 1800 PARKLAWN DRIVE COLUMBIA MO 65202 431721553 501(C)(3) 6000 0 HEART OF AMERICA MARATHON COLUMBIA PUBLIC SCHOOLS 1818 WEST WORLEY COLUMBIA MO 65203 436000318 GOVERNMENT 10000 0 ATHLETICS AND ACTIVITIES INITIATIVE BOONE COUNTY 801 E WALNUT COLUMBIA MO 65201 GOVERNMENT 500000 0 HEALTH PROGRAMMING FUND 3 0 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 870477 0 255926 0 0 0 21817 0 17858 0 1166078 0 0 0 JOSS FERNANDEZ CARDIOTHORACIC SURGEON 820818 0 227105 0 0 0 16138 0 0 0 1064061 0 0 0 JIM SINEK PRIOR CEO 758020 0 181230 0 0 0 0 0 0 0 939250 0 0 0 ROBIN BLOUNT CMO/SECRETARY (TERM ENDED) 689650 0 106408 0 0 0 27186 0 8704 0 831948 0 0 0 TROY GREER PRESIDENT/CEO 615354 0 0 0 0 0 49174 0 26864 0 691392 0 0 0 MONICA SMITH COO/VICE CHAIR (TERM ENDED) 540639 0 83131 0 0 0 32782 0 26639 0 683191 0 0 0 TAREQ ABU SALAH PULMONOLOGIST 311968 0 288381 0 0 0 15577 0 20345 0 636271 0 0 0 BARRY CHAMBERS PRIOR CFO 405562 0 93583 0 0 0 4260 0 6151 0 509556 0 0 0 MICHELLE ZVANUT VP - HUMAN RESOURCES 357597 0 83131 0 0 0 14204 0 16695 0 471627 0 0 0 ANNE PETERSEN GENERAL SURGEON 445991 0 0 0 0 0 8598 0 13772 0 468361 0 0 0 REGGIE VADEN COLORECTAL SURGEON 440122 0 0 0 0 0 14897 0 6434 0 461453 0 0 0 KENYON WOODWARD CIO 232299 0 71371 0 0 0 21302 0 17633 0 342605 0 0 0 KATE PITZER HOSPITAL ADMINISTRATION/SECRETARY 315867 0 0 0 0 0 12359 0 0 0 328226 0 0 0 MARLENE LYON EXECUTIVE DIRECTOR - PATIENT CARE SE 262425 0 26804 0 0 0 11883 0 17858 0 318970 0 0 0 CHAD PEW VP PROVIDER SERVICES 177648 0 30000 0 0 0 9000 0 17010 0 233658 0 0 0 BRIAN WINN INTERIM CFO 116240 0 23544 0 0 0 9663 0 26639 0 176086 0 0 0 PART I, LINE 4B CONTRIBUTIONS TO A 457(F) PLAN WERE MADE BY THE ORGANIZATION FOR THE FOLLOWING PERSONS: MICHELLE ZVANUT - $12,443 MONICA SMITH - $17,401 ROBIN BLOUNT - $21,439 TROY GREER - $31,000 LAURA THOMAS - $6,655 KENYON WOODWARD - $14,037 CHAD PEW - $9,000 DISTRIBUTIONS FROM A 457(F) PLAN WERE TAKEN FOR THE FOLLOWING PERSONS: BARRY CHAMBERS - $17,018 MICHELLE ZVANUT - $9,918 MONICA SMITH - $14,186 ROBIN BLOUNT - $18,540 MISSOURI CARDIOVASCULAR SPECIALISTS PRACTICE OF BOARD MEMBER JERRY KENNETT 18908970 PSA PAYMENTS 0 MID MO NEURO SURGERY PRACTICE OF BOARD MEMBER CHARLES BONDURANT 1946073 PSA PAYMENTS 0 BRIANA WINN DAUGHTER OF OFFICER BRIAN WINN 49946 WAGES 0 PATSY WINN WIFE OF OFFICER BRIAN WINN 26528 WAGES 0 X INHERENT CONTRIBUTION 1 125977072 FMV 0 0 0 FORM 990, SCHEDULE M, PART I, LINE 25 A CHANGE IN CONTROL WAS DETERMINED TO HAVE OCCURRED ON JANUARY 1, 2021 AND AS A RESULT, THE ORGANIZATION RECOGNIZED AN INHERENT CONTRIBUTION FOR THE NET ASSETS CONTRIBUTED IN EXCESS OF LIABILITIES ASSUMED, AT FAIR VALUE. 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 3 BJC WAS PREVIOUSLY THE SOLE CORPORATE MEMBER OF CHAS AND A TRANSITION OF CONTROL OCCURRED FROM BJC TO BOONE HEALTH, INC. DURING THE PERIOD OF JANUARY 1, 2021 TO MARCH 31, 2021. DURING THIS PERIOD HEALTH SYSTEM PAID BJC A MANAGEMENT FEE AND THE DIRECT COST OF OTHER SERVICES CONSISTENT WITH THE ORIGINAL LEASE AGREEMENT. INCLUDED IN THE AGREEMENT THE HEALTH SYSTEM RECEIVED SERVICES, INCLUDING LEGAL, INTERNAL AUDIT, MARKETING, RISK