2018-06-06T09:36:21-05:00 2017-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2016-10-01 430899356 Samuel U Rodgers Health Center Inc % CHRISTOPHER WALKER SAMU 8164744920 825 Euclid Avenue Kansas City MO 64124 BOB THEIS ACTING CEO 8162216300 2018-08-15 true Michael J Engle P00482834 8162216300 2016 2022-09-23 18:48:47Z BOB THEIS 825 EUCLID AVENUE KANSAS CITY MO 64124 21923470 false X WWW.RODGERSHEALTH.ORG X 1968 MO THE CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE FOR ALL. 13 13 292 83 0 0 10340160 9921866 10186841 10073170 -8837 119729 389463 384589 20907627 20499354 254038 166733 0 0 13582764 14370657 0 0 0 8894238 8397331 22731040 22934721 -1823413 -2435367 34247911 32756500 4708868 5546286 29539043 27210214 X THE CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE FOR ALL. true false 19580911 166733 10073170 SEE SCHEDULE O 19580911 true true false false false false false true false false true false false false false false true false false false false false false false false false false true false true false false false false false false false false true false false false false true true true false false true 45 0 true 292 true false false false false false false false false false false X 13 13 false false false false false false false true true false false true true true true true true true true true true MO X CHRISTOPHER WALKER 8168894801 825 EUCLID KANSAS CITY MO 64124 X JOE VALENCIANO DIRECTOR/CHAIRPERSON TO DEC 16 1.0 0.0 X X 0 0 0 DONNA WILSON PETERS DIRECTOR 1.0 0.0 X 0 0 0 XIMENA ILABACA-SOMOZA DIRECTOR 1.0 0.0 X 0 0 0 MELINA JOHNSON DIRECTOR/TREASURER 1.0 0.0 X X 0 0 0 JON TROZZOLO DIRECTOR/SECRETARY 1.0 0.0 X X 0 0 0 SIDNEY KING DIRECTOR/CHAIRPERSON 1.0 0.0 X X 0 0 0 THOMAS WRIGHT III DIRECTOR/VICE CHAIRPERSON 1.0 0.0 X X 0 0 0 ANNE VAN GARSSE DIRECTOR 1.0 0.0 X 0 0 0 LEONARDO LOZADA DIRECTOR 1.0 0.0 X 0 0 0 KATIE CASTRO GALICIA DIRECTOR 1.0 0.0 X 0 0 0 GINA MACE DIRECTOR 1.0 0.0 X 0 0 0 POORNIMA KUMAR DIRECTOR 1.0 0.0 X 0 0 0 BENOIT BLONDEAU DIRECTOR 1.0 0.0 X 0 0 0 BOB THEIS ACTING CEO/CFO/COO 40.0 1.0 X 179554 0 20415 HILDA FUENTES PRESIDENT AND CEO 40.0 1.0 X 259459 0 32144 CHRIS WALKER CHIEF FINANCIAL OFFICER 40.0 0.0 X 83936 0 24132 SUDEEP ROSS CHIEF HEALTH OFFICER TO AUG 16 40.0 0.0 X 319160 0 43695 JOSE CRUZ PHYSICIAN 40.0 0.0 X 177267 0 18333 ANTHONY GUTIERREZ PHYSICIAN 40.0 0.0 X 147364 0 17748 CINDY RUTTAN PSYCHIATRIST TO NOV 16 40.0 0.0 X 172702 0 15437 DANIEL PURDOM CHIEF HEALTH OFFICER/PHYSICIAN 40.0 0.0 X 181903 0 14067 1521345 0 185971 17 false true false PHARMACY SYSTEMS INC 5050 BRADENTON AVE DUBLIN OH 43017 PHARMACY MANAGEMENT 532925 PRIORITY MANAGEMENT GROUP INC 700 SCHOOL ST PAWTUCKET RI 02860 BILLING MANAGMENT 384563 ALEXANDER OPEN SYSTEMS INC 12980 FOSTER ST SUITE 300 OVERLAND PARK KS 66213 INFORMATION TECH 225138 CYRACOM 5780 SWAN RD TUSCON AZ 85718 TRANSLATION