CARROLL COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CARROLL COUNTY MEMORIAL HOSPITAL (EIN 44-0629397)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201411359349307646
- Schema version
- 2012v2.3
- 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) |
|---|---|---|
| Timestamp | 2014-05-15T15:13:37-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440629397 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % JEFF TINDLE | InCareOfName |
| Name Control | CARR | NameControl |
| Phone | 6605421695 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFF TINDLE | Name |
| Title | CEO | Title |
| Phone | 6605421695 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JEFF TINDLE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 15457730 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | CARROLLCOUNTYHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1957 | YearFormation |
| State Legal Domicile | MO | StateLegalDomicile |
| Activity Or Mission Description | CARROLL COUNTY MEMORIAL HOSPITAL IS COMMITTED TO MEETING THE CHANGING NEEDS OF OUR COMMUNITY BY PROVIDING COMPREHENSIVE, INNOVATIVE AND PROFESSIONAL QUALITY HEALTHCARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 177 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2265 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 17685 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11417157 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14196300 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 203028 | InvestmentIncomePriorYear |
| Investment Income Current Year | -33883 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1243590 | OtherRevenuePriorYear |
| Other Revenue Current Year | 431858 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12866040 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14611960 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4966 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6370781 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6663126 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6111294 | OtherExpensePriorYear |
| Other Expenses Current Year | 8316025 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12487075 | TotalExpensesPriorYear |
| Total Expenses Current Year | 14984117 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 378965 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -372157 | RevenuesLessExpensesCY |
| Total Assets BOY | 24796834 | TotalAssetsBOY |
| Total Assets EOY | 25902518 | TotalAssetsEOY |
| Total Liabilities BOY | 2874488 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4206204 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21922346 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 21696314 | NetAssetsOrFundBalancesEOY |
| Mission Description | CARROLL COUNTY MEMORIAL HOSPITAL IS COMMITTED TO MEETING THE CHANGING NEEDS OF OUR COMMUNITY BY PROVIDING COMPREHENSIVE, INNOVATIVE AND PROFESSIONAL QUALITY HEALTHCARE SERVICES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 11721042 | Expense |
| Grants | 4966 | Grants |
| Revenue | 14196300 | Revenue |
| Description | ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. | Description |
| Total Program Service Expense | 11721042 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 25 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 177 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JEFF TINDLE | NamePerson |
| Telephone Number | 6605421695 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| REX BUHRMESTER | |||||||||
| DIRECTOR/PRESIDENT | 1.0 | 0.0 | X | X | 0 | 0 | 0 | ||
| CAROLYN LOCK | |||||||||
| DIRECTOR/VICE PRESIDENT | 1.0 | 0.0 | X | X | 0 | 0 | |||
| RANDALL BARRY | |||||||||
| DIRECTOR/SECRETARY | 1.0 | 0.0 | X | X | 0 | 0 | |||
| BEN POLEN | |||||||||
| DIRECTOR | 1.0 | 0.0 | X | ||||||
| JIM GIBSON | |||||||||
| DIRECTOR | 1.0 | 0.0 | X | ||||||
| CHARLIE LOCK | |||||||||
| DIRECTOR | 1.0 | X | |||||||
| BLAKE RILEY | |||||||||
| DIRECTOR | 1.0 | 0.0 | X | ||||||
| LINDA ROSS | |||||||||
| DIRECTOR | 1.0 | 0.0 | X | ||||||
| DEBBIE MINNICK | |||||||||
| DIRECTOR | 1.0 | X | |||||||
| JEFFREY TINDLE | |||||||||
| CEO | 40.0 | 0.0 | X | 153562 | 0 | 27867 | |||
| RICHARD SMITH | |||||||||
| PHYSICIAN | 40.0 | 0.0 | 348854 | 0 | 36480 | X | |||
| TIM REID | |||||||||
| PHYSICIAN | 40.0 | 0.0 | 134926 | 0 | 44465 | X | |||
| JERRY DOVER | |||||||||
| FORMER CEO | 0.0 | 0.0 | 106255 | 0 | 15582 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 743597 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 124394 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| CERNER CORPORATION | |
| COMPUTER SYSTEMS | 312042 |
| HSMC TECHNOLOGY | |
| IT SERVICE | 224087 |
| Copland Development | |
| Construction | 240173 |
| CLINSHARE INC | |
| NUCLEAR MEDICINE | 232908 |
| Tribridge Holdings LLC | |
| COMPUTER SYSTEMS | 198786 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| All Other Contributions | 17685 | AllOtherContributions |
| Total Contributions | 17685 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 14196300 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14196300 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14196300 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 123280 | TotalRevenueColumn |
| Exclusion | $123,280 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 345688 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 345688 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 345688 | TotalRevenueColumn |
| Exclusion | $345,688 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 685054 | Securities |
| Other | 3553 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 839065 | Securities |
| Other | 6705 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -154011 | Securities |
| Other | -3152 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -157163 | TotalRevenueColumn |
| Exclusion | -$157,163 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS INCOME | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 86170 | TotalRevenueColumn |
| Exclusion | $86,170 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 86170 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14611960 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14196300 | RelatedOrExemptFunctionIncome |
| Exclusion | $397,975 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2566 | Total |
| Program Services | 2566 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2400 | Total |
| Program Services | 2400 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158559 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 158559 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71434 | Total |
| Program Services | 71434 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5304643 | Total |
| Program Services | 5063797 | ProgramServices |
| Management And General | 240846 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 273507 | Total |
| Program Services | 253769 | ProgramServices |
| Management And General | 19738 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 484847 | Total |
| Program Services | 246909 | ProgramServices |
| Management And General | 237938 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 370136 | Total |
| Program Services | 343425 | ProgramServices |
| Management And General | 26711 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8305 | Total |
| Management And General | 8305 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42614 | Total |
| Management And General | 42614 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130 | Total |
| Management And General | 130 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1988243 | Total |
| Program Services | 1479890 | ProgramServices |
| Management And General | 508353 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114058 | Total |
| Program Services | 15209 | ProgramServices |
| Management And General | 98849 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 987746 | Total |
| Program Services | 584005 | ProgramServices |
| Management And General | 403741 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 747757 | Total |
| Program Services | 436385 | ProgramServices |
| Management And General | 311372 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 496073 | Total |
| Program Services | 462655 | ProgramServices |
| Management And General | 33418 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74693 | Total |
| Program Services | 65543 | ProgramServices |
| Management And General | 9150 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49022 | Total |
| Program Services | 9663 | ProgramServices |
| Management And General | 39359 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1442538 | Total |
| Program Services | 847958 | ProgramServices |
| Management And General | 594580 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 523857 | Total |
| Program Services | 8036 | ProgramServices |
| Management And General | 515821 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 785506 | 785506 | |
| MEDICAL EQUIPMENT LEASES | 58336 | 58336 | |
| BAD DEBT EXPENSE | 931914 | 931914 | |
| MISCELLANEOUS EXPENSES | 65233 | 51642 | 13591 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14984117 | Total |
| Program Services | 11721042 | ProgramServices |
| Management And General | 3263075 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7058597 | BOY |
| EOY | 9427632 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3645265 | BOY |
| EOY | 2092723 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123491 | BOY |
| EOY | 160533 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69670 | BOY |
| EOY | 70505 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 24165203 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11660858 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12026667 | BOY |
| EOY | 12504345 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1773144 | BOY |
| EOY | 1521444 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100000 | BOY |
| EOY | 125336 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24796834 | BOY |
| EOY | 25902518 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1093625 | BOY |
| EOY | 1689223 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1780863 | BOY |
| EOY | 2516981 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2874488 | BOY |
| EOY | 4206204 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21922346 | BOY |
| EOY | 21690978 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 5336 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21922346 | BOY |
| EOY | 21696314 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24796834 | BOY |
| EOY | 25902518 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -372157 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 140789 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 5336 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Belongs To Affiliated Group | X | OrgBelongsToAffiliatedGroup |
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Form4720 Filed | true | Form4720Filed |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $2,870 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 2870 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 251007 | OtherCostOrOtherBasis |
| Book Value | 251007 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18472949 | OtherCostOrOtherBasis |
| Depreciation | 8302324 | Depreciation |
| Book Value | 10170625 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5295993 | OtherCostOrOtherBasis |
| Depreciation | 3294057 | Depreciation |
| Book Value | 2001936 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 145254 | OtherCostOrOtherBasis |
| Depreciation | 64477 | Depreciation |
| Book Value | 80777 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 12504345 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 13820835 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 140789 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 140789 | RevenueNotRptdF990 |
| Revenue Subtotal | 13680046 | RevenueSubtotal |
| Other Revenues Not Included | 931914 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 931914 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 14611960 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 14052203 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 14052203 | ExpensesSubtotal |
| Other Expenses Not Included | 931914 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 931914 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 14984117 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS DISCLOSURE | 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. |
| RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS | SCHEDULE D, PART XI, LINE 4B | BAD DEBT EXPENSE $ 931,914 |
| RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS | SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $ 931,914 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 55344 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 55344 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1642403 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1488307 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 154096 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01100 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1697747 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1488307 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 209440 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01490 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 551664 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 551664 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03930 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 551664 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 551664 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03930 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2249411 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1488307 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 761104 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05420 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $931,914 | BadDebtExpenseAmount |
| Amount Attributable To | 205021 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6634451 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6713713 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -79262 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| 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 | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | PHYSICIAN CLINICS | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARROLL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| JEFFERSON MEDICAL GROUP - CARROLLTON | ||||
| 1403 JEFFERSON | CARROLLTON | MO | 64633 | RURAL HEALTH CLINIC |
| JEFFERSON MEDICAL GROUP - NORBONNE | ||||
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 EXPESNE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $931,914. SCHEDULE H, PART I, LINE 7G NO PHYSICIAN CLINIC COSTS ARE INCLUDED. | |
| BAD DEBT EXPENSE | 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. LINE 3: THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS BASED ON SELF-PAY ONLY PATIENTS COVERED BY MEDICAID. | SCHEDULE H, PART III, LINES 2 & 3 |
| BAD DEBT EXPENSE | THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS. | SCHEDULE H, PART III, LINE 4 |
| MEDICARE | 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 METHODOLGY USED WAS THE COST TO CHARGE METHOD, USING THE COST TO CHARGE % FROM WORKSHEET 2. | SCHEDULE H, PART III, LINE 8 |
| COLLECTION PRACTICES | 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 III, LINE 9B |
| 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 20D | THE HOSPITAL UTILIZES A STANDARDIZED CHARGE RATE FOR EACH PROCEDURE AND SUPPLY CHARGED TO PATIENTS REGARDLESS OF PAYOR TYPE OR ABILITY TO PAY. | |
| NEEDS ASSESSMENT | 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 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | 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-ASSISSTANCE OR CHARITY CARE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | CARROLL COUNTY MEMORIAL HOSPITAL IS LOCATED IN CARROLLTON, MISSOURI. THE HOSPITALS PRIMARY SERVICE AREA CONSISTS OF CARROLLTON AND THE SURRONDING 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 3 |
| PROMOTION OF COMMUNITY HEALTH | THE HOSPITALS 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 4 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | true | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFFREY TINDLE | ||||||||||||||
| CEO | 142047 | 0 | 0 | 0 | 11515 | 0 | 12285 | 0 | 15582 | 0 | 181429 | 0 | 0 | 0 |
| RICHARD SMITH | ||||||||||||||
| PHYSICIAN | 334125 | 0 | 0 | 0 | 14729 | 0 | 14400 | 0 | 22080 | 0 | 385334 | 0 | 0 | 0 |
| TIM REID | ||||||||||||||
| PHYSICIAN | 131618 | 0 | 0 | 0 | 3308 | 0 | 11385 | 0 | 33080 | 0 | 179391 | 0 | 0 | 0 |
| JERRY DOVER | ||||||||||||||
| FORMER CEO | 105697 | 0 | 0 | 0 | 558 | 0 | 0 | 0 | 15582 | 0 | 121837 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER COMPENSATION | SCHEDULE J, PART I, LINE 1A | ALL STAFF RECEIVE MEMBERSHIP TO LIFESTYLE FITNESS. LIONS AND KIWANIS CLUB MEMBERSHIPS ARE PAID FOR JEFFERY TINDLE & JERRY DOVER, THE MEMBERSHIPS WERE USED ONLY FOR BUSINESS PURPOSES, THEREFORE THE AMOUNT OF THE DUES WERE NOT INCLUDED IN HIS W-2. COUNTRY CLUB DUES WERE PAID FOR JEFFERY TINDLE & JERRY DOVER, THE AMOUNT OF THE DUES WAS NOT INCLUDED IN HIS W-2. |
| COMPENSATION CONTINGENT ON REVENUES | SCHEDULE J, PART I, LINE 5 | PHYSICIAN BONUSES WERE CALCULATED QUARTERLY USING A % OF GROSS CHARGES. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SEE SCHEDULE L PART V | NamePerson |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS | Identifier |
| Return Reference | SCHEDULE L, PART IV, LINE 1 | ReturnReference |
| Explanation | (A) MARVIN ROSS (B) SPOUSE OF BOARD MEMBER, LINDA ROSS (C) $46,153.86 (D) EMPLOYED PHYSICIAN OF CARROLL COUNTY MEMORIAL HOSPITAL (E) NO (A) SUSAN STARK (B) SISTER OF BOARD MEMBER, RANDALL BARRY (C) $25,279.86 (D) EMPLOYED REGISTERED NURSE OF CARROLL COUNTY MEMORIAL HOSPITAL (E) NO | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FORM 990 REVIEW PROCESS | 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. |
| MONITORING OF CONFLICT OF INTEREST POLICY | 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. |
| COMPENSATION REVIEW | 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 2012. LINE 15B: ALL OTHER MANAGEMENT POSITIONS ARE HIRED, REVIEWED, AND MONITORED BY THE CEO, CNO AND COO. COMPENSATION REVIEWS OCCUR ANNUALLY. |
| AVAILABILITY OF DOCUMENTS | Form 990, Part VI, SECTION C, LINE 19 | THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| RECONCILIATION OF NET ASSETS | FORM 990, PART XI, LINE 9 | CHANGE IN BENEFICIAL INTEREST IN FOUNDATION $ 5,336 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:ER PHYSICIAN FEES TOTAL FEES:537985 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAID ADMINISRATION TOTAL FEES:486135 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:964123 |