2016-07-12T06:58:39-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2014-10-01 430662495 HANNIBAL REGIONAL HEALTHCARE SYSTEM INC HANN 5732481300 6500 HOSPITAL DRIVE PO BOX 551 HANNIBAL MO 63401 ROGER DIX CHIEF FINANCIAL OFFICER 5732481300 2016-06-29 1 JEFF PARKER P00970069 3149254300 2014 2016-09-27 15:27:22Z C TODD AHRENS 6500 HOSPITAL DRIVE PO BOX 551 HANNIBAL MO 63401 127532535 0 X WWW.HRHONLINE.ORG X 1987 MO SYSTEM OPERATES A FULL SERVICE ACUTE CARE FACILITY 13 12 1049 279 0 0 604340 917708 123830316 122089502 2149338 2014873 2279316 2171452 128863310 127193535 105252 44699 0 0 66800149 66695836 0 0 368296 54557662 54181374 121463063 120921909 7400247 6271626 136145065 142040624 43425839 48497274 92719226 93543350 TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES FOR A BETTER LIFE. 0 0 105540020 44699 123214921 THE SYSTEM OPERATES A FULL SERVICE 91 BED ACUTE CARE HOSPITAL FACILITY, SEVERAL PHYSICIAN PRACTICES AND PRIMARY CARE CLINICS, AND A HOME HEALTH AGENCY IN HANNIBAL MISSOURI AND SURROUNDING COUNTIES. 17,232 TOTAL INPATIENT DAYS WERE PROVIDED DURING THE COURSE OF THE YEAR. THE SYSTEM PROVIDES SERVICES TO PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE POLICY AS WELL AS SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. THE TOTAL COST OF UNCOMPENSATED CARE WAS, CHARITY CARE - $3,369,556 AND STATE MEDICAID AND OTHER PUBLIC AID PROGRAMS - $4,178,362. 105540020 1 1 0 1 0 1 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 132 0 1049 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X ROGER DIX 5732481300 6500 HOSPITAL DRIVE HANNIBAL MO 63401 ROBERT GILSTRAP DIRECTOR 1.00 X 789 0 0 JACK WHITAKER CHAIRPERSON 1.00 X X 0 0 0 CAROLYN SHAW SECRETARY 1.00 X X 0 0 0 PAUL EWERT VICE CHAIRPERSON 1.00 X X 0 0 0 DIRK SAUER DIRECTOR 1.00 X 0 0 0 STEVE MILLER SECRETARY PRO TEM 1.00 X X 737 0 0 JASON POAGE TREASURER 1.00 X X 0 0 0 JERRY TROWER ASST TREASURER 1.00 X X 0 0 0 LINDA STRAUBE DIRECTOR 1.00 X 0 0 0 GENE SCHOLES JR DIRECTOR 1.00 X 0 0 0 PAT BENSON DIRECTOR 1.00 X 0 0 0 ERIK MEIDL DIRECTOR 1.00 X 0 0 0 RICHARD VALUCK DIRECTOR/CARDIOLOGIST 40.00 X 598427 0 40131 C TODD AHRENS PRESIDENT & CEO 40.00 1.00 X 468621 0 133384 ROGER DIX VICE PRESIDENT - FINANCIAL SERVICES 40.00 X 362437 0 84294 LYNN OLSON CEO - HOSPITAL 40.00 1.00 X 355053 0 74641 TIMOTHY REUSCHEL VICE PRESIDENT - GENERAL COUNSEL 40.00 X 270160 0 34800 JULIE LEVERENZ VICE PRESIDENT - STRATEGY & PLANNING 40.00 X 209190 0 81597 PRANAV PARIKH MD VICE PRESIDENT - QUALITY & MEDICAL AFFAIRS 20.00 X 231710 0 9268 SARAH BRADSHAW VICE PRESIDENT - NURSING 40.00 X 213274 0 64394 G DOUG RUBLE VICE PRESIDENT - FACILITIES 40.00 X 173953 0 48828 JEFF EVANS VICE