2022-11-10T09:17:44-05:00 2021-12-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2021-01-01 593051173 CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC CALH 8506745411 20370 NE BURNS AVENUE BLOUNTSTOWN FL 324241045 CHRISTINIA JEPSEN CEO 8506745411 2022-11-09 true CHRISTINIA JEPSEN 999009999 WILLIAM EDWARD PHILLIPS P00451499 2298837878 2022-11-09 2021 2022-09-23 18:48:47Z CALHOUN-LIBERTY HOSPITAL CHRISTINIA JEPSEN 20370 NE BURNS AVENUE BLOUNTSTOWN FL 324241045 17868224 false X WWW.CALHOUNLIBERTYHOSPITAL.COM X 1991 FL TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. 9 9 188 0 1670666 8181355 7180339 9349776 42598 40621 670395 296472 9563998 17868224 0 0 4637325 6021046 0 0 6042312 6471755 10679637 12492801 -1115639 5375423 13665461 15521432 15122428 11602976 -1456967 3918456 TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. false false 10856920 9655348 TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY THROUGH INPATIENT CARE, OUTPATIENT CARE, EMERGENCY ROOM CARE AND OTHER RELATED SERVICES. 10856920 true true false true false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 30 0 false 188 true false false false false false false false false false false false false X 9 9 false true false false false false false true true false false true true false false true true false false false X BRENDA POTTER 8506745411 P O BOX 419 BLOUNTSTOWN FL 32424 TERESA EDENFIELD NURSE PRACTI X 175826 0 5804 LAURA FORD NURSE PRACTI X 147675 0 0 BRENDA POTTER CFO 40.00 X 94683 0 5717 LABAN BONTRAGER DMD MEMBER 1.00 X 0 0 0 TERRY EUBANKS MEMBER 1.00 X 0 0 0 MELBA FAUROT MEMBER 1.00 X 0 0 0 JOHN TOMLINSON JR TREASURER 1.00 X X 0 0 0 MARY SUE NEVES MEMBER 1.00 X 0 0 0 MARK PLUMMER CHAIRMAN 1.00 X X 0 0 0 TIM REVELL VICE-CHAIRMA 1.00 X X 0 0 0 MARILYN RUSSELL SECRETARY 1.00 X X 0 0 0 LADDIE WILLIAMS MEMBER 1.00 X 0 0 0 CHRISTINIA JEPSEN CEO 50.00 X 0 0 0 418184 11521 2 false true false EM CARE 13737 NOEL ROAD SUITE 1600 DALLAS TX 75240 PHYSICIAN 1939656 EVIDENT PO BOX 11407 DEPT 6448 BIRMINGHAM AL 352466448 EHR 625240 ALLIANT 12800 N MERIDIAN ST SUITE 400 CARMEL IN 46302 MANAGEMENT 488132 AYA HEALTHCARE PO BOX 123519 DEPT 3519 DALLAS TX 753123519 STAFFING 280531 CRITICAL REHAB 4381 KIMBERLY CIRCLE TALLAHASSEE FL 32309 PHYSICAL THERAP 104000 5 8181179 176 8181355 NET PATIENT SERVICE REVENUE 9272471 9272471 340B INCOME 77305 77305 9349776 31521 31521 9100 9100 9100 9100 RHC WRAP AND CAP PAYMENTS 164639 164639 MISCELLANEOUS INCOME 116475 116475 CAFETERIA 14073 14073 1285 1285 296472 17868224 9655348 31521 X 96694 96694 4956730 4426902 529828 93966 93966 434673 434673 438983 438983 48647 48647 44049 44049 3810326 3014090 796236 25720 25720 666122 603354 62768 29793 29793 166058 166058 46014 45106 908 16373 5843 10530 13637 13637 152289 152289 267204 247933 19271 MEDICAL SUPPLIES 745624 745624 REPAIRS & MAINTENANCE 225088 222097 2991 PROVIDER TAX 74090 74090 AMBULANCE MEDICAL SUPPLIE 52218 52218 88503 64544 23959 12492801 10856920 1635881 0 11451714 10387641 847539 914226 243122 481782 101957 119666 8883572 6006849 829641 2876723 191488 741394 13665461 15521432 964875 1461068 2456471 2318501 8850458 6445382 2850624 1378025 15122428 11602976 X -1555977 3918456 99010 -1456967 3918456 13665461 15521432 5375423 X false true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 24000 true 483 false 24483 false SCHEDULE C, PART II-B, LINE 1 CONTRACTOR IS PAID TO REPRESENT THE HOSPITAL'S INTEREST AND A PERCENTAGE OF DUES PAID TO MEMBERSHIP ORGANIZATION'S IS ALLOCATED TO LOBBYING. 