2011-05-16T11:55:02-05:00 2010-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2009-07-01 430715842 General John J Pershing Memorial Hospital Association GENE 6602582222 130 E Lockling PO Box 408 Brookfield MO 64628 PHIL HAMILTON 2011-05-15 true Michael J Engle 8162216300 2009 2016-02-24 21:20:13Z PHIL HAMILTON 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 16621863 false X N/A X 1955 MO THIS FISCAL YEAR WE STARTED ON OUR ELECTRONIC MEDICAL RECORD PREPARATION. WE WILL INSTALL CLINICAL MODULES IN THE ED, OR, CLINIC, IP, AND MOST ANCILLIARY DEPARTMENTS. 10 7 171 33 0 0 13688 10702 15328772 16445181 73131 64548 96349 101432 15511940 16621863 6851 9137 0 7071655 7338054 0 0 8083261 9089658 15161767 16436849 350173 185014 21218425 21405960 8520838 8523359 12697587 12882601 SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. false false 2462570 1827 3301711 INPATIENT ACUTE CARE SERVICES WITH 548 INPATIENT ADMISSIONS 6895195 5117 9244791 OUTPATIENT SERVICES WITH 25,092 REGISTRATIONS. THIS INCLUDES 5,321 EMERGENCY ROOM VISITS. SEPERATE FROM THIS IS 3,897 HOME HEALTH AGENCY VISITS. 861899 640 1155599 COMMUNITY MEDICAL ASSOCIATES, OUR PROVIDER BASED RURAL HEALTH CLINIC, WITH BOTH SCHEDULED AND WALK-IN SERVICES, IS OPEN 10 HOURS A DAY MONDAY THRU SATURDAY AND 5 HOURS ON SUNDAY. IT HAD 19,436 VISITS THIS PAST FISCAL YEAR. IT IS A LOWER COST ALTERNATIVE THAN USING THE EMERGENCY ROOM. 2093184 1553 2806454 12312848 true false false true false false false false false true true false false false false false false false false false true false false true false false false false false true true false false false false false false false false false false true 43 0 true 171 true false false false false false false false false false 10 7 false true false false true true true true true false false false true true true true true true true false MO X GARY TANDY CFO 6602582222 130 E LOCKLING PO BOX 408 BROOKFIELD MO 64628 ANGELA P LITTRELL 1.0 X 0 0 0 WILLIAM THUDIUM 1.0 X X 0 0 0 ED KENNEDY 1.0 X X 0 0 0 DR J D URE 1.0 X 170724 0 0 DR B K KNOWLES 1.0 X 19405 0 0 IRENE STEFFES 1.0 X X 0 0 0 GAIL TURNER 1.0 X X 0 0 0 GARY ROUTLEDGE 1.0 X 0 0 0 CARY SAYRE 1.0 X 0 0 0 MARK CLEVELAND 1.0 X 0 0 0 DR SP GALVEZ 24.0 X 163820 0 1035 PHIL HAMILTON 40.0 X 145173 0 14816 GARY TANDY 40.0 X 93678 0 12614 DR JAMES L BOWERS 40.0 X 131709 0 13192 BRIAN CASEBOLT 40.0 X 101020 0 16972 GARY FITE 40.0 X 119432 0 14513 944961 0 73142 6 false true true BOONE HOSPITAL CENTER COLUMBIA MO MANAGEMENT 243705 DR PEPITO RIVERA BROOKFIELD MO PHYSICIAN 434188 HAVE A NICE DAY ANESTHESIA CHILLICO ANETHESIOLOGIST 186574 DELTA LOCUM TENENS DALLAS TX PHYSICIAN SERVICES 174926 JERRY WAIT KIRKSVILLE MO PHYSICIAN 172165 10 10702 10702 Net Patient Service Rev 621400 16445181 16445181 16445181 49548 49548 0 0 38058 38058 38058 38058 15000 0 15000 15000 15000 0 0 0 CAFETERIA 722210 30854 30854 MEDICAL RECORDS 561499 8598 8598 VENDING MACHINES 900099 13544 13544 10378 10378 63374 16621863 16508555 102606 9137 9137 0 0 0 536043 536043 0 5152042 3968637 1183405 77893 54525 23368 1158234 823787 334447 413842 289689 124153 0 88003 88003 63852 63852 0 0 0 3325543 2752928 572615 13933 9753 4180 1756833 1229783 527050 0 0 418129 292690 125439 43892 43892 0 18826 18826 309779 216845 92934 0 1016847 711793 305054 141420 98994 42426 BAD DEBT EXPENSE 1426620 1426620 EDUCATION 15713 15713 TAXES & LICENSES 36419 36419 MEDICAID FRA PAYMENTS 367700 367700 DUES & SUBSCRIPTIONS 30372 30372 15777 13882 1895 16436849 12312848 4124001 0 6339943 7751401 2738910 2296738 31584 153891 160936 88606 151878 17338826 6523968 11701788 10814858 195287 198565 21218425 21405960 1269264 1241042 11825 7251574 7270492 8520838 8523359 X 12676018 12862162 21569 20439 12697587 12882601 21218425 21405960 X false true false X false X false false false false false true 5253 false false false 5253 false 107129 107129 13853234 4069152 9784082 3367591 2454816 912775 10872 10872 10814858 16621863 16436849 185014 1130 1130 186144 16622993 8054 8054 16614939 6924 6924 16621863 16436849 16436849 16436849 UNCERTAIN TAX POSITIONS DISCLOSURE SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 NET ASSETS RELEASED FROM RESTRICTIONS: $8,054 RESTRICTED CONTRIBUTIONS RECEIVED: $(6,924) -------- OTHER CHANGES IN NET ASSETS $1,130 RECONCILIATION OF REVENUE SCHEDULE D, PART XII, LINE 2D NET ASSETS RELEASED FROM RESTRICTIONS: $8,054 RECONCILIATION OF REVENUE SCHEDULE D, PART XII, LINE 4B RESTRICTED CONTRIBUTIONS RECEIVED: $6,924 true true true X true X 150. true true false false 435006 226711 208295 0.01270 1584945 934394 650551 0.03960 2019951 1161105 858846 0.05230 9681 24875 -15194 11678 11678 0.00070 21359 24875 -3516 0.00070 2041310 1185980 855330 0.05300 5000 5000 5000 5000 true 726944 109042 6909250 6840828 68422 X true true GENERAL JOHN J PERSHING MEM HOSPITAL

130 E LOCKLING AVE PO BOX 408 BROOKFIELD MO 64628

X X X X HOME HEALTH, HOSPICE COMMUNITY MEDICAL ASSOCIATES THE COST-TO-CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. N/A THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS 1,426,620. 4A- Bad Debt expense is that portion of any self pay balance referred on for outside collection services, and that either did not apply or did not qualify under our Charity Care policy. The hospital provides services without charge or at amounts less than its established rate (to patients who meet the criteria of it's charity care policy). The hospital's charity care policy is founded on the federal poverty income quidelines. Accounts and amounts determined to meet this criteria are not reported as net revenue and are not pursued for collection. 4B- Used the Cost to Charge Ratio DERIVED FROM Worksheet 2 and applied THAT PERCENTAGE TO Net Bad Debts to arrive at AN ESTIMATED COST OF BAD DEBT. Then, per Collection Supervisor's estimate, applied 15% to the Net Bad Debts to arrive at estimated cost that could be Charity. We have both a Collection Policy and a Charity Care Policy that covers criteria for payment arrangements and for partial or full charity care write-off. Pershing is a small rural Critical Access Hospital and as such receives continuous feedback from the patients we serve, our physicians, other medical providers, board members (who represent a wide representation of our community), and from various ongoing patient satisfaction surveys. Such surveys are reported at board meetings and distributed to all hospital departments. A 9 page telephone survey was conducted (by an independent organization) in 2007 which covered all providers of health care services in Linn County, and made available to all entities. Information on our charity care and collection (payment arrangements) policies are available thru our collection personnel and others at Pershing Hospital and thru our walk-in clinic, Community Medical Associates. Last year, in an effort to more widely advertise our policies, our collection staff were interviewed by our local newspaper and they published (main page) an extensive article on our policies, citing examples and guidelines. Further, we print an abbreveated version of our charity care policy guidelines with an example on patient statements sent out. Social Services - thru the assessment/consultation process, identifies and assists in the application process for individuals. Pershing Health System serves Linn County (population of around 13,000) and surrounding area. It is made up of rural communities with a mixture of businesss and agriculture. Contributed to Brookfield Area Growth Partnership $5,000 - a non profit 501C 3 organization. This organization promotes activities that help assure business and residents remain in our community, therefore a healthy community for the future. "Promoting the health of the community" Activities by: Community Medical Associates, our provider based RHC: -Provided a presentation to the Rotary Club on RHC's Nurse Practitioners. -Provided a presentation to the hospital Auxiliary on the differences between MDs and DOs. -Provided weight and blood pressure readings to Apex Plastics and United Missouri Bank for their employee wellness program. -Once a year, the clinic provides patient education articles for publication in the local newspaper. -Provided job shadowing and clinical rotations to the area career centers. -Provide sports physicals at a reduced price at the beginning of each school year. -Nurse practitioners provide well child exams yearly at the Linn Co. Health Dept. Hospital Week, annual public event done at the local YMCA: -Processed 888 blood draws; Physical Therapy health booth; Home Health participated; Diabetic informational