GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION (EIN 43-0715842)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201421349349305677
- Schema version
- 2012v2.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-14T14:34:57-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 430715842 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | General John J Pershing | BusinessNameLine1 |
| Business Name Line2 | Memorial Hospital Association | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % GARY TANDY CFO | InCareOfName |
| Name Control | GENE | NameControl |
| Phone | 6602582222 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E Lockling | AddressLine1 |
| Address Line2 | PO Box 408 Suite | AddressLine2 |
| City | Brookfield | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PHIL HAMILTON | Name |
| Title | CEO | Title |
| Phone | 6602582222 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PHIL HAMILTON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E LOCKLING PO BOX 408 | AddressLine1 |
| City | BROOKFIELD | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19443172 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | MO | StateLegalDomicile |
| Activity Or Mission Description | WE CREATED A NEW RURAL HEALTH CLINIC AND ADDED AN OCCUPATIONAL THERAPY UNIT TO OUR FACILITY. WE ALSO CONTINUED TO IMPLEMENT THE ELECTRONIC MEDICAL RECORD SYSTEM. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 187 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 42953 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3310 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17635299 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19236979 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 53855 | InvestmentIncomePriorYear |
| Investment Income Current Year | 76670 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 173728 | OtherRevenuePriorYear |
| Other Revenue Current Year | 121069 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17905835 | TotalRevenuePriorYear |
| Total Revenue Current Year | 19438028 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 9407 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 8609 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8219236 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8621000 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10214203 | OtherExpensePriorYear |
| Other Expenses Current Year | 10076174 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 18442846 | TotalExpensesPriorYear |
| Total Expenses Current Year | 18705783 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -537011 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 732245 | RevenuesLessExpensesCY |
| Total Assets BOY | 20792539 | TotalAssetsBOY |
| Total Assets EOY | 21152431 | TotalAssetsEOY |
| Total Liabilities BOY | 8147973 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7775620 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 12644566 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13376811 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2884298 | Expense |
| Grants | 1721 | Grants |
| Revenue | 3814264 | Revenue |
| Description | INPATIENT ACUTE CARE SERVICES WITH 748 INPATIENT ADMISSIONS | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 8076033 | Expense |
| Grants | 4821 | Grants |
| Revenue | 10679938 | Revenue |
| Description | OUTPATIENT SERVICES WITH APPROXIMATELY 22,964 REGISTRATIONS. THIS INCLUDES 4,854 EMERGENCY ROOM VISITS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1009504 | Expense |
| Grants | 603 | Grants |
| Revenue | 1334992 | Revenue |
| Description | 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 15,768 VISITS THIS PAST FISCAL YEAR. IT IS A LOWER COST ALTERNATIVE THAN USING THE EMERGENCY ROOM. APPLEGATE MEDICAL GROUP SAW 10,021 PATIENTS. OUR NEW CLINIC, MEADVILLE MEDICAL CENTER IS OPEN 3 DAYS A WEEK AND SAW 909 PATIENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 2451653 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 1464 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 3407785 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 14421488 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 44 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 187 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MO | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | GARY TANDY CFO | NamePerson |
| Telephone Number | 6602582222 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E LOCKLING PO BOX 408 | AddressLine1 |
| City | BROOKFIELD | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ANGELA P LITTRELL | |||||||
| DIRECTOR/SECRETARY | 1.0 | X | X | ||||
| WILLIAM THUDIUM | |||||||
| DIRECTOR/ PRESIDENT | 1.0 | X | X | ||||
| PAUL WILLIAMS | |||||||
| DIRECTOR/CONTRACTED PHYSICIAN | 1.0 | X | |||||
| GAIL TURNER | |||||||
| DIRECTOR/TREASURER | 1.0 | X | X | ||||
| GARY ROUTLEDGE | |||||||
| DIRECTOR | 1.0 | X | |||||
| CARY SAYRE | |||||||
| DIRECTOR | 1.0 | X | |||||
| MARK CLEVELAND | |||||||
| DIRECTOR | 1.0 | X | |||||
| TOD SYLVARA | |||||||
| DIRECTOR/CONTRACTED PHYSICIAN | 40.0 | X | 133665 | ||||
| JIM ELLIOTT | |||||||
| DIRECTOR | 1.0 | X | |||||
| DAVID SHAW | |||||||
| DIRECTOR | 1.0 | X | |||||
| PHIL HAMILTON | |||||||
| CEO | 40.0 | X | 141428 | 0 | 9999 | ||
| GARY TANDY | |||||||
| CFO | 40.0 | X | 109144 | 13426 | |||
| BRIAN CASEBOLT | |||||||
| EMPLOYEE/PHARMACIST | 40.0 | 114845 | 30122 | X | |||
| GARY FITE | |||||||
| EMPLOYEE/PHYS. THERAPIST | 40.0 | 123501 | 26602 | X | |||
| WACLAW DYMEK | |||||||
| EMPLOYED PHYSICIAN | 40.0 | 350291 | 25561 | X | |||
| GRACE DYMEK | |||||||
| EMPLOYED PHYSICIAN | 40.0 | 174996 | 2120 | X | |||
| DR SP GALVEZ | |||||||
| EMPLOYED PHYSICIAN | 24.0 | 209874 | 1010 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1357744 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 108840 | TotalOtherCompensation |
| Number Individuals GT100 K | 16 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | true | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| BOONE HOSPITAL CENTER | |
| MANAGEMENT | 245672 |
| DR PEPITO RIVERA | |
| PHYSICIAN SERVICES | 521420 |
| HAVE A NICE DAY ANESTHESIA | |
| ANETHESIOLOGIST | 192655 |
| DR B K KNOWLES | |
| PHYSICIAN SERVICES | 188325 |
| DR JERRY WAIT | |
| PHYSICIAN SERVICES | 185850 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| All Other Contributions | 3310 | AllOtherContributions |
| Total Contributions | 3310 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient Service Rev | 621400 | 19071318 | 19071318 |
| 340B REVENUE | 900099 | 165661 | 165661 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19236979 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 81814 | TotalRevenueColumn |
| Exclusion | $81,814 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25911 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25911 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25911 | TotalRevenueColumn |
| Exclusion | $25,911 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5144 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -5144 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -5144 | TotalRevenueColumn |
| Exclusion | -$5,144 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria | 900099 | 30413 | $30,413 |
| MISCELLANEOUS INCOME | 900099 | 30644 | $30,644 |
| Vending Machines | 900099 | 34101 | $34,101 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 95158 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19438028 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19236979 | RelatedOrExemptFunctionIncome |
| Exclusion | $197,739 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8609 | Total |
| Program Services | 8609 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 407348 | Total |
| Program Services | 128415 | ProgramServices |
| Management And General | 278933 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104328 | Total |
| Program Services | 76159 | ProgramServices |
| Management And General | 28169 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6284967 | Total |
| Program Services | 4740062 | ProgramServices |
| Management And General | 1544905 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78874 | Total |
| Program Services | 61171 | ProgramServices |
| Management And General | 17703 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1275208 | Total |
| Program Services | 944221 | ProgramServices |
| Management And General | 330987 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 470275 | Total |
| Program Services | 343301 | ProgramServices |
| Management And General | 126974 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107230 | Total |
| Management And General | 107230 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105587 | Total |
| Management And General | 105587 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4453 | Total |
| Management And General | 4453 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3254895 | Total |
| Program Services | 2744825 | ProgramServices |
| Management And General | 510070 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16206 | Total |
| Program Services | 11830 | ProgramServices |
| Management And General | 4376 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 725822 | Total |
| Program Services | 529850 | ProgramServices |
| Management And General | 195972 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 399263 | Total |
| Program Services | 291462 | ProgramServices |
| Management And General | 107801 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5003 | Total |
| Management And General | 5003 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8129 | Total |
| Management And General | 8129 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 285691 | Total |
| Program Services | 208554 | ProgramServices |
| Management And General | 77137 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1686417 | Total |
| Program Services | 1231084 | ProgramServices |
| Management And General | 455333 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193036 | Total |
| Program Services | 140916 | ProgramServices |
| Management And General | 52120 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt Expense | 1728073 | 1728073 | |
| Medical Supplies | 994169 | 725743 | 268426 |
| Taxes & Licenses | 50711 | 50711 | |
| Medicaid FRA Payments | 431051 | 431051 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80438 | Total |
| Program Services | 76162 | ProgramServices |
| Management And General | 4276 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18705783 | Total |
| Program Services | 14421488 | ProgramServices |
| Management And General | 4284295 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4829694 | BOY |
| EOY | 6908017 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3463296 | BOY |
| EOY | 3179548 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 245745 | BOY |
| EOY | 242211 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 232501 | BOY |
| EOY | 234688 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 239535 | BOY |
| EOY | 211978 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19842510 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9720658 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11504817 | BOY |
| EOY | 10121852 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 276951 | BOY |
| EOY | 254137 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20792539 | BOY |
| EOY | 21152431 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1316892 | BOY |
| EOY | 1179167 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6831081 | BOY |
| EOY | 6596453 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8147973 | BOY |
| EOY | 7775620 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12626367 | BOY |
| EOY | 13366686 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18199 | BOY |
| EOY | 10125 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12644566 | BOY |
| EOY | 13376811 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20792539 | BOY |
| EOY | 21152431 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 732245 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $4,453 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 4453 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 107129 | OtherCostOrOtherBasis |
| Book Value | 107129 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13891956 | OtherCostOrOtherBasis |
| Depreciation | 6332809 | Depreciation |
| Book Value | 7559147 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5839324 | OtherCostOrOtherBasis |
| Depreciation | 3387849 | Depreciation |
| Book Value | 2451475 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4101 | OtherCostOrOtherBasis |
| Book Value | 4101 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10121852 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 17929326 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 12518 | OtherRevenues |
| Revenue Not Rptd F990 | 12518 | RevenueNotRptdF990 |
| Revenue Subtotal | 17916808 | RevenueSubtotal |
| Other Revenues Not Included | 1521220 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1521220 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 19438028 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 17189007 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 17189007 | ExpensesSubtotal |
| Other Expenses Not Included | 1516776 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1516776 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 18705783 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XI, LINE 2D | NET ASSETS RELEASED FROM RESTRICTIONS $ 12,518 |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XI, LINE 4B | RESTRICTED CONTRIBUTIONS RECEIVED $ 4,444 PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,516,776 ----------- TOTAL $ 1,521,220 |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XII, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,516,776 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 130. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 195. | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 170992 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 170992 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2995896 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2452639 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 543257 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03160 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3166888 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2452639 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 714249 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03170 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14460 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13735 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 725 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7534 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7534 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21994 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13735 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8259 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3188882 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2466374 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 722508 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03220 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,516,776 | BadDebtExpenseAmount |
| Amount Attributable To | 135609 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8122169 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8179886 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -57717 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GENERAL JOHN J PERSHING MEM HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E LOCKLING AVE PO BOX 408 | AddressLine1 |
| City | BROOKFIELD | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | COMMUNITY MED ASSOC APPLEGATE MED GROUP MEADVILLE MED CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GENERAL JOHN J PERSHING MEM HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 130. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 195. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| COMMUNITY MEDICAL ASSOCIATES | ||||
| 130 E LOCKLING AVE | BROOKFIELD | MO | 64628 | PROVIDER BASED RURAL HEALTH CLINIC |
| APPLEGATE MEDICAL GROUP | ||||
| 130 E LOCKLING AVE | BROOKFIELD | MO | 64628 | PROVIDER BASED RURAL HEALTH CLINIC |
| MEADVILLE MEDICAL CLINIC | ||||
| 130 E LOCKLING AVE | MEADVILLE | MO | 64659 | PROVIDER BASED RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 1,728,073. | |
| PART I, LINE 7 | THE COST-TO-CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. | |
| METHODOLOGY USED TO ESIMATE BAD DEBT EXPENSE | 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 2 |
| BAD DEBT EXPENSE FOR PATIENTS UNDER FINANCIAL ASSISTANCE POLICY | 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 COLLECTION SUPERVISOR'S ESTIMATE, APPLIED 15% TO THE NET BAD DEBTS TO ARRIVE AT ESTIMATED COST THAT COULD BE CHARITY. | PART III, SECTION A, LINE 3 |
| BAD DEBT EXPENSE | 4A- BAD DEBT EXPENSE IS THAT PORTION OF ANY SELF PAY 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 ACCOUNTS DETERMINED TO MEET THIS CRITERIA ARE NOT REPORTED AS NET REVENUE AND ARE NOT PURSUED FOR COLLECTION. 4B- 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 COLLECTION SUPERVISOR'S ESIMATE, APPLIED 15% TO THE NET BAD DEBTS TO ARRIVE AT ESTIMATED COST THAT COULD BE CHARITY. | PART III, SECTION A, LINE 4 |
| MEDICARE SHORTFALL | PERSHING MEMORIAL HOSPITAL BELIEVES THAT THE COMMUNITY DESERVES TO BE PROVIDED QUALITY HEALTHCARE LOCALLY. MEDICARE CURRENTLY REIMBURSES THE HOSPITAL LESS THAN THE COST OF THE SERVICES PROVIDED TO ITS PATIENTS. THEREFORE, PERSHING MEMORIAL HOSPITAL BELIEVES THAT THIS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. | PART III, LINE 8 |
| PART III, LINE 9B | WE HAVE BOTH A COLLECTION POLICY AND A CHARITY CARE POLICY THAT COVERS CRITERIA FOR PAYMENT ARRANGEMENTS AND FOR PARTIAL OR FULL CHARITY CARE WRITE-OFF. | |
| REPRESENTATIVES OF THE COMMUNITY | 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, QUESTION 3 |
| 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. | |
| 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 CHARITY CARE AND COLLECTION (PAYMENT ARRANGEMENTS) POLICIES ARE AVAILABLE THRU OUR COLLECTION PERSONNEL AND OTHERS AT PERSHING HOSPITAL AND THRU OUR WALK-IN CLINIC, COMMUNITY MEDICAL ASSOCIATES, AND AT APPLEGATE MEDICAL GROUP, AND AT MEADVILLE MEDICAL CENTER, A NEW RHC OPENED IN JULY 2012. FURTHER, WE PRINT AN ABBREVEATED VERSION OF OUR CHARITY CARE POLICY GUIDELINES WITH AN EXAMPLE ON PATIENT STATEMENTS 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 OPENED ANOTHER PROVIDER BASED RHC - MEADVILLE MEDICAL GROUP IN JULY 2012. APPLEGATE MEDICAL GROUP INCLUDES THE ONLY LOCALLY AVAILABLE PEDIATRICIAN. IT ALSO INCLUDES AN INTERNAL MEDICINE PHYSICIAN. COMMUNITY MEDICAL ASSOCIATES, OUR OTHER PROVIDER BASED RHC: -PROVIDED WEIGHT AND BLOOD PRESSURE READINGS TO APEX PLASTICS AND UNITED MISSOURI BANK FOR THEIR EMPLOYEE WELLNESS PROGRAM. -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 SPORTS PHYSICALS AT A REDUCED PRICE AT THE BEGINNING OF EACH SCHOOL YEAR. -NURSE PRACTITIONERS PROVIDE WELL CHILD EXAMS YEARLY AT THE LINN CO. HEALTH DEPT. HOSPITAL WEEK, ANNUAL PUBLIC EVENT DONE AT THE LOCAL (BROOKFIELD) YMCA AND AT MARCELINE WALSWORTH CENTER: -PROCESSED BLOOD DRAWS; PHYSICAL THERAPY HEALTH BOOTH; BLOOD PRESSURES AND PULSE OXIMETRY TESTS WERE PERFORMED. SPONSOR OF A YMCA YOUTH ATHLETIC TEAM. OTHER HEALTH FAIRS AND EVENTS: -CONDUCTED FAIRS AT OTHER BUSINESSES IN OUR SERVICE AREA, INCLUDING THE LOCAL WAL-MART. RADIOLOGY SPOKE AT A MASH CAMP - A CAREER DAY EVENT. TOURS: -TOURS OF THE HOSPITAL WERE CONDUCTED THIS YEAR WITH 4 SCHOOLS - A ONCE A YEAR PUBLIC EVENT WHICH LETS US PROMOTE THE POSITIVE ASPECTS OF PERSHING HEALTH SYSTEM. NEWSPAPER ARTICLES: -RADIOLOGY-NEW MAXVIEW SYSTEM-MAMMOGRAPHY UNIT; RHC-COMMUNITY CHALLENGES; MEDICAL RECORDS-ACCESS AND DISCLOSURE OF PROTECTED HEALTH INFORMATION; NURSING- PATIENT PROTECTION; RHC-PEDIATRICIAN-WEBSITES FOR CHILDREN, WHAT TO DO ABOUT THE MEDIA; NURSE PRACTITIONER- HEAT EXHAUSTION; FINANCIAL ASSISTANCE CHARITY CARE -NUMEROUS OTHER MINOR CONTRIBUTIONS TO THE GENERAL WELFARE AND SAFETY OF OUR COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PHIL HAMILTON | |||||||||||||
| CEO | 121638 | 0 | 19565 | 0 | 226 | 0 | 2639 | 0 | 7360 | 0 | 151427 | 0 | 0 |
| GARY FITE | |||||||||||||
| EMPLOYEE/PHYS. THERAPIST | 116651 | 6850 | 2506 | 24096 | 150103 | ||||||||
| WACLAW DYMEK | |||||||||||||
| EMPLOYED PHYSICIAN | 279734 | 70557 | 1452 | 24110 | 375853 | ||||||||
| GRACE DYMEK | |||||||||||||
| EMPLOYED PHYSICIAN | 174996 | 1085 | 1035 | 177116 | |||||||||
| DR SP GALVEZ | |||||||||||||
| EMPLOYED PHYSICIAN | 196664 | 13210 | 1010 | 210884 | |||||||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | COMPENSATION FROM AN UNRELATED ORGANIZATION | Identifier |
| Return Reference | FORM 990, PART VII, LINE 5 | ReturnReference |
| Explanation | PHIL HAMILTON RECEIVED $151,427 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DR KAREN SYLVARA | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SPOUSE OF DIRECTOR | Relationship |
| Amount Of Transaction | 104328 | AmountOfTransaction |
| Description Of Transaction | EMPLOYEE | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER PROGRAM SERVICES | 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. |
| DELEGATION OF CONTROL OVER MANAGMENT DUTIES | 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. |
| MEMBERS OR STOCKHOLDERS | 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. |
| MEMBERS OR STOCKHOLDERS MAY ELECT GOVERNING BODY | FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OF THE CORPORATION HAVE THE RIGHT TO ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS AT THE ANNUAL MEETING OF MEMBERSHIP. |
| FORM 990 REVIEW PROCESS | 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. |
| CONFLICT OF INTEREST POLICY | 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. |
| COMPENSATION REVIEW | 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. |
| AVAILABILITY OF DOCUMENTS | 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. |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:1565765 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL & COLLECTION FEES TOTAL FEES:73979 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SERVICES TOTAL FEES:1615151 |
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