2021-11-14T15:09:15-05:00 2020-12-31 474875084 TWRP and Associates PC PO Box 850 Braselton GA 30517 990 2020-01-01 593051173 CALHOUN LIBERTY HOSPITAL ASSOC INC CALH P O BOX 419 Blountstown FL 32424 CHRISTINIA JEPSEN CEO 8506437881 2021-11-10 true CHRISTINIA JEPSEN XXX-XX-XXXX Tina Wham P01270187 4043074184 2021-11-14 0 00 AAL2 IAL1 2020 2022-09-23 18:48:47Z 10692240 false X www.calhounlibertyhospital.com X 1991 FL TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. 9 9 180 0 0 34469 113381 8996562 10536261 29757 42598 0 9060788 10692240 0 0 5926972 5460784 0 0 4576477 6291533 10503449 11752317 -1442661 -1060077 8533840 13665461 10160045 15122428 -1626205 -1456967 TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. false false 8271674 TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY THROUGH INPATIENT CARE, OUTPATIENT CARE, EMERGENCY ROOM CARE AND OTHER RELATED SERVICES. 8271674 true false false true false false false false false true false false false false false true true false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 35 0 true 180 true false false false false false false false false X 9 9 false true false false false false false true true false false true true false true true true false false false X BRENDA POTTER 8506745411 PO BOX 419 Blountstown FL 32424 X TERESSA EDENFIELD ARNP 40.00 0.00 X 157855 0 0 LAURA FORD ARNP 40.00 0.00 X 129222 0 0 JANNA MATAUTIA CNO 40.00 0.00 X 126332 0 0 MELBA FAUROT DIRECTOR 1.00 0.00 X 0 0 0 TERRY EUBANKS DIRECTOR 1.00 0.00 X 0 0 0 MARY SUE NEVES DIRECTOR 1.00 0.00 X 0 0 0 LABAN BONTRAGER DIRECTOR 1.00 0.00 X 0 0 0 LADDIE WILLIAMS DIRECTOR 1.00 0.00 X 0 0 0 MARK PLUMMER CHAIRMAN 1.00 0.00 X X 0 0 0 JOHN TOMLINSON TREASURER 1.00 0.00 X X 0 0 0 MARILYN RUSSELL SECRETARY 1.00 0.00 X X 0 0 0 TIM REVELL VICE-CHAIR 1.00 0.00 X X 0 0 0 CHRISTINIA JEPSEN CEO 40.00 0.00 X 0 0 0 413409 0 0 3 false true false 107972 5409 113381 PATIENT REVENUE 621990 8116588 8116588 OTHER PROGRAM REVENUE 621990 754416 754416 CARES ACT FUNDING 621990 1665257 1665257 10536261 42598 42598 10692240 10578859 0 0 X 4563307 3232068 1331239 68652 48626 20026 479203 339419 139784 349622 247637 101985 40787 40787 80690 80690 3066849 2984098 82751 16042 16042 278912 217633 61279 165878 165878 MEDICAL SUPPLIES 1046251 1046251 OTHER DEPARTMENTAL EXPENSES 1596124 155942 1440182 11752317 8271674 3480643 0 5960619 11451714 1597947 847538 118786 243122 55337 101957 6693200 5863558 679751 829642 121400 191488 8533840 13665461 2770820 5480756 791214 7389225 8850458 10160045 15122428 X 99010 -1626205 -1555977 -1626205 -1456967 8533840 13665461 -1060077 1229315 0 X false true X false false X false false false false false false false false true 24000 24000 false Activities to influence legislation (Part II-B, lines 1a - 1h) 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. 236156 236156 1705916 1620248 85668 4714677 4243310 471367 36451 36451 829642 Other receivables 191488 191488 10692240 10692240 10692240 11752317 11752317 11752317 true true X true X true X true true true false false 202190 202190 2242959 1810484 432475 2477658 577685 1899973 4922807 2388169 2534638 4922807 2388169 2534638 true 5776847 3196976 2740649 456327 X true true 1 1 CALHOUN-LIBERTY HOSPITAL 20370 NE BURNS AVE Blountstown FL 32424 X 1 CALHOUN-LIBERTY HOSPITAL 1 false false true X X X X X X X 18 true false false true X WWW.CALHOUNLIBERTYHOSPITAL.COM X true 18 true www.calhounlibertyhospital.com false false true X 200.00 250.00 X X X true true X X X true X WWW.CALHOUNLIBERTYH X true X false true false false 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. 2 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 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. X true X false false false false false false false false false TERESSA EDENFIELD ARNP 157855 157855 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