SHELBY COUNTY MEDICAL CORP: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- SHELBY COUNTY MEDICAL CORP (EIN 42-1355694)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-13
- IRS object ID
- 202421349349304527
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-13T13:34:19-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421355694 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELBY COUNTY MEDICAL CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHEL | BusinessNameControlTxt |
| Phone | 7127554314 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1220 CHATBURN | AddressLine1Txt |
| City | HARLAN | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51537 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BARRY JACOBSEN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7127554314 | PhoneNum |
| Signature | 2024-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | BARRY | PersonFirstNm |
| Person Last | JACOBSEN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL CPA | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2024-05-06 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BARRY JACOBSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1220 CHATBURN | AddressLine1Txt |
| City | HARLAN | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51537 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,121,328 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1990 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING SUPPORT FOR SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL AND SIMILAR ORGANIZATIONS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 11 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,639,600 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,119,068 | CYProgramServiceRevenueAmt |
| PY Investment Income | $352 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,260 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $5,639,952 | PYTotalRevenueAmt |
| CY Total Revenue | $6,121,328 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,537,950 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,688,826 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $855,572 | PYOtherExpensesAmt |
| CY Other Expenses | $1,118,123 | CYOtherExpensesAmt |
| PY Total Expenses | $5,393,522 | PYTotalExpensesAmt |
| CY Total Expenses | $5,806,949 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $246,430 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $314,379 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $438,312 | TotalAssetsBOYAmt |
| Total Assets EOY | $745,307 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $302,209 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $294,825 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $136,103 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $450,482 | NetAssetsOrFundBalancesEOYAmt |
| Mission | NONE | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,636,642 | ExpenseAmt |
| Revenue | $6,119,068 | RevenueAmt |
| Desc | SHELBY COUNTY MEDICAL CORPORATION RECRUITED, EMPLOYED, AND FURNISHED PHYSICIANS FOR RURAL HEALTH CLINICS, OTHER PHYSICIAN CLINICS, AN EMERGENCY ROOM, AND A HOSPITAL PHYSICIAN PRACTICE AT SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL. SERVICES PROVIDED INCLUDED SERVING AS MEDICAL STAFF FOR THE HOSPITAL AND APPROXIMATELY 123,115 PATIENT SERVICE VISITS. | Desc |
| Total Program Service Expenses | $5,636,642 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 11 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KRISTY HANSEN | PersonNm |
| Phone | 7127554314 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1213 GARFIELD AVENUE | AddressLine1Txt |
| City | HARLAN | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51537 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| LEROY HODGES | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $508,809 | $0 | $63,175 | ||
| BRET HEILESON | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $480,406 | $0 | $48,210 | ||
| TIMOTHY BRELJE | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $435,296 | $0 | $49,803 | ||
| TINA SCHECHINGER | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $426,040 | $0 | $52,963 | ||
| SCOTT MARKHAM | ||||||||
| DIRECTOR/PHYSICIAN | 40.00 | 0.00 | $416,599 | $0 | $39,536 | Yes (X) | ||
| BRIAN ANDERSON | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $395,934 | $0 | $53,548 | ||
| BARRY JACOBSEN | ||||||||
| CEO/DIRECTOR | 2.00 | 38.00 | $0 | $305,072 | $45,485 | Yes (X) | Yes (X) | |
| MATT HUDSON | ||||||||
| PRESIDENT | 0.20 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| TERRY TORNETEN | ||||||||
| VICE PRESIDENT | 0.20 | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| TIM MEYER | ||||||||
| VICE PRESIDENT THRU 10/22 | 0.20 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JEANINE LARSEN | ||||||||
| SECRETARY/TREASURER | 0.20 | 0.20 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| KRISTEN VAN BAALE | ||||||||
| DIRECTOR | 0.20 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KELLI KLAASSEN | ||||||||
| DIRECTOR THRU 12/22 | 0.20 | 0.20 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,663,084 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $305,072 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $352,720 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MILLER ORTHOPAEDICS AFFILIATES | |||||
| 1 EDMUNDSON PLACE SUITE 500 | COUNCIL BLUFFS | IA | 51503 | ORTHOPAEDIC SURGICAL SERVICES | $451,804 |
| MIDWEST GASTROINTESTINAL ASSOCIATES | |||||
| 8901 INDIAN HILLS DR SUITE 200 | OMAHA | NE | 68114 | GASTROINTESTINAL PHYSICIAN SERVICES | $123,000 |
| JACKSON & COKER LOCUMTENENS LLC | |||||
| PO BOX 277638 | ATLANTA | GA | 30384 | PROFESSIONAL MEDICAL SERVICES | $105,882 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CONTRACT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $6,073,068 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,073,068 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,119,068 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,260 | TotalRevenueColumnAmt |
| Exclusion | $2,260 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,121,328 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,119,068 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,260 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,135 | TotalAmt |
| Program Services | $456,135 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,665,752 | TotalAmt |
| Program Services | $3,665,752 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,912 | TotalAmt |
| Program Services | $207,912 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,661 | TotalAmt |
| Program Services | $182,661 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,366 | TotalAmt |
| Program Services | $176,366 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,900 | TotalAmt |
| Management And General | $2,900 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $985,898 | TotalAmt |
| Program Services | $821,706 | ProgramServicesAmt |
| Management And General | $164,192 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34 | TotalAmt |
| Management And General | $34 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,181 | TotalAmt |
| Management And General | $3,181 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,567 | TotalAmt |
| Program Services | $23,567 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,052 | TotalAmt |
| Program Services | $85,052 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUES AND SUBSCRIPTIONS | Desc |
| Total | $17,491 | TotalAmt |
| Program Services | $17,491 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,806,949 | TotalAmt |
| Program Services | $5,636,642 | ProgramServicesAmt |
| Management And General | $170,307 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $316,703 | BOYAmt |
| EOY | $424,205 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,163 | BOYAmt |
| EOY | $305,391 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,446 | BOYAmt |
| EOY | $15,711 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438,312 | BOYAmt |
| EOY | $745,307 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,209 | BOYAmt |
| EOY | $294,825 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,209 | BOYAmt |
| EOY | $294,825 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,103 | BOYAmt |
| EOY | $450,482 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,103 | BOYAmt |
| EOY | $450,482 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438,312 | BOYAmt |
| EOY | $745,307 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $314,379 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 426037826 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $6,073,068 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $6,073,068 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LEROY HODGES | ||||||||||||||
| PHYSICIAN | $445,701 | $0 | $45,981 | $0 | $17,127 | $0 | $32,604 | $0 | $30,571 | $0 | $571,984 | $0 | $0 | $0 |
| BRET HEILESON | ||||||||||||||
| PHYSICIAN | $228,593 | $0 | $191,369 | $0 | $60,444 | $0 | $21,518 | $0 | $26,692 | $0 | $528,616 | $0 | $0 | $0 |
| TIMOTHY BRELJE | ||||||||||||||
| PHYSICIAN | $127,074 | $0 | $82,971 | $0 | $225,251 | $0 | $23,267 | $0 | $26,536 | $0 | $485,099 | $0 | $0 | $0 |
| TINA SCHECHINGER | ||||||||||||||
| PHYSICIAN | $237,527 | $0 | $177,399 | $0 | $11,114 | $0 | $23,577 | $0 | $29,386 | $0 | $479,003 | $0 | $0 | $0 |
| SCOTT MARKHAM | ||||||||||||||
| DIRECTOR/PHYSICIAN | $236,542 | $0 | $111,189 | $0 | $68,868 | $0 | $21,169 | $0 | $18,367 | $0 | $456,135 | $0 | $0 | $0 |
| BRIAN ANDERSON | ||||||||||||||
| PHYSICIAN | $237,844 | $0 | $97,455 | $0 | $60,635 | $0 | $24,262 | $0 | $29,286 | $0 | $449,482 | $0 | $0 | $0 |
| BARRY JACOBSEN | ||||||||||||||
| CEO/DIRECTOR | $0 | $284,649 | $0 | $13,084 | $0 | $7,339 | $0 | $26,887 | $0 | $18,598 | $0 | $350,557 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | SHELBY COUNTY MEDICAL CORPORATION (SCMC) DOES NOT PAY COMPENSATION TO A CEO OR EXECUTIVE DIRECTOR. SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL PAYS THE COMPENSATION OF BARRY JACOBSEN WHO SERVES AS THE TOP MANAGEMENT OFFICIAL OF SCMC. SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL UTILIZED THE FOLLOWING FOR DETERMINING HIS COMPENSATION: INFORMATION PROVIDED BY MEDICAL GROUP MANAGEMENT ASSOCIATION FOR PEER GROUPS AND OTHER AVAILABLE SURVEYS AND BOARD APPROVAL. |
| PART I, LINE 7 | ALL PHYSICIANS ARE PAID A BASE SALARY PLUS ADDITIONAL COMPENSATION BASED ON RVUS PRODUCED. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | THE BOARD DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE CEO, CFO OF SHELBY COUNTY CHRIS A. MYRTUE MEMORIAL HOSPITAL, AND GOVERNING BOARD MEMBERS PRIOR TO FILING THE RETURN WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE SIGNED ANNUALLY. BOARD MEMBERS ABSTAIN FROM VOTING WHEN THEY HAVE A POSSIBLE CONFLICT OF INTEREST. THIS PROCESS IS MONITORED BY ALL ADMINISTRATION, STAFF, AND BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL IS COMPARED TO INFORMATION PROVIDED BY MEDICAL GROUP MANAGEMENT ASSOCIATION FOR PEER GROUPS AND OTHER AVAILABLE SURVEYS AND IS DISCUSSED WITH BOARD MEMBERS AND THE FIRM PROVIDING ACCOUNTING SERVICES TO THE ORGANIZATION. THE ORGANIZATION DOES NOT COMPENSATE OTHER OFFICERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL INFORMATION ARE MADE AVAILABLE TO THE PUBLIC BY REQUEST AT THE ORGANIZATION'S BUSINESS OFFICE DURING NORMAL BUSINESS HOURS. |
| FORM 990, PART IX, LINE 11G | RECRUITING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 164,192. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 164,192. PHYSICIAN CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 770,932. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 770,932. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 50,774. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,774. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE COMPILATION AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1213 GARFIELD AVENUE | AddressLine1Txt |
| City | HARLAN | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 51537 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 426037826 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(1) | ExemptCodeSectionTxt |
| Public Charity Status | N/A | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL | ||
| L | $6,073,068 | FEE BASED ON RVU'S PRODUCED |
| SHELBY COUNTY CHRIS A MYRTUE MEMORIAL HOSPITAL | ||
| Q | $6,073,068 | PAYMENT OF AMOUNT CHARGED |