2014-05-13T10:47:34-05:00 2013-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2012-07-01 320290671 LEWIS AND CLARK INFORMATION EXCHANGE % MICHAEL DITTEMORE LEWI 8162146894 12200 NW AMBASSADOR DRIVE Suite 232 KANSAS CITY MO 64143 MICHAEL DITTEMORE 8162146894 2014-05-15 true Michael J Engle 8162216300 2012 2016-03-07 17:11:31Z X MICHAEL DITTEMORE 12200 NW AMBASSADOR DRIVE KANSAS CITY MO 64143 538557 false X WWW.LACIE-HIE.COM X 2009 MO COORDINATION OF HEALTH INFORMATION SHARING FOR BETTER UNDERSTANDING OF THE PATIENT'S MEDICAL HISTORY. 11 11 0 11 0 0 0 239409 196352 299148 0 0 0 0 196352 538557 0 112000 0 0 537347 385725 0 0 0 302082 316369 839429 814094 -643077 -275537 1717 1180013 963651 1093111 -961934 86902 COORDINATION OF HEALTH INFORMATION SHARING FOR BETTER UNDERSTANDING OF THE PATIENT'S MEDICAL HISTORY. false false 755364 112000 299148 COORDINATION OF HEALTH INFORMATION SHARING FOR BETTER UNDERSTANDING OF THE PATIENT'S MEDICAL HISTORY. 755364 true true false false false false false false false false false false false false true false true false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true 0 0 0 false false false false false false false false false false X 11 11 true false true false true true true true true false false true true true true true true true true false X MICHAEL DITTEMORE 8162146894 12200 NW AMBASSADOR DRIVE STE 232 KANSAS CITY MO 64143 GREG ATOR MD 1.0 X 0 0 0 LAURA FITZMAURICE MD 1.0 X 0 0 0 JACK WAGNER 1.0 X 0 0 0 JOE BOYCE MD 1.0 59.0 X X 0 405396 77761 MITZI CARDENAS 1.0 X 0 0 0 DAVID NILL MD 1.0 X 0 0 0 JILL WATSON 1.0 X 0 0 0 BEN ERNST 1.0 X 0 0 0 HAROLD JOHNSON 1.0 X 0 0 0 AL SINISI 1.0 X 0 0 0 JENNIFER KOZINN 1.0 X 0 0 0 DIRCK CLARK 1.0 59.0 X X 0 354135 63789 LINDA BAHRKE 1.0 59.0 X 0 292596 69619 BRIAN BRADLEY 1.0 X 0 0 0 JON DOOLITTLE 1.0 X 0 0 0 DEBBIE GASH 1.0 X 0 0 0 CLAY PATTERSON 1.0 X 0 0 0 SAM TURNER 1.0 X 0 0 0 MICHAEL DITTEMORE 50.0 X 88016 0 10114 JEFFREY BLOEMKER 60.0 X 141356 0 27519 DOUGLAS BRANDT 1.0 59.0 X 0 264270 77509 JOHN P WILSON 1.0 59.0 X 0 667480 88988 HELEN THOMPSON X 0 218945 10528 229372 2202822 425827 1 true true false CERNER CORPORATION SOFTWARE SYSTEMS 105000 1 239409 239409 PROGRAM SERVICE REVENUE 518210 299148 299148 299148 0 0 0 0 0 0 0 0 0 0 0 538557 299148 112000 112000 0 0 0 142030 142030 0 189542 156764 32778 13189 13189 15962 10402 5560 25002 23527 1475 0 103510 101254 2256 0 0 0 0 167995 158132 9863 0 0 12917 11587 1330 0 0 14775 11820 2955 8451 6761 1690 0 3639 3639 0 0 0 4836 4063 773 Miscellaneous expenses 246 196 50 814094 755364 58730 0 1717 1148515 0 0 0 0 0 14281 0 0 0 0 0 0 0 0 0 14748 0 0 0 0 0 0 0 0 0 0 2469 1717 1180013 49972 73373 0 0 0 1019738 0 0 0 0 0 0 0 0 0 0 913679 0 963651 1093111 X -961934 86902 0 0 0 0 -961934 86902 1717 1180013 X -275537 1324373 X false true X true false X 0 0 0 0 239409 239409 327213 359949 196352 299148 1182662 0 0 0 0 327213 359949 196352 