2022-08-08T10:18:09-05:00 2021-09-30 430352985 KERBER ECK & BRAECKEL LLP 3401 OFFICE PARK DRIVE MARION IL 62959 990 2020-10-01 430633449 MISSOURI DELTA MEDICAL CENTER MISS 5734711600 1008 NORTH MAIN ST SIKESTON MO 638015044 JASON SCHRUMPF PRESIDENT 5734711600 2022-08-04 1 JASON SCHRUMPF 999009999 AMBER HALSTEAD P01343727 6189938724 2022-08-04 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JASON SCHRUMPF 1008 NORTH MAIN ST SIKESTON MO 638015044 139273478 0 X WWW.MISSOURIDELTA.COM X 1948 MO MISSOURI DELTA MEDICAL CENTER IS A NOT FOR PROFIT CORPORATION WHICH STRIVESTO PROVIDE A COMPLETE HEALTH CARE SYSTEM TO RESIDENTS IN THE SERVICEAREA EITHER DIRECTLY OR IN COOPERATION WITH OTHERS. 22 19 1098 24 0 0 1655179 12719604 88328147 111815670 1119463 1525258 15168710 13229996 106271499 139290528 8000 12000 0 0 56497737 66305461 0 0 0 51607553 60688322 108113290 127005783 -1841791 12284745 111187514 113462739 61364845 49346706 49822669 64116033 X MISSOURI DELTA MEDICAL CENTER IS A NOT FOR PROFIT CORPORATION WHICHWILL STRIVE TO PROVIDE A COMPLETE HEALTH CARE SYSTEM TO RESIDENTS INTHE SERVICE AREA EITHER DIRECTLY OR IN COOPERATION WITH OTHERS.REFERRAL AGREEMENTS WILL BE SOUGHT FOR SERVICES NOT OFFERED LOCALLY.THE HOSPITAL WILL ALSO ACTIVELY OFFER OR SUPPORT APPROPRIATE PROGRAMSTO PROMOTE THE GENERAL HEALTH, AND TO MEET THE REHABILITATION,EDUCATIONAL AND SOCIAL NEEDS OF OUR SERVICE AREA. SERVICES WILL BEPROVIDED TO ALL RESIDENTS OF OUR SERVICE AREA REGARDLESS OF RACE,COLOR, RELIGION, SEX, AGE, NATIONAL ORIGIN, OR DISABILITY." 0 0 100839033 12000 111832720 MISSOURI DELTA MEDICAL CENTER PROVIDES QUALITY MEDICAL CARE TO THERESIDENTS OF ITS COMMUNITY REGARDLESS OF ABILITY TO PAY. MDMC ALSO PROVIDES SHORT TERM REHABILITATION SERVICES THROUGH AN ACUTE IP REHABILITATION UNIT AND PSYCHIATRIC SERVICES THROUGH AN ACUTE IP GERIATRIC PSYCHIATRIC FACILITY. THESE SERVICES ARE SUMMARIZED AS FOLLOWS:HOSPITAL:ACUTE INPATIENT DAYS 13,513ACUTE INPATIENT ADMISSIONS 3,102EMERGENCY ROOM VISITS 19,665RURAL HEALTH CLINIC VISITS 93,676 LABORATORY TESTS PERFORMED 437,581 RADIOLOGY EXAMS PERFORMED 47,850 PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY TREATMENTS 107,501 PHYSICIAN OFFICE VISITS 61,082 REHAB INPATIENT DAYS 2,022REHAB INPATIENT ADMISSIONS 204GERIATRIC PSYCH INPATIENT DAYS 4,020GERIATRIC PSYCH INPATIENT ADMISSIONS 499ADOLESCENT PSYCH INPATIENT DAYS 2,475ADOLESCENT PSYCH INPATIENT ADMISSIONS 569THE HOSPITAL PROVIDED FREE CARE TO INDIGENT PATIENTS IN THE AMOUNTOF $605,934 IN FY 2021, VALUED AT BILLED CHARGES. THE HOSPITALALSO PROVIDED NUMEROUS FREE PROGRAMS AND REDUCED PRICE SERVICESTHROUGH THE YEAR THAT THE HOSPITAL BELIEVES SERVES A COMMUNITYNEED. SERVICES PROVIDED FREE OF CHARGE OR BELOW COST TO THEGENERAL PUBLIC INCLUDE:1. PERIODIC BLOOD PRESSURE AND CHOLESTEROL SCREENS2. OUTPATIENT DIABETIC EDUCATION AND OTHER HEALTH EDUCATION CLASSES3. CHILDBIRTH CLASSES, FIRST AID CLASSES, AND CPR COURSES4. RED CROSS BLOOD DRIVES5. COVID 19 VACCINATION CLINICS6. HEALTH EDUCATION ARTICLES IN THE LOCAL NEWSPAPER 100839033 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 171 0 1098 1 0 0 0 0 0 0 0 0 0 0 X 22 19 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MO X GREG CARDA 5734711600 1008 NORTH MAIN STREET SIKESTON MO 638015044 DWIGHT BIZZELL DIRECTOR 1.00 X 0 0 0 JOHN BOLLINGER DIRECTOR 1.00 X 0 0 0 LEVEN COX DIRECTOR 1.00 X 0 0 0 EDWARD DEMENT DIRECTOR 1.00 X 0 0 0 JOEL PATRICK EVANS SECRETARY 1.00 X 0 0 0 BART GRANT DIRECTOR 1.00 X 0 0 0 JEFFREY HUX DIRECTOR 1.00 X 0 0 0 CHARLES D JENNINGS JR DIRECTOR 1.00 X 0 0 0 ELIZABETH JOHNSON CHAIRMAN 1.00 X 0 0 0 MICHAEL JONES VICE CHAIRMAN 1.00 X 0 0 0 DANIEL DEKE LAPE DIRECTOR 1.00 X 0 0 0 ROBERT MACGILLIVRAY DIRECTOR 1.00 X 0 0 0 BRITT MCCONNELL DIRECTOR 1.00 X 0 0 0 BRIAN MENZ DIRECTOR 1.00 X 0 0 0 JEFF PARTRIDGE DIRECTOR 1.00 X 0 0 0 MATT TANNER TREASURER 1.00 X 0 0 0 TAMMY BURCH DIRECTOR 1.00 X 0 0 0 MATHEW DRAKE DIRECTOR 1.00 X 0 0 0 DAVID JONES DIRECTOR 1.00 X 0 0 0 MIKE MARSHALL DIRECTOR 1.00 X 0 0 0 BRETT MATTHEWS DIRECTOR 1.00 X 0 0 0 JULIE AYCOCK DIRECTOR 1.00 X 0 0 0 JASON SCHRUMPF PRESIDENT/CEO 40.00 X 361529 0 12946 GREG CARDA VP. FINANCE 40.00 X 226200 0 12524 JIM HENSON SENIOR VICE PRESIDENT 40.00 X 231804 0 9521 JULIE FRASER VP, NURSING 40.00 X 191870 0 11586 DR RUDY RODRIGUEZ PHYSICIAN 40.00 X 1246766 0 14532 DR KENNETH MOY PHYSICIAN 40.00 X 665301 0 10983 DR MUHANNAD AL-KILANI PHYSICIAN 40.00 X 622130 0 15914 DR ANIMESH SAHAI PHYSICIAN 40.00 X 587829 0 5800 DR PAUL MONTANY PHYSICIAN 40.00 X 702828 0 8550 4836257 0 102356 86 0 1 0 HORIZON HEALTH PO BOX 840839 DALLAS TX 752840839 MANAGEMENT SERVICES 2295920 TRUSTAFF TRAVEL NURSES LLC 4675 CORNELL ROAD SUITE 100 CINCINNATI OH 45241 CONTRACTED NURSES 2195980 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 303682289 DIETARY SERVICES 1813168 MEDICAL SOLUTIONS LLC 1010 NORTH 102ND ST SUITE 300 OMAHA NE 68114 CONTRACTED NURSES 1340526 RESOURCE ANESTHESIOLOGY ASSOCIATION 450 MAMARONECK AVENUE HARRISON NY 11528 ANESTHESIA SERVICES 1336371 34 275499 12444105 12719604 NET PATIENT SERVICE REVENUE 621110 111815670 111815670 111815670 1508208 1508208 -17050 17050 17050 17050 340 B PHARMACY PROGRAM 900099 8005802 8005802 EMPLOYEE PHARMACY SALES 722514 3005328 3005328 OTHER OPERATING REVENUE 621990 1842243 1842243 376623 376623 13229996 139290528 111832720 0 14738204 12000 12000 1011403 1011403 52710176 47274990 5435186 711786 626372 85414 8559076 7531987 1027089 3313020 2915458 397562 24210 16947 7263 157790 110453 47337 3759678 2631775 1127903 100177 70124 30053 1940984 1355089 585895 3499558 2449691 1049867 79962 55973 23989 101350 70945 30405 370214 259150 111064 4858329 3400830 1457499 1163082 814157 348925 MEDICAL SUPPLIES 22354034 15647824 6706210 PURCHASE SERVICE 18490618 12943433 5547185 REPAIRS AND MAINTENANCE 2160012 1512008 648004 OTHER 1179436 825605 353831 448888 314222 134666 127005783 100839033 26166750 0 5645150 2940556 35937960 25732772 16432783 23010066 489989 377231 3260344 3658084 3433278 3112581 132118357 78727665 44618566 53390692 1369444 1240757 111187514 113462739 15616118 17762940 11952862 1454614 10395728 9593312 681919 1084778 22718218 19451062 61364845 49346706 X 49822669 64116033 49822669 64116033 111187514 113462739 12284745 2008619 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 12210 0 0 0 12210 0 849547 849547 54513270 26882631 27630639 61312353 50850580 10461773 8018099 7425088 994454 14448733 53390692 PROFESSIONAL LIABILITY 929703 DUE TO THIRD PARTY 18521359 19451062 X PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITION 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. 1 1 1 X 1 X 180.000000000000 1 1 1 0 1 1 1145687 1145687 0.00900 22037965 17637890 4400075 0.03460 23183652 17637890 5545762 0.04360 103550 103550 0.00080 103550 103550 0.00080 23287202 17637890 5649312 0.04440 1 12955611 31019920 28877406 2142514 X 1 1 1 1 MISSOURI DELTA MEDICAL CENTER 1008 NORTH MAIN STREET SIKESTON MO 63801 X X MISSOURI DELTA MEDICAL CENTER 1 0 0 1 X X X X X X X X 17 1 1 1 1 X WWW.MISSOURIDELTA.COM X 1 17 1 WWW.MISSOURIDELTA.COM 0 1 X 100.000000000000 180.000000000000 X 1 1 X X X 1 X WWW.MISSOURIDELTA.COM X X 1 X X X 1 X X X X X 1 0 0 MISSOURI DELTA MEDICAL CENTER PART V, SECTION B, LINE 6A: FOR THE PURPOSES OF THE ASSESSMENT, COMMUNITY IS DEFINED AS THE GEOGRAPHIC AREA FROM WHICH A SIGNIFICANT NUMBER OF PATIENTS USING MDMC SERVICES RESIDE. THE PRIMARY SERVICE AREA FOR MDMC IS BASED ON THE NUMBER OF INPATIENT DISCHARGES AND OUTPATIENT VISITS BY PATIENTS THAT RESIDE IN SCOTT, MISSISSIPPI AND NEW MADRID COUNTIES. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR SCOTT COUNTY WAS CONDUCTED IN PARTNERSHIP WITH SAINT FRANCIS MEDICAL CENTER. AS MISSISSIPPI COUNTY AND NEW MADRID COUNTY WERE THE PRIMARY SERVICE AREAS OF MDMC ALONE THE CHNA WAS NOT CONDUCTED IN PARTERNSHIP WITH SAINT FRANCIS MEDICAL CENTER. MISSOURI DELTA MEDICAL CENTER PART V, SECTION B, LINE 6B: FOR PURPOSES OF THE ASSESSMENT, THE HOSPITAL HAS BEEN WORKING WITH THE FOLLOWING LOCAL ENTITIES TO CONDUCT THE CHNA: (1) MISSISSIPPI COUNTY HEALTH DEPARTMENT, (2) NEW MADRID COUNTY HEALTH DEPARTMENT, (3) L&S PHARMACY, (4) BOOTHEEL COUNSELING, (5) SEMO HEALTH NETWORK, (6) DAOEC. MISSOURI DELTA MEDICAL CENTER PART V, SECTION B, LINE 11: MEMBERS OF THE MISSOURI DELTA CHNA TEAM ANALYZED THE SURVEY DATA, FOCUS GROUP DATA, AND SECONDARY DATA TO PRIORITIZE THE COMMUNITY HEALTH NEEDS FOR MISSISSIPPI, NEW MADRID AND SCOTT COUNTIES. THE TOP FIVE PRIORITY NEEDS INCLUDE:1. CHILD AND ADULT OBESITY2. CHRONIC DISEASE A. DIABETES (DIET AND EXERCISE)B. CHRONIC RESPIRATORY DISEASE (SMOKING)C. HEART DISEASE (SMOKING/DIET AND EXERCISE)D. STROKE (HEALTHY LIFESTYLE)3. CANCER (SMOKING)4. MENTAL ILLNESS5. DRUG AND ALCOHOL ABUSECHILD AND ADULT OBESITY:SPECIFIC STRATEGIES INCLUDE EDUCATIONAL ACTIVITY BOOKS GEARED TOWARD FAMILIES WHICH INCLUDES HEALTHY EATING HABITS. BOOKS WILL BE AVAILABLE IN MDMC CLINIC WAITING ROOMS AND THE EMERGENCY ROOM. CREATON OF FITKIDZ THROUGH POSTERS, HANDOUTS, TV LOBBY, AND HEALTH FAIRS. CONTINUE TO HOLD CHRONIC DISEASE EDUCATIONAL WORKSHOPS AT MISSOURI DELTA MEDICAL CENTER. CONTINUE TO IDENTIFY PATIENTS IN NEED OF ATTENDING CHRONIC DESEASE EDUCATION WORKSHOPS OFFERED. PROVIDE SPEAKERS/PRESENTERS ABOUT HEALTHY EATING AT EVENTS SUCH AS THE ANNUAL WOMEN'S SHOW AND THE ANNUAL WOMEN'S HEALTH CONFERENCE. PARTICIPATE IN THE ANNUAL HEALTHY KIDS DAY PROGRAM AT THE YMCA WITH EDUCATIONAL DIETARY INFORMATION. PARTNER WITH STRATUS MEDICAL GROUP WITH PROMOTION OF THEIR HEALTHY WEIGHT MANAGEMENT PROGRAM. CHRONIC DISEASE: SPECIFIC STRATEGIES INCLUDE TO CONTINUE OFFERING CHRONIC DISEASE EDUCATIONAL WORKSHOPS AND PROMOTING THOSE THROUGH THE PHYSICIANS, CASE MANAGERS AND OTHER CIVIC ORGANIZATIONS. CONTINUE TO PROVIDE FREE PUBLIC HEALTH SCREENINGS AT HEALTH FAIRS THROUGHOUT THE COUNTIES WE SERVE; BLOOD PRESSURE, GLUCOSE, LUNG. POPULATION HEALTH WORKING THROUGH OUTREACH TO HELP EDUCATE PATIENTS AND PREVENT READMISSIONS. WORK WITH LOCAL HEALTH DEPARTMENTS IN EACH COUNTY TO PROMOTE THEIR DIABETES SUPPORT GROUPS AND SELF-HELP PROGRAMS. CANCER: SPECIFIC STRATEGIES INCLUDE TO CONTINUE TO PROMOTE SMOKING-CESSATION PROGRAMS THE LOCAL HEALTH DEPARTMENTS ARE PROVIDING AND EDUCATE MEDICAL PROVIDERS ON THE RESOURCES AVAILABLE FOR PATIENTS WHO WANT TO QUIT TOBACCO USAGE. MENTAL ILLNESS AND DRUG AND ALCOHOL ABUSE:SPECIFIC STRATEGIES INCLUDE TO PARTNER WITH BOOTHEEL COUNSELING IN PROVIDING MENTAL HEALTH FIRST AID PROGRAMS TO AREA EMPLOYERS. THIS PROGRAM INTRODUCES PARTICIPANTS TO RISK FACTORS AND WARNING SIGNS OF MENTAL ILLNESS. CONTINUE TO SUPPORT THE MENTAL HEALTH COUNSELORS IMPLEMENTED IN MDMC'S RURAL HEALTH CLINICS IN SIKESTON AND NEW MADRID. PARTNER WITH PHARMACIES THAT OFFER A MEDICATION RECONCILIATION PROGRAM IN WHICH THE PHARMACIST VISITS THE PATIENT'S HOME AND COMPARES HOME MEDS WITH DISCHARGE MEDS TO ENSURE NO DISCREPANCIES. 31 1 - RESTART OF SIKESTON 1008 NORTH MAIN STREET SIKESTON MO 63801 PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY 2 - RESTART OF CHARLESTON 512 EAST MARSHALL STREET CHARLESTON MO 63834 PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY 3 - RESTART OF NEW MADRID 406 HIGHWAY 61 NEW MADRID MO 63869 PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY 4 - RESTART OF EAST PRAIRIE 106 SOUTH WASHINGTON EAST PRAIRIE MO 63845 PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY 5 - BARTON-JOLLY PHYSICIAN SERVICES 1019 NORTH MAIN STREET SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 6 - EXPRESS CARE 1008 NORTH MAIN STREET SIKESTON MO 63801 RURAL HEALTH CLINIC 7 - MISSOURI DELTA ORTHOPEDICS 201 PLAZA DRIVE SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 8 - WOMEN'S CARE CENTER 1013 NORTH MAIN STREET SIKESTON MO 63801 RURAL HEALTH CLINIC 9 - WELLPOINT PAIN CENTER 201 PLAZA DRIVE SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 10 - MISSOURI DELTA CANCER & INFUSION CENTER 1126 NORTH MAIN STREET SIKESTON MO 63801 INFUSION CENTER 11 - MEDX MEDICAL EQUIPMENT 708 N MAIN STREET SIKESTON MO 63801 DURABLE MEDICAL EQUIPMENT 12 - SMITH STREET CLINIC 123 SMITH STREET SIKESTON MO 63801 RURAL HEALTH CLINIC 13 - MISSOURI DELTA PRIMARY CARE 102 HOSPITALITY DRIVE SIKESTON MO 63801 RURAL HEALTH CLINIC 14 - PORTAGEVILLE COMMUNITY CARE CENTER 204 EAST 3RD STREET SIKESTON MO 63801 RURAL HEALTH CLINIC 15 - MISSOURI DELTA UROLOGY 1106 NORTH MAIN STREET SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 16 - SURGEONS NORTH 1124 NORTH MAIN STREET SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 17 - FAMILY MEDICINE 1017 NORTH MAIN SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 18 - SURGEONS - 1ST FLOOR JOLLY BUILDING 1013 NORTH MAIN STREET SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 19 - NEW MADRID COMMUNITY CARE CENTER 615 MAIN STREET SIKESTON MO 63801 RURAL HEALTH CLINIC 20 - MISSOURI DELTA WOUND & HYPERBARIC 201 PLAZA DRIVE SIKESTON MO 63801 WOUND CARE CENTER 21 - CHARLESTON COMMUNITY CARE CENTER 1403 EAST MARSHALL STREET CHARLESTON MO 63834 RURAL HEALTH CLINIC 22 - MISSOURI DELTA ENDOCRINE & DIABETES CENT 1118 NORTH MAIN STREET SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 23 - RESTART SOUTH 806 SOUTH KINGSHIGHWAY SIKESTON MO 63801 PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY 24 - DEXTER COMMUNITY CARE CENTER 911B WEST BUS HWY 60 DEXTER MO 63841 RURAL HEALTH CLINIC 25 - BENTON COMMUNITY CARE CENTER 6468 STATE HWY 77 BENTON MO 63736 RURAL HEALTH CLINIC 26 - CHAFFEE MEDICAL CENTER 209 WEST YOAKUM CHAFFEE MO 63740 RURAL HEALTH CLINIC 27 - MISSOURI DELTA OCCUPATIONAL MEDICINE 135 PLAZA DRIVE SUITE 202 SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 28 - GYNECOLOGIC ONCOLOGY 201 PLAZA DRIVE SUITE C SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 29 - ENT & ALLERGY CLINIC 135 PLAZA DRIVE SUITE 102 SIKESTON MO 63801 RURAL HEALTH CLINIC 30 - SPECIALTY CLINIC 135 PLAZA DRIVE SUITE 102 SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING 31 - DERMATOLOGY 1015 NORTH MAIN SIKESTON MO 63801 PHYSICIAN OFFICE BUILDING PART III, LINE 2: THE CENTER REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. THE CENTER PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE CENTER BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. PART III, LINE 8: IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUONT REPORTED ON LINE 6 IS ESTIMATED BY USING THE PERCENT OF OPERATING EXPENSE TO PATIENT REVENUE. PART III, LINE 9B: THE BAD DEBT POLICY STATES THAT IF IT IS DETERMINED THAT A PATIENT IS INDIGENT, PROCEED AS FOLLOWS: A. COMPLETE ACCOUNT ADJUSTMENT FORMS FOLLOWING ACCOUNT ADJUSTMENT PROCEDURES OR NOTE THE BALANCE WILL BE WRITTEN OFF AS CHARITY ACCORDING TO THE CHARITY CARE POLICY.B. ENTER THE FOLLOWING NOTATIONS ON THE COPY OF THE PATIENT ACCOUNTS ADMISSION REGISTRATION FORMS OR IN ACCOUNTS RECEIVABLE NOTES IN THE COMPUTER: "CHARGES DUE BY PATIENT WILL BE WRITTEN OFF AS MEDICARE BAD DEBT OR UNCOMPENSATED CARE." 0 RAY CLINTON HEALTHCARE SCHOLARSHIPS 2 2000 JUANITA WILLIAMS NURSING SCHOLARSHIPS 3 3000 COOPER SCHOLARSHIPS 2 2000 BRUCE MEMORIAL SCHOLARSHIPS 4 4000 CASH SCHOLARSHIP FUND 1 1000 PART I, LINE 2: THE SCHOLARSHIP PROGRAM IS DESIGNED TO PROVIDE A CONSISTENT FLOW OF REGISTERED NURSES TO MISSOURI DELTA MEDICAL CENTER. THE OBJECTIVE OF THE PLAN IS TO ENCOURAGE AND FINANCIALLY ASSIST QUALIFIED STUDENTS IN THEIR ENDEAVOR TO BECOME A REGISTERED NURSE. TO THE EXTENT OF AVAILABLE FUNDS, THE MEDICAL CENTER WILL PAY SCHOLARSHIPS TO QUALIFIED STUDENTS OF AN ACCREDITED REGISTERED NURSE PROGRAM. TO QUALIFY FOR THE PROGRAM A STUDENT MUST: A. HIGH SCHOOL GRADUATE 1. RANK IN THE UPPER THIRD OF HIGH SCHOOL CLASS ACADEMICALLY. 2. SHOW EVIDENCE OF MOTIVATION FOR NURSING EITHER BY APTITUDE TESTING OR BY REPORTED DEMONSTRATION OF INTEREST. 3. PROVIDE LETTER OF RECOMMENDATION FROM AN APPROPRIATE SCHOOL OFFICIAL. 4. BE APPROVED BY THE HOSPITAL SCHOLARSHIP SELECTION COMMITTEE. B. STUDENT NURSES - ALL STUDENT NURSES MUST: 1. HAVE AT LEAST THE EQUIVALENT OF A 2.5 GRADE POINT AVERAGE IN A 4 POINT SYSTEM. 2. MUST PROVIDE A LETTER OF RECOMMENDATION FROM RESPONSIBLE AND APPROPRIATE PERSON. 3. BE APPROVED BY THE SCHOLARSHIP COMMITTEE. C. CURRENT EMPLOYEES - ALL CURRENT EMPLOYEES MUST: 1. BE ENROLLED IN A NURSING PROGRAM AS A FULL-TIME STUDENT. 2. NOT BE RECEIVING ANY HOSPITAL BENEFITS. 3. BE APPROVED BY THE SCHOLARSHIP COMMITTEE. X X X X 0 0 0 0 0 0 0 0 0 DR RUDY RODRIGUEZ PHYSICIAN 768233 0 459533 0 19000 0 5800 0 8732 0 1261298 0 0 0 DR PAUL MONTANY PHYSICIAN 370622 0 313206 0 19000 0 5800 0 2750 0 711378 0 0 0 DR KENNETH MOY PHYSICIAN 260734 0 385567 0 19000 0 5800 0 5183 0 676284 0 0 0 DR MUHANNAD AL-KILANI PHYSICIAN 394850 0 207620 0 19660 0 5800 0 10114 0 638044 0 0 0 DR ANIMESH SAHAI PHYSICIAN 212286 0 356543 0 19000 0 5800 0 0 0 593629 0 0 0 JASON SCHRUMPF PRESIDENT/CEO 289793 0 52530 0 19206 0 5800 0 7146 0 374475 0 0 0 JIM HENSON SENIOR VICE PRESIDENT 214071 0 17646 0 87 0 4338 0 5183 0 241325 0 0 0 GREG CARDA VP. FINANCE 208179 0 17646 0 375 0 4286 0 8238 0 238724 0 0 0 JULIE FRASER VP, NURSING 176695 0 14858 0 317 0 3653 0 7933 0 203456 0 0 0 RAYMOND EARL SISK SON-IN-LAW OF DIRECTOR 146657 EMPLOYEE COMPENSATION 0 CATHERINE SCHRUMPF SPOUSE OF PRESIDENT 18868 EMPLOYEE COMPENSATION 0 ANTHONY COPPAGE BROTHER-IN-LAW OF DIRECTOR 90743 EMPLOYEE COMPENSATION 0 TRACY COPPAGE SISTER OF DIRECTOR 63976 EMPLOYEE COMPENSATION 0 RHONDA MENZ WIFE OF DIRECTOR 35026 EMPLOYEE COMPENSATION 0 JUDITH MENZ MOTHER OF DIRECTOR 89224 EMPLOYEE COMPENSATION 0 CHRIS STEWARD-STEWARD STEEL BOARD MEMBER 7873 BUILDING SUPPLIES 0 BETH JOHNSON- MITCHELL INSURANCE BOARD MEMBER 68834 INSURANCE POLICIES 0 JEFFERY HUX- HUX AND HUX BOARD MEMBER 15514 LEGAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 DAN JENNINGS JR AND JOHN BOLLINGER HAVE A BUSINESS RELATIONSHIP. BRITT MCCONNEL AND ROBERT MACGILLIVRAY HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B BEFORE THE FORM 990 IS FILED, THE VICE-PRESIDENT OF FINANCE OF THE ORGANIZATION REVIEWS THE FORM 990, WHICH IS PREPARED BY AN OUTSIDE TAX PREPARER. THE FINANCE COMMITTEE OF MISSOURI DELTA MEDICAL CENTER WILL ALSO PERFORM A REVIEW OF THE FORM 990 AFTER THE FORM HAS BEEN FILED. IN ADDITION, COPIES OF THE FORM 990 WILL BE AVAILABLE TO THE MISSOURI DELTA MEDICAL CENTER'S BOARD OF DIRECTORS AFTER THE ORGANIZATION'S FORM 990 HAS BEEN FILED. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS AS FOLLOWS: MEMBERS OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS HAVE AN OBLIGATION TO MAKE DECISIONS AND TO PERFORM THEIR DUTIES FOR THE SOLE BENEFIT OF THE HOSPITAL. ALL PERSONS SERVING IN SUCH CAPACITY SHOULD AVOID PLACING HIMSELF/HERSELF IN A POSITION WHERE PERSONAL INTERESTS ARE IN CONFLICT WITH THE INTERESTS OF THE HOSPITAL. THE FOLLOWING DEFINITIONS SHALL APPLY TO THIS POLICY: 1. AN "INTERESTED PERSON" IS A MEMBER OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICER OR MEMBER OF ANY COMMITTEE WITH BOARD DELEGATED POWERS; 2. A PERSON HAS A "FINANCIAL INTEREST" IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH BUSINESS, INVESTMENT OR FAMILY: A. A PRESENT OR POTENTIAL OWNERSHIP, INVESTMENT, INTEREST, OR COMPENSATION ARRANGEMENT IN ANY ENTITY WITH WHICH THE HOSPITAL HAS OR MAY HAVE A TRANSACTION OR ARRANGEMENT; B. A COMPENSATION ARRANGEMENT WITH THE HOSPITAL OR ANY ENTITY OR INDIVIDUAL WITH WHICH THE ORGANIZATION HAS A TRANSACTION OR ARRANGEMENT. COMPENSATION INCLUDES ANY REMUNERATION, DIRECTLY OR INDIRECTLY, AND GIFTS OF FAVORS, WHICH ARE SUBSTANTIAL IN NATURE; 3. AN "AFFILIATED ORGANIZATION" INCLUDES ANY ORGANIZATION OR ENTITY OWNED OR OPERATED BY THE HOSPITAL OR IN WHICH THE HOSPITAL HAS A DIRECT FINANCIAL INTEREST; ANY "INTERESTED PERSON" MUST DISCLOSE