2025-08-04T11:46:29-04:00 2024-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2023-10-01 630307951 MIZELL MEMORIAL HOSPITAL INC MIZE 3344939111 P O BOX 1010 OPP AL 364671010 JANA WYATT CFO 3344939113 2025-08-04 true false WILLIAM EDWARD PHILLIPS P00451499 2298837878 2025-08-03 2023 2025-03-06 01:10:19Z LORI STANFIELD PO BOX 1010 OPP AL 364671010 22061285 false X WWW.MIZELLMH.COM X 1945 AL OUR MISSION IS TO PROVIDE THE HIGHEST QUALITY HEALTHCARE, IN A CHRISTIAN MANNER WITH HOMETOWN COMPASSION TO THE COMMUNITIES WE SERVE. 9 6 373 6 0 1856499 757951 22426165 20355994 108735 221749 578239 718763 24969638 22054457 0 0 13222932 13081933 0 0 12865400 12814049 26088332 25895982 -1118694 -3841525 16040326 14213751 7027683 9042633 9012643 5171118 OUR MISSION IS TO PROVIDE THE HIGHEST QUALITY HEALTHCARE, IN A CHRISTIAN MANNER WITH HOMETOWN COMPASSION TO THE COMMUNITIES WE SERVE. false false 18789437 20833899 PROVIDE QUALITY HEALTH CARE FOR RESIDENTS OF COVINGTON COUNTY, ALABAMA REGARDLESS OF ABILITY TO PAY. THE HOSPITAL'S FACILITIES INCLUDE GENERAL MEDICAL, SURGICAL SERVICES, 5 BED INTENSIVE CARE UNIT, 24 HOUR EMERGENCY SERVICES AND SENIOR BEHAVIORAL CARE UNIT. MIZELL MEMORIAL HOSPITAL ALSO OFFERS THE SERVICES OF THE WELLNESS CENTER, RURAL HEALTH CLINICS, URGENT CARE AND OUTPATIENT THERAPY. 18789437 true true false true false false false false false false true false false true false true true false false false false false false false false false true true false false true false false false false false false true false false false false false true true true true false false true X 73 0 373 true false false false false false false false false false false false false X 9 6 true false false false false true false true true false false true true true true false false true true true false X JANA WYATT 3344935790 702 NORTH MAIN STREET OPP AL 364671010 SEAN OWEN ORTHOPEDIC S 40.00 X 383548 0 8000 JAMES NORMAN PHYSICIAN 40.00 X 321377 0 17047 PATRICIA ROUNTREE CRNP 40.00 X 174683 0 17047 LARRY NORRIS PHYS ASST 40.00 X 152013 0 17047 LARRY DICKEY RN 40.00 X 124765 0 17047 BRENNEN BOWEN COO 40.00 X 104613 0 17047 REBECCA JONES CNO 40.00 X 97402 0 12449 MITCHELL MYERS CEO(RESIGN 6 40.00 X 103708 0 0 JANA WYATT CFO 40.00 X 87069 0 11976 LORI STANFIELD INTERIM CEO( 40.00 X 38060 0 0 JOHN ADAMS VICE CHAIRMA 1.00 X X 0 0 0 NEAL PRESLEY PHARM D BOARD MEMBER 1.00 X 0 0 0 STEVEN DAVIS DO BOARD MEMBER 1.00 X 0 0 0 MELINDA HALL BOARD MEMBER 1.00 X 0 0 0 J MICHAEL STANFIELD MD BOARD MEMBER 1.00 X 0 0 0 JEFFREY WORLEY MD CHAIRMAN(TER 1.00 X X 0 0 0 FRANK MCGUIRE SECRETARY 1.00 X X 0 0 0 JOSH DRIVER OD TREASURER 1.00 X 0 0 0 SKIP SPURLIN BOARD MEMBER 1.00 X 0 0 0 DONNA YOUMANS BOARD MEMBER 1.00 X 0 0 0 1587238 117660 12 false true false SYCAMORE PHYSICIAN CONTRACTING 119 E MOBILE ST ST 12 POB 283 FLORENCE AL 35631 PHYSICIAN 613855 COMMUNITY ANESTHESIA PO BOX 756 ANDALUSIA AL 36420 ANESTHESIA SVS 514850 COMPUTER PROGRAMS & SYSTEMS INC DEPT6448 PO BOX 11407 BIRMINGHAM AL 35246 COMPUTER NETWK 429712 CORONIS HEALTH RCM LLC PO BOX 66936 ST LOUIS MO 63104 BILLING SVCS 408000 FELDER SERVICES PO BOX 70171 MOBILE AL 36670 HOUSEKEEPING SV 402120 9 16844 693354 47753 757951 NET PROGRAM SERVICE REVENUE 621990 18629498 18629498 MEDICAID ACCESS NET 1726496 1726496 20355994 133749 133749 61500 1828 59672 59672 59672 93000 5000 88000 88000 88000 INCENTIVE CLINIC REVENUES 621990 319305 319305 CAFETERIA SALES 722210 268184 268184 MISCELLANEOUS REVENUES 621990 63211 63211 8391 7389 1002 659091 22054457 20745899 550607 X 434264 434264 10917421 8392030 2525391 60893 45018 15875 880423 650897 229526 788932 583257 205675 70777 70777 114221 114221 4536280 3069290 1466990 5436 1607 3829 2067504 1450768 616736 783402 550732 232670 10362 10362 276037 276037 1147025 804867 342158 344780 246538 98242 MEDICAL SUPPLIES 2431093 2431093 REPAIRS & MAINTENANCE 704140 458772 245368 MISCELLANEOUS 236789 94214 142575 TAXES & LICENSES 57419 57419 28784 10354 18430 25895982 18789437 7106545 0 873912 44409 669191 587069 2698051 2825616 859031 875528 514423 232788 23808439 15396519 8653684 8411920 127410 303679 1644624 932742 16040326 14213751 1321098 3178830 5706585 5863803 7027683 9042633 X 9012643 5171118 9012643 5171118 16040326 14213751 -3841525 X true true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4897 4897 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS MEMBERSHIP DUES TO A STATE ORGANIZATION. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THAT ORGANIZATION PARTICIPATES. 173313 173313 13493691 9783141 3710550 86386 70680 15706 8288250 5542698 2745552 1766799 1766799 8411920 ROU ASSET- FINANCE 366735 ROU ASSET- OPERATING 319839 OTHER RECEIVABLES 128430 THIRD PARTY SETTLEMENTS 102176 DEPOSITS 15562 932742 X 22056285 1828 1828 22054457 22054457 25897810 1828 1828 25895982 25895982 SCHEDULE D, PAGE 3, PART X THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE CORPORATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2024 AND 2023 OR FOR THE YEARS THEN ENDED. THE CORPORATION'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 1,828 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 1,828 true true X true X true X true true true false false 207033 207033 0.00800 3066807 3732759 3273840 3732759 207033 0.00800 6336 6336 0.00020 775 775 7111 7111 0.00030 3280951 3732759 214144 0.00830 5483 5483 0.00020 7300 7300 0.00030 31762 31762 0.00120 44545 44545 0.00170 false 3891794 583769 6525939 5298991 1226948 X true true 1 1 MIZELL MEMORIAL HOSPITAL INC P O BOX 1010/702 N MAIN ST OPP AL 364671010 WWW.MIZELLMH.COM H2004 X X X SWINGBED; PSYCH UNIT; RHC MIZELL MEMORIAL HOSPITAL INC 1 false false true X X X X X X X X X X 22 true false false true X WWW.MIZELLMH.COM X true 22 true HTTPS://WWW.MIZELLMH.COM/DOCS/MMH_2022 false false true X 100.000000000000 300.000000000000 X true true X X X true X WWW.MIZELLMH.COM X WWW.MIZELLMH.COM X WWW.MIZELLMH.COM X X X X X X true X false X X X X true X false false FACILITY 1, MIZELL MEMORIAL HOSPITAL, INC. - PART V, LINE 3E THE 2022 CHNA IDENTIFIED THE FOLLOWING SIGNIFICANT HEALTH NEEDS FOR COVINGTON COUNTY: ACCESS TO CARE O TRANSPORTATION O AVAILABILITY OF MENTAL HEALTH PROFESSIONALS AND COUNSELORS AFFORDABILITY OF CARE COMMUNITY COLLABORATION O HEART DISEASE AND STROKE O OBESITY AND RELATED ISSUES (DIABETES) O RELATIONSHIP WITH LOW-INCOME AREAS CANCER AND RELATED ILLNESSES MENTAL HEALTH O UNDERAGE TRANSPORT ISSUES DRUG ABUSE PRIORITIZED NEEDS IDENTIFIED FOR COVINGTON COUNTY ARE: ACCESS TO CARE AFFORDABILITY OF CARE COMMUNITY COLLABORATION TRANSPORTATION MENTAL HEALTH FACILITY 1, MIZELL MEMORIAL HOSPITAL, INC. - PART V, LINE 5 THE 2022 CHNA WAS CONDUCTED FROM APRIL 15, 2022 TO JUNE 15, 2022. THE CHNA INCLUDES INPUT RECEIVED FROM HOSPITAL, COMMUNITY LEADERS, AND COVINGTON COUNTY RESIDENTS. DURING THE CHNA PROCESS, THE INFORMATION AND DATA WERE COLLECTED FROM PRIMARY AND SECONDARY SOURCES TO HELP IDENTIFY THE NEEDS WITHIN COVINGTON COUNTY. MMH SOLICITED AND TOOK INTO ACCOUNT INPUT RECEIVED FROM PERSONS WITH BROAD INTEREST IN COVINGTON COUNTY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH THROUGH MULTIPLE METHODS. COMMUNITY SURVEYS AND THE HEALTH NEEDS FORUM HELPED TO GAIN DIRECT INPUT FROM THESE INDIVIDUALS IDENTIFYING AND PRIORITIZING HEALTH NEEDS, INCLUDING THE HEALTH ISSUES ASSOCIATED WITH THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS IDENTIFYING RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THOSE HEALTH NEEDS. IN ADDITION, TO FOCUS GROUPS AND CONDUCTING INTERVIEWS, COMMUNITY INPUT WAS GATHERED THROUGH A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF RESPECTED ORGANIZATIONS ON A BROAD ARRAY OF HEALTH INDICATORS AND OTHER INFORMATION AND ANALYZED AND SUMMARIZED. THE TYPES OF DATA INCLUDED DEMOGRAPHIC, SOCIOECONOMIC, MORTALITY AND MORBIDITY, HEALTH STATUS INDICATORS, HEALTH BEHAVIORS, INSURANCE STATUS, AND GENERAL COMMUNITY/ENVIRONMENTAL INFORMATION. SEE THE DISCUSSION BEGINNING ON PAGE 13 OF THE 2022 CHNA FOR MORE INFORMATION. FACILITY 1, MIZELL MEMORIAL HOSPITAL, INC. - PART V, LINE 11 THE HOSPITAL'S ACTION PLAN ADDRESSES COMMUNITY CONCERNS IDENTIFIED IN THE ASSESSMENT AS FOLLOWS: AFFORDABILITY OF CARE COMMUNITY COLLABORATION/CONECTING COMMUNITY RESOURCES ACCESS TO PRIMARY MEDICAL CARE CANCER AND RELATED ILLNESSES OBESITY AND DIABETES HEART AND STROKE, BLOOD PRESSURE, CHOLESTEROL MENTAL HEALTH RESPIRATORY DISEASE AND ILLNESS (COPD, FLU, PNEUOMONIA) DRUG ABUSE CHRONIC PAIN EMERGENCY ROOM CARE ALL SIGNIFICANT HEALTH ISSUES ARE ADDRESSED IN THE IMPLEMENTATION STRATEGY PORTION OF THE 2022 CHNA. 7 MIZELL MEM GERIATRIC PSYCH UNIT 702 N