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COMMUNITY MEDICAL CENTER OF IZARD COUNTY: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEDICAL CENTER OF IZARD COUNTY (EIN 71-0410601)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201133199349307453
Schema version
2010v3.2
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

FieldValueIRS element (for citing)
Timestamp2011-11-15T12:37:57-08:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Hughes Welch & MilliganCPASLTDBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 2094AddressLine1
CityBatesvilleCity
StateARState
ZIP Code725032094ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN710410601EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEDICAL CENTER OF IZARD COUNTYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone8702973739Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 438AddressLine1
CityCALICO ROCKCity
StateARState
ZIP Code72519ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePHILIP HUGHESName
TitleCEOTitle
Date Signed2011-11-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameTOMMY J MILLIGANName
Phone8707935231Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts7698270GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.cmcofic.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1991YearFormation
State Legal DomicileARStateLegalDomicile
Activity Or Mission DescriptionHEALTH CARE PROVIDERActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees162TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year111704ContributionsGrantsPriorYear
Contributions Grants Current Year372155ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7103097ProgramServiceRevenuePriorYear
Program Service Revenue CY6451511ProgramServiceRevenueCY
Investment Income Prior Year27439InvestmentIncomePriorYear
Investment Income Current Year106197InvestmentIncomeCurrentYear
Other Revenue Prior Year828621OtherRevenuePriorYear
Other Revenue Current Year768407OtherRevenueCurrentYear
Total Revenue Prior Year8070861TotalRevenuePriorYear
Total Revenue Current Year7698270TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4569457SalariesEtcPriorYear
Salaries Etc Current Year3828882SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4624226OtherExpensePriorYear
Other Expenses Current Year4339854OtherExpensesCurrentYear
Total Expenses Prior Year9193683TotalExpensesPriorYear
Total Expenses Current Year8168736TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1122822RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-470466RevenuesLessExpensesCY
Total Assets BOY6290079TotalAssetsBOY
Total Assets EOY5525096TotalAssetsEOY
Total Liabilities BOY5146398TotalLiabilitiesBOY
Total Liabilities EOY4851881TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1143681NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY673215NetAssetsOrFundBalancesEOY
Mission DescriptionHEALTH CARE PROVIDERMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense6118078Expense
DescriptionTHE HOSPITAL PROVIDES ACUTE HOSPITAL AND OUTPATIENT CARE TO RESIDENTS OF IZARD COUNTY AND SURROUNDING AREAS.Description
Total Program Service Expense6118078TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPtrueLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109617NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees162NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteesfalseMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Annual Disclosure Covered PersonsfalseAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPHILIP HUGHESNamePerson
Telephone Number8702973739TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 438AddressLine1
CityCALICO ROCKCity
StateARState
ZIP Code72519ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeFormerFormer
SUSAN KEMP
Director0.00X000
ROBERT C LANE MD
Director0.00X3953000
REED PERRYMAN
Director0.00X000
PHILIP HUGHES
CEO0.006336700XX
PAUL MILLER
Director40.00X000
MONDALYN C McCORMACK
Sec/Treasurer0.00X000X
MARK HERRINGTON
Director0.00X000
KIM SKIDMORE
COO40.005050100XX
KAREN CONRAD MOORE
CFO40.001782700XX
GENNA NAVE
COO0.002239200X
DR MERLY GRASSE
Director0.00X17902300XX
DANNY MOSER
Director0.00X000
COURT FABYAN MATHEY
Director0.00X000
CATHY FRANKS
CNO40.005616300XX
CARL PITTS
Director0.00X000
ANGELA RICHMOND
CEO0.005726300X
FieldValueIRS element (for citing)
Total Reportable Comp From Org486066TotalReportableCompFromOrg
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ANTHONY M GRASSE MD
HC 70 BOX 136CALICO ROCKAR72519MEDICAL DIRECTOR179023
CORRECT CARE INC
17438 HARD HAT DRIVECOVINGTONLA70435ER PHYSICIANS825505
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
All Other Contributions372155AllOtherContributions
Total Contributions372155TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Total Revenue Column6451511TotalRevenueColumn
Related Or Exempt Function Income6451511RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue6451511TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column106197TotalRevenueColumn
Related Or Exempt Function Income105886RelatedOrExemptFunctionIncome
Exclusion$311ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real581731Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real581731Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column581731TotalRevenueColumn
Related Or Exempt Function Income581731RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
VENDING MACHINES2796$2,796
OTHER MISC REVENUE150520$150,520
MEAL REVENUE31307$31,307

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2053TotalRevenueColumn
Exclusion$2,053ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue186676TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7698270TotalRevenueColumn
Related Or Exempt Function Income7139128RelatedOrExemptFunctionIncome
Exclusion$186,987ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total486066Total
Management And General486066ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2709782Total
Program Services2458475ProgramServices
Management And General251307ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total23040Total
Program Services17741ProgramServices
Management And General5299ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total319527Total
Program Services246036ProgramServices
Management And General73491ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total290467Total
Program Services223660ProgramServices
Management And General66807ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total50954Total
Management And General50954ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total179677Total
Program Services22907ProgramServices
Management And General156770ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total16634Total
Program Services15069ProgramServices
Management And General1565ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total172874Total
Management And General172874ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total467386Total
Management And General467386ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total98726Total
Management And General98726ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES & OTHER942984787534155450
REPAIRS & MAINTENANCE4462944629
PURCHASED SERVICES1363368132246040908
PROPERTY TAXES2305523055
BAD DEBTS979567979567

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8168736Total
Program Services6118078ProgramServices
Management And General2050658ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2677BOY
EOY150298EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1559439BOY
EOY1090325EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY105830BOY
EOY94859EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY44851BOY
EOY39571EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8929895LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5179177LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4191535BOY
EOY3750718EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY385747BOY
EOY399325EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6290079BOY
EOY5525096EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1743709BOY
EOY1273389EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
EOY490330EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3402689BOY
EOY3088162EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5146398BOY
EOY4851881EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1143681BOY
EOY673215EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1143681BOY
EOY673215EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6290079BOY
EOY5525096EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-470466ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis66556OtherCostOrOtherBasis
Book Value66556BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4419204OtherCostOrOtherBasis
Depreciation1284100Depreciation
Book Value3135104BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis135368OtherCostOrOtherBasis
Depreciation87032Depreciation
Book Value48336BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4280251OtherCostOrOtherBasis
Depreciation3805430Depreciation
Book Value474821BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis28516OtherCostOrOtherBasis
Depreciation2615Depreciation
Book Value25901BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3750718TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
THIRD-PARTY SETTLEMENT328960
INVESTMENT IN CMC HH & HOSPICE15763
ASSETS LIMITED TO USE54602
FieldValueIRS element (for citing)
Total Book Value Other Assets399325TotalBookValueOtherAssets
Total Revenue7698270TotalRevenue
Total Expenses8168736TotalExpenses
Excess Or Deficit For Year-470466ExcessOrDeficitForYear
Excess Or Deficit Per FS-470466ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt7698270TotRevenueEtcAuditedFinclStmt
Revenue Subtotal7698270RevenueSubtotal
Total Revenue Per Form9907698270TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8168736TotExpensesEtcAuditedFinclStmt
Expenses Subtotal8168736ExpensesSubtotal
Total Expenses Per Form9908168736TotalExpensesPerForm990

