CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC (EIN 59-3051173)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-14
- IRS object ID
- 202133189349300728
- Schema version
- 2020v4.1
- 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 | 2021-11-14T15:09:15-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 474875084 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWRP and Associates PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 850 | AddressLine1Txt |
| City | Braselton | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30517 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | 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 ASSOC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CALH | BusinessNameControlTxt |
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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTINIA JEPSEN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8506437881 | PhoneNum |
| Signature | 2021-11-10 | 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 | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tina Wham | PreparerPersonNm |
| PTIN | P01270187 | PTIN |
| Phone | 4043074184 | PhoneNum |
| Preparation | 2021-11-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| OOB Security Verification | 00 | OOBSecurityVerificationCd |
| Authentication Assurance Level | AAL2 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,692,240 | 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 | 180 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $34,469 | PYContributionsGrantsAmt |
| CY Contributions Grants | $113,381 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,996,562 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,536,261 | CYProgramServiceRevenueAmt |
| PY Investment Income | $29,757 | PYInvestmentIncomeAmt |
| CY Investment Income | $42,598 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $9,060,788 | PYTotalRevenueAmt |
| CY Total Revenue | $10,692,240 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,926,972 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,460,784 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,576,477 | PYOtherExpensesAmt |
| CY Other Expenses | $6,291,533 | CYOtherExpensesAmt |
| PY Total Expenses | $10,503,449 | PYTotalExpensesAmt |
| CY Total Expenses | $11,752,317 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,442,661 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,060,077 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,533,840 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,665,461 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,160,045 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,122,428 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,626,205 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,456,967 | 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 | $8,271,674 | ExpenseAmt |
| 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 | $8,271,674 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | 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 | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 180 | 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 |
| 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 | Yes (true) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
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 | PO BOX 419 | AddressLine1Txt |
| City | Blountstown | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32424 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| TERESSA EDENFIELD | |||||||||
| ARNP | 40.00 | 0.00 | Yes (X) | $157,855 | $0 | $0 | |||
| LAURA FORD | |||||||||
| ARNP | 40.00 | 0.00 | Yes (X) | $129,222 | $0 | $0 | |||
| JANNA MATAUTIA | |||||||||
| CNO | 40.00 | 0.00 | Yes (X) | $126,332 | $0 | $0 | |||
| MELBA FAUROT | |||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| TERRY EUBANKS | |||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| MARY SUE NEVES | |||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| LABAN BONTRAGER | |||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| LADDIE WILLIAMS | |||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| MARK PLUMMER | |||||||||
| CHAIRMAN | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JOHN TOMLINSON | |||||||||
| TREASURER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| MARILYN RUSSELL | |||||||||
| SECRETARY | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| TIM REVELL | |||||||||
| VICE-CHAIR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| CHRISTINIA JEPSEN | |||||||||
| CEO | 40.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $413,409 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $107,972 | GovernmentGrantsAmt |
| All Other Contributions | $5,409 | AllOtherContributionsAmt |
| Total Contributions | $113,381 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621990 | $8,116,588 | $8,116,588 |
| OTHER PROGRAM REVENUE | 621990 | $754,416 | $754,416 |
| CARES ACT FUNDING | 621990 | $1,665,257 | $1,665,257 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,536,261 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,598 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,598 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,692,240 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,578,859 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,563,307 | TotalAmt |
| Program Services | $3,232,068 | ProgramServicesAmt |
| Management And General | $1,331,239 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,652 | TotalAmt |
| Program Services | $48,626 | ProgramServicesAmt |
| Management And General | $20,026 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $479,203 | TotalAmt |
| Program Services | $339,419 | ProgramServicesAmt |
| Management And General | $139,784 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,622 | TotalAmt |
| Program Services | $247,637 | ProgramServicesAmt |
| Management And General | $101,985 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,787 | TotalAmt |
| Management And General | $40,787 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,690 | TotalAmt |
| Management And General | $80,690 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,066,849 | TotalAmt |
| Program Services | $2,984,098 | ProgramServicesAmt |
| Management And General | $82,751 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,042 | TotalAmt |
| Management And General | $16,042 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $278,912 | TotalAmt |
| Program Services | $217,633 | ProgramServicesAmt |
| Management And General | $61,279 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,878 | TotalAmt |
| Management And General | $165,878 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,046,251 | $1,046,251 | |
| OTHER DEPARTMENTAL EXPENSES | $1,596,124 | $155,942 | $1,440,182 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,752,317 | TotalAmt |
| Program Services | $8,271,674 | ProgramServicesAmt |
| Management And General | $3,480,643 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,960,619 | BOYAmt |
| EOY | $11,451,714 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,597,947 | BOYAmt |
| EOY | $847,538 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,786 | BOYAmt |
| EOY | $243,122 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,337 | BOYAmt |
| EOY | $101,957 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,693,200 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,863,558 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $679,751 | BOYAmt |
| EOY | $829,642 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,400 | BOYAmt |
| EOY | $191,488 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,533,840 | BOYAmt |
| EOY | $13,665,461 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,770,820 | BOYAmt |
| EOY | $5,480,756 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $791,214 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,389,225 | BOYAmt |
| EOY | $8,850,458 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,160,045 | BOYAmt |
| EOY | $15,122,428 | 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) |
|---|---|---|
| EOY | $99,010 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,626,205 | BOYAmt |
| EOY | -$1,555,977 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,626,205 | BOYAmt |
| EOY | -$1,456,967 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,533,840 | BOYAmt |
| EOY | $13,665,461 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,060,077 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $1,229,315 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $24,000 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $24,000 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Activities to influence legislation (Part II-B, lines 1a - 1h) | FormAndLineReferenceDesc |
| Explanation | The Hospital used the services of Capital Solutions, LLC to engage in lobbying activities on critical healthcare issues and concerns in the State of Florida. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $236,156 | InvestmentCostOrOtherBasisAmt |
| Book Value | $236,156 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,705,916 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,620,248 | DepreciationAmt |
| Book Value | $85,668 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $4,714,677 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $4,243,310 | DepreciationAmt |
| Book Value | $471,367 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $36,451 | InvestmentCostOrOtherBasisAmt |
| Book Value | $36,451 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $829,642 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Other receivables | Desc |
| Book Value | $191,488 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $191,488 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $10,692,240 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $10,692,240 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $10,692,240 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,752,317 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $11,752,317 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $11,752,317 | TotalExpensesPerForm990Amt |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $202,190 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $202,190 | NetCommunityBenefitExpnsAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,242,959 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,810,484 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $432,475 | NetCommunityBenefitExpnsAmt |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,477,658 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $577,685 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,899,973 | NetCommunityBenefitExpnsAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,922,807 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,388,169 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,534,638 | NetCommunityBenefitExpnsAmt |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,922,807 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,388,169 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,534,638 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,776,847 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,196,976 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,740,649 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $456,327 | 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 HOSPITAL | 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) |
