2025-11-17T10:49:46-06:00 2024-12-31 752570395 D & CO LLP 1500 BROADWAY SUITE 1000 LUBBOCK TX 79401 990 2024-01-01 752425436 CLAY COUNTY MEMORIAL HOSPITAL FOUNDATION CLAY 9405385621 310 WEST SOUTH STREET HENRIETTA TX 76365 DEBRA HAEHN CFO 9405385621 2025-11-17 0 TOMMY DAVIS P03007276 8067911591 2024 2025-03-06 01:10:19Z DEBRA HAEHN 310 WEST SOUTH STREET HENRIETTA TX 76365 150148 0 X WWW.CCMHOSPITAL.COM X 1992 TX THIS CORPORATION IS ORGANIZED TO PROVIDE FINANCIAL SUPPORT TO CLAY COUNTY MEMORIAL HOSPITAL. 7 7 0 7 0 0 57531 59837 109024 0 88206 64412 12150 25899 266911 150148 0 0 0 0 1051465 0 0 0 5932 74576 186542 1126041 186542 -859130 -36394 2952884 3551676 1873781 1998592 1079103 1553084 X THE PURPOSE FOR WHICH THIS CORPORATION IS ORGANIZED IS TO PROVIDE FINANCIAL SUPPORT TO CLAY COUNTY MEMORIAL HOSPITAL TO ENSURE THE HOSPITAL REMAINS OPEN AND THAT PERSONS IN AND AROUND CLAY COUNTY WILL CONTINUE TO RECEIVE APPROPRIATE MEDICAL CARE. THE FOUNDATION WILL ASSIST CLAY COUNTY MEMORIAL HOSPITAL WITH FACILITY MAINTENANCE, IMPROVEMENT PROJECTS, PURCHASE OF EQUIPMENT, PHYSICIAN RECRUITEMENT, AND OTHER AREAS OF SUPPORT. ALL OF THE PURPOSES INCLUDED IN THE ARTICLEES OF INCORPORATION ARE INCLUDED AS THE CORPORATE PURPOSES AS A PART OF THE BY-LAWS. 0 0 179812 3721 THE HOSPITAL IS A GOVERNMENTAL AGENCY OWNED BY CLAY COUNTY. 179812 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X DEBRA HAEHN 9405385621 310 WEST SOUTH STREET HENRIETTA TX 76365 X TONY DUNKERLEY CHAIRMAN 0.80 X X 0 0 0 SHERRY CLEVELAND VICE CHAIR 0.80 X X 0 0 0 CINDY DEAN SECRETARY 0.80 X X 0 0 0 JACQUETTA GRAVES DIRECTOR 0.40 X 0 0 0 GINGER SCHAFFNER DIRECTOR 0.80 X 0 0 0 GARY PARRISH DIRECTOR 0.40 X 0 0 0 CASEY CODY DIRECTOR 0.40 X 0 0 0 JIM KOULOVATOS CEO 0.30 39.80 X 0 0 0 DEBRA HAEHN CFO 0.30 39.08 X 0 0 0 0 0 0 0 0 0 0 0 59837 59837 64412 64412 22178 0 22178 22178 22178 UTILITY REIMBURSEMENT 900099 3721 3721 3721 150148 3721 0 86590 798 798 9579 3647 5932 15195 15195 28143 28143 40295 40295 PHYSICIAN RECRUITMENT 50524 50524 TMC PROJECTS 19923 19923 PROPERTY TAX 16033 16033 CLINIC EXP 3227 3227 2825 2825 186542 179812 798 5932 189626 185106 410601 271618 379812 800156 783330 362082 476674 421248 1496171 1873548 2952884 3551676 1873781 1998592 1873781 1998592 X 1079103 1553084 1079103 1553084 2952884 3551676 -36394 510375 0 X 0 0 0 X X 1 CLAY COUNTY MEMORIAL HOSPITAL 756000727 6 1 183410 0 1 183410 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 760905 347585 413320 22425 14497 7928 421248 DUE TO HOSPITAL 1998592 1998592 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES AND ALL AUTHORITY IS HELD BY THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. MANAGEMENT REVIEWS THE FORM AND IT IS PROVIDED TO THE BOARD FOR APPROVAL BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REVIEWS THE CONFLICT OF INTEREST POLICY ONCE A YEAR AND ALL BOARD MEMBERS SIGN AN ANNUAL STATEMENT CONFIRMING NO CONLICTS EXIST. ANY BOARD MEMBERS, OFFICERS, OR EMPLOYEES WITH A CONFLICT ARE EXCUSED FROM VOTING AND DISCUSSING ANY TRANSACTIONS CONNECTED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF MANAGERS USES COMPENSATION SURVEYS TO REVIEW AND APPROVE THE CEO'S COMPENSATION. THE REVIEW IS DOCUMENTED WITHIN THE CEO'S CONTRACT AND GETS UPDATED EVERY 3 YEARS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMETNS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CLAY COUNTY MEMORIAL HOSPITAL 310 WEST SOUTH STREET HENRIETTA TX 76365 756000727 HOSPITAL TX 501(C)(3) NA 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0