CARROLL COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- CARROLL COUNTY MEMORIAL HOSPITAL (EIN 44-0629397)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-13
- IRS object ID
- 202101339349304875
- Schema version
- 2019v5.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-05-13T16:18:43-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440629397 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARR | BusinessNameControlTxt |
| Phone | 6605421695 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON STREET | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF TINDLE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6605421695 | PhoneNum |
| Signature | 2021-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF TINDLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON STREET | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,967,883 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CARROLLCOUNTYHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1957 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 264 | TotalEmployeeCnt |
| Total Volunteers | 28 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,562,677 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,542,859 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,966,427 | CYProgramServiceRevenueAmt |
| PY Investment Income | $270,500 | PYInvestmentIncomeAmt |
| CY Investment Income | $179,057 | CYInvestmentIncomeAmt |
| PY Other Revenue | $409,325 | PYOtherRevenueAmt |
| CY Other Revenue | $214,944 | CYOtherRevenueAmt |
| PY Total Revenue | $31,222,684 | PYTotalRevenueAmt |
| CY Total Revenue | $36,923,105 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,028 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,705 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,700,285 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,201,348 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,577,691 | PYOtherExpensesAmt |
| CY Other Expenses | $18,420,179 | CYOtherExpensesAmt |
| PY Total Expenses | $32,281,004 | PYTotalExpensesAmt |
| CY Total Expenses | $33,623,232 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,058,320 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,299,873 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,922,388 | TotalAssetsBOYAmt |
| Total Assets EOY | $47,527,402 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,610,872 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,747,114 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,311,516 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,780,288 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,825,938 | ExpenseAmt |
| Grant | $1,705 | GrantAmt |
| Revenue | $34,019,833 | RevenueAmt |
| Desc | ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $29,825,938 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 264 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY IRELAND | PersonNm |
| Phone | 6605421695 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 NORTH JEFFERSON ST | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| RICHARD SMITH | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $487,906 | $0 | $32,588 | ||
| ANDREW HORINE | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $415,398 | $0 | $41,530 | ||
| PAMELA RALLS | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $364,714 | $0 | $41,747 | ||
| TIM REID MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $286,645 | $0 | $52,970 | Yes (X) | ||
| GREGORY STAFFORD | ||||||||
| PHYSICIAN'S ASSISTANT | 40.00 | 0.00 | Yes (X) | $260,565 | $0 | $31,200 | ||
| MARVIN ROSS | ||||||||
| PHYSICIAN | 40.00 | 0.00 | Yes (X) | $240,132 | $0 | $19,236 | ||
| RANDALL BARRY | ||||||||
| PRESIDENT | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| REX BUHRMESTER | ||||||||
| VICE PRESIDENT | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JUDITH DELANY | ||||||||
| VICE PRESIDENT THRU 01/20 | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JENNIFER POSTON | ||||||||
| SECRETARY | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| KEN BROWN | ||||||||
| SECRETARY THRU 01/20 | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JODI AHNEFELD | ||||||||
| MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ANNA BARLOW | ||||||||
| MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JIM GIBSON | ||||||||
| MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| SHELLY KUSSMAN | ||||||||
| MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| MATT LOCK | ||||||||
| MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KIM RITCHHART | ||||||||
| MEMBER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| CHARLIE LOCK | ||||||||
| MEMBER THRU 01/20 | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| BEN POLEN | ||||||||
| MEMBER THRU 01/20 | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JEFF TINDLE | ||||||||
| CEO | 39.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| AMY IRELAND | ||||||||
