2023-12-04T10:47:16-06:00 2023-03-31 430352985 KERBER ECK & BRAECKEL LLP 3401 OFFICE PARK DRIVE MARION IL 62959 990 2022-04-01 431741457 PERRY COUNTY HEALTH SYSTEM PERR 5735472536 434 NORTHWEST STREET PERRYVILLE MO 63775 PAT NAEGER DESIGNATED SIGNATORY OFFICER 5735472536 2023-11-27 1 PAT NAEGER 999009999 1 AMBER HALSTEAD P01343727 6185291040 2023-11-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z PAT NAEGER 434 NORTHWEST STREET PERRYVILLE MO 63775 70539216 0 X WWW.PCHMO.ORG X 1996 MO TO PROVIDE QUALITY HOSPITAL AND HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. 5 5 576 29 0 0 9005868 482354 64115545 62544830 -253737 -808918 2666425 7250509 75534101 69468775 0 0 0 0 31172829 34445247 0 0 0 34137894 32164489 65310723 66609736 10223378 2859039 69313234 69876813 10677892 8350007 58635342 61526806 TO PROVIDE QUALITY HOSPITAL & HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF PERRY COUNTY AND SURROUNDING COMMUNITIES. 0 0 60581963 68724898 5,002 PATIENT DAYS OF CARE OF WHICH 198 DAYS WERE NURSERY CARE WERE PROVIDED THROUGH INPATIENT SERVICES IN 2023. THE HOSPITAL PROVIDED 2,138 HOME HEALTH AGENCY VISITS, 69,843 RURAL HEALTH CLINIC VISITS, 7,709 EMERGENCY ROOM VISITS, 31,375 OUTPATIENT VISITS AND 1,959 SURGERIES IN 2023. FOR FURTHER INFORMATION ABOUT PROGRAMS AND SERVICES PLEASE SEE SCHEDULE H PART VI, LINE 2. 60581963 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 76 0 1 576 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MO X CASEY CATHCART 5735472536 434 NORTHWEST STREET PERRYVILLE MO 63775 DR KEITH MOECKEL BOARD PRESIDENT 2.00 X 0 0 0 DARRELL NISWONGER BOARD VICE PRESIDENT 3.00 X 0 0 0 BETH GUTH BOARD SECRETARY 2.00 X 0 0 0 KAY TAYLOR BOARD TREASURER 1.00 X 0 0 0 DR LINDA BUERCK BOARD MEMBER 1.00 X 0 0 0 CHRISTOPHER WIBBENMEYER CEO 50.00 X 273982 0 29493 MICHAEL ELLIS CFO 50.00 X 240926 0 50952 STACEY M REITZEL ASSOCIATE VP 50.00 X 191275 0 37063 AMBER BISHOP CNO 50.00 X 155293 0 44854 ANGIE BREWER HR DIRECTOR 50.00 X 191717 0 48308 JOSEPH B BYRNE PHYSICIAN 50.00 X 999619 0 52349 CRAIG FRAYER PHYSICIAN 50.00 X 472248 0 47275 SANDEEP RAO HOSPITALIST 50.00 X 923232 0 53054 HOPE BANTE PHYSICIAN 40.00 X 275746 0 31086 MATTHEW GAETA GASTROLOGY 50.00 X 830969 0 53323 PATRICK CARRON FORMER PRESIDENT/CEO 0.00 X 296154 0 0 4851161 0 447757 34 1 1 0 PERRY KIDS PEDIATRICS 210 HOSPITAL LANE SUITE 202 PERRYVILLE MO 63775 PHYSICIAN SERVICES 496054 EMERGENCY MEDICAL CARE LLC 1415 ELBRIDGE PAYNE SUITE ROAD SUIT ST LOUIS MO 63141 ER PHYSICIAN SERVICES 434216 PAUL ALLEN SALMON MD 2701 JANET DRIVE CAPE GIRARDEAU MO 63701 ER PHYSICIAN SERVICES 374163 NEWPOINT HEALTHCARE ADVISORS LLC 2929 N CENTRAL AVE 21ST FLOOR PHOENIX AZ 85012 CONSULTING 300000 SHAYNE KEDDY DO 361 BLOSSOM HILL LANE FARMINGTON MO 63640 ER DIRECTOR 236680 9 482354 482354 HEALTHCARE SERVICES 621990 62544830 62544830 62544830 261523 261523 829605 240836 -829605 -240836 -1070441 -1070441 INSURANCE PROCEEDS 621990 4491885 4491885 PHARMACY REVENUE 621990 1954412 1954412 OTHER INCOME 621990 739117 739117 65095 65095 7250509 69468775 68724898 0 261523 1560018 1560018 24701943 22801021 1900922 747800 649251 98549 5445339 4727723 717616 1990147 1727875 262272 239565 239565 215558 215558 3998270 3502627 495643 1059557 1006202 53355 110006 47415 62591 2604284 2604284 423992 216460 207532 PROFESSIONAL FEES 12707001 12707001 MEDICAL SUPPLIES 9332972 9327625 5347 REPAIRS AND MAINTENANCE 1289171 1264335 24836 CHARITABLE CONTRIBUTION 151487 151487 32626 144 32482 66609736 60581963 6027773 0 18828992 17037695 8122080 6752422 340752 2481706 1870019 1602332 317150 392358 71539197 38365117 31705230 33174080 5802557 5378804 2326454 3057416 69313234 69876813 8986892 6474007 1676000 1576000 15000 300000 10677892 8350007 X 58635342 61526806 58635342 61526806 69313234 69876813 2859039 32425 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14278 14278 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND MISSOURI HOSPITAL ASSOCIATION (MHA). A PORTION OF THE HOSPITAL'S DUES PAID TO THE AHA AND MHA ARE INDIRECTLY USED FOR LOBBYING PURPOSES. 1514365 1514365 49666933 22593668 27073265 18924305 15771449 3152856 1433594 1433594 33174080 THIRD-PARTY REIMBURSEMENT PROGRAMS 300000 300000 X 69349713 32425 -151487 -119062 69468775 0 69468775 66458249 0 66458249 151487 151487 66609736 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER CODE SECTION 501(C)(3) FOR ACTIVITIES DIRECTLY RELATED TO ITS TAX-EXEMPT FUNCTION. UNRELATED BUSINESS INCOME IS SUBJECT TO TAX. PERRYVILLE HEALTHCARE CORPORATION IS A TAXABLE CORPORATION AND FILES A SEPARATE CORPORATE RETURN. THE HOSPITAL HAS RECOGNIZED IN THE FINANCIAL STATEMENTS THE EFFECTS OF ALL TAX POSITIONS AND CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE HOSPITAL IS NOT AWARE OF ANY SIGNIFICANT CIRCUMSTANCES OR EVENTS THAT MAKE IT REASONABLY POSSIBLE THAT UNRECOGNIZED TAX BENEFITS MAY INCREASE OR DECREASE WITHIN 12 MONTHS OF THE STATEMENT OF FINANCIAL POSITION DATE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHARITABLE CONTRIBUTIONS OFFSET AGAINST RELATED REVENUE -151,487. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITABLE CONTRIBUTIONS OFFSET AGAINST RELATED REVENUE 151,487. 1 1 1 X 1 X 190.000000000000 1 1 1 0 1 1 169521 169521 0.00250 6452660 2467194 3985466 0.05980 6622181 2467194 4154987 0.06230 30000 30000 0.00050 30000 30000 0.00050 6652181 2467194 4184987 0.06280 1 1321000 660355 27646812 31637079 -3990267 X 1 1 1 1 PERRY COUNTY MEMORIAL HOSPITAL 434 NORTHWEST STREET PERRYVILLE MO 63775 WWW.PCHMO.ORG X X X X PERRY COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X 19 1 0 1 1 X WWW.PCHMO.ORG X 1 19 1 WWW.PCHMO.ORG 0 1 X 150.000000000000 190.000000000000 X X X X 1 1 X X X 1 X 1 X 0 1 X 0 0 PERRY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THIS ASSESSMENT HAS EXPLORED THE NEEDS OF THE IDENTIFIED GROUPS BY SPECIFICALLY SEEKING INPUT FROM PERSONS WITH KNOWLEDGE OF THE SPECIFIC HEALTH CONCERNS. INPUT WAS ALSO SOUGHT FROM MEMBERS OF THE COMMUNITY CHARGED PROFESSIONALLY WITH ADVANCING THE HEALTH AND EDUCATION OF THE COMMUNITY AND ALL ITS MEMBERS. THOSE CONSULTED INCLUDE THE HOSPITAL EXECUTIVE STAFF AND AN INTERNAL WORKING GROUP. THE REFERENCE COMMUNITY AND OUTSIDE RESOURCES INCLUDE: COUNTY HEALTH DEPARTMENT, CITY POLICE, COUNTY SHERIFF, SCHOOLS, TASK FORCE, MENTAL HEALTH BOARD, AND OTHERS. A SECOND, HEALTHCARE SPECIFIC SURVEY, WAS THEN DEVELOPED AND CIRCULATED TO OVER 450 HOSPITAL STAFF, VOLUNTEERS, PHYSICIANS, AND DEPARTMENT DIRECTORS. IT WAS ALSO DISTRIBUTED ONLINE FOR TWO WEEKS DURING THE WEEK OF MARCH 20 - APRIL 14, 2019 ALONG WITH PAPER COPIES DISTRIBUTED FOR THOSE WHO DID NOT HAVE ONLINE ACCESS. A TOTAL OF 192 RESPONSES WERE RECEIVED. PERRY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: PCMH WAS A PARTICIPANT IN A COMMUNITY WIDE SURVEY ALONG WITH OTHER SIGNIFICANT COMMUNITY AGENCIES (COUNTY HEALTH DEPARTMENT, CITY POLICE, COUNTY SHERIFF, SCHOOLS, TASK FORCE, MENTAL HEALTH BOARD, AND OTHERS) TO OBTAIN DATA ON INDIVIDUAL PERCEPTIONS OF HEALTH NEEDS. THIS SURVEY IS CONDUCTED EVERY TEN YEARS. PERRY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: DEMENTIA AND ALZHEIMER'S DISEASE - PROMOTE AWARENESS BY INCREASING EVIDENCE-BASED COGNITIVE SCREENINGS FOR AT RISK POPULATIONS AND PROVIDING ONGOING COMMUNITY SCREENINGS IN TARGETED POPULATIONS WHILE INCREASING PROVIDER AND CAREGIVER EDUCATION AND SUPPORT. SUBSTANCE ABUSE AND MENTAL HEALTHCARE - INCREASE AWARENESS OF MENTAL HEALTH ISSUES THROUGH PUBLIC OUTREACH AND INCREASE ACCESS TO MENTAL HEALTH SERVICES THROUGH COORDINATION OF PHYSICAL, MENTAL, AND SUBSTANCE ABUSE TREATMENT TO FACILITATE CONSISTENCY AND CONTINUITY IN TREATEMENT. CANCER CARE - BUILD AWARENESS AND PROVIDE EDUCATION RELATED TO PREVENTION STRATEGIES AS WELL AS OFFER CLINICAL SUPPORT FOR PATIENTS IN NEED OF ONCOLOGY SERVICES. MAINTAIN LOCAL MEDICAL ONCOLOGY PROVIDER ACCESS AND BUILD AWARENESS OF LOCAL CANCER TREATMENT OPTIONS. 