2018-03-14T15:40:05-05:00 2017-04-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2016-05-01 440655986 JOHN FITZGIBBON MEMORIAL HOSPITAL % ANGELA LITTRELL JOHN 6608867431 2305 S HIGHWAY 65 MARSHALL MO 65340 ANGELA P LITTRELL CFO/COO 2017-09-05 true Brian D Todd P00422601 4178658701 167.68.126.162 43032920180735000246 2018-03-14 P 35B2FEF9FD89B74F90B63698513A1BB518488CA1 92996119D705B961BF1767000FEBD157C9C05609 2016 2021-01-29 14:40:06Z DARIN L HAUG 2305 S HIGHWAY 65 MARSHALL MO 65340 60468711 false X WWW.FITZGIBBON.ORG X 1923 MO TO IMPROVE THE HEALTH OF OUR COMMUNITY BY OFFERING QUALITY SERVICES, IMPROVING ACCESS AND OUTCOMES, EMPOWERING THE COMMUNITY WE SERVE, AND PARTICIPATING IN HEALTH CARE PARTNERSHIPS. 10 7 581 56 0 0 275200 945899 56869873 59006905 362911 263041 -166654 19141 57341330 60234986 35905 32690 0 0 27997108 28485673 0 0 81622 31391316 31758289 59424329 60276652 -2082999 -41666 56391967 56648528 22541421 22871000 33850546 33777528 X TO IMPROVE THE HEALTH OF OUR COMMUNITY. false false 41650279 41201741 HOSPITAL SERVICE - FITZGIBBON HOSPITAL IS A 60 BED ACUTE CARE FACILITY SERVING MARSHALL, MO AND THE SURROUNDING COMMUNITIES. THE FACILITY PROVIDES HEALTH CARE WITH A 24 HOUR PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, AN INTENSIVE CARE UNIT, IN AND OUT-PATIENT MEDICAL/SURGICAL SERVICES, AN OBSTETRICS UNIT, A BEHAVIORAL HEALTH UNIT AND A 24 HOUR HOSPITALIST PROGRAM TO SERVE IN-PATIENT NEEDS AT ALL TIMES. ANCILLARY SERVICES SUCH AS RADIOLOGY, LABORATORY, RESPIRATORY THERAPY AND REHABILITATIVE SERVICES ARE AVAILABLE ON SITE. FOR MORE INFORMATION, SEE SCHEDULE O. 9001436 8193419 CLINIC SERVICE-SPECIALTY CLINICS WITHIN THE HOSPITAL PROVIDE ORTHOPEDIC, WOUND CARE, NEUROLOGIC AND PAIN MANAGEMENT SERVICES TO BOTH IN AND OUT-PATIENTS. THESE CLINICS PROVIDED SERVICES TO 10,163 PATIENTS. THE HOSPITAL ALSO SUPPORTS A SEPARATE OUT-PATIENT CLINIC ON CAMPUS FOR FAMILY MEDICINE, OB/GYN, GENERAL SURGERY, CHIROPRACTIC, AND PSYCHIATRY STAFFED MEDICAL PROFESSIONALS PRACTICING IN THESE SPECIALTIES FOR FISCAL YEAR 2017. THIS CLINIC PROVIDED SERVICES FOR 24,014 PATIENT VISITS. THREE SATELLITE FAMILY PRACTICE CLINICS ARE ALSO SUPPORTED BY THE HOSPITAL. THESE CLINICS PROVIDED SERVICES FOR 10,099 PATIENT VISITS. 1451382 32690 896989 COMMUNITY HEALTH SERVICES - HOSPICE, HOME HEALTH, AND HOMEMAKER SERVICES. HOSPICE PROVIDED 3,980 PALLIATIVE CARE VISITS, HOME HEALTH PROVIDED 6,006 VISITS AND HOMEMAKER PERFORMED 8,491 HOURS OF SERVICE TO RESIDENTS. THE COMMUNITY SERVICES GROUP ALSO COORDINATES PARTICIPATION IN THE OATS TRANSPORTATION PROGRAM BY PERFORMING THE SCHEDULING FOR ALL RIDERS. THE HOSPITAL DONATED $14,400 TO OATS IN 2017 AND WILL BE DONATING $14,400 ANNUALLY TO HELP SUSTAIN IT IN THE MARSHALL COMMUNITY. THE PROGRAM PROVIDED TRANSPORTATION FOR 3,996 RIDERS DURING FY 2017. 699739 8714756 52802836 true true false true false false false false false true true false false false true false false true false false false false false false true false true true true false true true false false false false false false false false true true true true false false false true true true false false true 131 0 true 581 true false false false false false true true false false false false X 10 7 false false false false false true false true true false false false true true true true true false false false X ANGELA LITTRELL 6608313251 2305 S HIGHWAY 65 PO BOX 250 MARSHALL MO 65340 X FRED UTLAUT PRESIDENT ENDING 01/17 1.0 1.0 X X 0 0 0 WILLIAM SUMMERS PRESIDENT BEGINNING 01/17 1.0 1.0 X X 0 0 0 DON VOGELSMEIER SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 GAYLE CARTER TRUSTEE ENDING 06/16 1.0 1.0 X 0 0 0 ROOK EVANS TRUSTEE 1.0 1.0 X 0 0 0 JACK UHRIG MD TRUSTEE/MEDICAL DIRECTOR 1.0 1.0 X 14450 0 0 JACQUELYN EIDSON TRUSTEE 1.0 1.0 X 0 0 0 SCOTT HARTWIG TRUSTEE 1.0 1.0 X 0 0 0 JAN STAPLETON VICE PRESIDENT BEGINNING 01/17 1.0 1.0 X X 0 0 0 J BRIAN BRIZENDINE MD TRUSTEE/PRESIDENT OF MEDICAL 40.0 1.0 X 330013 0 2366 JILL HARRIMAN LILLEMAN JDLLM TRUSTEE BEGINNING 10/16 1.0 1.0 X 0 0 0 MARY LOU PORTER TRUSTEE BEGINNING 10/16 1.0 1.0 X 0 0 0 DARIN HAUG DO PRESIDENT/CEO 40.0 1.0 X 441043 0 4916 ANGELA LITTRELL CFO/COO 40.0 1.0 X 178704 0 12342 DENNIS SOUSLEY VP OF CLINICAL SERVICES 40.0 1.0 X 167912 0 4111 KELLY ROSS ORTHOPEDIC SURGEON 40.0 0.0 X 572644 0 2000 RAVINDER ARORA NEUROLOGIST 40.0 0.0 X 443390 0 2000 KAREN SONG OB/GYN 40.0 0.0 X 388013 0 2366 LORENZO M ROMNEY HOSPITALIST/CLINIC PHYSICIAN 40.0 0.0 X 350129 0 2508 CLINTON PICKETT ORTHOPEDIC SURGEON 40.0 0.0 X 302571 0 7129 RONALD A OTT FORMER PRESIDENT/CEO 0.0 0.0 X 123261 0 0 3312130 0 39738 33 true true false PHARMACY SYSTEMS INC 5050 BRADENTON AVE DUBLIN OH 43017 PHARMACY MANAGEMENT 613077 BOYCE BYNUM PATHOLOGY LABORATORIE PO BOX 7406 COLUMBIA MO 65205 PATHOLOGY 377643 PAUL brizendine MD 485 NW RIVEN ROCK TRAIL LEES SUMMIT MO 64081 ED PHYSICIAN 323600 BKD LLP 910 E ST LOUIS SPRINGFIELD MO 65801 AUDIT/TAX/CONSULTING 321617 C A INDUSTRIES 13609 CALIFORNIA STREET OMAHA NE 68154 NURSING 261965 16 184728 9596 751575 20930 945899 NET PATIENT SERVICE REVENUE 900099 57696561 57696561 EHR INCENTIVE REVENUE 900099 185981 185981 CAFETERIA 722514 268922 268922 MANAGEMENT FEES 561000 60000 60000 304(B) REVENUE 900099 680391 680391 115050 115050 59006905 256873 256873 0 0 172621 154681 17940 0 17940 17940 33413 27245 6168 6168 6168 53000 184728 51799 1201 1201 0 0 0 0 0 0 0 60234986 59006905 282182 32690 32690 0 0 0 1155857 518852 637005 516864 393603 123261 22156647 19809973 2275581 71093 248214 221056 27158 2849350 2516883 332467 1558741 1365907 187438 5396 0 98201 98201 153695 153695 0 0 0 4804189 3357957 1446232 167555 649 166906 3418080 2299418 1113529 5133 0 0 727045 626020 101025 213240 195475 17765 0 114835 80596 34239 700971 586990 113981 0 2758329 2309810 448519 618015 549368 68647 BAD DEBT 9259928 9259928 MEDICAL SUPPLIES & DRUGS 6103778 6103778 PROVIDER TAX 2334182 2334182 RECRUITING & RETENTION 286246 239701 46545 60276652 52802836 7392194 81622 X 6130820 4980775 14839547 12953186 0 0 7777359 6781867 0 0 0 0 0 0 1159674 1069800 1181563 861928 65144657 42111901 21014777 23032756 3027816 3039277 0 0 0 0 0 2089816 1260411 1839123 56391967 56648528 4039504 4330629 0 0 0 0 13872640 12911350 0 0 0 0 3337590 5041266 0 0 1291687 587755 22541421 22871000 X 32660900 32436860 734429 885451 455217 455217 33850546 33777528 56391967 56648528 -41666 -31352 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 2762 false true 12302 15064 false SCHEDULE C, PART II-B, LINE 1(G) DIRECT CONTACT: MANAGEMENT ATTENDED AN MHA-SPONSORED TRIP AND AHA ORGANIZED TRIP TO WASHINGTON DC, WHICH INCLUDED TIME SPENT WITH LEGISLATORS AND OTHER HOSPITAL ADVOCATES in an effort to educate legislators about healthcare legislative issues. SCHEDULE C, PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE MISSOURI HOSPITAL ASSOCIATION, THE AMERICAN HOSPITAL ASSOCIATION, AND THE SAFETY NET HOSPITALS FOR PHARMACEUTICAL ACCESS. A PORTION OF THESE DUES ARE ALLOCATED TO LOBBYING. 743732 13257 13332 743657 724023 23258 3549 743732 701570 28779 6326 724023 733363 8693 1000 39486 701570 719060 20163 1000 4800 60 733363 0.33000 0.63000 0.04000 false false 71000 71000 31411434 13925829 17485605 0 31673404 27089368 4584036 1988819 1096704 892115 23032756 0 EST AMT DUE TO 3RD PTY PYRS 30796 EST SELF INSURANCE COSTS 556959 587755 51030516 -9158570 -9158570 60189086 45900 45900 60234986 51223204 206480 206480 51016724 9259928 9259928 60276652 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: THE ORGANIZATION HAS ENDOWMENT FUNDS FROM THE L.P. ADAMS FUND. PER THE AGREEMENT, THE INCOME FROM THE FUND IS USED FOR GENERAL PURPOSES OF THE HOSPITAL. THE ORGANIZATION ALSO HAS FUNDS FROM THE BUCKNER ENDOWMENT. THESE FUNDS ARE RESTRICTED TO INVESTMENTS IN EQUIPMENT FOR THE BUCKNER WELLNESS CENTER. FINALLY, THE ORGANIZATION HAS FUNDS FROM THE NURSING ENDOWMENT SCHOLARSHIP FUND. THIS FUND WAS CREATED TO PROVIDE NURSING SCHOLARSHIPS TO SALINE COUNTY RESIDENTS ATTENDING THE NURSING PROGRAM AT THE MO VALLEY COLLEGE IN MARSHALL, MISSOURI. IN THE EVENT THAT THE MO VALLEY COLLEGE DOES NOT HAVE A NURSING PROGRAM, SCHOLARSHIPS CAN BE USED FOR NURSING PROGRAMS IN SURROUNDING AREAS. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITION: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS 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. SCHEDULE D, PART XI, LINE 2D OTHER REVENUE INCLUDED ON LINE 1, BUT NOT FORM 990, PART VIII, LINE 12: $ ( 9,259,928) BAD DEBT EXPENSE 101,358 NET ASSETS RELEASED FROM RESTRICTION ------------- $ ( 9,158,570) SCHEDULE D, PART XI, LINE 4B OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT LINE 1: $ ( 51,799) SPECIAL EVENTS EXPENSES 252,380 TEMPORARILY RESTRICTED CONTRIBUTIONS ( 154,681) RENTAL EXPENSES ------------- $ 45,900 SCHEDULE D, PART XII, LINE 2D OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT FORM 990, PART IX, LINE 25: $ 51,799 SPECIAL EVENTS EXPENSES 154,681 RENTAL EXPENSES ------------- $ 206,480 SCHEDULE D, PART XII, LINE 4B OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT LINE 1: $ 9,259,928 BAD DEBT EXPENSE SPRING FLING 126682 103522 23160 10187 15454 GOLF TOURNAMENT 31939 11700 20239 6245 4760 3038 2025 543 3 79107 69506 9601 9547 237728 184728 53000 6245 4760 3038 12212 25544 51799 1201 true true X true X true X 180. true true true false false 268994 268994 0.00530 4393824 4017404 376420 0.00740 4662818 4017404 645414 0.01270 63809 5057 58752 0.00120 165637 1950 163687 0.00320 6292701 3686649 2606052 0.05110 18290 18290 0.00040 6540437 3693656 2846781 0.05590 11203255 7711060 3492195 0.06860 4307 4307 0.00010 4307 4307 0.00010 true 9259928 1472329 12613889 13255464 -641575 X true true 1 1 JOHN FITZGIBBON MEMORIAL HOSPITAL 2305 S HIGHWAY 65 MARSHALL MO 65340 WWW.FITZGIBBON.ORG 27-56 X X X ORTHO, WOUND CARE, REHAB, ONCOLOGY, PAIN, NEUROLOGIC JOHN FITZGIBBON MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 15 true false true true X https://www.fitzgibbon.org/ X X true 15 false true false true X 100 180. X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: THE HOSPITAL LAUNCHED AN ONLINE SURVEY IN FEBRUARY 2016 WITH INDIVIDUAL OUTREACH TO PERSONS AND ORGANIZATIONS ACROSS THE BROAD SPECTRUM OF COMMUNITY ORGANIZATIONS, SPECIFICALLY SEEKING INPUT FROM THE HEALTH DISPARITIES, LOW-INCOME, DISABILITIES, THE CHRONICALLY ILL, LANGUAGE BARRIERS AND VARYING SOCIO-ECONOMIC BACKGROUNDS. THOSE RECEIVING THE E-MAILED SURVEY INVITATIONS, PERSONAL TELEPHONE OUTREACH AND MINORITY POPULATIONS INCLUDED FITZGIBBON HOSPITAL MEDICAL STAFF, PROVIDERS, NURSING STAFF, SOCIAL WORKERS, AND MEDICAL HOME STAFF, MARSHALL MINISTERIAL ALLIANCE, FITZGIBBON HOSPITAL AUXILIARY AMBASSADORS, CONAGRA NURSING STAFF, CARGILL MEAT SOLUTIONS NURSING STAFF, AND SALINE COUNTY INTERAGENCY COUNCIL AND ATTENDEES; WHICH INCLUDES THE SALINE COUNTY HEALTH DEPARTMENT, KATY TRAIL COMMUNITY HEALTH, MO VALLEY COMMUNITY ACTION AGENCY, SALINE COUNTY MENTAL HEALTH, SALT FORK YMCA AND TWENTY OTHER SOCIAL SERVICE AGENCIES. SCHEDULE H, PART V, SECTION B, LINE 6B CHNA CONDUCTION: THE ORGANIZATION'S CHNA WAS CONDUCTED ALONG WITH THE FOLLOWING: -MARSHALL MINISTERIAL ALLIANCE -CONAGRA -CARGILL -SALINE COUNTY INTERAGENCY COUNCIL, WHICH INCLUDES SALINE COUNTY HEALTH PUBLIC HEALTH DEPARTMENT, KATY TRAIL COMMUNITY HEALTH, MO VALLEY COMMUNITY ACTION AGENCY, SALINE COUNTY MENTAL HEALTH, SALT FORK YMCA, AND 20 OTHER SOCIAL SERVICE AGENCIES. SCHEDULE H, PART V, SECTION B, LINE 7D CHNA AVAILABILITY TO PUBLIC: DESCRIPTION OF THE CHNA AND ITS FINDINGS WERE DISCUSSED AT THE SALINE COUNTY INTERAGENCY COUNCIL MEETING, WHICH IS ATTENDED BY A BROAD CROSS-SECTION OF SOCIAL SERVICE AGENCY REPRESENTATIVES AND RECEIVES MEDIA COVERAGE. THE PAPER COPY AVAILABLE FOR PUBLIC INSPECTION WITHOUT CHARGE AT THE HOSPITAL FACILITY INCLUDED CONTACT INFORMATION IN THE INTRODUCTORY SECTION DESCRIBING THE FINDINGS. SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: THE NEEDS NOT DIRECTLY ADDRESSED IN THE CHNA IMPLEMENTATION PLAN WERE AS FOLLOWS: -COST AND ABILITY TO PAY FOR CARE -TRANSPORTATION -CANCER -LACK OF HEALTH INSURANCE -LACK OF DENTAL CARE -MENTAL HEALTH CONCERNS -POVERTY -TEEN PREGNANCY RATES AND LANGUAGE BARRIERS. THE CHNA COMMITTEE AGGREGATED AND ANALYZED PRIMARY AND SECONDARY DATA SOURCES AT LENGTH AND COMPARED TO THE INVENTORY OF EXISTING SERVICES IN THE COMMUNITY AND EVALUATED PROGRAMMING WHICH ADDRESS IDENTIFIED HEALTH NEEDS. CONSIDERATION OF COMMUNITY RESOURCES, BUDGETARY CONSTRAINTS, AVAILABLE PERSONNEL AND HOSPITAL MISSION AND VISION WERE ALL CONSIDERATIONS IN SELECTING WHICH HEALTH NEEDS TO PRIORITIZE. WE ALSO USED A TREND ANALYSIS FROM THE ROBERT WOODS JOHNSON FOUNDATION SHOWING THE IDENTIFIED HEALTH NEEDS FROM THE 2013 CHNA. THIS COMPARATIVE SNAPSHOT GAVE THE COMMITTEE AN IDEA OF WHAT PROGRAMS WERE POSITIVELY IMPACTED. UPDATE FOR SCHEDULE H, SPECIFICALLY COVERING ACTIVITIES FOR THE PERIOD MAY 1, 2016, TO APRIL 30, 2017, ADDRESSING THE CHNA ADOPTED BY THE BOARD OF TRUSTEES IN THE SPRING OF 2016. OF SPECIAL NOTE IS THAT FINAL PREPARATION OF THE 2016 CHNA WAS OCCURRING SIMULTANEOUSLY TOWARD THE END OF THIS TAX YEAR, AS DATA GATHERING OCCURRED IN LATE 2015 INTO EARLY 2016. THE CHNA WAS OFFICIALLY ADOPTED BY THE BOARD IN APRIL 2016. IN RESPONSE TO THE RESULTS OF THE ORGANIZATIONS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY DELINEATING ACTIVITIES, BOTH INDEPENDENT AND COLLABORATIVE, WHICH COULD IMPACT THE THREE MOST-PRESSING HEALTH NEEDS IN OUR COMMUNITY: -OBESITY AND RELATED CHRONIC DISEASES OF DIABETES AND HIGH BLOOD PRESSURE PREVENTIVE CARE AND WELLNESS AND HEALTH LITERACY IMPROVEMENT -EARLY HEALTH EDUCATION OBESITY - HOSPITAL-EMPLOYED REGISTERED DIETICIANS, IN CONJUNCTION WITH MARKETING AND PUBLIC RELATIONS DEPARTMENT, DEVELOPED DIABETES EDUCATION FLIERS AND OTHER MATERIALS AND PUBLICIZED THE AVAILABILITY OF DIABETES EDUCATION CLASSES IN THE LOCAL MEDIA AND TO AREA SERVICE GROUPS. MULTIPLE EDUCATIONAL PRESS RELEASES WERE COMPILED REGARDING OBESITY PREVENTION AND MANAGEMENT OF THE CHRONIC DISEASES WHICH ARE A CAUSED BY OBESITY. THESE ARTICLES WERE PRINTED IN AREA NEWS MEDIA, DISPLAYED ON THE HOSPITAL WEBSITE AND DEPICTED ON INTERNAL VIDEO MESSAGE CENTERS SEEN BY PATIENTS AND EMPLOYEES. TOPICS INCLUDED CARDIOVASCULAR HEALTH AS IT RELATES TO OBESITY, DIABETES EDUCATION AND CONTROL, LIVING WITH HYPERTENSION, HEART HEALTH, SURVIVING THE HOLIDAYS WHILE DIABETIC, CARDIAC EVENT RECOVERY VIA REHAB AND THE BENEFITS OF GOOD NUTRITION. EXCERPTS FROM THESE ARTICLES ALSO APPEARED ON SOCIAL MEDIA ON THE HOSPITAL FACEBOOK PAGE AND ON THE HOSPITAL INSTAGRAM PAGE. DIETARY PERSONNEL CONTINUED TO WORK TO OFFER HEALTHIER SELECTIONS IN THE CAFETERIA AND TO WORK WITH THE HOSPITALS VENDING MACHINE COMPANY TO ENSURE HEALTHY CHOICES WERE AVAILABLE IN BOTH THE HOT AND COLD FOOD MACHINES WHICH ARE AVAILABLE TO THE PUBLIC WHEN THE CAFETERIA LINE IS NOT OPEN. THIS INFORMATION AIDS WITH EMPLOYEE AND VISITOR SELECTION OF HEALTHIER FOOD ITEMS. BECAUSE OBESITY IS ONE OF THE CO-MORBIDITIES FOR PATIENT QUALIFICATION OF THE NCQA-ACCREDITED PRIMARY CARE HEALTH HOME MODEL THAT HAS BEEN INTEGRATED INTO THE HOSPITAL-OPERATED RURAL HEALTH CLINICS, NURSE CARE MANAGERS ASSISTED PATIENTS WITH A DIAGNOSIS OF OBESITY, ENCOURAGING THEM TO TAKE CONTROL OF THEIR WEIGHT AND PROVIDING GUIDANCE FOR HEALTHIER CHOICES. HOSPITAL STAFF ALSO PROVIDED HEALTH AND DIETARY EDUCATION TO AREA EMPLOYERS AT NO CHARGE. A SCREENING FOR BLOOD PRESSURE WAS CONDUCTED ON-SITE AT A LARGE LOCAL EMPLOYER, AND HEALTH EDUCATIONAL MATERIALS WERE DISTRIBUTED. THE HOSPITAL ALSO HOSTED ITS ANNUAL HEALTH FAIR, AT WHICH A VARIETY OF SCREENINGS ARE CONDUCTED, INCLUDING A DIABETES SCREEN (A1C) AND BLOOD PRESSURE. THESE TESTS ARE PROVIDED ON A COST-ONLY BASIS FOR ANYONE IN THE COMMUNITY. PREVENTIVE CARE AND WELLNESS - MUCH OF THE EXTERNAL MESSAGING ROLLED OUT TO THE COMMUNITY HIGHLIGHTS THE NEED FOR PREVENTIVE CARE AND WELLNESS. THESE ACTIVITIES HAVE BEEN INCORPORATED INTO A NUMBER OF DIFFERENT ACTIVITIES, INCLUDING INCORPORATION OF TIPS ONTO THE SCORECARD AT THE ANNUAL FOUNDATION GOLF TOURNAMENT, DISTRIBUTION OF HEALTH TIPS IN FLIERS DISTRIBUTED AT PARADES AND A COLLABORATIVE DAY IN THE PARK EVENT FOR FAMILIES AND IN MATERIALS DISTRIBUTION THE ENTIRE MONTH OF OCTOBER DURING FOCUSING ON CANCER SCREENING AND AWARENESS. COMMUNITY PRESENTATIONS ON A NUMBER OF TOPICS, INCLUDING THE NEED FOR EARLY MAMMOGRAMS, CERVICAL CANCER SCREENING, PSA TESTING AND FLU SHOTS AND VARIOUS IMMUNIZATIONS WERE AMONG THE TOPICS PRESENTED TO AREA CLUBS, ORGANIZATION AND SENIOR CITIZENS. HEALTH LITERACY IMPROVEMENT AND EARLY HEALTH EDUCATION - FITZGIBBON HOSPITAL IS A MEMBER OF THE MARSHALL SCHOOL DISTRICTS WELLNESS COMMITTEE, WHICH MEETS TO COLLABORATE ON WAYS TO IMPROVE THE HEALTH OF BOTH TEACHERS AND STUDENTS WITHIN THE DISTRICT. AS PART OF THIS GROUP MEMBERSHIP, THE HOSPITAL PURCHASED APPROXIMATELY 50 VOLUMES OF A STUDY GUIDE TO ACCOMPANY AN ONLINE SERIES CALLED "THE WEIGHT OF THE NATION," WHICH FOCUSES ON THE OBESITY EPIDEMIC. THE ACTIVITY COULD FALL UNDER THE PRIOR HEALTH NEED OF OBESITY, BUT BECAUSE THE ACTIVITY IS TARGETED AT HIGH SCHOOL AGED STUDENTS, WE BELIEVE THIS FALLS INTO IMPROVEMENT IN HEALTH LITERACY AND EARLY HEALTH EDUCATION. HOSPITAL PUBLIC RELATIONS STAFF ALSO ROLLED OUT AN ACTIVITY CALLED "SLOW, WHOA, GO" WHICH HIGHLIGHTS FOOD/NUTRITION EDUCATION TO THE YOUNGEST MEMBERS OF OUR COMMUNITY. THIS TRAVELING DISPLAY USES A STOPLIGHT TO SYMBOLIZE WHICH FOODS SHOULD BE CONSUMED IN MODERATION. ADDITIONAL MATERIALS ON HEALTH LITERACY WERE DISTRIBUTED AT COMMUNITY PARADES AND EVENTS. THE HOSPITAL ALSO SPONSORED A MULTI-WEEK EVENT AT THE LOWER GRADES IN THE SCHOOL DISTRICT CALLED "READ, DEED, AND FEED," DURING WHICH CHARACTER DEVELOPMENT, READING DEVELOPMENT AND AN ACTIVE LIFESTYLE AND HEALTHY NUTRITION WERE EMPHASIZED. SCHEDULE H, PART V, SECTION B, LINES 16A-C FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY: https://www.fitzgibbon.org/patients-visitors/financial-assistance SCHEDULE H, PART V, LINE 16I LEP FAP TRANSLATIONS: THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R). HOWEVER, A LANGUAGE TRANSLATION LINE IS AVAILABLE TO OUR PATIENTS AT NO COST. THIS SERVICE IS AVAILABLE THROUGHOUT THE HOSPITAL AND CLINICS WHEN PATIENTS HAVE QUESTIONS OR NEED INFORMATION TRANSLATED. THIS WOULD BE USED WITH A PATIENT THAT WOULD NEED THE FAP INFORMATION TRANSLATED TO THEM AND TO ANSWER ANY QUESTIONS WHICH THEY MAY HAVE. IN ADDITION, THE EXTENDED BUSINESS OFFICE HAS STAFF WHICH TRANSLATE FOR PATIENTS. 6 FITZGIBBON PROFESSIONAL BUILDING 2301 S 65 HIGHWAY MARSHALL MO 65340 OB/GYN, SURGERY, Chiropractic FAMILY PRACTICE, MENTAL HEALTH CLINIC FITZGIBBON COMMUNITY HOME HEALTH CARE 2303 S 65 HIGHWAY MARSHALL MO 65340 HOME HEALTH, HOSPICE, HOMEMAKER AKEMAN MCBURNEY MEDICAL CLINIC 420 WEST FRONT STREET SLATER MO 65349 OFFSITE MEDICAL CLINIC GRAND RIVER MEDICAL CLINIC 815 EAST BROADWAY BRUNSWICK MO 65236 OFFSITE MEDICAL CLINIC BUCKNER WELLNESS CENTER 2299 S 65 HIGHWAY MARSHALL MO 65340 CARDIAC/PULMONARY WELLNESS FITZGIBBON FAMILY HEALTH 600 W MORRISON FAYETTE MO 65248 OFFSITE MEDICAL CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990, WAS REDUCED BY BAD DEBT EXPENSE OF $9,259,928. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1. IRS WORKSHEETS 3 AND 6 USED INTERNAL COST ACCOUNTING METHODOLOGY. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION HAS SEVERAL EMPLOYEES INVOLVED IN LOCAL COMMUNITY BOARDS AS WELL AS STATE BOARDS, WHICH ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT AND ADVOCACY. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE ORGANIZATION REPORTED BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS FROM THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. THIS AMOUNT EXPENSED BY THE ORGANIZATION IS ATTRIBUTABLE TO LOW INCOME INDIVIDUALS IN THEIR TARGET COMMUNITY AND IS CONSIDERED A COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE 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 UNCOLLECTIBLE 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 UNCOLLECTIBLE 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 UNCOLLECTIBLE 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 SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY 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. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: THE ORGANIZATION'S BILLING AND PAYMENT POLICY NOTES: IF ACCOUNTS HAVE ALREADY BEEN CONSIDERED BAD DEBT BY FITZGIBBON HOSPITAL AND CLINICS, THEN FINANCIAL ASSISTANCE/CHARITY CARE IS AN OPTION UNTIL 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT. BAD DEBT IS DEFINED AS EXPENSES RESULTING FROM TREATMENT FOR SERVICES PROVIDED TO A PATIENT WHO HAS NOT MET THEIR FINANCIAL OBLIGATION NOR SET UP AN AGREEABLE PAYMENT ARRANGEMENT WITH FITZGIBBON HOSPITAL AND CLINICS WITHIN 120 DAYS FROM THE DATE THE PATIENT HAS BEEN MADE RESPONSIBLE FOR ANY BALANCES DUE EITHER AFTER INSURANCE HAS PAID THEIR PORTION OR WHEN NO INSURANCE IS INVOLVED. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: OUR MISSION AT FITZGIBBON HOSPITAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN ORDER TO MEET THIS MISSION WE STRIVE TO UNDERSTAND THE NEEDS OF OUR COMMUNITY IN SEVERAL DIFFERENT WAYS. OUR LEADERSHIP AND STAFF ARE MEMBERS OF CIVIC CLUBS, BOARDS, AND COMMITTEES. OUR BOARD OF TRUSTEES IS COMPRISED OF MEMBERS FROM COUNTIES THROUGHOUT OUR SERVICE AREA. WE WORK CLOSELY WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY AGENCIES. STATE, REGIONAL AND LOCAL MEDIAS ARE USED TO MONITOR NEEDS AT ALL LEVELS. WE ALSO BELONG TO MANY HEALTHCARE RELATED ORGANIZATIONS THAT PROVIDE INFORMATION REGARDING USAGE AND NEEDS OF HEALTHCARE IN OUR SERVICE AREA WHICH IS USED TO EVALUATE WHAT WE NEED TO FOCUS ON TO IMPROVE THE HEALTH IN OUR COMMUNITY. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL USES SEVERAL AVENUES TO PROVIDE PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. ALL PATIENTS WILL BE OFFERED A PLAIN LANGUAGE SUMMARY AND AN APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) AS PART OF THE INTAKE OR DISCHARGE PROCESS TO/FROM FH. INFORMATION REGARDING THE FAP MAY BE AVAILABLE THROUGH THE HOSPITAL'S PATIENT ACCOUNTS DEPARTMENT AT (660) 831-3730, FH WEBSITE AT WWW.FITZGIBBON.ORG, OR THE FH FACILITY AT 2305 SOUTH 65 HIGHWAY, MARSHALL, MO 65340. THE PATIENT ACCOUNTS DEPARTMENT DEVELOPED A BROCHURE WHICH IS AVAILABLE TO PATIENTS AT THE TIME OF REGISTRATION. THE BROCHURE OUTLINES WHAT THE PATIENT IS TO EXPECT IN THE BILLING PROCESS, HOW TO CONTACT THE DEPARTMENT, AND WHAT ASSISTANCE IS AVAILABLE. WE HAVE A DETAILED POLICY WHICH OUTLINES PATIENT RESPONSIBILITY AND QUALIFICATIONS FOR CHARITY CARE. OUR PATIENT ACCOUNTS REPRESENTATIVES MEET WITH SELF PAY PATIENTS WHEN THEY ARE IN THE FACILITY TO DISCUSS OUR POLICY. OUR CARE COORDINATORS AND SOCIAL WORKERS ALSO EDUCATE OUR PATIENTS ON ASSISTANCE THEY MAY BE ELIGIBLE FOR UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS. WE ALSO UTILIZE AN OUTSIDE AGENCY TO MAKE CONTACT WITH PATIENTS AND IDENTIFY THOSE THAT MIGHT BE ELIGIBLE FOR ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: FITZGIBBON HOSPITAL'S PRIMARY SERVICE AREA IS SALINE COUNTY, MISSOURI WHICH IS A MID-MISSOURI AGRICULTURAL REGION AND INCLUDES THE TOWNS OF MARSHALL AND SLATER, MO. THE SECONDARY SERVICE AREA IS PORTIONS OF THE CONTIGUOUS COUNTIES SURROUNDING SALINE COUNTY. A REPORT FROM THE MISSOURI CENSUS DATA CENTER, POPULATION ESTIMATES WITH COMPONENTS OF CHANGE 2010-2015, EXTRACTED ON APRIL 4, 2016, SHOWS THE FOLLOWING: A JULY 2015 POPULATION ESTIMATE OF 23,258. SALINE COUNTY DATA FOR 2017, ACCORDING TO A JULY 1, 2017 U.S. CENSUS BUREAU REPORT, SHOWED THE MEDIAN HOUSEHOLD INCOME WAS $40,645. THE AGE DISTRIBUTION OF THE POPULATION IN SALINE COUNTY IN 2017 SHOWED 17.5% AGED 65 AND OVER. ITS DEMOGRAPHICS ARE PRIMARILY WHITE, WITH 80.7% AS WHITE, NON-LATINO; 9.8% HISPANIC OR LATINO; 5.3% AFRICAN-AMERICAN; 2.7% TWO OR MORE RACES; 1.1% PACIFIC ISLANDER AND .9% ASIAN. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: FITZGIBBON HOSPITAL ENGAGED IN NUMEROUS ACTIVITIES RELATED TO ITS MISSION, "IMPROVING THE HEALTH OF OUR COMMUNITY." WHILE MANY OF THESE ACTIVITIES WERE GUIDED BY THE IMPLEMENTATION PLAN AS A RESULT OF A COMMUNITY HEALTH NEEDS ASSESSMENT PUBLISHED IN 2013 AND 2016, MANY HEALTH PROMOTION ACTIVITIES OCCUR IN THE COURSE OF DOING BUSINESS AND ARE A RESULT OF COMPREHENSIVE PATIENT CARE PROGRAMS WHICH ENCOURAGE WELLNESS, PATIENT SAFETY AND FAMILY ENGAGEMENT. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ANY QUALIFIED PHYSICIAN WHO APPLIES AND MEETS THE HOSPITAL CREDENTIALING STANDARDS. CREDENTIALING IS REQUIRED TO ENSURE PROPER TRAINING, LICENSURE AND MALPRACTICE INSURANCE COVERAGE AND HELPS TO ENSURE THE SAFETY OF THE HOSPITAL'S PATIENTS. FITZGIBBON IS LOCATED WITHIN A HEALTH PROFESSIONAL SHORTAGE AREA SCORED AS A 17 FOR PRIMARY CARE AND WELCOMES THE ADDITION OF NEW PHYSICIANS TO ITS STAFF. ENSURING ACCESS TO HIGH QUALITY HEALTH CARE IS A VITAL PART OF ITS MISSION AND IS EVIDENCED BY THE OPERATION OF FOUR RURAL HEALTH CLINICS, ONE OF WHICH IS A NATIONAL HEALTH SERVICES CORPS SITE WHICH WELCOMED AN NHSC SCHOLAR IN 2014. ANY SURPLUS FUNDS ARE USED TO IMPROVE PATIENT CARE AND MEDICAL EDUCATION. SOME ACTIVITIES INCLUDE SCHOLARSHIPS AND PRECEPTOR COLLABORATION FOR A BACHELOR'S DEGREE PROGRAM IN NURSING AT A LOCAL LIBERAL ARTS COLLEGE, MISSOURI VALLEY COLLEGE. IMPROVING PATIENT CARE IS THE HOSPITAL'S OVERRIDING CONCERN AS EVIDENCED BY THE RESOURCES DEDICATED TO TRAINING IN SUCH AREAS AS INFECTION CONTROL, BEST PRACTICE PATIENT CARE, REDUCING HOSPITAL READMISSIONS, AND ENSURING THAT LANGUAGE TRANSLATIONS OCCUR IN A CULTURALLY COMPETENT MANNER. IN EVERYTHING FITZGIBBON HOSPITAL UNDERTAKES, IMPROVEMENT IN THE HEALTH OF THE COMMUNITY REMAINS THE GUIDING PRINCIPLE. PARTICIPATION IN PROCESS IMPROVEMENT TRAINING, EDUCATION AND COLLABORATING WITH OTHER HEALTH ENTITIES IS VITAL TO ENSURING PROMOTION OF COMMUNITY AND PUBLIC HEALTH. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE AFFILIATED HEALTH SYSTEM INCLUDES THE ACTIVITIES OF JOHN FITZGIBBON MEMORIAL HOSPITAL AND FITZGIBBON HEALTH SERVICES, DOING BUSINESS AS THE LIVING CENTER, (COLLECTIVELY, THE "COMPANIESTHE "HOSPITAL"). JOHN FITZGIBBON MEMORIAL HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY CARE, PSYCHIATRIC AND SKILLED NURSING SERVICES TO PATIENTS IN THE MARSHALL, MISSOURI, AREA. IT ALSO OPERATES A HOME HEALTH AGENCY IN THE SAME GEOGRAPHIC AREA. IT WAS DESIGNATED AS A MEDICARE DEPENDENT HOSPITAL BY MEDICARE EFFECTIVE JANUARY 1, 2007. IN MARCH 2012, THE HOSPITAL WAS DESIGNATED AS A SOLE COMMUNITY HOSPITAL BY MEDICARE. THE COMPANIES ALSO OPERATE A LONG-TERM CARE FACILITY IN MARSHALL, MISSOURI, DOING BUSINESS AS THE LIVING CENTER. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: MISSOURI true OATS INC 2501 MCGUIRE BLVD COLUMBIA MO 65201 431016961 501(C)(3) 14400 COMMUNITY SERVICES 1 SCHEDULE I, PART I, LINE 2 MONITORING USE OF GRANT FUNDS: THE HOSPITAL WORKS IN CONJUNCTION WITH THE LOCAL OATS TRANSPORTATION PROGRAM TO COORDINATE TRANSPORTATION FOR MEMBERS OF THE COMMUNITY. THE ORGANIZATION WITNESSES FIRSTHAND THE WORK DONE BY OATS IN THE COMMUNITY. X X X true false false false false false false false false DARIN HAUG DO PRESIDENT/CEO 440623 0 0 0 420 0 2000 0 2916 0 445959 0 0 0 ANGELA LITTRELL CFO/COO 178320 0 0 0 384 0 2000 0 10342 0 191046 0 0 0 J BRIAN BRIZENDINE MD TRUSTEE/PRESIDENT OF MEDICAL 330013 0 0 0 0 0 2000 0 366 0 332379 0 0 0 KELLY ROSS ORTHOPEDIC SURGEON 546291 0 0 0 26353 0 2000 0 0 0 574644 0 0 0 RAVINDER ARORA NEUROLOGIST 274997 0 156295 0 12098 0 2000 0 0 0 445390 0 0 0 KAREN SONG OB/GYN 332452 0 55129 0 432 0 2000 0 366 0 390379 0 0 0 LORENZO M ROMNEY HOSPITALIST/CLINIC PHYSICIAN 317987 0 0 0 32142 0 2000 0 508 0 352637 0 0 0 CLINTON PICKETT ORTHOPEDIC SURGEON 300463 0 0 0 2108 0 2000 0 5129 0 309700 0 0 0 DENNIS SOUSLEY VP OF CLINICAL SERVICES 160605 0 0 0 7307 0 2000 0 2111 0 172023 0 0 0 RONALD A OTT FORMER PRESIDENT/CEO 0 0 0 0 123261 0 0 0 0 0 123261 0 0 0 SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT: RONALD OTT RECEIVED A SEVERANCE PAYMENT OF $ 123,261 AS PART OF A SEPARATION AGREEMENT. A INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO 430980296 79516LBC7 2010-11-29 12218468 1998 BOND REFINANCING false false false B INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO 430980296 2016-03-14 7550000 REFINANCING OF SERIES 2005 BONDS false false false A 550000 0 12218468 1146985 0 11985656 232812 0 0 0 0 0 2010 true false true true B 335000 0 7550000 0 0 0 170000 0 0 0 7380000 0 2016 true false true true A 0 B false false false false 0 false false false true A false false false true false false 0 false 0 false true B false true false false false false 0 false 0 false true A true B true SCHEDULE K, PART IV, LINE 2C, COLUMN A DATE OF REBATE COMPUTATION: THE REBATE COMPUTATION OCCURRED ON JANUARY 6, 2016. RED CROSS PHARMACY SEE PART V 383420 PHARMACY false KATHRYN LYNNE OTT SEE PART V 70031 COMPENSATION false PAUL BRIZENDINE SEE PART V 323600 COMPENSATION false SCHEDULE L, PART IV, LINE 1, COLUMN B: TRANSACTIONS WITH INTERESTED PERSONS: (1) SCOTT HARTWIG, TRUSTEE, OWNS 47.5% OF RED CROSS PHARMACY. (2) KATHRYN LYNNE OTT WAS VICE PRESIDENT OF NURSING SERVICES AND RETIRED 1/4/16. SHE IS MARRIED TO RON OTT, FORMER PRESIDENT/CEO. (3) PAUL BRIZENDINE IS THE FATHER OF TRUSTEE J. BRIAN BRIZENDINE, MD AND RECEIVES COMPENSATION AS AN INDEPENDENT CONTRACTOR. X 13 10816 COST X 6021 COST X 21 4093 COST false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTIONS: THE NUMBER OF CONTRIBUTIONS WAS DETERMINED BY THE NUMBER OF ITEMS CONTRIBUTED FOR EACH TYPE OF ITEM. FORM 990, PART III, LINE 4A PROGRAM SERVICES ACTIVITY #1: FOR THE FISCAL YEAR ENDED APRIL 30, 2017, THE EMERGENCY ROOM EXPERIENCED 12,011 PATIENT VISITS. THE SURGICAL TEAM PERFORMED 419 IN-PATIENT PROCEDURES AND 1,469 OUT-PATIENT PROCEDURES. THE RADIOLOGY GROUP PERFORMED 27,281 PROCEDURES WHICH INCLUDE 2,134 MAMMOGRAMS, 4,455 CT SCANS, 2,050 MRI'S, 2,472 ULTRASOUND IMAGES AND 728 NUCLEAR MEDICINE SCANS. THE LABORATORY TEAM PERFORMED 80,988 TESTS. THE RESPIRATORY THERAPY DEPARTMENT CONDUCTED 17,633 PROCEDURES AND THE REHABILITATIVE SERVICES GROUP WHICH INCLUDES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES PROVIDED 25,310 PROCEDURES. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES: A CARDIO-PULMONARY WELLNESS CENTER IS LOCATED ON THE CAMPUS AND STAFFED BY A REGISTERED DIETICIAN AND A REGISTERED NURSE TO COUNSEL AND EDUCATE PATIENTS ON HEALTHY LIVING THROUGH EXERCISE AND NUTRITION WITH SPECIAL EMPHASIS ON DIABETES MANAGEMENT. THROUGHOUT THE YEAR, THE STAFF ENCOUNTERED 1,388 PATIENT VISITS AT THE FACILITY. IN ADDITION, THE STAFF EDUCATED OVER 1,700 RESIDENTS IN THE SURROUNDING COMMUNITIES AT NO CHARGE THROUGH PARTICIPATION IN HEALTH FAIRS AND OTHER SOCIAL VENUES. THE HOSPITAL OFFERS CHILDBIRTH CLASSES AT A MINIMAL FEE WHICH COVERS THE COST OF THE EDUCATIONAL MATERIAL PRESENTED TO EACH PARTICIPANT. EACH YEAR, THE HOSPITAL HOSTS A COMMUNITY HEALTH FAIR OFFERING EDUCATION ON A VARIETY OF HEALTH ISSUES AND ROUTINE HEALTH SCREENINGS. MOST TESTING IS FREE, HOWEVER, PARTICIPANTS REQUESTING CERTAIN BLOOD TESTS PAY ONLY WHAT IT COSTS THE HOSPITAL FOR LABORATORY PROCESSING. FITZGIBBON IS A WILLING PARTICIPANT IN A COMMUNITY COMMITTEE TO HELP IMPROVE ACCESS TO HEALTH CARE IN THE AREA. HOSPITAL PERSONNEL ARE ENCOURAGED AND PROVIDED OPPORTUNITIES TO SERVE THE COMMUNITY THROUGH INVOLVEMENT IN VARIOUS COMMUNITY ORGANIZATIONS AS VOLUNTEER MEMBERS, OFFICERS, AND SPEAKERS ON HEALTH RELATED TOPICS. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS, STOCKHOLDERS, OR OTHER PERSONS: THE MEDICAL STAFF OF THE ORGANIZATION ELECTS THE CHIEF OF MEDICAL STAFF WHO IS A VOTING MEMBER OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A DRAFT OF THE RETURN IS REVIEWED WITH MANAGEMENT BEFORE BEING FINALIZED. THE 990 IS THEN PRESENTED TO THE BOARD OF TRUSTEES AFTER IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE COMPLIANCE OFFICER MONITORS THE CONFLICT OF INTEREST POLICY AND ANNUALLY REQUIRES OFFICERS, TRUSTEES, AND KEY EMPLOYEES TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. ALL CONFLICTS MUST BE REVIEWED BY THE CEO AND/OR BOARD OF TRUSTEES. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST WOULD ABSTAIN FROM VOTING ON ANY DECISION RELATED TO THAT CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION DETERMINATION: THE ORGANIZATION USES INDUSTRY DATA IN DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS/KEY EMPLOYEES. THE COMPENSATION FOR DR. DARIN HAUG WAS ESTABLISHED BY UTILIZING BENCHMARK DATA FROM THREE SOURCES. FITZGIBBON HOSPITAL HAD AN AGREEMENT WITH BOONE HOSPITAL CENTER WHICH ALLOWED BOONE HOSPITAL TO OVERSEE AND ASSIST IN EVALUATION OF THE WORK AND PERFORMANCE OF THE PRESIDENT OF THE HOSPITAL AND IN DETERMINING THE COMPENSATION AND BENEFITS TO WHICH THE PRESIDENT WILL BE ENTITLED. THE COMPENSATION WAS DETERMINED BY FITZGIBBON HOSPITAL BOARD REPRESENTATIVE FROM BOONE HOSPITAL CENTER IN CONSULTATION WITH THE FITZGIBBON HOSPITAL BOARD PRESIDENT AND FITZGIBBON HOSPITALS FORMER PRESIDENT/CEO. DR. HAUG ALSO PERFORMS DUTIES AS THE CHIEF MEDICAL OFFICER (CMO) AND AN EMERGENCY ROOM PHYSICIAN. THE COMPENSATION REPORTED IS FOR HIS ROLES AS PRESIDENT/CEO, CMO AND EMERGENCY ROOM PHYSICIAN. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ANNUAL FORM 990 INCLUDES THE ANNUAL AUDITED FINANCIAL STATEMENTS AND ARE AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES NOT MAKE THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, OR OTHER FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A TRUSTEE COMPENSATION: NO TRUSTEES RECEIVE COMPENSATION FOR THEIR DUTIES AS TRUSTEES. JACK UHRIG, MD, RECEIVED NONEMPLOYEE COMPENSATION FOR OTHER SERVICES PROVIDED TO THE ORGANIZATION. BRIAN BRIZENDINE RECEIVED COMPENSATION FOR HIS ROLE AS A GENERAL SURGEON. FORM 990, PART X, LINE 20 TAX EXEMPT BONDS: JOHN FITZGIBBON MEMORIAL HOSPITAL RECEIVED QUALIFIED HOSPITAL BOND PROCEEDS FROM 2010 AND 2016 BOND ISSUES. A PORTION OF THE BOND PROCEEDS WERE ALLOCATED TO FITZGIBBON HEALTH SERVICES FOR BOOK AND AUDIT PURPOSES. INFORMATION ABOUT THE BONDS ARE REPORTED ON JOHN FITZGIBBON MEMORIAL HOSPITAL'S SCHEDULE K. FITZGIBBON HEALTH SERVICES 2506 LINDEN TREE PARKWAY MARSHALL MO 65340 431731173 NURSING HOME MO 501(C)(3) 10 JF MEM HOSP true false false false false false false false false false false false true false true true true true false false FITZGIBBON HEALTH SERVICES L 60000 FMV FITZGIBBON HEALTH SERVICES P 110519 FMV FITZGIBBON HEALTH SERVICES Q 668457 FMV