2019-02-04T14:48:38-06:00 2018-03-31 430352985 KERBER ECK & BRAECKEL LLP 3401 OFFICE PARK DRIVE MARION IL 62959 990 2017-04-01 431741457 PERRY COUNTY HEALTH SYSTEM PERRY COUNTY MEMORIAL HOSPITAL PERR 5735472536 434 NORTHWEST STREET PERRYVILLE MO 63775 RANDALL WOLF VP OF FINANCE 5735472536 2018-12-19 1 AMBER HALSTEAD P01343727 6185291040 2018-12-19 64.83.254.138 2019-02-02 10:08:14 CS P 8FBDAAF724FD1D6222B37EDFD135E9DD0FF3B3E7 2B596217D46A1DF02F7DFC32C28E45542AFB7B54 2017 2019-02-21 02:37:17Z PATRICK CARRON 434 NORTHWEST STREET PERRYVILLE MO 63775 66244273 0 X WWW.PCHMO.ORG X 1996 MO TO PROVIDE QUALITY HOSPITAL AND HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. 8 5 601 51 214854 -8573 492501 429665 54257457 63567326 716649 405770 1158949 1299229 56625556 65701990 0 0 0 0 27255810 33217391 0 0 0 24534956 29382508 51790766 62599899 4834790 3102091 61982805 64380174 7925245 7167917 54057560 57212257 TO PROVIDE QUALITY HOSPITAL & HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES 0 0 62056530 64883447 6,597 PATIENT DAYS OF CARE OF WHICH 239 DAYS WERE NURSERY CARE WERE PROVIDED THROUGH INPATIENT SERVICES IN 2018. THE HOSPITAL PROVIDED 3,418 HOME HEALTH AGENCY VISITS, 70,717 RURAL HEALTH CLINIC VISITS, 8,702 EMERGENCY ROOM VISITS, 41,142 OUTPATIENT VISITS AND 2,585 SURGERIES IN 2018. FOR FURTHER INFORMATION ABOUT PROGRAMS AND SERVICES PLEASE SEE SCHEDULE H PART VI, LINE 2. 62056530 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 1 44 0 601 1 1 1 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MO X RANDY WOLF 5735472536 434 NORTHWEST STREET PERRYVILLE MO 63775 TIMOTHY BREWER BOARD PRESIDENT 1.00 X 0 0 0 JENNIFER JANET BOARD VICE PRESIDENT 1.00 X 0 0 0 LAUREN BREWER BOARD TREASURER 2.00 X 0 0 0 DR KEITH MOECKEL BOARD SECRETARY 1.00 X 0 0 0 STEPHEN ROZIER BOARD MEMBER 1.00 X 0 0 0 BETH GUTH BOARD MEMBER 1.00 X 0 0 0 GREGORY UNGER BOARD MEMBER 2.00 X 0 0 0 DARRELL NISWONGER BOARD MEMBER 1.00 X 0 0 0 PATRICK CARRON PRESIDENT/CEO 40.00 X 312670 0 55122 RANDALL WOLF VP OF FINANCE 50.00 X 214616 0 55554 BARBARA K ERNST VP OF NURSING 50.00 X 187119 0 37852 CHRISTOPHER WIBBENMEYER VP SUPPORT SERVICES 40.00 X 223894 0 37698 STACEY M REITZEL VP PHYS SERVICES 45.00 X 157373 0 31179 JOSEPH B BYRNE PHYSICIAN 40.00 X 1016265 0 49099 CRAIG FRAYER PHYSICIAN 40.00 X 493801 0 44278 SANDEEP RAO HOSPITALIST 40.00 X 1279306 0 50974 DAVID STEELE PHYSICIAN 40.00 X 389887 0 56299 MATTHEW GAETA GASTROLOGY 20.00 X 447729 0 39115 4722660 0 457170 10 0 1 0 WISCONSIN PHYSICIANS SERVICE 1717 WEST BROADWAY MONONA WI 53713 MEDICARE REIMBURSEMENT 3067459 MID AMERICA REHAB PC 3047 WILLIAM STREET CAPE GIRARDEAU MO 63703 PHYSICAL THERAPY 1836353 EMERGENCY MEDICAL CARE LLC 16091 SWINGLEY RIDGE ROAD 100 CHESTERFIELD MO 63017 PHYSICIANS 1622828 ZIMMER US INC 14235 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 MEDICAL SUPPLIES 635153 SIEMENS MEDICAL SOLUTIONS USA 2501 BARRINGTON ROAD PALENTINE IL 60055 MEDICAL SUPPLIES 631582 51 331303 98362 429665 HEALTHCARE SERVICES 621990 63567326 63567326 63567326 160228 160228 182410 539619 -357209 -357209 -357209 248206 0 2664 248206 -2664 245542 245542 PHARMACY REVENUE 863626 863626 EHR REIMBURSEMENT 277250 277250 MANAGEMENT FEES 541610 214854 214854 300708 300708 1656438 65701990 64897243 214854 160228 1095672 783002 312670 24330734 24330734 649406 625406 24000 5538201 5507079 31122 1603378 1583661 19717 27528 27528 72555 72555 11132 11132 230394 230394 8182274 8182274 192258 192258 810073 810073 177817 177817 2392146 2392146 180048 180048 PROFESSIONAL FEES 11325096 11325096 MEDICAL SUPPLIES 3483877 3483877 REPAIRS AND MAINTENANCE 1610147 1610147 MEDICAID FRA FEES 488859 488859 198304 153659 44645 62599899 62056530 543369 0 6805313 3356513 10561942 12702890 1064501 2983612 1995329 2550447 771954 587741 67045936 30244887 35730647 36801049 2455517 2645254 2597602 2752668 61982805 64380174 4710245 7052917 3215000 115000 7925245 7167917 X 54057560 57212257 54057560 57212257 61982805 64380174 3102091 52606 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8883 8883 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND MISSOURI HOSPITAL ASSOCIATION (MHA). A PORTION OF THE HOSPITALS DUES PAID TO THE AHA AND MHA ARE INDIRECTLY USED FOR LOBBYING PURPOSES. 1486865 1486865 45038466 16631961 28406505 19023078 13612926 5410152 1497527 1497527 36801049 THIRD-PARTY REIMBURSEMENT PROGRAMS 115000 115000 66294215 52606 539619 592225 65701990 0 65701990 63139518 539619 539619 62599899 0 62599899 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES OFFSET AGAINST REVENUE ON PART VIII PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES OFFSET AGAINST REVENUE ON PART VIII 1 1 1 X 1 X 190.000000000000 1 1 1 0 1 1 272506 272506 0.00440 4957016 3259849 1697167 0.02710 5229522 3259849 1969673 0.03150 30000 30000 0.00050 30000 30000 0.00050 5259522 3259849 1999673 0.03200 1 2602014 1301007 25092506 30540208 -5447702 X 1 1 1 1 PERRY COUNTY MEMORIAL HOSPITAL 434 NORTHWEST STREET PERRYVILLE MO 63775 WWW.PCHMO.ORG X X X X PERRY COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X 16 1 0 1 1 X WWW.PCHMO.ORG X 1 16 1 WWW.PCHMO.ORG 0 1 X 150.000000000000 190.000000000000 X X X X 1 1 X X X 1 X 1 X 0 1 X 0 0 PERRY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THIS ASSESSMENT HAS EXPLORED THE INSULAR NEEDS OF THE IDENTIFIED GROUPS BY SPECIFICALLY SEEKING INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS.THOSE CONSULATED INCLUDE THE HOSPITAL EXECUTIVE STAFF AND AN INTERNAL WORKING GROUP.THE REFERENCE COMMUNITY AND OUTSIDE RESOURCES INCLUDE: COUNTY HEALTH DEPARTMENT, CITY POLICE, COUNTY SHERIFF, SCHOOLS, TASK