| CHIEF REVENUE OFFICER | 40.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,055,360 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $219,271 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CERNER CORPORATION | |||||
| PO BOX 959159 | ST LOUIS | MO | 63195 | SOFTWARE & CONTRACT EMPLOYEES | $1,983,067 |
| MURRAY BUILDERS | |||||
| 7400 COLLEGE BLVD SUITE 210 | OVERLAND PARK | KS | 66210 | CONSTRUCTION PROJECTS | $692,817 |
| HCA MID AMERICA | |||||
| 5440 W 110TH ST STE 400 | OVERLAND PARK | KS | 66211 | MANAGEMENT SERVICES | $568,659 |
| PSYCHIATRIC MEDICAL CARE | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | MEDICAL SERVICES | $413,935 |
| PREMIER SPECIALTY NETWORK | |||||
| 1835 E REPUBLIC RD SUITE 200 | SPRINGFIELD | MO | 65804 | MEDICAL SERVICES | $383,248 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,562,677 | GovernmentGrantsAmt |
| Total Contributions | $2,562,677 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID | 624100 | $19,894,878 | $19,894,878 |
| NET PATIENT SERVICE REVENUE | 624100 | $12,429,072 | $12,429,072 |
| 340B DRUG PRICING PROGRAM | 624100 | $1,314,494 | $1,314,494 |
| ELECTRONIC HEALTH RECORD INCENTIV | 624100 | $60,399 | $60,399 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $267,584 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $267,584 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,966,427 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $189,123 | TotalRevenueColumnAmt |
| Exclusion | $189,123 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $88,118 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $34,712 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $53,406 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,406 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $53,406 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $10,066 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$10,066 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$10,066 | TotalRevenueColumnAmt |
| Exclusion | -$10,066 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 722514 | BusinessCd |
| Total Revenue Column | $161,538 | TotalRevenueColumnAmt |
| Exclusion | $161,538 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $161,538 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,923,105 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,019,833 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $340,595 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,705 | TotalAmt |
| Program Services | $1,705 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $339,615 | TotalAmt |
| Program Services | $339,615 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,335,487 | TotalAmt |
| Program Services | $10,477,875 | ProgramServicesAmt |
| Management And General | $857,612 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $558,920 | TotalAmt |
| Program Services | $518,368 | ProgramServicesAmt |
| Management And General | $40,552 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,967,326 | TotalAmt |
| Program Services | $2,637,930 | ProgramServicesAmt |
| Management And General | $329,396 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,777 | TotalAmt |
| Management And General | $315,777 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,733,683 | TotalAmt |
| Program Services | $6,771,773 | ProgramServicesAmt |
| Management And General | $961,910 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,990 | TotalAmt |
| Program Services | $27,896 | ProgramServicesAmt |
| Management And General | $25,094 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $747,804 | TotalAmt |
| Program Services | $531,315 | ProgramServicesAmt |
| Management And General | $216,489 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $422,621 | TotalAmt |
| Program Services | $399,866 | ProgramServicesAmt |
| Management And General | $22,755 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $753,118 | TotalAmt |
| Program Services | $617,442 | ProgramServicesAmt |
| Management And General | $135,676 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,972 | TotalAmt |
| Program Services | $103,707 | ProgramServicesAmt |
| Management And General | $17,265 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $682,002 | TotalAmt |
| Program Services | $495,037 | ProgramServicesAmt |
| Management And General | $186,965 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,917,738 | TotalAmt |
| Program Services | $2,394,739 | ProgramServicesAmt |
| Management And General | $522,999 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,053 | TotalAmt |
| Program Services | $91,025 | ProgramServicesAmt |
| Management And General | $16,028 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,770,264 | $2,770,264 | |
| BAD DEBT EXPENSE | $749,697 | $749,697 | |
| 340(B) PHARMACY EXPENSE | $570,192 | $570,192 | |
| FOOD | $236,308 | $234,092 | $2,216 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,960 | TotalAmt |
| Program Services | $93,400 | ProgramServicesAmt |
| Management And General | $146,560 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,623,232 | TotalAmt |
| Program Services | $29,825,938 | ProgramServicesAmt |