239237 239237 1681976 1378566 303410 21440 15953 5487 5005764 4612330 393434 1935155 1935155 2876723 CARES ACT REFUNDABLE ADVANCE PAYMENT 783751 MEDICARE ADVANCE PAYMENTS 594274 1378025 X 15876350 -20000 -20000 15896350 1971874 1971874 17868224 12472801 12472801 20000 20000 12492801 SCHEDULE D, PAGE 3, PART X THE ASSOCIATION 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 ASSOCIATION ANNUALLY FILES A FORM 990 TAX RETURN WHICH INCLUDES THE OPERATIONS OF THE HOSPITAL AND EMS. THE ASSOCIATION 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 ASSOCIATION 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 STATEMENT OF FINANCIAL POSITION FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2021 AND 2020 OR FOR THE YEARS THEN ENDED. THE ASSOCIATION'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE 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 RECLASSIFIED BAD DEBT EXPENSE -20,000 SCHEDULE D, PAGE 4, PART XI, LINE 4B GRANTS RECORDED AS CAPITAL CONTRIBUTIONS IN AFS 1,971,874 SCHEDULE D, PAGE 4, PART XII, LINE 4B RECLASSIFIED BAD DEBT EXPENSE 20,000 true true X true X true X true false true true 33204 33204 0.00270 1712854 1204633 508221 0.04070 1746058 1204633 541425 0.04330 2339 2339 0.00020 2339 2339 0.00020 1748397 1204633 543764 0.04350 true 3154456 2666817 2652324 14493 X true true 1 1 CALHOUN-LIBERTY PRIMARY CARE 20370 NE BURNS AVE BLOUNTSTOWN FL 32424 WWW.CALHOUNLIBERTYHOSPITAL.COM X CALHOUN-LIBERTY PRIMARY CARE 1 false false true X X X X X X X X X X 19 true false true true X WWW.CALHOUNLIBERTYHOSPITAL.COM X false false true X 100.000000000000 300.000000000000 X X false true X X X true X HTTPS://WWW.CALHOUNLIBERTYHOSPITAL.COM X HTTPS://WWW.CALHOUNLIBERTYHOSPITAL.COM X HTTPS://WWW.CALHOUNLIBERTYHOSPITAL.COM X X X X false X false X X X X true X false false FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 3E IN CONSIDERATION OF THE QUANTITATIVE AS WELL AS QUALITATIVE FEEDBACK, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED: ACCESS TO HEALTH CARE OBESITY MENTAL HEALTH/SUBSTANCE ABUSE FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 5 WHILE THE ORGANIZATION MADE PROGRESS ON THEIR 2016 CHNA AND 2017 - 2019 IMPLEMENTATION STRATEGY PLAN, HURRICANE MICHAEL DRAMATICALLY CHANGED THE TRAJECTORY OF THE HOSPITAL'S EFFORTS WHEN IT MADE LANDFALL DIRECTLY ON BLOUNTSTOWN, FLORIDA, ON OCTOBER 10, 2018. THE DAMAGE TO CLH WAS SIGNIFICANT TO SAY THE LEAST. DUE TO THE WIDESPREAD DAMAGE IN THE REGION, RESOURCES WERE LIMITED FOR IMMEDIATE ASSISTANCE TO CLEAN-UP, REPAIR AND RESTORE HOSPITAL DEPARTMENTS IN ORDER TO PROVIDE SERVICES. WHILE IT TOOK SEVERAL WEEKS AND, IN SOME