2015-05-12T14:49:59-05:00 2014-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-07-01 430715842 General John J Pershing Memorial Hospital Association % GARY TANDY CFO GENE 6602582222 130 E Lockling PO Box 408 Suite Brookfield MO 64628 PHIL HAMILTON CEO 6602582222 2015-05-15 true Kevin Ensminger CPA P01310558 6602582222 2013 2016-03-07 17:11:31Z PHIL HAMILTON 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 17915603 false X http://www.pershinghealthsystem.com/ X 1955 MO WE CONTINUED TO IMPLEMENT THE STAGES OF OUR ELECTRONIC MEDICAL RECORD SYSTEM. 10 8 192 25 0 0 3310 1226 19236979 17742920 76670 75017 121069 93825 19438028 17912988 8609 9109 0 0 8621000 8470983 0 0 0 10076174 10153657 18705783 18633749 732245 -720761 21152431 20400463 7775620 7744413 13376811 12656050 X SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. false false 2887105 1822 3548585 INPATIENT ACUTE CARE SERVICES WITH 610 INPATIENT ADMISSIONS 8083892 5101 9936035 OUTPATIENT SERVICES WITH APPROXIMATELY 22,978 REGISTRATIONS. THIS INCLUDES 4,978 EMERGENCY ROOM VISITS. 1010486 637 1242004 COMMUNITY MEDICAL ASSOCIATES, OUR PROVIDER BASED RURAL HEALTH CLINIC, WITH BOTH SCHEDULED AND WALK-IN SERVICES, IS OPEN 10 HOURS A DAY MONDAY THRU SATURDAY AND 5 HOURS ON SUNDAY. IT HAD 13,112 VISITS THIS PAST FISCAL YEAR. IT IS A LOWER COST ALTERNATIVE THAN USING THE EMERGENCY ROOM. APPLEGATE MEDICAL GROUP SAW 11,266 PATIENTS AND MEADVILLE MEDICAL CENTER IS OPEN 3 DAYS A WEEK AND SAW 955 PATIENTS. 2454039 1549 3016296 14435522 true false false true false false false false false false true false false false false false true false false false false false false false false false true true true false true false false false false false false true false false false false false false false false false false true 44 0 true 192 true false false false false false false false false false false X 10 8 true true false false true true true true true false false false true true true true true true true false MO X GARY TANDY CFO 6602582222 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 ANGELA P LITTRELL DIRECTOR/SECRETARY 1.0 X X 0 0 0 WILLIAM THUDIUM DIRECTOR/PRESIDENT 1.0 X X 0 0 0 PAUL WILLIAMS DIRECTOR/CONTRACTED PHYSICIAN 1.0 X 0 0 0 GAIL TURNER DIRECTOR/TREASURER 1.0 X X 0 0 0 GARY ROUTLEDGE DIRECTOR 1.0 X 0 0 0 CARY SAYRE DIRECTOR 1.0 X 0 0 0 MARK CLEVELAND DIRECTOR 1.0 X 0 0 0 TOD SYLVARA DIRECTOR/CONTRACTED PHYSICIAN 14.0 X 102830 0 0 JIM ELLIOTT DIRECTOR 1.0 X 0 0 0 DAVID SHAW DIRECTOR/SECRETARY 1.0 X 0 0 0 BRIAN WINN DIRECTOR 1.0 X 0 0 0 PHIL HAMILTON CEO 40.0 X 142559 0 13039 GARY TANDY CFO 40.0 X 105241 0 13834 BRIAN CASEBOLT EMPLOYEE/PHARMACIST 40.0 X 116738 0 36872 GARY FITE EMPLOYEE/PHYS. THERAPIST 40.0 X 118648 0 23886 WACLAW DYMEK EMPLOYED PHYSICIAN 40.0 X 416950 0 22845 GRACE DYMEK EMPLOYED PHYSICIAN 40.0 X 179235 0 2120 DR SP GALVEZ EMPLOYED PHYSICIAN 24.0 X 192959 0 1010 1375160 0 113606 13 false true true BOONE HOSPITAL CENTER MANAGEMENT 207910 DR PEPITO RIVERA PHYSICIAN SERVICES 580233 HAVE A NICE DAY ANESTHESIA ANETHESIOLOGIST 199405 DR GARRETT ELAM PHYSICIAN SERVICES 173880 DR JERRY WAIT PHYSICIAN SERVICES 168070 9 1226 1226 Net Patient Service Rev 621400 17321255 17321255 340B Revenue 900099 421665 421665 17742920 77632 77632 0 0 24843 24843 0 24843 24843 2615 -2615 -2615 -2615 0 0 0 Cafeteria 900099 31588 31588 Miscellaneous income 900099 13441 13441 Vending Machines 900099 23953 23953 68982 17912988 17742920 168842 9109 9109 0 0 0 386485 113260 273225 176070 128531 47539 6168742 4652492 1516250 82335 63562 18773 1191372 885808 305564 465979 340165 125814 0 13481 13481 65818 65818 5549 5549 0 0 3250698 2666710 583988 0 15838 11562 4276 759044 554102 204942 0 0 393073 286943 106130 6539 6539 0 16522 16522 275669 201238 74431 0 1514690 1105724 408966 196796 143661 53135 Bad Debt Expense 1867933 1867933 Medical Supplies 1169484 853723 315761 Taxes & Licenses 46988 46988 Medicaid FRA Payments 503505 503505 52030 47494 4536 18633749 14435522 4198227 0 0 0 6908017 6723106 0 0 3179548 3631472 0 0 0 0 242211 241240 234688 229166 211978 247853 19708637 10779323 10121852 8929314 0 0 0 0 0 0 0 0 254137 398312 21152431 20400463 1179167 1392611 0 0 0 0 0 0 0 0 0 0 6596453 6351802 0 0 0 0 7775620 7744413 X 13366686 12648703 10125 7347 0 0 13376811 12656050 21152431 20400463 -720761 X false true X false false X false false false false false true 5549 false false false 5549 false 107129 107129 13568409 6616613 6951796 5975343 4162710 1812633 57756 57756 8929314 16268751 5540 5540 16263211 1649777 1649777 17912988 16986734 16986734 1647015 1647015 18633749 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER 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, PART XI, LINE 2D NET ASSETS RELEASED FROM RESTRICTIONS $ 5,540 SCHEDULE D, PART XI, LINE 4B RESTRICTED CONTRIBUTIONS RECEIVED $ 2,762 PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,647,015 ----------- TOTAL $ 1,649,777 SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,647,015 true true true X 133. true X 213. true true false true true 140800 140800 0.00830 2792909 2201815 591094 0.03480 2933709 2201815 731894 0.04310 15714 19264 -3550 4999 4999 0.00030 20713 19264 1449 0.00030 2954422 2221079 733343 0.04340 true 1867933 247000 7938076 7894993 43083 X true true 1 1 GENERAL JOHN J PERSHING MEM HOSPITAL 130 E LOCKLING AVE PO BOX 408 BROOKFIELD MO 64628 X X X X COMMUNITY MED ASSOC APPLEGATE MED GROUP MEADVILLE MED CLINIC GENERAL JOHN J PERSHING MEM HOSPITAL 1 true X X X X X X X X X 12 true false true X http://www.pershinghealthsystem.com/ X X X X X X X true false true true 133. true 213. true X X X X X X true true X X X X X X true false X X X X true X false false PART V, SECTION B, LINE 3 THE HOSPITAL RECEIVED INPUT FROM SEVERAL REPRESENTATIVES FROM THE COMMUNITY INCLUDING INDEPENDENT HEALTHCARE PROFESSIONALS, COUNTY HEALTH DEPARTMENT OFFICIALS, PERSHING MEMORIAL HOSPITAL EMPLOYEES, AND OTHER MEMBERS OF THE COMMUNITY. PART V, SECTION B, LINE 20D THE HOSPITAL FACILITY DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY TAKING MANAGED CARE CONTRACTUAL WRITE OFFS DIVIDED BY MANAGE CARE REVENUES. 3 COMMUNITY MEDICAL ASSOCIATES 130 E LOCKLING AVE BROOKFIELD MO 64628 PROVIDER BASED RURAL HEALTH CLINIC APPLEGATE MEDICAL GROUP 125 E LOCKLING AVE BROOKFIELD MO 64628 PROVIDER BASED RURAL HEALTH CLINIC MEADVILLE MEDICAL CLINIC 101 E HAYWARD MEADVILLE MO 64659 PROVIDER BASED RURAL HEALTH CLINIC PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS 1,867,933. PART I, LINE 7 THE COST-TO-CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. PART III, SECTION A, LINE 2 BAD DEBT EXPENSE IS THAT PORTION OF ANY SELF SERVICE BALANCE REFERRED ON FOR OUTSIDE COLLECTION SERVICES, AND THAT EITHER DID NOT APPLY OR DID NOT QUALIFY UNDER OUR CHARITY CARE POLICY. THE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATE (TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY). THE HOSPITAL'S CHARITY CARE POLICY IS FOUNDED ON THE FEDERAL POVERTY INCOME GUIDELINES. ACCOUNTS AND AMOUNTS DETERMINED TO MEET THIS CRITERIA ARE NOT REPORTED AS NET REVENUE AND ARE NOT PURSUED FOR COLLECTION. PART III, SECTION A, LINE 3 USED THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 AND APPLIED THAT PERCENTAGE TO NET BAD DEBTS TO ARRIVE AT AN ESTIMATED COST OF BAD DEBT. THEN, PER COLLECTIOIN SUPERVISOR'S ESTIMATE, APPLIED 15% TO THE NET BAD DEBTS TO ARRIVE AT ESIMATED COST THAT COULD BE CHARITY. PART III, SECTION A, LINE 4 PLEASE SEE NOTE 1 BEGINNING ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 9B WE HAVE A FINANCIAL ASSISTANCE POLICY AND COLLECTION POLICY THAT COVERS CRITERIA FOR PAYMENT ARRANGEMENTS AND FOR PARTIAL OR FULL CHARITY CARE WRITE-OFF. NEEDS ASSESSMENT PERSHING IS A SMALL RURAL CRITICAL ACCESS HOSPITAL AND AS SUCH RECEIVES CONTINUOUS FEEDBACK FROM THE PATIENTS WE SERVE, OUR PHYSICIANS, OTHER MEDICAL PROVIDERS, BOARD MEMBERS (WHO REPRESENT A WIDE REPRESENTATION OF OUR COMMUNITY), AND FROM VARIOUS ONGOING PATIENT SATISFACTION SURVEYS. SUCH SURVEYS ARE REPORTED AT BOARD MEETINGS AND DISTRIBUTED TO ALL HOSPITAL DEPARTMENTS. YOU CAN FIND THE HOSPITAL'S STRATEGIC PLAN AT http://www.pershinghealthsystem.com/. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY (FAP) IS ON OUR WEBSITE. THE FAP, CHARITY CARE AND COLLECTION (PAYMENT ARRANGEMENTS) INFORMATION IS AVAILABLE THROUGH OUR COLLECTION PERSONNEL AND OTHERS AT PERSHING HOSPITAL AND THROUGH OUR WALK-IN CLINIC, COMMUNITY MEDICAL ASSOCIATES, AT APPLEGATE MEDICAL GROUP, AND MEADVILLE MEDICAL CLINIC. FURTHER, WE PRINT A REFERENCE TO OUR FAP POLICY ON THE FRONT OF EACH PATIENT BILLING STATEMENT SENT OUT. SOCIAL SERVICES - THROUGH THE ASSESSMENT/CONSULTATION PROCESS, IDENTIFIES AND ASSISTS IN THE APPLICATION PROCESS FOR INDIVIDUALS. COMMUNITY INFORMATION PERSHING HEALTH SYSTEM SERVES LINN COUNTY (POPULATION OF AROUND 13,000) AND SURROUNDING AREA. IT IS MADE UP OF RURAL COMMUNITIES WITH A MIXTURE OF BUSINESSES AND AGRICULTURE. PROMOTION OF COMMUNITY HEALTH "PROMOTING THE HEALTH OF THE COMMUNITY" WE OPERATE THREE (3) PROVIDER BASED RHCS: 1) APPLEGATE MEDICAL GROUP, WHICH INCLUDES THE ONLY LOCALLY AVAILABLE PEDIATRICIAN. IT ALSO INCLUDES AN INTERNAL MEDICINE PHYSICIAN. 2) COMMUNITY MEDICAL ASSOCIATES, LOCATED WITHIN THE HOSPITAL BUILDING, AND OPEN 7 DAYS A WEEK. PROVIDED CLINICAL ROTATION SITE FOR MEDICAL STUDENTS, NURSE PRACTITIONERS, NURSING, AND PHYSICAL THERAPY STUDENTS. PROVIDED JOB SHADOWING AND CLINICAL ROTATIONS TO THE AREA CAREER CENTERS. PROVIDE FREE SPORTS PHYSICALS AT THE BEGINNING OF EACH SCHOOL YEAR. NURSE PRACTITIONERS PROVIDE WELL CHILD EXAMS YEARLY AT THE LINN CO. HEALTH DEPT. 3) MEADVILLE MEDICAL CLINIC, 12 MILES FROM THE HOSPITAL, SERVES ONE OF THE SMALL COMMUNITIES WITHIN OUR SERVICE AREA WITH A 3 DAY A WEEK NURSE PRACTITIONER. HOSPITAL WEEK, ANNUAL PUBLIC EVENT DONE AT THE LOCAL (BROOKFIELD) YMCA AND AT MARCELINE BETHANY BAPTIST CHURCH: -PROCESSED 585 BLOOD DRAWS; OCCUPATIONAL THERAPY HEALTH BOOTH; BLOOD PRESSURES AND PULSE OXIMETRY TESTS WERE PERFORMED. PROMOTED ADVANCED DIRECTIVES INFORMATIONAL PACKETS. SPONSOR OF A YMCA YOUTH ATHLETIC TEAM. OTHER HEALTH FAIRS AND EVENTS: -CONDUCTED FAIRS AT OTHER BUSINESSES IN OUR SERVICE AREA. TOURS: -TOURS OF THE HOSPITAL WERE CONDUCTED THIS YEAR WITH AREA SCHOOLS - A ONCE A YEAR PUBLIC EVENT WHICH LETS US PROMOTE THE POSITIVE ASPECTS OF PERSHING HEALTH SYSTEM. NEWSPAPER ARTICLES: -RADIOLOGY-PERIPHERAL ARTERY DISEASE SCREENING; RHC-EFFECTS OF THE AFFORDABLE CARE ACT; SOCIAL SERVICES -COMMUNITY HEALTH NEEDS; OCCUPATIONAL THERAPY-O.T. AND THE PAINFUL SHOULDER; SPEECH AND LANGUAGE THERAPY SERVICES; CARDIAC AND PULMONARY REHAB PATIENTS; GERD; LAB- COMMUNITY BASED HEALTH SCREENINGS. -NUMEROUS OTHER MINOR CONTRIBUTIONS TO THE GENERAL WELFARE AND SAFETY OF OUR COMMUNITY. false SCHEDULE I, PART I, LINE 2 THE ORGANIZATION DOES NOT MONITOR THE USE OF THE CONTRIBUTION AS THE REQUESTED FUNDS ARE FOR STATED OPERATING COSTS, SUCH AS USAGE OF THE ORGANIZATION, STAFF PAYROLL, ETC. SCHEDULE I, PART II THE ORGANIZATION MADE NO GRANTS OVER $5,000 TO ANY GOVERNMENT OR ORGANIZATION IN THE UNITED STATES. X false false false false false false false false false PHIL HAMILTON CEO 121073 0 19858 0 1628 0 2664 0 10375 0 155598 0 0 0 BRIAN CASEBOLT EMPLOYEE/PHARMACIST 110095 0 0 0 6643 0 2169 0 34703 0 153610 0 0 0 WACLAW DYMEK EMPLOYED PHYSICIAN 346393 0 70557 0 0 0 1452 0 21394 0 439796 0 0 0 GRACE DYMEK EMPLOYED PHYSICIAN 179235 0 0 0 0 0 1085 0 1035 0 181355 0 0 0 DR SP GALVEZ EMPLOYED PHYSICIAN 192959 0 0 0 0 0 0 0 1010 0 193969 0 0 0 FORM 990, PART VII, LINE 5 PHIL HAMILTON RECEIVED $155,598 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. DR KAREN SYLVARA SPOUSE OF DIRECTOR 140455 INDEPENDENT CONTRACTOR false JENNIFER THUDIUM DAUGHTER-IN-LAW OF DIR 35615 EMPLOYEE false FORM 990, PART III, LINE 4D THE HOSPITAL ALSO ADVANCES THE QUALITY OF LIFE IN THE RURAL AREA THROUGH PUBLIC EDUCATION REGARDING HEALTH CARE ISSUES, PROMOTING HEALTHY LIFESTYLES AND PROVISION OF HEALTH SCREENING. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR THE OPERATION AND MANAGEMENT OF THE HOSPITAL. THE MANAGEMENT AGREEMENT PROVIDES DAILY OPERATING AUTHORITY TO THE MANAGEMENT COMPANY AND CEO SERVICES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CLASS OF ASSOCIATION MEMBERSHIP. ALL MEMBERS OF THE CORPORATION ARE ENTITLED TO VOTE IN PERSON AT ALL MEETINGS OF MEMBERSHIP. THE MEETING OF MEMBERSHIP IS AN ANNUAL MEETING HELD ON THE FOURTH MONDAY IN JUNE. MEMBERS OF THIS CORPORATION HAVE THE RIGHT TO ELECT THE MEMBERS OF THE BOARD OF DIRECTORS AT THIS MEETING. MEMBERS ARE NOT ENTITLED TO RECEIVE A SHARE OF THE CORPORATIONS PROFITS, EXCESS DUES OR A SHARE OF THE CORPORATIONS NET ASSETS UPON DISSOLUTION. FORM 990, PART VI, SECTION A, LINE 7A & 7B MEMBERS OF THE CORPORATION HAVE THE RIGHT TO ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS AT THE ANNUAL MEETING OF MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE FORM 990 IS THEN REVIEWED BY OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS THEY HAVE ARE ADDRESSED. THE FORM 990 IS THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY AND THE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE IS DISTRIBUTED ANNUALLY TO THE BOARD OF DIRECTORS AND OFFICERS. THE QUESTIONNAIRE IS COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IN SUCH A CASE THAT A CONFLICT OF INTEREST DOES OCCUR, THE DISCLOSING INDIVIDUAL WITH THE CONFLICT OF INTEREST DOES NOT ATTEND ANY MEETINGS OR DISCUSSIONS REGARDING THE MATTER. THE DISCLOSING INDIVIDUAL DOES NOT VOTE OR ENDEAVOR TO INFLUENCE CORPORATE ACTION IN ANY SUCH MATTER. FORM 990, PART VI, SECTION B, LINE 15A & 15B THE CEO'S COMPENSATION IS INCLUDED IN THE INDEPENDENT CONTRACT FEE TO BOONE HOSPITAL. BOONE HOSPITAL DETERMINES AND PAYS HIS COMPENSATION. THE INDEPENDENT CONTRACTOR FEE IS APPROVED BY THE FILING ORGANIZATION'S BOARD OF DIRECTORS. THE CEO DETERMINES THE CFO'S COMPENSATION ANNUALLY. COMPENSATION SURVEYS ARE USED TO EVALUATE COMPENSATION LEVELS. THE CEO CONDUCTS AN ANNUAL EVALUATION OF KEY MANAGEMENT STAFF. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1653034 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:23854 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:1573810