DOCTORS MEMORIAL HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- DOCTORS MEMORIAL HOSPITAL INC (EIN 59-3122517)
- Tax period
- 2021-06-01 to 2022-05-31
- Filed
- 2023-04-17
- IRS object ID
- 202321079349300302
- Schema version
- 2021v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-04-17T07:10:53-04:00 | ReturnTs |
| Tax Period End | 2022-05-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-06-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 593122517 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOCTORS' MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DOCT | BusinessNameControlTxt |
| Phone | 8505840800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 NORTH BYRON BUTLER PARKWAY | AddressLine1Txt |
| City | PERRY | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323472300 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DOUG FAIRCLOTH | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8505840800 | PhoneNum |
| Signature | 2023-04-14 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DOUG | PersonFirstNm |
| Person Last | FAIRCLOTH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRIS SCHMIDT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 NORTH BYRON BUTLER PARKWAY | AddressLine1Txt |
| City | PERRY | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323472300 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,073,382 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DOCTORSMEMORIAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO CITIZENS OF TAYLOR AND SURROUNDING COUNTIES. PATIENTS WHO MEET CERTAIN CRITERIA ARE PROVIDED FREE CARE OR CARE CHARGED AT REDUCED RATES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 289 | TotalEmployeeCnt |
| Total Volunteers | 32 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $4,455,238 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,738,046 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,480,708 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,331,263 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,159 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,073 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $22,943,105 | PYTotalRevenueAmt |
| CY Total Revenue | $25,073,382 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,351,660 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,091,811 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,850,672 | PYOtherExpensesAmt |
| CY Other Expenses | $9,356,792 | CYOtherExpensesAmt |
| PY Total Expenses | $19,202,332 | PYTotalExpensesAmt |
| CY Total Expenses | $21,448,603 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,740,773 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,624,779 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,104,022 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,891,631 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,271,964 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,434,794 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,832,058 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,456,837 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE HOSPITAL PROVIDES ACUTE INPATIENT, OUTPATIENT, EMERGENCY, AMBULANCE AND HEALTH CLINIC SERVICES TO THE CITIZENS OF TAYLOR COUNTY, FL AND SURROUNDING COUNTIES. PATIENTS WHO MEET CERTAIN CRITERIA ARE PROVIDED FREE CARE OR CARE AT REDUCED RATES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $14,460,017 | ExpenseAmt |
| Revenue | $19,331,263 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDED INPATIENT, OUTPATIENT, RURAL HEALTH CLINIC AND EMERGENCY SERVICES TO APPROXIMATELY 19,0000 RESIDENTS OF TAYLOR COUNTY FL AND SURROUNDING COUNTIES. TAYLOR COUNTY BOARD OF COMMISSIONERS PROVIDED 1,200,150 IN-KIND DONATIONS INCLUDING THE HOSPITAL BUILDING AND 227,721 IN MEDICAL EQUIPMENT. | Desc |
| Total Program Service Expenses | $14,460,017 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 289 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JULIE YOUNG CONTROLLER | PersonNm |
| Phone | 8505840800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 NORTH BYRON BUTLER PARKWAY | AddressLine1Txt |
| City | PERRY | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 323472300 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| CHRIS SCHMIDT | |||||||
