2016-11-15T10:27:13-06:00 2015-12-31 721396621 CARR RIGGS & INGRAM LLC PO BOX 555 BLOUNTSTOWN FL 32424 990 2015-01-01 593051173 CALHOUN LIBERTY HOSPITAL ASSOCIATIONINC CALH 8506437881 PO BOX 419 BLOUNTSTOWN FL 32424 LADDIE WILLIAMS BOARD CHAIRMAN 8506744559 2016-11-14 1 LESLIE TUCKER CPA P01272659 8506744531 2015 2017-02-10 21:41:12Z RUTH ATTAWAY P O BOX 423 BLOUNTSTOWN FL 32424 11415500 0 X N/A X 1991 FL TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY THROUGH INPATIENT CARE, OUTPATIENT CARE, EMERGENCY ROOM CARE AND OTHER RELATED SERVICES. 9 9 264 0 0 0 272302 400000 11027254 11010985 4300 4515 0 0 11303856 11415500 0 0 0 0 6905989 7124026 0 0 0 4234924 4627571 11140913 11751597 162943 -336097 4654381 4961749 1925564 2569029 2728817 2392720 TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS IN THE COMMUNITY IT SERVES. 0 0 11751597 11015500 TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITY THROUGH INPATIENT CARE, OUTPATIENT CARE, EMERGENCY ROOM CARE AND OTHER RELATED SERVICES. 11751597 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 47 0 1 264 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 1 0 0 0 X ALYSA SAMS 8506745411 PO BOX 419 BLOUNTSTOWN FL 32424 RUTH ATTAWAY CHAIRMAN 10.00 X 28000 0 0 LABAN BONTRAGER DMD VICE CHAIRMAN 2.00 X 0 0 0 LADDIE WILLIAMS BOARD MEMBER 2.00 X 0 0 0 MARILYN RUSSELL SECRETARY 2.00 X 0 0 0 JOHN TOMLINSON JR TREASURER 2.00 X 0 0 0 PAUL SMITH BOARD MEMBER 2.00 X 0 0 0 TIM REVELL BOARD MEMBER 2.00 X 0 0 0 TERRY EUBANKS BOARD MEMBER 2.00 X 0 0 0 MARK PLUMMER BOARD MEMBER 2.00 X 0 0 0 PHILLIP HILL ADMINISTRATOR 40.00 X 125799 0 4742 NATHAN EBERSOLE CFO/CONTROLLER 40.00 X 55566 0 1111 DR GERALD SKIPPER CHIEF OF STAFF 40.00 X 268765 0 8991 GARRETT H CHUMNEY MEDICAL DIRECTOR/ER PHYSICIAN 40.00 X 306030 0 0 MISBAH FAROOQI EMERGENCY ROOM PHYSICIAN 40.00 X 219780 0 0 WARREN STEWART EMERGENCY ROOM PHYSICIAN 40.00 X 230533 0 0 STANLEY WHITTAKER EMERGENCY ROOM PHYSICIAN 40.00 X 205180 0 8953 1439653 0 23797 6 0 1 0 MEDICAL BUSINESS OFFICE SUPPORT AND SOLU 500 NEWTON DRIVE ADEL GA 31620 MEDICAL BILLING COMPANY 287870 QUEST DIAGNOSTICS 12436 COLL CENTER CHICAGO IL 606932436 LAB SERVICES 180209 QUALITY CARE REHAB INC 8477 S SUNCOAST BLVD HOMOSASSA FL 34446 THERAPY 136136 SOUTHEASTERN MEDICAL SUPPLY 1700 N MONROE STREET SUITE 11-200 TALLAHASSEE FL 32303 SUPPLIES 135199 4 400000 400000 PATIENT REVENUE 621990 10427660 10427660 OTHER PROGRAM REVENUE 621990 583325 583325 11010985 4515 4515 11415500 11015500 0 0 1435450 1435450 4772333 4772333 916243 916243 