JOHN FITZGIBBON MEMORIAL HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC (EIN 44-0655986)
- Tax period
- 2010-05-01 to 2011-04-30
- Filed
- 2012-03-12
- IRS object ID
- 201210729349300031
- Schema version
- 2010v3.7
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-12T14:13:45-05:00 | Timestamp |
| Tax Period End Date | 2011-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E ST LOUIS 200/PO BOX 1190 | AddressLine1 |
| City | SPRINGFIELD | City |
| State | MO | State |
| ZIP Code | 658062523 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440655986 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN FITZGIBBON MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JOHN | NameControl |
| Phone | 6608867431 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2305 S 65 HIGHWAY | AddressLine1 |
| Address Line2 | PO BOX 250 | AddressLine2 |
| City | MARSHALL | City |
| State | MO | State |
| ZIP Code | 65340 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RONALD A OTT | Name |
| Title | PRESIDENT / CEO | Title |
| Phone | 6608867431 | Phone |
| Date Signed | 2012-03-05 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Brian D Todd | Name |
| Phone | 4178658701 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RONALD A OTT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2305 S 65 HIGHWAY | AddressLine1 |
| City | MARSHALL | City |
| State | MO | State |
| ZIP Code | 65340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 55887331 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.fitzgibbon.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1961 | YearFormation |
| State Legal Domicile | MO | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 571 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 98434 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 326412 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48021297 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 50352024 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 233923 | InvestmentIncomePriorYear |
| Investment Income Current Year | 193607 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 6229 | OtherRevenuePriorYear |
| Other Revenue Current Year | -238396 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 48359883 | TotalRevenuePriorYear |
| Total Revenue Current Year | 50633647 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 71779 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 17379 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21432094 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 22173271 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 24172702 | OtherExpensePriorYear |
| Other Expenses Current Year | 26575897 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 45676575 | TotalExpensesPriorYear |
| Total Expenses Current Year | 48766547 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2683308 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1867100 | RevenuesLessExpensesCY |
| Total Assets BOY | 51857906 | TotalAssetsBOY |
| Total Assets EOY | 54036579 | TotalAssetsEOY |
| Total Liabilities BOY | 22543087 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22819048 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 29314819 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 31217531 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO IMPROVE THE HEALTH OF OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 36900998 | Expense |
| Revenue | 40366959 | Revenue |
| Description | 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3924393 | Expense |
| Revenue | 3781098 | Revenue |
| Description | 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 15,497 PATIENTS. THE HOSPITAL ALSO SUPPORTS A SEPARATE OUT-PATIENT CLINIC ON CAMPUS FOR FAMILY MEDICINE, OB/GYN, GENERAL SURGERY, & PSYCHIATRY STAFFED BY MEDICAL PROFESSIONALS PRACTICING IN THESE SPECIALTIES. FOR FISCAL YEAR 2011, THIS CLINIC PROVIDED SERVICES FOR 13,303 PATIENT VISITS. TWO SATELLITE FAMILY PRACTICE CLINICS ARE ALSO SUPPORTED BY THE HOSPITAL. THESE CLINICS PROVIDED SERVICES FOR 10,300 PATIENT VISITS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 928113 | Expense |
| Grants | 12000 | Grants |
| Revenue | 1779975 | Revenue |
| Description | COMMUNITY HEALTH SERVICES - HOSPICE, HOME HEALTH, & HOMEMAKER SERVICES. HOSPICE PROVIDED 2,982 PALLIATIVE CARE VISITS, 167 WERE FREE FOR PATIENTS W/O INSURANCE. HOME HEALTH PROVIDED 5,577 VISITS & HOMEMAKER PERFORMED 11,617 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 3,500 RIDERS DURING FY 2011. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 461745 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 5379 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 4423992 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 42215249 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 102 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 571 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | true | LocalChapters |
