CALDWELL COUNTY HOSPITAL INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- CALDWELL COUNTY HOSPITAL INC (EIN 61-0432526)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2026-05-14
- IRS object ID
- 202611349349308311
- Schema version
- 2024v5.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-05-14T14:22:12-05:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621046406 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHNSON HICKEY & MURCHISON PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2215 OLAN MILLS DRIVE | AddressLine1Txt |
| City | CHATTANOOGA | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37421 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610432526 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL COUNTY HOSPITAL INC | BusinessNameLine1Txt |
| Business Name Line2 | CALDWELL MEDICAL CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CALD | BusinessNameControlTxt |
| Phone | 2703650321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42445 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NACY BUTTS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2703650327 | PhoneNum |
| Signature | 2026-05-14 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DIANA BOLEN | PreparerPersonNm |
| PTIN | P01226129 | PTIN |
| Phone | 4237560052 | PhoneNum |
| Preparation | 2026-05-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | NACY BUTTS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42038 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,436,997 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CALDWELLMEDICAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1947 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | CALDWELL MEDICAL CENTER IS AN ORGANIZATION THAT PROVIDES HEALTHCARE SERVICES FOR CALDWELL AND SURROUNDING COUNTIES TO RAISE AND MAINTAIN THE STANDARDS OF COMMUNITY HEALTH THROUGH EDUCATION, PREVENTION, AND TREATMENT OF ILLNESS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 303 | TotalEmployeeCnt |
| Total Volunteers | 2 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $38,214 | PYContributionsGrantsAmt |
| CY Contributions Grants | $48,020 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,610,975 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,543,776 | CYProgramServiceRevenueAmt |
| PY Investment Income | $732,177 | PYInvestmentIncomeAmt |
| CY Investment Income | $901,049 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,441,907 | PYOtherRevenueAmt |
| CY Other Revenue | $2,313,464 | CYOtherRevenueAmt |
| PY Total Revenue | $33,823,273 | PYTotalRevenueAmt |
| CY Total Revenue | $36,806,309 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,477,853 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,026,028 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,083,187 | PYOtherExpensesAmt |
| CY Other Expenses | $18,640,345 | CYOtherExpensesAmt |
| PY Total Expenses | $30,561,040 | PYTotalExpensesAmt |
| CY Total Expenses | $33,666,373 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,262,233 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,139,936 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,260,685 | TotalAssetsBOYAmt |
| Total Assets EOY | $38,606,647 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $29,639,364 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,703,328 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,621,321 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,903,319 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CALDWELL MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY, COMPASSIONATE HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $26,436,390 | ExpenseAmt |
| Revenue | $35,857,240 | RevenueAmt |
| Desc | CALDWELL MEDICAL CENTER PROVIDED INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES IN CALDWELL AND LYON COUNTIES. IN ADDITION CALDWELL MEDICAL CENTER'S MAJOR SERVICE ACCOMPLISHMENTS FOR THE YEAR INCLUDED HOSTING A COMMUNITY HEALTH FAIR, BLOOD DRIVES, BLOOD PRESSURE SCREENINGS, COVID DRIVE THRU TESTING SERVICES, COMMUNITY MAMMOGRAPHY EDUCATION, DIABETES EDUCATION, SPONSORED COMMUNITY EVENTS, AND PAYING EMPLOYEES TO SERVE ON VARIOUS COMMUNITY BOARDS. | Desc |
