CHICOT MEMORIAL MEDICAL CENTER: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- CHICOT MEMORIAL MEDICAL CENTER (EIN 38-3807713)
- Tax period
- 2014-04-01 to 2015-03-31
- Filed
- 2016-02-02
- IRS object ID
- 201630339349300008
- Schema version
- 2014v6.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-02-02T06:23:54-08:00 | ReturnTs |
| Tax Period End | 2015-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Welch Couch & Company PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 Barnett Dr | AddressLine1Txt |
| City | Batesville | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 383807713 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIC | BusinessNameControlTxt |
| Phone | 8702659229 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HWYS 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David Mantz | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2016-02-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WILLIAM T COUCH | PreparerPersonNm |
| PTIN | P00183609 | PTIN |
| Phone | 8707935231 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,143,104 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHICOTMEMORIAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE CONVENIENT, QUALITY HEALTHCARE TO EVERYONE IN A CARING, EFFICIENT AND FINANCIALLY RESPONSIBLE MANNER THAT WILL ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY, TO PROMOTE COMMUNITY WELLNESS; AND, TO DO SO WITH COMPASSION, DIGNITY, AND RESPECT FOR THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 275 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $285,142 | PYContributionsGrantsAmt |
| CY Contributions Grants | $175,154 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,761,781 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,965,456 | CYProgramServiceRevenueAmt |
| PY Investment Income | $11,597 | PYInvestmentIncomeAmt |
| CY Investment Income | $13,178 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,812,630 | PYOtherRevenueAmt |
| CY Other Revenue | $2,989,316 | CYOtherRevenueAmt |
| PY Total Revenue | $16,871,150 | PYTotalRevenueAmt |
| CY Total Revenue | $17,143,104 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,250 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,620 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,628,333 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,348,446 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,818,913 | PYOtherExpensesAmt |
| CY Other Expenses | $9,060,772 | CYOtherExpensesAmt |
| PY Total Expenses | $16,452,496 | PYTotalExpensesAmt |
| CY Total Expenses | $17,413,838 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $418,654 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$270,734 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,110,087 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,374,548 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,228,754 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,763,949 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,881,333 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,610,599 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE CONVENIENT, QUALITY HEALTHCARE TO EVERYONE IN A CARING, EFFICIENT AND FINANCIALLY RESPONSIBLE MANNER THAT WILL ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY, TO PROMOTE COMMUNITY WELLNESS; AND, TO DO SO WITH COMPASSION, DIGNITY, AND RESPECT FOR THOSE WE SERVE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $13,105,263 | ExpenseAmt |
| Desc | CHICOT MEMORIAL MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT CORPORATION OPERATING A 25-BED CRITICAL ACCESS HOSPITAL IN LAKE VILLAGE, CHICOT COUNTY, ARKANSAS. IN ADDITION TO THE 25 ACUTE CARE BEDS, CCMMC ALSO OPEATES TWO PROVIDER BASED HEALTH CLINICS (GENERAL SURGERY AND OBSTETRICS/GYNECOLOGY) WITH ONE PHYSICIAN IN EACH SPECIALTY IN EACH CLINIC. ADDITIONALLY, CMMC OPEATES A HOME HEALTH AGENCY, AND A COMMUNITY BASED FITNESS CENTER, ALL ON A NOT-FOR-PROFIT BASIS. | Desc |
| Total Program Service Expenses | $13,105,263 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 275 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | false | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIFFANY EDWARDS | PersonNm |
| Phone | 8702659229 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HWYS 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLIAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| HARRY DAVID MANTZ | ||||||||
| President & CEO | 40.00 | 0.00 | Yes (X) | Yes (X) | $201,468 | $0 | $0 | |
| SAM ANGEL | ||||||||
| Chairman | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TODD POTTER | ||||||||
| VICE CHAIRMAN | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVID HOLT | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TOMMY JARRETT | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| OLAN MENCER | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA THOMAS | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JP BURGE | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR MICHAEL B MAYFIELD | ||||||||
| CHIEF OF STAFF | 40.00 | 0.00 | Yes (X) | $309,123 | $0 | $0 | ||
| VALERIE ORBECK | ||||||||
| CRNA | 40.00 | 0.00 | $165,052 | $0 | $0 | Yes (X) | ||
| DR MARY S HENDERSON | ||||||||
| OB/GYN | 40.00 | 0.00 | $175,001 | $0 | $0 | Yes (X) | ||
| CAROLYN COOK | ||||||||
| CHIEF NURSING OFF. | 40.00 | 0.00 | $117,280 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $967,924 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MICHAEL MAYFIELD | |||||
| 169 STUART ISLAND ROAD | LAKE VILLAGE | AR | 71653 | PHYSICIAN | $165,156 |
| EMERGENCY STAFFING SOLUTIONS | |||||
| 17304 PRESTON RD | DALLAS | TX | 75252 | ER/HOSPITALIST | $1,027,517 |
| CPP WOUND CARE | |||||
| 111 PEAR ST | COVINGTION | LA | 70433 | WOUND CARE | $153,250 |
| PIONEER HEALTH SERVICES | |||||
| PO BOX 1100 | MAGEE | MS | 39111 | OUTSOURCED BILLING | $119,019 |
| ROY LYNN HOLLOWAY | |||||
| 332 HWY 144 N APT 2 | LAKE VILLAGE | AR | 71653 | CRNA | $149,423 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $161,399 | GovernmentGrantsAmt |
| All Other Contributions | $13,755 | AllOtherContributionsAmt |
| Total Contributions | $175,154 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $13,965,456 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,965,456 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,965,456 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,178 | TotalRevenueColumnAmt |
| Exclusion | $13,178 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $272,454 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $272,454 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $272,454 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $272,454 | RelatedOrExemptFuncIncomeAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 900099 | $98,308 | $98,308 |
| MISCELLANEOUS REVENUE | 900099 | $75,764 | $75,764 |
| SALES TAX REVENUE | 900099 | $2,496,278 | $2,496,278 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,512 | TotalRevenueColumnAmt |
| Exclusion | $46,512 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,716,862 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,143,104 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,237,910 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $2,730,040 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,620 | TotalAmt |
| Program Services | $4,620 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $510,591 | TotalAmt |
| Management And General | $510,591 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,590,652 | TotalAmt |
| Program Services | $5,936,238 | ProgramServicesAmt |
| Management And General | $654,414 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,260 | TotalAmt |
| Program Services | $65,934 | ProgramServicesAmt |
| Management And General | $7,326 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $675,363 | TotalAmt |
| Program Services | $607,827 | ProgramServicesAmt |
| Management And General | $67,536 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $498,580 | TotalAmt |
| Program Services | $418,807 | ProgramServicesAmt |
| Management And General | $79,773 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,931 | TotalAmt |
| Management And General | $28,931 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,205 | TotalAmt |
| Management And General | $64,205 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,951 | TotalAmt |
| Management And General | $17,951 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $331,994 | TotalAmt |
| Program Services | $331,994 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,285 | TotalAmt |
| Program Services | $85,347 | ProgramServicesAmt |
| Management And General | $12,938 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,355 | TotalAmt |
| Management And General | $236,355 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,492,989 | TotalAmt |
| Program Services | $1,492,989 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,341 | TotalAmt |
| Program Services | $232,341 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $4,363,882 | $2,398,148 | $1,965,734 |
| SUPPLIES & OTHER | $1,768,505 | $1,214,473 | $554,032 |
| UPL FEES | $163,156 | $163,156 | |
| EQUIPMENT RENTAL/MAINT. | $147,112 | $90,057 | $57,055 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,066 | TotalAmt |
| Program Services | $63,332 | ProgramServicesAmt |
| Management And General | $51,734 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,413,838 | TotalAmt |
| Program Services | $13,105,263 | ProgramServicesAmt |
| Management And General | $4,308,575 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,891,132 | BOYAmt |
| EOY | $3,526,658 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,002 | BOYAmt |
| EOY | $820,614 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,138,527 | BOYAmt |
| EOY | $2,698,300 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $289,899 | BOYAmt |
| EOY | $306,263 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,211 | BOYAmt |
| EOY | $171,993 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,953,436 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,449,351 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,422,909 | BOYAmt |
| EOY | $8,504,085 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,389,407 | BOYAmt |
| EOY | $3,346,635 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,110,087 | BOYAmt |
| EOY | $19,374,548 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,536,330 | BOYAmt |
| EOY | $1,390,397 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,528,982 | BOYAmt |
| EOY | $4,177,773 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $163,442 | BOYAmt |
| EOY | $195,779 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,228,754 | BOYAmt |
| EOY | $5,763,949 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,881,333 | BOYAmt |
| EOY | $13,610,599 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,881,333 | BOYAmt |
| EOY | $13,610,599 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,110,087 | BOYAmt |
| EOY | $19,374,548 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$270,734 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $115,000 | OtherCostOrOtherBasisAmt |
| Book Value | $115,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,634,357 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,626,519 | DepreciationAmt |
| Book Value | $3,007,838 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $838,296 | OtherCostOrOtherBasisAmt |
| Depreciation | $565,555 | DepreciationAmt |
| Book Value | $272,741 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,107,843 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,541,326 | DepreciationAmt |
| Book Value | $1,566,517 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,257,940 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,715,951 | DepreciationAmt |
| Book Value | $3,541,989 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,504,085 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ASSETS LIMITED TO USE | $1,585,012 |
| BOND ISSUE COST, NET | $199,729 |
| ESTIMATED 3RD PARTY PAYER SETTLEMENT | $850,755 |
| OTHER RECEIVABLES | $711,139 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,346,635 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,143,104 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $17,143,104 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $17,143,104 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,413,838 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $17,413,838 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $17,413,838 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X : FIN48 Footnote | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITION AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $176,945 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,945 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $176,945 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,945 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $176,945 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,945 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,078,622 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,302,059 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,698,781 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,592,385 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $106,396 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HIGHWAY 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CHICOTMEMORIAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.CHICOTMEMORIAL.COM | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.0000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | false | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Selling Debt | Yes (X) | PermitSellingDebtInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Engaged Selling Debt | Yes (X) | EngagedSellingDebtInd |
| Engaged Legal Judicial Process | Yes (X) | EngagedLegalJudicialProcessInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 5 - Account Input from Persons Who Represent the Community | FormAndLineReferenceDesc |
| Explanation | INTEREVIEWS AND FOCUS GROUPS | ExplanationTxt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | CHARITY CARE MAY BE GRANTED PROSPECTIVELY OR RETROSPECTIVELY. ALL OVERDUE ACCOUNTS WILL BE REVIEWED INTERNALLY TO DETERMINE WHETHER ANY FINANCIAL ASSISTANCE IS AVAILABLE PRIOR TO THE INITIATION OF ANY LEGAL PROCEDDINGS OR COLLECTION ACTION OUTSIDE OF THE HOSPITAL |
| Part VI - Needs Assessment | UTILIZES ANNUAL STATISTICAL REPORT WITH DEMOGRAPHIC INFORMATION FROM DHS AS WELL AS REPORTS SHOWING PERCENT OF ACTIVITY OF COMMUNITY BY PAYOR SOURCE |
| Part VI - Patient Education of Eligibility for Assistance | INFORMS PATIENTS UPON ADMISSION AND POSTS NOTICES IN CONSPICUOUS AREAS |
| Part VI - Community Information | RURAL SETTING, PREDOMINANTLY AGRICULATURAL BASE. AVERAGE INCOME AT OR BELOW FEDERAL POVERTY GUIDELINES. HIGH SCHOOL EDUCATED AND GERIATRIC IN NATURE. |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | CHICOT MEMORIAL MEDICAL CENTER PROVIDES GENERAL MEDICAL AND SURGICAL CARE FOR INPATIENT, OUTPATIENT, AND EMERGENCEY ROOM PATIENTS, AND PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS. CMMC PROMOTES COMMUNITY WELLNESS THROUGH VOLUNTEERING AND DONATIONS FROM THE HOSPITAL |
| Part V - Explanation of Number of Facility Type | HOSPITAL WITH HOME HEALTH AGENCY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| DR MARY S HENDERSON | ||
| OB/GYN | $175,001 | $175,001 |
| DR MICHAEL B MAYFIELD | ||
| CHIEF OF STAFF | $309,123 | $309,123 |
| HARRY DAVID MANTZ | ||
| President & CEO | $201,468 | $201,468 |
| VALERIE ORBECK | ||
| CRNA | $165,052 | $165,052 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|
| CHICOT COUNTY ARKANSAS | ||||||
| A | 2005-12-28 | $2,750,000 | FINANCE IMPROVEMENTS | false | false | false |
| CHICOT COUNTY ARKANSAS | ||||||
| B | 2003-07-23 | $9,800,000 | CAPITAL IMPROVEMENTS | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|
| A | $2,750,000 | $68,265 | $2,459,083 |
| B | $9,800,000 | $333,831 | $9,800,000 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | THE 990 IS REVIEWED BY A MEMBER OF MANAGEMENT AND PROVIDED TO BOARD MEMBERS AT A SCHEDULED MEETING FOR REVIEW AND APPROVAL. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | INDIVIDUAL WHO SERVE AS DIRECTORS, MANAGERS, SUPERVISORS OF CLINICAL DEPARTMENTS AND ANY OTHER EMPLOYEE OR MEDICAL STAFF MEMBER DEEMED BY AN ADMINISTRATIVE OFFICER TO BE IN A POSITION TO INFLUENCE DECISION-MAKING FOR THE HOSPITAL, ARE REQUIRED TO DISCLOSE ALL CONFLICTS OF INTEREST. DISCLOSURE WILL OCCUR THROUGH AN ANNUAL CONFLICT OF INTEREST STATEMENT AND THE DISCLOSURE OF OTHER ACTUAL OR POTENTIAL CONFLICTS AS THEY ARISE. PRIOR TO DECISIONS BEING MADE, DIRECTORS, OFFICERS, AND KEY EMPLOYEES STATE ALL CONFLICTS AND DO NOT DISCUSS THE ISSUES OF POTENTIAL CONFLICT AND DO NOT PARTICIPATE IN DECISION MAKING OF THOSE ISSUES. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | COMPENSATION IS APPROVED BY BOARD OF DIRECTORS AND IS BASED ON MARKET CONDITIONS AND PERFORMANCE EVALUATION. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | COMPENSATION IS APPROVED BY CEO AND IS BASED ON SALARY SURVEYS AND PERFORMANCE EVALUATIONS. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | AVAILABLE UPON REQUEST FROM ADMINISTRATION |
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