2024-05-14T14:04:20-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 440629397 CARROLL COUNTY MEMORIAL HOSPITAL CARR 6605421695 1502 N JEFFERSON STREET CARROLLTON MO 64633 SCOTT THORESON CEO 6605421695 2024-05-14 1 SCOTT THORESON 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SCOTT THORESON 1502 N JEFFERSON STREET CARROLLTON MO 64633 39602822 0 X WWW.CARROLLCOUNTYHOSPITAL.ORG X 1957 MO CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. 10 9 286 16 0 0 412109 269787 41685369 38859361 97056 221862 131623 214771 42326157 39565781 0 0 0 0 20094898 20696966 0 0 0 20197326 20054804 40292224 40751770 2033933 -1185989 41868787 39557467 10409202 9111066 31459585 30446401 CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. 0 0 35250017 38913326 ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. 35250017 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 1 1 0 0 0 1 55 0 1 286 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 X LESLEY DELANEY 6605421695 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 TIMOTHY REID MD MEMBER 40.00 0.00 X 283477 0 56591 JENNIFER POSTON PRESIDENT 1.00 0.00 X X 0 0 0 JODI AHNEFELD VICE PRESIDENT THRU 12/22 1.00 0.00 X X 0 0 0 WADE MERTENSMEYER VICE PRESIDENT 1.00 0.00 X X 0 0 0 ANNA BARLOW SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 MATT LOCK MEMBER 1.00 0.00 X 0 0 0 KEVIN BROWN MEMBER 1.00 0.00 X 0 0 0 SHELLY KUSSMAN MEMBER THRU 01/23 1.00 0.00 X 0 0 0 KIM RITCHHART MEMBER 1.00 0.00 X 0 0 0 JANICE BURNSIDE MEMBER 1.00 0.00 X 0 0 0 JENNIFER LINK MEMBER 1.00 0.00 X 0 0 0 TOM BURKHART MEMBER 1.00 0.00 X 0 0 0 SCOTT THORESON CEO 39.00 1.00 X 230278 0 30331 LESLEY DELANEY CFO 39.00 1.00 X 118722 0 42496 GREGORY HUBBARD MD PHYSICIAN 40.00 0.00 X 548905 0 51186 RICHARD SMITH MD PHYSICIAN 40.00 0.00 X 541556 0 35514 ANDREW HORINE MD PHYSICIAN 40.00 0.00 X 509015 0 45120 JEREMY STAYTON MD PHYSICIAN 40.00 0.00 X 448121 0 29609 PAMELA RALLS MD PHYSICIAN 40.00 0.00 X 265877 0 40729 2945951 0 331576 22 0 1 0 HOSPITAL CARE CONSULTANTS INC 17304 PRESTON ROAD SUITE 1400 DALLAS TX 75252 HOSPITALIST SERVICES 700510 EMERGENCY STAFFING SOLUTIONS INC 17304 PRESTON ROAD SUITE 1400 DALLAS TX 75252 HOSPITALIST SERVICES 665700 CERNER CORPORTATION PO BOX 959156 ST LOUIS MO 631959156 SOFTWARE & CONTRACT EMPLOYEES 655117 BERGANKDVCREATIVE PLANNING PO BOX 735496 DALLAS TX 753735496 IT SERVICES 585017 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 753734606 MEDICAL SERVICES 388483 16 258376 11411 269787 MEDICARE/MEDICAID 624100 25532876 25532876 NET PATIENT SERVICE REVENUE 624100 11871610 11871610 340B DRUG PRICING PROGRAM 624100 1230004 1230004 ELECTRONIC HEALTH RECORD INCENTIV 624100 76564 76564 148307 148307 38859361 204428 204428 84117 30152 53965 53965 53965 24323 6889 17434 17434 17434 CAFETERIA 722514 160806 160806 160806 39565781 38913326 0 382668 X 761895 340068 421827 14997135 13207101 1790034 800820 685016 115804 4137116 3503726 633390 32487 32487 78275 78275 9876510 9463544 412966 67894 38869 29025 1184786 759760 425026 578701 526306 52395 829953 638741 191212 165261 124357 40904 228214 160208 68006 2487145 1997178 489967 267978 200514 67464 MEDICAL SUPPLIES 2379688 2379688 MISC 823076 174803 648273 340(B) PHARMACY EXPENSE 813932 813932 FOOD 240904 236206 4698 40751770 35250017 5501753 0 28492 135368 14747469 12558998 5046362 4212410 840128 902610 477641 479880 42772416 27650479 16388254 15121937 1921538 1901536 1178921 1217101 1239982 3027627 41868787 39557467 3449099 3421142 6945703 5542641 14400 147283 10409202 9111066 X 30895157 29817653 564428 628748 31459585 30446401 41868787 39557467 X -1185989 108485 64320 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12291 12291 0 PART II-B, LINE 1: THE AMOUNT OF SCHEDULE C, PART II-B, LINE 1I REPRESENTS THE LOBBYING PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 268115 268115 30424842 18985351 11439491 10006648 7214210 2792438 2072811 1450918 621893 15121937 ACCRUED INTEREST RECEIVABLE 34960 BENEFICIAL INTEREST IN FOUNDATION 628754 ESTIMATED THIRD-PARTY PAYOR SETTLEM 1447639 OTHER ACCOUNTS RECEIVABLE 645412 FINANCE LEASE ROU ASSET 270862 3027627 RENTAL DEPOSITS 14400 FINANCE LEASE LIABILITY 132883 147283 X 39768738 108485 94472 202957 39565781 0 39565781 40781922 30152 30152 40751770 0 40751770 PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AS OF JUNE 30, 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 64,320. RENTAL EXPENSES 30,152. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 30,152. 1 1 X 1 X 1 X 1 1 1 0 1 0 318380 0 318380 0.00780 1864367 1598746 265621 0.00650 2182747 1598746 584001 0.01430 63983 0 63983 0.00160 1023158 577237 445921 0.01090 47290 0 47290 0.00120 1134431 577237 557194 0.01370 3317178 2175983 1141195 0.02800 1 1332595 0 12906838 13181778 -274940 X 1 1 1 1 CARROLL COUNTY MEMORIAL HOSPITAL 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 210-58 X X X X CARROLL COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY X 1 21 1 HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY X X X X X X 1 X 0 X X X X X 1 X 0 0 CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: CARROLL COUNTY MEMORIAL HOSPITAL INTERVIEWED HOSPITAL STAKEHOLDERS, COMMUNITY LEADERS, AND BUSINESS OWNERS TO ASSESS PUBLIC PERCEPTIONS OF THE COUNTY'S HEALTH STATUS AND UNMET NEEDS. THE INFORMATION GATHERED FROM THE INTERVIEWS PLAYED AN INSTRUMENTAL PART IN THE DEVELOPMENT OF AN IMPLEMENATATION PLAN TO ADDRESS THE NEEDS OF THE COMMUNITY. CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: CARROLL COUNTY HAS AN IMPLEMENATION PLAN THAT WE FOLLOW TO MEET THE NEEDS IDENTIFIED IN THE CHNA. THREE PRIORITY AREAS OF SIGNIFICANT NEED WERE IDENTIFIED: SUBSTANCE ABUSE, MENTAL HEALTH AND OBESITY. EACH OF THESE WERE ADDRESSED IN THE IMPLEMENTATION STRATEGY.TO ADDRESS SUBSTANCE ABUSE, CCMH CONTINUES TO MONITOR PRESCRIPTION DRUG ABUSE AND SUPPORTS PHYSICIANS IN DISCOURAGING PRESCRIPTION DRUG ABUSE. THE HOSPITAL SUPPLIES EDUCATIONAL HANDOUTS FOR MEDICAL PROVIDERS TO DISTRIBUTE TO PATIENTS WHEN PRESCRIBING SCHEDULE II DRUGS. CCMH CONTINUES TO SUPPORT AFTER-SCHOOL PROGRAMS AND ACTIVITY OPTIONS TO PREVENT YOUTH FROM DEVELOPING DRUG/ALCOHOL HABITS, INCLUDING RED RIBBON WEEK. THE HOSPITAL PROVIDES SUBSTANCE ABUSE COUNSELING FOR COMMUNITY MEMBERS AND EDUCATES THE SCHOOLS AND LOCAL COMMUNITIES ON SIGNS OF DRUG ABUSE. THE MENTAL HEALTH TASK FORCE CONDUCTED A COMMUNITY SURVEY REGARDING INDIVIDUAL PREPAREDNESS WHEN ENCOUNTERING SOMEONE WITH SUICIDAL THOUGHTS. BASED ON THE RESULTS AND DISCUSSION AMONG THE TASK FORCE MEMBERS, THE GROUP FELT THERE WAS STILL MORE WORK TO BE DONE TOWARDS THE GOAL OF A "SUICIDE-SAFER" COMMUNITY. AS A RESULT, THROUGHOUT THE YEAR, MULTIPLE SUICIDE PREVENTION TRAININGS WERE OFFERED TO THE COMMUNITY AND T-SHIRTS WERE GIVEN OUT. IN THE SPRING, A NEW COMMUNITY FACEBOOK GROUP WAS UNVEILED AS A PLACE TO SHARE COMMUNITY MENTAL HEALTH RESOURCES AND A SOCIAL MEDIA CAMPAIGN TOOK PLACE FOR ALCOHOL AWARENESS MONTH. IN SEPTEMBER THEY HOSTED A SUICIDE PREVENTION AND RECOVERY AWARENESS WALK WITH GUEST SPEAKERS FROM THE COMMUNITY SPEAKING OUT ABOUT THEIR OWN EXPERIENCES. DURING RED RIBBON WEEK, THE GROUP PROVIDED INCENTIVES, EDUCATIONAL MATERIALS, AND AWARENESS VIDEOS TO LOCAL SCHOOL DISTRICTS. ALSO IN OCTOBER, THE GROUP BROUGHT IN A GUEST SPEAKER TO TALK ABOUT VETERAN MENTAL HEALTH STATISTICS AND RESOURCES AVAILABLE TO VETERANS WHO ARE STRUGGLING. FOLLOWING THE PRESENTATION, THE GROUP DECIDED TO CREATE TWO VETERAN SPECIFIC INITIATIVES: BUILD AN AWARENESS CAMPAIGN AROUND 988 PRESS 1 FOR VETERANS AND PROVIDE MILITARY CULTURAL COMPETENCY TRAINING TO LOCAL HEALTHCARE PROVIDERS. TO END THE 2023 SEASON, THE TASK FORCE OFFERED A VIRTUAL GRIEF & LOSS EDUCATION FORUM. ON MARCH 15 OF 2023, CCMH ESTABLISHED A COMMUNITY-WIDE TASK FORCE TO ADDRESS OBESITY, CARROLL COUNTY HEALTHY HABITS TASK FORCE. DURING THE FIRST FEW MEETINGS THEY NARROWED THEIR TOP PRIORITIES TO: HOLD A COMMUNITY WALK, CREATE A COMMUNITY CHALLENGE, AND BUILD A RESOURCE GUIDE, ALL OF WHICH WERE PUT INTO PLACE OVER THE NEXT FEW MONTHS. THEY ALSO ESTABLISHED AND PROMOTED A COMMUNITY GARDEN AND OFFERED GROCERY STORE TOURS TO HELP INFORM THE PUBLIC. CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: IF EMPLOYMENT IS LISTED, WE TRY TO REACH EMPLOYER, IF PHONE NUMBER ON FILE DOESN'T REACH PATIENT. ALSO ATTEMPT TO REACH ANY LISTED CONTACTS IN ORDER TO SOLICIT INFORMATION REGARDING DIFFERENT PHONE NUMBERS OR ADDRESSES ON FILE FOR THE PATIENT. MULTIPLE ATTEMPTS ARE MADE TO REACH THE PATIENT UTILIZING AVAILABLE INFORMATION PRIOR TO COLLECTION ACTIVITIES BEING INSTITUTED. 5 1 - JEFFERSON MEDICAL GROUP 1502 N JEFFERSON CARROLLTON MO 64633 RURAL HEALTH CLINIC 2 - JEFFERSON MEDICAL GROUP - NORBORNE 105 EAST 2ND STREET NORBONNE MO 64668 RURAL HEALTH CLINIC 3 - JEFFERSON MEDICAL GROUP - HALE 221 ELM STREET HALE MO 64643 RURAL HEALTH CLINIC 4 - CCMH HOME HEALTH 1502 N JEFFERSON CARROLLTON MO 64633 HOME HEALTH AGENCY 5 - JEFFERSON MEDICAL GROUP - BRUNSWICK 807 EAST BROADWAY STREET BRUNSWICK MO 65236 RURAL HEALTH CLINIC PART I, LINE 3C: DISCOUNTED OR FREE CARE IS BASED OFF OF 200% OF FEDERAL POVERTY GUIDELINES. OTHER FACTORS USED INCLUDE ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED PARTY. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. PART I, LINE 7G: NO PHYSICAN CLINIC COSTS ARE INCLUDED. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION DOES NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES. PART III, LINE 2: THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: THE AMOUNT OF IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS BASED ON SELF-PAY ONLY PATIENTS COVERED BY MEDICAID HMOS AND THE PERCENT OF THE ELIGIBLE MEDICAID AND MEDICAID HMO PATIENTS DIVIDED BY TOTAL IMPLICIT PRICE CONCESSIONS THIS PERCENTAGE IS THEN MULTIPLIED BY SELF-PAY PATIENTS (PRIM HEALTH PLAN). THE TWO ESTIMATES ARE THEN COMBINED. NONE OF THIS AMOUNT IS CONSIDERED COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 9, 11, AND 13 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE." PART III, LINE 8: CCMH BELIEVES THAT MEDICARE SHORTFALLS SHOULD QUALIFY AS A COMMUNITY BENEFIT COST IF THE MEDICARE BENEFICIARY IS INDIGENT. PART III, LINE 9B: EACH PATIENT IS PROVIDED WITH PAYMENT INFORMATION IN CLEAR, EASY-TO-UNDERSTAND LANGUAGE. CCMH CHECKS ON PUBLIC-ASSISTANCE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. THE HOSPITAL OFFERS DISCOUNTS ON CHARGES TO UNDERINSURED PATIENTS WHEN POSSIBLE. PART VI, LINE 2: CARROLL COUNTY MEMORIAL HOSPITAL RELIES ON INTERACTION WITH LOCAL CARE AGENCIES AS WELL AS FEEDBACK FROM PATIENTS AND PRIMARY SERVICE AREA RESIDENTS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. PART VI, LINE 3: WE DO NOT PRESUME ELIGIBILITY FOR FINANCIAL ASSISTANCE. THOSE WHO BELIEVE THEY ARE ELIGIBLE, MUST FILL OUT AN APPLICATION. OUR PATIENT FINANCE SPECIALISTS OFTEN CALL BEFORE SENDING A PATIENT TO COLLECTIONS AND WILL ASK IF THE PATIENT WOULD LIKE AN APPLICATION AT THAT TIME AS WELL. IF A PATIENT IS ELIGIBLE, THEY RECEIVE THE APPLICABLE DISCOUNT AND THEN THE REMAINING BALANCE IS STILL SUBJECT TO OUR ORDINARY COLLECTIONS PRACTICES (MUST PAY BALANCES OFF WITHIN TWO YEARS AND HAVE A MINIMUM PAYMENT OF $25). PART VI, LINE 4: CARROLL COUNTY MEMORIAL HOSPITAL IS LOCATED IN CARROLLTON, MISSOURI. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF CARROLLTON AND THE SURROUNDING AREAS OF CARROLL COUNTY. CARROLL COUNTY MEMORIAL HOSPITAL OPERATES THREE SATELLITE CLINICS LOCATED IN BRUNSWICK, HALE AND NORBORNE. CARROLL COUNTY HAS A POPULATION OF APPROXIMATELY 8,679 RESIDENTS, WITH 35.5% OF THE RESIDENTS LIVING IN URBAN AREAS AND 64.5% LIVING IN RURAL AREAS. THE MEDIAN ANNUAL HOUSEHOLD INCOME FOR CARROLL COUNTY IS APPROXIMATELY $43,583. PART VI, LINE 5: CARROLL COUNTY MEMORIAL HOSPITAL WAS ORIGINALLY FOUNDED BY LOCAL CITIZENS FOCUSED ON HEALTHCARE FOR CARROLL COUNTY AND THE SURROUNDING AREA. CCMH IS "DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE AND UNDERSTANDS COMMUNITY HEALTH GOES BEYOND THE WALLS OF THE HOSPITAL.CCMH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. THE ASSESSMENT HELPS THE HOSPITAL SET GOALS TO IMPROVE THE HEALTH STATUS OF ITS PATIENTS AND THE COMMUNITY. CCMH'S CURRENT GOALS ARE FOCUSED ON LIFESTYLE BEHAVIORS, ACCESS TO CARE, AND MENTAL HEALTH FOR YOUTH AND ADULTS.CCMH PARTICIPATES IN THE CARROLL COUNTY COALITION FOCUSING ON MENTAL HEALTH AND SUBSTANCE USE DISORDER. CCMH HAS IMPLEMENTED THE FOLLOWING STRATEGIES TO ADDRESS MENTAL HEALTH INITIATIVES:1. INCREASE AWARENESS OF COMMUNITY RESOURCES THROUGH A COMMUNITY RESOURCE GUIDE.2. COLLABORATE WITH LOCAL SCHOOL DISTRICTS TO REVIEW CURRENT METHODS OF IDENTIFYING YOUTH AT-RISK AND OFFER COLLABORATIVE ASSISTANCE.3. PROVIDE RESOURCES TO SUPPORT AND ASSIST WITH PREVENTION AND TREATMENT OF SUBSTANCE USE DISORDER.4. PROVIDE PSYCHIATRIC AND THERAPY SERVICES.CCMH ALSO WORKS TO IMPROVE ACCESS TO BASIC AND PREVENTATIVE CARE ESPECIALLY FOR THE UNINSURED AND UNDER-INSURED THROUGH THE FOLLOWING STRATEGIES:1. PROVIDE COMMUNITY EDUCATION AND AWARENESS.2. IMPROVE ACCESSIBILITY THROUGH SATELLITE CLINICS IN SURROUNDING COMMUNITIES.3. SUPPORT THE NURSE NAVIGATOR PROGRAM TO ASSIST PATIENTS WITH GUIDANCE THROUGHOUT THEIR HEALTHCARE JOURNEY.4. EXPAND VIRTUAL VISITS.THE HOSPITAL ALSO HOUSES THE CCMH WELLNESS CENTER, A UNIQUE REHAB AND FITNESS CENTER, WHICH INCORPORATES AN INDOOR POOL, SAUNA, HOT TUB, INDOOR 1/16-MILE WALKING TRACK, AND STATE OF THE ART FITNESS EQUIPMENT WITH CERTIFIED THERAPISTS AND TRAINERS PROVIDING THERAPY AND PROGRAMS TO RESIDENTS OF CARROLL COUNTY AND THE SURROUNDING AREAS. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES MO 1 X X 0 0 0 1 0 0 0 0 0 GREGORY HUBBARD MD PHYSICIAN 547409 0 100 0 1396 0 19085 0 32101 0 600091 0 0 0 RICHARD SMITH MD PHYSICIAN 415804 0 125283 0 469 0 24400 0 11114 0 577070 0 0 0 ANDREW HORINE MD PHYSICIAN 426735 0 82108 0 172 0 24400 0 20720 0 554135 0 0 0 JEREMY STAYTON MD PHYSICIAN 430632 0 17021 0 468 0 8380 0 21229 0 477730 0 0 0 TIMOTHY REID MD MEMBER 224288 0 58991 0 198 0 23547 0 33044 0 340068 0 0 0 PAMELA RALLS MD PHYSICIAN 196082 0 69633 0 162 0 19760 0 20969 0 306606 0 0 0 SCOTT THORESON CEO 228720 0 100 0 1458 0 9488 0 20843 0 260609 0 0 0 LESLEY DELANEY CFO 113635 0 5000 0 87 0 10190 0 32306 0 161218 0 0 0 PART I, LINE 5 A PORTION OF PHYSICIAN COMPENSATION WAS CALCULATED QUARTERLY USING A PERCENTAGE OF REIMBURSEMENT. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, COMPRISED OF THE ELECTED OFFICERS AND TWO OTHER MEMBERS OF THE BOARD APPOINTED BY THE PRESIDENT, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A SEPARATE ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD SETS THE CONFLICT OF INTEREST POLICY AND ADMINISTRATION IS CHARGED WITH ASSURING THAT COMPLIANCE IS MAINTAINED. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY AND EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST DISCLOSURE FORM. IF A CONFLICT ARISES THE CONFLICTED PERSON DOES NOT TAKE PART IN THE VOTE ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD CONDUCTS AN ANNUAL SALARY REVIEW FOR THE CEO. THE BOARD APPROVES THE AMOUNT OF COMPENSATION. THE LAST REVIEW WAS CONDUCTED IN 2022. ALL OTHER MANAGEMENT POSITIONS ARE HIRED, REVIEWED, AND MONITORED BY THE CEO AND LEADERSHIP TEAM. COMPENSATION REVIEWS OCCUR ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHARMACY EXPENSE: PROGRAM SERVICE EXPENSES 2,807,733. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,807,733. OTHER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 6,655,811. MANAGEMENT AND GENERAL EXPENSES 412,966. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,068,777. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST - FND 64,320. PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CARROLL COUNTY MEMORIAL HOSPITAL FDN 1502 N JEFFERSON ST CARROLLTON MO 64633 463696048 SUPPORT MO 501(C)(3) LINE 7 CARROLL COUNTY MEMORIAL HOSPITAL 1 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0