2012-03-23T09:44:54-07:00 2011-06-30 990 2010-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325103 1125 South Madison Jefferson City MO 65101 Jim McMillan 5736325103 2012-03-22 2010 2016-02-24 21:20:13Z Ed Farnsworth 1125 Madison Street Jefferson City MO 65101 165159739 0 X crmc.org X 1945 MO Capital Region Medical Center embraces its mission: To improve the health and promote wellness of the people and communities we serve to reflect commitment to a charitable purpose. 12 8 1588 649 45931 0 21043 718793 163713086 163748193 460170 538051 3894 1580 164198193 165006617 0 0 0 0 79162741 82675796 0 0 0 75049316 76169596 154212057 158845392 9986136 6161225 159806812 164024291 57811733 57917537 101995079 106106754 Capital Region Medical Center embraces its mission: To improve the health and promote wellness of the people and communities we serve to reflect commitment to a charitable purpose, in the form of a resident clinic as well as general inpatient and outpatient charity care. The medical center provides many services to the community at little or no financial gain. 0 0 3175476 0 0 Inpatient and Outpatient Charity Care: Capital Region Medical Center serves the community by providing medical care to all patients regardless of their ability to pay. In FY 2011, the medical center provided $3,175,476.21 in charitable care (excluding Resident Clinic). Patients who qualify for charity care will be identified as soon as possible, either before the services are provided or after an individual has received services to stabilize their medical condition. If difficult to determine a patient's eligibility for charity care prior to providing the service, the determination should be made as soon as possible after the provision of the service. Upon registration, patients without Medicare/Medicaid, adequate health insurance or other local health care financial assistance will receive either a packet of information tha addresses the financila assistance policy and procedures or immediate financila counseling assistance from staff within established business hours. The packet of information will clearly indicate that CRMC provides care without regard to ability to pay, to individuals with limited financial resources and explain how patients apply for financil assistnace. CRMC provides a variety of services ranging from emergency services to inpatient and out patient elective surgery, diagnostic testing and educational programs. Charity care policies and procedures are in place to address any instances in which patients may access services 399045 0 101325 Resident Clinic: In 1988 Capital Region accepted its first Family Practice resident. Since then the program has offered one-on-one guidance and the opportunity to become fully integrated into culture at Capital Region. The Family Practice residency and resident clinic is unopposed, giving residents a great deal of hands on experience, no need to wait in line to perform procedures. The mission of our program is to train capable, compassionate family physicians in an environment of mutual respect based in real-world experiences. We reinforce values of ethical practice, community orientation, personal/professional balance, and lifelong learning. The resident clinic serves approximately 2,267 patients from the eight county service area which bases the charge on the individual's ability to pay, which in many cases is free. 75456 0 0 Support of Medical Education - Capital Region Medical Center supports Lincoln University School of Nursing Program and Nichols Career Center Radiology Tech Program. In addition to the direct financial support that Capital Region provides, we also provide support to Columbia College MSN students in leadership training. We assist students from Rolla Technical College and Columbia Technical College in the surgical tech programs. CRMC provides training to phlebotomist/tech students from Moberly Community College and Metro Business College to assist them with fulfilling their clinical requirements. Our support for these programs is not only through the provision of training facilities but also adjunct faculty and resources. 141658749 0 163606973 All Other Inpatient and Outpatient Services provided to patients. 