MISSOURI DELTA MEDICAL CENTER: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
MISSOURI DELTA MEDICAL CENTER (EIN 43-0633449)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-13
IRS object ID
201512259349303821
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-08-13T16:02:24-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN430352985PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KERBER ECK & BRAECKEL LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11116 W MAIN STAddressLine1
CityCARBONDALECity
StateILState
ZIP Code629012335ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN430633449EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MISSOURI DELTA MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlMISSBusinessNameControlTxt
Phone5734711600PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11008 NORTH MAIN STREETAddressLine1
CitySIKESTONCity
StateMOState
ZIP Code638015044ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJASON SCHRUMPFPersonNm
Person TitleCEOPersonTitleTxt
Phone5734711600PhoneNum
Signature2015-08-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARK DALLASPreparerPersonNm
PTINP00187265PTIN
Phone6185291040PhoneNum
Preparation2015-08-13PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJASON SCHRUMPFPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11008 NORTH MAIN STREETAddressLine1
CitySIKESTONCity
StateMOState
ZIP Code638015044ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$85,712,099GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MISSOURIDELTA.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1948FormationYr
Legal Domicile StateMOLegalDomicileStateCd
Activity Or MissionMISSOURI DELTA MEDICAL CENTER IS A NOT FOR PROFIT CORPORATION WHICH STRIVES TO PROVIDE A COMPLETE HEALTH CARE SYSTEM TO RESIDENTS IN THE SERVICE AREA EITHER DIRECTLY OR IN COOPERATION WITH OTHERS.ActivityOrMissionDesc
Voting Members Governing Body26VotingMembersGoverningBodyCnt
Voting Members Independent21VotingMembersIndependentCnt
Total Employee1019TotalEmployeeCnt
Total Volunteers50TotalVolunteersCnt
Total Gross UBI-$18,310TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$13,643NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,375,516PYContributionsGrantsAmt
CY Contributions Grants$177,701CYContributionsGrantsAmt
PY Program Service Revenue$83,308,645PYProgramServiceRevenueAmt
CY Program Service Revenue$83,378,557CYProgramServiceRevenueAmt
PY Investment Income$976,424PYInvestmentIncomeAmt
CY Investment Income$901,620CYInvestmentIncomeAmt
PY Other Revenue$1,206,804PYOtherRevenueAmt
CY Other Revenue$1,221,511CYOtherRevenueAmt
PY Total Revenue$86,867,389PYTotalRevenueAmt
CY Total Revenue$85,679,389CYTotalRevenueAmt
PY Grants And Similar Paid$56,500PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$46,000CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$49,528,490PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$50,298,059CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$169,289CYTotalFundraisingExpenseAmt
PY Other Expenses$35,340,602PYOtherExpensesAmt
CY Other Expenses$37,182,859CYOtherExpensesAmt
PY Total Expenses$84,925,592PYTotalExpensesAmt
CY Total Expenses$87,526,918CYTotalExpensesAmt
PY Revenues Less Expenses$1,941,797PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,847,529CYRevenuesLessExpensesAmt
Total Assets BOY$67,746,871TotalAssetsBOYAmt
Total Assets EOY$62,714,839TotalAssetsEOYAmt
Total Liabilities BOY$24,735,987TotalLiabilitiesBOYAmt
Total Liabilities EOY$21,295,785TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$43,010,884NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$41,419,054NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionMISSOURI DELTA MEDICAL CENTER IS A NOT FOR PROFIT CORPORATION WHICH STRIVES TO PROVIDE A COMPLETE HEALTH CARE SYSTEM TO RESIDENTS IN THE SERVICE AREA EITHER DIRECTLY OR IN COOPERATION WITH OTHERS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$76,646,109ExpenseAmt
Grant$46,000GrantAmt
Revenue$83,378,557RevenueAmt
DescMISSOURI DELTA MEDICAL CENTER PROVIDES QUALITY MEDICAL CARE TO THE RESIDENTS OF ITS COMMUNITY REGARDLESS OF ABILITY TO PAY. MISSOURI DELTA MEDICAL CENTER ALSO PROVIDES SHORT TERM REHABILITATION SERVICES THROUGH AN ACUTE INPATIENT REHABILITATION UNIT AND PSYCHIATRIC SERVICES THROUGH A GERIATRIC PSYCHIATRIC FACILITY. THESE SERVICES ARE SUMMARIZED AS FOLLOWS: HOSPITAL: NUMBER OF ACUTE PATIENT DAYS 13,358 NUMBER OF ACUTE ADMISSIONS 3,402 NUMBER OF EMERGENCY ROOM VISITS 19,307 NUMBER OF RURAL HEALTH CLINIC VISITS 58,296 NUMBER OF LABORATORY TESTS PERFORMED 290,562 NUMBER OF RADIOLOGY EXAMS PERFORMED 64,015 NUMBER OF THERAPY TREATMENTS 68,315 NUMBER OF PHYSICIAN OFFICE VISITS 40,759 ACUTE INPATIENT REHAB: NUMBER OF INPATIENT REHAB PATIENT DAYS 2,097 NUMBER OF INPATIENT REHAB PATIENT ADMISSIONS 167 PSYCHIATRIC FACILITY: NUMBER OF PATIENT DAYS 3,433 NUMBER OF PATIENT ADMISSIONS 397 THE HOSPITAL PROVIDED FREE CARE TO INDIGENT PATIENTS IN THE AMOUNT OF 12,390,127 IN FY 2014, VALUED AT BILLED CHARGES. THE HOSPITAL ALSO PROVIDED NUMEROUS FREE PROGRAMS AND REDUCED PRICE SERVICES THROUGHOUT THE YEAR THAT THE HOSPITAL BELIEVES SERVES A COMMUNITY NEED. SERVICES PROVIDED FREE OF CHARGE OR BELOW COST TO THE GENERAL PUBLIC INCLUDE: 1. PERIODIC BLOOD PRESSURE AND CHOLESTEROL SCREENS 2. OUTPATIENT DIABETIC EDUCATION 3. FIRST AID CLASSES 4. CPR COURSES 5. CHILDBIRTH CLASSES 6. EMERGENCY PREPAREDNESS COURSES 7. HEALTH EDUCATION ARTICLES IN THE LOCAL NEWSPAPER 8. OTHER HEALTH EDUCATION CLASSES 8. OTHER HEALTH EDUCATION CLASSESDesc
Total Program Service Expenses$76,646,109TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonYes (true)GrantToRelatedPersonInd
Business Rln With Org MemYes (true)BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document129IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee1019EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members26GoverningBodyVotingMembersCnt
Independent Voting Member21IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGREG CARDAPersonNm
Phone5734711600PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11008 NORTH MAIN STREETAddressLine1
CitySIKESTONCity
StateMOState
ZIP Code638015044ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
JIM CULLISON
DIRECTOR1.00Yes (X)$0$0$0
BRIAN MENZ
DIRECTOR1.00Yes (X)$0$0$0
DIANE PETERSON
CHAIRMAN15.00Yes (X)$0$0$0Yes (X)
CHRIS STEWARD
DIRECTOR1.00Yes (X)$0$0$0
LINDA BOYD
DIRECTOR2.00Yes (X)$0$0$0
ROBERT BUCHANAN
DIRECTOR1.00Yes (X)$0$0$0
JOHN BOLLINGER
DIRECTOR1.00Yes (X)$0$0$0
KEITH DAVIDSON
DIRECTOR1.00Yes (X)$0$0$0
EDWARD DEMENT
DIRECTOR1.00Yes (X)$0$0$0
JEFF PATRIDGE
DIRECTOR1.00Yes (X)$0$0$0
BILL HAMPTON
DIRECTOR6.00Yes (X)$0$0$0
DAN JENNINGS JR
VICE CHAIRMA1.00Yes (X)$0$0$0Yes (X)
ELIZABETH JOHNSON
DIRECTOR2.00Yes (X)$0$0$0
MICHAEL JONES
DIRECTOR2.00Yes (X)$0$0$0
JEFF HUX
DIRECTOR1.00Yes (X)$0$0$01.00
ROBERT MACGILLIVRAY
TREASURER2.00Yes (X)$0$0$0Yes (X)
DENNY KOONCE
DIRECTOR1.00Yes (X)$0$0$0
BRITT MCCONNELL
DIRECTOR1.00Yes (X)$0$0$0
ROBERT MITCHELL
DIRECTORYes (X)$0$0$0
MIKE MOLL
SECRETARY1.00Yes (X)$0$0$0Yes (X)
DOUG SCOTT
DIRECTOR1.00Yes (X)$0$0$0
CHARLES MOXLEY
DIRECTOR1.00Yes (X)$0$0$0
MIKE POBST
DIRECTOR1.00Yes (X)$0$0$0
GERALD SETTLES
DIRECTOR1.00Yes (X)$0$0$0
STEVE SIKES
DIRECTOR1.00Yes (X)$0$0$0
RON WATKINS
DIRECTOR1.00Yes (X)$0$0$0
JASON SCHRUMPF
PRESIDENT40.00$210,001$0$8,494Yes (X)2.00
JON BRANSTETTER
VP FINANCE40.00$147,951$0$5,102Yes (X)2.00
MOWAFFAQ SAID MD
PHYSICIAN40.00$683,163$0$8,706Yes (X)
CARY SANDERS MD
PHYSICIAN40.00$663,126$0$10,896Yes (X)
JENNIFER WALLER MD
PHYSICIAN40.00$422,583$0$8,959Yes (X)
LINZA KILLION MD
PHYSICIAN40.00$421,204$0$9,686Yes (X)
KEVIN P RANKIN MD
PHYSICIAN40.00$406,364$0$11,302Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,954,392TotalReportableCompFromOrgAmt
Total Other Compensation$63,145TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K51IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
HORIZON HEALTH MENTAL HEALTH
PO BOX 840839DALLASTX752840839PSYCH SERVICES$832,630
CREDIT SOLUTIONS
2277 THUNDERSTICK DRIVELEXINGTONKY40505BILLING$682,148
MERAMEC EMERGENCY PHYSICIAN
PO BOX 674579DETROITMI482674579ER PHYSICIAN$577,788
HORIZON HEALTH ACUTE REHAB
PO BOX 840839DALLASTX752840839ACUTE REHAB$540,835
MAYO COLLABORATIVE SERVICES INC
PO BOX 9146MINNEAPOLISMN554809146LABORATORY SVC$487,677
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K27CntrctRcvdGreaterThan100KCnt
Related Organizations$176,732RelatedOrganizationsAmt
All Other Contributions$969AllOtherContributionsAmt
Total Contributions$177,701TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE621110$82,208,585$82,208,585
EMR INCENTIVE PAYMENT621110$1,169,972$1,169,972
FieldValueIRS element (for citing)
Total Program Service Revenue$83,378,557TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$901,620TotalRevenueColumnAmt
Exclusion$901,620ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$14,400RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$32,710RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$18,310RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$18,310TotalRevenueColumnAmt
Unrelated Business Revenue-$18,310UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
OTHER OPERATING REVENUE900099$927,275$927,275
CAFETERIA INCOME722514$211,548$211,548
MEDICAL RECORD REVENUE621990$100,998$100,998
FieldValueIRS element (for citing)
Other Revenue Total$1,239,821OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$85,679,389TotalRevenueColumnAmt
Related Or Exempt Func Income$83,378,557RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue-$18,310UnrelatedBusinessRevenueAmt
Exclusion$2,141,441ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$46,000TotalAmt
Program Services$46,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$371,549TotalAmt
Management And General$371,549ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$41,097,694TotalAmt
Program Services$37,855,814ProgramServicesAmt
Management And General$3,179,601ManagementAndGeneralAmt
Fundraising$62,279FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$313,146TotalAmt
Program Services$284,963ProgramServicesAmt
Management And General$25,052ManagementAndGeneralAmt
Fundraising$3,131FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,887,263TotalAmt
Program Services$5,357,409ProgramServicesAmt
Management And General$470,981ManagementAndGeneralAmt
Fundraising$58,873FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,628,407TotalAmt
Program Services$2,375,340ProgramServicesAmt
Management And General$248,777ManagementAndGeneralAmt
Fundraising$4,290FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$19,007TotalAmt
Management And General$19,007ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$73,890TotalAmt
Management And General$73,890ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$10,369,543TotalAmt
Program Services$7,509,255ProgramServicesAmt
Management And General$2,831,823ManagementAndGeneralAmt
Fundraising$28,465FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$192,653TotalAmt
Program Services$5,436ProgramServicesAmt
Management And General$187,217ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,831,767TotalAmt
Program Services$3,771,583ProgramServicesAmt
Management And General$2,048,700ManagementAndGeneralAmt
Fundraising$11,484FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$898,591TotalAmt
Program Services$898,591ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$181,415TotalAmt
Program Services$173,603ProgramServicesAmt
Management And General$7,145ManagementAndGeneralAmt
Fundraising$667FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$28,832TotalAmt
Program Services$25,881ProgramServicesAmt
Management And General$2,951ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$594,578TotalAmt
Program Services$594,578ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,749,670TotalAmt
Program Services$4,749,670ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,002,067TotalAmt
Management And General$1,002,067ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$12,935,599$12,897,194$38,405
RECRUITING$124,308$124,308
DUES & SUBSCRIPTIONS$118,405$100,792$17,513$100
FARM EXPENSE$62,534$62,534

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$87,526,918TotalAmt
Program Services$76,646,109ProgramServicesAmt
Management And General$10,711,520ManagementAndGeneralAmt
Fundraising$169,289FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$5,037,769BOYAmt
EOY$5,272,203EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$759,153BOYAmt
EOY$786,571EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$14,947,812BOYAmt
EOY$14,340,887EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,247,027BOYAmt
EOY$962,446EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,448,068BOYAmt
EOY$3,501,322EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,757,414BOYAmt
EOY$2,425,492EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$80,743,563LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$46,389,094LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$37,502,544BOYAmt
EOY$34,354,469EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,047,084BOYAmt
EOY$1,071,449EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$67,746,871BOYAmt
EOY$62,714,839EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$14,010,295BOYAmt
EOY$6,728,304EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,810,511BOYAmt
EOY$2,467,043EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$7,915,181BOYAmt
EOY$12,100,438EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$24,735,987BOYAmt
EOY$21,295,785EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$42,770,937BOYAmt
EOY$41,179,107EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$239,947BOYAmt
EOY$239,947EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$43,010,884BOYAmt
EOY$41,419,054EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$67,746,871BOYAmt
EOY$62,714,839EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,847,529ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$255,699OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$15,670GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$15,670TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$211,682BeginningYearBalanceAmt
Investment Earnings Or Losses$1,805InvestmentEarningsOrLossesAmt
End Year Balance$213,487EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$212,608BeginningYearBalanceAmt
Investment Earnings Or Losses-$926InvestmentEarningsOrLossesAmt
End Year Balance$211,682EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$205,741BeginningYearBalanceAmt
Investment Earnings Or Losses$6,867InvestmentEarningsOrLossesAmt
End Year Balance$212,608EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$219,883BeginningYearBalanceAmt
Investment Earnings Or Losses-$3,185InvestmentEarningsOrLossesAmt
Other Expenditures$10,957OtherExpendituresAmt
End Year Balance$205,741EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,322,552BeginningYearBalanceAmt
Contributions$2,500ContributionsAmt
Investment Earnings Or Losses$73,935InvestmentEarningsOrLossesAmt
Other Expenditures$3,179,104OtherExpendituresAmt
End Year Balance$219,883EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$4,273,774InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$618,603OtherCostOrOtherBasisAmt
Book Value$4,892,377BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$31,912,323OtherCostOrOtherBasisAmt
Depreciation$16,256,875DepreciationAmt
Book Value$15,655,448BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$42,870,052OtherCostOrOtherBasisAmt
Depreciation$29,281,376DepreciationAmt
Book Value$13,588,676BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,068,811OtherCostOrOtherBasisAmt
Depreciation$850,843DepreciationAmt
Book Value$217,968BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$34,354,469TotalBookValueLandBuildingsAmt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 3, PART XMANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONSUNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PAGE 4, PART XIIITHE ORGANIZATION'S ENDOWMENT FUNDS ARE RESTRICTED BY DONORS AND SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSES.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other1.800000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,787,501TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,787,501NetCommunityBenefitExpnsAmt
Total Expense0.04330TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,647,687TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$19,355,488DirectOffsettingRevenueAmt
Net Community Benefit Expns$292,199NetCommunityBenefitExpnsAmt
Total Expense0.00330TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,435,188TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$19,355,488DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,079,700NetCommunityBenefitExpnsAmt
Total Expense0.04660TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$60,435TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$60,435NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$60,435TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$60,435NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,495,623TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$19,355,488DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,140,135NetCommunityBenefitExpnsAmt
Total Expense0.04730TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$9,787,761BadDebtExpenseAmt
Reimbursed By Medicare$27,312,676ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$30,423,628CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$3,110,952MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MISSOURI DELTA MEDICAL CENTERBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11008 NORTH MAIN STREETAddressLine1
CitySIKESTONCity
StateMOState
ZIP Code63801ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MISSOURI DELTA MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
OtherYes (X)OtherInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.MISSOURIDELTA.COMOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs AddressedfalseAllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (true)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care180.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Available On RequestYes (X)AvailableOnRequestInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Lowest Negotiated RatesYes (X)LowestNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, MISSOURI DELTA MEDICAL CENTER - PART V, LINE 3PRIMARY DATA COLLECTION FOR THE CHNA INCLUDED A FOCUS GROUP HELD IN EACH OF THE THREE COUNTIES DEFINED AS THE GEOGRAPHIC AREA OF PATIENTS USING MDMC, WHICH ARE SCOTT, MISSISSIPPI AND NEW MADRID COUNTIES. INDIVIDUALS FROM A BROAD INTEREST WERE INCLUDED IN THE FOCUS GROUPS. EFFORTS WERE MADE TO INCLUDE AT-RISK, TARGETED POPULATIONS AND PRINCIPLE SPECIALTY AREAS THAT ARE SERVED BY THE HOSPITAL AND PRESENT WITHIN THE COMMUNITY, SUCH AS THE MEDICALLY UNDERSERVED, LOW INCOME PERSONS, MINORITY GROUPS, AND THOSE WITH CHRONIC DISEASE NEEDS. PRIMARY DATA WAS ALSO GATHERED THROUGH THE USE OF A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY, A QUESTIONNAIRE-STYLE, SELF- ADMINISTERED SURVEY, AVAILABLE ONLY TO THOSE PARTICIPANTS THAT A GRADUATE STUDENT SOCIAL WORKER AND A HOSPITAL MARKETING INTERN CAME INTO CONTACT WITH AT CERTAIN LOCATIONS. THE SURVEY WAS DESIGNED TO COLLECT DATA ON HEALTH BELIEFS, HEALTH BEHAVIORS, ACCESS TO AND UTILIZATION OF HEALTH CARE SERVICES, AND CONCERNS ABOUT COMMUNITY HEALTH ISSUES.
FACILITY 1, MISSOURI DELTA MEDICAL CENTER - PART V, LINE 4FOR THE PURPOSES OF THE ASSESSMENT, COMMUNITY IS DEFINED AS THE GEOGRAPHIC AREA FROM WHICH A SIGNIFICANT NUMBER OF PATIENTS USING MDMC SERVICES RESIDE. THE PRIMARY SERVICE AREA FOR MDMC IS BASED ON THE NUMBER OF INPATIENT DISCHARGES AND OUTPATIENT VISITS BY PATIENTS THAT RESIDE IN SCOTT, MISSISSIPPI AND NEW MADRID COUNTIES. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR SCOTT COUNTY WAS CONDUCTED IN PARTNERSHIP WITH SOUTHEASTHEALTH AND SAINT FRANCIS MEDICAL CENTER. AS MISSISSIPPI COUNTY AND NEW MADRID COUNTY WERE THE PRIMARY SERVICE AREA OF MDMC ALONE THE CHNA WAS NOT CONDUCTED IN PARTNERSHIP WITH SOUTHEASTHEALTH AND SAINT FRANCIS MEDICAL CENTER.
FACILITY 1, MISSOURI DELTA MEDICAL CENTER - PART V, LINE 7THE SUBSTANCE ABUSE NEED WAS NOT ADDRESSED DUE TO LIMITED FUNDS AND EXPERTISE IN THE AREA OF SUBSTANCE ABUSE. HOSPITAL LEADERSHIP DID NOT MOVE FORWARD WITH IMPLEMENTING STRATEGIES TO IMPROVE THE ISSUE OF SUBSTANCE ABUSE IN THE COMMUNITY.
FieldValueIRS element (for citing)
Facility18FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (18 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
CONTINU-CARE HOME HEALTH
104 SMITH STREETSIKESTONMO63801HOME HEALTH AGENCY
CHARLESTON COMMUNITY CARE CENTER
1200 EAST MARSHALL STREETCHARLESTONMO63834RURAL HEALTH CLINIC
RESTART OF CHARLESTON
512 EAST MARSHALL STREETCHARLESTONMO63834PHYSICAL THERAPY
RESTART OF NEW MADRID
406 HIGHWAY 61NEW MADRIDMO63869PHYSICAL THERAPY
RESTART OF EAST PRAIRIE
106 SOUTH WASHINGTONEAST PRAIRIEMO63845PHYSICAL THERAPY
BARTON-JOLLEY PHYSICIAN SVCS
1013 NORTH MAIN STREETSIKESTONMO63801PHYSICIAN OFFICE BUILDING
MUHANNAD AL-KILANI MD
1118 NORTH MAIN STREETSIKESTONMO63801PHYSICIAN OFFICE BUILDING
MISSOURI DELTA CANCER & INFUSION
1126 NORTH MAIN STREETSIKESTONMO63801INFUSION CENTER
KENNETH STONE MD
121 SMITH STREETSIKESTONMO63801PHYSICIAN OFFICE BUILDING
SMITH STREET CLINIC
119 SMITH STREETSIKESTONMO63801RURAL HEALTH CLINIC
JAYCEE RENAL DIALYSIS CENTER
135 PLAZA DRIVESIKESTONMO63801DIALYSIS CENTER
LINZA KILLION MD
1106 NORTH MAIN STREETSIKESTONMO63801PHYSICIAN OFFICE BUILDING
MISSOURI DELTA PRIMARY CARE
1015 NORTH MAIN STREETSIKESTONMO63801RURAL HEALTH CLINIC
MISSOURI DELTA ORTHOPEDICS
201 PLAZA DRIVESIKESTONMO63801PHYSICIAN OFFICE BUILDING
MISSOURI DELTA WOUND & HYPERBARIC
201 PLAZA DRIVESIKESTONMO63801WOUND CARE CENTER
MISSOURI DELTA MEDICAL EQUIPMENT
102 SMITH STREETSIKESTONMO63801DURABLE MEDICAL EQUIPMENT
NEW MADRID COMMUNITY CARE
615 MAIN STREETNEW MADRIDMO63869RURAL HEALTH CLINIC
PORTAGEVILLE COMMUNITY CARE
204 EAST 3RD STREETPORTAGEVILLEMO63873RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONTHE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE CENTER 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 CENTER 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 BALANCES (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARY COVERAGE EXISTS FOR PART OF THE BILL), THE CENTER RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY 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. THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 WAS THE AMOUNT OF THE EXPENSE REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, WHICH IS VALUED AT BILLED CHARGES. IT IS DIFFICULT TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO COULD QUALIFY FOR CHARITY CARE DUE TO THE LIMITED NUMBER OF FINANCIAL APPLICATIONS COMPLETED BY PATIENTS.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSFOR RECEIVABLES ASSOCIATED WITH SELF-PAY BALANCES (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 CENTER RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY 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 - MEDICARE EXPLANATIONIRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS ESTIMATED BY USING THE PERCENT OF OPERATING EXPENSE TO PATIENT REVENUE.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATIONTHE BAD DEBT POLICY STATES THAT IF IT IS DECIDED THAT A PATIENT IS INDIGENT, PROCEED AS FOLLOWS: A. COMPLETE ACCOUNT ADJUSTMENT FORMS FOLLOWING ACCOUNT ADJUSTMENT PROCEDURES OR NOTE THE BALANCE WILL BE WRITTEN OFF AS CHARITY ACCORDING TO THE CHARITY CARE POLICY. B. ENTER THE FOLLOWING NOTATIONS ON THE COPY OF THE PATIENT ACCOUNTS ADMISSION REGISTRATION FORMS OR IN ACCOUNTS RECEIVABLE NOTES IN THE COMPUTER: "CHARGES DUE BY PATIENT WILL BE WRITTEN OFF AS MEDICARE BAD DEBT OR UNCOMPENSATED CARE."
PART VI, LINE 2 - NEEDS ASSESSMENTTHE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITY OR COMMUNITIES SERVED BY MISSOURI DELTA MEDICAL CENTER IS BASED ON ALL OR A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITY, SUPPLY, DEMONSTRATED NEED, VOICE OF THE CUSTOMER, AND/OR COLLABORATIVE EFFORTS WITH OUTSIDE ENTITIES, GOVERNMENT AGENCIES, AND OTHER HEALTH CARE PROVIDERS THAT WOULD ENABLE THE FILLING OF A NEED OR ENHANCE AND COMPLIMENT AN ALREADY EXISTING SERVICE. DATA IS GATHERED CONSTANTLY THROUGH HIDI, BENCHMARKING, MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT (REGARDING TECHNOLOGIES REQUIRED TO KEEP SERVICES ON THE CUTTING EDGE), AND THROUGH CONSTANT MONITORING OF STATE AND FEDERAL GUIDELINES. THIS INFORMATION IS REVIEWED AND ANALYZED BY THE HOSPITAL'S ADMINISTRATIVE TEAM AND INCORPORATED INTO THE HOSPITAL'S STRATEGIC PLANNING PROCESS THROUGH THE PLANNING COMMITTEE OF THE BOARD OF DIRECTORS AND EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEALL PATIENT BILLING STATEMENTS FOR MISSOURI DELTA MEDICAL CENTER INCLUDE A STATEMENT THAT THE PATIENT MAY CONTACT THE MEDICAL CENTER WITH ANY QUESTIONS OR PAYMENT ISSUES REGARDING THEIR BILL. IF A PATIENT CONTACTS THE CENTER WITH AN INABILITY TO MAKE PAYMENT ISSUE, THEY INFORM THE PATIENT OF THE AVAILABLE OPTION INCLUDING CHARITY CARE AND OTHER ASSISTANCE. THEY ALSO EXPLAIN HOW THE PATIENT CAN APPLY FOR ASSISTANCE. OUR SOCIAL WORKERS WILL ALSO COMMUNICATE WITH THOSE PATIENTS WHO MAY QUALIFY FOR MEDICAID AND ASSIST THOSE PATIENTS IN COMPLETING THEIR MEDICAID APPLICATIONS.
PART VI, LINE 4 - COMMUNITY INFORMATIONMISSOURI DELTA MEDICAL CENTER IS A SOLE COMMUNITY HOSPITAL IN SIKESTON, MISSOURI THAT PRIMARILY SERVES THE RESIDENTS OF SCOTT, MISSISSIPPI, STODDARD, AND NEW MADRID COUNTIES IN SOUTHEASTERN MISSOURI. MISSOURI DELTA MEDICAL CENTER SERVES PATIENTS WITHOUT REGARD TO AGE, GENDER, INCOME, ETHNIC ORIGIN, INSURANCE COVERAGE, OR ABILITY TO PAY. APPROXIMATELY 72% OF THE MISSOURI DELTA MEDICAL CENTER'S NET PATIENT REVENUE IS FROM PARTICIPATION IN THE MEDICARE AND STATE SPONSORED MEDICAID PROGRAM FOR THE YEAR ENDED SEPTEMBER 30, 2014.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHOUR BOARD OF DIRECTORS IS MADE UP OF 26 COMMUNITY MEMBERS FROM OUR SERVICE AREAS. THESE BOARD MEMBERS HAVE REGULAR INPUT ON STRATEGIC PLANNING, NEW SERVICES, TECHNOLOGY, AND PHYSICIAN RECRUITMENT FOR OUR COMMUNITY. THE USE OF ANY SURPLUS FUNDS IS REINVESTED BACK INTO THE MEDICAL CENTER THROUGH THE PURCHASE OF PROPERTY AND EQUIPMENT TO PROVIDE SERVICES THAT FULFILL THE NEEDS OF THE SERVICE AREA.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEMNOT APPLICABLE.
ADDITIONAL INFORMATIONSCHEDULE H, PART I, LINE 7B - THE MEDICAID BENEFIT REIMBURSES THE HOSPITAL TO HELP COVER THE UNCOMPENSATED COST OF TREATING THE UNINSURED, MEDICARE AND MEDICAID PATIENTS. MISSOURI DELTA MEDICAL CENTER HAS A LARGE AMOUNT OF UNINSURED, MEDICARE AND MEDICAID PATIENTS, INCLUDING DUAL BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS. DUE TO THE LARGE MIX OF THESE TYPES OF PATIENTS THE HOSPITAL HAS AN OVERALL LARGE AMOUNT OF UNCOMPENSATED CARE WHICH CAUSES AN INCREASE TO THE MEDICAID ADD-ON PAYMENT.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeMEDICAL STUDENT SCHOLARSHGrantTypeTxt
Recipient8RecipientCnt
Cash Grant$46,000CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE SCHOLARSHIP PROGRAM IS DESIGNED TO PROVIDE A CONSISTENT FLOW OF REGISTERED NURSES TO MISSOURI DELTA MEDICAL CENTER. THE OBJECTIVE OF THE PLAN IS TO ENCOURAGE AND FINANCIALLY ASSIST QUALIFIED STUDENTS IN THEIR ENDEAVOR TO BECOME A REGISTERED NURSE. TO THE EXTENT OF AVAILABLE FUNDS, THE MEDICAL CENTER WILL PAY SCHOLARSHIPS TO QUALIFIED STUDENTS OF AN ACCREDITED REGISTERED NURSE PROGRAM. TO QUALIFY FOR THE PROGRAM A STUDENT MUST: A. HIGH SCHOOL GRADUATE 1. RANK IN THE UPPER THIRD OF HIGH SCHOOL CLASS ACADEMICALLY. 2. SHOW EVIDENCE OF MOTIVIATION FOR NURSING EITHER BY APTITUTE TESTING OR BY REPORTED DEMONSTRATION OF INTEREST. 3. PROVIDE LETTER OF RECOMMENDATION FROM AN APPROPRIATE SCHOOL OFFICIAL. 4. BE APPROVED BY THE HOSPITAL SCHOLARSHIP SELECTION COMMITTEE. B. STUDENT NURSES - ALL STUDENT NURSES MUST: 1. HAVE AT LEAST THE EQUIVALENT OF A 2.5 GRADE POINT AVERAGE IN A 4 POINT SYSTEM. 2. MUST PROVIDE A LETTER OF RECOMMENDATION FROM RESPONSIBLE AND APPROPRIATE PERSON. 3. BE APPROVED BY THE SCHOLARSHIP COMMITTEE. C. CURRENT EMPLOYEES - ALL CURRENT EMPLOYEES MUST: 1. BE ENROLLED IN A NURSING PROGRAM AS A FULL-TIME STUDENT 2. NOT BE RECEIVING ANY HOSPITAL BENEFITS 3. BE APPROVED BY THE SHOLARSHIP COMMITTEE.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmount
JASON SCHRUMPF
PRESIDENT$209,949$52$1,977$6,517$218,495
JON BRANSTETTER
VP FINANCE$147,899$52$1,459$3,643$153,053
MOWAFFAQ SAID MD
PHYSICIAN$637,290$401$2,500$6,206$691,869$45,472
CARY SANDERS MD
PHYSICIAN$600,057$63,069$2,500$8,396$674,022
JENNIFER WALLER MD
PHYSICIAN$322,358$174$2,500$6,459$431,542$100,051
LINZA KILLION MD
PHYSICIAN$420,054$1,150$2,500$7,186$430,890
KEVIN P RANKIN MD
PHYSICIAN$350,062$1,150$2,500$8,802$417,666$55,152

Schedule L IRS990ScheduleL

Grnt Asst Bnft Interested Prsn GrntAsstBnftInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonALEC PETERSONPersonNm
Relationship With OrgSON OF CHAIRMANRelationshipWithOrgTxt
Cash Grant$4,000CashGrantAmt
Type Of AssistanceSCHOLARSHIPTypeOfAssistanceTxt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
JASON SCHRUMPF
EMPLOYEE$210,001COMPENSATIONfalse
ROBERT BUCHANAN
EMPLOYEE$51,891COMPENSATIONfalse
RHONDA MENZ
EMPLOYEE$33,664COMPENSATIONfalse
JUDITH MENZ
EMPLOYEE$96,761COMPENSATIONfalse
ANTHONY COPPAGE
EMPLOYEE$78,166COMPENSATIONfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationJASON SCHRUMPF IS THE SON-IN-LAW OF A DIRECTOR. ROBERT BUCHANAN IS THE SON OF A DIRECTOR. RHONDA MENZ IS THE WIFE OF A DIRECTOR. JUDITH MENZ IS THE MOTHER OF A DIRECTOR. ANTHONY COPPAGE IS THE BROTHER-IN-LAW OF A DIRECTOR. ELIZABETH JOHNSON IS PRESIDENT OF MITCHELL INSURANCE. MISSOURI DELTA MEDICAL CENTER PURCHASES INSURANCE FROM MITCHELL INSURANCE AT MARKET RATES.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4ANUMBER OF LABORATORY TESTS PERFORMED 290,562 NUMBER OF RADIOLOGY EXAMS PERFORMED 64,015 NUMBER OF THERAPY TREATMENTS 68,315 NUMBER OF PHYSICIAN OFFICE VISITS 40,759 ACUTE INPATIENT REHAB: NUMBER OF INPATIENT REHAB PATIENT DAYS 2,097 NUMBER OF INPATIENT REHAB PATIENT ADMISSIONS 167 PSYCHIATRIC FACILITY: NUMBER OF PATIENT DAYS 3,433 NUMBER OF PATIENT ADMISSIONS 397 THE HOSPITAL PROVIDED FREE CARE TO INDIGENT PATIENTS IN THE AMOUNT OF 12,390,127 IN FY 2014, VALUED AT BILLED CHARGES. THE HOSPITAL ALSO PROVIDED NUMEROUS FREE PROGRAMS AND REDUCED PRICE SERVICES THROUGHOUT THE YEAR THAT THE HOSPITAL BELIEVES SERVES A COMMUNITY NEED. SERVICES PROVIDED FREE OF CHARGE OR BELOW COST TO THE GENERAL PUBLIC INCLUDE: 1. PERIODIC BLOOD PRESSURE AND CHOLESTEROL SCREENS 2. OUTPATIENT DIABETIC EDUCATION 3. FIRST AID CLASSES 4. CPR COURSES 5. CHILDBIRTH CLASSES 6. EMERGENCY PREPAREDNESS COURSES 7. HEALTH EDUCATION ARTICLES IN THE LOCAL NEWSPAPER 8. OTHER HEALTH EDUCATION CLASSES 8. OTHER HEALTH EDUCATION CLASSES
FORM 990, PAGE 6, PART VI, LINE 2ROBERT MITCHELL ELIZABETH JOHNSON DIRECTOR DIRECTOR FAMILY RELATIONSHIP JOHN BOLLINGER LINDA BOYD DIRECTOR DIRECTOR FAMILY RELATIONSHIP BRITT MCCONNELL ROBERT MACGILLIVRAY DIRECTOR TREASURER BUSINESS RELATIONSHIP BRITT MCCONNELL KEITH DAVIDSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP ROBERT MACGILLIVRAY KEITH DAVIDSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JIM CULLISON MICHAEL JONES DIRECTOR DIRECTOR FAMILY RELATIONSHIP
FORM 990, PAGE 6, PART VI, LINE 11BBEFORE THE FORM 990 IS FILED, THE VICE-PRESIDENT OF FINANCE OF THE ORGANIZATION REVIEWS THE FORM 990, WHICH IS PREPARED BY AN OUTSIDE TAX PREPARER. THE FINANCE COMMITTEE OF MISSOURI DELTA MEDICAL CENTER WILL ALSO PERFORM A REVIEW OF THE FORM 990 AFTER THE FORM HAS BEEN FILED. IN ADDITION, COPIES OF THE FORM 990 WILL BE AVAILABLE TO THE MISSOURI DELTA MEDICAL CENTER'S BOARD OF DIRECTORS AFTER THE ORGANIZATIONS' FORM 990 HAS BEEN FILED.
FORM 990, PAGE 6, PART VI, LINE 12CTHE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS AS FOLLOWS: MEMBERS OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS HAVE AN OBLIGATION TO MAKE DECISIONS AND TO PERFORM THEIR DUTIES FOR THE SOLE BENEFIT OF THE HOSPITAL. ALL PERSONS SERVING IN SUCH CAPACITY SHOULD AVOID PLACING HIMSELF/HERSELF IN A POSITION WHERE PERSONAL INTERESTS ARE IN CONFLICT WITH THE INTERESTS OF THE HOSPITAL. THE FOLLOWING DEFINITIONS SHALL APPLY TO THIS POLICY: 1. AN "INTERESTED PERSON" IS A MEMBER OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICE OR MEMBER OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS; 2. A PERSON HAS A "FINANCIAL INTEREST" IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH BUSINESS, INVESTMENT OR FAMILY: A. A PRESENT OR POTENTIAL OWNSERHIP, INVESTMENT, INTEREST, OR COMPENSATION ARRANGEMENT IN ANY ENTITY WITH WHICH THE HOSPITAL HAS OR MAY HAVE A TRANSACTION OR ARRANGEMENT; B. A COMPENSATION ARRANGEMENT WITH THE HOSPITAL OR ANY ENTITY OR INDIVIDUAL WITH WHICH THE ORGANIZATION HAS A TRANSACTION OR ARRANGEMENT. COMPENSATION INCLUES ANY REMUNERATION, DIRECTLY OR INDIRECTLY, AND GIFTS OF FAVORS, WHICH ARE SUBSTANTIAL IN NATURE; 3. AN "AFFILIATED ORGANIZATION" INCLUDES ANY ORGANIZATION OR ENTITY OWNED OR OPERATED BY THE HOSPITAL OR IN WHICH THE HOSPITAL HAS A DIRECT FINANCIAL INTEREST; IF A CONFLICT DOES ARISE, THE HOSPITAL AND ANY AFFILIATED ORGANIZATION SHALL: 1. REQUIRE THAT THE "INTERESTED PERSON" LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST; 2. APPOINT, IF APPROPRIATE, UNDER THE CIRCUMSTANCES THEN APPEARING, A NON- INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 3. DETERMINE, BY A MAJORITY VOTE OF NON-INTERESTED PERSONS PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL OR AFFILIATED ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND IS FAIR AND REASONABLE TO THE HOSPITAL OR AFFILIATED ORGANIZATION. 4. TAKE APPROPRAITE DISCIPLINARY ACTION WITH RESPECT TO AN "INTERESTED PERSON" WHO VIOLATES THIS CONFLICT OF INTEREST POLICY TO PROTECT THE ORGANIZATION'S BEST INTERESTS. THE MINUTES OF ANY MEETING OF THE BOARD OF DIRECTORS OR ANY COMMITTEE WITH BOARD-DELEGATED POWERS SHALL INCLUDE THE FOLLOWING: 1. THE NAMES OF THE PERSONS WHO DISCLOSED FINANCIAL INTERESTS AND THE NATURE OF THEIR FINANCIAL INTEREST; 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT AND RECORD OF THE VOTE. NO PHYSICIAN, WHO RECEIVES COMPENSATION DIRECTLY OR INDIRECTLY FROM THE HOSPITAL OR ANY AFFILIATED ORGANIZATION, SHALL BE A MEMBER OR SERVE ON ANY COMMITTEE DECIDING ON COMPENSATION FOR INDEPENDENT CONTRACTORS OR PRINCIPAL OFFICERS OF THE CORPORATION. NO MEMBER OF ANY COMPENSATION COMMITTEE WHO HAS A CONFLICT OF INTEREST SHALL, DIRECTLY OR INDIRECTLY, VOTE ON MATTERS PERTAINING TO THAT INDIVIDUALS' COMPENSATION. EVERY MEMBER OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS SHALL SIGN AN ANNUAL STATEMENT THAT SUCH PERSON: 1. RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; 2. READ AND UNDERSTANDS THE POLICY; 3. AGREES TO COMPLY WITH THE POLICY; 4. UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5. UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS TAX EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES.
FORM 990, PAGE 6, PART VI, LINE 15ATHE ORGANIZATION'S SALARY AND ADMINISTRATIVE REVIEW COMMITTEE, WHICH IS MADE UP OF MEMBERS OF THE BOARD OF DIRECTORS, REVIEWS THE COMPENSATION FOR THE PRESIDENT AND VICE-PRESIDENTS OF THE MEDICAL CENTER. THE REVIEW OF COMPENSATION UTILIZES THE ANNUAL "EXECUTIVE COMPENSATION REPORT" THAT IS PUBLISHED BY THE MISSOURI HOSPITAL ASSOCIATION. A REVIEW OF THE MISSOURI DELTA MEDICAL CENTER'S PRESIDENT AND VICE-PRESIDENTS WAS CONDUCTED FOR THE YEAR ENDINGS SEPTEMBER 30, 2014.
FORM 990, PAGE 6, PART VI, LINE 15BTHE ORGANIZATION'S SALARY AND ADMINISTRATIVE REVIEW COMMITTEE, WHICH IS MADE UP OF MEMBERS OF THE BOARD OF DIRECTORS, REVIEWS THE COMPENSATION FOR THE PRESIDENT AND VICE-PRESIDENTS OF THE MEDICAL CENTER. THE REVIEW OF COMPENSATION UTILIZES THE ANNUAL "EXECUTIVE COMPENSATION REPORT" THAT IS PUBLISHED BY THE MISSOURI HOSPITAL ASSOCIATION. A REVIEW OF THE MISSOURI DELTA MEDICAL CENTER'S PRESIDENT AND VICE-PRESIDENTS WAS CONDUCTED FOR THE YEAR ENDINGS SEPTEMBER 30, 2014.
FORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATIONS' GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G7,509,255 2,831,823 28,465
FORM 990, PART XI, LINE 9INTEREST RATE SWAP 169,925 TRANSFERS RELATED TO CONSOLIDATION 85,774

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
CONTINU-CARE HOMEMAKER SERVICES
1008 NORTH MAIN STREETSIKESTONMO63801431835384HOME HEALTMO501C39MDMCYes (true)
MISSOURI DELTA MEDICAL CENTER FOUND
1008 NORTH MAIN STREETSIKESTONMO63801431577510FUNDRAISINMO501C311AMDMCYes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1SOUTHEAST MO UROLOGYBusinessNameLine1
Business Name Line2SOUTHEAST MO UROLOGYBusinessNameLine2

US Address USAddress

FieldValueIRS element (for citing)
Address Line11106 NORTH MAINAddressLine1
CitySIKESTONCity
StateMOState
ZIP Code63801ZIPCode
FieldValueIRS element (for citing)
EIN431723563EIN
Primary ActivitiesHEALTH CARPrimaryActivitiesTxt
Legal Domicile StateMOLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MDMCBusinessNameLine1
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Share Of Total Income-$646ShareOfTotalIncomeAmt
Ownership1.00000OwnershipPct
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtBusiness Name Line2OtherOrganizationName/BusinessNameLine2
CONTINU-CARE HOMEMAKER SERVICES INC
R$139,353
MISSOURI DELTA MEDICAL CENTER
C$176,732FOUNDATION
MISSOUR DELTA MEDICAL CENTER
R$89,522FOUNDATION

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