2017-11-15T10:58:37-05:00 2016-12-31 474875084 TWRP and Associates PC PO Box 3534 Loganville GA 30052 990 2016-01-01 593051173 CALHOUN LIBERTY HOSPITAL ASSOC INC CALH P O BOX 419 Blountstown FL 32424 PAUL SMITH BOARD CHAIRMAN 8506437881 2017-08-28 false Tina Wham P01270187 4043074184 2017-11-15 76.17.49.120 2017-11-15 10:59:27 5844892017319isonobu 2017-11-15 P 0A827F5558556A39D781DBDEBAD3890B541A790F 0A827F5558556A39D781DBDEBAD3890B541A790F 2016 2021-01-29 14:40:06Z PAUL SMITH 11641263 false X N/A X 1991 FL TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. 9 9 285 0 0 400000 41827 11010985 11598732 4515 704 0 11415500 11641263 0 0 7124026 7051292 0 0 4627571 4815171 11751597 11866463 -336097 -225200 4961749 5887706 2569029 3735858 2392720 2151848 TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. false false 11866463 TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY THROUGH INPATIENT CARE, OUTPATIENT CARE, EMERGENCY ROOM CARE AND OTHER RELATED SERVICES. 11866463 true false false true false false false false false true false false false false false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 61 0 true 285 true false false false false false false false false false false false false X 9 9 false true false false false false false true true false false true true false true true true false false false X ALYSA SAMS 8506745411 PO BOX 419 Blountstown FL 32424 X LABAN BONTRAGER DIRECTOR 0.00 0.00 X 0 0 0 MARILYN RUSSELL SECRETARY 0.00 0.00 X X 0 0 0 JOHN TOMLINSON TREASURER 0.00 0.00 X X 0 0 0 LADDIE WILLIAMS DIRECTOR 0.00 0.00 X 0 0 0 PAUL SMITH CHAIRMAN 0.00 0.00 X X 0 0 0 TIM REVELL DIRECTOR 0.00 0.00 X 0 0 0 TERRY EUBANKS DIRECTOR 0.00 0.00 X 0 0 0 MARK PLUMMER VICE CHAIRMAN 0.00 0.00 X X 0 0 0 MARY NEVES DIRECTOR 0.00 0.00 X 0 0 0 GARRETT CHUMNEY MEDICAL DIRECTOR ER PHYSICIA 40.00 0.00 X 385161 0 0 STANLEY WHITTAKER NURSE PRACTITIONER 40.00 0.00 X 260602 0 5210 MISBAH FAROOQI PHYSICIAN 40.00 0.00 X 224067 0 0 RONALD WATSON NURSE PRACTITIONER 40.00 0.00 X 137861 0 1092 TERESSA EDENFIELD NURSE PRACTITIONER 40.00 0.00 X 129857 0 2595 1137548 0 8897 5 false true false MAHENDRA SHETH 2072 SE GIFFEN AVENUE Port Saint Lucie FL 34952 ER PHYSICIAN 126704 1 41827 41827 PATIENT REVENUE 621990 9843011 9843011 OTHER PROGRAM REVENUE 621990 1755721 1755721 11598732 704 704 11641263 11599436 0 0 6024002 6024002 61930 61930 500256 500256 465104 465104 38636 38636 27300 27300 15500 15500 51225 51225 441801 441801 188363 188363 PROFEESIONAL FEES 547687 547687 SUPPLIES 1250476 1250476 OTHER DEPARTMENTAL EXPENSES 2254183 2254183 11866463 11866463 0 0 496670 297940 1980967 3508385 114757 113354 30876 28804 6293555 4583020 2317082 1710535 15673 5724 228688 4961749 5887706 1892263 2108454 676766 1627404 2569029 3735858 X 2392720 2151848 2392720 2151848 4961749 5887706 X -225200 -15672 X false true X false false X false false false false false false false false true 15500 15500 false Activities to influence legislation (Part II-B, lines 1a - 1h) 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. 61156 61156 1566552 1411652 154900 4665847 3171368 1494479 1710535 Other receivables 228688 228688 10913841 10913841 727422 727422 11641263 10997241 10997241 869222 869222 11866463 Other revenues included on Form 990 (Part XI, line 4b) EMS OPERATIONS Other expenses included on Form 990 (Part XII, line 4b) EMS OPERATIONS true true true X true X true true true false false 322467 121973 200494 0.01690 2302527 2605356 -302829 0.00000 1868326 395298 1473028 0.12410 4493320 3122627 1370693 0.11550 4493320 3122627 1370693 0.11550 true 5466507 3873442 3707715 165727 X true true 1 1 CALHOUN-LIBERTY HOSPITAL 20370 NE BURNS AVE Blountstown FL 32424 X 1 CALHOUN-LIBERTY HOSPITAL 1 false false false false true X 200.00 250.00 X X X X true true X X X true X WWW.CALHOUNLIBERTYH X true X false X X true false true Facility Group 1 Part V line 13b SEE ATTACHED Facility Group 1 Part V line 24 SEE ATTACHED 2 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 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 X false false false false false false false false false GARRETT CHUMNEY DR MEDICAL DIRECTOR ER PHYSICIAN 385161 385161 306030 STANLEY WHITTAKER NURSE PRACTITIONER 260602 5210 265812 214133 MISBAH FAROOQI PHYSICIAN 224067 224067 219780 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