CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC (EIN 59-3051173)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-08-16
- IRS object ID
- 201812289349300416
- Schema version
- 2017v2.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-16T10:47:32-04:00 | ReturnTs |
| Tax Period End | 2017-12-31 | 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 3534 | AddressLine1Txt |
| City | Loganville | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30052 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | 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 | MARK PLUMMER | PersonNm |
| Person Title | BOARD CHAIRMAN | PersonTitleTxt |
| Phone | 8506437881 | PhoneNum |
| Signature | 2018-04-24 | SignatureDt |
| Discuss With Paid Preparer | false | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tina Wham | PreparerPersonNm |
| PTIN | P01270187 | PTIN |
| Phone | 4043074184 | PhoneNum |
| Preparation | 2018-08-16 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,327,972 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | 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 | 246 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $41,827 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,598,732 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,416,157 | CYProgramServiceRevenueAmt |
| PY Investment Income | $704 | PYInvestmentIncomeAmt |
| CY Investment Income | -$88,185 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $11,641,263 | PYTotalRevenueAmt |
| CY Total Revenue | $12,327,972 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,051,292 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,919,224 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,815,171 | PYOtherExpensesAmt |
| CY Other Expenses | $5,068,832 | CYOtherExpensesAmt |
| PY Total Expenses | $11,866,463 | PYTotalExpensesAmt |
| CY Total Expenses | $12,988,056 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$225,200 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$660,084 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,887,706 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,042,038 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,735,858 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,669,858 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,151,848 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,372,180 | 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 | $12,988,056 | 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 | $12,988,056 | 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 |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| 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 | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 | 32 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 246 | 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 |
| 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 | BRUCE DAVIS | 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 (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LABAN BONTRAGER | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARILYN RUSSELL | ||||||||
| SECRETARY | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JOHN TOMLINSON | ||||||||
| TREASURER | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LADDIE WILLIAMS | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TIM REVELL | ||||||||
| VICE CHAIR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TERRY EUBANKS | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK PLUMMER | ||||||||
| CHAIR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARY NEVES | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MELBA FAUROT | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GARRETT CHUMNEY | ||||||||
| MEDICAL DIRECTOR ER PHYSICIA | 40.00 | 0.00 | $440,202 | $0 | $0 | Yes (X) | ||
| STANLEY WHITTAKER | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $251,152 | $0 | $0 | Yes (X) | ||
| MISBAH FAROOQI | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $223,797 | $0 | $0 | Yes (X) | ||
| RONALD WATSON | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $219,142 | $0 | $0 | Yes (X) | ||
| TERESSA EDENFIELD | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $135,134 | $0 | $0 | Yes (X) | ||
| LAURA FORD | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $104,058 | $0 | $0 | Yes (X) | ||
| MARY MOORE | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $140,935 | $0 | $0 | Yes (X) | ||
| MARY WATSON | ||||||||
| PHYSICIAN | 0.00 | 0.00 | $165,482 | $0 | $0 | Yes (X) | ||
| ROBERT DOBSON | ||||||||
| ARNP | 40.00 | 0.00 | $124,133 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,804,035 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621990 | $11,370,430 | $11,370,430 |
| OTHER PROGRAM REVENUE | 621990 | $1,045,727 | $1,045,727 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,416,157 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,826 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,826 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$91,011 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$91,011 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$91,011 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$91,011 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,327,972 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,327,972 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,792,761 | TotalAmt |
| Program Services | $6,792,761 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,625 | TotalAmt |
| Program Services | $73,625 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,204 | TotalAmt |
| Program Services | $573,204 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $479,634 | TotalAmt |
| Program Services | $479,634 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,483 | TotalAmt |
| Program Services | $63,483 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,668 | TotalAmt |
| Program Services | $84,668 | ProgramServicesAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,000 | TotalAmt |
| Program Services | $8,000 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,233 | TotalAmt |
| Program Services | $186,233 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,680 | TotalAmt |
| Program Services | $81,680 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,835 | TotalAmt |
| Program Services | $405,835 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,612 | TotalAmt |
| Program Services | $129,612 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $1,146,941 | $1,146,941 |
| OTHER DEPARTMENTAL EXPENSES | $2,962,380 | $2,962,380 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,988,056 | TotalAmt |
| Program Services | $12,988,056 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $297,940 | BOYAmt |
| EOY | $900,539 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,508,385 | BOYAmt |
| EOY | $2,782,097 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,354 | BOYAmt |
| EOY | $125,098 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,804 | BOYAmt |
| EOY | $35,833 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,104,748 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,906,277 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,710,535 | BOYAmt |
| EOY | $1,198,471 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $228,688 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,887,706 | BOYAmt |
| EOY | $5,042,038 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,108,454 | BOYAmt |
| EOY | $1,735,729 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,627,404 | BOYAmt |
| EOY | $1,934,129 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,735,858 | BOYAmt |
| EOY | $3,669,858 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,151,848 | BOYAmt |
| EOY | $1,372,180 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,151,848 | BOYAmt |
| EOY | $1,372,180 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,887,706 | BOYAmt |
| EOY | $5,042,038 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$660,084 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$119,584 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | $8,000 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,000 | 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 | CALHOUN-LIBERTY 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 | $61,156 | InvestmentCostOrOtherBasisAmt |
| Book Value | $61,156 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,566,552 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,422,972 | DepreciationAmt |
| Book Value | $143,580 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $4,477,040 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $3,483,305 | DepreciationAmt |
| Book Value | $993,735 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,198,471 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Other receivables | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Rev Etc Audited Fincl Stmt | $11,272,058 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $11,272,058 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,055,914 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,055,914 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,327,972 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,047,032 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $12,047,032 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $941,024 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $941,024 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,988,056 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Other revenues included on Form 990 (Part XI, line 4b) | EMS OPERATIONS |
| Other expenses included on Form 990 (Part XII, line 4b) | EMS OPERATIONS |
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 | $276,278 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $276,278 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02130 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,076,064 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,718,661 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $357,403 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02750 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,193,606 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $368,668 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $824,938 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06350 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,545,948 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,087,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,458,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11230 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,545,948 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,087,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,458,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11230 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,686,679 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,447,847 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,194,915 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $252,932 | 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 | false | CHNAConductedInd |
| 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 |
| 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 BURNES AVE | Blountstown | FL | 32424 | RURAL HEALTH CLINIC |
| CALHOUN AMBULANCE SERVICE | ||||
| 20370 NE BURNES 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 MEHODOLOGY 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. Debt expense included (Part I, line 7, col(f)) | BAD DEBT EXPENSE IN THE AMOUNT OF $3686679 WAS SUBTRACTED FROM TOTAL EXPENSE PER FORM 990, PART IX, LINE 25 FOR PURPOSES OF CALCULATING THE PERCENTAGE FOR LINE 7, COLUMN F |
| 03. Part III, line 2 | THE PROVISION FOR BAD DEBT IS BASED UPON MANAGEMENTS ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. |
| 04. Bad debt description footnote (Part III, line 4) | PROVISION FOR BAD DEBTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS, PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENT |
| 05. Allowable Medicare costing methodology (Part III, line 8) | THE MEDICARE SHORTFALL 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 ORGANIZATION 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 GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR THE CARE OF MEDICARE BENEFICIARIES. |
| 06. Collection practices (Part III, line 9b) | FOR PATIENTS WHO ARE FINANCIALLY OR MEDICALLY INDIGENT (BASED UPON THE PATIENTS HOUSEHOLD INCOME AS DEFINED ANNUALLY BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES IN THE FEDERAL REGISTER AS THE FEDERAL POVERTY LEVEL):A) PATIENTS ARE DEEMED FINANCIALLY INDIGENT IF THEIR INCOME IS BELOW 200% OF FPL. IF A PATIENT MAKES BETWEEN 200% AND 400% OF THE FPL, THEN THEY MY ONLY RECEIVE A PARTIAL WRITE-OFF.B) PATIENTS MAY BE DEEMED MEDICALLY INDIGENT IF THEIR HOUSEHOLD MEDICAL EXPENSES EXCEED 25% 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| GARRETT CHUMNEY DR | ||
| MEDICAL DIRECTOR ER PHYSICIAN | $440,202 | $440,202 |
| STANLEY WHITTAKER | ||
| NURSE PRACTITIONER | $251,152 | $251,152 |
| MISBAH FAROOQI | ||
| PHYSICIAN | $223,797 | $223,797 |
| RONALD WATSON | ||
| NURSE PRACTITIONER | $219,142 | $219,142 |
| MARY WATSON | ||
| PHYSICIAN | $165,482 | $165,482 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 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 |