TO THE HOSPITAL AND ANY AFFILIATED ORGANIZATION ALL FINANCIAL INTERESTS AND ALL MATERIAL FACTS RELATING THERETO. IF A CONFLICT DOES ARISE, THE HOSPITAL AND ANY AFFILIATED ORGANIZATION SHALL: 1. REQUIRE THAT THE "INTERESTED PERSON" LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST; 2. APPOINT, IF APPROPRIATE, UNDER THE CIRCUMSTANCES THEN APPEARING, A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 3. DETERMINE, BY A MAJORITY VOTE OF NON-INTERESTED PERSONS PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL OR AFFILIATED ORGANIZATION'S BEST INTERESTS AND FOR ITS OWN BENEFIT AND IS FAIR AND REASONABLE TO THE HOSPITAL OR AFFILIATED ORGANIZATION. 4. TAKE APPROPRIATE DISCIPLINARY ACTION WITH RESPECT TO AN "INTERESTED PERSON" WHO VIOLATES THIS CONFLICT OF INTEREST POLICY TO PROTECT THE ORGANIZATION'S BEST INTERESTS. THE MINUTES OF ANY MEETING OF THE BOARD OF DIRECTORS OR ANY COMMITTEE WITH BOARD-DELEGATED POWERS SHALL INCLUDE THE FOLLOWING: 1. THE NAMES OF THE PERSONS WHO DISCLOSED FINANCIAL INTERESTS AND THE NATURE OF THEIR FINANCIAL INTEREST; 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT AND A RECORD OF THE VOTE. NO PHYSICIAN, WHO RECEIVES COMPENSATION DIRECTLY OR INDIRECTLY FROM THE HOSPITAL OR ANY AFFILIATED ORGANIZATION, SHALL BE A MEMBER OR SERVE ON ANY COMMITTEE DECIDING ON COMPENSATION FOR INDEPENDENT CONTRACTORS OR PRINCIPAL OFFICERS OF THE CORPORATION. NO MEMBER OF ANY COMPENSATION COMMITTEE WHO HAS A CONFLICT OF INTEREST SHALL, DIRECTLY OR INDIRECTLY, VOTE ON MATTERS PERTAINING TO THAT INDIVIDUAL'S COMPENSATION. EVERY MEMBER OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICER, AND MEMBER OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS SHALL SIGN AN ANNUAL STATEMENT THAT SUCH PERSON: 1. RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; 2. READ AND UNDERSTANDS THE POLICY; 3. AGREES TO COMPLY WITH THE POLICY; 4. UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5. UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS TAX EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S SALARY AND ADMINISTRATIVE REVIEW COMMITTEE, WHICH IS MADE UP OF MEMBERS OF THE BOARD OF DIRECTORS, REVIEWS THE COMPENSATION FOR THE PRESIDENT AND VICE-PRESIDENT OF THE MEDICAL CENTER. THE REVIEW OF COMPENSATION UTILIZES THE ANNUAL 'EXECUTIVE COMPENSATION REPORT' THAT IS PUBLISHED BY THE MISSOURI HOSPITAL ASSOCIATION. A REVIEW OF THE MISSOURI DELTAL MEDICAL CENTER'S PRESIDENT AND VICE-PRESIDENTS COMPENSATION WAS CONDUCTED FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS' GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. MISSOURI DELTA MEDICAL CENTER FOUNDATION 1008 NORTH MAIN STREET SIKESTON MO 63801 431577510 FUNDRAISING MO 501(C)(3) LINE 3 MISSOURI DELTA MEDICAL CENTER 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1