2017-01-11T09:00:11-06:00 2016-09-30 710355269 BEALL BARCLAY & COMPANY PLC P O BOX 10148 FORT SMITH AR 729170148 990 2015-10-01 237237381 ARKANSAS FOUNDATION FOR MEDICAL CARE INC ARKA 4795737616 PO BOX 180001 FORT SMITH AR 729180001 MARY COUNTS CHIEF FINANCIAL OFFICER 4795737616 2017-01-09 1 BARBARA HAMBRICK P00387600 4794845740 2017-01-09 2015 2021-01-29 14:40:06Z MARY COUNTS PO BOX 180001 FORT SMITH AR 729180001 30044139 0 X WWW.AFMC.ORG X 1972 AR ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. DEVELOPS AND PROMOTES COOPERATIVE QUALITY IMPROVEMENT PROJECTS INVOLVING HOSPITALS, NURSING HOMES, HOME HEALTH AGENCIES, PHYSICIANS, AND OTHER STAKEHOLDERS IN ORDER TO IMPROVE THE DELIVERY, QUALITY, AND COST-EFFECTIVENESS OF HEALTH CARE PROVIDED FOR MEDICARE AND MEDICAID BENEFICIARIES. 15 15 266 0 0 0 0 28627730 21820940 671258 582662 -1827698 20222 56198 22423824 27527488 2624 7630 0 0 15840766 19695077 0 0 0 4976843 6597497 20820233 26300204 1603591 1227284 25100485 27715188 2139037 3210541 22961448 24504647 X TO PROMOTE EXCELLENCE IN HEALTH CARE THROUGH EVALUATION AND EDUCATION 0 0 1666442 CMS QIN/QIO 11TH SOW WHICH WE PARTICIPATE IN AS A SUB TO TMF (TEXAS MEDICAL FOUNDATION) - PROVIDED UTILIZATION AND QUALITY CONTROL PEER REVIEW SERVICES IN ACORDANCE WITH SECTION 1154 OF THE SOCIAL SECURITY ACT IN ACCORDANCE WITH THE REQUIREMENTS AND DELIVERABLES OF THE 11TH SCOPE OF WORK. 6092970 ARKANSAS MEDICAID REVIEW - PROVIDED REVIEW SERVICES AS REQUIRED BY CONTRACT:PRIOR AUTHORIZATION OF MED/SURG PROCEDURES - 7,190PRIOR AUTHORIZATION OF MUMPS - 23,306PRIOR AUTHORIZATION OF DME - 25,397TARGETED CASE MANAGEMENT REVIEW - 39RETRO EMERGENCY ROOM REVIEW - 41,126RETRO INPATIENT REVIEW - 32,801EXTENSION OF BENEFIT/MOLECULAR PATHOLOGY REVIEW - 38,192ORGAN TRANSPLANT REVIEW - 70PVT OPTION REVIEWS - 92NICU - 573 5018971 MEDICAID BENEFICIARY RELATIONS - A CONTRACT TO MAINTAIN ACTIVE FEEDBACK AND PROFESSIONAL RELATIONS WITH MEDICAID BENEFICIARIES. IT ALSO INCLUDES MAINTAINING A CALL SERVICE CENTER TO ASSIST INDIVIDUALS WITH MEDICAID AND PRIVATE OPTION COVERAGE. SURVEYS AND MONITORING OF THE NON-EMERGENCY TRANSPORTATION (NET) SERVICES ARE ADDITIONAL DELIVERABLES UNDER THIS CONTRACT. 12410758 7630 671258 OTHER PROGRAMS CONSIST OF CONTRACTS THAT THE ORGANIZATION HAS WITH VARIOUS FEDERAL, STATE, AND PRIVATE AGENCIES. 12410758 7630 671258 25189141 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 68 0 1 266 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 AR X MARY COUNTS 4795737616 PO BOX 180001 FORT SMITH AR 72918 E SCOTT FERGUSON MD CHAIRMAN OF BOARD 1.00 X X 5613 0 0 ROBERT SANDERS VICE CHAIRMAN 1.00 X X 1400 0 0 JENNIFER STYRON TREASURER 1.00 X X 1588 0 0 M CARL COVEY MD DABPM SECRETARY 1.00 X X 4824 0 0 RONALD WAUTERS MD MEMBER-AT-LARGE 1.00 X 5025 0 0 TOM BUTLER BOD 1.00 X 5613 0 0 AMY DUNN JOHNSON BOD 1.00 X 4725 0 0 RAY MONTGOMERY II FACHE BOD 1.00 X 5488 0 0 MARCUS OSBORNE BOD 1.00 X 1400 0 0 KAREN PETTIT RNP CPHQ BOD 1.00 X 4225 0 0 MELISSA PIERCE RNP BOD 1.00 X 5113 0 0 MICHAEL MOODY MD BOD 1.00 X 3694 0 0 STACY C ZIMMERMAN MD BOD 1.00 X 4100 0 0 CAROLYN HOOD RN BSN BOD 1.00 X 0 0 0 ALAN WILSON MD BOD 1.00 X 0 0 0 WALLACE R HANLEY CEO/PRESIDENT 40.00 X 339071 0 22919 DEBBIE HOPKINS CHIEF OPERATING OFFICER 37.00 X 152854 0 8730 MARILYN LITTLE CHIEF OPERATING OFFICER 37.00 X 24881 0 2453 MARY S MOORE CHIEF COMPLIANCE OFFICER 42.00 X 137434 0 12482 MARY N COUNTS CHIEF FINANCIAL OFFICER 46.00 X 162263 0 10639 AMY ROSSI VP INNOVATION AND STRAT DE 40.00 X 118746 0 5660 PEGGY J STARLING CHIEF OUTREACH SERVICES OF 44.00 X 181485 0 12497 NATHAN RAY CHIEF TECHNOLOGY OFFICER 44.00 X 139893 0 17564 CATHY BAIN CHIEF ADMINISTRATIVE OFFIC 48.00 X 114011 0 11220 CHAD T RODGERS MD CHIEF MEDICAL OFFICER 15.00 X 36330 0 5025 JULIA KETTLEWELL DIRECTOR QUALITY 39.00 X 132347 0 12374 JENNA CLEMONS DIRECTOR FINANCE 45.00 X 127010 0 13515 JARROD MCCLAIN DIRECTOR CLINICAL REVIEW 42.00 X 126365 0 6908 BETTY BENNETT MANAGER AIPP 40.00 X 115480 0 9895 THOMAS D TINSMAN ASSOC MED DIRECTOR 40.00 X 214397 0 9066 2175375 0 160947 18 0 1 0 MEDECISION INC PO BOX 7777 PHILIDELPHIA PA 19175 HEALTH MANAGEMENT 836060 FLEMING ELECTRIC INC 212 MCCLANAHAN DRIVE BRYANT AR 72022 ELECTRICAL CONTRACTOR 469198 NORMAN COMPANY INC 7600 BALL RD FORT SMITH AR 72908 GENERAL CONSTRUCTION 284376 SALESFORCECOM INC ONE MARKET SUITE 300 SAN FRANCISCO CA 94105 CUSTOMER RELATIONSHIP MGMT 234410 DELL MARKETING ONE DELL WAY RR1-33 ROUND ROCK TX 78682 COMPUTER SERVICES 231495 5 28627730 28627730 PRIVATE REVENUE FROM OPERATIONS 900099 671258 671258 671258 159580 159580 275926 219728 56198 56198 56198 309645 496986 1799937 -187341 -1799937 -1987278 -1987278 27527488 671258 0 -1771500 7630 7630 1503690 1503690 12392804 11942658 450146 516346 516346 4145105 3950121 194984 1137132 1137132 23986 23986 69534 69534 506091 396065 110026 147475 146913 562 1221666 1006171 215495 2111861 2111861 328777 328295 482 773290 759439 13851 250388 184889 65499 627042 626851 191 238324 238324 PASS THROUGH COSTS 266794 266794 0 PARKING 1019 769 250 31250 -28327 59577 26300204 25189141 1111063 0 1100 1100 1716506 2667709 2735980 4594159 1002735 970810 11437252 4008476 8331977 7428776 10835096 12052634 477091 0 25100485 27715188 2113778 3210541 25259 0 2139037 3210541 X 22961448 24504647 22961448 24504647 25100485 27715188 X 1227284 767747 -451832 X X 0 1 X 1 1 1 X 16482232 18415093 19727752 20147853 28627730 103400660 898663 1821331 1206796 1673087 671258 6271135 17380895 20236424 20934548 21820940 29298988 109671795 0 0 0 109671795 341664 353996 335894 329862 435506 1796922 341664 353996 335894 329862 435506 1796922 100 2362 2462 17722659 20590420 21272804 22150802 29734494 111471179 0.98390 0.01610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 X 110000 0 110000 0 26190204 0 26300204 0 1000000 0 250000 0 0 0 PART I-A, LINE 1: THE CEO WAS INVOLVED IN EDUCATING LEGISLATORS ON PRIVATE OPTION IMPACT DURING THIS YEAR'S SESSION. 1060000 1060000 5734137 880151 4853986 424668 55044 369624 1190964 817868 373096 3027483 2255413 772070 7428776 X 28295235 767747 767747 27527488 0 27527488 26300204 0 26300204 0 26300204 PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) CODIFICATION TOPIC INCOME TAXES. FASB CODIFICATION TOPIC INCOME TAXES CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AND REQUIRES THE ORGANIZATION TO RECOGNIZE IN THEIR FINANCIAL STATEMENTS THE IMPACT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, IF THAT POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED UNDER AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. MANAGEMENT HAS ASSESSED THE TAX POSITIONS OF THE ORGANIZATION AND DETERMINED THAT NO POSITIONS EXIST THAT REQUIRE ADJUSTMENT OR DISCLOSURE UNDER THE PROVISIONS OF FASB CODIFICATION TOPIC INCOME TAXES. ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) FILES INFORMATIONAL "RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX" (FORM 990) IN THE U.S. FEDERAL JURISDICTION AND ARKANSAS. 1 SECOND BAPTIST CHURCH 55 CHARITABLE CONTRIBUTION ARKANSAS FOODBANK NETWORK 500 CHARITABLE CONTRIBUTION UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES 5000 CHARITABLE CONTRIBUTION CHILDREN'S EMERGENCY SHELTER 500 CHARITABLE CONTRIBUTION COMPREHENSIVE JUVENILE SERVICES 500 CHARITABLE CONTRIBUTION OUR HOUSE INC 1000 CHARITABLE CONTRIBUTION ANTIOCH MISSIONARY BAPTIST 75 CHARITABLE CONTRIBUTION X 0 0 0 0 0 0 0 0 0 WALLACE R HANLEY CEO/PRESIDENT 339071 0 0 0 0 0 13764 0 9155 0 361990 0 0 0 DEBBIE HOPKINS CHIEF OPERATING OFFICER 152854 0 0 0 0 0 6182 0 2548 0 161584 0 0 0 MARY N COUNTS CHIEF FINANCIAL OFFICER 162263 0 0 0 0 0 6627 0 4012 0 172902 0 0 0 PEGGY J STARLING CHIEF OUTREACH SERVICES OF 181485 0 0 0 0 0 4038 0 8459 0 193982 0 0 0 NATHAN RAY CHIEF TECHNOLOGY OFFICER 139893 0 0 0 0 0 5623 0 11941 0 157457 0 0 0 THOMAS D TINSMAN ASSOC MED DIRECTOR 214397 0 0 0 0 0 8642 0 424 0 223463 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 ON APRIL 17, 2015, THE BOARD OF DIRECTORS OF AFMC RESOLVED THAT RESTATED ARTICLES OF INCORPORATION AND RESTATED BYLAWS BE ADOPTED FOR PURPOSES OF COVERTING THE COMPANY TO A 501(C)(3) ORGANIZATION. THE BOARD OF DIRECTORS WITH RATIFICATION OF THE MEMBERSHIP ADOPTED THESE ARTICLES OF RESTATEMENT OF THE ARTICLES OF INCORPORATION ON APRIL 17, 2015 TO ESTABLISH THE NONPROFIT CORPORATION AS A PUBLIC BENEFIT CORPORATION UNDER THE ARKANSAS NONPROFIT CORPORATION ACT OF 1993. A FORM 1023 WAS SUBMITTED WITH THESE REVISED ORGANIZATIONAL DOCUMENTS AND WAS APPROVED BY THE IRS WITH AN EFFECTIVE DATE OF EXEMPTION OF JANUARY 8, 2016. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS REVIEWS A PRELIMINARY 990 AT THEIR BOARD MEETING. ANY QUESTIONS ARE ANSWERED. THE RETURN IS THEN APPROVED BY THE BOARD FOR FILING. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER OF THE ORGANIZATION CONTINOUSLY MONITORS THESE POLICIES. THEY ALSO PROVIDE TRAINING AND EDUCATION RELATED TO CONFLICTS OF INTEREST AND REQUIRE THAT ALL EMPLOYEES AND BOARD MEMBERS SIGN A CONFLICTS OF INTEREST FORM ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE HIRING COMMITTEE OF THE BOARD OF DIRECTORS SET THE MAXIMUM DOLLAR AMOUNT OF SALARY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BAD DEBT ON PRIOR YEAR NET RELATED PARTY RECEIVABLES -451,832. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ARKANSAS QUALITY FOUNDATION INC PO BOX 1800001 FORT SMITH AR 72918 264518098 TO PROMOTE HEALTH THROUGH RESEARCH AND DEVELOPMENT IN ARKANSAS AR 501(C)(3) LINE 9 N/A 0 QUALITY EXCELLENCE INC PO BOX 180001 FORT SMITH AR 72918 263908892 TO PROVIDE CONSULTING AND ADVISORY SERVICES FOR HEALTHCARE INDUSTRY AR N/A C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 ARKANSAS QUALITY FOUNDATION INC N 0 QUALITY EXCELLENCE INC N 0