2021-11-15T15:48:35-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2020-01-01 446005758 OZARKS MEDICAL CENTER OZAR 4172569111 PO BOX 1100 WEST PLAINS MO 65775 THOMAS KELLER CEO 4172569111 2021-11-15 1 THOMAS KELLER 446005758 JEFF PARKER P00970069 6182331200 2021-11-15 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z THOMAS KELLER PO BOX 1100 WEST PLAINS MO 65775 221074375 0 X OZARKSHEALTHCARE.COM X 1955 MO TO BRING HIGH QUALITY HEALTH CARE TO THE REGION THROUGH DEVELOPMENT OF NEW SERVICES, ACQUIRING NEW EQUIPMENT AND RECRUITMENT OF HIGH QUALITY PROFESSIONALS. 15 11 1592 148 11392 0 763401 8785649 173059659 174959730 11121268 3450100 1042858 931962 185987186 188127441 112250 159694 0 0 97735026 94808694 0 0 0 74690174 87978956 172537450 182947344 13449736 5180097 166118816 214623489 52690078 94520176 113428738 120103313 TO PROVIDE EXCEPTIONAL, COMPASSIONATE CARE TO ALL WE SERVE. 0 0 137242930 159694 147388155 INPATIENT AND OUTPATIENT SERVICES-INPATIENT ADMISSIONS WERE 5,171; TOTAL PATIENT DAYS WERE 20,171. THERE WERE 33,240 EMERGENCY DEPARTMENT VISITS, 2,195 OBSERVATION ADMISSIONS, AND 97,684 OTHER OUTPATIENT REGISTRATIONS FOR 2020. THE OBJECTIVE IS TO CONTINUE TO EXPAND IN SERVICES AND HEALTH CARE PROFESSIONALS THAT WILL PROVIDE THE SCOPE AND COVERAGE TO MEET THE NEEDS OF THE COMMUNITY MEMBERS AND OTHERS. 22514784 0 24285057 THE RURAL HEALTH AND SPECIALTY CLINICS, INCLUDING BEHAVIORAL HEALTH CLINIC PROGRAMS, PERFORMED 315,341 CLINIC ENCOUNTERS WITH PATIENTS DURING 2020. THE RURAL HEALTH AND SPECIALTY CLINICS MADE UP 130,521 OF THOSE ENCOUNTERS, WITH THE REMAINING 184,820 ENCOUNTERS BELONGING TO OTHER BEHAVIORAL HEALTHCARE CLINICS. BEHAVIORAL HEALTHCARE OFFERED SERVICES SUCH AS PSYCHOTHERAPY, PSYCHOLOGICAL TESTING, CASE MANAGEMENT, PSYCHO-SOCIAL REHABILITATION, MEDICATION MANAGEMENT/SERVICES, FAMILY ASSISTANCE, AND CRISIS STABILIZATION SERVICES. 2828010 0 3275126 OMC HOME CARE PROGRAMS SERVICED PATIENTS THROUGH 42,013 VISITS DURING 2020. PROGRAMS INCLUDE: OMC HOME CARE (HEALTH CARE PROVIDED TO PATIENTS IN THEIR HOMES USING SKILLED NURSES, HOME HEALTH AIDES, REHABILITATION THERAPISTS AND SOCIAL WORKERS). OMC SUPPORT SERVICES (HOMEMAKING, PERSONAL CARE, RESPITE CARE, AND IN-HOME COMPANION CARE), OMC TRANSITIONS (END-OF-LIFE CARE OFFERING ASSISTANCE, ENCOURAGEMENT, AND SUPPORT), AND OMC HOSPICE (PHYSICAL, EMOTIONAL AND SPIRITUAL CARE) IN THE FINAL STAGES OF ILLNESS. 162585724 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 124 0 1592 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X NICHOLE COOK 4172569111 PO BOX 1100 WEST PLAINS MO 65775 X JACK BATES TREASURER 2.00 0.00 X X 0 0 0 CHRISTOPHER D COCHRAN BOARD MEMBER/PHYSICIAN 55.00 0.00 X 338761 0 22050 MAGDY F GIURGIUS BOARD MEMBER/PHYSICIAN 55.00 0.00 X 564061 0 21968 KEVIN GLEGHORN BOARD MEMBER 2.00 1.00 X 0 0 0 DAVID GOHN BOARD MEMBER 1.00 0.00 X 0 0 0 REID GRIGSBY BOARD MEMBER 1.00 0.00 X 0 0 0 SHAWN MARHEFKA BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT MARTIN BOARD MEMBER 1.00 0.00 X 0 0 0 CHARLES H MORGAN BOARD MEMBER/PHYSICIAN 55.00 0.00 X 441443 0 20211 JESSE CHARLES RHOADS BOARD MEMBER/PHYSICIAN 55.00 0.00 X 314678 0 16121 ROGER SHAW III BOARD MEMBER 1.00 0.00 X 0 0 0 TRAVIS SMITH SECRETARY 2.00 0.00 X X 0 0 0 ROBERT STAUFFER BOARD MEMBER 1.00 0.00 X 0 0 0 MELISSA STEWART VICE-CHAIR 2.00 0.00 X X 0 0 0 BILL WOOD CHAIRMAN 2.00 0.00 X X 0 0 0 JASON SPURLING BOARD MEMBER (TERM ENDED 4/20) 1.00 0.00 X 0 0 0 NICHOLE COOK CFO/VP FINANCE 55.00 1.00 X 189673 0 17872 KURTIS MATTHEW ABBEY CNO/COO 55.00 0.00 X 206181 0 12554 THOMAS WILLIAM KELLER CEO 55.00 1.00 X 513578 0 18349 CONSTANCE HARRISON SCHOTT VP HUMAN RESOURCES 55.00 0.00 X 45209 0 4471 PAMMY REAM VP OF OMC MEDICAL GROUP 40.00 0.00 X 45654 0 11847 MUHAMMAD FAISAL KHAN INTERVENTIONAL CARDIOLOGIST 40.00 0.00 X 901008 0 22663 CURTIS LEE HORSTMAN ER PHYSICIAN 40.00 0.00 X 872985 0 21795 LAURA MCKENZIE ANESTHESIOLOGIST 40.00 0.00 X 836076 0 17275 KORBY POGUE ER PHYSICIAN 40.00 0.00 X 835042 0 20654 ELI DENNEY ER PHYSICIAN 40.00 0.00 X 788810 0 17872 6893159 0 245702 107 0 1 0 XTEND HEALTHCARE LLC 99 VOLUNTEER DRIVE SUITE 150 HENDERSONVILLE TN 37075 REVENUE CYCLE SERVICES 1365448 RODNEY WILLIAMS 12176 TOLLGATE CT PICKERINGTON OH 43147 PHYSICIAN SERVICES 736200 DIVERSIFIED CLINICAL SERVICES INC 28525 NETWORK PLACE CHICAGO IL 60673 WOUND CARE SERVICES 575139 CCS-SALYER LLC 31330 SCHOOLCRAFT ROAD LIVONIA MI 48150 PERFUSION SERVICES 392226 RK WARDEN LLC 9066 COUNTY ROAD 6470 WEST PLAINS MO 65775 CONSTRUCTION SERVICES 371854 30 941847 7646768 197034 8785649 PATIENT REVENUE 624100 153294797 153294797 CONTRACT REVENUE 446110 12612466 12612466 OTHER REVENUE 900099 8862961 8851569 11392 CAFETERIA 722514 176756 176756 EHR INCENTIVE REVENUE 900099 12750 12750 174959730 1332154 1332154 170093 69212 100881 100881 100881 34995668 32877722 2117946 2117946 2117946 MALPRACTICE INS DIVIDEND 900099 831081 831081 831081 188127441 174948338 11392 4382062 X 113694 113694 46000 46000 2804669 1739286 1065383 73988441 66723121 7265320 437329 389842 47487 12826346 11492896 1333450 4751909 4239467 512442 331404 331404 137640 137640 29907 29907 183245 128920 54325 22372172 15739677 6632495 517887 364353 153534 1497825 1351068 146757 46629 32805 13824 2477886 2235102 242784 807518 728397 79121 589622 521335 68287 7410398 6552166 858232 2435678 1713592 722086 MEDICAL SUPPLIES & DRUG 36159841 36159841 PROVIDER TAX EXPENSE 7291199 7291199 LICENSES, DUE, SUBSCRIP 3666319 3307092 359227 DIETARY 828127 746987 81140 1195659 968884 226775 182947344 162585724 20361620 0 38012 47702 40118019 43331475 2269 23350245 30794260 1953506 1785129 2687464 2380791 1723662 184430785 109282473 53729038 75148312 37697402 54392793 2306871 1436092 2757534 5061729 166118816 214623489 13459873 18696605 2748818 20847501 39748932 2784716 1937796 15597988 31388025 52690078 94520176 X 113408136 120081428 20602 21885 113428738 120103313 166118816 214623489 X 5180097 2431290 -936812 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 29907 29907 0 PART II-B, LINE 1: OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING PURPOSES. ALSO, LEADERS ATTEND COMMUNITY FORUMS AND LOCAL REPRESENTATIVE FORUMS TO COMMUNICATE THE EFFECT OF HEALTHCARE LEGISLATION ON OMC, OTHER HEALTH CARE PROVIDERS, AND THE COMMUNITY. THERE IS NO EXPENSE TO OMC FOR THESE ACTIVITIES. 4810349 4810349 48022727 30565582 17457145 1644587 1644587 0 96330595 77072304 19258291 33622527 33622527 75148312 EST AMT DUE TO 3RD PTY PYRS 8439429 DEFERRED COMPENSATION LIABILITY 4169101 MALPRACTICE RESERVES 282000 MEDICARE ADVANCE PAYMENTS 18497495 31388025 189507886 2431290 -867600 1563690 187944196 183245 183245 188127441 182833311 69212 69212 182764099 183245 183245 182947344 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 69,212. LOSS ON EQUITY INVESTMENT -936,812. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 69,212. 1 1 X 1 X 1 X 225.000000000000 1 1 0 1 1 2088208 2088208 0.01140 20866187 6074502 14791685 0.08090 22954395 6074502 16879893 0.09230 12100794 5908764 6192030 0.03380 73626 73626 0.00040 12174420 5908764 6265656 0.03420 35128815 11983266 23145549 0.12650 1 7580117 5486259 38822053 34537251 4284802 X 1 1 1 1 OZARKS MEDICAL CENTER 1100 KENTUCKY AVE WEST PLAINS MO 65775 WWW.OZARKSMEDICALCENTER.COM 174-55 X X X OZARKS MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE PART V FOR URL X 1 20 1 SEE PART V FOR URL 0 1 X 100.000000000000 225.000000000000 X X X 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 X 1 X 0 0 OZARKS MEDICAL CENTER PART V, SECTION B, LINE 5: COMMUNITY INPUT:INTERVIEWS WITH 9 KEY STAKEHOLDERS WERE CONDUCTED ON AUGUST 6, 2019.INTERVIEWEES WERE DETERMINED BASED ON:A) THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTHB) THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRYC) THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONSKEY INFORMANTS FROM THE COMMUNITY WORKED FOR THE FOLLOWING TYPES OFORGANIZATIONS AND AGENCIES:- LOCAL SCHOOL SYSTEM AND COMMUNITY COLLEGE- LOCAL CITY AND COUNTY GOVERNMENT- COMMUNITY LEADERS- PUBLIC HEALTH AGENCIES- LAW ENFORCEMENT- MEDICAL PROVIDERSINFORMATION GATHERED WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUESOF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS AND THECOMMUNITY AS A WHOLE. HEALTH NEEDS WERE RANKED UTILIZING A WEIGHTINGMETHOD THAT WEIGHS:1) THE ABILITY TO EVALUATE AND MEASURE THE OUTCOMES AND DATA2) THE SIZE OF THE PROBLEM3) THE SERIOUSNESS OF THE PROBLEM4) THE PREVALENCE OF COMMON THEMES5) THE IMPACT OF THE ISSUE ON VULNERABLE POPULATIONS6) THE ALIGNMENT WITH THE MEDICAL CENTER'S GOALS AND RESOURCES OZARKS MEDICAL CENTER PART V, SECTION B, LINE 11: IMPLEMENTATION STRATEGY:THE MEDICAL CENTER ENGAGED A LEADERSHIP TEAM TO REVIEW THE HEALTH NEEDSAND PRIORITY AREAS WERE DETERMINED BASED ON ASSESSMENT OF THE QUALITATIVEAND QUANTITATIVE DATA. IDENTIFIED NEEDS WERE PRIORITIZED BASED ON THEFOLLOWING CRITERIA:1) HOW MANY PEOPLE ARE AFFECTED BY THE ISSUE2) WHAT ARE THE CONSEQUENCES OF NOT ADDRESSING THIS PROBLEM3) WHAT IS THE IMPACT ON VULNERABLE POPULATIONS4) PREVALENCE OF COMMON THEMES5) ALIGNMENT WITH MEDICAL CENTER'S RESOURCESAS A RESULT OF THE ANALYSIS DESCRIBED ABOVE, THE FOLLOWING HEALTH NEEDSWERE IDENTIFIED AS THE MOST SIGNIFICANT HEALTH NEEDS FOR THE COMMUNITY:-TO ADDRESS LEADING CAUSES OF DEATH/MOST PREVALENT HEALTH ISSUES IN THECOMMUNITY-TO ADDRESS ACCESS TO CARE OZARKS MEDICAL CENTER PART V, SECTION B, LINE 13B: ELIGIBILITY CRITERIA:13B) THE RELATIONSHIP OF INCOME TO CHARGE AMOUNTS EVEN WHEN INCOMEEXCEEDS FPG LIMITS. OZARKS MEDICAL CENTER PART V, SECTION B, LINE 13H: ELIGIBILITY CRITERIA:13H) WHEN SERVICES ARE MEDICALLY NECESSARY AND THERE IS AGREEANCE TOSCREENING FOR OTHER ASSISTANCE PROGRAMS AND PRIOR PAYMENT OBLIGATIONS ONPAST DISCOUNTED SERVICES WERE MET. OZARKS MEDICAL CENTER PART V, SECTION B, LINE 18E: BILLING AND COLLECTIONS:THE WRITTEN FINANCIAL ASSISTANCE POLICY EXPLAINS THAT THE ORGANIZATIONWILL NOT INITIATE COLLECTION EFFORTS OR REQUESTS FOR PAYMENT PROVIDEDTHAT THE RESPONSIBLE PARTY IS COOPERATIVE WITH OMC'S FINANCIAL COUNSELORSEFFORTS TO GET PAYMENT FROM OTHER SOURCES OR OBTAIN INFORMATION FORCHARITY CARE DETERMINATION. THE FAP DOES NOT LIST ANY OF THE ITEMS LISTEDIN #18 OR #19. SCHEDULE H, PART V, SECTION B, LINE 7A THE ORGANIZATION'S 2019 COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT:HTTPS://WWW.OZARKSHEALTHCARE.COM/APP/FILES/PUBLIC/1B8A17C1-B1AA-4A19-AA9B-FF9CCE743EC4/2020-CHNA.PDF SCHEDULE H, PART V, SECTION B, LINE 10A THE ORGANIZATION'S 2020 IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.OZARKSHEALTHCARE.COM/APP/FILES/PUBLIC/FE42BD94-580D-4D2E-BA5F-2BEDD0D5D07F/COMMUNITY-HEALTH-IMPLEMENTATION-2020.PDF SCHEDULE H, PART V, SECTION B, LINE 16A THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT:HTTPS://WWW.OZARKSHEALTHCARE.COM/APP/FILES/PUBLIC/1B61DE69-D925-46B3-973C-9C31D446CAA3/FINANCIAL-ASSIST-PROGRAM.PDF SCHEDULE H, PART V, SECTION B, LINE 16B THE ORGANIZATION'S FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND AT:HTTPS://WWW.OZARKSHEALTHCARE.COM/APP/FILES/PUBLIC/BE692346-6A95-4D0E-A364-F6B4BE243C09/2020-FINANCIAL-APP.PDF SCHEDULE H, PART V, SECTION B, LINE 16C THE ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF ITS FAP CAN BE FOUND AT:HTTPS://WWW.OZARKSHEALTHCARE.COM/APP/FILES/PUBLIC/1B61DE69-D925-46B3-973C-9C31D446CAA3/FINANCIAL-ASSIST-PROGRAM.PDF 24 1 - ALTON MEDICAL CLINIC 100 MEDICAL DR ALTON MO 65606 RURAL HEALTH CLINIC 2 - GAINESVILLE MEDICAL CENTER 37 MEDICAL DRIVE GAINESVILLE MO 65655 RURAL HEALTH CLINIC 3 - MAMMOTH SPRINGS MEDICAL CENTER 260 S MAIN MAMMOTH SPRINGS AR 72554 RURAL HEALTH CLINIC 4 - MOUNTAIN GROVE MEDICAL COMPLEX 500 E 19TH ST MOUNTAIN GROVE MO 65711 RURAL HEALTH CLINIC OP SERVICES 5 - MOUNTAIN VIEW MEDICAL CLINIC 220 N ELM ST PO BOX 32 MOUNTAIN VIEW MO 65548 RURAL HEALTH CLINIC 6 - WINONA MEDICAL CLINIC 9104 STATE HWY 19 WINONA MO 65588 RURAL HEALTH CLINIC 7 - THAYER MEDICAL CLINIC 1375 NETTLETON AVENUE THAYER MO 65791 RURAL HEALTH CLINIC 8 - BEHAVORIAL HEALTH CARE 23 PARKWAY CENTER WEST PLAINS MO 65775 MENTAL HEALTH SERVICES 9 - HEART CARE SERVICES 1115 ALASKA AVE STE 114 WEST PLAINS MO 65775 CARDIOVASCULAR SPECIALTY CLINIC 10 - OZARK WORKSURGENT CARE CLINIC 181 N KENTUCKY AVE WEST PLAINS MO 65775 RURAL HEALTH CLINICOCCUPATIONAL MEDICINE SPECIALTY CLINIC 11 - PAIN MANAGEMENT 3000 INDEPENDENCE SQUARE WEST PLAINS MO 65775 OP SERVICES 12 - ARCH SHAW BUILDING 1111 KENTUCKY AVE WEST PLAINS MO 65775 ONCOLOGY, IMAGING AND REHABILITATION 13 - SLEEP LAB 11 PARKWAY CENTER WEST PLAINS MO 65775 SLEEP LAB 14 - SURGERY CLINIC 2600 INDEPENDENCE SQUARE WEST PLAINS MO 65775 SPECIALTY CLINIC 15 - INTERNAL MEDICINE CLINIC 1115 ALASKA AVE STE 215 WEST PLAINS MO 65775 SPECIALTY CLINIC 16 - HOME CARE 114 E MAIN ST WEST PLAINS MO 65775 HOME HEALTH, HOSPICE SUPPORT SERVICES 17 - ORTHOPEDICS CLINIC 1210 N KENTUCKY AVE WEST PLAINS MO 65775 ORTHOPEDIC SPECIALTY CLINIC 18 - RHEUMATOLOGY 2900 INDEPENDENCE SQUARE WEST PLAINS MO 65775 OP SERVICES 19 - WOMEN'S HEALTHCARE CLINIC 1627 GIBSON ST WEST PLAINS MO 65775 SPECIALTY CLINIC 20 - UROLOGY 181 KENTUCKY AVE STE 200 WEST PLAINS MO 65775 SPECIALTY CLINIC 21 - WOUND CARE 1665 GIBSON ST WEST PLAINS MO 65775 OUTPATIENT SERVICES 22 - WEST PLAINS IMAGING 3102 INDEPENDENCE SQUARE WEST PLAINS MO 65775 OUTPATIENT IMAGING SERVICES 23 - OMC FAMILY MEDICINE 312 KENTUCKY AVE WEST PLAINS MO 65775 RURAL HEALTH CLINIC 24 - OMC WILLOW SPRINGS PO BOX 1100 WEST PLAINS MO 65793 FAMILY MEDICINE PART I, LINE 7: PERCENT OF TOTAL EXPENSE:TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTALOPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990. 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 I, LN 7 COL(F): BAD DEBT EXPENSE FOOTNOTE:THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBESBAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBESPATIENT ACCOUNTS RECEIVABLE: THAT FOOTNOTE CAN BE FOUND ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 2: BAD DEBT EXPENSE:THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FORWHICH THE HEALTH SYSTEM DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROMTHE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROMTHE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUERECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIALSTATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2020. HOWEVER, THE HOSPITALINTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICESAND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A,LINE 2. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE:OZARKS MEDICAL CENTER ESTIMATES THAT APPROXIMATELY 5.7% OF THE PATIENTACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHERASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WASDETERMINED USING 5.7% OF THE AMOUNT REPORTED ON SCHEDULE H, PART III,SECTION A, LINE 2. PART III, LINE 8: COMMUNITY BENEFIT:SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS ACOMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITYBENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTREPORTED ON LINE 6, WHICH ONLY REFLECTS HOSPITAL FACILITY ACTIVITY ANDPAYMENTS FROM CMS AGENTS. WHEN SEQUESTRATION WITHHOLDINGS, COSTS ANDPAYMENTS FOR MEDICARE ADVANTAGE PLAN PATIENTS, AND PHYSICIAN AND CLINICSERVICES AND PAYMENTS ARE ALSO CONSIDERED, THE SHORTFALL BECOMESSIGNIFICANT. PART III, LINE 9B: COLLECTION POLICY:IF A PATIENT APPLIES FOR ASSISTANCE PROGRAMS, THE COLLECTIONS PROCESSCEASES UNTIL THERE IS A DETERMINATION OF WHETHER OR NOT THE PATIENTQUALIFIES FOR ASSISTANCE. PENDING FINAL ELIGIBILITY DETERMINATION, OMCWILL NOT INITIATE COLLECTION EFFORTS OR REQUESTS FOR PAYMENT PROVIDEDTHAT THE RESPONSIBLE PARTY IS COOPERATIVE WITH OMC'S FINANCIALCOUNSELORS' EFFORTS TO GET PAYMENT FROM OTHER SOURCES OR OBTAININFORMATION FOR CHARITY CARE DETERMINATION. PART VI, LINE 2: NEEDS ASSESSMENT:BESIDES THE CHNA SURVEY, OMC HAS MANY OTHER WAYS OF ASSESSING NEEDS OFTHE COMMUNITIES. COMMENTS ON PATIENT SATISFACTION SURVEYS, THE HEALTHCONDITION OF PATIENTS ARRIVING AT THE EMERGENCY ROOM AND OTHER CLINICALAREAS OF OMC, INPUT FROM OTHER AREA PHYSICIANS AND MEDICAL FACILITIES,INPUT FROM SCHOOLS, COLLEGES, AND SOCIAL ASSISTANCE ORGANIZATIONS,QUESTIONS AND COMMENTS SUBMITTED VIA OUR WEBSITE, EDITORIALS IN THE LOCALNEWSPAPERS, RESULTS FROM HEALTH SCREENING EVENTS AND CENSUS DATA ARE ALLSOURCES OF INFORMATION REGARDING THE HEALTH NEEDS OF OUR COMMUNITIES.ALSO, OUR BOARD OF TRUSTEE MEMBERS ARE ALL LEADERS IN OTHER BUSINESSESAND HAVE INPUT BASED ON THEIR EMPLOYEES. OMC ENCOURAGES ALL OF THEIRLEADERS AND STAFF TO BE INVOLVED IN THE COMMUNITY, WHICH ALSO LEADS TOOPPORTUNITIES TO BECOME AWARE OF HEALTH NEEDS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:FINANCIAL COUNSELORS MEET WITH PATIENTS UPON ADMISSION OR DISCHARGE AS APPLICABLE AND DISCUSS PAYMENT OPTIONS INCLUDING DMH, MEDICAID ANDCHARITY, ETC. APPLICATIONS AND INSTRUCTIONS ARE GIVEN TO THOSE THATAPPEAR TO QUALIFY. SOCIAL WORKERS ARE ALSO USED FOR PATIENTS WITH SPECIALNEEDS. EACH CLINIC AND REGISTRATION AREA HAS A PAMPHLET DISPLAY WITHINFORMATION ON THE CHARITY CARE POLICY. PART VI, LINE 4: COMMUNITY INFORMATION:OZARKS MEDICAL CENTER IS LOCATED IN THE 11TH POOREST CONGRESSIONALDISTRICT IN THE COUNTRY. THE LOCATION IS IN SOUTH CENTRAL MISSOURI WHICHIS A VERY RURAL AREA. WEST PLAINS IS A TOWN OF APPROXIMATELY 11,000PEOPLE AND THE LARGEST TOWN FOR APPROXIMATELY 50 MILES ACROSS THE STATELINE INTO ARKANSAS. THERE ARE MANY RETIRED INDIVIDUALS RESIDING IN THISAREA DUE TO THE MANY RIVERS AND LAKES SO A MAJORITY OF OUR PATIENTS AREMEDICARE OR MEDICAID RECIPIENTS. THE CLOSEST HOSPITAL WITH OUR RANGE OFSERVICES IN THE STATE OF MISSOURI IS OVER 1 1/2 HOURS AWAY. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:THE ORGANIZATION PROVIDES NUMEROUS HEALTH CARE SCREENINGS, WELLNESSACTIVITIES, EDUCATIONAL OPPORTUNITIES, AND ATHLETIC PHYSICALS FOR LOCALSTUDENTS. THE ORGANIZATION ALSO PROVIDES FOR MANY COMMUNITY FUNCTIONS AND FUNDRAISING EVENTS FOR OTHER CHARITABLE ORGANIZATIONS. MULTIPLE COMMUNITY EVENTS ARE SPONSORED BY OMC, WHICH INCLUDE GOLF TOURNAMENTS, JUNIOR COLLEGE BASKETBALL AND VOLLEYBALL GAMES/TOURNAMENTS. OMC WORKS WITH THE LOCAL SCHOOLS TO PROVIDE JOB SHADOWING AND HEALTHCARE FAIRS FOR STUDENTS INTERESTED IN A CAREER IN HEALTHCARE.OMC IS THE LARGEST EMPLOYER IN TOWN AND PROVIDES EMPLOYMENT ANDAFFORDABLE BENEFITS TO OVER 1,300 EMPLOYEES AND THEIR FAMILIES. THEORGANIZATION INFUSES $76 MILLION IN WAGES EACH YEAR INTO THE COMMUNITY,BRINGS HEALTHCARE PROFESSIONALS INTO THE COMMUNITY WHICH IN TURN BENEFITS THE HOUSING MARKET, LOCAL SHOPS, RESTAURANTS, AND OTHER BUSINESSES. THE EMPLOYEES OF OMC ARE EXTREMELY GIVING AND PARTICIPATE IN MANY LOCAL FUNDRAISING ACTIVITIES PROMOTED BY OMC. EACH MEMBER OF MANAGEMENT TEAM ALSO PARTICIPATES IN AT LEAST ONE CIVIC ORGANIZATION AND SOME SERVE ON COMMITTEES FOR THESE CIVIC ORGANIZATIONS IN OMC'S SERVICE AREA.OMC PROVIDES THE FULL CONTINUUM OF CARE. DUE TO THE RURAL AREA, OMC HASSET UP RURAL HEALTH CLINICS IN OUR SERVICE AREA TO PROVIDE PRIMARY CAREIN UNDERSERVED AREAS. THE ORGANIZATION ALSO OPERATES A 24/7 EMERGENCYDEPARTMENT THAT PROVIDERS CARE TO OVER 26,000 VISITS PER YEAR. ACUTECARE AND BEHAVIORAL HEALTH CARE IS PROVIDED AS WELL AS HOME HEALTH,HOSPICE, AND HOMEMAKER SUPPORT SERVICES. THE ORGANIZATION ALSO OFFERS ATRANSITION PROGRAM TO MOVE THOSE IN HOME HEALTH TO HOSPICE WHEN THE TIME IS RIGHT, WHICH IS A NON-REIMBURSED SERVICE.OMC IS A COMMUNITY OWNED HOSPITAL THAT DOES NOT RECEIVE ANY TAX MONEYFROM THE CITY OR COUNTY. ALL REVENUES GENERATED ARE USED TO PURCHASECAPITAL EQUIPMENT TO ADVANCE THE SERVICES WE PROVIDE. THERE ARE SERVICESPROVIDED BY OMC THAT ARE NOT AVAILABLE ELSEWHERE IN THE COMMUNITY SUCH AS WOUND CARE, OBSTETRICS, RHEUMATOLOGY, CANCER TREATMENT OPTIONS, ANDOTHERS. EACH SERVICE IS REVIEWED AND THE COMMUNITY NEED DRIVES THE DECISIONS MADE ON THE SERVICES WE PROVIDE. DETAILS OF COMMUNITY HEALTHPROMOTION ARE INCLUDED IN THE COMMUNITY BENEFIT PLAN. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:OZARKS MEDICAL CENTER (THE MEDICAL CENTER) OPERATES AN ACUTE CAREHOSPITAL FACILITY IN WEST PLAINS, MISSOURI. WEST PLAINS HEALTH SERVICES,INC. (WPHS), A WHOLLY OWNED SUBSIDIARY OF THE MEDICAL CENTER, OPERATES ADURABLE MEDICAL EQUIPMENT COMPANY, HEART OF THE OZARKS MEDICAL EQUIPMENT, IN WEST PLAINS, MISSOURI. WPHS OWNS WEST PLAINS OCCUPATIONAL WHICH PROVIDES PRE-EMPLOYMENT SCREENING SERVICES AS WELL AS ONGOING EMPLOYMENT SCREENING SERVICES FOR LOCAL EMPLOYERS. OZARKS MEDICAL CENTER FOUNDATION (THE FOUNDATION) IS AN AFFILIATE ESTABLISHED TO PROVIDE FUNDRAISING ASSISTANCE TO THE MEDICAL CENTER. OZARKS MEDICAL CENTER PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN WEST PLAINS, MISSOURI, AND THE SURROUNDING AREA. THE MEDICAL CENTER ALSO OPERATES A HOME HEALTH AND HOSPICE AGENCY AND A NUMBER OF PHYSICIAN CLINICS IN THE SAME GEOGRAPHIC AREA. 1 MISSOURI STATE UNIVERSITY 128 GARFIELD WEST PLAINS MO 65775 446000308 GOVERNMENT 101000 OPERATING SUPPORT 1 SCHOLARSHIPS/TUITION REIMBURSEMENT 24 46000 PART I, LINE 2: MONITORING THE USE OF GRANT FUNDS: RECIPIENTS MUST TURN IN THEIR GRADES TO THE HUMAN RESOURCES DEPARTMENT BEFORE THEY RECEIVE THE NEXT INSTALLMENT OF THE SCHOLARSHIP. THE RECIPIENTS MUST MAINTAIN A 2.75 GPA. X X X X 0 0 0 0 0 0 0 0 0 MUHAMMAD FAISAL KHAN INTERVENTIONAL CARDIOLOGIST 795699 0 32750 0 72559 0 4791 0 17872 0 923671 0 0 0 CURTIS LEE HORSTMAN ER PHYSICIAN 868374 0 4611 0 0 0 3923 0 17872 0 894780 0 0 0 KORBY POGUE ER PHYSICIAN 815363 0 19679 0 0 0 8100 0 12554 0 855696 0 0 0 LAURA MCKENZIE ANESTHESIOLOGIST 834786 0 750 0 540 0 3751 0 13524 0 853351 0 0 0 ELI DENNEY ER PHYSICIAN 788060 0 750 0 0 0 0 0 17872 0 806682 0 0 0 MAGDY F GIURGIUS BOARD MEMBER/PHYSICIAN 507242 0 43599 0 13220 0 4096 0 17872 0 586029 0 0 0 THOMAS WILLIAM KELLER CEO 513578 0 0 0 0 0 477 0 17872 0 531927 0 0 0 CHARLES H MORGAN BOARD MEMBER/PHYSICIAN 375211 0 750 0 65482 0 6687 0 13524 0 461654 0 0 0 CHRISTOPHER D COCHRAN BOARD MEMBER/PHYSICIAN 331251 0 750 0 6760 0 4178 0 17872 0 360811 0 0 0 JESSE CHARLES RHOADS BOARD MEMBER/PHYSICIAN 273825 0 750 0 40103 0 3567 0 12554 0 330799 0 0 0 KURTIS MATTHEW ABBEY CNO/COO 205431 0 750 0 0 0 0 0 12554 0 218735 0 0 0 NICHOLE COOK CFO/VP FINANCE 188923 0 750 0 0 0 0 0 17872 0 207545 0 0 0 PART I, LINE 5 COMPENSATION CONTINGENT ON REVENUES: FOUR BOARD MEMBERS ARE ALSO EMPLOYED PHYSICIANS OF OZARKS MEDICAL CENTER WHO RECEIVE COMPENSATION BASED ON RVU VALUES FOR SERVICES PROVIDED TO PATIENTS. PART I, LINE 7 BONUS DETERMINATION: SENIOR MANAGEMENT'S BONUSES ARE BASED ON A SET OF CORPORATE AND INDIVIDUAL STRATEGIC GOALS THAT ARE WEIGHTED AND ASSIGNED A VALUE. EACH INDIVIDUAL'S POTENTIAL BONUS AMOUNT IS BASED ON THEIR SALARY. THE PERCENTAGE ABOVE OR BELOW THE POTENTIAL BONUS THAT THEY RECEIVE IS IN RELATION TO THE COMPLETION OF THE GOAL AND THE WEIGHT GIVEN TO THAT GOAL. THEY CAN EARN 115% - 0% OF THE POTENTIAL GOAL. A INDUSTRIAL DEVELOPMENT AUTHORITY OF WP SERIES 2018A 431343355 2018-10-01 52832000 HEALTH FACILITIES REVENUE BONDS 0 0 0 B INDUSTRIAL DEVELOPMENT AUTHORITY OF WP SERIES 2018B 431343355 2018-10-01 15000000 HEALTH FACILITIES REVENUE BONDS 0 0 0 A 52832000 15387 563825 26592445 25660343 0 0 0 1 B 1632627 15000000 225774 14774226 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS: DAVID GOHN, MELISSA STEWART, AND ROGER SHAW SHARE A BUSINESS RELATIONSHIP. KEVIN GLEGHORN IS A RELATIVE TO OMC'S EMPLOYED INPATIENT PHARMACY DIRECTOR, CHAD GLEGHORN. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS/STOCKHOLDERS: OZARKS MEDICAL CENTER HAS ONE CLASS OF MEMBERSHIP. ALL INTERESTED PARTIES ARE ELIGIBLE FOR MEMBERSHIP UPON PAYMENT OF THE MEMBERSHIP FEES SET BY THE BOARD OF DIRECTORS. MEMBERSHIP IS NOT TRANSFERABLE OR ASSIGNABLE. MEMBERS, AFTER BEING A MEMBER FOR AT LEAST THIRTY DAYS, SHALL BE ELIGIBLE TO VOTE ON ANY BUSINESS OF THE CORPORATION. EACH MEMBER IS ENTITLED TO ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS CONSISTS OF 15 DIRECTORS. TEN OF THE CORPORATION'S BOARD MEMBERS, ELECTED FROM OZARKS MEDICAL CENTER'S SERVICE AREA, ARE ELECTED BY THE MEMBERS OF THE CORPORATION. ANY DIRECTOR PREVIOUSLY ELECTED BY THE MEMBERS MAY BE REMOVED FROM OFFICE BY THE MEMBERS AT AN ANNUAL MEETING OR ANY PROPERLY CALLED SPECIAL MEETING, BY THE VOTE OF TWO-THIRDS OF THE MEMBERS PRESENT, IN WHICH EVENT THE MEMBERS PRESENT WILL ELECT A SUCCEEDING DIRECTOR TO SERVE THE UNEXPIRED TERM OF THE REMOVED DIRECTOR. EACH MEMBER HAS ONE VOTE. ANY VACANCY DUE TO DEATH OR RESIGNATION SHALL BE FILLED BY ELECTION BY THE REMAINING MEMBERS OF THE BOARD. THREE DIRECTORS ARE ELECTED BY THE MEDICAL STAFF OF THE ORGANIZATION AND MUST BE A MEDICAL STAFF MEMBER THAT IS ALSO A MEMBER OF THE CORPORATION TO BE ELIGIBLE TO BE ELECTED TO THE BOARD. ANY VACANCIES OF THESE THREE BOARD POSITIONS ARE FILLED BY THE MEDICAL STAFF. THE REMAINING TWO BOARD OF DIRECTORS ARE DESIGNATED BY THEIR POSITION IN THE ORGANIZATION. THE CHIEF OF THE MEDICAL STAFF AND THE CHIEF ELECT OR CHIEF EMERITUS, WHICHEVER IS IN EXISTENCE IN THE GIVEN YEAR, OF THE MEDICAL STAFF ARE BOTH BOARD MEMBERS FOR AS LONG AS THEY HOLD THOSE TITLES. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS OF THE CORPORATION MAY BE AMENDED AT AN ANNUAL OR PROPERLY CALLED SPECIAL MEETING OF THE MEMBERS OF THE CORPORATION BY TWO-THIRDS OF THE VOTE CAST OR A MAJORITY OF THE VOTING POWER, WHICHEVER IS LESS. THE BYLAWS MAY ALSO BE AMENDED BY THE BOARD PROVIDED THAT THE AMENDMENT DOES NOT RELATE TO THE NUMBER OF DIRECTORS, THE COMPOSITION OF THE BOARD, THE TERM OF OFFICE OF DIRECTORS, OR THE METHOD OR WAY IN WHICH DIRECTORS ARE ELECTED OR SELECTED, OR PROVIDED THAT THE BASIC PURPOSE OF THE CORPORATION SHALL NOT BE CHANGED OR ALTERED. IF ANY OF THOSE CONDITIONS DOES NOT APPLY, THE AMENDMENT MUST BE VOTED ON BY THE MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B REVIEW PROCESS FOR FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE BOARD WILL REVIEW THE FORM AND RECORD IN THE MEETING MINUTES THEIR ACCEPTANCE OF THE DRAFT. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH CONFLICT OF INTEREST POLICY: CONFLICT STATEMENTS ARE REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE TO DETERMINE IF NEW ITEMS WERE DISCLOSED. IF A BOARD MEMBER DID HAVE A CONFLICT OF INTEREST, HE/SHE WOULD ABSTAIN FROM VOTING ON ANY TRANSACTIONS RELATED TO THAT CONFLICT. STATEMENTS ARE ALSO OBTAINED FROM EXECUTIVES. FORM 990, PART VI, SECTION B, LINE 15 OFFICER AND KEY EMPLOYEE COMPENSATION REVIEW: THE BOARD OF DIRECTORS ENGAGED INTEGRATED HEALTH STRATEGIES (AN EXECUTIVE COMPENSATION CONSULTING PRACTICE) TO DO MARKET STUDIES AND ANALYSIS OF EXECUTIVE COMPENSATION. THE MARKET IS REVIEWED ANNUALLY. THE BOARD OF DIRECTORS SETS THE CEO'S COMPENSATION AND THE CEO PROVIDES RECOMMENDATIONS TO THE BOARD FOR OTHER OFFICERS/KEY EMPLOYEE'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO VIEW UPON WRITTEN REQUEST AT THE ADMINISTRATIVE OFFICE OF THE HOSPITAL DURING REGULAR BUSINESS HOURS. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: BOARD MEMBERS CHARLES MORGAN, M.D., CHRISTOPHER COCHRAN, M.D., MAGDY GIURGIUS, M.D. AND JESSE RHOADS, M.D. RECEIVE COMPENSATION FOR THEIR ROLES AS PHYSICIANS. NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DUTIES AS A MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,902,068. MANAGEMENT AND GENERAL EXPENSES 1,644,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,546,348. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,687,507. MANAGEMENT AND GENERAL EXPENSES 1,553,868. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,241,375. BILLING & COLLECTIONS: PROGRAM SERVICE EXPENSES 2,228,364. MANAGEMENT AND GENERAL EXPENSES 939,004. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,167,368. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,597,198. MANAGEMENT AND GENERAL EXPENSES 673,039. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,270,237. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 3,766,169. MANAGEMENT AND GENERAL EXPENSES 1,587,014. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,353,183. CONSULTING FEES: PROGRAM SERVICE EXPENSES 543,988. MANAGEMENT AND GENERAL EXPENSES 229,229. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 773,217. OTHER FEES: PROGRAM SERVICE EXPENSES 14,383. MANAGEMENT AND GENERAL EXPENSES 6,061. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,444. FORM 990, PART XI, LINE 9: EQUITY LOSS ON INVESTMENT -936,812. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OZARKS MEDICAL CENTER FOUNDATION 12 PARKWAY CENTER WEST PLAINS MO 65775 431834356 SUPPORT OMC MO 501(C)(3) LINE 7 N/A 0 WEST PLAINS HEALTH SERVICES 1703 WEST EIGHTH STREET WEST PLAINS MO 65775 431329201 DURABLE MED EQUIP MO OZARKS MEDICAL CENTER C 1861852 1782761 1.00000 1 1 0 1 1 0 0 0 0 0 1 1 0 1 0 1 0 1 0 0 WEST PLAINS HEALTH SERVICES INC A 18945 AMORT SCHED