| Management And General | $3,797,294 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $772 | BOYAmt |
| EOY | $822 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,188,656 | BOYAmt |
| EOY | $16,954,165 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,775,216 | BOYAmt |
| EOY | $2,933,252 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,227 | BOYAmt |
| EOY | $915,034 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $431,282 | BOYAmt |
| EOY | $441,618 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,696,909 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,237,583 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,825,549 | BOYAmt |
| EOY | $20,459,326 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $859,184 | BOYAmt |
| EOY | $874,193 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,131,086 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,382,502 | BOYAmt |
| EOY | $3,817,906 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,922,388 | BOYAmt |
| EOY | $47,527,402 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,880,393 | BOYAmt |
| EOY | $2,986,368 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,215 | BOYAmt |
| EOY | $4,121 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,683,264 | BOYAmt |
| EOY | $13,632,715 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,067,449 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,000 | BOYAmt |
| EOY | $2,056,461 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,610,872 | BOYAmt |
| EOY | $21,747,114 | 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 | $21,960,883 | BOYAmt |
| EOY | $25,296,577 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $350,633 | BOYAmt |
| EOY | $483,711 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,311,516 | BOYAmt |
| EOY | $25,780,288 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,922,388 | BOYAmt |
| EOY | $47,527,402 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,299,873 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $35,821 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $133,078 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $14,781 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $14,781 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $268,115 | OtherCostOrOtherBasisAmt |
| Book Value | $268,115 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,770,239 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,926,521 | DepreciationAmt |
| Book Value | $15,843,718 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,615,769 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,348,579 | DepreciationAmt |
| Book Value | $3,267,190 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,042,786 | OtherCostOrOtherBasisAmt |
| Depreciation | $962,483 | DepreciationAmt |
| Book Value | $1,080,303 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,459,326 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BENEFICIAL INTEREST IN FOUNDATION | $433,711 |
| OTHER ACCOUNTS RECEIVABLE | $345,063 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $1,974,418 |
| DUE FROM FOUNDATION | $50,000 |
| ACCRUED INTEREST RECEIVABLE | $28,685 |
| PATIENT CUSTOMER CONTRACTS | $986,029 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,817,906 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| RENTAL DEPOSITS | $16,850 |
| REFUNDABLE ADVANCE - COVID-19 RELIEF FUND LIABILITY | $2,039,611 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,056,461 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $36,377,019 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $35,821 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $167,790 | OtherRevenueAmt |
| Revenue Not Reported | $203,611 | RevenueNotReportedAmt |
| Revenue Subtotal | $36,173,408 | RevenueSubtotalAmt |
| Other Revenues Not Included | $749,697 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $749,697 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $36,923,105 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,908,247 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $34,712 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $34,712 | ExpensesNotReportedAmt |
| Expenses Subtotal | $32,873,535 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $749,697 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $749,697 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $33,623,232 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. 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. AT JUNE 30, 2020 THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 133,078. RENTAL EXPENSES 34,712. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 749,697. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 34,712. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 749,697. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $243,925 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $243,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00740 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,796,851 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,231,711 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $565,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01720 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,040,776 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,231,711 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $809,065 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02460 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,139 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,139 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $597,446 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $597,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01820 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,698 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,698 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $655,283 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $655,283 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02000 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,696,059 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,231,711 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,464,348 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04460 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $749,697 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,337,189 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,552,942 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,215,753 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 NORTH JEFFERSON ST | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 210-58 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PHYSICIAN CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY | 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11: CARROLL COUNTY HAS AN IMPLEMENTATION PLAN THAT WE FOLLOW TO MEET THE NEEDS IDENTIFIED IN THE CHNA. THREE PRIORITY AREAS OF SIGNIFICANT NEED WERE IDENTIFIED: MENTAL HEALTH (YOUTH AND ADULT), LIFESTYLE BEHAVIORS, AND ACCESS TO CARE. EACH OF THESE WERE ADDRESSED IN THE IMPLEMENTATION STRATEGY.IT SHOULD BE NOTED THAT IN ANY CASE OF PRIORITIZATION, THERE WOULD ALSO BE SOME AREAS OF NEEDS THAT ARE IDENTIFIED BUT NOT CHOSEN AS A PRIORITY. IF THE OPPORTUNITY ARISES, WE WILL TRY TO INTEGRATE OTHER AREAS OF NEED INTO THE PLAN. INSTEAD OF DIRECTLY ADDRESSING INDIVIDUAL CHRONIC HEALTH CONDITIONS SUCH AS CANCER, HEART DISEASE, AND OBESITY; THE DECISION WAS MADE TO ADDRESS HEALTHY LIFESTYLE BEHAVIORS. RESEARCH HAS SUGGESTED THAT MODIFICATION OF LIFESTYLE BEHAVIORS CAN IMPACT CHRONIC HEALTH CONDITIONS. INCREASED AWARENESS OF THE BENEFIT OF HEALTHY LIFESTYLES TO PREVENT CHRONIC DISEASES IS AN AREA FOR CONTINUED EMPHASIS. ANOTHER CRITICAL AREA RELATED TO CHRONIC HEALTH CONDITIONS IS ASSISTING INDIVIDUALS WITH CHRONIC HEALTH ISSUES LEARN TO MANAGE THEIR CONDITION AND MAINTAIN OPTIMUM HEALTH. IDEALLY, BETTER MANAGEMENT DECREASES HOSPITALIZATIONS AND EMERGENCY ROOM VISITS DUE TO CHRONIC HEALTH CONDITIONS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - JEFFERSON MEDICAL GROUP | ||||
| 1502 N JEFFERSON | CARROLLTON | MO | 64633 | HOME HEALTH AGENCY |
| 2 - JEFFERSON MEDICAL GROUP - NORBORNE | ||||
| 105 EAST 2ND STREET | NORBONNE | MO | 64668 | RURAL HEALTH CLINIC |
| 3 - JEFFERSON MEDICAL GROUP - HALE | ||||
| 321 ELM STREET | HALE | MO | 64643 | RURAL HEALTH CLINIC |
| 4 - CCMH HOME HEALTH | ||||
| 1502 N JEFFERSON | CARROLLTON | MO | 64633 | HOME HEALTH AGENCY |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | DISCOUNTED OR FREE CARE IS BASED OFF OF 200% OF FEDERAL POVERTY GUIDELINES. ALSO, IN CATASTROPHIC MEDICAL CASES WHERE THE PATIENTS MEDICAL BILLS EXCEED 20% OF THEIR GROSS INCOME, PLUS ASSETS FOR THE YEAR. |
| 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 I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $749,697. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE ORGANIZATION DOES NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES. |
| PART III, LINE 2: | PATIENT ACCOUNTS MEETING THE REQUIREMENTS TO QUALIFY FOR BAD DEBT ARE WRITTEN OFF TO BAD DEBT AND SENT TO A THIRD PARTY COLLECTION AGENCY. THE AMOUNT OF BAD DEBT IS ROUTED TO A SPECIFIC GL ACCOUNT. DISCOUNTS AND PATIENT PAYMENTS APPLIED TO ACCOUNTS IN BAD DEBT ARE RECORDED THROUGH BAD DEBT ADJUSTMENTS IN ORDER TO RECONCILE THE BAD DEBT AMOUNT ACCORDINGLY. |
| PART III, LINE 3: | THE AMOUNT OF BAD DEBT 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 BAD DEBT, THIS PERCENTAGE IS THEN MULTIPLIED BY SELF-PAY PATIENTS (PRIM HEALTH PLAN). THE TWO ESTIMATES ARE THEN COMBINED. |
| PART III, LINE 4: | THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10, 11 AND 12 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: | CARROLL COUNTY MEMORIAL HOSPITAL PROVIDES EACH PATIENT WITH A LETTER THAN CLEARLY STATES PAYMENT INFORMATION IN AN EASY-TO-UNDERSTAND LANGUAGE. THE HOSPITAL INFORMS PATIENTS PROMPTLY ABOUT THE CHARGE FOR ANY ITEM OF SERVICE PROVIDED. THE LETTER INFORMS THE PATIENTS THAT IF THEY ARE NOT ABLE TO PAY THEIR HOSPITAL BILL THERE ARE PROGRAMS THAT MAY HELP ALLEVIATE THE BURDEN. IF THE HOSPITAL IS PROMPTED IT WILL CHECK FOR PUBLIC-ASSISTANCE OR CHARITY CARE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. |
| 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 HALE AND NORBORNE. CARROLL COUNTY HAS A POPULATION OF APPROXIMATELY 8,909 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: | IN 2014, CCMH REACHED A MANAGEMENT AGREEMENT WITH HCA MIDWEST HEALTH SYSTEM. THIS STRATEGIC PARTNERSHIP MEANS CCMH - THE COMMUNITY'S PREMIER HEALTHCARE PROVIDER - WILL HAVE GREATER ACCESS TO RESOURCES, ADVANCED TECHNOLOGY AND SERVICES THAT MIGHT NOT OTHERWISE BE AVAILABLE. PATIENTS AND THEIR FAMILIES WHO ENTRUST CARE TO US WILL BENEFIT FROM BEST PRACTICES, POLICIES AND PROCEDURES, TOOLKITS, PROTOCOLS, TRAINING AND MORE. MOST IMPORTANTLY, THIS AGREEMENT WITH HCA MIDWEST HEALTH SYSTEM ALIGNS WITH CCMH'S COMMITMENT TO PROVIDE HIGH-QUALITY, COMPASSIONATE AND INNOVATIVE CARE TO THE COMMUNITY.AS THE REGION'S LEADING HEALTHCARE PROVIDER, HCAM MIDWEST HEALTH SYSTEM IS COMMITTEE TO THE COMMUNITIES IT SERVES. IT HAS SIX ACUTE CARE HOSPITALS, ONE PSYCHIATRIC HOSPITAL, FOUR CRITICAL ACCESS HOSPITALS (INCLUDING CCMH), SIX SURGERY CENTERS, 10 URGENT CARE LOCATIONS, MORE THAN 30 PRIMARY CARE LOCATIONS, 2,100 PHYSICIANS AND HEALTHCARE PROVIDERS AND 9,000 SUPPORTING TEAM MEMBERS.IN ADDITION TO SOLIDIFYING CCMH'S LONGSTANDING MISSION, VISION AND CORE VALUES OF BEING A TRUSTED COMMUNITY HEALTHCARE PARTNER, THE HCA AGREEMENT MEANS:- STAFF REMAINS CCMH EMPLOYEES- PATIENTS WILL HAVE ACCESS TO THEIR SAME CCMH PHYSICIANS- OPPORTUNITY TO BRING SPECIALTY PHYSICIANS TO THE COMMUNITY THROUGH ONSIDE CLINICS AND TELEMEDICINE SO EMPLOYEES AND PATIENTS HAVE INCREASED ACCESS TO MORE CARE OPTIONS WITHOUT LEAVING THE COMMUNITY.- IF A PATIENT DOES REQUIRE HIGHER-LEVEL CARE, TRANSFER TO AN HCA FACILITY WILL BE SEAMLESS WITH THE GOAL TO RETURN THE PATIENT BACK TO THE COMMUNITY HOSPITAL AS SOON AS POSSIBLE FOR POST-ACUTE AND FOLLOW-UP CARE. - THE CCMH HOSPITAL BOARD WILL REMAIN IN COMPLETE CONTROL OF LEADERSHIP AND MANAGEMENT DECISIONS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MO |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD SMITH | ||||||||||||||
| PHYSICIAN | $411,644 | $0 | $76,262 | $0 | $0 | $0 | $22,400 | $0 | $10,188 | $0 | $520,494 | $0 | $0 | $0 |
| ANDREW HORINE | ||||||||||||||
| PHYSICIAN | $369,988 | $0 | $45,410 | $0 | $0 | $0 | $22,400 | $0 | $19,130 | $0 | $456,928 | $0 | $0 | $0 |
| PAMELA RALLS | ||||||||||||||
| PHYSICIAN | $327,238 | $0 | $37,476 | $0 | $0 | $0 | $22,400 | $0 | $19,347 | $0 | $406,461 | $0 | $0 | $0 |
| TIM REID MD | ||||||||||||||
| PHYSICIAN | $240,106 | $0 | $46,539 | $0 | $0 | $0 | $22,401 | $0 | $30,569 | $0 | $339,615 | $0 | $0 | $0 |
| GREGORY STAFFORD | ||||||||||||||
| PHYSICIAN'S ASSISTANT | $237,618 | $0 | $22,947 | $0 | $0 | $0 | $21,012 | $0 | $10,188 | $0 | $291,765 | $0 | $0 | $0 |
| MARVIN ROSS | ||||||||||||||
| PHYSICIAN | $207,692 | $0 | $32,440 | $0 | $0 | $0 | $19,211 | $0 | $25 | $0 | $259,368 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | COUNTRY CLUB MEMBERSHIP DUES ARE PAID FOR JEFFREY TINDLE. THE MEMBERSHIPS WERE USED ONLY FOR BUSINESS PURPOSES. THEREFORE, THE AMOUNT OF DUES WAS NOT INCLUDED IN HIS W-2. |
| PART I, LINE 5 | A PORTION OF PHYSICIAN COMPENSATION WAS CALCULATED QUARTERLY USING A PERCENTAGE OF REIMBURSEMENT. |
| SCHEDULE J, PART II: | JEFF TINDLE, CEO, WAS PAID BY AN UNRELATED ORGANIZATION, HCA MANAGEMENT SERV, LP. HCA MANAGEMENT SERV, LP HAS A MANAGEMENT AGREEMENT WITH CARROLL COUNTY MEMORIAL HOSPITAL. CARROLL COUNTY MEMORIAL HOSPITAL PAYS HCA MANAGEMENT SERV, LP FOR THE COMPENSATION OF THE CEO/ADMINISTRATOR. THE AMOUNT OF COMPENSATION PAID BY HCA MANAGEMENT SERV, LP TO JEFF TINDLE FOR HIS SERVICES AS CEO TO CARROLL COUNTY MEMORIAL HOSPITAL WAS $282,740. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | HOSPITAL CORPORATION OF AMERICA (HCA), AN UNRELATED ORGANIZATION, SUPPLIES THE CEO AS PART OF A MANAGEMENT AGREEMENT. ALL COMPONENTS OF THAT COMPENSATION ARE REIMBURSED BY CARROLL COUNTY MEMORIAL HOSPITAL TO HCA. |
| 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, WITH PARTICIPATION FROM HCA. HCA PROVIDES SALARY RECOMMENDATIONS. THE BOARD APPROVES THE AMOUNT OF COMPENSATION. THE LAST REVIEW WAS CONDUCTED IN 2019. 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 1,401,404. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,401,404. MEDICAID ADMINISTRATION: PROGRAM SERVICE EXPENSES 1,051,435. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,051,435. OTHER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 4,318,934. MANAGEMENT AND GENERAL EXPENSES 961,910. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,280,844. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 133,078. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL FDN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON ST | AddressLine1Txt |
| City | CARROLLTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64633 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 463696048 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |