2016-03-18T12:18:41-07:00 2015-06-30 990 2014-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325000 1125 Madison Street Jefferson City MO 65101 Tom Luebbering Vice President of Finance 5736325101 2016-03-18 2014 2016-08-17 19:52:53Z Tom Luebbering 1432 Southwest Blvd Jefferson City MO 65109 166762920 0 X crmc.org X 1945 MO Capital Region Medical Center embraces its mission: To improve the health and promote the wellness of the people and communities we serve to reflect commitment to a charitable purpose. 12 10 1572 327 -42000 0 405085 58340 157520549 166315903 405285 403111 521 -42000 158331440 166735354 0 0 0 0 86493346 93489493 0 0 0 67894319 70449123 154387665 163938616 3943775 2796738 175204296 181791207 54456906 58062024 120747390 123729183 Capital Region Medical Center embraces its mission; To imporove the health and promote wellness of the people and communities we serve to reflect commitment to a charitable purpose, in the form of a resident clinic as well as general inpatient and outpatient charity care. The medical Center provides many services to the community at little or no financial gain. 0 0 2841326 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. 2012835 0 784542 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. 83964 0 106393 Resident Clinic: The Resident Clinc is unopposed, giving residents a great deal of hands on experience. The mission of our program is to train capable, compassionate family physicians in an environment of mutual respect based in real-world experiences. In addition to providing a valuable training tool, 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. 143574069 0 165828079 All other inpatient and outpatient services provided to patients. 143574069 0 165828079 148512194 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 1 1 1 0 0 0 0 0 1 0 0 0 1 116 0 1 1572 1 1 1 0 0 0 0 0 X 12 10 1 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 Charles Dudenhoeffer Board Member 2 0 X 0 0 0 Lisa Kolb Waggoner Board Member/Physician 40 0 X 210126 0 56297 Diane Light Board Member/Physician 40 0 X 363677 0 51288 Ken Littlefield Vice Chair 2.5 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 2.5 0 X 0 0 0 Ed Farnsworth President (partial year) 40 0 X 340977 0 54700 Gaspare Calvaruso President (partial year) 40 0 X 144732 0 27753 Tom Luebbering Vice President 40 0 X 201445 0 52156 Janet Weckenborg Vice President 40 0 X 198548 0 48459 Bob Mazur Vice President 40 0 X 144916 0 43401 Tanya Sandifer Vice President 40 0 X 180542 0 51660 Jason Cecil Vice President 40 0 X 145913 0 48925 Randall Haight Vice President/Physician 40 0 X 278703 0 61927 Thomas Niekamp Vice President 40 0 X 3290 0 0 Mitchell Godbee Physician 40 0 X 920308 0 85165 Matthew Hrastich Physician 40 0 X 734407 0 77879 Dennis Luetkemeyer Physician 40 0 X 681727 0 70989 Eston Schwartz Physician 40 0 X 596620 0 72697 Adam Patterson Physician 40 0 X 595768 0 67465 5741699 0 870761 111 0 1 1 Sircal Contracting 1341 North Rock Hill Road St Louis MO 63124 construction 5488411 Aramark Healthcare Support Services 25271 Network Place Chicago IL 606731252 Management Services 1744666 Boyce and Bynum Laboratory PO Box 7406 Columbia MO 65205 Lab Services 1576817 Simon Oswald Associates 700 Cherry Street Suite A Columbia MO 65202 Architect 1054998 Watkins Roofing 4401 I70 Drive SE Columbia MO 65201 Roof Replacement 648250 73 0 0 0 49574 0 8766 0 58340 Net Patient Service Revenue Less Allowance 622000 160884355 160884355 0 0 Other 900099 5431548 5431548 0 0 0 0 0 0 166315903 390412 390412 0 0 30516 30516 0 0 0 0 0 0 0 0 0 9749 0 27566 0 -17817 -17817 -17817 0 0 0 Share of K1 Loss 611710 -2220 0 -2220 0 Share of K-1 Loss 561000 -39780 0 -39780 0 0 0 0 0 -42000 166735354 166719014 -42000 0 0 0 0 0 0 0 0 0 2706143 0 2706143 0 0 0 0 0 72502420 65948532 6553888 0 2560309 2255376 304933 0 11163265 9823673 1339592 0 4557356 4014575 542781 0 0 0 0 0 220667 194379 26288 0 142773 125764 17009 0 0 0 0 0 0 0 0 0 0 0 8952484 8071691 880793 0 286537 252402 34135 0 0 0 0 0 0 0 0 0 0 0 0 0 811092 714466 96626 0 0 0 0 0 0 0 0 0 409322 360559 48763 0 608667 608667 0 0 0 0 0 0 9894718 8716257 