2023-05-08T12:10:38-07:00 2022-06-30 990 2021-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325000 1125 Madison Street Jefferson City MO 65101 Tom Luebbering Vice President of Finance 5736325101 2023-05-08 1 11 0 AAL2 2021 2023-04-26 12:10:37Z Tom Luebbering 1125 Madison Street Jefferson City MO 65101 221199974 0 X crmc.org X 1945 MO Capital Region Medical Center embraces its mission: To improve health and promote wellness in the communities we serve. 12 10 1908 91 2484255 0 299637 721000 233252025 219835484 11755399 385366 0 0 245307061 220941850 0 0 0 0 109635091 116596729 0 0 166458 127077923 139331154 236713014 255927883 8594047 -34986033 246856940 210267346 93457632 93209259 153399308 117058087 Capital Region Medical Center embraces its mission; To imporove the health and promote wellness in the communities we serve. 0 0 2853302 0 0 Inpatient and Outpatient Charity Care: Capital Region Medical Center serves the community by providing medical care to all patients regardless of their ability to pay. Patients who qualify for charity care will be identified as soon as possible, either before the services are provided or after an individual has received services to stabilize their medical condition. If it is difficult to determine a patient's eligibility for charity care prior to providing the service, the determination should be made as soon as possible after the provision of the service. Upon registration, patients without Medicare/Medicaid, adequate health insurance or other local health care financial assistance will receive either a packet of information that addresses the financial assistance policy and procedures or immediate financial counseling assistance from staff within established business hours. The packet of information will clearly indicate that CRMC provides care without regard to ability to pay, to individuals with limited financial resources and explain how patients apply for financial assistance. CRMC provides a variety of services ranging from emergency services to inpatient and outpatient elective surgery, diagnostic testing and education programs. Charity care policies and procedures are in place to address any instances in which patients may access services. 2420457 0 854375 Support of Medical Education - In 1952 CRMC entered into the teaching and training of physicians with programs to teach medical students and interns. Today CRMC serves as the primary clinical training site for one of the two Family Medicine Residency Programs sponsored by the University of Missouri-Columbia School of Medicine. CRMC also serves as a clinical training site for other specialty Residency Programs sponsored by the University of Missouri-Columbia School of Medicine. In addition medical students from the Kirksville College of Osteopathic Medicine and University of Health Sciences located in Kansas City schools of Medicine complete clinical rotations at CRMC. Capital Region Medical Center supports Lincoln University School of Nursing program, Columbia College Nursing Program, Missouri State University and Drury University; RN, BSN and MSN from Central Missouri State, Central Methodist, LPN and RN at State Tech; Social Work and Case Management students from MU, Missouri State University, and Lincoln; MSN students from St. Louis University, UMKC, Maryville, Chamberlain College, Frontier Nursing; Graceland, Herzing, Vanderbilt, University of Southern Alabama, New York International University. and Walden University in Family Nurse Practitioner clinicals for which we provide the preceptors/clinical supervisors as well as the facilities. CRMC assists Stephens College, Bell-Brown College, and State Fair College with Registered Medical Assistants; Stephens College and the University of North Dakota Physician's Assistant programs and local schools for Paramedic and EMT training. CRMC also assists State Tech for Radiology. Dietary students from Herzing University, Keiser University, UMC and UMSL, as well as assistance to the University of Missouri dietetics program. In addition to the direct financial support that Capital Region provides, we also provide support to