2013-05-14T16:05:46-05:00 2012-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2011-07-01 430715842 General John J Pershing Memorial Hospital Association % GARY TANDY CFO GENE 6602582222 130 E Lockling PO Box 408 Brookfield MO 64628 PHIL HAMILTON 2013-05-15 true Jakeb D Blake 8162216300 2011 2016-02-24 21:20:13Z PHIL HAMILTON 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 17905835 false X N/A X 1955 MO THIS FISCAL YEAR WE IMPLEMENTED OUR ELECTRONIC MEDICAL RECORD SYSTEM. WE WILL INSTALL CLINICAL MODULES IN THE ED, OR, CLINIC, INPATIENT, AND MOST ANCILLIARY DEPARTMENTS. 10 8 182 25 0 0 0 42953 16436626 17635299 53919 53855 76792 173728 16567337 17905835 7743 9407 0 0 7212350 8219236 0 0 0 9048268 10214203 16268361 18442846 298976 -537011 21480994 20792539 8299417 8147973 13181577 12644566 X SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. false false 2870768 1881 3527060 INPATIENT ACUTE CARE SERVICES WITH 548 INPATIENT ADMISSIONS 8038152 5268 9875767 OUTPATIENT SERVICES WITH APPROXIMATELY 19,076 REGISTRATIONS. THIS INCLUDES 5,206 EMERGENCY ROOM VISITS. SEPERATE FROM THIS IS 1,108 HOME HEALTH AGENCY VISITS. 1004769 658 1234471 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 17,704 VISITS THIS PAST FISCAL YEAR. IT IS A LOWER COST ALTERNATIVE THAN USING THE EMERGENCY ROOM. OUR NEW CLINIC, APPLEGATE MEDICAL GROUP, SAW 6,943 PATIENTS. 2440153 1599 2998001 14353842 true true false true false false false false false false true false false false false true true false false false false false false false false false true true true false true false false false false false false true false false false false false false false false false false false true 35 0 true 182 true false false false false false false false false false false X 10 8 false true false false true true true true true false false false true true true true true false false false MO X X GARY TANDY CFO 6602582222 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 ANGELA P LITTRELL 1.0 X X 0 0 WILLIAM THUDIUM 1.0 X X 0 0 DR B K KNOWLES 36.0 X 180570 0 0 PAUL WILLIAMS 1.0 X 0 0 GAIL TURNER 1.0 X X 0 0 GARY ROUTLEDGE 1.0 X 0 0 CARY SAYRE 1.0 X 0 0 MARK CLEVELAND 1.0 X 0 0 DR SP GALVEZ 24.0 X 192590 0 1951 JIM ELLIOTT 1.0 X 0 0 DAVID SHAW 1.0 X 0 0 PHIL HAMILTON 40.0 X 153752 0 13261 GARY TANDY 40.0 X 95519 0 11531 DR JAMES L BOWERS 40.0 X 107570 12763 BRIAN CASEBOLT 40.0 X 105703 0 16543 GARY FITE 40.0 X 121558 0 14084 DAVID DOLLINS 40.0 X 127363 0 WACLAW DYMEK 40.0 X 125755 0 1210380 0 70133 10 false true true BOONE HOSPITAL CENTER MANAGEMENT 224254 DR PEPITO RIVERA PHYSICIAN SERVICES 490290 HAVE A NICE DAY ANESTHESIA ANETHESIOLOGIST 179005 DR B K KNOWLES PHYSICIAN SERVICES 180570 DR GARRETT ELAM PHYSICIAN SERVICES 199710 10 6556 36397 42953 Net Patient Service Rev 621400 17635299 17635299 17635299 52055 52055 0 0 29556 0 29556 29556 29556 1800 0 1800 1800 1800 0 0 0 Cafeteria 722210 28173 28173 Medical Records 561499 8306 8306 Vending Machines 900099 26260 26260 81433 81433 144172 17905835 17635299 0 227583 9407 9407 0 0 0 652565 388375 264190 25170 18374 6796 5856503 4355105 1501398 76930 56159 20771 1131332 834013 297319 476736 348017 128719 0 18084 18084 91098 91098 0 0 0 3646490 3015707 630783 14770 10782 3988 674652 492496 182156 0 0 361798 264113 97685 13253 13253 0 22997 22997 296355 216339 80016 0 1469426 1072681 396745 192684 140659 52025 Bad Debt Expense 1660397 1660397 Medical Supplies 920811 672192 248619 Taxes & Licenses 28998 28998 Medicaid FRA Payments 734664 734664 67726 64362 3364 18442846 14353842 4089004 0 0 0 5586068 4829694 0 0 3269840 3463296 0 0 0 0 126662 245745 164488 232501 191301 239535 20423002 8918185 11948543 11504817 0 0 0 0 0 0 0 0 194092 276951 21480994 20792539 1231501 1316892 0 0 12869 0 0 0 0 0 0 0 7055047 6831081 0 0 0 0 8299417 8147973 X 13165118 12626367 16459 18199 0 0 13181577 12644566 21480994 20792539 -537011 X false true false X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 4008 false false false 4008 false 107129 107129 13906037 5592196 8313841 6409836 3325989 3083847 11504817 0 0 17905835 18442846 -537011 -1740 -1740 -538751 16447548 11774 11774 16435774 1470061 1470061 17905835 16986299 16986299 1456547 1456547 18442846 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 CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 NET ASSETS RELEASED FROM RESTRICTIONS $ 11,774 RESTRICTED CONTRIBUTIONS RECEIVED $ (13,514) --------- OTHER CHANGES IN NET ASSETS $ (1,740) RECONCILIATION OF REVENUE SCHEDULE D, PART XII, LINE 2D NET ASSETS RELEASED FROM RESTRICTIONS $ 11,774 RECONCILIATION OF REVENUE SCHEDULE D, PART XII, LINE 4B RESTRICTED CONTRIBUTIONS RECEIVED $ 13,514 PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,456,547 ----------- TOTAL $ 1,470,061 RECONCILIATION OF EXPENSES SCHEDULE D, PART XIII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS: $ 1,456,547 true true true X 130. true X 195. true true false false 177755 177755 0.00960 2325715 1751575 574141 0.03110 2503470 1751575 751896 0.04070 7878 23686 0 0.00090 7878 23686 0 0.00090 2511348 1775261 751896 0.04160 2700 2700 0.00010 2700 2700 0.00010 false 820053 123008 8428545 8493948 -65403 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 HOME HEALTH, HOSPICE COMMUNITY MEDICAL APPLEGATE MEDICAL GENERAL JOHN J PERSHING MEM HOSPITAL 1 true true 130. true 195. true X true true X X X X true false true X false false 4 COMMUNITY MEDICAL ASSOCIATES

130 E LOCKLING AVE BROOKFIELD MO 64628

PROVIDER BASED RURAL HEALTH CLINIC PERSHING MEMORIAL HOSPITAL HOME HEALTH

130 E LOCKLING BROOKFIELD MO 64628

HOME HEALTH DISCONTINUED IN OCT 2011 PERSHING HOSPICE

130 E LOCKLING AVE BROOKFIELD MO 64628

HOSPICE DISCONTINUED IN OCT 2011 APPLEGATE MEDICAL GROUP

125 E LOCKLING AVE BROOKFIELD MO 64628

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 1,660,397. PART I, LINE 7 THE COST-TO-CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. BAD DEBT EXPENSE PART III, 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 AMOUNTS 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 ESTIMATE, 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. 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. A 9 PAGE TELEPHONE SURVEY WAS CONDUCTED (BY AN INDEPENDENT ORGANIZATION) IN 2007 WHICH COVERED ALL PROVIDERS OF HEALTH CARE SERVICES IN LINN COUNTY, AND MADE AVAILABLE TO ALL ENTITIES. 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, A NEW RHC OPENED IN JULY 2011. FURTHER, WE PRINT AN ABBREVEATED VERSION OF OUR CHARITY CARE POLICY GUIDELINES WITH AN EXAMPLE ON PATIENT STATEMENTS SENT OUT. SOCIAL SERVICES - THRU 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 businesss and agriculture. PROMOTION OF COMMUNITY HEALTH "PROMOTING THE HEALTH OF THE COMMUNITY" WE OPENED ANOTHER PROVIDER BASED RHC - APPLEGATE MEDICAL GROUP IN JULY 2011, WHICH 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 721 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. NEW PAPER 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. CHARGES FOR MEDICAL CARE PART V, SECTION B, LINE 19 the hospital facility determined the maxium amounts that can be charged to FAP-eligiable individuals for emergency or other medically necessary care by taking managed care contractual write offs divided by manage care revenues false X PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES PART I, LINE 2 THE ORGANIZATION DOES NOT MONITOR THE USE OF THE CONTRIBUTION AS THE REQUESTED FUNDS ARE FOR STATED OPERATING COSTS, SUCH AS USAGE OF THE ORGANIZATION, STAFF PAYROLL, ETC. X false false false false false false false false false DR B K KNOWLES 180570 0 0 0 0 0 0 0 0 0 180570 0 0 0 PHIL HAMILTON 127008 0 18391 0 8353 0 2736 0 10525 0 167013 0 0 0 DR SP GALVEZ 192590 0 0 0 0 0 0 0 1951 0 194541 0 0 0 COMPENSATION FROM AN UNRELATED ORGANIZATION FORM 990, PART VII, LINE 5 PHIL HAMILTON RECEIVED $167,013 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. SHANNON KNOWLES SPOUSE OF DIRECTOR 25170 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.