2019-05-15T11:32:20-05:00 2018-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2017-07-01 440629397 CARROLL COUNTY MEMORIAL HOSPITAL % JEFF TINDLE CARR 6605421695 1502 N JEFFERSON STREET CARROLLTON MO 64633 JEFF TINDLE CEO 6605421695 2019-05-15 true Kevin R Ensminger CPA P01310558 8162216300 2019-05-15 167.68.126.162 43372220191345000034 2019-05-14 P 3FC9EFFABEED0D212CAE4C9B84B4434B88FC6471 05BF3D2C04DC7F26D6541C8D2E1E912A8523520D 2017 2019-02-21 02:37:17Z JEFF TINDLE 1502 N JEFFERSON ST CARROLLTON MO 64633 33298751 false X CARROLLCOUNTYHOSPITAL.ORG X 1957 MO CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. 10 10 248 15 0 0 11230 13939 26133296 32499341 161604 157170 721699 627734 27027829 33298184 1973 11411 0 0 11291677 13376856 0 0 0 15091168 19717791 26384818 33106058 643011 192126 40608294 41454466 17503993 18187910 23104301 23266556 CARROLL COUNTY MEMORIAL HOSPITAL IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL WE SERVE. false false 26035919 11411 32499341 ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. 26035919 true false false true false false false false false false true false false true true false 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 true true true false false true 16 0 true 248 true false false false false false false false false false false X 10 10 false true false false false false false true true false false true true true true false true true false false MO X X JEFF TINDLE 6605421695 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 BEN POLEN DIRECTOR 1.0 0.0 X 0 0 0 JENNIFER POSTON DIRECTOR 1.0 0.0 X 0 0 0 CHARLIE LOCK DIRECTOR 1.0 0.0 X 0 0 0 DEBBIE MINNICK DIRECTOR 1.0 0.0 X 0 0 0 JIM GIBSON DIRECTOR 1.0 1.0 X 0 0 0 RANDALL BARRY DIRECTOR/PRESIDENT 1.0 0.0 X X 0 0 0 REX BUHRMESTER DIRECTOR 1.0 0.0 X 0 0 0 JUDITH DELANY DIRECTOR/VICE PRESIDENT 1.0 0.0 X X 0 0 0 KEN BROWN DIRECTOR/SECRETARY 1.0 0.0 X X 0 0 0 TIM REID DIRECTOR 1.0 0.0 X 0 0 0 JEFFREY TINDLE CEO 60.0 1.0 X 328644 0 23594 RICHARD SMITH PHYSICIAN 40.0 0.0 X 441385 0 39345 TIMOTHY REID PHYSICIAN 40.0 0.0 X 264835 0 70224 GREG STAFFORD PHYSICIAN ASSISTANT 40.0 0.0 X 251847 0 38896 ANTHONY HORINE PHYSICIAN 40.0 0.0 X 355599 0 53862 PAMELA RALLS PHYSICIAN 40.0 0.0 X 296463 0 30080 1938773 0 256001 12 false true false MIMEDX 1775 WEST OAK COMMONS CT NE MARIETTA GA 30062 MEDICAL SUPPLIES 2443090 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 63195 COMPUTER SYSTEMS 1841787 CARROLLTON BRANCH - BTC BANK 1201-2 N HWY 65 CARROLLTON MO 64633 BANKING 1209335 HCA MIDAMERICA DIVISION 5440 W 110TH ST SUITE 400 OVERLAND PARK KS 66211 MANAGEMENT 598788 MED PAY PO BOX 10909 SPRINGFIELD MO 65808 HEALTH SERVICES 565393 31 11489 2450 13939 NET PATIENT SERVICE REVENUE 621990 31303494 31303494 PHARMACY 340B INCOME 621990 1079176 1079176 EHR INCENTIVE INCOME 621990 116671 116671 32499341 157737 157737 0 0 86035 86035 0 86035 86035 567 -567 -567 -567 0 0 0 0 0 0 0 0 0 MISCELLANEOUS INCOME 900099 541699 541699 541699 33298184 32499341 784904 7411 7411 4000 4000 0 0 441987 441987 0 9809154 9278080 531074 512719 268903 243816 1943566 1312451 631115 669430 605886 63544 319025 319025 291 291 0 18487 18487 0 0 3780821 2589239 1191582 0 76812 3437 73375 2097511 1552128 545383 1315224 835982 479242 0 601903 412374 189529 172674 135455 37219 0 0 672063 35437 636626 0 3218388 2228242 990146 569338 42201 527137 MEDICAL SUPPLIES 4657483 4657483 MEDICAL EQUIPMENT LEASES 18161 18161 BAD DEBT EXPENSE 1949412 1949412 LICENSES/FEES/DUES 39600 39600 210598 60037 150561 33106058 26035919 7070139 0 641 773 7299815 7826859 0 0 3167873 3670301 0 0 0 0 0 0 485843 603842 276071 344767 46661268 22294780 25967737 24366488 1630519 1633025 0 0 0 0 0 0 1779795 3008411 40608294 41454466 3088083 3108168 0 0 140466 68461 0 0 0 0 0 0 14259244 14995081 0 0 16200 16200 17503993 18187910 X 22852250 22971854 252051 294702 0 0 23104301 23266556 40608294 41454466 X 192126 -72522 42651 X false true X true false X X true false false false false false true 18487 false false false 18487 false SCHEDULE C, PART II-B, LINE 1F THIS AMOUNT REPRESENTS THE LOBBYING PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 1665690 1665690 21197968 13341624 7856344 23787168 8953156 14834012 10442 10442 24366488 BENEFICIAL INT IN FOUNDATION 294702 Other Accounts Receivable 623887 Due from Medicare 2018849 Due to/from Foundation 70973 3008411 0 RENTAL DEPOSITS 16200 16200 31276250 -72522 -72522 31348772 1949412 1949412 33298184 31156646 31156646 1949412 1949412 33106058 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSE $ 1,949,412 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $ 1,949,412 true true true X true X true true true false false 196256 196256 0.00770 3634148 1919329 1714819 0.06690 3830404 1919329 1911075 0.07460 14712 14712 0.00060 10000 10000 0.00040 937388 57547 361641 0.01410 962100 57547 386353 0.01510 4792504 1976876 2297428 0.08970 false 1949412 517530 11704274 12807229 -1102955 X true true 1 1 CARROLL COUNTY MEMORIAL HOSPITAL 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 X X X X PHYSICIAN CLINICS CARROLL COUNTY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 200. 300. X X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 CARROLL COUNTY MEMORIAL HOSPITAL INTERVIEWED HOSPITAL STAKEHOLDERS, COMMUNITY LEADERS, AND BUSINESS OWNERS TO ASSESS PUBLIC PERCEPTIONS OF THE COUNTY'S HEALTH STATUS AND UNMET NEEDS. THE INFORMATION GATHERED FROM THE INTERVIEWS PLAYED AN INSTRUMENTAL PART IN THE DEVELOPMENT OF AN IMPLEMENTATION PLAN TO ADDRESS THE NEEDS OF THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 7A THE URL FOR THE CHNA IS: WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 10A THE URL FOR THE IMPLEMENTATION STRATEGY IS: WWW.CARROLLCOUNTYHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 11 CARROLL COUNTY HAS AN IMPLEMENTATION PLAN THAT WE FOLLOW TO MEET THE NEEDS IDENTIFIED IN THE CHNA. THREE PRIORITY AREAS OF SIGNIFICANT NEED WERE IDENTIFIED : CHRONIC HEALTH CONDITIONS: CANCER, HEART DISEASE, OBESITY; MENTAL HEALTH/SUBSTANCE ABUSE; ACCESS TO CARE. EACH OF THESE WERE ADDRESSED IN THE IMPLEMENTATION STRATEGY. SCHEDULE H, PART V, SECTION B, LINE 16A, 16B & 16C WWW.CARROLLCOUNTYHOSPITAL.ORG/PATIENTS/FINANCIAL-ASSISTANCE-POLICY 4 JEFFERSON MEDICAL GROUP - CARROLLTON 1502 N JEFFERSON CARROLLTON MO 64633 HOME HEALTH AGENCY JEFFERSON MEDICAL GROUP - NORBORNE 105 EAST 2ND STREET NORBONNE MO 64668 RURAL HEALTH CLINIC JEFFERSON MEDICAL GROUP - HALE 321 ELM STREET HALE MO 64643 RURAL HEALTH CLINIC CCMH HOME HEALTH 1502 N JEFFERSON ST CARROLLTON MO 64633 HOME HEALTH AGENCY SCHEDULE H, PART I, LINCE 3C OTHER FACTORS USED IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY ARE OUTLINED IN SCHEDULE H, PART V, SECTION B, LINE 13. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,949,412. SCHEDULE H, PART I, LINE 7G NO PHYSICIAN CLINIC COSTS ARE INCLUDED. SCHEDULE H, PART III, SECTION A, LINE 2 PATIENT ACCOUNTS MEETING THE REQUIREMENTS TO QUALIFY FOR BAD DEBT ARE WRITTEN OFF TO BAD DEBT AND SENT TO A THIRD PARTY COLLECTION AGENCY. THE AMOUNT OF BAD DEBT IS ROUTED TO A SPECIFIC GL ACCOUNT. DISCOUNTS AND PATIENT PAYMENTS APPLIED TO ACCOUNTS IN BAD DEBT ARE RECORDED THROUGH BAD DEBT ADJUSTMENTS IN ORDER TO RECONCILE THE BAD DEBT AMOUNT ACCORDINGLY. SCHEDULE H, PART III, SECTION A, LINE 3 THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS BASED ON SELF-PAY ONLY PATIENTS COVERED BY MEDICAID HMOS AND THE PERCENT OF THE ELIGIBLE MEDICAID AND MEDICAID HMO PATIENTS DIVIDED BY TOTAL BAD DEBT, THIS PERCENT IS THEN MULTIPLIED BY SELF PAY PATIENTS (PRIM HEALTH PLAN). THE TWO ESTIMATES ARE THEN COMBINED. SCHEDULE H, PART III, SECTION A, LINE 4 THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 CCMH BELIEVES THAT MEDICARE SHORTFALLS SHOULD QUALIFY AS A COMMUNITY BENEFIT COST IF THE MEDICARE BENEFICIARY IS INDIGENT. SCHEDULE H, PART III, SECTION C, LINE 9B EACH PATIENT IS PROVIDED WITH PAYMENT INFORMATION IN CLEAR, EASY-TO-UNDERSTAND LANGUAGE. CCMH CHECKS ON PUBLIC-ASSISTANCE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. THE HOSPITAL OFFERS DISCOUNTS ON CHARGES TO UNDERINSURED PATIENTS WHEN POSSIBLE. SCHEDULE H, PART VI, LINE 2 CARROLL COUNTY MEMORIAL HOSPITAL RELIES ON INTERACTION WITH LOCAL HEALTH CARE AGENCIES AS WELL AS FEEDBACK FROM PATIENTS AND PRIMARY SERVICE AREA RESIDENTS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. SCHEDULE H, PART VI, LINE 3 CARROLL COUNTY MEMORIAL HOSPITAL PROVIDES EACH PATIENT WITH A LETTER THAT CLEARLY STATES PAYMENT INFORMATION IN AN EASY-TO-UNDERSTAND LANGUAGE. THE HOSPITAL INFORMS PATIENTS PROMPTLY ABOUT THE CHARGE FOR ANY ITEM OR SERVICE PROVIDED. THE LETTER INFORMS THE PATIENT THAT IF THEY ARE NOT ABLE TO PAY THEIR HOSPITAL BILL THERE ARE PROGRAMS THAT MAY HELP ALLEVIATE THE BURDEN. IF THE HOSPITAL IS PROMPTED IT WILL CHECK FOR PUBLIC-ASSISTANCE OR CHARITY CARE PROGRAMS TO SEE IF THE PATIENT QUALIFIES. SCHEDULE H, PART VI, LINE 4 CARROLL COUNTY MEMORIAL HOSPITAL IS LOCATED IN CARROLLTON, MISSOURI. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF CARROLLTON AND THE SURROUNDING AREAS OF CARROLL COUNTY. CARROLL COUNTY MEMORIAL HOSPITAL OPERATES TWO SATELLITE CLINICS LOCATED IN HALE AND NORBORNE. CARROLL COUNTY HAS A POPULATION OF APPROXIMATELY 9,216 RESIDENTS, WITH 35.5% OF THE RESIDENTS LIVING IN URBAN AREAS AND 64.5% LIVING IN RURAL AREAS. THE MEDIAN ANNUAL HOUSEHOLD INCOME FOR CARROLL COUNTY IS APPROXIMATELY $46,002. SCHEDULE H, PART VI, LINE 5 THE HOSPITAL'S BOARD OF DIRECTORS IS ELECTED FROM THE LOCAL COMMUNITY AND SURROUNDING AREA THAT COMPRISES THE LOCAL SERVICE AREA. THE HOSPITAL'S ACTIVE MEDICAL STAFF MEMBERS ARE RESIDENTS OF THE COUNTY. CCMH SPONSORS COMMUNITY HEALTH FAIRS AND EDUCATION CLASSES IN MANY AREAS. ANY SURPLUS IN FUNDS ARE REINVESTED IN THE HOSPITAL'S FACILITIES AND PATIENT SERVICE PROGRAMS. SCHEDULE H, PART VI, LINE 6 IN 2014, CCMH REACHED A MANAGEMENT AGREEMENT WITH HCA MIDWEST HEALTH SYSTEM. THIS STRATEGIC PARTNERSHIP MEANS CCMH - THE COMMUNITY'S PREMIER HEALTHCARE PROVIDER - WILL HAVE GREATER ACCESS TO RESOURCES, ADVANCED TECHNOLOGY AND SERVICES THAT MIGHT NOT OTHERWISE BE AVAILABLE. PATIENTS AND THEIR FAMILIES WHO ENTRUST CARE TO US WILL BENEFIT FROM BEST PRACTICES, POLICIES AND PROCEDURES, TOOLKITS, PROTOCOLS, TRAINING AND MORE. MOST IMPORTANTLY, THIS AGREEMENT WITH HCA MIDWEST HEALTH SYSTEM ALIGNS WITH CCMH'S COMMITMENT TO PROVIDE HIGH-QUALITY, COMPASSIONATE AND INNOVATIVE CARE TO THE COMMUNITY. AS THE REGION'S LEADING HEALTHCARE PROVIDER, HCA MIDWEST HEALTH SYSTEM IS COMMITTED TO THE COMMUNITIES IT SERVES. IT HAS SIX ACUTE CARE HOSPITALS, ONE PSYCHIATRIC HOSPITAL, FOUR CRITICAL ACCESS HOSPITALS (INCLUDING CCMH), SIX SURGERY CENTERS, 10 URGENT CARE LOCATIONS, MORE THAN 30 PRIMARY CARE LOCATIONS, 2,100 PHYSICIANS AND HEALTHCARE PROVIDERS AND 9,000 SUPPORTING TEAM MEMBERS. IN ADDITION TO SOLIDIFYING CCMH'S LONGSTANDING MISSION, VISION AND CORE VALUES OF BEING A TRUSTED COMMUNITY HEALTHCARE PARTNER, THE HCA AGREEMENT MEANS: *STAFF REMAINS CCMH EMPLOYEES. *PATIENTS WILL HAVE ACCESS TO THEIR SAME CCMH PHYSICIANS. *OPPORTUNITY TO BRING SPECIALTY PHYSICIANS TO THE COMMUNITY THROUGH ONSITE CLINICS AND TELEMEDICINE SO EMPLOYEES AND PATIENTS HAVE INCREASED ACCESS TO MORE CARE OPTIONS WITHOUT LEAVING THE COMMUNITY. *IF A PATIENT DOES REQUIRE HIGHER-LEVEL CARE, TRANSFER TO AN HCA FACILITY WILL BE SEAMLESS WITH THE GOAL TO RETURN THE PATIENT BACK TO THE COMMUNITY HOSPITAL AS SOON AS POSSIBLE FOR POST-ACUTE AND FOLLOW-UP CARE. *THE CCMH HOSPITAL BOARD WILL REMAIN IN COMPLETE CONTROL OF LEADERSHIP AND MANAGEMENT DECISIONS. SCHEDULE H, PART VI, LINE 7 MISSOURI SECTION 501(R) REQUIREMENTS THE ORGANIZATION IS IN THE PROCESS OF UPDATING THE HOSPITAL'S WEBSITE WITH CURRENT DOCUMENTS REQUIRED BY SECTION 501(R) REGULATIONS. X true true X X false false false true false false false false false JEFFREY TINDLE CEO 211201 0 72828 0 44615 0 5326 0 18268 0 352238 0 0 0 RICHARD SMITH PHYSICIAN 376264 0 65121 0 0 0 20675 0 18670 0 480730 0 0 0 TIMOTHY REID PHYSICIAN 221654 0 43181 0 0 0 21600 0 48624 0 335059 0 0 0 GREG STAFFORD PHYSICIAN ASSISTANT 227154 0 24693 0 0 0 20226 0 18670 0 290743 0 0 0 ANTHONY HORINE PHYSICIAN 310909 0 44690 0 0 0 21600 0 32262 0 409461 0 0 0 PAMELA RALLS PHYSICIAN 265776 0 30687 0 0 0 0 0 30080 0 326543 0 0 0 SCHEDULE J, PART I, LINE 1A COUNTRY CLUB MEMBERSHIP DUES ARE PAID FOR JEFFREY TINDLE. THE MEMBERSHIPS WERE USED ONLY FOR BUSINESS PURPOSES. THEREFORE, THE AMOUNT OF THE DUES WAS NOT INCLUDED IN HIS W-2. SCHEDULE J, PART I, LINE 5A A PORTION OF PHYSICIAN COMPENSATION WAS CALCULATED QUARTERLY USING A PERCENTAGE OF REIMBURSEMENT. FORM 990, PART VI, SECTION A, LINE 3 HOSPITAL CORPORATION OF AMERICA (HCA), AN UNRELATED ORGANIZATION, SUPPLIES THE CEO AS PART OF A MANAGEMENT AGREEMENT. ALL COMPONENTS OF THAT COMPENSATION ARE REIMBURSED BY CARROLL COUNTY MEMORIAL HOSPITAL TO HCA. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD SETS POLICY AND ADMINISTRATION IS CHARGED WITH ASSURING THAT COMPLIANCE IS MAINTAINED. CONFLICT OF INTEREST IS REVIEWED ANNUALLY AND EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST DISCLOSURE FORM. IF A CONFLICT ARISES THE CONFLICTED PERSON DOES NOT TAKE PART IN THE VOTE ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15A & 15B LINE 15A: THE BOARD CONDUCTS AN ANNUAL SALARY REVIEW FOR THE CEO, WITH PARTICIPATION FROM HCA. HCA PROVIDES SALARY RECOMMENDATIONS. THE BOARD APPROVES THE AMOUNT OF COMPENSATION. THE LAST REVIEW WAS CONDUCTED IN 2017. LINE 15B: ALL OTHER MANAGEMENT POSITIONS ARE HIRED, REVIEWED, AND MONITORED BY THE CEO AND LEADERSHIP TEAM. COMPENSATION REVIEWS OCCUR ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 CHANGE IN BENEFICIAL INTEREST IN FOUNDATION $ 42,651 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:2176689 FORM 990 PART IX LINE 11G DESCRIPTION:ER PHYSICIAN FEES TOTAL FEES:911415 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAID ADMINISTRATION TOTAL FEES:692717 CARROLL COUNTY MEMORIAL HOSPITAL FDN 1502 N JEFFERSON ST CARROLLTON MO 64633 463696048 SUPPORT MO 501(C)(3) 7 CCMH true false false true true false false false false false false false false false false true false false true false CARROLL COUNTY MEMORIAL HOSPITAL FOUNDATION D 50000 BOOK CARROLL COUNTY MEMORIAL HOSPITAL FOUNDATION O 105592 BOOK