1178461 0 1695769 1493751 202018 0 Supplies 33496174 33060057 436117 0 Repairs and Maintenance 3833913 3377176 456737 0 Utilities and Phone 2566701 2260928 305773 0 FRA Tax 5042579 5042579 0 0 2487727 2191362 296365 0 163938616 148512194 15426422 0 5264549 4739638 1980401 2016426 0 17288801 17038090 0 0 0 3601972 3786088 2305645 2771090 236319236 153360954 59655698 82958282 76601338 59923221 8505892 8558372 175204296 181791207 20348993 23471018 29380000 27585000 4727913 7006006 54456906 58062024 X 117379757 119432428 3297287 4226409 70346 70346 120747390 123729183 175204296 181791207 X 2796738 0 0 0 0 185055 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 0 1 32813 32813 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 the Missouri Hospital Association. Just one of the many benefits of the membership is that MHA communicates with government on issues that are important to Missouri hospitals. A portion of the annual dues is attributable to lobbying ($23063). 0 2868288 2868288 0 151072620 88698820 62373800 0 2961495 2113790 847705 0 79416833 62548344 16868489 0 0 0 0 82958282 Mortgage Backed Securities 10006172 F Money market accounts 22518238 F Corporate Bonds 3414734 F U.S Treasury Obligations 73678 F Certificates of Deposit 21604351 F Bonds - Mortgage Backed Securities 2901326 F Bonds - Money Market Account 1421148 F Bonds - Less Current Amounts -2016426 F 59923221 Malpractice Insurance Payable 3106463 457(b) Liability 1665779 Insurance Payable 2062415 Other Long Term Liabilities 171349 7006006 166727780 0 0 0 42000 42000 166685780 0 49574 49574 166735354 164059906 0 0 0 121290 121290 163938616 0 0 0 163938616 Schedule D, Part XI, Line 2d Share of K-1 loss 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 0 0 2841326 0 2841326 0.0173 15261241 12965238 2296003 0.0155 0 0 0 0 0 0 18102567 12965238 5137329 0.0328 215 14664 576735 272061 304674 0.0018 2012835 784542 1228263 0.0075 2263536 1857178 406358 0.0025 4988 0 4988 0 128997 0 128997 0.0008 215 14664 4987091 2913781 2073280 0.0126 215 14664 23089658 15879019 7210609 0.0454 16194 0 16194 0 10850 0 10850 0 5837223 3845294 1991929 0.012 10000 10000 0 0 0 5874267 3845294 2028973 0.012 0 4856330 0 41728389 41753546 -25157 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 12 1 1 1 1 X crmc.org X X 1 12 0 1 0 1 X 200 250 X X X X 1 1 X X X X 1 X www.crmc.org X www.crmc.org X www.crmc.org X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 1-Capital Region Medical Center Capital Region Medical Center (CRMC) is developing an individual strategic implementation plan as part of the organization's strategic planning process. Schedule H, Part V, Section B, Line 3-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 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 4-Capital Region Medical Center The CHNA was done in cooperation with SSM St. Mary's Schedule H, Part V, Section B, Line 5-Capital Region Medical Center CMCHAP held community discussion groups, much like town hall meetings. Meetings were facilitated by a community health development specialist. More than 150 individuals participated in 12 discussion groups and consumer interview sessions. This valuable input from community members added depth and quality to the data. Schedule H, Part V, Section B, Line 6a-Capital Region Medical Center Capital Region collaborated with SSM-St. Mary's, another local unaffiliated hospital to complete the CHNA in 2012. A partnership was created with these two hospitals and several other health care and social service providers and was named the Central Missouri Community Health Assessment Partnership (CMCHAP). The mission of which was to work collaboratively to collect and analyze health data and gather input from community members to aid in assessing and prioritizing needs. This unique partnership was financially funded by the two hospitals. Schedule H, Part V, Section B, Line 6b-Capital Region Medical Center CMCHAP included members of the health departments of Cole, Miller, Moniteau and Osage Counties, the Samaritan Center, the United Way, Jefferson City Medical Group, Missouri Primary Care Association, and the Community