8000 8000 49765 49765 24000 24000 30620 30620 81304 81304 22183 22183 329930 329930 122001 122001 PURCHASED SERVICES 2394816 2394816 SUPPLIES 1563061 1563061 OTHER EXPENSES 1891 1891 11751597 11751597 0 0 736092 496670 2143646 1980967 116430 114757 31862 30876 6458301 4141219 1608787 2317082 17564 15673 0 5724 4654381 4961749 838240 1892263 1087324 676766 1925564 2569029 X 2728817 2392720 2728817 2392720 4654381 4961749 -336097 0 X 0 1 X 0 0 X 0 0 0 0 0 0 0 0 1 24000 24000 0 PART II-B, LINE 1: CALHOUN-LIBERTY HOSPITAL USED THE SERVICES OF CAPITAL SOLUTIONS, LLC TO ENGAGE IN LOBBYING ACTIVITIES ON CRITICAL HEALTHCARE ISSUES AND CONCERNS IN THE STATE OF FLORIDA. 61156 61156 1566552 1364702 201850 4830593 2776517 2054076 2317082 10195320 0 10195320 1220180 1220180 11415500 10567855 0 10567855 1183742 1183742 11751597 PART XI, LINE 4B - OTHER ADJUSTMENTS: EMS OPERATIONS 1,220,180. PART XII, LINE 4B - OTHER ADJUSTMENTS: EMS OPERATIONS 1,181,851. OTHER ASSOCIATION EXPENSES 1,891. 1 1 1 X 1 X 1 1 1 0 0 456193 166616 289577 0.02460 530850 583890 -53040 0.00000 1509769 374362 1135407 0.09660 2496812 1124868 1371944 0.12120 2496812 1124868 1371944 0.12120 1 4154922 4038646 4102082 -63436 X 1 1 1 1 CALHOUN-LIBERTY HOSPITAL 20370 NE BURNS AVE BLOUNTSTOWN FL 32424 X CALHOUN-LIBERTY HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 0 1 1 X WWW.CALHOUNLIBERTYHOSPITAL.COM X 1 13 1 WWW.CALHOUNLIBERTYHOSPITAL.COM 0 0 1 X 200.000000000000 250.000000000000 X X X X 1 1 X X X 1 X WWW.CALHOUNLIBERTYHOSPITAL.COM X 1 X 0 X X X 1 X 0 1 CALHOUN-LIBERTY HOSPITAL PART V, SECTION B, LINE 5: SEE ATTACHED CALHOUN-LIBERTY HOSPITAL PART V, SECTION B, LINE 23: SEE ATTACHED 2 1 - CALHOUN AMBULANCE SERVICE 20370 NE BURNES AVE BLOUNTSTOWN FL 32424 EMS SERVICES 2 - CALHOUN-LIBERTY PRIMARY CARE CLINIC 20370 NE BURNES AVE BLOUNTSTOWN FL 32424 RURAL HEALTH CLINIC X 0 0 0 0 0 0 0 0 0 DR GERALD SKIPPER CHIEF OF STAFF 268765 0 0 0 0 0 5300 0 3691 0 277756 0 0 0 GARRETT H CHUMNEY MEDICAL DIRECTOR/ER PHYSICIAN 306030 0 0 0 0 0 0 0 0 0 306030 0 0 0 MISBAH FAROOQI EMERGENCY ROOM PHYSICIAN 219780 0 0 0 0 0 0 0 0 0 219780 0 0 0 WARREN STEWART EMERGENCY ROOM PHYSICIAN 230533 0 0 0 0 0 0 0 0 0 230533 0 0 0 STANLEY WHITTAKER EMERGENCY ROOM PHYSICIAN 205180 0 0 0 0 0 4104 0 4849 0 214133 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ADMINISTRATION, AS WELL AS THE BOARD OF DIRECTORS, HOLD ANNUAL AND PERIODIC COMPLIANCE REVIEWS. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTATION IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST.