LAKE REGIONAL HEALTH SYSTEM: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
LAKE REGIONAL HEALTH SYSTEM (EIN 23-7339737)
Tax period
2010-05-01 to 2011-04-30
Filed
2011-12-15
IRS object ID
201113499349300926
Schema version
2010v3.4
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)
Timestamp2011-12-15T15:14:30-05:00Timestamp
Tax Period End Date2011-04-30TaxPeriodEndDate

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 Date2010-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237339737EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKE REGIONAL HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
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 Signed2011-11-18DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
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 Receipts157793918GrossReceipts
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 Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees1141TotalNbrEmployees
Total Nbr Volunteers401TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year154328ContributionsGrantsPriorYear
Contributions Grants Current Year819907ContributionsGrantsCurrentYear
Program Service Revenue Prior Year155426399ProgramServiceRevenuePriorYear
Program Service Revenue CY160273614ProgramServiceRevenueCY
Investment Income Prior Year1519673InvestmentIncomePriorYear
Investment Income Current Year1733573InvestmentIncomeCurrentYear
Other Revenue Prior Year-4209557OtherRevenuePriorYear
Other Revenue Current Year-6332946OtherRevenueCurrentYear
Total Revenue Prior Year152890843TotalRevenuePriorYear
Total Revenue Current Year156494148TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year157522GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY110074GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year57766253SalariesEtcPriorYear
Salaries Etc Current Year60347837SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year89475804OtherExpensePriorYear
Other Expenses Current Year88615726OtherExpensesCurrentYear
Total Expenses Prior Year147399579TotalExpensesPriorYear
Total Expenses Current Year149073637TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5491264RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7420511RevenuesLessExpensesCY
Total Assets BOY168899989TotalAssetsBOY
Total Assets EOY176979780TotalAssetsEOY
Total Liabilities BOY73112645TotalLiabilitiesBOY
Total Liabilities EOY71977895TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY95787344NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY105001885NetAssetsOrFundBalancesEOY
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
Expense59245639Expense
Revenue64553939Revenue
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 238,807 OUTPATIENT SERVICES VISITS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense50973211Expense
Revenue60246772Revenue
DescriptionLAKE REGIONAL HEALTH SYSTEM PROVIDES INPATIENT SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED 22,308 INPATIENT DAYS, 3,976 SKILLED NURSING FACILITY INPATIENT DAYS AND 1,141 NURSERY PATIENT DAYS FOR A TOTAL OF 27,425 INPATIENT DAYS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense13556032Expense
Revenue31373302Revenue
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 36,993 VISITS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp5451755TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt110074TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev4099601TotalOfOtherProgramServiceRev
Total Program Service Expense129226637TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
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 EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096148NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1141NumberOfEmployees
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 Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
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
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
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

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
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
DIRECTOR1.0X0566120
OTIS MOSELEY MD
DIRECTOR1.0X000
JOHN PARRISH
DIRECTOR1.0X000
LARRY SHIELDS
DIRECTOR1.0X000
DENNIS MICHAELREE
VICE PRESIDENT1.0XX000
ANDREW MCKIBBEN MD
DIRECTOR1.0X03153300
MICHAEL HENZE
CEO40.0X482343073062
VICKI L FRANKLIN
SENIOR VP/COO40.0X247272031985
M DANIEL PROBSTFIELD
SENIOR VP/CFO40.0X286907032028
JANICE L DUNGAN
SENIOR VP - CLINICAL SERVICES40.0239316027459X
F JOE BUTTS
SENIOR VP - FACILITY SERVICES40.0220833030565X
KEVIN G MCROBERTS
SENIOR VP - BUSINESS DEVELOP.40.0211208027765X
CINDY J OTRADOVEC
CIO THROUGH 02/1140.0166828022587X
ROBERT HYATT
SENIOR VP - MEDICAL AFFAIRS40.0338622024708X
STEVEN GROTEWIEL
DIRECTOR OF DIAGNOSTIC IMAGING40.018437309635X
THOMAS MYLER
DIRECTOR OF PHARMACY40.0170462017544X
MICHAEL DOW
CLINICAL COORDINATOR40.0159874014724X
KELLY PHILLIPS
REGISTERED NURSE40.0154676011240X
JOE SCOTT
PHARMACIST40.0146220011322X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3008934TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs371942TotalReportableCompFrmRltdOrgs
Total Other Compensation334624TotalOtherCompensation
Number Individuals GT100 K42NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
LAKE EMERGENCY SPECIALISTS
PHYSICIAN SERVICES4302255
NATIONAL THERAPEUTIC ASSOCIATES
MEDICAL SERVICES2456175
LAKE OZARK ANESTHESIA ASSOC
PHYSICIAN SERVICES625755
NATIONAL WOUND CARE HYPERBARIC
WOUND CARE MGMT SRVC450999
REVENUE CYCLE PARTNERS HOLDINGS LL
BILLING SERVICES413033
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Fundraising Events283622FundraisingEvents
All Other Contributions536285AllOtherContributions
Noncash Contributions594656NoncashContributions
Total Contributions819907TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE624100156174013156174013
AUXILIARY900099421577421577
CAFETERIA INCOME722210964135964135
OTHER62410027138892713889
FieldValueIRS element (for citing)
Total Program Service Revenue160273614TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1733573TotalRevenueColumn
Exclusion$1,733,573ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real989586Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1153933Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-164347Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-164347TotalRevenueColumn
Exclusion-$164,347ExclusionAmount