| Total Program Service Expenses | $26,436,390 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 303 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2703650321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42445 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| J BRENT BUGG | |||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOE FALDER | |||||||
| VICE CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOE GRAY | |||||||
| TREASURER/CHAIRMAN FINANCE | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ELLEN DUNNING | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MONTE NESMITH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KEITH ADCOCK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID LEE OLIVER DMD | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAT LANDER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CMICHAEL LITTLEJOHN MD | |||||||
| DIRECTOR/PHYSICIAN | 40.00 | Yes (X) | $346,921 | $0 | $13,731 | ||
| CHANTAY STALLINS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE WOODWARD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRADLEY HUTCHINS | |||||||
| PA | 40.00 | $188,799 | $0 | $9,304 | Yes (X) | ||
| JOSEPH DRAWDY | |||||||
| APRN | 40.00 | $138,751 | $0 | $14,218 | Yes (X) | ||
| DAVID FRENCH | |||||||
| MD | 40.00 | $373,729 | $0 | $13,706 | Yes (X) | ||
| JOHN MOBLEY | |||||||
| MD | 40.00 | $406,259 | $0 | $23,672 | Yes (X) | ||
| ELIZABETH SCHEIDLER | |||||||
| APRN | 40.00 | $154,583 | $0 | $6,917 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,609,042 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $81,548 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RH EMERGENCY MEDICINE OF CM LLC | |||||
| PO BOX 7058 | TUPELO | MS | 38802 | ED PHYSICIAN COMPANY | $1,033,909 |
| QUORUM | |||||
| 1573 MALLORY LANE SUITE 200 | BRENTWOOD | TN | 37027 | MANAGEMENT | $944,233 |
| NEW CHANCE INFUSION | |||||
| 102 W 18TH STREET | HOPKINSVILLE | KY | 42240 | CRNA | $249,500 |
| SANJAY BOSE MD | |||||
| 6811 TURNBERRY DRIVE | PADUCAH | KY | 42001 | PHYSICIAN COVERAGE | $163,999 |
| JENNIE STUART MEDICAL GROUP | |||||
| 320 W 18TH STREET | HOPKINSVILLE | KY | 42240 | MEDICAL SERVICES | $122,153 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $48,020 | GovernmentGrantsAmt |
| Total Contributions | $48,020 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTH CARE SERVICES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $33,543,776 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,543,776 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,543,776 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $891,641 | TotalRevenueColumnAmt |
| Exclusion | $891,641 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,640,096 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,630,688 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,408 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,408 | TotalRevenueColumnAmt |
| Exclusion | $9,408 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| 340B INCOME | 900099 | $2,089,086 | $2,089,086 |
| CAFETERIA SALES | 900099 | $55,256 | $55,256 |
| EMP OTCS SALES | 900099 | $7,737 | $7,737 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $161,385 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $161,385 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,313,464 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,806,309 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,857,240 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $901,049 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,747,903 | TotalAmt |
| Program Services | $9,822,680 | ProgramServicesAmt |
| Management And General | $2,925,223 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,664 | TotalAmt |
| Program Services | $128,420 | ProgramServicesAmt |
| Management And General | $38,244 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,228,389 | TotalAmt |
| Program Services | $946,514 | ProgramServicesAmt |
| Management And General | $281,875 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $883,072 | TotalAmt |
| Program Services | $680,436 | ProgramServicesAmt |
| Management And General | $202,636 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $944,233 | TotalAmt |
| Management And General | $944,233 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,531 | TotalAmt |
| Management And General | $69,531 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,560 | TotalAmt |
| Management And General | $73,560 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,893 | TotalAmt |
| Management And General | $21,893 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,692,186 | TotalAmt |
| Program Services | $2,842,983 | ProgramServicesAmt |
| Management And General | $849,203 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,549 | TotalAmt |
| Program Services | $43,549 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,867,838 | TotalAmt |
| Program Services | $1,438,235 | ProgramServicesAmt |
| Management And General | $429,603 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,832 | TotalAmt |
| Program Services | $80,721 | ProgramServicesAmt |
| Management And General | $24,111 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,330 | TotalAmt |
| Program Services | $17,964 | ProgramServicesAmt |
| Management And General | $5,366 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,360,811 | TotalAmt |
| Program Services | $1,048,549 | ProgramServicesAmt |
| Management And General | $312,262 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,670,166 | TotalAmt |
| Program Services | $1,286,918 | ProgramServicesAmt |
| Management And General | $383,248 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $700,221 | TotalAmt |
| Program Services | $539,543 | ProgramServicesAmt |
| Management And General | $160,678 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES AND DR | $3,869,146 | $3,869,146 | |
| BAD DEBT | $2,891,636 | $2,891,636 | |
| SUPPLIES | $530,170 | $140,151 | $390,019 |
| DUES TAXES LICENSES | $365,107 | $281,132 | $83,975 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,136 | TotalAmt |
| Program Services | $377,813 | ProgramServicesAmt |
| Management And General | $34,323 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,666,373 | TotalAmt |
| Program Services | $26,436,390 | ProgramServicesAmt |
| Management And General | $7,229,983 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,488,208 | BOYAmt |
| EOY | $8,957,112 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,522,164 | BOYAmt |
| EOY | $4,512,183 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $713,308 | BOYAmt |
| EOY | $728,449 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,879 | BOYAmt |
| EOY | $257,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $38,513,611 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $28,079,152 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,918,357 | BOYAmt |
| EOY | $10,434,459 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,446,440 | BOYAmt |
| EOY | $9,771,166 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,563,824 | BOYAmt |
| EOY | $3,622,484 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $485,505 | BOYAmt |
| EOY | $323,360 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,260,685 | BOYAmt |
| EOY | $38,606,647 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,300,763 | BOYAmt |
| EOY | $2,287,018 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $43,006 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,045,133 | BOYAmt |
| EOY | $23,775,667 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,293,468 | BOYAmt |
| EOY | $2,597,637 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,639,364 | BOYAmt |
| EOY | $28,703,328 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,621,321 | BOYAmt |
| EOY | $9,903,319 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,621,321 | BOYAmt |
| EOY | $9,903,319 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,260,685 | BOYAmt |
| EOY | $38,606,647 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,139,936 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $142,062 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,399 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,399 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ORGANIZATION'S DIRECT AND INDIRECT POLICIAL CAMPAIGN ACTIVITIES - FORM 990, SCH C, PART II-B, LINE 1I: THE ORGANIZATION MAKES INDIRECT DONATIONS THROUGH AHA AND KHA DUES. DESCRIPTION OF OTHER ACTIVITIES - FORM 990, SCH C, PART II-III, LINE 1I: A PERCENTAGE OF AHA AND KHA DUES ARE USED FOR LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,445,515 | OtherCostOrOtherBasisAmt |
| Book Value | $1,445,515 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,708,790 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,512,767 | DepreciationAmt |
| Book Value | $6,196,023 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,889,756 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,457,274 | DepreciationAmt |
| Book Value | $2,432,482 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,469,550 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,109,111 | DepreciationAmt |
| Book Value | $360,439 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,434,459 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER DESIGNATED CASH | Desc |
| Book Value | $3,622,484 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,622,484 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| REFUNDABLE ADVANCE | $2,283,379 |
| OPERATING LEASE LIABILITIES | $314,258 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,597,637 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $34,034,842 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $142,062 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $142,062 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,892,780 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $21,893 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $2,891,636 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,913,529 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $36,806,309 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $30,752,844 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $30,752,844 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $21,893 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $2,891,636 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,913,529 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $33,666,373 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740-10 "ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES" WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS WITHIN THE FINANCIAL STATEMENTS. THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2025 AND 2024. AS OF JUNE 30, 2025 AND 2024, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTIONS. WITH A FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2022. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT NETTED AGAINST REVENUE 2,891,636. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,891,636. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $341,044 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $341,044 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01110 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,374,885 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,096,843 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,278,042 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04150 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,715,929 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,096,843 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,619,086 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05260 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,318 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $58,264 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,318 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $58,264 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,776,511 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,099,161 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,677,350 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05450 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,334,490 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $80,069 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,822,974 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,755,496 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $67,478 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL COUNTY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42445 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CALDWELLMEDICAL.COM | WebsiteAddressTxt |
| State License | 600072 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL COUNTY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | CALDWELLMEDICAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | CALDWELLMEDICAL.COM | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.CALDWELLHOSP.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Other Actions | Yes (X) | OtherActionsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CALDWELL COUNTY HOSPITAL INC. | PART V, SECTION B, LINE 5: CALDWELL MEDICAL CENTER CONTRACTED WITH QUORUM HEALTH RESOURCES TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. WITH THE ASSISTANCE OF THE COMMUNITY STEERING COMMITTEE, INPUT FROM THE COMMUNITY WAS COLLECTED THROUGH FOCUS GROUP DISCUSSIONS AND SURVEYS. THESE INDIVIDUALS REPRESENT ORGANIZATIONS AND AGENCIES FROM THE SERVICE AREA AND THE INDIVIDUALS WHO WERE WILLING TO VOLUNTEER ENABLED THE HOSPITAL TO GET INPUT FROM POPULATIONS THAT WERE OFTEN NOT ENGAGED IN CONVERSATIONS ABOUT THEIR HEALTH NEEDS. |
| CALDWELL COUNTY HOSPITAL INC. | PART V, SECTION B, LINE 11: RESPONSE TO SIGNIFCANT NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA:THE TOP SIGNIFICANT NEEDS WHERE THE HOSPITAL HAS DEVELOPED AN ACTION PLAN TO ADDRESS THE IDENTIFIED HEALTH PRIORITIES WILL BE ORGANIZED IN SUBGROUPS IN ORDER TO ADEQUATELY ADDRESS THE HEALTH NEEDS WITH AVAILABLE TIME AND RESOURCES ARE: (1) OBESITY, (2) DRUG/SUBSTANCE ABUSE (3) HEALTH CARE SERVICES:PREVENTION (4) HEALTHCARE SERVICES: AFFORDABILITY, (5) CANCER (6) SMOKING/VAPING/TOBACCO USE, AND (7) HEALTHCARE SERVICES: PHYSICAL PRESENCE. VARIOUS STRATEGIES WERE DEVELOPED TO ADDRESS EACH OF THESE RESPECTIVE NEEDS. ONE SIGNIFICANT NEEDS WHICH WAS IDENTIFIED BUT FOR WHICH THE HOSPITAL DID NOT DEVELOP IMPLEMENTATION STRATEGIES WAS MENTAL HEALTH. THE REASON IMPLEMENTATION STRATEGIES WERE NOT DEVELOPED AND IMPLEMENTED FOR THIS NEED WAS OTHER COMMUNITY ORGANIZATIONS CAN ADDRESS THIS NEED WHICH ARE BETTER QUALIFIED TO SERVE. |
| CALDWELL COUNTY HOSPITAL INC. | PART V, SECTION B, LINE 18E: CALDWELL MEDICAL CENTER CONTRACTS WITH A COMPANY THAT WORKS WITH EACH UNINSURED PATIENT THAT COMES INTO OUR FACILITY. THE PATIENT RECEIVES CARE REGARDLESS OF THEIR ABILITY TO PAY. THE PATIENT IS BILLED THE SAME RATES AS ALL OTHER PATIENTS. THE CONTRACT COMPANY SENDS EACH PATIENT PAPERS TO ASSIST THEM WITH GETTING ON MEDICAID OR OUR CHARITY PROGRAM. THE ENTIRE AMOUNT OF THE BILL IS WRITTEN OFF IF THE PATIENT DOESN'T QUALIFY FOR MEDICAID BUT QUALIFIES FOR OUR CHARITY CARE PROGRAM. THE PATIENT'S BILL IS PUT ON HOLD WHILE THIS PROCESS IS TAKING PLACE SO THAT NO ACTION WILL BE TAKEN AGAINST THE PATIENT.CMC HAS A FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE AND GIVES TO PATIENTS AT REGISTRATION. |
| CALDWELL COUNTY HOSPITAL INC. | PART V, SECTION B, LINE 19E: CMC WILL ONLY IMPLEMENT EXTRAORDINARY COLLECTION ACTION 120 DAYS AFTER IT HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT ACCOUNT IS ELIGIBLE FOR ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | A FINANCIAL ASSISTANCE POLICY. |
| PART I, LINE 7: | COST OF CHARITY CARE WAS CALCULATED WITH A COST TO CHARGE RATIO CALCULATED BY THE HOSPITAL. COST OF MEDICAID WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 3. |
| PART I, LN 7 COL(F): | BAD DEBTS INCLUDED IN PART IX, LINE 25 TOTALED $2,891,636. THIS AMOUNT HAS BEEN REMOVED FROM TOTAL EXPENSES CALCULATED IN COLUMN F ON SCHEDULE H, PART I AND II. |
| PART III, LINE 4: | CMC PROVIDED $79,000 OF CHARITY CARE DURING THE YEAR. THE HOSPITAL USED THE COST TO CHARGE RATIO CALCULATED BY THE HOSPITAL TO DETERMINE THE COST. CMC INCLUDES THIS AMOUNT AS A COMMUNITY BENEFIT DUE TO THE FACT THAT WE TREATED PATIENTS FROM THE COMMUNITY WHO COULD NOT PAY FOR SERVICES. |
| PART III, LINE 8: | CALDWELL MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED FROM MEDICARE AT 99% OF COST RELATED TO CARING FOR MEDICARE PATIENTS. IF THERE IS A SHORTFALL IT IS A COMMUNITY BENEFIT DUE THAT WE TREATED PATIENTS FROM THE COMMUNITY WHO DID NOT PAY FOR SERVICES. |
| PART III, LINE 9B: | PATIENTS THAT QUALIFY FOR CHARITY NEVER ENTER INTO OUR COLLECTION PRACTICES. THESE ACCOUNTS ARE WRITTEN OFF AS SOON AS THE PATIENT QUALIFIES FOR CHARITY. |
| PART VI, LINE 2: | CALDWELL MEDICAL CENTER CONTRACTED WITH QUORUM HEALTH RESOURCES TO CONDUCT A COMMUNITY NEEDS ASSESSMENT. CALDWELL MEDICAL CENTER IS ALWAYS AVAILABLE IF A NEED ARISES AND ASSISTS OTHER COMMUNITY AGENCIES TO MEET THE NEEDS OF THE COMMUNITY.THE ASSESSMENT PROCESS INCLUDED COLLECTING SECONDARY DATA RELATED TO THE HEALTH OF THE COMMUNITY. SOCIAL AND ECONOMIC DATA AS WELL AS HEALTH OUTCOMES DATA WERE COLLECTED FROM SECONDARY SOURCES TO HELP PROVIDE CONTEXT FOR THE COMMUNITY. IN ADDITION HOSPITAL UTILIZATION DATA WAS COMPILED TO BETTER UNDERSTAND WHO WAS USING THE FACILITY AND FOR WHAT SERVICES. FINALLY, WITH THE ASSISTANCE OF THE COMMUNITY STEERING COMMITTEE, INPUT FROM THE COMMUNITY WAS COLLECTED THROUGH FOCUS GROUP DISCUSSIONS AND SURVEYS. |
| PART VI, LINE 3: | ANY UNINSURED PATIENT IS PROVIDED WITH THE FINANCIAL ASSISTANCE POLICY. CALDWELL MEDICAL CENTER CONTRACTS WITH DISABILITY MANAGEMENT SERVICES TO CONTACT EACH OF THE PATIENTS AND PROVIDE THEM WITH INFORMATION ON HOW TO GET QUALIFIED FOR MEDICAID OR THE CHARITY PROGRAM. |
| PART VI, LINE 4: | CALDWELL MEDICAL CENTER'S PRIMARY SERVICE AREAS ARE CALDWELL AND LYON COUNTIES. CALDWELL MEDICAL CENTER IS THE ONLY HOSPITAL LOCATED IN THESE COMMUNITIES. BOTH OF THESE COUNTIES ARE RURAL COMMUNITIES AND ARE DESIGNATED AS HPSA'S. THE COMBINED POPULATION IS 21,753. THESE COMMUNITIES HAVE PER CAPITA INCOME LEVELS BELOW THE AVERAGE FOR KENTUCKY. THE PERCENT OF POPULATION THAT WAS 65 OR OLDER WAS 24% FOR CALDWELL COUNTY AND 27.3% FOR LYON COUNTY. CALDWELL COUNTY AND LYON COUNTY HAVE 6% AND 7% UNINSURED RATES RESPECTIVELY. |
| PART VI, LINE 5: | CALDWELL MEDICAL CENTER'S BOARD OF DIRECTORS IS COMPRISED OF 13 COMMUNITY VOLUNTEERS FROM THE SERVICE AREA. THE BOARD EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN THE SERVICE AREA. CALDWELL MEDICAL CENTER OPERATES AN ER THAT IS STAFFED 24/7 AND SERVES ALL PERSONS REGARDLESS OF ABILITY TO PAY. CALDWELL MEDICAL CENTER ALSO PARTICIPATES IN ALL GOVERMENT SPONSORED HEALTH PROGRAMS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN MOBLEY | ||||||||||||||
| MD | $396,259 | $0 | $10,000 | $0 | $0 | $0 | $9,875 | $0 | $13,797 | $0 | $429,931 | $0 | $0 | $0 |
| DAVID FRENCH | ||||||||||||||
| MD | $202,955 | $0 | $170,774 | $0 | $0 | $0 | $0 | $0 | $13,706 | $0 | $387,435 | $0 | $0 | $0 |
| CMICHAEL LITTLEJOHN MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | $220,000 | $0 | $126,921 | $0 | $0 | $0 | $6,346 | $0 | $7,385 | $0 | $360,652 | $0 | $0 | $0 |
| BRADLEY HUTCHINS | ||||||||||||||
| PA | $135,726 | $0 | $53,073 | $0 | $0 | $0 | $1,938 | $0 | $7,366 | $0 | $198,103 | $0 | $0 | $0 |
| ELIZABETH SCHEIDLER | ||||||||||||||
| APRN | $123,562 | $0 | $31,021 | $0 | $0 | $0 | $3,708 | $0 | $3,209 | $0 | $161,500 | $0 | $0 | $0 |
| JOSEPH DRAWDY | ||||||||||||||
| APRN | $110,865 | $0 | $27,886 | $0 | $0 | $0 | $3,295 | $0 | $10,923 | $0 | $152,969 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | QUORUM HEALTH RESOURCE, LLC PROVIDE CEO AND CFO |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS EMAILED TO EACH BOARD MEMBER PRIOR TO FILING. THE BOARD IS TO CONTACT ADMINISTRATION IF THEY HAVE ANY CONCERNS OR QUESTIONS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH EMPLOYEE AND BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY EACH YEAR. THE BOARD AND ADMINISTRATION RELY ON SELF-REPORTING TO MONITOR COMPLIANCE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS REVIEWS THE CEO AND CFO COMPENSATION ON AN ANNUAL BASIS. QHR PRESENTS THE BOARD WITH SALARY COMPARISONS DURING EACH REVIEW. THE BOARD OF DIRECTORS HAVE TO APPROVE PHYSICIAN COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR & OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,842,983. MANAGEMENT AND GENERAL EXPENSES 849,203. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,692,186. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL COUNTY HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | PRINCETON | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42445 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203941757 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL COUNTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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