SERVICES 177756 BURTIN ASSOCIATES 5227 BLUE PARKWAY KANSAS CITY MO 64130 CUSTODIAL SVS 133640 6 191284 0 8750019 980563 82381 9921866 Net Patient Service Revenue 621400 10073170 10073170 10073170 54276 54276 0 0 6000 9170 -3170 0 -3170 -3170 1467335 13064 1363456 51490 103879 -38426 65453 65453 0 0 0 0 0 0 0 0 0 340B DRUG PROGRAM 900099 71843 71843 EHR Incentives 900099 238000 238000 All Other Misc Revenue 900099 77916 77916 77916 77916 387759 20499354 10073170 504318 166733 166733 0 0 0 713747 249811 463936 0 9998971 9166487 832484 215519 191920 23599 2810061 2543989 266072 632359 590000 42359 0 160053 160053 116220 116220 0 0 13336 13336 2397559 2001209 396350 0 60114 60027 87 789214 709051 80163 510521 345057 165464 0 522607 423312 99295 76525 64800 11725 0 30477 13188 17289 0 0 1726885 1398777 328108 100168 100168 Bad Debt Expense 473980 473980 Repairs & Maintenance 204998 178073 26925 Medical Supplies 940348 940348 Dues & Subscriptions 54739 30879 23860 219587 33270 186317 22934721 19580911 3353810 0 346820 753508 4566208 3531527 941424 414439 1922189 2244906 0 0 0 0 0 0 61561 32801 158901 173211 36285582 13102213 24232587 23183369 1581887 1782088 0 0 105093 120050 0 0 331241 520601 34247911 32756500 4644581 5391598 0 0 64287 154688 0 0 0 0 0 0 0 0 0 0 0 0 4708868 5546286 X 24904843 22853233 4634200 4356981 0 0 29539043 27210214 34247911 32756500 X -2435367 57283 49255 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X false 1815173 1815173 26971639 7541882 19429757 55836 37867 17969 7393186 5522464 1870722 49748 49748 23183369 19911758 57283 9170 66453 19845305 13336 640713 654049 20499354 22289842 9170 9170 22280672 13336 640713 654049 22934721 SCHEDULE D, PART III, LINE 4 PAINTINGS BY RITA BLITT WERE INSTALLED AT THE HEALTH CENTER IN APRIL 2012. THESE PAINTINGS ARE PART OF THE RITA BLITT MUSEUM WITHOUT WALLS EXHIBITION. THE RITA BLITT MUSEUM WITHOUT WALLS WAS DEVELOPED IN 2012 TO LIST AND ILLUSTRATE EXHIBITIONS THAT ARE AVAILABLE FOR LOAN TO GALLERIES AND MUSEUMS, TO MAP THE NUMEROUS PUBLIC PLACES THROUGHOUT THE WORLD THAT ONE CAN VISIT TO VIEW BLITT'S ARTWORK, TO SHARE EDUCATIONAL CURRICULUM AND FILMS RELATING TO HER PRACTICE, AND TO SHOWCASE WORKS IN HER PORTFOLIO. THE EXHIBITION FEATURED IN THE ON VIEW SECTION WILL CHANGE ON A MONTHLY BASIS. BLITT HAS INDEFINITELY LOANED COLLECTIONS OF HER ART TO NON-PROFIT ORGANIZATIONS THROUGH THE RITA BLITT FOUNDATION, WHOSE MISSION IS TO SHARE, EDUCATE, AND INSPIRE THROUGH THE ARTWORKS OF BLITT. SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D RENTAL EXPENSES $ 9,170 SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSE $ 473,980 GRANT TO SURHC FOUNDATION 166,733 ----------- TOTAL $ 640,713 SCHEDULE D, PART XII, LINE 2D RENTAL EXPENSES $ 9,170 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $ 473,980 GRANT TO SURHC FOUNDATION 166,733 ----------- TOTAL $ 640,713 true SAMUEL U RODGERS HEALTH CENTER FOUNDATION 825 EUCLID AVE KANSAS CITY MO 64124 200751739 501(C)(3) 166733 OPERATIONS 1 SCHEDULE I, PART I, LINE 2 SAMUEL U. RODGERS HEALTH CENTER GRANTED SAMUEL U. RODGERS HEALTH CENTER FOUNDATION THE MONIES FOR ITS OPERATIONS. THE FOUNDATION IS A CONTROLLED ENTITY OF THE HEALTH CENTER, AND THEREFORE THE USE OF THE FUNDS IS KNOWN PRIOR TO TRANSFER. X X X X false false false false false false false false false BOB THEIS ACTING CEO/CFO/COO 173773 0 5533 0 248 0 8941 0 11474 0 199969 0 HILDA FUENTES PRESIDENT AND CEO 259113 0 0 0 346 0 12247 0 19897 0 291603 0 SUDEEP ROSS CHIEF HEALTH OFFICER TO AUG 16 318690 0 0 0 470 0 13250 0 30445 0 362855 0 JOSE CRUZ PHYSICIAN 176769 0 250 0 248 0 8997 0 9336 0 195600 0 ANTHONY GUTIERREZ PHYSICIAN 147116 0 0 0 248 0 0 0 17748 0 165112 0 CINDY RUTTAN PSYCHIATRIST TO NOV 16 172471 0 0 0 231 0 6907 0 8530 0 188139 0 DANIEL PURDOM CHIEF HEALTH OFFICER/PHYSICIAN 181903 0 0 0 0 0 8476 0 5591 0 195970 0 X 2 82381 FMV false true false SCHEDULE M, PART I, COLUMN B THE AMOUNTS IN COLUMN B REPRESENT THE NUMBER OF CONTRIBUTIONS MADE. FORM 990, PART III, LINE 2 SAMUEL U. RODGERS HEALTH CENTER ADDED A NEW LOCATION BASED IN THE NORTHERN PART OF KANSAS CITY, MISSOURI. THIS NEW LOCATION STARTED SEEING PATIENTS IN JANUARY 2017. FORM 990, PART III, LINE 4A AT THE SAMUEL U. RODGERS HEALTH CENTER, WE HAVE BELIEVED IN FAMILY SINCE THE BEGINNING. IN 1967 OUR FOUNDER, DR. SAMUEL U. RODGERS, OPENED THE FIRST FEDERALLY-RECOGNIZED COMMUNITY HEALTH CENTER IN MISSOURI AT THE WAYNE MINER HOUSING PROJECT, PROVIDING CARE FOR FAMILIES WHERE IT WAS NEEDED MOST, RIGHT IN THEIR OWN NEIGHBORHOOD. LOCATED IN NORTHEAST KANSAS CITY, THE HEALTH CENTER'S DOWNTOWN CAMPUS IS A VITAL PART OF THE COMMUNITY'S MULTICULTURAL FABRIC. WE STILL SERVE FAMILIES RESIDING IN NEARBY PUBLIC HOUSING COMMUNITIES, AS WELL AS IMMIGRANTS AND REFUGEES WHO DESPERATELY NEED HEALTH CARE. THE HEALTH CENTER'S GOAL IS THE SAME AS ITS MISSION: EACH DAY WE STRIVE TO PROVIDE HIGH QUALITY, COMPASSIONATE HEALTH CARE TO ALL. RODGERS HEALTH PROVIDES COMPREHENSIVE CARE TO PEOPLE THROUGHOUT THE KANSAS CITY METROPOLITAN AREA AS WELL AS RURAL LAFAYETTE COUNTY AND SURROUNDING AREAS IN MISSOURI. OUR OUTPATIENT PRIMARY CARE SERVICES INCLUDE: - ADULT & SENIOR SERVICES - BEHAVIORAL HEALTH - CHILDREN'S & ADOLESCENTS HEALTH - WOMEN'S HEALTH - DENTAL HEALTH - PODIATRY ON-SITE ANCILLARY AND SUPPORTIVE SERVICES INCLUDE: - LABORATORY - IMAGING - PHARMACY - INTERPRETERS - PATIENT TRANSPORTATION A FULL RANGE OF OUTREACH SERVICES COMPLETE THE ARRAY OF PRIMARY CARE SERVICES. THESE INCLUDE: - EDUCATION AND SCREENING FOR BREAST AND CERVICAL CANCER - COUNSELING AND TREATMENT FOR ALCOHOL, TOBACCO AND OTHER DRUG ABUSE - WIC AND NUTRITION EDUCATION SERVICES (SERVING MORE THAN 3,500 INDIVIDUALS MONTHLY) - MEDICAID AND ACA ENROLLMENT - COMMUNITY OUTREACH AND HEALTH EDUCATION TODAY'S CONSTANTLY CHANGING HEALTH CARE SYSTEM CREATES A SPECIAL CHALLENGE TO THE HEALTH CENTER'S ABILITY TO CARE FOR THE MEDICALLY UNDERSERVED PEOPLE IN OUR SERVICE AREA: - THE KANSAS CITY AREA IS HOME TO AN INCREASING NUMBER OF FINANCIALLY INDIGENT AND UNINSURED PATIENTS WHO ARE INELIGIBLE FOR PUBLIC SUPPORT PROGRAMS. - MANY OF THE HEALTH CENTER'S PATIENTS ARE MEDICALLY UNINSURED,WITH NO SOURCE OF PAYMENT. THE HEALTH CENTER'S PATIENT BASE IS EXTRAORDINARILY DIVERSE. BECAUSE WE ARE LOCATED NEAR TWO OF THE LARGEST REFUGEE RESETTLEMENT FACILITIES IN THE MIDWEST, OUR HEALTH CENTER IS A POINT OF ENTRY TO PRIMARY CARE SERVICES FOR IMMIGRANTS FROM WAR-TORN NATIONS. ABOUT 33 PERCENT OF OUR PATIENTS ARE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. TO ENSURE OUR PATIENTS RECEIVE HIGH QUALITY CARE, THE HEALTH CENTER EMPLOYS A CADRE OF INTERPRETERS AND STAFF WHO SPEAK 10 LANGUAGES. AMONG PATIENTS SERVED, 42 PERCENT ARE HISPANIC/LATINO, 26 PERCENT CAUCASIAN, 19 PERCENT BLACK OR AFRICAN AMERICAN, 7 PERCENT REPRESENT OTHER ETHNICITIES/OR REFUSED TO REPORT, AND 6 PERCENT ARE ASIAN/PACIFIC ISLANDER. ADDITIONALLY, MORE THAN 20 PERCENT OF THE 1.9 MILLION RESIDENTS OF THE KANSAS CITY METROPOLITAN AREA ARE UNINSURED OR ARE ON MEDICAID. CHILDREN 17 YEARS OF AGE AND YOUNGER REPRESENT 41 PERCENT OF OUR PATIENT BASE. THUS, PROTECTING CHILDREN FROM CHILDHOOD DISEASES IS A VITAL PART OF OUR MISSION. UNCHECKED, THE RAVAGES OF CHILDHOOD ILLNESSES SUCH AS MEASLES, MUMPS, AND RUBELLA CAN CAUSE PERMANENT DISABILITY OR EVEN DEATH. 2011 - PROVIDED HEALTH CARE FOR 19,047 INDIVIDUALS THROUGH OVER 69,500 VISITS - LAUNCHED A DENTAL PRACTICE AT J.A. ROGERS ELEMENTARY SCHOOL TO PROVIDE ORAL HEALTH CARE SERVICES FOR LOW-INCOME CHILDREN - PROVIDED $2.9 MILLION IN INDIGENT CARE. 2012 - PROVIDED HEALTHCARE FOR 21,114 INDIVIDUALS THROUGH OVER 77,000 VISITS - LAUNCHED A DENTAL PRACTICE AT THE CLAY COUNTY LOCATION TO EXPAND THE HEALTH CENTER'S PRESENCE AT THAT LOCATION. - PROVIDED $4.4 MILLION IN INDIGENT CARE. 2013 - PROVIDED HEALTH CARE FOR 21,400 INDIVIDUALS THROUGH OVER 73,800 VISITS - PROVIDED $4.2 MILLION IN INDIGENT CARE. - PATIENT-CENTERED MEDICAL HOME RECOGNITION LEVEL 3 - ESTABLISHED A PATIENT PORTAL. 2014 - PROVIDED HEALTH CARE FOR 25,512 INDIVIDUALS THROUGH OVER 81,143 VISITS - PROVIDED $6.3 MILLION IN INDIGENT CARE. - ONE OF 10 SITES IN THE U.S. TO RECEIVE A SPECIAL GRANT FROM THE AMERICAN CANCER SOCIETY FOR AN HPV VACCINATION EFFORT FOR ADOLESCENTS. 2015 - PROVIDED HEALTH CARE FOR 24,611 INDIVIDUALS THROUGH OVER 77,804 VISITS - PROVIDED $7.3 MILLION IN INDIGENT CARE. - WIC SERVICES EARNED THE WIC LOVING SUPPORT AWARD OF EXCELLENCE FOR EXEMPLARY BREASTFEEDING SUPPORT AND PRACTICES FROM THE USDA. - HEALTH CENTER RECEIVED TWO QUALITY AWARDS, ONE FROM THE STATE OF MISSOURI AND ONE FROM THE FEDERAL GOVERNMENT FOR QUALITY CARE IMPROVEMENTS. 