CARROLL COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CARROLL COUNTY MEMORIAL HOSPITAL (EIN 44-0629397)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-15
- IRS object ID
- 201501359349304695
- Schema version
- 2013v4.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-15T12:41:38-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440629397 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JEFF TINDLE | InCareOfNm |
| Business Name Control | CARR | BusinessNameControlTxt |
| Phone | 6605421695 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON ST | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | CARROLLTON | City |
| State | MO | State |
| ZIP Code | 64633 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF TINDLE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6605421695 | PhoneNum |
| Signature | 2015-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin Ensminger CPA | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 6605421695 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF TINDLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON ST | AddressLine1 |
| City | CARROLLTON | City |
| State | MO | State |
| ZIP Code | 64633 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,931,391 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | CARROLLCOUNTYHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1957 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | CARROLL COUNTY MEMORIAL HOSPITAL IS COMMITTED TO MEETING THE CHANGING NEEDS OF OUR COMMUNITY BY PROVIDING COMPREHENSIVE,INNOVATIVE AND PROFESSIONAL QUALITY HEALTHCARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 174 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $17,685 | PYContributionsGrantsAmt |
| CY Contributions Grants | $61,532 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,196,300 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,281,542 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$33,883 | PYInvestmentIncomeAmt |
| CY Investment Income | $152,192 | CYInvestmentIncomeAmt |
| PY Other Revenue | $431,858 | PYOtherRevenueAmt |
| CY Other Revenue | $433,575 | CYOtherRevenueAmt |
| PY Total Revenue | $14,611,960 | PYTotalRevenueAmt |
| CY Total Revenue | $16,928,841 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,966 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $23,884 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,663,126 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,926,947 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,316,025 | PYOtherExpensesAmt |
| CY Other Expenses | $9,358,097 | CYOtherExpensesAmt |
| PY Total Expenses | $14,984,117 | PYTotalExpensesAmt |
| CY Total Expenses | $17,308,928 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$372,157 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$380,087 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,902,518 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,849,563 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,206,204 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,435,889 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $21,696,314 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $21,413,674 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CARROLL COUNTY MEMORIAL HOSPITAL IS COMMITTED TO MEETING THE CHANGING NEEDS OF OUR COMMUNITY BY PROVIDING COMPREHENSIVE, INNOVATIVE AND PROFESSIONAL QUALITY HEALTHCARE SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $14,281,287 | ExpenseAmt |
| Grant | $23,884 | GrantAmt |
| Revenue | $16,281,542 | RevenueAmt |
| Desc | ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $14,281,287 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | 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 |
| 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 | Yes (true) | 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 | Yes (true) | 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 | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 174 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF TINDLE | PersonNm |
| Phone | 6605421695 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 NORTH JEFFERSON ST | AddressLine1 |
| City | CARROLLTON | City |
| State | MO | State |
| ZIP Code | 64633 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| REX BUHRMESTER | ||||||||
| DIRECTOR/PRESIDENT | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CAROLYN LOCK | ||||||||
| DIRECTOR/VICE PRESIDENT | 1.0 | Yes (X) | Yes (X) | |||||
| RANDALL BARRY | ||||||||
| DIRECTOR/SECRETARY | 1.0 | Yes (X) | Yes (X) | |||||
| BEN POLEN | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| JIM GIBSON | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | 1.0 | ||
| CHARLIE LOCK | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| BLAKE RILEY | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| LINDA ROSS | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| DEBBIE MINNICK | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| JEFFREY TINDLE | ||||||||
| CEO | 40.0 | Yes (X) | $145,000 | $19,500 | ||||
| RICHARD SMITH | ||||||||
| PHYSICIAN | 40.0 | $378,934 | $46,056 | Yes (X) | ||||
| TIM REID | ||||||||
| PHYSICIAN | 40.0 | $214,346 | $39,519 | Yes (X) | ||||
| MARVIN ROSS | ||||||||
| PHYSICIAN | 40.0 | $412,955 | $27 | Yes (X) | ||||
| GREG STAFFORD | ||||||||
| PHYSICIAN ASSIST | 40.0 | $215,878 | $23,040 | Yes (X) | ||||
| ERIC WITT | ||||||||
| PHARMACIST | 40.0 | $106,666 | $10,303 | 0.0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,473,779 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $138,445 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| ServicesServicesDesc | CompensationCompensationAmt |
|---|---|
| CERNER CORPORATION | |
| COMPUTER SYSTEMS | $1,288,760 |
| BSA LIFESTRUCTURES | |
| ARCHITECT/CONSTRUCT | $243,509 |
| PSYCHIATRIC MEDICAL | |
| GERIATRIC PSYCH | $226,092 |
| CLINISHARE | |
| NUC MED/NUC MED STRE | $177,857 |
| HMN ARCH | |
| ARCHITECT/CONSTRUCT | $133,268 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $31,250 | GovernmentGrantsAmt |
| All Other Contributions | $30,282 | AllOtherContributionsAmt |
| Total Contributions | $61,532 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621990 | $15,379,458 | $15,379,458 |
| PHARMACY 340B INCOME | 621990 | $221,523 | $221,523 |
| EHR INCENTIVE INCOME | 621990 | $680,561 | $680,561 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,281,542 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $147,742 | TotalRevenueColumnAmt |
| Exclusion | $147,742 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $364,273 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $364,273 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $364,273 | TotalRevenueColumnAmt |
| Exclusion | $364,273 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,550 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,450 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,450 | TotalRevenueColumnAmt |
| Exclusion | $4,450 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $69,302 | TotalRevenueColumnAmt |
| Exclusion | $69,302 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $69,302 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,928,841 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,281,542 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $585,767 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,884 | TotalAmt |
| Program Services | $3,884 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,000 | TotalAmt |
| Program Services | $20,000 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,899 | TotalAmt |
| Management And General | $172,899 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,191 | TotalAmt |
| Program Services | $22,191 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,048,896 | TotalAmt |
| Program Services | $5,759,374 | ProgramServicesAmt |
| Management And General | $289,522 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,372 | TotalAmt |
| Program Services | $276,672 | ProgramServicesAmt |
| Management And General | $52,700 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $882,577 | TotalAmt |
| Program Services | $720,992 | ProgramServicesAmt |
| Management And General | $161,585 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $471,012 | TotalAmt |
| Program Services | $436,616 | ProgramServicesAmt |
| Management And General | $34,396 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,540 | TotalAmt |
| Management And General | $14,540 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,762 | TotalAmt |
| Management And General | $76,762 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,321 | TotalAmt |
| Management And General | $9,321 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70 | TotalAmt |
| Management And General | $70 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,019,024 | TotalAmt |
| Program Services | $1,510,429 | ProgramServicesAmt |
| Management And General | $508,595 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,981 | TotalAmt |
| Program Services | $39,876 | ProgramServicesAmt |
| Management And General | $116,105 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $872,350 | TotalAmt |
| Program Services | $603,021 | ProgramServicesAmt |
| Management And General | $269,329 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,130,749 | TotalAmt |
| Program Services | $685,343 | ProgramServicesAmt |
| Management And General | $445,406 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $471,934 | TotalAmt |
| Program Services | $422,555 | ProgramServicesAmt |
| Management And General | $49,379 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,102 | TotalAmt |
| Program Services | $86,311 | ProgramServicesAmt |
| Management And General | $14,791 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,691 | TotalAmt |
| Management And General | $38,691 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,606,082 | TotalAmt |
| Program Services | $1,087,584 | ProgramServicesAmt |
| Management And General | $518,498 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,959 | TotalAmt |
| Program Services | $27,738 | ProgramServicesAmt |
| Management And General | $145,221 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $922,437 | $922,437 |
| MEDICAL EQUIPMENT LEASES | $40,102 | $40,102 |
| BAD DEBT EXPENSE | $1,507,295 | $1,507,295 |
| _ |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,698 | TotalAmt |
| Program Services | $108,867 | ProgramServicesAmt |
| Management And General | $109,831 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,308,928 | TotalAmt |
| Program Services | $14,281,287 | ProgramServicesAmt |
| Management And General | $3,027,641 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,427,632 | BOYAmt |
| EOY | $9,502,059 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,092,723 | BOYAmt |
| EOY | $1,209,674 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,533 | BOYAmt |
| EOY | $240,767 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,505 | BOYAmt |
| EOY | $87,704 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $25,477,226 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,211,516 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,504,345 | BOYAmt |
| EOY | $12,265,710 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,521,444 | BOYAmt |
| EOY | $2,017,200 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,336 | BOYAmt |
| EOY | $526,449 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,902,518 | BOYAmt |
| EOY | $25,849,563 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,689,223 | BOYAmt |
| EOY | $1,938,063 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $7,200 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,516,981 | BOYAmt |
| EOY | $2,490,626 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,206,204 | BOYAmt |
| EOY | $4,435,889 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,690,978 | BOYAmt |
| EOY | $21,399,559 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,336 | BOYAmt |
| EOY | $14,115 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,696,314 | BOYAmt |
| EOY | $21,413,674 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,902,518 | BOYAmt |
| EOY | $25,849,563 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$380,087 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $88,668 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $8,779 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Belongs Afflt Grp | Yes (X) | OrganizationBelongsAffltGrpInd |
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Form4720 Filed | Yes (true) | Form4720FiledInd |
| 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 | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $9,321 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $9,321 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,511,985 | OtherCostOrOtherBasisAmt |
| Book Value | $1,511,985 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,401,265 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,132,396 | DepreciationAmt |
| Book Value | $8,268,869 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,931,172 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,009,568 | DepreciationAmt |
| Book Value | $1,921,604 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $632,804 | OtherCostOrOtherBasisAmt |
| Depreciation | $69,552 | DepreciationAmt |
| Book Value | $563,252 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,265,710 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $15,510,214 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $88,668 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $88,668 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,421,546 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,507,295 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,507,295 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $16,928,841 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,801,633 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $15,801,633 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,507,295 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,507,295 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,308,928 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 4B | BAD DEBT EXPENSE $ 1,507,295 |
| SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $ 1,507,295 |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,298 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,319,398 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,806,886 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $512,512 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03240 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,348,696 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,806,886 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $541,810 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03430 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,011 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $960 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,051 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,881 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,881 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $110,703 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $75,813 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $34,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,769 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,769 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $204,364 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $76,773 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $127,591 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,553,060 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,883,659 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $669,401 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04240 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,507,295 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $300,525 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,318,242 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,391,819 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$73,577 | 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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 NORTH JEFFERSON ST | AddressLine1 |
| City | CARROLLTON | City |
| State | MO | State |
| ZIP Code | 64633 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PHYSICIAN CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Section C for link | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, LINE 3 | Stakeholder and local business owners/community leaders were interviewed to discuss the future of CCMH and what they saw as a health need for the community. A local physician was interviewed to gather his thoughts of the health of the community. An RN from the Carroll County Health Department was consulted to help with reports regarding public health. |
| SCHEDULE H, PART V, LINE 5 | The Hospital's CHNA Report is available at: http://www.carrollcountyhospital.org/about_us/our_community/community_heal th_needs_assesment.aspx |
| SCHEDULE H, PART V, LINE 20D | THE HOSPITAL UTILIZES A STANDARDIZED CHARGE RATE FOR EACH PROCEDURE AND SUPPLY CHARGED TO PATIENTS REGARDLESS OF PAYOR TYPE OR ABILITY TO PAY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| JEFFERSON MEDICAL GROUP - CARROLLTON | ||||
| 1403 JEFFERSON | CARROLLTON | MO | 64633 | RURAL HEALTH CLINIC |
| JEFFERSON MEDICAL GROUP - NORBORNE | ||||
| 105 EAST 2ND STREET | NORBONNE | MO | 64668 | RURAL HEALTH CLINIC |
| JEFFERSON MEDICAL GROUP - HALE | ||||
| 321 ELM STREET | HALE | MO | 64643 | RURAL HEALTH CLINIC |
| REID MEDICAL GROUP | ||||
| 1401 N JEFFERSON | CARROLLTON | MO | 64633 | RURAL HEALTH CLINIC |
| CCMH HOME HEALTH | ||||
| 1502 N JEFFERSON ST | CARROLLTON | MO | 64633 | HOME HEALTH AGENCY |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,507,295. |
| SCHEDULE H, PART I, LINE 7, COLUMN G | NO PHYSICIAN CLINIC COSTS ARE INCLUDED. |
