2025-02-17T09:17:07-06:00 2024-03-31 430352985 KERBER ECK & BRAECKEL LLP 3401 OFFICE PARK DRIVE MARION IL 62959 990 2023-04-01 431741457 PERRY COUNTY HEALTH SYSTEM PERR 5735172896 434 NORTH WEST STREET PERRYVILLE MO 63775 BETH GUTH DESIGNATED SIGNATORY OFFICER 5735172896 2025-02-16 1 1 AMBER HALSTEAD P01343727 6185291040 2025-02-14 2023 2025-03-06 01:10:19Z BETH GUTH 434 NORTH WEST STREET PERRYVILLE MO 63775 33608846 0 X N/A X 1996 MO TO PROVIDE QUALITY HOSPITAL AND HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. 5 5 538 27 0 0 482354 390237 62544830 30716191 -808918 424575 7250509 2051219 69468775 33582222 0 0 0 0 34445247 18349807 0 0 0 32164489 20218213 66609736 38568020 2859039 -4985798 69876813 12426231 8350007 5717513 61526806 6708718 X TO PROVIDE QUALITY HOSPITAL & HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. 0 0 31857744 32740786 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. 31857744 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 99 0 1 538 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MO X BETH GUTH 5735172896 434 NORTH WEST STREET PERRYVILLE MO 63775 DR KEITH MOECKEL TREASURER 2.00 X 0 0 0 PATRICK NAEGER BOARD MEMBER 2.00 X 0 0 0 BETH GUTH PRESIDENT 2.00 X 0 0 0 KAY TAYLOR VICE PRESIDENT 1.00 X 0 0 0 DR LINDA BUERCK SECRETARY 1.00 X 0 0 0 CHRISTOPHER WIBBENMEYER CEO 50.00 X 226182 0 25039 MICHAEL ELLIS CFO 50.00 X 136586 0 38834 STACEY M REITZEL ASSOCIATE VP 50.00 X 154924 0 28321 ANGIE BREWER HR DIRECTOR 50.00 X 152471 0 43486 JOSEPH B BYRNE PHYSICIAN 50.00 X 806241 0 42319 CRAIG FRAYER PHYSICIAN 50.00 X 331864 0 39669 SANDEEP RAO HOSPITALIST 50.00 X 858779 0 47162 HOPE BANTE PHYSICIAN 40.00 X 234752 0 27901 MATTHEW GAETA GASTROLOGY 50.00 X 712421 0 41448 PATRICK CARRON FORMER PRESIDENT/CEO 0.00 X 125568 0 0 3739788 0 334179 22 1 1 0 PERRYVILLE FAMILY CARE CLINIC PC 212 HOSPITAL LANE SUITE 202 PERRYVILLE MO 63775 PHYSICIAN SERVICES 2761483 MID AMERICA REHAB 206 HOSPITAL LANE SUITE 100 PERRYVILLE MO 63775 PHYSICAL THERAPY SERVICES 2020087 BLUSKY RESTORATION CONTRACTORS LLC 13701 GREEN ASH CT EARTH CITY MO 63045 CONTRACTOR SERVICES 1922259 CAPE RADIOLOGY GROUP 434 N WEST ST PERRYVILLE MO 63775 RADIOLOGY SERVICES 951360 PERRY KIDS PEDIATRICS 210 HOSPITAL LANE SUITE 202 PERRYVILLE MO 63775 PHYSICIAN SERVICES 405820 18 390237 390237 HEALTHCARE SERVICES 621990 30716191 30716191 30716191 451199 451199 26624 -26624 -26624 -26624 PHARMACY REVENUE 621990 1295043 1295043 INSURANCE PROCEEDS 621990 440285 440285 OTHER INCOME 621990 281928 281928 33963 33963 2051219 33582222 32740786 0 451199 1100970 1100970 13064219 12465366 598853 397094 349443 47651 3054644 2688087 366557 732880 644934 87946 569778 569778 91090 73783 17307 1296593 1050243 246350 624108 505527 118581 29314 23744 5570 1368068 1368068 1225528 992678 232850 PROFESSIONAL FEES 9321439 7084294 2237145 MEDICAL SUPPLIES 4949399 4009013 940386 REPAIRS AND MAINTENANCE 727191 589025 138166 POSTAGE 11400 9234 2166 4305 4305 38568020 31857744 6710276 0 17037695 9169044 6752422 226691 2481706 260583 1602332 313314 392358 0 20000 0 33174080 20000 5378804 223 3057416 2436376 69876813 12426231 6474007 800246 1576000 1576000 300000 3341267 8350007 5717513 X 61526806 6708718 61526806 6708718 69876813 12426231 X -4985798 -244457 -49587833 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7139 7139 0 PART II-B, LINE 1: 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. 20000 20000 20000 INVESTMENTS - P'VILLE HEALTH CARE 1591662 THIRD PARTY REIMBURSEMENT PROGRAMS 700000 INVESTMENT - PARETO HEALTH 144714 2436376 THIRD-PARTY REIMBURSEMENT PROGRAMS 3341267 3341267 X PART X, LINE 2: 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. 1 1 1 X 1 X 190.000000000000 1 1 1 0 1 1 129583 129583 0.00340 3674313 1878511 1795802 0.04660 3803896 1878511 1925385 0.05000 30000 30000 0.00080 30000 30000 0.00080 3833896 1878511 1955385 0.05080 1 1102000 550986 11902765 17729799 -5827034 X 1 1 1 1 PERRY COUNTY HEALTH SYSTEM 434 NORTHWEST STREET PERRYVILLE MO 63775 X X X X PERRY COUNTY HEALTH SYSTEM 1 0 0 1 X X X X X X X 22 1 0 1 1 X 1 22 0 0 0 1 X 150.000000000000 190.000000000000 X X X X 1 1 X X X 1 X 1 X 0 1 X 0 0 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. 9 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 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. X X X 0 0 0 0 0 0 0 0 0 SANDEEP RAO HOSPITALIST 858779 0 0 0 0 0 22500 0 24662 0 905941 0 0 0 JOSEPH B BYRNE PHYSICIAN 806241 0 0 0 0 0 17440 0 24879 0 848560 0 0 0 MATTHEW GAETA GASTROLOGY 712421 0 0 0 0 0 16569 0 24879 0 753869 0 0 0 CRAIG FRAYER PHYSICIAN 331864 0 0 0 0 0 24234 0 15435 0 371533 0 0 0 HOPE BANTE PHYSICIAN 234752 0 0 0 0 0 19870 0 8031 0 262653 0 0 0 CHRISTOPHER WIBBENMEYER CEO 226182 0 0 0 0 0 10500 0 14539 0 251221 0 0 0 ANGIE BREWER HR DIRECTOR 152471 0 0 0 0 0 18996 0 24490 0 195957 0 0 0 STACEY M REITZEL ASSOCIATE VP 154924 0 0 0 0 0 3927 0 24394 0 183245 0 0 0 MICHAEL ELLIS CFO 136586 0 0 0 0 0 24840 0 13994 0 175420 0 0 0 PATRICK CARRON FORMER PRESIDENT/CEO 125568 0 0 0 0 0 0 0 0 0 125568 0 0 0 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. PCMH AMUBLANCE SERVICE LLC 434 NORTHWEST STREET PERRYVILLE MO 63775 320321807 AMBULANCE MO 1675025 PERRY COUNTY HEALTH SYSTEM PERRYVILLE HEALTHCARE CORP 212 HOSPITAL LANE PERRYVILLE MO 63775 431859823 PHARMACY MO PERRY COUNTY HEALTH SYSTEM C -281041 1591662 1.00000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 PERRYVILLE HEALTHCARE CORPORATION A FMV PERRYVILLE HEALTHCARE CORPORATION O 594090 FMV PERRYVILLE HEALTHCARE CORPORATION Q 1076373 FMV