|---|---|---|
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN-LIBERTY HOSPITAL | 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 |
| 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 |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | 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 | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.calhounlibertyhospital.com | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| 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 | 200.00 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.00 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (true) | 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 | WWW.CALHOUNLIBERTYH | FAPAvailableOnWebsiteURLTxt |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Facility Group 1 Part V line 5 | THE CHNA PROCESS WAS FACILITATED BY THE HOSPITAL AND PRESENTED TO AND REVIEWED BY THE CALHOUN LIBERTY HOSPITAL ASSOCIATION BOARD OF DIRECTORS. THE RESULTS OF THE ASSESSMENT WERE SHARED WITH, AND COMMENTS WERE SOLICTED FROM, THE LOCAL COMMUNITY STEERING COMMITTEE MEMBERS FROM CALHOUN AND LIBERTY COUNTIES. |
| Facility Group 1 Part V line 11 | BEHAVIORAL HEALTH, INCLUDING MENTAL HEALTH & SUBSTANCE ABUSE, CAN NOT BE SERVED DUE TO THE LACK OF FUNDS, BUT THE HOSPITAL DOES WORK CLOSELY WITH FACILITIES THAT PROVIDE THESE SERVICES.ADDITIONALY, THE COMMUNITY IS CLASSIFIED AS A FOOD DESERT SINCE THERE IN ONLY ONE GROCERY STORE IN EACH COMMUNITY. THE HOSPITAL DOES NOT HAVE AN AVAILABLE COLD CONTAINER TO HOUSE PERISHABLE ITEMS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| CALHOUN-LIBERTY PRIMARY CARE | ||||
| 20370 NE BURNS AVE | Blountstown | FL | 32424 | RURAL HEALTH CLINIC |
| CALHOUN AMBULANCE SERVICE | ||||
| 20370 NE BURNS AVE | Blountstown | FL | 32424 | EMS SERVICES |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 01. Costing methodology explanation (Part I, line 7) | THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 7 IS THE COST TO CHARGE RATIO CALCULATED PURSUANT TO THE IRS SCHEDULE H WORKSHEET 2 INSTRUCTIONS. THE COST OF UNREIMBURSED MEDICAID WAS COMPUTED USING THE COST REPORT. |
| 02. Part III, line 2 | SEE AUDIT REPORT, PAGE 13, FOOTNOTE 2 |
| 03. Bad debt description footnote (Part III, line 4) | SEE AUDIT REPORT, PAGE 13, FOOTNOTE 2 |
| 04. Allowable Medicare costing methodology (Part III, line 8) | THE MEDICARE SHORTFALL/OVERAGE WAS NOT INCLUDED IN THE COMMUNITY BENEFIT COST, AND THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE ORGANIZATIONS MEDICARE COST REPORT. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE ENTIRE COST OF PROVIDING CARE TO MEDICARE PATIENTS CAUSING THE ORGRANIZATION TO USE OTHER SURPLUS FUNDS TO COVER THE SHORTFALL. HOWEVER, THE ORGANIZATION PROVIDES CARE TO MEDICARE PATIENTS REGARDLESS OF THIS SHORTFALL, WHICH RELIEVES THE STATE AND FEDERAL GOVERNMENTS OF THE BURDEN OF PAYING THE FULL COST FOR THE CARE OF MEDICARE BENEFICIARIES. |
| 05. Collection practices (Part III, line 9b) | FOR PATIENTS WHO ARE FINANCIALLY OR MEDICALLY INDIGENT -BASED ON THE PATIENTS HOUSEHOLD INCOME AS DEFINED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES IN THE FEDERAL REGISTER AS THE FEDERAL POVERTY LEVEL - FPL GUIDELINES:A) PATIENTS ARE DEEMED FINANCIALLY INDIGIENT IF THEIR INCOME IS BELOW 200% OF FPL. IF A PATIENT MAKES BETWEEN 200% AND 400% OF THE FPL, THEN THEY MAY ONLY RECEIVE A PARTIAL WRITE-OFF.B) PATIENTS MAY BE DEEMED MEDICALLY INDIGIENT IF THEIR HOUSEHOLD MEDICAL EXPENSES EXCEED 2% OF THE ANNUAL HOUSEHOLD INCOME REGARDLESS OF INCOME LEVEL.FOR ANY PATIENT THAT QUALIFIES UNDER THE ORGANIZATIONS CHARITY CARE POLICY, THE PATIENT ACCOUNT IS WRITTEN OFF AS CHARITY CARE AND THE ORGANIZATION DOES NOT PURSUE ANY COLLECTIONS. |
| 06. Debt expense included (Part I, line 7, col(f)) | THERE IS NO DEBT EXPENSE INCLUDED IN THESE NUMBERS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| 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 | TERESSA EDENFIELD | PersonNm |
| Title | ARNP | TitleTxt |
| Base Compensation Filing Org | $157,855 | BaseCompensationFilingOrgAmt |
| Total Compensation Filing Org | $157,855 | TotalCompensationFilingOrgAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Management duties delegation Part VI line 3 | THE DUTIES OF THE HOSPITAL ADMINISTRATOR, CFO AND OTHER VARIOUS DUTIES HAVE BEEN CONTRACTED TO A MANAGEMENT COMPANY THAT PAYS THOSE POSITIONS DIRECTLY. THE HOSPITAL PAYS A FEE TO THE MANAGEMENT COMPANY FOR THESE SERVICES. |
| Form 990 governing body review Part VI line 11 | THE FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS AND MANAGEMENT FOR REVIEW PRIOR TO FILING. |
| Conflict of interest policy compliance Part VI line 12c | THE ADMINISTRATION, AS WELL AS THE BOARD OF DIRECTORS, HOLD ANNUAL AND PERIODIC COMPLIANCE REVIEWS. |
| Governing documents etc available to public Part VI line 19 | ALL DOCUMENTATION IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Explanation of other changes in net assets or fund balances Part XI line 9 | PRIOR PERIOD ADJUSTMENT TO NET ASSETS FOR EMS OPERATIONS |
| List of other fees for services expenses Part IX line 11g | LABORATORY PHYSICIAN FEES 10800ER PROFESSIONAL FEES 1252899HOSPITALIST PROF FEE 932036RADIOLOGY PROF FEE 4760PHARMACY PROF FEE 58200NURSING PURCHASED SERVICES 20350SWING BED PURCHASED SERVICES 115938ER PURCHASED SERVICES 35148LAB PURCHASED SERVICES 416854BLOOK BANK PURCHASED SERVICES 9845RADIOLOGY PURCHASED SERVICES 32021PHARMACY PURCHASED SERVICES 12080RHC PURCHASED SERVICES 32002AMBULANCE PURCHASED SERVICES 96370OTHER 37546 |