PRESIDENT - INFORMATION & TECHNOLOGY 40.00 X 335022 0 32207 SUSAN WATHEN VICE PRESIDENT - HUMAN RESOURCES 40.00 X 163068 0 47158 TIMOTHY POLLEY EXECUTIVE DIRECTOR 40.00 X 317223 0 44616 WENDY HARRINGTON PRESIDENT & CEO - HRH FOUNDATION 40.00 X 152397 0 51224 LUVELL GLANTON ANESTHESIOLOGIST - PAIN MANAGEMENT 40.00 X 781065 0 44264 HARSHA DESAI PATHOLOGIST 40.00 X 581621 0 41723 STEPHEN SHERWOOD EMERGENCY ROOM PHYSICIAN 40.00 X 567687 0 45206 PERVEZ ALVI CARDIOLOGIST 40.00 X 542519 0 29214 KEVIN LOLLAR PHYSICIAN 40.00 X 425332 0 24784 6750285 0 931733 76 0 1 0 BANC OF AMERICA LEASING PO BOX 100918 ATLANTA GA 30384 LEASING COMPANY 1374327 MURRAY COMPANY INC 1215 FERN RIDGE PARKWAY SUITE 213 SAINT LOUIS MO 63141 BUILDING CONTRACTOR 1358096 ALLSCRIPTS HEALTHCARE LLC PO BOX 8538-0133 PHILADELPHIA PA 19171 IT SERVICES 1303798 HOUSE AFH LLC 148 STONE RIDGE DRIVE HANNIBAL MO 63401 LOCUM PHYSICIAN 674713 DONALD A MILLER DO PLLC 3850 WASHINGTON ST HOLLYWOOD FL 33021 LOCUM PHYSICIAN 642950 39 917708 917708 NET PATIENT SERVICE REVENUE 621110 120655935 120655935 EHR MEANINGFUL USE 621110 1433567 1433567 122089502 1528939 1528939 330492 28173 302319 302319 302319 768373 28388 171124 139703 597249 -111315 485934 485934 CHILDREN'S DEVELOPMENT CENTER 624410 719862 719862 CAFETERIA 722210 600751 600751 CONTRACTED SERVICES 621110 260293 260293 288227 145264 142963 1869133 127193535 123214921 0 3060906 44699 44699 3550581 536817 3013764 46998719 40572317 6148133 278269 2083775 1799506 272688 11581 10919257 9429646 1428923 60688 3143504 2714416 411330 17758 382413 382413 97500 97500 25069 21701 3368 10485253 10429728 55525 791691 791691 17921656 15513592 2408064 781878 676820 105058 1489123 1289035 200088 691414 598511 92903 147360 127560 19800 814926 705428 109498 8483801 8483801 697086 603421 93665 BAD DEBT EXPENSE 6148259 6148259 PHARMACY DRUGS 2949223 2949223 RECRUITING EXPENSE 733180 634665 98515 FOOD 686497 686497 855045 782687 72358 120921909 105540020 15013593 368296 17513688 15979575 1260378 1512892 13780703 14681850 22500 1128047 1212160 2376402 2699743 881968 773239 143529929 95471386 47035604 48058543 44574801 50005661 611358 404174 373772 349383 6608344 6340904 136145065 142040624 21455304 25248378 13952527 12466969 3885328 5766918 4132680 5015009 43425839 48497274 X 87880141 89143883 4839085 4399467 92719226 93543350 136145065 142040624 X 6271626 -2291170 -3156332 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 25069 0 0 0 25069 0 PART II-B, LINE 1: PORTION OF MISSOURI HOSPITAL ASSOCIATION DUES RELATED TO LOBBYING 1 1826 6961 25026 0 0 2693370 2693370 64682949 37646347 27036602 7124877 5531979 1592898 67827550 52293060 15534490 1201183 1201183 48058543 MINIMUM PENSION LIABILITY 3048546 SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN 1966463 5015009 X PART X, LINE 2: THE SYSTEM 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 SYSTEM IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE SYSTEM APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. 1 1 X 1 X 0 1 1 1 0 1 1 2869336 659712 2209624 0.01930 10365166 6992649 3372517 0.02950 13234502 7652361 5582141 0.04880 14992752 6010640 8982112 0.07850 346379 346379 0.00300 278146 278146 0.00240 15617277 6010640 9606637 0.08390 28851779 13663001 15188778 0.13270 1784062 751591 1032471 0.00900 1226 1226 0.00000 755291 755291 0.00660 2540579 751591 1788988 0.01560 1 6148259 4611194 39109817 48594284 -9484467 X 1 1 1 HANNIBAL MEDICAL SUPPLY DME COMPANY 0.33000 0.33000 2 HANNIBAL MOBILE DIAGNOSTICS MOBILE IMAGING/RADIOLOGY SERVICES 0.50000 0.50000 3 ADVANCE HANNIBAL REGIONAL HOSPITAL LLC OUTPATIENT PHYSICAL THERAPY 0.50000 0.50000 1 1 HANNIBAL REGIONAL HOSPITAL 6000 HOSPITAL DRIVE HANNIBAL MO 63401 101-57 X X X HANNIBAL REGIONAL HEALTHCARE SYSTEM INC 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X HANNIBALHEALTH.ORG X 1 13 1 HANNIBALHEALTH.ORG 0 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X HRHONLINE.ORG X HRHONLINE.ORG X HRHONLINE.ORG X X X 1 0 X X X X X 1 X 0 0 HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 5: A BROAD-BASED STEERING COMMITTEE OF HEALTHCARE LEADERS FROM THROUGHOUT THE SIX COUNTY REGION WAS FORMED TO GUIDE THE ASSESSMENT PROCESS AND ESTABLISH THE THREE-YEAR STRATEGY TO ADDRESS THE PRIORITIES IDENTIFIED. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 6A: PIKE COUNTY MEMORIAL HOSPITAL, LOUISIANA, MISSOURI HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 6B: SIX COUNTY HEALTH DEPARTMENTS, FREE CLINIC, FQHC, MULTIPLE SOCIAL SERVICE AGENCIES, NON-EMPLOYED PHYSICIAN GROUPS AND OTHERS. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 11: BROAD-BASED OVERSIGHT GROUP IS MEETING ON A QUARTERLY BASIS TO ASSESS PROGRESS AND INFLUENCE THE WORK ESTABLISHED IN THE PLAN; A VARIETY OF BEHAVIORAL HEALTH SERVICES HAVE EMERGED IN THE REGION DUE TO THE VISIBILITY OF THIS PROBLEM; MENTAL HEALTH FIRST AID CLASSES ARE RAISING HEALTH LITERACY; SERVICES HAVE BEEN EXPANDED AT THE LOCAL FREE CLINIC TO ADDRESS BY ACCESS TO CARE, MENTAL HEALTH AND DENTAL HEALTH; A POPULATION HEALTH GRANT IS RESULTING IN REDUCING THE INCIDENCE OF EMERGENCY DEPARTMENT VISITS FOR PATIENTS WITH CHRONIC DISEASE WHO WERE FORMERLY HIGH UTILIZERS; A NEW FQHC HAS ADDED MENTAL HEALTH AND DENTAL HEALTH CAPACITY IN THE REGION; A COMMUNITY HEALTH INITIATIVE KNOWN AS "LIVING BETTER" IS BEGINNING TO EMERGE AND IS INTENDED TO ENHANCE THE SOCIAL VALUING OF HEALTH; COME COMMITTED COALITIONS FOCUSING ON THE PRIORITY PROBLEMS IDENTIFIED IN THE CHNA ARE NOW IN PLACE. ALTHOUGH WE'RE EXPERIENCING PROGRESS, ACCESS TO DENTAL HEALTH AND MENTAL HEALTH CONTINUE TO BE SIGNIFICANT PROBBLEMS. COORDINATION OF CARE IN THE COMMUNITY CONTINUES TO BE A HIGH PRIORITY. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 13B: THE PATIENTS ABILITY TO PAY OUTSIDE OF NORMAL LIVING EXPENSES AND DEBT HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 20E: COMMUNICATIONS THROUGH MAIL AND PHONE INTERVIEWS ARE PURSUED TO RESOLVE ISSUES AND OBTAIN NEEDED INFORMATION TO QUALIFY PATIENTS. HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. PART V, SECTION B, LINE 22D: THE ABILITY TO PAY IS BASED ON THE PATIENTS AVAILABLE ASSETS OR EXPECTED INCOME AVAILABLE TO MEET THE AMOUNTS OUTSTANDING. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC PART V, SECTION B, LINE 16A WEBSITE: HRHONLINE.ORG HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC PART V, SECTION B, LINE 16B WEBSITE: HRHONLINE.ORG HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC PART V, SECTION B, LINE 16C WEBSITE: HRHONLINE.ORG PART I, LINE 3C: THE CRITERIA UTILIZED TO DETERMINE ELIGIBILITY FOR CHARITY CARE IS BASED ON THE ABILITY TO PAY. A PERSON IS ELIGIBLE FOR CHARITY CARE IF THEY MEET ANY OF THE FOLLOWING CRITERIA; THEIR INSURANCE IS INADEQUATE, THEY ARE UNINSURED, PATIENTS WITH A FAMILY INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINE, PATIENTS WITH A SPENDABLE INCOME THAT IS LESS THAN 5% OF THE BALANCE OWED TO THE HOSPITAL, THERE IS LESS THAN $2,000 IN TOTAL ASSETS AVAILABLE TO PAY HOSPITAL EXPENSES (EXCEPTIONS HOME EQUITY, AUTO EQUITY, LIFE INSURANCE EQUITY). PART I, LINE 6A: THE MISSOURI HOSPITAL ASSOCIATION HAS INCLUDED HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. IN THEIR ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: COST ACCOUNTING PART I, LN 7 COL(F): A GROSS ESTIMATE WAS MADE BASED ON CURRENT EXPERIENCE. PART III, LINE 2: HISTORICAL EXPERIENCE WAS USED TO ESTIMATE BAD DEBTS BY PAYOR CLASSIFICATION AND AGING CO-HORT PART III, LINE 3: AN ESTIMATE BASED ON AVAILABLE DATA PART III, LINE 4: THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE SYSTEM BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AT SEPTEMBER 30, 2015 AND 2014, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WAS APPROXIMATELY $4,501,000 AND $5,338,000, RESPECTIVELY. PART III, LINE 8: SOME MEDICARE SERVICES ARE PAID AT SUBSTANTIALLY LESS THAN COST THROUGH THE PROGRAM. THESE SERVICES COULD BE ELIMINATED TO INCREASE MARGIN BUT ARE PROVIDED IN THIS COMMUNITY DESPITE THE LOSS. PART III, LINE 9B: WHEN CHARITY CONSIDERATION IS REQUESTED ALL COLLECTION EFFORTS ARE HALTED UNTIL A DETERMINATION ON ELIGIBILITY IS MADE. COLLECTION EFFORTS ARE RESUMED ONLY IF THE INDIVIDUAL DOES NOT MEET ONE OF THE CHARITY CRITERIA. PART VI, LINE 2: THE ORGANIZATION RECEIVES ANNUAL UPDATES ON THE HEALTH STATUS OF ITS POPULATION FROM THE STATE THAT INCLUDE MORTALITY AND DISEASE STATUS. THE ORGANIZATION ALSO MONITORS NATIONAL DATA ON TRENDS AND DISEASE STATUS. PART VI, LINE 3: THE ORGANIZATION MAINTAINS EDUCATIONAL PROGRAMS TO KEEP STAFF APPRISED OF ALL POTENTIAL PROGRAMS THAT MIGHT ASSIST PATIENTS IN PAYING THEIR HOSPITAL CLAIM. STAFF MEMBERS ARE ENCOURAGED TO UTILIZE THIS KNOWLEDGE TO RECONCILE ALL OUTSTANDING BALANCES. PART VI, LINE 4: THE ORGANIZATION SERVES THE POPULACE OF AN 8 COUNTY REGION IN NORTHEAST MISSOURI. THE AREA IS PRIMARILY A RURAL FARMING AREA WITH NUMEROUS POCKETS OF MEDICALLY UNDERSERVED AREAS. RESIDENTS ARE SERVED BY DISTANT ORGANIZATIONS IN COLUMBIA, MO AND ST. LOUIS, MO. CARE CAN ALSO BE ACCESSED IN QUINCY, IL. PART VI, LINE 5: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, LINE 4A. 1 AMERICAN CANCER SOCIETY 3145 HIGHWAY 61 HANNIBAL MO 63401 131788491 501(C)(3) 7635 2015 PARTNERSHIP COMMITMENT AND 2015 JECCC ON T-SHIRT AND SPONSORSHIP MHA CENTER FOR EDUCATION PO BOX 60 JEFFERSON CITY MO 65102 430898947 501(C)(3) 37064 MCE HEALTH IMPR., RESEARCH AND SCHOLARSHIP FUND, MHA SPECIAL PROJECTS, MISSOURI CENTER FOR PATIENT SAFETY CONTRIBUTION AND DELIVERABLES, MISSOURI POISON CENTER CONTRIBUTION 2 PART I, LINE 2: POLICY GA 1-112 CORPORATE CITIZENSHIP GUIDES THE ORGANIZATION IN CONTRIBUTING TO OTHER ORGANIZATIONS. ALL ACTIVITIES WHICH CONSTITUTE A CHARITABLE CONTRIBUTION ARE DOCUMENTED ON THE CHARITABLE CONTRIBUTION FORM. X 1 1 X X X X 1 1 0 0 0 0 0 1 0 RICHARD VALUCK DIRECTOR/CARDIOLOGIST 598427 0 0 0 0 0 0 0 40131 0 638558 0 0 0 C TODD AHRENS PRESIDENT & CEO 397078 0 59912 0 11631 0 85600 0 47784 0 602005 0 0 0 ROGER DIX VICE PRESIDENT - FINANCIAL SERVICES 313587 0 38825 0 10025 0 53778 0 30516 0 446731 0 0 0 LYNN OLSON CEO - HOSPITAL 302722 0 38306 0 14025 0 31664 0 42977 0 429694 0 0 0 TIMOTHY REUSCHEL VICE PRESIDENT - GENERAL COUNSEL 226452 0 33354 0 10354 0 23100 0 11700 0 304960 0 0 0 JULIE LEVERENZ VICE PRESIDENT - STRATEGY & PLANNING 184025 0 14190 0 10975 0 39310 0 42287 0 290787 0 0 0 PRANAV PARIKH MD VICE PRESIDENT - QUALITY & MEDICAL A 214652 0 17058 0 0 0 0 0 9268 0 240978 0 0 0 SARAH BRADSHAW VICE PRESIDENT - NURSING 194133 0 11185 0 7956 0 18401 0 45993 0 277668 0 0 0 G DOUG RUBLE VICE PRESIDENT - FACILITIES 148136 0 10279 0 15538 0 14238 0 34590 0 222781 0 0 0 JEFF EVANS VICE PRESIDENT - INFORMATION & TECHN 149401 0 0 0 185621 0 0 0 32207 0 367229 0 0 0 SUSAN WATHEN VICE PRESIDENT - HUMAN RESOURCES 145080 0 11115 0 6873 0 15620 0 31538 0 210226 0 0 0 TIMOTHY POLLEY EXECUTIVE DIRECTOR 295057 0 13602 0 8564 0 23550 0 21066 0 361839 0 0 0 WENDY HARRINGTON PRESIDENT & CEO - HRH FOUNDATION 133958 0 11913 0 6526 0 14071 0 37153 0 203621 0 0 0 LUVELL GLANTON ANESTHESIOLOGIST - PAIN MANAGEMENT 717315 0 63750 0 0 0 0 0 44264 0 825329 0 0 0 HARSHA DESAI PATHOLOGIST 581621 0 0 0 0 0 0 0 41723 0 623344 0 0 0 STEPHEN SHERWOOD EMERGENCY ROOM PHYSICIAN 548887 0 0 0 18800 0 0 0 45206 0 612893 0 0 0 PERVEZ ALVI CARDIOLOGIST 542519 0 0 0 0 0 0 0 29214 0 571733 0 0 0 KEVIN LOLLAR PHYSICIAN 396582 0 0 0 28750 0 0 0 24784 0 450116 0 0 0 PART I, LINE 1A STEVE MILLER, TRAVEL, $737 ROBERT GILSTRAP, TRAVEL, $789 PART I, LINE 1B ALL EXPENSES WERE APPROVED THROUGH THE NORMAL CHECK REQUEST AND EXPENSE REPORT PROCESS WHICH REQUIRES TWO SIGNATURES. CEO EXPENSES ARE APPROVED BY A BOARD MEMBER AND VALIDATED BY THE CONTROLLER, ALL BOARD MEMBER EXPENSES ARE APPROVED BY THE CEO AND VALIDATED BY THE CONTROLLER, AND ALL OFFICER AND KEY EMPLOYEE EXPENSES ARE APPROVED BY THE CEO AND VALIDATED BY THE CONTROLLER OR ANOTHER OFFICER. PART I, LINES 4A-B ROGER DIX, SERP, $53,778 SARAH BRADSHAW, SERP, $18,915 G. DOUG RUBLE, SERP, $14,238 TIMOTHY POLLEY, SERP, $66,393 JEFF EVANS, SEVERANCE, $180,000 PART I, LINE 7 THE ORGANIZATION PROVIDES BONUSES BASED UPON THE ORGANIZATION'S FINANCIAL OUTCOME. A THE INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HANNIBAL MISSOURI 531320446 410632AT0 2006-04-01 24064011 HOSPITAL REFUNDING REVENUE BONDS 0 0 0 A 11330000 26630884 2144250 410812 24075822 2014 1 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 1 SOCIETE GENERALE 14.800000000000 1 0 1 A 1 STEPHEN SHERWOOD PHYSICIAN RELOCATION X 25000 22500 0 1 1 22500 FORM 990, PART VI, SECTION A, LINE 4 ORGANIZATIONAL DOCUMENTS WERE CHANGED TO IDENTIFY THAT HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC. IS NOW THE SOLE MEMBER OF HANNIBAL REGIONAL HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11 THE PREPARED FORM 990 WILL BE FORWARDED TO EACH MEMBER OF THE BOARD OF DIRECTORS, AS WELL AS THE OFFICERS OF THE CORPORATION APPROXIMATELY ONE WEEK PRIOR TO A REGULAR BOARD MEETING AT WHICH THE PREPARED FORM 990 WILL BE ON THE AGENDA. THE CHIEF FINANCIAL OFFICER WILL PRESENT THE PREPARED FORM 990 TO THE BOARD OF DIRECTORS AND ENTERTAIN QUESTIONS FROM DIRECTORS AND OFFICERS. THE CHIEF EXECUTIVE OFFICER AND GENERAL COUNSEL FOR THE CORPORATION WILL ALSO BE PRESENT TO ASSIST WITH QUESTIONS FOR THE DIRECTORS AND OFFICERS. THIS PROCEDURE WILL BE COMPLETED PRIOR TO THE FILING OF THE PREPARED FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A POLICY TITLED BUSINESS ETHICS AND CONFLICT OF INTEREST WHICH REQUIRES THAT ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THE SYSTEM ALWAYS ACT IN THE BEST INTEREST OF THE SYSTEM WITHOUT CONFLICTS OF INTEREST. ANNUALLY EACH MEMBER OF THE BOARD OF DIRECTORS, EACH OFFICER OF THE ORGANIZATION, AND CERTAIN OTHER MANAGERS RECEIVE A COPY OF THE POLICY AND ARE REQUIRED TO COMPLETE A CONFIDENTIALITY AGREEMENT AND A CONFLICT OF INTEREST QUESTIONNAIRE WHEREBY THE INDIVIDUAL ANSWERS QUESTIONS REGARDING FAMILY MEMBERS, SUBSTANTIAL BUSINESS OR INVESTMENT HOLDINGS, AND OTHER TRANSACTIONS OR AFFILIATIONS WITH BUSINESSES OR OTHER ORGANIZATIONS THAT MIGHT AFFECT THEIR RELATIONSHIP WITH THE SYSTEM. AS PART OF THE CONFLICTS OF INTEREST QUESTIONNAIRE THE INDIVIDUAL IS ASKED TO ACKNOWLEDGE THAT THEY HAVE RECEIVED AND READ A COPY OF THE POLICY, AGREE TO COMPLY WITH THE POLICY, ACKNOWLEDGE THAT THE SYSTEM IS A CHARITABLE ORGANIZATION, WHICH MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH OUR TAX EXEMPT PURPOSES IN ORDER TO MAINTAIN OUR TAX EXEMPT STATUS, AGREE TO REPORT PROMPTLY TO THE BOARD OF DIRECTORS ANY CHANGES IN THEIR ANSWERS TO THE QUESTIONS OR ANY CHANGE IN CIRCUMSTANCE THAT MIGHT DEVELOP PRIOR TO THE COMPLETION OF THEIR NEXT ANNUAL QUESTIONNAIRE. WITH RESPECT TO DIRECTORS OF THE ORGANIZATION, THEY ALSO ACKNOWLEDGE THAT NONE OF THE CONDITIONS OF THE POLICY WHICH WOULD MAKE THEM INELIGIBLE TO REMAIN ON THE BOARD EXIST AT THE TIME THEY SIGN THE ACKNOWLEDGMENT AND THAT THEY WOULD REPORT ANY CONDITIONS WHICH BECOME APPLICABLE IMMEDIATELY TO THE CHAIRPERSON OF THE BOARD OF DIRECTORS. ON AN ANNUAL BASIS THESE DOCUMENTS ARE SENT BY THE SECRETARY OF THE SYSTEM TO EACH INTERESTED PERSON AND TO THOSE EMPLOYEES OF THE SYSTEM THAT THE BOARD DETERMINES. THE DOCUMENT IS COMPLETED BY THE INDIVIDUAL AND RETURNED TO THE SECRETARY OF THE BOARD THROUGH GENERAL COUNSEL, WHO ANNUALLY ANALYZES ANY DISCLOSED CONFLICT OF INTEREST OR ANY OTHER FACT THAT MIGHT MAKE THE INDIVIDUAL NOT INDEPENDENT FOR IRS TAX EXEMPT PURPOSES. THE SECRETARY THEN SUBMITS TO THE BOARD OF DIRECTORS A CONFIDENTIAL REPORT CONCERNING ANY INTEREST OF EMPLOYEES OF THE SYSTEM DISCLOSED BY SUCH QUESTIONNAIRE, ANY INTEREST OF DIRECTORS AND OFFICERS WHO ARE NOT EMPLOYEES OF THE SYSTEM, AND WHAT ACTIONS THE PRESIDENT OF THE ORGANIZATION MAY TAKE AS A RESULT OF ANY CONFLICTS DISCLOSED BY SUCH INDIVIDUALS. AN INDIVIDUAL IS INELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS FOR ANY OF THE FOLLOWING REASONS AS TAKEN FROM HANNIBAL REGIONAL SYSTEM BOARD OF DIRECTORS POLICY B-VII: A. FAILURE TO ADHERE COMPLETELY TO DISCLOSURE REQUIREMENTS; B. THE INDIVIDUAL IS AN OWNER, PARTNER, EMPLOYEE, BOARD MEMBER OR INVESTOR IN A DIRECT COMPETITOR OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM. AN OWNERSHIP OR INVESTMENT INTEREST IN A DIRECT COMPETITOR OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM, OF FIVE (5) PERCENT OR LESS WILL NOT MAKE INDIVIDUAL INELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS; C. THE INDIVIDUAL IS AN EMPLOYEE OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM, OR A FAMILY MEMBER IS A MEMBER OF THE MANAGEMENT TEAM OF THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM; D. THE INDIVIDUAL RECEIVES DIRECT COMPENSATORY BENEFIT FOR ONGOING SERVICES PROVIDED TO THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM (SERVING AS A "DE FACTO EMPLOYEE"); E. THE INDIVIDUAL IS AN OWNER, PARTNER, EMPLOYEE, BOARD MEMBER OR INVESTOR OR OTHER VENDOR WHO RECEIVES A SUBSTANTIAL AMOUNT OF REVENUE FROM THE SYSTEM, OR ANY ENTITY AFFILIATED WITH THE SYSTEM - THE GREATER OF $200,000.00 OR 2% OF THE ANNUAL REVENUES OF THAT VENDOR IN THE PRECEDING OR CURRENT YEAR. F. THE INDIVIDUAL IS AN OWNER, PARTNER, EMPLOYEE, BOARD MEMBER OR INVESTOR OF AN ENTITY WHO HAS CONTRACTED WITH SYSTEM FOR THE EXCLUSIVE PROVISION OF ANY MEDICAL SERVICES WITHIN THE SYSTEM, OR ITS AFFILIATES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS DELEGATED TO THE COMPENSATION COMMITTEE, PURSUANT TO A CHARTER ADOPTED BY THE BOARD OF DIRECTORS, THE RESPONSIBILITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS IN ADMINISTERING COMPENSATION PLANS AND IN MAKING DECISIONS ON THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER AND THOSE EXECUTIVES WHO REPORT DIRECTLY TO THE CHIEF EXECUTIVE OFFICER WHO QUALIFY AS "DISQUALIFIED PERSONS" WITHIN THE MEANING OF SECTION 4958 OF THE INTERNAL REVENUE CODE. THE COMMITTEE THEN REPORTS ITS ACTIONS TO THE BOARD OF DIRECTORS. THE COMMITTEE IS COMPOSED SOLELY OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE SCOPE OF THE COMMITTEE INCLUDES, BUT IS NOT LIMITED TO, REVIEWING AND APPROVING THE ANNUAL BASE SALARY LEVELS, ANNUAL INCENTIVE OPPORTUNITY LEVELS, EXECUTIVE PERQUISITES, EMPLOYMENT AGREEMENTS, BENEFITS AND SUPPLEMENTAL BENEFITS. FORM 990, PART VI, SECTION C, LINE 19 THE ARTICLES OF INCORPORATION AND AMENDMENTS THERETO ARE AVAILABLE ON THE MISSOURI SECRETARY OF STATE'S WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY -2,716,714. PEARL LOWRIE FUND NET ACTIVITY -5,135. NET CONTRIBUTION REVENUE FROM FOUNDATION -434,483. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S POLICY REGARDING OVERSIGHT OF AUDIT IS CONSISTENT WITH THE PRIOR YEAR. 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