2025-11-17T13:59:56+00:00 2024-12-31 440160260 Forvis Mazars LLP PO Box 3667 Little Rock AR 722033667 990 2024-01-01 710403278 Johnson Regional Medical Center JOHN 4797545454 PO BOX 738 CLARKSVILLE AR 72830 TOMMY HOBBS CEO 4797545454 2025-11-17 true true Amber Sherrill P00748683 5013721040 2025-11-17 2024 2025-03-06 01:10:19Z TOMMY HOBBS 1100 EAST POPLAR STREET CLARKSVILLE AR 72830 42823437 false X WWW.JRMC.COM X 1996 AR INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO SURROUNDING RURAL COMMUNITY. 7 7 590 29 0 378648 305366 36122274 41425936 583951 1092135 4826839 0 41911712 42823437 0 0 0 0 24072512 27073300 0 0 0 21271631 19337933 45344143 46411233 -3432431 -3587796 48340761 43280624 21363919 19891578 26976842 23389046 INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO SURROUNDING RURAL COMMUNITY. false false 35421813 0 41425936 INPATIENT AND OUTPATIENT HEALTHCARE SERVICES WHICH INCLUDES CHARITABLE CARE OF $172,923 FOR 2024 BASED ON ESTIMATED COSTS. 35421813 true true false true false false false false false false true false false false true false false false false false false false false false false false true true false false true true false false false false false false false false false false false false false false false false false false false false true 25 0 true 590 true false false false false false false false false false false false false X 7 7 false false false false false false false true true false false false true true true true true true true true false false X TOMMY HOBBS 4797545454 1100 EAST POPLAR STREET CLARKSVILLE AR 72830 Heather Patton Board Vice President 1.0 0.0 X X 0 0 0 Matthew McCormick Board Secretary/Treasurer 1.0 0.0 X X 0 0 0 Rickey Casey Chairman of the Board 1.0 0.0 X X 0 0 0 Clayton Caldwell Board Member 1.0 0.0 X 0 0 0 Darrel Wheeler Board Member 1.0 0.0 X 0 0 0 Josh Nelson Board Member 1.0 0.0 X 0 0 0 Shannon Case Physician 40.0 0.0 X 891701 0 11029 Thomas Pennington Board member 1.0 0.0 X 0 0 0 Andy Altenburger CIO 40.0 0.0 X 111140 0 8517 Elizabeth Moore Interim CFO 5/6/24 through 10/4/2024 40.0 0.0 X 120000 0 0 Julie Hopkins CNO since 02/18/2024 40.0 0.0 X 102289 0 7176 Mark Woolery CFO since 9/15/2024 40.0 0.0 X 40036 0 420 Nancy Hill CNO through 3/8/2024 40.0 0.0 X 32826 0 660 Tommy Hobbs CEO 40.0 0.0 X 240203 0 12726 Whitney Stepp CFO through 5/28/2024 40.0 0.0 X 58400 0 231 Bryan Smith Physician 40.0 0.0 X 313405 0 4767 Clinton Twaddell Physician 40.0 0.0 X 393329 0 10538 Ezechiel Nehus Physician 40.0 0.0 X 756874 0 14034 Kevin Meyer Physician 40.0 0.0 X 400252 0 8081 Rolando Cheng Physician 40.0 0.0 X 561685 0 13731 4022140 0 91910 20 false true false Qualivis LLC 5930 CORNERSTONE CR W 300 SAN DIEGO CA 92121 STAFFING 998543 Conway Regional Medical Center Inc 2302 COLLEGE AVE CONWAY AR 72034 HOSPITALIST 381500 Wayne Brooks MD PO BOX 215 GOSHEN AR 72735 INPATIENT REHAB 273750 Denise Beaumont CRNA 6371 E MISSION BLVD FAYETTEVILLE AR 72703 CRNA 176000 Huron Consulting Services LLC 3005 MOMENTUM PLACE CHICAGO IL 606895330 FINANCIAL CONSULTING 131494 6 275366 30000 305366 PATIENT SERVICE REVENUE 622110 41201839 41201839 Medical Office Building Rental 531120 128658 128658 OTHER PROGRAM SERVICE REVENUE 622110 95439 95439 0 0 0 0 41425936 1092135 1092135 0 0 0 0 0 0 0 0 0 42823437 41425936 0 1092135 X 1637353 1637353 20948437 16337070 4611367 2646931 2064264 582667 253989 198079 55910 1586590 1237335 349255 31500 24566 6934 23964 18689 5275 7911165 6169685 1741480 0 16007 12483 3524 2797458 2181655 615803 877337 684209 193128 123893 96621 27272 14754 11506 3248 831322 648324 182998 1993229 1554461 438768 1092379 851914 240465 MEDICAL SUPPLIES 2289474 2289474 FOOD 326537 254657 71880 REPAIRS AND MAINTENANCE 270154 210685 59469 HAZARDOUS WASTE 60023 46810 13213 678737 529326 149411 0 46411233 35421813 10989420 0 20219781 12477480 1043613 3708687 4417351 5489641 0 0 1007305 0 1406457 1887119 647743 389053 72648896 53581744 19453141 19067152 61817 61817 0 0 82828 0 725 199675 48340761 43280624 4325177 3221498 17365000 16202763 0 -326258 467317 21363919 19891578 X 26976842 23389046 26976842 23389046 48340761 43280624 -3587796 0 X false false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6906 6906 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING ACTIVITIES INCLUDE A PORTION OF DUES FOR THE ARKANSAS HOSPITAL ASSOCIATION & THE AMERICAN HOSPITAL ASSOCIATION. 499069 499069 30641625 18930045 11711580 38239797 33149297 5090500 3268405 1502402 1766003 19067152 Federal Income Taxes DUE TO THIRD PARTY PAYORS 371387 OTHER LIABILITIES 8883 LEASE LIABILITY 87047 467317 true true X true X true X 90283 90283 0.00195 7478694 5214433 2264261 0.04879 0 0.0 0 0 7568977 5214433 2354544 0.05073 0 0.0 0 0.0 2183150 1026125 1157025 0.02493 0 0.0 0 0.0 0 0 2183150 1026125 1157025 0.02493 0 0 9752127 6240558 3511569 0.07566 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 3494542 6680052 6734499 -54447 X true true 1 1 JOHNSON REGIONAL MEDICAL CENTER 1100 E POPLAR STREET CLARKSVILLE AR 72830 JRMC.COM AR3028 X X X JOHNSON REGIONAL MEDICAL CENTER 1 false false true X X X X X X X X X 22 true false false true X https://www.jrmc.com/community-health-needs-assessments/ X true 22 true https://www.jrmc.com/community-health-needs-assessments/ false true X 200.0 300.0 X X X X true true X X X X true X https://www.jrmc.com/billing-services/ X https://www.jrmc.com/billing-services/ X https://www.jrmc.com/billing-services/ X X X X X X true X false X X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - JOHNSON REGIONAL MEDICAL CENTER. Speaking with key interviewees (community stakeholders who represent the broad interest of the community with knowledge of or expertise in public health) is a technique employed to assess public perceptions of the county's health status and unmet needs. These interviews are intended to ascertain opinions among individuals likely to be knowledgeable about the community and influential over the opinions of others about health concerns in the community. Key interviewees include individuals who are knowledgeable about populations within the community whose health and quality of life may not be as good as others, such as representatives of organizations serving the elderly. Interviews were conducted in October 2022. 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 Medical Center personnel using a standard questionnaire. A copy of the interview instrument is included in the appendices. A summary of the interviewees' opinions is reported without judging the truthfulness or accuracy of their remarks. Interviewees provided comments on the following issues: Health and quality of life for residents of the primary community Barriers to improving health and quality of life for residents of the primary community Opinions regarding the important health issues that affect community residents and the types of services that are important for addressing these issues Delineation of the most important healthcare issues or services discussed and actions necessary for addressing those issues 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 this report. This technique does not provide a quantitative analysis of the leaders' opinions, but reveals community input for some of the factors affecting the views and sentiments about overall health and quality of life within the community. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - JOHNSON REGIONAL MEDICAL CENTER. The Medical Center prepared an implementation strategy in response to the needs identified in its 2022 needs assessment. A listing of those needs, along with the steps taken by the Medical Center to address them, is below. 1 Recruitment of additional primary care providers The Medical Center has hosted medical students from UAMS, ARCOM, and NYIT for the last two years. These students are interested in careers in rural health. These students spoke with community physicians and toured the Medical Center in hopes of recruiting physicians to local practices. The Medical Center will continue to assist in recruiting efforts. 2 Health and wellness education The Medical Center will continue to offer classes for diabetic community members, training for first responders, and maternity classes. Health education will also be provided at local health fairs. 3 Mental health, including substance abuse treatment and prevention The Medical Center will offer educational information on drug and alcohol prevention at our local health fairs and through other community events. 6 PAIN CLINIC 1100 E POPLAR ST CLARKSVILLE AR 72830 PAIN CLINIC JOHNSON REGIONAL MEDICAL CENTER OUTPATIENT PHYSICAL THERAPY 1100 E POPLAR ST CLARKSVILLE AR 72830 PHYSICAL THERAPY CLINIC RIVER VALLEY ENT 200 QUANAH AVE RUSSELLVILLE AR 72801 EAR, NOSE, AND THROAT CLINIC JOHNSON REGIONAL MEDICAL CENTER ORTHOPEDIC CLINIC 1100 E POPLAR ST CLARKSVILLE AR 72830 ORTHOPEDIC CLINIC JOHNSON COUNTY SURGERY CLINIC 1 MEDICINE DR CLARKSVILLE AR 72830 SURGERY CLINIC CLARKSVILLE WOMEN'S CENTER 1100 E POPLAR ST CLARKSVILLE AR 72830 WOMEN'S CLINIC Schedule H, Part I, Line 3c IN ADDITION TO USING THE FEDERAL POVERTY GUIDELINES, JRMC ALSO USES AN ASSET TEST TO DETERMINE ELIGIBILITY OF FREE OR DISCOUNTED CARE. Schedule H, Part I, Line 7 THE COST TO CHARGE RATIO (CALCULATED USING WORKSHEET 2) WAS USED FOR LINE 7 AMOUNTS Schedule H, Part I, Line 7g Subsidized Health Services JRMC INCLUDED IN SUBSIDIZED HEALTH SERVICES COSTS ATTRIBUTABLE TO HOSPITAL OWNED PHYSICIAN CLINICS : HOME HEALTH CARE SERVICES Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBT PER THE AUDITED FINANCIAL STATEMENTS AT GROSS CHARGES. ACCOUNTS OVER 30 DAYS OLD ARE CONSIDERED PAST DUE. AN ACCOUNT THAT IS APPROXIMATELY 90 DAYS PAST DUE WITH NO PAYMENT ACTIVITY IS SENT TO AN OUTSIDE BILLING AND COLLECTION SERVICE WHO MAKE ADDITIONAL ATTEMPTS TO COLLECT PAST DUE AMOUNTS. AFTER THE OUTSIDE COLLECTION SERVICE ADVISES THAT THEY HAVE MADE ALL REASONABLE ATTEMPTS TO COLLECT A PAST DUE ACCOUNT, IT IS REVIEWED AGAIN BY THE HOSPITAL AND A DETERMINATION IS MADE WHETHER TO WRITE OFF THE ACCOUNT. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE AUDIT REPORT WAS NOT ISSUED BEFORE THE EXTENDED DUE DATE OF THE RETURN Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE MEDICARE COST REPORT WAS USED TO CALCULATE THE MEDICARE ALLOWABLE COSTS. THE ORGANIZATION DOES NOT COUNT MEDICARE SHORTFALL AS COMMUNITY BENEFIT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance PATIENTS WHO CAN SHOW THAT PAYMENT OF THEIR HOSPITAL BILL WOULD BE AN UNBEARABLE HARDSHIP MAY APPLY FOR FINANCIAL ASSISTANCE TO PAY ALL OR PART OF THEIR BILL. APPLICANTS MUST COMPLETE THE REQUIRED FINANCIAL APPLICATION AND MEET MINIMUM GUIDELINE REQUIREMENTS AS SET FORTH IN THE JRMC CHARITY CARE POLICY. APPLICANTS WILL BE RESPONSIBLE FOR OBTAINING THE INFORMATION NEEDED TO DETERMINE THEIR ELIGIBILITY AND PROVIDE VERIFICATION OF INCOME AS REQUIRED. Schedule H, Part V, Section B, Line 16a FAP website - JOHNSON REGIONAL MEDICAL CENTER: Line 16a URL: https://www.jrmc.com/billing-services/; Schedule H, Part V, Section B, Line 16b FAP Application website - JOHNSON REGIONAL MEDICAL CENTER: Line 16b URL: https://www.jrmc.com/billing-services/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - JOHNSON REGIONAL MEDICAL CENTER: Line 16c URL: https://www.jrmc.com/billing-services/; Schedule H, Part VI, Line 2 Needs assessment THE ORGANIZATION ATTENDS AND PUTS ON LOCAL HEALTH FAIRS AND OTHER COMMUNITY EVENTS. AT THESE EVENTS THE ORGANIZATION PROVIDES THE COMMUNITY WITH HEALTH EDUCATION AND INFORMATION ON DRUG AND ALCOHOL PREVENTION. THE HEALTH NEEDS OF THE COMMUNITY ARE EVALUATED AT THESE EVENTS AND HEALTH FAIRS. THE HOSPITAL STAFF SUPPORT, PARTICIPATE , AND PROVIDE LEADERSHIP TO MANY DIFFERENT AND VARIED ORGANIZATIONS IN ITS SERVICE AREA OF SEVEN COUNTIES CONTAINING OVER 5,381 SQUARE MILES . THESE ORGANIZATIONS INCLUDE THE CHAMBER OF COMMERCE, COMMUNITY SERVICE CLUBS ( ROTARY, LIONS, KIWANIS), ALL PUBLIC SCHOOLS, TWO UNIVERSITIES, THE BLOOD BANK, UNITED WAY FOR THREE COUNTIES, JOHNSON COUNTY RESOURCE ALLIANCE, FORRESTER DAVIS DEVELOPMENT CENTER, AND THE AMERICAN CANCER SOCIETY. TO NAME A FEW. SOME EXAMPLES OF THE ACTIVITIES AND PROJECTS INCLUDE COMMUNITY BUILDING PROJECTS FOR THE UNITED WAY, LOCAL BLOOD DRIVES, FLU SHOTS FOR PUBLIC SCHOOLS, AND GENERAL PUBLIC AT LARGE, HEALTH FAIRS FOR SENIOR CITIZENS, LOCAL NIGHT OUT SPONSORSHIP TO PROMOTE GOOD WORKING RELATIONSHIPS TO SUPPORT LAW ENFORCEMENT, AND MANY OTHER NUMEROUS PROJECTS. THE HOSPITAL PROVIDES STAFF, MEDICAL SUPPLIES, AND FOOD AS NECESSARY TO PROMOTE, MAINTAIN AND OR DEVELOP EACH PROJECT TO ITS FULLEST POTENTIAL. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance 1.ANY PATIENT THAT INDICATES AN INABILITY TO PAY IS OFFERED A CHARITY CARE/INDIGENT CARE APPLICATION. 2. THE MEDICAL CENTER PLACES NOTICES IN ALL REGISTRATION AREAS THAT WE OFFER CHARITY CARE PROGRAMS AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE. 3. THE MEDICAL CENTER PLACES A NOTE ON STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE. Schedule H, Part VI, Line 4 Community information THE SOCIOECONOMIC CHARACTERISTICS OF A GEOGRAPHIC AREA INFLUENCE THE WAY RESIDENTS ACCESS HEALTHCARE SERVICES AND PERCEIVE THE NEED FOR HEALTHCARE SERVICES. FACTORS SUCH AS EDUCATIONAL ATTAINMENT, POVERTY LEVELS, UNEMPLOYMENT RATES AND INSURANCE COVERAGE LEVELS CONTRIBUTE SIGNIFICANTLY TO THE HEALTH STATUS OF THE COMMUNITY. SOCIOECONOMICALLY, THE COMMUNITY SERVED BY THE MEDICAL CENTER IS SIMILAR TO MANY OTHER PARTS OF RURAL ARKANSAS. ABOUT 15% OF THE POPULATION AGED 25 OR OLDER HAS OBTAINED A BACHELOR'S DEGREE OR HIGHER, COMPARED TO ABOUT 32% OF THE U.S. AND 23% OF ARKANSAS. ABOUT 21% OF THE POPULATION AGED 25 OR OLDER DOES NOT HAVE A HIGH SCHOOL DIPLOMA, COMPARED TO ABOUT 12% IN THE COUNTRY AS A WHOLE AND 13% IN ARKANSAS. LOWER LEVELS OF EDUCATION HAVE BEEN LINKED TO NEGATIVE HEALTH OUTCOMES, SO THE EDUCATIONAL 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 MEDIAN HOUSEHOLD INCOME IN THE MEDICAL CENTER'S COMMUNITY IS $38,511, COMPARED TO $47,597 FOR THE STATE OF ARKANSAS AND $62,843 FOR THE UNITED STATES. LOWER-THAN-AVERAGE MEDIAN HOUSEHOLD INCOME SUGGESTS THAT MANY MEMBERS OF THE COMMUNITY MAY HAVE DIFFICULTY OBTAINING HEALTHCARE, ESPECIALLY PREVENTIVE CARE. SOME SOCIOECONOMIC MEASURES IN THE COMMUNITY HAVE BEEN IMPROVING SINCE THE PUBLICATION OF THE 2016 AND 2019 COMMUNITY HEALTH NEEDS ASSESSMENTS. ONE SUCH MEASURE IS THE PERCENTAGE OF THE COMMUNITY THAT IS WITHOUT HEALTH INSURANCE COVERAGE. The community served by the Medical Center is a primarily rural area in northwest Arkansas. According to the most recent U.S. Census Bureau estimates, about 26,400 people live in Johnson County. The chart below shows the breakdown of the community's population by age group. According to the U.S. Census Bureau, approximately 42% of the community's population is over age 45, which is consistent with Arkansas (42%), and higher than in the United States (41%) as a whole. These age groups use more health services than any other; consequently, the Medical Center could experience an increase in patient volume in the future. Schedule H, Part VI, Line 5 Promotion of community health JOHNSON REGIONAL MEDICAL CENTER HAS AN OPEN MEDICAL STAFF AND WELCOMES NEW PRACTITIONERS TO THE SERVICE AREA. JOHNSON REGIONAL ALSO ENSURES ACCESS TO BASIC PRIMARY CARE BY SUPPORTING THE RECRUITMENT OF PRIMARY CARE PHYSICIANS TO PRACTICE IN JOHNSON COUNTY. WE ALSO HAVE A BOARD OF DIRECTORS THAT REPRESENTS THE NEEDS OF THE COMMUNITY AND PURSUES THE BEST POSSIBLE CARE FOR OUR SERVICE AREA. EACH BOARD MEMBER IS A VOLUNTEER AND DONATES A CONSIDERABLE AMOUNT OF TIME AND ENERGY TO ASSURE A VIABLE, PROGRESSIVE, AND WELL-MANAGED HOSPITAL. JOHNSON REGIONAL MEDICAL CENTER ALSO PARTICIPATES WITH FIVE COLLEGES AND UNIVERSITIES TO TRAIN FUTURE HEALTHCARE WORKERS. WE HAVE AFFILIATION AGREEMENTS FOR NURSES, PHYSICAL THERAPISTS, PHARMACISTS, EMS STAFF, AND STUDENT ROTATIONS THROUGH VARIOUS ANCILLARY DEPARTMENTS. THIS REQUIRES A REAL DEDICATION OF TIME AND EFFORT BY OUR STAFF TO EDUCATE AND TRAIN FUTURE HEALTHCARE PROFESSIONALS . JOHNSON REGIONAL MEDICAL CENTER'S SUPPORT ALSO INCLUDES SUBSTANTIAL AMOUNTS OF CHARITY CARE OF OVER 172,923 AND BAD DEBT RECOGNIZED OF OVER 3,000,000 BASED ON GROSS CHARGES JRMC IS A 501(C)(3) NOT FOR PROFIT CORPORATION AND AS SUCH, NO ONE INDIVIDUALLY PROFITS THROUGH OWNERSHIP. X X false false false false false false false true false Shannon Case Physician 348991 0 498863 0 43847 0 3450 0 7579 0 902730 0 0 0 Tommy Hobbs CEO 221933 0 0 0 18270 0 2500 0 10226 0 252929 0 0 0 Bryan Smith Physician 290790 0 18000 0 4615 0 0 0 4767 0 318172 0 0 0 Rolando Cheng Physician 504185 0 0 0 57500 0 3450 0 10281 0 575416 0 0 0 Ezechiel Nehus Physician 365217 0 367041 0 24616 0 3450 0 10584 0 770908 0 0 0 Clinton Twaddell Physician 357944 0 0 0 35385 0 3450 0 7088 0 403867 0 0 0 Kevin Meyer Physician 351021 0 0 0 49231 0 3300 0 4781 0 408333 0 0 0 Schedule J, Part I, Line 7 Non-fixed payments PHYSICIANS HAVE A RVU TARGET. EACH YEAR THEY RECEIVE A BONUS BASED ON HOW MANY RVUS THEY ARE ABOVE THE TARGET. A Johnson County Arkansas 716001704 478378CQ3 2015-09-18 2120000 HOSPITAL REVENUE IMPROVEMENT BONDS false true false B JOHNSON COUNTY ARKANSAS 716001704 478378DB5 2018-05-22 18352616 CURRENT REFUNDING OF 2012A, 2012B, AND 2013 BONDS false true false A 1430000 2120000 126200 42397 1951403 2016 false false true true B 2670000 18352616 622428 363268 17366920 true false true true A false false false false false false 0.0 0.0 0.0 false false 0 false false B false false false false false false 0.0 0.0 0.0 false false 0 false false A false false true false false false 0 false false false 0 false false false B false false false true false false 0 false false false 0 false false false A false B false Schedule K, Part II Column A AND COLUMN B THIS SCHEDULE K IS CALCULATED AS OF BOND YEAR ENDING 11/01/2024. Schedule K, Part IV, Line 2c COLUMN B Issuer name: JOHNSON COUNTY, ARKANSAS The calculation for computing no rebate due was performed on 05/22/2019 Form 990, Part IV, Line 20b THE 2024 AUDIT WAS NOT ISSUED BEFORE THE EXTENDED DUE DATE OF THE RETURN. THE MOST RECENT ISSUED AUDIT, 2023, HAS BEEN ATTACHED TO THE RETURN. Form 990, Part VI, Line 15 LINES 15A AND 15B THE CEO AND OFFICER'S COMPENSATION IS REVIEWED BY THE BOARD OF DIRECTORS AND IS COMPARED TO THE COMPENSATION OF COMPARABLE POSITIONS FROM OTHER 990S ANNUALLY BY THE BOARD. THE DECISION IS DOCUMENTED IN THE BOARD MINUTES. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 WILL BE REVIEWED BY THE CEO AND CFO BEFORE BEING SENT TO THE BOARD. THE BOARD OF DIRECTORS WILL REVIEW THE RETURN PRIOR TO FILING. Form 990, Part VI, Line 12c Conflict of interest policy EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY; AND HAS AGREED TO COMPLY WITH THE POLICY. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. Form 990, Part IX, Line 11g Other Fees PURCHASED SERVICES - Total Expense: 5337360, Program Service Expense: 4162451, Management and General Expenses: 1174909, Fundraising Expenses: 0; CONTRACT SERVICES - Total Expense: 1137330, Program Service Expense: 886970, Management and General Expenses: 250360, Fundraising Expenses: 0; BILLING AND COLLECTION FEES - Total Expense: 12260, Program Service Expense: 9561, Management and General Expenses: 2699, Fundraising Expenses: 0; SERVICE CONTRACTS - Total Expense: 1424215, Program Service Expense: 1110703, Management and General Expenses: 313512, Fundraising Expenses: 0; Form 990, Part XII, Line 2b THE AUDIT REPORT WAS NOT ISSUED BEFORE THE EXTENDED DUE DATE OF THE RETURN.