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigentfalseFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReportfalseAnnualCommunityBenefitReport
Report Publically AvailablefalseReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense144990TotalCommunityBenefitExpense
Net Community Benefit Expense144990NetCommunityBenefitExpense
Percent Of Total Expense0.01770PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense397356TotalCommunityBenefitExpense
Net Community Benefit Expense397356NetCommunityBenefitExpense
Percent Of Total Expense0.04860PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense542346TotalCommunityBenefitExpense
Net Community Benefit Expense542346NetCommunityBenefitExpense
Percent Of Total Expense0.06630PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense542346TotalCommunityBenefitExpense
Net Community Benefit Expense542346NetCommunityBenefitExpense
Percent Of Total Expense0.06630PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$979,567BadDebtExpenseAmount
Amount Reimbursed By Medicare3515181AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare3558235CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-43054MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1CMC HOME HLTH & HOSPICELLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityHEALTHCAREDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.33000OrganizationProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number0FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MED CTR OF IZARD COBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1PO BOX 438AddressLine1
CityCALICO ROCKCity
StateARState
ZIP Code72519ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MED CTR OF IZARD COBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedfalseCHNAConducted
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent115.0000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.0000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
State RegulationXStateRegulation
Other FactorsXOtherFactors
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Actions On NonpaymentfalseActionsOnNonpayment
Collection ActivitiestrueCollectionActivities
Report To Credit AgencyXReportToCreditAgency
Other ActionsXOtherActions
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledtrueAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part V - Explanation of Number of Facility Type1-HOSPITAL, 3-RURAL CLINICS
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeOPEN MEDICAL STAFF AND HEALTHCARE EDUCATON IN THE COMMUNITY
Part VI - Community InformationRURAL SETTING, PREDOMINANTLY AGRICULTURAL BASE, AVERAGE INCOME AT OR BELOW POVERTY GUIDELINES. PREDOMINANTLY CAUCASION, HIGH SCHOOL EDUCATED AND GERIATRIC IN NATURE.
Part VI - Patient Education of Eligibility for AssistanceINFORMS PATIENTS UPON ADMISSION AND POSTS NOTICES IN CONSPICUOUS AREAS
Part VI - Needs AssessmentUTILIZES ANNUAL STATISTICAL REPORT WITH DEMOGRAPHIC INFORMATION FROM DHS AS WELL AS REPORTS SHOWING PERCENT OF ACTIVITY OF COMMUNITY PAYOR SOURCE
Part V, Line 21 - Charge Patients Amount Equal Gross Charge for ServicesNO SELF PAY DISCOUNT IN PLACENumber of Hospital Faciltiy - 0
Part V, Line 20 - Explanation of Eligible Assistance Patients Billed More Than Insurance RatesNO SELF PAY DISCOUNT IN PLACENumber of Hospital Faciltiy - 0
Part V, Line 19d - Other Billing Determination of Individuals Without Insurance15% DISCOUNT TO ACCOUNTS PAID IN FULLNumber of Hospital Faciltiy - 0
Part V, Line 16e - Other Collection Actions by Facility or Third Party EngagedWRITTEN AND VERBAL COMMUNICATIONS WITH PATIENTS REGARDING ACCOUNT BALANCESNumber of Hospital Faciltiy - 0
Part V, Line 11h - Other Factors Used in Determing Amounts Charged PatientsREASONABLE LIVING EXPENSESNumber of Hospital Faciltiy - 0
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsPATIENTS ARE INFORMED OF CHARITY CARE PROGRAM.
Part III, Line 8 - Explanation Of Shortfall As Community BenefitTHE FACILITY IS A CRITICAL ACCESS HOSPITAL AND ALL MEDICARE ALLOWABLE COSTS ARE REIMBURSED THROUGH THE COST REPORT PROCESS.
Part III, Line 4 - Bad Debt ExpenseTHE HOSPITAL HAS ESTABLISHED ALLOWANCES FOR BAD DEBTS AND FOR CONTRACTUAL ADJUSTMENTS ON MEDICARE-MEDICAID ACCOUNTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
GENNA NAVE
2239222392
DR MERLY GRASSE
179023179023
ANGELA RICHMOND
5726357263

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonDR ANTHONY MERYL GRASSENamePerson
Purpose Of LoanGENERAL OPERATING EXPENSESPurposeOfLoan
Loan To OrganizationXLoanToOrganization
Original Principal$590,330OriginalPrincipalAmount
Balance Due490330BalanceDue
DefaultfalseDefault
Approved By BoardtrueApprovedByBoard
Written AgreementtrueWrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due490330TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableAVAILABLE UPON REQUEST FROM ADMINISTRATION
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessEXAMINED AND APPROVED BY BOARD. AVAILABLE FOR REVIEW UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CMC HOME HEALTH AND HOSPICE LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1420 WEST PINHOOK SUITE AAddressLine1
CityLAFAYETTECity
StateLAState
ZIP Code70503ZIPCode
FieldValueIRS element (for citing)
EIN262688869EIN
Primary ActivityHEALTHCAREPrimaryActivity
Legal Domicile StateLALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg