2021-03-15T21:41:15-05:00 2020-06-30 431001367 BROWN SMITH WALLACE LLP 6 CITYPLACE DRIVE SUITE 900 ST LOUIS MO 63141 990 2019-07-01 430666765 THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN RANK 3148726400 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 R BRETT MOOREHOUSE PRESIDENT & CEO 3148726400 2021-03-12 1 JENNIFER M VACHA P01251998 3149831200 2019 2022-09-23 18:48:47Z WALTER BAZAN JR 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 71955949 0 X WWW.RANKENJORDAN.ORG X 1940 MO PEDIATRIC BRIDGE HOSPITAL PROVIDING A CONTINUUM OF CARE FOR MEDICALLY COMPLICATED CHILDREN 27 24 555 198 0 0 3189474 2749319 40717492 49561527 922709 1380377 317996 150020 45147671 53841243 34795 43589 0 0 24607563 27327983 0 0 623476 13477943 13946174 38120301 41317746 7027370 12523497 95334862 108487501 40176754 39916512 55158108 68570989 RANKEN JORDAN IS A PEDIATRIC BRIDGE HOSPITAL PROVIDING A CONTINUUM OF CARE FOR MEDICALLY COMPLICATED CHILDREN AND THEIR FAMILIES. WE ARE A LEADER IN PROVIDING INTENSIVE TRANSITIONAL CARE AND LIVING SUPPORT FOR THESE CHILDREN. 0 0 31278793 43589 49196912 DURING THE CURRENT FISCAL YEAR, RANKEN JORDAN PROVIDED 15,515 DAYS OF MEDICAL CARE FOR INPATIENTS. 63% OF INPATIENTS WERE DISCHARGED HOME TO CONTINUED CARE BY THEIR FAMILIES AND HAVE NOT NEEDED ADMISSION TO ANOTHER CARE FACILITY. OF THE DAYS OF CARE PROVIDED, 90% OF INPATIENTS WERE CHILDREN ELIGIBLE TO RECEIVE SOME FORM OF MEDICAID ASSISTANCE. NO INPATIENT EVER LEAVES RANKEN JORDAN WITH A PATIENT RESPONSIBILITY DUE. IT IS THE GOAL OF THE ENTIRE STAFF AT RANKEN JORDAN TO ASSURE THAT WHEN A CHILD LEAVES OUR CARE, THEIR FAMILY HAS BEEN WELL TRAINED TO PROVIDE QUALITY CARE AND THEY HAVE A SAFE ENVIRONMENT TO GO HOME TO. 951279 364615 DURING THE CURRENT FISCAL YEAR, RANKEN JORDAN PROVIDED 16,244 UNITS OF OUTPATIENT SERVICES TO CHILDREN REQUIRING INTENSIVE THERAPY. RANKEN JORDAN PROVIDES PHYSICAL, OCCUPATIONAL, SPEECH, AND AQUATIC THERAPIES ON AN OUTPATIENT BASIS. RANKEN JORDAN OUTPATIENT PROGRAMS ALSO INCLUDE CONSTRAINT INDUCED MOVEMENT THERAPY AND PHYSIATRY SERVICES. 817352 A VARIETY OF COMMUNITY PROGRAMS ARE ALSO PROVIDED TO SUPPORT CHILDREN WITH COMPLEX MEDICAL NEEDS AND THEIR FAMILIES. THESE PROGRAMS ARE ALWAYS OFFERED FREE OF CHARGE AND OPEN TO THE GENERAL PUBLIC. THIS PROGRAMMING INCLUDES (BUT IS NOT LIMITED TO) SUPPORT GROUPS, SPORTS-RELATED ACTIVITIES FOR CHILDREN WITH SPECIAL NEEDS, AND SOCIAL ENRICHMENT ACTIVITIES FOR CHILDREN WITH COMPLEX MEDICAL NEEDS. A TOTAL OF 3,323 INDIVIDUALS WERE SERVED BY THE COMMUNITY PROGRAMS DURING THE YEAR. 33047424 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 5 0 1 555 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 27 24 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 3148726400 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 R BRETT MOOREHOUSE PRESIDENT/CEO 50.00 X X 311746 0 16843 WALTER BAZAN JR CHAIR 10.00 X X 0 0 0 ELIZABETH PROSPERI VICE CHAIR 5.00 X X 0 0 0 THOMAS J MINOGUE SECRETARY 5.00 X X 0 0 0 SONDRA M DENK TREASURER 5.00 X X 0 0 0 NICHOLAS A HOLEKAMP MD CHIEF MEDICAL OFFICER 50.00 X X 391679 0 54922 DAWN ANDREW MD BOARD MEMBER 3.00 X 0 0 0 ROMA NEMANI BORDEWICK BOARD MEMBER 5.00 X 0 0 0 CHRIS CIOFFI BOARD MEMBER 3.00 X 0 0 0 STEVE CORTOPASSI BOARD MEMBER 3.00 X 0 0 0 MIKE DETWILER BOARD MEMBER 3.00 X 0 0 0 PAM DUFFY BOARD MEMBER 3.00 X 0 0 0 DEREK GLANVILL BOARD MEMBER 3.00 X 0 0 0 KRISTEN HOGAN BOARD MEMBER 3.00 X 0 0 0 NOREEN LAFFEY BOARD MEMBER 3.00 X 0 0 0 KEN MARX BOARD MEMBER 3.00 X 0 0 0 MIKE MATHENY BOARD MEMBER 3.00 X 0 0 0 TERI MURRAY BOARD MEMBER 3.00 X 0 0 0 JOHN PROSPERI BOARD MEMBER 3.00 X 0 0 0 JOHN RAHAL BOARD MEMBER 3.00 X 0 0 0 STEVE RENNE BOARD MEMBER (RESIGN 12/2019) 3.00 X 0 0 0 MICHAEL SCULLY BOARD MEMBER 3.00 X 0 0 0 RABBI MARK L SHOOK BOARD MEMBER 3.00 X 0 0 0 THAD SIMONS BOARD MEMBER 3.00 X 0 0 0 KURTIS T SOBUSH MD BOARD MEMBER 3.00 X 0 0 0 RICHARD A VANDEGRIFT BOARD MEMBER 3.00 X 0 0 0 BILL WILLHITE BOARD MEMBER 5.00 X 0 0 0 NICK WILLIAMSON BOARD MEMBER 3.00 X 0 0 0 JOHN CLAGG CFO 50.00 X 128802 0 3159 SUSAN CONGER MD PHYSICIAN 40.00 X 261805 0 16160 AMY ZIMMERMANN MD PHYSICIAN 40.00 X 244334 0 15743 EUGENE EVRA MD PHYSICIAN 40.00 X 237249 0 15456 LYNDA BRADY MD PHYSICIAN 40.00 X 225830 0 16985 ROD PELLENBERG MD PHYSICIAN 40.00 X 211915 0 14174 2013360 0 153442 37 0 1 0 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 CONSULT/ELEC HEALTH REC 1288327 OPTION CARE 535 AXMINISTER DRIVE FENTON MO 63026 PHARMACY IV MEDICATIONS 411833 MB TECHNOLOGY SOLUTIONS 1001 CRAIG ROAD SUITE 400 ST LOUIS MO 63146 COMPUTER CONSULTING 320233 LYNCH MEDIA CONSULTANTS 639 LOCKSLEY PLACE ST LOUIS MO 63119 MARKETING CONSULTANTS 164733 THOMPSON COBURN PO BOX 18379M ST LOUIS MO 63195 LEGAL SERVICES 122274 5 157934 83608 2507777 2749319 INPATIENT CARE 621110 49196912 49196912 OUTPATIENT CARE 621110 364615 364615 49561527 718532 718532 18671756 18009911 661845 661845 661845 40875 157934 102745 -61870 -61870 5955 2050 3905 3905 MO HOSPITAL PLAN 900099 106244 106244 REFUNDS/REBATES 900099 76712 76712 MISCELLANEOUS REVENUE 900099 25029 25029 207985 53841243 49561527 0 1530397 43589 43589 1185431 788699 396732 21272438 18368500 2803503 100435 492407 492407 2815169 2712651 99796 2722 1562538 1283841 246139 32558 5581 5581 135691 135691 97210 97210 903622 323187 580435 203515 202331 1184 3558038 3237238 311587 9213 1610671 7150 1603521 548606 495254 53352 27088 11495 15593 101245 61025 40220 1615983 1517441 82118 16424 3081220 2897930 152742 30548 508531 85907 422624 FRA ASSESSMENT 1506360 1506360 COMMUNITY OUTREACH 42813 3449 5704 33660 41317746 33047424 7646846 623476 400 400 1962064 4629393 1043637 699425 5531722 6578518 1535504 1399462 75172752 22793918 54878392 52378834 30383143 42801469 95334862 108487501 3018314 3479426 86850 13350 36513899 35835453 557691 588283 40176754 39916512 X 53263640 66558121 1894468 2012868 55158108 68570989 95334862 108487501 X 12523497 899941 -10557 X X 0 1 X 1 0 X 4214060 3010704 3610545 3189474 2749319 16774102 4214060 3010704 3610545 3189474 2749319 16774102 6296059 10478043 441183 477752 523973 613266 718532 2774706 26737 413848 207985 648570 20197378 174102031 0.51880 0.55230 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2015 AMOUNT: $ 26,737. 2018 AMOUNT: $ 413,848. 2019 AMOUNT: $ 207,985. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 37142 37142 0 PART II-B, LINE 1: RANKEN JORDAN PAYS DUES TO A VARIETY OF OTHER PROFESSIONAL ORGANIZATIONS. A PORTION OF THOSE DUES ARE IDENTIFIED BY EACH ORGANIZATION AS ALLOCABLE TO LOBBYING. THE TOTAL DEEMED AS LOBBYING BY EACH ORGANIZATION FOR THE YEAR IS REFELCTED ABOVE AS "OTHER ACTIVITIES". 272500 47330 319830 0 272500 272500 0.00000 1.00000 0.00000 0 0 759000 1600177 2359177 54021826 10627845 43393981 16484414 11504526 4979888 2307335 661547 1645788 52378834 OTHER LIABILITIES 588283 588283 X 54741184 899941 899941 53841243 0 53841243 41328303 10557 10557 41317746 0 41317746 PART V, LINE 4: THE HOSPITAL WAS GIFTED A DONOR-RESTRICTED AMOUNT OF $272,500 IN JUNE 2019 TO ESTABLISH AN ENDOWMENT FUND. THE EARNINGS ON THE INVESTED ENDOWMENT GIFT ARE TO BE USED FOR ANNUAL MAINTENANCE OF THE PLAYGROUND IN PERPETUITY AND ANNUAL FUNDING TO FOSTER PLAY FOR KIDS IN PERPETUITY. THE BOARD OF DIRECTORS IS IN THE PROCESS OF FORMALIZING THE INVESTMENT AND SPENDING POLICIES SURROUNDING THE ENDOWMENT RECEIVED IN JUNE 2019. PART X, LINE 2: THE HOSPITAL 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 HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL HAS ADDRESSED THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, ACCOUNTING FOR INCOME TAXES. IN THAT REGARD, THE HOSPITAL HAS EVALUATED ITS TAX POSITIONS, EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS AND BELIEVES THAT NO PROVISION FOR INCOME TAXES IS NECESSARY, AT THIS TIME, TO COVER ANY UNCERTAIN TAX POSITIONS. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT ON PROMISE RECEIVABLES 10,557. GOLF TOURNAMENT 158810 117935 40875 2000 5000 56863 1478 750 14812 DINNER AUCTION 38329 38329 4750 15947 2 1670 1670 1145 198809 157934 40875 2000 5000 56863 1478 5500 31904 102745 -61870 FORM 990, SCHEDULE G, PART II: AS A RESULT OF THE COVID-19 PANDEMIC, MANY IN-PERSON PROGRAM AND FUNDRAISING EVENTS HOSTED BY NONPROFIT ORGANIZATIONS WERE CANCELLED, POSTPONED, TRANSITIONED TO A VIRTUAL ENVIRONMENT, OR HOSTED WITH LIMITED ATTENDANCE. RANKEN JORDAN, THANKFULLY, WAS ABLE TO CONTINUE SERVING PATIENTS WITH LIMITATIONS IMPOSED ONLY FROM A VISITATION PERSPECTIVE. FUNDRAISING EVENTS, HOWEVER, DID REQUIRE MORE EXTENSIVE MODIFICATIONS. THE ANNUAL GALA, TYPICALLY HOSTED IN MARCH, WAS CANCELLED DUE TO COVID IN 2020. DUE TO THE CURRENT ENVIRONMENT, IT IS ALSO UNLIKELY TO BE HELD IN 2021. RANKEN JORDAN IS TAKING STEPS TO CREATE ALTERNATIVE VENUES FOR DONORS TO CONTINUE SUPPORTING THE MISSION OF THE HOSPITAL. 1 1 1 X 400.000000000000 1 X 1 1 0 1 1 5 71385 71385 0.00170 23357316 13705864 9651452 0.23410 30652551 17273966 13378585 0.32440 5 54081252 30979830 23101422 0.56020 3323 13415 13415 0.00030 3 526 122140 122140 0.00300 3 3849 135555 135555 0.00330 3 3854 54216807 30979830 23236977 0.56350 1 81277 81277 34987 250182 -215195 X 1 1 1 1 THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 X X PEDIATRIC SPECIALTY HOSPITAL THE RANKEN-JORDAN HOME FOR CONVALESCENT 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X WWW.RANKENJORDAN.ORG X 0 0 1 X 400.000000000000 400.000000000000 1 1 X X X 1 X RANKENJORDAN.ORG/WP-CONTENT/UPLOADS/2020/02/FINANCIAL-ASSISTANCE-PROGRAM_02 X RANKENJORDAN.ORG/WP-CONTENT/UPLOADS/2020/02/FINANCIAL-ASSISTANCE-PROGRAM_02 X RANKENJORDAN.ORG/WP-CONTENT/UPLOADS/2020/02/FINANCIAL-ASSISTANCE-PROGRAM_02 X X X X X X 1 X 0 X 0 X X 0 0 THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED C PART V, SECTION B, LINE 5: IN CONDUCTING THE 2018 TAX YEAR CHNA, RANKEN JORDAN TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH FACILITATION OF A PATIENT AND FAMILY ADVISORY COUNCIL, INTERNAL FOCUS GROUP, ANONYMOUS COMMUNITY SURVEYS, COMMUNITY PROGRAM PARTICIPANT SURVEYS, AND ONE ON ONE INTERVIEWS. PERSONS CONSULTED DURING THIS PROCESS INCLUDE CURRENT AND FORMER PATIENTS AND THEIR FAMILY MEMBERS, MEMBERS OF OUR MULTIDISCIPLINARY STAFF, PERSONS LIVING IN THE LOCAL COMMUNITY, REPRESENTATIVES FROM LOCAL CHILDREN'S HOSPITALS, AND POLITICAL REPRESENTATIVES OF THE AREAS FROM WHICH WE ADMIT PATIENTS. THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED C PART V, SECTION B, LINE 6B: ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED C PART V, SECTION B, LINE 11: RANKEN JORDAN IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA THROUGH COMMUNITY PROGRAMMING AND WORKING WITH LOCAL PARTNERS. THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED C PART V, SECTION B, LINE 20E: NO COLLECTION ACTIONS ARE TAKEN AGAINST OUR PATIENTS. RANKEN JORDAN HAS NO AFFILIATION WITH ANY COLLECTION AGENCY OR ORGANIZATION. COLLECTION ACTIVITIES WOULD GO AGAINST THE MISSION OF RANKEN JORDAN, TO CARE FOR CHILDREN. PART I, LN 7 COL(F): BAD DEBT IS RECORDED FOR PATIENTS THAT ARE ELIGIBLE FOR HEALTH INSURANCE BUT THE SERVICE IS NOT COVERED. BAD DEBT IS RECORDED AT THE NET REALIZABLE AMOUNT. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.) FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT CERTAIN PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: BAD DEBT IS RECORDED FOR PATIENTS THAT ARE ELIGIBLE FOR HEALTH INSURANCE BUT THE SERVICE IS NOT COVERED AND DEEMED TO BE A MEDICAL BENEFIT AND PROVIDED WITHOUT COST TO THE PATIENT. BAD DEBT IS DETERMINED BY TAKING THE GROSS CHARGES, LESS ANY CONTRACTUAL ALLOWANCE AGREEMENT WITH THE PAYER. BAD DEBT IS THEN RECORDED AT THE NET REALIZABLE AMOUNT. THE AMOUNTS SHOULD BE INCLUDED IN COMMUNITY BENEFIT BECAUSE EFFORTS WERE NOT MADE TO COLLECT THE AMOUNT FROM THE PATIENT'S FAMILY. PART III, LINE 4: THE HOSPITAL'S PATIENT ACCOUNTS RECEIVABLE ARE PRIMARILY COMPRISED OF AMOUNTS DUE FROM MEDICAID, PRIVATE INSURANCE, SELF-PAY PATIENTS, AND OTHER THIRD-PARTY PAYORS. THE HOSPITAL EVALUATES THE VALUATION OF PATIENT ACCOUNTS RECEIVABLE BASED ON ANALYSIS OF HISTORICAL TRENDS, AS WELL AS ITS UNDERSTANDING OF THE NATURE AND COLLECTABILITY OF ACCOUNTS BASED ON THEIR AGE AND OTHER FACTORS. PART III, LINE 9B: RANKEN JORDAN DOES NOT HAVE A FORMAL WRITTEN COLLECTION POLICY BECAUSE NO COLLECTION ACTION IS TAKEN AGAINST OUR PATIENTS. RANKEN JORDAN HAS NO AFFILIATION WITH ANY COLLECTION AGENCY OR ORGANIZATION. RANKEN JORDAN INTERNALLY IDENTIFIES THE TIME PERIOD FOR WHICH UNPAID PATIENT ACCOUNTS WILL REMAIN OPEN AND AVAILABLE TO COLLECT. FORMAL COLLECTION ACTIVITIES WOULD GO AGAINST THE MISSION OF RANKEN JORDAN, TO CARE FOR CHILDREN. PART VI, LINE 2: RANKEN JORDAN IS A MEMBER OF THE MISSOURI HOSPITAL ASSOCIATION, THE ILLINOIS HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND THE CHILDREN'S HOSPITAL ASSOCIATION. THROUGH THESE AFFILIATIONS, RANKEN JORDAN IS ABLE TO MONITOR AND PARTICIPATE IN PROGRAMS THAT HAVE BEEN DETERMINED TO MEET THE NEEDS OF THE COMMUNITY ON THE LOCAL LEVEL. RANKEN JORDAN PARTNERS WITH DISABLED ATHLETES SPORTS ASSOCIATION (DASA), ST. LOUIS ARC, AND THE CITY OF MARYLAND HEIGHTS TO PROVIDE PROGRAMMING THAT MEETS THE NEEDS OF CHILDREN WITH COMPLEX MEDICAL ISSUES. PART VI, LINE 3: ALL RANKEN JORDAN PATIENTS AND FAMILIES ARE ASSIGNED A SOCIAL WORKER UPON ADMISSION. THAT PERSON WORKS DIRECTLY WITH THE PATIENT AND THE FAMILY TO MAKE SURE THAT THEIR FINANCIAL RESPONSIBILITIES ARE FULLY EXPLAINED. RANKEN JORDAN HAS THE ABILITY TO ASSIST FAMILIES IN APPLYING FOR MEDICAID/MEDICARE COVERAGE IF THEY HAVE NOT ALREADY DONE SO. DUE TO THE SPECIAL NATURE OF THE PATIENTS, RANKEN JORDAN SERVICES, AND THE MISSION OF THE ORGANIZAITON, NO INPATIENT RECEIVES A BILL FOR CARE RECEIVED. RANKEN JORDAN DOES NOT WORK WITH OR TURN ANY PATIENT'S ACCOUNTS OVER FOR COLLECTION. PART VI, LINE 4: RANKEN JORDAN SERVES THE METROPOLITAN ST. LOUIS AREA. PATIENTS ARE ACCEPTED BASED ON ADMISSION CRITERIA FOR SPECIALTY HOSPITALS. THE SERVICES PROVIDED ARE UNIQUE IN THAT THEY ARE ONLY AVAILABLE IN A LIMITED AMOUNT OF LOCATIONS THROUGHOUT THE COUNTRY. CARE IS PROVIDED FOR CHILDREN WITH COMPLEX MEDICAL NEEDS, WITH THE GOAL OF SEEING THEM RETURN TO A SAFE HOME ENVIRONMENT. PART VI, LINE 5: RANKEN JORDAN PROVIDES THE COMMUNITY WITH MANY OPPORTUNITES FOR CHILDREN WITH COMPLEX MEDICAL NEEDS AND THEIR FAMILIES TO BE ABLE TO BECOME ACTIVE IN THE COMMUNITY. PROGRAMS ARE OFFERED SUCH AS "CHALLENGER BASEBALL AND GOLF THAT ALLOW CHILDREN TO PARTICIPATE IN SPORTS DESPITE THEIR PHYSICAL LIMITATIONS. EDUCATION OPPORTUNITIES ARE PROVIDED FOR THESE CHILDREN THAT INCLUDE COOKING, MARTIAL ARTS, CAMP, AND SOCIAL GATHERING PROGRAMS. ALL PROGRAMS ARE PROVIDED FREE OF CHARGE TO FAMILIES AND ARE OPEN TO THE GENERAL PUBLIC. PART VI, LINE 6: RANKEN JORDAN IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 TRANSPORTATION FOR PATIENT FAMILIES 1078 24481 LODGING FOR OUT-OF-TOWN PARENTS 13 6065 INTERPRETER SERVICES FOR PATIENTS THAT DO NOT SPEAK ENGLISH OR ARE HEARING IMPAIRED 19 12778 PERSONAL ITEMS FOR PATIENTS AND PATIENT FAMILIES 12 265 PART I, LINE 2: THE ORGANIZATION HAS POLICIES IN PLACE TO RECEIVE REQUESTS FOR ASSISTANCE. ALL REQUESTS FOR ASSISTANCE ARE EVALUATED BY THE SOCIAL SERVICES DEPARTMENT AND EVALUATED AGAINST SET POLICIES. ALL REQUESTS ARE THOROUGHLY DOCUMENTED IN THE PATIENT'S FILE. THE ORGANIZATION TAKES CARE TO ENSURE THAT PATIENTS RECEIVING GRANT ASSISTANCE MEET ESTABLISHED CRITERIA. ANY GRANT ASSISTANCE PROVIDED TO INDIVIDUALS IS HANDLED INTERNALLY AND THE INDIVIDUALS DO NOT RECEIVE DIRECT PAYMENT OF THE FUNDS AWARDED. X X X X X X 0 1 0 0 0 0 0 1 0 R BRETT MOOREHOUSE PRESIDENT/CEO 301281 0 10000 0 465 0 11200 0 5643 0 328589 0 0 0 NICHOLAS A HOLEKAMP MD CHIEF MEDICAL OFFICER 380854 0 10000 0 825 0 49279 0 5643 0 446601 0 0 0 SUSAN CONGER MD PHYSICIAN 