Columbia College MSN students and Lincoln University School of Nursing BSN program in leadership training. We assist students from East Central College in the surgical tech program. CRMC provides training to phlebotomist/tech students from Moberly Community College to assist them with fulfilling their clinical requirements. CRMC provides oversight and mentoring to the St. Louis College of Pharmacy, University of Missouri-Columbia and Kansas City Pharmacy Programs. We provide support to St. Louis University and University of Missouri-Columbia PT and Kansas City Ozark Technical College and State Tech PTA, OTA and Speech Therapy programs. Our support for these programs in not only through the provision of training facilities but also adjunct faculty and resources. 190613 0 75000 Community Health Resident Clinic: CRMC provides Residents and Physician Supervisors to staff the Community Health Center clinic. In addition to providing a valuable training tool for the medical students, the resident clinic serves a unique community benefit by providing over 2160 patient visits from the eight county service area. The charge for service is based on the individual's ability to pay, which in many cases is free. 227840579 0 0 All other inpatient and outpatient services provided to patients. 227840579 0 0 233304951 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 185 0 1 1908 1 1 1 0 0 0 0 0 0 0 X 12 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Tom Luebbering 5736325101 1125 Madison Street Jefferson City MO 65101 Mitchell Godbee Physician 40 0 X 1512331 0 80595 Sharmilla Suri-Mohanram Physician 40 0 X 1008919 0 33953 Scott Anderson Physician 40 0 X 791808 0 70613 Jeffrey Sanders Board member/Physician 40 0 X X 734866 0 47705 Nyatanga Noyln Physician 40 0 X 701491 0 44743 Gaspare Calvaruso President 40 0 X 466184 0 65894 Randall Haight Vice President/Physician 40 0 X 380535 0 64389 Diane Light Board Member/Physician 40 0 X 385780 0 55048 Thomas Luebbering Vice President 40 0 X 293210 0 51594 Michelle Barg Vice President/Physician 40 0 X 295893 0 27312 Ted Brandt Vice President - Salary paid by Univ of MO 40 0 X 12676 210174 56658 Janet Weckenborg Vice President 40 0 X 232499 0 39361 Sarah Morrow Vice President 40 0 X 227788 0 39496 Glenda Dahlstrom Vice President 40 0 X 188783 0 39855 Janet Pestle Vice President 40 0 X 71655 0 10329 Beylnda Imhoff Vice President - Salary paid by Cerner 40 0 X 11359 0 0 Carlos Graham Board Chair 2.5 0 X 0 0 0 Lorilei Schwartz Board Member 2.5 0 X 0 0 0 Stevan Whitt Board member 2.5 0 X 0 0 0 Marc Ellinger Board member 2.5 0 X 0 0 0 David Minton Treasurer 2.5 0 X 0 0 0 Phillip Burger Vice Chair 2.5 0 X 0 0 0 Kristina Naught Secretary 2.5 0 X 0 0 0 Frank Burkhead Board member 2.5 0 X 0 0 0 Nimalan Chinniah Board member 2.5 0 X 0 0 0 Katrina Lambrecht Board member 2.5 0 X 0 0 0 7315777 210174 727545 137 0 1 1 Cerner Corporation 2800 Rockcreek Parkway Kansas City MO 641172551 Computer Management and Support 5782583 Aya Healthcare PO Box 123519 Dept 3519 Dallas TX 753123519 Contract Nursing Services 4699630 McCarthy Building Companies Inc 12851 Manchester Road St Louis MO 63131 Construction Management 4566415 University of Missouri One Hospital Drive Columbia MO 65201 Physician and Professional Services 3837753 Inpatient Consultants of MO Inc PO Box 844929 Los Angeles CA 900844929 Physician Service 2272898 94 0 0 0 721000 0 0 0 721000 Net Patient Service Revenue 622000 202364445 199814396 2550049 0 Other Revenue 900099 17471039 17471039 0 0 0 0 0 0 219835484 642858 708652 -65794 0 632 0 0 632 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 258124 0 -258124 -258124 0 0 -258124 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 220941850 217994087 2484255 -257492 X 0 0 0 0 0 0 0 0 3713166 3341849 371317 0 0 0 0 0 96186297 87317404 8773059 95834 2543853 2289468 254385 0 9121415 8166683 935728 19004 5031998 4528798 503200 0 0 0 0 0 177474 141000 36474 0 198357 157591 40766 0 0 0 0 0 0 0 0 0 0 0 34767451 27654166 7109085 4200 201919 160421 41498 0 200931 182073 18858 0 9418106 8156648 1261458 0 0 0 0 0 726095 657950 68145 0 0 0 0 0 0 0 0 0 269963 244627 25336 0 1250246 1093520 153912 2814 0 0 11861598 10341347 1492958 27293 2384092 2160341 223751 0 Supplies and Med Supplies 60542168 60292054 232801 17313 Repairs/Maintenance and Utilities 6613231 5992249 620982 0 FRA Tax 7601228 7601228 0 0 Rent Expense 949639 860514 89125 0 2168656 1965020 203636 0 255927883 233304951 22456474 166458 0 0 23587724 13431617 0 0 29687875 34444109 0 0 0 0 0 0 5621592 5425614 4197690 3255679 290449717 208797533 77624713 81652184 78162095 44782946 27975251 27275197 246856940 210267346 35208417 35151267 0 0 0 0 47632303 45088733 0 0 0 0 0 0 0 0 10616912 12969259 93457632 93209259 X 147844252 112332228 5555056 4725859 153399308 117058087 246856940 210267346 X -34986033 -359533 0 0 0 -995655 X 1 X 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10761 10761 0 Schedule C, Part II-B, Line 1 CRMC is a member of Missouri Hospital Association. Just one of the benefits of membership is that MHA communicates with government on issues that are important to Missouri hospitals. A portion of the annual dues (22.5% of $47,825.14) 0 11868336 11868336 0 173448222 126116554 47331668 0 2269442 1925494 343948 0 102863717 80755485 22108232 0 0 0 0 81652184 Interest in Net Assets of Capital Region Foundation 4725859 Long-term receivables and other noncurrent assets 10054789 Intangible assets, net 12494549 27275197 0 Capital Leases 430494 Other Long Term Debt 1813085 457B PLan Liability 4765295 Insurance Payable 3790483 Malpractice 2169902 12969259 X 220220850 0 0 0 0 0 220220850 721000 0 721000 220941850 256352465 0 0 0 424582 424582 255927883 0 0 0 255927883 Schedule D, Part X, Line 2 Because CRMC did not have any tax liabilities, the wording is silent. Footnote 1 would have disclosed this if it was applicable. Income taxes: The Medical Center has been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However, the Medical Center is subject to federal income tax on any unrelated business taxable income. Schedule D, Part XII, Line 2d Foundation expenses $166,458 Loss on sale of assets $258,124 1 1 X 1 X 1 X 1 1 1 0 0 2853302 0 2853302 0.0111 23160137 14689239 8470898 0.033 0 0 26013439 14689239 11324200 0.0441 450139 70192 379947 0.0015 2611070 929375 1681695 0.0065 5060 0 5060 0.00001 118579 0 118579 0.0005 0 0 3184848 999567 2185281 0.00851 0 0 29198287 15688806 13509481 0.05261 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56040 0 56040 0.0002 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6145302 4845559 1299743 0.005 0 0 0 0 0 0 0 0 6201342 4845559 1355783 0.0052 0 5601188 0 42727056 42930345 -203289 X 1 1 1 1 Capital Region Medical Center 1125 Madison Street Jefferson City MO 65101 crmc.org 419-19 X X X X Capital Region Medical Center 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X www.crmc.org X X 1 18 1 https://www.crmc.org/about-us/community-involvement/community-health-needs-assessment/ 0 0 1 X 200 200 X X X 1 1 X X X 1 X https://www.crmc.org/patients-and-visitors/billing-insurance/financial-assistance/ X https://www.crmc.org//media/1268/2404-007.pdf X https://www.crmc.org/patients-and-visitors/billing-insurance/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Capital Region Medical Center Capital Region Medical Center - The Central Missouri Community Health Assessment Partnership (CMCHAP) was created and embarked on a mission to improve the health of residents of the four counties of Cole, Miller, Moniteau, and Osage. The partnership worked collaboratively to collect and analyze health data and gather input from community members to aid in assessing and prioritizing health needs. This unique healthcare and social service provider partnership was financially funded by Capital Region Medical Center. Schedule H, Part V, Section B, Line 6a-Capital Region Medical Center Capital Region Medical Center Schedule H, Part V, Section B, Line 6b-Capital Region Medical Center The Health Departments of Cole, Callaway, Miller, Moniteau, and Osage counties, Community Health Center of Central Missouri, Central Missouri United Way, Compass Health Network, and the Missouri Coalition for Community Behavioral healthcare. Schedule H, Part V, Section B, Line 7d-Capital Region Medical Center Capital Region Medical Center made the CHNA available online at crmc.org. Additionally, paper copies were made available through the public relations department. A review of the CHNA was provided to medical center managers, Board of Directors, the CRMC foundation, and at the Community Outreach meeting held in several of the outlying clinics we serve. Schedule H, Part V, Section B, Line 11-Capital Region Medical Center CRMC has a dedicated department referenced as Community Benefit that works collectively with community partners to address such needs. An internal team also reviews the CHNA and determines the strategic plan for implementing strategies to address such needs. The top five needs determined in the August 2021 CHNA are as follows: 1. Mental health 2. Substance abuse 3. Diabetes, disability, and chronic pain 4. Heart disease and stroke 5. Nutrition, physical activity, and weight. Strategies have included support groups, smoking cessation, and lifestyle programs. Continued tracking and education of depression and body mass index screenings at all primary care visits. We have increased the number of participating providers, including primary and psychiatrists. We have embedded behavioral health specialists in several clinics. We work with the Council for Drug Free Youth on many projects and created the Behavioral Health Resource Partnership. CRMC has been actively engaging the medical team in policies to decrease the usage of controlled substances, emphasizing reducing the risk of opioid abuse. To help combat environmental and abuse issues, CRMC also places a bin in the pharmacy for people to safely dispose of unused prescription medications. Our implementation strategies also encourage improved nutrition and increased physical activity. We sponsor farmer's markets, and buddy packs at local schools, and partnered with several schools and recreation centers to develop health concession policies. CRMC has worked with multiple city governments on bike/pedestrian plans, complete street policies, as well as trails, including the Rock Island Trail. With the pandemic, we implemented virtual support groups and call chains to stay connected and continue providing services when unable to meet in person. 18 Capital Region Physicians 1125 Madison Street Jefferson City MO 65101 Medical Center Expansion - Physician clinics and outpatient services Capital Region Southwest 1432 Southwest Blvd Jefferson City MO 65109 Outpatient and Wellness Services Capital Region Central Missouri Cardiology 3501 West Truman Blvd Jefferson City MO 65109 Cardiology Physician Office Primary Care 1014 Madison Street Jefferson City MO 65101 Primary Care - Family Practice Clinic CRMC Healthplex West 3308 West Edgewood Jefferson City MO 65109 Urgent Care and Outpatient Therapy CRMC-SW Clinic 1500 Southwest Blvd Jefferson City MO 65109 Family Practice Clinic CRMC- Versailles 901 Kidwell Drive Versailles MO 65084 Family Practice Clinic CRMC - Eldon 103 Business Hwy 54 North Eldon MO 65026 Family Practice Clinic CRMC Surgicare 1705 Christy Drive Jefferson City MO 65101 Surgeon CRMC-Owensville 3536 Kuhne Road Owensville MO 65066 Family Practice Clinic Eastland Urgent Care 915 A Eastland Drive Jefferson City MO 65101 Urgent Care Clinic Capital Region Physicians - West Truman 3527 W Truman Jefferson City MO 65109 Family Practice clinic CRMC-Linn 916 East Main Street Linn MO 65051 Family Practice CRMC-California 704 Buchanan California MO 65018 Family Practice Clinic CRMC-Holts Summit 180 North Star Holts Summit MO 65043 Family Practice Clinic Capital Region Family Medical Center 420 East High Street Jefferson City MO 65101 Family Practice Clinic - closed 4/30/22 St Elizabeth Clinic 631 S Walnut Street St Elizabeth MO 65075 Physician Clinic CRMC Quick Care 3721 W Truman Blvd Jefferson City MO 65109 Quick Care Clinic Schedule H, Part I, Line 3c Average Medicare and Commercial/Managed Care Adjustments were used to calculate 65% auto self pay. Schedule H, Part I, Line 7 Cost to Charge ratios from Worksheet 2 Schedule H, Part I, Line 7e Community Benefit is dedicated to implementing strategies to address the top needs identified in the community health needs assessment (CHNA). The top five needs determined in the August 2021 CHNA are 1. Mental health 2. Substance abuse 3. Diabetes, disability, and chronic pain 4. Heart disease and stroke 5. Nutrition, physical activity, and weight. Community Benefit operates to impact areas of improvement based on the community health needs assessment, included programs for support, self-help, screenings such as cholesterol screenings, health fairs, diabetes education, smoking cessation, and community education through presentations. Other initiatives include: safe drug disposal options in CRMC's retail pharmacy and outreach to groups in underserved areas. CRMC also actively works with the Jefferson City Area Parks and Recreation on its initiatives to promote parks and healthy living through financial assistance and sponsoring programming in the areas. CRMC initiated its response to the COVID-19 pandemic by initiating incident command and establishing drive-through testing sites and vaccine clinics close to the hospital campus. CRMC launched community education campaigns and worked closely with the Cole County Health Department, SSM Health - St. Mary's Hospital of Jefferson City, and the City to help slow the spread of the virus. Schedule H, Part I, Line 7i CRMC leadership and administration council prioritize involvement in other organizations' boards and committees focusing on community health initiatives. The in-kind contributions represent the hours individuals spend participating in these community-building coalitions. Schedule H, Part II CRMC participates with many community partners throughout the year to carry out our mission to improve health and promote wellness in the communities we serve. Strategically, our implementation strategy focuses our community health activities and resources based on the community health needs assessment findings. In order to be impactful on the health and wellness of our community, partnerships, collaborations, and working with coalitions are a must. The expenses noted in this section reflect our participation in such community-building activities. Specific details are included on each particular line. Schedule H, Part II, Line 3 CRMC provides a building for use to the St. Nicholas Academy. It is a not-for-profit organization which has a group home for at-risk youth. This is the normal rental amount for this square footage. St. Nicholas Academy pays $1 per year for rent. Schedule H, Part II, Line 8 CRMC recruits and retains physicians to provide medical care in rural or underserved areas. Schedule H, Part III, Section A, Line 2 determined using Cost to Charge ratios from worksheet 2 Schedule H, Part III, Section A, Line 4 Footnote #3 of audit report Schedule H, Part III, Section B, Line 8 Line 2 is determined using the cost to charge ratio from Worksheet 2. Schedule H, Part III, Section C, Line 9b All Self Pay patients automatically receive a 65% Self Pay discount. For collections practices, we run presumptive charity using Experian Presumption Charity software to identify all patients equal to 200%FPL. They must complete the financial application to prove need of charity assistance. In additional, patients are screened for Medicaid eligibility using a company called Human Arc. Schedule H, Part VI, Line 2 CRMC conducted a comprehensive community health assessment using both secondary and primary analysis, which allowed us to measure perception, health risks, health factors, health outcomes, and characteristics specific to the communities in these five central counties. This is the third comprehensive regional health assessment completed in this collaborative fashion by the CMCHAP. The objectives were to identify factors influencing health status, determine and prioritize issues of greater concern, identify unmet health needs, and project a source of reliable information that will support the development of solutions. The needs assessment was conducted using three methods: secondary data analysis, discussions with community groups, and providing clients with surveys completed by community members, community leaders, and local physicians. Existing data previously collected for other purposes, called secondary data, was compiled from various credible local, state, and federal sources to provide a context for analysis and interpretation. In addition to the data collection for 2021, a survey was included to assess the perception of health care and health status across the five-county region in the analysis. These surveys were available in physician offices, online, and in community health departments. Upon reviewing the findings from all the sources of information, the Steering Team identified the most serious health issues and then ranked them using a priority matrix. The results were 1. Mental health 2. Substance abuse 3. Diabetes, disability, and chronic pain 4. Heart disease and stroke 5. Nutrition, physical activity, and weight. Schedule H, Part VI, Line 3 At every location, registration staff have financial assistance packets available to hand out. All self pay patients are referred to one of the three financial counselors in the area. Patient financial counselors visit all self pay in-house patients. Also Human Arc helps patients apply for Medicaid. Signs are posted in rooms and at registration sites. For every statement sent, there is a number printed to call for assistance. All first letters indicate who to call for assistance. All clinics are aware of the policy- so is the medical staff. it is posted on our website and on our online bill pay. Schedule H, Part VI, Line 4 The five-county regions, consisting of Callaway, Cole, Miller, Moniteau and Osage, included urban and rural areas. The local area economy is heavily dependent on the state government. The total population for the region, based on the 2010 census, was 176,8474. Between the 2000 and 2010 US Censuses, the population of the total service area increased by 12,829, or 7.9%. Cole County, which has the largest population in the region, had the highest percentage increase in the population at 9.3%. It is important to understand the population's age distribution, as different age groups have unique health needs that should be considered separately from others along the age spectrum. In the total service area, 22.6% of the population are children aged 0-17, 61.0% are aged 18 to 64, and 16.4% are aged 65 and older. Schedule H, Part VI, Line 5 As a community-based hospital, Capital Region Medical Center lives its mission to improve health and promote wellness to the communities it serves every day. A full-service hospital offering a complete continuum of care, CRMC provides access to exceptional healthcare services throughout its service area. CRMC operates a large clinic network and comprehensive cancer facility, employs over 120 providers, houses an inpatient rehabilitation facility, and includes a medically based fitness facility. Schedule H, Part VI, Line 6 CRMC is an affiliate of MU Health. Through this partnership, our community benefits from access of a community-based hospital and a higher level of care when needed. X 1 1 X X X 0 1 0 1 0 1 0 1 0 Mitchell Godbee Physician 863623 0 647799 0 910 0 11186 0 69409 0 1592927 0 0 0 Sharmilla Suri-Mohanram Physician 745962 0 262180 0 777 0 5912 0 28041 0 1042872 0 0 0 Scott Anderson Physician 773136 0 15008 0 3664 0 11573 0 59040 0 862421 0 0 0 Jeffrey Sanders Board member/Physician 583524 0 148089 0 3253 0 11382 0 36323 0 782571 0 0 0 Gaspare Calvaruso President 396619 0 57489 0 12076 0 11469 0 54425 0 532078 0 0 0 Diane Light Board Member/Physician 367717 0 15785 0 2278 0 11596 0 43452 0 440828 0 0 0 Randall Haight Vice President/Physician 330072 0 48847 0 1615 0 10544 0 53845 0 444923 0 0 0 Michelle Barg Vice President/Physician 251747 0 43851 0 296 0 9662 0 17650 0 323206 0 0 0 Thomas Luebbering Vice President 262500 0 29425 0 1285 0 10489 0 41105 0 344804 0 0 0 Sarah Morrow Vice President 209522 0 17866 0 400 0 8634 0 30862 0 267284 0 0 0 Janet Weckenborg Vice President 176658 0 49419 0 6422 0 7296 0 32065 0 271860 0 0 0 Glenda Dahlstrom Vice President 159829 0 27779 0 1176 0 11591 0 28264 0 228639 0 0 0 Ted Brandt Vice President - Salary paid by Univ of MO 0 210174 12676 0 0 0 0 31990 0 24668 12676 266832 0 0 Beylnda Imhoff Vice President - Salary paid by Cerner 0 0 11359 0 0 0 0 0 0 0 11359 0 0 0 Janet Pestle Vice President 61419 0 10000 0 236 0 0 0 10329 0 81984 0 0 0 Nyatanga Noyln Physician 683405 0 17500 0 586 0 10107 0 34636 0 746234 0 0 0 Schedule J, Part I, Line 1a Capital Region pays for the President's membership with the Jefferson City Country Club. This is used for many business reasons. Any personal expenses incurred are reimbursed by the President to the Medical Center Schedule J, Part I, Line 3 Annually, all board members complete an evaluation of the CEO and individually present the results to the board chair who presents them to the compensation committee, consisting of 3 board members, including the Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri and the region. The compensation committee members do not have a conflict of interest with respect to the compensation arrangements. The committee documents their review and decisions. Schedule J, Part I, Line 4 Officers and Directors and some of the Highly compensated participated in the 457(b) plan. Calvaruso $6975, Luebbering $5315, Weckenborg $19,500, Dahlstrom $10,062, Morrow $17507, Haight $5285, Barg $19500, Godbee $18018, Suri $19500, Nyatanga $19500 Schedule J, Part I, Line 5 For all employees, an annual bonus is partially based on the achievement of certain organizational goals. These goals pertain to quality, service, and financial indicators. Schedule J, Part I, Line 6 For all employees, an annual bonus is partially based on the achievement of certain organizational goals. These goals pertain to quality, service, and financial indicators. Schedule J, Part I, Line 7 The President, Vice President, Directors, and Managers participate in the Management Incentive Compensation Program. They receive additional bonus compensation if certain stated goals are met. Most Physicians receive a base salary, but also have the ability to earn an additional amount based on production A Health & Educational Facilities State of MO 431178966 000000000 2017-03-09 20000000 Acquire, construct, and equipment for health facilities 0 0 0 B Health & Educational Facilities of State of MO 431178966 60637ASU7 2020-11-10 33254282 Refund Series 2011 bonds (issued 11/22/2011) 0 0 0 A 5972795 0 20000000 0 0 0 0 0 0 0 20000000 0 2016 0 0 1 1 B 935000 0 33255398 0 0 0 429728 0 0 13701348 12809637 6314512 1 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 Schedule K, Part II, Line 3-11/10/2020 33,254,282 Health & Educational Facilities of State of MO 33,255,398 Health and Educational Facilities of State of MO- difference in issue price listed in Part I, column is investment earnings. Schedule K, Part II, Line 11-11/10/2020 33,254,282 Health & Educational Facilities of State of MO 12,809,637 Health & Educational Facilities of State of MO - Series 2011 Bonds pay off Schedule K, Part II, Line 12-11/10/2020 33,254,282 Health & Educational Facilities of State of MO 6,314,512 Health & Educational Facilities of State of MO- Note for Line 13- Project is still underway at 6/30/2022 Nathan Luebbering son of Tom Luebbering 11675 employee of Capital Region 0 Jessica Luebbering daughter in law of Tom Luebbering 219917 Employed physician of Capital Region 0 Zachary Luebbering Son of Tom Luebbering 36153 Employed physician of Capital Region 0 Form 990, Part VI, Section A, Line 2 Frank Burkhead, board member is a brother in law to Tom Luebbering, Vice President. Form 990, Part VI, Section A, Line 6 The organization has 2 members - The University of Missouri-Columbia Medical Alliance and CRMC Healthcare Form 990, Part VI, Section A, Line 7a All elections for appointment to the Governing Body are subject to approval of the member, the University of Missouri Medical Alliance Form 990, Part VI, Section A, Line 7b The bylaws provide a number of instances requiring approval by the University of Missouri Medical Alliance (e.g. amendment of the bylaws, dissolution of the organization, sale of substantial assets, and discontinuance of a major service.) Form 990, Part VI, Section B, Line 11b The 990 is reviewed by the Director of Accounting, legal counsel, the Vice President of Finance, and the President. The 990 is presented to the Board of Directors and copies are available to all members. Form 990, Part VI, Section B, Line 12c The hospital legal counsel attends board meetings. He is continually monitoring if any transaction would be a conflict of interest. The Vice President of Finance reviews all payments to physicians and identifies any potential conflicts. The Director of Accounting reviews payments and identifies any potential conflicts. Form 990, Part VI, Section B, Line 15 All board members complete an evaluation of the CEO and individually present the results to the board chair, who presents to the compensation committee, consisting of three board members, including Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri and the region. The compensation committee members do not have a conflict of interest with respect to the compensation agreements. The committee documents their review and decision and meets at least annually. The CEO sets the recommended salaries for key employees using comparable data from three salary surveys. The Vice President of Human Resources participates in determining the appropriate salary. Form 990, Part VI, Section C, Line 19 The Capital Region website (crmc.org) provides important information about the medical center to the community. The "Fraud and Wrongdoing" policy, "Privacy Policy", "Affiliation and Accreditations" policy, leader profiles, site location and contact information are all disclosed on the website. Capital Region includes financial statements in the annual report provided to the Board of Governors (approximately 500 members). Financial information is reviewed at the Medical Executive and Medical Staff meetings monthly. The information is then shared at the monthly managers' meeting and then communicated to all staff at department meetings. Form 990, Part IX, Line 11g Purchased Services for physicians, nurses, and other healthcare providers. Also consultants, biomedical, maintenance and other companies providing services. Form 990, Part XI, Line 9 Decrease in Foundation Net Assets - 829,197 + Paid Foundation Expenses -166,458 = -$995655 Capital Region Medical Foundation PO Box 1128 Jefferson City MO 651021128 431506900 Raise Money and manage funds to be used by Capital Region Medical Center MO 501(c)(3) Supporting Org Typ I N/A Still Osteopathic Medical Foundation PO Box 1128 Jefferson City MO 651021128 431720296 Support Capital Region Medical Center MO 501(c)(3) Support Org Typ III N/A Capital Region Medical Center Partners 1125 Madison Street Jefferson City MO 65101 446014361 Support Capital Region Medical Center MO 501(c)(3) Support Org Typ I N/A CRMC Healthcare Inc 1125 Madison Street Jefferson City MO 65101 461699021 Support Capital Region Medical Center MO 501 (c)(3) Type II Support Org N/A University of Missouri - Columbia Medical Alliance 1000 West Nifong Building 7 Suite 300 Columbia MO 65211 311574931 Support and encourage health care delivery and medical education MO 501 (c)(3) Type I Support Org N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 Capital Region Medical Center Partners m 216432 Partners donated 18036 volunteer hours for the period July 1, 2021 to June 30 2022. 18,036 hours x $12 per hour Capital Region Medical Foundation c 721000 Cash value of donations from the Foundation Capital Region Medical Center Partners c 360 Cash value of items donated to Capital Region Medical Center Capital Region Medical Center Partners o 22023 The manager of the Partners gift shop is employed by Capital Region Medical Center. The Partners reimburses CRMC for her salary and employment taxes. Capital Region Medical Foundation o 114838 Salary of Foundation Director $95834 + Benefits $19004 A filing extension was approved. Return is due 5/15/2023. PLEASE NOTE: THE ATTACHED AUDIT REPORT IS NOT FINAL. IT IS A DRAFT. CRMC IS STILL WAITING ON THE FINAL AUDIT REPORT FOR FISCAL YEAR ENDING 6/30/2022. ALL DATA IN THIS TAX RETURN IS BASED ON THIS DRAFT AUDIT.