CARROLL COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: CARROLL COUNTY MEMORIAL HOSPITAL (EIN 44-0629397)
Tax period: 2009-07-01 to 2010-06-30
Filed: 2011-05-12
IRS object ID: 201101329349302800
Schema version: 2009v1.7
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule D
Schedule H
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-05-12T13:09:19-05:00	Timestamp
Tax Period End Date	2010-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Wendling Noe Nelson & Johnson LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	534 S Kansas Ave Suite 1500	AddressLine1
City	Topeka	City
State	KS	State
ZIP Code	666033491	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2009-07-01	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)
Name Control	CARR	NameControl
Phone	6605421695	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1502 N Jefferson St	AddressLine1
City	Carrollton	City
State	MO	State
ZIP Code	64633	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Jerry Dover	Name
Title	CEO	Title
Phone	6605421695	Phone
Date Signed	2011-05-05	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Gary D Knoll	Name
Phone	7852334226	Phone
Date Prepared	2011-05-05	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Jerry Dover	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	12997843	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c	X	Organization501c
Web Site	N/A	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 an acute care hospital providing inpatient and outpatient medical care regardless of ability to pay.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	201	TotalNbrEmployees
Total Nbr Volunteers	12	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	42751	ContributionsGrantsPriorYear
Contributions Grants Current Year	8960	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	11606395	ProgramServiceRevenuePriorYear
Program Service Revenue CY	12629286	ProgramServiceRevenueCY
Investment Income Prior Year	292424	InvestmentIncomePriorYear
Investment Income Current Year	224828	InvestmentIncomeCurrentYear
Other Revenue Prior Year	108223	OtherRevenuePriorYear
Other Revenue Current Year	121255	OtherRevenueCurrentYear
Total Revenue Prior Year	12049793	TotalRevenuePriorYear
Total Revenue Current Year	12984329	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	6428822	SalariesEtcPriorYear
Salaries Etc Current Year	6870281	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	5242593	OtherExpensePriorYear
Other Expenses Current Year	5387191	OtherExpensesCurrentYear
Total Expenses Prior Year	11671415	TotalExpensesPriorYear
Total Expenses Current Year	12257472	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	378378	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	726857	RevenuesLessExpensesCY
Total Assets BOY	21509515	TotalAssetsBOY
Total Assets EOY	22779169	TotalAssetsEOY
Total Liabilities BOY	1042509	TotalLiabilitiesBOY
Total Liabilities EOY	1049342	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	20467006	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	21729827	NetAssetsOrFundBalancesEOY
Mission Description	To improve the health of the community by assuring excellent medical care to our citizens.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	8492909	Expense
Revenue	12629286	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	8492909	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	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
Balance Sheet Amounts Reported	1	BalanceSheetAmountsReported
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
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	1	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	17	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	0	ComplianceWithBackupWitholding
Number Of Employees	201	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
Excess Business Holdings	0	ExcessBusinessHoldings
Taxable Distributions	0	TaxableDistributions
Distribution To Donor	0	DistributionToDonor
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	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	0	ConflictOfInterestPolicy
Whistleblower Policy	0	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MO	StatesWhereCopyOfReturnIsFiled
Own Website	X	OwnWebsite
Other Website	X	OtherWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Jeff Tindle CFO	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6605421695	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1502 NORTH JEFFERSON	AddressLine1
City	CARROLLTON	City
State	MO	State
ZIP Code	64633	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 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
Edward E Butts
President	4.00	X	X	0	0	0
Stanley Kruse
Vice President	4.00	X	X	0	0	0
Rex Buhrmester
Secretary	4.00	X	X	0	0	0
Carolyn Lock
Director	4.00	X		0	0	0
Linda Ross
Director	4.00	X		0	0	0
Dick Woodward
Director	4.00	X		0	0	0
Donald Kampschmidt
Director	4.00	X		0	0	0
Randall Barry
Director	4.00	X		0	0	0
Debbie Minnick
Director	4.00	X		0	0	0
Jerry Dover
CEO	40.00		X	167105	0	17414
Jeffrey Tindle
CFO	40.00		X	114270	0	13427
Waclaw A Dymek
Physician	40.00			140881	0	16105	X
Julie Marvin
Pharmacist	40.00			141856	0	9075	X
Richard Smith
Physician	40.00			180686	0	24000	X
Tim Reid
Physician	40.00			55994	0	7200	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	744798	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	80021	TotalOtherCompensation
Number Individuals GT100 K	5	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
Cerner Corporation
2800 Rock Creek Parkway	Kansas City	MO	64117	Computer Systems	250088
Clinishare Inc
19600 E 39th Street	Independence	MO	64057	Nuclear Medicine	246661
Richard L Smith MD
20644 HWY Z	Chillicothe	MO	64601	ER Physician Coverage	155445
Emcare Physician Services
7032 Collection Center Dr	Chicago	IL	60693	ER Physician Coverage	141849
HSMC Technology Services Inc
3550 NE Ralph Powell Rd	Lees Summit	MO	64184	IT Service	107159

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
All Other Contributions	8960	AllOtherContributions
Total Contributions	8960	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Net Patient service re	Description
Business Code	621990	BusinessCode
Total Revenue Column	12629286	TotalRevenueColumn
Related Or Exempt Function Income	12629286	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	12629286	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	238342	TotalRevenueColumn
Exclusion	$238,342	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	57600	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	57600	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	57600	TotalRevenueColumn
Exclusion	$57,600	ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	13514	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	-13514	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-13514	TotalRevenueColumn
Exclusion	-$13,514	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
Other income	900099	44089	$44,089
Vending	900099	10611	$10,611
Medical record fees	621990	4819	$4,819

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4136	TotalRevenueColumn
Exclusion	$4,136	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	63655	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	12984329	TotalRevenueColumn
Related Or Exempt Function Income	12629286	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$346,083	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	308353	Total
Management And General	308353	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	5156855	Total
Program Services	4333182	ProgramServices
Management And General	823673	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	258975	Total
Program Services	224200	ProgramServices
Management And General	34775	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	768111	Total
Program Services	619355	ProgramServices
Management And General	148756	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	377987	Total
Program Services	301976	ProgramServices
Management And General	76011	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	21855	Total
Program Services	596	ProgramServices
Management And General	21259	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	717409	Total
Program Services	580966	ProgramServices
Management And General	136443	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	19255	Total
Program Services	12929	ProgramServices
Management And General	6326	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	999483	Total
Program Services	849343	ProgramServices
Management And General	150140	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	96049	Total
Program Services	96049	ProgramServices

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	448821	Total
Program Services	137501	ProgramServices
Management And General	311320	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	555	Total
Management And General	555	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1110176	Total
Management And General	1110176	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	108617	Total
Management And General	108617	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Collection fees and bad	527131	527131
Professional Fees	470877	440916	29961
Medicaid FRA Tax	319811		319811
Equipment rental and ma	315395	181585	133810
Dietary supplies	122022	122022

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	109735	Total
Program Services	65158	ProgramServices
Management And General	44577	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	12257472	Total
Program Services	8492909	ProgramServices
Management And General	3764563	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	6277030	BOY
EOY	7533874	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	1522126	BOY
EOY	1596950	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	116404	BOY
EOY	117529	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	28577	BOY
EOY	101789	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	18338032	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	7771720	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	11290918	BOY
EOY	10566312	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	1865348	BOY
EOY	2306776	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	409112	BOY
EOY	555939	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	21509515	BOY
EOY	22779169	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1017808	BOY
EOY	1026725	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	24701	BOY
EOY	22617	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1042509	BOY
EOY	1049342	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	20467006	BOY
EOY	21729827	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	20467006	BOY
EOY	21729827	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	21509515	BOY
EOY	22779169	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	0	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	18338032	OtherCostOrOtherBasis
Depreciation	7771720	Depreciation
Book Value	10566312	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	10566312	TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
Equity securities	1369120	F
Corporate bonds	937656	F

Field	Value	IRS element (for citing)
Total Of Book Value Securities	2306776	TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	Property and equipment purchases payable	Description
Amount	$22,617	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	22617	TotalOfAmounts
Total Revenue	12984329	TotalRevenue
Total Expenses	12257472	TotalExpenses
Excess Or Deficit For Year	726857	ExcessOrDeficitForYear
Net Unrealized GL On Investments	535964	NetUnrealizedGLOnInvestments
Total Adjustments	535964	TotalAdjustments
Excess Or Deficit Per FS	1262821	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	13520293	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	535964	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	535964	RevenueNotRptdF990
Revenue Subtotal	12984329	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	12984329	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	12257472	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	12257472	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	12257472	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Part X:	Identifier
Return Reference	Description of Uncertain Tax Positions Under FIN 48:	ReturnReference
Explanation	N/A	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
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	0	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	134654	TotalCommunityBenefitExpense
Direct Offsetting Revenue	84138	DirectOffsettingRevenue
Net Community Benefit Expense	50516	NetCommunityBenefitExpense
Percent Of Total Expense	0.00430	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1729711	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1328331	DirectOffsettingRevenue
Net Community Benefit Expense	401380	NetCommunityBenefitExpense
Percent Of Total Expense	0.03420	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1864365	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1412469	DirectOffsettingRevenue
Net Community Benefit Expense	451896	NetCommunityBenefitExpense
Percent Of Total Expense	0.03850	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2210	TotalCommunityBenefitExpense
Net Community Benefit Expense	2210	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4000	TotalCommunityBenefitExpense
Net Community Benefit Expense	4000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3623025	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2164886	DirectOffsettingRevenue
Net Community Benefit Expense	1458139	NetCommunityBenefitExpense
Percent Of Total Expense	0.12430	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	504	TotalCommunityBenefitExpense
Net Community Benefit Expense	504	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3629739	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2164886	DirectOffsettingRevenue
Net Community Benefit Expense	1464853	NetCommunityBenefitExpense
Percent Of Total Expense	0.12480	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	5494104	TotalCommunityBenefitExpense
Direct Offsetting Revenue	3577355	DirectOffsettingRevenue
Net Community Benefit Expense	1916749	NetCommunityBenefitExpense
Percent Of Total Expense	0.16330	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$279,432	BadDebtExpenseAmount
Amount Attributable To	184807	AmountAttributableTo
Amount Reimbursed By Medicare	4805225	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4757649	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	47576	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

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	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 VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Bad Debt Footnote	Part III, Line 4: The Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Hospital estimates this allowance based on the aging of each type of payor.The Hospitals bad debt at cost was determined by applying an overall ratio of cost to charges. The amount of bad debt attributable to patients eligible for charity care is based on self-pay only patients and patients covered by Medicaid.	BadDebtFootnote
Shortfall As Community Benefit	Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ending June 30, 2010.	ShortfallAsCommunityBenefit
Debt Collection Policy	Part III, Line 9b: Each patient is provided with payment information in clear, easy-to-understand language. CCMH checks on public-assistance programs to see if the patient qualifies. The Hospital offers discounts on charges to underinsured and uninsured patients when possible.	DebtCollectionPolicy
Needs Assessment	Part VI, Line 2: Carroll County Memorial Hospital relies on interaction with local health care agencies as well as feedback from patients and primary service area residents to assess the health care needs of the community.	NeedsAssessment
Patient Education Assistance	Part VI, Line 3: Carroll County Memorial Hospital provides each patient with a letter that clearly states payment information in an easy-to-understand language. The Hospital informs patients promptly about the charge for any item or service provided. The letter informs the patient that if they are not able to pay their hospital bill that there are programs that may help alleviate the burden. If the Hospital is prompted it will check for public-assistance or charity care programs to see if the patient qualifies.	PatientEducationAssistance
Community Information	Part VI, Line 4: Carroll County Memorial Hospital is located in Carrollton, Missouri. The Hospital's primary service area consists of Carrollton and the surrounding areas in Carroll County. Carroll County Memorial Hospital operates two satellite clinics located in Hale and Norborne. Carroll County has a population of approximately 9,500 residents, with 35% of the residents living in urban areas and 65 % living rural 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.	CommunityInformation
Other Information	Part VI, Line 6: The Hospital's Board of Directors is elected from the local community and surrounding area that comprises the local service area. The Hospital's active medical staff members are residents of the local community. 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.	OtherInformation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (4 entries)

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
Jerry Dover
167105	0	0	0	0	0	13094	0	4320	0	184519	0	81193	0
Waclaw A Dymek
140881	0	0	0	0	0	11785	0	4320	0	156986	0	71382	0
Julie Marvin
141856	0	0	0	0	0	9075	0	0	0	150931	0	56376	0
Richard Smith
180686	0	0	0	0	0	14400	0	9600	0	204686	0	9002	0

Schedule L IRS990ScheduleL

Loan Table LoanTable (3 entries)

Purpose Of LoanPurposeOfLoan	Loan From OrganizationLoanFromOrganization	Original PrincipalOriginalPrincipalAmount	Balance DueBalanceDue	DefaultDefault	Approved By BoardApprovedByBoard	Written AgreementWrittenAgreement
Dr Alex Dymek
Operating	X	$20,000	20000	0	1	1
Dr Alex Dymek
Operating	X	$40,000	40000	0	1	1
Andrew Horine
Medical School	X	$40,000	40000	0	1	1

Field	Value	IRS element (for citing)
Total Balance Due	100000	TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifier	ExplanationExplanation
Form 990, Part VI, Section B, line 11	A copy of the Form 990 is provided to members of the Board of Directors prior to filling.
Form 990, Part VI, Section B, line 15a	The organization uses comparability data to determine the compensation of the chief executive officer, with final approval by the board of directors.
Form 990, Part VI, Section C, line 19	The organization makes its governing documents and audited financial statements available to the public upon written request.