STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

ADVANCE CARE HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ADVANCE CARE HOSPITAL (EIN 71-0816634)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-13
IRS object ID
201202269349302600
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-13T16:10:30-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11111 BAGBY STREET SUITE 4500AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code770022591ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN710816634EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ADVANCE CARE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlADVANameControl
Phone7132772300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 WERNER STREET 3RD FLOORAddressLine1
CityHOT SPRINGSCity
StateARState
ZIP Code71913ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN SELIGName
TitlePRESIDENTTitle
Phone7132772300Phone
Date Signed2012-08-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBROOKE KITCHENName
Phone7139822000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN SELIGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1300 WERNER STREET 3RD FLOORAddressLine1
CityHOT SPRINGSCity
StateARState
ZIP Code71913ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16061092GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileARStateLegalDomicile
Activity Or Mission DescriptionTO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST TO PATIENTS WHO REQUIRE AN EXTENDED HOSPITALIZATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers6TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year413ContributionsGrantsCurrentYear
Program Service Revenue Prior Year22336111ProgramServiceRevenuePriorYear
Program Service Revenue CY16055284ProgramServiceRevenueCY
Investment Income Prior Year16633InvestmentIncomePriorYear
Investment Income Current Year3909InvestmentIncomeCurrentYear
Other Revenue Prior Year814OtherRevenuePriorYear
Other Revenue Current Year1486OtherRevenueCurrentYear
Total Revenue Prior Year22353558TotalRevenuePriorYear
Total Revenue Current Year16061092TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1067044GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY8789GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9915500SalariesEtcPriorYear
Salaries Etc Current Year7570827SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12190817OtherExpensePriorYear
Other Expenses Current Year6808037OtherExpensesCurrentYear
Total Expenses Prior Year23173361TotalExpensesPriorYear
Total Expenses Current Year14387653TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-819803RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1673439RevenuesLessExpensesCY
Total Assets BOY8078468TotalAssetsBOY
Total Assets EOY7189616TotalAssetsEOY
Total Liabilities BOY4148160TotalLiabilitiesBOY
Total Liabilities EOY1585869TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3930308NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5603747NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCONSISTENT WITH THE SISTERS OF MERCY HEALTH SYSTEM - ST. LOUIS, THE MISSION OF ADVANCE CARE HOSPITAL IS TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12103390Expense
Grants8789Grants
Revenue16055284Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense12103390TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109641NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PAUL VEILLONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7132772300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11700 W LOOP SOUTH SUITE 1100AAddressLine1
CityHOUSTONCity
StateTXState
ZIP Code770270000ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormer
JOHN SELIG
BOARD MEMBER/PRESIDENT4.00XX3268800
MIKE FINLEY
BOARD MEMBER1.00X000
TONY HOLOHAN
BOARD MEMBER1.00X000
HELEN HARRIS
BOARD MEMBER1.00X000
JOHN SIMPSON
BOARD MEMBER1.00X000
MARIE MARQUEZ
SECRETARY1.00X000
PAUL VEILLON
TREASURER1.00X000
ERICK SMITH
SECRETARY/TREASURER1.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org32688TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CHRISTUS DUBUIS HEALTH SYSTEM
1700 WEST LOOP SOUTH STE 1100AHOUSTONTX77027MANAGEMENT SERVICES4364898
ST JOSEPH'S MERCY HEALTH CENTER
300 WERNER STREETHOT SPRINGSAR71903ANCILLARY SERVICES3132496
ST EDWARD MERCY MEDICAL CENTER
5501 EUPER LANEFORT SMITHAR72903ANCILLARY SERVICES1462687
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
All Other Contributions413AllOtherContributions
Total Contributions413TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionINPATIENT REVENUESDescription
Business Code900099BusinessCode
Total Revenue Column16055284TotalRevenueColumn
Related Or Exempt Function Income16055284RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue16055284TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3909TotalRevenueColumn
Exclusion$3,909ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
VENDING MACHINE INCOME900099822$822
MEDICAL RECORDS FEES900099664$664
FieldValueIRS element (for citing)
Total Other Revenue1486TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column16061092TotalRevenueColumn
Related Or Exempt Function Income16055284RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$5,395ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total8789Total
Program Services8789ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total32688Total
Management And General32688ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6307425Total
Program Services5743511ProgramServices
Management And General563914ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total229948Total
Program Services208333ProgramServices
Management And General21615ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total670305Total
Program Services607296ProgramServices
Management And General63009ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total330461Total
Program Services289998ProgramServices
Management And General40463ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total510829Total
Management And General510829ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total-520Total
Management And General-520ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total605004Total
Management And General605004ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total82008Total
Program Services103266ProgramServices
Management And General-21258ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total6582Total
Management And General6582ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2552470Total
Program Services2277213ProgramServices
Management And General275257ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total60000Total
Program Services25851ProgramServices
Management And General34149ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total121310Total
Program Services121310ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total51662Total
Management And General51662ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PURCHASED SERVICES23175552283202343530
EQUIPMENT RENTAL29603528791581200
BAD DEBT EXPENSE14670614670600
TAXES58396583960

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total14387653Total
Program Services12103390ProgramServices
Management And General2284263ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3293454BOY
EOY4622708EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1785392BOY
EOY1936053EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY347713BOY
EOY155623EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY13475BOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1550604LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1075372LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY596542BOY
EOY475232EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2041892BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8078468BOY
EOY7189616EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1449950BOY
EOY1130225EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2698210BOY
EOY455644EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4148160BOY
EOY1585869EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3930308BOY
EOY5603747EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3930308BOY
EOY5603747EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8078468BOY
EOY7189616EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1673439ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$809OtherActivitiesAmount
Total Lobbying Expenditures IIB809TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationA PORTION OF ANNUAL DUES PAID TO THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS IS ALLOCATED TO LOBBYING ACTIVITIES ON BEHALF OF THE MEMBERSHIP.Explanation

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis27626OtherCostOrOtherBasis
Depreciation21782Depreciation
Book Value5844BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1522978OtherCostOrOtherBasis
Depreciation1053590Depreciation
Book Value469388BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings475232TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
THIRD PARTY PAYOR SETTLEMENTS-$191,264
PAYABLE TO HOST FACILITIES$206,909
PAYABLE TO CHRISTUS DUBUIS HEALTH SYSTEM$403,704
MISC TAXES PAYABLE$36,295
FieldValueIRS element (for citing)
Total Of Amounts455644TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense531783TotalCommunityBenefitExpense
Net Community Benefit Expense531783NetCommunityBenefitExpense
Percent Of Total Expense0.03730PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense531783TotalCommunityBenefitExpense
Net Community Benefit Expense531783NetCommunityBenefitExpense
Percent Of Total Expense0.03730PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense13578TotalCommunityBenefitExpense
Net Community Benefit Expense13578NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense8789TotalCommunityBenefitExpense
Net Community Benefit Expense8789NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense22367TotalCommunityBenefitExpense
Net Community Benefit Expense22367NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense554150TotalCommunityBenefitExpense
Net Community Benefit Expense554150NetCommunityBenefitExpense
Percent Of Total Expense0.03890PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$146,706BadDebtExpenseAmount
Amount Attributable To141997AmountAttributableTo
Amount Reimbursed By Medicare10791639AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare10445227CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall346412MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalOtherOther
ADVANCE CARE HOSPITAL OF HOT SPRINGS
1300 WERNER STREET 3RD FLOORHOT SPRINGSAR71913XLONG TERM ACUTE CARE HOSPITAL
ADVANCE CARE HOSPITAL OF FORT SMITH
27301 ROGERS AVE 4TH FLOORFORT SMITHAR72917XLONG TERM ACUTE CARE HOSPITAL

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: THE COMMUNITY BENEFIT OF COST OF CHARITY CARE WAS CALCULATED AS THE TOTAL VOLUNTARY FREE CARE TIMES THE RATIO OF COST TO GROSS PATIENT BILLING. THE COMMUNITY BENEFIT FOR IN-KIND CONTRIBUTIONS TO HEALTH PROFESSIONS WAS CALCULATED BASED ON THE NUMBER OF EMPLOYEE HOURS.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 146706.
PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE FROM PATIENTS AND THIRD-PARTY PAYORS FOR MEDICAL SERVICES AND ARE NET OF ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. ALLOWANCES ARE ESTIMATED BASED ON ESTABLISHED BILLING RATES AND HISTORICAL EXPERIENCE. IN ORDER TO DETERMINE THE BAD DEBT EXPENSE AT COST FOR PART III SECTION A LINE 2, THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS WAS MULTIPLIED BY THE COST-TO-CHARGE RATIO.
PART III, LINE 9B: ADVANCE CARE HOSPITAL DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARTY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INCAPACITY TO PAY. UPON ADMISSION, PATIENTS WHO HAVE NO INSURANCE COVERAGE AND NO ABILITY TO PAY WILL BE GIVEN CONSIDERATION FOR CHARITY CARE. EVERY EFFORT WILL BE MADE TO OBTAIN THE APPROPRIATE FINANCIAL DOCUMENTATION TO DETERMINE THE ABILITY TO PAY FOR SERVICES. PATIENTS RECEIVE PRIVATE LETTERS/BILLS EACH MONTH INDICATING THEIR BALANCE DUE. PATIENTS WHO HAVE NOT MADE PAYMENTS FOR A 30-DAY PERIOD WILL RECEIVE A LETTER REQUESTING PAYMENT. PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE WILL BE CONSIDERED FOR CHARITY CARE IF APPROPRIATE. COLLECTION EFFORTS WILL CONTINUE FOR 120 DAYS WITH THE PATIENT/GUARANTOR RECEIVING AT LEAST THREE LETTERS REQUESTING PAYMENT WITHIN SAID 120 DAY PERIOD. ACCOUNTS THAT ARE NOT DEEMED ELIGIBLE FOR CHARITY CARE OR MEDICAL INDIGENCE WILL BE WRITTEN OFF AS BAD DEBT FOLLOWING THE 120 DAY COLLECTION PERIOD.
PART VI, LINE 2: ADVANCE CARE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED THROUGH REGULAR EXCHANGES WITH CIVIC, COMMUNITY AND RELIGIOUS LEADERS, AS WELL AS PATIENT SURVEYS THAT SOLICIT INFORMATION ON SPECIFIC AND GENERAL ONGOING AND UPCOMING NEEDS.
PART VI, LINE 3: ALL PATIENTS ARE ASSESSED DURING THE REGISTRATION PROCESS. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM BUT ARE NOT CURRENTLY ENROLLED ARE REFERRED TO THE APPROPRIATE PROGRAM. PATIENTS WHO CAN PROVE ELIGIBILITY FOR MEDICAID WILL BE DEEMED AS INDIGENT AND AUTOMATICALLY QUALIFY FOR CHARITY CARE. PATIENTS ADMITTED TO THE HOSPITAL WITH MEDICARE AS THE ONLY INSURANCE WILL BE MONITORED AS MEDICARE DAYS NEAR DEPLETION. THIRTY DAYS PRIOR TO THE END OF THE MEDICARE COVERAGE, AN INTERVIEW AND AN APPLICATION FOR FINANCIAL ASSISTANCE WILL BE REQUESTED AS APPROPRIATE. THESE PATIENTS ARE ASSESSED AS TO MEETING THE GUIDELINES FOR RECEIVING CHARITY CARE IF THE STAY SHOULD EXCEED MEDICARE COVERAGE LIMITS. AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORT IS PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATIONS ARE MADE.
PART VI, LINE 4: ADVANCE CARE HOSPITAL'S SERVICE AREAS IN ARKANSAS INCLUDE LONG-TERM ACUTE CARE HOSPITALS IN FORT SMITH AND HOT SPRINGS. THE ADVANCE CARE HOSPITAL COMMUNUITY IS COMPRISED OF PATIENTS FROM LOCAL COMMUNITIES WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPHY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. SPECIAL EFFORTS ARE TAKEN TO ENSURE THAT POOR AND OTHER UNDERSERVED INDIVIDUALS ARE INCLUDED IN THE COMMUNITY SERVED. ADVANCE CARE HOSPITAL OF FORT SMITH IS LOCATED IN SEBASTIAN COUNTY. TOTAL POPULATION IN THE COUNTY IS 125,127 OF WHICH 13.3% ARE AGES 65 AND OVER ACCORDING TO THE 2010 CENSUS BUREAU. IN ADDITION, 18.0% OF THE POPULATION IS BELOW THE POVERTY LEVEL. ADVANCE CARE HOSPITAL OF HOT SPRINGS IS LOCATED IN GARLAND COUNTY. TOTAL POPULATION IN THE COUNTY IS 97,124 OF WHICH 21.1% ARE AGE 65 AND OVER ACCORDING TO THE 2010 CENSUS BUREAU. IN ADDITION, 17.7% OF THE POPULATION IS BELOW POVERTY LEVEL.
PART VI, LINE 6: IN ADDITION TO ITS PRIMARY MISSION TO PROVIDE LONG-TERM ACUTE MEDICAL CARE TO THE COMMUNITY INCLUDING THE POOR AND UNDERSERVED, ADVANCE CARE HOSPITAL ANNUALLY PROVIDES CASH AND/OR IN-KIND SUPPORT TO TAX-EXEMPT CHARITABLE ORGANIZATIONS WITH ESTABLISHED NEED.
PART VI, LINE 7: THE ADVANCE CARE HOSPITAL IS PRIMARILY FOCUSED ON THE PROVISION OF LONG-TERM ACUTE CARE WHICH IS DIRECTED TO PERSONS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. BY CONTRAST THE SISTERS OF MERCY HEALTH SYSTEM INCLUDES OVER 400 CLINIC AND HOSPITAL LOCATIONS IN THE MIDWEST OF THE UNITED STATES PROVIDING MEDICAL CARE AT ALL LEVELS. NEITHER ADVANCE CARE HOSPITAL NOR THE SISTERS OF MERCY HEALTH SYSTEM WILL REFUSE TO PROVIDE NECESSARY MEDICAL TEATMENT DUE TO A PATIENT'S INABILITY TO PAY.
ARREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: DONATIONS ARE PROVIDED TO TAX-EXEMPT CHARITABLE ORGANIZATIONS WITH AN ESTABLISHED NEED. THE DECISION TO DONATE AND TO WHICH CHARITY TO DONATE IS DETERMINED BY THE HOSPITAL ADMINISTRATOR AND/OR THE BOARD OF DIRECTORS. ALL DONATIONS ARE DOCUMENTED.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICE STATEMENTFORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:GENERAL INFORMATION THE GOSPEL VALUES UNDERLYING THE MISSION STATEMENT CHALLENGES ADVANCE CARE HOSPITAL TO MAKE CHOICES WHICH RESPOND TO THE PATIENT'S NEEDS IN PROVIDING THE NECESSARY SETTING FOR THE APPROPRIATE CONTINUUM OF CARE. SPECIAL CONSIDERATION IS GIVEN TO THOSE WHO ARE ECONOMICALLY DISADVANTAGED AND UNDERSERVED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES AND SIGNIFICANT OTHERS ARE PROVIDED FOR AS WELL. THE GROWTH AND DEVELOPMENT OF ADVANCE CARE HOSPITAL IS DETERMINED BY THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES, AVAILABLE RESOURCES, AND THE INTERRELATIONSHIP OF THOSE SERVING AND THOSE BEING SERVED. RESPONSIBLE STEWARDSHIP MANDATES THAT ADVANCE CARE HOSPITAL SEARCH OUT NEW, EFFECTIVE MEANS TO DELIVER QUALITY HEALTH CARE AND TO PROMOTE WHOLENESS IN THE HUMAN PERSON FOR THOSE WHO REQUIRE THIS LONG-TERM ACUTE CONTINUUM OF CARE. THE VISION OF ADVANCE CARE HOSPITAL IS TO PROVIDE HEALTH CARE THAT IS SPIRITUALLY ROOTED, FULLY INTEGRATED IN THE CONTINUUM OF CARE, SUPPORTIVE OF HEALTHIER COMMUNITIES, INNOVATIVE AND INTERDISCIPLINARY IN A HOLISTIC APPROACH TO CARE, AND COMPASSIONATE IN RESPONSE TO THE NEEDS OF PATIENTS IN THEIR LIFE JOURNEY. ADVANCE CARE HOSPITAL'S APPROACH TO STRENGTHEN CURRENT MINISTRIES AND TO EXPAND INTO NEW LOCATIONS AND SERVICES; TO IMPLEMENT INNOVATIVE APPROACHES TO CARING FOR THE WHOLE PERSON; TO INCREASE ACCESS TO HEALTH CARE FOR THE POOR AND UNDERSERVED THROUGH ADVOCACY AND OTHER INITIATIVES; TO MAKE A CONTRIBUTION TO CREATING HEALTHY COMMUNITIES; AND TO CREATE A WORK ENVIRONMENT FILLED WITH HOPE, DIGNITY, AND MUTUAL RESPECT. COMMUNITY BENEFITS IN SUPPORT OF ITS MISSION AND PHILOSOPHY REGARDING SOCIAL ACCOUNTABILITY, ADVANCE CARE HOSPITAL PROVIDES CARE TO PATIENTS WHO BEAR A SIGNIFICANT HEALTH-CARE FINANCIAL BURDEN RELATIVE TO THEIR FINANCIAL RESOURCES. ADVANCE CARE HOSPITAL CLASSIFIES THE RESOURCES UTILIZED FOR THE CARE OF PATIENTS BEARING A SIGNIFICANT HEALTH CARE FINANCIAL BURDEN AS COMPARED TO THEIR RESOURCES AS CHARITY CARE. CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF THE FINANCIAL BURDEN OF THE HEALTH CARE SERVICES AND/OR WHO ARE UNINSURED OR UNDERINSURED. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHO'S MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY. IN ADDITION TO UNCOMPENSATED COSTS, ADVANCE CARE HOSPITAL SUPPORTS AND PARTICIPATES IN COMMUNITY BENEFIT PROGRAMS DESIGNED TO POSITIVELY IMPACT THE HEALTH STATUS OF THE COMMUNITIES SERVED. REIMBURSED GOVERNMENT SPONSORED PROGRAMS IN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), ADVANCE CARE HOSPITAL PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, TRICARE (FORMERLY CHAMPUS WHICH PROVIDES CIVILIAN HEALTH CARE BENEFITS TO MILITARY PERSONNEL, MILITARY RETIREES AND THEIR DEPENDENTS, AND SOME MEMBERS OF THE RESERVE COMPONENT) AND TRICARE FOR LIFE (A MEDICARE SUPPLEMENT INSURANCE PROGRAM AVAILABLE TO INDIVIDUALS WHO HAD BEEN ELIGIBLE FOR TRICARE). AS ALREADY CITED, ADVANCE CARE HOSPITAL PROVIDED MEDICAL SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM WHICH, IN FACT, COMPRISED THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. NUMBER OF PATIENTS SERVED BY THE LTACH: 436 NUMBER OF PATIENT DAYS OF CARE PROVIDED BY THE LTACH: 12,927 NUMBER OF PATIENT DAYS OF CHARITY CARE PROVIDED BY THE LTACH: 544 CHARITY CARE COST: $531,783 TOTAL PROGRAM SERVICE EXPENSES (GRANTS $8,789) $12,103,390
FORM 990, PART VI, SECTION A, LINE 3ADVANCE CARE HOSPITAL IS MANAGED BY CHRISTUS DUBUIS HEALTH SYSTEM, AN UNRELATED TAX-EXEMPT ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 6ADVANCE CARE HOSPITAL'S CORPORATE MEMBER IS SISTERS OF MERCY HEALTH SYSTEM, ST. LOUIS, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE BYLAWS OF ADVANCE CARE HOSPITAL PERMIT THE CORPORATE MEMBER TO APPOINT ONE NON-VOTING MEMBER OF THE BOARD WHO SERVES EX-OFFICIO, WITHOUT VOTE. THE CORPORATE MEMBER DOES NOT CONTROL THE DAILY OPERATIONS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7BTHE BYLAWS PROVIDE TO THE CORPORATE MEMBER THE POWER TO APPROVE OR DISAPPROVE AMENDMENTS, MODIFICATIONS OR RESTATEMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND CORPORATIONS CONTROLLED BY IT; TO APPOINT THE INITIAL MEMBERS OF THE BOARD; TO APPOINT ONE NON-VOTING MEMBER OF THE BOARD WHO SERVES EX-OFFICIO, WITHOUT VOTE; AND TO APPROVE OR DISAPPROVE THE FOLLOWING ACTIONS OF THE CORPORATION: 1. ADOPTION OF, OR AMENDMENTS TO, THE MISSION, VISION AND VALUES OF THE CORPORATION; 2. ADOPTION OF A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF CORPORATION; AND 3. AUTHORIZATION OF ANY PROPOSED CHANGES IN THE TAX STATUS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM 990 BY THE INDEPENDENT ACCOUNTING FIRM, THE FORM 990 IS SUBMITTED TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CADVANCE CARE HOSPITAL IS MANAGED BY CHRISTUS DUBUIS HEALTH SYSTEM (CDHS), AN UNRELATED EXEMPT ORGANIZATION. THE MANAGEMENT AGREEMENT STATES THAT CDHS SHALL PROVIDE ALL STAFFING REQUIREMENTS TO THE ORGANIZATION. CDHS MAINTAINS A CONFLICT OF INTEREST POLICY FOR THEIR EMPLOYEES WHICH REQUIRES COMPLETION OF AN ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURES ARE REVIEWED BY THE EMPLOYEES' IMMEDIATE SUPERVISORS. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE CDHS ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, CDHS IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. ADVANCE CARE HOSPITAL MAINTAINS A POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS WHICH REQUIRES ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY ADVANCE CARE HOSPITAL UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS.
FORM 990, PART VI, LINE 15: COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL WAS INITIALLY DETERMINED BY THE ORGANIZATION UPON FORMATION IN 1998. IT WAS REEVALUATED AND ADJUSTED IN 2004 AND 2006 TO ENSURE REASONABLENESS AND ADHERANCE TO ADVANCE CARE HOSPITAL'S COMPENSATION PHILOSOPHY.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC FROM THE ARKANSAS SECRETARY OF STATE.
EXPLANATION OF FINANCIAL STATEMENTS:FORM 990, PART XII, LINE 2A & 2B:THE BOARD OF ADVANCE CARE HOSPITAL ELECTED TO RETAIN THE SERVICES OF AN INDEPENDENT PUBLIC ACCOUNTING FIRM TO PERFORM AGREED UPON PROCEDURES RELATED TO PATIENT FILE TESTING, THIRD PARTY LIABILITIES AND MANAGEMENT FEE EXPENSES FOR THE YEAR ENDED SEPTEMBER 30, 2011.
DESCRIPTION OF METHOD USED TO DETERMINE THE VALUE OF THE SERVICES, ETC:SCHEDULE R, PART V, LINE 2:ADVANCE CARE HOSPITAL RENTS FACILITIES FROM ST. JOSEPH REGIONAL HEALTH CENTER AND ST. EDWARD MERCY MEDICAL CENTER AT THE FAIR MARKET VALUE RENT RATE. ADVANCE CARE HOSPITAL ALSO RECEIVES ANCILLARY SERVICES FROM ST JOSEPH REGIONAL HEALTH CENTER AND ST. EDWARD MERCY MEDICAL CENTER AT COST. ANCILLARY SERVICES INCLUDE PHYSICAL, RESPIRATORY AND OCCUPATIONAL THERAPY, RADIOLOGY, DIETARY, PHARMACY, SURGERY, DIALYSIS, ANESTHESIOLOGY, CENTRAL SERVICES AND LAUNDRY.
FORM 990, PART V, LINE 2A AND PART IX, LINES 7-10:ADVANCE CARE HOSPITAL IS MANAGED BY CHRISTUS DUBUIS HEALTH SYSTEM (CDHS), AN UNRELATED EXEMPT ORGANIZATION. IN KEEPING WITH THE TERMS OF THE MANAGEMENT AGREEMENT, CDHS PROVIDES ALL OF ADVANCE CARE HOSPITAL'S STAFFING REQUIREMENTS VIA ITS OWN CDHS EMPLOYEES. CDHS APPROPRIATELY ISSUES ALL FORMS W-2 TO ITS EMPLOYEES. ADVANCE CARE HOSPITAL'S ASSOCIATED SALARY COSTS ARE REFLECTED ON FORM 990, PART IX, LINES 7-10.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (64 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
BREECH REGIONAL MEDICAL CENTER
100 HOSPITAL DRIVELEBANONMO65536431767432HOSPITALMO501(C)(3)LINE 3: 170(B)(1)(A)ST JOHNS HS0
CARROLL HEALTH FOUNDATION
214 CARTER STREETBERRYVILLEAR72616710759301FOUNDATIONAR501(C)(3)11AOZARK RG HS0
CASA DE MISERICORDIA
1602 MCCLELLAND STREETLAREDOTX78044742912461WOMEN'S SHELTERTX501(C)(3)7MM LAREDO0
HEALDTON MERCY HOSPITAL CORPORATION
918 SOUTH STREETHEALDTONOK73438263173902HOSPITALOK501(C)(3)LINE 3: 170(B)(1)(A)MMHC0
LAREDO MEDICAL GROUP
14528 S OUTER FORTY SUITE 100CHESTERFIELDMO63017742764726INACTIVETX501(C)(3)LINE 9: 509(A)(2)MHS-TX0
MCAULEY PORTFOLIO MANAGEMENT COMPANY
14528 S OUTER FORTY SUITE 100CHESTERFIELDMO63017261708048INVESTMENT MANAGEMENTMO501(C)(3)11BSMHS0
MERCY EL RENO HOSPITAL CORPORATION
2115 PARKVIEW DRIVEEL RENOOK73036736617948LEASED HOSPITALOK501(C)(3)3MHS0
MERCY EMERGENCY MEDICAL SERVICES INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120810627035INACTIVEOK501(C)(3)LINE 9: 509(A)(2)MHC0
MERCY FOUNDATION FOR HEALTH INNOVATION
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017200901499FOUNDATIONMO501(C)(3)11BSMHS0
MERCY HEALTH CENTER FOUNDATION
401 WOODLAND HILLS BLVDFORT SCOTTKS66701481077073FOUNDATIONKS501(C)(3)11CMHS-KS0
MERCY HEALTH CENTER FOUNDATION INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120731593024FOUNDATIONOK501(C)(3)11AMHC0
MERCY HEALTH CENTER INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120730579285HOSPITALOK501(C)(3)3MHS0
MERCY HEALTH MHMCH INC
220 PENNSYLVANIA AVENUECOLUMBUSKS66725270842031HOSPITALMO501(C)(3)9MHS-JOPLIN0
MERCY HEALTH OF JOPLIN FOUNDATION
2727 MCCLELLAND BLVDJOPLINMO64804270906136FOUNDATIONMO501(C)(3)11AMHS-JOPLIN0
MERCY HEALTH OF JOPLIN INC
2727 MCCLELLAND BLVDJOPLINMO64804270814858HOSPITALMO501(C)(3)9MHS-JOPLIN0
MERCY HEALTH SERVICES INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120141838609DISSOLVED 6/30/10OK501(C)(3)9MHC0
MERCY HEALTH SYSTEM OF KANSAS INC
401 WOODLAND HILLS BLVDFORT SCOTTKS66701480956045HOSPITALKS501(C)(3)3MHS-JOPLIN0
MERCY HEALTH SYSTEM OF NORTHWEST ARKANSAS
2710 RIFE MEDICAL DRIVEROGERSAR72758621684203PHYSICIAN GROUPAR501(C)(3)11BSMHS0
MERCY HEALTH SYSTEM OF TEXAS INC
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017742764727INACTIVETX501(C)(3)11BSMHS0
MERCY HEALTH SYSTEM INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120731453048HOLDING COMPANYOK501(C)(3)11BSMHS0
MERCY HEALTH SYSTEM-JOPLIN INC
2727 MCCLELLAND BLVDJOPLINMO64804300584463HEALTH SYSTEMMO501(C)(3)11BSMHS0
MERCY HOSPITAL FOUNDATION OF INDEPENDENCE
800 W MYRTLEINDEPENDENCEKS67301481079981FOUNDATIONKS501(C)(3)11AMHS-KS0
MERCY HOSPITAL OF LAREDO
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017741189682INACTIVETX501(C)(3)3MHS-TX0
MERCY MEDICAL GROUP
645 MARYVILLE CENTRE STE 100ST LOUISMO63141431771217PHYSICIAN GROUPMO501(C)(3)9ST JOHN MHC0
MERCY MEMORIAL HEALTH CENTER FOUNDATION
1011 14TH AVENUE NWARDMOREOK73401710962525FOUNDATIONOK501(C)(3)11AMMHC0
MERCY MEMORIAL HEALTH CENTER INC
1011 14TH AVENUE NWARDMOREOK73401731500629HOSPITALOK501(C)(3)3MHS0
MERCY MINISTRIES OF LAREDO
2500 ZACATECASLAREDOTX78043200198462OUTREACHTX501(C)(3)7SMHS0
MERCY PHYSICIANS OF OKLAHOMA INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120270473057PHYSICIAN GROUPOK501(C)(3)9MHS0
MHM SUPPORT SERVICES
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017202553101SUPPORT HEALTH SYSTEMMO501(C)(3)11BSMHS0
MISSION CLINICAL SERVICES
300 WERNER STREETHOT SPRINGSAR71913134239691PHYSICIAN GROUPAR501(C)(3)9ST JOS MHS0
OZARKS REGIONS HEALTH SYSTEM INC
214 CARTER STREETBERRYVILLEAR72616710759299HOSPITALAR501(C)(3)3ST JOHNS HS0
SISTERS OF MERCY HEALTH SYSTEM
14528 S OUTER FORTY SUITE 100CHESTERFIELDMO63017431423050SUPPORT HEALTH SYSTEMMO501(C)(3)LINE 1: 170(B)(1)(A)0N/A
SISTERS OF MERCY MINISTRIES
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017721069468OUTREACHMO501(C)(3)7SMHS0
ST EDWARD HLTH FAC-FRANKLIN CO
801 W RIVER STREETOZARKAR72949710689680HOSPITALAR501(C)(3)3SEMMC0
ST EDWARD HLTH FAC-LOGAN CO
500 E ACADEMYPARISAR72855710655753HOSPITALAR501(C)(3)3SEMMC0
ST EDWARD HLTH FAC-SCOTT CO
1341 W 6TH STREETWALDRONAR72958710557895HOSPITALAR501(C)(3)3SEMMC0
ST EDWARD MERCY FOUNDATION
PO BOX 17000FORT SMITHAR72917237330425FOUNDATIONAR501(C)(3)7SEMMC0
ST EDWARD MERCY CLINIC INC
7301 ROGERS AVENUEFORT SMITHAR72917261318597PHYSICIAN GROUPAR501(C)(3)9SEMHS0
ST EDWARD MERCY HEALTH SYSTEM INC
7301 ROGERS AVENUEFORT SMITHAR72917261318515HOLDING COMPANYAR501(C)(3)11BSMHS0
ST EDWARD MERCY MEDICAL CENTER
7301 ROGERS AVEFORT SMITHAR72917710240352HOSPITALAR501(C)(3)LINE 3: 170(B)(1)(A)SEMHS0
ST FRANCIS HOSPITAL
100 W HIGHWAY 60MOUNTAIN VIEWMO65548440607149HOSPITALMO501(C)(3)3ST JOHNS HS0
ST JOHN'S AURORA INC
500 PORTER AVENUEAURORAMO65605431936696LEASE HOSPITALMO501(C)(3)3ST JOHNS HS0
ST JOHN'S CASSVILLE INC
94 MAIN STREETCASSVILLEMO65625431936699LEASE HOSPITALMO501(C)(3)3ST JOHNS HS0
ST JOHN'S CHILDREN'S HOSPITAL INC
1235 E CHEROKEE STREETSPRINGFIELDMO65804INACTIVEMO501(C)(3)3ST JOHNS HS0
ST JOHN'S CLINIC INC
1965 FREMONT STREET SUITE 2950SPRINGFIELDMO65804431560263PHYSICIAN GROUPMO501(C)(3)9ST JOHNS HS0
ST JOHN'S FDN FOR COMM HEALTH INC
1235 E CHEROKEE STREETSPRINGFIELDMO65804320195818FOUNDATIONMO501(C)(3)11BST JOHNS HS0
ST JOHN'S HEALTH SYSTEM INC
1235 E CHEROKEE STREETSPRINGFIELDMO65804431856028HOLDING COMPANYMO501(C)(3)11BSMHS0
ST JOHN'S HOME CARE OF BERRYVILLE INC
214 CARTER STREETBERRYVILLEAR72616870781247HOME HEALTHAR501(C)(3)11CST JOHNS RHC0
ST JOHN'S MEDICAL RESEARCH INST INC
1235 E CHEROKEE STREETSPRINGFIELDMO65804870796305RESEARCHMO501(C)(3)4ST JOHN HS0
ST JOHN'S MERCY FOUNDATION
645 MARYVILLE CENTRE STE 100ST LOUISMO63141562410022FOUNDATIONMO501(C)(3)11BST JOHNS MHC0
ST JOHN'S MERCY HEALTH CARE
645 MARYVILLE CENTRE STE 100ST LOUISMO63141431718408HEALTH SYSTEMMO501(C)(3)11BSMHS0
ST JOHN'S MERCY HEALTH SYSTEM
645 MARYVILLE CENTRE STE 100ST LOUISMO63141430653493HOSPITALMO501(C)(3)3ST JOHNS MHC0
ST JOHN'S MERCY HOSPITAL FOUNDATION
901 E FIFTH STREETWASHINGTONMO63090562410020FOUNDATIONMO501(C)(3)11BST JOHNS MHC0
ST JOHN'S MERCY SUPPORT SERVICES
615 S NEW BALLAS ROADST LOUISMO63141431677952INACTIVEMO501(C)(3)11CST JOHNS MHS0
ST JOHN'S REGIONAL HEALTH CENTER
1235 E CHEROKEE STREETSPRINGFIELDMO65804440552485HOSPITALMO501(C)(3)3ST JOHNS HS0
ST JOSEPH'S MERCY CLINIC INC
1 MERCY LANEHOT SPRINGSAR71913261125131PHYSICIAN GROUPAR501(C)(3)9ST JOS MHS0
ST JOSEPH'S MERCY HEALTH CENTER
300 WERNER STREETHOT SPRINGSAR71913710236913HOSPITALAR501(C)(3)LINE 3: 170(B)(1)(A)ST JOS MHS0
ST JOSEPH'S MERCY HEALTH FOUNDATION
300 WERNER STREETHOT SPRINGSAR71913710804718FOUNDATIONAR501(C)(3)11BST JOS MHC0
ST JOSEPH'S MERCY HEALTH SYSTEM INC
300 WERNER STREETHOT SPRINGSAR71913261125064HOLDING COMPANYAR501(C)(3)11BSMHS0
ST MARY-ROGERS MEMORIAL HOSPITAL INC
2710 RIFE MEDICAL DRIVEROGERSAR72758710294390HOSPITALAR501(C)(3)3MHS-NWA0
ST MARY'S HOSPITAL FOUNDATION
2710 RIFE MEDICAL DRIVEROGERSAR77858710601687FOUNDATIONAR501(C)(3)11CST MARY RMC0
ST MARY'S HOSPITAL OF ENID OKLAHOMA INC
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017730614655INACTIVEOK501(C)(3)3MHS0
THE SISTER M CORNELIA BLASKO FNDN
100 W HIGHWAY 60MOUNTAIN VIEWMO65548431873914FOUNDATIONMO501(C)(3)11AST FRAN HOS0
UNITY AMBULATORY CARE
645 MARYVILLE CENTRE STE 100ST LOUISMO63141431861745INACTIVEMO501(C)(3)11CST JOHN MHC0

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
HORIZONTAL PROPERTY
7301 ROGERS AVENUEFORT SMITHAR72903710554050OFFICE BUILDINGARN/A
HOT SPRINGS EQUIP
300 WERNER STREETHOT SPRINGSAR71913204340915DISSOLVED 9/30/09ARN/A
HOT SPRINGS MRI
100 RIDGEWAY PLACEHOT SPRINGSAR72901710675196DISSOLVED 8/05/09ARN/A
MERC AMBU SURG CTR
7301 ROGERS AVENUEFORT SMITHAR72917710827721AMB. SURG. CENTERARN/A
RES OPT & INNOVA
645 MARYVILLE CENTERST LOUISMO63141460468368DISTRIBUTION CENTERMON/A
SO OK DIAG CTR
1011 14TH AVENUE NWARDMOREOK73401431971232MRI SERVICESOKN/A
FORT SMITH EMERG MEDICAL SERVICES
1701 GREENWOODFORT SMITHAR72901710416615EMERGENCY MEDICALARN/A
SO OK PHY HP ORG
1011 14TH AVENUE NWARDMOREOK73401731462104DISSOLVED 12/31/09OKN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (13 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
CONSOLIDATED LOGISTICS INC
2710 RIFE MEDICAL LANEROGERSAR72758710474406DISSOLVED 8/04/09ARN/AC
FRONTENAC PROPERTIES INC
14528 S OUTER FORTY SUITE 100CHESTERFIELDMO63017521914421HOLDING COMPANYDEN/AC
INVENO HEALTH INC
1235 E CHEROKEE STREETSPRINGFIELDMO65804264509571IT SERVICESMON/AC
MERCY COMMUNITY SERVICES INC
401 WOODLAND HILLS BLVDFORT SMITHKS66701481078101CATERINGKSN/AC
MERCY HEALTH CENTER CONDOMINIUMS
4300 W MEMORIAL RDOKLAHOMA CITYOK73120680640970REAL ESTATEOKN/AC
MERCY HEALTH NETWORK OF THE SOUTHERN REGION
1011 14TH AVENUE NWARDMOREOK73401731580607HEALTH CAREOKN/AC
MERCY HEALTH NETWORK INC
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120731381689HEALTH CAREOKN/AC
MERCY MANAGED CARE CORPORATION
4300 W MEMORIAL ROADOKLAHOMA CITYOK73120731441665HOLDING COMPANYOKN/AC
MERCY MEDICAL SERVICES INC
14528 S OUTER FORTY SUITE 100CHESTERFIELDMO63017710641246DISSOLVED 7/01/09MON/AC
MHP INC
14528 S OUTER FORTY SUITE 100CHESTERFIELDMO63017431697048HOLDING COMPANYDEN/AC
ST EDWARD MEDICAL SERVICES INC
7301 ROGERS AVENUEFORT SMLTHAR72903202965518DISSOLVED 7/01/09ARN/AC
UH L CORP INC
645 MARYVILLE CENTRE DRIVE SUITE 10ST LOUISMO63141742499535HOLDING COMPANYMON/AC
UNITY SUPPORT SERVICES INC
645 MARYVILLE CENTRE DRIVE SUITE 10ST LOUISMO63141431797042MANAGEMENTMON/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE R, PART VReturnReference
ExplanationADVANCE CARE HOSPITAL IS NOT UNDER THE CONTROL OF THE HOSPITALS WITH WHICH IT SHARES SPACE. ADVANCE CARE HOSPITAL MAINTAINS A SEPARATE AND INDEPENDENT GOVERNING BODY, CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, ADMINISTRATORS, AND DIRECTORS OF PATIENT CARE. COSTS FOR FACILITY RENTAL IS BASED ON A FIXED COST REIMBURSEMENT FORMULA. SERVICES ARE PRICED BASED ON A VARIABLE COST REIMBURSEMENT FORMULA.Explanation