2024-03-15T14:24:39-05:00 2023-04-30 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2022-05-01 431731173 FITZGIBBON HEALTH SERVICES % NANCY HARRIS FITZ 6608313271 2506 LINDEN TREE PARKWAY MARSHALL MO 65340 NANCY HARRIS CFO 6608867431 2023-08-22 true NANCY HARRIS XXX-XX-XXXX Brian D Todd P00422601 4178658701 2 2022 2023-04-26 12:10:37Z THE LIVING CENTER ANGELA P LITTRELL 2305 S HIGHWAY 65 PO BOX 250 MARSHALL MO 65340 5527232 false X WWW.FITZGIBBON.ORG X 1995 MO TO PROMOTE QUALITY OF LIFE THROUGH CARE AND SERVICES TO RESIDENTS, THEIR FAMILIES AND THE COMMUNITY WE SERVE IN AS HOME LIKE, LEAST RESTRICTIVE ENVIRONMENT AS POSSIBLE. 7 4 75 4 0 0 771743 0 4731902 5527232 0 0 0 0 5503645 5527232 0 0 0 0 2937893 3022037 0 0 0 4135122 4940401 7073015 7962438 -1569370 -2435206 1874531 2009391 2520807 2694547 -646276 -685156 X NONE false false 7424792 5527232 FITZGIBBON HEALTH SERVICES IS A 99 BED ELDER CARE FACILITY WHICH IS 47% MEDICAID AND 14% MEDICARE DEPENDENT WITH RESPECT TO NET REVENUE. THE FACILITY OFFERS A 9 BED SKILLED CARE UNIT AND A 21 BED ALZHEIMER'S UNIT IN ADDITION TO THE 69 BED REGULAR CARE UNIT. THIS FACILITY ADJOINS FITZGIBBON HOSPITAL IN THE EVENT THAT MEDICAL ATTENTION IS NEEDED IMMEDIATELY. SEE SCHEDULE O FOR A DESCRIPTION OF THE SERVICES PROVIDED. 7424792 true false false false false false false false true false true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 true 75 true false false false false false false false false false false false false X 7 4 false false false false false false false true true false false false true true true true true false false false X NANCY HARRIS 6608313271 2305 S HIGHWAY 65 PO BOX 250 MARSHALL MO 65340 ANGELA LITTRELL PRESIDENT/CEO 1.0 40.0 X 0 322715 4360 JASON GAULT PRESIDENT OF MEDICAL STAFF 1.0 32.0 X 0 315801 2000 NANCY K HARRIS CFO 1.0 40.0 X 0 206118 5360 JACK UHRIG MD DIRECTOR/MEDICAL DIRECTOR 1.0 1.0 X 0 14400 0 JAN V STAPLETON VICE PRESIDENT 1.0 1.0 X X 0 0 0 JILL HARRIMAN LILLEMAN DIRECTOR 1.0 1.0 X 0 0 0 MARY LOU PORTER DIRECTOR 1.0 1.0 X 0 0 0 SCOTT HARTWIG SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 WILLIAM SUMMERS PRESIDENT 1.0 1.0 X X 0 0 0 0 859034 11720 0 false true false 0 0 NET PATIENT SERVICE REVENUE 623000 5526386 5526386 MISCELLANEOUS 623000 846 846 5527232 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5527232 5527232 X 0 0 0 0 0 0 2240326 2034384 205942 11726 10129 1597 608867 525961 82906 161118 139179 21939 60000 60000 1354 1354 23450 23450 0 0 0 3269610 3256099 13511 0 480647 465291 15356 0 0 118480 118480 22851 22762 89 0 5214 3809 1405 120753 101118 19635 0 215414 180387 35027 49602 49602 MEDICAL SUPPLIES & DRUGS 289812 289812 PROVIDER TAX 276975 276975 LICENSES, DUES, SUBSCRIPTION 6239 406 5833 7962438 7424792 537646 0 250 250 56512 18260 0 0 670087 958453 0 0 0 0 0 0 0 0 0 6377 6404213 5397645 1076564 1006568 0 0 0 0 0 0 57892 14473 13226 5010 1874531 2009391 274597 257666 0 0 0 459753 2172464 1934766 15213 8244 0 0 0 0 0 0 58533 34118 2520807 2694547 X -651119 -689999 4843 4843 -646276 -685156 1874531 2009391 X -2435206 2396326 X false true X true true true X 0 90995 462432 254932 0 808359 4555535 5011006 4812614 4731902 5527232 24638289 0 0 0 4555535 5102001 5275046 4986834 5527232 25446648 0 0 0 25446648 0 0 0 0 0 4555535 5102001 5275046 4986834 5527232 25446648 1.00000 1.00000 0.00000 0.00000 X false true X 15000 15000 4944429 4306058 638371 1429927 1077904 352023 14857 13683 1174 1006568 0 ESTIMATED SELF INSURANCE COSTS 34118 34118 SCHEDULE D, PART IV, LINE 2B RESIDENT TRUST FUND: FITZGIBBON HEALTH SERVICES PROVIDES EACH RESIDENT WITH AN OPPORTUNITY TO DEPOSIT HIS/HER PERSONAL FUNDS INTO RESIDENT TRUST ACCOUNT HELD BY FITZGIBBON HEALTH SERVICES. THE RESIDENT OR THEIR RESPONSIBLE PARTY MUST AUTHORIZE IN WRITING WHO HAS PERMISSION (OTHER THAN FITZGIBBON HEALTH SERVICES) TO HANDLE OR WITHDRAW-IF APPROPRIATE- FROM THESE FUNDS. A COPY IS PLACED IN THE RESIDENT'S FINANCIAL FILE. NO ADDITIONAL SERVICE CHARGE WILL BE LEVIED AGAINST THE RESIDENT. THE COST OF SUCH SERVICE IS INCLUDED IN FITZGIBBON HEALTH SERVICES' BASIC ROOM RATE. FUNDS IN EXCESS OF FIFTY (50) DOLLARS WILL BE DEPOSITED IN AN INTEREST-BEARING ACCOUNT THAT IS SEPARATE FROM THE FACILITY'S OPERATING EXPENSES. ANY INTEREST EARNED ON THIS POOLED ACCOUNT IS PRO-RATED AND POSTED PER INDIVIDUAL ON THE BASIS OF ACTUAL EARNINGS OR END-OF QUARTER BALANCE. THE RESIDENT SHALL HAVE ACCESS TO FUNDS OF FIFTY (50) DOLLARS OR LESS WITHIN TWENTY-FOUR (24) HOURS OF REQUEST. REQUESTS FOR FUNDS IN EXCESS OF FIFTY (50) DOLLARS SHALL BE HONORED WITHIN THREE (3) BUSINESS DAYS. THE RESIDENT OR THEIR RESPONSIBLE PARTY WILL RECEIVE A CONFIDENTIAL STATEMENT QUARTERLY OF FUNDS. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. false false false false false false false false false ANGELA LITTRELL PRESIDENT/CEO 0 320378 0 0 0 2337 0 2000 0 2360 0 327075 0 0 NANCY K HARRIS CFO 0 205863 0 0 0 255 0 2000 0 3360 0 211478 0 0 JASON GAULT PRESIDENT OF MEDICAL STAFF 0 314931 0 0 0 870 0 2000 0 0 0 317801 0 0 SCHEDULE J, PART I, LINE 3 ESTABLISHING CEO COMPENSATION: JOHN FITZGIBBON MEMORIAL HOSPITAL, A RELATED ORGANIZATION, USES A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS: REHABILITATION SERVICES ARE AVAILABLE WHICH INCLUDE PHYSICAL, RESPIRATORY, SPEECH AND OCCUPATIONAL THERAPIES. THE THERAPISTS COORDINATE EFFORTS WITH THE PHYSICIANS AND NURSING STAFF TO ENSURE THAT EACH RESIDENT'S THERAPY NEEDS ARE BEING MET. DIETARY SERVICES ARE UNDER THE DIRECTION OF A REGISTERED DIETICIAN. DIETARY NEEDS ARE ASSESSED, PLANNED AND IMPLEMENTED TO PROMOTE ADEQUATE NUTRITIONAL INTAKE AND TAKING INTO ACCOUNT RESIDENTS PREFERENCES. THE ACTIVITY DEPARTMENT ASSESSES, PLANS AND IMPLEMENTS DAILY ACTIVITY PROGRAMS BASED ON THE RESIDENTS' NEEDS AND DESIRES. IN ADDITION, SPECIAL WEEKLY ACTIVITIES ARE PLANNED WHICH INCLUDE CHURCH, BIBLE STUDY, BINGO, SOCIAL HOUR, BIRTHDAY PARTIES, MUSICAL ENTERTAINMENT, CRAFT CLUB, AND WALKS OUTSIDE THE FACILITY (WEATHER PERMITTING). THE CENTER ENCOURAGES FAMILIES TO COME AND HAVE SPECIAL GATHERINGS WITH THEIR LOVED ONES. THE FACILITY ALSO HAS A PERMANENT LIVE BIRD DISPLAY AND WELCOMES VISITS FROM CATS AND DOGS TO INTERACT WITH RESIDENTS, ALL IN AN EFFORT TO PROVIDE A MORE HOMELIKE ATMOSPHERE. FORM 990, PART IV, LINE 24 & PART X, LINE 20 TAX EXEMPT BONDS: THE ORGANIZATION'S RELATED ENTITY, JOHN FITZGIBBON MEMORIAL HOSPITAL, RECEIVED QUALIFIED HOSPITAL BOND PROCEEDS FROM 2010 AND 2016 BOND ISSUES. A PORTION OF THE BOND PROCEEDS WERE ALLOCATED TO FITZGIBBON HEALTH SERVICES FOR AUDIT AND TAX PURPOSES. INFORMATION ABOUT THE BONDS ARE REPORTED ON JOHN FITZGIBBON MEMORIAL HOSPITAL'S SCHEDULE K. FORM 990, PART VI, SECTION A, LINES 6 & 7A MEMBERS OR STOCKHOLDERS: THE ORGANIZATION IS AFFILIATED WITH FITZGIBBON MEMORIAL HOSPITAL BY HAVING A COMMON BOARD OF TRUSTEES. ALSO, THE MEDICAL STAFF VOTES ON THE CHIEF OF THE MEDICAL STAFF WHO IS A VOTING MEMBER OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A DRAFT OF THE RETURN IS REVIEWED BY THE PRESIDENT/CEO AND CFO/COO BEFORE BEING FINALIZED. THE 990 IS PRESENTED TO THE BOARD AFTER IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE COMPLIANCE OFFICER MONITORS THE CONFLICT OF INTEREST POLICY AND ANNUALLY REQUIRES OFFICERS, DIRECTORS AND KEY EMPLOYEES TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. ALL CONFLICTS MUST BE REVIEWED BY THE PRESIDENT/CEO AND/OR BOARD OF DIRECTORS. A BOARD MEMBER WITH ANY CONFLICT OF INTEREST WOULD ABSTAIN FROM VOTING ON ANY DECISION RELATED TO THAT CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION DETERMINATION: JOHN FITZGIBBON MEMORIAL HOSPITAL, A RELATED ORGANIZATION, USES AN INDEPENDENT COMPENSATION CONSULTANT WHICH WAS ENGAGED TO REVIEW THE COMPENSATION OF ANGELA LITTRELL AS WELL AS OTHER OFFICERS AND KEY EMPLOYEES AND THEIR REPORT WAS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ANNUAL FORM 990 OF THE RELATED ORGANIZATION, JOHN FITZGIBBON MEMORIAL HOSPITAL, INCLUDES THE ANNUAL AUDITED FINANCIAL STATEMENTS AND ARE AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES NOT MAKE THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, OR OTHER FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: NO TRUSTEES RECEIVED COMPENSATION FOR THEIR DUTIES AS TRUSTEES. JACK UHRIG, MD, RECEIVED NONEMPLOYEE COMPENSATION FOR OTHER CLINICAL SERVICES PROVIDED TO JOHN FITZGIBBON MEMORIAL HOSPITAL. JASON GAULT, DO RECEIVED COMPENSATION FOR HIS ROLE AS A PROVIDER IN JOHN FITZGIBBON MEMORIAL HOSPITAL'S SURGICAL SERVICES. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $2,396,326 TRANSFER FROM RELATED PARTY FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:3225948 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:36166 FORM 990 PART IX LINE 11G DESCRIPTION:DIRECTOR SERVICES TOTAL FEES:7496 JOHN FITZGIBBON MEMORIAL HOSPITAL 2305 S HIGHWAY 65 PO BOX 250 MARSHALL MO 65340 440655986 HEALTHCARE MO 501(C)(3) 3 NA false false false false false false false false false false false false false true true true true true false false