9 1 - MID AMERICA REHAB 206 HOSPITAL LANE PERRYVILLE MO 63775 PHYSICAL THERAPY 2 - PERRYVILLE FAMILY CARE CENTER 212 HOSPITAL LANE PERRYVILLE MO 63775 PHYSICIANS 3 - PERRY COUNTY PHYSICIAN SERVICES 206 HOSPITAL LANE PERRYVILLE MO 63775 PHYSICIANS 4 - PFCC WEST 1508 EDGEMONT BLVD PERRYVILLE MO 63775 PHYSICIANS 5 - PCMH AMBULANCE SERVICE LLC 434 N WEST STREET PERRYVILLE MO 63775 AMBULANCE SERVICES 6 - WOUND CARE CLINIC 434 N WEST STREET PERRYVILLE MO 63775 WOUND CARE 7 - PERRY COUNTY SPECIALTY SERVICES 210 HOSPITAL LANE PERRYVILLE MO 63775 PHYSICIANS - PEDIATRICS 8 - EQUIPMENT PLUS HOME SERVICES 519 N MAIN STREET SUITE 2 PERRYVILLE MO 63775 DURABLE MEDICAL EQUIPMENT 9 - HOME HEALTH 434 N WEST STREET PERRYVILLE MO 63775 HOME HEALTH PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. THE HOSPITAL USED ACTUAL COSTS AS REPORTED IN THE GENERAL LEDGER SYSTEM TO DETERMINE THE AMOUNTS OF LINES 7E OF PART I OF SCHEDULE H. PART III, LINE 2: THE HOSPITAL CALCULATED BAD DEBT EXPENSE AT COST USING THE COST-TO-CHARGE RATIO AS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED AS OUTLINED IN SCHEDULE H, PART III, LINE 9B. PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL DISCOUNTS AND PAYMENTS HAVE BEEN APPLIED. BASED ON THE HOSPITAL'S EXPERIENCE WITH ALL ITS PATIENTS, THEY ESTIMATE THAT IT IS LIKELY THAT UP TO 50% OF THE PATIENT ACCOUNTS WRITTEN OFF TO BAD DEBTS MAY QUALIFY FOR CHARITY CARE OR OTHER ASSISTANCE BUT CHOSE NOT TO APPLY. THEREFORE, 50% OF THE BAD DEBT EXPENSE WAS INCLUDED ON PART III, LINE 3 AT COST. THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE THAT SPECIFICALLY ADDRESSES BAD DEBTS (NOTE D). THE PROVISION FOR BAD DEBTS REPRESENTS UNCOMPENSATED CARE FOR PATIENTS OF WHICH A MAJORITY ARE UNINSURED OR UNDERINSURED, BUT DID NOT APPLY FOR OR QUALIFY FOR CHARITY CARE. PART III, LINE 9B: THE HOSPITAL'S CREDIT AND COLLECTION POLICY, PURPOSE, AND PROCEDURES ARE AS FOLLOWS:PURPOSE: ASSIST AND ADVISE PATIENTS ON INSURANCE AND FINANCIAL RESOURCES. PERFORM DUTIES IN CONNECTION WITH CREDIT, COLLECTIONS, AND SOCIAL SERVICES. ARRANGE PAYMENT OF ANY BALANCE NOT COVERED BY INSURANCE. EVALUATE THE CREDIT HISTORY AND DETERMINE PAYMENTS BASED ON THE PATIENT'S ABILITY TO PAY AND THE POLICY OF THE HOSPITAL AS BELOW.ALL EFFORT WILL BE MADE TO COLLECT THE BALANCE AS FOLLOWS:BALANCE UNDER $1,000.00 - PAID WITHIN 3 MONTHS.FOR EACH ADDITIONAL $1,000.00 BALANCE - ADD 3 MONTHS.(EXAMPLE: FOR BALANCES BETWEEN $4,000.00 AND $5,000.00 - PAID WITHIN 12 MONTHS.)ACCOUNTS WITH A BALANCE OF $3.00 AND UNDER WILL NOT BE MAILED A BILLING STATEMENT. THE BALANCE WILL BE CHARGED OFF AS A SMALL BALANCE ADJUSTMENT.STATEMENTS ARE GENERATED ON A WEEKLY BASIS BY RUNNING FIRST TIME STATEMENTS AND CYCLE STATEMENTS 1, 2, 3, OR 4.ACCOUNTS FOLLOW A REGULAR COMPUTER GENERATED BILLING SYSTEM. FIRST TIME STATEMENTS ARE SENT AFTER THE INSURANCE PAYMENT HAS BEEN PROCESSED AND THE ACCOUNT FALLS INTO A BILLING CYCLE. WHEN THAT CYCLE IS PRINTED, A FIRST TIME STATEMENT WILL BE GENERATED. THE FOLLWOING MONTH, A CYCLE STATEMENT IS GENERATED. THE COLLECTION CYCLE ADVANCES AS FOLLOWS: 1, 2, 3, A (FIRST LETTER) AND B (FINAL NOTICE LETTER).AFTER ACCOUNTS WITH A BALANCE OVER $1,000.00 RECEIVE A FIRST TIME STATEMENT, THEY ARE REVIEWED BY THE FINANCIAL COUNSELOR TO DETERMINE IF A COLLECTION PHONE CALL SHOULD BE MADE. FINANCIAL ARRANGEMENTS ARE DISCUSSED AND PAYMENT SCHEDULES ARE AGREED UPON. MONTHLY TERMS CAN BE SET, WHEREBY A DESIGNATED AMOUNT AND DATE OF PAYMENT IS ARRANGED ON A MONTHLY BASIS. ACCOUNTS THAT DO NOT FOLLOW THE DESIGNATED PAYMENT PLAN RECEIVE LETTERS 2, 3, A, AND B. IF THE ACCOUNT IS STILL UNPAID AFTER THE ABOVE PROCEDURES ARE USED, ACCOUNTS ARE WRITTEN OFF AND PREPARED FOR THE COLLECTION AGENCY BY PRINTING THE COLLECTION AGENCY REPORT. REPORTS ARE ALSO PREPARED FOR THE APPROVAL OF THE VICE PRESIDENT OF FINANCE AND THE BUSINESS OFFICE MANAGER. REGULAR WRITE-OFFS ARE DONE ON A MONTHLY BASIS. MEDICARE WRITE OFFS ARE DONE ON A MONTHLY BASIS.ASSISTANCE IS GIVEN TO THE THIRD PARTY AGENCY TO AID IN THE COLLECTION OF ACCOUNTS. THE AGENCY IS NOTIFIED DAILY OF PAYMENTS AND BALANCE DUE ON TURNED ACCOUNTS. WHEN THE AGENCY ADVISES OF SUIT FILING ON ACCOUNTS, AN AFFIDAVIT IS SENT TO OBTAIN PERMISSION. THE AFFIDAVIT IS SIGNED BY THE BUSINESS OFFICE MANAGER AND NOTORIZED PRIOR TO RETURNING TO THE AGENCY. THEY WILL ACT AS OUR REPRESENTATIVE AND SELECT AN ATTORNEY TO REPRESENT THE HOSPITAL IN LEGAL PROCEEDINGS, AND ATTEND ANY COURT PROCEEDINGS ON THE DATE SCHEDULED.WHEN THE COLLECTION AGENCY HAS CEASED ALL COLLECTION EFFORTS AND THE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE COLLECTION AGENCY WILL SEND A RETURN REPORT. AT THAT TIME, ACCOUNTS WILL BE POSTED AS AN ACCOUNT RETURNED FROM THE COLLECTION AGENCY AND CAN BE INCLUDED AS A BAD DEBT ON THE COST REPORT.ACCOUNTS ARE ALSO REVIEWED FOR REFUNDS, CHARGE OFFS, AND PAYROLL DEDUCTION.THE FINANCIAL COUNSELOR SPEAKS WITH PRIVATE PAY PATIENTS IN