| Policies Reference Chapters | true | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NANCY HARRIS | NamePerson |
| Telephone Number | 6608313722 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2305 S 65 HIGHWAY PO BOX 250 | AddressLine1 |
| City | MARSHALL | City |
| State | MO | State |
| ZIP Code | 65340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| FRED UTLAUT | ||||||||
| PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | ||
| WILLIAM L SUMMERS | ||||||||
| VICE PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | ||
| DON VOGELSMEIER | ||||||||
| SECRETARY/TREASURER | 1.0 | X | X | 0 | 0 | 0 | ||
| VIRGINIA HUPP | ||||||||
| DIRECTOR BEGINNING 6/2010 | 1.0 | X | 0 | 0 | 0 | |||
| ROOK EVANS | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| B F KNIPSCHILD MD | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| RANDY MORROW | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JAMES SOWASH MD | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JACK UHRIG MD | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| GAYLE CARTER | ||||||||
| DIRECTOR BEGINNING 6/2010 | 1.0 | X | 0 | 0 | 0 | |||
| CRAIG MCCOY DO | ||||||||
| MEDICAL STAFF PRESIDENT | 1.0 | X | 120100 | 0 | 0 | |||
| BILL JACKSON | ||||||||
| DIRECTOR BEGINNING 6/2010 | 1.0 | X | 0 | 0 | 0 | |||
| RONALD A OTT | ||||||||
| PRESIDENT/CEO | 40.0 | X | 232031 | 0 | 18210 | |||
| NANCY HARRIS | ||||||||
| VP FINANCIAL SERVICES | 40.0 | X | 124620 | 0 | 8700 | |||
| LYNNE OTT | ||||||||
| VP PATIENT CARE SERVICES | 40.0 | 156594 | 0 | 7920 | X | |||
| DENNIS SOUSLEY | ||||||||
| VP CLINICAL SERVICES | 40.0 | 161945 | 0 | 9154 | X | |||
| KELLY ROSS DO | ||||||||
| ORTHOPEDIC SURGEON | 40.0 | 450941 | 0 | 2000 | X | |||
| DEVINDER GUPTA MD | ||||||||
| HOSPITALIST | 40.0 | 347415 | 0 | 19281 | X | |||
| JOHN BRIZENDINE MD | ||||||||
| GENERAL SURGEON | 40.0 | 330654 | 0 | 19281 | X | |||
| LORENZO ROMNEY DO | ||||||||
| HOSPITALIST | 40.0 | 304012 | 0 | 19915 | X | |||
| CRAIG SIMONS DO | ||||||||
| HOSPITALIST/ER PHYSICIAN | 40.0 | 291239 | 0 | 19481 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2519551 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 123942 | TotalOtherCompensation |
| Number Individuals GT100 K | 15 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| PHARMACY SYSTEMS INC | |
| PHARMACY MGMT | 624383 |
| THOMAS LAIRD MD | |
| ER PHYSICIAN | 239629 |
| BKD LLP | |
| AUDIT & CONSULTING | 175405 |
| PAUL T BRIZENDINE MD | |
| ER PHYSICIAN | 141318 |
| MEDICAL PHYSICS CONSULTING | |
| ONCOLOGY THERAPY | 139759 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Fundraising Events | 54442 | FundraisingEvents |
| Government Grants | 9046 | GovernmentGrants |
| All Other Contributions | 262924 | AllOtherContributions |
| Noncash Contributions | 14628 | NoncashContributions |
| Total Contributions | 326412 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUES | 900099 | 50042190 | 50042190 |
| CAFETERIA | 722210 | 209958 | 209958 |
| OTHER | 900099 | 39876 | 39876 |
| MANAGEMENT FEES | 561000 | 60000 | 60000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 50352024 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 185097 | TotalRevenueColumn |
| Exclusion | $185,097 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5209696 | Securities |
| Other | 8510 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5209696 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 8510 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8510 | TotalRevenueColumn |
| Exclusion | $8,510 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 45106 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 54442 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 43988 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1118 | TotalRevenueColumn |
| Exclusion | $1,118 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | LOSS EXTINGUISHMENT OF DEBT | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | -239514 | TotalRevenueColumn |
| Exclusion | -$239,514 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -239514 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 50633647 | TotalRevenueColumn |
| Related Or Exempt Function Income | 50352024 | RelatedOrExemptFunctionIncome |
| Exclusion | -$44,789 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17379 | Total |
| Program Services | 17379 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 839274 | Total |
| Program Services | 455713 | ProgramServices |
| Management And General | 383561 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42813 | Total |
| Program Services | 42813 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17619635 | Total |
| Program Services | 15082367 | ProgramServices |
| Management And General | 2537268 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 274416 | Total |
| Program Services | 236859 | ProgramServices |
| Management And General | 37557 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2149950 | Total |
| Program Services | 1851200 | ProgramServices |
| Management And General | 298750 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1247183 | Total |
| Program Services | 1063660 | ProgramServices |
| Management And General | 183523 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82706 | Total |
| Management And General | 82706 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190320 | Total |
| Management And General | 190320 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5175 | Total |
| Program Services | 4334 | ProgramServices |
| Management And General | 841 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4808482 | Total |
| Program Services | 3754050 | ProgramServices |
| Management And General | 1054432 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109971 | Total |
| Program Services | 48892 | ProgramServices |
| Management And General | 61079 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2216758 | Total |
| Program Services | 1813428 | ProgramServices |
| Management And General | 403330 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 787207 | Total |
| Program Services | 672852 | ProgramServices |
| Management And General | 114355 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 198506 | Total |
| Program Services | 174971 | ProgramServices |
| Management And General | 23535 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59255 | Total |
| Program Services | 26174 | ProgramServices |
| Management And General | 33081 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 985598 | Total |
| Program Services | 825335 | ProgramServices |
| Management And General | 160263 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3099361 | Total |
| Program Services | 2595389 | ProgramServices |
| Management And General | 503972 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 645790 | Total |
| Program Services | 546589 | ProgramServices |
| Management And General | 99201 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 6135120 | 6135120 | |
| LICENSES, DUES & SUBSCRIPTIONS | 182319 | 105708 | 76611 |
| RECRUITING | 371072 | 69996 | 301076 |
| MEDICAL SUPPLIES & DRUGS | 4411128 | 4405291 | 5837 |
| MEDICAID RELATED EXPENSE | 2287129 | 2287129 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48766547 | Total |
| Program Services | 42215249 | ProgramServices |
| Management And General | 6551298 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5711384 | BOY |
| EOY | 4392747 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10388101 | BOY |
| EOY | 14273107 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 139811 | BOY |
| EOY | 1667 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5664301 | BOY |
| EOY | 6736879 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1117088 | BOY |
| EOY | 1153318 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1011528 | BOY |
| EOY | 928877 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 49393940 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 26298586 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23508581 | BOY |
| EOY | 23095354 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4206608 | BOY |
| EOY | 3421840 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 110504 | BOY |
| EOY | 32790 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51857906 | BOY |
| EOY | 54036579 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3275103 | BOY |
| EOY | 4365808 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17352660 | BOY |
| EOY | 17055755 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 613510 | BOY |
| EOY | 267848 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1301814 | BOY |
| EOY | 1129637 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22543087 | BOY |
| EOY | 22819048 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28395400 | BOY |
| EOY | 30232173 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 464202 | BOY |
| EOY | 530141 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 455217 | BOY |
| EOY | 455217 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29314819 | BOY |
| EOY | 31217531 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51857906 | BOY |
| EOY | 54036579 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1867100 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 35612 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $6,934 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6934 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER LOBBYING ACTIVITIES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1(I) | ReturnReference |
| Explanation | THE 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 677227 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 21898 | InvestmentEarningsOrLosses |
| Other Expenditures | 4296 | OtherExpenditures |
| Administrative Expenses | 60 | AdministrativeExpenses |
| End Of Year Balance | 694769 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 618998 | BeginningOfYearBalance |
| Contributions | 25296 | Contributions |
| Investment Earnings Or Losses | 36603 | InvestmentEarningsOrLosses |
| Other Expenditures | 3670 | OtherExpenditures |
| End Of Year Balance | 677227 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 579322 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 39676 | InvestmentEarningsOrLosses |
| End Of Year Balance | 618998 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 71000 | OtherCostOrOtherBasis |
| Book Value | 71000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20495826 | OtherCostOrOtherBasis |
| Depreciation | 6075538 | Depreciation |
| Book Value | 14420288 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2506181 | OtherCostOrOtherBasis |
| Depreciation | 1489907 | Depreciation |
| Book Value | 1016274 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 24407184 | OtherCostOrOtherBasis |
| Depreciation | 18103232 | Depreciation |
| Book Value | 6303952 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1913749 | OtherCostOrOtherBasis |
| Depreciation | 629909 | Depreciation |
| Book Value | 1283840 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23095354 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO RELATED PARTY | $288,362 |
| EST AMT DUE TO 3RD PARTY | $841,275 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1129637 | TotalOfAmounts |
| Total Revenue | 50633647 | TotalRevenue |
| Total Expenses | 48766547 | TotalExpenses |
| Excess Or Deficit For Year | 1867100 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 35612 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 35612 | TotalAdjustments |
| Excess Or Deficit Per FS | 1902712 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 50669259 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 35612 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 35612 | RevenueNotRptdF990 |
| Revenue Subtotal | 50633647 | RevenueSubtotal |
| Total Revenue Per Form990 | 50633647 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 48766547 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 48766547 | ExpensesSubtotal |
| Total Expenses Per Form990 | 48766547 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | SPRING FLING | NameOfEvent1 |
| Gross Receipts Event1 | 37479 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 16608 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 20871 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 0 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 0 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 3874 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 0 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 19239 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF TOURNEY | NameOfEvent2 |
| Gross Receipts Event2 | 30302 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 14221 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 16081 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 4445 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 2489 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 1224 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 2039 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 0 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 2524 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 17639 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 9485 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 8154 | GrossRevenueOtherEvents |
| Cash Prizes Other Events | 0 | CashPrizesOtherEvents |
| Non Cash Prizes Other Events | 0 | NonCashPrizesOtherEvents |
| Rent Facility Costs Other Events | 0 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 0 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 0 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 8154 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 85420 | GrossReceiptsTotal |
| Charitable Contributions Total | 40314 | CharitableContributionsTotal |
| Gross Revenue Total Events | 45106 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 4445 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 2489 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1224 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 5913 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 0 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 29917 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 43988 | DirectExpenseSummaryEvents |
| Net Income Summary | 1118 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 344859 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 344859 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8411619 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7514141 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 897478 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02110 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8756478 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7514141 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1242337 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02920 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22860 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 22860 | NetCommunityBenefitExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 289522 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 289522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00680 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 568704 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 568704 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01330 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17379 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 17379 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 898465 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 898465 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9654943 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7514141 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2140802 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04970 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,568,625 | BadDebtExpenseAmount |
| Amount Attributable To | 1078823 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10886012 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11381334 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -495322 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN FITZGIBBON MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2305 S 65 HIGHWAY | AddressLine1 |
| City | MARSHALL | City |
| State | MO | State |
| ZIP Code | 65340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | ORTHO, WOUND CARE, REHAB, ONCOLOGY, PAIN, NEOUROLOGIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN FITZGIBBON MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| GRAND RIVER MEDICAL CLINIC | ||||
| 815 EAST BROADWAY | BRUNSWICK | MO | 65236 | OFFSITE MEDICAL CLINIC |
| AKEMAN MCBURNEY MEDICAL CLINIC | ||||
| 420 WEST FRONT STREET | SLATER | MO | 65349 | OFFSITE MEDICAL CLINIC |
| FITZGIBBON PROFESSIONAL BUILDING | ||||
| 2301 S 65 HIGHWAY | MARSHALL | MO | 65340 | OB/GYN, SURGERY, FAMILY PRACTICE, MENTAL HEALTH CLINIC |
| FITZGIBBON COMMUNITY HOME HEALTH CARE | ||||
| 2299 S 65 HIGHWAY | MARSHALL | MO | 65340 | HOME HEALTH, HOSPICE, HOMEMAKER |
Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 ($48,766,547) WAS REDUCED BY BAD DEBT EXPENSE ($6,135,120). |
| 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 CALCULATED BAD DEBT AT COST BY TAKING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TIMES THE RATIO OF PATIENT CARE COST TO CHARGES USED FOR SCHEDULE H, PART I CALCULATIONS. 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. |
| COMMUNITY BENEFIT RATIONAL | 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 | 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 | 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 | 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. | |
| STATE FILING OF COMMUNITY BENEFIT REPORT | 990 SCHEDULE H, PART VI | MO, |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| OATS INC | |||||||
| 2501 MCGUIRE BLVD | COLUMBIA | MO | 65201 | 431016961 | 501(C)(3) | 12000 | COMMUNITY SERVICES |
| ST LOUIS REGIONAL DSH FUNDING AUTHORITY | |||||||
| PO BOX 6766 | JEFFERSON CITY | MO | 651026766 | 061642698 | 501(C)(3) | 5379 | SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MONITORING USE OF GRANT FUNDS | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | THE HOSPITAL WORKS IN CONJUCTION 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. THROUGH AMENDMENT 3 OF THE ORGANIZATION'S AGREEMENT WITH MHA MANAGEMENT SERVICES CORPORATION AND INCREASED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS TO ALL MISSOURI HOSPITALS UNDER THE FEDERAL REIMBURSEMENT ALLOWANCE PROGRAM, THE HOSPITAL MADE CHARITABLE CONTRIBUTIONS TO THE DSH FUNDING AUTHORITY. THESE CONTRIBUTIONS ARE USED TO SUSTAIN THE VARIOUS CHARITY CARE CLINICS IN THE ST. LOUIS AREA, WITH LOCAL COMMUNITY HOSPITALS ABSORBING THE INPATIENT AND OUTPATIENT NEEDS OF THE COMMUNITY'S MEDICALLY INDIGENT POPULATION. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|
| RONALD A OTT | |||||||||||
| 177031 | 0 | 55000 | 0 | 0 | 0 | 2000 | 0 | 16210 | 0 | 250241 | 0 |
| KELLY ROSS DO | |||||||||||
| 434990 | 0 | 0 | 0 | 15951 | 0 | 2000 | 0 | 0 | 0 | 452941 | 0 |
| DEVINDER GUPTA MD | |||||||||||
| 318915 | 0 | 22500 | 0 | 6000 | 0 | 2000 | 0 | 17281 | 0 | 366696 | 0 |
| JOHN BRIZENDINE MD | |||||||||||
| 317000 | 0 | 0 | 0 | 13654 | 0 | 2000 | 0 | 17281 | 0 | 349935 | 0 |
| LORENZO ROMNEY DO | |||||||||||
| 253862 | 0 | 35000 | 0 | 15150 | 0 | 2000 | 0 | 17915 | 0 | 323927 | 0 |
| CRAIG SIMONS DO | |||||||||||
| 256239 | 0 | 35000 | 0 | 0 | 0 | 2000 | 0 | 17481 | 0 | 310720 | 0 |
| LYNNE OTT | |||||||||||
| 120594 | 0 | 36000 | 0 | 0 | 0 | 2000 | 0 | 5920 | 0 | 164514 | 0 |
| DENNIS SOUSLEY | |||||||||||
| 151945 | 0 | 10000 | 0 | 0 | 0 | 2000 | 0 | 7154 | 0 | 171099 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | NON-FIXED PAYMENTS | Identifier |
| Return Reference | SCHEDULE J, PART I, LINE 7 | ReturnReference |
| Explanation | ACCORDING TO THEIR RESPECTIVE CONTRACTS, PHYSICIANS ARE DUE AN ANNUAL INCENTIVE COMPENSATION NOT TO EXCEED 15% OF THEIR RESPECTIVE BASE SALARIES. THIS INCENTIVE IS BASED ON DEVELOPMENT OF PROTOCOLS; UTILIZATION OF STANDING ORDERS WHICH INCLUDE APPROPRIATE CARE MEASURES AS DEFINED BY CMS; COOPERATION WITH CARE COORDINATION AND UTILIZATION MANAGEMENT; COMPLETION OF ACCURATE AND TIMELY DOCUMENTATION; PATIENT SATISFACTION SCORES; AND ATTENDING CE PROVIDED BY HOSPITAL. 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 EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Amount UnspentAmountUnspent | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 10365462 | 0 | 0 | 0 | 193724 | 0 | 10171738 | 0 | 0 | 0 | 2007 | false | false | true | true |
| 0 | 0 | 12218468 | 0 | 0 | 11985656 | 232812 | 0 | 0 | 0 | 0 | 0 | 2010 | true | false | true | true |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | false | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| false | false | false | false | false | false |
| false | false | false | false | false | false |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JUDY VOGELSMEIER | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SPOUSE OF DON VOGELSMEIER | Relationship |
| Amount Of Transaction | 42813 | AmountOfTransaction |
| Description Of Transaction | EMPLOYEE COMPENSATION | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICES ACTIVITY #1 | FORM 990, PART III, LINE 4A | FOR THE FISCAL YEAR ENDED APRIL 30, 2011, THE EMERGENCY ROOM EXPERIENCED 12,487 PATIENT VISITS. THE SURGICAL TEAM PERFORMED 426 IN-PATIENT AND 2,184 OUT-PATIENT PROCEDURES. THE RADIOLOGY GROUP PERFORMED 35,987 PROCEDURES WHICH INCLUDED 4,273 MAMMOGRAMS, 5,636 CT SCANS, 1,859 MRI'S, 3,858 ULTRASOUND IMAGES AND 2,903 NUCLEAR MEDICINE SCANS. THE LABORATORY TEAM PERFORMED 98,243 TESTS. THE RESPIRATORY THERAPY DEPARTMENT CONDUCTED 31,812 PATIENT TREATMENTS AND THE REHABILITATIVE SERVICES GROUP WHICH INCLUDES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES PROVIDED 21,755 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 4,670 PATIENT VISITS AT THE FACILITY. IN ADDITION, THE STAFF EDUCATED 767 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 2011, 391 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. |
| RELATIONSHIP | 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 BEFORE IT IS FILED. |
| 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. 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. |
| BOARD MEMBER COMPENSATION | FORM 990, PART VII | CRAIG MCCOY, DO, RECEIVES COMPENSATION FOR HIS SERVICES AS AN INDEPENDENT CONTRACTOR. NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR SERVICES AS BOARD MEMBERS. |
| 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 | 35,612 UNREALIZED GAIN ON INVESTMENTS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FITZGIBBON HEALTH SERVICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2305 S 65 HWY PO BOX 250 | AddressLine1 |
| City | MARSHALL | City |
| State | MO | State |
| ZIP Code | 65340 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431731173 | EIN |
| Primary Activities | NURSING HOME | PrimaryActivities |
| Legal Domicile State | MO | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 9 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| FITZGIBBON HEALTH SERVICES | |
| K | 60000 |
| FITZGIBBON HEALTH SERVICES | |
| O | 127062 |
| FITZGIBBON HEALTH SERVICES | |
| P | 507939 |