Health Center. Schedule H, Part V, Section B, Line 7d-Capital Region Medical Center CRMC 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 Line 11: Capital Region Medical Center included in the Implementation Strategy several actions for each of the top 5 identified needs; Access to Care, Heart Disease/Obesity Prevention, Cancer Screenings/Treatment, Diabetes Prevention/Management, and Miller County Focus. In addition, the Medical Center chose two additional needs Bacterial Pneumonia and Congestive Heart Failure. Actions for these needs include the following, although this is not a complete list of all activities completed to date. Access to Care: Recruitment of Family Practice Physicians and Nurse Practioners to meet need Delivery of quarterly healthy publication Continuation of Resident Clinic Health Screenings at minimal price in all outlying communities Heart Disease/Obesity Prevention: Include Lipid, CMP, A1c and waist circumference with clinic screenings Educate and encourage employees and community members to increase exercise levels, Created fitbit program for all staff Add biometrics and health risk assessments to all employees Education community on heart disease and obesity prevention with two educational sessions per year Cancer Screening/Treatment Educational programs regarding cancer screenings and treatment twice per year Smoking policy change at Capital Region Offer free skin cancer screen annually Offer smoking cessation option several times per year Lung cancer screening program Diabetes Prevention/Management Bi-monthly community A1c Educational programs regarding diabetes twice per year Cooking classes Diabetes support group Miller County Focus Partnering with Miller County Health Dept and started annual community health fair Provide, twice per year, inexpensive health screenings at clinic Applied for grant with MFH for childhood obesity and now working with school on a 5 year grant 17 Capital Region Southwest 1432 Southwest Blvd Jefferson City MO 65109 Outpatient and Wellness Services Women & Children Building 1014 Madison Street Jefferson City MO 65101 OB/GYN and Pediatrics CRMC-Capital City Medical Associates 1505 Southwest Blvd Jefferson City MO 65109 Family Practice, Internal Medicine, Low Income Clinic Mid Mo Med Assoc and General Surgery 1125 Madison Monroe Building Jefferson City MO 65101 Outpatient Clinics 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 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- Versailles 901 Kidwell Drive Versailles MO 65084 Family Practice Clinic CRMC-California 704 Buchanan California MO 65018 Family Practice Clinic Capital Region Family Medical Center 420 East High Street Jefferson City MO 65101 Family Practice Clinic Capital Region Family Medicine 1616 Southridge Suite 203 Jefferson City MO 65109 Family Practice Clinic CRMC-Holts Summit 180 North Star Holts Summit MO 65043 Family Practice Clinic Integrative Medicine 1002 Diamond Ridge Suite 203 Jefferson City MO 65109 Family Practice/Alternative Medicine CRMC-Linn 916 East Main Street Linn MO 65051 Family Practice CRMC Surgicare and Miller Clinic 1705 Christy Drive Jefferson City MO 65101 Surgeon and Family Practice Downtown Urgent Care 220 Madison Street Jefferson City MO 65101 Urgent Care Schedule H, Part I, Line 7 Cost to charge ratio Schedule H, Part I, Line 7, Column f none Schedule H, Part II Line 3: CRMC was involved in a state and community wide training for ebola virus. In addition, 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. Line 6: CRMC partners with the Community Health Center to provide leadership and resources. One of our VP's served as an interim CEO for the Community Health Center for a period of 4 months. He continues to serve on the board of directors and attends regular meetings. Line 8: CRMC recruited and retained physicians to provide medical care in rural and underserved areas. Line 9: CRMC partnered with the City of Jefferson and provided a $10,000 donation for Way Finding signs for hospitals and other emergency signage. Schedule H, Part III, Section A, Line 4 Page 13 in the notes to the financial statement Schedule