2014-03-14T14:07:19-05:00 2013-04-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2012-05-01 440655986 JOHN FITZGIBBON MEMORIAL HOSPITAL % ROBERTA NIENHUESER JOHN 6608867431 2305 S 65 HIGHWAY PO BOX 250 Suite MARSHALL MO 65340 RONALD A OTT 6608867431 2014-03-06 true Brian D Todd 4178658701 2012 2015-11-30 17:44:51Z RONALD A OTT 2305 S 65 HIGHWAY MARSHALL MO 65340 55079871 false X www.fitzgibbon.org X 1923 MO TO IMPROVE THE HEALTH OF OUR COMMUNITY BY OFFERING QUALITY HEALTH CARE SERVICES, IMPROVING ACCESS & OUTCOMES, EMPOWERING THE COMMUNITY & PEOPLE WE SERVE, & PARTICIPATING IN HEALTH CARE PARTNERSHIPS. 12 10 627 60 0 0 215558 208149 54203327 54489658 227551 249357 45384 14541 54691820 54961705 12000 12000 0 0 22977067 24747211 0 0 40852 29846908 27653450 52835975 52412661 1855845 2549044 55752440 58481007 22649341 22842176 33103099 35638831 X TO IMPROVE THE HEALTH OF OUR COMMUNITY. false false 38352421 42472220 HOSPITAL SERVICE - FITZGIBBON HOSPITAL IS A 60 BED ACUTE CARE FACILITY SERVING MARSHALL, MO & 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 & REHABILITATIVE SERVICES ARE AVAILABLE ON SITE. FOR MORE INFORMATION, SEE SCHEDULE O. 5104257 5259248 CLINIC SERVICE-SPECIALTY CLINICS WITHIN THE HOSPITAL PROVIDE ORTHOPEDIC, WOUND CARE, NEUROLOGIC & PAIN MANAGEMENT SERVICES TO BOTH IN & OUT-PATIENTS. THESE CLINICS PROVIDED SERVICES TO 13,448 PATIENTS. THE HOSPITAL ALSO SUPPORTS A SEPARATE OUT-PATIENT CLINIC ON CAMPUS FOR FAMILY MEDICINE, OB/GYN, GENERAL SURGERY & PSYCHIATRY STAFFED MEDICAL PROFESSIONALS PRACTICING IN THESE SPECIALTIES FOR FISCAL YEAR 2013. THIS CLINIC PROVIDED SERVICES FOR 18,789 PATIENT VISITS. TWO SATELLITE FAMILY PRACTICE CLINICS ARE ALSO SUPPORTED BY THE HOSPITAL. THESE CLINICS PROVIDED SERVICES FOR 14,544 PATIENT VISITS. 1204018 12000 1957520 COMMUNITY HEALTH SERVICES - HOSPICE, HOME HEALTH, & HOMEMAKER SERVICES. HOSPICE PROVIDED 4,043 PALLIATIVE CARE VISITS, 168 WERE FREE FOR PATIENTS W/O INSURANCE. HOME HEALTH PROVIDED 6,740 VISITS & HOMEMAKER PERFORMED 11,854 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 DONATES $12,000 ANNUALLY TO OATS TO HELP SUSTAIN IT IN THE MARSHALL COMMUNITY. THE PROGRAM PROVIDED TRANSPORTATION FOR 3,587 RIDERS DURING FY 2013. 639732 4800670 45300428 true true false true false false false false false true true false false true 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 false false false false false false true true true false false true 127 0 true 627 true false false false false false true true false false false false X 12 10 true false false false false true false true true false false false true true true true true false false false X ROBERTA NIENHUESER 6608313251 2305 S 65 HIGHWAY PO BOX 250 MARSHALL MO 65340 X FRED UTLAUT 1.0 1.0 X X 0 0 0 WILLIAM L SUMMERS 1.0 1.0 X X 0 0 0 DON VOGELSMEIER 1.0 1.0 X X 0 0 0 VIRGINIA HUPP 1.0 1.0 X 0 0 0 ROOK EVANS 1.0 1.0 X 0 0 0 B F KNIPSCHILD MD 1.0 1.0 X 0 0 0 RANDY MORROW 1.0 1.0 X 0 0 0 JAMES SOWASH MD 1.0 1.0 X 0 0 0 JACK UHRIG MD 1.0 1.0 X 0 0 0 GAYLE CARTER 1.0 1.0 X 0 0 0 SHARI THOMPSON MD 40.0 1.0 X 129242 0 2000 BILL JACKSON 1.0 1.0 X 0 0 0 RONALD A OTT 40.0 1.0 X 282546 0 12704 ROBERTA NIENHUESER 40.0 1.0 X 141922 0 8728 LYNNE OTT 40.0 X 175416 0 3414 DENNIS SOUSLEY 40.0 X 174809 0 4735 KELLY ROSS DO 40.0 X 561501 0 2000 JOHN B BRIZENDINE MD 40.0 X 333253 0 7000 CRAIG SIMMONS DO 40.0 X 317695 0 2466 REUEL GREGORY DO 40.0 X 245928 0 7643 LORENZO ROMNEY DO 40.0 X 255455 0 2466 2617767 0 53156 18 false true false PHARMACY SYSTEMS INC PHARMACY MANAGEMENT 620202 WATERSTONE BENEFIT ADMINISTRATOR 514658 SIEMENS MEDICAL SOLUTIONS MAINTENANCE 364006 SEPTAGON CONSTRUCTION CO CONSTRUCTION 288232 THOMAS LAIRD MD ER PHYSICIAN 268343 24 91774 42225 74150 208149 NET PATIENT SERVICE REVENUE 900099 52482745 52482745 EHR INCENTIVE REVENUE 900099 1651000 1651000 CAFETERIA 722514 246869 246869 MANAGEMENT FEES 561000 60000 60000 OTHER REVENUE 900099 49044 49044 54489658 231983 231983 0 0 3722 3722 0 3722 3722 96910 79536 17374 17374 17374 49449 91774 38630 10819 10819 0 0 0 54961705 54489658 263898 12000 12000 0 0 0 921294 471869 449425 42852 42852 19831492 16957144 2837700 36648 214826 184211 30615 2301152 1978513 322639 1435595 1222008 210833 2754 0 55448 55448 114600 114600 0 0 0 4462223 3260971 1201252 155498 95747 59751 3296148 2611001 683697 1450 0 0 589270 506579 82691 229452 201969 27483 0 78133 32615 45518 862989 722662 140327 0 2875324 2407781 467543 608431 468649 139782 BAD DEBT 6829363 6829363 MEDICAL SUPPLIES & DRUGS 4443540 4443540 PROVIDER TAX 2731309 2731309 RECRUITING & RETENTION 321722 119645 202077 52412661 45300428 7071381 40852 X 4144337 4477769 14273733 16881503 0 0 9132104 5484045 0 0 0 0 0 0 1067081 1095723 956364 926046 54289889 31561274 21813547 22728615 4150421 3170309 0 0 0 0 0 0 214853 3716997 55752440 58481007 5410671 4758316 0 0 0 0 16554667 16879280 0 0 0 0 0 0 0 0 684003 1204580 22649341 22842176 X 32105961 34550755 541921 632859 455217 455217 33103099 35638831 55752440 58481007 2549044 -13312 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5897 5897 false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION PAYS DUES TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE ALLOCATED TO LOBBYING. 719060 20163 1000 4800 60 733363 694769 24351 60 719060 677227 21898 4296 60 694769 618998 25296 36603 3670 677227 579322 39676 618998 0.26620 0.62073 0.11308 false false 71000 71000 23830723 9438198 14392525 27739552 21370422 6369130 2648614 752654 1895960 22728615 INTEREST RECEIVABLE 48177 OTHER RECEIVABLES 2677964 EST AMT DUE FROM 3RD PTY PYRS 908569 DUE FROM RELATED PARTY 82287 3716997 0 EST AMT DUE TO 3RD PTY PYRS 904007 ESTIMATED SELF INSURANCE COSTS 300573 1204580 48157660 -13312 -6829363 -6842675 55000335 -38630 -38630 54961705 45621928 38630 38630 45583298 6829363 6829363 52412661 ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 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. UNCERTAIN TAX POSITION SCHEDULE D, PART X, LINE 2 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. OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XI, LINE 2D $ (6,829,363) BAD DEBT EXPENSE OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XI, LINE 4B $ (38,630) SPECIAL EVENTS EXPENSES OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XII, LINE 2D $ 38,630 SPECIAL EVENTS EXPENSES OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $ 6,829,363 BAD DEBT EXPENSE SPRING FLING 58402 39880 18522 1093 5356 6521 GOLF TOURNEY 38276 19042 19234 5245 4001 1492 1668 1561 2 44545 32852 11693 220 11473 141223 91774 49449 5245 4001 2585 7244 19555 38630 10819 true true X true X true X true true false true true 181874 181874 0.00400 10505458 8511115 1994343 0.04370 10687332 8511115 2176217 0.04770 27282 8126 19156 0.00040 620864 620864 0.01360 5815433 4666131 1149302 0.02520 12000 12000 0.00030 6475579 4674257 1801322 0.03950 17162911 13185372 3977539 0.08720 true 6829363 2868333 12522306 14046353 -1524047 X true true 1 1 JOHN FITZGIBBON MEMORIAL HOSPITAL

2305 S 65 HIGHWAY MARSHALL MO 65340

X X X ORTHO, WOUND CARE, REHAB, ONCOLOGY, PAIN, NEUROLOGIC JOHN FITZGIBBON MEMORIAL HOSPITAL 1 true X X X X X X X X X 12 true false true X X X X X X X X X X X false false true true 100 true 200. true X true true X X X true X false X X X true X false false 5 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 PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990 ($52,412,661) WAS REDUCED BY BAD DEBT EXPENSE ($6,829,363). COSTING METHODOLOGY SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. IRS WORKSHEET 6 USED INTERNAL COST ACCOUNTING METHODOLOGY. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINES 2, 3 & 4 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. THE ORGANIZATION REPORTED BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS FROM THE AUDITED FINANCIAL STATEMENTS. 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. COMMUNITY BENEFIT RATIONALE SCHEDULE H, PART III, SECTION B, LINE 8 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. COLLECTION POLICY SCHEDULE H, PART III, SECTION C, LINE 9B 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 NOT AN OPTION. "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. CHNA COMMUNITY INPUT SCHEDULE H, PART V, SECTION B, LINE 3 KEY COMMUNITY HEALTH AND SOCIAL SERVICE STAKEHOLDERS WERE ENGAGED TO ASSIST IN THE PROCESS TO ENSURE INPUT FROM THE UNDERSERVED, CHRONICALLY ILL, LOW INCOME AND MINORITY POPULATIONS IN OUR SERVICE AREA. KEY COMMUNITY PARTNERS INVOLVED WITH THE PROCESS WERE FITZGIBBON HOSPITAL, SALINE COUNTY HEALTH DEPARTMENT, SALT FORK YMCA AND MARSHALL HOUSING AUTHORITY. TO ENSURE PUBLIC HEALTH EXPERTS COULD PROVIDE THEIR EXPERTISE THE COMMITTEE SOUGHT INPUT THROUGH PERSONAL INTERVIEWS AND FOCUS GROUPS FROM SALINE COUNTY HEALTH DEPARTMENT, FITZGIBBON HOSPITAL PRIMARY CARE SITE NURSES, JACK UHRIG, M.D. PRIVATE PRACTICE PHYSICIAN, MELANIE ELFRINK, M.D. SALINE COUNTY HEALTH DEPARTMENT, MARSHALL PUBLIC SCHOOL NURSING STAFF, AND REV CHARLES STEPHENSON, EXECUTIVE DIRECTOR OF POWERHOUSE COMMUNITY DEVELOPMENT AGENCY. IN ADDITION, AN ONLINE SURVEY WAS CONDUCTED. THE SURVEY WAS AVAILABLE FOR A SIX-WEEK PERIOD WITH VARIOUS NOTICES TO THE PUBLIC ON ACCESSING AND COMPLETING THE SURVEY. SURVEY INTAKE STAFF WAS POSITIONED AT HOSPITAL-OPERATED RURAL HEALTH CLINICS, MARSHALL HOUSING AUTHORITY, SALINE COUNTY HEALTH DEPARTMENT, AND MARSHALL SENIOR CENTER TO ASSIST IN ACCESSING THE SURVEY. CHNA AVAILABILITY TO PUBLIC SCHEDULE H, PART V, SECTION B, LINE 5C PRESS RELEASES WERE SENT TO THE LOCAL DAILY NEWSPAPER, THE MARSHALL DEMOCRAT NEWS, AND AREA WEEKLY NEWSPAPERS. IN ADDITION, ONLINE ACCESS WAS MADE AVAILABLE VIA WWW.MARSHALLNEWS.COM WITH A LINK THROUGH TO THE COMPLETE CHNA REPORT WHICH IS HOUSED PERMANENTLY ON THE HOSPITAL WEB SITE. A FLIER DESCRIBING THE ONLINE AND PRINTED ACCESS TO THE REPORT WAS DISTRIBUTED AT THE FITZGIBBON HOSPITAL APRIL 2013 COMMUNITY HEALTH FAIR AND WAS DISTRIBUTED TO THE PARTNER SITES FOR BROAD DISTRIBUTION TO THEIR CLIENT BASE. IMPLEMENTATION STRATEGY SCHEDULE H, PART V, SECTION B, LINE 6 IN RESPONSE TO THE RESULTS OF THE ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION PLAN IS ATTACHED TO THE RETURN. ADDRESSING NEEDS IDENTIFIED IN THE CHNA SCHEDULE H, PART V, SECTION B, LINE 7 THE NEEDS NOT DIRECTLY ADDRESSED IN THE CHNA IMPLEMENTATION STRATEGY WERE AS FOLLOWS: COST AND ABILITY TO PAY FOR CARE, ALCOHOL AND DRUG ABUSE, CANCER, LACK OF HEALTH INSURANCE, LACK OF DENTAL CARE, MENTAL HEALTH CONCERNS, COST OF PRESCRIPTION MEDICATION AND TEEN PREGNANCY. THE CHNA COMMITTEE USED A DECISION MATRIX TO PRIORITIZE WHICH HEALTH NEEDS WOULD BE ADDRESSED BY THE COMMITTEE GOING FORWARD. IN ADDITION, CONSIDERATION WAS GIVEN TO PARTNER AGENCY CAPACITIES WHICH WOULD HAVE THE HIGHEST IMPACT ON RESIDENTS IN THE COMMUNITY WITH PLANS FOR COMMUNITY HEALTH CHANGE. OTHER FACTORS INFLUENCING THE COMMITTEE'S DECISION TO NOT ADDRESS NEEDS IDENTIFIED INCLUDED THE CONSEQUENCES OF NOT INTERVENING, COMMUNITY OPINION, AND NUMBERS OF PEOPLE AFFECTED. COLLECTION ACTIONS SCHEDULE H, PART V, SECTION B, LINE 16E COLLECTION ACTIONS AGAINST THE PATIENT WHICH ARE PERMITTED BEFORE MAKING REASONABLE EFFORTS TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY INCLUDE REQUESTING A DEPOSIT FOR ANY NON-LIFE THREATENING SERVICES AND SENDING CLAIMS TO PATIENT FOR 120 DAYS. THIS 120 DAY PERIOD IS TO ALLOW PATIENT TIME TO CONTACT FACILITY FOR FINANCIAL ASSISTANCE OR PAYMENT ARRANGEMENTS BEFORE FURTHER COLLECTION EFFORTS ARE MADE. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 HOSPITAL USES SEVERAL AVENUES TO PROVIDE PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. 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. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 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 2009 WAS 22,586 RESIDENTS. SALINE COUNTY DATA FOR 2009 SHOWED 61.3% OF HOUSEHOLDS WITH INCOME UNDER $49,999. OF THIS NUMBER, 42.3% OF HOUSEHOLDS FELL INTO THE $34,999 AND BELOW BRACKET. THE AGE DISTRIBUTION OF THE POPULATION IN SALINE COUNTY IN 2009 WAS 72.8% AGE 54 AND UNDER AND 27.2% WERE 55 AND OLDER. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 THE AFFILIATED HEALTH SYSTEM INCLUDES THE ACTIVITIES OF JOHN FITZGIBBON MEMORIAL HOSPITAL AND FITZGIBBON HEALTH SERVICES, DOING BUSINESS AS THE LIVING CENTER, (COLLECTIVELY, THE "COMPANIES" OR THE "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. true OATS INC 2501 MCGUIRE BLVD COLUMBIA MO 65201 431016961 501(C)(3) 12000 COMMUNITY SERVICES 1 MONITORING USE OF GRANT FUNDS SCHEDULE I, PART I, LINE 2 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 false false false false false false false true false RONALD A OTT 214261 0 67685 0 600 0 2000 0 10704 0 295250 0 0 0 ROBERTA NIENHUESER 121772 0 20000 0 150 0 0 0 8728 0 150650 0 0 0 LYNNE OTT 145816 0 29000 0 600 0 2000 0 1414 0 178830 0 0 0 DENNIS SOUSLEY 156811 0 17000 0 998 0 2000 0 2735 0 179544 0 0 0 KELLY ROSS DO 521550 0 0 0 39951 0 2000 0 0 0 563501 0 0 0 JOHN B BRIZENDINE MD 320000 0 0 0 13252 0 2000 0 5000 0 340253 0 0 0 CRAIG SIMMONS DO 316843 0 0 0 852 0 2000 0 466 0 320161 0 0 0 REUEL GREGORY DO 211313 0 0 0 34616 0 0 0 7643 0 253571 0 0 0 LORENZO ROMNEY DO 239369 0 0 0 16087 0 2000 0 466 0 257921 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS MADE TO RONALD OTT, ROBERTA NIENHUESER, LYNNE OTT, AND DENNIS SOUSLEY 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 ORGANIZATIONAL 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 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. A INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO 431386697 79516LAD6 2005-12-22 10000000 CONSTRUCTION REVENUE BONDS false false false B INDUSTRIAL DEVELOPMENT AUTHORITY - CO OF SALINE MO 430980296 79516lbc7 2010-11-29 12218468 1998 BOND REFINANCING false false false A 0 0 10365462 0 0 0 193724 0 9806276 0 0 0 2007 false false true true B 0 0 12218468 0 0 11985656 232812 0 0 0 0 0 2010 false false true true A false false false false 0.00000 0.00000 0.00000 false false false true B 0 A false true false false 0 false 0 false true B false true false false 0 false 0 false true A true B true TOTAL PROCEEDS OF ISSUE SCHEDULE K, PART II, LINE 3 TOTAL PROCEEDS OF ISSUE INCLUDE INVESTMENT EARNINGS ON BOND PROCEEDS WITH ISSUE PRICE OF $10,000,000 REPORTED ON SCHEDULE K, PART 1, LINE A, COLUMN (E). DATE OF REBATE COMPUTATION SCHEDULE K, PART IV, LINE 2C, COLUMN A THE REBATE COMPUTATION FOR THE PERIOD OF DECEMBER 22, 2005 TO DECEMBER 1, 2010 OCCURED ON JANUARY 21, 2011. JUDY VOGELSMEIER SPOUSE OF DON VOGELSMEIER 42852 EMPLOYEE COMPENSATION false PROGRAM SERVICES ACTIVITY #1 FORM 990, PART III, LINE 4A FOR THE FISCAL YEAR ENDED APRIL 30, 2013, THE EMERGENCY ROOM EXPERIENCED 11,991 PATIENT VISITS. THE SURGICAL TEAM PERFORMED 385 IN-PATIENT AND 1,833 OUT-PATIENT PROCEDURES. THE RADIOLOGY GROUP PERFORMED 32,958 PROCEDURES WHICH INCLUDED 3,985 MAMMOGRAMS, 4,788 CT SCANS, 1,889 MRI'S, 3,282 ULTRASOUND IMAGES AND 2,458 NUCLEAR MEDICINE SCANS. THE LABORATORY TEAM PERFORMED 96,413 TESTS. THE RESPIRATORY THERAPY DEPARTMENT CONDUCTED 45,345 PATIENT TREATMENTS AND THE REHABILITATIVE SERVICES GROUP WHICH INCLUDES PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES PROVIDED 18,078 PATIENT ENCOUNTERS. OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D 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 1,327 PATIENT VISITS AT THE FACILITY. IN ADDITION, THE STAFF EDUCATED 697 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 WIDE 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. FAMILY RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 RONALD OTT, PRESIDENT AND CEO, IS MARRIED TO LYNNE OTT, VP OF PATIENT CARE SERVICES, KEY EMPLOYEE. MEMBERS, STOCKHOLDERS, OR OTHER PERSONS FORM 990, PART VI, SECTION A, LINE 7A THE MEDICAL STAFF OF THE ORGANIZATION ELECTS THE CHIEF OF MEDICAL STAFF WHO IS A VOTING MEMBER OF THE BOARD. REVIEW OF FORM 990 FORM 990, PART VI, SECTION B, LINE 11B 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 BY THE VP OF FINANCIAL SERVICES AND THE CEO BEFORE BEING FINALIZED. THE 990 IS THEN PRESENTED TO THE BOARD AFTER IT IS FILED. MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C 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. COMPENSATION DETERMINATION FORM 990, PART VI, SECTION B, LINE 15A & 15B THE ORGANIZATION USES INDUSTRY DATA IN DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS/KEY EMPLOYEES. 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 PRESIDENT WILL BE ENTITLED, THEREFORE, THE COMPENSATION WAS DETERMINED BY BOONE HOSPITAL IN CONSULTATION WITH THE FITZGIBBON HOSPITAL BOARD PRESIDENT. DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO BE VIEWED IN THE ADMINISTRATION DEPARTMENT UPON WRITTEN REQUEST. BOARD MEMBER COMPENSATION FORM 990, PART VII, SECTION A NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. BOARD MEMBER SHARI THOMPSON IS EMPLOYED BY JOHN FITZGIBBON MEMORIAL HOSPITAL AND COMPENSATED FOR HER ROLE AS A FAMILY PRACTICE PHYSICIAN. TAX EXEMPT BONDS FORM 990, PART X, LINE 20 JOHN FITZGIBBON MEMORIAL HOSPITAL RECEIVED QUALIFIED HOSPITAL BOND PROCEEDS FROM 2005 AND 2010 BOND ISSUES. A PORTION OF THE BOND PROCEEDS WERE ALLOCATED TO FITZGIBBON HEALTH SERVICES FOR AUDIT AND TAX PURPOSES. INFORMATION ABOUT THE BONDS ARE REPORTED ON JOHN FITZGIBBON MEMORIAL HOSPITAL'S SCHEDULE K. FITZGIBBON HEALTH SERVICES 2305 S 65 HWY PO BOX 250 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 146926 FMV FITZGIBBON HEALTH SERVICES Q 377136 FMV