141658749 0 163606973 145308726 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 85 0 1 1588 1 1 1 0 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Jim McMillan 5736325100 1432 Southwest Blvd Jefferson City MO 65109 Dr Peter A Boyer 2 X 267581 0 28475 Charlie Dudenhoeffer 2.5 X 0 0 0 Kristi Gafford 2 X 0 0 0 Dr Neal G Lapointe 40 X 199911 0 22769 Kenneth Littlefield 2.50 X 0 0 0 Anne Lock 2.50 X 0 0 0 Naught Sharon 2.5 X 0 0 0 John Pletz 2 X 0 0 0 Richard L Samson 2 X 0 0 0 James Ross 2 X 0 0 0 James Wisch 2 X 0 0 0 Joseph Tomblinson 3 X 12548 0 0 Samuel Bushman 2.50 X 0 0 0 Ed Farnsworth 40 X 265069 0 29719 Jim McMillan 40 X 165262 0 23861 Jason Cecil 40 X 124432 0 18061 Janet Weckenborg 40 X 165538 0 23950 Robert Mazur 40 X 126031 0 21441 Tawny Sandifer 40 X 143408 0 22706 Thomas Niekamp 40 X 99972 0 0 Randall Haight 40 X 257752 0 18437 Mitchell Godbee 40 X 838635 0 38036 William P Sweezer Jr 40 X 535089 0 33634 Patricia Owensby-Macfarlane 40 X 459202 0 27942 Matthew Hrastich 40 X 680382 0 35741 Thomas Hetherington 40 X 406015 0 31763 4746827 0 376535 89 0 1 1 Septagon Construction 601 Monroe Jeffeson City MO 65101 Construction 615198 Aramark Healthcare Support Services PO box 651009 Charlotte NC 282651009 Management Services 1780383 Boyce and Bynum Laboratory PO Box 7406 Columbia MO 65205 lab services 1003448 SE Emergancy Physicians PO Box 634850 Cincinnati OH 452634850 Emergency Room Physicians 558440 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Physician coverage 556252 39 0 0 0 718793 0 0 0 718793 Patient Service Revenue 622000 162161759 162115828 45931 0 Other 900099 1586434 1586434 0 0 0 0 0 0 163748193 533595 0 0 533595 0 0 0 0 0 0 0 157578 0 153122 0 4456 4456 4456 0 0 0 Share of K-1 income 611710 1580 1580 0 0 0 0 0 0 1580 165006617 163708298 45931 533595 0 0 0 0 0 0 0 0 1876600 0 1876600 0 0 0 0 0 66353288 59054426 7298862 0 2250698 2003121 247577 0 7910342 7040204 870138 0 4284868 3813533 471335 0 0 0 0 0 181512 161126 20386 0 190015 168674 21341 0 0 0 0 0 0 0 0 0 0 0 11186742 10280708 906034 0 407950 362133 45817 0 0 0 0 0 0 0 0 0 0 0 0 0 688285 610983 77302 0 0 0 0 0 0 0 0 0 394151 349883 44268 0 1953961 1953961 0 0 0 0 0 0 8519654 8250441 269213 0 1299248 1153328 145920 Medical Supplies and Other 31688695 31278742 409953 0 Repairs and Maintenance 3055625 2712444 343181 0 Utilities and Phone 2542410 2256869 285541 0 FRA Taxes 7288090 7288090 0 0 6773258 6570060 203198 0 158845392 145308726 13536666 0 5944333 7020382 1373559 1412656 16777895 16477438 3057668 3228076 1540763 1824392 195325100 126303690 73684450 69021410 52066947 59972272 5361197 5067665 159806812 164024291 19118098 21209488 35080001 34025000 3613634 2683049 57811733 57917537 X 98432377 102827456 3492356 3208952 70346 70346 101995079 106106754 159806812 164024291 X 6161225 -2049550 X 1 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15598 15598 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 We paid $8,750 to join the Medicare Dependent Hospital Coalition. This group lobbied in an attempt to protect the Medicare Dependent Hospital Status for hospitals. We are also members of the Missouri Hospital Association. Just one of many benefits of this membership is that MHA communicates with government on issues that are important to Missouri hospitals. A portion of our annual dues ($6,848) is attributable to lobbying. 2050735 0 2050735 117581347 0 70442505 47138842 3477339 0 1967230 1510109 72215679 0 53893955 18321724 0 0 0 0 69021410 Mortgage based securities 18005820 F Federal Farm Callable Note 4996290 F Money Market Account 19670776 F US Treasury Obligations 73678 F Corporate Bonds 5025274 F Certificates of Deposit 13613091 F Less: Current Amounts -1412657 F 59972272 Other Long Term Liabilities 182833 Capital Lease Obligation 185934 457b Liability 973528 Note Payable 1340754 2683049 165006617 158845392 6161225 0 0 0 0 0 0 6161225 164286244 0 0 0 0 0 164286244 0 720373 720373 165006617 159384530 0 0 0 274840 274840 159109690 0 -264298 -264298 158845392 SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Share of K-! income 1580 Donations from CapReg Foundation 618793, Donations from Partners 100000 not reported as Revenue on financial statements SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Basis of Sale of Assets (line 7B) 153,122 Cash transfer (Foundation Expenses) 121,718 SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Increase in Allowance for Uncollectable Accounts 1 1 1 X 1 X 1 1 1 0 0 3175476 0 3175476 0.0205 18372555 15211170 3161385 0.0204 0 0 0 0 0 0 21548031 15211170 6336861 0.0409 3452 34682 273425 148752 124673 0 833809 759767 74042 0.0005 2737019 1883200 853819 0.0055 99600 0 99600 0 158292 0 152570 0.001 3452 34682 4102145 2791719 1304704 0.0070 3452 34682 25650176 18002889 7641565 0.0479 1633 0 1633 0.00001 5865 0 5865 0.00004 27583 0 27583 0.0002 0 0 35081 0 35081 0.00025 0 1429915 852092 48767427 46668916 2098511 X 1 1 1 1 Capital Region Medical Center

1125 Madison Street Jefferson City MO 65101

X X X X Capital Region Medical Center 1 0 1 1 200 1 400 1 X X X X X 1 1 X X X X X X X 1 X X 1 X X X X X X 1 X 0 0 17 Capital Region Southwest

1432 Southwest Blvd Jefferson City MO 65109

Outpatient Services CRMC-Women & Children Building

1014 Madison Street Jefferson City MO 65109

OB/GYN and Pediatrics CRMC Cap City Medical Assoc

1505 Southwest Blvd Jefferson City MO 65109

Family Practice and Internal Medicine Mid Mo Medical Assoc and CRMC Surgical and Cardio

1125 Madison Jefferson City MO 65101

Specialty Outpatient Clinic CRMC - SW Clinic

1500 Southwest Blvd Jefferson City MO 65109

Family Practice CRMC Healthplex West

3308 West Edgewood Drive Jefferson City MO 65109

Family Practice CRMC - Eldon

103 Business Highway 54 North Eldon MO 65026

Family Practice CRMC - Owensville

3536 Kuhne Road Owensville MO 65066

Family Practice CRMC - Versailles Clinic

901 Kidwell Drive PO Box 160 Versailles MO 65084

Family Practice Capital Region Family Medical Center

420 East High Street Jefferson City MO 65101

Family Practice CRMC - Holts Summit

180 North Star Holts Summit MO 65043

Family Practice Resident Clinic-Doctors Park Bldg

1111 Madison Street Jefferson City MO 65109

Low Income Health Clinic CRMC - California

704 Buchanan Hwy 50 West California MO 65018

Family Practice CRMC - Linn Clinic

916 East Main Street Linn MO 65051

Family Practice Integrative Medicine

1002 Diamond Ridge Suite 200 Jefferson City MO 65109

Family Practice Capital Region Family Medicine

1616 Southridge Suite 203 Jefferson City MO 65109

Family Practice CRMC - Stover

2nd Street and Oak PO Box 489 Stover MO 65078

Family Practice SchH_P01_S00_L07 Schedule H, Part I, Line 7 Cost to Charge ratio. SchH_P02_S00_L00 Schedule H, Part II Capital Region's mission is to improve the health and promote wellness of the people and communities we serve, and this mission is carried out through community building activities. Board members and leaders travel to communities in which the hospital has a clinic presence to educate and update community members about hospital activities, wellness initiatives, expansion projects, wellness screenings and educational opportunities, etc. Senior leaders meet with leaders at St. Mary's, and area cardioligists to collaborate on cardiac care. The purpose is to provide the best quality care for patients while considering the most efficient use of resources. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 a. The Medical Center maintains an allowance for doubtful accounts for estimated losses inherent in its accounts receivable portfolio. In establishing the required allowance, management considers historical bad debt write offs and current receivable aging. b. The amount in Line 2 was determined using Cost to Charge ratios from worksheet 2. We have no method of determining the amount to report on Line 3. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 No shortfall SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b CRMC will use Presumptive Charity software to score potential accounts meeting the charity guideline. CRMC will use the Federal Poverty Level, estimated household income and family size identified by the Presumptive software product in lieu of a completed application. Each patients account will proceed thru the normal collection process up to and including a Final Notice Letter. Prior to referral to the collection agency, CRMC will batch each account and process thru the software to identify potential accounts meeting the established guidelines for charity. These accounts will then be processed for adjustment to 100% of the charity discount and not forwarded to the collection agency. If a patient/guarantor after receiving the charity care discount and are financially responsible for a portion of the charges do not meet their obligation the account will then follow the credit polices of the hospital. These policies may include collection activity up to and including placement to a collection agency, reporting on the credit bureau and filing of lawsuits.. SchH_P05_S0B_L13 Schedule H, Part V, Section B, Line 13 The policy is explained on the back of the charity application. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Currently, CRMC assesses the health care needs of people and communities in our 8 county service area by developing an annual environmental analysis, conducting Hospital Choice Behavioral and Attitudinal Studies and focus groups - both personal and virtual. CRMC is actively developing a Population Based Health Assessment in association with other community entities (St. Mary's Health Center, Cole County Health Department and the Community Health Center). The primary focus is to determine utilization of existing data, conduct community focus groups, create a purpose statement and eventually develop our collaborative strategy. Timeline for completion of research portion of the strategy is June 2012 with complete Community Needs Health Assessment completed by December 2012. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Patient Financial Services counsels patients/persons regarding financial assistance via telephone and in person as needed. This information is presented to the patient in the Patient Handbook, at time of registration. Information also appears on our website at www.crmc.org. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 CRMC's service area includes 8 counties: Callaway, Cole, Gasconade, Maries, Miller, Morgan, Moniteau and Osage. The Primary Service Area (PSA) includes Cole, Miller, Moniteau and Osage counties with a secondary focus on Callaway, Gasconade, Maries and Morgan. The organization's PSA makes up 44% of inpatient discharges while the SSA is 23%. Population trends for the entire service area indicates a 3.1% increase from 2011-2016 regarding total population with a 6.5% increase reflective of those age 65 and older. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 CRMC promotes community health by conducting numerous community health fairs, lunch and learns, participation on local community awareness events/activities, health specific screenings/education sessions for corporate partners, etc. CRMC also actively sponsors community events/activities that mirror the organization's strategic direction - most specifically programs that support the hospital's mission in promoting health and wellness. These activities are promoted and supported (via time and finances) by medical staff, administration and front-line staff. Physicians provide presentations to numerous civic groups/associations and also participate in hospital sponsored/supported community philanthropic events. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 CRMC is affiliated with University of Missouri Health Care. This relationship combines the strengths of an academic health care system with that of a community hospital. Both parties share similar service areas) and are able to co-promote similar/shared health care capabilities and the continuum of care available via this partnership. X X 1 1 X X X 0 0 0 1 0 1 0 1 0 Dr Peter A Boyer 242687 0 24894 0 0 0 10970 0 17505 0 296056 0 Dr Neal G Lapointe 137753 0 14356 0 47802 0 6938 0 15831 0 222680 0 Ed Farnsworth 247561 0 17507 0 0 0 12250 0 17469 0 294787 0 Jim McMillan 154227 0 11035 0 0 0 7839 0 16022 0 189123 0 Janet Weckenborg 154394 0 11144 0 0 0 7924 0 16026 0 189488 0 Robert Mazur 117547 0 8484 0 0 0 5988 0 15453 0 147472 0 Tawny Sandifer 133349 0 10059 0 0 0 7001 0 15705 0 166114 0 Jason Cecil 115773 0 8659 0 0 0 2631 0 15430 0 142493 0 Randall Haight 216355 0 41397 0 0 0 1074 0 17363 0 276189 0 Mitchell Godbee 772988 0 65646 0 0 0 12250 0 25786 0 876670 0 Matthew Hrastich 670268 0 10114 0 0 0 12250 0 23491 0 716123 0 William P Sweezer Jr 524841 0 10248 0 0 0 12250 0 21384 0 568723 0 Patricia Owensby-Macfarlane 458954 0 248 0 0 0 7658 0 20284 0 487144 0 Thomas Hetherington 405767 0 248 0 0 0 12250 0 19513 0 437778 0 Thomas Niekamp 99972 0 0 0 0 0 0 0 0 0 99972 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Ed Farnsworth - CRMC pays monthly dues for Jefferson City County Club. Country Club is used for many business reasons. If Ed incurs any personal expenses, he reiumburses the medical center. Bob Mazur - CRMC pays for his YMCA membership. Bob is a member of the YMCA board, and it is expected that he be a member. Gross up payment of taxes - The medical center gives most employees a gift card for the holidays. This is taxable income to the employee. The hospital pays the employee's portion of the taxes on this, and the employee's taxable gross is increased accordingly. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 All board members complete an evaluation of the CEO and individually present the results to the board chair who presents them to the compensation committee, consisting of three board members, including the Chair and Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on salary surveys from three different organizations. The comparable data are based on Missouri or the region. The compensation committee members do not have a conflict of interest with respect to the compensation arrangement. The committee documents their review and decisions. SchJ_P01_S00_L05 Schedule J, Part I, Line 5 For all employees, annual merit increases are partially based on the achievement of goals (personal and organizational). Some of these organizational goals may be tied to revenues. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 For all employees, annual merit increases are partially based on the achievement of goals (personal and organizational). Some of these organizational goals may be tied to net earnings. SchJ_P01_S00_L07 Schedule J, Part I, Line 7 Some Directors and Vice Presidents participate in the Managment Incentive Compensation Program (MICP). They receive additional bonus compensation if certain stated goals are met. Most physicians receive a base salary, but also are paid an additional amount based on production. SchJ_P02_S00_L00 Schedule J, Part II Thomas Niekamp is a Vice President at CRMC. He is a leased employee from the University of Missouri. He receives his reportable earnings from the University. The amounts reported on the CRMC Form 990, and Schedule J are those amounts paid by Capital Region to the University of Missouri for his services. Health Facilities Revenue Bonds Series 2004 431178966 60635RQ91 2004-06-01 17500000 Construction 0 0 0 0 0 17500000 1655611 0 0 517500 0 0 15322544 0 0 2004 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 Dr Peter Boyer board member 205824 Rent paid to a partnership in which Dr. Boyer is a partner 0 Charlie Dudenhoeffer Board Vice Chair 500955 Bank deposits and banking fees at Hawthorn Bank, where he is a board member. 0 Dayna Lapoint Employee and Wife, of Neal Lapoint, board member 31208 Salary 0 Ken Littlefield CRMC Board treasurer and President at Central Bank 15313683 Bank deposits and banking fees. Bank Business is competitively bid. 0 Sharon Naught CRMC Board Secretary 17140 Directors and Officers Insurance purchased from Naught Naught Insurance, owned by Naught family. 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The organization has one member, The University of Missouri Medical Alliance. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a All elections for appointment to the Governing Body are subject to approval of the sole member, the University of Missouri-Medical Alliance. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b The bylaws provide a number of instances requiring approval by the sole member, e.g. amendment of the bylaws, dissolution of the organization, sale of substantial assets, and discontinuance of the major service lines. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The Form 990 is reviewed by the Director of Accounting, legal counsel, the Vice President of Finance, and the President. The President presents it to the board chair and the Executive Committee of the Board. The Executive Committee makes a presentation to the Board and copies are available to each member. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The hospital's legal counsel attends all board meetings. He is continually monitoring if any transactions would be a conflict of interest. The Director of Accounting reviews payments and identifies any potential conflicts. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 All board members complete an evaluation of the CEO and individually present the results to the board Chair who presents them to the compensation committee, consisting of three board members, including the Chair and the Vice Chair. The compensation committee reviews the evaluation results with the CEO and determines the CEO's salary based on the salary surveys from three different organizations. The comparable data are based on Missouri or the region. The compensation committee members do not have a conflict of interest with respect to the compensation arrangement. The committee documents their review and decisions. The committee meets at least once annually. The CEO sets the recommended salaries for key employees using the comparable data from three salary surveys. The Vice President of Human Resources participates in determining the appropriate salaries for key employees. The board compensation committee reviews the salary survey data: and reviews and approves the recommended salaries for key employees. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Capital Region includes financial statements in the annual report provided to the Board of Governors (approximately 500 people). Financial information is reviewed at the Medical Executive and Medical Staff meetings monthly. This information is then shared at the managers meeting, and communicated to all staff at department meetings. The Capital Region website (crmc. org), provides important information about the medical center to the community. The "Fraud and Wrongdoing" policy, "Privacy" policy, "Affiliation and Accreditations" policy, leader profiles, site locations, and contact information are all disclosed on the website. F990_P11_S00_L05 Form 990, Part XI, Line 5 SFAS#136 $283404 Cash Transfers to Related Party (Foundation Expenses) -$121718 Cash Transfers to UM Health System -$1225428 Increase in Allowance for Uncollectible Accounts -$264298 K-1 Income - not recorded on books -$1580 Basis on Sale of Assets -$153122 Capital Region Medical Foundation PO Box 1128 Jefferson City MO 651021128 431506900 Raise money and manage funds to be used in the furtherance of the exempt purpose of the medical ctr MO 501(c)(3) Support Org Typ I N/A Still Osteopathic Medical Foundation PO Box 1128 Jefferson City MO 651021128 431720296 Support Osteopathic Education MO 501(c)(3) Support Org Typ III N/A Capital Region Medical Center Partners 1125 Madison Street Jefferson City MO 65101 446014361 Support Capital Region Medical Center, and the communities i MO 501(c)(3) Supporting Org Typ 1 N/A 0 Osteopathic Postdoctural Training 800 W Jefferson Kirksville MO 63501 431831943 To promote the highest quality of osteopathic postdoctoral education training. MO N/A Related 1580 15858 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 Capital Region Medical Foundation c 618793 Cash value Capital Region Medical Foundation n 89431 Salary is actual amount paid. Benefits is actual paid in addition to some estimated allocations. Capital Region Medical Center Partners c 100000 Cash value Extension to May 15, 2012 was approved