PERRY COUNTY HEALTH SYSTEM: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- PERRY COUNTY HEALTH SYSTEM (EIN 43-1741457)
- Tax period
- 2023-04-01 to 2024-03-31
- Filed
- 2025-02-17
- IRS object ID
- 202520489349300632
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-02-17T09:17:07-06:00 | ReturnTs |
| Tax Period End | 2024-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 430352985 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3401 OFFICE PARK DRIVE | AddressLine1Txt |
| City | MARION | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62959 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431741457 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERRY COUNTY HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PERR | BusinessNameControlTxt |
| Phone | 5735172896 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 434 NORTH WEST STREET | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BETH GUTH | PersonNm |
| Person Title | DESIGNATED SIGNATORY OFFICER | PersonTitleTxt |
| Phone | 5735172896 | PhoneNum |
| Signature | 2025-02-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMBER HALSTEAD | PreparerPersonNm |
| PTIN | P01343727 | PTIN |
| Phone | 6185291040 | PhoneNum |
| Preparation | 2025-02-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BETH GUTH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 434 NORTH WEST STREET | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $33,608,846 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HOSPITAL AND HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 538 | TotalEmployeeCnt |
| Total Volunteers | 27 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $482,354 | PYContributionsGrantsAmt |
| CY Contributions Grants | $390,237 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $62,544,830 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,716,191 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$808,918 | PYInvestmentIncomeAmt |
| CY Investment Income | $424,575 | CYInvestmentIncomeAmt |
| PY Other Revenue | $7,250,509 | PYOtherRevenueAmt |
| CY Other Revenue | $2,051,219 | CYOtherRevenueAmt |
| PY Total Revenue | $69,468,775 | PYTotalRevenueAmt |
| CY Total Revenue | $33,582,222 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $34,445,247 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,349,807 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $32,164,489 | PYOtherExpensesAmt |
| CY Other Expenses | $20,218,213 | CYOtherExpensesAmt |
| PY Total Expenses | $66,609,736 | PYTotalExpensesAmt |
| CY Total Expenses | $38,568,020 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,859,039 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,985,798 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $69,876,813 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,426,231 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,350,007 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,717,513 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $61,526,806 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,708,718 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY HOSPITAL & HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $31,857,744 | ExpenseAmt |
| Revenue | $32,740,786 | RevenueAmt |
| Desc | 2556 PATIENT DAYS OF CARE OF WHICH 112 DAYS WERE NURSERY CARE WERE PROVIDED THROUGH INPATIENT SERVICES IN THE SIX MONTHS FROM APRIL 1, 2023 TO SEPTEMBER 30, 2023. THE HOSPITAL PROVIDED 35,081 RURAL HEALTH CLINIC VISITS, 3,926 EMERGENCY ROOM VISITS, AND 1,153 SURGERIES DURING THAT PERIOD AS WELL. IN 1998, THE BOARD OF TRUSTEES OF PERRY COUNTY MEMORIAL HOSPITAL (BOARD OF TRUSTEES) ENTERED INTO AN AGREEMENT WITH PERRY COUNTY HEALTH SYSTEM (PCHS), WHEREBY ALL ASSETS, LIABILITIES AND OPERATIONS WERE TRANSFERRED TO PCHS (THE 1998 AGREEMENT). ON MARCH 2, 2023, THE PCHS BOARD OF DIRECTORS PASSED A RESOLUTION TO TERMINATE THE 1998 AGREEMENT EFFECTIVE OCTOBER 1, 2023. ON SEPTEMBER 30, 2023, THE BOARD OF TRUSTEES AND PCHS ENTERED INTO A LEASE TERMINATION AGREEMENT NOTHING THAT THE 1998 AGREEMENT IS TERMINATED EFFECTIVE OCTOBER 1, 2023. THIS EARLY TERMINATION OF THE 1998 AGREEMENT WAS PREDICATED ON A NEW LEASE WITH MERCY HEALTH EAST COMMUNITIES. PCHS WILL CONTINUE ITS CORPORATE AFFAIRS BYOND PCHS'S LEASE TERMINATION IN ORDER TO CONCLUDE ANY AND ALL BUSINESS ASSOCIATED WITH ITS PRIOR HEALTHCARE OPERATIONS. SUCH CONCLUDING BUSINESS INCLUDES THE FILING OF MEDICARE AND MEDICAID COST REPORTS, AUDITS OF PRIOR MEDICARE AND MEDICAID COST REPORTS, FINANCIAL AUDITS, COLLECTION OF ACCOUNTS RECEIVABLE, TAX RETURN COMPLIANCE AND ARCHIVE STORAGE OF PCHS DATA. | Desc |
