LAKE REGIONAL HEALTH SYSTEM: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
LAKE REGIONAL HEALTH SYSTEM (EIN 23-7339737)
Tax period
2011-05-01 to 2012-04-30
Filed
2012-12-13
IRS object ID
201233489349300208
Schema version
2011v1.3
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-12-13T09:14:32-06:00Timestamp
Tax Period End Date2012-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

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

Filer Filer

FieldValueIRS element (for citing)
EIN237339737EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKE REGIONAL HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% DAN PROBSTFIELDInCareOfName
Name ControlLAKENameControl
Phone5733488000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line154 HOSPITAL DRIVEAddressLine1
CityOSAGE BEACHCity
StateMOState
ZIP Code65065ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAN PROBSTFIELDName
TitleSENIOR VP/CFOTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHAEL E HENZENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line154 HOSPITAL DRIVEAddressLine1
CityOSAGE BEACHCity
StateMOState
ZIP Code65065ZIPCode
FieldValueIRS element (for citing)
Gross Receipts164525936GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LAKEREGIONAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionLAKE REGIONAL HLTH SYSTEM PROVIDES AN EXTENSIVE VARIETY OF OUTPATIENT & INPATIENT HLTH CARE SERVICES AS WELL AS AN EMERGENCY DEPARTMENT TO RESIDENTS & VISITORS OF THE LAKE REGION. SEE SCHEDULE O FOR MORE INFO.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees1184TotalNbrEmployees
Total Nbr Volunteers415TotalNbrVolunteers
Total Gross UBI381TotalGrossUBI
Contributions Grants Prior Year819907ContributionsGrantsPriorYear
Contributions Grants Current Year388577ContributionsGrantsCurrentYear
Program Service Revenue Prior Year160273614ProgramServiceRevenuePriorYear
Program Service Revenue CY165010891ProgramServiceRevenueCY
Investment Income Prior Year1733573InvestmentIncomePriorYear
Investment Income Current Year2372881InvestmentIncomeCurrentYear
Other Revenue Prior Year-6332946OtherRevenuePriorYear
Other Revenue Current Year-4579770OtherRevenueCurrentYear
Total Revenue Prior Year156494148TotalRevenuePriorYear
Total Revenue Current Year163192579TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year110074GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY69466GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year60347837SalariesEtcPriorYear
Salaries Etc Current Year63940768SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year88615726OtherExpensePriorYear
Other Expenses Current Year94730010OtherExpensesCurrentYear
Total Expenses Prior Year149073637TotalExpensesPriorYear
Total Expenses Current Year158740244TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7420511RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4452335RevenuesLessExpensesCY
Total Assets BOY176979780TotalAssetsBOY
Total Assets EOY182513513TotalAssetsEOY
Total Liabilities BOY71977895TotalLiabilitiesBOY
Total Liabilities EOY73122740TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY105001885NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY109390773NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionLAKE REGIONAL HEALTH SYSTEM WILL PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF THE LAKE REGION WITH EMPHASIS ON QUALITY OUTCOMES AND SERVICE SATISFACTION WHILE OPERATING IN A SOUND FISCAL MANNER.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense56507404Expense
Revenue57924229Revenue
DescriptionLAKE REGIONAL HEALTH SYSTEM PROVIDES OUTPATIENT SERVICES SUCH AS DIAGNOSTIC IMAGING, LABORATORY AND PHYSICAL THERAPY SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED A TOTAL OF 225,218 OUTPATIENT SERVICES VISITS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense53603081Expense
Revenue59556533Revenue
DescriptionLAKE REGIONAL HEALTH SYSTEM PROVIDES INPATIENT SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED 24,433 INPATIENT DAYS, 3,779 SKILLED NURSING FACILITY INPATIENT DAYS AND 1,189 NURSERY PATIENT DAYS FOR A TOTAL OF 29,401 INPATIENT DAYS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense14411966Expense
Revenue39075985Revenue
DescriptionLAKE REGIONAL HEALTH SYSTEM'S EMERGENCY DEPARTMENT IS A LEVEL III TRAUMA CENTER (GRANTED THROUGH A SPECIAL STATE CREDENTIALING PROCESS REQUIRING EXTENSIVE EDUCATION AND SERVICE REVIEW) PROVIDING 24-HOUR EMERGENCY MEDICAL SERVICE TO A FIVE COUNTY AREA. THE UNIVERSITY OF MISSOURI STAFF FOR LIFE HELICOPTER IS BASED HERE. THE EMERGENCY DEPARTMENT PROVIDED 37,862 VISITS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp10754350TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt69466TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev8454144TotalOfOtherProgramServiceRev
Total Program Service Expense135276801TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096172NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1184NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChapterstrueLocalChapters
Policies Reference ChapterstruePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
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Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDAN PROBSTFIELDNamePerson
Telephone Number5733488000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line154 HOSPITAL DRAddressLine1
CityOSAGE BEACHCity
StateMOState
ZIP Code65065ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
KEVIN BYRNE DO
PRESIDENT1.0XX000
CHARLES MCELYEA
ASSISTANT SECRETARY1.0XX000
ROBERT G SCHWENDINGER
SECRETARY1.0XX000
GREG GAGNON
TREASURER1.0XX000
GREG ANDERSON
DIRECTOR1.0X000
SUSAN BROWN
DIRECTOR1.0X000
JOHN CAINE
DIRECTOR1.0X000
WAYNE COMPTON
DIRECTOR1.0X000
ROBERT MASON DO
DIRECTOR1.0X0967413870
GRANT BARNUM DO
DIRECTOR1.0X026276327053
JOHN PARRISH
DIRECTOR1.0X000
LARRY SHIELDS
DIRECTOR1.0X000
DENNIS MICHAELREE
VICE PRESIDENT1.0XX000
ANDREW MCKIBBEN MD
DIRECTOR1.0X028512426914
COREY TEN BENSEL
DIRECTOR BEGINNING 06/111.0X000
MICHAEL HENZE
CEO40.0X829323074952
VICKI L FRANKLIN
SENIOR VP/COO40.0X360751017186
M DANIEL PROBSTFIELD
SENIOR VP/CFO40.0X299478019093
JANICE L DUNGAN
SENIOR VP - CLINICAL SERVICES40.0230783016054X
F JOE BUTTS
SENIOR VP - FACILITY SERVICES40.0319029018255X
KEVIN G MCROBERTS
SENIOR VP - BUSINESS DEVELOP.40.0276452033214X
ROBERT HYATT MD
SENIOR VP - MEDICAL AFFAIRS40.0424431010744X
SCOTT POEST
CIO40.0157676021157X
THOMAS MYLER
DIRECTOR OF PHARMACY40.0171587017771X
MICHAEL DOW
CLINICAL COORDINATOR40.0169599015874X
STEVEN GROTEWIEL
DIRECTOR OF DIAGNOSTIC IMAGING40.0159135010360X
JOE SCOTT
PHARMACIST40.0157326011569X
DARLA WILKERSON-ERVIN
DIRECTOR OF REVENUE CYCLE40.014187508812X
CYNTHIA OTRADOVEC
FORMER CIO40.010842104740X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3805866TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs644628TotalReportableCompFrmRltdOrgs
Total Other Compensation337618TotalOtherCompensation
Number Individuals GT100 K47NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
LAKE EMERGENCY SPECIALISTS
PHYSICIAN SERVICES4410014
NATIONAL THERAPEUTIC ASSOCIATES
MEDICAL SERVICES2590581
LAKE OZARK ANESTHESIA ASSOC
PHYSICIAN SERVICES624000
ARMSTRONG TEASDALE LLP
LEGAL SERVICES547682
REVENUE CYCLE PARTNERS HOLDINGS LL
COLLECTION SERVICES525947
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Fundraising Events263255FundraisingEvents
All Other Contributions125322AllOtherContributions
Noncash Contributions84898NoncashContributions
Total Contributions388577TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE624100156556747156556747
ELECTRONIC HEALTH RECORDS62410032970733297073
MANAGEMENT FEES54161013014261301426
CAFETERIA INCOME722210993971993971
AUXILIARY900099290914290914

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column2570760TotalRevenueColumn
Related Or Exempt Function Income2570760RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue165010891TotalProgramServiceRevenue

Investment Income InvestmentIncome

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Total Revenue Column2386506TotalRevenueColumn
Exclusion$2,386,506ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

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Real1027860Real

Less Rental Expenses LessRentalExpenses

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Real1114929Real

Rental Income Or Loss RentalIncomeOrLoss

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Real-87069Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-87069TotalRevenueColumn
Unrelated Business Revenue381UnrelatedBusinessRevenue
Exclusion-$87,450ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

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Other96674Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

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Gain Or Loss GainOrLoss

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Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column-13625TotalRevenueColumn
Exclusion-$13,625ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events63742GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events263255CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses108129FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-44387TotalRevenueColumn
Exclusion-$44,387ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionCHANGE IN INTEREST IN EQUITY INVESTEESDescription
Business Code900099BusinessCode
Total Revenue Column-4448314TotalRevenueColumn
Exclusion-$4,448,314ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue-4448314TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column163192579TotalRevenueColumn
Related Or Exempt Function Income165010891RelatedOrExemptFunctionIncome
Unrelated Business Revenue381UnrelatedBusinessRevenue
Exclusion-$2,207,270ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total38466Total
Program Services38466ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

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Total31000Total
Program Services31000ProgramServices

Foreign Grants ForeignGrants

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Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

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Total3108578Total
Program Services1885733ProgramServices
Management And General1222845ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

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Total266696Total
Program Services266696ProgramServices

Other Salaries And Wages OtherSalariesAndWages

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Total47864671Total
Program Services40310500ProgramServices
Management And General7554171ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1948442Total
Program Services1670821ProgramServices
Management And General277621ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7031274Total
Program Services5838186ProgramServices
Management And General1193088ManagementAndGeneral

Payroll Taxes PayrollTaxes

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Total3721107Total
Program Services3087877ProgramServices
Management And General633230ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

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Total0Total

Fees For Services Legal FeesForServicesLegal

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Total641465Total
Management And General641465ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

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Total103997Total
Management And General103997ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

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Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

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Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

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Total152933Total
Management And General152933ManagementAndGeneral

Fees For Services Other FeesForServicesOther

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Total19281699Total
Program Services12385679ProgramServices
Management And General6896020ManagementAndGeneral

Advertising Advertising

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Total30995Total
Management And General30995ManagementAndGeneral

Office Expenses OfficeExpenses

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Total6898544Total
Program Services5021312ProgramServices
Management And General1877232ManagementAndGeneral

Information Technology InformationTechnology

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Total53111Total
Management And General53111ManagementAndGeneral

Royalties Royalties

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Total0Total

Occupancy Occupancy

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Total1977564Total
Program Services1684396ProgramServices
Management And General293168ManagementAndGeneral

Travel Travel

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Total303682Total
Program Services161113ProgramServices
Management And General142569ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

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Total51521Total
Program Services10197ProgramServices
Management And General41324ManagementAndGeneral

Interest Interest

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Total2503873Total
Program Services2236953ProgramServices
Management And General266920ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

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Total0Total

Depreciation Depletion DepreciationDepletion

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Total7810274Total
Program Services6977676ProgramServices
Management And General832598ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1083507Total
Management And General1083507ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT2080679220806792
MEDICAL SUPPLIES & DRUGS2379986323799863
PROVIDER TAX82469578246957
CAFETERIA/VENDING86204177014591896

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Management And General74753ManagementAndGeneral

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Program Services135276801ProgramServices
Management And General23463443ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

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EOY2568EOY

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EOY0EOY

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EOY14684518EOY

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EOY0EOY

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Inventories For Sale Or Use InventoriesForSaleOrUse

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EOY4617959EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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BOY866298BOY
EOY963701EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis148101019LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec90870385LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

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EOY57230634EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

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BOY46401270BOY
EOY63858177EOY

Investments Other Securities InvestmentsOtherSecurities

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BOY5044166BOY
EOY5125960EOY

Investments Program Related InvestmentsProgramRelated

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Intangible Assets IntangibleAssets

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EOY0EOY

Other Assets Total OtherAssetsTotal

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BOY333264BOY
EOY4077978EOY

Total Assets TotalAssets

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BOY176979780BOY
EOY182513513EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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EOY13045665EOY

Grants Payable GrantsPayable

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BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

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Tax Exempt Bond Liabilities TaxExemptBondLiabilities

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BOY51410000BOY
EOY49175000EOY

Escrow Account Liability EscrowAccountLiability

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BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

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EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

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BOY3225233BOY
EOY3776066EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

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BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

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BOY5290550BOY
EOY7126009EOY

Total Liabilities TotalLiabilities

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EOY73122740EOY
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Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

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BOY104984627BOY
EOY109373515EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

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EOY17258EOY

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EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

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BOY105001885BOY
EOY109390773EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY176979780BOY
EOY182513513EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4452335ReconcilationRevenueExpenses
Reconcilation Other Changes-63447ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$11,504OtherActivitiesAmount
Total Lobbying Expenditures IIB11504TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER LOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1(I)ReturnReference
ExplanationA PORTION OF THE DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING PURPOSES: $ 6,985 MISSOURI HOSPITAL ASSOCIATION 4,519 AMERICAN HOSPITAL ASSOCIATION -------- $ 11,504Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis530500InvestmentCostOrOtherBasis
Other Cost Or Other Basis4322066OtherCostOrOtherBasis
Book Value4852566BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis84550830OtherCostOrOtherBasis
Depreciation47936293Depreciation
Book Value36614537BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis56006324OtherCostOrOtherBasis
Depreciation40997217Depreciation
Book Value15009107BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2691299OtherCostOrOtherBasis
Depreciation1936875Depreciation
Book Value754424BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings57230634TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionEST AMT DUE TO 3RD PTY PYRSDescription
Amount$7,126,009Amount
FieldValueIRS element (for citing)
Total Of Amounts7126009TotalOfAmounts
Total Revenue163192579TotalRevenue
Total Expenses158740244TotalExpenses
Excess Or Deficit For Year4452335ExcessOrDeficitForYear
Net Unrealized GL On Investments-63447NetUnrealizedGLOnInvestments
Total Adjustments-63447TotalAdjustments
Excess Or Deficit Per FS4388888ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt164095578TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-63447NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities17500DonatedSrvcAndUseOfFacilities
Other Revenues-165983OtherRevenues
Revenue Not Rptd F990-211930RevenueNotRptdF990
Revenue Subtotal164307508RevenueSubtotal
Other Revenues Not Included-1114929OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-1114929RevenueNotRptdOnFinStmt
Total Revenue Per Form990163192579TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt159706690TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities17500DonatedServicesUseOfFacilities
Other Expenses Included1114929OtherExpensesIncluded
Expenses Not Rptd F9901132429ExpensesNotRptdF990
Expenses Subtotal158574261ExpensesSubtotal
Investment Expenses Not Included2152933InvestmentExpensesNotIncluded2
Other Expenses Not Included13050OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt165983ExpensesNotRptdOnFinStmt
Total Expenses Per Form990158740244TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
UNCERTAIN TAX POSITIONSSCHEDULE D, PART X, LINE 2MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
RECONCILIING ITEMSSCHEDULE D, PART XII, LINE 2DTHE FOLLOWING ITEMS WERE INCLUDED WITH REVENUES ON THE AUDIT REPORT; HOWEVER, HAVE BEEN MOVED TO BE PROPERLY INCLUDED ON THE STATEMENT OF FUNCTIONAL EXPENSES ON THE FORM 990: $ 152,933 INVESTMENT FEES 13,050 AUXILIARY EXPENSES ------------ $ 165,983 SCHEDULE D, PART XII, LINE 4B AND PART XIII, LINE 2D THE FOLLOWING ITEMS WERE INCLUDED WITH EXPENSES ON THE AUDIT REPORT; HOWEVER, HAVE BEEN MOVED TO BE PROPERLY INCLUDED ON THE STATEMENT OF REVENUE ON THE FORM 990: $ 1,114,929 RENTAL EXPENSES SCHEDULE D, PART XIII, LINE 4B THE FOLLOWING ITEMS WERE INCLUDED WITH REVENUES ON THE AUDIT REPORT; HOWEVER, HAVE BEEN MOVED TO BE PROPERLY INCLUDED ON THE STATEMENT OF FUNCTIONAL EXPENSES ON THE FORM 990: $ 13,050 AUXILIARY EXPENSES

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1ANNUAL BALLNameOfEvent1
Gross Receipts Event1125356GrossReceiptsEvent1
Charitable Contributions Event1104813CharitableContributionsEvent1
Gross Revenue Event120543GrossRevenueEvent1
Food And Beverage Event128148FoodAndBeverageEvent1
Entertainment Event15250EntertainmentEvent1
Other Direct Expenses Event115429OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNAMENTNameOfEvent2
Gross Receipts Event2197475GrossReceiptsEvent2
Charitable Contributions Event2158192CharitableContributionsEvent2
Gross Revenue Event239283GrossRevenueEvent2
Cash Prizes Event220736CashPrizesEvent2
Non Cash Prizes Event27685NonCashPrizesEvent2
Rent Facility Costs Event23844RentFacilityCostsEvent2
Food And Beverage Event214778FoodAndBeverageEvent2
Entertainment Event23250EntertainmentEvent2
Other Direct Expenses Event27773OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total322831GrossReceiptsTotal
Charitable Contributions Total263005CharitableContributionsTotal
Gross Revenue Total Events59826GrossRevenueTotalEvents
Cash Prizes Total Events20736CashPrizesTotalEvents
Non Cash Prizes Total Events7685NonCashPrizesTotalEvents
Rent Facility Costs Total Events3844RentFacilityCostsTotalEvents
Food And Beverage Total Events42926FoodAndBeverageTotalEvents
Entertainment Total Events8500EntertainmentTotalEvents
Other Direct Expenses Total Events23202OtherDirectExpensesTotalEvents
Direct Expense Summary Events106893DirectExpenseSummaryEvents
Net Income Summary-47067NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3124184TotalCommunityBenefitExpense
Net Community Benefit Expense3124184NetCommunityBenefitExpense
Percent Of Total Expense0.02270PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense24626885TotalCommunityBenefitExpense
Direct Offsetting Revenue23810778DirectOffsettingRevenue
Net Community Benefit Expense816107NetCommunityBenefitExpense
Percent Of Total Expense0.00590PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense27751069TotalCommunityBenefitExpense
Direct Offsetting Revenue23810778DirectOffsettingRevenue
Net Community Benefit Expense3940291NetCommunityBenefitExpense
Percent Of Total Expense0.02860PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense84636TotalCommunityBenefitExpense
Direct Offsetting Revenue40324DirectOffsettingRevenue
Net Community Benefit Expense44312NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense255202TotalCommunityBenefitExpense
Net Community Benefit Expense255202NetCommunityBenefitExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense169477TotalCommunityBenefitExpense
Net Community Benefit Expense169477NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense509315TotalCommunityBenefitExpense
Direct Offsetting Revenue40324DirectOffsettingRevenue
Net Community Benefit Expense468991NetCommunityBenefitExpense
Percent Of Total Expense0.00340PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense28260384TotalCommunityBenefitExpense
Direct Offsetting Revenue23851102DirectOffsettingRevenue
Net Community Benefit Expense4409282NetCommunityBenefitExpense
Percent Of Total Expense0.03200PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense5292TotalCommunityBuildingExpense
Net Community Building Expense5292NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense42096TotalCommunityBuildingExpense
Net Community Building Expense42096NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense47388TotalCommunityBuildingExpense
Net Community Building Expense47388NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$20,806,792BadDebtExpenseAmount
Amount Attributable To3495541AmountAttributableTo
Amount Reimbursed By Medicare61480617AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare70225114CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-8744497MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1LAKE REG IMAGING PTRBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityDIAGNOSTIC IMAGING SERVICESDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.51000OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.49000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKE REGIONAL HEALTH SYSTEMBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line154 HOSPITAL DRAddressLine1
CityOSAGE BEACHCity
StateMOState
ZIP Code65065ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1LAKE REGIONAL HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.FPGDiscountPercent
Explains BasistrueExplainsBasis
Other FactorsXOtherFactors
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
LAKE REGIONAL IMAGING PARTNERS
54 HOSPITAL DROSAGE BEACHMO65065IMAGING CENTER
ELDON REHAB THERAPY
304 EAST 4TH STREETELDONMO65026REHAB THERAPY
LAKE OZARK REHAB THERAPY
1870 BAGNELL DAM BLVDLAKE OZARKMO65049REHAB THERAPY
LAURIE REHAB THERAPY
156 MISSOURI BLVDLAURIEMO65038REHAB THERAPY
CAMDENTON REHAB THERAPY
1930 N BUSINESS ROUTE 5CAMDENTONMO65020REHAB THERAPY

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PERCENT OF TOTAL EXPENSESCHEDULE H, PART I, LINE 7, COLUMN FTHE PERCENT OF TOTAL EXPENSE ON SCHEDULE H, PART I, LINE 7, COLUMN (F), WAS CALCULATED USING TOTAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) OF $158,740,244 LESS BAD DEBT EXPENSE OF $20,806,792.
COSTING METHODOLOGYSCHEDULE H, PART I, LINE 7GTHE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3.
BAD DEBT AND COSTING METHODOLOGYSCHEDULE H, PART III, SECTION A, LINE 4COLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E. MEDICARE, MEDICAID, ETC.) A NOTE WILL BE ENTERED INTO THE PATIENT'S ACCOUNT TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETE. IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY, THE AGENCY WILL BE NOTIFIED TO SUSPEND COLLECTION EFFORTS UNTIL A DETERMINATION IS MADE. THIS NOTIFICATION WILL BE DOCUMENTED IN THE ACCOUNT NOTES. THE PATIENT WILL BE NOTIFIED VERBALLY THAT THE COLLECTION ACTIVITY WILL BE SUSPENDED DURING CONSIDERATION. IF A FINANCIAL ASSISTANCE DETERMINATION ALLOWS FOR A PERCENT REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE, PAYMENT TERMS WILL BE ESTABLISHED ON THE BASIS OF DISPOSABLE INCOME.
COMMUNITY BENEFITSCHEDULE H, PART III, SECTION B, LINE 8MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT, AS LRHS IS CLASSIFIED AS A RURAL REFERRAL CENTER AND MEDICARE-DEPENDENT HOSPITAL, AND ALTERNATIVELY COULD QUALIFY AS A SOLE COMMUNITY HOSPITAL. THIS DEMONSTRATES THAT LRHS IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
COLLECTION POLICYSCHEDULE H, PART III, SECTION C, LINE 9BCOLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E. MEDICARE, MEDICAID, ETC.) A NOTE WILL BE ENTERED INTO THE PATIENT'S ACCOUNT TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETE. IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY, THE AGENCY WILL BE NOTIFIED TO SUSPEND COLLECTION EFFORTS UNTIL A DETERMINATION IS MADE. THIS NOTIFICATION WILL BE DOCUMENTED IN THE ACCOUNT NOTES. THE PATIENT WILL BE NOTIFIED VERBALLY THAT THE COLLECTION ACTIVITY WILL BE SUSPENDED DURING CONSIDERATION. IF A FINANCIAL ASSISTANCE DETERMINATION ALLOWS FOR A PERCENT REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE, PAYMENT TERMS WILL BE ESTABLISHED ON THE BASIS OF DISPOSABLE INCOME.
FACTORS USED IN DETERMINING BASIS FOR AMOUNTS CHARGED TO PATIENTSSCHEDULE H, PART V, SECTION B, LINE 11TO OBTAIN PRICING FOR GROSS CHARGES, THE ORGANIZATION USES REGIONAL COMPARATIVE PRICING DATA FROM MEDASSETS AS A STANDARD FOR DEFENSIBLE PRICING.
OTHER METHODS OF PUBLICIZING CHARITY CARE POLICYSCHEDULE H, PART V, SECTION B, LINE 13GALL PATIENTS OF THE HOSPITAL IN ROOMS HAVE ACCESS TO A BINDER THAT EXPLAINS THE FINANCIAL ASSISTANCE POLICY. THIS BINDER IS ALSO AVAILABLE AT THE CASHIERS DESK.
METHOD FOR DETERMINING MAX AMOUNTS CHARGED TO FAP ELIGIBLE PATIENTSSCHEDULE H, PART V, SECTION B, LINE 19DFULL CHARGES ARE BILLED TO ALL PATIENTS. IF THE SELF-PAY PATIENT PAYS THE BILL WITHIN THE FIRST 30 DAYS, THEY WILL RECEIVE A 40% DISCOUNT. OTHERWISE, THEY RECEIVE NO DISCOUNT. THE DISCOUNTS FOR ALL INDIVIDUALS THAT QUALITY FOR FREE OR DISCOUNTED CARE, INCLUDING EMERGENCY OR MEDICALLY NECESSARY CARE, ARE DETERMINED USING THE FEDERAL POVERTY GUIDELINE MATRIX IN LRHS POLICY #112-190-2 UNCOMPENSATED CARE.
NEEDS ASSESSMENTSCHEDULE H, PART VI, LINE 2LRHS USES DATA COMPILED BY AN INDEPENDENT ENTITY, HOSPITAL INDUSTRY DATA INSTITUTE (HIDI), ON INPATIENTS AND OUTPATIENT PROVIDER USE DIVIDED BY DEMOGRAPHIC AND GEOGRAPHIC SUBSET. LRHS PERFORMS A BIENNIAL COMMUNITY ASSESSMENT WHICH IS A RANDOM SAMPLE, FACE-TO-FACE SURVEY, WHICH ASKS WHAT SERVICES LRHS SHOULD ADD AND WHY. OTHER COMMUNITY DATA IS COLLECTED AT HEALTH FAIRS AND SCREENINGS AS WELL AS CIVIC ORGANIZATIONS. THESE SURVEYS PROFILE PARTICIPANTS BY ZIP CODE AND IDENTIFY DESIRED SERVICES. SURVEYS PROFILE PARTICIPANTS BY ZIP CODE AND IDENTIFY DESIRED SERVICES.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCESCHEDULE H, PART VI, LINE 3SIGNAGE WILL BE POSTED IN ALL PATIENT INTAKE AREAS, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY ROOM, AND THE ADMISSION/PATIENT REGISTRATION AREAS. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISION OF FINANCIAL ASSISTANCE WILL USE LANGUAGES THAT ARE APPROPRIATE FOR LRHS SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. THIS POLICY WILL BE MADE AVAILABLE IN SPANISH. THE FINANCIAL ASSISTANCE APPLICATION IS POSTED ON THE LRHS WEBSITE. LRHS HAS FINANCIAL COUNSELORS IN THE PATIENT FINANCIAL SERVICES DEPARTMENT. THESE COUNSELORS MEET WITH SELF PAY PATIENTS WHEN THEY ARE IN THE FACILITY TO DISCUSS THE POLICY, AS WELL AS EDUCATE PATIENTS ON ASSISTANCE THEY MAY BE ELIGIBLE FOR UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS.
COMMUNITY INFORMATIONSCHEDULE H, PART VI, LINE 4LRHS IS LOCATED IN OSAGE BEACH, MISSOURI, AND SERVES THE AREA SURROUNDING THE LAKE OF THE OZARKS, A 54,000 ACRE MAN-MADE LAKE LOCATED IN CENTRAL MISSOURI. LRHS' SERVICE AREA ENCOMPASSES A THREE COUNTY AREA: CAMDEN, MILLER, AND MORGAN COUNTIES. THE SECONDARY SERVICE INCLUDES LACLEDE AND PULASKI COUNTIES. THE OVERALL SERVICE AREA 2010 POPULATION IS ESTIMATED AT 177,760. IN ADDITION TO THE RESIDENT POPULATION OF NEARLY 178,000, IN THE OVERALL SERVICE AREA, THE EVER-INCREASING VISITOR POPULATION IS A SIGNIFICANT FACTOR FOR THIS POPULAR TOURIST DESTINATION. THE LAKE OF THE OZARKS CONVENTION AND VISITORS BUREAU ESTIMATES THAT 5.0 MILLION VISITORS WILL TRAVEL TO THE REGION IN 2010. THE PROJECTED POPULATION GROWTH OF LRHS' SERVICE AREA AND ESPECIALLY THE CONTINUING MIGRATION INTO THE LAKE AREA OF RETIREES AND THE EVER-INCREASING VISITOR POPULATION, IS A SIGNIFICANT FACTOR IN THE RISING NEED FOR ACCESSIBLE AND EXPANDED MEDICAL SERVICES FOR THE LAKE AREA. THE MEDIAN HOUSEHOLD INCOME FOR EACH COUNTY IS AS FOLLOWS: CAMDEN = $44,617, LACLEDE = $37,294, MILLER = $35,838, MORGAN = $36,696 AND PULASKI = $43,155. THE CAMDEN COUNTY 2011 ANNUAL UNEMPLOYMENT RATE WAS 10.7%, ABOVE THE STATE (8.6%) AND NATIONAL (8.9%) AVERAGES. CAMDEN COUNTY HAS APPROXIMATELY 11.8% OF PERSONS BELOW POVERTY LEVEL. THE IMMEDIATE 3-COUNTY AREA OF CAMDEN, MILLER, & MORGAN ESTIMATES UNINSURED INDIVIDUALS AT 23.27%. THERE ARE NO OTHER HOSPITALS WITHIN A 25-MILE RADIUS. USING HOSPITAL INDUSTRY DATA INSTITUTE DATA, THE LRHS MARKET IS PRIMARILY SHARED WITH 4 HOSPITALS IN THE AREA.
PROMOTION OF COMMUNITY HEALTHSCHEDULE H, PART VI, LINE 5LRHS SHOWS ITS SUPPORT OF THE COMMUNITY BY PROVIDING A TRIM KIDS PROGRAM. TRIM KIDS IS A 12-WEEK PLAN TO BUILD HEALTHY KIDS, HEALTHY FAMILIES, AND HEALTHY COMMUNITIES. THE TRIM KIDS PROGRAM IS A PROVEN, PRACTICAL GUIDE FOR PARENTS TO TAKE SPECIFIC SEQUENTIAL STEPS TO ENCOURAGE HEALTHY HABITS IN THEIR CHILDREN SUCH AS MAKING HEALTHY FOOD CHOICES AND ONGOING PHYSICAL ACTIVITY. THE PROGRAM IS FACILITATED BY A DIETITIAN, EXERCISE PHYSIOLOGIST, REGISTERED NURSE, AND BEHAVIOR MODIFICATION PROFESSIONAL ASSOCIATED WITH LRHS. LRHS' WORKFORCE DEVELOPMENT PROGRAM INCLUDES A TWO-DAY CAREER CAMP FOR STUDENTS 10-14. THE STUDENTS LEARN ABOUT CAREERS IN NURSING, REHAB THERAPIES, LABORATORY, SURGERY AND RESPIRATORY THERAPY. CAMP INSTRUCTORS ALSO COVER TOPICS SUCH AS PATIENT CONFIDENTIALITY, INFECTION CONTROL, DISASTER MANAGEMENT, DATA MANAGEMENT, PROFESSIONAL SCHOOLS IN MISSOURI AND SCHOLARSHIP OPPORTUNITIES. ANOTHER WORKFORCE DEVELOPMENT PROGRAM AVAILABLE TO HIGH SCHOOL STUDENTS AND ADULTS INTERESTED IN PURSUING NURSING CAREERS IS A FIVE-DAY NURSING CAMP. PARTICIPANTS GAIN AN UNDERSTANDING OF NURSING FUNDAMENTALS AS THEY VISIT NURSING UNITS, JOB SHADOW EXPERIENCED NURSES, LEARN ABOUT STATE-OF-THE-ART EQUIPMENT, RECEIVE CPR TRAINING, PARTICIPATE IN DISASTER MANAGEMENT TRAINING AND INTERACT WITH STAFF. LRHS MAINTAINS AN OPEN MEDICAL STAFF BY ALLOWING ANY PHYSICIAN, DENTIST, ORAL SURGEON OR PODIATRIST ENTRY WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS, AND REQUIREMENTS SET FORTH BY LRHS. MEMBERS OF THE BOARD OF DIRECTORS MUST BE REPRESENTATIVE OF THE COMMUNITIES AND POPULATION SERVED BY LRHS. NO DIRECTOR RECEIVES COMPENSATION FOR ANY SERVICE THEY MAY RENDER AS A DIRECTOR. ALL SURPLUS FUNDS ARE RE-INVESTED INTO THE CORPORATION BY PURCHASING CAPITAL EQUIPMENT. INTO THE CORPORATION BY PURCHASING CAPITAL EQUIPMENT.
AFFILIATED HEALTH CARE SYSTEMSCHEDULE H, PART VI, LINE 6THE AFFILIATED HEALTH CARE SYSTEM OF THE ORGANIZATION INCLUDES LAKE REGIONAL MEDICAL MANAGEMENT AND LAKE REGIONAL IMAGING PARTNERS. A WHOLLY OWNED SUBSIDIARY, LAKE REGIONAL MEDICAL MANAGEMENT, INC., D/B/A LAKE REGIONAL MEDICAL GROUP (MEDICAL MANAGEMENT), OPERATES MEDICAL CLINICS AND RETAIL PHARMACIES IN CAMDEN, MILLER AND MORGAN COUNTIES. THE ORGANIZATION HAS A 51% OWNERSHIP OF LAKE REGIONAL IMAGING PARTNERS, LLC (IMAGING PARTNERS). IMAGING PARTNERS IS A LIMITED LIABILITY COMPANY THAT OPERATES AN IMAGING CENTER IN OSAGE BEACH, MISSOURI, WHICH OFFERS CLOSED HYBRID MRI SERVICES, PET AND CT SCANS, ULTRASOUND SERVICES AND RADIOGRAPHY IMAGING SERVICES. THE 49% MINORITY INTEREST IN IMAGING PARTNERS IS OWNED BY A GROUP OF LOCAL RADIOLOGISTS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1MHA CENTER FOR EDUCATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 6766AddressLine1
CityJEFFERSON CITYCity
StateMOState
ZIP Code651020060ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient430898947EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant25226AmountOfCashGrant
Purpose Of GrantSCHOLARSHIP FUNDPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantNURSING SCHOLARSHIPSTypeOfGrant
Number Of Recipients8NumberOfRecipients
Amount Of Cash Grant31000AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.Identifier
Return ReferenceSCHEDULE I, PART 1, LINE 2ReturnReference
ExplanationTHE ORGANIZATION HAS AN AGREEMENT WITH MHA, AND DUE TO INCREASED PAYMENTS UNDER THE FEDERAL REIMBURSEMENT ALLOWANCE PROGRAM, THE ORGANIZATION MADE CHARITABLE CONTRIBUTIONS TO THE MHA CENTER FOR EDUCATION. THE CONTRIBUTIONS ARE USED FOR FUNDING SCHOLARSHIPS TO MEDICAL, NURSING AND ALLIED HEALTH PROFESSIONALS, AND WORKFORCE INITIATIVES TO ADDRESS THE SHORTAGES OF NURSING AND ALLIED HEALTH PROFESSIONALS. THE RECIPIENT OF THE SCHOLARSHIP MUST SUBMIT THEIR GRADES TO LAKE REGIONAL HEALTH SYSTEM. IN ORDER FOR THE GRADES TO BE GIVEN TO THE STUDENT, THEIR TUITION MUST BE PAID IN FULL.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgstrueCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (16 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
GRANT BARNUM DO
0257634000512902281304240028981600
ANDREW MCKIBBEN MD
028494200018202411402800031203800
MICHAEL HENZE
3660470110479035279707107303879090427503083160
VICKI L FRANKLIN
18932403634801350790159070127903779370890870
M DANIEL PROBSTFIELD
209040037914052524015907031860318571000
JANICE L DUNGAN
18036103031102011101511009440246837000
F JOE BUTTS
16010203015301287740151690308603372840775270
KEVIN G MCROBERTS
1636660286770841090283890482503096660719620
ROBERT HYATT MD
3055610544500644200980009440435175000
SCOTT POEST
14032705607011742018099030580178833000
THOMAS MYLER
1546550745009482011070067010189358000
MICHAEL DOW
1550430739307163010894049800185473000
STEVEN GROTEWIEL
135176063270176320977405860169495000
JOE SCOTT
1359250002140109744018250168895000
DARLA WILKERSON-ERVIN
125128058700108770786809440150687000
CYNTHIA OTRADOVEC
19150000892710464209801131610641860

