SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
GENERAL JOHN J PERSHING
MEMORIAL HOSPITAL ASSOCIATION
Employer identification number

43-0715842
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    182,692   182,692 1.150 %
b Medicaid (from Worksheet 3, column a) . . . . .     2,585,766 2,613,060 -27,294  
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     2,768,458 2,613,060 155,398 1.150 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     19,646 35,438 -15,792  
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     4,999   4,999 0.030 %
j Total. Other Benefits . .     24,645 35,438 -10,793 0.030 %
k Total. Add lines 7d and 7j .     2,793,103 2,648,498 144,605 1.180 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,798,863
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
209,289
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
7,604,983
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
7,449,062
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
155,921
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 GENERAL JOHN J PERSHING MEM HOSPITAL
130 E LOCKLING AVE PO BOX 408
BROOKFIELD,MO64628
WWW.PERSHINGHEALTHSYSTEM.COM
198-56
X X     X   X   COMMMUNITY MED ASSOC APPLEGATE MED GROUP MEADVILLE MED CLINIC  
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
GENERAL JOHN J PERSHING MEM HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GENERAL JOHN J PERSHING MEM HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

GENERAL JOHN J PERSHING MEM HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 7
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 5 THREE LOCAL STAFF MEMBERS WERE INVOLVED IN THE CHNA PROJECT, ALONG WITH COLLABORATION WITH THE LINN COUNTY HEALTH DEPARTMENT. FURTHER, A MASTERS OF PUBLIC HEALTH STUDENT FROM THE UNIVERSITY OF MISSOURI-COLUMBIA WAS USED TO CONDUCT THE 2016 ASSESSMENT.
SCHEDULE H, PART V, SECTION B, LINE 7A THE COMPLETE CHNA CAN BE FOUND AT: http://www.phsmo.org/Documents/2016%20Pershing%20CHNA%20final%20copy.docx
SCHEDULE H, PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: http://www.phsmo.org/Documents/CHNA%20Implementation%20Plan%202016.doc
SCHEDULE H, PART V, SECTION B, LINE 11 MANY FACTORS DURING THE LAST THREE YEARS SINCE THE PREVIOUS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED HAVE GONE UNCHANGED AS INDICATED BY THE MOST CURRENT 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. OVERALL, THIS ASSESSMENT SUGGESTS THAT THE HEALTH SERVICES WITHIN LINN COUNTY ARE SUFFICIENT TO SERVE THE RESIDENTS IN THE COUNTY. HOWEVER, OUR FINDINGS INDICATED SEVERAL VULNERABILITIES IN HEALTHCARE SERVICES PROVIDED TO THE COMMUNITY AND UNFAVORABLE TRENDS IN HEALTHCARE FACTORS. ONE POSITIVE FACTOR NOTED IS THE CONTINUED TREND OF A DECLINE IN UNEMPLOYMENT IN LINN COUNTY. WHILE UNEMPLOYMENT RATES FOR LINN COUNTY REMAIN SLIGHTLY HIGHER THAN STATE AVERAGES, THE TREND CONTINUES DOWNWARD. UNEMPLOYMENT IS A LARGE FACTOR CONTRIBUTING TO INDIVIDUALS LACKING THE FINANCIAL CAPABILITY TO ACCESS HEALTHCARE. INCREASING RATES OF UNEMPLOYMENT WILL RAISE THE NEED FOR COMMUNITY HEALTH CENTERS AND ADDITIONAL SAFETY-NET CLINICS IN THE COUNTY. IN TERMS OF ECONOMIC STATUS, LINN COUNTY IS WORSE OFF IN RELATION TO THE REST OF MISSOURI AND THE UNITED STATES AND HAS A HIGH PERCENTAGE OF FAMILIES BELOW THE POVERTY LEVEL. ANALYZING THE VARIOUS CLASSES OF WORKERS GIVES AN IDEA AS TO THE AVAILABILITY OF HEALTH INSURANCE TO THE LABOR FORCE. THE 2016 CHNA INDICATED THAT A LARGE PERCENTAGE OF LINN COUNTY WORKERS ARE EMPLOYED IN THE EDUCATION, MANUFACTURING, AND RETAIL INDUSTRIES. THE 2013 CHNA INDICATED LINN COUNTY BOASTS A LARGER PERCENTAGE OF SELF-EMPLOYED WORKERS THAN BOTH MISSOURI AND THE UNITED STATES. HAVING A HIGH NUMBER OF SELF-EMPLOYED WORKERS COULD MEAN THAT PORTION OF THE POPULATION HAS TO PROVIDE THEIR OWN HEALTH INSURANCE AND THE INCREASINGLY HIGH PREMIUMS AND DEDUCTIBLES COULD BE A DETERRENT. IT WOULD BE EASY FOR ONE TO FOCUS ON THE OBVIOUS HEALTHCARE FACTORS AFFECTING THE CITIZENS OF LINN COUNTY SUCH AS OBESITY, HEART DISEASE, DIABETES, LACK OF EXERCISE, AND LACK OF ACCESS TO RECREATIONAL LOCATIONS AS THE NEEDS TO ADDRESS IN THE COUNTY; HOWEVER, IT WOULD BE A DISSERVICE TO THE CITIZENS AND THE COMMUNITY IF PERSHING HEALTH SYSTEM DID NOT CONSIDER THE SIGNIFICANT IMPACT THAT THE LEVEL OF POVERTY PLAYS IN ALL OF THESE ISSUES. THIS WOULD LEAD ONE TO QUESTION IF THE TRUE ISSUE IS RELATED TO THE SIGNIFICANT AMOUNT OF CITIZENS WHO LIVE IN POVERTY IN LINN COUNTY AS THE PRIMARY CAUSE FOR MANY, IF NOT ALL, OF THE HEALTH NEEDS IDENTIFIED. RESIDENTS LIVING IN POVERTY REGARD HEALTH NEEDS AS SIGNIFICANTLY LESS IMPORTANT, ESPECIALLY WHEN TRYING TO MEET BASIC NEEDS TO SURVIVE. HOW CAN A PERSON LIVING IN POVERTY BE EXPECTED TO ADDRESS OBESITY, HEART DISEASE, AND DIABETES IF THEY ARE UNABLE ADDRESS THE BASIC NEEDS OF THEIR HOUSEHOLD SUCH AS RUNNING WATER, FOOD, RENT, AND UTILITIES WITHOUT STRUGGLES? UNLESS OR UNTIL POVERTY IS ADDRESSED CHRONIC ILLNESS WILL ALWAYS BE SIGNIFICANT FOR COUNTY RESIDENTS. POVERTY ISSUES RELATED TO HEALTHCARE WILL IMPACT THE QUALITY OF CARE THAT CITIZEN'S ACCESS, WHICH IN RETURN IMPACT THE OVERALL HEALTH OF THE CITIZENS. LINN COUNTY RANKS 33RD IN HEALTH OUTCOMES ACCORDING TO COUNTY HEALTH RANKINGS AND 77TH IN HEALTH FACTORS FOR THE STATE OF MISSOURI. NEGATIVE TRENDS IN ADULT OBESITY, HEART DISEASE, AND PHYSICAL INACTIVITY ARE ALL HIGHER THAN MISSOURI AND NATIONAL AVERAGES AND CONTRIBUTE TO AN INCREASING PREMATURE DEATH RATE FOR THE COUNTY. HOWEVER, UNTIL POVERTY IS ADDRESSED, ANY INTERVENTION APPLIED TO THESE CHRONIC ISSUES WITH HAVE VERY LITTLE IMPACT. ANOTHER AREA OF CONCERN IDENTIFIED WAS LACK OF RECREATIONAL AREAS FOR EXERCISE. MANY CITIZENS WHO LIVE IN POVERTY WOULD BE QUICK TO SAY THAT WHETHER OR NOT THEY HAVE ACCESS TO RECREATIONAL AREAS IS NOT A PRIORITY FOR THEM. AFTER SPEAKING WITH COMMUNITY HEALTHCARE SERVICE PROVIDERS, SEVERAL WEAKNESSES IN THE PROVISION OF SERVICES TO THE COMMUNITY WERE REVEALED. ONE OF THE WEAKNESSES THAT FALLS BELOW ACCEPTABLE LEVELS IS THE NUMBER OF PRIMARY CARE PROVIDERS PER NUMBER OF THE POPULATION, AS INDICATED IN SURVEY POPULATION. PERSHING MEMORIAL HOSPITAL IS ATTEMPTING TO RECRUIT AND RETAIN PRIMARY CARE PROVIDERS IN ORDER TO ADDRESS THE SHORTAGE IN THE COMMUNITY. IT IS INDICATED THAT A LARGE NUMBER OF PREVENTABLE HOSPITALIZATIONS ARE STILL OCCURRING IN THE COUNTY, SO IF PRIMARY CARE SERVICES CAN BE STRENGTHENED IT WOULD LIKELY OFFSET THOSE EVENTS AND REDUCE THE BURDEN ON THE COUNTY'S EMERGENCY DEPARTMENT. PERSHING HAS A STRONG PLAN IN PLACE TO ADDRESS THIS ISSUE INCLUDING PERSHING'S PARTICIPATION IN PRIMARY CARE RESOURCE INITIATIVE FOR MISSOURI (PRIMO). PERSHING MEMORIAL HOSPITAL CURRENTLY SUPPORTS TWO STUDENTS IN MEDICAL SCHOOL THROUGH THIS PROGRAM AND WILL EMPLOY THEM UPON COMPLETION OF THEIR RESIDENCY. PERSHING HIRED A FOURTH NURSE PRACTITIONER TO WORK FULL TIME IN THE COMMUNITY MEDICAL ASSOCIATES CLINIC. PERSHING HEALTH SYSTEM IS CONTINUALLY RECRUITING FAMILY PRACTICE PHYSICIANS AND NURSE PRACTITIONERS TO THE AREA TO PROVIDE INPATIENT CONSULTS AND PRIMARY CARE AND WILL CONTINUE TO DO SO IN THE FORESEEABLE FUTURE. PERSHING ALSO HAS MULTIPLE RESIDENT PHYSICIANS PRACTICING IN THE CLINICS AND EMERGENCY DEPARTMENT THIS COULD LEAD TO EMPLOYMENT OF THESE PHYSICIANS IN THE FUTURE UPON THEIR GRADUATION. LINN COUNTY'S PROXIMITY TO KANSAS CITY AND COLUMBIA CREATES A NUMBER OF UNIQUE WEAKNESSES AND STRENGTHS. FIRST, THE ATTRACTION OF KANSAS CITY AND COLUMBIA OFTEN LURES PROVIDERS, MAKING IT DIFFICULT FOR LINN COUNTY TO RECRUIT PROVIDERS. KANSAS CITY ALSO BOASTS A STRONG HEALTHCARE INFLUENCE CREATING A MISPERCEPTION OF LOWER QUALITY HEALTHCARE IN LINN COUNTY. THIS MISPERCEPTION LEADS TO A PORTION OF THE POPULATION BELIEVING THAT IN ORDER TO RECEIVE QUALITY HEALTHCARE THEY MUST TRAVEL OUTSIDE OF THE COMMUNITY. THIS TAKES A NUMBER OF POSSIBLE PATIENTS OUTSIDE THE COMMUNITY. ANOTHER STRESSOR ON THE HEALTH OF LINN COUNTY IS THE LACK OF SPECIALTY PROVIDERS. WHILE THE LACK OF LOCAL SPECIALISTS COULD MAKE FOR A DEFICIENCY IN SPECIALTY CARE FOR THE COMMUNITY, IT IS ONE ASPECT THAT THE PROXIMITY TO KANSAS CITY AND COLUMBIA ALLEVIATES. WITH KANSAS CITY OFFERING A NUMBER OF SPECIALTY SERVICES, LINN COUNTY IS RELIEVED FROM THE PRESSURES OF THESE HARD TO RECRUIT POSITIONS. NONETHELESS, PERSHING MEMORIAL HOSPITAL SHOULD CONTINUE TO ATTEMPT TO RECRUIT SPECIALISTS IN ORDER TO ADDRESS THE SHORTAGE THEY HAVE IN THE COMMUNITY. ONE OTHER WAY THAT PERSHING HEALTH SYSTEM HAS ADDRESSED THE LACK OF ACCESS TO HEALTH CARE IS OFFERING MULTIPLE HEALTH FAIRS IN THE COMMUNITY INCLUDING THE ANNUAL HEALTH FAIR THAT OCCURS IN THE MARCELINE, MO AND BROOKFIELD, MO AREAS AND IS ALWAYS COORDINATED DURING NATIONAL HOSPITAL WEEK. PERSHING OFFERS MANY HEALTH SCREENINGS DURING THIS TIME AT A REDUCED COST TO THE PUBLIC. PERSHING ALSO HAS MULTIPLE HEALTH FAIRS FOR LOCAL EMPLOYERS WHERE PERSHING STAFF WILL GO TO THE WORKPLACE AND CONDUCT A HEALTH FAIR. THIS ADDRESSES THE NEED FOR CITIZENS TO TRAVEL FOR NEEDED HEALTH SCREENINGS. PERSHING ALSO OFFERS FREE PHYSICALS TO ALL LINN COUNTY SCHOOL AGED CHILDREN, ONE TIME MONTHLY DURING THE SUMMER MONTHS. PERSHING ALSO HAS AN EVER-GROWING NUMBER OF SPECIALISTS WHO TRAVEL TO PERSHING MEMORIAL HOSPITAL FOR SPECIALTY CLINICS INCLUDING: CARDIOVASCULAR, OB/GYN, DERMATOLOGY, OPHTHALMOLOGY, ORTHOPEDICS AND GENERAL/SAME DAY SURGERY, TO NAME ONLY A FEW. PERSHING NEEDS TO CONTINUE TO FOCUS ON WAYS OF MAKING THE PUBLIC AWARE OF THE MULTIPLE CLINICS THAT ARE AVAILABLE IN THE AREA AND ENCOURAGE THE PUBLIC TO TAKE ADVANTAGE OF THE SERVICES. THE INFORMATION PROVIDED IN THIS ASSESSMENT SHOULD BE USED AS A TOOL TO COMMUNITY STAKEHOLDERS WHEN DECIDING THE NEXT STEP IN COMMUNITY HEALTH. THE HEALTH OF LINN COUNTY IS STABLE, BUT ALSO SHOULD EXPECT TO CONFRONT CHALLENGES CAUSED BY NEGATIVE TRENDS IN HEALTH FACTORS AND A CHANGING POPULATION MIX. IT WILL BE IMPORTANT THAT THE COMMUNITY ADDRESSES THESE CHALLENGES AND MAKE DECISIONS BASED ON COMMUNITY NEEDS MOVING FORWARD.
SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP CAN BE FOUND AT: http://www.phsmo.org/FAP_Files/FAP07012016/070616%20rev/Pershing%20Health% 20System%20FAP.docx
SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION CAN BE FOUND AT: http://www.phsmo.org/FAP_Files/FAP07012016/070616%20rev/PHS%20FAP%20applic ation%20final%20version.xlsx
SCHEDULE H, PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: http://www.phsmo.org/FAP_Files/FAP07012016/070616%20rev/PHS%20fap%20plain% 20lang%20sum,%20hosp%20&%20clinics%20final%20version.docx
SCHEDULE H, PART V, SECTION B, LINE 22D THE HOSPITAL FACILITY DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIABLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY TAKING THE AVERAGE OF ALL MANAGED CARE DISCOUNTS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 8
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 COMMUNITY MEDICAL ASSOCIATES
130 E LOCKLING AVE
BROOKFIELD,MO64628
PROVIDER BASED RURAL HEALTH CLINIC
2 APPLEGATE MEDICAL GROUP
125 E LOCKLING AVE
BROOKFIELD,MO64628
PROVIDER BASED RURAL HEALTH CLINIC
3 MEADVILLE MEDICAL CLINIC
101 E HAYWARD
MEADVILLE,MO64659
PROVIDER BASED RURAL HEALTH CLINIC
4
5
6
7
8
9
10
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
SCHEDULE H, PART I, LINE 3C SEE PART VI, SECTION B, LINE 13 FOR THE LIST OF OTHER FACTORS USED IN ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNT CARE.
SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT CONTAINED IN THE TABLE OF SCHEDULE H, PART I, LINE 7 IS A COST-TO-CHARGE RATIO.
SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS 1,395,263.
SCHEDULE H, PART III, SECTION A, LINE 2 THE BAD DEBT EXPENSE BEING REPORTED IS ACTUAL BAD DEBTS WRITTEN OFF PER OUR POLICY PLUS ACCRUAL OF ESTIMATES ON ACCOUNTS RECEIVABLE. OUR FINANCIAL ASSISTANCE POLICY ALLOWED FOR INDIGENT CARE DISCOUNTS. ANY PAYMENT ON A PREVIOUS BAD DEBT IS RECORDED AS A RECOVERY ON OUR BOOKS SEPARATELY.
SCHEDULE H, PART III, SECTION A, LINE 3 USED THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 AND APPLIED THAT PERCENTAGE TO NET BAD DEBTS TO ARRIVE AT AN ESTIMATED COST OF BAD DEBT. THEN, PER COLLECTION SUPERVISOR'S ESTIMATE, APPLIED 15% TO THE NET BAD DEBTS TO ARRIVE AT ESTIMATED COST THAT COULD BE CHARITY.
SCHEDULE H, PART III, SECTION A, LINE 4 PLEASE SEE NOTE 1 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE.
SCHEDULE H, PART III, SECTION C, LINE 9B OUR FINANCIAL ASSISTANCE POLICY AND COLLECTION POLICY IS APPLIED TO ALL TYPES OF PATIENTS.
SCHEDULE H, PART VI, LINE 2 PERSHING IS A SMALL RURAL CRITICAL ACCESS HOSPITAL AND AS SUCH RECEIVES CONTINUOUS FEEDBACK FROM THE PATIENTS WE SERVE, OUR PHYSICIANS, OTHER MEDICAL PROVIDERS, BOARD MEMBERS (WHO REPRESENT A WIDE REPRESENTATION OF OUR COMMUNITY), AND FROM VARIOUS ONGOING PATIENT SATISFACTION SURVEYS. SUCH SURVEYS ARE REPORTED AT BOARD MEETINGS AND DISTRIBUTED TO ALL HOSPITAL DEPARTMENTS.
SCHEDULE H PART VI, LINE 3 INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY (FAP) IS ON OUR WEBSITE. THE FAP, CHARITY CARE AND COLLECTION (PAYMENT ARRANGEMENTS) INFORMATION IS AVAILABLE THROUGH OUR COLLECTION PERSONNEL AND OTHERS AT PERSHING HOSPITAL AND THROUGH OUR WALK-IN CLINIC, COMMUNITY MEDICAL ASSOCIATE AT APPLEGATE MEDICAL GROUP, AND MEADVILLE MEDICAL CLINIC. FURTHER, WE PRINT A REFERENCE TO OUR FAP POLICY ON THE FRONT OF EACH PATIENT BILLING STATEMENT SENT OUT. SOCIAL SERVICES, THROUGH THE ASSESSMENT/CONSULTATION PROCESS, IDENTIFIES AND ASSISTS IN THE APPLICATION PROCESS.
SCHEDULE H, PART VI, LINE 4 PERSHING HEALTH SYSTEM SERVES LINN COUNTY (POPULATION OF AROUND 13,000) AND SURROUNDING AREA. IT IS MADE UP OF RURAL COMMUNITIES WITH A MIXTURE OF BUSINESSES AND AGRICULTURE.
SCHEDULE H, PART VI, LINE 5 WE OPERATE THREE (3) PROVIDER BASED RHCS: 1) APPLEGATE MEDICAL GROUP, WHICH INCLUDES THE ONLY LOCALLY AVAILABLE PEDIATRICIAN. IT ALSO INCLUDES AN INTERNAL MEDICAL PHYSICIAN. 2) COMMUNITY MEDICAL ASSOCIATES, LOCATED WITHIN THE HOSPITAL BUILDING AND OPEN 7 DAYS A WEEK, PROVIDED CLINICAL ROTATION SITE FOR MEDICAL STUDENTS AND NURSE PRACTITIONERS AND PROVIDED JOB SHADOWING AND CLINICAL ROTATIONS TO THE AREA CAREER CENTERS. THEY ALSO PROVIDED FREE SPORTS PHYSICALS AT THE BEGINNING OF EACH SCHOOL YEAR. NURSE PRACTITIONERS PROVIDE WELL CHILD EXAMS YEARLY AT THE LINN COUNTY HEALTH DEPT. 3) MEADVILLE MEDICAL CLINIC, 12 MILES FROM THE HOSPITAL, SERVES ONE OF THE SMALL COMMUNITIES WITHIN OUR SERVICE AREA WITH A 3 DAY A WEEK NURSE PRACTITIONER. HOSPITAL WEEK, AN ANNUAL PUBLIC EVENT DONE AT THE LOCAL (BROOKFIELD) YMCA AND AT MARCELINE BETHANY BAPTIST CHURCH: -PROCESSED BLOOD DRAWS; PHYSICAL AND OCCUPATIONAL THERAPY HEALTH BOOTH; BLOOD PRESSURE AND PULSE OXIMETRY TESTS WERE PERFORMED. PROMOTED WEB VIEW ACCESS FOR PATIENTS FROM OUR 3 RURAL HEALTH CLINICS. PROVIDED ADVANCED DIRECTIVES INFORMATIONAL PACKETS. OTHER HEALTH FAIRS AND EVENTS: -CONDUCTED FAIRS AT OTHER BUSINESSES IN OUR SERVICE AREA. TOURS: TOURS OF THE HOSPITAL WERE CONDUCTED THIS YEAR WITH AREA SCHOOLS - A ONCE A YEAR PUBLIC EVENT WHICH LETS US PROMOTE THE POSITIVE ASPECTS OF PERSHING HEALTH SYSTEM. NEWSPAPER ARTICLES: RADIOLOGY-MRI; RHC-GERD, HIGH BLOOD PRESSURE EDUCATION, UNDERSTANDING COST SHARING, SETTING LIMITS, DISCIPLINE TECHNIQUES; SOCIAL SERVICES -TIPS FOR HEALTHY AGING; OCCUPATIONAL THERAPY-O.T. AND THE PAINFUL SHOULDER; SPEECH AND LANGUAGE THERAPY SERVICES; CARDIAC AND PULMONARY REHAB PATIENTS; LAB-COMMUNITY BASED HEALTH SCREENINGS, POISONOUS HOUSE PLANTS; RESPIRATORY THERAPY-SLEEP. -NUMEROUS OTHER MINOR CONTRIBUTIONS TO THE GENERAL WELFARE AND SAFETY OF OUR COMMUNITY.
Schedule H (Form 990) 2015
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