2016 - PROVIDED HEALTH CARE FOR 24,774 INDIVIDUALS THROUGHOVER 70,372 VISITS - PROVIDED $5.5 MILLION IN INDIGENT CARE. - HEALTH CENTER RECEIVED TWO QUALITY IMPROVEMENT AWARDS FOR MEETING OR EXCEEDING HEALTHY PEOPLE 2020 GOALS OR OTHER DEFINED CLINICAL OUTCOMES, ONE FROM THE STATE OF MISSOURI PRIMARY CARE ASSOCIATION AND ONE FROM THE FEDERAL GOVERNMENT FOR QUALITY CARE IMPROVEMENTS. 2017 - PROVIDED HEALTHCARE FOR 23,187 INDIVIDUALS THROUGH OVER 66,500 VISITS - PROVIDED $5.2 MILLION IN INDIGENT CARE. REDUCED A MAJOR BARRIER TO CARE BY OFFERING GREATER ACCESS TO TRANSPORTATION RESOURCES THROUGH AN INNOVATIVE PARTNERSHIP WITH CIRCULATION AND LYFT. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE COMPLETED. THE 990 IS THEN PROVIDED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. ANY QUESTIONS AND CONCERNS THE FINANCE COMMITTEE HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE COMPLETED. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C DUTY TO DISCLOSE: IF AN INTERESTED PERSON HAS A POSITION OR FINANCIAL INTEREST IN ANY BUSINESS OR OTHER ENTITY WITH WHICH THE HEALTH CENTER IS CONSIDERING ENTERING INTO AN ARRANGEMENT OR TRANSACTION, THE INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE CONFLICT TO THE HEALTH CENTER'S BOARD OF DIRECTORS (BOARD) OR EXECUTIVE COMMITTEE AS SOON AS THE INTERESTED PERSON HAS KNOWLEDGE OF THE POTENTIAL ARRANGEMENT OR TRANSACTION, AND WHENEVER REQUESTED BY THE BOARD OR THE EXECUTIVE COMMITTEE. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS: THE BOARD OF DIRECTORS WILL MAKE THE DETERMINATION. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: - PRIOR TO ANY DISCUSSION AND VOTE ON WHETHER A CONFLICT OF INTEREST EXISTS, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OR THE EXECUTIVE COMMITTEE REGARDING THE INTERESTED PERSON'S POSITION OR FINANCIAL INTEREST. AFTER SUCH PRESENTATION, THE INTERESTED PERSON WILL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION. - THE BOARD OR THE EXECUTIVE COMMITTEE WILL UNDERTAKE APPROPRIATE DUE DILIGENCE AND INFORM ITSELF OF ALL MATERIAL INFORMATION REASONABLY AVAILABLE TO IT AND EXPLORE ALL REASONABLE ALTERNATIVES TO THE PROPOSED TRANSACTION THAT WOULD NOT INVOLVE THE CONFLICT OF INTEREST. - IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OR THE EXECUTIVE COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE PROPOSED TRANSACTION IS (I) IN THE HEALTH CENTER'S BEST INTEREST, (II) FOR THE HEALTH CENTER'S OWN BENEFIT, AND (III) FAIR AND REASONABLE TO THE HEALTH CENTER. IN CONFORMITY WITH THIS DETERMINATION, THE BOARD OR THE EXECUTIVE COMMITTEE WILL MAKE ITS DECISION AS TO WHETHER THE HEALTH CENTER MAY ENTER INTO THE PROPOSED TRANSACTION. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: IF THE BOARD OR THE EXECUTIVE COMMITTEE DETERMINES THAT THE COVERED PERSON HAS IN FACT FAILED TO DISCLOSE A POSITION OR A FINANCIAL INTEREST, THE BOARD OR THE EXECUTIVE COMMITTEE WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. DOCUMENTATION IN MINUTES: WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS, THE NAME OF THE INTERESTED PERSON WHO DISCLOSED OR WAS OTHERWISE FOUND TO HAVE A POSITION OR FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST; THE NATURE OF THE POSITION OR FINANCIAL INTEREST; ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT; AND THE BOARD OR THE EXECUTIVE COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. ANNUAL STATEMENTS: EACH COVERED PERSON WILL ANNUALLY SIGN A STATEMENT THAT AFFIRMS SUCH PERSON: - HAS RECEIVED A COPY OF THIS POLICY; - HAS READ AND UNDERSTANDS THE POLICY; - HAS AGREED TO COMPLY WITH THE POLICY; AND - UNDERSTANDS THE HEALTH CENTER IS EXEMPT FROM FEDERAL INCOME TAX AND TO MAINTAIN ITS FEDERAL TAX EXEMPTION THE HEALTH CENTER MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION, EACH COVERED PERSON WILL ANNUALLY COMPLETE, SIGN AND PROMPTLY RETURN TO THE BOARD OR THE EXECUTIVE COMMITTEE A QUESTIONNAIRE AND DISCLOSURE STATEMENT. A COVERED PERSON NEED NOT DISCLOSE COMPENSATION PAID TO THE COVERED PERSON BY HEALTH CENTER PURSUANT TO A RESOLUTION OF THE BOARD. PERIODIC REVIEWS: THE PERIODIC REVIEWS AS REQUIRED BY THE POLICY WILL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: - WHETHER THE HEALTH CENTER COMPENSATION ARRANGEMENTS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND ARE THE RESULT OF ARM'S- LENGTH BARGAINING; AND - WHETHER TRANSACTIONS AND ARRANGEMENTS WITH OTHER ENTITIES AND INDIVIDUALS CONFORM TO THE HEALTH CENTER'S POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE HEALTH CENTER'S TAX-EXEMPT PURPOSES AND DO NOT RESULT IN PRIVATE INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT, OR IN AN EXCESS BENEFIT TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A THE EVALUATION FOR THE CEO FOR THE YEAR ENDING SEPTEMBER 30, 2017 WAS IN JANUARY, 2017. THIS EVALUATION WAS PERFORMED BY THE HEALTH CENTER'S BOARD OF DIRECTORS. THE CHAIRPERSON OF THE BOARD WILL LEAD THE ASSESSMENT PROCESS. THE CHAIR SHALL SELECT A PERFORMANCE AND COMPENSATION COMMITTEE AND ITS CHAIR. THE CEO WILL COMPLETE A SELF-ASSESSMENT. THIS ALLOWS THE BOARD AND CEO TO COMPARE ONE ANOTHER'S PERCEPTION OF THE CEO'S PERFORMANCE. THE CHAIRPERSON OF THE PERFORMANCE AND COMPENSATION COMMITTEE WILL HAVE EACH BOARD MEMBER COMPLETE THE ASSESSMENT FORM INDIVIDUALLY AND COMPILE RESULTS. DISTRIBUTION OF THE ASSESSMENT FORM: THE COMMITTEE CHAIRPERSON WILL DISTRIBUTE THE CEO SELF-ASSESSMENT AND THE BOARD'S ASSESSMENT OF THE CEO WELL ENOUGH IN ADVANCE TO ALLOW AMPLE TIME FOR COMPLETION. THE COMMITTEE CHAIRPERSON WILL SET A DEADLINE FOR COMPLETING THE BOARD'S ASSESSMENT OF THE CEO. ANALYSIS OF THE RESULTS: THE RESPONSES FOR EACH QUESTION WILL BE ADDED TOGETHER AND THE AVERAGE RESPONSE COMPUTED. NEXT, THE AVERAGE RESPONSES FOR EACH QUESTION WILL BE ADDED TOGETHER AND THE AVERAGE RESPONSE FOR THE ASSESSMENT AS A WHOLE SHOULD BE CALCULATED. THE RESULTS WILL BE SHARED WITH THE BOARD FOR DISCUSSION AND ANALYSIS IN CLOSED SESSION. REVIEW OF THE RESULTS WITH THE CEO: THE CEO AND THE BOARD WILL MEET IN A CLOSED EXECUTIVE SESSION OR A SPECIAL MEETING TO REVIEW AND DISCUSS THE RESULTS. BASED ON THE RESULTS, THE BOARD AND CEO WILL DEVELOP A WRITTEN PERFORMANCE PLAN AND PERFORMANCE GOALS FOR THE CEO DESCRIBING AREAS OF FOCUS AND IMPROVEMENT FOR THE NEXT YEAR. THE PERFORMANCE ASSESSMENT WILL BE USED AS A BASIS FOR DETERMINING COMPENSATION. AN INDEPENDENT COMMITTEE, USING COMPARABILITY DATA WILL CONDUCT COMPENSATION ANALYSIS. SUCH DELIBERATIONS AND DECISIONS REGARDING COMPENSATION SHALL BE DOCUMENTED AND SUBSTANTIATED. THIS COMPENSATION REVIEW METHODOLOGY SHALL BE USED FOR ALL CHIEF OFFICER POSITIONS. SOLICIT THE CEO'S FEEDBACK: THE BOARD WILL OBTAIN THE CEO'S FEEDBACK REGARDING THE ASSESSMENT PROCESS. FEEDBACK WILL INCLUDE UNDERSTANDING THE CEO'S AGREEMENT OR DISAGREEMENT WITH THE BOARD'S ASSESSMENT; WHETHER THE FORMAT WAS APPROPRIATE, WHETHER THE BOARD AND THE CEO BELIEVED THAT THE FORM USED CAPTURED ALL OF THE NECESSARY ELEMENTS, AND WHICH AREAS COULD BE IMPROVED IN THE NEXT ASSESSMENT. FORM 990, PART VI, SECTION B, LINE 15B OTHER OFFICERS AND KEY EMPLOYEES: ON A REGULAR BASIS, HUMAN RESOURCES WILL CONDUCT SALARY SURVEYS TO ENSURE CURRENT JOB PAY RANGES AND MEDIAN PAY FOR CERTAIN BENCHMARKED POSITIONS REMAIN COMPETITIVE IN THE MARKETPLACE AND CONSISTENT WITH THE COMPANY'S COMPENSATION PHILOSOPHY. AN INDEPENDENT COMMITTEE USING COMPARABILITY DATA WILL CONDUCT A COMPENSATION ANALYSIS. SUCH DELIBERATIONS AND DECISIONS REGARDING COMPENSATION SHOULD BE DOCUMENTED AND SUBSTANTIATED. THIS REVIEW WAS PERFORMED IN NOVEMBER/DECEMBER OF 2016. ALL PROVIDER REVIEWS WERE DONE BY THE HEALTH CENTER'S CHIEF HEALTH OFFICER. ALL MEMBERS OF THE EXECUTIVE COMMITTEE WERE EVALUATED BY THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 CHANGE OF THE INTEREST IN SAMUEL U RODGERS HEALTH CENTER FDN $ 49,255 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT PROFESSIONAL SERVICES TOTAL FEES:1451286 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE LAB REFERRAL TOTAL FEES:269851 FORM 990 PART IX LINE 11G DESCRIPTION:FACILITY MAINT & SECURITY TOTAL FEES:260294 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTANTS - PHYSICIANS TOTAL FEES:94701 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:321427 SAMUEL U RODGERS FOUNDATION INC 825 EUCLID KANSAS CITY MO 64124 200751739 SUPPORT ORG MO 501(C)3) 12A SURHC true false true false false false false false false true false false false true true true true false true false Samuel U Rodgers Health Center Foundation B 166733 COST