A/C, ER, AND ON MED/SURG TO SET UP PAYMENT ARRANGEMENTS. A FORM IS SIGNED BY THE PATIENT SETTING UP TERMS WHEN POSSIBLE. IF PATIENT STATES THEY ARE UNABLE TO PAY, THE CHARITY CARE PROGRAM APPLICATION IS GIVEN AND THE PATIENT IS COUNSELED ON CHARITY CARE GUIDELINES. PART VI, LINE 2: GENERALLY SPEAKING, THE DETERMINATION OF CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED BY THE HOSPITAL IS BASED ON ALL OR A COMBINATION OF THE FOLLOWING FACTORS: EXISTENCE OR NONEXISTENCE OF SERVICES, OPPORTUNITIES, SUPPLY, DEMONSTRATED NEED, "VOICE OF THE CONSUMER", 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 THROUGH BENCHMARKING, MARKET RESEARCH, CUSTOMER SURVEYS, PHYSICIAN INPUT, AND THROUGH CONSTANT MONITORING OF STATE AND FEDERAL GUIDELINES. IN ADDITION, NEEDS ASSESSMENTS ARE ON-GOING THROUGH THE VARIOUS PROGRAMS AND SERVICES PROVIDED TO THE COMMUNITY BY THE HOSPITAL AS FOLLOWS: - SPEAK TO COMMUNITY GROUPS ON A VARIETY OF HEALTHCARE TOPICS - SPEAK TO SCHOOL CLASSES ABOUT HEALTHY LIVING AND HEALTHCARE TOPICS - OFFER CLASSES ON CHILDBIRTH (48 HRS/YR BK), AND SIBLINGS (1 HR/MO) - OFFER CPR CLASSES TO THE PUBLIC AND TO AREA BUSINESS FOR THEIR EMPLOYEES - PROVIDE TOURS OF THE HOSPITAL TO STUDENT AND CIVIC GROUPS - COOPERATIVE AGREEMENT WITH THE HEALTH OCCUPATIONS CLASS - CLINICAL SITE FOR PHYSICAL THERAPY, RESPIRATORY, ANESTHESIA, AND RADIOLOGY STUDENTS - PROVIDE A PHYSICAL THERAPIST ASSISTANT, PHYSICAL THERAPIST, AND ATHLETIC TRAINER FOR HIGH SCHOOL SPORTING EVENTS - PROVIDE ATHLETIC TRAINING ONCE A WEEK AT SPORTS PRACTICES - SPONSOR SIX CHAMPIONS FOR LIFE BLOOD DRIVES EACH YEAR - PROVIDE A FREE MEETING ROOM FOR AT LEAST 12 COMMUNITY GROUPS ON A REGULAR BASIS - PROVIDE A BETTER BREATHERS SUPPORT GROUP QUARTERLY - PROVIDE AN ALZHEIMERS SUPPORT GROUP MONTHLY - OFFER BLOOD PRESSURE SCREENINGS AND CHOLESTEROL CHECKS MONTHLY - HOST A FREE WOMEN'S CONFERENCE ANNUALLY - PROVIDE $18,000 IN SCHOLARSHIPS ANNUALLY - OFFER A MEDI-ALERT PROGRAM TO THE AGING POPULATION IN THE COMMUNITY - PARTICIPATE ANNUALLY IN THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE - CONTRIBUTE ANNUALLY TO THE AMERICAN LUNG ASSOCIATION, AMERICAN HEART ASSOCIATION, BOY SCOUTS OF AMERICA, AND GIRL SCOUTS OF AMERICA - SPONSOR THE FIRST AID STATION AT EAST PERRY COMMUNITY FAIR - OFFER SAFE SITTERS CLASSES 3 TIMES A YEAR - OFFER SPORTS PHYSICALS ANNUALLY GIVING BACK THE PROCEEDS TO THE PARTICIPATING SCHOOLS - OFFER MEDICAL AND NON-MEDICAL TRANSPORTATION FOR A SUGGESTED DONATION - CO-SPONSOR THE JR/SR CONFERENCE ANNUALLY - PARTICIPATE IN THE CHAMPS MENTORING PROGRAM - STAFF REPRESENTATION ON NUMEROUS COMMUNITY COMMITTEES - SPONSOR VARIOUS CHAMBER AND COMMUNITY ACTIVITIES (CHAMBER LEADERSHIP DAY, MAYFEST 5K, MAYFEST BOOTH, MAYFEST TOP SPONSOR, CUSTOMER APPRECIATION ON THE SQUARE, CHAMBER WOMEN'S CONFERENCE TOP SPONSOR, TURKEY BURN OFF 5K) - HOST VARIOUS HEALTHCARE RELATED EDUCATIONAL SEMINARS FOR THE PUBLIC - HOST A SPEECH/PHYSICAL/OCCUPATIONAL SCREENING ANNUALLY TO AREA CHILDREN AGES 3 TO 5 YEARS OLD - PERRY CO ESTATES SENIOR HOUSING OFFERED TO LOW-INCOME SENIORS - DONATE PROMOTIONAL ITEMS TO NUMEROUS ORGANIZATIONS/GROUPS (I.E. HAND SANITIZER TO SCHOOLS DURING THE H1N1 FLU SEASON, FIRST AID ITEMS TO SCHOOLS) - PROVIDE CAR SEAT SAFETY CHECKS - PROVIDE FREE SPEECH SCREENINGS ANNUALLY - PROVIDE FREE EDUCATIONAL SEMINARS REGARDING SPEECH AND HEARING - PROVIDE FREE HEARING SCREENINGS AS NEEDED - AMBULANCE PROVIDED STANDBY AT 30 EVENTS FREE OF CHARGE - OFFER COGNITIVE STIMULATION THERAPY PROGRAM FOR ALZHEIMERS PATIENTS - PARTICIPATE IN THE BACKPACK BONANZA FOR UNDERPRIVILEGED CHILDREN - HOST AN ANNUAL SKEET SHOOT TO RAISE FUNDS FOR CHILDREN WITH CHRONIC ILLNESSES ($9,000.00 - 10,000.00 ANNUALLY) - SPONSOR TEEN COUNCIL'S EFFORTS ON HUNGER/RECYCLING AT EAST PERRY FAIR - SPONSORED 60 CHILDREN WITH FIREPUP PROGRAM WITH PERRYVILLE FIRE DEPARTMENT - SPONSOR EAST PERRY FAIR ANNUALLY - POST MESSAGES ON DIGITAL SIGN FOR VARIOUS COMMUNITY ORGANIZATIONS FREE OF CHARGE (TEXTING AND JR/SR CONF) - SPONSOR WATER TENT AT CENTER FOR LIFE 5K AND RYAN BEHRLE 5K - PERRY PARK CENTER SPONSORSHIP (YOUTH BASKETBALL, YOUTH TRACK, PLAY DAY AT THE PARK, DISC GOLF TOURNAMENT) - CO-SPONSOR THE PROCTOR AND GAMBLE BOOTH AT THREE EVENTS THROUGHOUT THE YEAR PROVIDING PROMOTIONAL ITEMS TO ALL WHO STOP AT THE BOOTH - SPONSOR AND PARTICIPATE IN COMMUNITY-WIDE SURVEY PART VI, LINE 3: THE HOSPITAL APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. CHARITY CARE PROGRAM INFORMATION IS SENT OUT WITH WEEKLY STATEMENTS ON PRIVATE PAY ACCOUNTS TO PATIENTS RESIDING IN PERRY COUNTY OR AN ADJACENT COUNTY THAT DOES NOT HAVE A HEALTH CARE FACILITY WITH ACCOUNT BALANCES OVER $1,000.00. PATIENTS ARE ADVISED TO CONTACT THE BUSINESS OFFICE FOR A COMPLETE APPLICATION IF THEY WISH TO APPLY. PART VI, LINE 4: PERRY COUNTY IS A RURAL COMMUNITY OF 18,000 PEOPLE. THE GEOGRAPHY IS DENSE FOREST, ROLLING HILLS USED FOR LIVESTOCK FARMING, AND VALLEY AND RIVER BOTTOM-LAND FARMING. AGRICULTURAL WORK NO LONGER DOMINATES THE ECONOMIC LANDSCAPE. LIGHT INDUSTRIAL AND LIGHT MANUFACTURING IS A PREDOMINANT ECONOMIC FORCE. THE ECONOMIC DEMOGRAPHIC IS GENERALLY LOWER TO MIDDLE TO MID-MIDDLE CLASS WEALTH FOR THE WORKING AGED RESIDENTS. RETIREMENT AGED RESIDENTS CONSTITUTE OVER 40% OF THE POPULATION. LOWER SOCIOECONOMIC AND INDIGENT POPULATIONS CONSITUTE LESS THATN 10% OF THE COMMUNITY. X X X 0 0 0 0 0 0 0 0 0 JOSEPH B BYRNE PHYSICIAN 999619 0 0 0 0 0 19526 0 32823 0 1051968 0 0 0 SANDEEP RAO HOSPITALIST 923232 0 0 0 0 0 20500 0 32554 0 976286 0 0 0 MATTHEW GAETA GASTROLOGY 830969 0 0 0 0 0 20500 0 32823 0 884292 0 0 0 CRAIG FRAYER PHYSICIAN 472248 0 0 0 0 0 27000 0 20275 0 519523 0 0 0 HOPE BANTE PHYSICIAN 275746 0 0 0 0 0 20500 0 10586 0 306832 0 0 0 CHRISTOPHER WIBBENMEYER CEO 273982 0 0 0 0 0 10400 0 19093 0 303475 0 0 0 PATRICK CARRON FORMER PRESIDENT/CEO 296154 0 0 0 0 0 0 0 0 0 296154 0 0 0 MICHAEL ELLIS CFO 240926 0 0 0 0 0 27000 0 23952 0 291878 0 0 0 ANGIE BREWER HR DIRECTOR 191717 0 0 0 0 0 15984 0 32324 0 240025 0 0 0 STACEY M REITZEL ASSOCIATE VP 191275 0 0 0 0 0 4921 0 32142 0 228338 0 0 0 AMBER BISHOP CNO 155293 0 0 0 0 0 12754 0 32100 0 200147 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS GIVEN A QUESTIONNAIRE THAT INCLUDES ASKING THEM TO DISCLOSE ANY APPLICABLE CONFLICTS OF INTEREST. THIS IS DONE ON AN ANNUAL BASIS AND ENFORCEMENT IS DONE ON A PER INCIDENT BASIS, WITH ALL ASPECTS OF THE CONFLICT TAKEN INTO CONSIDERATION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR TOP OFFICIALS - INDUSTRY COMPARABILITY DATA IS MADE AVAILABLE TO THE BOARD OF DIRECTORS. AN EXECUTIVE SESSION IS HELD TO DETERMINE AND APPROVE ALL TOP MANAGEMENT COMPENSATION. THIS IS PERFORMED ON AN ANNUAL BASIS. COMPENSATION PROCESS FOR OFFICERS AND KEY EMPLOYEES - THE CEO PERFORMS AN ANNUAL SALARY EVALUATION OF OFFICERS AND KEY EMPLOYEES. USING INDUSTRY COMPARIBILITY DATA AND AN ANNUAL REVIEW, THE CEO RECOMMENDS SALARY FOR OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 18 THIS ORGANIZATION MAKES ITS IRS FORM 1023, 990 AND 990-T AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. THIS ORGANIZATION ALSO RELIES ON THE WEB-SITE WWW.GUIDESTAR.ORG TO MAKE READILY AVAILABLE ITS TAX RETURNS TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PCMH AMUBLANCE SERVICE LLC 434 NORTHWEST STREET PERRYVILLE MO 63775 320321807 AMBULANCE MO 3249918 PERRY COUNTY HEALTH SYSTEM PERRYVILLE HEALTHCARE CORP 212 HOSPITAL LANE PERRYVILLE MO 63775 431859823 PHARMACY MO PERRY COUNTY HEALTH SYSTEM C -302595 1872702 1.00000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 PERRYVILLE HEALTHCARE CORPORATION A FMV PERRYVILLE HEALTHCARE CORPORATION O 1150364 FMV PERRYVILLE HEALTHCARE CORPORATION Q 1533637 FMV