CCMH CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CCMH CORPORATION (EIN 61-1297707)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201323199349306527
- Schema version
- 2012v2.1
- 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 | 2013-11-15T13:16:56-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271235638 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNTJOY CHILTON MEDLEY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 462 S FOURTH ST SUITE 2600 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 402023445 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611297707 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CCMH CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CCMH | NameControl |
| Phone | 5027323200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 ELEVENTH ST | AddressLine1 |
| City | CARROLLTON | City |
| State | KY | State |
| ZIP Code | 41008 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL KOZAR | Name |
| Title | CEO | Title |
| Phone | 5027323200 | Phone |
| Date Signed | 2013-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | REBECCA L PHILLIPS CPA | Name |
| PTIN | P00024055 | PTIN |
| Phone | 5027491900 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL KOZAR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 ELEVENTH ST | AddressLine1 |
| City | CARROLLTON | City |
| State | KY | State |
| ZIP Code | 41008 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 17529153 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CCMHOSP.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2007 | YearFormation |
| State Legal Domicile | KY | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE A HEALTHCARE FACILITY OFFERING ACUTE CARE, SKILLED CARE, OUTPATIENT SERVICES, AND EMERGENCY MEDICAL SERVICES TO RESIDENTS OF CARROLL COUNTY, KENTUCKY AND SURROUNDING AREAS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 204 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 149896 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 47094 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16859508 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 17190867 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 487 | InvestmentIncomePriorYear |
| Investment Income Current Year | 459 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 197964 | OtherRevenuePriorYear |
| Other Revenue Current Year | 290733 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17207855 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17529153 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8148608 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8101507 | 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 | 9590414 | OtherExpensePriorYear |
| Other Expenses Current Year | 9280587 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 17739022 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17382094 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -531167 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 147059 | RevenuesLessExpensesCY |
| Total Assets BOY | 6882587 | TotalAssetsBOY |
| Total Assets EOY | 6450836 | TotalAssetsEOY |
| Total Liabilities BOY | 6411391 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5832581 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 471196 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 618255 | NetAssetsOrFundBalancesEOY |
| Mission Description | PROVIDE A HEALTHCARE FACILITY OFFERING ACUTE CARE, SKILLED CARE, OUTPATIENT SERVICES, AND EMERGENCY MEDICAL SERVICES TO RESIDENTS OF CARROLL COUNTY, KENTUCKY AND SURROUNDING AREAS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 13350923 | Expense |
| Revenue | 16329627 | Revenue |
| Description | SERVICED 23,311 PATIENTS THIS YEAR. APPROXIMATELY 10,676 PATIENTS WERE SERVICED IN EMERGENCY ROOMS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2032474 | Expense |
| Description | PROVIDED MEDICAL CARE FOR THOSE UNABLE TO PAY | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 608129 | Expense |
| Revenue | 992341 | Revenue |
| Description | PROVIDED RURAL HEALTH CLINIC TO SERVE THE INDIGENT OF THE COMMUNITY | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 15991526 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 256 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 204 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | KY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5027323200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 ELEVENTH ST | AddressLine1 |
| City | CARROLLTON | City |
| State | KY | State |
| ZIP Code | 41008 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JEAN PYLES | |||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| MIKE NEVIN | |||||||
| VICE CHAIR & SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| DENNIS RAISOR | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DONALD GARNER | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DONNA BURNS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| HAROLD TOMLINSON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JAMES STEVENSON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| LISA JAMES | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| NACHO PASCUAL | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| NICK MARSH | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| KANUTE RAREY | |||||||
| CEO | 40.00 | X | 150582 | 0 | 10458 | ||
| STEVE EIGLE | |||||||
| CFO | 40.00 | X | 94856 | 0 | 4847 | ||
| JEANNINE PERRENOUD | |||||||
| PHYSICIAN | 40.00 | 298235 | 0 | 15581 | X | ||
| KATHY SHORT | |||||||
| PHYSICIAN | 40.00 | 263162 | 0 | 4948 | X | ||
| SHERRELL NUNNELLEY | |||||||
| PHYSICIAN | 40.00 | 207450 | 0 | 6516 | X | ||
| MILAGROS RIVERA | |||||||
| PHYSICIAN | 40.00 | 182117 | 0 | 4730 | X | ||
| WINSTON YAP | |||||||
| PHYSICIAN | 40.00 | 282340 | 0 | 1289 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1478742 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 48369 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| EMCARE PHYSICIAN SERVICES | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | ER PHYSICIANS | 530808 |
| CARROLLTON INTERNAL MEDICINE | |||||
| 307 11TH STREET | CARROLLTON | KY | 41008 | HOSPITALISTS | 178526 |
| DIAGNOSTIC SHARED SERVICES | |||||
| 2650 EASTPOINT PKWY STE 300 | LOUISVILLE | KY | 40223 | MRI SERVICE | 162957 |
| HMS DIRECT | |||||
| 2739 MOMENTUM PLACE | CHICAGO | IL | 60689 | COMPUTER SERVICES | 162300 |
| CREST RESOURCES | |||||
| 735 PLAZA BLVD SUITE 210 | COPPELL | TX | 75019 | BIO MEDICAL MAINTENANCE | 156301 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| All Other Contributions | 47094 | AllOtherContributions |
| Total Contributions | 47094 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 17190867 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17190867 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 17190867 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 459 | TotalRevenueColumn |
| Exclusion | $459 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 128873 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 128873 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 128873 | TotalRevenueColumn |
| Exclusion | $128,873 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MEDICAID EMR INCENTIVES | 900099 | 85000 | 85000 | |
| MISCELLANEOUS | 900099 | 46101 | 46101 | |
| CAFETERIA SALES | 722210 | 21523 | $21,523 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9236 | TotalRevenueColumn |
| Exclusion | $9,236 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 161860 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17529153 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17321968 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $160,091 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 245438 | Total |
| Program Services | 150582 | ProgramServices |
| Management And General | 94856 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6793848 | Total |
| Program Services | 6657971 | ProgramServices |
| Management And General | 135877 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 517809 | Total |
| Program Services | 512631 | ProgramServices |
| Management And General | 5178 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 544412 | Total |
| Program Services | 517191 | ProgramServices |
| Management And General | 27221 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175575 | Total |
| Management And General | 175575 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11865 | Total |
| Management And General | 11865 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36329 | Total |
| Management And General | 36329 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2259331 | Total |
| Program Services | 1405599 | ProgramServices |
| Management And General | 853732 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13268 | Total |
| Program Services | 5440 | ProgramServices |
| Management And General | 7828 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 945597 | Total |
| Program Services | 936141 | ProgramServices |
| Management And General | 9456 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 724972 | Total |
| Program Services | 724972 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19235 | Total |
| Program Services | 16542 | ProgramServices |
| Management And General | 2693 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101873 | Total |
| Program Services | 101873 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 566489 | Total |
| Program Services | 566489 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259609 | Total |
| Program Services | 259609 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBT | 2823983 | 2823983 |
| DRUGS & MEDICAL SUPPLIE | 880887 | 880887 |
| PROVIDER TAX | 283192 | 283192 |
| FOOD COSTS | 86601 | 86601 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91781 | Total |
| Program Services | 61823 | ProgramServices |
| Management And General | 29958 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17382094 | Total |
| Program Services | 15991526 | ProgramServices |
| Management And General | 1390568 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97019 | BOY |
| EOY | 264180 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200289 | BOY |
| EOY | 499619 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2291323 | BOY |
| EOY | 2034388 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 158027 | BOY |
| EOY | 169658 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 172904 | BOY |
| EOY | 163824 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 13591652 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10933325 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3101895 | BOY |
| EOY | 2658327 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 861130 | BOY |
| EOY | 660840 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6882587 | BOY |
| EOY | 6450836 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2010831 | BOY |
| EOY | 1725208 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3153853 | BOY |
| EOY | 2216840 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69092 | BOY |
| EOY | 90533 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1177615 | BOY |
| EOY | 1800000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6411391 | BOY |
| EOY | 5832581 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 471196 | BOY |
| EOY | 618255 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 471196 | BOY |
| EOY | 618255 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6882587 | BOY |
| EOY | 6450836 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 147059 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 376450 | OtherCostOrOtherBasis |
| Book Value | 376450 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4507132 | OtherCostOrOtherBasis |
| Depreciation | 3964568 | Depreciation |
| Book Value | 542564 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1038755 | OtherCostOrOtherBasis |
| Depreciation | 257830 | Depreciation |
| Book Value | 780925 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7669315 | OtherCostOrOtherBasis |
| Depreciation | 6710927 | Depreciation |
| Book Value | 958388 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2658327 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CERTIFICATE OF NEED | Description |
| Book Value | 660840 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 660840 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ADVANCES FROM CARROLL COUNTY | $400,000 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $1,400,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1800000 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 17529153 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 17529153 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 17529153 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 17382094 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 17382094 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 17382094 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS A TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECOGNIZES UNCERTAIN TAX POSITIONS USING THE "MORE LIKELY-THAN-NOT" APPROACH AS DEFINED IN THE ASC. NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL'S 2010-2012 TAX YEARS REMAIN OPEN AND SUBJECT TO EXAMINATION. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1164392 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 409996 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 754396 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05180 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2601878 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1852952 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 748926 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05140 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1105409 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1105409 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07590 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4871679 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2262948 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2608731 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17910 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4871679 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2262948 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2608731 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17910 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,823,983 | BadDebtExpenseAmount |
| Amount Attributable To | 650000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 4847733 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4804906 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 42827 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| 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 | 309 ELEVENTH ST | AddressLine1 |
| City | CARROLLTON | City |
| State | KY | State |
| ZIP Code | 41008 | 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 |
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 |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 236.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| BEDFORD FAMILY PRACTICE | ||||
| 470 HIGHWAY 421 NORTH | BEDFORD | KY | 40006 | PHYSICIAN OFFICE |
| WARSAW FAMILY PRACTICE | ||||
| 302 W MAIN ST | WARSAW | KY | 41095 | PHYSICIAN OFFICE |
| CARROLL COUNTY RURAL HEALTH CLINIC | ||||
| 309 ELEVENTH ST | CARROLLTON | KY | 41008 | RURAL |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE ORGANIZATION USED THE MEDICARE COST TO CHARGE RATIO TO COMPLETE PART I, LINE 7. | |
| PART I, LINE 7, COLUMN (F): THE 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 $ 2823983. | |
| PART III, LINE 4: A SEPARATE FOOTNOTE FOR BAD DEBT EXPENSE IS NOT INCLUDED IN THE AUDITED FINANCIAL STATEMENTS.PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS MANAGEMENT'S ESTIMATE BASED UPON HISTORICAL COLLECTION INFORMATION AND OTHER INDUSTRY TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE BILLED UPON DISCHARGE AND ARE ORDINARILY DUE WITHIN 30 DAYS OF BILLING. BALANCES MORE THAN 120 DAYS PAST DUE ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE TURNED OVER TO A COLLECTION AGENCY. IN DETERMINING THE AMOUNT OF BAD DEBT AT COST, THE ORGANIZATION USED THE MEDICARE COST REPORT (MCR), COST TO CHARGE RATIO OF 28.5%. | |
| PART III, LINE 9B: THE ORGANIZATION'S COLLECTION POLICY STATES THAT ANY PERSON INDICATING AN INABILITY TO PAY WILL BE SCREENED FOR FINANCIAL ASSISTANCE. | |
| PART V, SECTION B, LINE 20D: A 40% DISCOUNT IS OFFERRED TO ALL SELF-PAY PATIENTS. | CARROLL COUNTY MEMORIAL HOSPITAL |
| PART VI, LINE 2: INPUT FROM COMMUNITY LEADERS, BOARD MEMBERS, EMPLOYEES AND PATIENTS. CEO IS MEMBER OF SEVERAL LOCAL ORGANIZATIONS (ROTARY, ECONOMIC DEVELOPMENT, ETC.). | |
| PART VI, LINE 3: FINANCIAL COUNSELORS ASSIST THOSE WITHOUT INSURANCE INCLUDING THOSE WITH INSURANCE THAT EXPRESS A NEED FOR FINANCIAL ASSISTANCE. | |
| PART VI, LINE 4: THE ORGANIZATION SERVES A LARGELY RURAL POPULATION. COMMERCE IS CENTERED AROUND THE OHIO RIVER AND INDUSTRIES RELATED TO SUCH. THE POPULATION IS GENERALLY POORER THAN THE STATE AVERAGE WITH HIGHER THAN AVERAGE UNEMPLOYMENT. | |
| PART VI, LINE 5: HOSPITAL SPONSORED COMMUNITY HEALTH FAIR OFFERING SCREENINGS, PREVENTATIVE EDUCATION, AND INFORMATION TO PROMOTE GOOD HEALTH.BOARD OF DIRECTORS REPRESENT THE ENTIRE COMMUNITY AND WORK WITH THE HOSPITAL TO PROMOTE AND PROVIDE HEALTHY COMMUNITY BENEFITS.HOSPITAL WORKS WITH COUNTY HEALTH DEPARTMENT TO PROMOTE HEALTHY LIVING AND PREVENTION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KANUTE RAREY | ||||||||||||||
| CEO | 150582 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 10458 | 0 | 161040 | 0 | 0 | 0 |
| JEANNINE PERRENOUD | ||||||||||||||
| PHYSICIAN | 298235 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15581 | 0 | 313816 | 0 | 0 | 0 |
| KATHY SHORT | ||||||||||||||
| PHYSICIAN | 248162 | 0 | 0 | 0 | 15000 | 0 | 0 | 0 | 4948 | 0 | 268110 | 0 | 0 | 0 |
| SHERRELL NUNNELLEY | ||||||||||||||
| PHYSICIAN | 207450 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 6516 | 0 | 213966 | 0 | 0 | 0 |
| MILAGROS RIVERA | ||||||||||||||
| PHYSICIAN | 182117 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4730 | 0 | 186847 | 0 | 0 | 0 |
| WINSTON YAP | ||||||||||||||
| PHYSICIAN | 179787 | 0 | 102553 | 0 | 0 | 0 | 0 | 0 | 1289 | 0 | 283629 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | ALLIANT MANAGEMENT SERVICES OVERSEES OPERATION OF THE HOSPITAL. THE COMPANY REPORTS TO THE BOARD OF DIRECTORS AND SERVES AT THEIR DIRECTION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CFO REVIEWS THE 990 AND THEN THE 990 IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO ITS FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY HAVING BOARD MEMBERS COMPLETE A FORM EACH YEAR. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE CEO IS REVIEWED, DETERMINED AND APPROVED BY THE CCMH BOARD OF DIRECTORS. IT IS PART OF AN EMPLOYMENT CONTRACT FOR THE CEO. COMPARATIVE DATA FOR A HOSPITAL OF THIS SIZE AND IN THIS GEOGRAPHIC AREA ARE USED AMONG OTHER FACTORS. SALARY ADJUSTMENT IS REVIEWED ANNUALLY BY THE BOARD. THE CONTRACT IS REVIEWED EVERY TWO YEARS. COMPENSATION FOR THE CFO, CNO AND DEPARTMENT MANAGER SALARY AND WAGES ARE BASED ON A SALARY SCALE CONSIDERING YEARS OF EXPERIENCE AND YEARS OF SERVICE AT THE HOSPITAL. ANNUAL INCREASES ARE REVIEWED AND APPROVED BY THE CCMH BOARD AS PART OF THE BUDGETARY PROCESS AND AT THE TIME OF THE SALARY AND WAGE INCREASE. THE SALARY SCALE IS REVIEWED ANNUALLY THROUGH A MARKET ANALYSIS WITH COMPARATIVE DATA FOR HOSPITALS OF THIS SIZE IN THE GEOGRAPHIC AREA. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART IX, LINE 11G | COLLECTION FEES: PROGRAM SERVICE EXPENSES 55,116. MANAGEMENT AND GENERAL EXPENSES 31,003. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,119. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 465,551. MANAGEMENT AND GENERAL EXPENSES 261,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 727,423. LAUNDRY SERVICE: PROGRAM SERVICE EXPENSES 50,181. MANAGEMENT AND GENERAL EXPENSES 28,227. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,408. REFUSE SERVICES: PROGRAM SERVICE EXPENSES 6,465. MANAGEMENT AND GENERAL EXPENSES 3,637. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,102. AMBULANCE SERVICES: PROGRAM SERVICE EXPENSES 2,948. MANAGEMENT AND GENERAL EXPENSES 1,658. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,606. OTHER FEES: PROGRAM SERVICE EXPENSES 825,338. MANAGEMENT AND GENERAL EXPENSES 527,335. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,352,673. | OTHER FEES |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. THE ORGANIZATION HAS A FINANCE COMMITTEE THAT OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE INDEPENDENT AUDITOR MEETS WITH THE FINANCE COMMITTEE AT THE CONCLUSION OF THE AUDIT. |