2017-04-10T08:24:44-07:00 2016-06-30 990 2015-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325000 1125 Madison Street Jefferson City MO 65101 Tom Luebbering Vice President of Finance 5736325101 2017-04-10 2015 2021-01-29 14:40:06Z Tom Luebbering 1432 Southwest Blvd Jefferson City MO 65109 180676639 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 1668 240 0 0 58340 1372384 166315903 178692339 403111 458797 -42000 -26379 166735354 180497141 0 0 0 0 93489493 99848000 0 0 0 70449123 78965969 163938616 178813969 2796738 1683172 181791207 175071802 58062024 50130436 123729183 124941366 Capital Region Medical Center embraces its mission; To imporove the health and promote wellness in the communities we serve. 0 0 2655162 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. 2013324 811414 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 Linn State 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 Univerith of Missouri dietetics program. Our support for these programs in not only through the provision of training facilities but also adjunct faculty and resources. 194289 0 82248 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. 148505601 0 178231095 All other inpatient and outpatient services provided to patients. 148505601 0 178231095 153368376 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 1 130 0 1 1668 1 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 Samuel Bushman Secretary 2 0 X 0 0 0 Lisa Kolb Waggoner Board Member/Physician 40 0 X 189390 0 53583 Diane Light Board Member/Physician 40 0 X 309098 0 50645 Ken Littlefield Vice Chair 2.50 0 X 0 0 0 Deborah Pasch Board Member 2 0 X 0 0 0 Jack Pletz Board member 2 0 X 0 0 0 Lorilei Schwartz Treasurer 2 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 2.50 0 X 0 0 0 Marc Ellinger board member 2 0 X 0 0 0 Gaspare Calvaruso President 40 0 X 391747 0 55910 Tom Luebbering Vice President 40 0 X 195905 0 50314 Janet Weckenborg Vice President 40 0 X 201515 0 46626 Bob Mazur Vice President 40 0 X 148452 0 42498 Tanya Sandifer Vice President - partial year 0 0 X 202797 0 29447 Jason Cecil Vice President 40 0 X 144641 0 47838 Randall Haight Vice President/Physician 40 0 X 278162 0 59431 Thomas Niekamp Vice President 40 0 X 9343 0 0 Sarah Morrow Vice President - partial year 40 0 X 14000 0 2748 Deborah Voskamp Vice President - partial year 40 0 X 85120 0 18605 Mitchell Godbee Chief of Staff/Physician 40 0 X 1027492 0 86726 Matthew Hrastich Physician 40 0 X 657074 0 71719 Dennis Luetkemeyer Physician 40 0 X 753281 0 71006 Eston Schwartz Physician 40 0 X 581823 0 72291 Adam Patterson Physician 40 0 X 617170 0 71134 5807010 0 830521 115 0 1 1 Sircal Contracting 1331 Monroe Jefferson City MO 65101 construction 23521339 Aramark Healthcare Support Services 25271 Network Place Chicago IL 606731252 Management Services 1705449 Boyce and Bynum Laboratory PO Box 7406 Columbia MO 65205 Lab Services 1546860 AOS 1859 Bowles Ave Suite 200 Fenton MO 63026 Computer maintenance 913931 University of Missouri One Hospital Drive Columbia MO 65201 Medical and other Professional services 642402 67 0 0 0 1246984 0 125400 0 1372384 Net Patient Service Revenue 622000 173450257 173450257 0 0 Other 900099 5242082 5242082 0 0 0 0 0 0 178692339 391856 391856 0 0 30978 30978 0 0 0 0 0 0 0 0 0 215461 0 179498 0 35963 35963 35963 0 0 0 K-1 Loss Still OPTI 611710 -123 -123 0 0 K-1 Loss Health Network of MO 561000 -26256 -26256 0 0 0 0 0 0 -26379 180497141 179124757 0 0 0 0 0 0 0 0 0 0 2247328 0 2247328 0 0 0 0 0 78341523 64780605 13560918 0 1752229 1448918 303311 0 12656583 10465729 2190854 0 4850337 4010744 839593 0 0 0 0 0 134011 110807 23204 0 156162 129123 27039 0 0 0 0 0 0 0 0 0 0 0 11843770 10345811 1497959 0 225281 186274 39007 0 319305 264033 55272 0 1312859 1085603 227256 0 0 0 0 0 779464 644501 134963 0 0 0 0 0 0 0 0 0 388322 321085 67237 0 804012 804012 0 0 0 0 0 0 11399666 9281378 2118288 0 628906 520012 108894 0 Supplies 37858178 37248930 609248 0 Repairs and Maintenance 3994404 3302781 691623 0 Utilities and Phone 2625302 2170736 454566 0 FRA Taxes 5057779 5057779 0 0 1438548 1189515 249033 0 178813969 153368376 25445593 0 4739638 3073706 2016426 2054526 0 0 17038090 18374551 0 0 0 0 0 0 3786088 3986251 2771090 2469665 242945037 158842073 82958282 84102964 59923221 52304590 8558372 8705549 181791207 175071802 23471018 16985143 27585000 25745000 7006006 7400293 58062024 50130436 X 119432428 120959907 4226409 3911113 70346 70346 123729183 124941366 181791207 175071802 X 1683172 0 0 0 0 -470989 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 31204 31204 0 Schedule C, Part II-B, Line 1 CRMC joined the Medicare Dependent Hospital coalition $9750. This group lobbied in an attempt to project 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 ($21454) 9244429 0 9244429 149620191 0 95163418 54456773 2129960 0 1346217 783743 81950457 0 62332438 19618019 0 0 0 0 84102964 Money Market Accounts 19369688 F Mortgage Backed Securities 13054892 F Interest Receivable 104416 F US Treasury 73678 F Corporate Bonds 4670971 F Certificates of Deposit 15030945 F 52304590 3029267 Accrued vacation pay 3293583 Other liabilities 1077443 7400293 179276536 0 0 0 26379 26379 179250157 0 1246984 1246984 180497141 178944342 0 0 0 130373 130373 178813969 0 0 0 178813969 Schedule D, Part XI, Line 2d Share of K-1 losses Schedule D, Part XI, Line 4b Contribution from Foundation Schedule D, Part XII, Line 2d Foundation Expenses paid by CRMC 1 1 1 X 1 X 1 1 0 0 2655162 0 2655162 0.0148 18693425 15988022 2705403 0.0151 0 0 0 0 0 0 21348587 15988022 5360565 0.0299 1391 27308 657394 439634 243401 0.0014 2185493 811414 1374079 0.0077 2436678 1767016 669661 0.0037 0 0 0 0 58588 0 58588 0.0003 1391 27308 5338153 3018064 2345729 0.0131 1391 27308 26686740 19006086 7706294 0.0430 72502 0 72502 0.0004 0 0 0 0 4102 0 4102 0 0 0 0 0 0 0 0 0 45400 0 45400 0.0003 1400 0 1400 0 5659217 3834519 1824698 0.0101 0 0 5782621 3834519 1948102 0.0108 0 5748825 0 46285164 44732131 1553033 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 X 1 15 1 www.crmc.org 0 0 1 X 200 200 X X 1 1 X X X 1 X www.crmc.org X www.crmc.org X www.crmc.org X X X X X 1 X 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 our 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 encourages improved nutrition which we are sponsoring community supported agriculture, farmers' market and implemented fresh fruits and vegetable 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. This grant's goal is to reduce childhood obesity by 5% in 5 years. 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. 18 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-SW Clinic 1500 Southwest Blvd Jefferson City MO 65109 Family Practice Clinic CRMC Healthplex West 3308 West Edgewood Jefferson City MO 65109 Urgent Care and Outpatient Therapy Primary Care 1014 Madison Street Jefferson City MO 65101 Primary Care - Family Practice Clinic CRMC- Versailles 901 Kidwell Drive Versailles MO 65084 Family Practice Clinic CRMC - Eldon 103 Business Hwy 54 North Eldon MO 65026 Family Practice Clinic CRMC Surgicare 1705 Christy Drive Jefferson City MO 65101 Surgeon Integrative Medicine 1002 Diamond Ridge Suite 203 Jefferson City MO 65109 Family Practice/Alternative Medicine CRMC-Owensville 3536 Kuhne Road Owensville MO 65066 Family Practice Clinic Capital Region Family Medical Center 420 East High Street Jefferson City MO 65101 Family Practice Clinic CRMC-California 704 Buchanan California MO 65018 Family Practice Clinic CRMC-Holts Summit 180 North Star Holts Summit MO 65043 Family Practice Clinic CRMC-Family Medicine 1616 Southridge Ste 203 Jefferson City MO 65101 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 Quick Care 3721 W Truman Blvd Jefferson City MO 65109 Quick Care Clinic 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 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 to 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 appication 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 provider clients and surverys 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 for analysis and interpretatioin. Community discussion groups, much like town hall meetings, were organized by the Steering Team and facilitated by Michael Feliz, a community health development specialist. Throughout this process, more than 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-county 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 of information, the Steering Team identified the most serious health issues and then ranked 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. it is posted on our website and on our online bill pay. Schedule H, Part VI, Line 4 The four county region includes 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 region 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 that older populations generally have more chronic disease and face more barriers in accessing care, it was noted that the concentration of the aging population in the 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 welness to the communities it serves every day. A full service hospital offering a complete continuum of care, CRMC provides access to exceptional 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 X X 1 1 X X X 1 1 0 1 0 1 0 1 0 Gaspare Calvaruso President 346676 0 38937 0 6135 0 3826 0 52084 0 447658 0 0 0 Tom Luebbering Vice President 174953 0 20817 0 135 0 7177 0 43137 0 246219 0 0 0 Janet Weckenborg Vice President 170699 0 30681 0 135 0 6986 0 39640 0 248141 0 0 0 Bob Mazur Vice President 103504 0 42773 0 2175 0 5500 0 36998 0 190950 0 0 0 Sarah Morrow Vice President - partial year 0 0 14000 0 0 0 0 0 2748 0 16748 0 0 0 Deborah Voskamp Vice President - partial year 84985 0 0 0 135 0 0 0 18605 0 103725 0 0 0 Tanya Sandifer Vice President - partial year 47697 0 155100 0 0 0 985 0 28462 0 232244 0 0 0 Jason Cecil Vice President 132461 0 12045 0 135 0 5519 0 42319 0 192479 0 0 0 Randall Haight Vice President/Physician 246431 0 31596 0 135 0 9053 0 50378 0 337593 0 0 0 Lisa Kolb Waggoner Board Member/Physician 186509 0 2746 0 135 0 7709 0 45874 0 242973 0 0 0 Diane Light Board Member/Physician 295769 0 13193 0 135 0 10600 0 40045 0 359742 0 0 0 Mitchell Godbee Chief of Staff/Physician 776554 0 250728 0 210 0 10600 0 76126 0 1114218 0 0 0 Dennis Luetkemeyer Physician 573092 0 180064 0 135 0 5300 0 65706 0 824297 0 0 0 Matthew Hrastich Physician 614454 0 42485 0 135 0 9521 0 62198 0 728793 0 0 0 Adam Patterson Physician 525744 0 91291 0 135 0 10600 0 60534 0 688304 0 0 0 Eston Schwartz Physician 581054 0 559 0 210 0 10600 0 61691 0 654114 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. Travel for Companions - When it is determined that there is a business benefit for the spouse to attend, CRMC will pay expenses for companion travel. For Employee Star awards, the check is grossed up and the medical center pays the taxes on the employee behalf. 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 conflect of interest with respect to the compensation arrangements. The committee documents their review and decisions. Schedule J, Part I, Line 4 Tanya Sandifer received $147,617 in severance payments in 2015 (calender year). Contributed to a 457(b) Deferred Comp Plan: Calvaruso $2600, Luebbering $3535, Weckenborg $8139, Mazur $3528, Sandifier $4258, Cecil $2699, Haight $3337, Godbee $18000, Hrastich $15525, Patterson $17500, Schwartz $17966 Schedule J, Part I, Line 5 For all employees annual merit increases are patially based on the achievement of goals (personal and organizational). some of the organizational goals may be tied to Revenues. Schedule J, Part I, Line 6 For all employees annual merit increases are partially based on the achievement of goals (personal and organizational). Some of the organizational goals may be tied to net earnings. Schedule J, Part I, Line 7 Some Directors, Vice Presidents, and the President participate in the Management Incentive Compensation Program (MICP). They receive additional bonus compensation if certain stated goals are met. Most physicians receive a base salary, but also are paid an additional amount based on production. Schedule J, Part II Thomas Niekamp is an employee of the University of Missouri. Capital Region Medical Center makes payments to the University for the services he provides to CRMC as Vice President. 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 A 7090000 0 32690247 2908325 0 0 460920 0 0 0 29320002 0 2004 1 0 1 1 A 0 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 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. amendments 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 each member. 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 conflects. 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 the salary surveys from three different organizations. The comparable data are based on Missouri or the regions. The compensation committee members do not have a conflict of interest with respect to the compensation agreement. The committee documents their review and decisions and meets at least once annually. The CEO set the recommended salaries for key employees using comparable data from three salary surveys. The Vice President of Human Resources participates in determining the appropriate salaries for key employees. 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 loss 123, K1 loss 26256, Transfers to UMC-MA -51699, Decrease in Foundation NA SFAS#136 - 315296, Paid Foundation Expenses -130373 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 130373 Salary and other expenses of the Foundation Director. University of Missouri - Medical Alliance r 51699 CRMC must make an annual contribution equal to the lessor of 1% of the Medical Center's annual net patient service revenues or 25% of excess of revenues over expenses excluding contributions. Capital Region Medical Foundation c 1246984 Cash value of donations. Capital Region Medical Center Partners m 337089 In Fiscal year ending June 30, 2016, the Partners donated 44063 hours of service valued at $337089. Capital Region Medical Center Partners q 294558 Partners reimburses Capital Region for various items that Capital Region purchases from their suppliers. (fleece swaddles, pillows, patient magazines, lifeline service assistance, folders, heart monitor bags, Tshirts, Daisy Foundation, lung cancer screening, and contributions toward expansion project) Health Network of Missouri LLC b 37745 Capital contributed from K-1 Capital Region Medical Center Partners q 26749 Partners reimburses CRMC for the salary (24803) and FICA (1946) of the gift shop manager. Capital Region Medical Center was granted an extension until May 15, 2017.