| SCHEDULE H, PART III, LINE 2 | LINE 2: THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF EACH TYPE OF PAYOR. THE HOSPITAL'S BAD DEBT AT COST WAS DETERMINED BY APPLYING AN OVERALL RATIO OF COST TO CHARGES. |
| SCHEDULE H, PART III, LINE 3 | LINE 3: THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS BASED ON SELF-PAY ONLY PATIENTS COVERED BY MEDICAID HMOS AND THE PERCENT OF ELIGIBLE MEDICAID AND MEDICAID HMO PATIENTS DIVIDED BY TOTAL BAD DEBT, THIS PERCENT THEN MULTIPLIED BY SELF PAY PATIENTS (PRIM HEALTH PLAN). THE TWO ESTIMATES ARE THEN COMBINED. |
| SCHEDULE H, PART III, LINE 4 | THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | THE MEDICARE ALLOWABLE FAILS TO COVER COST. NON-PAYMENT BY MEDICARE RECIPIENTS FOR THEIR DEDUCTIBLE AND COINSURANCE AMOUNTS INCREASES FINANCIAL ASSISTANCE AND BAD DEBT. THESE SHORTFALLS DECREASE THE ORGANIZATION'S POOL OF ASSETS AND IT'S ABILITY TO SUCCESSFULLY ATTRACT HIGHLY-TRAINED STAFF AND INVEST IN MEDICAL TECHNOLOGY. IF SERVICES ARE TO BE MAINTAINED, THEN THE COSTS WILL HAVE TO BE COVERED BY THOSE WHO PAY. THE COSTING METHODOLOGY USED WAS THE COST TO CHARGE METHOD, USING THE COST TO CHARGE % FROM WORKSHEET 2. |
| SCHEDULE H, PART III, LINE 9B | EACH PATIENT IS PROVIDED WITH PAYMENT INFORMATION IN CLEAR, EASY-TO-UNDERSTAND LANGUAGE. CCMH CHECKS ON PUBLIC-ASSISTANCE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. THE HOSPITAL OFFERS DISCOUNTS ON CHARGES TO UNDERINSURED AND UNINSURED PATIENTS WHEN POSSIBLE. |
| SCHEDULE H, PART VI, LINE 2 | CARROLL COUNTY MEMORIAL HOSPITAL RELIES ON INTERACTION WITH LOCAL HEALTH CARE AGENCIES AS WELL AS FEEDBACK FROM PATIENTS AND PRIMARY SERVICE AREA RESIDENTS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. |
| SCHEDULE H, PART VI, LINE 3 | CARROLL COUNTY MEMORIAL HOSPITAL PROVIDES EACH PATIENT WITH A LETTER THAT CLEARLY STATES PAYMENT INFORMATION IN AN EASY-TO-UNDERSTAND LANGUAGE. THE HOSPITAL INFORMS PATIENTS PROMPTLY ABOUT THE CHARGE FOR ANY ITEM OR SERVICE PROVIDED. THE LETTER INFORMS THE PATIENT THAT IF THEY ARE NOT ABLE TO PAY THEIR HOSPITAL BILL THERE ARE PROGRAMS THAT MAY HELP ALLEVIATE THE BURDEN. IF THE HOSPITAL IS PROMPTED IT WILL CHECK FOR PUBLIC-ASSISTANCE OR CHARITY CARE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. |
| SCHEDULE H, PART VI, LINE 4 | CARROLL COUNTY MEMORIAL HOSPITAL IS LOCATED IN CARROLLTON, MISSOURI. THE HOSPITALS PRIMARY SERVICE AREA CONSISTS OF CARROLLTON AND THE SURROUNDING AREAS OF CARROLL COUNTY. CARROLL COUNTY MEMORIAL HOSPITAL OPERATES TWO SATELLITE CLINICS LOCATED IN HALE AND NORBORNE. CARROLL COUNTY HAS A POPULATION OF APPROXIMATELY 9,300 RESIDENTS, WITH 35% OF THE RESIDENTS LIVING IN URBAN AREAS AND 65% LIVING IN RURAL AREAS. THE MEDIAN ANNUAL HOUSEHOLD INCOME FOR CARROLL COUNTY IS APPROXIMATELY $36,500. APPROXIMATELY 13.7% OF CARROLL COUNTY RESIDENTS HAVE ANNUAL INCOME BELOW THE FEDERAL POVERTY LEVEL, AND 4.5% OF CARROLL COUNTY RESIDENTS HAVE ANNUAL INCOME BELOW 50% OF THE FEDERAL POVERTY LEVEL. THE CLOSEST HOSPITALS ARE LOCATED IN MARSHALL, LEXINGTON, AND RICHMOND. THE DISTANCE BETWEEN CARROLL COUNTY MEMORIAL HOSPITAL AND THESE FACILITIES IS APPROXIMATELY 20, 25, AND 27 MILES. |
| SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL'S BOARD OF DIRECTORS IS ELECTED FROM THE LOCAL COMMUNITY AND SURROUNDING AREA THAT COMPRISES THE LOCAL SERVICE AREA. THE HOSPITAL'S ACTIVE MEDICAL STAFF MEMBERS ARE RESIDENTS OF THE COUNTY. CCMH SPONSORS COMMUNITY HEALTH FAIRS AND EDUCATION CLASSES IN MANY AREAS. ANY SURPLUS IN FUNDS ARE REINVESTED IN THE HOSPITAL'S FACILITIES AND PATIENT SERVICE PROGRAMS. CCMH HAS INVESTED OVER $15 MILLION IN PATIENT CARE IMPROVEMENTS OVER THE PAST 8 YEARS. |
| SCHEDULE H, PART VI, LINE 6 | IN 2014, CCMH REACHED A MANAGEMENT AGREEMENT WITH HCA MIDWEST HEALTH SYSTEM. THIS STRATEGIC PARTNERSHIP MEANS CCMH - THE COMMUNITY'S PREMIER HEALTHCARE PROVIDER - WILL HAVE GREATER ACCESS TO RESOURCES, ADVANCED TECHNOLOGY AND SERVICES THAT MIGHT NOT OTHERWISE BE AVAILABLE. PATIENTS AND THEIR FAMILIES WHO ENTRUST CARE TO US WILL BENEFIT FROM BEST PRACTICES, POLICIES AND PROCEDURES, TOOLKITS, PROTOCOLS, TRAINING AND MORE. MOST IMPORTANTLY, THIS AGREEMENT WITH HCA MIDWEST HEALTH SYSTEM ALIGNS WITH CCMH'S COMMITMENT TO PROVIDE HIGH-QUALITY, COMPASSIONATE AND INNOVATIVE CARE TO THE COMMUNITY. AS THE REGION'S LEADING HEALTHCARE PROVIDER, HCA MIDWEST HEALTH SYSTEM IS COMMITTED TO THE COMMUNITIES IT SERVES. IT HAS SIX ACUTE CARE HOSPITALS, ONE PSYCHIATRIC HOSPITAL, FOUR CRITICAL ACCESS HOSPITALS (INCLUDING CCMH), SIX SURGERY CENTERS, 10 URGENT CARE LOCATIONS, MORE THAN 30 PRIMARY CARE LOCATIONS, 2,100 PHYSICIANS AND HEALTHCARE PROVIDERS AND 9,000 SUPPORTING TEAM MEMBERS. IN ADDITION TO SOLIDIFYING CCMH'S LONGSTANDING MISSION, VISION AND CORE VALUES OF BEING A TRUSTED COMMUNITY HEALTHCARE PARTNER, THE HCA AGREEMENT MEANS: *STAFF REMAINS CCMH EMPLOYEES. *PATIENTS WILL HAVE ACCESS TO THEIR SAME CCMH PHYSICIANS. *OPPORTUNITY TO BRING SPECIALTY PHYSICIANS TO THE COMMUNITY THROUGH ONSITE CLINICS AND TELEMEDICINE SO EMPLOYEES AND PATIENTS HAVE INCREASED ACCESS TO MORE CARE OPTIONS WITHOUT LEAVING THE COMMUNITY. *IF A PATIENT DOES REQUIRE HIGHER-LEVEL CARE, TRANSFER TO AN HCA FACILITY WILL BE SEAMLESS WITH THE GOAL TO RETURN THE PATIENT BACK TO THE COMMUNITY HOSPITAL AS SOON AS POSSIBLE FOR POST-ACUTE AND FOLLOW-UP CARE. *THE CCMH HOSPITAL BOARD WILL REMAIN IN COMPLETE CONTROL OF LEADERSHIP AND MANAGEMENT DECISIONS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | GROW GRANT | GrantTypeTxt |
| Recipient | 5 | RecipientCnt |
| Cash Grant | $20,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PROCEDURES FOR MONITORING GRANTS | FormAndLineReferenceDesc |
| Explanation | The grant writer and executor has responsibility for ensuring all grant recording and documentation. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | Yes (true) | 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 | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt |
|---|---|---|---|---|---|---|---|
| JEFFREY TINDLE | |||||||
| CEO | $145,000 | $0 | $0 | $9,500 | $10,000 | $164,500 | $0 |
| RICHARD SMITH | |||||||
| PHYSICIAN | $378,934 | $0 | $0 | $14,462 | $31,594 | $424,990 | $0 |
| TIM REID | |||||||
| PHYSICIAN | $214,346 | $0 | $0 | $11,213 | $28,306 | $253,865 | $0 |
| MARVIN ROSS | |||||||
| PHYSICIAN | $412,955 | $0 | $0 | $0 | $27 | $412,982 | $0 |
| GREG STAFFORD | |||||||
| PHYSICIAN ASSIST | $215,878 | $0 | $0 | $7,428 | $15,612 | $238,918 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 1A | ALL STAFF RECEIVE MEMBERSHIP TO LIFESTYLE FITNESS. LIONS AND KIWANAS CLUB MEMBERSHIPS ARE PAID FOR JEFFREY TINDLE. THE MEMBERSHIPS WERE USED ONLY FOR BUSINESS PURPOSES. THEREFORE, THE AMOUNT OF THE DUES WAS NOT INCLUDED IN HIS W-2. COUNTRY CLUB DUES WERE PAID FOR JEFFREY TINDLE. THE AMOUNT OF THE DUES WAS NOT INCLUDED IN HIS W-2. |
| SCHEDULE J, PART I, LINE 5A | A PORTION OF PHYSICIAN COMPENSATION WAS CALCULATED QUARTERLY USING A PERCENTAGE OF GROSS CHARGES. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE SCHEDULE L PART V | PersonNm |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV, LINE 1 | FormAndLineReferenceDesc |
| Explanation | (A) AMANDA RILEY (B) SPOUSE OF BOARD MEMBER, BLAKE RILEY (C) $22,191 (D) EMPLOYED PHYSICIAN OF CARROLL COUNTY MEMORIAL HOSPITAL (E) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| Form 990, Part VI, SECTION B, LINE 12C | THE BOARD SETS POLICY AND ADMINISTRATION IS CHARGED WITH ASSURING THAT COMPLIANCE IS MAINTAINED. Conflict of interest is reviewed annually and each board member signs a conflict of interest disclosure form. IF A CONFLICT ARISES THE CONFLICTED PERSON DOES NOT TAKE PART IN THE VOTE ON THE ISSUE. |
| Form 990, Part VI, SECTION B, LINES 15A & 15B | LINE 15A: THE CEO IS HIRED, REVIEWED AND COMPENSATION IS SET BY THE BOARD. COMPENSATION REVIEWS OCCUR ANNUALLY WITH THE LAST ONE BEING CONDUCTED IN DECEMBER OF 2013. LINE 15B: ALL OTHER MANAGEMENT POSITIONS ARE HIRED, REVIEWED, AND MONITORED BY THE CEO, CNO AND COO. COMPENSATION REVIEWS OCCUR ANNUALLY. |
| Form 990, Part VI, SECTION C, LINE 19 | THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN BENEFICIAL INTEREST IN FOUNDATION $ 8,779 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ER PHYSICIANS FEES TOTAL FEES:572325 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:GERIATRIC PSYCH TOTAL FEES:240333 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:WOUND CARE PROFEE TOTAL FEES:150375 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAID ADMINISTRATION TOTAL FEES:554003 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:578750 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL FDN | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 N JEFFERSON | AddressLine1 |
| City | CARROLLTON | City |
| State | MO | State |
| ZIP Code | 64633 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 463696048 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CCMH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | 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 | false | 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 |