2011-04-22T10:02:56-07:00 2010-06-30 990 2009-07-01 440546366 CAPITAL REGION MEDICAL CENTER CAPI 5736325103 1125 South Madison Jefferson City MO 65101 Jim McMillan 5736325103 2011-04-22 2009 2016-02-24 21:20:13Z Ed Farnsworth 1125 Madison Street Jefferson City MO 65101 164428607 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 1603 262 50464 0 76031 21043 157625490 163713086 762500 460170 3233 3894 158467254 164198193 0 0 0 0 78338680 79162741 0 0 0 73955150 75049316 152293830 154212057 6173424 9986136 151729257 159806812 59512215 57811733 92217042 101995079 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 1 4369645 0 2278672 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 2010, the medical center provided $2,090,973 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 that addresses the financial assistance policy and procedures or immediate financial 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 financial assistance. 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. 442156 0 88177 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 2,000 patients annually from the eight county service area which bases the charge on the individual's ability to pay, which in many cases is free. 71780 0 0 Capital Region Medical Center supports Lincoln University's School of Nursing Education Program and Nichols Career Center's Radiology Tech Program. In addition to the direct financial support that Capital Region provides, we also provide support to Columbia College BSN students and MSN students in leadership training. We assist students from Rolla Technical College and Columbia Technical College in the surgical tech programs. Our support for these programs is not only through the provision of training facilities but also adjunct faculty and resources. 134335100 161083040 All Other Inpatient and Outpatient Services provided to patients. 134335100 0 161083040 139218681 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 97 0 1 1603 1 1 1 0 0 0 0 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jim McMillan 5736325100 1432 Southwest Blvd Jefferson City MO 65109 Dr Peter A Boyer 2 X 262483 0 24960 Samuel Bushman 2.5 X 0 0 0 Charlie Dudenhoeffer 2.5 X 0 0 0 Kristi Gafford 2 X 0 0 0 Dr Neal G Lapointe 2 X 185337 0 21522 Kenneth Littlefield 2.5 X 0 0 0 Anne Lock 2.5 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 Dennis Stambaugh 2 X 0 0 0 James Wisch 2 X 0 0 0 Joseph Tomblinson 3 X 1600 0 0 Ed Farnsworth 40 X 253938 0 31816 Jim McMillan 40 X 160462 0 25352 Janet Weckenborg 40 X 160212 0 21495 Robert Mazur 40 X 119746 0 22538 Tawny Sandifer 40 X 141683 0 24141 Thomas Niekamp 40 X 99972 0 0 Randall Haight 20 X 254075 0 23836 Mitchell Godbee 40 X 802082 0 39974 William P Sweezer Jr 40 X 549417 0 33104 Patricia Owensby-Macfarlane 40 X 677104 0 33262 Raleigh Johnson 40 X 715219 0 31125 Howard Huddleston 40 X 487059 0 21318 4870389 0 354443 81 0 1 1 Septagon Construction 601 Monroe Jeffeson City MO 65101 Construction 1587972 Aramark Healthcare Support Services PO box 651009 Charlotte NC 282651009 Management Services 1367091 Boyce and Bynum Laboratory PO Box 7406 Columbia MO 65205 lab services 842412 Healthlink Inc PO Box 66971 N St Louis MO 63166 Managed Care 609048 SE Emergancy Physicians PO Box 634850 Cincinnati OH 452634850 Emergency Room Physicians 558804 46 0 0 0 20018 0 1025 0 21043 Patient Service Revenue 622000 162179659 162129195 50464 0 Other 900099 1533427 1533427 0 0 0 0 0 0 163713086 676797 0 0 676797 0 0 0 0 0 0 0 0 0 0 0 13787 0 230414 0 -216627 -216627 -216627 0 0 0 Share of K-1 Income 611710 3894 3894 0 0 0 0 0 0 3894 164198193 163449889 50464 676797 1735196 0 1735196 0 62508461 55632530 6875931 0 1003490 898446 105044 0 9866739 8781398 1085341 0 4048855 3603481 445374 0 123949 109928 14021 0 120938 107258 13680 0 8968809 8260970 707839 0 319880 283697 36183 0 664741 589549 75192 0 379571 336636 42935 0 1950243 1950243 0 0 11098543 8466141 2632402 0 1477863 1310694 167169 0 Total Supplies 30384596 30032794 351802 0 Repairs and Maintenance 2905423 2576775 328648 0 Utilities/Phone 2215775 1965137 250638 0 FRA Taxes 6810534 6810534 0 0 7628451 7502470 125981 154212057 139218681 14993376 0 6622178 5944333 1338732 1373559 16674155 16777895 2538039 3057668 1549218 1540763 192823048 119138598 77478528 73684450 40084455 52066947 5443952 5361197 151729257 159806812 18913980 19118098 36090000 35080001 4508235 3613634 59512215 57811733 X 87808391 98432377 4343330 3492356 65321 70346 92217042 101995079 151729257 159806812 X 1 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 6481758 6481758 0 112739687 66953496 45786191 0 3444059 1721243 1722816 0 69455090 50463859 18991231 0 702454 0 702454 73684450 Money Market Account 21982448 F Mortgage Backed Securities 14499630 F US Treasury Obgligations 73678 F Repurchase Agreements 3070584 F Corporate Bonds 3173352 F Certificates of Deposit 10640814 F Less: Current Amounts -1373559 F 52066947 Interest in Net Assets of Capital Region Medical Foundation 3562702 Deferred Financing Costs 675547 Long Term Receivable and Other Non Current 1122948 5361197 Other LT Liabilities 179247 Capital Lease Obligation 286239 457 B Liability 780076 2008 Note Payable 2368072 3613634 164198193 154212057 9986136 0 0 0 0 0 0 9986136 164194299 0 0 0 0 0 164194299 0 3894 3894 164198193 153811693 0 0 0 355015 355015 153456678 0 755379 755379 154212057 SchD_P10_S00_L00 Schedule D, Part X The audit report for Capital Region Medical Center does not contain any footnotes for FIN48. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Share of K-1 income. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Cash Transfers 124,601 Basis on sale of assets (line 7B) 230,414 SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Decrease in Allowance for Uncollectible Accounts 1 1 1 X 0 1 1 0 1 1 4369645 2278672 2090973 0.014 0 0 4369645 2278672 2090973 0.014 2702 35794 308874 148286 160588 0.001 665938 569787 96151 0.0006 2437597 1983476 454121 0.0029 86589 1200 85389 0.0006 228429 0 228429 0.0015 2702 35794 3727427 2702749 1024678 0.0066 2702 35794 8097072 4981421 3115651 0.0206 9667 0 9667 0.00006 2753 0 2753 0.00002 0 0 12420 0 12420 0.00008 0 1563860 148567 48860941 46481360 2379581 X 1 1 Capital Region Medical Center

1125 Madison Street Jefferson City MO 65101

X X X X Capital Region Southwest Facility

1432 Southwest Blvd Jefferson City MO 65109

Outpatient Services CRMC - Womens and Childrens Building

1014 Madison Street Jefferson City MO 65101

Physician Clinic CRMC - Health Branch West

3308 W Edgewood Jefferson City MO 65109

Urgent Care Clinic CRMC - California Clinic

704 Buchanan Hwy 50 West California MO 65018

Physician Clinic CRMC - Eldon Clinic

103 Business Highway 54 North Eldon MO 65026

Physician Clinic CMRC - Holts Summit Clinic

180 North Star Holts Summit MO 65043

Physician Clinic CRMC - Owensville Clinic

3536 Kuhne Road Owensville MO 65066

Physician Clinic CRMC - Stover Clinic

PO Box 489 2nd and Oak Stover MO 65078

Physician Clinic CRMC - Southwest Clinic

1500 Southwest Blvd Jefferson City MO 65109

Physician Clinic CRMC - Versailles Clinic

901 Kidwell Drive Versailles MO 65084

Physician Clinic CRMC - Linn Clinic

916 East Main Street Linn MO 65051

Physician Clinic Resident Clinic

1111 Madison Street Jefferson City MO 65101

Physician Clinic CRMC Healthplex West

3308 West Edgewood Drive Jefferson City MO 65109

Outpatient Therapy Services CRMC - Family Medical Center

402 E High Street Jefferson City MO 65101

Physician Clinic CRMC - CCMA

1505 Southwest Blvd Jefferson City MO 65109

Physician Clinic CRMC - Integrative Medicine

1002 Diamond Ridge Suite 200 Jefferson City MO 65109

Physician Clinic Eligibility care will be determined based on CSA Poverty guidelines in conjunction with other available resources. Once approved, applications will be reviewed every six (6) months. CRMC bases income and family size (for purposes of qualifying charity care) on the Federal poverty guidelines as published and updated annually in February by the U.S. Department of Health and Human Services. The department of Health and Human Services publishes updates to the Federal poverty guidelines on its website: a. (http//aspe.os.dhhs.gov/poverty/XX computations.htm-XX meaning the specific year; i.e. 08 for 2008). A patient's income and family size must be at or below 200% of the Federal poverty guidelines to receive 100% charity care. A sliding scale up to 400% 350% of the Federal Poverty Level is us used to determine partial charity allowance as presented below: Some persons may exceed the poverty guidelines but may still be eligible for charity when additional criteria are considered such as catastrophic medical costs, etc. Other obligations should be evaluated to determine if they are basic needs or luxury items. CRMC reserves the right to adjust monthly living expenses to reasonableness. Cost to charge ratios. 197,800 costs associated with a clinic staffed by medical interns and residents in included in Schedule H, Part 1, line 7 (g). $4,583,542 Cost to Charge ratio method. N/A - no shortfall 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.. CRMC assesses health care needs of the 8 communities we serve by conducting consumer perception studies, developing an annual environmental analysis, conducting focus groups, etc. Patient Financial Services consels patients /persons regarding financial assistance via telephone and in person as needed. Information also appears on our website, www.crmc.org. CRMC service area includes 8 counties; Callaway, Cole Gasconade, Maries, Miller, Morgan, Moniteau and Osage. 46% of inpatient discharges include patients residing in Cole County. Corporate/Community Health department conducts numerous community health fairs, lunch and learns, participation in local community awareness events, health specific screenings/education sessions for corporate partners, etc. CRMC works closely with nearly 500 Board of Governor members who reside in the 8 county service area. Annual Outreach Meetings and focus groups provide county specific feedback regarding health needs, allowing an assessment of the health of our communities. 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 area(s) and are able to co-promote health care capabilities. X 1 1 X X X 0 0 0 1 0 1 0 0 0 Dr Peter A Boyer 218177 0 22655 0 21651 0 6898 0 18062 0 287443 0 Dr Neal G Lapointe 137547 0 186 0 47604 0 5269 0 16253 0 206859 0 Ed Farnsworth 216303 0 15634 0 22000 0 13878 0 17938 0 285753 0 Jim McMillan 128198 0 10263 0 22000 0 8770 0 16582 0 185813 0 Janet Weckenborg 115956 0 10426 0 33830 0 4916 0 16579 0 181707 0 Robert Mazur 107507 0 7686 0 4554 0 6546 0 15992 0 142285 0 Tawny Sandifer 126844 0 9391 0 5448 0 7831 0 16310 0 165824 0 Randall Haight 187621 0 49955 0 16500 0 5896 0 17940 0 277912 0 Mitchell Godbee 785396 0 186 0 16500 0 14088 0 25886 0 842056 0 Raleigh Johnson 715033 0 186 0 0 0 6499 0 24626 0 746344 0 Patricia Owensby-Macfarlane 676918 0 186 0 0 0 9188 0 24074 0 710366 0 William P Sweezer Jr 510730 0 186 0 38500 0 10882 0 22222 0 582520 0 Howard Huddleston 436373 0 12186 0 38500 0 0 0 21318 0 508377 0 Joseph Tomblinson 1600 0 0 0 0 0 0 0 0 0 1600 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 The hospital gives most employees a gift card annually. 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 appropriately to account for this. 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 are 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 are tied to earnings. 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 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 17500000 1655611 0 0 517500 0 15322544 2004 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 Ken Littlefield Ken Littlefield (board member) is also President of Central Bank, a bank that CMRC does business. 18124397 Banking transactions performed at arms length. Banking services are competitively bid. 0 Dr Peter Boyer Dr. Boyer is a partner with CCMA. CRMC rents office space from CCMA. 205824 Rent income for clinic 0 Dayna Lapoint Employee and wife of Dr. Neal Lapoint, board member 34779 Salary 0 Charlie Dudenhoeffer Board Vice Chair - Also on board at Hawthorn Bank 311749 Bank deposits and banking fees. All banking services are competitively bid. 0 F990_P03_S00_L03 Form 990, Part III, Line 3 Citizens of Cole County approved a tax increase to support the Ambulance service. In July of 2009, Cole County assumed the responsibility for operation of the Ambulance service. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The organiztion 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, discontinuance of major service lines are examples. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 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 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. The committee meets annually and the last meeting was November 2009. The prior meeting was October 2008. 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", leader profiles, site locations, and contact information are all disclosed on the website. 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 Osteopathic Postdoctural Training 800 W Jefferson Kirksville MO 63501 431831943 To promote the highest quality of osteopathic postdoctoral education training. MO N/A Related 3894 14278 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0