2016-02-19T09:03:00-06:00 2015-06-30 431001367 BROWN SMITH WALLACE LLP 6 CITYPLACE DRIVE SUITE 900 ST LOUIS MO 63141 990 2014-07-01 430666765 THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN RANK 3148726400 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 LAUREEN K TANNER PRESIDENT 3148726400 2016-01-26 1 JENNIFER M VACHA P01251998 3149831200 2014 2016-08-17 19:52:53Z LAUREEN K TANNER 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 35633308 0 X WWW.RANKENJORDAN.ORG X 1940 MO PEDIATRIC BRIDGE HOSPITAL PROVIDING A CONTINUUM OF CARE FOR MEDICALLY COMPLICATED CHILDREN 31 29 395 192 0 0 3643384 3865887 24319795 25548335 1306893 1033874 -96808 -67200 29173264 30380896 57137 58451 0 0 17992524 18865072 0 0 707540 10280069 10418590 28329730 29342113 843534 1038783 64546564 63504775 22685440 21332650 41861124 42172125 RANKEN JORDAN IS A PEDIATRIC BRIDGE HOSPITAL PROVIDING A CONTINUUM OF CARE FOR MEDICALLY COMPLICATED CHILDREN AND THEIR FAMILIES. WE ARE A LEADER IN PROVIDING INTENSIVE TRANSITIONAL CARE AND LIVING SUPPORT FOR THESE CHILDREN. 0 0 20508855 56697 23629647 DURING THE CURRENT FISCAL YEAR, RANKEN JORDAN PROVIDED 10,034 DAYS OF MEDICAL CARE FOR INPATIENTS. OF THOSE DAYS, 92% WERE CHILDREN THAT WERE ABLE TO RECEIVE SOME FORM OF MEDICAID ASSISTANCE. NO INPATIENT EVER LEAVES RANKEN JORDAN WITH A PATIENT RESPONSIBILITY DUE. IT IS THE GOAL OF THE ENTIRE STAFF AT RANKEN JORDAN TO ASSURE THAT WHEN A CHILD LEAVES OUR CARE, THEIR FAMILY HAS BEEN WELL TRAINED TO PROVIDE QUALITY CARE AND THEY HAVE A SAFE ENVIRONMENT TO GO HOME TO. 1256474 1754 1926762 DURING THE CURRENT FISCAL YEAR, RANKEN JORDAN PROVIDED 28,792 UNITS OF OUTPATIENT SERVICES TO CHILDREN REQUIRING INTENSIVE THERAPY. RANKEN JORDAN PROVIDES PHYSICAL, OCCUPATIONAL, SPEECH, AND AQUATIC THERAPIES ON AN OUTPATIENT BASIS. RANKEN JORDAN ALSO OFFERS A DAY TREATMENT PROGRAM THAT PROVIDES INTENSIVE THERAPY THROUGHOUT THE DAY. RANKEN JORDAN HAS EXPANDED ITS OUTPATIENT PROGRAMS TO INCLUDE CONSTRAINT INDUCED MOVEMENT THERAPY, PAIN MANAGEMENT SERVICES AND PHYSIATRY SERVICES. 235265 A VARIETY OF COMMUNITY PROGRAMS ARE ALSO PROVIDED TO SUPPORT CHILDREN WITH COMPLEX MEDICAL NEEDS AND THEIR FAMILIES. THESE PROGRAMS ARE ALWAYS OFFERED FREE OF CHARGE AND OPEN TO THE GENERAL PUBLIC. THIS PROGRAMMING INCLUDES (BUT IS NOT LIMITED TO) SUPPORT GROUPS, SPORTS-RELATED ACTIVITIES FOR CHILDREN WITH SPECIAL NEEDS, AND SOCIAL ENRICHMENT ACTIVITIES FOR CHILDREN WITH COMPLEX MEDICAL NEEDS. A TOTAL OF 4,876 INDIVIDUALS WERE SERVED BY THE COMMUNITY PROGRAMS DURING THE YEAR. THIS PROGRAM CONTINUES TO GROW ANNUALLY. 22000594 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 10 0 1 395 1 0 0 0 0 0 1 1 0 0 0 0 X 31 29 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 3148726400 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 STEVE CORTOPASSI CHARIMAN OF THE BOARD 15.00 X X 0 0 0 BILL WILLHITE VICE CHAIRMAN OF THE BOARD 10.00 X X 0 0 0 THOMAS J MINOGUE SECRETARY OF THE BOARD 5.00 X X 0 0 0 KEN MARX TREASURER OF THE BOARD 5.00 X X 0 0 0 LAUREEN K TANNER PRESIDENT/CEO 50.00 X X 388134 0 41539 NICHOLAS A HOLEKAMP MD CHIEF MEDICAL OFFICER 50.00 X X 359661 0 44714 WALTER BAZAN JR BOARD MEMBER 3.00 X 0 0 0 CHRIS CIOFFI BOARD MEMBER 3.00 X 0 0 0 MIKE DETWILER BOARD MEMBER 3.00 X 0 0 0 DAVID DREW BOARD MEMBER 3.00 X 0 0 0 PAM DUFFY BOARD MEMBER 3.00 X 0 0 0 GEORGE R EDINGER SR BOARD MEMBER 3.00 X 0 0 0 R BRUCE FRAZER BOARD MEMBER 3.00 X 0 0 0 DEREK GLANVILL BOARD MEMBER 3.00 X 0 0 0 MICHAEL HART BOARD MEMBER 3.00 X 0 0 0 CHARLES HESSLER BOARD MEMBER 3.00 X 0 0 0 NOREEN LAFFEY BOARD MEMBER 3.00 X 0 0 0 MIKE MATHENY BOARD MEMBER 3.00 X 0 0 0 MICHAEL MAURER JR MD BOARD MEMBER 3.00 X 0 0 0 JEREMY MICHELMAN BOARD MEMBER 3.00 X 0 0 0 BETSY PROSPERI BOARD MEMBER 3.00 X 0 0 0 JOHN PROSPERI BOARD MEMBER 3.00 X 0 0 0 JEANA REISINGER BOARD MEMBER 3.00 X 0 0 0 PAUL SCHWETZ BOARD MEMBER 3.00 X 0 0 0 MICHAEL SCULLY BOARD MEMBER 3.00 X 0 0 0 RABBI MARK L SHOOK BOARD MEMBER 3.00 X 0 0 0 THAD SIMONS BOARD MEMBER 3.00 X 0 0 0 KURTIS T SOBUSH MD BOARD MEMBER 3.00 X 0 0 0 MICHAEL TUCKEY BOARD MEMBER 3.00 X 0 0 0 RICHARD A VANDEGRIFT BOARD MEMBER 3.00 X 0 0 0 NICK WILLIAMSON BOARD MEMBER 3.00 X 0 0 0 JEAN L BARDWELL VICE PRESIDENT & CFO 50.00 X 247899 0 12224 R BRETT MOOREHOUSE VICE PRESIDENT & COO 50.00 X 216293 0 7360 ELIZABETH AKRE MD PHYSICIAN 40.00 X 165863 0 7567 SUSAN CONGER MD MEDICAL STAFF ADMINISTRATOR 40.00 X 233121 0 13838 EUGENE EVRA MD PHYSICIAN 40.00 X 208079 0 11540 SUZANNE N L'ECUYER MD PHYSICIAN 40.00 X 204668 0 11182 AMY ZIMMERMANN MD PHYSICIAN 40.00 X 214199 0 11209 2237917 0 161173 23 0 1 0 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 COMPUTER SUPPORT 873011 MB TECHNOLOGY SOLUTIONS 225 S MERAMEC SUITE 621 ST LOUIS MO 63105 IT HELP DESK SUPPORT 202189 THOMPSON COBURN ONE US BANK PLAZA ST LOUIS MO 63101 LEGAL SERVICES 191201 3 527784 43945 3294158 3865887 INPATIENT CARE 621110 23621573 23621573 OUTPATIENT CARE 621110 1926762 1926762 25548335 467076 467076 5625493 5058358 337 567135 -337 566798 566798 112401 527784 193717 -81316 -81316 MEDICAL RECORDS 561000 8074 8074 MISCELLANEOUS REVENUE 900099 6042 6042 14116 30380896 25556409 0 958600 58451 58451 1254396 940797 313599 14120940 10432033 3488803 200104 216689 160082 53536 3071 2220418 1721259 445307 53852 1052629 812340 204812 35477 11579 11579 57268 57268 82554 10554 72000 1389395 1374362 11275 3758 316285 303633 9489 3163 1489052 1252796 230746 5510 886175 834982 38395 12798 482414 463118 14472 4824 29443 28662 586 195 85737 82308 2572 857 902026 902026 1631272 1557725 55160 18387 523841 502888 15715 5238 FRA ASSESSMENT 1517016 1395655 75851 45510 LABORATORY FEES AND PHA 868764 868764 DUES AND SUBSCRIPTIONS 109126 104339 3590 1197 BAD DEBT EXPENSE 36643 36643 29342113 22000594 6633979 707540 25535 25273 206554 668063 3315205 2669424 3381151 3273761 1667588 1376507 36256021 10876790 26707459 25379231 28941509 29824272 301563 288244 64546564 63504775 2703897 2331839 161060 127585 18401905 17932547 1418578 940679 22685440 21332650 X 34052858 33155278 7808266 9016847 41861124 42172125 64546564 63504775 1038783 -727782 0 X X 0 1 X 1 0 X 1566011 2493847 6564750 3643384 3865887 18133879 1566011 2493847 6564750 3643384 3865887 18133879 3675234 14458645 396733 372784 378478 408960 467076 2024031 86661 334201 420862 466820 27221 9720 26415 14116 544292 21123064 125441125 0.68450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 82554 82554 0 PART II-B, LINE 1: RANKEN JORDAN USES THE SERVICES OF A LOCAL LAW FIRM, THOMPSON COBURN, TO PROVIDE LEGISLATIVE SERVICES FOR THE HOSPITAL. IN ADDITION, RANKEN JORDAN PAYS DUES TO OTHER ORGANIZATIONS OF WHICH A PORTION IS SPENT ON LOBBYING. 759000 1600177 2359177 19740704 5240274 14500430 11713146 5369265 6343881 2442994 267251 2175743 25379231 OTHER LIABILITIES 386820 CERNER LONG-TERM LIABILITY 553859 940679 X 29616471 -727782 -727782 30344253 36643 36643 30380896 29305470 0 29305470 36643 36643 29342113 PART X, LINE 2: THE HOSPITAL HAS ADDRESSED THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, ACCOUNTING FOR INCOME TAXES. IN THAT REGARD, THE HOSPITAL HAS EVALUATED ITS TAX POSITIONS, EXPIRING STATUTES OF LIMIATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS AND BELIEVES THAT NO PROVISION FOR INCOME TAXES IS NECESSARY, AT THIS TIME TO COVER ANY UNCERTAIN TAX POSITIONS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS NETTED AGAINST REVENUE ON FS 36,643. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS NETTED AGAINST REVENUE ON FS 36,643. DINNER AUCTION 442527 375258 67269 16144 67650 12200 26806 GOLF TOURNAMENT 170567 125435 45132 10220 37370 19424 750 2053 2 27091 27091 200 900 640185 527784 112401 200 10220 53514 87074 12950 29759 193717 -81316 1 1 1 X 400.000000000000 1 X 1 1 1 0 1 1 3 174122 174122 0.00590 25806399 23767403 2038996 0.06960 6871562 1965637 4905925 0.16740 3 32852083 25733040 7119043 0.24290 198 2587 36194 36194 0.00120 2 782 66470 66470 0.00230 8 722 56467 56467 0.00190 208 4091 159131 159131 0.00540 208 4094 33011214 25733040 7278174 0.24830 7 771 92095 92095 0.00310 10 608 15256 15256 0.00050 17 1379 107351 107351 0.00360 1 36643 36643 1442 4121 -2679 X 1 1 1 1 RANKEN JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 X X PEDIATRIC SPECIALTY HOSPITAL RANKEN JORDAN HOME FOR CONVALESCENT CRIP 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.RANKENJORDAN.ORG X 1 12 1 WWW.RANKENJORDAN.ORG 0 0 1 X 400.000000000000 400.000000000000 1 1 X X X 1 X X 1 X 0 X X 1 X 0 0 RANKEN JORDAN HOME FOR CONVALESCENT CRIPPLED CHILD PART V, SECTION B, LINE 5: IN CONDUCTING THE CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH THE USE OF A FOCUS GROUP. IN JANUARY 2013, RANKEN JORDAN FOUNDED ITS PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) CONSISTING OF STAFF, PRESENT AND FORMER PATIENTS AND FAMILY MEMBERS. PFAC'S VISION IS TO BE A TRANSFORMATIONAL FORCE IN THE EVOLUTION AND ADVANCEMENT OF PATIENT AND FAMILY-CENTERED CARE THROUGH COLLABORATION AND TEAMWORK. WHILE ESTABLISHING A VENUE TO GATHER NEEDS ASSESSMENT INFORMATION, PFAC ALSO WORKS TO CREATE A PATIENT AND FAMILY-CENTERED ENVIRONMENT WHICH PROMOTES THE BEST POSSIBLE MEDICAL AND EMOTIONAL OUTCOMES FOR RANKEN JORDAN PATIENTS AND FAMILY MEMBERS. GOALS OF PFAC INCLUDE: A) ENHANCE COMMUNICATIONS BETWEEN PATIENTS, FAMILY MEMBERS, AND THE RANKEN JORDAN TEAM; B) EMPOWER PATIENTS, FAMILY MEMBERS AND STAFF THROUGH CONTINUOUS EDUCATION; C) IDENTIFY AND ADDRESS PATIENT AND FAMILY NEEDS IN ALL ASPECTS (BODY, MIND, AND SPIRIT) THROUGHOUT THEIR RANKEN JORDAN JOURNEY AND DURING THE TRANSITION HOME; D) PROMOTE THE BEST POSSIBLE MEDICAL AND EMOTIONAL OUTCOMES FOR PATIENTS AND FAMILY MEMBERS. INITIALLY MEETING BI-MONTHLY, PFAC IS SCHEDULED TO MEET ONCE A MONTH FOR APPROXIMATELY 2 HOURS. PARTICIPATION IS VOLUNTARY. IN APRIL 2013, PFAC WAS RESOURCED TO FACILITATE A FOCUS GROUP. IN TOTAL, 8 COMMUNITY PERSONS PARTICIPATED. DISCUSSION WAS HELD IN AN ORGANIC CONVERSATIONAL SETTING. A STAFF FACILITATOR PROMPTED THE FOCUS GROUP WITH THE BROAD QUESTION OF "WHAT DO MEMBERS OF THE COMMUNITY NEED AND ALLOWED THE GROUP TO DISCUSS AND VET THOUGHTS AND OPINIONS. ULTIMATELY, THE FOCUS GROUP IDENTIFIED SEVERAL NEEDS THAT FALL INTO THE OVERARCHING CATEGORY OF QUALITY OF LIFE. RANKEN JORDAN HOME FOR CONVALESCENT CRIPPLED CHILD PART V, SECTION B, LINE 11: RANKEN JORDAN IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA THROUGH COMMUNITY PROGRAMMING AND WORKING WITH LOCAL PARTNERS. RANKEN JORDAN HOME FOR CONVALESCENT CRIPPLED CHILD PART V, SECTION B, LINE 20E: NO COLLECTION ACTIONS ARE TAKEN AGAINST OUR PATIENTS. RANKEN JORDAN HAS NO AFFILIATION WITH ANY COLLECTION AGENCY OR ORGANIZATION. COLLECTION ACTIVITIES WOULD GO AGAINST THE MISSION OF RANKEN JORDAN, TO CARE FOR CHILDREN "REGARDLESS OF THEIR ABILITY TO PAY". PART I, LN 7 COL(F): BAD DEBT IS RECORDED FOR PATIENTS THAT ARE ELIGIBLE FOR HEALTH INSURANCE BUT THE SERVICE IS NOT COVERED. BAD DEBT IS RECORDED AT THE NET REALIZABLE AMOUNT. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.) FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT CERTAIN PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: BAD DEBT IS RECORDED FOR PATIENTS THAT ARE ELIGIBLE FOR HEALTH INSURANCE BUT THE SERVICE IS NOT COVERED AND DEEMED TO BE A MEDICAL BENEFIT AND PROVIDED WITHOUT COST TO THE PATIENT. BAD DEBT IS DETERMINED BY TAKING THE GROSS CHARGES, LESS ANY CONTRACTUAL ALLOWANCE AGREEMENT WITH THE PAYER. BAD DEBT IS THEN RECORDED AT THE NET REALIZABLE AMOUNT. THE AMOUNTS SHOULD BE INCLUDED IN COMMUNITY BENEFIT BECAUSE EFFORTS WERE NOT MADE TO COLLECT THE AMOUNT FROM THE PATIENT'S FAMILY. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.) FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT CERTAIN PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE AMOUNT OF SHORTFALL REPORTED ON LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT DUE TO THE FACT THAT THE COST OF TREATING MEDICARE PATIENTS EXCEEDS THE AMOUNT OF REIMBURSEMENT FROM THE GOVERNMENT. THE ORGANIZATION IS PROVIDING A SERVICE TO PATIENTS IN NEED FROM THEIR OWN FUNDS. THE METHOD USED TO DETERMINE THE AMOUNT OF MEDICARE COSTS IS THE TOTAL CHARGES FOR ALL THE MEDICARE PATIENTS AS RECORDED ON THE ORGANIZATION'S CHARGES LOG. PART III, LINE 9B: RANKEN JORDAN DOES NOT HAVE A FORMAL WRITTEN COLLECTION POLICY BECAUSE NO COLLECTION ACTION IS TAKEN AGAINST OUR PATIENTS. RANKEN JORDAN HAS NO AFFILIATION WITH ANY COLLECTION AGENCY OR ORGANIZATION. RANKEN JORDAN INTERNALLY IDENTIFIES THE TIME PERIOD FOR WHICH UNPAID PATIENT ACCOUNTS WILL REMAIN OPEN AND AVAILABLE TO COLLECT. FORMAL COLLECTION ACTIVITIES WOULD GO AGAINST THE MISSION OF RANKEN JORDAN, TO CARE FOR CHILDREN "REGARDLESS OF THEIR ABILITY TO PAY". PART VI, LINE 2: RANKEN JORDAN IS A MEMBER OF THE MISSOURI HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS. THROUGH THESE AFFILIATIONS, RANKEN JORDAN IS ABLE TO MONITOR AND PARTICIPATE IN PROGRAMS THAT HAVE BEEN DETERMINED TO MEET THE NEEDS OF THE COMMUNITY ON THE LOCAL LEVEL. RANKEN JORDAN PARTNERS WITH DISABLED ATHLETES SPORTS ASSOCIATION (DASA), ST. LOUIS ARC, AND THE CITY OF MARYLAND HEIGHTS TO PROVIDE PROGRAMMING THAT MEETS THE NEEDS OF CHILDREN WITH COMPLEX MEDICAL ISSUES. PART VI, LINE 3: ALL RANKEN JORDAN PATIENTS AND FAMILIES ARE ASSIGNED A SOCIAL WORKER UPON ADMISSION. THAT PERSON WORKS DIRECTLY WITH THE PATIENT AND THE FAMILY TO MAKE SURE THAT THEIR FINANCIAL RESPONSIBILITIES ARE FULLY EXPLAINED. RANKEN JORDAN HAS THE ABILITY TO ASSIST FAMILIES IN APPLYING FOR MEDICAID/MEDICARE COVERAGE IF THEY HAVE NOT ALREADY DONE SO. DUE TO THE SPECIAL NATURE OF THE PATIENTS RANKEN JORDAN SERVICES AND THE MISSION OF THE ORGANIZAITON, NO INPATIENT RECEIVES A BILL FOR CARE RECEIVED. RANKEN JORDAN DOES NOT WORK WITH OR TURN ANY PATIENT'S ACCOUNTS OVER FOR COLLECTION. PART VI, LINE 4: RANKEN JORDAN SERVES THE METROPOLITAN ST LOUIS AREA. PATIENTS ARE ACCEPTED BASED ON ADMISSION CRITERIA FOR SPECIALTY HOSPITALS. THE SERVICES PROVIDED ARE UNIQUE IN THAT THEY ARE ONLY AVAILABLE IN A LIMITED AMOUNT OF LOCATIONS THROUGHOUT THE COUNTRY. CARE IS PROVIDED FOR CHILDREN WITH COMPLEX MEDICAL NEEDS, WITH THE GOAL OF SEEING THEM RETURN TO A SAFE HOME ENVIRONMENT. PART VI, LINE 5: RANKEN JORDAN PROVIDES THE COMMUNITY WITH MANY OPPORTUNITES FOR CHILDREN WITH COMPLEX MEDICAL NEEDS AND THEIR FAMILIES TO BE ABLE TO BECOME ACTIVE IN THE COMMUNITY. PROGRAMS ARE OFFERED SUCH AS "CHALLENGER BASEBALL AND "POWER SOCCER" THAT ALLOW CHILDREN TO PARTICIPATE IN SPORTS DESPITE THEIR PHYSICAL LIMITAITONS. EDUCATION OPPORTUNITIES ARE PROVIDED FOR THESE CHILDREN THAT INCLUDE COOKING, MARTIAL ARTS, CAMP, AND SOCIAL GATHERING PROGRAMS. ALL PROGRAMS ARE PROVIDED FREE OF CHARGE TO FAMILIES AND ARE OPEN TO THE GENERAL PUBLIC. PART VI, LINE 6: RANKEN JORDAN IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 MEDICAL SERVICES FOR INDIVIDUALS 93 58451 PART I, LINE 2: THE ORGANIZATION HAS POLICIES IN PLACE TO RECEIVE REQUESTS FOR ASSISTANCE. ALL REQUESTS FOR ASSISTANCE ARE EVALUATED BY THE SOCIAL SERVICES DEPARTMENT AND EVALUATED AGAINST SET POLICIES. ALL REQUESTS ARE THOROUGHLY DOCUMENTED IN THE PATIENT'S FILE. THE ORGANIZATION TAKES CARE TO ENSURE THAT PATIENTS RECEIVING GRANT ASSISTANCE MEET ESTABLISHED CRITERIA. ANY GRANT ASSISTANCE PROVIDED TO INDIVIDUALS IS HANDLED INTERNALLY AND THE INDIVIDUALS DO NOT RECEIVE DIRECT PAYMENT OF THE FUNDS AWARDED. X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 LAUREEN K TANNER PRESIDENT/CEO 363134 0 25000 0 0 0 38870 0 2669 0 429673 0 0 0 NICHOLAS A HOLEKAMP MD CHIEF MEDICAL OFFICER 334661 0 25000 0 0 0 39865 0 4849 0 404375 0 0 0 JEAN L BARDWELL VICE PRESIDENT & CFO 222899 0 25000 0 0 0 7206 0 5018 0 260123 0 0 0 R BRETT MOOREHOUSE VICE PRESIDENT & COO 191293 0 25000 0 0 0 6504 0 856 0 223653 0 0 0 ELIZABETH AKRE MD PHYSICIAN 165863 0 0 0 0 0 2590 0 4977 0 173430 0 0 0 SUSAN CONGER MD MEDICAL STAFF ADMINISTRATOR 230121 0 3000 0 0 0 7193 0 6645 0 246959 0 0 0 EUGENE EVRA MD PHYSICIAN 208079 0 0 0 0 0 6397 0 5143 0 219619 0 0 0 SUZANNE N L'ECUYER MD PHYSICIAN 204668 0 0 0 0 0 6287 0 4895 0 215850 0 0 0 AMY ZIMMERMANN MD PHYSICIAN 214199 0 0 0 0 0 6565 0 4644 0 225408 0 0 0 PART I, LINE 1A THERE IS A MEMBERSHIP TO NORWOOD HILLS COUNTRY CLUB THAT IS IN LAUREEN K. TANNER'S (CEO) NAME. THE MEMBERSHIP IS PAID FOR BY RANKEN JORDAN. ANY PERSONAL EXPENSES CHARGED TO THE ACCOUNT ARE REIMBURSED TO RANKEN JORDAN. PART I, LINE 4B LAUREEN K. TANNER AND NICHOLAS HOLEKAMP ARE PARTICIPANTS IN A 457(F) PLAN. CONTRIBUTIONS WERE MADE ON THEIR BEHALF. PART I, LINE 7 INCENTIVES PAID BY THE ORGANIZATION ARE DISCRETIONARY. THE BOARD DETERMINES IF/WHEN INCENTIVES WILL BE PAID AT THE END OF THE FISCAL YEAR. THEY RESEARCH CURRENT EXECUTIVE SALARIES OF LIKE ORGANIZATIONS, RESULTS OF THE YEAR, AND BENEFITS PACKAGES, TO COME TO A DETERMINATION. THERE IS NO WRITTEN AGREEMENT OR GUARANTEE INCENTIVES WILL BE PAID ANNUALLY. THE FOLLOWING INDIVIDUALS RECEIVED THE NON-FIXED PAYMENT: LAUREEN K. TANNER, NICHOLAS HOLEKAMP, JEAN BARDWELL, AND R. BRETT MOOREHOUSE. A IDA OF THE COUNTY OF ST LOUIS MISSOURI 431170145 79130GGZ8 2007-04-12 21082299 REFUNDING ORG ISSUE SERIES 2003A-C 0 1 0 A 21082299 399583 20760310 2007 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: IDA OF THE COUNTY OF ST. LOUIS, MISSOURI DATE THE REBATE COMPUTATION WAS PERFORMED: 11/15/2012 PART 1, 2007 BOND ISSUE CUSIPS CONTINUED: 79130GGY1 79130GGX3 79130GGW5 79130GGV7 79130GGU9 79130GGT2 LISA MONTELEONE DAUGHTER OF BOARD MEMBER GEORGE EDINGER 140461 EMPLOYEE 0 FORM 990, PART VI, SECTION A, LINE 2 JOHN PROSPERI (BOARD MEMBER) AND ELIZABETH PROSPERI (BOARD MEMBER) HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE INITIAL FORM 990 IS ORIGINALLY PRESENTED TO THE FINANCE COMMITTEE BY OUR INDEPENDENT AUDITORS. ONCE APPROVED BY THE FINANCE COMMITTEE, IT WILL BE MADE AVAILABLE ELECTRONICALLY TO THE FULL BOARD FOR FINAL APPROVAL. ONCE FINAL APPROVAL IS RECEIVED, THE FORM 990 WIL BE FILED ELECTRONICALLY BY OUR INDEPENDENT AUDITORS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL EMPLOYEES, OFFICERS, DIRECTORS AND KEY EMPLOYEES OF THE ORGANIZATION. THE GOVERNANCE COMMITTEE HAS OVERSIGHT RESPONSIBILITIES FOR THE PROGRAM AND SHALL REPORT TO THE BOARD PERIODICALLY, AS DETERMINED BY THE BOARD, BUT NOT LESS THAN ANNUALLY. THE COMPLIANCE OFFICER CONDUCTS THE DAY-TO-DAY OPERATIONS OF THE COMPLIANCE PROGRAM, INCLUDING COORDINATION OF THE RECEIPT OF REPORTS OF NONCOMPLIANCE. THE ORGANIZATION ADDED THE POSITION OF COMPLIANCE OFFICER/RISK MANAGER AS A FULL-TIME POSITION DURING FISCAL YEAR 6/30/14. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S EXECUTIVE COMPENSATION COMMITTEE, UNDER THE ADVISEMENT OF ALEXANDER-SIEFERT CONSULTING GROUP, LLC, MEETS ANNUALLY TO REVIEW THE COMPENSATION OF TOP MANAGEMENT OFFICIALS. THE MEETINGS ARE HELD ANNUALLY IN MAY. THE EXECUTIVE COMPENSATION COMMITTEE FINDINGS ARE APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.