2012-05-14T14:07:43-05:00 2011-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2010-07-01 430715842 General John J Pershing Memorial Hospital Association GENE 6602582222 130 E Lockling PO Box 408 Brookfield MO 64628 PHIL HAMILTON 2012-05-15 Michael J Engle 8162216300 2010 2016-02-24 21:20:13Z PHIL HAMILTON 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 16567337 false X N/A X 1955 MO THIS FISCAL YEAR WE STARTED ON OUR ELECTRONIC MEDICAL RECORD PREPARATION. WE WILL INSTALL CLINICAL MODULES IN THE ED, OR, CLINIC, INPATIENT, AND MOST ANCILLIARY DEPARTMENTS. 10 7 182 25 0 0 10702 0 16445181 16436626 64548 53919 101432 76792 16621863 16567337 9137 7743 0 0 7338054 7212350 0 0 0 9089658 9048268 16436849 16268361 185014 298976 21405960 21480994 8523359 8299417 12882601 13181577 X SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. false false 2421380 1549 3287325 INPATIENT ACUTE CARE SERVICES WITH 445 INPATIENT ADMISSIONS 6779863 4336 9204511 OUTPATIENT SERVICES WITH 25,870 REGISTRATIONS. THIS INCLUDES 5,335 EMERGENCY ROOM VISITS. SEPERATE FROM THIS IS 3,867 HOME HEALTH AGENCY VISITS. 847483 542 1150564 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 20,052 VISITS THIS PAST FISCAL YEAR. IT IS A LOWER COST ALTERNATIVE THAN USING THE EMERGENCY ROOM. 2058173 1316 2794226 12106899 true false false true false false false false false true false false false false true true false false false false false false false false false true true false false true false false false false false false true false false false false false false false false false false false true 43 0 true 182 true false false false false false false false false false false X 10 7 false true false false true true true true true false false false true true true true true false false false MO X GARY TANDY CFO 6602582222 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 ANGELA P LITTRELL 1.0 X 0 0 0 WILLIAM THUDIUM 1.0 X X 0 0 0 ED KENNEDY 1.0 X X 0 0 0 DR B K KNOWLES 1.0 X 147990 0 0 IRENE STEFFES 1.0 X X 0 0 0 GAIL TURNER 1.0 X X 0 0 0 GARY ROUTLEDGE 1.0 X 0 0 0 CARY SAYRE 1.0 X 0 0 0 MARK CLEVELAND 1.0 X 0 0 0 DR SP GALVEZ 24.0 X 185880 0 1951 PHIL HAMILTON 40.0 X 146648 0 15248 GARY TANDY 40.0 X 90953 0 14584 DR JAMES L BOWERS 40.0 X 133641 0 3616 BRIAN CASEBOLT 40.0 X 102975 0 18234 GARY FITE 40.0 X 117358 0 15781 925445 0 69414 4 false true true BOONE HOSPITAL CENTER COLUMBIA MO MANAGEMENT 244624 DR PEPITO RIVERA BROOKFIELD MO PHYSICIAN 530588 HAVE A NICE DAY ANESTHESIA CHILLICO ANETHESIOLOGIST 215298 DR B K KNOWLES PHYSICIAN SERVICES 147990 DR GARRETT ELAM PHYSICIAN 181125 5 0 Net Patient Service Rev 621400 16436626 16436626 16436626 53169 53169 0 0 29173 29173 29173 29173 750 750 750 750 0 0 0 Cafeteria 722210 28275 28275 Medical Records 561499 7807 7807 Vending Machines 900099 1546 1546 9991 9991 47619 16567337 16436626 130711 7743 7743 0 0 0 623064 362643 260421 74701 52291 22410 5088838 3635688 1453150 81659 57161 24498 915015 640511 274505 429073 300351 128722 0 153751 153751 85869 85869 0 0 0 3477513 2837866 639647 11132 7792 3340 1613826 1129678 484148 0 0 312357 218650 93707 43225 43225 0 21413 21413 304874 213412 91462 0 976353 683447 292906 174796 122357 52439 Bad Debt Expense 1349817 1349817 Education 14303 14303 Taxes & Licenses 32649 32649 Medicaid FRA Payments 427145 427145 Dues & Subscriptions 32987 32987 16258 13057 3201 16268361 12106899 4161463 0 7751401 5586068 2296738 3269840 31584 126662 160936 164488 151878 191301 19448863 7500320 10814858 11948543 198565 194092 21405960 21480994 1241042 1231501 11825 12869 7270492 7055047 8523359 8299417 X 12862162 13165118 20439 16459 12882601 13181577 21405960 21480994 298976 X false true false X false X false false false false false true 2921 false false false 2921 false 107129 107129 13906037 4830101 9075936 3397875 2670219 727656 2037822 2037822 11948543 0 0 16567337 16268361 298976 3980 3980 302956 16571317 10080 10080 16561237 6100 6100 16567337 16268361 16268361 16268361 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 $10,080 RESTRICTED CONTRIBUTIONS RECEIVED $(6,100) --------- OTHER CHANGES IN NET ASSETS $3,980 RECONCILIATION OF REVENUE SCHEDULE D, PART XII, LINE 2D NET ASSETS RELEASED FROM RESTRICTIONS $10,080 RECONCILIATION OF REVENUE SCHEDULE D, PART XII, LINE 4B RESTRICTED CONTRIBUTIONS RECEIVED $6,100 true true true X 130. true X 195. true true false false 221135 221135 0.01360 1987055 1543035 444020 0.02730 2208190 1543035 665155 0.04090 9372 27532 -18160 0.00020 9372 27532 -18160 0.00020 2217562 1570567 646995 0.04110 2500 2500 0.00020 2500 2500 0.00020 false 651499 97725 7770240 7914628 -144388 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 ASSOCIATES GENERAL JOHN J PERSHING MEM HOSPITAL 1 3 COMMUNITY MEDICAL ASSOCIATES

