2013-08-13T08:15:31-05:00 2012-09-30 BKD LLP 211 N BROADWAY SUITE 600 ST LOUIS MO 631022733 990 2011-10-01 430633449 Missouri Delta Medical Center % JON BRANSTETTER MISS 5734711600 1008 NORTH MAIN STREET SIKESTON MO 638015044 JON BRANSTETTER 5734711600 2013-08-08 true Troy A Lindsey 3142315544 2011 2016-02-24 21:20:13Z JASON SCHRUMPF 1008 NORTH MAIN STREET SIKESTON MO 638015044 97085375 false X WWW.MISSOURIDELTA.COM X 1948 MO MISSOURI DELTA MEDICAL CENTER IS A NOT FOR PROFIT CORPORATION WHICH WILL STRIVE TO PROVIDE A COMPLETE HEALTH CARE SYSTEM TO RESIDENTS IN THE SERVICE AREA EITHER DIRECTLY OR IN COOPERATION WITH OTHERS. 26 19 1023 52 -20662 -20662 851778 348557 88822984 94527177 3077679 959482 548652 1206572 93301093 97041788 92500 49000 0 0 48648740 51598880 0 0 101609 44458716 46614498 93199956 98262378 101137 -1220590 60044388 59444886 18252743 18601366 41791645 40843520 X MISSOURI DELTA MEDICAL CENTER IS A NOT FOR PROFIT CORPORATION WHICH WILL STRIVE TO PROVIDE A COMPLETE HEALTH CARE SYSTEM TO RESIDENTS IN THE SERVICE AREA EITHER DIRECTLY OR IN COOPERATION WITH OTHERS. REFERRAL AGREEMENTS WILL BE SOUGHT FOR SERVICES NOT OFFERED LOCALLY. THE HOSPITAL WILL ALSO ACTIVELY OFFER OR SUPPORT APPROPRIATE PROGRAMS TO PROMOTE THE GENERAL HEALTH, AND TO MEET THE REHABILITATION, EDUCATIONAL AND SOCIAL NEEDS OF OUR SERVICE AREA. SERVICES WILL BE PROVIDED TO ALL RESIDENTS OF OUR SERVICE AREA REGARDLESS OF RACE, COLOR, RELIGION, SEX, AGE, NATIONAL ORIGIN, OR DISABILITY. false false 91950378 49000 94527177 MISSOURI DELTA MEDICAL CENTER PROVIDES QUALITY MEDICAL CARE TO THE RESIDENTS OF ITS COMMUNITY REGARDLESS OF ABILITY TO PAY. MISSOURI DELTA MEDICAL CENTER ALSO PROVIDES SHORT TERM REHABILITATION SERVICES THROUGH AN ACUTE INPATIENT REHABILITATION UNIT AND PSYCHIATRIC SERVICES THROUGH A GERIATRIC PSYCHIATRIC FACILITY. THESE SERVICES ARE SUMMARIZED AS FOLLOWS: HOSPITAL: NUMBER OF HOSPITAL PATIENT DAYS 23,438 NUMBER OF INPATIENT ADMISSIONS 5,104 NUMBER OF OUTPATIENT VISITS 141,514 ACUTE INPATIENT REHAB: NUMBER OF INPATIENT REHAB PATIENT DAYS 1,816 NUMBER OF INPATIENT REHAB PATIENT ADMISSIONS 156 PSYCHIATRIC FACILITY: NUMBER OF PATIENT DAYS 3,092 NUMBER OF PATIENT ADMISSIONS 355 THE HOSPITAL PROVIDED FREE CARE TO INDIGENT PATIENTS IN THE AMOUNT OF $11,777,479 IN FY 2012, VALUED AT BILLED CHARGES. THE HOSPITAL ALSO PROVIDED