H, Part III, Section B, Line 8 Line 2 is determined using the cost to charge from Worksheet 2. Schedule H, Part III, Section C, Line 9b CRMC will use Presumptive Charity software to score potential accounts meeting the charity guideline. CRMC will use the Federal Poverty Level, estimated household income and family size identified by the Presumptive software product in lieu of a completed application. Each patient account will proceed through the normal collection process up to and including a Final Notice Letter. Prior to referral to the collection agency. CRMC will batch each account and process through the software to identify potential accounts meeting the established guidelines for charity. These accounts will then be processed for adjustment to 100% of the charity discount and not forwarded to the collection agency. If a patient/guarantor, after receiving the charity care discount, are financially responsible for a portion of the charges and do not meet the obligation of the account we will then follow the credit policies of the hospital. These policies may include collection activity up to and including placement to a collection agency, reporting to the credit bureau and filing lawsuits. 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 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 for analysis and interpretation. Community discussion groups, much like town hall meetings, were organized by the Steering Team and facilitated by Michael Felix, 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 FAP available to hand out. All self pays are referred to one of the 3 financial counselors in the area. Patient financial counselors visit all self pay in house patients. Also, Human Arc helps patients apply for Medicaid, and also an Accountable care rep on site one day a week. Signs are posted in rooms and at registrations 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 medical staff. It is posted on our website and one 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 130,223. The region is expecting an increase of 5.51% from 2010 - 2020. Cole County, which has the largest population in 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 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 exceptional health care services throughout its service area. CRMC operates a large clinic network and comprehensive cancer facility, employs 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 X 1 1 X X X 1 1 0 1 0 1 0 1 0 Diane Light Board Member/Physician 312795 0 50882 0 0 0 13000 0 38285 0 414962 0 0 0 Lisa Kolb Waggoner Board Member/Physician 201725 0 8401 0 0 0 10098 0 46199 0 266423 0 0 0 Ed Farnsworth President (partial year) 246490 0 77987 0 16500 0 12266 0 0 0 353243 0 0 0 Gaspare Calvaruso President (partial year) 114669 0 30063 0 0 0 0 0 27753 0 172485 0 0 0 Tom Luebbering Vice President 177132 0 22563 0 1750 0 9147 0 43008 0 253600 0 0 0 Janet Weckenborg Vice President 170340 0 23392 0 4816 0 8879 0 39580 0 247007 0 0 0 Bob Mazur Vice President 131137 0 12059 0 1720 0 6812 0 36589 0 188317 0 0 0 Tanya Sandifer Vice President 157496 0 20938 0 2108 0 8264 0 43397 0 232203 0 0 0 Jason Cecil Vice President 132601 0 11986 0 1326 0 6966 0 41960 0 194839 0 0 0 Randall Haight Vice President/Physician 250501 0 26550 0 1652 0 12118 0 49809 0 340630 0 0 0 Mitchell Godbee Physician 816917 0 103392 0 0 0 13000 0 72165 0 1005474 0 0 0 Matthew Hrastich Physician 634099 0 82809 0 17500 0 12688 0 65191 0 812287 0 0 0 Dennis Luetkemeyer Physician 603397 0 78330 0 0 0 7800 0 63189 0 752716 0 0 0 Eston Schwartz Physician 578836 0 285 0 17500 0 13000 0 59697 0 669318 0 0 0 Adam Patterson Physician 503305 0 74963 0 17500 0 7800 0 59665 0 663233 0 0 0 Thomas Niekamp Vice President 0 0 3290 0 0 0 0 0 0 0 3290 0 0 0 Schedule J, Part I, Line 1a CRMC pays monthly 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. Bob Mazur - CRMC pays for his YMCA membership. Bob is a member of the YMCA board, and it is expected that he be a member. Gross up Payment of Taxes - The medical center gave most employees a gift card to a grocery store in November of 2014. This is taxable income to the employees. The hospital pays the employees's portion of the taxes on this and the employees taxable gross is increased accordingly. In addition, a retirement gift valued at $11662 was given to Ed Farnsworth and CRMC paid the taxes. Earnings were grossed up to account for this, for a total of $17496. Residence for personal use - CRMC paid for temporary housing of $4875 for Gaspare Calvaruso when he began employment. This was reported as taxable income. Travel for Companions: Historically CRMC has not paid travel expenses for companions. However, this year exceptions were made when it was determined that there were business benefits for the spouse to attend with the employee. Schedule J, Part I, Line 3 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 surverys 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 Tanya Sandifer received severance payments in 2015. Since all compensation amounts are reported on a calendar (W2) year basis, these amounts will be detailed in next years return. Contributed to a 457(b) Deferred Comp Plan: Ed Farnsworth - $16,500, Tom Luebbering - $1750, Janet Weckenborg - $4816, Bob Mazur - $1720, Tanya Sandifer - $2108, Jason Cecil - $1326, Randall Haight - $1652, Matthew Hrastich - $17,500, Eston Schwartz - $17,500, Adam Patterson $17,500. Schedule J, Part I, Line 5 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 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 and Vice Presidents 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 1715000 0 32690247 2908325 0 0 460920 0 0 0 29320002 0 2004 1 0 1 1 A 0 0 0 0 0 1 0 0 A 0 1 0 0 0 0 0 0 0 A 1 Lisa Kolb CRMC board member 205824 CRMC rents office from DBSW Docs LLC, Kolb is partner 0 Form 990, Part VI, Section A, Line 2 Jim Wisch reported that he has a business relationship with Central Bank (Ken Littlefield). He also has a business relationship with Lorelei Schwartz. Ken Littlefield (Central Bank) has a business relationship with Capital Region Medical Center 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 the major service lines. 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 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 the 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 agreement. The committee documents their review and decisions and meets at least once annually. The CEO sets the recommended salaries for key employees using comparable data from the 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 managers' meeting and 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 Share of K1 Loss +39780, Share of K1 Loss +2220, Transfers to UMC -664777, Paid Foundation Expenses -121290, Increase of Found Net Assets SFAS136 +929122 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 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 -2220 24285 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 Unrelated -39780 1553 0 39780 0 0.16667 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 Still Osteopathic Medical Foundation q 100 The Still Foundation reimburses CRMC for any expenses incurred with the Physician Health Program Capital Region Medical Foundation o 121290 Salary, benefits, and other expenses of Foundation Director University of Missouri - Medical Alliance r 664777 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 49574 Cash value of donations Capital Region Medical Center Partners m 340218 In Fiscal year ending June 30, 2015, the Partners donated 44,473 hours of service - Valued at $340,218. Capital Region Medical Center Partners q 25317 Partners purchases specific items for Capital Region Medical Center, or if CRMC purchased the item from their supplier, Partners may offer to reimburse the medical center for these. (fleece swaddles, folders, magazines for patients, lifeline assistance, infant caskets, wheel chair alarms, and peds equipment) Health Network of Missouri LLC b 41333 Capital contributed from K1 Capital Region Medical Center Partners q 25528 Partners reimburses CRMC for the salary (23660) and FICA (1867.74) of the gift shop manager Capital Region was granted an extension request. The 2014 Form 990 is due May 15, 2016