130 E LOCKLING AVE BROOKFIELD MO 64628

PROVIDED BASED RURAL HEALTH CLINIC PERSHING MEMORIAL HOSPITAL HOME HEALTH

130 E LOCKLING BROOKFIELD MO 64628

HOME HEALTH PERSHING HOSPICE

130 E LOCKLING AVE BROOKFIELD MO 64628

HOSPICE 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 1,349,817. 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 it's charity care policy). The hospital's charity care policy is founded on the federal poverty income quidelines. 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. 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" Activities by: Community Medical Associates, our provider based RHC: -Provided a presentation to the Rotary Club on RHC's Nurse Practitioners. -Provided a presentation to the hospital Auxiliary on the differences between MDs and DOs. -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, Physical Therapy and Radiology 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 YMCA: -Processed 884 blood draws; Physical Therapy health booth; Home Health and Hospice participated; Bone density tests (156 screenings) (letting people at risk know that they should share their results with their family physician); 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 3 schools - a once a year public event which lets us promote the positive aspects of Pershing Health System. Home Health Services: -Provides approximately 50-60 free visits per year (flu shots, blood draws, vital signs, etc). Newspaper Articles: -Home Health/Hospice - Still a Benefit; Electronic Medical Records; Bed Bugs; Sleep Disorders; Holiday Stress; Dietary - Diabetes; Community Medical Associates - Germ Buster; Healthy Holidays, Fever in a Young Child; Radiology - Measuring bone Strength (DEXA); Nursing - What is a Swing Bed; Financial Assistance Charity Care -Numerous other minor contributions to the general welfare and safety of our community. X false false false false false false false false false PHIL HAMILTON 119558 0 19565 0 7525 0 2757 0 12491 0 161896 0 0 0 DR SP GALVEZ 185880 0 0 0 0 0 0 0 1951 0 187831 0 0 0 COMPENSATION FROM AN UNRELATED ORGANIZATION FORM 990, PART VII, LINE 5 PHIL HAMILTON RECEIVED $161,896 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. ANGELA CLEVELAND SPOUSE OF DIRECTOR 51615 EMPLOYEE false SHANNON KNOWLES SPOUSE OF DIRECTOR 23086 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 MANGEMENT 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 TUESDAY 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 ORGANIZATIONS 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.