538557 1422071 0 317213 337239 170452 244446 1069350 317213 337239 170452 244446 1069350 352721 0 0 0 0 0 0 327213 359949 196352 538557 1422071 X 0.00000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 UNCERTAIN TAX POSITIONS DISCLOSURE 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. true HIAWATHA COMMUNITY HOSPITAL 300 UTAH STREET HIAWATHA KS 66434 480577658 501(C)(3) 9000 SET-UP COSTS ANTHONY MEDICAL CENTER 1101 E SPRING STREET ANTHONY KS 67003 480993940 501(C)(3) 60000 SET-UP COSTS UNIVERSITY OF KANSAS MEDICAL CENTER 3901 RAINBOW BLVD KANSAS CITY KS 66160 481202402 GOVERNMENT 43000 FMV MONTHLY SVC FEES MEMBER SERVICE FEES 3 PROCESS FOR MONITORING THE USE OF GRANTS IN THE U.S. SCHEDULE I, PART I, LINE 2 CASH GRANTS FOR EXPENSE REIMBURSEMENTS REQUIRE THE SUBMISSION OF DETAILED INVOICES/RECEIPTS WITH PAID CHECK COPIES. THESE ARE COMPARED TO ALLOWABLE COSTS, AND REIMBURSEMENT IS MADE FOR THOSE ALLOWABLE EXPENDITURES. NON-CASH GRANTS ARE FOR MEMBER SERVICE FEES. NO MONITORING IS NECESSARY. X true true false false false false false false JOE BOYCE MD 0 314774 0 85833 0 4789 0 58930 0 18831 0 483157 0 0 DIRCK CLARK 0 234845 0 56880 0 62410 0 45409 0 18380 0 417924 0 0 LINDA BAHRKE 0 215432 0 30394 0 46770 0 47197 0 22422 0 362215 0 0 JEFFREY BLOEMKER 123828 0 14017 0 3511 0 5753 0 21766 0 168875 0 0 0 DOUGLAS BRANDT 0 222791 0 35197 0 6283 0 58315 0 19194 0 341779 0 0 JOHN P WILSON 0 403494 0 124620 0 139366 0 88988 0 0 0 756468 0 0 HELEN THOMPSON 0 59293 0 0 0 159652 0 4055 0 6473 0 229473 0 0 SEVERENCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT SCHEDULE J, PART I, LINE 4A HELEN THOMPSON $129,880 SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B JOHN WILSON 78,988 DOUGLAS BRANDT 48,459 DIRCK CLARK 34,090 JOE BOYCE, MD 48,487 LINDA BAHRKE 36,357 FOR JOE BOYCE,MD, JOHN P. WILSON, DIRCK CLARK, DOUGLAS BRANDT, AND LINDA BAHRKE THE COMPENSATION WAS PROVIDED BY HEARTLAND REGIONAL MEDICAL CENTER. INCLUDED IN THE DEFERRED COMPENSATION ARE EMPLOYER CONTRIBUTIONS INTO QUALIFIED PLANS AND NON-QUALIFIED DEFERRED COMPENSATION PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE AND SEVERANCE THAT IS PROVIDED WITHIN THE EXECUTIVE'S EMPLOYMENT AGREEMENT. THEREFORE, AMOUNTS MAY NEVER BE PAID. HELEN THOMPSON RECEIVED A SEVERANCE PAYMENT AFTER SEPARATING FROM HEARTLAND REGIONAL MEDICAL CENTER PER HER EMPLOYMENT CONTRACT. COMPENSATION OF CHIEF OPERATING OFFICER FORM 990, PART VII & SCHEDULE J, PART II Helen Thompson was employed as CIO for Heartland Regional Medical Center and terminated in January 2011. Her severance package included compensation through June 2012. As a part of her duties as CIO, she also served as Director and CEO of LACIE; no additional compensation was earned. BUSINESS/FAMILY RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 JOHN P. WILSON, DOUG BRANDT, DIRCK CLARK, KAREN DITTEMORE, JOE BOYCE, MD AND LINDA BAHRKE ARE ALL EMPLOYEES OF A PAST AFFILIATE, HEARTLAND REGIONAL MEDICAL CENTER. SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE APRIL 1, 2013, HEARTLAND HEALTH WITHDREW FROM ITS POSITION AS SOLE MEMBER OF LACIE, AND LACIE IS NOW GOVERNED BY A SELF-PERPETUATING BOARD. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 HEARTLAND HEALTH, A MISSOURI NONPROFIT CORPORATION, WAS THE SOLE MEMBER OF LEWIS AND CLARK INFORMATION EXCHANGE FOR NINE MONTHS ENDING MARCH 31, 2013. HEARTLAND HEALTH HAD THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF LEWIS AND CLARK INFORMATION EXCHANGE. HEARTLAND HEALTH WAS NOT ENTITLED TO RECEIVE A SHARE OF LEWIS AND CLARK INFORMATION EXCHANGE'S PROFITS, EXCESS DUES, OR ASSETS UPON DISSOLUTION. AS OF APRIL 1, 2013 LEWIS AND CLARK INFORMATION EXCHANGE HAS NO MEMBERS OR STOCKHOLDERS. MEMBERS OR STOCKHOLDERS MAY ELECT GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A HEARTLAND HEALTH WAS THE SOLE MEMBER OF LEWIS AND CLARK INFORMATION EXCHANGE UNTIL MARCH 31, 2013 AND HAD THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS. AS OF APRIL 1, 2013, HEARTLAND HEALTH HAS THE RIGHT TO NOMINATE AND ELECT 10% OF THE TOTAL NUMBER OF DIRECTORS UNTIL SUCH TIME SPECIFIED IN THE SEPARATION AGREEMENT. GOVERNING BOARD DECISIONS SUBJECT TO APPROVAL OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 7B FOR JULY, 2012 THROUGH MARCH, 2013, THE CORPORATE BYLAWS OF LEWIS AND CLARK INFORMATION EXCHANGE IDENTIFIED CERTAIN RIGHTS AND POWERS WHICH WERE RESERVED TO HEARTLAND HEALTH, THE SOLE MEMBER. IN EACH INSTANCE, THE RIGHTS AND POWERS RESERVED TO THE SOLE MEMBER MAY BE SUMMARIZED AS FOLLOWS: A. OVERALL STRATEGIC DIRECTION B. ELECTION OF BOARD MEMBERS C. APPOINTMENT OF THE PRESIDENT, OTHER SENIOR OFFICERS, AUDITORS, AND LEGAL COUNSEL D. ESTABLISHMENT OF BANKING RELATIONSHIPS E. MANAGEMENT OF CASH AND OTHER ASSETS F. APPROVAL OF CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS G. LONG-RANGE PLANNING H. ADOPTION OF ANNUAL OPERATING BUDGETS FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION A, LINE 11B RETURNS ARE PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, REVIEWED BY THE TREASURER AND ASSISTANT TREASURER AND THEN POSTED TO A WEBSITE FOR REVIEW BY DIRECTORS PRIOR TO FILING. MONITORING OF CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C UPON AGREEING TO FILL A BOARD POSITION, THE PROSPECTIVE MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST DOCUMENT WHICH DISCLOSES FAMILY AND BUSINESS RELATIONSHIPS THAT COULD BE CONSIDERED IN CONFLICT WITH THEIR POSITION ON THE BOARD. IN THIS DOCUMENT, THEY AGREE THAT THEY WILL DISCLOSE ANY ACTIVITIES IN WHICH THEY MAY NOT BE INDEPENDENT IN REGARDS TO A TRANSACTION. THIS DOCUMENT IS DISTRIBUTED AND HELD BY LEGAL COUNSEL. ANNUALLY, THE CORPORATE COMPLIANCE OFFICER DISTRIBUTES A SURVEY TO EACH BOARD MEMBER TO FACILITATE DISCLOSURE OF ANY REPORTABLE ACTIVITIES. DURING THE COURSE OF BOARD MEETINGS, BOARD MEMBERS WILL DISMISS THEMSELVES FROM MEETINGS AND/OR ABSTAIN FROM VOTING DURING DISCUSSIONS OF ISSUES THAT RELATE TO THOSE SPECIFIC MEMBERS OR THE COMPANIES THAT THEY REPRESENT. ALL DISMISSALS AND ABSTENTIONS ARE RECORDED IN THE MINUTES OF THE BOARD MEETING. ANNUALLY, THE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO ETHICAL BEHAVIOR AND ADHERING TO CONFIDENTIALITY POLICIES. THEY ALSO RECIEVE A QUESTIONNAIRE WHICH FACILITATES THE DISCLOSURE OF ANY REPORTABLE ACTIVITIES TO THE CORPORATE COMPLIANCE OFFICER. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE COMPENSATION ANNUALLY DURING THE BUDGET PROCESS. THE FINANCE COMMITTEE CONSIDERS EXTERNAL FACTORS SUCH AS COMPENSATION FOR LIKE POSITIONS IN THE MARKET AREA OBTAINED FROM COBALT ASTRA, A HUMAN RESOURCES CONSULTING FIRM. THEY ALSO REVIEW INFLATION AND COST OF LIVING CHANGES. THE FINANCE COMMITTEE MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS REGARDING COMPENSATION MATTERS. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. RECONCILIATION OF NET ASSETS FORM 990, PART XII, LINE 9 DECONSOLIDATION FROM HEARTLAND HEALTH $ 1,324,373 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:158537 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:9458 HEARTLAND HEALTH 5325 FARAON ST JOSEPH MO 64506 431283316 HEALTH CARE MO 501(C)(3) 11a NA false HEARTLAND FOUNDATION 5325 FARAON ST JOSEPH MO 64506 431262768 SUPPORT MO 501(C)(3) 9 HH true HEARTLAND LONG TERM ACUTE CARE HOSPITAL 5325 FARAON ST JOSEPH MO 64506 261972987 HEALTH CARE MO 501(C)(3) 3 HH true HEARTLAND REGIONAL MEDICAL CENTER 5325 FARAON ST JOSEPH MO 64506 440545289 HEALTH CARE MO 501(C)(3) 3 HH true REGIONAL EMERGENCY MEDICAL SERVICE 5325 FARAON ST JOSEPH MO 64506 273923442 AMBULANCE SVC MO 501(C)(3) 9 HH true HEARTLAND HEALTH CARE PLAN TRUST FUND 5325 FAROAN ST JOSEPH MO 64506 431286484 EMP BENEFITS MO 501(C)(9) HH true MIDWESTERN HEALTH MANAGEMENT INC 5325 FARAON ST JOSEPH MO 64506 431264358 HEALTH CARE MO HH C - CORPORATION 0 0 true COMMUNITY HEALTH PLAN 5325 FARAON ST JOSEPH MO 64506 431690582 INSURANCE MO HH C - CORPORATION 0 0 true COMMUNITY HEALTH PLAN INSURANCE COMPANY 5325 FARAON ST JOSEPH MO 64506 431210152 INSURANCE MO HH C - CORPORATION 0 0 true HHS PROPERTIES INC 5325 FARAON ST JOSEPH MO 64506 431593799 DEVELOPMENT MO HH C - CORPORATION 0 0 true UPTOWN HOUSING INC 5325 FARAON ST JOSEPH MO 64506 261416252 DEVELOPMENT MO HH C - CORPORATION 0 0 true UPTOWN ST JOSEPH REDEVELOPMENT 5325 FARAON ST JOSEPH MO 64506 201742813 DEVELOPMENT MO HH C - CORPORATION 0 0 true SHOAL CREEK FAMILY MEDICINE AND ALLERGY 5325 FARAON ST JOSEPH MO 64506 010754265 HEALTH SVC.S MO HH C - CORPORATION 0 0 true false false true false true false false false false false true true true false false true false false false HEARTLAND REGIONAL MEDICAL CENTER C 395170 FMV HEARTLAND REGIONAL MEDICAL CENTER M 52434 FMV HEARTLAND REGIONAL MEDICAL CENTER P 505742 FMV