2015-02-02T09:46:55-08:00 2014-03-31 Welch Couch & Company PA 410 Barnett Dr Batesville AR 72501 990 2013-04-01 383807713 CHICOT MEMORIAL MEDICAL CENTER CHIC 8702659229 2729 HWYS 65 82 SOUTH LAKE VILLAGE AR 71653 David Mantz CEO 2015-02-02 true WILLIAM T COUCH P00183609 8707935231 2013 2016-02-25 16:41:14Z 16871150 false false X WWW.CHICOTMEMORIAL.COM X 2010 AR 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. 8 8 273 23 0 503920 285142 16395515 13761781 14396 11597 3952828 2812630 20866659 16871150 7250 5250 0 8817606 8628333 0 0 9445065 7818913 18269921 16452496 2596738 418654 21969731 21110087 8507052 7228754 13462679 13881333 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. false false 12320383 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. 12320383 true true false false false false false false false false true false false true false true true false false false false false false false false false true true false true true true false false false false false false false false false false false false false false false false false false false false true 52 0 true 273 true false false false false false false false false 0 false false false false false false false false false false X 8 8 false false false false false false false true false false false true true true true true true true true false X VICKI ALLEN 8702659229 2729 HWYS 65 82 SOUTH LAKE VILLIAGE AR 71653 SAM ANGEL Chairman 1.00 0.00 X 0 0 0 TODD POTTER VICE CHAIRMAN 1.00 0.00 X 0 0 0 DAVID HOLT Secretary 1.00 0.00 X 0 0 0 TOMMY JARRETT MEMBER 1.00 0.00 X 0 0 0 OLAN MENCER MEMBER 1.00 0.00 X 0 0 0 LINDA THOMAS MEMBER 1.00 0.00 X 0 0 0 DR JP BURGE MEMBER 1.00 0.00 X 0 0 0 JUDGE MACK BALL JR ExofficioDirect 1.00 0.00 X 0 0 0 HARRY DAVID MANTZ President & CEO 40.00 0.00 X 194347 0 0 VICKI ALLEN CFO 40.00 0.00 X 83907 0 0 DR MICHAEL B MAYFIELD CHIEF OF STAFF 40.00 0.00 X 309123 0 0 VALERIE ORBECK CRNA 40.00 0.00 X 161538 0 0 DR MARY S HENDERSON OB/GYN 40.00 0.00 X 175001 0 0 JOE WRIGHT CRNA 40.00 0.00 X 152333 0 0 DAVID FRENCH PHARMACIST 40.00 0.00 X 117915 0 0 1194164 6 false true false CORRECT CARE 17438 HARD HAT DROVE CONVINGTON LA 70435 ER PHYSICIANS 487737 EMERGENCY STAFFING SOLUTIONS 17304 PRESTON RD DALLAS TX 75252 ER/HOSPITALIST 213768 CPP WOUND CARE 111 PEAR ST COVINGTION LA 70433 WOUND CARE 175350 3 276662 8480 285142 PROGRAM SERVICE REVENUE 621990 13761781 13761781 13761781 11416 11416 0 0 257014 257014 257014 257014 181 181 181 181 0 0 0 CAFETERIA REVENUE 900099 97267 97267 ELECTRONIC HEALTH RECORDS 900099 190509 190509 SALES TAX REVENUE 900099 2145383 2145383 122457 122457 2555616 16871150 14018976 2567032 0 5250 5250 0 0 587377 587377 0 6600840 5948756 652084 0 951124 694321 256803 488992 356964 132028 0 0 0 0 0 0 0 23893 23893 0 0 0 360714 360714 131398 122168 9230 0 0 304588 304588 0 1534990 1534990 235474 235474 PURCHASED SERVICES 3266741 1706151 1560590 SUPPLIES & OTHER 1494209 1058969 435240 UPL FEES 152424 152424 EQUIPMENT RENTAL/MAINT. 145577 95859 49718 168905 48343 120562 16452496 12320383 4132113 0 3091356 2891132 812949 816002 0 3002551 4138527 0 0 0 240839 289899 283426 162211 23379271 13956362 10774705 9422909 0 0 0 0 3763905 3389407 21969731 21110087 1541009 1536330 6772292 5528982 193751 163442 8507052 7228754 X 13462679 13881333 13462679 13881333 21969731 21110087 418654 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 115000 115000 8602766 5244047 3358719 838296 545231 293065 6749754 5004048 1745706 7073455 3163036 3910419 9422909 ASSETS LIMITED TO USE 1596278 BOND ISSUE COST, NET 214808 ESTIMATED 3RD PARTY PAYER SETTLEMENT 651672 OTHER RECEIVABLES 926649 3389407 X 14725767 14725767 2145383 2145383 16871150 14307113 14307113 2145383 2145383 16452496 Part X : FIN48 Footnote MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITION AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE FINANCIAL STATEMENTS. Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S BAD DEBT EXPENSE $2145383 Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S $2145383 true true X true X true X true true false false true true 614897 614897 0.03740 614897 614897 0.03740 614897 614897 0.03740 true 2383842 1448326 6791574 6754329 37245 false false 1 1 CHICOT MEMORIAL MEDICAL CENTER 2729 SOUTH HIGHWAY 65 82 LAKE VILLAGE AR 71653 X X X X true X X X X X X X X X 11 true false true X X true false false true true 200.0000 true 200.0000 true X X true true X X X true X X true X X X X X X true false false Part V, Line 1j - Description of Other Needs Assessment CMMC CONDUCTED THEIR COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE FISCAL YEAR ENDED MARCH 31, 2012 Part V, Line 3 - Account Input from Person Who Represent the Community INTEREVIEWS AND FOCUS GROUPS 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 false 0 0 SCHOLARSHIP 4 5250 CASH BASIS X false false false false false false false false false false DR MARY S HENDERSON OB/GYN 175001 175001 DR MICHAEL B MAYFIELD CHIEF OF STAFF 309123 309123 HARRY DAVID MANTZ President & CEO 194347 194347 JOE WRIGHT CRNA 152333 152333 VALERIE ORBECK CRNA 161538 161538 A CHICOT COUNTY ARKANSAS 2005-12-28 2750000 FINANCE IMPROVEMENTS false false false B CHICOT COUNTY ARKANSAS 2003-07-23 9800000 CAPITAL IMPROVEMENTS false false false A 114482 2750000 68265 2459083 B 915000 9800000 333831 9800000 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