CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC (EIN 59-3051173)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201733199349304413
- Schema version
- 2016v3.0
- 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 | 2017-11-15T10:58:37-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 | 2016-01-01 | 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 | PAUL SMITH | PersonNm |
| Person Title | BOARD CHAIRMAN | PersonTitleTxt |
| Phone | 8506437881 | PhoneNum |
| Signature | 2017-08-28 | 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 | 2017-11-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 76.17.49.120 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-15 | IPDt |
| IP Tm | 10:59:27 | IPTm |
| Federal Original Submission Id | 5844892017319isonobu | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2017-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 0A827F5558556A39D781DBDEBAD3890B541A790F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 0A827F5558556A39D781DBDEBAD3890B541A790F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL SMITH | PrincipalOfficerNm |
| Gross Receipts | $11,641,263 | 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 | 285 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $400,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $41,827 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,010,985 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,598,732 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,515 | PYInvestmentIncomeAmt |
| CY Investment Income | $704 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $11,415,500 | PYTotalRevenueAmt |
| CY Total Revenue | $11,641,263 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,124,026 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,051,292 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,627,571 | PYOtherExpensesAmt |
| CY Other Expenses | $4,815,171 | CYOtherExpensesAmt |
| PY Total Expenses | $11,751,597 | PYTotalExpensesAmt |
| CY Total Expenses | $11,866,463 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$336,097 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$225,200 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,961,749 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,887,706 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,569,029 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,735,858 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,392,720 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,151,848 | 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 | $11,866,463 | 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 | $11,866,463 | 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 | 61 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 285 | 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 |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| 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 | ALYSA SAMS | 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 (14 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 | ||
| PAUL SMITH | ||||||||
| CHAIRMAN | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TIM REVELL | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TERRY EUBANKS | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK PLUMMER | ||||||||
| VICE CHAIRMAN | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARY NEVES | ||||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GARRETT CHUMNEY | ||||||||
| MEDICAL DIRECTOR ER PHYSICIA | 40.00 | 0.00 | $385,161 | $0 | $0 | Yes (X) | ||
| STANLEY WHITTAKER | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $260,602 | $0 | $5,210 | Yes (X) | ||
| MISBAH FAROOQI | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $224,067 | $0 | $0 | Yes (X) | ||
| RONALD WATSON | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $137,861 | $0 | $1,092 | Yes (X) | ||
| TERESSA EDENFIELD | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $129,857 | $0 | $2,595 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,137,548 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $8,897 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MAHENDRA SHETH | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2072 SE GIFFEN AVENUE | AddressLine1Txt |
| City | Port Saint Lucie | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34952 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | ER PHYSICIAN | ServicesDesc |
| Compensation | $126,704 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $41,827 | GovernmentGrantsAmt |
| Total Contributions | $41,827 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621990 | $9,843,011 | $9,843,011 |
| OTHER PROGRAM REVENUE | 621990 | $1,755,721 | $1,755,721 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,598,732 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $704 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $704 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,641,263 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,599,436 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,024,002 | TotalAmt |
| Program Services | $6,024,002 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,930 | TotalAmt |
| Program Services | $61,930 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,256 | TotalAmt |
| Program Services | $500,256 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,104 | TotalAmt |
| Program Services | $465,104 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,636 | TotalAmt |
| Program Services | $38,636 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,300 | TotalAmt |
| Program Services | $27,300 | ProgramServicesAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,500 | TotalAmt |
| Program Services | $15,500 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,225 | TotalAmt |
| Program Services | $51,225 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $441,801 | TotalAmt |
| Program Services | $441,801 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,363 | TotalAmt |
| Program Services | $188,363 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PROFEESIONAL FEES | $547,687 | $547,687 |
| SUPPLIES | $1,250,476 | $1,250,476 |
| OTHER DEPARTMENTAL EXPENSES | $2,254,183 | $2,254,183 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,866,463 | TotalAmt |
| Program Services | $11,866,463 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $496,670 | BOYAmt |
| EOY | $297,940 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,980,967 | BOYAmt |
| EOY | $3,508,385 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,757 | BOYAmt |
| EOY | $113,354 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,876 | BOYAmt |
| EOY | $28,804 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,293,555 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,583,020 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,317,082 | BOYAmt |
| EOY | $1,710,535 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,673 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,724 | BOYAmt |
| EOY | $228,688 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,961,749 | BOYAmt |
| EOY | $5,887,706 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,892,263 | BOYAmt |
| EOY | $2,108,454 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $676,766 | BOYAmt |
| EOY | $1,627,404 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,569,029 | BOYAmt |
| EOY | $3,735,858 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,392,720 | BOYAmt |
| EOY | $2,151,848 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,392,720 | BOYAmt |
| EOY | $2,151,848 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,961,749 | BOYAmt |
| EOY | $5,887,706 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$225,200 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$15,672 | 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 | $15,500 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $15,500 | 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 AND BULLDOG STRATEGY GROUP 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 | $1,411,652 | DepreciationAmt |
| Book Value | $154,900 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $4,665,847 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $3,171,368 | DepreciationAmt |
| Book Value | $1,494,479 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,710,535 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Other receivables | Desc |
| Book Value | $228,688 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $228,688 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $10,913,841 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $10,913,841 | RevenueSubtotalAmt |
| Other Revenues Not Included | $727,422 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $727,422 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,641,263 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,997,241 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $10,997,241 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $869,222 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $869,222 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,866,463 | 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 |
| 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 | $322,467 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $121,973 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $200,494 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01690 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,302,527 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,605,356 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$302,829 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,868,326 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $395,298 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,473,028 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12410 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,493,320 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,122,627 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,370,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11550 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,493,320 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,122,627 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,370,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11550 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,466,507 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,873,442 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,707,715 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $165,727 | 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Facility Group 1 Part V line 13b | SEE ATTACHED |
| Facility Group 1 Part V line 24 | SEE ATTACHED |
| 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) | SEE ATTACHED |
| 02. Debt expense included (Part I, line 7, col(f)) | SEE ATTACHED |
| 03. Part III, line 2 | SEE ATTACHED |
| 04. Bad debt description footnote (Part III, line 4) | SEE ATTACHED |
| 05. Allowable Medicare costing methodology (Part III, line 8) | SEE ATTACHED |
| 06. Collection practices (Part III, line 9b) | SEE ATTACHED |
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 (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt |
|---|---|---|---|---|
| GARRETT CHUMNEY DR | ||||
| MEDICAL DIRECTOR ER PHYSICIAN | $385,161 | $385,161 | $306,030 | |
| STANLEY WHITTAKER | ||||
| NURSE PRACTITIONER | $260,602 | $265,812 | $214,133 | $5,210 |
| MISBAH FAROOQI | ||||
| PHYSICIAN | $224,067 | $224,067 | $219,780 | |
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 |