2013-03-13T17:30:19-05:00 2012-04-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-05-01 440655986 JOHN FITZGIBBON MEMORIAL HOSPITAL % ROBERTA NIENHUESER JOHN 6608867431 2305 S 65 HIGHWAY PO BOX 250 MARSHALL MO 65340 RONALD A OTT 2013-03-07 true Brian D Todd 4178658701 2011 2016-02-25 16:41:14Z RONALD A OTT 2305 S 65 HIGHWAY MARSHALL MO 65340 54721443 false X www.fitzgibbon.org X 1923 MO TO 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. 12 10 593 58 0 0 326412 215558 50352024 54203327 193607 227551 -238396 45384 50633647 54691820 17379 12000 0 0 22173271 22977067 0 0 39255 26575897 29846908 48766547 52835975 1867100 1855845 54036579 55752440 22819048 22649341 31217531 33103099 X TO IMPROVE THE HEALTH OF OUR COMMUNITY. false false 39858875 42061429 HOSPITAL 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. 4664235 5122066 CLINIC 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. 1074710 2064176 COMMUNITY 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. 520762 12000 4955656 46118582 true true false true false false false false false true true false false false true false false true false false false false false false true false true true true false true true false false false false false false false false true false false false false false false true true true false false true 120 0 true 593 true false false false false false true true false false false false X 12 10 true false false false false true false true true false false false true true true true true false false false X ROBERTA NIENHUESER 6608313251 2305 S 65 HIGHWAY PO BOX 250 MARSHALL MO 65340 X FRED UTLAUT 1.0 X X 0 0 0 WILLIAM L SUMMERS 1.0 X X 0 0 0 DON VOGELSMEIER 1.0 X X 0 0 0 VIRGINIA HUPP 1.0 X 0 0 0 ROOK EVANS 1.0 X 0 0 0 B F KNIPSCHILD MD 1.0 X 0 0 0 RANDY MORROW 1.0 X 0 0 0 JAMES SOWASH MD 1.0 X 0 0 0 JACK UHRIG MD 1.0 X 0 0 0 GAYLE CARTER 1.0 X 0 0 0 CRAIG MCCOY DO 1.0 X 81862 0 0 BILL JACKSON 1.0 X 0 0 0 RONALD A OTT 40.0 X 275368 0 11128 ROBERTA NIENHUESER 40.0 X 12000 0 0 NANCY HARRIS 40.0 X 109674 0 4454 LYNNE OTT 40.0 X 160028 0 6159 DENNIS SOUSLEY 40.0 X 174571 0 4824 KELLY ROSS DO 40.0 X 483941 0 2000 CRAIG SIMONS DO 40.0 X 381332 0 2466 JOHN BRIZENDINE MD 40.0 X 333253 0 7000 DEVINDER GUPTA MD 40.0 X 329114 0 4600 LORENZO ROMNEY DO 40.0 X 257978 0 2466 2599121 0 45097 19 false true false PHARMACY SYSTEMS INC PHARMACY MGMT 712175 WATERSTONE BENEFIT ADMINISTRATOR 442661 PAUL T BRIZENDINE MD ER PHYSICIAN 260610 THOMAS LAIRD MD ER PHYSICIAN 259865 MO MEDICAL COLLECTIONS COLLECTIONS 210505 15 61563 26184 127811 215558 NET PATIENT SERVICE REVENUE 900099 53255217 53255217 EHR INCENTIVE REVENUE 722210 606836 606836 CAFETERIA 900099 234754 234754 MANAGEMENT FEES 561000 60000 60000 OTHER REVENUE 900099 