FORCE, MENTAL HEALTH BOARD, AND OTHERS. A SECOND, HEALTHCARE SPECIFIC SURVEY, WAS THEN DEVELOPED AND CIRCULATED TO OVER 250 HOSPITAL STAFF, VOLUNTEERS, PHYSICIANS, AND DEPARTMENT DIRECTORS. PERRY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: PCMH WAS A PARTICIPANT IN A COMMUNITY WIDE SURVEY ALONG WITH OTHER SIGNIFICANT COMMUNITY AGENCIES (COUNTY HEALTH DEPARTMENT, CITY POLICE, COUNTY SHERIFF, SCHOOLS, TASK FORCE, MENTAL HEALTH BOARD, AND OTHERS) TO OBTAIN DATA ON INDIVIDUAL PERCEPTIONS OF HEALTH NEEDS. PERRY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: COMMUNITY LIFESTYLE EDUCATION; WELLNESS PROGRAM PROMOTION; OBESITY TREATMENT OPTIONS, AND PARTNERSHIP WITH AN ESTABLISHED WEIGHT LOSS HEALTHCARE LEADER; MENTAL HEALTH AWARENESS EDUCATION AND RESOURCE IDENTIFICATION DURING CRISIS MOMENTS; DIETARY EDUCATION; AND MORE. 3 1 - WOUND CLINIC 206 HOSPITAL LANE PERRYVILLE MO 63775 WOUND CLINIC 2 - PERRYVILLE SURGICAL CLINIC 206 HOSPITAL LANE SUITE 204 PERRYVILLE MO 63775 PHYSICIANS 3 - NEPHROLOGY 212 HOSPITAL LANE SUITE 202 PERRYVILLE MO 63775 PHYSICIANS PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. THE HOSPITAL USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS OF LINES 7E OF PART I OF SCHEDULE H. PART III, LINE 2: THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST-TO-CHARGE RATIO AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION PROCEDURES HAVE BEEN EXHAUSTED AS OUTLINED IN SCHEDULE H, PART III, LINE 9B. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. BASED ON THE HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THEY ESTIMATE THAT IT IS LIKELY THAT UP TO 50% OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, 50% OF THE BAD DEBT EXPENSE WAS INCLUDED ON PART III, LINE 3 AT COST.THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT SPECIFICALLY ADDRESSES BAD DEBTS, HOWEVER, THE PROVISION FOR BAD DEBTS IS CLEARLY OUTLINED ON THE STATEMENT OF ACTIVITIES. THE PROVISION FOR BAD DEBTS REPRESENTS UNCOMPENSATED CARE FOR PATIENTS OF WHICH A MAJORITY ARE UNINSURED OR UNDERINSURED, BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE. PART III, LINE 9B: THE HOSPITAL'S CREDIT AND COLLECTION POLICY, PURPOSE, AND PROCEDURES ARE AS FOLLOWS:PURPOSE: ASSIST AND ADVISE PATIENTS ON INSURANCE AND FINANCIAL RESOURCES. PERFORM DUTIES IN CONNECTION WITH CREDIT, COLLECTIONS, AND SOCIAL SERVICES. ARRANGE PAYMENT OF ANY BALANCE NOT COVERED BY INSURANCE. EVALUATE THE CREDIT HISTORY AND DETERMINE PAYMENTS BASED ON THE PATIENT'S ABILITY TO PAY AND THE POLICY OF THE HOSPITAL AS BELOW.ALL EFFORT WILL BE MADE TO COLLECT THE BALANCE AS FOLLOWS:BALANCE UNDER $1,000.00 - PAID WITHIN 3 MONTHS.FOR EACH ADDITIONAL $1,000.00 BALANCE - ADD 3 MONTHS.(EXAMPLE: FOR BALANCES BETWEEN $4,000.00 AND $5,000.00 - PAID WITHIN 12 MONTHS.)ACCOUNTS WITH A BALANCE OF $3.00 AND UNDER WILL NOT BE MAILED A BILLING STATEMENT. THE BALANCE WILL BE CHARGED OFF AS A SMALL BALANCE ADJUSTMENT.STATEMENTS ARE GENERATED ON A WEEKLY BASIS BY RUNNING FIRST TIME STATEMENTS AND CYCLE STATEMENTS 1, 2, 3, OR 4.ACCOUNTS FOLLOW A REGULAR COMPUTER GENERATED BILLING SYSTEM. FIRST TIME STATEMENTS ARE SENT AFTER THE INSURANCE PAYMENT HAS BEEN PROCESSED AND THE ACCOUNT FALLS INTO A BILLING CYCLE. WHEN THAT CYCLE IS PRINTED, A FIRST TIME STATEMENT WILL BE GENERATED. THE FOLLWOING MONTH, A CYCLE STATEMENT IS GENERATED. THE COLLECTION CYCLE ADVANCES AS FOLLOWS: 1, 2, 3, A (FIRST LETTER) AND B (FINAL NOTICE LETTER).AFTER ACCOUNTS WITH A BALANCE OVER $1,000.00 RECEIVE A FIRST TIME STATEMENT, THEY ARE REVIEWED BY THE FINANCIAL COUNSELOR TO DETERMINE IF A COLLECTION PHONE CALL SHOULD BE MADE. FINANCIAL ARRANGEMENTS ARE DISCUSSED AND PAYMENT SCHEDULES ARE AGREED UPON. MONTHLY TERMS CAN BE SET, WHEREBY A DESIGNATED AMOUNT AND DATE OF PAYMENT IS ARRANGED ON A MONTHLY BASIS. ACCOUNTS THAT DO NOT FOLLOW THE DESIGNATED PAYMENT PLAN RECEIVE LETTERS 2, 3, A, AND B. IF THE ACCOUNT IS STILL UNPAID AFTER THE ABOVE PROCEDURES ARE USED, ACCOUNTS ARE WRITTEN OFF AND PREPARED FOR THE COLLECTION AGENCY BY PRINTING THE COLLECTION AGENCY REPORT. REPORTS ARE ALSO PREPARED FOR THE APPROVAL OF THE VICE PRESIDENT OF FINANCE AND THE BUSINESS OFFICE MANAGER. REGULAR WRITE-OFFS ARE DONE ON A MONTHLY BASIS. MEDICARE WRITE OFFS ARE DONE ON A MONTHLY BASIS.ASSISTANCE IS GIVEN TO THE THIRD PARTY AGENCY TO AID IN THE COLLECTION OF ACCOUNTS. THE AGENCY IS NOTIFIED DAILY OF PAYMENTS AND BALANCE DUE ON TURNED ACCOUNTS. WHEN THE AGENCY ADVISES OF SUIT FILING ON ACCOUNTS, AN AFFIDAVIT IS SENT TO OBTAIN PERMISSION. THE AFFIDAVIT IS SIGNED BY THE BUSINESS OFFICE MANAGER AND NOTORIZED PRIOR TO RETURNING TO THE AGENCY. THEY WILL ACT AS OUR REPRESENTATIVE AND SELECT AN ATTORNEY TO REPRESENT THE HOSPITAL IN LEGAL PROCEEDINGS, AND ATTEND ANY COURT PROCEEDINGS ON THE DATE SCHEDULED.WHEN THE COLLECTION AGENCY HAS CEASED ALL COLLECTION EFFORTS AND THE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE COLLECTION AGENCY WILL SEND A RETURN REPORT. AT THAT TIME, ACCOUNTS WILL BE POSTED AS AN ACCOUNT RETURNED FROM THE COLLECTION AGENCY AND CAN BE INCLUDED AS A BAD DEBT ON THE COST REPORT.ACCOUNTS ARE ALSO REVIEWED FOR REFUNDS, CHARGE OFFS, AND PAYROLL DEDUCTION.THE FINANCIAL COUNSELOR SPEAKS WITH PRIVATE PAY PATIENTS IN A/C, ER, AND ON MED/SURG TO SET UP PAYMENT ARRANGEMENTS. A FORM IS SIGNED BY THE PATIENT SETTING UP TERMS WHEN POSSIBLE. IF PATIENT STATES THEY ARE UNABLE TO PAY, THE CHARITY CARE PROGRAM APPLICATION IS GIVEN AND THE PATIENT IS COUNSELED ON CHARITY CARE GUIDELINES. PART VI, LINE 2: GENERALLY SPEAKING, THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED BY THE HOSPITAL IS BASED ON ALL OR A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITIES, SUPPLY, DEMONSTRATED NEED, "VOICE OF THE CONSUMER", AND/OR COLLABORATIVE EFFORTS WITH OUTSIDE ENTITIES, GOVERNMENT AGENCIES, AND OTHER HEALTH CARE PROVIDERS THAT WOULD ENABLE THE FILLING OF A NEED OR ENHANCE AND COMPLIMENT AN ALREADY EXISTING SERVICE. DATA IS GATHERED THROUGH BENCHMARKING, MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT, AND THROUGH CONSTANT MONITORING OF STATE AND FEDERAL GUIDELINES. IN ADDITION, NEEDS ASSESSMENTS ARE ON-GOING THROUGH THE VARIOUS PROGRAMS AND SERVICES PROVIDED TO THE COMMUNITY BY THE HOSPITAL AS FOLLOWS: - SPEAK TO COMMUNITY GROUPS ON A VARIETY OF HEALTHCARE TOPICS - SPEAK TO SCHOOL CLASSES ABOUT HEALTHY LIVING AND HEALTHCARE TOPICS - OFFER CLASSES ON CHILDBIRTH (48 HRS/YR BK), AND SIBLINGS (1 HR/MO) - OFFER CPR CLASSES TO THE PUBLIC AND TO AREA BUSINESS FOR THEIR EMPLOYEES - PROVIDE TOURS OF THE HOSPITAL TO STUDENT AND CIVIC GROUPS - COOPERATIVE AGREEMENT WITH THE HEALTH OCCUPATIONS CLASS - CLINICAL SITE FOR PHYSICAL THERAPY, RESPIRATORY, ANESTHESIA, AND RADIOLOGY STUDENTS - PROVIDE A PHYSICAL ASSISTANT, PHYSICAL THERAPIST, AND ATHLETIC TRAINER FOR HIGH SCHOOL SPORTING EVENTS - PROVIDE ATHLETIC TRAINING ONCE A WEEK AT SPORTS PRACTICES - SPONSOR SIX CHAMPIONS FOR LIFE BLOOD DRIVES EACH YEAR - PROVIDE A FREE MEETING ROOM FOR AT LEAST 12 COMMUNITY GROUPS ON A REGULAR BASIS - PROVIDE A BETTER BREATHERS SUPPORT GROUP QUARTERLY - PROVIDE AN ALZHEIMERS SUPPORT GROUP MONTHLY - OFFER BLOOD PRESSURE SCREENINGS AND CHOLESTEROL CHECKS MONTHLY - HOST A FREE WOMEN'S CONFERENCE ANNUALLY - PROVIDE $18,000 IN SCHOLARSHIPS ANNUALLY - OFFER A MEDI-ALERT PROGRAM TO THE AGING POPULATION IN THE COMMUNITY - PARTICIPATE ANNUALLY IN THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE - CONTRIBUTE ANNUALLY TO THE AMERICAN LUNG ASSOCIATION, AMERICAN HEART ASSOCIATION, BOY SCOUTS OF AMERICA, AND GIRL SCOUTS OF AMERICA - SPONSOR THE FIRST AID STATION AT EAST PERRY COMMUNITY FAIR - OFFER SAFE SITTERS CLASSES 3 TIMES A YEAR - OFFER SPORTS PHYSICALS ANNUALLY GIVING BACK THE PROCEEDS TO THE PARTICIPATING SCHOOLS - OFFER MEDICAL AND NON-MEDICAL TRANSPORTATION FOR A SUGGESTED DONATION - CO-SPONSOR THE JR/SR CONFERENCE ANNUALLY - PARTICIPATE IN THE CHAMPS MENTORING PROGRAM - STAFF REPRESENTATION ON NUMEROUS COMMUNITY COMMITTEES - SPONSOR VARIOUS CHAMBER AND COMMUNITY ACTIVITIES (CHAMBER LEADERSHIP DAY, MAYFEST 5K, MAYFEST BOOTH, MAYFEST TOP SPONSOR, CUSTOMER APPRECIATION ON THE SQUARE, CHAMBER WOMEN'S CONFERENCE TOP SPONSOR, TURKEY BURN OFF 5K) - HOST VARIOUS HEALTHCARE RELATED EDUCATIONAL SEMINARS FOR THE PUBLIC - HOST A SPEECH/PHYSICAL/OCCUPATIONAL SCREENING ANNUALLY TO AREA CHILDREN AGES 3 TO 5 YEARS OLD - PERRY CO ESTATES SENIOR HOUSING OFFERED TO LOW-INCOME SENIORS - DONATE PROMOTIONAL ITEMS TO NUMEROUS ORGANIZATIONS/GROUPS (I.E. HAND SANITIZER TO SCHOOLS DURING THE H1N1 FLU SEASON, FIRST AID ITEMS TO SCHOOLS) - PROVIDE CAR SEAT SAFETY CHECKS - PROVIDE FREE SPEECH SCREENINGS ANNUALLY - PROVIDE FREE EDUCATIONAL SEMINARS REGARDING SPEECH AND HEARING - PROVIDE FREE HEARING SCREENINGS AS NEEDED - AMBULANCE PROVIDED STANDBY AT 30 EVENTS FREE OF CHARGE - OFFER COGNITIVE STIMULATION THERAPY PROGRAM FOR ALZHEIMERS PATIENTS - PARTICIPATE IN THE BACKPACK BONANZA FOR UNDERPRIVILEGED CHILDREN - HOST AN ANNUAL SKEET SHOOT TO RAISE FUNDS FOR CHILDREN WITH CHRONIC ILLNESSES ($9,000.00 - 10,000.00 ANNUALLY) - SPONSOR TEEN COUNCIL'S EFFORTS ON HUNGER/RECYCLING AT EAST PERRY FAIR - SPONSORED 60 CHILDREN WITH FIREPUP PROGRAM WITH PERRYVILLE FIRE DEPARTMENT - SPONSOR EAST PERRY FAIR ANNUALLY - POST MESSAGES ON DIGITAL SIGN FOR VARIOUS COMMUNITY ORGANIZATIONS FREE OF CHARGE (TEXTING AND JR/SR CONF) - SPONSOR WATER TENT AT CENTER FOR LIFE 5K AND RYAN BEHRLE 5K - PERRY PARK CENTER SPONSORSHIP (YOUTH BASKETBALL, YOUTH TRACK, PLAY DAY AT THE PARK, DISC GOLF TOURNAMENT) - CO-SPONSOR THE PROCTOR AND GAMBEL BOOTH AT THREE EVENTS THROUGHOUT THE YEAR PROVIDING PROMOTIONAL ITEMS TO ALL WHO STOP AT THE BOOTH - SPONSOR AND PARTICIPATE IN COMMUNITY-WIDE SURVEY PART VI, LINE 3: THE HOSPITAL APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. CHARITY CARE PROGRAM INFORMATION IS SENT OUT WITH WEEKLY STATEMENTS ON PRIVATE PAY ACCOUNTS TO PATIENTS RESIDING IN PERRY COUNTY OR AN ADJACENT COUNTY THAT DOES NOT HAVE A HEALTH CARE FACILITY WITH ACCOUNT BALANCES OVER $1,000.00. PATIENTS ARE ADVISED TO CONTACT THE BUSINESS OFFICE FOR A COMPLETE APPLICATION IF THEY WISH TO APPLY. PART VI, LINE 4: PERRY COUNTY IS A RURAL COMMUNITY OF 18,000 PEOPLE. THE GEOGRAPHY IS DENSE FOREST, ROLLING HILLS USED FOR LIVESTOCK FARMING, AND VALLEY AND RIVER BOTTOM-LAND FARMING. AGRICULTURAL WORK NO LONGER DOMINATES THE ECONOMIC LANDSCAPE. LIGHT INDUSTRIAL AND LIGHT MANUFACTURING IS A PREDOMINANT ECONOMIC FORCE. THE ECONOMIC DEMOGRAPHIC IS GENERALLY LOWER TO MIDDLE TO MID-MIDDLE CLASS WEALTH FOR THE WORKING AGED RESIDENTS. RETIREMENT AGED RESIDENTS CONSTITUTE OVER 40% OF THE POPULATION. LOWER SOCIOECONOMIC AND INDIGENT POPULATIONS CONSITUTE LESS THATN 10% OF THE COMMUNITY. ADDITIONAL INFORMATION PERRY COUNTY MEMORIAL HOSPITAL (PCMH) HAS A CHARITY CARE PROGRAM FOR RURAL HEALTH CLINIC (RHC) AND HOSPITAL CLIENTELE; PCMH HAS WRITTEN OFF $670,192 IN UNCOLLECTIBLE ACCONTS IN FISCAL YEAR 2018 FOR PATIENTS IT DEEMS UNABLE TO PAY FOR HEALTHCARE SERVICES UNDER ITS CHARITY CARE POLICY. PCMH ACCEPTS PATIENTS WITHOUT REGARD FOR THEIR ABILITY TO PAY FOR CARE. PCMH PROVIDES FREE SCREENINGS FOR VARIOUS CONDITIONS (MAMMOGRAPHY, PSA AND PROSTATE SCREENINGS, SKIN CANCER SCREENINGS, BLOOD PSI SCREENINGS, ETC.) PCMH HAS A WHEELCHAIR ACCESSIBLE COURTESY TRANSPORTATION SYSTEM THAT OPERATES 40 HOURS PER WEEK AND PROVIDES AMBULANCE SERVICES TO THE COMMUNITY AT A FINANCIAL LOSS. PCMH OFFERS A COMPREHENSIVE WELLNESS PROGRAM TO PUBLIC AND PRIVATE ENTITIES AT 50% OF PCMH'S PROGRAM COSTS (ALTHOUGH THE PROGRAM IS REFUNDED BY THE COMPANY IF THEIR HEALTHCARE COST SAVINGS EXCEED PCMH'S WELLNESS PROGRAM COSTS.) PCMH PROVIDES MENTAL HEALTH SERVICES TO THE INDIGENT THROUGH THE RHC. PCMH OFFERS CHAIR-SIDE EXERCISE CLASSES WEEKLY TO THE VISITORS OF THE COMMUNITY SENIOR CENTER. PCMH OFFERS INFANT SWIM/WATER SAFETY COURSES SEVERAL TIMES A YEAR. PCMH OFFERS AN ANNUAL "COACHES CLINIC" WHEREBY PCMH PROVIDERS SPEAK ON RELEVANT SPORTS HEALTH TOPICS. PCMH OFFERS A FREE INFANT CAR SEAT SAFETY CHECK. X X X 0 0 0 0 0 0 0 0 0 PATRICK CARRON PRESIDENT/CEO 312670 0 0 0 0 0 24000 0 31122 0 367792 0 0 0 RANDALL WOLF VP OF FINANCE 214616 0 0 0 0 0 24000 0 31554 0 270170 0 0 0 BARBARA K ERNST VP OF NURSING 187119 0 0 0 0 0 24000 0 13852 0 224971 0 0 0 CHRISTOPHER WIBBENMEYER VP SUPPORT SERVICES 223894 0 0 0 0 0 18000 0 19698 0 261592 0 0 0 STACEY M REITZEL VP PHYS SERVICES 157373 0 0 0 0 0 7055 0 24125 0 188553 0 0 0 JOSEPH B BYRNE PHYSICIAN 1016265 0 0 0 0 0 18000 0 31099 0 1065364 0 0 0 CRAIG FRAYER PHYSICIAN 493801 0 0 0 0 0 23998 0 20280 0 538079 0 0 0 SANDEEP RAO HOSPITALIST 1279306 0 0 0 0 0 18000 0 32974 0 1330280 0 0 0 DAVID STEELE PHYSICIAN 389887 0 0 0 0 0 24000 0 32299 0 446186 0 0 0 MATTHEW GAETA GASTROLOGY 447729 0 0 0 0 0 18000 0 21115 0 486844 0 0 0 X MEDICAL EQUIPMENT 9 42353 0 0 0 PART I, COLUMN (B): THE PERRY COUNTY MEMORIAL AUXILIARY PURCHASED EQUIPMENT THAT WAS DONATED TO THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW AND COMMENT BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS GIVEN A QUESTIONNAIRE THAT INCLUDES ASKING THEM TO DISCLOSE ANY APPLICABLE CONFLICTS OF INTEREST. THIS IS DONE ON AN ANNUAL BASIS AND ENFORCEMENT IS DONE ON A PER INCIDENT BASIS, WITH ALL ASPECTS OF THE CONFLICT TAKEN INTO CONSIDERATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIALS - INDUSTRY COMPARABILITY DATA IS MADE AVAILABLE TO THE BOARD OF DIRECTORS. AN EXECUTIVE SESSION IS HELD TO DETERMINE AND APPROVE ALL TOP MANAGEMENT COMPENSATION. THIS IS PERFORMED ON AN ANNUAL BASIS. COMPENSATION PROCESS FOR OFFICERS AND KEY EMPLOYEES - THE CEO PERFORMS AN ANNUAL SALARY EVALUATION OF OFFICERS AND KEY EMPLOYEES. USING INDUSTRY COMPARIBILITY DATA AND AN ANNUAL REVIEW, THE CEO RECOMMENDS SALARY FOR OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PCMH AMUBLANCE SERVICE LLC 434 NORTHWEST STREET PERRYVILLE MO 63775 320321807 AMBULANCE MO PCHS PERRYVILLE HEALTHCARE CORP 212 HOSPITAL LANE PERRYVILLE MO 63775 431859823 PHARMACY MO N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0