FURP.ORG / PUBLIC DATA EXPLORER

JOHN FITZGIBBON MEMORIAL HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
JOHN FITZGIBBON MEMORIAL HOSPITAL INC (EIN 44-0655986)
Tax period
2011-05-01 to 2012-04-30
Filed
2013-03-13
IRS object ID
201300729349300825
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-03-13T17:30:19-05:00Timestamp
Tax Period End Date2012-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code658062523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN440655986EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1JOHN FITZGIBBON MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% ROBERTA NIENHUESERInCareOfName
Name ControlJOHNNameControl
Phone6608867431Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12305 S 65 HIGHWAYAddressLine1
Address Line2PO BOX 250AddressLine2
CityMARSHALLCity
StateMOState
ZIP Code65340ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRONALD A OTTName
TitleCEOTitle
Date Signed2013-03-07DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRONALD A OTTNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12305 S 65 HIGHWAYAddressLine1
CityMARSHALLCity
StateMOState
ZIP Code65340ZIPCode
FieldValueIRS element (for citing)
Gross Receipts54721443GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.fitzgibbon.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1923YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE THE HEALTH OF OUR COMMUNITY BY OFFERING QUALITY HEALTH CARE SERVICES, IMPROVING ACCESS & OUTCOMES, EMPOWERING THE COMMUNITY & PEOPLE WE SERVE, & PARTICIPATING IN HEALTH CARE PARTNERSHIPS.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees593TotalNbrEmployees
Total Nbr Volunteers58TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year326412ContributionsGrantsPriorYear
Contributions Grants Current Year215558ContributionsGrantsCurrentYear
Program Service Revenue Prior Year50352024ProgramServiceRevenuePriorYear
Program Service Revenue CY54203327ProgramServiceRevenueCY
Investment Income Prior Year193607InvestmentIncomePriorYear
Investment Income Current Year227551InvestmentIncomeCurrentYear
Other Revenue Prior Year-238396OtherRevenuePriorYear
Other Revenue Current Year45384OtherRevenueCurrentYear
Total Revenue Prior Year50633647TotalRevenuePriorYear
Total Revenue Current Year54691820TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year17379GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY12000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22173271SalariesEtcPriorYear
Salaries Etc Current Year22977067SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year39255TotalFundrsngExpCurrentYear
Other Expense Prior Year26575897OtherExpensePriorYear
Other Expenses Current Year29846908OtherExpensesCurrentYear
Total Expenses Prior Year48766547TotalExpensesPriorYear
Total Expenses Current Year52835975TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1867100RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1855845RevenuesLessExpensesCY
Total Assets BOY54036579TotalAssetsBOY
Total Assets EOY55752440TotalAssetsEOY
Total Liabilities BOY22819048TotalLiabilitiesBOY
Total Liabilities EOY22649341TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY31217531NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY33103099NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO IMPROVE THE HEALTH OF OUR COMMUNITY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense39858875Expense
Revenue42061429Revenue
DescriptionHOSPITAL SERVICE - FITZGIBBON HOSPITAL IS A 60 BED ACUTE CARE FACILITY SERVING MARSHALL, MO & THE SURROUNDING COMMUNITIES. THE FACILITY PROVIDES STATE OF THE ART HEALTH CARE WITH A 24 HOUR PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, AN INTENSIVE CARE UNIT, IN AND OUT-PATIENT MEDICAL/SURGICAL SERVICES, AN OBSTETRICS UNIT, A BEHAVIOR HEALTH UNIT AND A 24 HOUR HOSPITALIST PROGRAM TO SERVE IN-PATIENT NEEDS AT ALL TIMES. ANCILLARY SERVICES SUCH AS RADIOLOGY, LABORATORY, RESPIRATORY THERAPY & REHABILITATIVE SERVICES ARE AVAILABLE ON SITE. FOR MORE INFORMATION, SEE SCHEDULE O.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4664235Expense
Revenue5122066Revenue
DescriptionCLINIC SERVICE-SPECIALTY CLINICS WITHIN THE HOSPITAL PROVIDE ORTHOPEDIC, WOUND CARE, NEUROLOGIC & PAIN MANAGEMENT SERVICES TO BOTH IN & OUT-PATIENTS. THESE CLINICS PROVIDED SERVICES TO 19,679 PATIENTS. THE HOSPITAL ALSO SUPPORTS A SEPARATE OUT-PATIENT CLINIC ON CAMPUS FOR FAMILY MEDICINE, OB/GYN, GENERAL SURGERY & PSYCHIATRY STAFFED MEDICAL PROFESSIONALS PRACTICING IN THESE SPECIALTIES FOR FISCAL YEAR 2012. THIS CLINIC PROVIDED SERVICES FOR 13,654 PATIENT VISITS. TWO SATELLITE FAMILY PRACTICE CLINICS ARE ALSO SUPPORTED BY THE HOSPITAL. THESE CLINICS PROVIDED SERVICES FOR 15,368 PATIENT VISITS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1074710Expense
Revenue2064176Revenue
DescriptionCOMMUNITY HEALTH SERVICES - HOSPICE, HOME HEALTH, & HOMEMAKER SERVICES. HOSPICE PROVIDED 4,600 PALLIATIVE CARE VISITS, 71 WERE FREE FOR PATIENTS W/O INSURANCE. HOME HEALTH PROVIDED 6,530 VISITS & HOMEMAKER PERFORMED 12,276 HOURS OF SERVICE TO RESIDENTS. THE COMMUNITY SERVICES GROUP ALSO COORDINATES PARTICIPATION IN THE OATS TRANSPORTATION PROGRAM BY PERFORMING THE SCHEDULING FOR ALL RIDERS. THE HOSPITAL DONATES $12,000 ANNUALLY TO OATS TO HELP SUSTAIN IT IN THE MARSHALL COMMUNITY. THE PROGRAM PROVIDED TRANSPORTATION FOR 3,590 RIDERS DURING FY 2012.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp520762TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt12000TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev4955656TotalOfOtherProgramServiceRev
Total Program Service Expense46118582TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096120NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees593NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonROBERTA NIENHUESERNamePerson
Telephone Number6608313251TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12305 S 65 HIGHWAY PO BOX 250AddressLine1
CityMARSHALLCity
StateMOState
ZIP Code65340ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
FRED UTLAUT
PRESIDENT1.0XX000
WILLIAM L SUMMERS
VICE PRESIDENT1.0XX000
DON VOGELSMEIER
SECRETARY/TREASURER1.0XX000
VIRGINIA HUPP
DIRECTOR1.0X000
ROOK EVANS
DIRECTOR1.0X000
B F KNIPSCHILD MD
DIRECTOR1.0X000
RANDY MORROW
DIRECTOR1.0X000
JAMES SOWASH MD
DIRECTOR1.0X000
JACK UHRIG MD
DIRECTOR1.0X000
GAYLE CARTER
DIRECTOR1.0X000
CRAIG MCCOY DO
MEDICAL STAFF PRESIDENT1.0X8186200
BILL JACKSON
DIRECTOR1.0X000
RONALD A OTT
PRESIDENT/CEO40.0X275368011128
ROBERTA NIENHUESER
VP FINANCIAL SRVCS, BEG 11/1140.0X1200000
NANCY HARRIS
VP FINANCIAL SRVCS, THRU 11/1140.0X10967404454
LYNNE OTT
VP PATIENT CARE SERVICES40.016002806159X
DENNIS SOUSLEY
VP CLINICAL SERVICES40.017457104824X
KELLY ROSS DO
ORTHOPEDIC SURGEON40.048394102000X
CRAIG SIMONS DO
HOSPITALIST/ER PHYSICIAN40.038133202466X
JOHN BRIZENDINE MD
GENERAL SURGEON40.033325307000X
DEVINDER GUPTA MD
HOSPITALIST40.032911404600X
LORENZO ROMNEY DO
HOSPITALIST40.025797802466X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2599121TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation45097TotalOtherCompensation
Number Individuals GT100 K19NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
PHARMACY SYSTEMS INC
PHARMACY MGMT712175
WATERSTONE BENEFIT
ADMINISTRATOR442661
PAUL T BRIZENDINE MD
ER PHYSICIAN260610
THOMAS LAIRD MD
ER PHYSICIAN259865
MO MEDICAL COLLECTIONS
COLLECTIONS210505
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Fundraising Events61563FundraisingEvents
Government Grants26184GovernmentGrants
All Other Contributions127811AllOtherContributions
Total Contributions215558TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE9000995325521753255217
EHR INCENTIVE REVENUE722210606836606836
CAFETERIA900099234754234754
MANAGEMENT FEES5610006000060000
OTHER REVENUE9000994652046520
FieldValueIRS element (for citing)
Total Program Service Revenue54203327TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column208992TotalRevenueColumn
Exclusion$208,992ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other19839Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1280Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other18559Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column18559TotalRevenueColumn
Exclusion$18,559ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events26858GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events61563CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses28343FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-1485TotalRevenueColumn
Exclusion-$1,485ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionINSURANCE PROCEEDSDescription
Business Code900099BusinessCode
Total Revenue Column46869TotalRevenueColumn
Exclusion$46,869ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue46869TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column54691820TotalRevenueColumn
Related Or Exempt Function Income54203327RelatedOrExemptFunctionIncome
Exclusion$272,935ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total12000Total
Program Services12000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total867992Total
Program Services405969ProgramServices
Management And General462023ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total48334Total
Program Services48334ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total18977037Total
Program Services16292077ProgramServices
Management And General2648949ManagementAndGeneral
Fundraising36011Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total227477Total
Program Services193641ProgramServices
Management And General33836ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1473463Total
Program Services1249412ProgramServices
Management And General224051ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1382764Total
Program Services1160235ProgramServices
Management And General219890ManagementAndGeneral
Fundraising2639Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total70676Total
Management And General70676ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total159694Total
Management And General159694ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4870006Total
Program Services3850226ProgramServices
Management And General1019780ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total116485Total
Program Services60592ProgramServices
Management And General55893ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3196894Total
Program Services2569485ProgramServices
Management And General626856ManagementAndGeneral
Fundraising553Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total621824Total
Program Services532704ProgramServices
Management And General89120ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total214525Total
Program Services188542ProgramServices
Management And General25931ManagementAndGeneral
Fundraising52Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total81007Total
Program Services30569ProgramServices
Management And General50438ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total885507Total
Program Services741519ProgramServices
Management And General143988ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3037563Total
Program Services2543639ProgramServices
Management And General493924ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total634473Total
Program Services436729ProgramServices
Management And General197744ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT87830418783041
MEDICAL SUPPLIES & DRUGS48257234825723
MEDICAID TAX21154592115459
RECRUITING & RETENTION23403178686155345

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total52835975Total
Program Services46118582ProgramServices
Management And General6678138ManagementAndGeneral
Fundraising39255Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4392747BOY
EOY4144337EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY14273107BOY
EOY14273733EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1667BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6736879BOY
EOY9132104EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1153318BOY
EOY1067081EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY928877BOY
EOY956364EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis50887619LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec29074072LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23095354BOY
EOY21813547EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3421840BOY
EOY4150421EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY32790BOY
EOY214853EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY54036579BOY
EOY55752440EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4365808BOY
EOY5410671EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY17055755BOY
EOY16554667EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY267848BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1129637BOY
EOY684003EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY22819048BOY
EOY22649341EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY30232173BOY
EOY32105961EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY530141BOY
EOY541921EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY455217BOY
EOY455217EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY31217531BOY
EOY33103099EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY54036579BOY
EOY55752440EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1855845ReconcilationRevenueExpenses
Reconcilation Other Changes29723ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$9,332OtherActivitiesAmount
Total Lobbying Expenditures IIB9332TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER LOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1(I)ReturnReference
ExplanationTHE ORGANIZATION PAYS DUES TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ALLOCATED TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance694769BeginningOfYearBalance
Investment Earnings Or Losses24351InvestmentEarningsOrLosses
Administrative Expenses60AdministrativeExpenses
End Of Year Balance719060EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance677227BeginningOfYearBalance
Investment Earnings Or Losses21898InvestmentEarningsOrLosses
Other Expenditures4296OtherExpenditures
Administrative Expenses60AdministrativeExpenses
End Of Year Balance694769EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance618998BeginningOfYearBalance
Contributions25296Contributions
Investment Earnings Or Losses36603InvestmentEarningsOrLosses
Other Expenditures3670OtherExpenditures
End Of Year Balance677227EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance579322BeginningOfYearBalance
Investment Earnings Or Losses39676InvestmentEarningsOrLosses
End Of Year Balance618998EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.24865BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.63307PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.11828TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis71000OtherCostOrOtherBasis
Book Value71000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis23520648OtherCostOrOtherBasis
Depreciation8521587Depreciation
Book Value14999061BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis26001580OtherCostOrOtherBasis
Depreciation19858204Depreciation
Book Value6143376BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1294391OtherCostOrOtherBasis
Depreciation694281Depreciation
Book Value600110BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings21813547TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO RELATED PARTY$34,003
EST AMT DUE TO 3RD PTY PYRS$650,000
FieldValueIRS element (for citing)
Total Of Amounts684003TotalOfAmounts
Total Revenue54691820TotalRevenue
Total Expenses52835975TotalExpenses
Excess Or Deficit For Year1855845ExcessOrDeficitForYear
Net Unrealized GL On Investments29723NetUnrealizedGLOnInvestments
Total Adjustments29723TotalAdjustments
Excess Or Deficit Per FS1885568ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt54749886TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments29723NetUnrealizedGainsInvestments
Revenue Not Rptd F99029723RevenueNotRptdF990
Revenue Subtotal54720163RevenueSubtotal
Other Revenues Not Included-28343OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-28343RevenueNotRptdOnFinStmt
Total Revenue Per Form99054691820TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt52864318TotExpensesEtcAuditedFinclStmt
Other Expenses Included28343OtherExpensesIncluded
Expenses Not Rptd F99028343ExpensesNotRptdF990
Expenses Subtotal52835975ExpensesSubtotal
Total Expenses Per Form99052835975TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4THE ORGANIZATION HAS ENDOWMENT FUNDS FROM THE L.P. ADAMS FUND. PER THE AGREEMENT, THE INCOME FROM THE FUND IS USED FOR GENERAL PURPOSES OF THE HOSPITAL. THE ORGANIZATION ALSO HAS FUNDS FROM THE BUCKNER ENDOWMENT. THESE FUNDS ARE RESTRICTED TO INVESTMENTS IN EQUIPMENT FOR THE BUCKNER WELLNESS CENTER. FINALLY, THE ORGANIZATION HAS FUNDS FROM THE NURSING ENDOWMENT SCHOLARSHIP FUND. THIS FUND WAS CREATED TO PROVIDE NURSING SCHOLARSHIPS TO SALINE COUNTY RESIDENTS ATTENDING THE NURSING PROGRAM AT THE MO VALLEY COLLEGE IN MARSHALL, MISSOURI. IN THE EVENT THAT THE MO VALLEY COLLEGE DOES NOT HAVE A NURSING PROGRAM, SCHOLARSHIPS CAN BE USED FOR NURSING PROGRAMS IN SURROUNDING AREAS.
UNCERTAIN TAX POSITIONSCHEDULE D, PART X, LINE 2MANAGEMENT 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.
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1SCHEDULE D, PART XII, LINE 4B$( 28,343) SPECIAL EVENTS EXPENSES
OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25SCHEDULE D, PART XIII, LINE 2D$ 28,343 SPECIAL EVENTS EXPENSES

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1SPRING FLINGNameOfEvent1
Gross Receipts Event145621GrossReceiptsEvent1
Charitable Contributions Event133233CharitableContributionsEvent1
Gross Revenue Event112388GrossRevenueEvent1
Food And Beverage Event13342FoodAndBeverageEvent1
Other Direct Expenses Event16488OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNEYNameOfEvent2
Gross Receipts Event228147GrossReceiptsEvent2
Charitable Contributions Event219325CharitableContributionsEvent2
Gross Revenue Event28822GrossRevenueEvent2
Cash Prizes Event25249CashPrizesEvent2
Non Cash Prizes Event22951NonCashPrizesEvent2
Rent Facility Costs Event21188RentFacilityCostsEvent2
Food And Beverage Event21226FoodAndBeverageEvent2
Other Direct Expenses Event21088OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events14653GrossReceiptsOtherEvents
Charitable Contrib Other Events9005CharitableContribOtherEvents
Gross Revenue Other Events5648GrossRevenueOtherEvents
Other Direct Expenses Other Events6811OtherDirectExpensesOtherEvents
Gross Receipts Total88421GrossReceiptsTotal
Charitable Contributions Total61563CharitableContributionsTotal
Gross Revenue Total Events26858GrossRevenueTotalEvents
Cash Prizes Total Events5249CashPrizesTotalEvents
Non Cash Prizes Total Events2951NonCashPrizesTotalEvents
Rent Facility Costs Total Events1188RentFacilityCostsTotalEvents
Food And Beverage Total Events4568FoodAndBeverageTotalEvents
Other Direct Expenses Total Events14387OtherDirectExpensesTotalEvents
Direct Expense Summary Events28343DirectExpenseSummaryEvents
Net Income Summary-1485NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense185808TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense185808NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8873810TotalCommunityBenefitExpense
Direct Offsetting Revenue7011019DirectOffsettingRevenue
Net Community Benefit Expense1862791NetCommunityBenefitExpense
Percent Of Total Expense0.04230PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9059618TotalCommunityBenefitExpense
Direct Offsetting Revenue7011019DirectOffsettingRevenue
Net Community Benefit Expense2048599NetCommunityBenefitExpense
Percent Of Total Expense0.04650PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense32901TotalCommunityBenefitExpense
Direct Offsetting Revenue5202DirectOffsettingRevenue
Net Community Benefit Expense27699NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense361961TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense361961NetCommunityBenefitExpense
Percent Of Total Expense0.00820PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense5107941TotalCommunityBenefitExpense
Direct Offsetting Revenue4606431DirectOffsettingRevenue
Net Community Benefit Expense501510NetCommunityBenefitExpense
Percent Of Total Expense0.01140PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense12000TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense12000NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5514803TotalCommunityBenefitExpense
Direct Offsetting Revenue4611633DirectOffsettingRevenue
Net Community Benefit Expense903170NetCommunityBenefitExpense
Percent Of Total Expense0.02050PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense14574421TotalCommunityBenefitExpense
Direct Offsetting Revenue11622652DirectOffsettingRevenue
Net Community Benefit Expense2951769NetCommunityBenefitExpense
Percent Of Total Expense0.06700PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$8,783,041BadDebtExpenseAmount
Amount Attributable To3688877AmountAttributableTo
Amount Reimbursed By Medicare11816554AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare12240073CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-423519MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1JOHN FITZGIBBON MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12305 S 65 HIGHWAYAddressLine1
CityMARSHALLCity
StateMOState
ZIP Code65340ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherORTHO, WOUND CARE, REHAB, ONCOLOGY, PAIN, NEUROLOGICOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1JOHN FITZGIBBON MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedfalseCHNAConducted
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent100FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent200.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
FITZGIBBON PROFESSIONAL BUILDING
2301 S 65 HIGHWAYMARSHALLMO65340OB/GYN, SURGERY, FAMILY PRACTICE, MENTAL HEALTH CLINIC
FITZGIBBON COMMUNITY HOME HEALTH CARE
2303 S 65 HIGHWAYMARSHALLMO65340HOME HEALTH, HOSPICE, HOMEMAKER
AKEMAN MCBURNEY MEDICAL CLINIC
420 WEST FRONT STREETSLATERMO65349OFFSITE MEDICAL CLINIC
GRAND RIVER MEDICAL CLINIC
815 EAST BROADWAYBRUNSWICKMO65236OFFSITE MEDICAL CLINIC
BUCKNER WELLNESS CENTER
2299 S 65 HIGHWAYMARSHALLMO65340CARDIAC/PULMONARY WELLNESS

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PERCENT OF TOTAL EXPENSESCHEDULE H, PART I, LINE 7, COLUMN FTO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990 ($52,835,975) WAS REDUCED BY BAD DEBT EXPENSE ($8,783,041). COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7G THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. IRS WORKSHEET 6 USED INTERNAL COST ACCOUNTING METHODOLOGY.
BAD DEBT EXPENSESCHEDULE H, PART III, SECTION A, LINE 4THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE ORGANIZATION REPORTED BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS FROM THE AUDITED FINANCIAL STATEMENTS. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. THIS AMOUNT EXPENSED BY THE ORGANIZATION IS ATTRIBUTABLE TO LOW INCOME INDIVIDUALS IN THEIR TARGET COMMUNITY AND IS CONSIDERED A COMMUNITY BENEFIT.
COMMUNITY BENEFIT RATIONALESCHEDULE H, PART III, SECTION B, LINE 8MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
COLLECTION POLICYSCHEDULE H, PART III, SECTION C, LINE 9BTHE ORGANIZATION'S BILLING AND PAYMENT POLICY NOTES: IF ACCOUNTS HAVE ALREADY BEEN CONSIDERED "BAD DEBT" BY FITZGIBBON HOSPITAL AND CLINICS THEN FINANCIAL ASSISTANCE/CHARITY CARE IS NOT AN OPTION. "BAD DEBT" IS DEFINED AS EXPENSES RESULTING FROM TREATMENT FOR SERVICES PROVIDED TO A PATIENT WHO HAS NOT MET THEIR FINANCIAL OBLIGATION NOR SET UP AN AGREEABLE PAYMENT ARRANGEMENT WITH FITZGIBBON HOSPITAL AND CLINICS WITHIN 120 DAYS FROM THE DATE THE PATIENT HAS BEEN MADE RESPONSIBLE FOR ANY BALANCES DUE EITHER AFTER INSURANCE HAS PAID THEIR PORTION OR WHEN NO INSURANCE IS INVOLVED.
NEEDS ASSESSMENTSCHEDULE H, PART VI, LINE 2OUR MISSION AT FITZGIBBON HOSPITAL IS TO "IMPROVE THE HEALTH OF OUR COMMUNITY". IN ORDER TO MEET THIS MISSION WE STRIVE TO UNDERSTAND THE NEEDS OF OUR COMMUNITY IN SEVERAL DIFFERENT WAYS. OUR LEADERSHIP AND STAFF ARE MEMBERS OF CIVIC CLUBS, BOARDS, AND COMMITTEES. OUR BOARD OF DIRECTORS IS COMPRISED OF MEMBERS FROM COUNTIES THROUGHOUT OUR SERVICE AREA. WE WORK CLOSELY WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY AGENCIES. STATE, REGIONAL AND LOCAL MEDIAS ARE USED TO MONITOR NEEDS AT ALL LEVELS. WE ALSO BELONG TO MANY HEALTHCARE RELATED ORGANIZATIONS THAT PROVIDE INFORMATION REGARDING USAGE AND NEEDS OF HEALTHCARE IN OUR SERVICE AREA WHICH IS USED TO EVALUATE WHAT WE NEED TO FOCUS ON TO IMPROVE THE HEALTH IN OUR COMMUNITY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCESCHEDULE H, PART VI, LINE 3THE HOSPITAL USES SEVERAL AVENUES TO PROVIDE PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. THE PATIENT ACCOUNTS DEPARTMENT DEVELOPED A BROCHURE WHICH IS AVAILABLE TO PATIENTS AT THE TIME OF REGISTRATION. THE BROCHURE OUTLINES WHAT THE PATIENT IS TO EXPECT IN THE BILLING PROCESS, HOW TO CONTACT THE DEPARTMENT, AND WHAT ASSISTANCE IS AVAILABLE. WE HAVE A DETAILED POLICY WHICH OUTLINES PATIENT RESPONSIBILITY AND QUALIFICATIONS FOR CHARITY CARE. OUR PATIENT ACCOUNTS REPRESENTATIVES MEET WITH SELF PAY PATIENTS WHEN THEY ARE IN THE FACILITY TO DISCUSS OUR POLICY. OUR CARE COORDINATORS AND SOCIAL WORKERS ALSO EDUCATE OUR PATIENTS ON ASSISTANCE THEY MAY BE ELIGIBLE FOR UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS. WE ALSO UTILIZE AN OUTSIDE AGENCY TO MAKE CONTACT WITH PATIENTS AND IDENTIFY THOSE THAT MIGHT BE ELIGIBLE FOR ASSISTANCE.
COMMUNITY INFORMATIONSCHEDULE H, PART VI, LINE 4FITZGIBBON HOSPITAL'S PRIMARY SERVICE AREA IS SALINE COUNTY, MISSOURI WHICH IS A MID-MISSOURI AGRICULTURAL REGION AND INCLUDES THE TOWNS OF MARSHALL AND SLATER, MO. THE SECONDARY SERVICE AREA IS PORTIONS OF THE CONTIGUOUS COUNTIES SURROUNDING SALINE COUNTY. THE SALINE COUNTY POPULATION IN 2009 WAS 22,586 RESIDENTS. SALINE COUNTY DATA FOR 2009 SHOWED 61.3% OF HOUSEHOLDS WITH INCOME UNDER $49,999. OF THIS NUMBER, 42.3% OF HOUSEHOLDS FELL INTO THE $34,999 AND BELOW BRACKET. THE AGE DISTRIBUTION OF THE POPULATION IN SALINE COUNTY IN 2009 WAS 72.8% AGE 54 AND UNDER AND 27.2% WERE 55 AND OLDER.
AFFILIATED HEALTH CARE SYSTEMSCHEDULE H, PART VI, LINE 6THE AFFILIATED HEALTH SYSTEM INCLUDES THE ACTIVITIES OF JOHN FITZGIBBON MEMORIAL HOSPITAL AND FITZGIBBON HEALTH SERVICES, DOING BUSINESS AS THE LIVING CENTER, (COLLECTIVELY, THE "COMPANIES" OR THE "HOSPITAL"). JOHN FITZGIBBON MEMORIAL HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY CARE, PSYCHIATRIC AND SKILLED NURSING SERVICES TO PATIENTS IN THE MARSHALL, MISSOURI, AREA. IT ALSO OPERATES A HOME HEALTH AGENCY IN THE SAME GEOGRAPHIC AREA. IT IS DESIGNATED AS A MEDICARE DEPENDENT HOSPITAL BY MEDICARE EFFECTIVE JANUARY 1, 2007. IN MARCH 2012, THE HOSPITAL WAS DESIGNATED AS A SOLE COMMUNITY HOSPITAL BY MEDICARE. THE COMPANIES ALSO OPERATE A LONG-TERM CARE FACILITY IN MARSHALL, MISSOURI, DOING BUSINESS AS THE LIVING CENTER.
CHARGES FOR MEDICAL CARESCHEDULE H, PART V, SECTION B, LINE 19THE FACILITY INITIALLY CHARGES ALL PATIENTS FROM THE SAME FEE SCHEDULE WHEN SERVICES ARE PROVIDED. THOSE PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE ELIGIBLE FOR A DISCOUNT BASED ON A SLIDING SCALE. THE AMOUNT OF FINANCIAL ASSISTANCE IS BASED ON FAMILY INCOME AND FAMILY SIZE. FEDERAL POVERTY GUIDELINES ARE USED WHEN EVALUATING AMOUNT OF ASSISTANCE GRANTED.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1OATS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12501 MCGUIRE BLVDAddressLine1
CityCOLUMBIACity
StateMOState
ZIP Code65201ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient431016961EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant12000AmountOfCashGrant
Purpose Of GrantCOMMUNITY SERVICESPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierMONITORING USE OF GRANT FUNDSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationTHE HOSPITAL WORKS IN CONJUNCTION WITH THE LOCAL OATS TRANSPORTATION PROGRAM TO COORDINATE TRANSPORTATION FOR MEMBERS OF THE COMMUNITY. THE ORGANIZATION WITNESSES FIRSTHAND THE WORK DONE BY OATS IN THE COMMUNITY.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RONALD A OTT
2096680657000002000091280286496000
LYNNE OTT
1229280371000002000041590166187000
DENNIS SOUSLEY
1545710200000002000028240179395000
KELLY ROSS DO
43499003300001595102000000485941000
CRAIG SIMONS DO
38133200000200004660383798000
JOHN BRIZENDINE MD
3200000001325302000050000340253000
DEVINDER GUPTA MD
323114000600002000026000333714000
LORENZO ROMNEY DO
242829000151490200004660260444000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierNON-FIXED PAYMENTSIdentifier
Return ReferenceSCHEDULE J, PART I, LINE 7ReturnReference
ExplanationACCORDING TO THE RESPECTIVE CONTRACT, ONE PHYSICIAN WAS DUE A MONTHLY INCENTIVE COMPENSATION. THIS INCENTIVE WAS BASED ON TRAINING AND COLLABORATION WITH A PHYSICIAN ASSISTANT AND COMPLETION OF DOCUMENTATION. IT IS NOT BASED ON HOSPITAL EARNINGS. NON-FIXED PAYMENTS MADE TO RONALD OTT, NANCY HARRIS, LYNNE OTT, AND DENNIS SOUSLEY WERE BASED ON PERFORMANCE OF THE INDIVIDUALS AND ORGANIZATION. BONUSES ARE PAID TO INDIVIDUALS WHO HAVE CONTRIBUTED POSITIVELY TO THE ORGANIZATION AND THEIR PERFORMANCE HAS ALLOWED THE ORGANIZATION TO MEET DEPARTMENTAL AND ORGANIZATIONAL GOALS AS OUTLINED ON THE ANNUAL PERFORMANCE APPRAISAL. THESE GOALS INCLUDE, BUT ARE NOT LIMITED TO, SAFETY, PATIENT SATISFACTION AND FINANCIAL PERFORMANCE. FITZGIBBON HOSPITAL HAS AN AGREEMENT WITH BOONE HOSPITAL CENTER WHICH ALLOWS BOONE HOSPITAL TO OVERSEE AND ASSIST IN EVALUATING THE WORK AND PERFORMANCE OF THE PRESIDENT OF THE HOSPITAL AND IN DETERMINING THE COMPENSATION AND BENEFITS TO WHICH THE PRESIDENT WILL BE ENTITLED. THEREFORE, THE BONUSES WERE DETERMINED BY BOONE HOSPITAL IN CONSULTATION WITH THE FITZGIBBON HOSPITAL BOARD PRESIDENT. THE BONUS AMOUNTS WERE A PERCENTAGE OF THE BASE SALARIES.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO
43138669779516LAD62005-12-2210000000CONSTRUCTION REVENUE BONDSfalsefalsefalse
INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO
43098029679516LBC72010-11-29122184681998 BOND REFINANCINGfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
0010365462000193724098062760002007falsefalsetruetrue
00122184680011985656232812000002010falsefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalse0.000000.000000.00000true
falsefalsefalsefalse0true

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Gross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
0
falsefalsefalsefalse0falsefalse
0
falsefalsefalsefalse0falsefalse
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierTOTAL PROCEEDS OF ISSUEIdentifier
Return ReferenceSCHEDULE K, PART II, LINE 3ReturnReference
ExplanationTOTAL PROCEEDS OF ISSUE INCLUDE INVESTMENT EARNINGS ON BOND PROCEEDS WITH ISSUE PRICE OF $10,000,000 REPORTED ON SCHEDULE K, PART 1, LINE A, COLUMN (E).Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonJUDY VOGELSMEIERNamePerson
FieldValueIRS element (for citing)
RelationshipSPOUSE OF DON VOGELSMEIERRelationship
Amount Of Transaction48334AmountOfTransaction
Description Of TransactionEMPLOYEE COMPENSATIONDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICES ACTIVITY #1FORM 990, PART III, LINE 4AFOR THE FISCAL YEAR ENDED APRIL 30, 2012, THE EMERGENCY ROOM EXPERIENCED 12,088 PATIENT VISITS. THE SURGICAL TEAM PERFORMED 375 IN-PATIENT AND 2,021 OUT-PATIENT PROCEDURES. THE RADIOLOGY GROUP PERFORMED 34,957 PROCEDURES WHICH INCLUDED 4,295 MAMMOGRAMS, 4,518 CT SCANS, 1,962 MRI'S, 3,007 ULTRASOUND IMAGES AND 2,845 NUCLEAR MEDICINE SCANS. THE LABORATORY TEAM PERFORMED 99,114 TESTS. THE RESPIRATORY THERAPY DEPARTMENT CONDUCTED 40,668 PATIENT TREATMENTS AND THE REHABILITATIVE SERVICES GROUP WHICH INCLUDES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES PROVIDED 18,164 PATIENT ENCOUNTERS.
OTHER PROGRAM SERVICESFORM 990, PART III, LINE 4DA CARDIO-PULMONARY WELLNESS CENTER IS LOCATED ON THE CAMPUS AND STAFFED BY A REGISTERED DIETICIAN AND A REGISTERED NURSE TO COUNSEL AND EDUCATE PATIENTS ON HEALTHY LIVING THROUGH EXERCISE AND NUTRITION WITH SPECIAL EMPHASIS ON DIABETES MANAGEMENT. THROUGHOUT THE YEAR, THE STAFF ENCOUNTERED 1,250 PATIENT VISITS AT THE FACILITY. IN ADDITION, THE STAFF EDUCATED 301 RESIDENTS IN THE SURROUNDING COMMUNITIES AT NO CHARGE THROUGH PARTICIPATION IN HEALTH FAIRS AND OTHER SOCIAL VENUES. FITZGIBBON ALSO SPONSORS A FREE BICYCLE SAFETY CLINIC FOR CHILDREN. IN FY 2012, 441 KINDERGARTEN STUDENTS ATTENDED, AND EACH CHILD RECEIVED A FREE HELMET AT THE END OF THE PROGRAM. THE HOSPITAL OFFERS CHILDBIRTH CLASSES AT A MINIMAL FEE WHICH COVERS THE COST OF THE EDUCATIONAL MATERIAL PRESENTED TO EACH PARTICIPANT. EACH YEAR, THE HOSPITAL HOSTS A COMMUNITY HEALTH FAIR OFFERING EDUCATION ON A VARIETY OF HEALTH ISSUES AND ROUTINE HEALTH SCREENINGS. MOST TESTING IS FREE, HOWEVER, PARTICIPANTS REQUESTING CERTAIN BLOOD TESTS PAY ONLY WHAT IT COSTS THE HOSPITAL FOR LABORATORY PROCESSING. FITZGIBBON IS A WILLING PARTICIPANT IN A COMMUNITY WIDE COMMITTEE TO HELP IMPROVE ACCESS TO HEALTH CARE IN THE AREA. HOSPITAL PERSONNEL ARE ENCOURAGED AND PROVIDED OPPORTUNITIES TO SERVE THE COMMUNITY THROUGH INVOLVEMENT IN VARIOUS COMMUNITY ORGANIZATIONS AS VOLUNTEER MEMBERS, OFFICERS, AND SPEAKERS ON HEALTH RELATED TOPICS.
FAMILY RELATIONSHIPSFORM 990, PART VI, SECTION A, LINE 2RONALD OTT, PRESIDENT AND CEO, IS MARRIED TO LYNNE OTT, VP OF PATIENT CARE SERVICES, KEY EMPLOYEE.
MEMBERS, STOCKHOLDERS, OR OTHER PERSONSFORM 990, PART VI, SECTION A, LINE 7ATHE MEDICAL STAFF OF THE ORGANIZATION ELECTS THE CHIEF OF MEDICAL STAFF WHO IS A VOTING MEMBER OF THE BOARD.
REVIEW OF FORM 990FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A DRAFT OF THE RETURN IS REVIEWED BY THE CFO AND THE CEO BEFORE BEING FINALIZED. THE 990 IS THEN PRESENTED TO THE BOARD AFTER IT IS FILED.
MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CTHE COMPLIANCE OFFICER MONITORS THE CONFLICT OF INTEREST POLICY AND ANNUALLY REQUIRES OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. ALL CONFLICTS MUST BE REVIEWED BY THE CEO AND/OR BOARD OF DIRECTORS. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST WOULD ABSTAIN FROM VOTING ON ANY DECISION RELATED TO THAT CONFLICT OF INTEREST.
COMPENSATION DETERMINATIONFORM 990, PART VI, SECTION B, LINE 15A & 15BTHE ORGANIZATION USES INDUSTRY DATA IN DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS/KEY EMPLOYEES. FITZGIBBON HOSPITAL HAS AN AGREEMENT WITH BOONE HOSPITAL CENTER WHICH ALLOWS BOONE HOSPITAL TO OVERSEE AND ASSIST IN EVALUATING THE WORK AND PERFORMANCE OF THE PRESIDENT OF THE HOSPITAL AND IN DETERMINING THE COMPENSATION AND BENEFITS TO WHICH THE PRESIDENT WILL BE ENTITLED, THEREFORE, THE COMPENSATION WAS DETERMINED BY BOONE HOSPITAL IN CONSULTATION WITH THE FITZGIBBON HOSPITAL BOARD PRESIDENT.
DOCUMENT DISCLOSUREFORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO BE VIEWED IN THE ADMINISTRATION DEPARTMENT UPON WRITTEN REQUEST.
HOURS WORKED FOR RELATED ORGANIZATIONS AND BOARD MEMBER COMPENSATIONFORM 990, PART VII, SECTION A, COLUMN BOFFICERS RONALD A. OTT, ROBERTA NIENHUESER, AND NANCY HARRIS WORK APPROXIMATELY 40 HOURS PER WEEK BETWEEN JOHN FITZGIBBON MEMORIAL HOSPITAL ("THE HOSPITAL") AND FITZGIBBON HEALTH SERVICES. CRAIG MCCOY, DO, A BOARD MEMBER, IS CONTRACTED WITH THE HOSPITAL TO PROVIDE COLLABORATION WITH NURSE MIDWIVES. ALL BOARD MEMBERS ALSO SERVE ON THE BOARD OF FITZGIBBON HEALTH SERVICES FOR APPROXIMATELY 1 HOUR PER WEEK.
TAX EXEMPT BONDSFORM 990, PART X, LINE 20JOHN FITZGIBBON MEMORIAL HOSPITAL RECEIVED QUALIFIED HOSPITAL BOND PROCEEDS FROM 2005 AND 2010 BOND ISSUES. A PORTION OF THE BOND PROCEEDS WERE ALLOCATED TO FITZGIBBON HEALTH SERVICES FOR BOOK AND AUDIT PURPOSES. INFORMATION ABOUT THE BONDS ARE REPORTED ON JOHN FITZGIBBON MEMORIAL HOSPITAL'S SCHEDULE K.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5$ 29,723 NET UNREALIZED GAINS

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1FITZGIBBON HEALTH SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12305 S 65 HWY PO BOX 250AddressLine1
CityMARSHALLCity
StateMOState
ZIP Code65340ZIPCode
FieldValueIRS element (for citing)
EIN431731173EIN
Primary ActivitiesNURSING HOMEPrimaryActivities
Legal Domicile StateMOLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1JF MEM HOSPBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgtrueControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
FITZGIBBON HEALTH SERVICES
K60000FMV
FITZGIBBON HEALTH SERVICES
O137793FMV
FITZGIBBON HEALTH SERVICES
P429610FMV