JOHN ED CHAMBERS MEMORIAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- JOHN ED CHAMBERS MEMORIAL HOSPITAL (EIN 71-6044543)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-11
- IRS object ID
- 201701319349300740
- Schema version
- 2015v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-11T07:52:02-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3667 | AddressLine1Txt |
| City | LITTLE ROCK | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 722033667 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 716044543 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN ED CHAMBERS MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % MICHAELLE STANDRIDGE | InCareOfNm |
| Business Name Control | JOHN | BusinessNameControlTxt |
| Phone | 4794952241 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 639 | AddressLine1Txt |
| City | DANVILLE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72833 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE MCCOY | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4794952241 | PhoneNum |
| Signature | 2017-05-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMBER SHERRILL | PreparerPersonNm |
| PTIN | P00748683 | PTIN |
| Phone | 5013721040 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAMBERS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MIKE MCCOY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 639 | AddressLine1Txt |
| City | DANVILLE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72833 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,496,246 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHAMBERSHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS & EXPECTATIONS OF PATIENTS & COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 261 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $172,641 | PYContributionsGrantsAmt |
| CY Contributions Grants | $53,150 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,868,879 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,894,472 | CYProgramServiceRevenueAmt |
| PY Investment Income | $45,729 | PYInvestmentIncomeAmt |
| CY Investment Income | $39,941 | CYInvestmentIncomeAmt |
| PY Other Revenue | $550,161 | PYOtherRevenueAmt |
| CY Other Revenue | $508,683 | CYOtherRevenueAmt |
| PY Total Revenue | $17,637,410 | PYTotalRevenueAmt |
| CY Total Revenue | $18,496,246 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,649,288 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,509,319 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,811,953 | PYOtherExpensesAmt |
| CY Other Expenses | $8,796,820 | CYOtherExpensesAmt |
| PY Total Expenses | $19,461,241 | PYTotalExpensesAmt |
| CY Total Expenses | $19,306,139 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,823,831 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$809,893 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $31,313,188 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,305,584 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,487,458 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,289,747 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,825,730 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,015,837 | NetAssetsOrFundBalancesEOYAmt |
| Mission | IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS AND EXPECTATIONS OF PATIENTS AND THE COMMUNITITES SERVED. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,489,557 | ExpenseAmt |
| Revenue | $17,894,472 | RevenueAmt |
| Desc | IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS AND EXPECTATIONS OF PATIENTS AND THE COMMUNITITES SERVED. | Desc |
| Total Program Service Expenses | $15,489,557 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (true) | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 261 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAELLE STANDRIDGE | PersonNm |
| Phone | 4794952241 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 719 DETROIT STREET | AddressLine1Txt |
| City | DANVILLE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72833 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| JOHNNY CHAMBERS | |||||||||
| CHAIRMAN | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAVID FISHER | |||||||||
| VICE CHAIRMAN | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| HOYT DALE | |||||||||
| SECRETARY | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| TODD SANDERS | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| TOMMY PAPASAN | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| RITCHIE TIPPIN | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| PHILIP ALEXANDER | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL SCOTT PEEK | |||||||||
| CEO | 40.0 | 0.0 | $284,481 | $0 | $10,600 | Yes (X) | |||
| MIKE MCCOY | |||||||||
| INTERIM CEO | 40.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| THOMAS JOHN TINNESZ MD | |||||||||
| PHYSICIAN | 40.0 | 0.0 | $402,312 | $0 | $28,936 | Yes (X) | |||
| JOHN J WESTWOOD MD | |||||||||
| PHYSICIAN | 32.0 | 0.0 | $235,476 | $0 | $13,430 | Yes (X) | |||
| TIMMY EUGENE KAY MD | |||||||||
| PHYSICIAN | 32.0 | 0.0 | $230,281 | $0 | $13,222 | Yes (X) | |||
| WILLIAM L BERRY MD | |||||||||
| PHYSICIAN | 32.0 | 0.0 | $228,939 | $0 | $13,169 | Yes (X) | |||
| PATTY K PETTWAY MD | |||||||||
| PHYSICIAN | 32.0 | 0.0 | $192,119 | $0 | $11,696 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,573,608 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $91,053 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SOUTH ARKANSAS EMERGENCY PHYSICIANS | |||||
| 700 WEST GROVE STREET | EL DORADO | AR | 71730 | ER | $1,547,714 |
| ANESTHESIA SPECIALISTS PA | |||||
| PO BOX 20343 | HOT SPRINGS | AR | 71903 | ANESTHESIA SERVICES | $304,620 |
| RIVER RIDGE RX INC | |||||
| PO BOX 394 | DANVILLE | AR | 728330394 | PHARMACY SERVICES | $297,250 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| FILE 55826 | LOS ANGELES | CA | 900745826 | RADIOLOGY | $109,480 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $8,914 | GovernmentGrantsAmt |
| All Other Contributions | $44,236 | AllOtherContributionsAmt |
| Total Contributions | $53,150 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $17,894,472 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,894,472 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,894,472 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,941 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $39,941 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,580 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,580 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,580 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $20,580 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| CAFETERIA REVENUE | $174,705 | $174,705 |
| 340B REVENUE | $122,076 | $122,076 |
| MANAGED CARE FEE | $42,895 | $42,895 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $148,427 | TotalRevenueColumnAmt |
| Exclusion | $148,427 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $488,103 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,496,246 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,894,472 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $548,624 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,982 | TotalAmt |
| Management And General | $270,982 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,724,213 | TotalAmt |
| Program Services | $7,065,856 | ProgramServicesAmt |
| Management And General | $1,658,357 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,493 | TotalAmt |
| Program Services | $203,688 | ProgramServicesAmt |
| Management And General | $47,805 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $653,395 | TotalAmt |
| Program Services | $529,193 | ProgramServicesAmt |
| Management And General | $124,202 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $609,236 | TotalAmt |
| Program Services | $493,428 | ProgramServicesAmt |
| Management And General | $115,808 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,004,839 | TotalAmt |
| Program Services | $2,433,659 | ProgramServicesAmt |
| Management And General | $571,180 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,256 | TotalAmt |
| Program Services | $45,562 | ProgramServicesAmt |
| Management And General | $10,694 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,507 | TotalAmt |
| Program Services | $134,856 | ProgramServicesAmt |
| Management And General | $31,651 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $356,542 | TotalAmt |
| Program Services | $288,768 | ProgramServicesAmt |
| Management And General | $67,774 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,853 | TotalAmt |
| Program Services | $137,566 | ProgramServicesAmt |
| Management And General | $32,287 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $676,014 | TotalAmt |
| Program Services | $547,513 | ProgramServicesAmt |
| Management And General | $128,501 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,158,659 | TotalAmt |
| Program Services | $938,413 | ProgramServicesAmt |
| Management And General | $220,246 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $229,491 | TotalAmt |
| Program Services | $185,868 | ProgramServicesAmt |
| Management And General | $43,623 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OPERATING SUPPLIES | $1,264,239 | $1,023,924 | $240,315 |
| BAD DEBTS EXPENSE | $382,616 | $382,616 | |
| EQUIPMENT EXPENSE | $378,389 | $306,462 | $71,927 |
| DIETARY EXPENSE | $295,829 | $239,596 | $56,233 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $657,586 | TotalAmt |
| Program Services | $532,589 | ProgramServicesAmt |
| Management And General | $124,997 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,306,139 | TotalAmt |
| Program Services | $15,489,557 | ProgramServicesAmt |
| Management And General | $3,816,582 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $797,459 | BOYAmt |
| EOY | $881,890 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,593,644 | BOYAmt |
| EOY | $8,425,259 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,178,453 | BOYAmt |
| EOY | $2,952,885 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $352,107 | BOYAmt |
| EOY | $396,891 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,935 | BOYAmt |
| EOY | $201,296 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $32,867,495 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $16,559,161 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,212,590 | BOYAmt |
| EOY | $16,308,334 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $139,029 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,313,188 | BOYAmt |
| EOY | $29,305,584 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,784,441 | BOYAmt |
| EOY | $923,297 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,703,017 | BOYAmt |
| EOY | $12,127,462 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $164,732 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $74,256 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,487,458 | BOYAmt |
| EOY | $13,289,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,825,730 | BOYAmt |
| EOY | $16,015,837 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,825,730 | BOYAmt |
| EOY | $16,015,837 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,313,188 | BOYAmt |
| EOY | $29,305,584 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$809,893 | ReconcilationRevenueExpnssAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,229,124 | OtherCostOrOtherBasisAmt |
| Book Value | $1,229,124 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,128,126 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,582,893 | DepreciationAmt |
| Book Value | $13,545,233 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,021,424 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,747,971 | DepreciationAmt |
| Book Value | $1,273,453 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $488,821 | OtherCostOrOtherBasisAmt |
| Depreciation | $228,297 | DepreciationAmt |
| Book Value | $260,524 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,308,334 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AMOUNT DUE FROM THIRD PARTY PAYERS | Desc |
| Amt | $74,256 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $74,256 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $18,113,630 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $18,113,630 | RevenueSubtotalAmt |
| Other Revenues Not Included | $382,616 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $382,616 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,496,246 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,923,523 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $18,923,523 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $382,616 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $382,616 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $19,306,139 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL INCOME TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| FORM 990, SCHEDULE D, PART XI, LINE 4B | BAD DEBT EXPENSE $382,616 |
| FORM 990, SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $382,616 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 110. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $581,093 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $581,093 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,044,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,875,591 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $168,425 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,625,109 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,875,591 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $749,518 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03960 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,023,712 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,264,690 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,759,022 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09290 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,023,712 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,264,690 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,759,022 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09290 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,648,821 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,140,281 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,508,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13250 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $382,616 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $210,439 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,218,530 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,901,196 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $2,317,334 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | CHAMBERS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 719 DETROIT STREET | AddressLine1Txt |
| City | DANVILLE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 728330639 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CHAMBERSHOSPITAL.COM | WebsiteAddressTxt |
| State License | AR4825 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAMBERS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CHAMBERSHOSPITAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.CHAMBERSHOSPITAL.COM | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 110. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.CHAMBERSHOSPITAL.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.CHAMBERSHOSPITAL.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.CHAMBERSHOSPITAL.COM | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE H, PART V, SECTION B, LINE 5 | THE HOSPITAL CALCULATED THE COMMUNITY HEALTH INPUT QUESTIONAIRES IN ORDER TO GATHER BROAD COMMUNITY INPUT REGARDING HEALTH ISSUES. THE HOSPITAL ENGAGED BKD, LLP TO ASSIST IN CONDUCTING A FORMAL COMMUNITY HEALTH NEEDS ASSESMENT (CHNA). KEY INTERVIEWEES INCLUDED COMMUNITY STAKEHOLDERS THAT REPRESENT THE BROAD INTEREST OF THE COMMUNITY WITH KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. DIAGLOGUES WITH FIVE KEY INTERVIEWEES WERE CONDUCTED. INTERVIEWEES WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH OR THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. ALL INTERVIEWS WERE CONDUCTED BY HOSPITAL PERSONNEL USING A STANDARD QUESTIONNAIRE. A SUMMARY OF THEIR OPINIONS IS REPORTED WITHOUT JUDGING THE TRUTHFULNESS OR ACCURACY OF THEIR REMARKS. INTERVIEW DATA WAS INITIALLY RECORDED IN NARRATIVE FORM. INTERVIEWEES WERE ASSURED THAT PERSONAL IDENTIFIERS SUCH AS NAME OR ORGANIZATIONAL AFFILIATIONS WOULD NOT BE CONNECTED IN ANY WAY TO THE INFORMATION PRESENTED IN THE CHNA. |
| FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11 | THE NEEDS THAT WILL BE ADDRESSED IN THE MOST CURRENTLY ADOPTED CHNA INCLUDE THE FOLLOWING ISSUES CONSISTENTLY RAISED DURING INTERVIEWS: 1. RECRUITMENT OF ADDITIONAL PRIMARY CARE PRACTITIONERS CHAMBERS MEMORIAL HOSPITAL IS AGGRESSIVELY RECRUITING ADDITIONAL PRIMARY CARE PROVIDERS WHICH INCLUDES PHYSICIANS AND MID-LEVEL PROVIDERS (NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS). TO ASSIST IN THE EFFORT WE WILL UTILIZE PROFESSIONAL RECRUITMENT FIRMS AS NEEDED. IN ADDITIONS, WE ARE EXPLORING OPPORTUNITIES WITH MEDICAL SCHOOLS AND RESIDENCY PROGRAMS TO ENHANCE OUR RELATIONSHIP WITH THOSE PROGRAMS AND THEIR STUDENTS WHO WILL BE PRACTICING PHYSICIANS IN THE FUTURE. WE ARE ALSO WORKING WITH NURSE PRACTITIONERS AS A PRACTICE SIDE FOR THEIR CLINICAL ROTATIONS WHICH HELPS IN RECRUITING THOSE PROVIDERS. WITH THESE EFFORTS WE BELIEVE WE WILL BE SUCCESSFUL IN RECRUITING ADDITIONAL PRIMARY CARE PROVIDERS TO OUR AREA. 2. OBESITY OBESITY INCREASES RISKS FOR MORBIDITY AND MORTALITY OF NUMEROUS MEDICAL CONDITIONS. YELL COUNTY HAS A 10% HIGHER INCIDENT OF OBESITY THAN THE NATIONAL BENCHMARK AND 2% HIGHER THAN THE STATE OF ARKANSAS AS A WHOLE. THE HOSPITAL HAVE PARTNERED WITH AND HELP SPONSOR HEALTHY ACTIVE YELL WHICH MEETS WITH MEMBERS OF THE COMMUNITY MONTHLY TO INCREASE AWARENESS OF THIS GROWING PROBLEM AND WORK TOGETHER TO EDUCATE AND HELP YELL COUNTY TO BECOME HEALTHIER AND MORE ACTIVE. THERE ARE REPRESENTATIONS FROM ALL SCHOOLS IN YELL COUNTY ALONG WITH ADH AND COUNTY EXTENSION SERVICES. THE GROUP HAS ALSO BECOME A PART OF ARKANSAS COALITION FOR OBESITY PREVENTION (ARCOPS) AND WILL GAIN ACCESS TO MANY WAYS THAT THIS PARTNERSHIP CAN ASSIST US TO ASSIST RESIDENTS OF YELL COUNTY. WE WILL CONTINUE TO PARTNER WITH OUR SCHOOLS, ADH, ARCOPS, COUNTY EXTENSION AS WELL AS ARKANSAS TECH TO BUILD A HEALTHIER AND MORE ACTIVE COMMUNITY. 3. HEALTH EDUCATION AND KNOWLEDGE THE HOSPITAL PLANS TO EDUCATE CITIZENS BY CONTINUING TO UTILIZE THE LOCAL NEWSPAPER, UPDATE AND KEEP EDUCATIONAL MATERIAL CURRENT ON THE FACILITY WEBSITE, THROUGH HEALTH FAIRS, YELL COUNTY FAIR, SENIOR CITIZEN CENTER, AND OUR LOCAL FAITH-BASED ORGANIZATIONS. THE HOSPITAL PLANS TO PROVIDE EDUCATION MATERIAL ON TOPICS SUCH AS FAMILY HEALTH, CHRONIC DISEASES, HEALTHY EATING THROUGH NUTRITION EDUCATION, PROMOTION OF INCREASED ACTIVITY AND SMOKING CESSATION. INFORMATION WILL BE PROVIDED BY OUR STAFF PHYSICIANS AS WELL AS OUR HOME HEALTH NURSING STAFF AND HOSPITAL NURSING STAFF. OUR NURSE PRACTITIONERS WILL ALSO TAKE PART IN GETTING THIS KNOWLEDGE AND EDUCATION TO OUR COMMUNITY. 4. SMOKING CESSATION SERVICES ALL HEALTH ENCOUNTERS ARE OPPORTUNITIES FOR COUNSELING AND OVER THE LAST 3 YEARS PLUS THE HOSPITAL HAS BEEN USING INPATIENT STAYS ESPECIALLY FOR MOTIVATING PATIENTS TO COMMIT TO CESSATION OR AT LEAST TO GET THEM THINKING ABOUT IT AND GETTING INFORMATION AND NUMBERS TO CALL FOR ASSISTANCE. IF A PATIENT CHOOSES TO MAKE A DECISION TO QUIT SMOKING THEY ARE ASSISTED TO FILL OUT A FORM AND THIS IS FAXED TO THE ARKANSAS DEPARTMENT OF HEALTH. THE HOSPITAL WORKS WITH THE ARKANSAS FOUNDATION FOR MEDICAL CARE TO IDENTIFY AND DOCUMENT SMOKING CESSATION COUNSELING. THIS IS A PRIORITY NATIONALLY FOR THE DELIVERY OF QUALITY MEDICAL CARE. IN ADDITION TO CONTINUING THIS EFFORT WITH OUR INPATIENTS WE HAVE BEGUN INCREASING AWARENESS TO OUR OUT PATIENTS BY PROVIDING SMOKING CESSATION INFORMATION IN OUR CLINICS. WE HAVE ALSO ADDED THIS ITEM TO OUR HEALTH FAIRS, TO OUR LOCAL FAIR BOOTH AND PLAN TO INCREASE AWARENESS IN OUR LOCAL SCHOOLS AND FAITH-BASED ORGANIZATION. 5. CHILDRENS HEALTH SERVICES THE HOSPITAL OUR FACILITY PROVIDES FREE PHYSICALS TO ALL CHILDREN INVOLVED IN ANY TYPE OF SPORTS FOR ALL SCHOOLS ON THE WEST SIDE OF YELL COUNTY. CAR SEAT EDUCATION COURSE HAS BEEN HELD WHICH ALLOWS FOR CIVILIANS TO RECEIVE A NEW CAR SEAT ONCE THE COURSE IS COMPLETED. THE HOSPITAL KEEPS ONE INSTRUCTOR WHO WORKS AND PLANS TO HOLD AT LEAST ONE CLASS PER YEAR TO EDUCATE FAMILIES ON CAR SEAT SAFETY. BIKE SAFTEY RODEOS IN CONJUNCTION WITH THE LOCAL EMS ARE CONDUCTED. THE HOSPITAL IS ALSO INVOLVED IN FARM SAFETY, A PROGRAM THAT IS HELD IN MAY OF EACH YEAR AIMED AT ELEMENTARY GRADE STUDENTS FROM ALL OVER THE COUNTY ON FIRST AIDE AND PROVIDES EACH PARTICIPANT WITH A FIRST AIDE PACKAGE AS WELL AS EDUCATING ON MATERIAL SAFETY. THE HOSPITAL WILL CONTINUE TO EDUCATE FAMILIES ON THE IMPORTANCE OF PREVENTATIVE MEDICINE AND THIS WILL BE DONE AT THE INPATIENT LEVEL AS WELL AS THE OUTPATIENT LEVEL. THIS IS ALSO BEING DONE WITH THROUGH PARTNERSHIP WITH HEALTHY ACTIVE YELL. 6. UNDERINSURED ADULTS DURING OPEN ENROLLMENT WINDOWS, OUR FACILITY PLANS TO PARTNER WITH ORGANIZATIONS THAT WILL BRING ENROLLMENT ASSISTANCE IN-HOUSE ON A SCHEDULED BASIS. WE WILL ALSO PROVIDE ASSISTANCE TO INDIVIDUALS WITH ENROLLMENT THROUGH OUR SOCIAL SERVICES DEPARTMENT. |
| FORM 990, SCHEDULE H, PART V, LINE 16 | ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/ OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. |
| FORM 990, SCHEDULE H, PART V, LINE 20E | INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY WILL BE PROVIDED ON MONTHLY BILLING STATEMENTS AS WELL AS EFFORTS TO CONTACT THE PATIENT OR RESPONSIBLE PARTY VIA TELEPHONE. CHAMBERS MEMORIAL HOSPITAL WILL PROVIDE PATIENTS OR OTHER PARTIES RESPONSIBLE FOR PAYMENT OF THE ACCOUNT WITH A NOTICE, A MINIMUM OF 30 DAYS IN ADVANCE OF INITIATING ANY EXTRAORDINARY COLLECTION ACTIVITIES. |
| FORM 990, SCHEDULE H, PART V, LINE 22D | UNINSURED PATIENTS AND PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AT RATES HIGHER THAN THE "AMOUNTS GENERALLY BILLED" TO THIRD PARTY PAYERS. THE USE OF GROSS CHARGES TO SUCH PATIENTS IS PROHIBITED. FOR PURPOSES OF THIS POLICY, "AMOUNTS GENERALLY BILLEDAGB WILL BE DETERMINED USING THE "LOOK BACK" METHOD BY TAKING 12 MONTHS' CLAIMS PAID BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE INSURANCES AND CALCULATING THE AVERAGE DISCOUNTS GIVEN TO THOSE PAYERS. THE DISCOUNTS PERCENTAGE WILL BE REVIEWED ANNUALLY AND ANY APPROPRIATE ADJUSTMENTS WILL BE MADE TO BE EFFECTIVE ON THE FIRST DATE OF THE UPCOMING FISCAL YEAR. THE CURRENT AGB DISCOUNT FOR CHAMBERS MEMORIAL HOSPITAL IS 35%. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| CHAMBERS MEMORIAL CLINIC | ||||
| 719 DETROIT AVENUE | DANVILLE | AR | 72833 | FAMILY CLINIC |
| SCENIC 7 MEDICAL CLINIC | ||||
| 402 SOUTH SCENIC 7 DRIVE | OLA | AR | 72853 | FAMILY CLINIC |
| WESTERN YELL COUNTY MEDICAL CLINIC | ||||
| 301 WEST BROADWAY | HAVANA | AR | 72842 | FAMILY CLINIC |
| PLAINVIEW MEDICAL CLINIC | ||||
| 102 NORTH GARFIELD AVENUE | PLAINVIEW | AR | 72857 | FAMILY CLINIC |
| CHAMBERS MEMORIAL HOME HEALTH AGENCY | ||||
| 719 DETROIT AVENUE | DANVILLE | AR | 72833 | HOME HEALTH |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE H, PART I, LINE 3C | PLEASE REFER TO THE FINANCIAL ASSISTANCE POLICY OR SCHEDULE H, PART V, LINES 13 THROUGH 16 FOR ADDITIONAL INFORMATION ON THE FAP. |
| FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F | BAD DEBT EXPENSES IN THE AMOUNT OF $382,616 IS INCLUDED ON FORM 990 PART IX, LINE 25, COLUMN (A) ("TOTAL FUNCTIONAL EXPENSES"), BUT IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN. |
| FORM 990, SCHEDULE H, PART I, LINE 7 | CHAMBERS MEMORIAL HOSPITAL USES THE MEDICARE COST REPORT COST TO CHARGE RATIO METHODOLOGY. |
| FORM 990, SCHEDULE H, PART III, LINE 4 | PLEASE SEE ATTACHED AUDIT REPORT NOTE 2. |
| FORM 990, SCHEDULE H, PART III, LINE 9B | PATIENTS ARE INFORMED OF CHARITY CARE PROGRAM UPON ADMISSION AND DISCHARGE. THE PLAIN LANGUAGE SUMMARY OF THE FAP IS INCLUDED IN THE REGISTRATION PACKET. ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECEIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT AND INFORMATION REGARDING THE FAP WILL BE MADE AVAIABLE WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. |
| FORM 990, SCHEDULE H, PART VI, LINE 2 | IN ADDITION TO ANY HEALTH NEEDS REPORTED ON PART V, SECTION B, THE HOSPITAL UTILIZES THE 'COUNTY HEALTH RANKINGS' MODEL TO WEIGH THE HEALTH FACTORS NEEDS TO THE COMMUNITIES IT SERVES. THE MODEL PROVIDES A RANKING METHOD THAT RANKS ALL 50 STATES AND THE COUNTIES WITHIN EACH STATE BASED ON TWO TYPES OF HEALTH OUTCOMES FOR EACH COUNTY: MORTALITY AND MORBIDITY. COUNTIES ARE RANKED RELATIVE TO THE HEALTH OF OTHER COUNTIES IN THE STATES. AS PART OF THE ANALYSIS OF THE CHNA FOR THE COMMUNITY, THE RELATIVE HEALTH STATUS FOR YELL COUNTY WILL BE COMPARED TO THE STATE OF ARKANSAS AS WELL AS TO THE NATIONAL BENCHMARK. A BETTER UNDERSTANDING OF THE FACTORS THAT AFFECT THE HEALTH OF THE COMMUNITY WILL ASSIST WITH HOW TO IMPROVE THE COMMUNITYS HABITS, CULTURE, AND ENVIRONMENT. YELL COUNTY FELL WITHIN THE LOWER 50TH PERCENTILE OF THE 75 COUNTIES IN ARKANSAS. THE HEALTH NEEDS ARE SIMILAR TO THE NEEDS ADDRESSED IN THE CHNA AND VOICED BY THE INTERVIEWS CONDUCTED. |
| FORM 990, SCHEDULE H, PART VI, LINE 3 | ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/ OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. IN ADDITION, PATIENTS WILL BE CONTACTED VIA TELEPHONE. |
| FORM 990, SCHEDULE H, PART VI, LINE 4 | THE COMMUNITY SERVED BY THE HOSPITAL IS A RURAL AREA IN CENTRAL WESTERN ARKANSAS. THE HOSPITAL IS LOCATED IN DANVILLE, ARKANSAS, WHICH IS THE SECOND LARGEST TOWN IN THE COMMUNITY WITH A POPULATION OF AROUND 2,400 PEOPLE. THE POPULATION IS ABOUT 85% CAUCASIAN, MAKING IT MUCH MORE RACIALLY HOMOGENOUS THAN EITHER THE STATE OF ARKANSAS OF THE UNITED STATES AS A WHOLE. MOST THE REMAINING POPULATION IS HISPANIC OR LATINO. ACCORDING TO THE U.S. CENSUS BUREAU, ABOUT 16% OF THE COMMUNITYS POPULATION IS OVER AGE 65, WHICH IS HIGHER THAN ARKANSAS (15%) OR THE UNITED STATES (13%). THIS AGE GROUPS USES MORE HEALTH SERVICES THAN ANY OTHER. THE HOSPITAL SHOULD BE PREPARED FOR AN INCREASE IN PATIENT VOLUMNE DURING THE NEXT FIVE YEARS. ADDITIONALLY, THE PERCENTAGE OF COMMUNITY POPULATION AGED 15 TO 44 IS EXPECTED TO SHRINK OVER THE NEXT FIVE YEARS, WHICH COULD CONTRIBUTE TO DIFFICULTIES IN RECRUITING ENOUGH CARE PROVIDERS TO MANAGE THE AGING POPULATION. FACTORS SUCH AS EDUCATIONAL, ATTAINMENT, POVERTY LEVELS, UNEMPLOYMENT RATES AND INSURANCE COVERAGE LEVELS CONTRIBUTE SIGNIFICANTLY TO THE HEALTH STATUS OF A COMMUNITY. ABOUT 15% OF THE POPULATION HAS OBTAINED AN ASSOCIATES DEGREE OR HIGHER, COMPARED TO 37% OF THE UNITED STATES AS A WHOLE. ABOUT 25% OF THE POPULATION DOES NOT HAVE A HIGH SCHOOL DIPOLMA. LOWER LEVELS OF EDUCATION HAVE BEEN LINKED TO NEGATIVE HEALTH OUTCOMES, SO THE EDUCATION ATTAINMENT OF THE COMMUNITY IS RELEVANT TO THE CONSIDERATION OF THE HEALTH NEEDS OF THE COMMUNITY. THE INCOME LEVELS OF INDIVIDUALS WITHIN THE COMMUNITY ALSO HAVE A SIGNIFICANT EFFECT ON THEIR ABILITY TO ACCESS HEALTH SERVICES. THE AVERAGE PER-CAPITA ICOME IN YELL COUNTY IS $18,170, COMPARED TO $22,295 FOR THE STATE OF ARKANSAS. LOWER THAN AVERAGE PER CAPITA INCOME SUGGESTS THAT MANY MEMBERS OF THE COMMUNITY MAY HAVE DIFFICULTY OBTAINING HEALTH CARE, ESPECIALLY PREVENTATIVE CARE. THE POVERTY LEVELS IN YELL COUNTY ARE SIGNIFICANTLY HIGHER THAN ARKANSAS IN GENERAL. |
| FORM 990, SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL AND OTHER HEALTH CARE FACILITIES FURTHER THEIR EXEMPT PURPOSE BY PROMOTING HEALTH CARE INITIATIVES IN THE COMMUNITIES SERVED. THE HOSPITAL IS INVOLVED WITH LOCAL SCHOOL DISTRICTS, HEALTH DEPARTMENTS, CHURCHES AND FAITH-BASED ORGANIZATIONS, SENIOR CITIZEN CENTERS, AND OTHER ORGANIZATIONS TO HELP PROMOTE HEALTH EDUCATION. A FEW EVENTS IN WHICH THE HOSPITAL IS INVOLVED IN INCLUDES CAR SEAT SAFETY, HEALTH FAIRS, YELL COUNTY FAIR, FARM SAFETY, AND OTHER LOCAL EVENTS THAT WILL HELP THE HOSPITAL DISTRIBUTE HEALTH KNOWLEDGE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS JOHN TINNESZ MD | ||||||||||||||
| PHYSICIAN | $402,312 | $0 | $0 | $0 | $0 | $0 | $24,925 | $0 | $4,011 | $0 | $431,248 | $0 | $0 | $0 |
| JOHN J WESTWOOD MD | ||||||||||||||
| PHYSICIAN | $230,476 | $0 | $5,000 | $0 | $0 | $0 | $9,419 | $0 | $4,011 | $0 | $248,906 | $0 | $0 | $0 |
| TIMMY EUGENE KAY MD | ||||||||||||||
| PHYSICIAN | $230,281 | $0 | $0 | $0 | $0 | $0 | $9,211 | $0 | $4,011 | $0 | $243,503 | $0 | $0 | $0 |
| WILLIAM L BERRY MD | ||||||||||||||
| PHYSICIAN | $228,939 | $0 | $0 | $0 | $0 | $0 | $9,158 | $0 | $4,011 | $0 | $242,108 | $0 | $0 | $0 |
| PATTY K PETTWAY MD | ||||||||||||||
| PHYSICIAN | $192,119 | $0 | $0 | $0 | $0 | $0 | $7,685 | $0 | $4,011 | $0 | $203,815 | $0 | $0 | $0 |
| MICHAEL SCOTT PEEK | ||||||||||||||
| CEO | $207,797 | $0 | $54,380 | $0 | $22,304 | $0 | $10,600 | $0 | $0 | $0 | $295,081 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| YELL COUNTY ARKANSAS | ||||||||
| A | 710420105 | 98544naa4 | 2006-11-14 | $8,100,000 | CONSTRUCTION & IMPROVEMENT BONDS | false | false | false |
| YELL COUNTY ARKANSAS | ||||||||
| B | 710420105 | 98544NAB2 | 2007-01-02 | $1,800,000 | CONSTRUCTION & IMPROVEMENT BONDS | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,552,508 | $0 | $8,100,000 | $0 | $0 | $0 | $55,514 | $0 | $0 | $8,100,000 | $0 | $0 | 2009 | false | false | Yes (true) | Yes (true) |
| B | $345,002 | $0 | $1,800,000 | $0 | $433,224 | $0 | $12,336 | $0 | $0 | $1,366,776 | $0 | $0 | 2009 | false | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Remedial Action TakenRemedialActionTakenInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | 0 | false | false | false | Yes (true) |
| B | false | false | false | false | 0 | false | false | false | Yes (true) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Business Name Line1GICProviderName/BusinessNameLine1Txt | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 0 | ||||||||||
| A | false | false | false | Yes (true) | false | false | false | 0 | false | false |
| 0 | ||||||||||
| B | false | false | false | Yes (true) | false | false | false | 0 | false | false |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (true) |
| B | Yes (true) |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE K, PART IV, LINE 2C | FOR BOND SERIES 2006A, THE LAST REBATE COMPUTATION DATE WAS 10/31/2011. FOR BOND SERIES 2006B, THE LAST REBATE COMPUTATION DATE WAS 10/31/2011. |
| FORM 990, SCHEDULE K, PART IV, LINE 2C | A - COMPLETED ON BOND YEAR OF 10/31/2015 B - COMPLETED ON BOND YEAR OF 10/31/2015 |
| FORM 990, SCHEDULE K, PART III, LINE 9 & PART IV, LINE 7 & PART V | THE ORGANIZATION IS IN THE PROCESS OF DRAFTING THESE POLICIES. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHAMBERS BANK | PersonNm |
| Relationship With Org | JOHNNY CHAMBERS-BOD | RelationshipWithOrgTxt |
| Loan Purpose | EQUIPMENT | LoanPurposeTxt |
| Loan To Organization | Yes (X) | LoanToOrganizationInd |
| Original Principal | $230,516 | OriginalPrincipalAmt |
| Balance Due | $164,732 | BalanceDueAmt |
| Default | false | DefaultInd |
| Board Or Committee Approval | Yes (true) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (true) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $164,732 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHAMBERS BANK | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | JOHNNY CHAMBERS - BOD | RelationshipDescriptionTxt |
| Transaction | $1,099,270 | TransactionAmt |
| Transaction | INVESTMENT INTEREST INC & EXP | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE L, PART IV, LINE (1), COLUMN B | FormAndLineReferenceDesc |
| Explanation | JOHNNY CHAMBERS, WHO IS A BOARD MEMBER OF CHAMBERS MEMORIAL HOSPITAL, HAS MORE THAN 35% OWNERSHIP IN CHAMBERS BANK WHICH THE HOSPITAL DOES BUSINESS WITH. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11A | THE CEO AND A BOARD MEMBER WILL REVIEW AND REPORT TO THE BOARD OF DIRECTORS FOR APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE HOSPITAL HAS A COMPLIANCE COMMITTEE THAT MONITORS FOR POLICY COMPLIANCE AND RECOMMENDS CHANGES OR NEW POLICIES TO THE CEO FOR APPROVAL. THE HOSPITAL HAS INSTITUTED A NEW POLICY FOR EMPLOYEES THAT WILL BE USED FOR BOARD MEMBERS GOING FORWARD. THE BOARD MEMBERS WILL SIGN THE AGREEMENT AND BE WITHDRAWN FROM VOTING DECISIONS AS CONFLICTS ARISE. |
| FORM 990, PART VI, SECTION B, LINES 15 A & B | COMPENSATION REVIEWS FOR THE CEO, TOP MANAGEMENT OFFICIALS, OTHER OFFICERS, AND KEY EMPLOYEES ARE COMPLETED AND APPROVED BY THE BOARD OF DIRECTORS. THE LATEST REVIEWS WERE CONDUCTED FOR THE YEAR 2016. COMPARABLE COMPENSATION DATA PROVIDED BY BOTH THE ARKANSAS AND OKLAHOMA HOSPITAL ASSOCIATIONS WAS USED AS GUIDANCE. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XII, LINE 2C | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EMERGENCY ROOM SERVICES TOTAL FEES:1567322 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARMACY SERVICES TOTAL FEES:333000 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ANESTHESIOLOGY SERVICES TOTAL FEES:296475 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMIN & OFFICE SERVICES TOTAL FEES:210436 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICAL THERAPY TOTAL FEES:153641 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB & X-RAY TOTAL FEES:145124 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SPEECH THERAPY SERVICES TOTAL FEES:136032 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OCCUPATIONAL THERAPY TOTAL FEES:66229 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RESPIRATORY CARE TOTAL FEES:56550 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:28528 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CLINICS TOTAL FEES:11502 |