CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC (EIN 59-3051173)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202243149349301864
- Schema version
- 2021v4.0
- 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 | 2022-11-10T09:17:44-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 580914992 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317081309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 593051173 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN-LIBERTY HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | ASSOCIATION INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CALH | BusinessNameControlTxt |
| Phone | 8506745411 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20370 NE BURNS AVENUE | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 324241045 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTINIA JEPSEN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8506745411 | PhoneNum |
| Signature | 2022-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CHRISTINIA | PersonFirstNm |
| Person Last | JEPSEN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WILLIAM EDWARD PHILLIPS | PreparerPersonNm |
| PTIN | P00451499 | PTIN |
| Phone | 2298837878 | PhoneNum |
| Preparation | 2022-11-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN-LIBERTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRISTINIA JEPSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20370 NE BURNS AVENUE | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 324241045 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,868,224 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CALHOUNLIBERTYHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 188 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,670,666 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,181,355 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,180,339 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,349,776 | CYProgramServiceRevenueAmt |
| PY Investment Income | $42,598 | PYInvestmentIncomeAmt |
| CY Investment Income | $40,621 | CYInvestmentIncomeAmt |
| PY Other Revenue | $670,395 | PYOtherRevenueAmt |
| CY Other Revenue | $296,472 | CYOtherRevenueAmt |
| PY Total Revenue | $9,563,998 | PYTotalRevenueAmt |
| CY Total Revenue | $17,868,224 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,637,325 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,021,046 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,042,312 | PYOtherExpensesAmt |
| CY Other Expenses | $6,471,755 | CYOtherExpensesAmt |
| PY Total Expenses | $10,679,637 | PYTotalExpensesAmt |
| CY Total Expenses | $12,492,801 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,115,639 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,375,423 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,665,461 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,521,432 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,122,428 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,602,976 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,456,967 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,918,456 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,856,920 | ExpenseAmt |
| Revenue | $9,655,348 | RevenueAmt |
| Desc | TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY THROUGH INPATIENT CARE, OUTPATIENT CARE, EMERGENCY ROOM CARE AND OTHER RELATED SERVICES. | Desc |
| Total Program Service Expenses | $10,856,920 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 188 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | false | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDA POTTER | PersonNm |
| Phone | 8506745411 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 419 | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32424 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| TERESA EDENFIELD | |||||||
| NURSE PRACTI | Yes (X) | $175,826 | $0 | $5,804 | |||
| LAURA FORD | |||||||
| NURSE PRACTI | Yes (X) | $147,675 | $0 | $0 | |||
| BRENDA POTTER | |||||||
| CFO | $94,683 | $0 | $5,717 | 40.00 | Yes (X) | ||
| LABAN BONTRAGER DMD | |||||||
| MEMBER | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| TERRY EUBANKS | |||||||
| MEMBER | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| MELBA FAUROT | |||||||
| MEMBER | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| JOHN TOMLINSON JR | |||||||
| TREASURER | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| MARY SUE NEVES | |||||||
| MEMBER | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| MARK PLUMMER | |||||||
| CHAIRMAN | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| TIM REVELL | |||||||
| VICE-CHAIRMA | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| MARILYN RUSSELL | |||||||