| CEO | 40.00 | Yes (X) | $239,074 | $0 | $0 | ||
| PAT BARBAREE | |||||||
| CHAIRMAN | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARK O'BRYANT | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| LAUREN FAISON-CLARK | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| DEBRA MCGREW | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| PRISCILLA TRIPP | |||||||
| VICE CHAIRMA | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KEN ARNOLD | |||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| NELDA PARKER-PACE | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| JENNIFER SHOPLACK | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| DOUG FAIRCLOTH | |||||||
| CFO | 24.00 | Yes (X) | $187,320 | $0 | $0 | ||
| MILES NELSON MD | |||||||
| PHYSICIAN | 40.00 | $380,374 | $0 | $11,957 | Yes (X) | ||
| TAE YU MD | |||||||
| PHYSICIAN | 40.00 | $315,540 | $0 | $19,306 | Yes (X) | ||
| RAMEL FAILMA MD | |||||||
| PHYSICIAN | 40.00 | $291,381 | $0 | $14,851 | Yes (X) | ||
| CARA PAPPAS | |||||||
| APRN | 32.00 | $140,402 | $0 | $0 | Yes (X) | ||
| TERRELL HEARTON-JONES | |||||||
| RN | 55.00 | $124,676 | $0 | $6,751 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,678,767 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $52,865 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EMCARE PHYSICIAN SERVICES | |||||
| 7032 COLLECTION CTR DRIVE | CHICAGO | IL | 60693 | ER PHYSICIANS | $234,237 |
| BLUE MANAGEMENT SERVICES | |||||
| 2650 EASTPOINT PARKWAY SUITE 200 | LOUISVILLE | KY | 40223 | MGMT CONSULTING | $223,873 |
| AYA HEALTHCARE INC | |||||
| BOX 123519 | DALLAS | TX | 75312 | NURSING STAFF | $207,444 |
| D FAIRCLOTH CONSULTING | |||||
| 315 BYRON PLANTATION ROAD | ALBANY | GA | 31721 | FINANCIAL CONS. | $187,320 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,800 | GovernmentGrantsAmt |
| All Other Contributions | $5,732,246 | AllOtherContributionsAmt |
| Noncash Contributions | $5,800 | NoncashContributionsAmt |
| Total Contributions | $5,738,046 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $19,331,263 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,331,263 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,331,263 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,073 | TotalRevenueColumnAmt |
| Exclusion | $4,073 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,073,382 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,331,263 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,073 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $426,394 | TotalAmt |
| Management And General | $426,394 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,819,097 | TotalAmt |
| Program Services | $7,887,053 | ProgramServicesAmt |
| Management And General | $1,932,044 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,167,319 | TotalAmt |
| Program Services | $937,633 | ProgramServicesAmt |
| Management And General | $229,686 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $679,001 | TotalAmt |
| Program Services | $542,605 | ProgramServicesAmt |
| Management And General | $136,396 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $880,264 | TotalAmt |
| Program Services | $791,432 | ProgramServicesAmt |
| Management And General | $88,832 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $577,348 | TotalAmt |
| Program Services | $70,152 | ProgramServicesAmt |
| Management And General | $507,196 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,446 | TotalAmt |
| Program Services | $2,446 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,952 | TotalAmt |
| Management And General | $35,952 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578,333 | TotalAmt |
| Management And General | $578,333 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $445,245 | TotalAmt |
| Program Services | $73,163 | ProgramServicesAmt |
| Management And General | $372,082 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $3,264,171 | $2,811,064 | $453,107 |
| SERVICES | $2,260,769 | $641,866 | $1,618,903 |
| REPAIRS & MAINTENANCE | $667,288 | $494,181 | $173,107 |
| MISCELLANEOUS | $644,976 | $208,422 | $436,554 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,448,603 | TotalAmt |
| Program Services | $14,460,017 | ProgramServicesAmt |
| Management And General | $6,988,586 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,666,669 | BOYAmt |
| EOY | $5,222,614 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,342,038 | BOYAmt |
| EOY | $3,242,047 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $639,327 | BOYAmt |
| EOY | $708,088 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $292,090 | BOYAmt |
| EOY | $328,055 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,161,080 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,770,253 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,163,898 | BOYAmt |
| EOY | $3,390,827 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,104,022 | BOYAmt |
| EOY | $12,891,631 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,610,759 | BOYAmt |
| EOY | $2,083,494 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,661,205 | BOYAmt |
| EOY | $351,300 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,271,964 | BOYAmt |
| EOY | $2,434,794 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,832,058 | BOYAmt |
| EOY | $10,456,837 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,832,058 | BOYAmt |
| EOY | $10,456,837 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,104,022 | BOYAmt |
| EOY | $12,891,631 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,624,779 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $318,126 | OtherCostOrOtherBasisAmt |
| Book Value | $318,126 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,683,407 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,634,993 | DepreciationAmt |
| Book Value | $1,048,414 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,159,547 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,135,260 | DepreciationAmt |
| Book Value | $2,024,287 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,390,827 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,437,437 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $1,328,103 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $35,952 | OtherRevenueAmt |
| Revenue Not Reported | $1,364,055 | RevenueNotReportedAmt |
| Revenue Subtotal | $25,073,382 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $25,073,382 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,740,754 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,328,103 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $1,328,103 | ExpensesNotReportedAmt |
| Expenses Subtotal | $21,412,651 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $35,952 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $35,952 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $21,448,603 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF MAY 31, 2022 AND 2021 OR FOR THE YEARS THEN ENDED. AS REQUIRED BY INTERNAL REVENUE SERVICE REGULATIONS, THE HOSPITAL ANNUALLY FILES A FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAXES WITH THE INTERNAL REVENUE SERVICE. THESE RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | INTEREST EXPENSE 35,952 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | INTEREST EXPENSE 35,952 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $54,423 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $54,423 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,292,391 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,264,357 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,028,034 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04790 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,346,814 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,264,357 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,082,457 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05050 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,346,814 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,264,357 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,082,457 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,483,040 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,651,820 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,627,730 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$975,910 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOCTORS' MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 NORTH BYRON BUTLER PARKWAY | AddressLine1Txt |
| City | PERRY | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 32347 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DOCTORSMEMORIAL.COM | WebsiteAddressTxt |
| State License | 3857 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 3 RURAL HEALTH CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOCTORS' MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.DOCTORSMEMORIAL.COM | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.FLORIDAHEALTH.GOV/CHDTAYLOR/INDEX. | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.FLORIDAHEALTH.GOV | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.DOCTORSMEMORIAL.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.DOCTORSMEMORIAL.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.DOCTORSMEMORIAL.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, DOCTORS' MEMORIAL HOSPITAL, INC. - PART V, LINE 3E | THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE HEALTH NEEDS OF THE COMMUNITY AND ARE IDENTIFIED THROUGH CHNA. THE NEEDS LISTED IN THE CHNA ARE: HEALTH AND HEALTH CARE HEALTH BEHAVIORS CHILDREN IN SINGLE PARENT HOMES LACK OF INSURANCE SEVERE HOUSING PROBLEMS NO PRENATAL CARE INCREASE IN DOMESTIC VIOLENCE INJURY DEATHS GRADUATION RATE LENGTH OF LIFE QUALITY OF LIFE AVAILABILITY OF HEALTH RESOURCES SMOKING AND OBESITY UNEMPLOYMENT POVERTY ACCESS TO EXERCISE OPPORTUNITIES VEHICLE CRASHES AND DEATHS ILLEGAL DRUG AND ALCOHOL USE |
| FACILITY 1, DOCTORS' MEMORIAL HOSPITAL, INC. - PART V, LINE 5 | THE COMMUNITY HEALTH ASSESSMENT RELIED ON A PARTICIPATORY, COLLABORATIVE APPROACH GUIDED BY THE MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS PROCESS (MAPP). THE TAYLOR COUNTY HEALTH DEPARTMENT WORKED WITHA NUMBER OF COMMUNITY HEALTH PARTNERS AND COMMUNITY RESIDENTS. MEETINGS AND WORKSHOPS WERE HELD TO IDENTIFY AND ASSESS PERCEPTIONS, HEALTH CONCERNS, STRENGTHS AND WEAKNESSES AND OTHER RELATED ISSUES ABOUT THE HEALTH PROGRAMS AND SERVICES AVAILABLE WITHIN TAYLOR COUNTY. THESE COMMUNITY HEALTH PARTNERS INCLUDED BOTH PUBLIC AND PRIVATE ORGANIZATIONS AND INDIVIDUAL MEMBERS ARE IDENTIFIED IN THE REPORT. THE COMMUNITY HEALTH STATUS PROFILE WAS CONDUCTED, A FORCES OF CHANGE WORKSHOP OCCURED AND INCLUDED 12 COMMUNITY HEALTH PARTNERS REPRESENTING SIX AGENCIES. THERE WAS ALSO A COMMUNITY THEMES AND STRENGTHS WORKSHOP WITH A SIGNIFICANT NUMBER OF COMMUNITY HEALTH PARTNERS ATTENDING. SOME WERE: TAYLOR COUNTY HEALTH DEPARTMENT TAYLOR COUNTY EMERGENCY MANAGEMENT BIG BEND AHEC HEALTH START TAYLOR COUNTY SCHOOL DISTRICT FLORIDA DEPARTMENT OF HEALTH |
| FACILITY 1, DOCTORS' MEMORIAL HOSPITAL, INC. - PART V, LINE 6B | TO LEVERAGE RESOURCES AND MOST EFFECTIVELY WORK TOGETHER, THE FLORIDA DEPARTMENT OF HEALTH, TAYLOR COUNTY, PARTNERED ITH DOCTORS' MEMORIAL HOSPITAL, INC. TO COMPLETE THE CHNA. |
| FACILITY 1, DOCTORS' MEMORIAL HOSPITAL, INC. - PART V, LINE 7D | THE TAYLOR COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IS MADE AVAILABLE TO THE GENERAL PUBLIC VIA THE FLORIDA DEPARTMENT OF HEALTH-TAYLOR COUNTY WEBSITE AS WELL AS DOCTORS' MEMORIAL HOSPITAL, INC. WEBSITE. A HARDCOPY MAY BE VIEWED AT THE OFFICE OF THE FDOH OR AT THE HOSPITAL. COPIES OF THE REPORT HAVE BEEN MADE AVAILABLE TO ALL OF THE COMMUNITY HEALTH PARTNERS. |
| FACILITY 1, DOCTORS' MEMORIAL HOSPITAL, INC. - PART V, LINE 11 | OBESITY WAS IDENTIFIED AS A SIGNIFICANT HEALTH NEED IN THE SERVICE AREA BUT WILL NOT BE ADDRESSED IN THIS CHNA. DUE TO A CONSTRAINT OF RESOURCES AND THE EFFORT REQUIRED TO ADDRESS THE HEALTH NEEDS, OBESITY WILL NOT BE DIRECTLY ADDRESSED AT THIS TIME. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| DOCTORS' MEMORIAL FAMILY PRACTICE | ||||
| 555 N BRYON BUTLER PARKWAY | PERRY | FL | 32347 | RURAL HEALTH CLINIC |
| DOCTORS' MEMORIAL FAMILY MEDICINE | ||||
| PO BOX 228 | MAYO | FL | 32066 | RURAL HEALTH CLINIC |
| STEINHATCHEE FAMILY MEDICAL CLINIC | ||||
| 29 FIRST AVE | STEINHATCHEE | FL | 32359 | RURAL HEALTH CLINIC |
| DOCTORS' MEMORIAL SURGICAL SERVICES | ||||
| 1224 N PEACOCK ST | PERRY | FL | 32347 | HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | THE COSTS FOR PART I, LINE 7A AND 7C WERE DETERMINED USING THE RATIO OF COSTS TO CHARGES CALCULATED USING WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990 SCHEDULE H. THE COST TO CHARGE RATIO AND THE MEDICAID SHORTFALL CALCULATIONS ARE ADJUSTED FOR HOSPITAL BASED PROVIDER TAXES AND MEDICAID SUPPLEMENTAL REVENUES. |
| SCHEDULE H, PART III, LINE 4 | PROVISION FOR BAD DEBTS AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATION TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED UNDER THE HOSPITAL'S POLICIES. |
| SCHEDULE H, PART III, LINE 8 | THE AMERICAN HOSPITAL ASSOCIATION HAS REPORTED THE MEDICARE AND MEDICAID PROGRAMS PAID HOSPITALS 86 & 89 CENTS RESPECTIVELY FOR EACH DOLLAR SPENT ON PATIENT CARE. OUR HOSPITAL HAS EXPERIENCED A REDUCTION IN THESE PAYMENTS WITH THE EXPANSION OF MANAGED CARE. THIS SHORTFALL IS A GROWING FINANCIAL BURDEN ON RURAL HOSPITALS AND IS A BENEFIT TO PATIENTS WHO ARE RECEIVING THIS UNCOMPENSATED CARE. SEE UNCOMPENSATED SERVICES ON PAGE 19 OF AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 9B | THE HOSPITAL ATTEMPTS TO IDENTIFY PATIENTS WHO QUALIFY FOR FINANCIAL ASSSITANCE AT THE TIME OF ADMISSION. IF THE PATIENT IS IDENTIFIED PRIOR TO RECEIVING SERVICE, THE PATIENT DOES NOT RECEIVE A BILL. IF THE PATIENT IS NOT IDENTIFIED PRIOR TO SERVICE, THE PATIENT WILL RECEIVE A BILL. THE BILL INCLUDES A NOTICE ADVISING THE PATIENT OF THE FINANCIAL ASSISTANCE PROGRAM AND ENCOURAGING THEM TO APPLY. |
| SCHEDULE H, PART VI, LINE 3 | THE HOSPITAL INFORMS & EDUCATES PATIENTS REGARDING OPTIONS FOR RESOLUTION OF THEIR ACCOUNT BALANCE, INCLUDING ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IN A VARIETY OF WAYS. SIGNAGE & BROCHURES ARE PLACED IN LOCATIONS WHERE PATIENTS REGISTER FOR CARE, PATIENT ACCESS AREAS AND VARIOUS POINTS OF ENTRY SUCH AS THE ER DEPARTMENT. ASSISTANCE FROM A FINANCIAL COUNSELOR IS AVAILABLE UPON REQUEST. ADMISSION SOFTWARE HAS THE CAPABILITY OF EVALUATING QUALIFICATION FOR ASSISTANCE BASED UPON INCOME LEVEL. THE PATIENT IS THEN PROVIDED AN APPLICATION AND REFERRED TO A FINANCIAL COUNSELOR. |
| SCHEDULE H, PART VI, LINE 4 | THE HOSPITAL PROVIDES HEALTH CARE SERVICES TO CITIZENS OF TAYLOR, LAFAYETTE, AND SURROUNDING COUNTIES IN FLORIDA. |
| SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL PROMOTES COMMUNITY HEALTH THROUGH EDUCATION, COUNSELING & SUPPORT SERVICES, HEALTH SCREENINGS, EDUCATION IN A CLINICAL SETTING, SPECIALTY IN-SERVICE PROGRAMS, SCHOLARSHIPS FOR HEALTH PROFESSIONAL'S EDUCATION, SPONSORSHIPS FOR RELAY FOR LIFE, PARTICIPATION IN COMMUNITY HEALTH FESTIVALS AND SUPPORT FOR THE BOY & GIRLS CLUB IN PERRY, FL. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt |
|---|---|---|---|---|
| CHRIS SCHMIDT | ||||
| CEO | $239,074 | $239,074 | ||
| DOUG FAIRCLOTH | ||||
| CFO | $187,320 | $187,320 | ||
| MILES NELSON MD | ||||
| PHYSICIAN | $380,374 | $392,331 | $11,957 | |
| TAE YU MD | ||||
| PHYSICIAN | $315,540 | $334,846 | $19,306 | |
| RAMEL FAILMA MD | ||||
| PHYSICIAN | $291,381 | $306,232 | $14,851 | |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE HOSPITAL PROVIDES ACUTE INPATIENT, OUTPATIENT, EMERGENCY, AMBULANCE AND HEALTH CLINIC SERVICES TO THE CITIZENS OF TAYLOR COUNTY, FL AND SURROUNDING COUNTIES. PATIENTS WHO MEET CERTAIN CRITERIA ARE PROVIDED FREE CARE OR CARE AT REDUCED RATES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 AND SUPPORTING SCHEDULES ARE DISTRIBUTED TO THE BUDGET & AUDIT COMMITTEE MEMBERS FOR A DETAIL REVIEW. THE CFO RESPONDS TO QUESTIONS AND CONCERNS FROM THE MEMBERS. COPIES ARE ALSO DISTRIBUTED TO EACH MEMBER OF THE GOVERNING BOARD FOR REVIEW AND APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE GOVERNING BODY REGULARLY REVIEWS AND DISCUSSES CONFLICT OF INTEREST POLICIES AND TAKES ACTION IF NECESSARY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | HIRING AND COMPENSATION OF TOP MANAGEMENT IS EVALUATED BY A MANAGEMENT CONSULTING FIRM. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE 15A ABOVE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | UPON REQUEST, THE ORGANIZATION MAKES AVAILABLE ITS GOVERNING DOCUMENT, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS. THESE DOCUMENTS ARE MAINTAINED IN THE ADMINISTRATIVE OFFICES AND ARE AVAILABLE DURING BUSINESS HOURS. IN ADDITION, THE AUDITED FINANCIAL STATEMENTS, INTERNAL FINANCIAL STATEMENTS AND OTHER INFORMATION RELATED TO THE ORGANIZATION IS POSTED ON THE WEBSITE. |