NUMEROUS FREE PROGRAMS AND REDUCED PRICE SERVICES THROUGH THE YEAR THAT THE HOSPITAL BELIEVES SERVES A COMMUNITY NEED. SERVICES PROVIDED FREE OF CHARGE OR BELOW COST TO THE GENERAL PUBLIC INCLUDE: 1. PERIODIC BLOOD PRESSURE AND CHOLESTEROL SCREENS 2. OUTPATIENT DIABETIC EDUCATION 3. FIRST AID CLASSES 4. CPR COURSES 5. CHILDBIRTH CLASSES 6. EMERGENCY PREPAREDNESS COURSES 7. HEALTH EDUCATION ARTICLES IN THE LOCAL NEWSPAPER 8. OTHER HEALTH EDUCATION CLASSES 91950378 true true false true false false false false false true true false false false false false false true false false false false false false false false true true false true true false false false false true true true false false false false false false true true true false false true 97 0 true 1023 true true true false false false false false false false false false X 26 19 true false false false false false false true true false false false true true true true true true true false X JON BRANSTETTER 5734711600 1008 NORTH MAIN STREET SIKESTON MO 638015044 X JIM CULLISON 1.0 X 0 0 0 BRIAN MENZ 1.0 X 0 0 0 DIANE PETERSEN 5.0 X X 0 0 0 CHRIS STEWARD 1.0 X 0 0 0 LINDA BOYD 1.0 X 0 0 0 ROBERT BUCHANAN 1.0 X 0 0 0 JOHN BOLLINGER 1.0 X 0 0 0 KEITH DAVIDSON 1.0 X 0 0 0 EDWARD DEMENT 1.0 X 0 0 0 JON GILMORE 1.0 X 0 0 0 BILL HAMPTON 1.0 X 0 0 0 DAN JENNINGS JR 2.0 X X 0 0 0 ELIZABETH JOHNSON 1.0 X 0 0 0 MICHAEL JONES 1.0 X 0 0 0 JEFF HUX 1.0 X 0 0 0 ROBERT MACGILLIVRAY 1.0 X X 0 0 0 DENNY KOONCE 1.0 X 0 0 0 BRITT MCCONNELL 1.0 X 0 0 0 ROBERT MITCHELL 1.0 X 0 0 0 MIKE MOLL 1.0 X X 0 0 0 DOUG SCOTT 1.0 X 0 0 0 CHARLES MOXLEY 1.0 X 0 0 0 MIKE POBST 1.0 X 0 0 0 GERALD SETTLES 1.0 X 0 0 0 STEVE SIKES 1.0 X 0 0 0 RON WATKINS 1.0 X 0 0 0 JON BRANSTETTER 40.0 X 140815 0 6191 JASON SCHRUMPF 40.0 X 179228 0 9961 MOWAFFAQ SAID MD 40.0 X 603613 0 12406 LY T PHAN MD 40.0 X 422347 0 11222 HOLLIS TIDMORE MD 40.0 X 424653 0 10432 MUHAMMAD NASEERUDDIN MD 40.0 X 504310 0 12406 EJAZ ALAM MD 40.0 X 467199 0 6636 2742165 0 69254 48 false true false HORIZON HEALTH MENTAL HEALTH PO BOX 840839 DALLAS TX 752840839 PSYCHIATRIC SERVICES 945187 CARESTREAM HEALTH INC DEPT CH 19286 PALATINE IL 600559286 RADIOLOGY 478334 AMERICAN RED CROSS PO BOX 73013 CHICAGO IL 606737013 BLOOD SERVICES 467850 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 500435 SHARED MEDICAL SERVICES INC PO BOX 330 COTTAGE GROVE WI 535270330 MRI SERVICES 511710 31 323557 25000 348557 NET PATIENT SERVICE REVENUE 621110 93782300 93782300 EMR INCENTIVE PAYMENT 621110 744877 744877 94527177 956379 956379 0 0 14400 39279 -24879 -24879 -20662 -4217 7411 4308 3103 3103 3103 0 0 0 PENSION TERM INCOME 900099 692024 692024 CAFETERIA INCOME 722210 361097 361097 MEDICAL RECORD REVENUE 621990 119017 119017 59313 59313 1231451 97041788 94527177 -20662 2186716 0 49000 49000 0 0 336916 336916 0 40106897 37714923 2317914 74060 447558 420866 25866 826 8123446 7638964 469482 15000 2584063 2429949 149342 4772 0 16125 16125 129837 129837 0 0 0 7569325 7044400 524925 169179 2994 166185 18722949 18029360 686798 6791 311340 311340 0 878399 693935 184464 202600 190615 11835 150 0 47532 46917 615 660157 660157 0 3953146 3122985 830161 1302546 1302546 BAD DEBT 12251217 12251217 DUES & SUBSCRIPTIONS 189280 140684 48586 10 RECRUITING 101819 101819 FARM EXPENSE 109047 109047 98262378 91950378 6210391 101609 8371361 7926268 700189 746607 0 0 10433531 9675095 0 0 0 0 1256191 1164084 3178697 3524873 1391804 1130561 79392332 45231251 33689701 34161081 0 0 0 0 0 0 0 0 1022914 1116317 60044388 59444886 7910485 6758972 0 0 0 0 3440698 3134692 0 0 0 0 6901560 8707702 0 0 0 0 18252743 18601366 X 41576698 40603573 0 0 214947 239947 41791645 40843520 60044388 59444886 X -1220590 272465 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 11406 false false false 11406 false 205741 6867 212608 219883 -3185 10957 205741 3322552 2500 73935 3179104 219883 7388571 146208 287786 42482 4457531 3322552 0.00000 1.00000 0.00000 false false 3061774 618603 3680377 32144139 14355244 17788895 41940112 29832013 12108099 1627704 1043994 583710 34161081 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT FUNDS ARE RESTRICTED BY DONORS AND SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS OVER WHICH THE BOARD RETAINS CONTROL AND MAY AT ITS DISCRETION SUBSEQUENTLY USE FOR OTHER PURPOSES. FIN 48 DISCLOSURE 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. true true X true X true X 180. true true true false true true 3338439 3338439 0.03880 22821453 19590514 3230939 0.03760 26159892 19590514 6569378 0.07640 9091 9091 55035 55035 0.00060 64126 64126 0.00060 26224018 19590514 6633504 0.07700 true 12251217 27703117 31899455 -4196338 X true true 1 1 MISSOURI DELTA MEDICAL CENTER

1008 NORTH MAIN STREET SIKESTON MO 63801

X X X MISSOURI DELTA MEDICAL CENTER 1 true true 100 true 180. true X true true X X true false X X X X true X false false 16 CONTINU-CARE HOME HEALTH

104 SMITH STREET SIKESTON MO 63801

HOME HEALTH AGENCY CHARLESTON COMMUNITY CARE CENTER

1200 EAST MARSHALL STREET SIKESTON MO 63834

RURAL HEALTH CLINIC RESTART OF CHARLESTON

512 EAST MARSHALL STREET SIKESTON MO 63834

PHYSICAL THERAPY RESTART OF NEW MADRID

406 HIGHWAY 61 NEW MADRID MO 63869

PHYSICAL THERAPY RESTART OF EAST PRAIRIE

106 SOUTH WASHINGTON EAST PRAIRIE MO 63845

PHYSICAL THERAPY BARTON-JOLLEY PHYSICIAN SVCS BUILDING

1013 NORTH MAIN STREET SIKESTON MO 63801

PHYSICIAN OFFICE BUILDING MUHANNAD AL-KILANI MD

1118 NORTH MAIN STREEET SIKESTON MO 63801

PHYSICIAN OFFICE BUILDING MISSOURI DELTA CANCER & INFUSION CENTER

1126 NORTH MAIN STREET SIKESTON MO 63801

INFUSION CENTER KENNETH STONE MD

121 SMITH STREET SIKESTON MO 63801

PHYSICIAN OFFICE BUILDING SMITH STREET CLINIC

119 SMITH STREET SIKESTON MO 63801

RURAL HEALTH CLINIC JAYCEE RENAL DIALYSIS CENTER

135 PLAZA DRIVE SIKESTON MO 63801

DIALYSIS CENTER LINZA KILLION MD

1106 NORTH MAIN STREET SIKESTON MO 63801

PHYSICIAN OFFICE BUILDING MISSOURI DELTA PRIMARY CARE

1015 NORTH MAIN STREET SIKESTON MO 63801

RURAL HEALTH CLINIC MISSOURI DELTA ORTHOPEDICS

201 PLAZA DRIVE SIKESTON MO 63801

PHYSICIAN OFFICE BUILDING MISSOURI DELTA WOUND & HYPERBARIC CENTER

201 PLAZA DRIVE SIKESTON MO 63801

WOUND CARE CENTER MISSOURI DELTA MEDICAL EQUIPMENT

102 SMITH STREET SIKESTON MO 63801

DURABLE MEDICAL EQUIPMENT COMMUNITY BENEFIT PERCENTAGE OF TOTAL COST PART I, LINE 7, COLUMN F THE ORGANIZATION HAD BAD DEBT EXPENSE IN THE AMOUNT OF $12,251,217 REPORTED ON FORM 990, PART IX, LINE 25; HOWEVER, THIS EXPENSE HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. COMMUNITY BENEFIT COST PART I, LINE 7 THE COSTS REPORTED IN THE TABLE IN PART I, LINE 7 USED A RATIO OF PATIENT CARE COSTS TO CHARGES AS COMPUTED IN WORKSHEET 2 OF THE FORM INSTRUCTIONS. THIS METHODOLOGY WAS USED FOR ALL PATIENT SEGMENTS. BAD DEBT EXPENSE PART III, LINE 4 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE CENTER 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 CENTER 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 BALANCES (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 CENTER 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 AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 WAS THE AMOUNT OF THE EXPENSE REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, WHICH IS VALUED AT BILLED CHARGES. IT IS DIFFICULT TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO COULD QUALIFY FOR CHARITY CARE DUE TO THE LIMITED NUMBER OF FINANCIAL APPLICATIONS COMPLETED BY PATIENTS. MEDICARE PART III, LINE 8 IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS ESTIMATED BY USING THE PERCENT OF OPERATING EXPENSE TO PATIENT REVENUE. COLLECTION PRACTICES PART III, LINE 9 THE BAD DEBT POLICY STATES THAT IF IT IS DECIDED THAT A PATIENT IS INDIGENT, PROCEED AS FOLLOWS: A. COMPLETE ACCOUNT ADJUSTMENT FORMS FOLLOWING ACCOUNT ADJUSTMENT PROCEDURES OR NOTE THE BALANCE WILL BE WRITTEN OFF AS CHARITY ACCORDING TO THE CHARITY CARE POLICY. B. ENTER THE FOLLOWING NOTATIONS ON THE COPY OF THE PATIENT ACCOUNTS ADMISSION REGISTRATION FORMS OR IN ACCOUNTS RECEIVABLE NOTES IN THE COMPUTER: "CHARGES DUE BY PATIENT WILL BE WRITTEN OFF AS MEDICARE BAD DEBT OR UNCOMPENSATED CARE." NEEDS ASSESSMENT PART VI, LINE 2 THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITY OR COMMUNITIES SERVED BY MISSOURI DELTA MEDICAL CENTER IS BASED ON ALL OR A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITY, SUPPLY, DEMONSTRATED NEED, VOICE OF THE CUSTOMER, AND/OR COLLABORATIVE EFFORTS WITH OUTSIDE ENTITIES, GOVERNMENT AGENCIES, AND OTHER HEALTH CARE PROVIDERS THAT WOULD ENABLE THE FILLING OF A NEED OR ENHANCE AND COMPLIMENT AN ALREADY EXISTING SERVICE. DATA IS GATHERED CONSTANTLY THROUGH HIDI, BENCHMARKING, MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT (REGARDING TECHNOLOGIES REQUIRED TO KEEP SERVICES ON THE CUTTING EDGE), AND THROUGH CONSTANT MONITORING OF STATE AND FEDERAL GUIDELINES. THIS INFORMATION IS REVIEWED AND ANALYZED BY THE HOSPITAL'S ADMINISTRATIVE TEAM AND INCORPORATED INTO THE HOSPITAL'S STRATEGIC PLANNING PROCESS THROUGH THE PLANNING COMMITTEE OF THE BOARD OF DIRECTORS AND EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 ALL PATIENT BILLING STATEMENTS FOR MISSOURI DELTA MEDICAL CENTER INCLUDE A STATEMENT THAT THE PATIENT MAY CONTACT THE MEDICAL CENTER WITH ANY QUESTIONS OR PAYMENT ISSUES REGARDING THEIR BILL. IF A PATIENT CONTACTS THE CENTER WITH AN INABILITY TO MAKE PAYMENT ISSUE, THEY INFORM THE PATIENT OF THE AVAILABLE OPTION INCLUDING CHARITY CARE AND OTHER ASSISTANCE. THEY ALSO EXPLAIN HOW THE PATIENT CAN APPLY FOR ASSISTANCE. OUR SOCIAL WORKERS WILL ALSO COMMUNICATE WITH THOSE PATIENTS WHO MAY QUALIFY FOR MEDICAID AND ASSIST THOSE PATIENTS IN COMPLETING THEIR MEDICAID APPLICATIONS. COMMUNITY INFORMATION PART VI, LINE 4 MISSOURI DELTA MEDICAL CENTER IS A SOLE COMMUNITY HOSPITAL IN SIKESTON, MISSOURI THAT PRIMARILY SERVES THE RESIDENTS OF SCOTT, MISSISSIPPI, STODDARD, AND NEW MADRID COUNTIES IN SOUTHEASTERN MISSOURI. MISSOURI DELTA MEDICAL CENTER SERVES PATIENTS WITHOUT REGARD TO AGE, GENDER, INCOME, ETHNIC ORIGIN, INSURANCE COVERAGE, OR ABILITY TO PAY. APPROXIMATELY 59% OF THE MISSOURI DELTA MEDICAL CENTER'S NET PATIENT SERVICE REVENUE IS FROM PARTICIPATION IN THE MEDICARE AND STATE SPONSORED MEDICAID PROGRAM FOR THE YEAR ENDED SEPTEMBER 30, 2012. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 OUR BOARD OF DIRECTORS IS MADE UP OF 26 COMMUNITY MEMBERS FROM OUR SERVICE AREAS. THESE BOARD MEMBERS HAVE REGULAR INPUT ON STRATEGIC PLANNING, NEW SERVICES, TECHNOLOGY, AND PHYSICIAN RECRUITMENT FOR OUR COMMUNITY. THE USE OF ANY SURPLUS FUNDS IS REINVESTED BACK INTO THE MEDICAL CENTER THROUGH THE PURCHASE OF PROPERTY AND EQUIPMENT TO PROVIDE SERVICES THAT FULFILL THE NEEDS OF THE SERVICE AREA. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 NOT APPLICABLE. STATE FILING OF COMMUNITY BENEFIT REPORT PART VI, LINE 7 NOT APPLICABLE. true MEDICAL STUDENT SCHOLARSHIPS 7 49000 PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES SCHEDULE I, PART I, LINE 2 THE SCHOLARSHIP PROGRAM IS DESIGNED TO PROVIDE A CONSISTENT FLOW OF REGISTERED NURSES TO MISSOURI DELTA MEDICAL CENTER. THE OBJECTIVE OF THE PLAN IS TO ENCOURAGE AND FINANCIALLY ASSIST QUALIFIED STUDENTS IN THEIR ENDEAVOR TO BECOME A REGISTERED NURSE. TO THE EXTENT OF AVAILABLE FUNDS, THE MEDICAL CENTER WILL PAY SCHOLARSHIPS TO QUALIFIED STUDENTS OF AN ACCREDITED REGISTERED NURSE PROGRAM. TO QUALIFY FOR THE PROGRAM A STUDENT MUST: A. HIGH SCHOOL GRADUATE 1. RANK IN THE UPPER THIRD OF HIGH SCHOOL CLASS ACADEMICALLY 2. SHOW EVIDENCE OF MOTIVATION FOR NURSING EITHER BY APTITUDE TESTING OR BY REPORTED DEMONSTRATION OF INTEREST 3. PROVIDE LETTER OF RECOMMENDATION FROM AN APPROPRIATE SCHOOL OFFICIAL. 4. BE APPROVED BY THE HOSPITAL SCHOLARSHIP SELECTION COMMITTEE B. STUDENT NURSES - ALL STUDENT NURSES MUST: 1. HAVE AT LEAST THE EQUIVALENT OF A 2.5 GRADE POINT AVERAGE IN A 4 POINT SYSTEM 2. MUST PROVIDE A LETTER OF RECOMMENDATION FROM RESPONSIBLE AND APPROPRIATE PERSON 3. BE APPROVED BY THE SCHOLARSHIP COMMITTEE C. CURRENT EMPLOYEES - ALL CURRENT EMPLOYEES MUST: 1. BE ENROLLED IN A NURSING PROGRAM AS A FULL-TIME STUDENT 2. NOT BE RECEIVING ANY HOSPITAL BENEFITS 3. BE APPROVED BY THE SCHOLARSHIP COMMITTEE. X X X X false false false false false false false false false MOWAFFAQ SAID MD 603199 0 0 0 414 0 4900 0 7506 0 616019 0 0 0 LY T PHAN MD 422167 0 0 0 180 0 4900 0 6322 0 433569 0 0 0 HOLLIS TIDMORE MD 398879 0 0 0 25774 0 4900 0 5532 0 435085 0 0 0 MUHAMMAD NASEERUDDIN MD 504040 0 0 0 270 0 4900 0 7506 0 516716 0 0 0 EJAZ ALAM MD 467019 0 0 0 180 0 0 0 6636 0 473835 0 0 0 JASON SCHRUMPF 179174 0 0 0 54 0 3720 0 6241 0 189189 0 0 0 ALEC PETERSEN SON OF CHAIRMAN 2000 SCHOLARSHIP JASON SCHRUMPF SON-IN-LAW OF DIRECTOR 179228 EMPLOYEE COMPENSATION false CATHERINE SCHRUMPF DAUGHTER OF DIRECTOR 38150 EMPLOYEE COMPENSATION false CATHERINE SCHRUMPF SPOUSE OF PRESIDENT 38150 EMPLOYEE COMPENSATION false BROOKE BUCHANAN DAUGHTER-IN-LAW OF DIR. 17249 EMPLOYEE COMPENSATION false ROBERT BUCHANAN SON OF DIRECTOR 45474 EMPLOYEE COMPENSATION false RHONDA MENZ WIFE OF DIRECTOR 28035 EMPLOYEE COMPENSATION false JUDITH MENZ MOTHER OF DIRECTOR 90074 EMPLOYEE COMPENSATION false ANTHONY COPPAGE BROTHER-IN-LAW OF DIR. 69291 EMPLOYEE COMPENSATION false ELIZABETH JOHNSON DIRECTOR 207134 SEE PART V false BUSINESS TRANSACTION WITH INTERESTED PERSONS SCHEDULE L, PART IV ELIZABETH JOHNSON IS PRESIDENT OF MITCHELL INSURANCE. MISSOURI DELTA MEDICAL CENTER PURCHASES INSURANCE FROM MITCHELL INSURANCE AT MARKET RATES. OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE RELATIONSHIPS FORM 990, PART VI, LINE 2 ROBERT MITCHELL AND ELIZABETH JOHNSON HAVE A FAMILY RELATIONSHIP. LINDA BOYD AND JOHN BOLLINGER HAVE A FAMILY RELATIONSHIP. STEVE SIKES AND JASON SCHRUMPF HAVE A FAMILY RELATIONSHIP. DAN JENNINGS JR AND JOHN BOLLINGER HAVE A BUSINESS RELATIONSHIP. BRITT MCCONNELL, ROBERT MACGILLIVRAY, AND KEITH DAVIDSON HAVE A BUSINESS RELATIONSHIP. PROCESS TO REVIEW FORM 990 FORM 990, PART VI, LINE 11B BEFORE THE FORM 990 IS FILED, THE VICE-PRESIDENT OF FINANCE OF THE ORGANIZATION REVIEWS THE FORM 990, WHICH IS PREPARED BY AN OUTSIDE TAX PREPARER. THE FINANCE COMMITTEE OF MISSOURI DELTA MEDICAL CENTER WILL ALSO PERFORM A REVIEW OF THE FORM 990 AFTER THE FORM HAS BEEN FILED. IN ADDITION, COPIES OF THE FORM 990 WILL BE AVAILABLE TO THE MISSOURI DELTA MEDICAL CENTER'S BOARD OF DIRECTORS AFTER THE ORGANIZATION'S FORM 990 HAS BEEN FILED. COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS AS FOLLOWS: MEMBERS OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS HAVE AN OBLIGATION TO MAKE DECISIONS AND TO PERFORM THEIR DUTIES FOR THE SOLE BENEFIT OF THE HOSPITAL. ALL PERSONS SERVING IN SUCH CAPACITY SHOULD AVOID PLACING HIMSELF/HERSELF IN A POSITION WHERE PERSONAL INTERESTS ARE IN CONFLICT WITH THE INTERESTS OF THE HOSPITAL. THE FOLLOWING DEFINITIONS SHALL APPLY TO THIS POLICY: 1. AN "INTERESTED PERSON" IS A MEMBER OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICER OR MEMBER OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS; 2. A PERSON HAS A "FINANCIAL INTEREST" IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH BUSINESS, INVESTMENT OR FAMILY: A. A PRESENT OR POTENTIAL OWNERSHIP, INVESTMENT, INTEREST, OR COMPENSATION ARRANGEMENT IN ANY ENTITY WITH WHICH THE HOSPITAL HAS OR MAY HAVE A TRANSACTION OR ARRANGEMENT; B. A COMPENSATION ARRANGEMENT WITH THE HOSPITAL OR ANY ENTITY OR INDIVIDUAL WITH WHICH THE ORGANIZATION HAS A TRANSACTION OR ARRANGEMENT. COMPENSATION INCLUDES ANY REMUNERATION, DIRECTLY OR INDIRECTLY, AND GIFTS OF FAVORS, WHICH ARE SUBSTANTIAL IN NATURE; 3. AN "AFFILIATED ORGANIZATION" INCLUDES ANY ORGANIZATION OR ENTITY OWNED OR OPERATED BY THE HOSPITAL OR IN WHICH THE HOSPITAL HAS A DIRECT FINANCIAL INTEREST; ANY "INTERESTED PERSON" MUST DISCLOSE TO THE HOSPITAL AND ANY AFFILIATED ORGANIZATION ALL FINANCIAL INTERESTS AND ALL MATERIAL FACTS RELATING THERETO. IF A CONFLICT DOES ARISE, THE HOSPITAL AND ANY AFFILIATED ORGANIZATION SHALL: 1. REQUIRE THAT THE "INTERESTED PERSON" LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST; 2. APPOINT, IF APPROPRIATE, UNDER THE CIRCUMSTANCES THEN APPEARING, A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 3. DETERMINE, BY A MAJORITY VOTE OF NON-INTERESTED PERSONS PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL OR AFFILIATED ORGANIZATION'S BEST INTERESTS AND FOR ITS OWN BENEFIT AND IS FAIR AND REASONABLE TO THE HOSPITAL OR AFFILIATED ORGANIZATION. 4. TAKE APPROPRIATE DISCIPLINARY ACTION WITH RESPECT TO AN "INTERESTED PERSON" WHO VIOLATES THIS CONFLICT OF INTEREST POLICY TO PROTECT THE ORGANIZATION'S BEST INTERESTS. THE MINUTES OF ANY MEETING OF THE BOARD OF DIRECTORS OR ANY COMMITTEE WITH BOARD-DELEGATED POWERS SHALL INCLUDE THE FOLLOWING: 1. THE NAMES OF THE PERSONS WHO DISCLOSED FINANCIAL INTERESTS AND THE NATURE OF THEIR FINANCIAL INTEREST; 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT AND A RECORD OF THE VOTE. NO PHYSICIAN, WHO RECEIVES COMPENSATION DIRECTLY OR INDIRECTLY FROM THE HOSPITAL OR ANY AFFILIATED ORGANIZATION, SHALL BE A MEMBER OR SERVE ON ANY COMMITTEE DECIDING ON COMPENSATION FOR INDEPENDENT CONTRACTORS OR PRINCIPAL OFFICERS OF THE CORPORATION. NO MEMBER OF ANY COMPENSATION COMMITTEE WHO HAS A CONFLICT OF INTEREST SHALL, DIRECTLY OR INDIRECTLY, VOTE ON MATTERS PERTAINING TO THAT INDIVIDUAL'S COMPENSATION. EVERY MEMBER OF THE BOARD OF DIRECTORS, PRINCIPAL OFFICER, AND MEMBER OF ANY COMMITTEE WITH BOARD-DELEGATED POWERS SHALL SIGN AN ANNUAL STATEMENT THAT SUCH PERSON: 1. RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; 2. READ AND UNDERSTANDS THE POLICY; 3. AGREES TO COMPLY WITH THE POLICY; 4. UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES AND SUBCOMMITTEES HAVING BOARD-DELEGATED POWERS; AND 5. UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS TAX EXEMPT STATUS, IT MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. PROCESS FOR DETERMINING COMPENSATION OF OFFICERS FORM 990, PART VI, LINE 15A & 15B THE ORGANIZATION'S SALARY AND ADMINISTRATIVE REVIEW COMMITTEE, WHICH IS MADE UP OF MEMBERS OF THE BOARD OF DIRECTORS, REVIEWS THE COMPENSATION FOR THE PRESIDENT AND VICE-PRESIDENTS OF THE MEDICAL CENTER. THE REVIEW OF COMPENSATION UTILIZES THE ANNUAL "EXECUTIVE COMPENSATION REPORT" THAT IS PUBLISHED BY THE MISSOURI HOSPITAL ASSOCIATION. A REVIEW OF THE MISSOURI DELTA MEDICAL CENTER'S PRESIDENT AND VICE-PRESIDENTS WAS CONDUCTED FOR THE YEAR ENDING SEPTEMBER 30, 2012. DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 UNREALIZED GAIN/(LOSS): $ 27,801 TRANSFERS RELATED TO CONSOLIDATION: 176,459 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP: 68,205 -------- $ 272,465 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JON GILMORE TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFF HUX TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JON BRANSTETTER TITLE:VICE PRESIDENT FINANCE HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JASON SCHRUMPF TITLE:PRESIDENT HOURS:2 CONTINU-CARE HOMEMAKER SERVICES 1008 NORTH MAIN STREET SIKESTON MO 63801 431835384 HOME HEALTH MO 501(C)(3) 9 MDMC true MISSOURI DELTA MEDICAL CENTER FOUNDATION 1008 NORTH MAIN STREET SIKESTON MO 63801 431577510 FUNDRAISING MO 501(C)(3) 11-I MDMC true SOUTHEAST MO UROLOGY CONSULTANTS INC 1106 NORTH MAIN SIKESTON MO 63801 431723563 HEALTH CARE MO MDMC C CORP 29026 962 1.00000 false false true false false false false false false false false false false false false false false true CONTINU-CARE HOMEMAKER SERVICES INC R 148201 CASH MISSOURI DELTA MEDICAL CENTER FOUNDATION C 323557 CASH MISSOURI DELTA MEDICAL CENTER FOUNDATION R 29353 CASH