CASES, MONTHS, CLH WAS ABLE TO OPEN ITS DOORS AGAIN IN THE MIDST OF RECOVERY AND CONTINUES TO BE IN A REBUILDING PROCESS. TO THAT END, CLH PARTICIPATED IN THE 2019 - 2021 COMMUNITY HEALTH IMPROVEMENT PLAN WITH THE FLORIDA DEPARTMENT OF HEALTH IN CALHOUN/LIBERTY COUNTIES TO UPDATE THE EXISTING 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND INCLUDE AN IMPLEMENTATION STRATEGY PLAN FOR 2019 - 2021. IN THE PREVIOUS CHNA (2016), THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT IS COMPRISED OF IDENTIFYING THE ISSUES RESIDENTS OF THE COMMUNITY DEEM AS THE MOST IMPORTANT; ALONG WITH DISTINGUISHING ANY RESOURCES AVAILABLE TO AID IN IMPROVING THE HEALTH OF THE COMMUNITY. COMMUNITY SURVEYS WERE DEVELOPED AND FIELDED AT VARIOUS LOCATIONS, INCLUDING GROCERY STORES, CONVENIENCE STORES, HOSPITAL/ER AND MEDICAL CLINICS. WITH THE ASSISTANCE OF THE FLORIDA DEPARTMENT OF COMMUNITY HEALTH, EXISTING DATA WAS REVIEWED AND COMMUNITY HEATLH INDICATORS WERE UPDATED AND REVIEWED. FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 6B FLORIDA DEPARTMENT OF HEALTH IN CALHOUN/LIBERTY COUNTIES. FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 11 BEHAVIORAL HEALTH, INCLUDING MENTAL HEALTH & SUBSTANCE ABUSE: AS IDENTIFIED DURING THE NEEDS ASSESSMENT CALHOUN LIBERTY HOSPITAL DOES NOT PROVIDE BEHAVIORAL HEALTH SERVICES, AND IT WOULD NOT BE FEASIBLE FOR THE HOSPITAL TO DEVELOP THIS TYPE OF PROGRAM DUE TO FUNDS. THE HOSPITAL WORKS CLOSELY WITH FACILITIES THAT PROVIDE THESE SERVICES TO ASSIST PATIENTS IN ACCESSING CARE. FOOD DESERT: THE HOSPITAL CANT PROVIDE SERVICES FOR THE PROBLEM OF ONLY HAVING ONE GROCERY STORE IN EACH COMMUNITY. THE HOSPITAL DOES NOT HAVE AN AVAILABLE COLD CONTAINER TO HOUSE PERISHABLE ITEMS AND DOES NOT SEE A TIME FRAME THAT THIS WOULD BE FEASIBLE. FACILITY 1, CALHOUN-LIBERTY PRIMARY CARE - PART V, LINE 13H A PATIENT IS CONSIDERED MEDICALLY INDIGENT IF THEY ARE UNABLE TO PAY THE OUTSTANDING BALANCE IN THEIR ACCOUNT IF, AFTER ALL INSURANCE ANC 3RD PARTY PAYMENTS, THE AMOUNT OUTSTANDING EXCEEDS 5% OF ANNUAL HOUSEHOLD INCOME AND THE TOTAL ANNNUAL HOUSE HOLD INCOME EXCEEDS 300% OF FPG BUT IS LESS THAN 500% OF FPG. SCHEDULE H, PART I, LINE 7 COSTS FOR PART I, LINE 7A AND 7B WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. SCHEDULE H, PART III, LINE 3 NET PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS AND INCLUDES VARIABLE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. GENERALLY, THE HOSPITAL BILLS THE PATIENTS AND THIRD-PARTY PAYORS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED AND/OR THE PATIENT IS DISCHARGED FROM THE FACILITY. REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE HOSPITAL. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED (OR ACTUAL) CHARGES. THE HOSPITAL BELIEVES THAT THIS METHOD PROVIDES A FAITHFUL DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS RECEIVING PATIENT CARE SERVICES. THE HOSPITAL MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE. THESE SERVICES ARE CONSIDERED TO BE A SINGLE PERFORMANCE OBLIGATION AND HAVE A DURATION OF LESS THAN ONE YEAR. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED AT A POINT IN TIME IS RECOGNIZED WHEN SERVICES ARE PROVIDED AND THE HOSPITAL DOES NOT BELIEVE IT IS REQUIRED TO PROVIDE ADDITIONAL SERVICES TO THE PATIENT. SEE FOOTNOTE 3 FOR A SUMMARY OF UNCOMPENSATED SERVICES, INCLUDING PRICE CONCESSIONS (BAD DEBTS). SCHEDULE H, PART III, LINE 4 SEE THE DISCUSSION REGARDING UNINSURED PATIENTS AND BAD DEBT EXPENSE WITH THE NET PATIENT SERVICE REVENUE FOOTNOTE ON PAGES 12-18 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. SCHEDULE H, PART VI, LINE 2 IN ADDITION TO CONDUCTING A CHNA EVERY 3 YEARS, THE HOSPITAL SEEKS INPUT FROM MEMBERS OF THE COMMUNITY, MEDICAL AND NURSING STAFF AND COMMUNITY HEALTH LEADERS THROUGHOUT THE YEAR. SCHEDULE H, PART VI, LINE 3 THE FAP, APPLICATION AND SUMMARY ARE POSTED ON THE ORGANIZATION'S WEBSITE. SIGNAGE THROUGHOUT THE HOSPITAL PROVIDES NOTICE OF THE FAP AND PATIENTS ARE INFORMED OF FINANCIAL ASSISTANCE PRIOR TO DISCHARGE. THE APPLICATION, FAP AND PLAIN LANGUAGE SUMMARY ARE AVAILABE UPON REQUEST AT THE HOSPITAL FACILITY'S ADMISSION POINTS. SCHEDULE H, PART VI, LINE 4 THE HOSPITAL'S SERVICE AREA IS DEFINED AS CALHOUN AND LIBERTY COUNTIES, FLORIDA. THE TOWNS AND CITIES OF BLOUNTSVILLE, BRISTOL, ALTHA, HOSFORD, CLARKVILLE, WEWAHITCHKA AND TELOGIA ARE IN THESE COUNTIES. APPROXIMATLEY 21,600 PEOPLE LIVE IN THESE 2 COUNTIES. THE MEDIAN INCOME OF BOTH COUNTIES IS SUBSTANTIALLY BELOW THE FLORIDA AVERAGE AND APPROXIMATEL 205 OF THE POPULATION IS BELOW THE FEDERAL POVERTY LINE. SCHEDULE H, PART VI, LINE 5 THE HOSPITAL HAS AN EMERGENCY ROOM OPEN 24/7/365 TO ALL PATIENTS ON A NON- DISCIMINATORY BASIS WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. THE HOSPITAL IS LEAD BY A BOARD OF DIRECTORS COMPRISED ON INDEPENDENT COMMUNITY MEMBERS AND THE MEDICAL STAFF IS OPEN TO PROPERLY CREDENTIALED PHYSICIANS. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS. SCHEDULE H, PART VI THE HOSPITAL AND ITS SERVICE COMMUNITY WERE SEVERELY IMPACTED BY THE LANDFALL OF HURRICANE MICHAEL, A CATEGORY 5 STORM THAT INFLICTED TREMENDOUS DAMAGE THROUGHT LIBERTY AND CALHOUN COUNTIES AFTER IT CAME ASHORE IN MEXICO BEACH FLORIDA WHICH IS 41 MILES SOUTHWEST OF BLOUNTSTOWN. X false false false false false false false false false TERESA EDENFIELD NURSE PRACTITIONER 118697 57129 5804 181630 FORM 990, PAGE 6, PART VI, LINE 3 THE POSITIONS OF HOSPITAL ADMINISTRATOR (AS WELL AS CERTAIN OTHER DUTIES) HAVE BEEN CONTRACTED TO AN UNRELATED MANAGEMENT COMPANY THAT COMPENSATES THOSE POSITIONS DIRECTLY. THE HOSPITAL PAYS A FEE TO THE MANAGEMENT COMPANY FOR THESE SERVICES. FORM 990, PAGE 6, PART VI, LINE 11B AN INDEPEDENT CPA PREPARES THE RETURN FROM INFORMATION OBTAINED DURING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FROM MANAGEMENT. THE RETURN IS REVIEWED BY MANAGEMENT AND A COPY IS PROVIDED TO MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND THE OTHER INFORMATION ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES 1,877,866 0 0 PHYSICIAN FEES 10,800 0 0 PURCHASED SERVICES 1,125,424 792,461 0 COLLECTION FEES 0 3,775 0 TOTAL 3,014,090 796,236 0