2016-03-11T16:23:42-06:00 2015-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2014-07-01 440629397 CARROLL COUNTY MEMORIAL HOSPITAL % JEFF TINDLE CARR 6605421695 1502 N JEFFERSON ST CARROLLTON MO 64633 JEFF TINDLE CEO 6605421695 2016-05-16 true Kevin Ensminger CPA P01310558 8162216300 2014 2016-08-17 19:52:53Z JEFF TINDLE 1502 N JEFFERSON ST CARROLLTON MO 64633 18719749 false X CARROLLCOUNTYHOSPITAL.ORG X 1957 MO CARROLL COUNTY MEMORIAL HOSPITAL IS COMMITTED TO MEETING THE CHANGING NEEDS OF OUR COMMUNITY BY PROVIDING COMPREHENSIVE,INNOVATIVE AND PROFESSIONAL QUALITY HEALTHCARE SERVICES. 9 8 181 15 0 0 61532 33544 16281542 18065319 152192 -10797 433575 516027 16928841 18604093 23884 25283 0 0 7926947 9024238 0 0 0 9358097 9121238 17308928 18170759 -380087 433334 25849563 27014071 4435889 5169454 21413674 21844617 CARROLL COUNTY MEMORIAL HOSPITAL IS COMMITTED TO MEETING THE CHANGING NEEDS OF OUR COMMUNITY BY PROVIDING COMPREHENSIVE, INNOVATIVE AND PROFESSIONAL QUALITY HEALTHCARE SERVICES. false false 14925078 25283 18065319 ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. 14925078 true true false true false false false false false false true false false false true false true false false false false false false false false false true true true true true false false false false false false true false false false false false false true true false false false true 39 0 true 181 true false false false false false false false false false false X 9 8 false true false false false false false true true false false true true false true false true true false false MO X X JEFF TINDLE 6605421695 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 BEN POLEN DIRECTOR/SECRETARY 1.0 0.0 X X 0 0 0 BLAKE RILEY DIRECTOR/VICE PRESIDENT 1.0 0.0 X 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/SECRETARY 1.0 0.0 X X 0 0 0 REX BUHRMESTER DIRECTOR/PRESIDENT 1.0 0.0 X X 0 0 0 JUDITH DELANY DIRECTOR 1.0 0.0 X 0 0 0 KEN BROWN DIRECTOR 1.0 0.0 X 0 0 0 CAROLYN LOCK DIRECTOR/VICE PRESIDENT 1.0 0.0 X X 0 0 0 JEFFREY TINDLE CEO 40.0 1.0 X 217695 0 15729 RICHARD SMITH PHYSICIAN 40.0 0.0 X 324723 0 37183 MARVIN ROSS PHYSICIAN 40.0 0.0 X 294485 0 14553 TIMOTHY REID PHYSICIAN 40.0 0.0 X 222986 0 39800 GREG STAFFORD PHYSICIAN ASSISTANT 40.0 0.0 X 251354 0 20905 ERIC WITT PHARMACIST 40.0 0.0 X 124356 0 16675 1435599 0 144845 6 false true false MURRAY COMPANY CONTRACTOR 2603785 CERNER CORPORATION COMPUTER SYSTEMS 1168061 BSA LIFESTRUCTURES ARCHITECT/CONSTRUCTI 519018 HCA MIDAMERICA DIVISION MANAGEMENT 454772 PSYCHIATRIC MEDICARE CARE GERIATRIC PSYCH 324717 12 16294 17250 33544 NET PATIENT SERVICE REVENUE 621990 17102292 17102292 PHARMACY 340B INCOME 621990 246270 246270 EHR INCENTIVE INCOME 621990 716757 716757 18065319 104859 104859 0 0 343032 343032 0 343032 343032 115656 -115656 -115656 -115656 0 0 0 MISCELLANEOUS INCOME 900099 172995 172995 172995 18604093 18065319 505230 15183 15183 10100 10100 0 0 268598 268598 32831 32831 6673444 6643270 30174 406699 348977 57722 1156505 827758 328747 486161 466601 19560 596350 596350 6778 6778 75893 75893 4395 4395 0 0 1636860 1283313 353547 0 143400 31478 111922 707925 427689 280236 1069776 683628 386148 0 480627 428501 52126 110933 91922 19011 0 0 38769 38769 0 1662353 1172778 489575 140626 14496 126130 MEDICAL SUPPLIES 1208399 1208399 MEDICAL EQUIPMENT LEASES 50414 50414 BAD DEBT EXPENSE 1066661 1066661 _ 121079 121079 18170759 14925078 3245681 0 0 555 9502059 5077473 0 0 1209674 2719154 0 0 0 0 0 0 240767 197390 87704 237594 30031289 14648020 12265710 15383269 2017200 3085735 0 0 0 0 0 0 526449 312901 25849563 27014071 1938063 2440162 0 0 7200 378626 0 0 0 0 0 0 2490626 2328956 0 0 0 21710 4435889 5169454 X 21399559 21812517 14115 32100 0 0 21413674 21844617 25849563 27014071 X 433334 -20376 17985 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false false true 4395 false false false 4395 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. 1644050 1644050 17153582 9327885 7825697 6545996 4481370 2064626 4687661 838765 3848896 15383269 0 OTHER LIABILITIES 21710 21710 17632712 -20376 115656 95280 17537432 1066661 1066661 18604093 17219754 115656 115656 17104098 1066661 1066661 18170759 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, LINES 2D & 4B LINE 2D COST OF FIXED ASSET DISPOSALS $ 115,656 LINE 4B BAD DEBT EXPENSE $ 1,066,661 SCHEDULE D, PART XII, LINE 2D & 4B LINE 2D COST OF FIXED ASSET DISPOSALS $ 115,656 LINE 4B BAD DEBT EXPENSE $ 1,066,661 true true true X true X true false true true 100078 100078 0.00590 1959899 1121112 838787 0.04910 2059977 1121112 938865 0.05500 38364 2285 36079 0.00210 111532 111532 0.00650 950566 62273 888293 0.05200 4500 4500 0.00030 1104962 64558 1040404 0.06090 3164939 1185670 1979269 0.11590 false 1066661 169198 7784988 8002599 -217611 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 12 true false false true X SEE PART V, SECTION C X true 13 true SEE PART V, SECTION C false false true X 100 300. X X X X X true true X X X true X X X X true X false 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 7 THE URL FOR THE CHNA IS: HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/ABOUT_US/OUR_COMMUNITY/COMMUNITY_HEAL TH_NEEDS_ASSESMENT.ASPX SCHEDULE H, PART V, SECTION B, LINE 10 THE URL FOR THE IMPLEMENTATION STRATEGY IS: HTTP://WWW.CARROLLCOUNTYHOSPITAL.ORG/ABOUT_US/OUR_COMMUNITY/COMMUNITY_HEAL TH_NEEDS_ASSESMENT.ASPX 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. WE MAKE SURE THAT THE PLANS LISTED ARE FOLLOWED THROUGH WITHIN THE GIVEN TIME FRAME. 6 JEFFERSON MEDICAL GROUP - CARROLLTON 1403 JEFFERSON CARROLLTON MO 64633 RURAL HEALTH CLINIC 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 REID MEDICAL GROUP 1401 N JEFFERSON CARROLLTON MO 64633 RURAL HEALTH CLINIC CCMH HOME HEALTH 1502 N JEFFERSON ST CARROLLTON MO 64633 HOME HEALTH AGENCY WAVERLY CLINIC 608 MISSOURI STREET WAVERLY MO 64020 FQHC 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 $1,066,661. SCHEDULE H, PART I, LINE 7, COLUMN G NO PHYSICIAN CLINIC COSTS ARE INCLUDED. SCHEDULE H, PART III, SECTION A, LINE 2 THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF EACH TYPE OF PAYOR. THE HOSPITAL'S BAD DEBT AT COST WAS DETERMINED BY APPLYING AN OVERALL RATIO OF COST TO CHARGES. 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 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 THE MEDICARE ALLOWABLE FAILS TO COVER COST. NON-PAYMENT BY MEDICARE RECIPIENTS FOR THEIR DEDUCTIBLE AND COINSURANCE AMOUNTS INCREASES FINANCIAL ASSISTANCE AND BAD DEBT. THESE SHORTFALLS DECREASE THE ORGANIZATION'S POOL OF ASSETS AND ITS ABILITY TO SUCCESSFULLY ATTRACT HIGHLY-TRAINED STAFF AND INVEST IN MEDICAL TECHNOLOGY. IF SERVICES ARE TO BE MAINTAINED, THEN THE COSTS WILL HAVE TO BE COVERED BY THOSE WHO PAY. THE COSTING METHODOLOGY USED WAS THE COST TO CHARGE METHOD, USING THE COST TO CHARGE % FROM WORKSHEET 2. 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. CCMH HAS INVESTED OVER $15 MILLION IN PATIENT CARE IMPROVEMENTS OVER THE PAST 8 YEARS. 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 true CARROLL COUNTY MEMORIAL HOSPITAL FOUNDATION 1502 N JEFFERSON STREET CARROLLTON MO 64633 463696048 501(C)(3) 7693 SUPPORT 1 GROW GRANT 4 10000 SCHEDULE I, PART I, LINE 2 The grant writer and executor has responsibility for ensuring all grant recording and documentation. X true true X X false false false true false false false false false JEFFREY TINDLE CEO 217695 0 0 0 0 0 8771 0 6958 0 233424 0 0 0 RICHARD SMITH PHYSICIAN 280548 0 44175 0 0 0 20033 0 17150 0 361906 0 0 0 MARVIN ROSS PHYSICIAN 267325 0 27160 0 0 0 14553 0 0 0 309038 0 0 0 TIMOTHY REID PHYSICIAN 191787 0 31199 0 0 0 16529 0 23271 0 262786 0 0 0 GREG STAFFORD PHYSICIAN ASSISTANT 231518 0 19836 0 0 0 13439 0 7466 0 272259 0 0 0 SCHEDULE J, PART I, LINE 1A LIONS, KIWANAS AND 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. SEE SCHEDULE L PART V SCHEDULE L, PART IV, LINE 1 (A) AMANDA RILEY (B) SPOUSE OF BOARD MEMBER, BLAKE RILEY (C) $32,831 (D) EMPLOYED PHYSICIAN OF CARROLL COUNTY MEMORIAL HOSPITAL (E) NO 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, LINES 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 2014. LINE 15B: ALL OTHER MANAGEMENT POSITIONS ARE HIRED, REVIEWED, AND MONITORED BY THE CEO, CNO AND COO. 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 $ 17,985 CARROLL COUNTY MEMORIAL HOSPITAL FDN 1502 N JEFFERSON ST CARROLLTON MO 64633 463696048 SUPPORT MO 501(C)(3) 7 CCMH true false true false false false false false false false false false false false false false false false false false