2018-04-18T13:39:44-07:00 2017-06-30 990 2016-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325000 1125 Madison Street Jefferson City MO 65101 Tom Luebbering Vice President of Finance 5736325101 2018-04-18 150.199.9.242 2016 2021-01-29 14:40:06Z Tom Luebbering 1432 Southwest Blvd Jefferson City MO 65109 186767609 0 X crmc.org X 1945 MO Capital Region Medical Center embraces its mission: To improve health and promote wellness in the communities we serve. 12 10 1659 300 0 0 1372384 462655 178692339 185704863 458797 579734 -26379 -31086 180497141 186716166 0 0 0 0 99848000 99620422 0 0 0 78965969 82313109 178813969 181933531 1683172 4782635 175071802 199928767 50130436 71045088 124941366 128883679 Capital Region Medical Center embraces its mission; To imporove the health and promote wellness in the communities we serve. 0 0 2964160 0 0 Inpatient and Outpatient Charity Care: Capital Region Medical Center serves the community by providing medical care to all patients regardless of their ability to pay. Patients who quality for charity care will be identified as soon as possible, either before the services are provided or after an individual has received services to stabilize their medical condition. If difficult to determine a patient's eligibility for charity care prior to providing the service, the determination should be made as soon as possible after the provision of the service. Upon registration, patients without Medicare/Medicaid, adequate health insurance or other local health care financial assistance will receive either a packet of information that addresses the financial assistance policy and procedures or immediate financial counseling assistance from staff within established business hours. The packet of information will clearly indicate that CRMC provides care without regard to ability to pay, to individuals with limited financial resources and explain how patients apply for financial assistance. CRMC provides a variety of services ranging from emergency services to inpatient and outpatient elective surgery, diagnostic testing and education programs. Charity care policies and procedures are in place to address any instances in which patients may access services. 2078199 0 810088 Support of Medical Education - In 1988, Capital Region accepted its first Family Practice resident. Since then, the program has offered one-on-one guidance. We reinforce values of ethical practice, community orientation, personal/professional balance, and lifelong learning. Capital Region Medical Center supports Lincoln University School of Nursing program. Columbia College Nursing Progarm, and the State Tech Physical Therapy Assistant Program. In addition to the direct financial support that Capital Region provides, we also provide support to Columbia College MSN students and Lincoln University School of Nursing BSN program in leadership training. We assist students from Rolla Technical College and Columbia Technical College in the surgical tech program. CRMC provides training to phlebotomist/tech students from Moberly Community College and Metro Business College to assist them with fulfilling their clinical requirements. CMRC provides oversight and mentoring to the St. Louis College of Pharmacy, University of Missouri-Columbia and Kansas City Pharmacy Programs. We provide support to St. Louis University and University of Missouri-Columbia and Kansas City PTA and PT programs. As well as assistance to the University of Missouri dietetics program. Our support for these programs in not only through the provision of training facilities but also adjunct faculty and resources. 221271 0 75000 Community Health Resident Clinic: CRMC provides Residents and Physician Supervisors to staff the Community Health Center clinic. In addition to providing a valuable training tool for the medical students, the resident clinic serves a unique community benefit by providing over 2000 patient visits from the eight county service area. The charge for service is based on the individual's ability to pay, which in many cases is free. 148479220 0 18536842 All other inpatient and outpatient services provided to patients. 148479220 0 18536842 153742850 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 131 0 1 1659 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Tom Luebbering 5736325101 1432 Southwest Blvd Jefferson City MO 65109 Thomas Niekamp Vice President 40 0 X 5301 0 0 Samuel Bushman Secretary 2 0 X 0 0 0 Lisa Kolb Waggoner Board Member/Physician 2 0 X 212747 0 58047 Diane Light Board Member/Physician 40 0 X 299079 0 56172 Ken Littlefield Chairman 2.50 0 X 0 0 0 Carlos Graham Board Member 2 0 X 0 0 0 Jack Pletz Board member 2 0 X 0 0 0 Lorilei Schwartz Vice Chair 2.5 0 X 0 0 0 Amy Freeman Board Member 2 0 X 0 0 0 Mitch Wasden Board member 2 0 X 0 0 0 Stevan Whitt Board member 2 0 X 0 0 0 Jim Wisch Board Chair Ex-Officio 2 0 X 0 0 0 Marc Ellinger board member 2 0 X 0 0 0 Gaspare Calvaruso President 40 0 X 392795 0 66815 Tom Luebbering Vice President 40 0 X 192418 0 53987 Janet Weckenborg Vice President 40 0 X 192385 0 49201 Bob Mazur Vice President - partial 40 0 X 25196 0 5178 Tanya Sandifer Vice President - partial year 0 0 X 39075 0 6350 Jason Cecil Vice President 40 0 X 142950 0 51862 Randall Haight Vice President/Physician 40 0 X 301440 0 65459 Sarah Morrow Vice President 40 0 X 145934 0 28956 Deborah Voskamp Vice President 40 0 X 182847 0 35155 Mitchell Godbee Chief of Staff/Physician 40 0 X 1115278 0 94043 Scott Anderson Physician 40 0 X 561839 0 73013 Dennis Luetkemeyer Physician 40 0 X 705969 0 73189 Eston Schwartz Physician 40 0 X 592881 0 75192 Adam Patterson Physician 40 0 X 694290 0 78046 5802424 0 870665 121 0 1 1 Missouri Orthopaedic Institute One Hospital Drive Columbia MO 65201 Physician Services 2017458 Boyce and Bynum Laboratory PO Box 7406 Columbia MO 65205 Lab Services 1716917 Aramark Healthcare Support Services 25271 Network Place Chicago IL 606731252 Management Services 1266277 University of Missouri One Hospital Drive Columbia MO 65201 Medical and other Services 570625 Sircal Contracting Inc 1331 Monroe Street Jefferson City MO 65101 Construction Contracting 508528 68 0 0 0 397759 0 64896 0 462655 Net Patient Service Revenue 622000 179866884 179866884 0 0 Other 900099 5837979 5837979 0 0 0 0 0 0 185704863 546969 546969 0 0 34508 34508 0 0 0 0 0 0 0 0 0 49700 0 51443 0 -1743 -1743 -1743 0 0 0 K1 Opti Gain 611710 264 264 0 0 K1 Health Network of Missouri 561000 -31350 -31350 0 0 -31086 186716166 186253511 0 0 0 0 0 0 0 0 0 0 2604049 0 2604049 0 0 0 0 0 78371524 64390044 13981480 0 2096843 1722766 374077 0 11651673 9573015 2078658 0 4896333 4022827 873506 0 0 0 0 0 134369 110398 23971 0 116525 95738 20787 0 0 0 0 0 0 0 13200 0 13200 0 13433342 11036834 2396508 0 457219 375654 81565 0 259733 213397 46336 0 1074666 882946 191720 0 0 0 0 0 565868 464921 100947 0 0 0 0 0 0 0 0 0 398537 327441 71096 0 1263684 1263684 0 0 0 0 0 0 11600283 8657705 2942578 0 1048178 861012 187166 0 Supplies 39583444 38923466 659978 0 Repairs and Maintenance 4116782 3382375 734407 0 Utilities and Phone 2566142 2108359 457783 0 FRA Taxes 3710694 3710694 0 0 1970443 1619574 350869 0 181933531 153742850 28190681 0 3073706 6005304 2054526 3221323 0 0 18374551 18967363 0 0 0 0 0 0 3986251 3986176 2469665 2698505 247655888 166545393 84102964 81110495 52304590 75082112 8705549 8857489 175071802 199928767 16985143 20505116 25745000 43027836 7400293 7512136 50130436 71045088 X 120959907 124887589 3911113 3925744 70346 70346 124941366 128883679 175071802 199928767 X 4782635 0 0 0 0 -840322 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28910 28910 0 Schedule C, Part II-B, Line 1 CRMC joined the Medicare Dependent Hospital coalition $9750. This group lobbied in an attempt to protect the Medicare Dependent Hospital status for hospitals. CRMC is also a member of Missouri Hospital Association. Just one of the benefits of membership is the MHA communicates with government on issues that are important to Missouri hospitals. A portion of the annual dues is attributable to lobbying ($14,655). In January of 2017, CRMC paid $4505 to the committee supporting a new high school in Jefferson City. The Chamber of Commerce assessed the members to pay a specific amount. 9665954 0 9665954 150103477 0 100680195 49423282 2162600 0 1453663 708937 85723857 0 64411535 21312322 0 0 0 0 81110495 Money Market Accounts 14845398 F Mortgage Backed Securities 10848573 F Interest Receivable 98600 F Mutual Funds 22137822 F Corporate Stock 161668 F US Treasury Obligations 74917 F Corporate Bonds 8231620 F Certificates of Deposit 18683514 F 75082112 Other Long Term 156669 457(b) Payable 2513143 Insurance Payable 2234539 Malpractice Liability 2607785 7512136 186349493 0 0 0 31086 31086 186318407 0 397759 397759 186716166 182064385 0 0 0 130854 130854 181933531 0 0 0 181933531 Schedule D, Part XI, Line 2d Net Share of K-1 losses (-31350 + 264) Schedule D, Part XI, Line 4b Contribution from Foundation Schedule D, Part XII, Line 2d Less Foundation Expenses ($129,111). Less Loss on Sale ($1743) Reported on Income schedule on 990 1 1 1 X 1 X 1 1 1 0 0 2964160 0 2964160 0.0163 17115494 14904630 2210864 0.0121 0 0 0 0 0 20079654 14904630 5175024 0.0284 451 21803 662953 537546 126407 0.0007 2078199 810088 1268111 0.0697 2492341 1622154 870187 0.0048 115677 0 115677 0.0006 451 21803 5349170 2969788 2380382 0.0758 451 21803 25428824 17874418 7555406 0.1042 46813 0 46813 0.0003 20924 0 20924 0.0001 21875 0 21875 0.0001 7682750 5231126 2451624 0.013 0 0 7772362 5231126 2541236 0.0135 0 5781619 0 49766036 47840764 1925272 X 1 1 1 1 Capital Region Medical Center 1125 Madison Street Jefferson City MO 65101 crmc.org 419-19 X X X X Capital Region Medical Center 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X www.crmc.org X 1 15 1 https://www.crmc.org/about-us/community-involvement/community-health-needs-assessment/ 0 0 1 X 200 65 X X X 1 1 X X X X 1 X https://www.crmc.org/patients-and-visitors/billing-insurance/financial-assistance/ X https://www.crmc.org/media/1195/application-18.pdf X https://www.crmc.org/patients-and-visitors/billing-insurance/financial-assistance/ X X X X X X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Capital Region Medical Center The Central Missouri Community Health Assessment Partnership (CMCHAP) was created and embarked on a mission to improve the health of residents of the four counties of Cole, Miller, Moniteau and Osage. The partnership worked collaboratively to collect and analyze health data and gather input from community members to aid in assessing and prioritizing needs. This unique partnership of health care and social services providers was financially funded by the two local hospitals - Capital Region Medical Center and SSM St. Mary's Health Center, and included six additional partners: the Community Health Center of Central Missouri, Cole County Health Department, Jefferson City Medical Group, Missouri Primary Care Association, Samaritan Center of Jefferson City and Central Missouri United Way. Schedule H, Part V, Section B, Line 6a-Capital Region Medical Center SSM St. Mary's Schedule H, Part V, Section B, Line 6b-Capital Region Medical Center The Community Health Center of Central Missouri, Cole County Health Department, Jefferson City Medical Group, Missouri Primary Care Association, Samaritan Center of Jefferson City and Central Missouri United Way. Schedule H, Part V, Section B, Line 7d-Capital Region Medical Center Capital Region Medical Center made the CHNA available online at www.crmc.org. Additionally, paper copies were made available through the public relations department. A review of the CHNA was provided to Medical Center managers, Board of Directors, the CRMC Foundation, and also at the Community Outreach meeting held in several of the outlying counties we serve. Schedule H, Part V, Section B, Line 11-Capital Region Medical Center Capital Region Medical Center approved the CHNA Implementation Strategy in June of 2015 to address the top 5 identified needs: Obesity/Cardiovascular Health, Mental Wellness, Health Literacy, Substance Abuse and Dental. The strategies involve many different internal and external partnerships. Strategies include community education and screenings, smoking cessation programs, support groups, employer sponsored wellness programs, and faith based parish nurse programs. Additionally, we have built in core measures with our physician group so that body mass index and depression screens are done with appropriate education and referral for abnormal screens at every visit. We have increased the number of primary care providers as well as mental health providers. In regards to substance abuse, we are working with our physician group, ED and county officials to strengthen our policies on opiate prescriptions and implementing pain medication contracts with our patients and providers. Our implementation strategies also encourage improved nutrition, which we are sponsoring community supported agriculture, farmers' market and implemented fresh fruits and vegetables at local food pantries, buddy packs and even school and local government policies on healthy concessions. Lastly, we are continuing our partnership with Missouri Foundation for Health in a 5 year grant with 3 school districts. The grant's goal is to reduce childhood obesity by 5% in 5 years. Schedule H, Part V, Section B, Line 13-Capital Region Medical Center We use FPL up to 242% of FPL for presumptive charity. We have catastrophic assistance if more than 15% of income is owed in medical bills regardless of income. Underinsured get assistance if application complete. We give 65% discount equal to average Medicare Plus all Commercial and managed care plans during 12 months of claims. Schedule H, Part V, Section B, Line 18-Capital Region Medical Center No actions taken on individuals before determining eligibility. We run presumptive charity and follow the 248 day rule before ECA's Schedule H, Part V, Section B, Line 22d-Capital Region Medical Center CRMC used average of Medicare and Commercial Managed Care discounts to calculate the 45% self pay automatic discount for all uninsured patients. 19 Capital Region Physicians 1125 Madison Street Jefferson City MO 65101 Medical Center Expansion - Physician clinics and outpatient services Capital Region Southwest 1432 Southwest Blvd Jefferson City MO 65109 Outpatient and Wellness Services CRMC Healthplex West 3308 West Edgewood Jefferson City MO 65109 Urgent Care and Outpatient Therapy CRMC-SW Clinic 1500 Southwest Blvd Jefferson City MO 65109 Family Practice Clinic CRMC- Versailles 901 Kidwell Drive Versailles MO 65084 Family Practice Clinic Primary Care 1014 Madison Street Jefferson City MO 65101 Primary Care - Family Practice Clinic CRMC - Eldon 103 Business Hwy 54 North Eldon MO 65026 Family Practice Clinic CRMC-Owensville 3536 Kuhne Road Owensville MO 65066 Family Practice Clinic CRMC-California 704 Buchanan California MO 65018 Family Practice Clinic CRMC Quick Care 3721 W Truman Blvd Jefferson City MO 65109 Quick Care Clinic Integrative Medicine 1002 Diamond Ridge Suite 203 Jefferson City MO 65109 Family Practice/Alternative Medicine CRMC-Holts Summit 180 North Star Holts Summit MO 65043 Family Practice Clinic CRMC-Linn 916 East Main Street Linn MO 65051 Family Practice Downtown Urgent Care 220 Madison Street Jefferson City MO 65101 Urgent Care CRMC-Family Medicine 1616 Southridge Ste 203 Jefferson City MO 65101 Family practice clinic Capital Region Family Medical Center 420 East High Street Jefferson City MO 65101 Family Practice Clinic Vienna Family Practice 111 Parkway Vienna MO 65582 Family Practice Clinic CRMC Surgicare 1705 Christy Drive Jefferson City MO 65101 Surgeon CRMC OMT Clinic 3306 Emerald Lane Jefferson City MO 65109 Physician Clinic Schedule H, Part I, Line 3c Average Medicare and Commercial/Managed Care Adjustments were used to calculate 45% auto self pay discount. Schedule H, Part I, Line 7 Cost to charge ratio Schedule H, Part I, Line 7f None Schedule H, Part II See descriptions on individual line numbers for additional details for how CRMC promotes the health for the communities it serves. Schedule H, Part II, Line 1 Neighborhood Improvement Efforts Capital Region Medical Center along with an advisory board of property owners, business owners, residents, and civic and community leaders has partnered with H3 Studios to develop a plan to revitalize the area in and around the Old Munichburg neighborhood. Project elements include sustainability and urban design, coding, landscape, and architectural professional services. Input and participation from those within the neighborhood are vital to creating safe, inviting areas, for working and living. In late 2015, H3 and the advisory board members began laying the foundation for community input sessions to allow neighborhood residents, business owners, those who work in the area and concerned citizens to provide their insight as to what would improve the area. After several public meeting sessions and meetings with various groups plans were developed and presented to the groups and evolved further based on continuous feedback. Adjustments to the plans were made and the final plan has gone to the city for feasibility of implementation. Some of the recommendations can be completed easily and some will progress over time. Projects of this nature often take more than a decade to come to fruition, but Capital Region Medical Center and those on the advisory board are committed to revitalizing the heart of the community. Schedule H, Part II, Line 3 CRMC participates in voluntary emergency management training through the Missouri Hospital Association and has partnered with several other local agencies to improve communication and planning. CRMC participates in local school district mentoring programs. Schedule H, Part II, Line 6 CRMC partners with the Community Health Center to provide leadership and resources. One of our VPs serves on the board of directors and attends regular meetings. CRMC Administration team provides leadership for Missouri Society for Healthcare Engineering. As well as the Rape and Abuse Crisis Center, Missouri Physical Therapy Association, and Physical Therapy Assistant Advisory. CRMC also provides onsite education to State Technical College PTA program and the University of Missouri PT programs. Schedule H, Part II, Line 7 CRMC administration provides leadership at a local YMCA by serving on the Board of Directors. Schedule H, Part II, Line 8 Capital Region recruited and retained physicians to provide medical care in rural and underserved areas. Schedule H, Part III, Section A, Line 4 Page 8-9 in the audit report. Schedule H, Part III, Section B, Line 8 Line 2 is determined using the cost of charge ratio from Worksheet 2. Schedule H, Part III, Section C, Line 9b All Self Pay patients automatically receive a 45% Self Pay discount. For collection practices we run presumptive charity using Paro Presumptive Charity software to identify all patients under 242% of FPL. We write off to charity all patients under the threshold to bad debt charity and do not send to collections. All over 242% of FPL must complete financial application to prove need of charity assistance. Schedule H, Part VI, Line 2 The CMCHAP conducted a comprehensive community health assessment using both secondary and primary analysis, which allowed us to measure perception, health risks, health factors, health outcomes and characteristics specific to the communities in these four central counties. This is the second comprehensive regional health assessment completed in this collaborative fashion by the CMCHAP. The objectives were to identify factors influencing health status, determine and prioritize issues of greatest concern, identify unmet health needs and produce a source of reliable information that will support the development of solutions. This needs assessment was conducted using three methods: secondary data analysis, discussions with community groups and provide clients and surveys completed by community members, community leaders and local physicians. Existing data previously collected for other purposes, called secondary data, was compiled from a variety of credible local state and federal sources to provide a context fro analysis and interpretation. Community discussion groups, much like town hall meetings, were organized by the Steering Team and facilitated by Micheal Feliz, a community health development specialist. Throughout this process, more then 150 individuals participated in nine discussion groups and consumer interview sessions. An addition to the data collection for 2015 was the inclusion of a survey to assess the perception of health care and health status across the four-count region in the analysis. These surveys were made available in physician offices, online and in community health departments. Upon reviewing the findings from all the sources information, the Steering Team identified the most serious health issues and then ranking them using a priority matrix. The results were 1. Heart Disease/Obesity prevention 2 Mental Health 3. Health Literacy 4. Substance Abuse and 5. Dental Care. Schedule H, Part VI, Line 3 At every location, registration staff have financial assistance packets available to hand out. All self pay patients are referred to one of the three financial counselors in the area. Patient financial counselors visit all self pay in house patients. Also, Human Arc helps patients apply for Medicaid, and an Accountable Care representative is on site one day per week. Signs are posted in rooms and at registration sites. For every statement sent, there is a number printed to call for assistance. All first letters indicate who to call for assistance. All clinics are aware of our policy - so is the medical staff. Is is posted on our website an on our online bill pay. Schedule H, Part VI, Line 4 The four county region included both urban and rural areas. The local area economy is heavily dependent on state government. The total population for the region based on the 2010 census was 130223. The regions is expecting an increase of 5.51% from 2010-2020. Cole County which has the largest population of our region, shows a projected growth in population of 6.11%, which is a slight increase over the actual growth experienced of 6.04% growth between the 2000-2010 censuses. The age distribution continues to shift toward a larger population of older adults. Understanding the older population generally have more chronic disease and face more barriers in accessing care, it was noted that the concentration of the aging population in the rural counties where there are fewer services is of growing concern. Schedule H, Part VI, Line 5 As a community based hospital, Capital Region Medical Center lives its mission to improve health and promote wellness to the communities it serves every day. A full service hospital offering a complete continuum of care, CRMC provides access to exception health care services, throughout its service area. CRMC operates a large clinic network and comprehensive cancer facility, employees over 120 providers, houses an inpatient rehabilitation facility and includes a medically based fitness facility. Schedule H, Part VI, Line 6 CRMC is an affiliate of MU Health. Through this partnership our community benefits from the access of a community based hospital and a higher level of care when needed. Schedule H, Part VI, Line 7 NA X 1 1 X X X 1 1 0 1 0 1 0 1 0 Lisa Kolb Waggoner Board Member/Physician 177218 0 34728 0 802 0 7400 0 50647 0 270795 0 0 0 Diane Light Board Member/Physician 272670 0 25401 0 1008 0 10600 0 45572 0 355251 0 0 0 Gaspare Calvaruso President 356428 0 29712 0 6655 0 10600 0 56215 0 459610 0 0 0 Tom Luebbering Vice President 177228 0 14723 0 467 0 7297 0 46689 0 246404 0 0 0 Janet Weckenborg Vice President 171774 0 19488 0 1124 0 7100 0 42100 0 241586 0 0 0 Bob Mazur Vice President - partial 10251 0 10841 0 4103 0 426 0 4752 0 30373 0 0 0 Tanya Sandifer Vice President - partial year 0 0 0 0 39075 0 0 0 6350 0 45425 0 0 0 Jason Cecil Vice President 133854 0 8898 0 198 0 5611 0 46251 0 194812 0 0 0 Randall Haight Vice President/Physician 248915 0 51790 0 735 0 10216 0 55243 0 366899 0 0 0 Sarah Morrow Vice President 143298 0 2432 0 204 0 0 0 28956 0 174890 0 0 0 Deborah Voskamp Vice President 171106 0 10656 0 1085 0 3499 0 31656 0 218002 0 0 0 Mitchell Godbee Chief of Staff/Physician 786542 0 328095 0 640 0 10600 0 83443 0 1209320 0 0 0 Scott Anderson Physician 549865 0 0 0 11974 0 10600 0 62413 0 634852 0 0 0 Dennis Luetkemeyer Physician 576211 0 128417 0 1342 0 5300 0 67889 0 779159 0 0 0 Eston Schwartz Physician 591971 0 0 0 910 0 10600 0 64592 0 668073 0 0 0 Adam Patterson Physician 540937 0 152768 0 586 0 10600 0 67446 0 772337 0 0 0 Schedule J, Part I, Line 1a CRMC pays dues for the President to be a member of the Jefferson City Country Club. This is used for many business reasons. Any personal expenses incurred are reimbursed by the President to the Medical Center Schedule J, Part I, Line 3 Annually, all board members complete an evaluation of the CEO and individually present the results to the board chair who presents them to the compensation committee, consisting of 3 board members, including the Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri or the region. The compensation committee members do not have a conflict of interest with respect to the compensation arrangements. The committee documents their review and decisions. Schedule J, Part I, Line 4 a. Tawnya Sandifer received severance payments of $39,075 in 2016 b. Contributed to 457(b) Deferred Comp Plan: Weckenborg $18000, Haight $5048, Mazur $10841, Godbee $18,000. Cecil $4092, Patterson $17186, Schwartz $17966, Luebbering $5347, Calvaruso $5200, Voskamp $1726, Morrow $500 Schedule J, Part I, Line 5 For all employees an annual bonus is partially based on the achievement of certain organizational goals. These goals pertain to quality, service, and financial indicators. Schedule J, Part I, Line 6 For all employees an annual bonus is partially based on the achievement of certain organizational goals. These goals pertain to quality, service, and financial indicators. Schedule J, Part I, Line 7 The President, and most Directors and Vice Presidents participate in the Management Incentive Compensation Program (MICP). They receive additional bonus compensation if certain stated goals are met. Most physicians received a base salary, but also have the ability to earn and additional amount based on production. A Health Facilities Revenue Bonds Series 2011 431178966 60637ACF7 2011-11-22 32690247 Refund Series 1998 and 2004 Bonds (issued 12/29/98 and 6/29/2004) 0 0 0 B Health Pacilities Revenue Bonds Series 2017 431178966 2017-03-09 20000000 Reimburse CRMC for constructions cost of medical office building 0 0 0 A 1715000 0 32690247 2908325 0 0 434131 0 0 0 29320002 0 2004 1 0 1 1 B 268530 0 20000000 0 0 0 0 0 0 0 20000000 0 2016 0 0 1 1 A 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 1 B 1 Schedule K, Part IV, Line 2c-11/22/2011 32,690,247 Health Facilities Revenue Bonds Series 2011 Rebate computation was performed as of November 1, 2016 Form 990, Part VI, Section A, Line 6 The organization has 2 members - The University of Missouri-Columbia Medical Alliance and CRMC Healthcare. Form 990, Part VI, Section A, Line 7a All elections for appointment to the Governing Body are subject to approval of the member, the University of Missouri Medical Alliance. Form 990, Part VI, Section A, Line 7b The bylaws provide a number of instances requiring approval by the University of Missouri Medical Alliance, e.g. amendment of the bylaws, dissolution of the organization, sale of substantial assets, and discontinuance of a major service line. Form 990, Part VI, Section B, Line 11b The Form 990 is reviewed by the Director of Accounting, legal counsel, the Vice President of Finance, and the President. The President