booth by our Registered Dietician.; Bone density tests (letting people at risk know that they should share their results with their family physician); Blood pressures and pulse oximetry tests were performed. Other health fairs and events: -Conducted fairs at other businesses in our service area, including the local Wal-Mart. Home Health participated in Chariton County Health Fair, Brookfield's Relay for Life, spoke at Alzheimer's Support Group, and Bereavement Support Group. Radiology spoke at a MASH camp - a career day event. Tours: -Tours of the hospital were conducted this year with 3 schools - a once a year public event which lets us promote the positive aspects of Pershing Health System. Home Health Services: -Provides approximately 50-60 free visits per year (flu shots, blood draws, vital signs, etc). Newspaper Articles: -Home Health/Hospice - service needs in nursing homes. -Dietary - what not to avoid when dieting. -Cardiac Rehab - exercise - here to stay. -Radiology - state of the art high definition MRI system. -Hospice - wisdom from the bereavement support group. -CFO - Financial Assistance Charity Care policy revisions. Numerous other minor contributions to the general welfare and safety of our community. X true true X false false false false false false false false false DR J D URE 170724 0 0 0 0 0 0 0 0 0 170724 0 0 0 PHIL HAMILTON 123984 0 16145 0 5044 0 2248 0 12568 0 159989 0 0 0 DR SP GALVEZ 162904 0 0 0 916 0 0 0 1035 0 164855 0 0 0 EXPENSE REIMBURSEMENTS SCHEDULE J, PART I, LINE 1A & 1B PHIL HAMILTON, THE ORGANIZATION'S CEO, IS PROVIDED A HEALTH CLUB MEMBERSHIP TO YMCA WHICH WAS INCLUDED IN HIS W-2. COMPENSATION FROM AN UNRELATED ORGANIZATION FORM 990, PART VII, LINE 5 PHIL HAMILTON RECEIVED $159,989 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. ANGELA CLEVELAND SPOUSE OF DIRECTOR 65898 EMPLOYEE false SHANNON KNOWLES SPOUSE OF DIRECTOR 17720 EMPLOYEE false OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D THE HOSPITAL ALSO ADVANCES THE QUALITY OF LIFE IN THE RURAL AREA THROUGH PUBLIC EDUCATION REGARDING HEALTH CARE ISSUES, PROMOTING HEALTHY LIFESTYLES AND PROVISION OF HEALTH SCREENING. DELEGATION OF CONTROL OVER MANAGMENT DUTIES FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR THE OPERATION AND MANAGEMENT OF THE HOSPITAL. THE MANAGEMENT AGREEMENT PROVIDES DAILY OPERATING AUTHORITY TO THE MANGEMENT COMPANY AND CEO SERVICES. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CLASS OF ASSOCIATION MEMBERSHIP. ALL MEMBERS OF THE CORPORATION ARE ENTITLED TO VOTE IN PERSON AT ALL MEETINGS OF MEMBERSHIP. THE MEETING OF MEMBERSHIP IS AN ANNUAL MEETING HELD ON THE FOURTH TUESDAY IN JUNE. MEMBERS OF THIS CORPORATION HAVE THE RIGHT TO ELECT THE MEMBERS OF THE BOARD OF DIRECTORS AT THIS MEETING. MEMBERS ARE NOT ENTITLED TO RECEIVE A SHARE OF THE CORPORATIONS PROFITS, EXCESS DUES OR A SHARE OF THE CORPORATIONS NET ASSETS UPON DISSOLUTION. MEMBERS OR STOCKHOLDERS MAY ELECT GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE CORPORATION HAVE THE RIGHT TO ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS AT THE ANNUAL MEETING OF MEMBERSHIP. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE FORM 990 IS THEN REVIEWED BY OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS THEY HAVE ARE ADDRESSED. THE FORM 990 IS THEN FILED WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY AND THE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE IS DISTRIBUTED ANNUALLY TO THE BOARD OF DIRECTORS AND OFFICERS. THE QUESTIONNAIRE IS COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IN SUCH A CASE THAT A CONFLICT OF INTEREST DOES OCCUR, THE DISCLOSING INDIVIDUAL WITH THE CONFLICT OF INTEREST DOES NOT ATTEND ANY MEETINGS OR DISCUSSIONS REGARDING THE MATTER. THE DISCLOSING INDIVIDUAL DOES NOT VOTE OR ENDEAVOR TO INFLUENCE CORPORATE ACTION IN ANY SUCH MATTER. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINE 15A & 15B THE CEO'S COMPENSATION IS INCLUDED IN THE INDEPENDENT CONTRACT FEE TO BOONE HOSPITAL. BOONE HOSPITAL DETERMINES AND PAYS HIS COMPENSATION. THE INDEPENDENT CONTRACTOR FEE IS APPROVED BY THE FILING ORGANIZATIONS BOARD OF DIRECTORS. THE CEO DETERMINES THE CFO'S COMPENSATION ANNUALLY. COMPENSATION SURVEYS ARE USED TO EVALUATE COMPENSATION LEVELS. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.