CLH QALICB INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- CLH QALICB INC (EIN 99-1590843)
- Tax period
- 2024-02-06 to 2024-12-31
- Filed
- 2025-11-14
- IRS object ID
- 202543189349310479
- Schema version
- 2024v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-11-14T15:07:51-05:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 580914992 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317081309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-02-06 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 991590843 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLH QALICB INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLHQ | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20370 NE BURNS AVENUE | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32424 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | EMILY BROWN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2025-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | false | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WILLIAM EDWARD PHILLIPS | PreparerPersonNm |
| PTIN | P00451499 | PTIN |
| Phone | 2298837878 | PhoneNum |
| Preparation | 2025-11-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Initial Return | Yes (X) | InitialReturnInd |
| Principal Officer | EMILY BROWN | PrincipalOfficerNm |
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) |
|---|---|---|
| Gross Receipts | $34,787 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2024 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANZATION'S TAX-EXEMPT PURPOSE IS TO TO OPERATE AND SUPPORT CALHOUN LIBERTY HOSPITAL ASSOCIATION, INC. BY FACILITATING THE CONSTRUCTION OF A NEW HOSPITAL BUILDING SERVING THE RESIDENTS OF CALHOUN COUNTY FLORIDA AND THE SURROUNDING COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 4 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| CY Investment Income | $34,787 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| CY Total Revenue | $34,787 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| CY Other Expenses | $1,166,087 | CYOtherExpensesAmt |
| CY Total Expenses | $1,166,087 | CYTotalExpensesAmt |
| CY Revenues Less Expenses | -$1,131,300 | CYRevenuesLessExpensesAmt |
| Total Assets EOY | $18,328,710 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $19,460,010 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | -$1,131,300 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANZATION'S TAX-EXEMPT PURPOSE IS TO TO OPERATE AND SUPPORT CALHOUN LIBERTY HOSPITAL ASSOCIATION, INC. BY FACILITATING THE CONSTRUCTION OF A NEW HOSPITAL BUILDING SERVING THE RESIDENTS OF CALHOUN COUNTY FLORIDA AND THE SURROUNDING COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,036,587 | ExpenseAmt |
| Desc | THE ORGANIZATION SUPPORTS CLH BY SERVING AS A QUALIFIED ACTIVE LOW-INCOME COMMUNITY BUSINESS OR QALICB (AS DEFINED IN CODE SECTION 45D(D)(2)) THAT IS OPERATED IN CONNECTION WITH CLH TO FACILITATE FINANCING A PORTION OF THE COSTS FOR CONSTRUCTION OF A NEW HOSPITAL BUILDING AND RELATED FACILITIES, WHICH ARE NEEDED TO REPLACE CLH'S FORMER HOSPITAL BUILDING. THE ORGANIZATION WILL BUILD AND LEASE THE NEW HOSPITAL BUIILING TO CLH, WHICH WILL OPERATE IT TO SERVE THE RESIDENTS OF CALHOUN COUNTY, FLORIDA AND THE SURROUNDING COMMUNITIES. | Desc |
| Total Program Service Expenses | $1,036,587 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | 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 | false | OperateHospitalInd |
| 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 | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | false | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| 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 | 4 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | 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 | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN-LINERTY HOSPITAL ASSOCIATIO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8506745411 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20370 NE BURNS AVENUE | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32424 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| CHRISTINIA JEPSEN | ||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $215,120 | $6,683 |
