2015-05-15T12:41:38-05:00 2014-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-07-01 440629397 CARROLL COUNTY MEMORIAL HOSPITAL % JEFF TINDLE CARR 6605421695 1502 N JEFFERSON ST Suite CARROLLTON MO 64633 JEFF TINDLE CEO 6605421695 2015-05-15 true Kevin Ensminger CPA P01310558 6605421695 2013 2016-03-07 17:11:31Z JEFF TINDLE 1502 N JEFFERSON ST CARROLLTON MO 64633 16931391 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 8 174 15 0 0 17685 61532 14196300 16281542 -33883 152192 431858 433575 14611960 16928841 4966 23884 0 0 6663126 7926947 0 0 0 8316025 9358097 14984117 17308928 -372157 -380087 25902518 25849563 4206204 4435889 21696314 21413674 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 14281287 23884 16281542 ACUTE CARE HOSPITAL ORGANIZED TO PROVIDE INPATIENT AND OUTPATIENT CARE TO AREA RESIDENTS REGARDLESS OF THEIR ABILITY TO PAY. 14281287 true true false true false false false false false false true false false false false false true false false false false false false false false false true true false true true false false false false false false true false false false false false false true true false false false true 29 0 true 174 true false false false false false false false false false false X 9 8 false false false false false false false true true false false true true true true false true true false false X X JEFF TINDLE 6605421695 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 REX BUHRMESTER DIRECTOR/PRESIDENT 1.0 X X 0 0 0 CAROLYN LOCK DIRECTOR/VICE PRESIDENT 1.0 X X RANDALL BARRY DIRECTOR/SECRETARY 1.0 X X BEN POLEN DIRECTOR 1.0 X JIM GIBSON DIRECTOR 1.0 1.0 X 0 0 0 CHARLIE LOCK DIRECTOR 1.0 X BLAKE RILEY DIRECTOR 1.0 X LINDA ROSS DIRECTOR 1.0 X DEBBIE MINNICK DIRECTOR 1.0 X JEFFREY TINDLE CEO 40.0 X 145000 19500 RICHARD SMITH PHYSICIAN 40.0 X 378934 46056 TIM REID PHYSICIAN 40.0 X 214346 39519 MARVIN ROSS PHYSICIAN 40.0 X 412955 27 GREG STAFFORD PHYSICIAN ASSIST 40.0 X 215878 23040 ERIC WITT PHARMACIST 40.0 0.0 X 106666 10303 1473779 0 138445 7 false true false CERNER CORPORATION COMPUTER SYSTEMS 1288760 BSA LIFESTRUCTURES ARCHITECT/CONSTRUCT 243509 PSYCHIATRIC MEDICAL GERIATRIC PSYCH 226092 CLINISHARE NUC MED/NUC MED STRE 177857 HMN ARCH ARCHITECT/CONSTRUCT 133268 7 31250 30282 61532 NET PATIENT SERVICE REVENUE 621990 15379458 15379458 PHARMACY 340B INCOME 621990 221523 221523 EHR INCENTIVE INCOME 621990 680561 680561 16281542 147742 147742 0 0 364273 364273 0 364273 364273 7000 2550 4450 4450 4450 0 0 0 MISCELLANEOUS REVENUE 900099 69302 69302 69302 16928841 16281542 585767 3884 3884 20000 20000 0 0 172899 172899 22191 22191 6048896 5759374 289522 329372 276672 52700 882577 720992 161585 471012 436616 34396 0 14540 14540 76762 76762 9321 9321 0 70 70 2019024 1510429 508595 0 155981 39876 116105 872350 603021 269329 1130749 685343 445406 0 471934 422555 49379 101102 86311 14791 0 0 38691 38691 0 1606082 1087584 518498 172959 27738 145221 MEDICAL SUPPLIES 922437 922437 MEDICAL EQUIPMENT LEASES 40102 40102 BAD DEBT EXPENSE 1507295 1507295 _ 218698 108867 109831 17308928 14281287 3027641 0 0 0 9427632 9502059 0 0 2092723 1209674 0 0 0 0 0 0 160533 240767 70505 87704 25477226 13211516 12504345 12265710 1521444 2017200 0 0 0 0 0 0 125336 526449 25902518 25849563 1689223 1938063 0 0 0 7200 0 0 0 0 0 0 2516981 2490626 0 0 0 0 4206204 4435889 X 21690978 21399559 5336 14115 0 0 21696314 21413674 25902518 25849563 X -380087 88668 8779 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false false true 9321 false false false 9321 false 1511985 1511985 17401265 9132396 8268869 5931172 4009568 1921604 632804 69552 563252 12265710 15510214 88668 88668 15421546 1507295 1507295 16928841 15801633 15801633 1507295 1507295 17308928 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 $ 1,507,295 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $ 1,507,295 true true true X true X true false true true 29298 29298 0.00190 2319398 1806886 512512 0.03240 2348696 1806886 541810 0.03430 17011 960 16051 0.00100 68881 68881 0.00440 110703 75813 34890 0.00220 7769 7769 0.00050 204364 76773 127591 0.00810 2553060 1883659 669401 0.04240 false 1507295 300525 7318242 7391819 -73577 X true true NONE 1 1 CARROLL COUNTY MEMORIAL HOSPITAL 1502 NORTH JEFFERSON ST CARROLLTON MO 64633 X X X X PHYSICIAN CLINICS CARROLL COUNTY MEMORIAL HOSPITAL 1 true X X X X X X X X X 12 true false true X See Part V, Section C for link X X X X X X true false true true 100 true 300. true X X X X X X true true X true false X X X true X X false false SCHEDULE H, PART V, LINE 3 Stakeholder and local business owners/community leaders were interviewed to discuss the future of CCMH and what they saw as a health need for the community. A local physician was interviewed to gather his thoughts of the health of the community. An RN from the Carroll County Health Department was consulted to help with reports regarding public health. SCHEDULE H, PART V, LINE 5 The Hospital's CHNA Report is available at: http://www.carrollcountyhospital.org/about_us/our_community/community_heal th_needs_assesment.aspx SCHEDULE H, PART V, LINE 20D THE HOSPITAL UTILIZES A STANDARDIZED CHARGE RATE FOR EACH PROCEDURE AND SUPPLY CHARGED TO PATIENTS REGARDLESS OF PAYOR TYPE OR ABILITY TO PAY. 5 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 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 $1,507,295. SCHEDULE H, PART I, LINE 7, COLUMN G NO PHYSICIAN CLINIC COSTS ARE INCLUDED. SCHEDULE H, PART III, LINE 2 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, LINE 3 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 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, LINE 4 THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, 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 IT'S 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, 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 AND UNINSURED 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 HOSPITALS 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 9,300 RESIDENTS, WITH 35% OF THE RESIDENTS LIVING IN URBAN AREAS AND 65% LIVING IN RURAL AREAS. THE MEDIAN ANNUAL HOUSEHOLD INCOME FOR CARROLL COUNTY IS APPROXIMATELY $36,500. APPROXIMATELY 13.7% OF CARROLL COUNTY RESIDENTS HAVE ANNUAL INCOME BELOW THE FEDERAL POVERTY LEVEL, AND 4.5% OF CARROLL COUNTY RESIDENTS HAVE ANNUAL INCOME BELOW 50% OF THE FEDERAL POVERTY LEVEL. THE CLOSEST HOSPITALS ARE LOCATED IN MARSHALL, LEXINGTON, AND RICHMOND. THE DISTANCE BETWEEN CARROLL COUNTY MEMORIAL HOSPITAL AND THESE FACILITIES IS APPROXIMATELY 20, 25, AND 27 MILES. 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. true GROW GRANT 5 20000 PROCEDURES FOR MONITORING GRANTS 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 145000 0 0 9500 10000 164500 0 RICHARD SMITH PHYSICIAN 378934 0 0 14462 31594 424990 0 TIM REID PHYSICIAN 214346 0 0 11213 28306 253865 0 MARVIN ROSS PHYSICIAN 412955 0 0 0 27 412982 0 GREG STAFFORD PHYSICIAN ASSIST 215878 0 0 7428 15612 238918 0 SCHEDULE J, PART I, LINE 1A ALL STAFF RECEIVE MEMBERSHIP TO LIFESTYLE FITNESS. LIONS AND KIWANAS CLUB MEMBERSHIPS 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. COUNTRY CLUB DUES WERE PAID FOR JEFFREY TINDLE. 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 GROSS CHARGES. SEE SCHEDULE L PART V SCHEDULE L, PART IV, LINE 1 (A) AMANDA RILEY (B) SPOUSE OF BOARD MEMBER, BLAKE RILEY (C) $22,191 (D) EMPLOYED PHYSICIAN OF CARROLL COUNTY MEMORIAL HOSPITAL (E) NO 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 CEO IS HIRED, REVIEWED AND COMPENSATION IS SET BY THE BOARD. COMPENSATION REVIEWS OCCUR ANNUALLY WITH THE LAST ONE BEING CONDUCTED IN DECEMBER OF 2013. 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 ORGANIZATIONS 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 $ 8,779 FORM 990 PART IX LINE 11G DESCRIPTION:ER PHYSICIANS FEES TOTAL FEES:572325 FORM 990 PART IX LINE 11G DESCRIPTION:GERIATRIC PSYCH TOTAL FEES:240333 FORM 990 PART IX LINE 11G DESCRIPTION:WOUND CARE PROFEE TOTAL FEES:150375 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAID ADMINISTRATION TOTAL FEES:554003 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:578750 CARROLL COUNTY MEMORIAL HOSPITAL FDN 1502 N JEFFERSON CARROLLTON MO 64633 463696048 SUPPORT MO 501(C)(3) 7 CCMH true false false false false false false false false false false false false false false false false false false false