2019-05-15T08:48:34-05:00 2018-06-30 431001367 BROWN SMITH WALLACE LLP 6 CITYPLACE DRIVE SUITE 900 ST LOUIS MO 63141 990 2017-07-01 430666765 THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN RANK 3148726400 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 R BRETT MOOREHOUSE PRESIDENT & CEO 3148726400 2019-04-29 1 JENNIFER M VACHA P01251998 3149831200 199.119.121.196 2019-04-29 08:30:02 CD P 7E5E2AEE04A14906F41F2FC1FEF69ADEA6675ABF 1B6177066F24304B924EC04201903EAD00EE74AA 2017 2019-02-21 02:37:17Z BILL WILLHITE 11365 DORSETT ROAD MARYLAND HEIGHTS MO 63043 58758250 0 X WWW.RANKENJORDAN.ORG X 1940 MO PEDIATRIC BRIDGE HOSPITAL PROVIDING A CONTINUUM OF CARE FOR MEDICALLY COMPLICATED CHILDREN 29 26 414 160 0 0 3010704 3610545 28071058 29229246 954474 1204486 -71689 -81200 31964547 33963077 30890 38730 0 0 19182221 20712896 0 0 1103385 10220716 11664786 29433827 32416412 2530720 1546665 88791260 88033644 42383336 40091698 46407924 47941946 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 20785574 38730 27687219 DURING THE CURRENT FISCAL YEAR, RANKEN JORDAN PROVIDED 11,186 DAYS OF MEDICAL CARE FOR INPATIENTS. OF THOSE DAYS, 88% WERE CHILDREN THAT WERE ABLE 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.IN FEBURARY 2018, RANKEN JORDAN OPENED ITS COMPLETED BUILDING ADDITION. THIS EXPANSION NEARLY DOUBLED THE NUMBER OF BEDS AT THE FACILITY TO 60 INPATIENT BEDS. 1073167 1542027 DURING THE CURRENT FISCAL YEAR, RANKEN JORDAN PROVIDED 22,992 UNITS OF OUTPATIENT SERVICES TO CHILDREN REQUIRING INTENSIVE THERAPY. RANKEN JORDAN PROVIDES PHYSICAL, OCCUPATIONAL, SPEECH, AND AQUATIC THERAPIES ON AN OUTPATIENT BASIS. RANKEN JORDAN ALSO OFFERS A DAY TREATMENT PROGRAM THAT PROVIDES INTENSIVE THERAPY THROUGHOUT THE DAY. RANKEN JORDAN HAS EXPANDED ITS OUTPATIENT PROGRAMS TO INCLUDE CONSTRAINT INDUCED MOVEMENT THERAPY, PAIN MANAGEMENT SERVICES AND PHYSIATRY SERVICES. 956810 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 3,950 INDIVIDUALS WERE SERVED BY THE COMMUNITY PROGRAMS DURING THE YEAR. 22815551 1 1 0 1 0 0 0 0 0 0 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 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 16 0 1 414 1 0 0 0 0 0 1 1 0 0 0 0 X 29 26 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 LAUREEN K TANNER PRESIDENT/CEO (RESIGN. 5/2018) 50.00 X X 442534 0 32388 BILL WILLHITE CHAIRMAN 15.00 X X 0 0 0 WALTER BAZAN JR VICE CHAIRMAN 10.00 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 371581 0 48860 ROMA NEMANI BORDEWICK BOARD MEMBER 3.00 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 GEORGE R EDINGER SR BOARD MEMBER 3.00 X 0 0 0 DEREK GLANVILL BOARD MEMBER 3.00 X 0 0 0 CHARLES HESSLER 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 MIKE MATHENY BOARD MEMBER 3.00 X 0 0 0 TERI MURRAY MD BOARD MEMBER 3.00 X 0 0 0 ELIZABETH PROSPERI BOARD MEMBER 3.00 X 0 0 0 JOHN PROSPERI BOARD MEMBER 3.00 X 0 0 0 JEANA REISINGER BOARD MEMBER 3.00 X 0 0 0 STEVE RENNE BOARD MEMBER 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 KIT SUNDARARAMAN BOARD MEMBER 3.00 X 0 0 0 RICHARD A VANDEGRIFT BOARD MEMBER 3.00 X 0 0 0 NICK WILLIAMSON BOARD MEMBER 3.00 X 0 0 0 JEAN L BARDWELL VP & CFO (RESIGN. 5/2018) 50.00 X 296317 0 14486 R BRETT MOOREHOUSE INTERIM PRESIDENT (EFF. 5/18) & COO 50.00 X 222924 0 5475 KEN MARX INTERIM VP & CFO (EFF. 5/18) 50.00 X 0 0 0 ELIZABETH AKRE SUGARBAKER MD PHYSICIAN 40.00 X 181436 0 8989 SUSAN CONGER MD PHYSICIAN 40.00 X 245878 0 10193 EUGENE EVRA MD PHYSICIAN 40.00 X 219731 0 9924 DAWN MCNAMEE MD PHYSICIAN 40.00 X 167107 0 8772 AMY ZIMMERMANN MD PHYSICIAN 40.00 X 226586 0 10061 2374094 0 149148 26 0 1 0 MCCARTHY BUILDING COMPANIES INC 1341 ROCK HILL ROAD ST LOUIS MO 63124 CONSTRUCTION SERVICES 31120815 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 CONSULT/ELEC HEALTH REC 1118031 THOMPSON COBURN PO BOX 18379M ST LOUIS MO 63195 LEGAL SERVICES 479649 MB TECHNOLOGY SOLUTIONS 1001 CRAIG ROAD SUITE 400 ST LOUIS MO 63146 COMPUTER CONSULTING 265662 BROWN SMITH WALLACE LLP 6 CITYPLACE DRIVE SUITE 900 ST LOUIS MO 63141 CONSULT/ACCOUNTING/AUDIT 125526 6 605876 61467 2943202 3610545 INPATIENT CARE 621110 27687219 27687219 OUTPATIENT CARE 621110 1542027 1542027 29229246 523973 523973 25172169 24491656 680513 680513 680513 222317 605876 303517 -81200 -81200 33963077 29229246 0 1123286 38730 38730 1313864 895646 418218 15833075 12722463 2953094 157518 202634 159522 35033 8079 2254124 1718525 479918 55681 1109199 832453 238901 37845 393526 393526 214236 214236 96045 96045 522634 183105 330318 9211 277604 208018 61236 8350 1857514 1095707 504648 257159 1346405 1009804 296209 40392 666663 499997 146666 20000 30308 8195 20814 1299 44259 15461 20257 8541 1074208 1074208 2250367 1666077 517647 66643 440582 330437 96928 13217 FRA ASSESSMENT 1453043 1453043 PHARMACY EXPENSES 870879 870879 DUES AND SUBSCRIPTIONS 91168 3135 86801 1232 BAD DEBT 35345 35345 32416412 22815551 8497476 1103385 1400 1400 267796 689714 1768359 1288199 5394961 4393391 1480382 1444962 72101313 16582386 39979713 55518927 39898649 24697051 88791260 88033644 4947817 2851659 175862 152345 36640791 36577345 618866 510349 42383336 40091698 X 35320628 46277557 11087296 1664389 46407924 47941946 88791260 88033644 1546665 -12643 0 X X 0 1 X 1 0 X 3643384 3865887 4214060 3010704 3697854 18431889 3643384 3865887 4214060 3010704 3697854 18431889 7108946 11322943 408960 467076 441183 477752 523973 2318944 26415 14116 26737 67268 20818101 133691142 0.54390 0.53480 X PART II, LINES 5 AND 15: IN THE PRIOR YEARS THE HOSPITAL RECEIVED FUNDING FROM TWO TRUSTS WHICH WERE NOT PREVIOUSLY INCLUDED IN LINE 5, THUS THE PERCENTAGE OF PUBLIC SUPPORT CALCULATED ON LINE 15 WAS TOO HIGH. THE 2016 FORM 990 SCHEDULE A, PART II LINE 5 SHOULD HAVE BEEN REPORTED AS $8,704,552 THE HOSPITAL PREVIOUSLY REPORTED 71.61% FOR 2016. THE CURRENT YEAR SCHEDULE A LINE 15 SHOWS THE REVISED CALCULATION AT 53.48%. 0 0 0 0 0 0 0 0 1 96045 96045 0 PART II-B, LINE 1: RANKEN JORDAN USES THE SERVICES OF A LOCAL LAW FIRM, THOMPSON COBURN, TO PROVIDE LEGISLATIVE SERVICES FOR THE HOSPITAL. IN ADDITION, RANKEN JORDAN PAYS DUES TO OTHER ORGANIZATIONS OF WHICH A PORTION IS SPENT ON LOBBYING. 759000 1600177 2359177 52310820 7239586 45071234 15195007 8875023 6319984 2236309 467777 1768532 55518927 OTHER LIABILITIES 510349 510349 X 33915089 -12643 -12643 33927732 35345 35345 33963077 32381067 0 32381067 35345 35345 32416412 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 XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS NETTED AGAINST REVENUE ON FS 35,345. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS NETTED AGAINST REVENUE ON FS 35,345. DINNER AUCTION 512614 403999 108615 97520 41623 34708 GOLF TOURNAMENT 257075 154223 102852 5850 22878 32169 3500 45897 5 58504 47654 10850 1000 9110 3000 6262 828193 605876 222317 5850 23878 138799 48123 86867 303517 -81200 1 1 1 X 400.000000000000 1 X 1 1 1 0 1 1 19 102938 102938 0.00320 24775178 14695288 10079890 0.31130 12664887 7794912 4869975 0.15040 19 37543003 22490200 15052803 0.46490 3950 131343 131343 0.00410 124 46500 46500 0.00140 4074 177843 177843 0.00550 4093 37720846 22490200 15230646 0.47040 31 39191 39191 0.00120 4 29419 29419 0.00090 35 68610 68610 0.00210 1 35345 35345 3978 11700 -7722 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 16 1 0 0 1 X WWW.RANKENJORDAN.ORG X 1 16 1 WWW.RANKENJORDAN.ORG 0 1 X 400.000000000000 400.000000000000 1 1 X X X X 1 X RANKENJORDAN.ORG/WP-CONTENT/UPLOADS/2018/05/FINANCIAL-ASSISTANCE_102618.PDF X RANKENJORDAN.ORG/WP-CONTENT/UPLOADS/2018/05/FINANCIAL-ASSISTANCE_102618.PDF X RANKENJORDAN.ORG/WP-CONTENT/UPLOADS/2018/05/FINANCIAL-ASSISTANCE_102618.PDF 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 2016 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 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 "REGARDLESS OF THEIR ABILITY TO PAY". 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: 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 8: THE AMOUNT OF SHORTFALL REPORTED ON LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT DUE TO THE FACT THAT THE COST OF TREATING MEDICARE PATIENTS EXCEEDS THE AMOUNT OF REIMBURSEMENT FROM THE GOVERNMENT. THE ORGANIZATION IS PROVIDING A SERVICE TO PATIENTS IN NEED FROM THEIR OWN FUNDS. THE METHOD USED TO DETERMINE THE AMOUNT OF MEDICARE COSTS IS THE TOTAL CHARGES FOR ALL THE MEDICARE PATIENTS AS RECORDED ON THE ORGANIZATION'S CHARGES LOG. 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 "REGARDLESS OF THEIR ABILITY TO PAY". PART VI, LINE 2: RANKEN JORDAN IS A MEMBER OF THE MISSOURI 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 "POWER SOCCER" 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 1277 31395 LODGING FOR OUT-OF-TOWN PARENTS 14 2713 INTERPRETER SERVICES FOR PATIENTS THAT DO NOT SPEAK ENGLISH OR ARE HEARING IMPAIRED 10 2443 RENT ASSISTANCE FOR PATIENT HOME 1 743 ASSISTANCE WITH UTILITY BILLS FOR PATIENT FAMILIES 4 689 CAR REPAIRS FOR PATIENT FAMILY 1 435 COURIER SERVICE FOR WHEELCHAIR 1 312 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 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 LAUREEN K TANNER PRESIDENT/CEO (RESIGN. 5/2018) 341089 0 7500 0 93945 0 27451 0 4937 0 474922 0 0 0 NICHOLAS A HOLEKAMP MD CHIEF MEDICAL OFFICER 360581 0 5000 0 6000 0 44490 0 4370 0 420441 0 0 0 JEAN L BARDWELL VP & CFO (RESIGN. 5/2018) 241112 0 5000 0 50205 0 4680 0 9806 0 310803 0 0 0 R BRETT MOOREHOUSE INTERIM PRESIDENT (EFF. 5/18) & COO 217924 0 5000 0 0 0 4478 0 997 0 228399 0 0 0 ELIZABETH AKRE SUGARBAKER MD PHYSICIAN 181436 0 0 0 0 0 3734 0 5255 0 190425 0 0 0 SUSAN CONGER MD PHYSICIAN 245878 0 0 0 0 0 5021 0 5172 0 256071 0 0 0 EUGENE EVRA MD PHYSICIAN 219731 0 0 0 0 0 4503 0 5421 0 229655 0 0 0 DAWN MCNAMEE MD PHYSICIAN 167107 0 0 0 0 0 3449 0 5323 0 175879 0 0 0 AMY ZIMMERMANN MD PHYSICIAN 226586 0 0 0 0 0 4640 0 5421 0 236647 0 0 0 PART I, LINE 1A THERE IS A MEMBERSHIP TO NORWOOD HILLS COUNTRY CLUB THAT IS IN LAUREEN K. TANNER'S (CEO) NAME. THE MEMBERSHIP IS PAID FOR BY RANKEN JORDAN. ANY PERSONAL EXPENSES CHARGED TO THE ACCOUNT ARE REIMBURSED TO RANKEN JORDAN. PART I, LINE 4B LAUREEN K. TANNER AND NICHOLAS HOLEKAMP ARE PARTICIPANTS IN A 457(F) PLAN. CONTRIBUTIONS WERE MADE ON THEIR BEHALF. LAUREEN K. TANNER RECEIVED A DISTRIBUTION OF $226,999. 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: LAUREEN K. TANNER, NICHOLAS HOLEKAMP, JEAN BARDWELL, 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 20900000 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 LAUREEN K TANNER OFFICER (SEE PART V) DISQUALIFIED PERSON RECEIVED REIMBURSEMENT IN EXCESS OF AMOUNT PERMITTED UNDER THE ORGANIZATION'S PTO POLICY. 1 JEAN L BARDWELL OFFICER (SEE PART V) DISQUALIFIED PERSON RECEIVED REIMBURSEMENT IN EXCESS OF AMOUNT PERMITTED UNDER THE ORGANIZATION'S PTO POLICY. 1 16403 ELLEN SIMONS (SEE PART V) FAMILY MEMBER OF BOARD MEMBER 51960 EMPLOYMENT WAGES 0 FORM 990, PART VI, SECTION A, LINE 2 JOHN PROSPERI (BOARD MEMBER) AND ELIZABETH PROSPERI (BOARD MEMBER) 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 GOVERNANCE COMMITTEE HAS OVERSIGHT RESPONSIBILITIES FOR THE PROGRAM AND SHALL REPORT TO THE BOARD PERIODICALLY, AS DETERMINED BY THE BOARD, BUT NOT LESS THAN ANNUALLY. 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 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.