CHICOT MEMORIAL MEDICAL CENTER: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- CHICOT MEMORIAL MEDICAL CENTER (EIN 38-3807713)
- Tax period
- 2023-04-01 to 2024-03-31
- Filed
- 2025-01-24
- IRS object ID
- 202500249349301315
- Schema version
- 2023v6.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-01-24T15:45:39-06:00 | ReturnTs |
| Tax Period End | 2024-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 201941244 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HORNE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 661 SUNNYBROOK ROAD STE 100 | AddressLine1Txt |
| City | RIDGELAND | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 39157 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 383807713 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIC | BusinessNameControlTxt |
| Phone | 8702659229 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HWYS 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN HEARD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8702659229 | PhoneNum |
| Signature | 2025-01-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| 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 | AMIE WHITTINGTON DEAN CPA | PreparerPersonNm |
| PTIN | P01082167 | PTIN |
| Phone | 6013261000 | PhoneNum |
| Preparation | 2025-01-22 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN HEARD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HWYS 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,053,737 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHICOTMEMORIAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE CONVENIENT, QUALITY HEALTHCARE TO EVERYONE IN A CARING, EFFICIENT AND FINANCIALLY RESPONSIBLE MANNER THAT WILL ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY, TO PROMOTE COMMUNITY WELLNESS; AND, TO DO SO WITH COMPASSION, DIGNITY, AND RESPECT FOR THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 197 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,429,811 | PYContributionsGrantsAmt |
| CY Contributions Grants | $801,230 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,811,936 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,695,484 | CYProgramServiceRevenueAmt |
| PY Investment Income | $221,830 | PYInvestmentIncomeAmt |
| CY Investment Income | $261,120 | CYInvestmentIncomeAmt |
| PY Other Revenue | $272,437 | PYOtherRevenueAmt |
| CY Other Revenue | $295,903 | CYOtherRevenueAmt |
| PY Total Revenue | $21,736,014 | PYTotalRevenueAmt |
| CY Total Revenue | $22,053,737 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $200 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,338,377 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,917,495 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,818,235 | PYOtherExpensesAmt |
| CY Other Expenses | $12,105,045 | CYOtherExpensesAmt |
| PY Total Expenses | $20,156,612 | PYTotalExpensesAmt |
| CY Total Expenses | $22,022,740 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,579,402 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $30,997 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,443,980 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,858,169 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,719,878 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,103,070 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,724,102 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,755,099 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE CONVENIENT, QUALITY HEALTHCARE TO EVERYONE IN A CARING, EFFICIENT AND FINANCIALLY RESPONSIBLE MANNER THAT WILL ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY, TO PROMOTE COMMUNITY WELLNESS; AND, TO DO SO WITH COMPASSION, DIGNITY, AND RESPECT FOR THOSE WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,515,564 | ExpenseAmt |
| Grant | $200 | GrantAmt |
| Revenue | $19,266,179 | RevenueAmt |
| Desc | CHICOT MEMORIAL MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT CORPORATION OPERATING A 25-BED CRITICAL ACCESS HOSPITAL IN LAKE VILLAGE, CHICOT COUNTY, ARKANSAS. IN ADDITION TO THE 25 ACUTE CARE BEDS, CMMC ALSO OPERATES A PROVIDER BASED HEALTH CLINIC WITH ONE PHYSICIAN IN THE CLINIC THAT SPECIALIZES IN GENERAL SURGERY. ADDITIONALLY, CMMC OPERATES A HOME HEALTH AGENCY, A PROVIDER-BASED DENTAL CLINIC AND A COMMUNITY BASED FITNESS CENTER, ALL ON A NOT-FOR-PROFIT BASIS. | Desc |
| Total Program Service Expenses | $16,515,564 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | 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 | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 45 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 197 | 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIFFANY ADAMS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8702659219 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HWYS 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| SAM ANGEL | |||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TODD POTTER | |||||||
| MEMBER - PART YEAR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA THOMAS | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JP BURGE | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL ELLIOT JR | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DINO SABBATINI | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHIRLEY CATALANI | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CARRIE H PIERONI | |||||||
| MEMBER - PART YEAR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAJUAN M SCALES | |||||||
| CNO/RN | 50.00 | $125,875 | $0 | $13,344 | Yes (X) | ||
| JOHN HEARD | |||||||
| CEO | 50.00 | $160,677 | $0 | $0 | Yes (X) | ||
| VICKI ALLEN | |||||||
| CFO | 50.00 | $90,009 | $0 | $12,620 | Yes (X) | ||
| MICHAEL BRADLEY MAYFIELD | |||||||
| CMO/SURGEON | 50.00 | $386,057 | $0 | $24,459 | Yes (X) | ||
| HALEY BURSON | |||||||
| DENTIST | 50.00 | $189,873 | $0 | $19,326 | Yes (X) | ||
| CHERYL BUSH | |||||||
| PHARMACIST | 50.00 | $119,037 | $0 | $8,882 | Yes (X) | ||
| SONYA SWAIN | |||||||
| RN | 50.00 | $121,472 | $0 | $8,194 | Yes (X) | ||
| KRISTA HALL | |||||||
| PT/THERAPY DIRECTOR | 50.00 | $109,158 | $0 | $16,469 | Yes (X) | ||
| HILDA LAUHON | |||||||
| COMPLIANCE/EMPLOYEE HEALTH RN | 50.00 | $106,817 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,408,975 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $103,294 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | 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 |
|---|---|---|---|---|---|
| EMERGENCY STAFFING SOLUTIONS | |||||
| 17304 PRESTON ROAD SUITE 1400 | DALLAS | TX | 75252 | ER PHYSICIANS | $912,000 |
| TRILOGY REVENUE CYCLE SOLUTIONS | |||||
| 911 FLYNT DR | FLOWOOD | MS | 39232 | BILLING & CODING SERVICES | $454,760 |
| AMERICAN CLEANING SYSTEMS | |||||
| PO BOX 772 | CROSSETT | AR | 71635 | HOUSEKEEPING | $301,475 |
| GATES ANESTHESIA LLC | |||||
| 214 BRADLEY 20 | WARREN | AR | 71671 | CONTRACT ANESTHESIA | $295,369 |
| QUALIVIS LLC | |||||
| PO BOX 123847 | DALLAS | TX | 75312 | STAFFING SERVICES | $154,628 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $688,368 | GovernmentGrantsAmt |
| All Other Contributions | $112,862 | AllOtherContributionsAmt |
| Total Contributions | $801,230 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $19,266,179 | $19,266,179 | |
| SALES TAX REVENUE | 621990 | $1,242,071 | $1,242,071 | |
| COUNTY TAX PROCEEDS | 621990 | $187,234 | $187,234 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,695,484 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $260,650 | TotalRevenueColumnAmt |
| Exclusion | $260,650 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $85,210 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $85,210 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,210 | TotalRevenueColumnAmt |
| Exclusion | $85,210 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $470 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $470 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $470 | TotalRevenueColumnAmt |
| Exclusion | $470 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| DIETARY MEALS | 722514 | $198,839 | $198,839 |
| OTHER | 900099 | $10,904 | $10,904 |
| VENDING MACHINE | 722515 | $950 | $950 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $210,693 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,053,737 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,266,179 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,986,328 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200 | TotalAmt |
| Program Services | $200 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $762,618 | TotalAmt |
| Management And General | $762,618 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,756,470 | TotalAmt |
| Program Services | $5,880,946 | ProgramServicesAmt |
| Management And General | $875,524 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,092 | TotalAmt |
| Program Services | $85,092 | ProgramServicesAmt |
| Management And General | $24,000 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,706,989 | TotalAmt |
| Program Services | $1,211,932 | ProgramServicesAmt |
| Management And General | $495,057 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $582,326 | TotalAmt |
| Program Services | $454,214 | ProgramServicesAmt |
| Management And General | $128,112 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,814,998 | TotalAmt |
| Program Services | $3,073,181 | ProgramServicesAmt |
| Management And General | $1,741,817 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,016 | TotalAmt |
| Management And General | $33,016 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $711,889 | TotalAmt |
| Program Services | $51,499 | ProgramServicesAmt |
| Management And General | $660,390 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,761 | TotalAmt |
| Program Services | $91,371 | ProgramServicesAmt |
| Management And General | $13,390 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,716 | TotalAmt |
| Management And General | $152,716 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $762,520 | TotalAmt |
| Program Services | $762,520 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $312,491 | TotalAmt |
| Management And General | $312,491 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $3,627,098 | $3,526,455 | $100,643 |
| BAD DEBT EXPENSE | $1,298,926 | $1,298,926 | |
| DUES AND SUBSCRIPTIONS | $123,042 | $123,042 | |
| MISC | $102,717 | $24,899 | $77,818 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,871 | TotalAmt |
| Program Services | $54,329 | ProgramServicesAmt |
| Management And General | $6,542 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,022,740 | TotalAmt |
| Program Services | $16,515,564 | ProgramServicesAmt |
| Management And General | $5,507,176 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,140,703 | BOYAmt |
| EOY | $4,083,703 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $595,329 | BOYAmt |
| EOY | $4,438,069 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,277,910 | BOYAmt |
| EOY | $3,791,663 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $185,167 | BOYAmt |
| EOY | $204,183 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $166,293 | BOYAmt |
| EOY | $213,964 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $28,875,092 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $22,513,434 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,582,413 | BOYAmt |
| EOY | $6,361,658 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,496,165 | BOYAmt |
| EOY | $764,929 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,443,980 | BOYAmt |
| EOY | $19,858,169 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,368,164 | BOYAmt |
| EOY | $2,506,394 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,055 | BOYAmt |
| EOY | $2,191,676 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,061,659 | BOYAmt |
| EOY | $405,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,719,878 | BOYAmt |
| EOY | $5,103,070 | 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 | $14,724,102 | BOYAmt |
| EOY | $14,755,099 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,724,102 | BOYAmt |
| EOY | $14,755,099 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,443,980 | BOYAmt |
| EOY | $19,858,169 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $30,997 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,050 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,050 | 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 | CHICOT MEMORIAL MEDICAL CENTER PAYS DUES TO ARKANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, TOTALING $20,251, OF WHICH 20% ($4,050.20) IS ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $115,000 | OtherCostOrOtherBasisAmt |
| Book Value | $115,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,854,320 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,557,416 | DepreciationAmt |
| Book Value | $1,296,904 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $862,871 | OtherCostOrOtherBasisAmt |
| Depreciation | $665,717 | DepreciationAmt |
| Book Value | $197,154 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,466,719 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,076,276 | DepreciationAmt |
| Book Value | $2,390,443 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,576,182 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,214,025 | DepreciationAmt |
| Book Value | $2,362,157 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,361,658 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 2017 BONDS PAYABLE TAXABLE | Desc |
| Amt | $405,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $405,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,754,341 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $20,754,341 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,299,396 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,299,396 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $22,053,737 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,723,344 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,723,344 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,299,396 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,299,396 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,022,740 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE MEDICAL CENTER IS ORGANIZED AS AN ARKANSAS NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). AS SUCH, THE MEDICAL CENTER IS REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, FORM 990, WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION, THE MEDICAL CENTER IS SUBJECT TO FEDERAL INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. MANAGEMENT HAS DETERMINED THAT THE MEDICAL CENTER IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN, FORM 990-T, WITH THE IRS. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBTS 1,298,926. REVENUE CLASSIFIED AS EXPENSE 470. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 1,298,926. REVENUE CLASSIFIED AS EXPENSE 470. |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $105,606 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $105,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $362,368 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,436,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $467,974 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,436,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $105,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,665 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,665 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,078 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,101 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $50,977 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $106,743 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,101 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $99,642 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $574,717 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,443,430 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $205,248 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00990 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,298,926 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $649,463 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,988,385 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,994,355 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,970 | 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 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HIGHWAY 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | HOME HEALTH AGENCY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| 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 | HTTPS://WWW.CHICOTMEMORIAL.COM/WP-CONTENT/UPLOADS/2023/02/2022-CMMC-CHNA-AS | 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 | HTTPS://WWW.CHICOTMEMORIAL.COM/WP-CONTENT/UPLOADS/2023/02/2022-CMMC-CHNA-AS | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.CHICOTMEMORIAL.COM/FINANCIALASSISTANCEPOLICY.ASPX | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.CHICOTMEMORIAL.COM/FINANCIALASSISTANCEPOLICY.ASPX | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.CHICOTMEMORIAL.COM/PATIENTFINANCIALSERVICES | FAPSummaryOnWebsiteURLTxt |
| 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Selling Debt | Yes (X) | PermitSellingDebtInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Engaged Selling Debt | Yes (X) | EngagedSellingDebtInd |
| Engaged Legal Judicial Process | Yes (X) | EngagedLegalJudicialProcessInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CHICOT MEMORIAL MEDICAL CENTER | PART V, SECTION B, LINE 5: EVERY THREE YEARS CMMC CONDUCTS A SURVEY ASSESSING THE NEEDS OF CHICOT COUNTY RESIDENTS AND HOSPITAL STAKEHOLDERS IN THE SURROUNDING AREA. THE ASSESSMENT INCLUDES INPUT FROM PERSONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY SERVED BY THE CHICOT MEMORIAL MEDICAL CENTER, INCLUDING THOSE WITH PUBLIC HEALTH EXPERTISE. THESE INDIVIDUALS FORM THE COMMUNITY ADVISORY COMMITTEE. THE COMMUNITY ADVISORY COMMITTEE ASSISTED HOSPITAL STAFF IN COLLECTING SURVEY DATA THAT INDICATE THE MOST PRESSING HEALTH CONCERNS IN THE HOSPITAL SERVICE AREA. PLEASE SEE THE CHNA: HTTPS://WWW.CHICOTMEMORIAL.COM/WP-CONTENT/UPLOADS/2023/02/2022-CMMC-CHNA-ASSESSMENT-FINAL-WITH-ATTACHMENTS.PDF |
| CHICOT MEMORIAL MEDICAL CENTER | PART V, SECTION B, LINE 11: PLEASE SEE THE IMPLEMENTATION STRATEGY FOR INFORMATION AND INFORMATION IN THE CHNA REGARDING NEEDS THAT WERE NOT ADDRESSED DUE TO LACK OF RESOURCES: HTTPS://WWW.CHICOTMEMORIAL.COM/WP-CONTENT/UPLOADS/2023/02/2022-CMMC-CHNA-ASSESSMENT-FINAL-WITH-ATTACHMENTS.PDF |
| CHICOT MEMORIAL MEDICAL CENTER | PART V, SECTION B, LINE 16J: THE FAP, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE CURRENTLY BEING TRANSLATED INTO SPANISH AND WILL BE AVAILABE IN SPANISH, UPON COMPLETION OF TRANSLATION. |
| CHICOT MEMORIAL MEDICAL CENTER | PART V, SECTION B, LINE 20E: PLEASE NOTE THAT THIRD PARTY VENDORS ARE REQUIRED TO INFORM PATIENTS OF THE FINANCIAL ASSISTANCE POLICY AND PROVIDE THEM WITH AN APPLICATION AHEAD OF ANY COLLECTION ACTIONS. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COSTING METHODOLOGY USED ON LINE 7 IS THE RATIO OF PATIENT CARE COST TOCHARGES DERIVED FROM WORKSHEET 2. |
| PART I, LINE 7G: | CHICOT MEMORIAL MEDICAL CENTER INCURS COSTS TO HAVE SPECIALTY DOCTORS COME AND SERVE THEIR PATIENT BASE. CHICOT RECEIVES NO REVENUE FROM HAVING THESE DOCTORS VISIT CHICOT PATIENTS, THE COST CHICOT INCURS IS PURELY FOR BENEFIT OF PATIENT TO SUBSIDIZE THE HEALTH SERVICES THAT THESE PATIENTS RECEIVE. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,298,926. |
| PART III, LINE 2: | THE BAD DEBT EXPENSE IS THAT AMOUNT REFLECTED ON THE INTERNAL TRIAL BALANCE OF THE HOSPITAL. FOR AUDIT PURPOSES, THESE AMOUNTS ARE CLASSIFIED AS IMPLICIT PRICE CONCESSIONS. PLEASE SEE NOTE ONE ON THE ATTACHED AUDITED FINANCIALS FOR AN EXPLANATION OF IMPLICIT PRICE CONCESSIONS. |
| PART III, LINE 3: | METHODOLGY USED IS BASED ON NUMBER OF FINANCIAL ASSISTANCE APPLICATIONS RECEIVED, RESULTS OF THOSE APPLICATIONS AND RATIO OF APPLICATIONS RECEIVED TO TOTAL PATIENTS, TAKING INTO CONSIDERATION DEMOGRAPHICS AND POVERTY LEVELS OF THE AREA. |
| PART III, LINE 4: | FOOTNOTE 1 OF THE AUDITED FINANCIALS CONTAINS THE INFORMATION REGARDING PATIENT ACCOUNTS RECEIVABLE. |
| PART III, LINE 8: | THE COST OF PROVIDING SERVICES TO MEDICARE PATIENTS HAS HISTORICALLY EXCEEDED REVENUE. THIS COST PROVIDES A NECESSARY HEALTH BENEFIT TO THE ELDERLY POPULATION IN THE HOSPITAL'S SERVICE AREA AND SHOULD BE CONSIDERED COMMUNITY BENEFIT. |
| PART III, LINE 9B: | FINANCIAL ASSISTANCE MAY BE GRANTED PROSPECTIVELY OR RETROSPECTIVELY. ALL OVERDUE ACCOUNTS WILL BE REVIEWED INTERNALLY TO DETERMINE WHETHER ANY FINANCIAL ASSISTANCE IS AVAILABLE PRIOR TO THE INITIATION OF ANY LEGAL PROCEEDINGS OR COLLECTION ACTIONS OUTSIDE OF THE HOSPITAL. |
| PART VI, LINE 2: | THE HOSPITAL CONDUCTS A CHNA EVERY 3 YEARS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES AND FOLLOWS IT UP WITH AN IMPLEMENTATION STRATEGY. SEE IMPLEMENTATION STRATEGY, ATTACHED, AND THE CHNA AND IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://WWW.CHICOTMEMORIAL.COM/WP-CONTENT/UPLOADS/2023/02/2022-CMMC-CHNA-ASSESSMENT-FINAL-WITH-ATTACHMENTS.PDF |
| PART VI, LINE 3: | THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE INFORMATION ON THEIR WEBISTE, INFORMS PATIENTS UPON ADMISSION AND ALSO POSTS CONSPICUOUS NOTICE OF POLICIES THROUGHT THE HOSPITAL. |
| PART VI, LINE 4: | THE COMMUNITY SERVED BY THE HOSPITAL IS A RURAL SETTING WITH A PREDOMINANTLY AGRICULTURAL BASED WORKFORCE. THE AVERAGE INCOME FOR THE AREA IS AT OR BELOW THE FEDERAL POVERTY GUIDELINES. MOST RESIDENTS ARE HIGH SCHOOL EDUCATED AND OF AN ADVANCED AGE. |
| PART VI, LINE 5: | CHICOT MEMORIAL MEDICAL CENTER PROVIDES GENERAL MEDICAL AND SURGICAL CARE FOR INPATIENT, OUTPATIENT AND EMERGENCY REOOM PATIENTS. THE HOSPITAL PARTICIPATES IN BOTH MEDICARE AND MEDICAID PROGRAMS. THE HOSPITAL PROMOTES COMMUNITY WELLNESS THROUGH VOLUNTEERING AND DONATIONS TO THE COMMUNITY, AS WELL AS HELPING TO PROVIDE A FREE COMMUNITY CENTER THAT OFFERS VARIOUS EXCERCISE CLASSES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL BRADLEY MAYFIELD | ||||||||||||||
| CMO/SURGEON | $386,057 | $0 | $0 | $0 | $0 | $0 | $12,617 | $0 | $11,842 | $0 | $410,516 | $0 | $0 | $0 |
| HALEY BURSON | ||||||||||||||
| DENTIST | $189,873 | $0 | $0 | $0 | $0 | $0 | $7,484 | $0 | $11,842 | $0 | $209,199 | $0 | $0 | $0 |
| JOHN HEARD | ||||||||||||||
| CEO | $160,677 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $160,677 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE CEO'S SALARY IS APPROVED BY THE BOARD AND IS BASED ON REGIONAL DATA AND LEVEL OF EXPERIENCE. THE BOARD PERIODICALLY CONDUCTS EVALUATIONS OF THE CEO AND ADJUST SALARY, ACCORDINGLY. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY A MEMBER OF MANAGEMENT WHO THEN PRESENTS TO FINANCE COMMITTEEE FOR APPROVAL. THE 990 IS ALSO MADE AVAILABLE FOR BOARD MEMBER REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | INDIVIDUALS WHO SERVE AS DIRECTORS, MANAGERS, SUPERVISORS OF CLINICAL DEPARTMENTS AND ANY OTHER EMPLOYEE OR MEDICAL STAFF MEMBER DEEMED BY AN ADMINISTRATIVE OFFICER TO BE IN A POSITION TO INFLUENCE DECISION-MAKING FOR THE HOSPITAL, ARE REQUIRED TO DISCLOSE ALL CONFLICTS OF INTEREST. DISCLOSURE WILL OCCUR THROUGH AN ANNUAL CONFLICT OF INTEREST STATEMENT AND THE DISCLOSURE OF OTHER ACTUAL OR POTENTIAL CONFLICTS AS THEY ARISE. PRIOR TO DECISIONS BEING MADE, DIRECTORS, OFFICERS, AND KEY EMPLOYEES STATE ALL CONFLICTS AND DO NOT DISCUSS THE ISSUES OF POTENTIAL CONFLICT AND DO NOT PARTICIPATE IN DECISION MAKING OF THOSE ISSUES. |
| FORM 990, PART VI, SECTION B, LINE 15 | CEO AND TOP MANAGEMENT COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS AND IS BASED ON MARKET CONDITIONS, REGIONAL DATA, EXPERIENCE LEVEL AND PERFORMANCE EVALUATIONS. OFFICER'S AND KEY EMPLOYEE'S COMPENSATION IS APPROVED BY THE CEO AND IS BASED ON SALARY SURVEYS AND PERFORMANCE EVALUATIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,073,181. MANAGEMENT AND GENERAL EXPENSES 1,741,817. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,814,998. |
| FORM 990, PART XII, LINE 2C: | PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |