2017-03-14T14:11:48-05:00 2016-04-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2015-05-01 440655986 JOHN FITZGIBBON MEMORIAL HOSPITAL % ANGELA LITTRELL JOHN 6608867431 2305 S 65 HIGHWAY MARSHALL MO 65340 ANGELA P LITTRELL CFO/COO 2016-12-07 true Brian D Todd P00422601 4178658701 2015 2021-01-29 14:40:06Z DARIN L HAUG 2305 S 65 HIGHWAY PO BOX 250 MARSHALL MO 65340 57401074 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. 11 8 581 50 0 0 277054 275200 59060003 56869873 288088 362911 -23285 -166654 59601860 57341330 14000 35905 0 0 26937470 27997108 0 0 75877 31993598 31391316 58945068 59424329 656792 -2082999 59879610 56391967 23950841 22541421 35928769 33850546 X TO IMPROVE THE HEALTH OF OUR COMMUNITY. false false 41718206 39493374 HOSPITAL SERVICE - FITZGIBBON HOSPITAL IS A 60 BED ACUTE CARE FACILITY SERVING MARSHALL, MO AND THE SURROUNDING COMMUNITIES. THE FACILITY PROVIDES STATE OF THE ART 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 BEHAVIOR 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. 7982337 8296115 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 11,388 PATIENTS. THE HOSPITAL ALSO SUPPORTS A SEPARATE OUT-PATIENT CLINIC ON CAMPUS FOR FAMILY MEDICINE, OB/GYN, GENERAL SURGERY AND PSYCHIATRY STAFFED MEDICAL PROFESSIONALS PRACTICING IN THESE SPECIALTIES FOR FISCAL YEAR 2016. THIS CLINIC PROVIDED SERVICES FOR 24,393 PATIENT VISITS. THREE SATELLITE FAMILY PRACTICE CLINICS ARE ALSO SUPPORTED BY THE HOSPITAL. THESE CLINICS PROVIDED SERVICES FOR 11,323 PATIENT VISITS. 1497047 14400 1167131 COMMUNITY HEALTH SERVICES - HOSPICE, HOME HEALTH, AND HOMEMAKER SERVICES. HOSPICE PROVIDED 168 PALLIATIVE CARE VISITS, HOME HEALTH PROVIDED 6,815 VISITS AND HOMEMAKER PERFORMED 8,481 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 2016 AND WILL BE DONATING $14,400 ANNUALLY TO HELP SUSTAIN IT IN THE MARSHALL COMMUNITY. THE PROGRAM PROVIDED TRANSPORTATION FOR 3,998 RIDERS DURING FY 2016. 688411 21505 7913253 51886001 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 false true true false false false false true true true false false true 123 0 true 581 true false false false false false true true false false false false X 11 8 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 65 HIGHWAY PO BOX 250 MARSHALL MO 65340 X FRED UTLAUT PRESIDENT 1.0 1.0 X X 0 0 0 WILLIAM SUMMERS VICE PRESIDENT 1.0 1.0 X X 0 0 0 DON VOGELSMEIER SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 GAYLE CARTER DIRECTOR 1.0 1.0 X 0 0 0 ROOK EVANS DIRECTOR 1.0 1.0 X 0 0 0 JACK UHRIG MD DIRECTOR/MEDICAL DIRECTOR 1.0 1.0 X 14400 0 0 JAMES SOWASH MD DIRECTOR END 1/2016 1.0 1.0 X 0 0 0 RANDY MORROW DIRECTOR 1.0 1.0 X 0 0 0 JACQUELYN EIDSON DIRECTOR BEG 9/2015 1.0 1.0 X 0 0 0 SCOTT HARTWIG DIRECTOR BEG 9/2015 1.0 1.0 X 0 0 0 JAN STAPLETON DIRECTOR BEG 9/2015 1.0 1.0 X 0 0 0 LORENZO M ROMNEY DO DIRECTOR, SEE SCHEDULE O 40.0 1.0 X 335467 0 2508 DARIN HAUG DO PRESIDENT/CEO, SEE SCHEDULE O 40.0 1.0 X 434907 0 4866 ANGELA LITTRELL CFO/COO 40.0 1.0 X 194715 0 9890 KATHRYN LYNNE OTT VICE PRESIDENT OF NURSING SERV 40.0 1.0 X 189780 0 5668 DENNIS SOUSLEY VP OF CLINICAL SERVICES 40.0 1.0 X 175933 0 5051 KELLY ROSS ORTHOPEDIC SURGEON 40.0 0.0 X 601226 0 2000 JOHN B BRIZENDINE GENERAL SURGEON 40.0 0.0 X 416978 0 2000 KAREN SONG OB/GYN 40.0 0.0 X 347677 0 366 BRIAN ELLEFSEN ORTHOPEDIC SURGEON 40.0 0.0 X 313143 0 2312 RAVINDER ARORA NEUROLOGIST 40.0 0.0 X 279418 0 0 RONALD OTT PRESIDENT/CEO END 4/2015 0.0 0.0 X 279627 0 4270 3583271 0 38931 30 true true false BOYCE BYNUM COLUMBIA MO 65205 PATHOLOGY 306164 PHARMACY SYSTEMS INC PHARMACY MANAGEMENT 614743 SIEMENS MEDICAL SOLUTIONS MAINTENANCE 351766 PAUL T BRIZENDINE MD ER PHYSICIAN 312665 AMERI EBO LLC MANITOWOC WI 54221 COLLECTIONS 278468 13 195724 9606 69870 31363 275200 NET PATIENT SERVICE REVENUE 900099 55775018 55775018 EHR INCENTIVE REVENUE 900099 632197 632197 CAFETERIA 722514 267719 267719 MANAGEMENT FEES 561000 60000 60000 OTHER REVENUE 900099 134939 134939 56869873 322102 322102 0 0 5721 5721 0 5721 5721 40809 40809 40809 40809 43665 195724 59744 -16079 -16079 0 0 LOSS ON EXTINGUISHMENT OF DEBT 900099 -156296 -156296 -156296 57341330 56869873 196257 35905 35905 0 0 0 1373185 728807 644378 283897 283897 21442030 18974619 2399773 67638 253431 224604 28827 3134120 2755822 378298 1510445 1317674 187573 5198 0 159813 159813 155877 155877 0 0 0 4662474 3689936 972389 149 139312 139312 3364056 2460562 900771 2723 0 0 726411 630130 96281 214348 195164 19015 169 0 106286 66151 40135 910802 762701 148101 0 3023147 2531567 491580 645227 546579 98648 BAD DEBT 7875869 7875869 MEDICAL SUPPLIES & DRUGS 6547838 6547838 PROVIDER TAX 2433059 2433059 RECRUITING & RETENTION 426797 109014 317783 59424329 51886001 7462451 75877 X 7931679 6130820 16113318 14839547 0 0 6890179 7777359 0 0 0 0 0 0 1011379 1159674 1029321 1181563 60515324 39500547 22459120 21014777 3315458 3027816 0 0 0 0 0 0 1129156 1260411 59879610 56391967 4281949 4039504 0 0 0 0 14952378 13872640 0 0 0 0 3415640 3337590 0 0 1300874 1291687 23950841 22541421 X 34711567 32660900 761985 734429 455217 455217 35928769 33850546 59879610 56391967 -2082999 4776 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 21170 23932 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 DISCUSSING LEGISLATION FOR HEALTHCARE. 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. 724023 23258 3549 743732 701570 28779 6326 724023 733363 8693 1000 39486 701570 719060 20163 1000 4800 60 733363 694769 24351 60 719060 0.35393 0.61450 0.03157 false false 71000 71000 28705873 12697838 16008035 30154430 25802269 4352161 1584021 1000440 583581 21014777 0 DUE TO RELATED PARTY 550851 EST AMT DUE TO 3RD PTY PYRS 124843 EST SELF INSURANCE COSTS 615993 1291687 49305936 -7810816 -7810816 57116752 224578 224578 57341330 51608204 59744 59744 51548460 7875869 7875869 59424329 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: $ (7,875,869) BAD DEBT 65,053 NET ASSETS RELEASED FROM RESTRICTION ------------ $ (7,810,816) SCHEDULE D, PART XI, LINE 4B OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT LINE 1: $ ( 59,744) SPECIAL EVENTS EXPENSES 284,322 TEMPORARILY RESTRICTED CONTRIBUTIONS ------------ $ 224,578 SCHEDULE D, PART XII, LINE 2D OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT FORM 990, PART IX, LINE 25: $ 59,744 SPECIAL EVENTS EXPENSES SCHEDULE D, PART XII, LINE 4B OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT LINE 1: $ 7,875,869 BAD DEBT EXPENSE SPRING FLING 122145 108581 13564 13353 14916 GOLF TOURNAMENT 28116 11138 16978 5484 4890 3850 2124 2004 3 89128 76005 13123 378 12745 239389 195724 43665 5484 4890 3850 15855 29665 59744 -16079 true true X true X true X 180. true true true false true true 284828 284828 0.00550 4796111 3968454 827657 0.01610 5080939 3968454 1112485 0.02160 45812 8584 37227 0.00070 339530 4587 334942 0.00650 6225797 3630285 2595512 0.05040 21505 21505 0.00040 6632644 3643456 2989186 0.05800 11713583 7611910 4101671 0.07960 5592 5592 0.00010 5592 5592 0.00010 true 7875869 1299518 12757654 13527840 -770186 X true true 1 1 JOHN FITZGIBBON MEMORIAL HOSPITAL 2305 S 65 HIGHWAY 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 www.fitzgibbon.org/page.php?p=2252 X X true 15 false true false true X 100 180. X true true 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 30 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 AND PROGRAMMING WHICH ADDRESS IDENTIFIED HEALTH NEEDS WAS EVALUATED. CONSIDERATION OF COMMUNITY RESOURCES, BUDGETARY CONSTRAINTS, AVAILABLE PERSONNEL AND HOSPITAL MISSION AND VISION WERE ALL CONSIDERATIONS IN SELECTING WHICH HEALTH NEEDS TO PRIORITIZE GOING FORWARD. UPDATE FOR SCHEDULE H, SPECIFICALLY COVERING ACTIVITIES FOR THE PERIOD MAY 1, 2015, TO APRIL 30, 2016, ADDRESSING THE CHNA ADOPTED BY THE BOARD OF TRUSTEES IN THE SPRING OF 2013. OF SPECIAL NOTE IS INITIAL WORK ON THE 2016 CHNA WAS OCCURRING SIMULTANEOUSLY TOWARD THE END OF THIS TAX YEAR, AS DATA GATHERING OCCURRED IN LATE 2015 INTO EARLY 2016, WITH THE CHNA 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 -SMOKING -PREVENTIVE CARE AND WELLNESS. 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 COLUMNS WERE COMPILED REGARDING OBESITY PREVENTION AND MANAGEMENT OF THE CHRONIC DISEASES WHICH ARE A CAUSED BY OBESITY. THESE COLUMNS WERE PRINTED IN LOCAL NEWS MEDIA AND DISPLAYED ON THE HOSPITAL WEBSITE. TOPICS INCLUDED CARDIOVASCULAR HEALTH AS IT RELATES TO OBESITY, DIABETES EDUCATION AND CONTROL, LIVING WITH HYPERTENSION, SURVIVING THE HOLIDAYS WHILE DIABETIC 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. IN ADDITION, INFORMATION ON HEALTHY LIFESTYLES WAS PROVIDED DURING A COLLABORATIVE EVENT AIMED AT VETERANS, CALLED THE VETERANS STAND DOWN, IN DECEMBER 2015, IN WHICH MORE THAN 50 AREA VETERANS IN NEED ATTENDED AND WERE PROVIDED A FREE MEAL AS WELL AS INFORMATION ON HEALTH AND SOCIAL SERVICES AVAILABLE IN THE AREA. SMOKING - THE WOMENS CENTER STAFF CONTINUED THE WORK VIA A GRANT FROM THE MARCH OF DIMES TO IMPLEMENT A PROGRAM CALLED "BABY AND ME TOBACCO FREE" FOR EXPECTANT MOTHERS WHO WISH TO QUIT SMOKING. ACTIVITIES UNDER THAT GRANT LAUNCHED EARLY, IN DECEMBER 2014, WHICH AN OFFICIAL GRANT-FUNDING LAUNCH OF JUNE 2015. VIA THIS PROGRAM, EXPECTANT MOTHERS ARE PROVIDED EDUCATION AND TESTING FOR THE PRESENCE OF NICOTINE IN THEIR BLOODSTREAM. THE PROGRAM THAN "REWARDS" THOSE MOTHERS AFTER DELIVERY WHO CONTINUE TO BE SMOKE-FREE WITH VOUCHERS FOR DIAPERS. CONTINUED DISTRIBUTION OF EDUCATIONAL MATERIALS REGARDING THE DANGERS OF SMOKING DURING PREGNANCY AND THE DANGERS OF SECOND-HAND SMOKE IN THE HOME OCCURRED AS PART OF THIS PROGRAM. THE HOPE IS THAT SMOKING CESSATION WILL BE LONG-TERM FOR THOSE MOTHERS WHO PARTICIPATE. HOSPITAL STAFF ALSO INVESTIGATED AMERICAN LUNG ASSOCIATION TRAINING TO RECEIVE CERTIFICATION TO TEACH SMOKING CESSATION CLASSES. TOBACCO-FREE ADVOCACY BY THE HOSPITAL INCLUDED SUCH ITEMS AS AN INCREASED ENFORCEMENT OF HOSPITAL "NO SMOKING" SIGNS ON HOSPITAL GROUNDS AND PUBLICIZING TOBACCO-FREE ZONES AND QUIT-SMOKING MESSAGING ON OUR PUBLIC VIDEO DISPLAYS. THE HOSPITAL ALSO COMPILED TOBACCO CESSATION AND TOBACCO EDUCATION MATERIALS WHICH ARE DISTRIBUTED TO EVERY INPATIENT WHO INDICATES THEY USE TOBACCO. PREVENTIVE CARE AND WELLNESS - THE WEEKLY NEWSPAPER COLUMNS FEATURED A PLETHORA OF EDUCATIONAL HEALTH TOPICS, AIMED AT IMPROVING THE HEALTH OF THE COMMUNITY. THIS COLUMN IS PUBLISHED WEEKLY IN THE LOCAL MARSHALL NEWSPAPER, AND SOMETIMES OTHER AREA NEWSPAPERS, AND IS ALMOST ALWAYS PURELY EDUCATIONAL ON A TOPIC OF HEALTH. THE GOAL OF THESE COLUMNS IS TO INCREASE PUBLIC HEALTH LITERACY OR TO EDUCATE THE PUBLIC REGARDING HEALTHY LIFESTYLE CHOICES, DISEASE DIAGNOSIS, EARLY HEALTH SCREENING AND PREVENTION. COLUMN TOPICS HAVE INCLUDED RECOMMENDATIONS FOR COLON CANCER SCREENING, BREAST CANCER SCREENING, THE IMPORTANCE OF FLU VACCINATIONS, SUICIDE PREVENTION, EARLY TREATMENT OF STROKE, SUN SAFETY AND MANY OTHERS. THE COLUMNS ARE PRINTED AS NEWS ITEMS ON THE PAPERS "HEALTH" PAGE. FITZGIBBON HOSPITAL HOSTED LOW-COST LAB SCREENING AT IS ANNUAL HEALTH FAIR HELD IN APRIL 2016. COLLABORATIVE ACTIVITIES SURROUNDING OUR NCQA-ACCREDITED PRIMARY CARE HEALTH HOME, WHICH TARGETS LOW-INCOME MEDICAID ENROLLEES WITH MULTIPLE CHRONIC CONDITIONS, TOOK PLACE AT OUR FOUR FEDERALLY DESIGNATED RURAL HEALTH CLINICS, WITH LOCATIONS IN MARSHALL, SLATER, BRUNSWICK AND FAYETTE, MO. THE CONCEPT OF THE PRIMARY CARE HEALTH HOME EMPHASIZES A TEAM APPROACH, INCREASED PATIENT AND FAMILY ENGAGEMENT AND INTENSIVE NURSE CARE MANAGER INTERVENTION WITH THE PATIENT. THE GOAL IS TO ENGAGE THE PATIENT AND THEIR FAMILY IN THEIR OWN HEALTH IMPROVEMENT INITIATIVES RATHER THAN WAITING UNTIL AN ACUTE EVENT FORCES THEM TO SEEK CARE IN A MORE COSTLY SETTING. HOSPITAL PHYSICIANS AND ADVANCED PRACTICE PROVIDERS ALSO STAFFED FREE SCHOOL PHYSICALS FOR ATHLETES IN THE MARSHALL SCHOOL DISTRICT IN MAY 2015. THE GOAL WAS TO ENSURE ALL ATHLETES WHO NEED A SCHOOL PHYSICAL WOULD BE ABLE TO RECEIVE ONE, ENSURING THAT PARTICIPATION IN A HIGH SCHOOL SPORT WOULD NOT BE HINDERED BY A STUDENTS FINANCIAL BARRIER TO RECEIVE A PHYSICAL. THE MISSOURI STATE HIGH SCHOOL ATHLETIC ASSOCIATION REQUIRES ATHLETES TO HAVE A YEARLY PHYSICAL FORM ON FILE AT THE SCHOOL STATING THE ATHLETE IS MEDICALLY CLEARED TO PARTICIPATE. ULTIMATELY THE GOAL IS INCREASED ACTIVITY LEVEL, LIFELONG LOVE OF EXERCISE AND HEALTHIER LONG-TERM LIFESTYLE. OTHER COLLABORATIVE ACTIVITIES INCLUDED PROVIDING HEALTH SCREENINGS AND PARTICIPATING IN SCHOOL-BASED "HEALTH FAIRS" THROUGHOUT THE 2015-2016 ACADEMIC YEAR. THESE FAIRS INCLUDED OUR REGISTERED DIETICIAN VISITING THE ELEMENTARY GRADES TO PROVIDING BASIC ON-SITE HEALTH SCREENINGS SUCH AS HEIGHT, WEIGHT, BLOOD PRESSURE AND BODY MASS INDEX AT SEVERAL AREA EMPLOYERS. DURING BREAST CANCER AWARENESS MONTH, THE HOSPITAL PRODUCED A VARIETY OF CANCER AWARENESS MATERIALS DISTRIBUTED AT BREAST CANCER AWARENESS EVENTS DURING THE MONTH OF OCTOBER 2014. THE SETTINGS AT WHICH THOSE MATERIALS WERE DISTRIBUTED INCLUDED AREA SCHOOLS AND COMMUNITY EVENTS. NOT ONLY WERE THESE MATERIALS IN PAPER FORM, BUT MANY OF THE SAME MATERIALS WERE PRODUCED AND PUBLISHED ON HOSPITAL SOCIAL MEDIA OUTLETS. HEALTH AND PREVENTIVE CARE REMINDERS WERE ALSO DISTRIBUTED ON SCORECARDS AT THE ANNUAL GOLF TOURNAMENT AND DISTRIBUTED DURING PINK OUT ACTIVITIES IN OCTOBER AND VARIOUS PARADES AT WHICH OUR ORGANIZATION WAS REPRESENTED. TRAINING DEDICATED STAFF MEMBERS TO ASSIST PATIENTS WITH QUESTIONS ABOUT THE HEALTH INSURANCE MARKETPLACE WAS ANOTHER INITIATIVE. REPRESENTATIVES FROM BUSINESS DEVELOPMENT AND FINANCIAL SERVICES ENGAGED WITH THE COVER MISSOURI COALITION AND OTHER RESOURCES TO OBTAIN EDUCATION ABOUT THE INSURANCE MARKETPLACE TO ASSIST PATIENTS AND MEMBERS OF THE PUBLIC WITH ENROLLMENT QUESTIONS. THE GOAL WAS TO ENSURE THAT UNINSURED PATIENTS - AT THE POINT OF ACCESSING CARE - ARE PROVIDED WITH EDUCATIONAL ASSISTANCE AND ENCOURAGED TO ENROLL IN INSURANCE AND, THEREBY, REDUCE THE FINANCIAL BARRIER TO RECEIVING CARE. ADDITIONAL HEALTH NEEDS AND/OR BARRIERS TO OPTIMAL HEALTH IDENTIFIED WERE: -COST AND ABILITY TO PAY FOR CARE (WE DO HAVE A FINANCIAL ASSISTANCE POLICY IN PLACE AND UTILIZE A SLIDING FEE SCHEDULE FOR THOSE IN NEED BOTH AT OUR CERTIFIED RURAL HEALTH CLINICS AND ACROSS OUR ORGANIZATION. WE ALSO OFFER PAYMENT PLANS AND DISCOUNTS FOR PROMPT PAYM SCHEDULE H, PART V, SECTION C, LINES 16A-C FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY: http://www.fitzgibbon.org/page.php?p=2454 SCHEDULE H, PART V, SECTION B, LINE 22D MAXIMUM AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS: AMOUNT GENERALLY BILLED (AGB) IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID TO FH FOR MEDICAL CARE BY MEDICARE FEE-FOR-SERVICE AND PRIVATE INSURANCES IN A PRIOR TWELVE (12) MONTH PERIOD. THIS AMOUNT CAN INCLUDE CO-INSURANCE, COPAYMENTS, AND DEDUCTIBLES. THE AGB WILL BE CALCULATED AT LEAST ANNUALLY. THE AMOUNT GENERALLY BILLED (AGB) EFFECTIVE MAY 1, 2015 WAS CALCULATED BASED ON A ROLLING TWELVE MONTH PERIOD OF APRIL 2015 THROUGH MARCH 2016. MEDICARE FEE-FOR-SERVICE AND PRIVATE INSURANCE CLAIMS WERE USED TO DETERMINE THE AGB OF FORTY PERCENT (40%). SCHEDULE H, PART V 501(R) FAILURE DISCLOSURE: IN MARCH 2017, DURING PREPARATION OF THE FORM 990, THE ORGANIZATION DISCOVERED THAT THE FINANCIAL ASSISTANCE POLICY AND PLAIN LANGUAGE SUMMARY WERE NOT ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION ADDED THESE DOCUMENTS TO THE WEBSITE BEFORE FILING OF THE FORM 990. THIS FAILURE DID NOT AFFECT ANY AMOUNTS BILLED TO FAP-ELIGIBILE INDIVIDUALS AND THEREFORE NO CORRECTIONS WERE NECESSARY. 6 FITZGIBBON PROFESSIONAL BUILDING 2301 S 65 HIGHWAY MARSHALL MO 65340 OB/GYN, SURGERY 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 $7,875,869. 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 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 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 DIRECTORS 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 HOSPITALS 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. THE SALINE COUNTY POPULATION IN 2014 WAS 23,347 RESIDENTS. SALINE COUNTY DATA FOR 2014 SHOWED THE MEDIAN HOUSEHOLD INCOME WAS $39,027. THE AGE DISTRIBUTION OF THE POPULATION IN SALINE COUNTY IN 2014 WAS 72% AGE 54 AND UNDER AND 28% WERE 55 AND OLDER. 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 IS 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 CITY OF MARSHALL MO 214 NORTH LAFAYETTE MARSHALL MO 65340 446000217 CITY OF MARSHAL 15000 COMMUNITY SAFETY 2 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 true false DARIN HAUG DO PRESIDENT/CEO, SEE SCHEDULE O 429487 0 5000 0 420 0 2000 0 2866 0 439773 0 0 0 ANGELA LITTRELL CFO/COO 163791 0 30000 0 924 0 0 0 9890 0 204605 0 0 0 RONALD OTT PRESIDENT/CEO END 4/2015 90832 0 73956 0 114839 0 2000 0 2270 0 283897 0 0 0 KELLY ROSS ORTHOPEDIC SURGEON 561275 0 0 0 39951 0 2000 0 0 0 603226 0 0 0 JOHN B BRIZENDINE GENERAL SURGEON 337500 0 0 0 79478 0 2000 0 0 0 418978 0 0 0 KAREN SONG OB/GYN 347492 0 0 0 185 0 0 0 366 0 348043 0 0 0 LORENZO M ROMNEY DO DIRECTOR, SEE SCHEDULE O 318798 0 0 0 16669 0 2000 0 508 0 337975 0 0 0 BRIAN ELLEFSEN ORTHOPEDIC SURGEON 313143 0 0 0 0 0 2000 0 312 0 315455 0 0 0 KATHRYN LYNNE OTT VICE PRESIDENT OF NURSING SERV 152655 0 34950 0 2175 0 2000 0 3668 0 195448 0 0 0 DENNIS SOUSLEY VP OF CLINICAL SERVICES 163041 0 5000 0 7892 0 2000 0 3051 0 180984 0 0 0 RAVINDER ARORA NEUROLOGIST 279418 0 0 0 0 0 0 0 0 0 279418 0 0 0 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: NON-FIXED PAYMENTS MADE WERE BASED ON PERFORMANCE OF THE INDIVIDUALS AND ORGANIZATION. BONUSES ARE PAID TO INDIVIDUALS WHO HAVE CONTRIBUTED POSITIVELY TO THE ORGANIZATION AND THEIR PERFORMANCE HAS ALLOWED THE ORGANIZATION TO MEET DEPARTMENTAL AND ORGANIZATION GOALS AS OUTLINED ON THE ANNUAL PERFORMANCE APPRAISAL. THESE GOALS INCLUDE, BUT ARE NOT LIMITED TO, SAFETY, PATIENT SATISFACTION AND FINANCIAL PERFORMANCE. FITZGIBBON HOSPITAL HAS AN AGREEMENT WITH BOONE HOSPITAL CENTER WHICH ALLOWS BOONE HOSPITAL TO OVERSEE AND ASSIST IN EVALUATING THE WORK AND PERFORMANCE OF THE PRESIDENT OF THE HOSPITAL AND IN DETERMINING THE COMPENSATION AND BENEFITS TO WHICH THE BENEFITS TO WHICH THE PRESIDENT WILL BE ENTITLED. THEREFORE, THE BONUSES WERE DETERMINED BY BOONE HOSPITAL IN CONSULTATION WITH THE FITZGIBBON HOSPITAL BOARD PRESIDENT. THE BONUS AMOUNTS WERE A PERCENTAGE OF THE BASE SALARIES. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT: RONALD OTT RECEIVED A SEVERANCE PAYMENT OF $80,594 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 530000 0 12218468 1142213 0 11985656 232812 0 0 0 0 0 2010 true false true true B 0 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 134098 PHARMACY false TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV, LINE 1, COLUMN B: SCOTT HARTWIG, BOARD MEMBER, OWNS 47.5% OF RED CROSS PHARMACY. X 9 5019 COST X 4915 COST X 27 6139 COST X VACATION PKGS 2 8000 COST X EQUIPMENT 1 6000 FMV X TICKETS 3 1290 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, 2016, THE EMERGENCY ROOM EXPERIENCED 12,119 PATIENT VISITS. THE SURGICAL TEAM PERFORMED 293 IN-PATIENT PROCEDURES AND 1,912 OUT-PATIENT PROCEDURES. THE RADIOLOGY GROUP PERFORMED 29,388 PROCEDURES WHICH INCLUDE 2,776 MAMMOGRAMS, 4,424 CT SCANS, 2,261 MRI'S, 2,608 ULTRASOUND IMAGES AND 2,247 NUCLEAR MEDICINE SCANS. THE LABORATORY TEAM PERFORMED 89,667 TESTS. THE RESPIRATORY THERAPY DEPARTMENT CONDUCTED 32,269 PATIENT TREATMENTS AND THE REHABILITATIVE SERVICES GROUP WHICH INCLUDES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES PROVIDED 45,170 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 1,278 PATIENT VISITS AT THE FACILITY. IN ADDITION, THE STAFF EDUCATED OVER 1,615 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 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, DIRECTORS, AND KEY EMPLOYEES TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. ALL CONFLICTS MUST BE REVIEWED BY THE CEO AND/OR BOARD OF DIRECTORS. 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 BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. BOARD MEMBER LORENZO ROMNEY IS EMPLOYED BY JOHN FITZGIBBON MEMORIAL HOSPITAL AND COMPENSATED FOR HIS ROLES AS HOSPITALIST & CLINIC PHYSICIAN. HE ALSO SERVES AS THE MEDICAL STAFF PRESIDENT. JACK UHRIG, MD, RECEIVED NONEMPLOYEE COMPENSATION FOR OTHER SERVICES PROVIDED TO THE ORGANIZATION. OFFICER DARIN HAUG, DO, BEGAN AS PRESIDENT/CEO IN MAY 2015. HE ALSO SERVES AS CHIEF MEDICAL OFFICER & EMERGENCY ROOM PHYSICIAN. THE COMPENSATION LISTED IN FORM 990, PART VII, SECTION A, IS FOR CALENDAR YEAR 2015 AND INCLUDES HIS COMPENSATION FOR HIS ROLES AS PRESIDENT/CEO, CHIEF MEDICAL OFFICER, AND EMERGENCY ROOM PHYSICIAN. 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) 9 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 106654 FMV FITZGIBBON HEALTH SERVICES Q 686360 FMV