46520 46520 54203327 208992 208992 0 0 19839 1280 18559 18559 18559 26858 61563 28343 -1485 -1485 0 0 INSURANCE PROCEEDS 900099 46869 46869 46869 54691820 54203327 272935 12000 12000 0 0 0 867992 405969 462023 48334 48334 18977037 16292077 2648949 36011 227477 193641 33836 1473463 1249412 224051 1382764 1160235 219890 2639 0 70676 70676 159694 159694 0 0 0 4870006 3850226 1019780 116485 60592 55893 3196894 2569485 626856 553 0 0 621824 532704 89120 214525 188542 25931 52 0 81007 30569 50438 885507 741519 143988 0 3037563 2543639 493924 634473 436729 197744 BAD DEBT 8783041 8783041 MEDICAL SUPPLIES & DRUGS 4825723 4825723 MEDICAID TAX 2115459 2115459 RECRUITING & RETENTION 234031 78686 155345 52835975 46118582 6678138 39255 4392747 4144337 14273107 14273733 1667 0 6736879 9132104 0 0 0 0 0 0 1153318 1067081 928877 956364 50887619 29074072 23095354 21813547 3421840 4150421 0 0 0 0 0 0 32790 214853 54036579 55752440 4365808 5410671 0 0 0 0 17055755 16554667 0 0 0 0 267848 0 0 0 1129637 684003 22819048 22649341 X 30232173 32105961 530141 541921 455217 455217 31217531 33103099 54036579 55752440 X 1855845 29723 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 9332 9332 false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION PAYS DUES TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ALLOCATED TO LOBBYING. 694769 24351 60 719060 677227 21898 4296 60 694769 618998 25296 36603 3670 677227 579322 39676 618998 0.24865 0.63307 0.11828 false false 71000 71000 23520648 8521587 14999061 0 0 0 26001580 19858204 6143376 1294391 694281 600110 21813547 0 DUE TO RELATED PARTY 34003 EST AMT DUE TO 3RD PTY PYRS 650000 684003 54691820 52835975 1855845 29723 29723 1885568 54749886 29723 29723 54720163 -28343 -28343 54691820 52864318 28343 28343 52835975 52835975 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE 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 POSITION 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. OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $( 28,343) SPECIAL EVENTS EXPENSES OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $ 28,343 SPECIAL EVENTS EXPENSES SPRING FLING 45621 33233 12388 3342 6488 GOLF TOURNEY 28147 19325 8822 5249 2951 1188 1226 1088 1 14653 9005 5648 6811 88421 61563 26858 5249 2951 1188 4568 14387 28343 -1485 true true X true X true X true true false true true 185808 0 185808 0.00420 8873810 7011019 1862791 0.04230 0 0 0 0.00000 9059618 7011019 2048599 0.04650 32901 5202 27699 0.00060 361961 0 361961 0.00820 5107941 4606431 501510 0.01140 0 0 0 0.00000 12000 0 12000 0.00030 5514803 4611633 903170 0.02050 14574421 11622652 2951769 0.06700 true 8783041 3688877 11816554 12240073 -423519 X true true 1 1 JOHN FITZGIBBON MEMORIAL HOSPITAL

2305 S 65 HIGHWAY MARSHALL MO 65340

X X X ORTHO, WOUND CARE, REHAB, ONCOLOGY, PAIN, NEUROLOGIC JOHN FITZGIBBON MEMORIAL HOSPITAL 1 false true true 100 true 200. true X true true X X X true false X X X true X false false 5 FITZGIBBON PROFESSIONAL BUILDING

2301 S 65 HIGHWAY MARSHALL MO 65340

OB/GYN, SURGERY, FAMILY PRACTICE, MENTAL HEALTH CLINIC FITZGIBBON COMMUNITY HOME HEALTH CARE

2303 S 65 HIGHWAY MARSHALL MO 65340

HOME HEALTH, HOSPICE, HOMEMAKER AKEMAN MCBURNEY MEDICAL CLINIC

420 WEST FRONT STREET SLATER MO 65349

OFFSITE MEDICAL CLINIC GRAND RIVER MEDICAL CLINIC

815 EAST BROADWAY BRUNSWICK MO 65236

OFFSITE MEDICAL CLINIC BUCKNER WELLNESS CENTER

2299 S 65 HIGHWAY MARSHALL MO 65340

CARDIAC/PULMONARY WELLNESS PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F TO 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 EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THE 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 RATIONALE SCHEDULE H, PART III, SECTION B, LINE 8 MEDICARE 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 POLICY SCHEDULE H, PART III, SECTION C, LINE 9B THE 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 ASSESSMENT SCHEDULE H, PART VI, LINE 2 OUR 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 ASSISTANCE SCHEDULE H, PART VI, LINE 3 THE 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 INFORMATION SCHEDULE H, PART VI, LINE 4 FITZGIBBON 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 SYSTEM SCHEDULE H, PART VI, LINE 6 THE 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 CARE SCHEDULE H, PART V, SECTION B, LINE 19 THE 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. true OATS INC 2501 MCGUIRE BLVD COLUMBIA MO 65201 431016961 501(C)(3) 12000 COMMUNITY SERVICES 1 MONITORING USE OF GRANT FUNDS SCHEDULE I, PART I, LINE 2 THE 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. X X false false false false false false false true false RONALD A OTT 209668 0 65700 0 0 0 2000 0 9128 0 286496 0 0 0 LYNNE OTT 122928 0 37100 0 0 0 2000 0 4159 0 166187 0 0 0 DENNIS SOUSLEY 154571 0 20000 0 0 0 2000 0 2824 0 179395 0 0 0 KELLY ROSS DO 434990 0 33000 0 15951 0 2000 0 0 0 485941 0 0 0 CRAIG SIMONS DO 381332 0 0 0 0 0 2000 0 466 0 383798 0 0 0 JOHN BRIZENDINE MD 320000 0 0 0 13253 0 2000 0 5000 0 340253 0 0 0 DEVINDER GUPTA MD 323114 0 0 0 6000 0 2000 0 2600 0 333714 0 0 0 LORENZO ROMNEY DO 242829 0 0 0 15149 0 2000 0 466 0 260444 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 ACCORDING 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. INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO 431386697 79516LAD6 2005-12-22 10000000 CONSTRUCTION REVENUE BONDS false false false INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO 430980296 79516LBC7 2010-11-29 12218468 1998 BOND REFINANCING false false false 0 0 10365462 0 0 0 193724 0 9806276 0 0 0 2007 false false true true 0 0 12218468 0 0 11985656 232812 0 0 0 0 0 2010 false false true true false false false false 0.00000 0.00000 0.00000 true false false false false 0 true false false false 0 false 0 false false false false false 0 false 0 false false X TOTAL PROCEEDS OF ISSUE SCHEDULE K, PART II, LINE 3 TOTAL 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). JUDY VOGELSMEIER SPOUSE OF DON VOGELSMEIER 48334 EMPLOYEE COMPENSATION false PROGRAM SERVICES ACTIVITY #1 FORM 990, PART III, LINE 4A FOR 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 SERVICES FORM 990, PART III, LINE 4D A 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 RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 RONALD OTT, PRESIDENT AND CEO, IS MARRIED TO LYNNE OTT, VP OF PATIENT CARE SERVICES, KEY EMPLOYEE. MEMBERS, STOCKHOLDERS, OR OTHER PERSONS FORM 990, PART VI, SECTION A, LINE 7A THE MEDICAL STAFF OF THE ORGANIZATION ELECTS THE CHIEF OF MEDICAL STAFF WHO IS A VOTING MEMBER OF THE BOARD. REVIEW OF FORM 990 FORM 990, PART VI, SECTION B, LINE 11B THE 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 POLICY FORM 990, PART VI, SECTION B, LINE 12C THE 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 DETERMINATION FORM 990, PART VI, SECTION B, LINE 15A & 15B THE 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 DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 GOVERNING 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 COMPENSATION FORM 990, PART VII, SECTION A, COLUMN B OFFICERS 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 BONDS FORM 990, PART X, LINE 20 JOHN 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 ASSETS FORM 990, PART XI, LINE 5 $ 29,723 NET UNREALIZED GAINS FITZGIBBON HEALTH SERVICES 2305 S 65 HWY PO BOX 250 MARSHALL MO 65340 431731173 NURSING HOME MO 501(C)(3) 9 JF MEM HOSP true false false false false false false false false false false true false true true true true false false FITZGIBBON HEALTH SERVICES K 60000 FMV FITZGIBBON HEALTH SERVICES O 137793 FMV FITZGIBBON HEALTH SERVICES P 429610 FMV