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
REIMBURSEMENT POLICYSCHEDULE J, PART I, LINE 1ATHE ORGANIZATION HAS A WRITTEN POLICY FOR REIMBURSEMENT RELATED TO TRAVEL FOR COMPANIONS. DIRECTORS AND KEY EMPLOYEES ARE ELIGIBLE TO RECEIVE THIS BENEFIT. THE ORGANIZATION PROVIDES ONE TYPE OF GROSS UP PAYMENT FOR THE CEO'S AUTO ALLOWANCE. THE CEO IS THE ONLY PERSON THAT RECEIVES THIS BENEFIT. THIS PAYMENT IS REPORTED AS TAXABLE COMPENSATION ON THE CEO'S W-2 FORM EACH YEAR.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANSCHEDULE J, PART I, LINE 4BTHE FOLLOWING PEOPLE PARTICIPATED IN A 457(F) NONQUALIFIED RETIREMENT PLAN AND RECEIVED AN EXECUTIVE 457(F) CONTRIBUTION. VICKI L. FRANKLIN $16,155 M. DANIEL PROBSTFIELD $16,851 F. JOE BUTTS $13,401 JANICE DUNGAN $13,472 CYNTHIA OTRADOVEC $11,392 ROBERT HYATT $24,200 THE FOLLOWING PEOPLE HAD A DEFERRED CONTRIBUTION TO A 457(F) NONQUALIFIED RETIREMENT PLAN. MICHAEL E. HENZE $55,166 KEVIN MCROBERTS $13,416 SCOTT POEST $9,333 THE FOLLOWING PARTICIPANTS ALSO RECEIVED A 457(F) DISTRIBUTION, WHICH WAS REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. MICHAEL E. HENZE $308,316 VICKI L. FRANKLIN $89,087 F. JOE BUTTS $77,527 KEVIN MCROBERTS $71,962 CYNTHIA OTRADOVEC $64,186
COMPENSATION PAID OR ACCRUED CONTINGENT ON NET EARNINGSSCHEDULE J, PART I, LINES 6A & 6BTHE CEO AND SENIOR MANAGEMENT ARE ELIGIBLE FOR INCENTIVE COMPENSATION AS PART OF THEIR OVERALL COMPENSATION PLAN. TARGETED BENCHMARKS INCLUDE CONSOLIDATED OPERATING MARGIN, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, CLINICAL OUTCOMES, PATIENT SAFETY AND INDIVIDUAL GOALS.
COMPENSATION REPORTED IN PRIOR YEAR FORM 990SCHEDULE J, PART II, COLUMN FCOMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION AMOUNTS ON THE FORM 990 FOR TWO CONSECUTIVE YEARS. THE AMOUNTS REPORTED IN COLUMN F: INCLUDE INCENTIVE AMOUNTS AND CAPITAL ACCUMULATION AMOUNTS WHICH WERE REPORTED IN PREVIOUS 990S AS DEFERRED COMPENSATION.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF MO
43117896660635RH672003-12-1027463751BUILDING EQUIPMENTfalsefalsefalse
HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF MO
43117896660635R8G52010-10-2028426416REFUND 1996 & 1998 REVENUES BONDSfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
33450000283094481901821004802310025929727002007falsefalsetruetrue
6950000284264162875426028188586237830000001998truefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsetruetruefalse0.000000.000000.00000true
0

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
0
falsefalsefalsetrueBAYERISCHE LANDESBAN2.33falsetruefalse
0
falsefalsefalsetrueJPMORGAN CHASE BANK12.82falsefalsetrue

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
GIC FAIR MARKET VALUESCHEDULE K, PART IV, LINE 4D4(D), COLUMN A AND B. THE GUARANTEED INVESTMENT CONTRACT FOR THE 2003 BONDS WAS ENTERED INTO AFTER THE ISSUE DATE OF THE BONDS. THE GUARANTEED INVESTMENT CONTRACT FOR THE 2010 BONDS WAS ORIGINALLY ENTERED INTO WITH RESPECT TO THE 1998 BONDS. THE TAXPAYER BELIEVES THE BIDDING PROCEDURES ESTABLISHED BY 1.148-5(D)(6)(III) OF THE REGULATIONS WERE FOLLOWED IN EACH CASE, BUT HAS BEEN UNABLE TO LOCATE COPIES OF THE BID SOLICITATION FORMS AND RELATED MATERIALS REQUIRED TO BE RETAINED UNDER THE REGULATION SAFE HARBOR.
PROCEEDS INVESTED BEYOND A TEMPORARY PERIODSCHEDULE K, PART IV, LINE 5THE PROJECT FUND WAS INVESTED BEYOND THE 3-YEAR TEMPORARY PERIOD. ALL PROCEEDS IN THE PROJECT FUND HAVE BEEN SPENT. THE YIELD ON INVESTMENTS WAS NOT MATERIALLY HIGHER THAN THE YIELD ON THE ISSUE AND NO YIELD REDUCTION PAYMENT LIABILITY WAS GENERATED ON THE BONDS.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
LAKE REGIONAL MEDICAL MANAGEMENT
COMMON DRTRS - SEE PART V8088852CONTRIBUTIONS, REIMBURSEMENTSfalse
MITCHELL SHIELDS
FAMILY MEMBER L SHIELDS39113EMPLOYMENTfalse
CENTRAL BANK OF LAKE OF THE OZARKS
SEE PART V242106BANKING FEESfalse
JULIE FRANKLIN
FAMILY MEMBER V FRANKLIN37252EMPLOYMENTfalse
BARBA PROBSTFIELD
FAM MEMBER D PROBSTFIELD77170EMPLOYMENTfalse

Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
INTERESTED PERSONS RELATIONSHIPSCHEDULE L, PART IV, COLUMN BGREG GAGNON, BOARD TREASURER, IS THE BANK PRESIDENT AT CENTRAL BANK OF LAKE OF THE OZARKS. ROBERT MASON, BOARD DIRECTOR, IS ALSO A BOARD DIRECTOR AT THE BANK.
SHARED DIRECTORSSCHEDULE L, PART IVINTERESTED PERSON, COLUMN A: LAKE REGIONAL MEDICAL MANAGEMENT RELATIONSHIP, COLUMN B: CHARLES MCELYEA, ROBERT G. SCHWENDINGER, GREG GAGNON, JOHN PARRISH, AND DENNIS MICHAELREE ARE OFFICERS OR DIRECTORS OF BOTH LAKE REGIONAL MEDICAL MANAGEMENT AND LAKE REGIONAL HEALTH SYSTEM. ROBERT G. SCHWENDINGER, JOHN PARRISH, DENNIS MICHAELREE, AND CHARLES MCELYEA WERE DETERMINED TO BE NON-INDEPENDENT MEMBERS OF LAKE REGIONAL HEALTH SYSTEM BASED SOLELY ON THEIR ROLE AS COMMON OFFICERS OR DIRECTORS OF LAKE REGIONAL MEDICAL MANAGEMENT AND LAKE REGIONAL HEALTH SYSTEM. LAKE REGIONAL MEDICAL MANAGEMENT IS AN ACTIVE, WHOLLY-OWNED FOR-PROFIT SUBSIDIARY. IT OPERATES SEVEN PRIMARY CARE MEDICAL CLINICS, THREE RETAIL PHARMACIES, AND FIFTEEN SPECIALTY CLINICS. LAKE REGIONAL HEALTH SYSTEM VIEWS THE COMMON OFFICERS AND DIRECTORS AS AN IMPORTANT ROLE IN HELPING BOTH ORGANIZATIONS IN ACHIEVING THEIR MISSIONS WHILE SERVING THE COMMUNITY.

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions14NumberOfContributions
Noncash Contribs Rptd F99025303NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts

Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XSILENT AUCTION28143210COST
XLIVE AUCTION2116385COST
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART I, LINE 1OUR MISSION: LAKE REGIONAL HEALTH SYSTEM WILL PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF THE LAKE REGION WITH EMPHASIS ON QUALITY OUTCOMES AND SERVICE SATISFACTION WHILE OPERATING IN A SOUND FISCAL MANNER. OUR VISION: OUR SHARED VISION IS FOR LAKE REGIONAL HEALTH SYSTEM TO BE RECOGNIZED AS THE FIRST CHOICE FOR PATIENTS, PHYSICIANS, AND WORKFORCE. OUR VALUES: PATIENT CENTERED, CONTINUOUS IMPROVEMENT, TEAMWORK, INTEGRITY, SERVICE QUALITY, SAFETY. THE SYSTEM WAS ORGANIZED IN 1973 FOR THE PURPOSE OF ESTABLISHING A NEW HOSPITAL FOR MEDICAL AND SURGICAL CARE AND FOR THE TREATMENT OF PERSONS RESIDING OR VISITING IN THE LAKE OF THE OZARKS AREA OF CENTRAL MISSOURI. IN THE 30 YEARS SINCE THEN, THE SYSTEM HAS EVOLVED TO PROVIDE MORE COMPREHENSIVE HEALTH CARE, INCLUDING ADDING CARDIAC-CARE, OUTPATIENT SERVICES, CANCER AND ORTHOPEDIC PROGRAMS AND CONTINUALLY EXPANDING SERVICES AND FACILITIES OVER THE YEARS. IT IS NOW DESIGNATED AS A REGIONAL REFERRAL CENTER BY MEDICARE AND HAS NEARLY 1,300 EMPLOYEES. ITS BOARD HAS ADOPTED GOVERNANCE BEST PRACTICES AND A WIDE-RANGING CORPORATE COMPLIANCE PROGRAM. BASED ON PERIODIC COMMUNITY ASSESSMENTS, THE BOARD HAS ALSO COMMITTED TO ENHANCED UNCOMPENSATED CARE POLICIES AND NUMEROUS COMMUNITY PROGRAMS (E.G. HEALTH SCREENINGS, WELLNESS ENHANCED AND RELATED CARE PROGRAMS). THE SYSTEM IS ORGANIZED AS A COMMUNITY-BASED NONPROFIT PUBLIC BENEFIT CORPORATION UNDER THE LAWS OF THE STATE OF MISSOURI. THE SYSTEM OWNS AND OPERATES A 116-LICENSED BED ACUTE CARE HOSPITAL (THE "HOSPITAL") LOCATED ON HIGHWAY 54 IN OSAGE BEACH, MISSOURI. THE HOSPITAL IS LICENSED BY THE MISSOURI DEPARTMENT OF HEALTH AND ACCREDITED BY THE JOINT COMMISSION. THE HOSPITAL IS DESIGNATED AS MEDICARE DEPENDENT, MEANING THAT THE HOSPITAL IS THE PRIMARY HEALTH CARE PROVIDER FOR A MAJORITY OF MEDICARE PATIENTS WITHIN A 35-MILE RADIUS OF THE HOSPITAL. THE CORPORATION HAS ONE ACTIVE, WHOLLY-OWNED FOR-PROFIT SUBSIDIARY, LAKE REGIONAL MEDICAL MANAGEMENT, INC. ("LRMM"), WHICH OPERATES SEVEN PRIMARY CARE MEDICAL CLINICS, THREE RETAIL PHARMACIES AND FIFTEEN SPECIALTY CLINICS. OPERATIONS OF LRMM ARE GOVERNED BY A SEPARATE BOARD OF DIRECTORS. THE SYSTEM IS CURRENTLY GOVERNED BY A FIFTEEN-MEMBER BOARD OF DIRECTORS (THE "BOARD"). THE BOARD HAS GENERAL RESPONSIBILITY FOR THE BUSINESS AND AFFAIRS OF THE SYSTEM, AND MAY DO AND PERFORM ALL ACTS NECESSARY TO CARRY OUT ITS PURPOSES. UNDER THE TERMS OF THE BYLAWS, THE MEMBERS OF THE BOARD SERVE THREE-YEAR STAGGERED TERMS, AND NEW MEMBERS ARE ELECTED BY THE CURRENT BOARD MEMBERS. THE OFFICERS OF THE BOARD ARE ELECTED BY THE BOARD FOR TWO-YEAR TERMS. BOARD MEMBERS SERVE IN A VOLUNTARY CAPACITY AND RECEIVE NO REMUNERATION FOR SERVICE RENDERED IN SUCH CAPACITY.
PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINES 4A-CTHE HOSPITAL PROVIDES CHARITY CARE IN SUPPORT OF ITS MISSION. THE HOSPITAL VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN NET PATIENT SERVICE REVENUE. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND MANY TIMES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED. UNCOMPENSATED CHARGES RELATING TO THESE SERVICES INCLUDE CHARITY CARE, BAD DEBT, UNPAID MEDICARE, FREE MEDICAL SERVICES, HEALTH PROFESSIONALS EDUCATION, FINANCIAL CONTRIBUTIONS, AND TAXES. IN ADDITION TO UNCOMPENSATED CHARGES, THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. SUCH PROGRAMS INCLUDE HEALTH SCREENING AND ASSESSMENTS, PRENATAL EDUCATION AND CARE, COMMUNITY EDUCATIONAL SERVICES AND VARIOUS SUPPORT GROUPS.
OTHER PROGRAM SERVICESFORM 990, PART III, LINE 4DOTHER SERVICES INCLUDE ELECTRONIC HEALTH RECORDS INCENTIVES, MANAGEMENT FEES, CAFETERIA INCOME, INCOME FROM THE AUXILIARY, AND OTHER PROGRAM SERVICE ACTIVITIES.
FAMILY AND BUSINESS RELATIONSHIPSFORM 990, PART VI, SECTION A, LINE 2GREG GAGNON AND ROBERT MASON HAVE A BUSINESS RELATIONSHIP. F JOE BUTTS, M DANIEL PROBTSFIELD, VICKI L FRANKLIN, AND MICHAEL HENZE HAVE A BUSINESS RELATIONSHIP. MICHAEL HENZE & F JOE BUTTS HAVE A BUSINESS RELATIONSHIP.
SIGNIFICANT CHANGES TO ORGANIZING DOCUMENTSFORM 990, PART VI, SECTION A, LINE 4THE ORGANIZATION AMENDED THEIR BYLAWS IN JUNE OF 2011. SIGNIFICANT CHANGES FROM THIS AMENDMENT INCLUDE THE REMOVAL OF THE REQUIREMENT FOR BOARD MEMBERS TO ATTEND HALF OF ALL BOARD MEETINGS AND THE ADDITION OF AN ADDITIONAL REVIEW OF BOARD ATTENDANCE FOR CONSIDERATION OF REMOVAL ON THE BOARD DUE TO LOW ATTENDANCE.
FORM 990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 WAS THOROUGHLY REVIEWED BY THE DIRECTOR OF ACCOUNTING, CFO, AND CEO. AFTER ANY NECESSARY CHANGES WERE MADE, THE MEMBERS OF THE BOARD OF DIRECTORS WERE PROVIDED A COPY. AT THE DECEMBER 2012 BOARD MEETING, THE 990 WAS PRESENTED TO THE BOARD BY THE INDEPENDENT ACCOUNTANTS WHO PREPARED THE 990, AND THE BOARD HAD THE OPPORTUNITY TO ASK ANY QUESTIONS BEFORE THE 990 WAS FILED.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CEACH YEAR, ALL MEMBERS OF THE BOARD OF DIRECTORS, SENIOR MANAGEMENT, AND DEPARTMENT HEADS ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND PROPERLY DISCLOSE ANY ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST. A COPY OF THE CONFLICT OF INTEREST POLICY IS PROVIDED TO EACH DIRECTOR AT THE TIME OF APPOINTMENT, TO EACH NEW PRINCIPAL OFFICER AND EMPLOYEE AT THE TIME OF EMPLOYMENT, AND ANNUALLY TO EVERY INTERESTED PERSON. EACH INTERESTED PERSON IS REQUIRED TO SUBMIT A STATEMENT TO THE CEO ANNUALLY VERIFYING THE UNDERSTANDING WITH THE POLICY AND STATING THAT ALL CONFLICTS HAVE BEEN DISCLOSED, OR THAT NO CONFLICTS EXIST. THE CEO SUBMITS HIS ANNUAL STATEMENT TO THE CHAIRMAN OF THE BOARD. IN THE EVENT AN INTERESTED PERSON DEVELOPS A POTENTIAL CONFLICT OF INTEREST, THE PERSON MUST IMMEDIATELY UPON LEARNING ABOUT THE POTENTIAL CONFLICT DISCLOSE THE NATURE OF THE CONFLICT TO THE BOARD OF DIRECTORS. THE PERSON THEN LEAVES THE BOARD OR COMMITTEE MEETING WHILE THE ISSUE IS DISCUSSED AMONG REMAINING BOARD MEMBERS TO DETERMINE WHETHER A CONFLICT EXISTS BY MAJORITY VOTE. IF A CONFLICT DOES EXIST, A SEPARATE PERSON IS ASSIGNED TO INVESTIGATE ALTERNATIVES TO THE CONFLICT AND DETERMINE IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS POSSIBLE. IF THIS IS NOT POSSIBLE, THE BOARD THEN DECIDES BY MAJORITY VOTE IF THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE, AND WHETHER IT SHOULD OR SHOULD NOT BE ENTERED. IF THE ORGANIZATION HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, THE PERSON WILL BE INFORMED OF THE BASIS FOR SUCH BELIEF AND WILL BE GIVEN AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE PERSON'S RESPONSE AND CONDUCTING FURTHER INVESTIGATION, THE ORGANIZATION DETERMINES THAT THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, APPROPRIATE CORRECTIVE ACTION WILL BE TAKEN. ADDITIONALLY, THE ORGANIZATION HAS IMPLEMENTED A TAX COMPLIANCE QUESTIONNAIRE THAT ASKS DETAILED QUESTIONS, AND PROVIDES RESPONDENTS WITH THE APPROPRIATE DEFINITIONS AND INSTRUCTIONS, TO ENABLE THE ORGANIZATION TO GATHER INFORMATION REQUIRED TO ANSWER QUESTIONS ON THE 990 RELATING TO THE FOLLOWING AREAS: 1) THE NUMBER OF INDEPENDENT VOTING BOARD MEMBERS, 2) RELATIONSHIPS BETWEEN INTERESTED PERSONS, 3) LOANS TO OR FROM INTERESTED PERSONS, 4) GRANTS OR ASSISTANCE BENEFITING INTERESTED PERSONS, AND 5) BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS.
COMPENSATION DETERMINATIONFORM 990, PART VI, SECTION B, LINES 15A & 15BDURING 2012, THE ORGANIZATION USED IHSTRATEGIES, AN INDEPENDENT ORGANIZATION, TO HELP THEM EVALUATE AND SET THE COMPENSATION FOR THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION DELIBERATIONS WERE DOCUMENTED IN THE BOARD MINUTES.
GOVERNING DOCUMENT AVAILABILITYFORM 990, PART VI, SECTION C, LINE 19CERTAIN ASPECTS OF THE FINANCIAL STATEMENTS ARE AVAILABLE IN THE ORGANIZATION'S ANNUAL REPORT WHICH CAN BE FOUND ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE GENERAL PUBLIC.
BOARD MEMBER COMPENSATIONFORM 990, PART VIIBOARD MEMBER ROBERT MASON, DO, IS PAID AS A PRN EMPLOYEE OF LAKE REGIONAL MEDICAL MANAGEMENT AND RECEIVES NO OTHER BENEFITS. ANDREW MCKIBBEN, MD, IS PAID AS A PHYSICIAN OF LAKE REGIONAL MEDICAL MANAGEMENT. GRANT BARNUM, DO, IS PAID AS A PHYSICIAN OF LAKE REGIONAL MEDICAL MANAGEMENT. BOARD MEMBERS DO NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES PROVIDED AS A MEMBER OF THE BOARD DIRECTORS. EACH WORKS APPROXIMATELY 40 HOURS PER WEEK FOR THE RELATED ORGANIZATION.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5UNREALIZED GAINS & LOSSES $ 63,447

Schedule R IRS990ScheduleR

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1LAKE REGIONAL IMAGING PARTNERSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line154 HOSPITAL DRIVEAddressLine1
CityOSAGE BEACHCity
StateMOState
ZIP Code65065ZIPCode
FieldValueIRS element (for citing)
EIN202107048EIN
Primary ActivityDIAGNOSTIC IMAGEPrimaryActivity
Legal Domicile StateMOLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income701795ShareOfTotalIncome
Share Of EOY Assets3018204ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
Code V$0CodeVAmount
General Or Managing PartnertrueGeneralOrManagingPartner
Percentage Ownership0.51000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1LAKE REGIONAL MEDICAL MANAGEMENTBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line154 HOSPITAL DRIVEAddressLine1
CityOSAGE BEACHCity
StateMOState
ZIP Code65065ZIPCode
FieldValueIRS element (for citing)
EIN431473438EIN
Primary ActivityPHYSICIAN SERPrimaryActivity
Legal Domicile StateMOLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPTypeOfEntity
Share Of Total Income33303319ShareOfTotalIncome
Share Of EOY Assets6894089ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LAKE REGIONAL MEDICAL MANAGEMENT
A/I879038FMV
LAKE REGIONAL MEDICAL MANAGEMENT
B5250000FMV
LAKE REGIONAL IMAGING PARTNERS LLC
J78694FMV
LAKE REGIONAL MEDICAL MANAGEMENT
K595457FMV
LAKE REGIONAL IMAGING PARTNERS LLC
K1158834FMV
LAKE REGIONAL MEDICAL MANAGEMENT
O3850902FMV

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