MAIN STREET OPP AL 36467 PSYCHIATRIC UNIT MIZELL MEMORIAL SWING BED 702 N MAIN STREET OPP AL 36467 SWING BED UNIT MIZELL MEDICAL CLINIC I 802 N BRANTLEY ST OPP AL 36467 RURAL HEALTH CLINIC MIZELL MEDICAL CLINIC II 103 E MEMORIAL AVE OPP AL 36467 RURAL HEALTH CLINIC ELBA HEALTHCARE CLINIC 918 DRAYTON AVENUE ELBA AL 36323 RURAL HEALTH CLINIC MIZELL SPECIALTY CLINIC 702 NORTH MAIN STREET OPP AL 36467 RURAL HEALTH CLINIC MIZELL STAT CARE 702 NORTH MAIN STREET OPP AL 36467 URGENT CARE SCHEDULE H, PART I, LINE 7, COLUMN (F) IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 25,897,811 ADD: EXPENSES REPORTED IN PART VIII 1,828 DENOMINATOR FOR COLUMN (F) 25,899,639 SCHEDULE H, PART I, LINE 7 THE ORGANIZATION USES THE COST TO CHARGE RATIO USING THE IRS' RECOMMENDED FORMAT IN WORKSHEET 2. OTHER COSTS IN PART I LINES 7E THROUGH 7I WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. SCHEDULE H, PART II COMMUNITY-BUILDING ACTIVITIES ADDRESS ROOT CAUSES OF THE COMMUNITY'S HEALTH PROBLEMS SUCH AS POVERTY. MMH VIEWS EACH OF THEIR COMMUNITY-BUILDING ACTIVITIES AS STRONGLY ALIGNED WITH THE VISION AND MISSION OF PUBLIC HEALTH. MMH COMMUNITY SUPPORT ACTIVITIES PROMOTE JOB OPPORTUNITIES FOR TEENS. MMH COALITION BUILDING AND ADVOCACY PROGRAMS ARE DESIGNED TO PROTECT AND PROMOTE HEALTHY CONDITIONS AND THE HEALTH FOR THE ENTIRE POPULATION; DIMINISH ADVERSE ENVIRONMENTAL AND SOCIAL EVENTS BY IMPLEMENTING POLICIES AND STRATEGIES TO REDUCE THE PROBABILITY OF PREVENTABLE INJURIES AND ILLNESS OR NEGATIVE OUTCOMES. MMH STAFF WORK IN COALITIONS TO ADDRESS COMMUNITY SAFETY AND HEALTH, AND ADVOCATE TO REDUCE OBESITY COMMUNITY-WIDE. MMH WORKFORCE DEVELOPMENT ACTIVITIES ADDRESS THE NEED FOR MORE HEALTHCARE WORKERS BY CONDUCTING CAREER FAIRS AND MOCK INTERVIEW SESSIONS. SCHEDULE H, PART III, LINE 2 AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 15%) BASED ON AN ANALYSIS OF SELF PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT. SCHEDULE H, PART III, LINE 4 SEE PAGES 14-19 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR THE FOOTNOTE DISCUSSING UNINSURED PATIENTS, BAD DEBTS, AND PRICE CONCESSIONS. SEE PAGE 20 FOR A SUMMARY OF UNCOMPENSATED SERVICES. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. SCHEDULE H, PART III, LINE 9B THE BILLING STATEMENT SHALL NOTIFY AND INFORM RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FAP AND INCLUDE THE TELEPHONE NUMBER OF THE PATIENT FINANCIAL SERVICES DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND FAP APPLICATION PROCESS AND THE DIRECT WEB ADDRESS WHERE COPIES OF THE FAP, FAP APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THE FAP MAY BE OBTAINED. FOR THOSE PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE, HOSPITAL WILL PROVIDE ADDITIONAL FINANCIAL ASSISTANCE AS SET FORTH IN THE FAP. THE PATIENT FINANCIAL SERVICES DEPARTMENT IS THE DEPARTMENT OF THE HOSPITAL WITH THE AUTHORITY AND RESPONSIBILITY FOR DETERMINING WHETHER AN INDIVIDUAL QUALIFIES FOR FINANCIAL ASSISTANCE OR WHETHER ECAS MAY BE INITIATED AGAINST INDIVIDUALS. IN COMPLIANCE WITH SECTION 9 OF THIS POLICY, BALANCES THAT REMAIN UNPAID MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY THAT WILL COMPLETE THE COLLECTION PROCESS. SUCH COLLECTION AGENCY SHALL BE OBLIGATED BY WRITTEN CONTRACT TO OBSERVE THE SAME PROCEDURES WITH RESPECT TO DETERMINING QUALIFICATION FOR FINANCIAL ASSISTANCE THAT APPLY TO HOSPITAL UNDER THE FAP. THOSE EFFORTS WILL INCLUDE A CONTINUATION OF STATEMENTS AND PHONE CALLS AS DEEMED APPROPRIATE. IN THE EVENT THAT THESE EFFORTS ARE INADEQUATE, THE EXTERNAL AGENCY MAY UNDERTAKE EXTRAORDINARY COLLECTION ACTIONS LISTED IN THE BILLING AND COLLECTIONS POLICY AVAILABLE ON THE ORGANIZATION'S WEBSITE. ALL STAFF ASSIGNED TO WORK FOR THE HOSPITAL AT THE CONTRACTED EXTERNAL COLLECTION AGENCY WILL BE AWARE OF THE HOSPITAL'S FAP AND OFFER THAT TO PATIENTS WHEN APPROPRIATE. NOTWITHSTANDING THE PROVISIONS OF THE PRECEDING PARAGRAPHS, THE FOLLOWING LIMITATIONS SHALL APPLY: A. DURING THE FIRST ONE HUNDRED AND TWENTY (120) DAYS AFTER THE PATIENT'S FIRST BILLING STATEMENT FOR CARE IS ISSUED, HOSPITAL SHALL NOT REFER THE ACCOUNT TO A COLLECTION AGENCY OR ENGAGE IN ANY OTHER ECAS. B. HOSPITAL SHALL OBSERVE ALL PATIENT NOTIFICATION PROCEDURES SET FORTH IN THE FAP. C. IF NO POSITIVE PATIENT RESPONSE IS RECEIVED AFTER ONE HUNDRED AND TWENTY (120) DAYS FROM THE FIRST BILLING STATEMENT, HOSPITAL SHALL CLASSIFY THE UNPAID BALANCE AS BAD DEBT AND MAY PROCEED WITH THE COLLECTION EFFORTS OR ANY OTHER ECAS DESCRIBED IN THIS POLICY. D. NOTWITHSTANDING BAD DEBT CLASSIFICATION OR REFERRAL TO A COLLECTION AGENCY OR INITIATION OF ANOTHER ECA, A PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE USING THE PROCESS OUTLINED IN THE FAP. E. ALL ECAS WILL BE PUT ON HOLD AS SOON AS A FAP APPLICATION IS RECEIVED AND UP UNTIL DETERMINATION IS MADE FOR ELIGIBILITY. AFTER FAP APPLICATIONS ARE PROCESSED, PATIENTS WILL BE NOTIFIED IN WRITING AS TO WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FAP. F. AT LEAST THIRTY (30) DAYS BEFORE INITIATING ECA, HOSPITAL SHALL (1) PROVIDE THE PATIENT WITH A WRITTEN NOTICE INDICATING THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR ELIGIBLE PATIENTS, IDENTIFYING THE ECAS THAT THE HOSPITAL MAY TAKE TO OBTAIN PAYMENT FOR CARE, AND STATING THE DEADLINE AFTER WHICH ECAS MAY BE INITIATED; (2) PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FAP; (3) MAKE A REASONABLE EFFORT TO ORALLY NOTIFY THE PATIENT ABOUT THE FAP AND HOW TO OBTAIN ASSISTANCE WITH THE FAP APPLICATION PROCESS. IF, BASED ON INFORMATION OTHER THAN THAT PROVIDED BY THE INDIVIDUAL OR BASED ON A PRIOR FAP ELIGIBILITY DETERMINATION, A PATIENT IS PRESUMPTIVELY DETERMINED TO BE ELIGIBLE FOR: LESS THAN THE MOST GENEROUS ASSISTANCE AVAILABLE UNDER THE FAP, HOSPITAL SHALL: A. NOTIFY THE INDIVIDUAL REGARDING THE BASIS FOR THE PRESUMPTIVE FAP-ELIGIBILITY DETERMINATION AND THE WAY TO APPLY FOR MORE GENEROUS ASSISTANCE AVAILABLE UNDER THE FAP. B. GIVE THE INDIVIDUAL A REASONABLE PERIOD OF TIME TO APPLY FOR MORE GENEROUS ASSISTANCE BEFORE INITIATING ECAS TO OBTAIN THE DISCOUNTED AMOUNT OWED FOR THE CARE. C. DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR A MORE GENEROUS DISCOUNT UPON THE RECEIPT OF A COMPLETE FAP APPLICATION FOR FINANCIAL ASSISTANCE. HOSPITAL WILL NOT ACCEPT A WAIVER OF THE FOREGOING PROCEDURES OR ANY SIGNED STATEMENT THAT THE INDIVIDUAL DOES NOT WISH TO APPLY FOR ASSISTANCE UNDER THE FAP OR RECEIVE THE INFORMATION ABOUT THE FAP DESCRIBED IN THIS POLICY AND THE FOREGOING PROCEDURES WILL APPLY IN ALL EVENTS. IN ADDITION TO THE PREVIOUS EFFORTS, THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP SHALL BE AVAILABLE FREE OF CHARGE ON THE HOSPITAL'S WEBSITE. ADDITIONALLY, PAPER COPIES OF THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP SHALL BE AVAILABLE UPON REQUEST AND FREE OF CHARGE IN PUBLIC LOCATIONS IN THE HOSPITAL (INCLUDING EACH REGISTRATION DESK THROUGHOUT THE HOSPITAL AND THE EMERGENCY ROOM) OR BY CONTACTING THE PATIENT ACCOUNTING DEPARTMENT. SCHEDULE H, PART VI, LINE 2 MIZELL CONDUCTS REGULAR COMMUNITY HEALTH NEEDS ASSESSMENTS THROUGH FORMAL AND INFORMAL SURVEYS AND PROCESSES, INCLUDING COLLABORATIONS WITH PUBLIC AND COMMUNITY AGENCIES. THROUGH STRATEGIC PLANNING, WHICH INVOLVES ALL EMPLOYEES AND BOARD MEMBERS, AND COMMUNITY INTERVIEWS, THE ORGANIZATION DEVELOPS PROGRAMS AND SERVICES THAT CONSIDER THE ECONOMIC IMPERATIVES OF THE REGION, THE EFFECT OF LEGISLATION AND THE INVOLVEMENT OF OTHER COMMUNITY-BASED ORGANIZATIONS AND PARTNERS. SCHEDULE H, PART VI, LINE 3 THE BOARD HAS A CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT INCLUDES A PLAIN LANGUAGE SUMMARY OF THE POLICY AND A LIST OF PROVIDERS WITHIN THE FACILITY THAT ARE EITHER COVERED OR NOT COVERED BY THE POLICY. THESE DOCUMENTS ARE AVAILABLE ON THE HOSPITAL'S WEB SITE AND ARE AVAILABLE FREE OF CHARGE AT EVERY REGISTRATION DESK WITHIN THE HOSPITAL AS WELL AS THE HOSPITAL BUSINESS OFFICE. SIGNS NOTIFYING PATIENTS ABOUT FINANCIAL ASSISTANCE ARE PROMINENTLY POSTED IN THE REGISTRATION AREA OF ALL HOSPITAL FACILITIES, THE HOSPITAL BUSINESS OFFICE, AND THE EMERGENCY ROOM WAITING AREA. PATIENT EDUCATION ON THE ORGANIZATION'S INDIGENT AND FINANCIAL AID PROGRAMS ARE CONDUCTED AT ANY TIME PATIENTS EXPRESS CONCERN ABOUT ABILITY TO PAY FOR THEIR CARE AND ASSISTANCE TO COMPLETE THE REQUIREMENTS IS ALSO AVAILABLE THROUGH PATIENT ACCOUNT REPRESENTATIVES. PATIENT STATEMENTS HIGHLIGHT THE ORGANIZATION'S CHARITY PROGRAM AND ENCOURAGE PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 4 MIZELL SERVES A PREDOMINATELY RURAL AREA IN OPP, ALABAMA. THE PRIMARY SERVICE AREA INCLUDES COVINGTON AND CONTIGUOUS COUNTIES IN SOUTH CENTRAL, ALABAMA. 2023 US CENSUS BUREAU DATA SHOWS THAT COVINGTON COUNTY'S MEDIAN HOUSEHOLD INCOME IS 50,886 COMPARED TO ALABAMA'S RATE OF 62,212 AND THE US RATE OF 77,719. THE COUNTY ALSO SERVES A HIGHER PERCENTAGE OF PERSONS AGE 65 YEARS AND OLDER THAN STATE AND US NUMBERS. ALSO, INDIVIDUALS WITH A DISABILITY UNDER AGE 65 REPRESENT A LARGER PERCENTAGE OF THE COVINGTON COUNTY'S POPULATION THAN THE STATE AND US POPULATION. THE REGION'S CITIZENS EXPERIENCE HIGH LEVELS OF DIABETES, HYPERTENSION, OBESITY, STROKE AND HEART ATTACK AND HAVE A HIGHER INCIDENCE OF CANCER COMPARED TO THE REMAINDER OF THE STATE, WITH HIGHER DEATH RATES FROM CANCER DUE TO LATE DIAGNOSIS AND BARRIERS TO ACCESS IN RURAL AREAS. SCHEDULE H, PART VI, LINE 5 THE ORGANIZATION AND ALL ITS VOLUNTEER BOARD ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS. OUR EMERGENCY DEPARTMENT HAS 24/7 PHYSICIAN COVERAGE AND IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. ANY SURPLUS OF FUNDS IS REINVESTED INTO THE OPERATIONS AND CAPITAL BUDGET OF THE ORGANIZATION TO STAY UP TO DATE ON TECHNOLOGY AND CONTINUALLY IMPROVE PATIENT CARE, SAFETY, AND OUTCOMES. MIZELL IS A LEADING HEALTH RESOURCE TO THE COMMUNITY OFFERING HEALTH EDUCATION PROGRAMS ON A VARIETY OF TOPICS IN VARIOUS SETTINGS. MIZELL SERVES AS A CLINICAL INSTRUCTION SITE PROVIDING CLASSROOM SPACE AND TRAINING OPPORTUNITIES AT NO CHARGE TO SURROUNDING COLLEGES. SCHEDULE H, PART VI, LINE 6 THE MIZELL MEMORIAL HOSPITAL FOUNDATION WAS ESTABLISHED AS A NON-PROFIT FOUNDATION TO RAISE FUNDS FOR THE CHARITABLE NEEDS OF COVINGTON COUNTY RESIDENTS, HEALTH CARE SERVICES, EDUCATIONAL SERVICES, AND FOR GIFTS AND GRANTS TO NON-PROFIT ORGANIZATIONS, STATE AND LOCAL INSTITUTIONS FOR EDUCATIONAL AND CHARITABLE ACTIVITIES, AND INDIVIDUALS IN FURTHERANCE OF CHARITABLE PURPOSES. WITH THE SUPPORT OF FOUNDATION DONORS, NEW MEDICAL EQUIPMENT CAN BE PURCHASED OR EXISTING EQUIPMENT UPGRADED FOR MIZELL MEMORIAL HOSPITAL. THE CORPORATION PURCHASED SHARES IN INSPIRIEN INSURANCE COMPANY (FORMERLY KNOWN AS COASTAL RISK RETENTION GROUP, INC.) IN ORDER TO PURCHASE INSURANCE THROUGH THE COMPANY. SCHEDULE H, PART VI, LINE 7 ALABAMA X X X false false false false false false false false false SEAN OWEN ORTHOPEDIC SURGEON 383548 8000 391548 JAMES NORMAN PHYSICIAN 213838 107539 17047 338424 PATRICIA ROUNTREE CRNP 84604 90079 17047 191730 LARRY NORRIS PHYS ASST 86303 65710 17047 169060 SCHEDULE J, PART III MITCHELL MYERS AND JANA WYATT WERE CONTRACTED THROUGH A MANAGEMENT SERVICES ARRANGEMENT WITH ALLIANT MANAGEMENT SERVICES, INC. DURING PART OF CALENDAR YEAR 2023. DURING MAY 2023 (PRIOR TO THE BEGINNING OF THE FISCAL YEAR), THE CONTRACT WITH ALLIANT WAS TERMINATED AND MR. MYERS AND MS. WYATT BECAME EMPLOYEES OF MIZELL MEMORIAL HOSPITAL. HAYLEY ELMORE FAMILY MEMBER 37413 COMPENSATION false KATIE BOWERS FAMILY MEMBER 39683 COMPENSATION false SCHEDULE L, PART V HAYLEY ELMORE IS THE DAUGHTER OF BOARD MEMBER MELINDA HALL. SHE RESIGNED IN NOVEMBER 2023. KATIE BOWERS IS THE DAUGHTER OF BOARD MEMBER SKIP SPURLIN AND IS EMPLOYED AND COMPENSATED BY THE HOSPITAL. FORM 990, PAGE 6, PART VI, LINE 2 STEVEN DAVIS, D.O. J. MICHAEL STANFIELD, M.D. BOARD MEMBER BOARD MEMBER BUSINESS RELATIONSHIP LORI STANFIELD J. MICHAEL STANFIELD, MD INTERIM CEO BOARD MEMBER FAMILY FORM 990, PAGE 6, PART VI, LINE 7A TWO MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS ARE APPOINTED BY THE CITY OF OPP, AL THROUGH THEIR SELECTION BY THE CITY'S MAYOR AND APPROVAL BY ITS CITY COUNCIL. FORM 990, PAGE 6, PART VI, LINE 11B FORM 990 IS REVIEWED AND APPROVED BY THE CFO AND CEO AND RECONCILED TO THE ORGANIZATION'S RECORDS BEFORE FILING WITH THE IRS. A COPY OF THE FORM 990 IS ELECTRONICALLY DISTRIBUTED TO EACH CURRENT VOTING MEMBER OF THE BOARD PRIOR TO FILING. FORM 990, PAGE 6, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR, PRINCIPAL OFFICER OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST. ANY CONFLICTS OF INTEREST ARE ADDRESSED IN BOARD MEETINGS. BOARD MEMBERS WITH POSSIBLE CONFLICTS OF INTEREST ABSTAIN FROM VOTING UNDER SUCH CIRCUMSTANCES. FORM 990, PAGE 6, PART VI, LINE 15A ALLIANT MANAGEMENT SERVICES RECOMMENDS COMPENSATION PACKAGE TO THE EXECUTIVE COMMITTEE OF THE BOARD. THEY COMPARE THESE AMOUNTS TO BUDGETED AMOUNTS AND CONSIDER THE CURRENT FINANCIAL POSITION OF THE HOSPITAL WHEN MAKING A FINAL DECISION. THIS PROCESS IS COMPLETED APPROXIMATELY EVERY THREE YEARS, MOST RECENTLY IN 2022. BEGINNING OCTOBER 1, 2019, THE CEO AND CFO ARE EMPLOYED AND COMPENSATED BY ALLIANT MANAGEMENT. THE AGREEMENT WITH ALLIANT MANAGEMENT WAS TERMINATED AS OF MAY 2023. FORM 990, PAGE 6, PART VI, LINE 15B THE CEO AND HR DIRECTOR REVIEW COMPENSATION FOR THE OTHER OFFICERS. COMPENSATION IS COMPARED TO SALARY SURVEYS FROM THE ALABAMA HOSPITAL ASSOCIATION FOR SIMILAR POSITIONS. THEY ALSO COMPARE THESE AMOUNTS TO BUDGETED AMOUNTS AND CONSIDER THE CURRENT FINANCIAL POSITION OF THE HOSPITAL WHEN MAKING A FINAL DECISION. THIS PROCESS IS COMPLETED APPROXIMATELY EVERY THREE YEARS, MOST RECENTLY IN 2022. FORM 990, PAGE 6, PART VI, LINE 19 DOCUMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART IX, LINE 11G CONTRACT LABOR 0 800,595 0 PROFESSIONAL FEES 1,551,311 0 0 PURCHASED SERVICES 1,517,979 657,011 0 CONSULTING 0 9,384 0 TOTAL 3,069,290 1,466,990 0 OPP IMAGING SERVICE LLC P O BOX 1010 OPP AL 36467 200911686 IMAGING AL MMH MIZELL MEMORIAL FOUNDATION INC P O BOX 1010 OPP AL 36467 300136672 FUNDRAISG AL 501C3 7 MMH true false false false false false false false false false false false true false false true false false false false MIZELL MEMORIAL FOUNDATION INC L AMOUNT UNDETERMINABLE MIZELL MEMORIAL FOUNDATION INC O AMOUNT UNDETERMINABLE