2017-05-11T07:52:02-05:00 2016-06-30 BKD LLP PO BOX 3667 LITTLE ROCK AR 722033667 990 2015-07-01 716044543 JOHN ED CHAMBERS MEMORIAL HOSPITAL INC % MICHAELLE STANDRIDGE JOHN 4794952241 PO BOX 639 DANVILLE AR 72833 MIKE MCCOY CEO 4794952241 2017-05-08 true AMBER SHERRILL P00748683 5013721040 2015 2021-01-29 14:40:06Z CHAMBERS MEMORIAL HOSPITAL MIKE MCCOY PO BOX 639 DANVILLE AR 72833 18496246 false X WWW.CHAMBERSHOSPITAL.COM X 1998 AR IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS & EXPECTATIONS OF PATIENTS & COMMUNITIES. 7 7 261 12 0 172641 53150 16868879 17894472 45729 39941 550161 508683 17637410 18496246 0 0 0 0 10649288 10509319 0 0 0 8811953 8796820 19461241 19306139 -1823831 -809893 31313188 29305584 14487458 13289747 16825730 16015837 IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS AND EXPECTATIONS OF PATIENTS AND THE COMMUNITITES SERVED. false false 15489557 17894472 IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS AND EXPECTATIONS OF PATIENTS AND THE COMMUNITITES SERVED. 15489557 true true false false false false false false false false true false false false true false true false false false false false false false false false true true false false true true false false false false false true false false false true false false false false false false false false false true 30 0 true 261 true false false false false false false false false false false X 7 7 false false false false false false false true true false false true true true true false true true true false AR X MICHAELLE STANDRIDGE 4794952241 719 DETROIT STREET DANVILLE AR 72833 X JOHNNY CHAMBERS CHAIRMAN 1.0 0.0 X X 0 0 0 DAVID FISHER VICE CHAIRMAN 1.0 0.0 X X 0 0 0 HOYT DALE SECRETARY 1.0 0.0 X X 0 0 0 TODD SANDERS DIRECTOR 1.0 0.0 X 0 0 0 TOMMY PAPASAN DIRECTOR 1.0 0.0 X 0 0 0 RITCHIE TIPPIN DIRECTOR 1.0 0.0 X 0 0 0 PHILIP ALEXANDER DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL SCOTT PEEK CEO 40.0 0.0 X 284481 0 10600 MIKE MCCOY INTERIM CEO 40.0 0.0 X 0 0 0 THOMAS JOHN TINNESZ MD PHYSICIAN 40.0 0.0 X 402312 0 28936 JOHN J WESTWOOD MD PHYSICIAN 32.0 0.0 X 235476 0 13430 TIMMY EUGENE KAY MD PHYSICIAN 32.0 0.0 X 230281 0 13222 WILLIAM L BERRY MD PHYSICIAN 32.0 0.0 X 228939 0 13169 PATTY K PETTWAY MD PHYSICIAN 32.0 0.0 X 192119 0 11696 1573608 0 91053 12 false true false SOUTH ARKANSAS EMERGENCY PHYSICIANS 700 WEST GROVE STREET EL DORADO AR 71730 ER 1547714 ANESTHESIA SPECIALISTS PA PO BOX 20343 HOT SPRINGS AR 71903 ANESTHESIA SERVICES 304620 RIVER RIDGE RX INC PO BOX 394 DANVILLE AR 728330394 PHARMACY SERVICES 297250 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 900745826 RADIOLOGY 109480 4 8914 44236 53150 PATIENT SERVICES 622110 17894472 17894472 17894472 39941 0 0 39941 0 0 20580 20580 0 20580 0 0 20580 0 0 0 0 CAFETERIA REVENUE 174705 174705 340B REVENUE 122076 122076 MANAGED CARE FEE 42895 42895 148427 148427 488103 18496246 17894472 0 548624 X 0 0 0 0 270982 270982 0 8724213 7065856 1658357 0 251493 203688 47805 653395 529193 124202 609236 493428 115808 0 0 0 0 0 0 3004839 2433659 571180 56256 45562 10694 166507 134856 31651 0 0 356542 288768 67774 169853 137566 32287 0 0 676014 547513 128501 0 1158659 938413 220246 229491 185868 43623 OPERATING SUPPLIES 1264239 1023924 240315 BAD DEBTS EXPENSE 382616 382616 EQUIPMENT EXPENSE 378389 306462 71927 DIETARY EXPENSE 295829 239596 56233 657586 532589 124997 19306139 15489557 3816582 0 797459 881890 8593644 8425259 0 0 4178453 2952885 0 0 0 0 0 0 352107 396891 178935 201296 32867495 16559161 17212590 16308334 0 0 0 0 0 0 0 0 0 139029 31313188 29305584 1784441 923297 0 0 0 0 12703017 12127462 0 0 0 164732 0 0 0 0 0 74256 14487458 13289747 X 16825730 16015837 0 0 0 0 16825730 16015837 31313188 29305584 -809893 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1229124 1229124 21128126 7582893 13545233 10021424 8747971 1273453 488821 228297 260524 16308334 0 AMOUNT DUE FROM THIRD PARTY PAYERS 74256 74256 18113630 18113630 382616 382616 18496246 18923523 18923523 382616 382616 19306139 FORM 990, SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL INCOME TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. FORM 990, SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSE $382,616 FORM 990, SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $382,616 true true true X 110. true X true true false true true 581093 581093 0.03070 2044016 1875591 168425 0.00890 2625109 1875591 749518 0.03960 3023712 1264690 1759022 0.09290 3023712 1264690 1759022 0.09290 5648821 3140281 2508540 0.13250 true 382616 210439 7218530 4901196 2317334 X true true 1 1 CHAMBERS MEMORIAL HOSPITAL 719 DETROIT STREET DANVILLE AR 728330639 WWW.CHAMBERSHOSPITAL.COM AR4825 X X X CHAMBERS MEMORIAL HOSPITAL false false true X X X X X X X X X 15 true false false true X WWW.CHAMBERSHOSPITAL.COM X true 15 true WWW.CHAMBERSHOSPITAL.COM false false true X 110. 200. X X X X true true X X X X true X WWW.CHAMBERSHOSPITAL.COM X WWW.CHAMBERSHOSPITAL.COM X WWW.CHAMBERSHOSPITAL.COM X X X X X true X false X X X X X true X false false FORM 990, SCHEDULE H, PART V, SECTION B, LINE 5 THE HOSPITAL CALCULATED THE COMMUNITY HEALTH INPUT QUESTIONAIRES IN ORDER TO GATHER BROAD COMMUNITY INPUT REGARDING HEALTH ISSUES. THE HOSPITAL ENGAGED BKD, LLP TO ASSIST IN CONDUCTING A FORMAL COMMUNITY HEALTH NEEDS ASSESMENT (CHNA). KEY INTERVIEWEES INCLUDED COMMUNITY STAKEHOLDERS THAT REPRESENT THE BROAD INTEREST OF THE COMMUNITY WITH KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. DIAGLOGUES WITH FIVE KEY INTERVIEWEES WERE CONDUCTED. INTERVIEWEES WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH OR THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. ALL INTERVIEWS WERE CONDUCTED BY HOSPITAL PERSONNEL USING A STANDARD QUESTIONNAIRE. A SUMMARY OF THEIR OPINIONS IS REPORTED WITHOUT JUDGING THE TRUTHFULNESS OR ACCURACY OF THEIR REMARKS. INTERVIEW DATA WAS INITIALLY RECORDED IN NARRATIVE FORM. INTERVIEWEES WERE ASSURED THAT PERSONAL IDENTIFIERS SUCH AS NAME OR ORGANIZATIONAL AFFILIATIONS WOULD NOT BE CONNECTED IN ANY WAY TO THE INFORMATION PRESENTED IN THE CHNA. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11 THE NEEDS THAT WILL BE ADDRESSED IN THE MOST CURRENTLY ADOPTED CHNA INCLUDE THE FOLLOWING ISSUES CONSISTENTLY RAISED DURING INTERVIEWS: 1. RECRUITMENT OF ADDITIONAL PRIMARY CARE PRACTITIONERS CHAMBERS MEMORIAL HOSPITAL IS AGGRESSIVELY RECRUITING ADDITIONAL PRIMARY CARE PROVIDERS WHICH INCLUDES PHYSICIANS AND MID-LEVEL PROVIDERS (NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS). TO ASSIST IN THE EFFORT WE WILL UTILIZE PROFESSIONAL RECRUITMENT FIRMS AS NEEDED. IN ADDITIONS, WE ARE EXPLORING OPPORTUNITIES WITH MEDICAL SCHOOLS AND RESIDENCY PROGRAMS TO ENHANCE OUR RELATIONSHIP WITH THOSE PROGRAMS AND THEIR STUDENTS WHO WILL BE PRACTICING PHYSICIANS IN THE FUTURE. WE ARE ALSO WORKING WITH NURSE PRACTITIONERS AS A PRACTICE SIDE FOR THEIR CLINICAL ROTATIONS WHICH HELPS IN RECRUITING THOSE PROVIDERS. WITH THESE EFFORTS WE BELIEVE WE WILL BE SUCCESSFUL IN RECRUITING ADDITIONAL PRIMARY CARE PROVIDERS TO OUR AREA. 2. OBESITY OBESITY INCREASES RISKS FOR MORBIDITY AND MORTALITY OF NUMEROUS MEDICAL CONDITIONS. YELL COUNTY HAS A 10% HIGHER INCIDENT OF OBESITY THAN THE NATIONAL BENCHMARK AND 2% HIGHER THAN THE STATE OF ARKANSAS AS A WHOLE. THE HOSPITAL HAVE PARTNERED WITH AND HELP SPONSOR HEALTHY ACTIVE YELL WHICH MEETS WITH MEMBERS OF THE COMMUNITY MONTHLY TO INCREASE AWARENESS OF THIS GROWING PROBLEM AND WORK TOGETHER TO EDUCATE AND HELP YELL COUNTY TO BECOME HEALTHIER AND MORE ACTIVE. THERE ARE REPRESENTATIONS FROM ALL SCHOOLS IN YELL COUNTY ALONG WITH ADH AND COUNTY EXTENSION SERVICES. THE GROUP HAS ALSO BECOME A PART OF ARKANSAS COALITION FOR OBESITY PREVENTION (ARCOPS) AND WILL GAIN ACCESS TO MANY WAYS THAT THIS PARTNERSHIP CAN ASSIST US TO ASSIST RESIDENTS OF YELL COUNTY. WE WILL CONTINUE TO PARTNER WITH OUR SCHOOLS, ADH, ARCOPS, COUNTY EXTENSION AS WELL AS ARKANSAS TECH TO BUILD A HEALTHIER AND MORE ACTIVE COMMUNITY. 