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events53254GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events283622CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses145837FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-92583TotalRevenueColumn
Exclusion-$92,583ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CHANGE IN INTEREST IN EQUITY INVESTEES900099-5306639-$5,306,639
LOSS ON EXTINGUISHMENT OF DEBT900099-769377-$769,377
FieldValueIRS element (for citing)
Total Other Revenue-6076016TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column156494148TotalRevenueColumn
Related Or Exempt Function Income160273614RelatedOrExemptFunctionIncome
Exclusion-$4,599,373ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total69658Total
Program Services69658ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total40416Total
Program Services40416ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2463488Total
Program Services555405ProgramServices
Management And General1908083ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total141290Total
Program Services141290ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total45606403Total
Program Services39707743ProgramServices
Management And General5898660ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1722514Total
Program Services1593300ProgramServices
Management And General129214ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6876094Total
Program Services5794671ProgramServices
Management And General1081423ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3538048Total
Program Services2976456ProgramServices
Management And General561592ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total377365Total
Management And General377365ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total155722Total
Management And General155722ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total109202Total
Management And General109202ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total16062465Total
Program Services11710530ProgramServices
Management And General4351935ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total503674Total
Management And General503674ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5277086Total
Program Services4160744ProgramServices
Management And General1116342ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total683213Total
Management And General683213ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1953917Total
Program Services1725168ProgramServices
Management And General228749ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total246093Total
Program Services128997ProgramServices
Management And General117096ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total39287Total
Program Services2050ProgramServices
Management And General37237ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2733768Total
Program Services2442341ProgramServices
Management And General291427ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total8131358Total
Program Services7264532ProgramServices
Management And General866826ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1142489Total
Management And General1142489ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES & DRUGS26097907260965631344
BAD DEBT1607146616071466
PROVIDER TAX78913647891364
CAFETERIA/VENDING81775073057687174
LICENSES, DUES & SUBSCRIPTIONS23168586247145438

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total89915Total
Program Services37120ProgramServices
Management And General52795ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total149073637Total
Program Services129226637ProgramServices
Management And General19847000ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2468BOY
EOY2818EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY53689040BOY
EOY46374525EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY14091BOY
EOY21540EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY13063732BOY
EOY15120389EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4867294BOY
EOY4791215EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1600502BOY
EOY866298EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis144749103LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec86724808LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY59840015BOY
EOY58024295EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY32289474BOY
EOY46401270EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3284265BOY
EOY5044166EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY249108BOY
EOY333264EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY168899989BOY
EOY176979780EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12862775BOY
EOY12052112EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY55450000BOY
EOY51410000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3522831BOY
EOY3225233EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1277039BOY
EOY5290550EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY73112645BOY
EOY71977895EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY95770086BOY
EOY104984627EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY17258BOY
EOY17258EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY95787344BOY
EOY105001885EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY168899989BOY
EOY176979780EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7420511ReconcilationRevenueExpenses
Reconcilation Other Changes1794030ReconcilationOtherChanges
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$11,471OtherActivitiesAmount
Total Lobbying Expenditures IIB11471TotalLobbyingExpendituresIIB
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 ASSOCATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING PURPOSES: $ 6,985 MISSOURI HOSPITAL ASSOCIATION 4,486 AMERICAN HOSPITAL ASSOCIATION ------- $11,471Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis530500InvestmentCostOrOtherBasis
Other Cost Or Other Basis4272244OtherCostOrOtherBasis
Book Value4802744BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis82067266OtherCostOrOtherBasis
Depreciation43901778Depreciation
Book Value38165488BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis53229576OtherCostOrOtherBasis
Depreciation40979453Depreciation
Book Value12250123BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4649517OtherCostOrOtherBasis
Depreciation1843577Depreciation
Book Value2805940BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings58024295TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionEST AMT DUE TO 3RD PTY PYRDescription
Amount$5,290,550Amount
FieldValueIRS element (for citing)
Total Of Amounts5290550TotalOfAmounts
Total Revenue156494148TotalRevenue
Total Expenses149073637TotalExpenses
Excess Or Deficit For Year7420511ExcessOrDeficitForYear
Net Unrealized GL On Investments1794030NetUnrealizedGLOnInvestments
Total Adjustments1794030TotalAdjustments
Excess Or Deficit Per FS9214541ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt159478746TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1794030NetUnrealizedGainsInvestments
Revenue Not Rptd F9901794030RevenueNotRptdF990
Revenue Subtotal157684716RevenueSubtotal
Investment Expenses Not Included109202InvestmentExpensesNotIncluded
Other Revenues Not Included-1299770OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-1190568RevenueNotRptdOnFinStmt
Total Revenue Per Form990156494148TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt150264205TotExpensesEtcAuditedFinclStmt
Other Expenses Included1299770OtherExpensesIncluded
Expenses Not Rptd F9901299770ExpensesNotRptdF990
Expenses Subtotal148964435ExpensesSubtotal
Investment Expenses Not Included2109202InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt109202ExpensesNotRptdOnFinStmt
Total Expenses Per Form990149073637TotalExpensesPerForm990

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 4B AND PART XIII, LINE 2DTHE 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 TAX RETURN: RENTAL EXPENSES $ 1,153,933 SPECIAL EVENTS EXPENSE 145,837 ---------- $ 1,299,770

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1ANNUAL BALLNameOfEvent1
Gross Receipts Event1130428GrossReceiptsEvent1
Charitable Contributions Event1113974CharitableContributionsEvent1
Gross Revenue Event116454GrossRevenueEvent1
Food And Beverage Event128939FoodAndBeverageEvent1
Entertainment Event14800EntertainmentEvent1
Other Direct Expenses Event116152OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNEYNameOfEvent2
Gross Receipts Event2203713GrossReceiptsEvent2
Charitable Contributions Event2166913CharitableContributionsEvent2
Gross Revenue Event236800GrossRevenueEvent2
Non Cash Prizes Event22425NonCashPrizesEvent2
Rent Facility Costs Event221953RentFacilityCostsEvent2
Food And Beverage Event224543FoodAndBeverageEvent2
Other Direct Expenses Event247025OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total334141GrossReceiptsTotal
Charitable Contributions Total280887CharitableContributionsTotal
Gross Revenue Total Events53254GrossRevenueTotalEvents
Non Cash Prizes Total Events2425NonCashPrizesTotalEvents
Rent Facility Costs Total Events21953RentFacilityCostsTotalEvents
Food And Beverage Total Events53482FoodAndBeverageTotalEvents
Entertainment Total Events4800EntertainmentTotalEvents
Other Direct Expenses Total Events63177OtherDirectExpensesTotalEvents
Direct Expense Summary Events145837DirectExpenseSummaryEvents
Net Income Summary-92583NetIncomeSummary

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 Expense3933819TotalCommunityBenefitExpense
Net Community Benefit Expense3933819NetCommunityBenefitExpense
Percent Of Total Expense0.02640PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense23663062TotalCommunityBenefitExpense
Direct Offsetting Revenue22734680DirectOffsettingRevenue
Net Community Benefit Expense928382NetCommunityBenefitExpense
Percent Of Total Expense0.00620PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense27596881TotalCommunityBenefitExpense
Direct Offsetting Revenue22734680DirectOffsettingRevenue
Net Community Benefit Expense4862201NetCommunityBenefitExpense
Percent Of Total Expense0.03260PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense98574TotalCommunityBenefitExpense
Direct Offsetting Revenue32335DirectOffsettingRevenue
Net Community Benefit Expense66239NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense247226TotalCommunityBenefitExpense
Net Community Benefit Expense247226NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense240372TotalCommunityBenefitExpense
Net Community Benefit Expense240372NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense586172TotalCommunityBenefitExpense
Direct Offsetting Revenue32335DirectOffsettingRevenue
Net Community Benefit Expense553837NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense28183053TotalCommunityBenefitExpense
Direct Offsetting Revenue22767015DirectOffsettingRevenue
Net Community Benefit Expense5416038NetCommunityBenefitExpense
Percent Of Total Expense0.03630PercentOfTotalExpense

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 Expense39603TotalCommunityBuildingExpense
Net Community Building Expense39603NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense44895TotalCommunityBuildingExpense
Net Community Building Expense44895NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$4,829,503BadDebtExpenseAmount
Amount Attributable To753403AmountAttributableTo
Amount Reimbursed By Medicare60710907AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare70051065CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-9340158MedicareSurplusOrShortfall

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

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 (8 entries)

IdentifierIdentifierExplanationExplanation
PART III, LINE 4THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. LINE 2 WAS DETERMINED BY TAKING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TIMES THE RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2, LINE 11. LINE 3 WAS DETERMINED BY TAKING THE BAD DEBT EXPENSE AT COST (LINE 2) TIMES THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL FOR 2009 BASED ON US CENSUS BUREAU DATA.
PART III, 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.
PART III, 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.
NEEDS ASSESSMENTLRHS 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.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCESIGNAGE 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 INFORMATIONLRHS 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 2009 POPULATION IS ESTIMATED AT 167,899. IN ADDITION TO THE RESIDENT POPULATION OF NEARLY 168,000, 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 = $43,720, LACLEDE = $35,325, MILLER = $36,069, MORGAN = $35,533 AND PULASKI = $44,540. THE CAMDEN COUNTY 2009 ANNUAL UNEMPLOYMENT RATE WAS 9.6%, ABOVE THE STATE (9.3%) AND NATIONAL (9.3%) AVERAGES. CAMDEN COUNTY HAS APPROXIMATELY 15.6% OF PERSONS BELOW POVERTY LEVEL. THE IMMEDIATE 3-COUNTY AREA OF CAMDEN, MILLER, & MORGAN ESTIMATES UNINSURED INDIVIDUALS AT 20.97%. THERE ARE NO OTHER HOSPITALS WITHIN A 25-MILE RADIUS. USING HOSPITAL INDUSTRA DATA INSTITUTE DATA, THE LRHS MARKET IS PRIMARILY SHARED WITH 4 HOSPITALS IN THE AREA.
COMMUNITY BUILDING ACTIVITIESLRHS 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.
OTHER ACTIVITIESLRHS 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1ST LOUIS REGIONAL DSH FUNDING AUTHORITYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 6766AddressLine1
CityJEFFERSON CITYCity
StateMOState
ZIP Code651026766ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient061642698EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant69658AmountOfCashGrant
Purpose Of GrantSUPPORTPurposeOfGrant
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 Recipients12NumberOfRecipients
Amount Of Cash Grant40416AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierMONITORING GRANT FUNDSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationTHE 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. THROUGH AMENDMENT 3 OF THE ORGANIZATION'S AGREEMENT WITH MHA MANAGEMENT SERVICES CORPORATION AND INCREASED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS TO ALL MISSOURI HOSPITALS UNDER THE FEDERAL REIMBURSEMENT ALLOWANCE PROGRAM, THE HOSPITAL MADE CHARITABLE CONTRIBUTIONS TO THE DSH FUNDING AUTHORITY. THESE CONTRIBUTIONS ARE USED TO SUSTAIN THE VARIOUS CHARITY CARE CLINICS IN THE ST. LOUIS AREA, WITH LOCAL COMMUNITY HOSPITALS ABSORBING THE INPATIENT AND OUTPATIENT NEEDS OF THE COMMUNITY'S MEDICALLY INDIGENT POPULATION.Explanation

Schedule J IRS990ScheduleJ

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 (14 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
MICHAEL HENZE
3542500862560418370698330322905554050551660
VICKI L FRANKLIN
1847590315210309920307060127902792570161550
M DANIEL PROBSTFIELD
199820030919056168031442058603189350168510
JANICE L DUNGAN
176145026286036885026515094402667750134720
F JOE BUTTS
1572080261480374770279790258602513980134010
KEVIN G MCROBERTS
1663300253140195640229400482502389730134160
CINDY J OTRADOVEC
144808018648033720210010158601894150113920
ROBERT HYATT
32528200013340024000070803633300242000
STEVEN GROTEWIEL
1318420614804638300096350194008000
THOMAS MYLER
14955307239013670000175440188006000
MICHAEL DOW
1514720718401218000147240174598000
KELLY PHILLIPS
13653800018138000112400165916000
JOE SCOTT
12818400018036000113220157542000
ANDREW MCKIBBEN MD
031533000000000031533000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 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 INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE FOLLOWING AMOUNTS: MICHAEL E. HENZE $53,850 VICKI L. FRANKLIN $15,760 M. DANIEL PROBSTFIELD $44,291 F. JOE BUTTS $13,074 JANICE DUNGAN $38,773 KEVIN MCROBERTS $12,657 CINDY OTRADOVEC $10,850 ROBERT HYATT $24,000
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 990 SCHEDULE J, PART II, COLUMN F COMPENSATION 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 RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindRefunding EscrowRefundingEscrow
3345000283094481901821480231259297272007falsefalsetruetrue
6950002842641628754262378301998truefalsetruetrue28188586

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtytrueMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Bond Counsel Routinely EngagedtrueBondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE LANDESBAN
falsefalsefalsetrue2.33falsetruefalse
JPMORGAN CHASE BANK
falsefalsefalsetrue12.82falsefalsetrue

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
IdentifierGIC FAIR MARKET VALUEIdentifier
Return ReferenceSCHEDULE K, PART IV, LINE 4DReturnReference
Explanation4(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 TEMPORARY PERIOD SCHEDULE K, PART IV, LINE 5 THE 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.Explanation

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 V8995208CONTRIBUTIONS, REIMBURSEMENTSfalse
MITCHELL SHIELDS
FAMILY MEMBER L SHIELDS38129EMPLOYMENTfalse
CENTRAL BANK OF LAKE OF THE OZARKS
SEE PART V196917BANKING FEESfalse
JULIE FRANKLIN
FAMILY MEMBER V FRANKLIN29981EMPLOYMENTfalse
BARBA PROBSTFIELD
FAM MEMBER D PROBSTFIELD73180EMPLOYMENTfalse

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. IN ADDITION, 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 FOURTEEN 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 Residential RealEstateResidential

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990530500NoncashContribsRptdF990
Method Of Determining RevenuesAPPRAISALMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions12NumberOfContributions
Noncash Contribs Rptd F99026434NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionSILENT AUCTIONDescription
Number Of Contributions291NumberOfContributions
Noncash Contribs Rptd F99037722NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received1NumberOf8283Received
Any Property That Must Be HeldtrueAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierARRANGEMENTS FOR HOLDING PROPERTY CONTRIBUTEDIdentifier
Return ReferenceSCHEDULE M, PART 1, LINE 30BReturnReference
ExplanationTHE ORGANIZATION RECIEVED A CONTRIBUTION OF REAL ESTATE THAT WILL BE HELD FOR THREE YEARS. THE HOUSE LOCATED ON THE PROPERTY IS VACANT AT THIS TIME. NEITHER THE HOUSE NOR THE LAND ARE REQUIRED TO BE USED FOR EXEMPT PURPOSES.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 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 100-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 FOURTEEN SPECIALTY CLINICS. OPERATIONS OF LRMM ARE GOVERNED BY A SEPARATE BOARD OF DIRECTORS. THE SYSTEM IS CURRENTLY GOVERNED BY A FOURTEEN-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-CCHARITY 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 ARE AS FOLLOWS: CHARITY CARE AT COST $4,828,708 BAD DEBT AT COST 5,928,186 UNPAID MEDICARE AT COST 12,277,770 FREE MEDICAL SERVICES 323,523 HEALTH PROFESSIONALS EDUCATION 57,592 FINANCIAL CONTRIBUTIONS 203,698 TAXES 4,524,589 ------------- TOTAL $28,144,066 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 SERVICES FORM 990, PART III, LINE 4D OTHER SERVICES INCLUDE CAFETERIA INCOME AND INCOME FROM THE AUXILIARY.
FAMILY & 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.
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 2011 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 2011, THE ORGANIZATION USED IHSTRATEGIES, AN INDEPENDENT ORGANIZATION, TO HELP THEM EVALUATE AND SET THE COMPENSATION FOR THE ORGANZATION'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 COMPENSATION FORM 990, PART VII BOARD 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 AND RECEIVES NO OTHER BENEFITS. BOARD MEMBERS DO NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES PROVIDED AS A MEMBER OF THE BOARD DIRECTORS.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5UNREALIZED GAINS & LOSSES $1,794,030

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 Code202107048ZIPCode
FieldValueIRS element (for citing)
EIN202107048EIN
Primary ActivityDIAGNOSTIC IMPrimaryActivity
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 Income530788ShareOfTotalIncome
Share Of EOY Assets3454828ShareOfEOYAssets
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 Income30574434ShareOfTotalIncome
Share Of EOY Assets6402292ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
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 OrgsfalseRentalOfFacilitiesFrOtherOrgs
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 OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
LAKE REGIONAL MEDICAL MANAGEMENT
Q7415000
LAKE REGIONAL MEDICAL MANAGEMENT
A/I936180
LAKE REGIONAL MEDICAL MANAGEMENT
K520222
LAKE REGIONAL IMAGING PARTNERS LLC
K1158834
LAKE REGIONAL MEDICAL MANAGEMENT
O2440524

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