FIVE RIVERS MEDICAL CENTER INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- FIVE RIVERS MEDICAL CENTER INC (EIN 27-3970823)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-09-08
- IRS object ID
- 201532519349300028
- Schema version
- 2014v5.0
- 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 | 2015-09-08T09:39:55-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 430352985 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 W MAIN ST | AddressLine1Txt |
| City | CARBONDALE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 629012335 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273970823 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIVE RIVERS MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FIVE | BusinessNameControlTxt |
| Phone | 8708926000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | POCAHONTAS | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72455 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOEY RADCLIFF | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8708926000 | PhoneNum |
| Signature | 2015-08-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK DALLAS | PreparerPersonNm |
| PTIN | P00187265 | PTIN |
| Phone | 6185291040 | PhoneNum |
| Preparation | 2015-09-08 | PreparationDt |
| 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) |
|---|---|---|
| Principal Officer | JOEY RADCLIFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | POCAHONTAS | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72455 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,125,959 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FIVERIVERSMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | FIVE RIVERS MEDICAL CENTER SHALL BE DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH OF OUR COMMUNITY AS ITS PRIMARY CARE PROVIDER THROUGH A NETWORK OF QUALITY SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 211 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $78,118 | PYContributionsGrantsAmt |
| CY Contributions Grants | $117,450 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,689,766 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,629,100 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,700 | PYInvestmentIncomeAmt |
| CY Investment Income | -$130,599 | CYInvestmentIncomeAmt |
| PY Other Revenue | $65,152 | PYOtherRevenueAmt |
| CY Other Revenue | $1,379,409 | CYOtherRevenueAmt |
| PY Total Revenue | $15,840,736 | PYTotalRevenueAmt |
| CY Total Revenue | $15,995,360 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,233,713 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,994,203 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,033,283 | PYOtherExpensesAmt |
| CY Other Expenses | $6,350,485 | CYOtherExpensesAmt |
| PY Total Expenses | $18,266,996 | PYTotalExpensesAmt |
| CY Total Expenses | $15,344,688 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,426,260 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $650,672 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,488,763 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,785,412 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,941,537 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,587,514 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,452,774 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$802,102 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | FIVE RIVERS MEDICAL CENTER SHALL BE DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH OF OUR COMMUNITY AS ITS PRIMARY CARE PROVIDER THROUGH A NETWORK OF QUALITY SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,884,758 | ExpenseAmt |
| Revenue | $4,858,902 | RevenueAmt |
| Desc | EMERGENCY DEPARTMENT - THE EMERGENCY DEPARTMENT AT FRMC TREATED OVER 6,100 PATIENTS IN 2014 AND IS A LEVEL 4 TRAUMA DESIGNATED ER. THE EMERGENCY DEPARTMENT STRIVES TO CONTINUALLY IMPROVE THE QUALITY OF EMERGENCY MEDICINE THAT IS PROVIDED TO THE COMMUNITY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,523,727 | ExpenseAmt |
| Revenue | $2,623,000 | RevenueAmt |
| Desc | HOME HEALTH - THE HOME HEALTH DEPARTMENT AT FRMC HAD OVER 21,000 SKILLED NURSING, PHYSICAL THERAPY, AND SPEECH THERAPY VISITS IN 2014. FRMC HOME HEALTH PROVIDES EXCEPTIONAL AT HOME NURSING AND THERAPY TO SEVERAL COUNTIES IN THE AREA. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,151,013 | ExpenseAmt |
| Revenue | $3,905,135 | RevenueAmt |
| Desc | INPATIENT ACUTE AND BEHAVIORAL HEALTH UNITS - FRMC PROVIDES EXCELLENT ACUTE CARE THROUGH OUR HOSPITALIST PROGRAM. OUR GERIATRIC BEHAVIORAL HEALTH PROGRAM TREATS PATIENTS 65 AND OVER WITH VARYING BEHAVIORAL PROBLEMS. BOTH UNITS COMBINED ADMITED OVER 800 PATIENTS IN 2014. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,585,995 | ExpenseAmt |
| Revenue | $4,402,291 | RevenueAmt |
| Desc | LABORATORY AND OTHER PROGRAM EXPENSE | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,585,995 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $4,402,291 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $10,145,493 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | 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 | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | 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 | false | TaxExemptBondsInd |
| 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 |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 211 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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 | Yes (true) | 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 |
| States Where Copy Of Return Is Fld | AR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIVE RIVERS MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8708926000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | POCAHONTAS | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72455 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| LUTHER LEWIS | |||||||
| CEO | 40.00 | Yes (X) | Yes (X) | $143,139 | $0 | $120 | |
| KYLE BALTZ | |||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SCOTT TRAMMEL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HAL S BARRE MD | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEROL SWAIM | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALEXANDER BALTZ MD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANGELA CALDWELL | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MANDY DOLLINS | |||||||
| CNO | 40.00 | Yes (X) | $92,703 | $0 | $10,020 | ||
| JOEY RADCLIFF | |||||||
| CFO | 40.00 | Yes (X) | $66,968 | $0 | $1,378 | ||
| JANE KUZAS | |||||||
| PHYSICIAN | 40.00 | $365,050 | $0 | $9,511 | Yes (X) | ||
| ROLANDO CHENG | |||||||
| PHYSICIAN | 40.00 | $263,368 | $0 | $102 | Yes (X) | ||
| PHILLIP JANSEN | |||||||
| PHYSICIAN | 40.00 | $249,930 | $0 | $5,048 | Yes (X) | ||
| WILLIAM LEWIS | |||||||
| PHYSICIAN | 40.00 | $244,599 | $0 | $7,998 | Yes (X) | ||
| ROBERT HALL | |||||||
| PHYSICIAN | 40.00 | $201,947 | $0 | $7,997 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,627,704 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $42,174 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CNB MEDICAL LLC | |||||
| PO DRAWER 1040 | CLEVELAND | MS | 38732 | HOSPITALIST | $261,430 |
| STEPHEN KING MC | |||||
| 205 TIMBER HILLS DRIVE | EL DORADO | AR | 71730 | HOSPITALIST | $159,600 |
| BKD LLP | |||||
| PO BOX 3667 | LITTLE ROCK | AR | 72203 | ACCOUNTING | $134,176 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $117,450 | AllOtherContributionsAmt |
| Total Contributions | $117,450 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| NET PATIENT SERVICE REVENUE | $13,786,123 | $13,786,123 |
| OTHER PROGRAM SERVICE REVENUE | $842,977 | $842,977 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,629,100 | TotalProgramServiceRevenueAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $130,599 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$130,599 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$130,599 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$130,599 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MEDICARE EHR INCENTIVE | $1,289,950 | $1,289,950 | |
| OTHER MISC. REVENUE | $75,101 | $75,101 | |
| CAFETERIA REVENUE | $12,345 | $12,345 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,013 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $877 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $1,136 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,379,409 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,995,360 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,789,328 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $88,582 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,328 | TotalAmt |
| Management And General | $314,328 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,551,879 | TotalAmt |
| Program Services | $5,097,518 | ProgramServicesAmt |
| Management And General | $2,454,361 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $576,863 | TotalAmt |
| Program Services | $389,383 | ProgramServicesAmt |
| Management And General | $187,480 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $551,133 | TotalAmt |
| Program Services | $372,015 | ProgramServicesAmt |
| Management And General | $179,118 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,202 | TotalAmt |
| Program Services | $58,186 | ProgramServicesAmt |
| Management And General | $28,016 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,680 | TotalAmt |
| Program Services | $13,959 | ProgramServicesAmt |
| Management And General | $6,721 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,864 | TotalAmt |
| Program Services | $83,608 | ProgramServicesAmt |
| Management And General | $40,256 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,820,692 | TotalAmt |
| Program Services | $1,228,967 | ProgramServicesAmt |
| Management And General | $591,725 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,457 | TotalAmt |
| Program Services | $7,058 | ProgramServicesAmt |
| Management And General | $3,399 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $562,567 | TotalAmt |
| Program Services | $379,733 | ProgramServicesAmt |
| Management And General | $182,834 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,048 | TotalAmt |
| Program Services | $273,407 | ProgramServicesAmt |
| Management And General | $131,641 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,357 | TotalAmt |
| Program Services | $96,766 | ProgramServicesAmt |
| Management And General | $46,591 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $472,138 | TotalAmt |
| Program Services | $318,693 | ProgramServicesAmt |
| Management And General | $153,445 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,038,854 | TotalAmt |
| Program Services | $701,226 | ProgramServicesAmt |
| Management And General | $337,628 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $201,392 | TotalAmt |
| Program Services | $135,940 | ProgramServicesAmt |
| Management And General | $65,452 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $937,773 | $632,997 | $304,776 |
| REPAIRS & MAINTENANCE | $237,721 | $160,462 | $77,259 |
| OTHER | $226,895 | $153,154 | $73,741 |
| DUES & SUBSCRIPTIONS | $40,356 | $27,240 | $13,116 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,489 | TotalAmt |
| Program Services | $15,181 | ProgramServicesAmt |
| Management And General | $7,308 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,344,688 | TotalAmt |
| Program Services | $10,145,493 | ProgramServicesAmt |
| Management And General | $5,199,195 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,251 | BOYAmt |
| EOY | $240,917 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,788,248 | BOYAmt |
| EOY | $1,457,300 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $471,268 | BOYAmt |
| EOY | $539,509 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,316 | BOYAmt |
| EOY | $68,370 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,843,940 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,531,401 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,992,843 | BOYAmt |
| EOY | $7,312,539 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,837 | BOYAmt |
| EOY | $166,777 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,488,763 | BOYAmt |
| EOY | $9,785,412 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,763,516 | BOYAmt |
| EOY | $1,900,174 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,631,123 | BOYAmt |
| EOY | $8,437,340 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $546,898 | BOYAmt |
| EOY | $250,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,941,537 | BOYAmt |
| EOY | $10,587,514 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,452,774 | BOYAmt |
| EOY | -$802,102 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,452,774 | BOYAmt |
| EOY | -$802,102 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,488,763 | BOYAmt |
| EOY | $9,785,412 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $650,672 | 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 | false | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,850 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,850 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART IV | FormAndLineReferenceDesc |
| Explanation | FRMC IS A MEMBER OF THE ARKANSAS HOSPITAL ASSOCIATION, THE ORGANIZATION PAID DUES OF 9,252 TO AHA DURING 2014, 20% OF WHICH WAS RELATED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $174,563 | OtherCostOrOtherBasisAmt |
| Book Value | $174,563 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,754,199 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,102,295 | DepreciationAmt |
| Book Value | $4,651,904 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,907,743 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,426,451 | DepreciationAmt |
| Book Value | $2,481,292 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,435 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,655 | DepreciationAmt |
| Book Value | $4,780 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,312,539 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD-PARTY REIMBURSEMENT | Desc |
| Amt | $250,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $250,000 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $15,995,360 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $15,995,360 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $15,995,360 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,344,688 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $15,344,688 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $15,344,688 | TotalExpensesPerForm990Amt |
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 | false | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $213,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $213,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,357,151 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $621,071 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $736,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04800 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,570,651 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $621,071 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $949,580 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06190 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,004,944 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,539,177 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $465,767 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,004,944 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,539,177 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $465,767 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,575,595 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,160,248 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,415,347 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09220 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $745,121 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $387,463 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,020,612 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,374,545 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$353,933 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | FIVE RIVERS MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1Txt |
| City | POCAHONTAS | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72455 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FIVERIVERSMC.COM | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | HOME HEALTH | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIVE RIVERS 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 | 13 | 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.FIVERIVERSMC.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | false | ImplementationStrategyAdoptInd |
| 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 Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (true) | 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, FIVE RIVERS MEDICAL CENTER - PART V, LINE 5 | INTERVIEWS WITH NINE KEY INFORMANTS, AS WELL AS, ONE FOCUS GROUP, WERE CONDUCTED IN OCTOBER 2013. INFORMANTS WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH OR THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. INTERVIEWS WERE CONDUCTED BY USING A STANDARD QUESTIONNAIRE. A SUMMARY OF THEIR OPINIONS WERE REPORTED WITHOUT JUDGING THE TRUTHFULNESS ORACCURACY OF THEIR REMARKS. COMMUNITY LEADERS PROVIDED COMMENTS ON THE FOLLOWING ISSUES - HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE COMMUNITY, BARRIERS TO IMPROVING HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE COMMUNITY, OPINIONS REGARDING THE IMPORTANT HEALTH ISSUES THAT AFFECT COMMUNITY RESIDENTS AND THE TYPES OF SERVICES THAT ARE IMPORTANT FOR ADDRESSING THESE ISSUES, DELINEATION OF THE MOST IMPORTANT HEALTHCARE ISSUES OR SERVICES DISCUSSED AND ACTIONS NECESSARY FOR ADDRESSING THOSE ISSUES. 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 REPORT. THE FOCUS GROUP WAS MADE UP OF MEMEBERS OF THE MEDICAL CENTER'S BOARD OF DIRECTORS AND MANAGEMENT. FOCUS GROUP PARTICIPANTS DISCUSSED THE SAME TOPICS AS THE INTERVIEWEES. AN INDEPENDANT CONSULTANT TOOK NOTES DURING THE DISCUSSION AND ANALYZED THE DATA FOR INCLUSION IN THE REPORT. |
| FACILITY 1, FIVE RIVERS MEDICAL CENTER - PART V, LINE 11 | EACH OF THE HEALTH NEEDS LISTED BELOW IS IMPORTANT AND IS BEING ADDRESSED IN PROGRAMS AND INITIATIVES OPERATED BY THE HOSPITAL. HOWEVER, THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS IDENTIFIED IN THE CHNA AS PART OF THIS IMPLEMENTATION PLAN DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE HEALTH NEEDS IDENTIFIED AS BEING ADDRESSED BY THE IMPLEMENTATION STRATEGY - ACCESS TO PRIMARY CARE, ACCESS TO RECREATIONAL FACILITIES, AGING ISSUES, CANCER, CEREBROVASCULAR DISEASES, CHILDREN IN POVERTY, DIABETES, HEART DISEASE, INADEQUATE SOCIAL SUPPORT, LIMITED ACCESS TO HEALTHY FOODS, LOW BIRTH WEIGHT, MOTOR VEHICLE CRASH DEATH RATE, OBESITY, POOR MENTAL HEALTH, POOR PHYSICAL HEALTH, PREVENTABLE HOSPITAL STAYS, SEXUALLY TRANSMITTED INFECTIONS, TEEN BIRTH RATE, TOBACCO USE, MEDICAL TRANSPORTATION. |
| FACILITY 1, FIVE RIVERS MEDICAL CENTER - PART V, LINE 13B | THE HOSPITAL ONLY PROVIDES DISCOUNTED CARE. IT DOES NOT PROVIDE FREE CARE. |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | BAD DEBT IS THE UNPAID OBLIGATION FOR CARE BASED ON A HOSPITAL'S FULL ESTABLISHED RATES FOR PATIENTS WHO ARE UNWILLING TO PAY THEIR BILL. UNLIKE CHARITY CARE, BAD DEBT ARISES IN SITUATIONS WHERE THE PATIENT HAS EITHER NOT REQUESTED FINANCIAL ASSISTANCE OR DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS RECEIVABLE IS CLASSIFIED AS A BAD DEBT WHEN THE RECEIVABLE IS OVER 90 DAYS FROM DISCHARGE. AN ESTIMATE OF 52% WAS CALCULATED AS THE BAD DEBT EXPENSE THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | THE HOSPITAL WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION EFFOTS BEFORE MAKING AND DOCUMENTING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THE HOSPITAL MAY CONTRACT WITH EXTERNAL COLLECTION AGENCIES (AND TAKE OTHER ACTIONS AS NECESSARY) IN ORDER TO COLLECT ON DELINQUENT ACCOUNTS. PRIOR TO DOING SO, HOWEVER, THE HOSPITAL WILL TAKE THE FOLLOWING ACTIONS: SEND A STATEMENT TO THE PATIENT (AT THE PATIENT'S MOST CURRENTADDRESS ON FILE). NOTIFY THE PATIENT OF OUTSTANDING ACCOUNT(S) AND PROVIDING THE PATIENT WITH INFORMATION REGARDING HOW TO APPLY FOR FINANCIAL ASSISTANCE. THIS INITIAL CONTACT WILL ALSO INCLUDE AN APPLICATION FOR FINANCIAL ASSISTANCE. SUCH INFORMATION WILL ALSO INCLUDE CONTACT INFORMATION FOR HOSPITAL STAFF MEMBERS WHO CAN ANSWER PATIENT QUESTIONS AND PROVIDE FURTHER INFORMATION AS NEEDED. AFTER NO LESS THAN FIFTEEN DAYS, THE ACCOUNT WILL BE TRANSFERRED FOR PROCESSING TO THE HOSPITAL'S EARLY OUT PROCESS, EITHER DIRECTLY THROUGH THE HOSPITAL OR THROUGH A THIRD PARTY CONTRACTOR. THE GOAL OF THE EARLY OUT PROCESS IS TO ESTABLISH A REASONABLE PAYMENT PLAN THAT THE PATIENT CAN MANAGE. IF THEY DO NOT QUALIFY FOR 100% FINANCIAL ASSISTANCE ALL PAYMENT PLAN PROPOSALS WILL BE CONSIDERED. THE PATIENT WILL RECEIVE AT LEAST TWO ADDITIONAL LETTERS (AT NO LESS THAN TWENTY DAY INTERVALS) REQUESTING PAYMENT AND NOTIFYING THE PATIENT OF THE POTENTIAL AVAILABILITY OF FINANCIAL ASSISTANCE AND STAFF CONTACT INFORMATION AS DESCRIBED ABOVE. THE PATIENT WILL ALSO RECEIVE A PHONE CALL DURING THE EARLY OUT PROCESS DURING WHICH THE PATIENT WILL BE ADVISED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IF THE ACCOUNT REMAINS OUTSTANDING FOR A PERIOD OF TWENTY DAYS AFTER THE SECOND OF THE LETTERS REFERENCED ABOVE. THEN THE ACCOUNT MAY BE TURNED OVER TO COLLECTIONS. THE COLLECTION AGENCY WILL ALSO ATTEMPT TO WORK WITH THE PATIENT FOR A PERIOD OF NO LESS THAN THIRTY DAYS PRIOR TO TAKING ANY ADDITIONAL ACTIONS. ANY COLLECTION AGENCIES USED BY THE HOSPITAL WILL AGREE TO REFRAIN FROM ABUSIVE COLLECTION PRACTICES. BENCH WARRANTS, AND PROPERTY FORECLOSURES WILL NOT BE PART OF COLLECTION EFFORTS. 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 PATIENTS WHO HAVE INSURANCE COVERING SUCH CARE. FOR PURPOSES OF THIS POLLICY, "AMOUNTS GENERALLY BILLED" WILL BE DETERMINED BASED ON AVERAGING THE THREE LOWEST NEGOTIATED COMMERCIAL RATES FOR THOSE SERVICES AT THE HOSPITAL. THESE RATES WILL BE REVIEWED ANNUALLY. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | FRMC COLLABORATES WITH OTHER LOCAL HEALTHCARE PROVIDERS TO ASSESS THE NEEDS OF THE COMMUNITY. FRMC ALSO PARTICIPATE IN ANNUAL HEALTH FAIRS TO GATHER FEEDBACK REGARDING HEALTH ISSUES. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PATIENTS ARE ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THE HOSPITAL SENDS A STATEMENT TO THE PATIENT (AT THE PATIENT'S MOST CURRENT ADDRESS ON FILE), NOTIFYING THE PATIENT OF OUTSTANDING ACCOUNT(S) AND PROVIDES THE PATIENT WITH INFORMATION REGARDING HOW TO APPLY FOR FINANCIAL ASSISTANCE. THIS INITIAL CONTACT WILL ALSO INCLUDE AN APPLICATION FOR FINANCIAL ASSISTANCE. SUCH INFORMATION WILL ALSO INCLUDE CONTACT INFORMATION FOR HOSPITAL STAFF MEMBERS WHO CAN ANSWER PATIENT QUESTIONS AND PROVIDE FURTHER INFORMATION AS NEEDED. THE GOAL OF THE HOSPITAL IS TO ESTABLISH A REASONABLE PAYMENT PLAN THAT THE PATIENT CAN MANAGE. IF THEY DO NOT QUALIFY FOR 100% FINANCIAL ASSISTANCE, ALL PAYMENT PLAN PROPOSALS WILL BE CONSIDERED. THE PATIENT WILL RECEIVE AT LEAST TWO ADDITIONAL LETTERS (AT NO LESS THAN TWENTY DAY INTERVALS) REQUESTING PAYMENT AND NOTIFYING THE PATIENT OF THE POTENTIAL AVAILABILITY OF FINANCIAL ASSISTANCE AND STAFF CONTACT INFORMATION AS DESCRIBED ABOVE. THE PATIENT WILL ALSO RECEIVE A PHONE CALL DURING THE PROCESS. DURING WHICH THE PATIENT WILL BE ADVISED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | THE HOSPITAL SERVES A SMALL, RURAL, DIVERSE COMMUNITY INCLUDING RANDOLPH COUNTY AND THE SURROUNDING COUNTIES. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | FRMC MAINTAINS AN OPEN MEDICAL STAFF AND THE GOVERNING BODY IS MADE UP OF VOLUNTARY LOCAL COMMUNITY MEMBERS ALONG WITH PHYSICIANS. THE HOSPITAL CARES FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND PROACTIVELY SEEKS TO ENROLL ALL ELIGIBLE PATIENTS INTO APPROPRIATE PROGRAMS TO IMPROVE ACCESS TO CARE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| 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 | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| JANE KUZAS | ||||
| PHYSICIAN | $364,342 | $708 | $9,511 | $374,561 |
| ROLANDO CHENG | ||||
| PHYSICIAN | $261,395 | $1,973 | $102 | $263,470 |
| PHILLIP JANSEN | ||||
| PHYSICIAN | $249,930 | $5,048 | $254,978 | |
| WILLIAM LEWIS | ||||
| PHYSICIAN | $244,020 | $579 | $7,998 | $252,597 |
| ROBERT HALL | ||||
| PHYSICIAN | $200,119 | $1,828 | $7,997 | $209,944 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 1A | 1,740 IN COUNTRY CLUB DUES TO THE ROLLING HILLS COUNTRY CLUB FOR MR. LUTHER LEWIS. ALL PERSONAL AMOUNTS WERE PAID DIRECTLY BY MR. LEWIS. |
| SCHEDULE J, PAGE 1, PART I, LINE 5A | THE FOLLOWING INCENTIVE PAY MAY BE EARNED IN ADDITION TO THE BASE SALARY EARNED. INCENTIVE PAY WILL BE REVIEWED AND PAID AT EACH ANNUAL ANNIVERSARY DATE OF MR. LEWIS'S EMPLOYMENT. THE INCENTIVE PROGRAM WILL CONSIST OF THE FOLLOWING CONDITIONS: 1) ALL ACCOUNTS PAYABLE OF ANY KIND MUST BE CURRENT. ANY ACCOUNT PAST DUE MORE THAN 30 DAYS WILL NOT BE CONSIDERED CURRENT. MEETING THIS CONDIDTION WILL EARN INCENTIVE PAY OF 10,000 AND WILL GIVE MR. LEWIS THE OPPORTUNITY TO EARN ADDITIONAL INCENTIVE PAY. 2) POSITIVE NET INCOME OVER THE TRAILING TWELVE MONTH PERIOD PRECEDING ANY ANNIVERSARY DATE. THE TRAILING TWELVE MONTH NET INCOME CALCULATED ON THE INCOME STATEMENT BEING REVIEWED BY THE BOARD ON A MONTHLY BASIS WILL BE USED TO DETERMINE ANY EARNED INCENTIVE. MEETING BOTH CONDITION 1 AND CONDITION 2 WILL EARN ADDITIONAL INCENTIVE PAY OF 10,000. 3) ALL AGREED UPON QUALITY INDICATORS DETERMINED BY THE BOARD OF DIRECTORS MUST BE AT ACCEPTABLE LEVELS. MEETING CONDITIONS 1, 2, & 3 WILL EARN ADDITIONAL INCENTIVE PAY OF 10,000. 4) INCREASED NET REVENUES FOR THE TRAILING TWELVE MONTHS. NET REVENUES PRECEDING ANY ANNIVERSARY DATE WILL BE COMPARED TO THE TRAILING TWELVE MONTH NET REVENUES FROM THE PRIOR YEAR PERIOD. IF CONDITIONS 1, 2, & 3 HAVE ALL BEEN MET, THEN ANY NET REVENUE INCREASE UP TO 6.25% WILL BE MULTIPLIED BY THE BASE PAY AND PAID AS AN INCENTIVE. SUCH ADDITIONAL INCENTIVE SHALL NOT EXCEED 10,000 (160,000 X .0625 = 10,000) TOTAL INCENTIVE PAY FOR ALL CONDITIONS MAY NOT EXCEED 40,000. |
| SCHEDULE J, PAGE 1, PART I, LINE 6A | THE FOLLOWING INCENTIVE PAY MAY BE EARNED IN ADDITION TO THE BASE SALARY EARNED. INCENTIVE PAY WILL BE REVIEWED AND PAID AT EACH ANNUAL ANNIVERSARY DATE OF MR. LEWIS'S EMPLOYMENT. THE INCENTIVE PROGRAM WILL CONSIST OF THE FOLLOWING CONDITIONS: 1) ALL ACCOUNTS PAYABLE OF ANY KIND MUST BE CURRENT. ANY ACCOUNT PAST DUE MORE THAN 30 DAYS WILL NOT BE CONSIDERED CURRENT. MEETING THIS CONDIDTION WILL EARN INCENTIVE PAY OF 10,000 AND WILL GIVE MR. LEWIS THE OPPORTUNITY TO EARN ADDITIONAL INCENTIVE PAY. 2) POSITIVE NET INCOME OVER THE TRAILING TWELVE MONTH PERIOD PRECEDING ANY ANNIVERSARY DATE. THE TRAILING TWELVE MONTH NET INCOME CALCULATED ON THE INCOME STATEMENT BEING REVIEWED BY THE BOARD ON A MONTHLY BASIS WILL BE USED TO DETERMINE ANY EARNED INCENTIVE. MEETING BOTH CONDITION 1 AND CONDITION 2 WILL EARN ADDITIONAL INCENTIVE PAY OF 10,000. 3) ALL AGREED UPON QUALITY INDICATORS DETERMINED BY THE BOARD OF DIRECTORS MUST BE AT ACCEPTABLE LEVELS. MEETING CONDITIONS 1, 2, & 3 WILL EARN ADDITIONAL INCENTIVE PAY OF 10,000. 4) INCREASED NET REVENUES FOR THE TRAILING TWELVE MONTHS. NET REVENUES PRECEDING ANY ANNIVERSARY DATE WILL BE COMPARED TO THE TRAILING TWELVE MONTH NET REVENUES FROM THE PRIOR YEAR PERIOD. IF CONDITIONS 1, 2, & 3 HAVE ALL BEEN MET, THEN ANY NET REVENUE INCREASE UP TO 6.25% WILL BE MULTIPLIED BY THE BASE PAY AND PAID AS AN INCENTIVE. SUCH ADDITIONAL INCENTIVE SHALL NOT EXCEED 10,000 (160,000 X .0625 = 10,000) TOTAL INCENTIVE PAY FOR ALL CONDITIONS MAY NOT EXCEED 40,000. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | LABORATORY AND OTHER PROGRAM EXPENSE |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE CFO REVIEWS THE 990 BEFORE IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | EACH DIRECTOR SHALL, AT THEIR FIRST REGULAR BOARD MEETING OF THE CALENDAR YEAR, EXECUTE AND DELIVER TO THE SECRETARY, A CONFLICT OF INTEREST STATEMENT PURSUANT TO THE CORPORATION'S CONFLICT OF INTEREST POLICY. EACH DIRECTOR SHALL AT ALL TIMES, COMPLY FULLY WITH THE PROVISIONS OF THE CORPORATION'S CONFLICT OF INTEREST POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION OF THE CEO AND OTHER OFFICERS IS DETERMINED USING COMPARABLE AHA WAGE DATA. THE BOARD OF DIRECTORS APPROVES THESE SALARIES. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE COMPENSATION OF THE OTHER OFFICERS IS DETERMINED USING COMPARABLE AHA WAGE DATA. THE BOARD OF DIRECTORS APPROVES THESE SALARIES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE NOT AVALIABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | OTHER FEES 1,228,967 591,725 0 |