2024-08-07T10:50:39-05:00 2023-09-30 721396621 CARR RIGGS & INGRAM LLC 1117 BOLL WEEVIL CIRCLE ENTERPRISE AL 36330 990 2022-10-01 596031176 HOLMES COUNTY HOSPITAL CORPORATION HOLM 8505478010 2600 HOSPITAL DRIVE BONIFAY FL 32425 RONALD JAMISON CHIEF FINANCIAL OFFICER 8505478001 2024-08-05 1 0 ASHLEY H STAFFORD P00248001 3343470088 2024-08-05 2022 2024-08-08 14:25:15Z DOCTORS MEMORIAL HOSPITAL RONALD JAMISON 2600 HOSPITAL DRIVE BONIFAY FL 324250188 25345234 0 X WWW.DOCTORSMEMORIAL.ORG X 1992 FL THE ORGANIZATION OPERATES A 20 BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF BONIFAY, FLORIDA AND THE SURROUNDING AREAS, REGARDLESS OF THEIR ABILITY TO PAY. 5 5 260 15 0 0 913860 947863 24109704 24248068 14552 -7861 634040 157164 25672156 25345234 0 0 0 0 9291691 10094586 0 0 0 17378798 16984279 26670489 27078865 -998333 -1733631 12359177 12336890 18901182 20612526 -6542005 -8275636 X DOCTORS MEMORIAL HOSPITAL IS A PROGRESSIVE, FULLY ACCREDITED CRITICAL ACCESS HEALTHCARE FACILITY, OFFERING COMPASSIONATE, QUALITY CARE IN A SAFE, FAMILY ORIENTED ENVIRONMENT TO THOSE IN NEED THROUGHOUT THE PANHANDLE AREA CENTERED IN HOLMES, WASHINGTON, JACKSON, AND WALTON COUNTIES. 0 0 27078865 24397371 PATIENT SERVICES ARE RENDERED TO MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. THESE SERVICES INCLUDE INPATIENT, OUTPATIENT CARE AND OTHER SERVICES. 27078865 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 42 0 1 260 1 0 0 0 0 0 1 1 0 0 0 0 X 5 5 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X RONALD JAMISON 8505478001 2600 HOSPITAL DRIVE BONIFAY FL 324250188 CYNTHIA BROOKS CHAIRMAN 1.00 X 0 0 0 JENNIE B GOODMAN BOARD MEMBER 1.00 X 0 0 0 JERRY DIXON BOARD MEMBER 1.00 X 0 0 0 AMANDA ELDRIDGE BOARD MEMBER 1.00 X 0 0 0 MARTHA ROBERTSON BOARD MEMBER 1.00 X 0 0 0 JOANN BAKER CHIEF ADMINISTRATOR 40.00 X 99266 0 2166 ROHAN ANDERSON CHIEF OPERATING OFFICER 40.00 X 95345 0 2425 RONALD JAMISON CHIEF FINANCIAL OFFICER 40.00 X 97537 0 2166 WARREN BAILEY PHARMACY DIRECTOR 40.00 X 122591 0 635 PAMALA MANNING RN 40.00 X 123704 0 0 JONATHAN PAUL ARNP 40.00 X 161987 0 11631 JOHN THOMAS MEDICAL DOCTOR 40.00 X 318361 0 1939 SHERRY YOUNG ARNP 40.00 X 139459 0 0 1158250 0 20962 5 0 1 0 CHARLES EAVES MD 3111 THOMAS DRIVE BONIFAY FL 32425 ER PROVIDER 275850 CHRIS FOX CRNA 1716 KUMQUAT CT EASTPOINT FL 32328 CONTRACTED CRNA 265770 KENNETH FLEMING 304 SHOAL CREEK CT APT 301 PANAMA CITY FL 32407 LAND PURCHASE 221593 JIMMY CARRILLO PLLC 4106 CREEK ROAD VERNON FL 32462 ER PROVIDER 214245 EXODUS REHABILITATION INC 17352 MAIN STREET NORTH BLOUNTSTOWN FL 32424 CONTRACT PHYSICAL THERAPY 213283 5 5000 942863 947863 PROGRAM SERVICE REVENUE 900099 24208009 24208009 40059 40059 24248068 -7861 -7861 5634 0 5634 5634 5634 MISC. REVENUE 900099 151530 151530 151530 25345234 24397371 0 0 292147 292147 9127639 9127639 674800 674800 27778 27778 37699 37699 162 162 864344 864344 1113803 1113803 1157710 1157710 BAD DEBT EXPENSE 5149124 5149124 SUPPLIES 4797541 4797541 CONTRACT LABOR 826662 826662 PHYSICIAN FEES 725853 725853 2283603 2283603 27078865 27078865 0 0 205617 716343 3164529 3059306 565888 654342 57262 95506 24610407 18671859 6835210 5938548 110000 0 1420671 1872845 12359177 12336890 2631676 2070024 16269506 18542502 18901182 20612526 X -7149343 -8870206 607338 594570 -6542005 -8275636 12359177 12336890 -1733631 0 X 0 1 X 1 0 X 0 0 0 0 0 0 1 36000 0 0 36000 0 PART II-B, LINE 1: SCHEDULE C, PART II-B, LINE 1G DOCTORS MEMORIAL HOSPITAL HIRED A FIRM TO LOBBY THE FLORIDA LEGISLATURE FOR CAPITAL FUNDING NEEDS. 543503 543503 6960315 4864687 2095628 1856984 1549866 307118 13722701 11470085 2252616 1526904 787221 739683 5938548 RESTRICTED CASH 1677440 OTHER CURRENT RECEIVABLES 188569 OTHER RECEIVABLES 6836 1872845 BONDS PAYABLE 14222772 ESTIMATED THIRD PARTY SETTLEMENTS 1907400 OTHER ACCRUED EXPENSES 631366 DUE TO THIRD-PARTIES 402387 ACCRUED INTEREST PAYABLE 336063 CURRENT PORTION OF CAPITAL LEASES 255207 CAPITAL LEASE OBLIGATION 248739 UNEARNED REVENUE 214909 CURRENT PORTION OF SUBSCRIPTION LIA 176360 SUBSCRIPTION LIABILITY 88738 CURRENT MATURITIES OF LONG TERM DEB 58561 18542502 20196110 0 20196110 5149124 5149124 25345234 21929741 0 21929741 5149124 5149124 27078865 PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 5,149,124. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 5,149,124. 1 1 X 1 X 1 X 1 1 0 1 1 280204 280204 0.01280 812432 150000 662432 0.03020 1092636 150000 942636 0.04300 241 241 0.00000 15067 15067 0.00070 69401 69401 0.00320 84709 84709 0.00390 1177345 150000 1027345 0.04690 1 5149124 1493246 4273039 6409854 -2136815 X 1 1 1 SMARTHEALTH LLC MANAGEMENT SERVCES 0.00000 0.00000 0.00000 1 1 HOLMES COUNTY HOSPITAL CORPORATION 2600 HOSPITAL DRIVE BONIFAY FL 32425 WWW.DOCTORSMEMORIAL.ORG X X X X HOLMES COUNTY HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X 20 1 0 1 1 X WWW.DOCTORSMEMORIAL.ORG X 1 20 1 WWW.DOCTORSMEMORIAL.ORG 0 1 X 100.000000000000 250.000000000000 1 1 X X X X 1 X WWW.DOCTORSMEMORIAL.ORG X WWW.DOCTORSMEMORIAL.ORG X WWW.DOCTORSMEMORIAL.ORG X X X X X 1 X 0 X X X X 1 X 0 0 HOLMES COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 5: DOCTORS MEMORIAL WANTED TO BETTER UNDERSTAND THE HEALTH STATUS OF HOLMES COUNTY THROUGH THE MINDSET OF THE COMMUNITY. AS A RESULT, AN ONLINE COMMUNITY SURVEY WAS DEVELOPED BY THE HOSPITAL. MEMBERS OF THE GENERAL PUBLIC WERE ENCOURAGED BY THE HOSPITAL TO PARTICIPATE IN THE ONLINE SURVEY. THE DATA COLLECTED FROM THE SURVEY WAS GIVEN CONSIDERATION AND USED BY THE STEERING COMMITTEE IN ESTABLISHING THE TOP HEALTH PRIORITIES FOR DOCTORS MEMORIAL TO FOCUS ON OVER THE NEXT THREE YEARS. OF THE SURVEY RESPONDENTS 94% WERE WHITE, AND OF THOSE THAT RESPONDED TO THE QUESTION ON GENDER 76% WERE FEMALE AND 24% WERE MALE. THE TOP THREE AGE GROUPS THAT RESPONDED TO THE QUESTION ABOUT AGE WERE 5564 (27%), 3544 (20%), AND 4554 (16%). EVERYONE THAT ANSWERED THE QUESTION REGARDING EDUCATION HAD A HIGH SCHOOL DEGREE OR HIGHER. ABOUT 95% OF THE RESPONDENTS WHO ANSWERED THE QUESTION RELATED TO EMPLOYMENT WERE EITHER EMPLOYED OR RETIRED. HOLMES COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 11: ACCORDING TO OUR MOST RECENT CHNA THAT WAS CONDUCTED IN 2020, HEALTHY LIFESTYLES AND CHRONIC DISEASE PREVENTION WERE AREAS IN WHICH OUR COMMUNITY EXHIBITED A NEED. TO TRY TO MEET THESE NEEDS. DOCTORS MEMORIAL HOSPITAL HAS DONE THE FOLLOWING: INCREASED PHYSICAL ACTIVITY BY SPONSORING/HOSTING HEALTHY HEART WALK AND ONE 5K RACE IN HOLMES COUNTY - PARTNER WITH HHTF TO PROVIDE NUTRITIONAL INFORMATION AND RESOURCES - INCREASED NUTRITION EDUCATION BY PROVIDING NUTRITION CLASS OPTIONS - PROVIDED CESSATION RESOURCES FOR TOBACCO USERS. MEETING THE NEEDS FOR OUR COMMUNITY IS WHAT WE STRIVE FOR, HOWEVER SOME BARRIERS PREVENT US FROM REACHING GOALS SUCH AS THE NUMBER OF SPECIALISTS WE WANT TO PROVIDE, AMOUNT OF EVENTS/WORKSHOPS WE HOST, OR THE EDUCATION PROGRAMS THAT WOULD BE SO USEFUL TO OUR COMMUNITY. SOME OF THESE BARRIERS INCLUDE LIMITED FUNDING AND LIMITED RESOURCES TO CRITICAL ACCESS HOSPITALS AND OUR COMMUNITY. PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: THE HOSPTIAL CHANGED ITS METHOD OF APPROVING CHARITY CARE IN MARCH OF 2014 TO PATIENTS BEING REQUIRED TO BRING IN DOCUMENTATION TO SUPPORT THE PATIENT'S INCOME AND EXPENSES. THE HOSPITAL ESTIMATED THAT APPROXIMATELY 29% OF THE BAD DEBT EXPENSE WOULD HAVE BEEN ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY HAD THE PROPER DOCUMENTATION BEEN PROVIDED. PART III, LINE 4: PLEASE SEE NOTE 1 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTES DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE ALLOWABLE FAILS TO COVER COSTS. 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 ATTRACT HIGHLY-TRAINED STAFF AND INVEST IN MEDICAL TECHNOLOGY. IF SERVICES ARE TO BE MAINTAINED, THEN COSTS WILL HAVE TO BE COVERED BY THOSE WHO PAY. THE BURDEN FALLS ON THE COMMUNITY. PART III, LINE 9B: ALL PATIENTS FOLLOW THE SAME COLLECTION PRACTICES. THE FFA IS A TOOL WE USE DURING THIS PROCESS TO SEE IF HELP IS NEEDED. DURING CONTRACT BY PHONE OR MAIL THE PATIENT IS GIVEN THE OPPORTUNITY TO APPLY FOR ASSISTANCE AT ANYTIME DURING THE COLLECTION PERIOD. IF THE PATIENT IS QUALIFIED FOR ASSISTANCE THE COLLECTION PROCESS CEASES AND THE ACCOUNT IS ADJUSTED. PART VI, LINE 3: THE HOSPITAL PAIRS WITH THE HEALTHY HOLMES TASK FORCE TO IMPROVE THE QUALITY OF LIFE FOR CITIZENS OF HOLMES COUNTY, FLORIDA. A NEEDS ASSESSMENT WAS CONDUCTED IN 2020 TO DETERMINE THE HEALTH CARE NEEDS OF THE COMMUNITY, IN CORPORATION WITH COMMUNITY LEADERS AND THE HEALTH DEPARTMENT OF HOLMES, AS A CONTINUOUS EFFORT TO IMPROVE UPON THE HEALTH CARE SERVICES PROVIDED TO RESIDENTS OF THE COUNTY. PART VI, LINE 4: THE HOSPITAL MAKES EVERY EFFORT TO FIND ASSISTANCE FOR PATIENTS WHO ARE UNINSURED AND REQUIRE TREATMENT. ANY PATIENT WHOSE VISIST IS DEEMED AN EMERGENCY BY THE PHYSICIAN IS TREATED, REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT IS A RESIDENT OF HOLMES COUNTY, FLORIDA, HOSPITAL STAFF WILL ASSIST THEM IN COMPLETING PAPERWORK TO QUALIFY FOR APPLICABLE COUNTY PROGRAMS THAT PROVIDE ASSISTANCE TO ELIGIBLE RESIDENTS. THE HOSPITAL ALSO PARTNERS WITH THE DEPARTMENT OF CHILDREN AND FAMILY SERVICES TO SERVE AS AN ACCESS COMMUNITY SITE. HOSPITAL STAFF ASSIST PATIENTS OR THIER FAMILY MEMBERS IN APPLYING FOR MEDICAID, IF ELIGIBLE, ON-SITE AT THE HOSPITAL. ADDITIONALLY, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS DISCUSSED WITH AND OFFERED TO ALL ELIGIBLE PATIENTS AND IS ADVERTISED THROUGHOUT THE FACILITY. ALL APPLICABLE STATE AND FEDERAL REGULATIONS ARE FOLLOWED. PART VI, LINE 5: THE HOSPITAL PRIMARILY SERVES RESIDENTS OF HOLMES COUNTY, FLORIDA AND IMMEDIATE SURROUNDING AREAS. HOLMES COUNTY IS LOCATED IS AN UNDERSERVED RURAL AREA WITH HIGH UNEMPLOYMENT. THE U.S. CENSUS BUREAU CALCULATES THAT 27% OF HOLMES COUNTY RESIDENT LIVE BELOW POVERTY LEVEL. PART VI, LINE 6: AS A CRITICAL ACCESS HOSPITAL AND THE ONLY HOSPITAL LOCATED IN HOLMES COUNTY, FLORIDA, THE HOSPITAL SERVES A VITAL ROLE IN PROVIDING LOCAL, QUALITY HEALTH CARE, INCLUDING 24 HOUR EMERGENCY ROOM ACCESS, TO THE RESIDENTS OF THE COUNTY, MANY OF WHOM LIVE AT OR BELOW THE FEDERAL POVERTY LINE AND, WITHOUT ACCESS TO THE HOSPITAL, WOULD OTHERWISE HAVE LIMITED OR NO ACCESS TO SUITABLE HEALTHCARE. THE HOSPITAL'S BOARD OF DIRECTORS CONSISTS OF LOCAL COMMUNITY LEADERS WHO ARE INVESTED IN THE COMMUNITY AND INTEGRAL IN GUIDING THE POLICY AND DIRECTION OF THE HOSPITAL. ADDITIONALLY, SEVERAL OF THE PHYSICIANS CURRENTLY SERVING PATIENTS AT THE HOSPITAL ARE RESIDENTS OF HOLMES COUNTY. 0 0 0 0 0 0 0 0 0 JOHN THOMAS MEDICAL DOCTOR 318361 0 0 0 0 0 0 0 1939 0 320300 0 0 0 JONATHAN PAUL ARNP 161987 0 0 0 0 0 0 0 11631 0 173618 0 0 0 A HOLMES COUNTY HOSPITAL CORPORATION 596031176 2006-11-29 17669800 CONSTRUCTION OF A REPLACEMENT FACILITY 0 0 0 B HOLMES COUNTY HOSPITAL CORPORATION 596031176 2017-02-24 375000 EQUIPMENT ACQUISITION 0 0 0 A 4044800 17920901 594570 961861 505000 15241185 2008 0 0 1 1 B 371798 375000 21000 375000 2017 0 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 PART II, LINE 3 EXCESS OVER SALES PROCEEDS IS INVESTMENT EARNINGS. PART II, LINE 7 HOLMES COUNTY HOSPITAL CORPORATION IS A 501(C)(3) ORGANIZATION THAT IS ALSO A GOVERNMENTAL ENTITY; ACCORDINGLY THESE BONDS ARE GOVERNMENT BONDS RATHER THAN 501(C)(3) BONDS AND ARE NOT SUBJECT TO THE 2% LIMIT ON ISSUNACE COSTS. PART IV, LINE 2C THE ARBITRAGE REBATE ANALYSIS WAS PERFORMED ON NOVEMBER 29, 2011. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION WAS LEASED TO JUBILEE DOCTORS MANAGEMENT FROM MARCH 2020 TO JULY 2020. IN AUGUST 2020 TO PRESENT, SMART-HEALTH HOME, LLC HAS BEEN ENGAGED AS THE MANAGERS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE BYLAWS OF THE ORGANIZATION IDENTIFY THE GOVERNOR OF THE STATE OF FLORIDA TO HAVE THE SOLE RIGHT TO APPOINT ALL MEMBERS OF THE BOARD OF TRUSTEES. 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 CONTROLLER. ANY QUESTIONS AND CONCERNS THE CONTROLLER MAY HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO THE BOARD FOR THEIR REVIEW PRIOR TO FILING THE 990. ANY QUESTIONS OR CONCERNS THE BOARD HAVE ARE ADDRESSED AND ANY CONCERNS 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 ANNUALLY, EACH BOARD MEMBER SHALL FILE WITH THE BOARD SECRETARY A WRITTEN STATEMENT DESCRIBING EACH ACTUAL OR PROPOSED RELATIONSHIP OF THAT MEMBER, WHETHER ECONOMIC OR OTHERWISE, OTHER THAN THE MEMBER'S STATUS AS A BOARD MEMBER AND/OR A MEMBER OF THE COMMUNITY, WHICH IN ANY WAY AND TO ANY DEGREE MAY HAVE AN IMPACT ON THE FINANCES OR OPERATIONS OF THE HOSPITAL OR ITS STAFF, OR THE HOSPITAL'S RELATIONSHIP TO THE COMMUNITY. A NEW BOARD MEMBER SHALL FILE THE WRITTEN STATEMENT IMMEDIATELY UPON BEING APPOINTED TO THE BOARD. THIS DISCLOSURE REQUIREMENT IS TO BE CONSTRUED BROADLY, AND A BOARD MEMBER SHOULD FINALLY DETERMINE THE NEED FOR ALL POSSIBLE DISCLOSURES OF WHICH HE/SHE IS UNCERTAIN ON THE SIDE OF DISCLOSURES, INCLUDING OWNERSHIP AND CONTROL OF ANY HEALTH CARE DELIVERY ORGANIZATION THAT IS CORPORATELY AND FUNCTIONALLY RELATED TO THE HOSPITAL. THIS DISCLOSURE PROCEDURE WILL NOT REQUIRE ANY ACTION WHICH WOULD BE DEEMED A BREACH OF ANY STATE OR FEDERAL CONFIDENTALITY LAW, BUT IN SUCH CIRCUMSTANCES MINIMUM ALLOWABLE DISCLOURES SHOULD BE MADE. BETWEEN ANNUAL DISCLOSURE DATES, ANY NEW RELATIONSHIP OF THE TYPE DESCRIBED, WHETHER ACTUAL OR PROPOSED, SHALL BE DISCLOSED IN WRITING TO THE BOARD SECRETARY BY THE NEXT REGULARLY SCHEDULED BOARD MEETING. THE BOARD SECRETARY WILL PROVIDE EACH BOARD MEMBER WITH A COPY OF EACH MEMBER'S WRITTEN DISCLOSURE AT THE NEXT BOARD MEETING FOLLOWING FILING BY THE MEMBER FOR REVIEW AND DISCUSSION BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTESS REVIEWS THE EXECUTIVE DIRECTOR'S COMPENSATION ANNUALLY BY COMPARING THE CEO CURRENT SALARY WITH OTHER AREA HOSPITALS SALARIES FOR EXECUTIVE DIRECTORS AND A SURVEY, OF HOSPITAL EXECUTIVE DIRECTORS SALARIES IN THE STATE, PREPARED BY THE FLORIDA HOSPITAL ASSOCIATION. THE BOARD MEETS IN EXECUTIVE SESSION AND DISCUSSES IF ANY ADJUSTMENTS NEED TO BE MADE TO THE CEO SALARY. THE BOARD SETS THE SALARY BASED ON THEIR COMPARATIVE FINDINGS. ANY CHANGES TO BE MADE ARE COMMUICATED TO THE HUMAN RESOURCE DEPARTMENT VIA A PERSONNEL ACTION FORM SIGNED BY THE CHAIRMAN OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 18 FINANCIAL STATEMENTS AND OTHER INFORMATION ARE SUBMITTED TO THE STATE OF FLORIDA, AS REQUIRED, AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS AND OTHER INFORMATION ARE SUBMITTED TO THE STATE OF FLORIDA, AS REQUIRED, AND ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.