TY 2017 Form 990 Schedule O

efile Public Visual Render ObjectId: 201901349349301000 - Submission: 2019-05-14 TIN: 55-6005561

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2017

Open to Public
Inspection

Name of the organization

Webster County Memorial Hospital

Employer identification number

55-6005561

Return Reference	Explanation
Form 990, Part VI, Section A, line 3	Webster County Memorial Hospital (Hospital) entered into a Management Services Agreement with Davis Health System (DHS) in January 2017. DHS provides a full-time Chief Executive Officer(CEO) and provides support to the CEO in the performance of his or her duties as appropriate. As of the filing date of the 990, James Parker is the CEO. The Hospital reimburses DHS for the CEO's compensation and benefits.
Form 990, Part VI, Section B, line 11b	During a regularly scheduled board meeting, each board member receives a copy of the completed Form 990. The board will vote and approve the completed form before filing. If the return is completed and due between regularly scheduled board meetings, an electronic copy of the 990 is emailed to all board members and approved before the return is filed.
Form 990, Part VI, Section B, line 12c	Officers and Directors are required to complete an annual conflict of interest questionnaire. This questionnaire is then reviewed by the Board of Trustees, annually, for any interests that could give rise to conflicts. If a conflict should arise, the individual would have to disclose this conflict to the Board of Trustees. The board member would not be permitted to vote on the issue, if applicable.
Form 990, Part VI, Section B, line 15	To determine compensation of the Organization's CEO, the organization compares Forms 990 of other organizations, reviews written employment contracts and performs compensation surveys of similar facilities. A review of compensation is conducted internally by the Board of Trustees.
Form 990, Part VI, Section C, line 19	The Organization's governing documents, conflict of interest policy and financial statements are made available upon request.

Return Reference

Explanation

Form 990, Part VI, Section A, line 3

Webster County Memorial Hospital (Hospital) entered into a Management Services Agreement with Davis Health System (DHS) in January 2017. DHS provides a full-time Chief Executive Officer(CEO) and provides support to the CEO in the performance of his or her duties as appropriate. As of the filing date of the 990, James Parker is the CEO. The Hospital reimburses DHS for the CEO's compensation and benefits.

Form 990, Part VI, Section B, line 11b

During a regularly scheduled board meeting, each board member receives a copy of the completed Form 990. The board will vote and approve the completed form before filing. If the return is completed and due between regularly scheduled board meetings, an electronic copy of the 990 is emailed to all board members and approved before the return is filed.

Form 990, Part VI, Section B, line 12c

Officers and Directors are required to complete an annual conflict of interest questionnaire. This questionnaire is then reviewed by the Board of Trustees, annually, for any interests that could give rise to conflicts. If a conflict should arise, the individual would have to disclose this conflict to the Board of Trustees. The board member would not be permitted to vote on the issue, if applicable.

Form 990, Part VI, Section B, line 15

To determine compensation of the Organization's CEO, the organization compares Forms 990 of other organizations, reviews written employment contracts and performs compensation surveys of similar facilities. A review of compensation is conducted internally by the Board of Trustees.

Form 990, Part VI, Section C, line 19

The Organization's governing documents, conflict of interest policy and financial statements are made available upon request.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2017

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