| Total Program Service Expenses | $31,857,744 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 99 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 538 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MO | StatesWhereCopyOfReturnIsFldCd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BETH GUTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5735172896 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 434 NORTH WEST STREET | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| DR KEITH MOECKEL | |||||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| PATRICK NAEGER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| BETH GUTH | |||||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| KAY TAYLOR | |||||||||
| VICE PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| DR LINDA BUERCK | |||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| CHRISTOPHER WIBBENMEYER | |||||||||
| CEO | 50.00 | $226,182 | $0 | $25,039 | Yes (X) | ||||
| MICHAEL ELLIS | |||||||||
| CFO | 50.00 | $136,586 | $0 | $38,834 | Yes (X) | ||||
| STACEY M REITZEL | |||||||||
| ASSOCIATE VP | 50.00 | $154,924 | $0 | $28,321 | Yes (X) | ||||
| ANGIE BREWER | |||||||||
| HR DIRECTOR | 50.00 | $152,471 | $0 | $43,486 | Yes (X) | ||||
| JOSEPH B BYRNE | |||||||||
| PHYSICIAN | 50.00 | $806,241 | $0 | $42,319 | Yes (X) | ||||
| CRAIG FRAYER | |||||||||
| PHYSICIAN | 50.00 | $331,864 | $0 | $39,669 | Yes (X) | ||||
| SANDEEP RAO | |||||||||
| HOSPITALIST | 50.00 | $858,779 | $0 | $47,162 | Yes (X) | ||||
| HOPE BANTE | |||||||||
| PHYSICIAN | 40.00 | $234,752 | $0 | $27,901 | Yes (X) | ||||
| MATTHEW GAETA | |||||||||
| GASTROLOGY | 50.00 | $712,421 | $0 | $41,448 | Yes (X) | ||||
| PATRICK CARRON | |||||||||
| FORMER PRESIDENT/CEO | 0.00 | $125,568 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,739,788 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $334,179 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PERRYVILLE FAMILY CARE CLINIC PC | |||||
| 212 HOSPITAL LANE SUITE 202 | PERRYVILLE | MO | 63775 | PHYSICIAN SERVICES | $2,761,483 |
| MID AMERICA REHAB | |||||
| 206 HOSPITAL LANE SUITE 100 | PERRYVILLE | MO | 63775 | PHYSICAL THERAPY SERVICES | $2,020,087 |
| BLUSKY RESTORATION CONTRACTORS LLC | |||||
| 13701 GREEN ASH CT | EARTH CITY | MO | 63045 | CONTRACTOR SERVICES | $1,922,259 |
| CAPE RADIOLOGY GROUP | |||||
| 434 N WEST ST | PERRYVILLE | MO | 63775 | RADIOLOGY SERVICES | $951,360 |
| PERRY KIDS PEDIATRICS | |||||
| 210 HOSPITAL LANE SUITE 202 | PERRYVILLE | MO | 63775 | PHYSICIAN SERVICES | $405,820 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $390,237 | AllOtherContributionsAmt |
| Total Contributions | $390,237 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTHCARE SERVICES | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $30,716,191 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,716,191 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,716,191 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $451,199 | TotalRevenueColumnAmt |
| Exclusion | $451,199 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,624 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$26,624 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$26,624 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$26,624 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PHARMACY REVENUE | 621990 | $1,295,043 | $1,295,043 |
| INSURANCE PROCEEDS | 621990 | $440,285 | $440,285 |
| OTHER INCOME | 621990 | $281,928 | $281,928 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,963 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,963 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,051,219 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,582,222 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,740,786 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $451,199 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,100,970 | TotalAmt |