3. HEALTH EDUCATION AND KNOWLEDGE THE HOSPITAL PLANS TO EDUCATE CITIZENS BY CONTINUING TO UTILIZE THE LOCAL NEWSPAPER, UPDATE AND KEEP EDUCATIONAL MATERIAL CURRENT ON THE FACILITY WEBSITE, THROUGH HEALTH FAIRS, YELL COUNTY FAIR, SENIOR CITIZEN CENTER, AND OUR LOCAL FAITH-BASED ORGANIZATIONS. THE HOSPITAL PLANS TO PROVIDE EDUCATION MATERIAL ON TOPICS SUCH AS FAMILY HEALTH, CHRONIC DISEASES, HEALTHY EATING THROUGH NUTRITION EDUCATION, PROMOTION OF INCREASED ACTIVITY AND SMOKING CESSATION. INFORMATION WILL BE PROVIDED BY OUR STAFF PHYSICIANS AS WELL AS OUR HOME HEALTH NURSING STAFF AND HOSPITAL NURSING STAFF. OUR NURSE PRACTITIONERS WILL ALSO TAKE PART IN GETTING THIS KNOWLEDGE AND EDUCATION TO OUR COMMUNITY. 4. SMOKING CESSATION SERVICES ALL HEALTH ENCOUNTERS ARE OPPORTUNITIES FOR COUNSELING AND OVER THE LAST 3 YEARS PLUS THE HOSPITAL HAS BEEN USING INPATIENT STAYS ESPECIALLY FOR MOTIVATING PATIENTS TO COMMIT TO CESSATION OR AT LEAST TO GET THEM THINKING ABOUT IT AND GETTING INFORMATION AND NUMBERS TO CALL FOR ASSISTANCE. IF A PATIENT CHOOSES TO MAKE A DECISION TO QUIT SMOKING THEY ARE ASSISTED TO FILL OUT A FORM AND THIS IS FAXED TO THE ARKANSAS DEPARTMENT OF HEALTH. THE HOSPITAL WORKS WITH THE ARKANSAS FOUNDATION FOR MEDICAL CARE TO IDENTIFY AND DOCUMENT SMOKING CESSATION COUNSELING. THIS IS A PRIORITY NATIONALLY FOR THE DELIVERY OF QUALITY MEDICAL CARE. IN ADDITION TO CONTINUING THIS EFFORT WITH OUR INPATIENTS WE HAVE BEGUN INCREASING AWARENESS TO OUR OUT PATIENTS BY PROVIDING SMOKING CESSATION INFORMATION IN OUR CLINICS. WE HAVE ALSO ADDED THIS ITEM TO OUR HEALTH FAIRS, TO OUR LOCAL FAIR BOOTH AND PLAN TO INCREASE AWARENESS IN OUR LOCAL SCHOOLS AND FAITH-BASED ORGANIZATION. 5. CHILDRENS HEALTH SERVICES THE HOSPITAL OUR FACILITY PROVIDES FREE PHYSICALS TO ALL CHILDREN INVOLVED IN ANY TYPE OF SPORTS FOR ALL SCHOOLS ON THE WEST SIDE OF YELL COUNTY. CAR SEAT EDUCATION COURSE HAS BEEN HELD WHICH ALLOWS FOR CIVILIANS TO RECEIVE A NEW CAR SEAT ONCE THE COURSE IS COMPLETED. THE HOSPITAL KEEPS ONE INSTRUCTOR WHO WORKS AND PLANS TO HOLD AT LEAST ONE CLASS PER YEAR TO EDUCATE FAMILIES ON CAR SEAT SAFETY. BIKE SAFTEY RODEOS IN CONJUNCTION WITH THE LOCAL EMS ARE CONDUCTED. THE HOSPITAL IS ALSO INVOLVED IN FARM SAFETY, A PROGRAM THAT IS HELD IN MAY OF EACH YEAR AIMED AT ELEMENTARY GRADE STUDENTS FROM ALL OVER THE COUNTY ON FIRST AIDE AND PROVIDES EACH PARTICIPANT WITH A FIRST AIDE PACKAGE AS WELL AS EDUCATING ON MATERIAL SAFETY. THE HOSPITAL WILL CONTINUE TO EDUCATE FAMILIES ON THE IMPORTANCE OF PREVENTATIVE MEDICINE AND THIS WILL BE DONE AT THE INPATIENT LEVEL AS WELL AS THE OUTPATIENT LEVEL. THIS IS ALSO BEING DONE WITH THROUGH PARTNERSHIP WITH HEALTHY ACTIVE YELL. 6. UNDERINSURED ADULTS DURING OPEN ENROLLMENT WINDOWS, OUR FACILITY PLANS TO PARTNER WITH ORGANIZATIONS THAT WILL BRING ENROLLMENT ASSISTANCE IN-HOUSE ON A SCHEDULED BASIS. WE WILL ALSO PROVIDE ASSISTANCE TO INDIVIDUALS WITH ENROLLMENT THROUGH OUR SOCIAL SERVICES DEPARTMENT. FORM 990, SCHEDULE H, PART V, LINE 16 ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/ OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. FORM 990, SCHEDULE H, PART V, LINE 20E INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY WILL BE PROVIDED ON MONTHLY BILLING STATEMENTS AS WELL AS EFFORTS TO CONTACT THE PATIENT OR RESPONSIBLE PARTY VIA TELEPHONE. CHAMBERS MEMORIAL HOSPITAL WILL PROVIDE PATIENTS OR OTHER PARTIES RESPONSIBLE FOR PAYMENT OF THE ACCOUNT WITH A NOTICE, A MINIMUM OF 30 DAYS IN ADVANCE OF INITIATING ANY EXTRAORDINARY COLLECTION ACTIVITIES. FORM 990, SCHEDULE H, PART V, LINE 22D UNINSURED PATIENTS AND PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AT RATES HIGHER THAN THE "AMOUNTS GENERALLY BILLED" TO THIRD PARTY PAYERS. THE USE OF GROSS CHARGES TO SUCH PATIENTS IS PROHIBITED. FOR PURPOSES OF THIS POLICY, "AMOUNTS GENERALLY BILLEDAGB WILL BE DETERMINED USING THE "LOOK BACK" METHOD BY TAKING 12 MONTHS' CLAIMS PAID BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE INSURANCES AND CALCULATING THE AVERAGE DISCOUNTS GIVEN TO THOSE PAYERS. THE DISCOUNTS PERCENTAGE WILL BE REVIEWED ANNUALLY AND ANY APPROPRIATE ADJUSTMENTS WILL BE MADE TO BE EFFECTIVE ON THE FIRST DATE OF THE UPCOMING FISCAL YEAR. THE CURRENT AGB DISCOUNT FOR CHAMBERS MEMORIAL HOSPITAL IS 35%. 5 CHAMBERS MEMORIAL CLINIC 719 DETROIT AVENUE DANVILLE AR 72833 FAMILY CLINIC SCENIC 7 MEDICAL CLINIC 402 SOUTH SCENIC 7 DRIVE OLA AR 72853 FAMILY CLINIC WESTERN YELL COUNTY MEDICAL CLINIC 301 WEST BROADWAY HAVANA AR 72842 FAMILY CLINIC PLAINVIEW MEDICAL CLINIC 102 NORTH GARFIELD AVENUE PLAINVIEW AR 72857 FAMILY CLINIC CHAMBERS MEMORIAL HOME HEALTH AGENCY 719 DETROIT AVENUE DANVILLE AR 72833 HOME HEALTH FORM 990, SCHEDULE H, PART I, LINE 3C PLEASE REFER TO THE FINANCIAL ASSISTANCE POLICY OR SCHEDULE H, PART V, LINES 13 THROUGH 16 FOR ADDITIONAL INFORMATION ON THE FAP. FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F BAD DEBT EXPENSES IN THE AMOUNT OF $382,616 IS INCLUDED ON FORM 990 PART IX, LINE 25, COLUMN (A) ("TOTAL FUNCTIONAL EXPENSES"), BUT IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN. FORM 990, SCHEDULE H, PART I, LINE 7 CHAMBERS MEMORIAL HOSPITAL USES THE MEDICARE COST REPORT COST TO CHARGE RATIO METHODOLOGY. FORM 990, SCHEDULE H, PART III, LINE 4 PLEASE SEE ATTACHED AUDIT REPORT NOTE 2. FORM 990, SCHEDULE H, PART III, LINE 9B PATIENTS ARE INFORMED OF CHARITY CARE PROGRAM UPON ADMISSION AND DISCHARGE. THE PLAIN LANGUAGE SUMMARY OF THE FAP IS INCLUDED IN THE REGISTRATION PACKET. ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECEIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT AND INFORMATION REGARDING THE FAP WILL BE MADE AVAIABLE WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. FORM 990, SCHEDULE H, PART VI, LINE 2 IN ADDITION TO ANY HEALTH NEEDS REPORTED ON PART V, SECTION B, THE HOSPITAL UTILIZES THE 'COUNTY HEALTH RANKINGS' MODEL TO WEIGH THE HEALTH FACTORS NEEDS TO THE COMMUNITIES IT SERVES. THE MODEL PROVIDES A RANKING METHOD THAT RANKS ALL 50 STATES AND THE COUNTIES WITHIN EACH STATE BASED ON TWO TYPES OF HEALTH OUTCOMES FOR EACH COUNTY: MORTALITY AND MORBIDITY. COUNTIES ARE RANKED RELATIVE TO THE HEALTH OF OTHER COUNTIES IN THE STATES. AS PART OF THE ANALYSIS OF THE CHNA FOR THE COMMUNITY, THE RELATIVE HEALTH STATUS FOR YELL COUNTY WILL BE COMPARED TO THE STATE OF ARKANSAS AS WELL AS TO THE NATIONAL BENCHMARK. A BETTER UNDERSTANDING OF THE FACTORS THAT AFFECT THE HEALTH OF THE COMMUNITY WILL ASSIST WITH HOW TO IMPROVE THE COMMUNITYS HABITS, CULTURE, AND ENVIRONMENT. YELL COUNTY FELL WITHIN THE LOWER 50TH PERCENTILE OF THE 75 COUNTIES IN ARKANSAS. THE HEALTH NEEDS ARE SIMILAR TO THE NEEDS ADDRESSED IN THE CHNA AND VOICED BY THE INTERVIEWS CONDUCTED. FORM 990, SCHEDULE H, PART VI, LINE 3 ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/ OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. IN ADDITION, PATIENTS WILL BE CONTACTED VIA TELEPHONE. FORM 990, SCHEDULE H, PART VI, LINE 4 THE COMMUNITY SERVED BY THE HOSPITAL IS A RURAL AREA IN CENTRAL WESTERN ARKANSAS. THE HOSPITAL IS LOCATED IN DANVILLE, ARKANSAS, WHICH IS THE SECOND LARGEST TOWN IN THE COMMUNITY WITH A POPULATION OF AROUND 2,400 PEOPLE. THE POPULATION IS ABOUT 85% CAUCASIAN, MAKING IT MUCH MORE RACIALLY HOMOGENOUS THAN EITHER THE STATE OF ARKANSAS OF THE UNITED STATES AS A WHOLE. MOST THE REMAINING POPULATION IS HISPANIC OR LATINO. ACCORDING TO THE U.S. CENSUS BUREAU, ABOUT 16% OF THE COMMUNITYS POPULATION IS OVER AGE 65, WHICH IS HIGHER THAN ARKANSAS (15%) OR THE UNITED STATES (13%). THIS AGE GROUPS USES MORE HEALTH SERVICES THAN ANY OTHER. THE HOSPITAL SHOULD BE PREPARED FOR AN INCREASE IN PATIENT VOLUMNE DURING THE NEXT FIVE YEARS. ADDITIONALLY, THE PERCENTAGE OF COMMUNITY POPULATION AGED 15 TO 44 IS EXPECTED TO SHRINK OVER THE NEXT FIVE YEARS, WHICH COULD CONTRIBUTE TO DIFFICULTIES IN RECRUITING ENOUGH CARE PROVIDERS TO MANAGE THE AGING POPULATION. FACTORS SUCH AS EDUCATIONAL, ATTAINMENT, POVERTY LEVELS, UNEMPLOYMENT RATES AND INSURANCE COVERAGE LEVELS CONTRIBUTE SIGNIFICANTLY TO THE HEALTH STATUS OF A COMMUNITY. ABOUT 15% OF THE POPULATION HAS OBTAINED AN ASSOCIATES DEGREE OR HIGHER, COMPARED TO 37% OF THE UNITED STATES AS A WHOLE. ABOUT 25% OF THE POPULATION DOES NOT HAVE A HIGH SCHOOL DIPOLMA. LOWER LEVELS OF EDUCATION HAVE BEEN LINKED TO NEGATIVE HEALTH OUTCOMES, SO THE EDUCATION ATTAINMENT OF THE COMMUNITY IS RELEVANT TO THE CONSIDERATION OF THE HEALTH NEEDS OF THE COMMUNITY. THE INCOME LEVELS OF INDIVIDUALS WITHIN THE COMMUNITY ALSO HAVE A SIGNIFICANT EFFECT ON THEIR ABILITY TO ACCESS HEALTH SERVICES. THE AVERAGE PER-CAPITA ICOME IN YELL COUNTY IS $18,170, COMPARED TO $22,295 FOR THE STATE OF ARKANSAS. LOWER THAN AVERAGE PER CAPITA INCOME SUGGESTS THAT MANY MEMBERS OF THE COMMUNITY MAY HAVE DIFFICULTY OBTAINING HEALTH CARE, ESPECIALLY PREVENTATIVE CARE. THE POVERTY LEVELS IN YELL COUNTY ARE SIGNIFICANTLY HIGHER THAN ARKANSAS IN GENERAL. FORM 990, SCHEDULE H, PART VI, LINE 5 THE HOSPITAL AND OTHER HEALTH CARE FACILITIES FURTHER THEIR EXEMPT PURPOSE BY PROMOTING HEALTH CARE INITIATIVES IN THE COMMUNITIES SERVED. THE HOSPITAL IS INVOLVED WITH LOCAL SCHOOL DISTRICTS, HEALTH DEPARTMENTS, CHURCHES AND FAITH-BASED ORGANIZATIONS, SENIOR CITIZEN CENTERS, AND OTHER ORGANIZATIONS TO HELP PROMOTE HEALTH EDUCATION. A FEW EVENTS IN WHICH THE HOSPITAL IS INVOLVED IN INCLUDES CAR SEAT SAFETY, HEALTH FAIRS, YELL COUNTY FAIR, FARM SAFETY, AND OTHER LOCAL EVENTS THAT WILL HELP THE HOSPITAL DISTRIBUTE HEALTH KNOWLEDGE. X X false false false false false false false false false THOMAS JOHN TINNESZ MD PHYSICIAN 402312 0 0 0 0 0 24925 0 4011 0 431248 0 0 0 JOHN J WESTWOOD MD PHYSICIAN 230476 0 5000 0 0 0 9419 0 4011 0 248906 0 0 0 TIMMY EUGENE KAY MD PHYSICIAN 230281 0 0 0 0 0 9211 0 4011 0 243503 0 0 0 WILLIAM L BERRY MD PHYSICIAN 228939 0 0 0 0 0 9158 0 4011 0 242108 0 0 0 PATTY K PETTWAY MD PHYSICIAN 192119 0 0 0 0 0 7685 0 4011 0 203815 0 0 0 MICHAEL SCOTT PEEK CEO 207797 0 54380 0 22304 0 10600 0 0 0 295081 0 0 0 A YELL COUNTY ARKANSAS 710420105 98544naa4 2006-11-14 8100000 CONSTRUCTION & IMPROVEMENT BONDS false false false B YELL COUNTY ARKANSAS 710420105 98544NAB2 2007-01-02 1800000 CONSTRUCTION & IMPROVEMENT BONDS false false false A 1552508 0 8100000 0 0 0 55514 0 0 8100000 0 0 2009 false false true true B 345002 0 1800000 0 433224 0 12336 0 0 1366776 0 0 2009 false false true true A false false false false 0 false false false true B false false false false 0 false false false true A false false false true false false 0 false 0 false false B false false false true false false 0 false 0 false false A true B true FORM 990, SCHEDULE K, PART IV, LINE 2C FOR BOND SERIES 2006A, THE LAST REBATE COMPUTATION DATE WAS 10/31/2011. FOR BOND SERIES 2006B, THE LAST REBATE COMPUTATION DATE WAS 10/31/2011. FORM 990, SCHEDULE K, PART IV, LINE 2C A - COMPLETED ON BOND YEAR OF 10/31/2015 B - COMPLETED ON BOND YEAR OF 10/31/2015 FORM 990, SCHEDULE K, PART III, LINE 9 & PART IV, LINE 7 & PART V THE ORGANIZATION IS IN THE PROCESS OF DRAFTING THESE POLICIES. CHAMBERS BANK JOHNNY CHAMBERS-BOD EQUIPMENT X 230516 164732 false true true 164732 CHAMBERS BANK JOHNNY CHAMBERS - BOD 1099270 INVESTMENT INTEREST INC & EXP false FORM 990, SCHEDULE L, PART IV, LINE (1), COLUMN B JOHNNY CHAMBERS, WHO IS A BOARD MEMBER OF CHAMBERS MEMORIAL HOSPITAL, HAS MORE THAN 35% OWNERSHIP IN CHAMBERS BANK WHICH THE HOSPITAL DOES BUSINESS WITH. FORM 990, PART VI, SECTION B, LINE 11A THE CEO AND A BOARD MEMBER WILL REVIEW AND REPORT TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS A COMPLIANCE COMMITTEE THAT MONITORS FOR POLICY COMPLIANCE AND RECOMMENDS CHANGES OR NEW POLICIES TO THE CEO FOR APPROVAL. THE HOSPITAL HAS INSTITUTED A NEW POLICY FOR EMPLOYEES THAT WILL BE USED FOR BOARD MEMBERS GOING FORWARD. THE BOARD MEMBERS WILL SIGN THE AGREEMENT AND BE WITHDRAWN FROM VOTING DECISIONS AS CONFLICTS ARISE. FORM 990, PART VI, SECTION B, LINES 15 A & B COMPENSATION REVIEWS FOR THE CEO, TOP MANAGEMENT OFFICIALS, OTHER OFFICERS, AND KEY EMPLOYEES ARE COMPLETED AND APPROVED BY THE BOARD OF DIRECTORS. THE LATEST REVIEWS WERE CONDUCTED FOR THE YEAR 2016. COMPARABLE COMPENSATION DATA PROVIDED BY BOTH THE ARKANSAS AND OKLAHOMA HOSPITAL ASSOCIATIONS WAS USED AS GUIDANCE. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. FORM 990 PART IX LINE 11G DESCRIPTION:EMERGENCY ROOM SERVICES TOTAL FEES:1567322 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:333000 FORM 990 PART IX LINE 11G DESCRIPTION:ANESTHESIOLOGY SERVICES TOTAL FEES:296475 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN & OFFICE SERVICES TOTAL FEES:210436 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICAL THERAPY TOTAL FEES:153641 FORM 990 PART IX LINE 11G DESCRIPTION:LAB & X-RAY TOTAL FEES:145124 FORM 990 PART IX LINE 11G DESCRIPTION:SPEECH THERAPY SERVICES TOTAL FEES:136032 FORM 990 PART IX LINE 11G DESCRIPTION:OCCUPATIONAL THERAPY TOTAL FEES:66229 FORM 990 PART IX LINE 11G DESCRIPTION:RESPIRATORY CARE TOTAL FEES:56550 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:28528 FORM 990 PART IX LINE 11G DESCRIPTION:CLINICS TOTAL FEES:11502