2014-05-14T14:34:57-05:00 2013-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2012-07-01 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 6602582222 2014-05-15 true Michael J Engle 8162216300 2012 2015-11-30 17:44:51Z PHIL HAMILTON 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 19443172 false X N/A X 1955 MO 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. 10 9 187 25 0 0 42953 3310 17635299 19236979 53855 76670 173728 121069 17905835 19438028 9407 8609 0 0 8219236 8621000 0 0 0 10214203 10076174 18442846 18705783 -537011 732245 20792539 21152431 8147973 7775620 12644566 13376811 X SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. false false 2884298 1721 3814264 INPATIENT ACUTE CARE SERVICES WITH 748 INPATIENT ADMISSIONS 8076033 4821 10679938 OUTPATIENT SERVICES WITH APPROXIMATELY 22,964 REGISTRATIONS. THIS INCLUDES 4,854 EMERGENCY ROOM VISITS. 1009504 603 1334992 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. 2451653 1464 3407785 14421488 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 false false true false false false false false false true false false false false false false false false false false true 44 0 true 187 true false false false false false false false false false false X 10 9 true true false false true true true true true false false false true true true true true true true false MO X X GARY TANDY CFO 6602582222 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 ANGELA P LITTRELL 1.0 X X WILLIAM THUDIUM 1.0 X X PAUL WILLIAMS 1.0 X GAIL TURNER 1.0 X X GARY ROUTLEDGE 1.0 X CARY SAYRE 1.0 X MARK CLEVELAND 1.0 X TOD SYLVARA 40.0 X 133665 JIM ELLIOTT 1.0 X DAVID SHAW 1.0 X PHIL HAMILTON 40.0 X 141428 0 9999 GARY TANDY 40.0 X 109144 13426 BRIAN CASEBOLT 40.0 X 114845 30122 GARY FITE 40.0 X 123501 26602 WACLAW DYMEK 40.0 X 350291 25561 GRACE DYMEK 40.0 X 174996 2120 DR SP GALVEZ 24.0 X 209874 1010 1357744 0 108840 16 false true true 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 9 3310 3310 Net Patient Service Rev 621400 19071318 19071318 340B REVENUE 900099 165661 165661 19236979 81814 81814 0 0 25911 25911 0 25911 25911 5144 -5144 -5144 -5144 0 0 0 Cafeteria 900099 30413 30413 MISCELLANEOUS INCOME 900099 30644 30644 Vending Machines 900099 34101 34101 95158 19438028 19236979 197739 8609 8609 0 0 0 407348 128415 278933 104328 76159 28169 6284967 4740062 1544905 78874 61171 17703 1275208 944221 330987 470275 343301 126974 0 107230 107230 105587 105587 4453 4453 0 0 3254895 2744825 510070 16206 11830 4376 725822 529850 195972 0 0 399263 291462 107801 5003 5003 0 8129 8129 285691 208554 77137 0 1686417 1231084 455333 193036 140916 52120 Bad Debt Expense 1728073 1728073 Medical Supplies 994169 725743 268426 Taxes & Licenses 50711 50711 Medicaid FRA Payments 431051 431051 80438 76162 4276 18705783 14421488 4284295 0 0 0 4829694 6908017 0 0 3463296 3179548 0 0 0 0 245745 242211 232501 234688 239535 211978 19842510 9720658 11504817 10121852 0 0 0 0 0 0 0 0 276951 254137 20792539 21152431 1316892 1179167 0 0 0 0 0 0 0 0 0 0 6831081 6596453 0 0 0 0 8147973 7775620 X 12626367 13366686 18199 10125 0 0 12644566 13376811 20792539 21152431 732245 X false true X false false X false false false false false true 4453 false false false 4453 false 107129 107129 13891956 6332809 7559147 5839324 3387849 2451475 4101 4101 10121852 17929326 12518 12518 17916808 1521220 1521220 19438028 17189007 17189007 1516776 1516776 18705783 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 true true true X 130. true X 195. true true false true true 170992 170992 0.00010 2995896 2452639 543257 0.03160 3166888 2452639 714249 0.03170 14460 13735 725 0.00010 7534 7534 0.00040 21994 13735 8259 0.00050 3188882 2466374 722508 0.03220 true 1516776 135609 8122169 8179886 -57717 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 X X X X X X X X true false true true 130. true 195. true X X X X X X true true X X X X X true false X X X X true X false false 3 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 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 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. BAD DEBT EXPENSE FOR PATIENTS UNDER FINANCIAL ASSISTANCE POLICY 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 COLLECTION SUPERVISOR'S ESTIMATE, APPLIED 15% TO THE NET BAD DEBTS TO ARRIVE AT ESTIMATED COST THAT COULD BE CHARITY. BAD DEBT EXPENSE PART III, SECTION A, LINE 4 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. MEDICARE SHORTFALL PART III, LINE 8 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 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 PART V, SECTION B, QUESTION 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. 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. X false false false false false false false false false PHIL HAMILTON 121638 0 19565 0 226 0 2639 0 7360 0 151427 0 0 GARY FITE 116651 6850 2506 24096 150103 WACLAW DYMEK 279734 70557 1452 24110 375853 GRACE DYMEK 174996 1085 1035 177116 DR SP GALVEZ 196664 13210 1010 210884 COMPENSATION FROM AN UNRELATED ORGANIZATION FORM 990, PART VII, LINE 5 PHIL HAMILTON RECEIVED $151,427 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. DR KAREN SYLVARA SPOUSE OF DIRECTOR 104328 EMPLOYEE false 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