presents it to the board chair and the Executive Committee of the Board. The Executive Committee makes a presentation to the board and copies are available to all members. Form 990, Part VI, Section B, Line 12c The hospital's legal counsel attends all board meetings. He is continually monitoring if any transaction would be a conflict of interest. The Vice President of Finance reviews all payments to physicians and identifies any potential conflicts. The Director of Accounting reviews payments and identifies any potential conflicts. Form 990, Part VI, Section B, Line 15 All board members complete an evaluation of the CEO and individually present the results to the board chair, who presents to the compensation committee, consisting of three board members, including the Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri or the region. The compensation committee members do not have a conflict of interest with respect to the compensation agreements. The committee documents their review and decisions and meets at least annually. The CEO sets the recommended salaries for key employees using comparable data from three salary surveys. The Vice President of Human Resources participates in determining the appropriate salary. Form 990, Part VI, Section C, Line 19 Capital Region includes financial statements in the annual report provided to the Board of Governors (approximately 500 members). Financial information is reviewed at the Medical Executive and Medical Staff meetings monthly. The information is then shared at the monthly managers' meeting and then communicated to all staff at department meetings. The Capital Region website (crmc.org) provides important information about the medical center to the community. The "Fraud and Wrongdoing" policy, "Privacy" policy, "Affiliation and Accreditations" policy, leader profiles, site locations, and contact information are all disclosed on the website. Form 990, Part XI, Line 9 K1 net loss $31,086, Transfer to UMC-MA -$991,823, Increase in Foundation Net Assets SFAS#136 $14,631, Paid Foundation Expenses -$129,111, Change in unrealized gains on other than trading securities $234895 Capital Region Medical Foundation PO Box 1128 Jefferson City MO 651021128 431506900 Raise Money and manage funds to be used by Capital Region Medical Center MO 501(c)(3) Supporting Org Typ I N/A Still Osteopathic Medical Foundation PO Box 1128 Jefferson City MO 651021128 431720296 Support Osteopathic Education MO 501(c)(3) Support Org Typ III N/A Capital Region Medical Center Partners 1125 Madison Street Jefferson City MO 65101 446014361 Support Capital Region Medical Center MO 501(c)(3) Support Org Typ I N/A CRMC Healthcare Inc 1125 Madison Street Jefferson City MO 65101 461699021 Support Capital Region Medical Center MO 501 (c)(3) Type II Support Org N/A University of Missouri - Medical Alliance 1000 West Nifong Building 7 Suite 300 Columbia MO 65211 311574931 Support and encourage health care delivery and medical education MO 501 (c)(3) Type I Support Org N/A Still Opti LLC 800 West Jefferson Street Kirksville MO 63501 431831943 To promote the highest quality of osteopathic education. MO N/A Related 1 0.0797 Health Network of Missouri LLC 227 University Hall Columbia MO 65211 471248962 To improve quality of care and establish clinical integration among participants MO N/A Unrelated 0 0 0.16667 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 Capital Region Medical Foundation o 129111 Salary and other expenses of the Foundation Director University of Missouri - Medical Alliance r 991823 The Medical Center is required to make annual contributions to the Medical Alliance for the purposes of the integrated healthcare delivery system created by the affiliation agreement. Each annual contribution represents 1% of the Medical Center's annual net patient service revenues, and may not exceed 25% of the Medical Center's excess of revenues over expenses. Capital Region Medical Foundation c 397759 Cash value of donations Capital Region Medical Center Partners q 26677 Partners reimburses CRMC for the salary and FICA tax of the gift shop manager Capital Region Medical Center Partners m 352648 In fiscal year ending June 30, 2016, the Partners donated 44063 hours of service valued at $352,648. Capital Region Medical Center Partners q 52328 Partners reimburses Capital Region for various items that Capital Region purchases from their suppliers. (magazines for patients, Lifeline service for patients unable to pay, employee appreciation, patient care kits, ipads and software for OB, outreach, 16 recliners, programs, adopt a family, buddy bear project) We were issued an extension until May 15, 2018