2018-08-09T16:34:35-05:00 2017-09-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2016-10-01 430662495 HANNIBAL REGIONAL HEALTHCARE SYSTEM INC HANN 5732481300 6500 HOSPITAL DRIVE PO BOX 551 HANNIBAL MO 63401 ROB GASAWAY VICE PRESIDENT - FINANCE 5732481300 2018-08-07 1 JEFF PARKER P00970069 3149254300 2016 2022-09-23 18:48:47Z C TODD AHRENS 6500 HOSPITAL DRIVE PO BOX 551 HANNIBAL MO 63401 155492563 0 X HOSPITAL.HANNIBALREGIONAL.ORG X 1987 MO THE SYSTEM OPERATES A FULL SERVICE ACUTE CARE FACILITY. 13 12 1105 281 0 0 480397 599661 133507994 147462759 2895120 3118772 2232078 2308837 139115589 153490029 38323 108678 0 0 69329159 84528833 0 0 405224 60507117 66796523 129874599 151434034 9240990 2055995 143832455 152196009 40716317 42304066 103116138 109891943 X TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES FOR A BETTER LIFE. 1 0 134509844 108678 148649841 THE SYSTEM OPERATES A FULL SERVICE 86 BED ACUTE CARE HOSPITAL FACILITY, A 13 BED INPATIENT REHAB FACILITY, SEVERAL PHYSICIAN PRACTICES AND PRIMARY CARE CLINICS, AND A HOME HEALTH AGENCY IN HANNIBAL MISSOURI AND SURROUNDING COUNTIES. 18,014 TOTAL INPATIENT DAYS WERE PROVIDED DURING THE COURSE OF THE YEAR. THE SYSTEM PROVIDES SERVICES TO PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE POLICY AS WELL AS SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. THE TOTAL COST OF UNCOMPENSATED CARE WAS: CHARITY CARE - $3,519,350 AND STATE MEDICAID AND OTHER PUBLIC AID PROGRAMS - $7,995,649. 134509844 1 1 0 1 0 1 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 168 0 1105 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X ROB GASAWAY 5732481300 6500 HOSPITAL DRIVE HANNIBAL MO 63401 ROBERT GILSTRAP DIRECTOR 1.00 X 0 0 0 JACK WHITAKER DIRECTOR 1.00 X 0 0 0 CAROLYN SHAW SECRETARY 1.00 X X 0 0 0 PAUL EWERT CHAIRPERSON 1.00 X X 0 0 0 DIRK SAUER DIRECTOR 1.00 X 0 0 0 STEVE MILLER ASST SECRETARY 1.00 X X 0 0 0 JASON POAGE TREASURER 1.00 X X 0 0 0 LINDA STRAUBE DIRECTOR 1.00 X 0 0 0 GENE SCHOLES JR DIRECTOR 1.00 X 0 0 0 PAT BENSON VICE CHAIRPERSON 1.00 X X 0 0 0 DEBORAH THORNBURG DIRECTOR 1.00 X 0 0 0 LACEY YOUNG DIRECTOR 1.00 X 0 0 0 RICHARD VALUCK DIRECTOR & CARDIOLOGIST 40.00 X 602816 0 36749 C TODD AHRENS PRESIDENT & CEO 40.00 1.00 X 581294 0 138987 ROGER DIX VICE PRESIDENT - FINANCE 40.00 X 358441 0 17292 ROB GASAWAY VICE PRESIDENT - FINANCE 40.00 X 0 0 0 TIMOTHY REUSCHEL VICE PRESIDENT - GENERAL COUNSEL 40.00 X 326965 0 70397 PRANAV PARIKH MD V.P. - QUALITY & MEDICAL AFFAIRS 40.00 X 469982 0 110097 JULIE LEVERENZ VICE PRESIDENT - STRATEGY & PLANNING 40.00 X 222773 0 72648 SUSAN WATHEN VICE PRESIDENT - HUMAN RESOURCES 40.00 X 193812 0 38109 G DOUG RUBLE VICE PRESIDENT - FACILITIES 40.00 X 188318 0 37441 PATRICIA BRAWNER VICE PRESIDENT - NURSING 40.00 X 176177 0 24797 KURT EBERS CLINIC ADMINISTRATOR 40.00 X 167152 0 32709 TIMOTHY POLLEY V.P. - HRHS BUSINESS DEVELOPMENT 40.00 X 333472 0 22508 WENDY HARRINGTON V.P. - HRHS DEVELOPMENT 1.00 40.00 X 189805 0 53726 LUVELL GLANTON ANESTHESIOLOGIST - PAIN MANAGEMENT 40.00 X 802938 0 44737 HARSHA DESAI PATHOLOGIST 40.00 X 629555 0 44990 PERVEZ ALVI CARDIOLOGIST 40.00 X 540746 0 29672 THELMA PEERY EMERGENCY ROOM PHYSICIAN 40.00 X 549040 0 21018 SATHISH KODALI CARDIOLOGIST 40.00 X 555743 0 521 LYNN OLSON FORMER CEO - HOSPITAL 0.00 0.00 X 134119 0 0 7023148 0 796398 91 1 1 0 ALLSCRIPTS LLC PO BOX 8538-0133 PHILADELPHIA PA 19171 IT SYSTEMS 1318498 ADVANCE HANNIBAL REGIONAL HOSPITAL 188A MEDICAL DRIVE HANNIBAL MO 63401 PT/OT PROVIDER 1031500 INTERIM PHYSICIANS LLC PO BOX 679139 DALLAS TX 75267 LOCUM PHYSICIAN 872380 HOUSE AFH LLC 148 STONE RIDGE DRIVE HANNIBAL MO 63401 LOCUM PHYSICIAN 870813 BANC OF AMERICA LEASING PO BOX 100918 ATLANTA GA 30384 LEASING COMPANY 804787 49 599661 599661 NET PATIENT SERVICE REVENUE 621110 146730694 146730694 EHR MEANINGFUL USE 621110 732065 732065 147462759 1502297 1502297 339611 17015 322596 322596 322596 3559950 42044 1964497 21022 1595453 21022 1616475 1616475 CHILDREN'S DEVELOPMENT CENTER 624410 708749 708749 CAFETERIA 722210 660208 660208 CONTRACTED SERVICES 621110 260689 260689 356595 217644 138951 1986241 153490029 148649841 0 4240527 X 108678 108678 4763954 788496 3858833 116625 60345316 53081067 7030959 233290 2275615 2210130 58554 6931 13149732 11579938 1533581 36213 3994216 3487642 494409 12165 174293 174293 97500 97500 12552 10955 1597 16639145 16557913 81232 640579 640579 18975531 16561746 2413785 1094873 955600 139273 1721911 1502875 219036 843991 736631 107360 105347 91946 13401 333225 290837 42388 7783443 7783443 639745 558366 81379 BAD DEBT EXPENSE 9876627 9876627 PHARMACY DRUGS 5734246 5734246 FOOD 699620 699620 RECRUITING EXPENSE 612479 534569 77910 811416 717940 93476 151434034 134509844 16518966 405224 18239051 15033473 1520546 1031240 15051045 17563230 1313654 1275128 2523994 3055896 832787 1102034 155979765 108597059 44949262 47382706 54212051 58604731 333782 652993 336908 1686020 4519375 4808558 143832455 152196009 20211323 25710322 78921 64270 9015000 7529351 5087420 6445428 6323653 2554695 40716317 42304066 X 98575052 105059949 4541086 4831994 103116138 109891943 143832455 152196009 X 2055995 2133926 2585884 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 12552 12552 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION IS RELATED TO LOBBYING. 1 1070 650 23436 0 0 2479295 2479295 65323044 41408865 23914179 7096883 6102604 994279 77113817 61085590 16028227 3966726 3966726 47382706 MINIMUM PENSION LIABILITY 547554 SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN 2007141 2554695 1 1 X 1 X 0 1 1 1 0 1 1 2970512 480000 2490512 0.01640 15153738 10306355 4847383 0.03200 18124250 10786355 7337895 0.04840 15765725 7400685 8365040 0.05520 276279 276279 0.00180 502185 502185 0.00330 16544189 7400685 9143504 0.06030 34668439 18187040 16481399 0.10870 2102850 737769 1365081 0.00900 1545 1545 0.00000 458969 458969 0.00300 2563364 737769 1825595 0.01200 1 9876627 7407470 36621306 41249189 -4627883 X 1 1 1 HANNIBAL MEDICAL SUPPLY DME COMPANY 0.33330 0.33330 3 ADVANCE HANNIBAL REGIONAL HOSPITAL LLC OUTPATIENT PHYSICAL THERAPY 0.50000 0.50000 4 HANNIBAL REGIONAL PHYSICIAN HOSPITAL ORGANIZATION INC INSURANCE REPRICING 0.50000 0.50000 1 1 HANNIBAL REGIONAL HOSPITAL 6000 HOSPITAL DRIVE HANNIBAL MO 63401 HRHONLINE.ORG 101-57 X X X HANNIBAL REGIONAL HEALTHCARE SYSTEM INC 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X SEE PART V, SECTION C FOR URL OF CHNA X 1 16 1 SEE PART V, SEC. C FOR IMPLEMENTATION STRATEGY URL 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, SECTION C FOR URL X SEE PART V, SECTION C FOR URL X SEE PART V, SECTION C FOR URL X X X X 1 X 0 X X X X X 1 X 0 0 HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 5: A BROAD-BASED STEERING COMMITTEE OF HEALTHCARE LEADERS FROM THROUGHOUT THE SIX COUNTY REGION WAS FORMED TO GUIDE THE ASSESSMENT PROCESS AND ESTABLISH THE THREE-YEAR STRATEGY TO ADDRESS THE PRIORITIES IDENTIFIED. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 6B: SIX COUNTY HEALTH DEPARTMENTS, FREE CLINIC, FQHC, MULTIPLE SOCIAL SERVICE AGENCIES, NON-EMPLOYED PHYSICIAN GROUPS AND OTHERS. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 11: A BROAD-BASED OVERSIGHT GROUP IS MEETING ON A QUARTERLY BASIS TO ASSESS PROGRESS AND INFLUENCE THE WORK ESTABLISHED IN THE PLAN; A VARIETY OF BEHAVIORAL HEALTH SERVICES HAVE EMERGED IN THE REGION DUE TO THE VISIBILITY OF THIS PROBLEM; MENTAL HEALTH FIRST AID CLASSES ARE RAISING HEALTH LITERACY; SERVICES HAVE BEEN EXPANDED AT THE LOCAL FREE CLINIC TO ADDRESS BY ACCESS TO CARE, MENTAL HEALTH AND DENTAL HEALTH; A POPULATION HEALTH GRANT IS RESULTING IN REDUCING THE INCIDENCE OF EMERGENCY DEPARTMENT VISITS FOR PATIENTS WITH CHRONIC DISEASE WHO WERE FORMERLY HIGH UTILIZERS; A NEW FQHC HAS ADDED MENTAL HEALTH AND DENTAL HEALTH CAPACITY IN THE REGION; A COMMUNITY HEALTH INITIATIVE KNOWN AS "LIVING BETTER" IS BEGINNING TO EMERGE AND IS INTENDED TO ENHANCE THE SOCIAL VALUING OF HEALTH; COME COMMITTED COALITIONS FOCUSING ON THE PRIORITY PROBLEMS IDENTIFIED IN THE CHNA ARE NOW IN PLACE. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 13B: THE PATIENTS ABILITY TO PAY OUTSIDE OF NORMAL LIVING EXPENSES AND DEBT. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 16J: PERSONAL CONTACT AND WEBSITE ACCCESS ARE THE MAIN POINTS OF CONTACT. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 20E: COMMUNICATIONS THROUGH MAIL AND PHONE INTERVIEWS ARE PURSUED TO RESOLVE ISSUES AND OBTAIN NEEDED INFORMATION TO QUALIFY PATIENTS. SCHEDULE H, PART V, SECTION B, LINE 7B THE ORGANIZATION'S MOST RECENT CHNA REPORT CAN BE FOUND AT:HTTPS://HANNIBALREGIONAL.ORG/COMMUNITYHEALTH/CHNA/2016-2019REGIONALHEALTHSTRATEGY/TABID/208/DEFAULT.ASPX SCHEDULE H, PART V, SECTION B, LINE 10 THE ORGANIZATION'S CURRENT IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://HANNIBALREGIONAL.ORG/COMMUNITYHEALTH/CHNA/2016-2019REGIONALHEALTHSTRATEGY/TABID/208/DEFAULT.ASPX SCHEDULE H, PART V, SECTION B, LINE 16A THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP) CAN BE FOUND AT:HTTPS://HANNIBALREGIONAL.ORG/PATIENTSVISITORS/PATIENTSERVICES/FINANCIALASSISTANCE/TABID/241/DEFAULT.ASPX SCHEDULE H, PART V, SECTION B, LINE 16B THE ORGANIZATION'S FINANCIAL ASSISTANCE APPLICATION CAN BE FOUND AT:HTTPS://HANNIBALREGIONAL.ORG/PATIENTSVISITORS/PATIENTSERVICES/FINANCIALASSISTANCE/TABID/241/DEFAULT.ASPX SCHEDULE H, PART V, SECTION B, LINE 16C THE ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FAP CAN BE FOUND AT:HTTPS://HANNIBALREGIONAL.ORG/PATIENTSVISITORS/PATIENTSERVICES/FINANCIALASSISTANCE/TABID/241/DEFAULT.ASPX 22 1 - HANNIBAL REGIONAL MEDICAL GROUP 6500 HOSPITAL DRIVE HANNIBAL MO 63401 CLINICS 2 - JAMES E CARY CANCER CENTER 5985 HOSPITAL DRIVE HANNIBAL MO 63401 CANCER CENTER 3 - VISION INSTITUTE 175 SHINN LANE HANNIBAL MO 63401 CLINICS 4 - COMPLETE FAMILY MEDICINE - KIRKSVILLE 1611 S BALTIMORE KIRKSVILLE MO 63501 RURAL HEALTH, SAME DAY/URGENT CARE, FAMILY PRACTICE CLINIC 5 - MONROE CITY FAMILY PRACTICE 821 BUSINESS HWY 24 WEST MONROE CITY MO 63456 CLINIC 6 - PIKE MEDICAL CLINIC - BOWLING GREEN 8 TOWN CENTER DR BOWLING GREEN MO 63334 CLINIC 7 - PIKE MEDICAL CLINIC - LOUISIANA 211 S 3RD ST LOUISIANA MO 63353 CLINIC 8 - CANTONLAGRANGE FAMILY PRACTICE 1802 ELM STREET CANTON MO 63435 CLINIC 9 - SHELBINA FAMILY PRACTICE 400 S CENTER STREET SHELBINA MO 63486 CLINIC 10 - PEDIATRIC THERAPY 150 MEDICAL DR HANNIBAL MO 63401 PEDIATRIC THERAPY 11 - EXPRESS CARE AT WAL-MART 3650 STARDUST DRIVE WAL-MART HANNIBAL MO 63401 SAME DAY CLINIC 12 - COMPLETE FAMILY MEDICINE MOBERLY UC 1600 N MORLEY SUITE A-120-A MOBERLY MO 65270 SAME DAY/URGENT CARE CLINIC 13 - COMPLETE FAMILY MEDICINE MACON UC 1206 N MISSOURI ST MACON MO 63552 SAME DAY/URGENT CARE CLINIC 14 - SPEECH THERAPY 188A MEDICAL DRIVE HANNIBAL MO 63401 SPEECH THERAPY 15 - COMPLETE FAMILY MEDICINE LANCASTER RHC 1000 W WASHINGTON LANCASTER MO 63548 RURAL HEALTH CLINIC 16 - COMPLETE FAMILY MEDICINE LAPLATA RHC 29934 JULY RD LA PLATA MO 63549 RURAL HEALTH CLINIC 17 - HANNIBAL MEDICAL SUPPLIES 188A MEDICAL DRIVE HANNIBAL MO 63401 JOINT VENTURES - MEDICAL SUPPLIES 18 - ADVANCE HANNIBAL REGIONAL HOSPITAL LLC 188A MEDICAL DRIVE HANNIBAL MO 63401 JOINT VENTURES - THERAPY 19 - ADVANCE HANNIBAL REGIONAL HOSPITAL LLC 710 S BUSINESS 61 SUITE 100 BOWLING GREEN MO 63334 JOINT VENTURES - THERAPY 20 - ADVANCE HANNIBAL REGIONAL HOSPITAL LLC 55 TROY SQUARE TROY MO 63379 JOINT VENTURES - THERAPY 21 - ADVANCE HANNIBAL REGIONAL HOSPITAL LLC 821 US 24 WEST MONROE CITY MO 63456 JOINT VENTURES - THERAPY 22 - ADVANCE HANNIBAL REGIONAL HOSPITAL LLC 1804 ELM ST CANTON MO 63435 JOINT VENTURES - THERAPY PART I, LINE 3C: THE ORGANIZATION USED AN ABILITY TO PAY STANDARD TO DETERMINE ELIGIBILITY. A PERSON IS ELIGIBLE FOR CHARITY CARE IF THEY MEET ANY OF THE FOLLOWING CRITERIA: THEIR INSURANCE IS INADEQUATE, THEY ARE UNINSURED, PATIENTS WITH A FAMILY INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINE, PATIENTS WITH A SPENDABLE INCOME THAT IS LESS THAN 5% OF THE BALANCE OWED TO THE HOSPITAL, THE PATIENT HAS LESS THAN $2,000 IN TOTAL ASSETS AVAILABLE TO PAY HOSPITAL EXPENSES (EXCEPTIONS INCLUDE HOME EQUITY, AUTO EQUITY, LIFE INSURANCE EQUITY). PART I, LINE 6A: THE MISSOURI HOSPITAL ASSOCIATION HAS INCLUDED HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. IN THEIR ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: THE COST TO CHARGES RATIO WAS USED AS DERIVED FORM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART I, LN 7 COL(F): A GROSS ESTIMATE WAS MADE BASED ON CURRENT EXPERIENCE. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES THAT PROMOTE THE HEALTH OF THE HOSPITAL'S COMMUNITY INCLUDES ITS CHILDREN'S CENTER FOR EDUCATION, DISASTER RECOVERY PLANNING, INTERPRETIVE SERVICES FOR NON-ENGLISH SPEAKING PATIENTS, AND RECRUITMENT COSTS FOR PHYSICIANS. PART III, LINE 2: HISTORICAL EXPERIENCE WAS USED TO ESTIMATE BAD DEBTS BY PAYOR CLASSIFICATION AND AGING CO-HORT. PART III, LINE 3: THE ESTIMATE WAS BASED ON AVAILABLE DATA. PART III, LINE 4: THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE SYSTEM BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AT SEPTEMBER 30, 2017 AND 2016, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS APPROXIMATELY $7,732,000 AND $5,310,000, RESPECTIVELY. PART III, LINE 8: SOME MEDICARE SERVICES ARE PAID AT SUBSTANTIALLY LESS THAN COST THROUGH THE PROGRAM. THESE SERVICES COULD BE ELIMINATED TO INCREASE MARGIN BUT ARE PROVIDED IN THIS COMMUNITY DESPITE THE LOSS. PART III, LINE 9B: WHEN CHARITY CONSIDERATION IS REQUESTED ALL COLLECTION EFFORTS ARE HALTED UNTIL A DETERMINATION ON ELIGIBILITY IS MADE. COLLECTION EFFORTS ARE RESUMED ONLY IF THE INDIVIDUAL DOES NOT MEET ONE OF THE CHARITY CRITERIA. PART VI, LINE 2: THE ORGANIZATION RECEIVES ANNUAL UPDATES ON THE HEALTH STATUS OF ITS POPULATION FROM THE STATE THAT INCLUDE MORTALITY AND DISEASE STATUS. THE ORGANIZATION ALSO MONITORS NATIONAL DATA ON TRENDS AND DISEASE STATUS. PART VI, LINE 3: PERSONAL CONTACT AND WEBSITE ACCESS ARE THE MAIN POINTS OF CONTACT. PART VI, LINE 4: THE ORGANIZATION SERVES THE POPULACE OF A 12 COUNTY REGION IN NORTHEAST MISSOURI. THE AREA IS PRIMARILY A RURAL FARMING AREA WITH NUMEROUS POCKETS OF MEDICALLY UNDERSERVED AREAS. RESIDENTS ARE SERVED BY DISTANT ORGANIZATIONS IN COLUMBIA, MO AND ST. LOUIS, MO. CARE CAN ALSO BE ACCESSED AT LOCAL HOSPITALS IN QUINCY, IL, MACON, MO, MOBERLY, MO, AND KIRKSVILLE, MO. PART VI, LINE 5: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. 1 AMERICAN CANCER SOCIETY 3145 HIGHWAY 61 HANNIBAL MO 63401 131788491 501(C)(3) 7500 RELAY FOR LIFE-MULTI COUNTIES MHA CENTER FOR EDUCATION PO BOX 60 JEFFERSON CITY MO 65102 430898947 501(C)(3) 56178 MCE HEALTH IMPR., RESEARCH AND SCHOLARSHIP FUND, MHA SPECIAL PROJECTS, MISSOURI CENTER FOR PATIENT SAFETY CONTRIBUTION AND DELIVERABLES, MISSOURI POISON CENTER CONTRIBUTION. HANNIBAL SCHOOL DISTRICT #60 4650 MCMASTERS AVE HANNIBAL MO 63401 436001555 GOVERNMENT 45000 SCOREBOARD PROGRAM 3 PART I, LINE 2: POLICY GA 1-112 CORPORATE CITIZENSHIP GUIDES THE ORGANIZATION IN CONTRIBUTING TO OTHER ORGANIZATIONS. ALL ACTIVITIES WHICH CONSTITUTE A CHARITABLE CONTRIBUTION ARE DOCUMENTED ON THE CHARITABLE CONTRIBUTION FORM. X X X X 1 1 0 0 0 0 0 0 0 RICHARD VALUCK DIRECTOR & CARDIOLOGIST 592166 0 10650 0 0 0 11925 0 24824 0 639565 0 0 0 C TODD AHRENS PRESIDENT & CEO 451706 0 117957 0 11631 0 107198 0 31789 0 720281 0 0 0 ROGER DIX VICE PRESIDENT - FINANCE 255416 0 0 0 103025 0 0 0 17292 0 375733 0 0 0 TIMOTHY REUSCHEL VICE PRESIDENT - GENERAL COUNSEL 253431 0 66533 0 7001 0 38794 0 31603 0 397362 0 0 0 PRANAV PARIKH MD V.P. - QUALITY & MEDICAL AFFAIRS 463071 0 750 0 6161 0 78592 0 31505 0 580079 0 0 0 JULIE LEVERENZ VICE PRESIDENT - STRATEGY & PLANNING 189895 0 25551 0 7327 0 49574 0 23074 0 295421 0 0 0 SUSAN WATHEN VICE PRESIDENT - HUMAN RESOURCES 165350 0 21627 0 6835 0 26450 0 11659 0 231921 0 0 0 G DOUG RUBLE VICE PRESIDENT - FACILITIES 145453 0 19157 0 23708 0 15037 0 22404 0 225759 0 0 0 PATRICIA BRAWNER VICE PRESIDENT - NURSING 155043 0 16115 0 5019 0 8047 0 16750 0 200974 0 0 0 KURT EBERS CLINIC ADMINISTRATOR 149098 0 13000 0 5054 0 6930 0 25779 0 199861 0 0 0 TIMOTHY POLLEY V.P. - HRHS BUSINESS DEVELOPMENT 238306 0 62455 0 32711 0 11925 0 10583 0 355980 0 0 0 WENDY HARRINGTON V.P. - HRHS DEVELOPMENT 161757 0 21420 0 6628 0 24212 0 29514 0 243531 0 0 0 LUVELL GLANTON ANESTHESIOLOGIST - PAIN MANAGEMENT 716688 0 86250 0 0 0 11925 0 32812 0 847675 0 0 0 HARSHA DESAI PATHOLOGIST 470334 0 158735 0 486 0 11925 0 33065 0 674545 0 0 0 PERVEZ ALVI CARDIOLOGIST 540746 0 0 0 0 0 11925 0 17747 0 570418 0 0 0 THELMA PEERY EMERGENCY ROOM PHYSICIAN 541040 0 0 0 8000 0 11925 0 9093 0 570058 0 0 0 SATHISH KODALI CARDIOLOGIST 555743 0 0 0 0 0 0 0 521 0 556264 0 0 0 LYNN OLSON FORMER CEO - HOSPITAL 0 0 0 0 134119 0 0 0 0 0 134119 0 0 0 PART I, LINES 4A-B ROGER DIX, SERP, $94,197 G. DOUG RUBLE, SERP, $15,473 TIMOTHY POLLEY, SERP $24,021 LYNN OLSON, SEVERANCE, $90,663 A THE INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HANNIBAL MISSOURI 531320446 2015-12-11 10560000 HOSPITAL REFUNDING REVENUE BONDS 0 0 0 A 2980000 10560000 49428 10510572 2017 1 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART III, LINE 2 THE SYSTEM ADDED 3 NEW RURAL HEALTH CARE CLINICS, 3 URGENT CARE LOCATIONS, AND 1 FAMILY PRACTICE LOCATION IN NORTHEAST MISSOURI AND ADDED PROFESSIONAL IMAGING SERVICES IN HOUSE. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS DELEGATED TO THE COMPENSATION COMMITTEE, PURSUANT TO A CHARTER ADOPTED BY THE BOARD OF DIRECTORS, THE RESPONSIBILITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS IN ADMINISTERING COMPENSATION PLANS AND IN MAKING DECISIONS ON THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER AND THOSE EXECUTIVES WHO REPORT DIRECTLY TO THE CHIEF EXECUTIVE OFFICER WHO QUALIFY AS "DISQUALIFIED PERSONS" WITHIN THE MEANING OF SECTION 4958 OF THE INTERNAL REVENUE CODE. THE COMMITTEE THEN REPORTS ITS ACTIONS TO THE BOARD OF DIRECTORS. THE COMMITTEE IS COMPOSED SOLELY OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE SCOPE OF THE COMMITTEE INCLUDES, BUT IS NOT LIMITED TO, REVIEWING AND APPROVING THE ANNUAL BASE SALARY LEVELS, ANNUAL INCENTIVE OPPORTUNITY LEVELS, EXECUTIVE PERQUISITES, EMPLOYMENT AGREEMENTS, BENEFITS AND SUPPLEMENTAL BENEFITS. FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 WILL BE FORWARDED TO EACH MEMBER OF THE BOARD OF DIRECTORS, AS WELL AS THE OFFICERS OF THE CORPORATION APPROXIMATELY ONE WEEK PRIOR TO A REGULAR BOARD MEETING AT WHICH THE PREPARED FORM 990 WILL BE ON THE AGENDA. THE CHIEF FINANCIAL OFFICER OR CHIEF EXECUTIVE OFFICER WILL PRESENT THE PREPARED FORM 990 TO THE BOARD OF DIRECTORS AND ENTERTAIN QUESTIONS FROM DIRECTORS AND OFFICERS. THE GENERAL COUNSEL FOR THE CORPORATION WILL ALSO BE PRESENT TO ASSIST WITH QUESTIONS FOR THE DIRECTORS AND OFFICERS. THIS PROCEDURE WILL BE COMPLETED PRIOR TO THE FILING OF THE PREPARED FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A POLICY TITLED BUSINESS ETHICS AND CONFLICT OF INTEREST WHICH REQUIRES THAT ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THE SYSTEM ALWAYS ACT IN THE BEST INTEREST OF THE SYSTEM WITHOUT CONFLICTS OF INTEREST. ANNUALLY EACH MEMBER OF THE BOARD OF DIRECTORS, EACH OFFICER OF THE ORGANIZATION, AND CERTAIN OTHER MANAGERS RECEIVE A COPY OF THE POLICY AND ARE REQUIRED TO COMPLETE A CONFIDENTIALITY AGREEMENT AND A CONFLICT OF INTEREST QUESTIONNAIRE WHEREBY THE INDIVIDUAL ANSWERS QUESTIONS REGARDING FAMILY MEMBERS, SUBSTANTIAL BUSINESS OR INVESTMENT HOLDINGS, AND OTHER TRANSACTIONS OR AFFILIATIONS WITH BUSINESSES OR OTHER ORGANIZATIONS THAT MIGHT AFFECT THEIR RELATIONSHIP WITH THE SYSTEM. AS PART OF THE CONFLICTS OF INTEREST QUESTIONNAIRE THE INDIVIDUAL IS ASKED TO ACKNOWLEDGE THAT THEY HAVE RECEIVED AND READ A COPY OF THE POLICY, AGREE TO COMPLY WITH THE POLICY, ACKNOWLEDGE THAT THE SYSTEM IS A CHARITABLE ORGANIZATION, WHICH MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH OUR TAX EXEMPT PURPOSES IN ORDER TO MAINTAIN OUR TAX EXEMPT STATUS, AGREE TO REPORT PROMPTLY TO THE BOARD OF DIRECTORS ANY CHANGES IN THEIR ANSWERS TO THE QUESTIONS OR ANY CHANGE IN CIRCUMSTANCE THAT MIGHT DEVELOP PRIOR TO THE COMPLETION OF THEIR NEXT ANNUAL QUESTIONNAIRE. WITH RESPECT TO DIRECTORS OF THE ORGANIZATION, THEY ALSO ACKNOWLEDGE THAT NONE OF THE CONDITIONS OF THE POLICY WHICH WOULD MAKE THEM INELIGIBLE TO REMAIN ON THE BOARD EXIST AT THE TIME THEY SIGN THE ACKNOWLEDGMENT AND THAT THEY WOULD REPORT ANY CONDITIONS WHICH BECOME APPLICABLE IMMEDIATELY TO THE CHAIRPERSON OF THE BOARD OF DIRECTORS. ON AN ANNUAL BASIS THESE DOCUMENTS ARE SENT BY THE SECRETARY OF THE SYSTEM TO EACH INTERESTED PERSON AND TO THOSE EMPLOYEES OF THE SYSTEM THAT THE BOARD DETERMINES. THE DOCUMENT IS COMPLETED BY THE INDIVIDUAL AND RETURNED TO THE SECRETARY OF THE BOARD THROUGH GENERAL COUNSEL, WHO ANNUALLY ANALYZES ANY DISCLOSED CONFLICT OF INTEREST OR ANY OTHER FACT THAT MIGHT MAKE THE INDIVIDUAL NOT INDEPENDENT FOR IRS TAX EXEMPT PURPOSES. THE SECRETARY THEN SUBMITS TO THE BOARD OF DIRECTORS A CONFIDENTIAL REPORT CONCERNING ANY INTEREST OF EMPLOYEES OF THE SYSTEM DISCLOSED BY SUCH QUESTIONNAIRE, ANY INTEREST OF DIRECTORS AND OFFICERS WHO ARE NOT EMPLOYEES OF THE SYSTEM, AND WHAT ACTIONS THE PRESIDENT OF THE ORGANIZATION MAY TAKE AS A RESULT OF ANY CONFLICTS DISCLOSED BY SUCH INDIVIDUALS. AN INDIVIDUAL IS INELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS FOR ANY OF THE FOLLOWING REASONS AS TAKEN FROM HANNIBAL REGIONAL SYSTEM BOARD OF DIRECTORS POLICY B-VII: A. FAILURE TO ADHERE COMPLETELY TO DISCLOSURE REQUIREMENTS; B. THE INDIVIDUAL IS AN OWNER, PARTNER, EMPLOYEE, BOARD MEMBER OR INVESTOR IN A DIRECT COMPETITOR OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM. AN OWNERSHIP OR INVESTMENT INTEREST IN A DIRECT COMPETITOR OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM, OF FIVE (5) PERCENT OR LESS WILL NOT MAKE INDIVIDUAL INELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS; C. THE INDIVIDUAL IS AN EMPLOYEE OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM, OR A FAMILY MEMBER IS A MEMBER OF THE MANAGEMENT TEAM OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM; D. THE INDIVIDUAL RECEIVES DIRECT COMPENSATORY BENEFIT FOR ONGOING SERVICES PROVIDED TO THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM (SERVING AS A "DE FACTO EMPLOYEE"); E. THE INDIVIDUAL IS AN OWNER, PARTNER, EMPLOYEE, BOARD MEMBER OR INVESTOR OR OTHER VENDOR WHO RECEIVES A SUBSTANTIAL AMOUNT OF REVENUE FROM THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM - THE GREATER OF $200,000.00 OR 2% OF THE ANNUAL REVENUES OF THAT VENDOR IN THE PRECEDING OR CURRENT YEAR. F. THE INDIVIDUAL IS AN OWNER, PARTNER, EMPLOYEE, BOARD MEMBER OR INVESTOR OF AN ENTITY WHO HAS CONTRACTED WITH SYSTEM FOR THE EXCLUSIVE PROVISION OF ANY MEDICAL SERVICES WITHIN THE SYSTEM, OR ITS AFFILIATES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS DELEGATED TO THE COMPENSATION COMMITTEE, PURSUANT TO A CHARTER ADOPTED BY THE BOARD OF DIRECTORS, THE RESPONSIBILITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS IN ADMINISTERING COMPENSATION PLANS AND IN MAKING DECISIONS ON THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER AND THOSE EXECUTIVES WHO REPORT DIRECTLY TO THE CHIEF EXECUTIVE OFFICER WHO QUALIFY AS "DISQUALIFIED PERSONS" WITHIN THE MEANING OF SECTION 4958 OF THE INTERNAL REVENUE CODE. THE COMMITTEE ENGAGES AN INDEPENDENT CONSULTANT TO ASSIST THE COMMITTEE WITH ITS GOVERNANCE AND OVERSIGHT ROLE AND ITS COMPLIANCE WITH SECTION 4958 OF THE INTERNAL REVENUE CODE, BY PROVIDING AN OPINION ON THE REASONABLENESS OF THE ORGANIZATION'S COMPENSATION PLAN. THE CONSULTANT USES PUBLISHED SURVEY DATA TO PROVIDE COMPARATIVE MARKET DATA FOR EACH POSITION. THE COMMITTEE THEN REPORTS ITS ACTIONS TO THE BOARD OF DIRECTORS. THE COMMITTEE IS COMPOSED SOLELY OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE SCOPE OF THE COMMITTEE INCLUDES, BUT IS NOT LIMITED TO, REVIEWING AND APPROVING THE ANNUAL BASE SALARY LEVELS, ANNUAL INCENTIVE OPPORTUNITY LEVELS, EXECUTIVE PERQUISITES, EMPLOYMENT AGREEMENTS, BENEFITS AND SUPPLEMENTAL BENEFITS. ANNUALLY, HRHS, THROUGH ITS COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT TO PROVIDE OPINIONS RELATED TO THE REASONABLENESS OF EXECUTIVE COMPENSATION AND TO PROVIDE ADVICE AND GUIDANCE AS TO CURRENT TRENDS AND ISSUES. IN 2017, INTEGRATED HEALTHCARE STRATEGIES (IHS) PROVIDED THIS SERVICE TO HRHS. FORM 990, PART VI, SECTION C, LINE 19 THE ARTICLES OF INCORPORATION AND AMENDMENTS THERETO ARE AVAILABLE ON THE MISSOURI SECRETARY OF STATE'S WEBSITE. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 117,030. MANAGEMENT AND GENERAL EXPENSES 17,057. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,087. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,844,515. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,844,515. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 10,551,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,551,500. LAUNDRY SERVICE: PROGRAM SERVICE EXPENSES 270,748. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 270,748. COLLECTION FEES: PROGRAM SERVICE EXPENSES 333,798. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 333,798. CLEANING SERVICE: PROGRAM SERVICE EXPENSES 440,322. MANAGEMENT AND GENERAL EXPENSES 64,175. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 504,497. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 2,294,976. PEARL LOWRIE FUND NET ACTIVITY 1,725. NET CONTRIBUTION REVENUE FROM FOUNDATION 289,183. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S POLICY REGARDING OVERSIGHT OF AUDIT IS CONSISTENT WITH THE PRIOR YEAR. LANAC 6000 HOSPITAL DRIVE HANNIBAL MO 63401 431822503 REAL ESTATE MO 0 0 HANNIBAL REGIONAL HOSPITAL HANNIBAL MOBILE DIAGNOSTICS LLC 6000 HOSPITAL DRIVE HANNIBAL MO 63401 300234397 DIAGNOSTIC IMAGING MO 13660 246598 HANNIBAL REGIONAL HOSPITAL HANNIBAL REGIONAL HOSPITAL FOUNDATION 175 SHINN LANE HANNIBAL MO 63401 431658744 FUNDRAISING MO 501(C)(3) LINE 12A, I HANNIBAL REGIONAL HEALTHCARE SYSTEM INC 1 HANNIBAL MOBILE DIAGNOSTICS PO BOX 1254 HANNIBAL MO 63401 300234397 IMAGING MO N/A RELATED 26646 0 0 0.50000 HANNIBAL MEDICAL SUPPLIES LLC PO BOX 40 QUINCY IL 62306 262362717 MEDICAL SUPPLIES MO N/A RELATED 60134 169567 0 0 0.33330 ADVANCE HANNIBAL REGIONAL HOSPITAL LLC 3652 STARDUST DRIVE HANNIBAL MO 63401 461561480 PT/OT SERVICES MO N/A RELATED 344330 28833 0 0 0.50000 HEALTH NETWORK OF MISSOURI LLC 227 UNIVERSITY HALL COLUMBIA MO 65211 471248962 COLLABORATIVE HEALTH NETWORK MO N/A RELATED -31350 19242 0 1 0.16670 HANNIBAL REGIONAL PHYSICIAN HOSPITAL ORGANIZATION INC 6500 HOSPITAL DRIVE HANNIBAL MO 64301 431706291 PHYSICIAN HOSPITAL ORGANIZATION MO C 42262 67579 0.50000 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 HANNIBAL REGIONAL HOSPITAL FOUNDATION C 599661 COST INCURRED HANNIBAL REGIONAL HOSPITAL FOUNDATION O 290655 COST INCURRED ADVANCE HANNIBAL REGIONAL HOSPITAL LLC J 79478 COST INCURRED ADVANCE HANNIBAL REGIONAL HOSPITAL LLC K 1057381 COST INCURRED HANNIBAL REGIONAL HOSPITAL FOUNDATION P 117027 COST INCURRED ADVANCE HANNIBAL REGIONAL HOSPITAL LLC R 175000 COST INCURRED SCHEDULE R PART I AND PART III THE ORGANIZATION BECAME THE SOLE OWNER OF HANNIBAL MOBILE DIAGNOSTICS, LLC ON 8/1/17. AS A RESULT, THIS ENTITY IS INCLUDED ON PART I AS A DISREGARDED ENTITY FOR THE TIME PERIOD 8/1/17-9/30/17 AND PART III AS A PARTNERSHIP FOR THE TIME PERIOD 10/1/16-7/31/17. SCHEDULE R, PAGE 2, PART III HRHS MAINTAINS CONTROL OF THE JOINT VENTURE ACTIVITIES LISTED ON SCHEDULE R, PART III BY HAVING ITS LEADERSHIP TEAM MEMBERS ON EACH JOINT VENTURE BOARD OF DIRECTORS. THAT IS WHY THE ENTITIES ARE LISTED ON SCHEDULE R, PART III AND WHY ANY RESULTING INCOME FROM THOSE ACTIVITIES HAS NOT BEEN SUBJECTED TO UBIT.