MANAGEMENT, INFORMATION SYSTEMS, AND CONTRACT AND REIMBURSEMENT SERVICES, FROM BJC. BJC WAS REIMBURSED FOR THE DIRECT COST OF INFORMATION SERVICES, REVENUE CYCLE, AND OTHER COSTS DIRECTLY ATTRIBUTABLE TO THE HEALTH SYSTEM. BJC ALSO RECEIVED A MANAGEMENT FEE OF 2.5% OF REVENUE TO COVER SOME OF THESE SERVICES. IN ADDITION TO THE MANAGEMENT FEE, EXPENSES FOR OTHER SERVICES, SUCH AS HEALTH INSURANCE, SELF-INSURANCE, AND PENSION FUNDING, WERE PAID TO BJC. FOR THE YEAR ENDED DECEMBER 31, 2021, THE HEALTH SYSTEM PAID BJC APPROXIMATELY $1,983,000 RELATED TO THE MANAGEMENT FEE. 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 6,860,265. MANAGEMENT AND GENERAL EXPENSES 1,355,917. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,216,182. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 3,981,910. MANAGEMENT AND GENERAL EXPENSES 787,016. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,768,926. JANITORIAL AND HOUSKEEPING CONTRACTS: PROGRAM SERVICE EXPENSES 119,102. MANAGEMENT AND GENERAL EXPENSES 23,540. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 142,642. CONSULTING FEES: PROGRAM SERVICE EXPENSES 204,012. MANAGEMENT AND GENERAL EXPENSES 40,323. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,335. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 34,959,655. MANAGEMENT AND GENERAL EXPENSES 6,909,699. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,869,354. ANSWERING SERVICE: PROGRAM SERVICE EXPENSES 63,342. MANAGEMENT AND GENERAL EXPENSES 12,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,861. COLLECTIONS SERVICE: PROGRAM SERVICE EXPENSES 76,772. MANAGEMENT AND GENERAL EXPENSES 15,174. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,946. COURIER SERVICE: PROGRAM SERVICE EXPENSES 8,057. MANAGEMENT AND GENERAL EXPENSES 1,593. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,650. LAB FEES: PROGRAM SERVICE EXPENSES 24,724. MANAGEMENT AND GENERAL EXPENSES 4,887. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,611. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 2,717,561. MANAGEMENT AND GENERAL EXPENSES 537,120. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,254,681. SECURITY: PROGRAM SERVICE EXPENSES 388. MANAGEMENT AND GENERAL EXPENSES 77. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 465. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 389,124. MANAGEMENT AND GENERAL EXPENSES 76,910. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 466,034. FOOD SERVICES: PROGRAM SERVICE EXPENSES 557,635. MANAGEMENT AND GENERAL EXPENSES 110,215. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 667,850. FORM 990, PART XI, LINE 9: EQUITY TRANSFER TO RELATED ORGANIZATION -1,526,052. ASSET TRANSFERS FROM BOARD OF TRUSTEES 35,385,151. DONATED SERVICES TO BE RECOGNIZED IN FUTURE YEARS 28,322,530. 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 11535141 3820326 CH ALLIED SERVICES INC BOONE PHYSICIAN SERVICES LLC 1600 E BROADWAY COLUMBIA MO 65201 460552280 PHYSICIAN SERVICES MO 23367357 9897899 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 1 0 BOONE HOSPITAL CENTER'S VISITING NURSES INC R 1526052 FMV