261340 0 0 0 465 0 10675 0 5485 0 277965 0 0 0 AMY ZIMMERMANN MD PHYSICIAN 244103 0 0 0 231 0 9996 0 5747 0 260077 0 0 0 EUGENE EVRA MD PHYSICIAN 236928 0 0 0 321 0 9709 0 5747 0 252705 0 0 0 LYNDA BRADY MD PHYSICIAN 225005 0 0 0 825 0 9309 0 7676 0 242815 0 0 0 ROD PELLENBERG MD PHYSICIAN 211684 0 0 0 231 0 8689 0 5485 0 226089 0 0 0 PART I, LINE 4B NICHOLAS HOLEKAMP IS A PARTICIPANT IN A 457(F) PLAN. CONTRIBUTIONS WERE MADE ON HIS BEHALF. PART I, LINE 7 INCENTIVES PAID BY THE ORGANIZATION ARE DISCRETIONARY. THE BOARD DETERMINES IF/WHEN INCENTIVES WILL BE PAID AT THE END OF THE FISCAL YEAR. THEY RESEARCH CURRENT EXECUTIVE SALARIES OF LIKE ORGANIZATIONS, RESULTS OF THE YEAR, AND BENEFITS PACKAGES, TO COME TO A DETERMINATION. THERE IS NO WRITTEN AGREEMENT OR GUARANTEE INCENTIVES WILL BE PAID ANNUALLY. THE FOLLOWING INDIVIDUALS RECEIVED THE NON-FIXED PAYMENT: NICHOLAS HOLEKAMP AND R. BRETT MOOREHOUSE. A IDA OF THE COUNTY OF ST LOUIS MISSOURI 431170145 79130GJC6 2016-09-26 37207987 REFUNDING SERIES 2007 BONDS; EXPANSION 1 0 0 A 615000 20285000 37207987 15642185 519597 21565802 2017 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 ELLEN SIMONS NAHLIK (SEE PART V) FAMILY MEMBER OF BOARD MEMBER 65764 EMPLOYMENT WAGES 0 FORM 990, PART VI, SECTION A, LINE 2 JOHN PROSPERI (BOARD MEMBER) AND ELIZABETH PROSPERI (VICE CHAIRMAN) HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE INITIAL FORM 990 IS ORIGINALLY PRESENTED TO THE FINANCE COMMITTEE BY OUR INDEPENDENT AUDITORS. ONCE APPROVED BY THE FINANCE COMMITTEE, IT WILL BE MADE AVAILABLE ELECTRONICALLY TO THE FULL BOARD FOR FINAL APPROVAL. ONCE FINAL APPROVAL IS RECEIVED, THE FORM 990 WIL BE FILED ELECTRONICALLY BY OUR INDEPENDENT AUDITORS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL EMPLOYEES, OFFICERS, DIRECTORS AND KEY EMPLOYEES OF THE ORGANIZATION. THE EXECUTIVE COMMITTEE HAS OVERSIGHT RESPONSIBILITIES FOR THE PROGRAM. THE COMPLIANCE OFFICER CONDUCTS THE DAY-TO-DAY OPERATIONS OF THE COMPLIANCE PROGRAM, INCLUDING COORDINATION OF THE RECEIPT OF REPORTS OF NONCOMPLIANCE. THE ORGANIZATION ADDED THE POSITION OF COMPLIANCE OFFICER/RISK MANAGER AS A FULL-TIME POSITION DURING FISCAL YEAR 6/30/14. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S EXECUTIVE COMPENSATION COMMITTEE, UNDER THE ADVISEMENT OF AN OUTSIDE CONSULTING GROUP, MEETS ANNUALLY TO REVIEW THE COMPENSATION OF TOP MANAGEMENT OFFICIALS. THE MEETINGS ARE HELD ANNUALLY IN MAY. THE EXECUTIVE COMPENSATION COMMITTEE FINDINGS ARE APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BAD DEBT ON PROMISE RECEIVABLES -10,557. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.