| SECRETARY | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| LADDIE WILLIAMS | |||||||
| MEMBER | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| CHRISTINIA JEPSEN | |||||||
| CEO | $0 | $0 | $0 | 50.00 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $418,184 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $11,521 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EM CARE | |||||
| 13737 NOEL ROAD SUITE 1600 | DALLAS | TX | 75240 | PHYSICIAN | $1,939,656 |
| EVIDENT | |||||
| PO BOX 11407 DEPT 6448 | BIRMINGHAM | AL | 352466448 | EHR | $625,240 |
| ALLIANT | |||||
| 12800 N MERIDIAN ST SUITE 400 | CARMEL | IN | 46302 | MANAGEMENT | $488,132 |
| AYA HEALTHCARE | |||||
| PO BOX 123519 DEPT 3519 | DALLAS | TX | 753123519 | STAFFING | $280,531 |
| CRITICAL REHAB | |||||
| 4381 KIMBERLY CIRCLE | TALLAHASSEE | FL | 32309 | PHYSICAL THERAP | $104,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $8,181,179 | GovernmentGrantsAmt |
| All Other Contributions | $176 | AllOtherContributionsAmt |
| Total Contributions | $8,181,355 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| NET PATIENT SERVICE REVENUE | $9,272,471 | $9,272,471 |
| 340B INCOME | $77,305 | $77,305 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,349,776 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,521 | TotalRevenueColumnAmt |
| Exclusion | $31,521 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,100 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,100 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,100 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,100 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| RHC WRAP AND CAP PAYMENTS | $164,639 | $164,639 |
| MISCELLANEOUS INCOME | $116,475 | $116,475 |
| CAFETERIA | $14,073 | $14,073 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,285 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,285 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $296,472 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,868,224 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,655,348 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $31,521 | 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 | $96,694 | TotalAmt |
| Management And General | $96,694 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,956,730 | TotalAmt |
| Program Services | $4,426,902 | ProgramServicesAmt |
| Management And General | $529,828 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,966 | TotalAmt |
| Program Services | $93,966 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $434,673 | TotalAmt |
| Program Services | $434,673 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $438,983 | TotalAmt |
| Program Services | $438,983 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,647 | TotalAmt |
| Management And General | $48,647 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,049 | TotalAmt |
| Management And General | $44,049 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,810,326 | TotalAmt |
| Program Services | $3,014,090 | ProgramServicesAmt |
| Management And General | $796,236 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,720 | TotalAmt |
| Program Services | $25,720 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $666,122 | TotalAmt |
| Program Services | $603,354 | ProgramServicesAmt |
| Management And General | $62,768 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,793 | TotalAmt |
| Program Services | $29,793 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,058 | TotalAmt |
| Program Services | $166,058 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,014 | TotalAmt |
| Program Services | $45,106 | ProgramServicesAmt |
| Management And General | $908 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,373 | TotalAmt |
| Program Services | $5,843 | ProgramServicesAmt |
| Management And General | $10,530 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,637 | TotalAmt |
| Program Services | $13,637 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,289 | TotalAmt |
| Program Services | $152,289 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $267,204 | TotalAmt |
| Program Services | $247,933 | ProgramServicesAmt |
| Management And General | $19,271 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $745,624 | $745,624 | |
| REPAIRS & MAINTENANCE | $225,088 | $222,097 | $2,991 |
| PROVIDER TAX | $74,090 | $74,090 | |
| AMBULANCE MEDICAL SUPPLIE | $52,218 | $52,218 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,503 | TotalAmt |
| Program Services | $64,544 | ProgramServicesAmt |
| Management And General | $23,959 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,492,801 | TotalAmt |
| Program Services | $10,856,920 | ProgramServicesAmt |
| Management And General | $1,635,881 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,451,714 | BOYAmt |
| EOY | $10,387,641 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $847,539 | BOYAmt |
| EOY | $914,226 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,122 | BOYAmt |
| EOY | $481,782 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,957 | BOYAmt |
| EOY | $119,666 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,883,572 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,006,849 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $829,641 | BOYAmt |
| EOY | $2,876,723 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,488 | BOYAmt |
| EOY | $741,394 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,665,461 | BOYAmt |
| EOY | $15,521,432 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $964,875 | BOYAmt |
| EOY | $1,461,068 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,456,471 | BOYAmt |
| EOY | $2,318,501 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,850,458 | BOYAmt |
| EOY | $6,445,382 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,850,624 | BOYAmt |
| EOY | $1,378,025 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,122,428 | BOYAmt |
| EOY | $11,602,976 | 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 | -$1,555,977 | BOYAmt |
| EOY | $3,918,456 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,010 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,456,967 | BOYAmt |
| EOY | $3,918,456 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,665,461 | BOYAmt |
| EOY | $15,521,432 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,375,423 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (true) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $24,000 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | Yes (true) | RalliesDemonstrationsInd |
| Rallies Demonstrations | $483 | RalliesDemonstrationsAmt |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $24,483 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | CONTRACTOR IS PAID TO REPRESENT THE HOSPITAL'S INTEREST AND A PERCENTAGE OF DUES PAID TO MEMBERSHIP ORGANIZATION'S IS ALLOCATED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $239,237 | OtherCostOrOtherBasisAmt |
| Book Value | $239,237 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,681,976 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,378,566 | DepreciationAmt |
| Book Value | $303,410 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,440 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,953 | DepreciationAmt |
| Book Value | $5,487 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,005,764 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,612,330 | DepreciationAmt |
| Book Value | $393,434 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,935,155 | OtherCostOrOtherBasisAmt |
| Book Value | $1,935,155 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,876,723 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CARES ACT REFUNDABLE ADVANCE PAYMENT | $783,751 |
| MEDICARE ADVANCE PAYMENTS | $594,274 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,378,025 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,876,350 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$20,000 | OtherRevenueAmt |
| Revenue Not Reported | -$20,000 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,896,350 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,971,874 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,971,874 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,868,224 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,472,801 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $12,472,801 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $20,000 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $20,000 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,492,801 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE ASSOCIATION IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. THE ASSOCIATION ANNUALLY FILES A FORM 990 TAX RETURN WHICH INCLUDES THE OPERATIONS OF THE HOSPITAL AND EMS. THE ASSOCIATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE ASSOCIATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING STATEMENT OF FINANCIAL POSITION FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2021 AND 2020 OR FOR THE YEARS THEN ENDED. THE ASSOCIATION'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | RECLASSIFIED BAD DEBT EXPENSE -20,000 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | GRANTS RECORDED AS CAPITAL CONTRIBUTIONS IN AFS 1,971,874 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | RECLASSIFIED BAD DEBT EXPENSE 20,000 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,204 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,204 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,712,854 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,204,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $508,221 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,746,058 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,204,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $541,425 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04330 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,339 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,339 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,339 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,339 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,748,397 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,204,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $543,764 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04350 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,154,456 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,666,817 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,652,324 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $14,493 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN-LIBERTY PRIMARY CARE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20370 NE BURNS AVE | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32424 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CALHOUNLIBERTYHOSPITAL.COM | WebsiteAddressTxt |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN-LIBERTY PRIMARY CARE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CALHOUNLIBERTYHOSPITAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | false | ImplementationStrategyAdoptInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | false | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.CALHOUNLIBERTYHOSPITAL.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.CALHOUNLIBERTYHOSPITAL.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.CALHOUNLIBERTYHOSPITAL.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | false | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 3E | IN CONSIDERATION OF THE QUANTITATIVE AS WELL AS QUALITATIVE FEEDBACK, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED: ACCESS TO HEALTH CARE OBESITY MENTAL HEALTH/SUBSTANCE ABUSE |
| FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 5 | WHILE THE ORGANIZATION MADE PROGRESS ON THEIR 2016 CHNA AND 2017 - 2019 IMPLEMENTATION STRATEGY PLAN, HURRICANE MICHAEL DRAMATICALLY CHANGED THE TRAJECTORY OF THE HOSPITAL'S EFFORTS WHEN IT MADE LANDFALL DIRECTLY ON BLOUNTSTOWN, FLORIDA, ON OCTOBER 10, 2018. THE DAMAGE TO CLH WAS SIGNIFICANT TO SAY THE LEAST. DUE TO THE WIDESPREAD DAMAGE IN THE REGION, RESOURCES WERE LIMITED FOR IMMEDIATE ASSISTANCE TO CLEAN-UP, REPAIR AND RESTORE HOSPITAL DEPARTMENTS IN ORDER TO PROVIDE SERVICES. WHILE IT TOOK SEVERAL WEEKS AND, IN SOME CASES, MONTHS, CLH WAS ABLE TO OPEN ITS DOORS AGAIN IN THE MIDST OF RECOVERY AND CONTINUES TO BE IN A REBUILDING PROCESS. TO THAT END, CLH PARTICIPATED IN THE 2019 - 2021 COMMUNITY HEALTH IMPROVEMENT PLAN WITH THE FLORIDA DEPARTMENT OF HEALTH IN CALHOUN/LIBERTY COUNTIES TO UPDATE THE EXISTING 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND INCLUDE AN IMPLEMENTATION STRATEGY PLAN FOR 2019 - 2021. IN THE PREVIOUS CHNA (2016), THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT IS COMPRISED OF IDENTIFYING THE ISSUES RESIDENTS OF THE COMMUNITY DEEM AS THE MOST IMPORTANT; ALONG WITH DISTINGUISHING ANY RESOURCES AVAILABLE TO AID IN IMPROVING THE HEALTH OF THE COMMUNITY. COMMUNITY SURVEYS WERE DEVELOPED AND FIELDED AT VARIOUS LOCATIONS, INCLUDING GROCERY STORES, CONVENIENCE STORES, HOSPITAL/ER AND MEDICAL CLINICS. WITH THE ASSISTANCE OF THE FLORIDA DEPARTMENT OF COMMUNITY HEALTH, EXISTING DATA WAS REVIEWED AND COMMUNITY HEATLH INDICATORS WERE UPDATED AND REVIEWED. |
| FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 6B | FLORIDA DEPARTMENT OF HEALTH IN CALHOUN/LIBERTY COUNTIES. |
| FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 11 | BEHAVIORAL HEALTH, INCLUDING MENTAL HEALTH & SUBSTANCE ABUSE: AS IDENTIFIED DURING THE NEEDS ASSESSMENT CALHOUN LIBERTY HOSPITAL DOES NOT PROVIDE BEHAVIORAL HEALTH SERVICES, AND IT WOULD NOT BE FEASIBLE FOR THE HOSPITAL TO DEVELOP THIS TYPE OF PROGRAM DUE TO FUNDS. THE HOSPITAL WORKS CLOSELY WITH FACILITIES THAT PROVIDE THESE SERVICES TO ASSIST PATIENTS IN ACCESSING CARE. FOOD DESERT: THE HOSPITAL CANT PROVIDE SERVICES FOR THE PROBLEM OF ONLY HAVING ONE GROCERY STORE IN EACH COMMUNITY. THE HOSPITAL DOES NOT HAVE AN AVAILABLE COLD CONTAINER TO HOUSE PERISHABLE ITEMS AND DOES NOT SEE A TIME FRAME THAT THIS WOULD BE FEASIBLE. |
| FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 13H | A PATIENT IS CONSIDERED MEDICALLY INDIGENT IF THEY ARE UNABLE TO PAY THE OUTSTANDING BALANCE IN THEIR ACCOUNT IF, AFTER ALL INSURANCE ANC 3RD PARTY PAYMENTS, THE AMOUNT OUTSTANDING EXCEEDS 5% OF ANNUAL HOUSEHOLD INCOME AND THE TOTAL ANNNUAL HOUSE HOLD INCOME EXCEEDS 300% OF FPG BUT IS LESS THAN 500% OF FPG. |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | COSTS FOR PART I, LINE 7A AND 7B WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. |
| SCHEDULE H, PART III, LINE 3 | NET PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS AND INCLUDES VARIABLE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. GENERALLY, THE HOSPITAL BILLS THE PATIENTS AND THIRD-PARTY PAYORS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED AND/OR THE PATIENT IS DISCHARGED FROM THE FACILITY. REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE HOSPITAL. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED (OR ACTUAL) CHARGES. THE HOSPITAL BELIEVES THAT THIS METHOD PROVIDES A FAITHFUL DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS RECEIVING PATIENT CARE SERVICES. THE HOSPITAL MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE. THESE SERVICES ARE CONSIDERED TO BE A SINGLE PERFORMANCE OBLIGATION AND HAVE A DURATION OF LESS THAN ONE YEAR. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED AT A POINT IN TIME IS RECOGNIZED WHEN SERVICES ARE PROVIDED AND THE HOSPITAL DOES NOT BELIEVE IT IS REQUIRED TO PROVIDE ADDITIONAL SERVICES TO THE PATIENT. SEE FOOTNOTE 3 FOR A SUMMARY OF UNCOMPENSATED SERVICES, INCLUDING PRICE CONCESSIONS (BAD DEBTS). |
| SCHEDULE H, PART III, LINE 4 | SEE THE DISCUSSION REGARDING UNINSURED PATIENTS AND BAD DEBT EXPENSE WITH THE NET PATIENT SERVICE REVENUE FOOTNOTE ON PAGES 12-18 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. |
| SCHEDULE H, PART VI, LINE 2 | IN ADDITION TO CONDUCTING A CHNA EVERY 3 YEARS, THE HOSPITAL SEEKS INPUT FROM MEMBERS OF THE COMMUNITY, MEDICAL AND NURSING STAFF AND COMMUNITY HEALTH LEADERS THROUGHOUT THE YEAR. |
| SCHEDULE H, PART VI, LINE 3 | THE FAP, APPLICATION AND SUMMARY ARE POSTED ON THE ORGANIZATION'S WEBSITE. SIGNAGE THROUGHOUT THE HOSPITAL PROVIDES NOTICE OF THE FAP AND PATIENTS ARE INFORMED OF FINANCIAL ASSISTANCE PRIOR TO DISCHARGE. THE APPLICATION, FAP AND PLAIN LANGUAGE SUMMARY ARE AVAILABE UPON REQUEST AT THE HOSPITAL FACILITY'S ADMISSION POINTS. |
| SCHEDULE H, PART VI, LINE 4 | THE HOSPITAL'S SERVICE AREA IS DEFINED AS CALHOUN AND LIBERTY COUNTIES, FLORIDA. THE TOWNS AND CITIES OF BLOUNTSVILLE, BRISTOL, ALTHA, HOSFORD, CLARKVILLE, WEWAHITCHKA AND TELOGIA ARE IN THESE COUNTIES. APPROXIMATLEY 21,600 PEOPLE LIVE IN THESE 2 COUNTIES. THE MEDIAN INCOME OF BOTH COUNTIES IS SUBSTANTIALLY BELOW THE FLORIDA AVERAGE AND APPROXIMATEL 205 OF THE POPULATION IS BELOW THE FEDERAL POVERTY LINE. |
| SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL HAS AN EMERGENCY ROOM OPEN 24/7/365 TO ALL PATIENTS ON A NON- DISCIMINATORY BASIS WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. THE HOSPITAL IS LEAD BY A BOARD OF DIRECTORS COMPRISED ON INDEPENDENT COMMUNITY MEMBERS AND THE MEDICAL STAFF IS OPEN TO PROPERLY CREDENTIALED PHYSICIANS. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS. |
| SCHEDULE H, PART VI | THE HOSPITAL AND ITS SERVICE COMMUNITY WERE SEVERELY IMPACTED BY THE LANDFALL OF HURRICANE MICHAEL, A CATEGORY 5 STORM THAT INFLICTED TREMENDOUS DAMAGE THROUGHT LIBERTY AND CALHOUN COUNTIES AFTER IT CAME ASHORE IN MEXICO BEACH FLORIDA WHICH IS 41 MILES SOUTHWEST OF BLOUNTSTOWN. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERESA EDENFIELD | PersonNm |
| Title | NURSE PRACTITIONER | TitleTxt |
| Base Compensation Filing Org | $118,697 | BaseCompensationFilingOrgAmt |
| Bonus Filing Organization | $57,129 | BonusFilingOrganizationAmount |
| Nontaxable Benefits Filing Org | $5,804 | NontaxableBenefitsFilingOrgAmt |
| Total Compensation Filing Org | $181,630 | TotalCompensationFilingOrgAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 3 | THE POSITIONS OF HOSPITAL ADMINISTRATOR (AS WELL AS CERTAIN OTHER DUTIES) HAVE BEEN CONTRACTED TO AN UNRELATED MANAGEMENT COMPANY THAT COMPENSATES THOSE POSITIONS DIRECTLY. THE HOSPITAL PAYS A FEE TO THE MANAGEMENT COMPANY FOR THESE SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | AN INDEPEDENT CPA PREPARES THE RETURN FROM INFORMATION OBTAINED DURING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FROM MANAGEMENT. THE RETURN IS REVIEWED BY MANAGEMENT AND A COPY IS PROVIDED TO MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS AND THE OTHER INFORMATION ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES 1,877,866 0 0 PHYSICIAN FEES 10,800 0 0 PURCHASED SERVICES 1,125,424 792,461 0 COLLECTION FEES 0 3,775 0 TOTAL 3,014,090 796,236 0 |