| EMILY BROWN | ||||||
| CEO | 1.00 | Yes (X) | Yes (X) | $0 | $91,954 | $667 |
| RUTH ATTAWAY | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BEN HALL | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $307,074 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $7,350 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ROEDER & COMPANY LLC | |||||
| 14205 NW BRONSON CREEK DRIVE | PORTLAND | OR | 97229 | CONSULTING SVS | $400,000 |
| STINSON LLP | |||||
| 1201 WALNUT STREET | KANSAS CITY | MO | 641062150 | LEGAL SVS | $106,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,787 | TotalRevenueColumnAmt |
| Exclusion | $34,787 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,787 | TotalRevenueColumnAmt |
| Exclusion | $34,787 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,500 | TotalAmt |
| Management And General | $23,500 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,000 | TotalAmt |
| Management And General | $106,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $808,055 | TotalAmt |
| Program Services | $808,055 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,882 | TotalAmt |
| Program Services | $170,882 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANOUS | Desc |
| Total | $57,650 | TotalAmt |
| Program Services | $57,650 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,166,087 | TotalAmt |
| Program Services | $1,036,587 | ProgramServicesAmt |
| Management And General | $129,500 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $883,963 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,444,747 | LandBldgEquipCostOrOtherBssAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $17,444,747 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $18,328,710 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $19,460,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $19,460,010 | 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 | -$1,131,300 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | -$1,131,300 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $18,328,710 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,131,300 | ReconcilationRevenueExpnssAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN LIBERTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 593051173 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | false | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (true) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (true) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (true) | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (true) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (true) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION D, LINE 3 | THE CLH BOARD HAS A SIGNIFICANT VOICE IN DIRECTING USE OF THE ORGANIZAION'S INCOME AND ASSETS THROUGH A DESIGNATED DIRECTOR. |
| PART IV, SECTION E, LINE 2A | THE ORGANIZATION WAS FORMED TO SUPPORT CLH BY SERVING AS A QUALIFIED ACTIVE LOW-INCOME COMMUNITY BUSINESS OR QALICB (AS DEFINED IN CODE SECTION 45D(D) (2)) THAT IS OPERATED IN CONNECTION WITH CLH TO FACILITATE FINANCING A PORTION OF THE COSTS FOR CONSTRUCTION OF A NEW HOSPITAL BUILDING AND RELATED FACILITIES, WHICH IS NEEDED TO REPLACE CLH'S FORMER HOSPITAL BUILDING. THE FORMER HOSPITAL BUILDING SUFFERED EXTENSIVE DAMAGE DURING HURRICANE MICHAEL IN 2018, AND AS A RESULT HAD TO CURTAIL ITS OPERATIONS, LOSING 15 OF ITS 25 PRE-HURRICANE BEDS. THE ORGANIATION WAS INCORPORATED TO SERVE AS THE QALICB IN A NMTC FINANCING TRANSACTION PURSUANT TO CODE SECTION 45D TO FINANCE A PORTION OF THE COST OF CONSTRUCTION OF THE PROJECT. IF THE PROJECT WERE NOT BEING FINANCED WITH NMTCS, CLH WOULD BE FORCED TO SEEK OTHER FINANCING FOR THE PROJECT, WHICH WOULD LIKELY NECESSITATE FURTHER REDUCTION IN THE SCOPE OF THE PROJECT OR DELAY THE PROJECT INDEFINITELY. THUS, THE ORGANIZATION'S ACTIVITIES DIRECTLY FURTHER CLH'S EXEMPT PURPOSE OF PROVIDING HEALTH CARE SERVICES IN A COMMUNITY THAT QUALIFIES AS BOTH A MEDICALLY UNDERSERVED AREA AND A HEALTH PROFESSIONAL SHORTAGE AREA SINCE ABSENT ORGANIZATION'S PARTICIPATION IN THE NMTC FINANCING FOR THE PROJECT THE SUBSIDY PROVIDED BY THE NMTC PROGRAM WOULD NOT BE AVAILABLE FOR THE PROJECT. FURTHER, PARTICIPATING IN A TRANSACTION TO FINANCE CONSTRUCTION OF A NEW HOSPITAL BUILDING IS AN ACTIVITY THAT WOULD NORMALLY BE ENGAGED IN BY CLH AND IN WHICH CLH IS ACTIVELY PARTICIPATING IN FURTHERANCE OF ITS EXEMPT PURPOSE. |
| PART IV, SECTION E, LINE 2B | UNDER THE ORGANIZATION'S BYLAWS, THE ORGANIZATION'S BOARD MUST CONSIST OF AT LEAST THREE DIRECTORS, ONE OF WHOM, THE DESIGNATED DIRECTOR, MUST BE THE CEO OR BOARD CHAIR OF THE SUPPORTED ORGANIZATION (CLH), OR SUCH OTHER PERSON AS MAY BE DESIGNATED BY THE CLH BOARD, AND TWO-THIRDS OF WHOM MUST BE INDIVIDUALS WHO ARE NOT THEN OFFICERS, DIRECTORS, OR EMPLOYEES OF CLH, WERE NOT COMPENSATED BY CLH FOR SERVICES WITHIN THE PREVIOUS 12 MONTHS, OR ARE NOT THE IMMEDIATE FAMILY MEMBER OF SUCH PERSONS. THE INITIAL BOARD OF DIRECTORS WAS SELECTED BY THE INCORPORATOR, SUBJECT TO SUCH REQUIREMENTS. THUS, THE ORGANIZATION AND THE SUPPORTED ORGANIZATION WILL MAINTAIN A CLOSE AND CONTINUOUS WORKING RELATIONSHIP THROUGH THE DESIGNATED DIRECTOR. BORROWER'S BYLAWS ALSO REQUIRE THE ORGANIZATION TO PROVIDE THE CLH BOARD THE INFORMATION REQUIRED TO MEET THE NOTIFICATION REQUIREMENT FOR THE TAXABLE YEAR PRECEDING THE YEAR IN WHICH SUCH NOTICE IS DELIVERED AND AT ALL TIMES MAINTAIN A CLOSE AND CONTINUOUS WORKING RELATIONSHIP CLH. |
Schedule D IRS990ScheduleD
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,444,747 | OtherCostOrOtherBasisAmt |
| Book Value | $17,444,747 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $17,444,747 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO CLH | Desc |
| Amt | $10 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 4, PART XIII | FormAndLineReferenceDesc |
| Explanation | AT THE TIME THE RETURN WAS FILED, THE AUDIT FOR THE CALENDAR YEAR WAS NOT COMPLETED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | CHRISTINIA JEPSEN | PersonNm |
| Title | PRESIDENT | TitleTxt |
| Compensation Based On Rltd Orgs | $212,902 | CompensationBasedOnRltdOrgsAmt |
| Other Compensation Rltd Orgs | $2,218 | OtherCompensationRltdOrgsAmt |
| Nontaxable Benefits Rltd Orgs | $6,683 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Rltd Orgs | $221,803 | TotalCompensationRltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION DOES NOT DIRECTLY COMPENSATE OR EMPLOYE ANY INDIVIDUALS. COMPENSATION IS DETERMINED BY CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC., A RELATED TAX-EXEMPT ORGANIZATION. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE ORGANZATION'S TAX-EXEMPT PURPOSE IS TO TO OPERATE AND SUPPORT CALHOUN LIBERTY HOSPITAL ASSOCIATION, INC. BY FACILITATING THE CONSTRUCTION OF A NEW HOSPITAL BUILDING SERVING THE RESIDENTS OF CALHOUN COUNTY FLORIDA AND THE SURROUNDING COMMUNITIES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE RETURN IS PREPARED BY A CPA FROM THE BOOKS AND RECORDS SUPPLIED BY MANAGEMENT. THE RETURN IS REVIEWED BY A BOARD MEMBER WHO ALSO SIGNS THE RETURN. OTHER MEMBERS OF THE BOARD ARE NOTIFIED THE RETURN IS AVAILABLE FOR REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC |
| FORM 990, PART IX, LINE 11G | CONSULTING/PROFESSIONAL FEES 808,055 0 0 |
| FORM 990, PART XII | AT THE TIME THE RETURN WAS FILED, THE AUDIT FOR THE CALENDAR YEAR WAS NOT COMPLETED. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALHOUN LIBERTY HOSPITAL ASSOCATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 16257 STATE ROAD 71 SOUTH | AddressLine1Txt |
| City | BLOUNTSTOWN | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32424 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 593051173 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |