2025-05-06T12:31:45-05:00 2024-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-07-01 440629397 CARROLL COUNTY MEMORIAL HOSPITAL CARR 6605421695 1502 N JEFFERSON STREET CARROLLTON MO 64633 SCOTT THORESON CEO 6605421695 2025-05-06 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-05-05 2023 2025-03-06 01:10:19Z SCOTT THORESON 1502 N JEFFERSON STREET CARROLLTON MO 64633 45148606 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 9 305 12 0 0 269787 41873 38859361 44618672 221862 174823 214771 264976 39565781 45100344 0 0 0 0 20696966 22503544 0 0 0 20054804 22031436 40751770 44534980 -1185989 565364 39557467 40220804 9111066 8729759 30446401 31491045 CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. 0 0 38707109 44705007 ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. 38707109 1 0 0 1 0 0 0 0 0 0 1 0 0 1 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 52 0 1 305 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/PHYSICIAN 40.00 0.00 X 304416 0 57981 WADE MERTENSMEYER PRESIDENT 2.00 0.00 X X 0 0 0 ANNA BARLOW VICE PRESIDENT 2.00 0.00 X X 0 0 0 TOM BURKHART SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 JENNIFER POSTON MEMBER 2.00 0.00 X 0 0 0 JANICE BURNSIDE MEMBER 2.00 0.00 X 0 0 0 JENNIFER LINK MEMBER 2.00 0.00 X 0 0 0 KEVIN BROWN MEMBER 2.00 0.00 X 0 0 0 MATT LOCK MEMBER 2.00 0.00 X 0 0 0 KEN BROWN MEMBER 2.00 0.00 X 0 0 0 KIM RITCHHART MEMBER THRU 9/2023 2.00 0.00 X 0 0 0 SCOTT THORESON CEO 39.00 1.00 X 232597 0 39241 LESLEY DELANEY CFO 39.00 1.00 X 131731 0 34567 GREGORY HUBBARD MD PHYSICIAN 40.00 0.00 X 570823 0 54822 RICHARD SMITH MD PHYSICIAN 40.00 0.00 X 543744 0 37323 ANDREW HORINE MD PHYSICIAN 40.00 0.00 X 471274 0 46943 JEREMY STAYTON MD PHYSICIAN 40.00 0.00 X 460935 0 23997 PAMELA RALLS MD PHYSICIAN 40.00 0.00 X 286565 0 42756 3002085 0 337630 23 0 1 0 HOSPITAL CARE CONSULTANTS INC 17304 PRESTON ROAD SUITE 1400 DALLAS TX 75252 HOSPITALIST SERVICES 754675 ORACLE CERNER PO BOX 203448 DALLAS TX 75320 EMR 685074 EMERGENCY STAFFING SOLUTIONS INC 17304 PRESTON ROAD SUITE 1400 DALLAS TX 75252 HOSPITALIST SERVICES 674122 CREATIVE PLANNING PO BOX 950443 ST LOUIS MO 63195 IT MANAGED SERVICES 660934 HAVE A NICE DAY ANESTHESIA 2106 WOODCREST DR CHILLICOTHE MO 64601 ANESTHESIA SERVICES 460206 16 41873 41873 MEDICARE/MEDICAID 624100 29022998 29022998 NET PATIENT SERVICE REVENUE 624100 13725633 13725633 340B DRUG PRICING PROGRAM 624100 1256204 1256204 ELECTRONIC HEALTH RECORD INCENTIV 624100 300376 300376 313461 313461 44618672 201985 201985 105935 19600 86335 86335 86335 1500 28662 -27162 -27162 -27162 CAFETERIA 722514 178641 178641 178641 45100344 44705007 0 353464 X 808098 351337 456761 16568617 14451516 2117101 852443 719810 132633 4274386 3546094 728292 36999 36999 124438 124438 11533874 10880033 653841 59331 34383 24948 1110333 804659 305674 655615 595437 60178 916395 734921 181474 202137 142357 59780 181487 126857 54630 2401249 1912409 488840 201542 142869 58673 MEDICAL SUPPLIES 2985711 2985092 619 340(B) PHARMACY EXPENSE 859289 859289 MISC 500730 162587 338143 FOOD 262306 257459 4847 44534980 38707109 5827871 0 135368 1172 12558998 12332443 4212410 5514797 902610 940982 479880 513459 42854628 29285509 15121937 13569119 1901536 3434101 1217101 1110874 3027627 2803857 39557467 40220804 3421142 4434799 5542641 4217299 147283 77661 9111066 8729759 X 29817653 30774817 628748 716228 30446401 31491045 39557467 40220804 X 565364 391800 87480 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 11455 11455 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 30414492 20511579 9902913 9977244 7176740 2800504 2194777 1597190 597587 13569119 ACCRUED INTEREST RECEIVABLE 37592 BENEFICIAL INTEREST IN FOUNDATION 716234 ESTIMATED THIRD-PARTY PAYOR SETTLEM 988052 OTHER ACCOUNTS RECEIVABLE 814007 FINANCE LEASE ROU ASSET 247972 2803857 RENTAL DEPOSITS 16200 FINANCE LEASE LIABILITY 61461 77661 X 45599224 391800 107080 498880 45100344 0 45100344 44554580 19600 19600 44534980 0 44534980 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, 2024 AND 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 87,480. RENTAL EXPENSES 19,600. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 19,600. 1 1 X 1 X 1 X 1 1 1 0 1 0 122467 122467 0.00270 1922673 1092141 830532 0.01860 2045140 1092141 952999 0.02130 56709 56709 0.00130 95842 95842 0.00220 13322 13322 0.00030 165873 165873 0.00380 2211013 1092141 1118872 0.02510 1 285802 285802 0.00640 1 285802 285802 0.00640 1 546432 75408 8873831 9920464 -1046633 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 1 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 IMPLEMENTATION PLAN TO ADDRESS THE NEEDS OF THE COMMUNITY. CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: CARROLL COUNTY HEALTH DEPARTMENT 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. BELOW ARE THE ACTIONS TAKEN DURING THE FISCAL YEAR TO ADDRESS THESE NEEDS:THE MENTAL HEALTH TASK FORCE BEGAN 2023 BY EVALUATING THE PROGRESS ON PREVIOUS SUICIDE PREVENTION INITIATIVES. IN FEBRUARY, THE GROUP CONDUCTED A COMMUNITY SURVEY REGARDING INDIVIDUAL PREPAREDNESS WHEN ENCOUNTERING SOMEONE WITH SUICIDAL THOUGHTS. SIXTY INDIVIDUALS RESPONDED TO THE SURVEY.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.THE TASK FORCE HOSTED ROBIN BALKE FROM THE ORGANIZATION DEFEET LOCATED IN SALINE COUNTY. SHE SHARED INFORMATION REGARDING THEIR "YOU OKAY TODAY" T-SHIRT INITIATIVE. THE T-SHIRTS ARE PROVIDED TO INDIVIDUALS FOR FREE AFTER RECEIVING SUICIDE PREVENTION TRAINING. AFTER HEARING THE PRESENTATION, THE TASK FORCE DECIDED A SIMILAR CAMPAIGN WOULD BE A GOOD FIT FOR CARROLL COUNTY AND RECEIVED PERMISSION FROM DEFEET TO PRODUCE SIMILAR T-SHIRTS. THE GROUP APPLIED FOR AND RECEIVED A MINI GRANT THROUGH 4IMPRINT TOWARD THE PRODUCTION COST OF THE T-SHIRTS AND CARROLL COUNTY MEMORIAL HOSPITAL COVERED THE REMAINING COST.IN THE SPRING, THE GROUP UNVEILED A NEW COMMUNITY FACEBOOK GROUP LOCATED AT FACEBOOK.COM/CARROLLCOUNTYMENTALHEALTH. IT WAS CREATED AS A PLACE TO SHARE COMMUNITY MENTAL HEALTH RESOURCES. IN APRIL, THE GROUP RECOGNIZED ALCOHOL AWARENESS MONTH WITH A SOCIAL MEDIA CAMPAIGN AND A NEWSPAPER COLORING-PAGE CAMPAIGN. THE GROUP ALSO PROVIDED ADDITIONAL SUICIDE PREVENTION TRAINING OPPORTUNITIES AND REACHED OUT TO LOCAL BUSINESSES AND SCHOOLS TO OFFER TRAINING RESOURCES. IN TOTAL, SIXTY ADDITIONAL COMMUNITY MEMBERS WERE TRAINED IN SUICIDE PREVENTION STRATEGIES.QPR TRAINING WAS OFFERED IN MAY - QPR (QUESTION, PERSUADE, AND REFER) GATEKEEPER TRAINING FOR SUICIDE PREVENTION IS A 1 HOUR EDUCATIONAL PROGRAM DESIGNED TO TEACH LAY AND PROFESSIONAL "GATEKEEPERS" THE WARNING SIGNS OF A SUICIDE CRISIS AND HOW TO RESPOND.SAFETALK TRAINING WAS OFFERED IN MAY - SAFETALK IS A FOUR-HOUR FACE-TO-FACE WORKSHOP FEATURING POWERFUL PRESENTATIONS, AUDIOVISUALS AND SKILLS PRACTICE. YOU'LL LEARN HOW TO PREVENT SUICIDE BY RECOGNIZING SIGNS, ENGAGING SOMEONE AND CONNECTING THEM TO AN INTERVENTION RESOURCE FOR FURTHER SUPPORT. A SKILLED, SUPPORTIVE TRAINER WILL GUIDE YOU THROUGH THE COURSE AND A COMMUNITY RESOURCE WILL BE ON HAND TO SUPPORT YOUR SAFETY AND COMFORT.OVER THE SUMMER, THE MENTAL HEALTH TASK FORCE PARTNERED WITH THE NEWLY FORMED CARROLL COUNTY HEALTHY HABITS TASK FORCE TO PARTICIPATE IN THEIR FIRST EVENT, THE LET'S GET MOVING COMMUNITY CHALLENGE, BY HOSTING A RESOURCE TABLE. AS THE GROUP MOVED INTO THE FALL, THE FOCUS SHIFTED BACK TO SUICIDE PREVENTION. DURING FARM HEALTH AND SAFEY WEEK, THE GROUP PROVIDED SNACKS AND MENTAL HEALTH INFORMATION FOR THE AGRICULTURAL COMMUNITY AT THE LOCAL GRAIN ELEVATOR. AT THE END OF THE MONTH, THEY HOSTED THE SUICIDE PREVENTION AND RECOVERY AWARENESS WALK ON SEPTEMBER 30. THREE COMMUNITY MEMBERS SPOKE ABOUT THEIR EXPERIENCES WITH SUICIDE AND SUBSTANCE USE WITH TWENTY-SIX INDIVIDUALS IN ATTENDANCE. THE EVENT ALSO RECEIVED POSITIVE SUPPORT FROM LOCAL BUSINESSES WHO PROVIDED SELF-CARE DOOR PRIZES. IN OCTOBER, THE GROUP PROVIDED INCENTIVES, EDUCATIONAL MATERIALS AND AWARENESS VIDEOS TO LOCAL SCHOOL DISTRICTS IN RECOGNITION OF RED RIBBON WEEK. RED RIBBON WEEK IS THE LARGEST DRUG-ABUSE PREVENTION CAMPAIGN IN THE UNITED STATES. IN THE SAME MONTH, THE TASK FORCE HOSTED PATRICK BAINBRIDGE, LCSW WITH KC VA MEDICAL CENTER. HE SHARED SOME IMPORTANT STATISTICS ABOUT VETERANS' RESOURCES IN OUR AREA. HE ALSO SHARED SOME OF THE UNIQUE CHALLENGES VETERANS EXPERIENCE. THE GROUP LEARNED ABOUT THE HIGHER PERCENTAGE OF VETERANS IN CARROLL COUNTY AND THE IMPORTANCE OF MILITARY CULTURAL COMPETENCIES. AFTER HEARING THE PRESENTATION, THE GROUP DECIDED TO CREATE TWO VETERAN SPECIFIC INITIATIVES: - BUILD AN AWARENESS CAMPAIGN AROUND 988 PRESS 1 FOR VETERANS. - PROVIDE MILITARY CULTURAL COMPETENCY TRAINING TO LOCAL HEALTHCARE PROVIDERS.BOTH INITIATIVES ARE IN PROGRESS WITH THE CULTURAL COMPETENCY TRAINING SCHEDULED FOR MARCH. TO END THE SEASON, THE TASK FORCE OFFERED A VIRTUAL GRIEF & LOSS EDUCATION FORUM IN DECECEMBER. THE GROUP CONTINUES TO MEET REGULARLY AND ALSO PLANS TO HOST AN IN-PERSON NARCAN TRAINING SOON. OVERALL, PARTICIPATION HAS BEEN STEADY WITH HOPES FOR CONTINUED GROWTH.IN MARCH, CCMH ESTABLISHED A COMMUNITY-WIDE TASK FORCE TO ADDRESS OBESITY. THE GROUP IDENTIFIED CURRENT CHALLENGES, RESOURCES AND GAPS WITHIN OUR LOCAL COMMUNITY. AT THE SECOND MEETING, THE TASK FORCE COMPLETED SEVERAL EXERCISES TO NARROW THE FOCUS TO THE TOP THREE IDEAS, WHICH INCLUDED: - HOLD A COMMUNITY WALK - CREATE A COMMUNITY CHALLENGE - BUILD A RESOURCE GUIDETHE GROUP RENAMED ITSELF THE CARROLL COUNTY HEALTH HABITS TASK FORCE AND IT HELD AN EVENT IN JUNE. THE EVENT WAS THE LET'S GET MOVING: 21 DAY JUMPSTART COMMUNITY CHALLENGE. IT WAS CREATED AS A 21-DAY JUMP START TO HEALTHIER HABITS. ALL AGES WERE WELCOME, GIVEAWAYS WERE PROVIDED, AND RESOURCE TABLES WERE AVAILABLE. ALTHOUGH ATTENDANCE WAS LOW DUE TO HIGH TEMPERATURES AND CONFLICTING EVENTS, THE PARTICIPANTS FELT IT WAS A GOOD WAY TO CONNECT WITH ONE ANOTHER AS A NEW GROUP.IN ADDITION TO THE EVENT, THE TASK FORCE IS CONTINUING TO PURSUE ADDITIONAL IDEAS INCLUDING GROCERY STORE TOURS, PROMOTION OF THE LOCAL COMMUNITY GARDEN, AND THE PREVIOUSLY MENTIONED RESOURCE GUIDE.IN ADDITION TO THE CARROLL COUNTY HEALTH HABITS TASK FORCE, CCMH CONTINUES TO PURSUE THE CREATION OF AN OBESITY-SPECIFIC CLINIC. CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: IF EMPLOYMENT IS LISTED, WE TRY TO REACH AN EMPLOYER, IF THE PHONE NUMBER ON FILE DOESN'T REACH PATIENT. WE 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. 3 1 - JEFFERSON MEDICAL GROUP 1502 N JEFFERSON CARROLLTON MO 64633 RURAL HEALTH CLINIC 3 - JEFFERSON MEDICAL GROUP - HALE 221 ELM STREET HALE MO 64643 RURAL HEALTH CLINIC 5 - JEFFERSON MEDICAL GROUP - BRUNSWICK 807 EAST BROADWAY STREET BRUNSWICK MO 65236 RURAL HEALTH CLINIC PART I, LINE 3C: ASIDE FROM THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE INCLUDE ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, SUBSIDIZED HEALTH SERVICES, LINE 7G AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART II, COMMUNITY BUILDING ACTIVITIES: CARROLL COUNTY MEMORIAL HOSPITAL PROVIDES SUPPORT TO THE SALARIES FOR THE INDIVIDUALS WORKING AT THE CHILDCARE CENTER. THE CHILDCARE CENTER PROVIDES MUCH NEEDED SERVICES TO FAMILIES IN THE COMMUNITY. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 13.8% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 12 AND 13 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: 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). IF A PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, ALL COLLECTION EFFORTS STOP UNTIL THE PROPER DISCOUNT CAN BE APPLIED. 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: 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. A PATIENT CAN OBTAIN A FINANCIAL ASSITANCE APPLICATION AT ANY CARROLL COUNTY MEMORIAL HOSPITAL FACILITY REGISTRATION DESK OR AT THE PATIENT ADVOCATE OFFICE(S) LOCATED AT CCMH. REQUEST TO HAVE AN APPLICATION MAILED TO YOU OR IF YOU HAVE ANY QUESTIONS CALL (660) 542-1695 EXT 7200. A PATIENT CAN ALSO REQUEST AN APPLICATION BY MAIL AT CARROLL COUNTY MEMORIAL HOSPITAL, OR DOWNLOAD AN APPLICATION FROM THE HOSPITAL'S WEBSITE. 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 TWO SATELLITE CLINICS LOCATED IN BRUNSWICK AND HALE. 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 7, REPORTS FILED WITH STATES MO 1 X X 0 0 0 1 0 0 0 0 0 GREGORY HUBBARD MD PHYSICIAN 568014 0 100 0 2709 0 26400 0 28560 0 625783 0 0 0 RICHARD SMITH MD PHYSICIAN 368736 0 174485 0 523 0 26400 0 10980 0 581124 0 0 0 ANDREW HORINE MD PHYSICIAN 393259 0 77818 0 197 0 26400 0 20598 0 518272 0 0 0 JEREMY STAYTON MD PHYSICIAN 434220 0 26247 0 468 0 8651 0 20451 0 490037 0 0 0 TIMOTHY REID MD MEMBER/PHYSICIAN 241320 0 62881 0 215 0 25086 0 32951 0 362453 0 0 0 PAMELA RALLS MD PHYSICIAN 205346 0 81030 0 189 0 22214 0 20592 0 329371 0 0 0 SCOTT THORESON CEO 231016 0 100 0 1481 0 18698 0 20600 0 271895 0 0 0 LESLEY DELANEY CFO 131522 0 100 0 109 0 11232 0 23369 0 166332 0 0 0 PART I, LINE 5 A PORTION OF PHYSICIAN COMPENSATION WAS CALCULATED MONTHLY 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 3,547,441. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,547,441. OTHER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 7,332,592. MANAGEMENT AND GENERAL EXPENSES 653,841. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,986,433. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST - FND 87,480. 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