2017-12-14T14:13:44-06:00 2017-09-30 710355269 BEALL BARCLAY & COMPANY PLC P O BOX 10148 FORT SMITH AR 729170148 990 2016-10-01 237237381 ARKANSAS FOUNDATION FOR MEDICAL CARE INC ARKA 4795737616 PO BOX 180001 FORT SMITH AR 729180001 MARY COUNTS CHIEF FINANCIAL OFFICER 4795737616 2017-12-05 1 BARBARA HAMBRICK P00387600 4794845740 2017-12-05 209.183.161.2 2017-12-05 10:24:27 CS P 48ED9BE23A3E34C74831001A58133E24A921A7B8 DCB85603FA269EA43F90FD55117C88741C696FCF 2016 2017-02-10 21:41:12Z MARY COUNTS PO BOX 180001 FORT SMITH AR 729180001 29484127 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 15 297 0 0 0 28627730 25029850 671258 3919768 -1827698 179137 56198 7085 27527488 29135840 7630 2500 0 0 19695077 22178498 0 0 0 6597497 6397709 26300204 28578707 1227284 557133 27715188 28650035 3210541 2837416 24504647 25812619 X TO PROMOTE EXCELLENCE IN HEALTH CARE THROUGH EVALUATION AND EDUCATION 0 0 1705464 CMS QIN/QIO 11TH SOW WHICH WE PARTICIPATE IN AS A SUB TO TMF (TEXAS MEDICAL FOUNDATION) - PROVIDED 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. 5758925 ARKANSAS MEDICAID REVIEW - PROVIDED REVIEW SERVICES AS REQUIRED BY CONTRACT:PRIOR AUTHORIZATION OF MED/SURG PROCEDURES - 7,565PRIOR AUTHORIZATION OF MUMPS - 23,441PRIOR AUTHORIZATION OF DME - 25,784TARGETED CASE MANAGEMENT REVIEW - 36RETRO EMERGENCY ROOM REVIEW - 42,179RETRO INPATIENT REVIEW - 33,575EXTENSION OF BENEFIT/MOLECULAR PATHOLOGY REVIEW - 34,225ORGAN TRANSPLANT REVIEW - 66PVT OPTION REVIEWS - 97NICU - 1,002 6572985 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. PROVIDER RELATIONS AND CONNECTCARE ACTIVITIES WERE ALSO ADDED TO THIS CONTRACT THIS YEAR. 13252258 2500 3919768 OTHER PROGRAMS CONSIST OF CONTRACTS THAT THE ORGANIZATION HAS WITH VARIOUS FEDERAL, STATE, AND PRIVATE AGENCIES. 13252258 2500 3919768 27289632 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 77 0 1 297 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 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 5300 0 0 JENNIFER STYRON TREASURER 1.00 X X 5425 0 0 RONALD WAUTERS MD MEMBER-AT-LARGE 1.00 X 5200 0 0 TOM BUTLER BOD 1.00 X 5300 0 0 AMY DUNN JOHNSON BOD 1.00 X 3650 0 0 RAY MONTGOMERY II FACHE BOD 1.00 X 4475 0 0 MARCUS OSBORNE BOD 1.00 X 4925 0 0 KAREN PETTIT RNP CPHQ BOD 1.00 X 4800 0 0 MELISSA PIERCE RNP BOD 1.00 X 4350 0 0 MICHAEL MOODY MD BOD 1.00 X 2800 0 0 STACY C ZIMMERMAN MD VICE CHAIRMAN 1.00 X X 4800 0 0 CAROLYN HOOD RN BSN SECRETARY 1.00 X X 2100 0 0 ALAN WILSON MD BOD 1.00 X 700 0 0 HARVEY POTTS MD MPH BOD 1.00 X 0 0 0 LADELL DOUGLAS MD BOD 1.00 X 0 0 0 WALLACE R HANLEY CEO/PRESIDENT 40.00 X 356132 0 39261 MARILYN LITTLE CHIEF OPERATING OFFICER 40.00 X 182903 0 8088 MARY S MOORE CHIEF COMPLIANCE OFFICER 40.00 X 149416 0 25655 MARY N COUNTS CHIEF FINANCIAL OFFICER 47.00 X 170496 0 25526 PEGGY J STARLING CHIEF OUTREACH SERVICES OF 42.00 X 185664 0 22438 NATHAN RAY CHIEF TECHNOLOGY OFFICER 44.00 X 161360 0 27014 MELISSA MASINGILL CHIEF PUBLIC AFFAIRS OFFICER 37.00 X 102585 0 22113 CATHY BAIN CHIEF ADMINISTRATIVE OFFIC 49.00 X 147595 0 12455 CHAD T RODGERS MD CHIEF MEDICAL OFFICER 15.00 X 102964 0 3735 JULIA KETTLEWELL DIRECTOR QUALITY 40.00 X 138762 0 24259 JENNA CLEMONS DIRECTOR FINANCE 43.00 X 126949 0 30258 ELENA DAVIS MED DIR CLINICAL AFFAIRS 28.00 X 138792 0 22849 STEVEN CHASTEEN DIRECTOR PRAC TRANSFORMATION 47.00 X 123372 0 31126 THOMAS D TINSMAN ASSOC MED DIRECTOR 42.00 X 233802 0 22383 2374617 0 317160 25 0 1 0 MEDECISION INC PO BOX 7777 PHILIDELPHIA PA 19175 HEALTH MANAGEMENT 675044 SALESFORCECOM INC PO BOX 3370 TUPELO MS 38803 CUSTOMER RELATIONSHIP MGMT 524015 ROARK PERKINS PERRY YELVINGTON 713 W 2ND STREET LITTLE ROCK AR 72201 ARCHITECT SERVICES 424174 COLLIERS INTERNATIONAL PO BOX 3546 LITTLE ROCK AR 72203 REAL ESTATE MANAGEMENT 349391 FLEMING NETWORK SERVICES PO BOX 856 BRYANT AR 72089 NETWORK AND SECURITY SERVICES 340444 18 25029850 25029850 PRIVATE REVENUE FROM OPERATIONS 900099 3919768 3919768 3919768 194366 194366 255027 247942 7085 7085 7085 85116 100345 -15229 -15229 -15229 29135840 3919768 0 186222 2500 2500 1713282 1713282 13239120 12789035 450085 611526 611526 5358230 5142112 216118 1256340 1256340 41855 41855 55417 55417 840953 678934 162019 99318 99072 246 1288013 1047233 240780 1715408 1715311 97 353392 353110 282 798171 778437 19734 270796 172086 98710 481558 453869 27689 226350 226350 PASS THROUGH COSTS 230000 230000 0 PARKING 964 714 250 -4486 -77551 73065 28578707 27289632 1289075 0 1100 1100 2667709 1781522 4594159 4841226 970810 1392694 11797937 4001155 7428776 7796782 12052634 12836711 27715188 28650035 3210541 2837416 3210541 2837416 X 24504647 25812619 24504647 25812619 27715188 28650035 557133 750839 0 X X 0 1 X 1 1 1 X 18415093 19727752 20147853 28627730 25029850 111948278 1821331 1206796 1673087 671258 3919768 9292240 20236424 20934548 21820940 29298988 28949618 121240518 0 0 0 121240518 353996 335894 329862 435506 449393 1904651 353996 335894 329862 435506 449393 1904651 2362 2362 20590420 21272804 22150802 29734494 29399011 123147531 0.98450 0.98390 0.01550 0.01610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 X 138000 138000 28440707 28578707 1000000 250000 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 6359643 1116772 5242871 424668 102225 322443 941409 465053 476356 3012217 2317105 695112 7796782 X 29886679 750839 750839 29135840 0 29135840 28578707 0 28578707 0 28578707 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 X 0 0 0 0 0 0 0 0 0 WALLACE R HANLEY CEO/PRESIDENT 356132 0 0 0 0 0 10600 0 28661 0 395393 0 0 0 MARILYN LITTLE CHIEF OPERATING OFFICER 182903 0 0 0 0 0 5877 0 2211 0 190991 0 0 0 MARY S MOORE CHIEF COMPLIANCE OFFICER 149416 0 0 0 0 0 6182 0 19473 0 175071 0 0 0 MARY N COUNTS CHIEF FINANCIAL OFFICER 170496 0 0 0 0 0 6958 0 18568 0 196022 0 0 0 PEGGY J STARLING CHIEF OUTREACH SERVICES OF 185664 0 0 0 0 0 7507 0 14931 0 208102 0 0 0 NATHAN RAY CHIEF TECHNOLOGY OFFICER 161360 0 0 0 0 0 6502 0 20512 0 188374 0 0 0 CATHY BAIN CHIEF ADMINISTRATIVE OFFIC 147595 0 0 0 0 0 5999 0 6456 0 160050 0 0 0 JULIA KETTLEWELL DIRECTOR QUALITY 138762 0 0 0 0 0 5744 0 18515 0 163021 0 0 0 JENNA CLEMONS DIRECTOR FINANCE 126949 0 0 0 0 0 5181 0 25077 0 157207 0 0 0 ELENA DAVIS MED DIR CLINICAL AFFAIRS 138792 0 0 0 0 0 5178 0 17671 0 161641 0 0 0 STEVEN CHASTEEN DIRECTOR PRAC TRANSFORMATION 123372 0 0 0 0 0 5072 0 26054 0 154498 0 0 0 THOMAS D TINSMAN ASSOC MED DIRECTOR 233802 0 0 0 0 0 9420 0 12963 0 256185 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B 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. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.