| Management And General | $1,100,970 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,064,219 | TotalAmt |
| Program Services | $12,465,366 | ProgramServicesAmt |
| Management And General | $598,853 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $397,094 | TotalAmt |
| Program Services | $349,443 | ProgramServicesAmt |
| Management And General | $47,651 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,054,644 | TotalAmt |
| Program Services | $2,688,087 | ProgramServicesAmt |
| Management And General | $366,557 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $732,880 | TotalAmt |
| Program Services | $644,934 | ProgramServicesAmt |
| Management And General | $87,946 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,778 | TotalAmt |
| Management And General | $569,778 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,090 | TotalAmt |
| Program Services | $73,783 | ProgramServicesAmt |
| Management And General | $17,307 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,296,593 | TotalAmt |
| Program Services | $1,050,243 | ProgramServicesAmt |
| Management And General | $246,350 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $624,108 | TotalAmt |
| Program Services | $505,527 | ProgramServicesAmt |
| Management And General | $118,581 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,314 | TotalAmt |
| Program Services | $23,744 | ProgramServicesAmt |
| Management And General | $5,570 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,368,068 | TotalAmt |
| Program Services | $1,368,068 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,225,528 | TotalAmt |
| Program Services | $992,678 | ProgramServicesAmt |
| Management And General | $232,850 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROFESSIONAL FEES | $9,321,439 | $7,084,294 | $2,237,145 |
| MEDICAL SUPPLIES | $4,949,399 | $4,009,013 | $940,386 |
| REPAIRS AND MAINTENANCE | $727,191 | $589,025 | $138,166 |
| POSTAGE | $11,400 | $9,234 | $2,166 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,305 | TotalAmt |
| Program Services | $4,305 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,568,020 | TotalAmt |
| Program Services | $31,857,744 | ProgramServicesAmt |
| Management And General | $6,710,276 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,037,695 | BOYAmt |
| EOY | $9,169,044 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,752,422 | BOYAmt |
| EOY | $226,691 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,481,706 | BOYAmt |
| EOY | $260,583 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,602,332 | BOYAmt |
| EOY | $313,314 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $392,358 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,000 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,174,080 | BOYAmt |
| EOY | $20,000 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,378,804 | BOYAmt |
| EOY | $223 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,057,416 | BOYAmt |
| EOY | $2,436,376 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,876,813 | BOYAmt |
| EOY | $12,426,231 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,474,007 | BOYAmt |
| EOY | $800,246 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,576,000 | BOYAmt |
| EOY | $1,576,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,000 | BOYAmt |
| EOY | $3,341,267 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,350,007 | BOYAmt |
| EOY | $5,717,513 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,526,806 | BOYAmt |
| EOY | $6,708,718 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,526,806 | BOYAmt |
| EOY | $6,708,718 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,876,813 | BOYAmt |
| EOY | $12,426,231 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,985,798 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$244,457 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$49,587,833 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,139 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,139 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PERRY COUNTY HEALTH SYSTEM IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND MISSOURI HOSPITAL ASSOCIATION (MHA). A PORTION OF THE HOSPITAL'S DUES PAID TO THE AHA AND MHA ARE INDIRECTLY USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $20,000 | InvestmentCostOrOtherBasisAmt |
| Book Value | $20,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,000 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INVESTMENTS - P'VILLE HEALTH CARE | $1,591,662 |
| THIRD PARTY REIMBURSEMENT PROGRAMS | $700,000 |
| INVESTMENT - PARETO HEALTH | $144,714 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,436,376 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD-PARTY REIMBURSEMENT PROGRAMS | Desc |
| Amt | $3,341,267 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,341,267 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER CODE SECTION 501(C)(3) FOR ACTIVITIES DIRECTLY RELATED TO ITS TAX-EXEMPT FUNCTION. UNRELATED BUSINESS INCOME IS SUBJECT TO TAX. PERRYVILLE HEALTHCARE CORPORATION IS A TAXABLE CORPORATION AND FILES A SEPARATE CORPORATE RETURN. THE HOSPITAL HAS RECOGNIZED IN THE FINANCIAL STATEMENTS THE EFFECTS OF ALL TAX POSITIONS AND CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE HOSPITAL IS NOT AWARE OF ANY SIGNIFICANT CIRCUMSTANCES OR EVENTS THAT MAKE IT REASONABLY POSSIBLE THAT UNRECOGNIZED TAX BENEFITS MAY INCREASE OR DECREASE WITHIN 12 MONTHS OF THE STATEMENT OF FINANCIAL POSITION DATE. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 190.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $129,583 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $129,583 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,674,313 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,878,511 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,795,802 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04660 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,803,896 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,878,511 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,925,385 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05000 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,833,896 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,878,511 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,955,385 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,102,000 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $550,986 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,902,765 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $17,729,799 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,827,034 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERRY COUNTY HEALTH SYSTEM | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 434 NORTHWEST STREET | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERRY COUNTY HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 190.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PERRY COUNTY HEALTH SYSTEM | PART V, SECTION B, LINE 5: THIS ASSESSMENT HAS EXPLORED THE NEEDS OF THE IDENTIFIED GROUPS BY SPECIFICALLY SEEKING INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS. THOSE CONSULTED INCLUDE THE HOSPITAL EXECUTIVE STAFF AND AN INTERNAL WORKING GROUP. AT THE BEGINNING OF 2022, PERRY COUNTY HEALTH SYSTEM (PCHS) AND PERRY COUNTY HEALTH DEPARTMENT (PCHD) FACILITATED A FOCUS GROUP WITH COMMUNITY AGENCIES TO IDENTIFY HEALTH TOPICS OF CONCERN THESE AGENCIES HAVE ENCOUNTERED IN THEIR EVERYDAY SERVICES TO THE COMMUNITY. IN ADDITION, PCHS BEGAN A SERIES OF COMMUNITY-WIDE DISCUSSIONS WHICH INCLUDED SIMILAR AGENCIES IN ADDITION TO SOME LOCAL BUSINESS REPRESENTATIVES. ALSO, SURVEYS WERE DISTRIBUTED TO PHYSICIANS OF PCHS AND THE COMMUNITY. BOTH SURVEYS INCLUDED POTENTIAL HEALTH NEEDS OF THE COMMUNITY AND ASKED FOR RESPONDENTS TO RANK WHAT THEY PERCEIVED AS THE HIGHEST COMMUNITY NEED. THE COMMUNITY MEMBER SURVEY ALSO INCLUDED SOME DATA ON HEALTH BEHAVIORS WITH ONE OF THE PURPOSES BEING TO HELP FILL DATA GAPS WITH INFORMATION NOT AVAILABLE FROM TRADITIONAL DATA SOURCES. IN ADDITION TO THESE METHODS, DATA WAS COLLECTED AND ANALYZED FROM A VARIETY OF SOURCES TO EXAMINE AND COMPARE RATES AND OCCURRENCES AMONG POPULATIONS AT THE LOCAL, STATE, REGIONAL, AND NATIONAL LEVELS. AFTER ALL DATA WAS COLLECTED, A REVIEW TOOK PLACE TO IDENTIFY AND PRIORITIZE THE TOP NEEDS OF THE COMMUNITY. |
| PERRY COUNTY HEALTH SYSTEM | PART V, SECTION B, LINE 6B: PCHS WAS A PARTICIPANT IN A COMMUNITY WIDE SURVEY ALONG WITH OTHER SIGNIFICANT COMMUNITY AGENCIES (COUNTY HEALTH DEPARTMENT, CITY POLICE, COUNTY SHERIFF, SCHOOLS, TASK FORCE, MENTAL HEALTH BOARD, AND OTHERS) TO OBTAIN DATA ON INDIVIDUAL PERCEPTIONS OF HEALTH NEEDS. |
| PERRY COUNTY HEALTH SYSTEM | PART V, SECTION B, LINE 11: THE TOP PRIORITIES IDENTIFIED FOR PERRY COUNY, MO INCLUDE MENTAL HEALTH, HEART DISEASE AND TOBACCO/SUBSTANCE USE.MENTAL HEALTH - ESTABLISH A COMMUNITY HEALTH WORKER TO BE A RESOURCE LIAISON WITHIN THE COMMUNITY. PROVIDE EDUCATION TO THE PROVIDERS AT PCHS. IN ADDITION, PROVIDE EDUCATION AND SUPPORT TO THE SCHOOL SYSTEMS IN PERRY COUNTY. HEART DISEASE - PROMOTE AND INCREASE AWARENESS AMONGST PCHS PROVIDERS OF VARIOUS HEART DISEASE PROGRAMS OFFERED THROUGH PCHD TO SHARE WITH PATIENTS. CREATE A PROCESS FOR PCHD TO FOLLOW UP WITH PCHS PROVIDERS WHO HAVE PATIENTS IN THE HEART DISEASE PROGRAMS. PROMOTE AND SHARE RESOURCES AND EDUCATION AVAILABLE THROUGH ORGANIZATIONS IN THE COMMUNITY REGARDING HEALTHY RECIPES, COOKING, NUTRITION, GARDENING, ACTIVITIES, AND MORE.TOBACCO/SUBSTANCE ABUSE - ASSIST IN THE DEVELOPMENT OF A DRUG COURT IN PERRY COUNTY WHOSE COAL IS LONG-TERM TREATMENT VERSUS PUNISHMENT. PARTICIPANTS ARE SUPERVISED AND MONITORED AND MUST ABSTAIN FROM SUBSTANCE USE AND FULFILL THE LEGAL RESPONSIBILITIES OF THE OFFENSES THEY COMMITTED. DETERMINE A REPRESENTATIVE FROM PCHS TO JOIN THE COALITION FOR HEROIN AND OPIOID PREVENTION GROUP. PROMOTE AND REFER PATIENTS TO PROGRAMS AVAILABLE THORUGH PCHD. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - MID AMERICA REHAB | ||||
| 206 HOSPITAL LANE | PERRYVILLE | MO | 63775 | PHYSICAL THERAPY |
| 2 - PERRYVILLE FAMILY CARE CENTER | ||||
| 212 HOSPITAL LANE | PERRYVILLE | MO | 63775 | PHYSICIANS |
| 3 - PERRY COUNTY PHYSICIAN SERVICES | ||||
| 206 HOSPITAL LANE | PERRYVILLE | MO | 63775 | PHYSICIANS |
| 4 - PCMH AMBULANCE SERVICE LLC | ||||
| 434 N WEST STREET | PERRYVILLE | MO | 63775 | AMBULANCE SERVICES |
| 5 - PFCC WEST | ||||
| 1508 EDGEMONT BLVD | PERRYVILLE | MO | 63775 | PHYSICIANS |
| 6 - PERRY COUNTY SPECIALTY SERVICES | ||||
| 210 HOSPITAL LANE | PERRYVILLE | MO | 63775 | PHYSICIANS - PEDIATRICS |
| 7 - WOUND CARE CLINIC | ||||
| 434 N WEST STREET | PERRYVILLE | MO | 63775 | WOUND CARE |
| 8 - HOME HEALTH | ||||
| 434 N WEST STREET | PERRYVILLE | MO | 63775 | HOME HEALTH |
| 9 - EQUIPMENT PLUS HOME SERVICES | ||||
| 519 N MAIN STREET SUITE 2 | PERRYVILLE | MO | 63775 | DURABLE MEDICAL EQUIPMENT |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE HOSPITAL USED A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. THE HOSPITAL USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS OF LINES 7E OF PART I OF SCHEDULE H. |
| PART III, LINE 2: | THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST-TO-CHARGE RATIO AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED AS OUTLINED IN SCHEDULE H, PART III, LINE 9B. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. BASED ON THE HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THEY ESTIMATE THAT IT IS LIKELY THAT UP TO 50% OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, 50% OF THE BAD DEBT EXPENSE WAS INCLUDED ON PART III, LINE 3 AT COST. THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE THAT SPECIFICALLY ADDRESSES BAD DEBTS (NOTE D). THE PROVISION FOR BAD DEBTS REPRESENTS UNCOMPENSATED CARE FOR PATIENTS OF WHICH A MAJORITY ARE UNINSURED OR UNDERINSURED, BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE. |
| PART III, LINE 9B: | THE HOSPITAL'S CREDIT AND COLLECTION POLICY, PURPOSE, AND PROCEDURES ARE AS FOLLOWS:PURPOSE: ASSIST AND ADVISE PATIENTS ON INSURANCE AND FINANCIAL RESOURCES. PERFORM DUTIES IN CONNECTION WITH CREDIT, COLLECTIONS, AND SOCIAL SERVICES. ARRANGE PAYMENT OF ANY BALANCE NOT COVERED BY INSURANCE. EVALUATE THE CREDIT HISTORY AND DETERMINE PAYMENTS BASED ON THE PATIENT'S ABILITY TO PAY AND THE POLICY OF THE HOSPITAL AS BELOW.ALL EFFORT WILL BE MADE TO COLLECT THE BALANCE AS FOLLOWS:BALANCE UNDER $1,000.00 - PAID WITHIN 3 MONTHS.FOR EACH ADDITIONAL $1,000.00 BALANCE - ADD 3 MONTHS.(EXAMPLE: FOR BALANCES BETWEEN $4,000.00 AND $5,000.00 - PAID WITHIN 12 MONTHS.)ACCOUNTS WITH A BALANCE OF $3.00 AND UNDER WILL NOT BE MAILED A BILLING STATEMENT. THE BALANCE WILL BE CHARGED OFF AS A SMALL BALANCE ADJUSTMENT.STATEMENTS ARE GENERATED ON A WEEKLY BASIS BY RUNNING FIRST TIME STATEMENTS AND CYCLE STATEMENTS 1, 2, 3, OR 4.ACCOUNTS FOLLOW A REGULAR COMPUTER GENERATED BILLING SYSTEM. FIRST TIME STATEMENTS ARE SENT AFTER THE INSURANCE PAYMENT HAS BEEN PROCESSED AND THE ACCOUNT FALLS INTO A BILLING CYCLE. WHEN THAT CYCLE IS PRINTED, A FIRST TIME STATEMENT WILL BE GENERATED. THE FOLLOWING MONTH, A CYCLE STATEMENT IS GENERATED. THE COLLECTION CYCLE ADVANCES AS FOLLOWS: 1, 2, 3, A (FIRST LETTER) AND B (FINAL NOTICE LETTER).AFTER ACCOUNTS WITH A BALANCE OVER $1,000.00 RECEIVE A FIRST TIME STATEMENT, THEY ARE REVIEWED BY THE FINANCIAL COUNSELOR TO DETERMINE IF A COLLECTION PHONE CALL SHOULD BE MADE. FINANCIAL ARRANGEMENTS ARE DISCUSSED AND PAYMENT SCHEDULES ARE AGREED UPON. MONTHLY TERMS CAN BE SET, WHEREBY A DESIGNATED AMOUNT AND DATE OF PAYMENT IS ARRANGED ON A MONTHLY BASIS. ACCOUNTS THAT DO NOT FOLLOW THE DESIGNATED PAYMENT PLAN RECEIVE LETTERS 2, 3, A, AND B. IF THE ACCOUNT IS STILL UNPAID AFTER THE ABOVE PROCEDURES ARE USED, ACCOUNTS ARE WRITTEN OFF AND PREPARED FOR THE COLLECTION AGENCY BY PRINTING THE COLLECTION AGENCY REPORT. REPORTS ARE ALSO PREPARED FOR THE APPROVAL OF THE VICE PRESIDENT OF FINANCE AND THE BUSINESS OFFICE MANAGER. REGULAR WRITE-OFFS ARE DONE ON A MONTHLY BASIS. MEDICARE WRITE OFFS ARE DONE ON A MONTHLY BASIS.ASSISTANCE IS GIVEN TO THE THIRD PARTY AGENCY TO AID IN THE COLLECTION OF ACCOUNTS. THE AGENCY IS NOTIFIED DAILY OF PAYMENTS AND BALANCE DUE ON TURNED ACCOUNTS. WHEN THE AGENCY ADVISES OF SUIT FILING ON ACCOUNTS, AN AFFIDAVIT IS SENT TO OBTAIN PERMISSION. THE AFFIDAVIT IS SIGNED BY THE BUSINESS OFFICE MANAGER AND NOTORIZED PRIOR TO RETURNING TO THE AGENCY. THEY WILL ACT AS OUR REPRESENTATIVE AND SELECT AN ATTORNEY TO REPRESENT THE HOSPITAL IN LEGAL PROCEEDINGS, AND ATTEND ANY COURT PROCEEDINGS ON THE DATE SCHEDULED.WHEN THE COLLECTION AGENCY HAS CEASED ALL COLLECTION EFFORTS AND THE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE COLLECTION AGENCY WILL SEND A RETURN REPORT. AT THAT TIME, ACCOUNTS WILL BE POSTED AS AN ACCOUNT RETURNED FROM THE COLLECTION AGENCY AND CAN BE INCLUDED AS A BAD DEBT ON THE COST REPORT.ACCOUNTS ARE ALSO REVIEWED FOR REFUNDS, CHARGE OFFS, AND PAYROLL DEDUCTION.THE FINANCIAL COUNSELOR SPEAKS WITH PRIVATE PAY PATIENTS IN A/C, ER, AND ON MED/SURG TO SET UP PAYMENT ARRANGEMENTS. A FORM IS SIGNED BY THE PATIENT SETTING UP TERMS WHEN POSSIBLE. IF PATIENT STATES THEY ARE UNABLE TO PAY, THE CHARITY CARE PROGRAM APPLICATION IS GIVEN AND THE PATIENT IS COUNSELED ON CHARITY CARE GUIDELINES. |
| PART VI, LINE 2: | GENERALLY SPEAKING, THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED BY THE HOSPITAL IS BASED ON ALL OR A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITIES, SUPPLY, DEMONSTRATED NEED, "VOICE OF THE CONSUMER", AND/OR COLLABORATIVE EFFORTS WITH OUTSIDE ENTITIES, GOVERNMENT AGENCIES, AND OTHER HEALTH CARE PROVIDERS THAT WOULD ENABLE THE FILLING OF A NEED OR ENHANCE AND COMPLIMENT AN ALREADY EXISTING SERVICE. DATA IS GATHERED THROUGH BENCHMARKING, MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT, AND THROUGH CONSTANT MONITORING OF STATE AND FEDERAL GUIDELINES. IN ADDITION, NEEDS ASSESSMENTS ARE ON-GOING THROUGH THE VARIOUS PROGRAMS AND SERVICES PROVIDED TO THE COMMUNITY BY THE HOSPITAL AS FOLLOWS: - SPEAK TO COMMUNITY GROUPS ON A VARIETY OF HEALTHCARE TOPICS - SPEAK TO SCHOOL CLASSES ABOUT HEALTHY LIVING AND HEALTHCARE TOPICS - OFFER CLASSES ON CHILDBIRTH (48 HRS/YR BK), AND SIBLINGS (1 HR/MO) - OFFER CPR CLASSES TO THE PUBLIC AND TO AREA BUSINESSES FOR THEIR EMPLOYEES - PROVIDE TOURS OF THE HOSPITAL TO STUDENT AND CIVIC GROUPS - COOPERATIVE AGREEMENT WITH THE HEALTH OCCUPATIONS CLASS - CLINICAL SITE FOR PHYSICAL THERAPY, RESPIRATORY, ANESTHESIA, AND RADIOLOGY STUDENTS - PROVIDE A PHYSICAL THERAPIST ASSISTANT, PHYSICAL THERAPIST, AND ATHLETIC TRAINER FOR HIGH SCHOOL SPORTING EVENTS - PROVIDE ATHLETIC TRAINING ONCE A WEEK AT SPORTS PRACTICES - SPONSOR SIX CHAMPIONS FOR LIFE BLOOD DRIVES EACH YEAR - PROVIDE A FREE MEETING ROOM FOR AT LEAST 12 COMMUNITY GROUPS ON A REGULAR BASIS - PROVIDE A BETTER BREATHERS SUPPORT GROUP QUARTERLY - PROVIDE AN ALZHEIMERS SUPPORT GROUP MONTHLY - OFFER BLOOD PRESSURE SCREENINGS AND CHOLESTEROL CHECKS MONTHLY - HOST A FREE WOMEN'S CONFERENCE ANNUALLY - PROVIDE $18,000 IN SCHOLARSHIPS ANNUALLY - OFFER A MEDI-ALERT PROGRAM TO THE AGING POPULATION IN THE COMMUNITY - PARTICIPATE ANNUALLY IN THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE - CONTRIBUTE ANNUALLY TO THE AMERICAN LUNG ASSOCIATION, AMERICAN HEART ASSOCIATION, BOY SCOUTS OF AMERICA, AND GIRL SCOUTS OF AMERICA - SPONSOR THE FIRST AID STATION AT EAST PERRY COMMUNITY FAIR - OFFER SAFE SITTERS CLASSES 3 TIMES A YEAR - OFFER SPORTS PHYSICALS ANNUALLY GIVING BACK THE PROCEEDS TO THE PARTICIPATING SCHOOLS - OFFER MEDICAL AND NON-MEDICAL TRANSPORTATION FOR A SUGGESTED DONATION - CO-SPONSOR THE JR/SR CONFERENCE ANNUALLY - PARTICIPATE IN THE CHAMPS MENTORING PROGRAM - STAFF REPRESENTATION ON NUMEROUS COMMUNITY COMMITTEES - SPONSOR VARIOUS CHAMBER AND COMMUNITY ACTIVITIES (CHAMBER LEADERSHIP DAY, MAYFEST 5K, MAYFEST BOOTH, MAYFEST TOP SPONSOR, CUSTOMER APPRECIATION ON THE SQUARE, CHAMBER WOMEN'S CONFERENCE TOP SPONSOR, TURKEY BURN OFF 5K) - HOST VARIOUS HEALTHCARE RELATED EDUCATIONAL SEMINARS FOR THE PUBLIC - HOST A SPEECH/PHYSICAL/OCCUPATIONAL SCREENING ANNUALLY TO AREA CHILDREN AGES 3 TO 5 YEARS OLD - PERRY CO ESTATES SENIOR HOUSING OFFERED TO LOW-INCOME SENIORS - DONATE PROMOTIONAL ITEMS TO NUMEROUS ORGANIZATIONS/GROUPS (I.E. HAND SANITIZER TO SCHOOLS DURING THE H1N1 FLU SEASON, FIRST AID ITEMS TO SCHOOLS) - PROVIDE CAR SEAT SAFETY CHECKS - PROVIDE FREE SPEECH SCREENINGS ANNUALLY - PROVIDE FREE EDUCATIONAL SEMINARS REGARDING SPEECH AND HEARING - PROVIDE FREE HEARING SCREENINGS AS NEEDED - AMBULANCE PROVIDED STANDBY AT 30 EVENTS FREE OF CHARGE - OFFER COGNITIVE STIMULATION THERAPY PROGRAM FOR ALZHEIMERS PATIENTS - PARTICIPATE IN THE BACKPACK BONANZA FOR UNDERPRIVILEGED CHILDREN - HOST AN ANNUAL SKEET SHOOT TO RAISE FUNDS FOR CHILDREN WITH CHRONIC ILLNESSES ($9,000.00 - 10,000.00 ANNUALLY) - SPONSOR TEEN COUNCIL'S EFFORTS ON HUNGER/RECYCLING AT EAST PERRY FAIR - SPONSORED 60 CHILDREN WITH FIREPUP PROGRAM WITH PERRYVILLE FIRE DEPARTMENT - SPONSOR EAST PERRY FAIR ANNUALLY - POST MESSAGES ON DIGITAL SIGN FOR VARIOUS COMMUNITY ORGANIZATIONS FREE OF CHARGE (TEXTING AND JR/SR CONF) - SPONSOR WATER TENT AT CENTER FOR LIFE 5K AND RYAN BEHRLE 5K - PERRY PARK CENTER SPONSORSHIP (YOUTH BASKETBALL, YOUTH TRACK, PLAY DAY AT THE PARK, DISC GOLF TOURNAMENT) - CO-SPONSOR THE PROCTOR AND GAMBLE BOOTH AT THREE EVENTS THROUGHOUT THE YEAR PROVIDING PROMOTIONAL ITEMS TO ALL WHO STOP AT THE BOOTH - SPONSOR AND PARTICIPATE IN COMMUNITY-WIDE SURVEY |
| PART VI, LINE 3: | THE HOSPITAL APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. CHARITY CARE PROGRAM INFORMATION IS SENT OUT WITH WEEKLY STATEMENTS ON PRIVATE PAY ACCOUNTS TO PATIENTS RESIDING IN PERRY COUNTY OR AN ADJACENT COUNTY THAT DOES NOT HAVE A HEALTH CARE FACILITY WITH ACCOUNT BALANCES OVER $1,000.00. PATIENTS ARE ADVISED TO CONTACT THE BUSINESS OFFICE FOR A COMPLETE APPLICATION IF THEY WISH TO APPLY. |
| PART VI, LINE 4: | PERRY COUNTY IS A RURAL COMMUNITY OF 18,000 PEOPLE. THE GEOGRAPHY IS DENSE FOREST, ROLLING HILLS USED FOR LIVESTOCK FARMING, AND VALLEY AND RIVER BOTTOM-LAND FARMING. AGRICULTURAL WORK NO LONGER DOMINATES THE ECONOMIC LANDSCAPE. LIGHT INDUSTRIAL AND LIGHT MANUFACTURING IS A PREDOMINANT ECONOMIC FORCE. THE ECONOMIC DEMOGRAPHIC IS GENERALLY LOWER TO MIDDLE TO MID-MIDDLE CLASS WEALTH FOR THE WORKING AGED RESIDENTS. RETIREMENT AGED RESIDENTS CONSTITUTE OVER 40% OF THE POPULATION. LOWER SOCIOECONOMIC AND INDIGENT POPULATIONS CONSTITUTE LESS THAN 10% OF THE COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SANDEEP RAO | ||||||||||||||
| HOSPITALIST | $858,779 | $0 | $0 | $0 | $0 | $0 | $22,500 | $0 | $24,662 | $0 | $905,941 | $0 | $0 | $0 |
| JOSEPH B BYRNE | ||||||||||||||
| PHYSICIAN | $806,241 | $0 | $0 | $0 | $0 | $0 | $17,440 | $0 | $24,879 | $0 | $848,560 | $0 | $0 | $0 |
| MATTHEW GAETA | ||||||||||||||
| GASTROLOGY | $712,421 | $0 | $0 | $0 | $0 | $0 | $16,569 | $0 | $24,879 | $0 | $753,869 | $0 | $0 | $0 |
| CRAIG FRAYER | ||||||||||||||
| PHYSICIAN | $331,864 | $0 | $0 | $0 | $0 | $0 | $24,234 | $0 | $15,435 | $0 | $371,533 | $0 | $0 | $0 |
| HOPE BANTE | ||||||||||||||
| PHYSICIAN | $234,752 | $0 | $0 | $0 | $0 | $0 | $19,870 | $0 | $8,031 | $0 | $262,653 | $0 | $0 | $0 |
| CHRISTOPHER WIBBENMEYER | ||||||||||||||
| CEO | $226,182 | $0 | $0 | $0 | $0 | $0 | $10,500 | $0 | $14,539 | $0 | $251,221 | $0 | $0 | $0 |
| ANGIE BREWER | ||||||||||||||
| HR DIRECTOR | $152,471 | $0 | $0 | $0 | $0 | $0 | $18,996 | $0 | $24,490 | $0 | $195,957 | $0 | $0 | $0 |
| STACEY M REITZEL | ||||||||||||||
| ASSOCIATE VP | $154,924 | $0 | $0 | $0 | $0 | $0 | $3,927 | $0 | $24,394 | $0 | $183,245 | $0 | $0 | $0 |
| MICHAEL ELLIS | ||||||||||||||
| CFO | $136,586 | $0 | $0 | $0 | $0 | $0 | $24,840 | $0 | $13,994 | $0 | $175,420 | $0 | $0 | $0 |
| PATRICK CARRON | ||||||||||||||
| FORMER PRESIDENT/CEO | $125,568 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $125,568 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | BOARD MEMBERS ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW BEFORE THE RETURN IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS GIVEN A QUESTIONNAIRE THAT INCLUDES ASKING THEM TO DISCLOSE ANY APPLICABLE CONFLICTS OF INTEREST. THIS IS DONE ON AN ANNUAL BASIS AND ENFORCEMENT IS DONE ON A PER INCIDENT BASIS, WITH ALL ASPECTS OF THE CONFLICT TAKEN INTO CONSIDERATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION PROCESS FOR TOP OFFICIALS - INDUSTRY COMPARABILITY DATA IS MADE AVAILABLE TO THE BOARD OF DIRECTORS. AN EXECUTIVE SESSION IS HELD TO DETERMINE AND APPROVE ALL TOP MANAGEMENT COMPENSATION. THIS IS PERFORMED ON AN ANNUAL BASIS. COMPENSATION PROCESS FOR OFFICERS AND KEY EMPLOYEES - THE CEO PERFORMS AN ANNUAL SALARY EVALUATION OF OFFICERS AND KEY EMPLOYEES. USING INDUSTRY COMPARIBILITY DATA AND AN ANNUAL REVIEW, THE CEO RECOMMENDS SALARY FOR OFFICERS AND KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 18 | THIS ORGANIZATION MAKES ITS IRS FORM 1023, 990 AND 990-T AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. THIS ORGANIZATION ALSO RELIES ON THE WEB-SITE WWW.GUIDESTAR.ORG TO MAKE READILY AVAILABLE ITS TAX RETURNS TO THE PUBLIC. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | RECORD CASH PURCHASES FROM MERCY -3,720. RECORD PREPAID PURCHASES FROM MERCY -15,775. RECORD PTO PURCHASES FROM MERCY 1,621,194. RECORD INVENTORY PURCHASES FROM MERCY -1,858,205. REMOVE PROPERTY, PLANT AND EQUIPEMTN FROM BALANCE SHEET -31,828,779. WIRE TRANSFERS -13,384,011. BOM ICS ACTIVITY -4,118,537. |
| FORM 990, PART XII | IN 1998, THE BOARD OF TRUSTEES OF PERRY COUNTY MEMORIAL HOSPITAL (BOARD OF TRUSTEES) ENTERED INTO AN AGREEMENT WITH PERRY COUNTY HEALTH SYSTEM (PCHS), WHEREBY ALL ASSETS, LIABILITIES AND OPERATIONS WERE TRANSFERRED TO PCHS (THE 1998 AGREEMENT). ON MARCH 2, 2023, THE PCHS BOARD OF DIRECTORS PASSED A RESOLUTION TO TERMINATE THE 1998 AGREEMENT EFFECTIVE OCTOBER 1, 2023. ON SEPTEMBER 30, 2023, THE BOARD OF TRUSTEES AND PCHS ENTERED INTO A LEASE TERMINATION AGREEMENT NOTING THAT THE 1998 AGREEMENT IS TERMINATED EFFECTIVE OCTOBER 1, 2023. THIS EARLY TERMINATION OF THE 1998 AGREEMENT WAS PREDICATED ON A NEW LEASE WITH MERCY HEALTH EAST COMMUNITIES. THE AUDIT REPORT ATTACHED TO THIS 990 IS FOR THE PERIOD ENDING SEPTEMBER 30, 2023 AND REFLECTS PCHS'S HOSPITAL ACTIVITY UP TO THAT DATE, WHICH IS THE LEASE TERMINATION DATE. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PCMH AMUBLANCE SERVICE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 434 NORTHWEST STREET | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320321807 | EIN |
| Primary Activities | AMBULANCE | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Total Income | $1,675,025 | TotalIncomeAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERRY COUNTY HEALTH SYSTEM | BusinessNameLine1Txt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERRYVILLE HEALTHCARE CORP | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 212 HOSPITAL LANE | AddressLine1Txt |
| City | PERRYVILLE | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63775 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431859823 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PERRY COUNTY HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$281,041 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,591,662 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt | InvolvedInvolvedAmt |
|---|---|---|
| PERRYVILLE HEALTHCARE CORPORATION | ||
| A | FMV | |
| PERRYVILLE HEALTHCARE CORPORATION | ||
| O | FMV | $594,090 |
| PERRYVILLE HEALTHCARE CORPORATION | ||
| Q | FMV | $1,076,373 |
Comments