2015-08-05T09:12:47-05:00 2014-09-30 990 2013-10-01 710850123 NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION INC NORT 8709345119 4802 EAST JOHNSON AVE JONESBORO AR 72401 GREGORY M DUCKETT SECRETARY 8709345119 2015-08-05 2013 2016-04-25 22:37:26Z X 4802 EAST JOHNSON AVE JONESBORO AR 72401 95021350 0 X WWW.NEABAPTISTCLINIC.COM X 2000 AR NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PROVIDES QUALITY (SEE SCHEDULE O, PG 40) MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR AGE. 17 0 769 0 1103964 103835 0 0 91133458 94583944 0 -13014 448303 397082 91581761 94968012 0 86983 0 0 53165176 52277874 0 0 0 38780004 44529669 91945180 96894526 -363419 -1926514 33431203 47724850 28596883 44580527 4834320 3144323 X NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR AGE. 0 0 81870189 86983 93877062 NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. (NEA BAPTIST CLINIC) PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR AGE. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF NEA BAPTIST CLINIC, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES, AND FURTHER, THAT THE MISSION OF THE CLINIC IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. SEE CONTINUATION AT SCHEDULE O, PAGE 40THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THEREFORE, IN KEEPING WITH ITS COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, NORTHEAST ARKANSAS BAPTIST CLINIC PROVIDES THE FOLLOWING:--FREE CARE AND/OR SUBSIDIZED CARE,--CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND--HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITYNEA BAPTIST CLINIC IS THE LARGEST AND MOST COMPREHENSIVE PHYSICIAN-LED AND PROFESSIONALLY MANAGED MULTI-SPECIALTY GROUP PRACTICE IN THE REGION. NEA BAPTIST CLINIC IS MADE UP OF OVER 110 PHYSICIANS PROVIDING CARE IN MORE THAN 35 MEDICAL SPECIALTIES. THE MISSION OF NEA BAPTIST CLINIC IS TO PROVIDE COMPREHENSIVE, PERSONALIZED, QUALITY HEALTH CARE FOR PATIENTS THROUGHOUT THE NORTHEAST ARKANSAS REGION. SINCE FORMING IN 1977, NEA BAPTIST CLINIC HAS BECOME A MULTI-SPECIALTY, AWARD-WINNING CLINIC AND PARTNER WITH NEA BAPTIST MEMORIAL HOSPITAL, INC. WE HAVE BECOME A LEADER IN CLINICAL RESEARCH AND KEY PROVIDER OF MEDICAL SPECIALTY SERVICES WITH HUNDREDS OF THOUSANDS OF CLINIC VISITS EACH YEAR.NEA BAPTIST CLINIC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS FROM WHICH WE MAY RECEIVE LESS THAN MARKET VALUE REIMBURSEMENT. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO MEDICARE, MEDICAID AND UNINSURED PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, NEA BAPTIST CLINIC RECOGNIZES THESE AMOUNTS AS CHARITY CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. DURING THE YEAR ENDING SEPTEMBER 30, 2014, THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS $28,921,171.CHARITY CARE IS ALSO PROVIDED THROUGH MANY REDUCED PRICED SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES THAT NEA BAPTIST CLINIC BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THROUGH ITS AFFILIATION WITH BAPTIST MEMORIAL HEALTH CARE CORPORATION, NEA BAPTIST CLINIC PROVIDES THE FOLLOWING PROGRAMS AND SERVICES FOR THE COMMUNITY:--COMMUNITY HEALTH FAIRS--PHYSICAL EXAMS FOR STUDENTS ACTIVE IN COMPETITIVE SPORTS--PROVISION OF STAFF NURSES TO HELP SENIOR CITIZENS HEALTH FAIR--EMPLOYEE ACTIVITIES TO RAISE MONEY FOR UNITED WAY, AMERICAN HEART ASSOCIATION, AND MARCH OF DIMES--PROVISIONS OF PHYSICIANS FOR SPEAKING ENGAGEMENTS ON TOPICAL HEALTH ISSUES TO THE COMMUNITYONE OF THE BIGGEST PROGRAMS AT NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION IS THE WELLNESS CENTER. THE WELLNESS CENTER AT NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION HAS A STATE OF THE ART CARDIO THEATRE, SELECTORIZED EQUIPMENT, FREE WEIGHTS, INDOOR RUBBERIZED RUNNING TRACK, INDOOR HEATED POOL, JUICE BAR AND NUTRITION CENTER, LOCKER ROOMS, PERSONAL TRAINING AND MORE. WE STRIVE TO DO WHATEVER IS NECESSARY TO HELP OUR MEMBERS MEET THEIR GOALS. OUR TRAINING PHILOSPHY IS BASED ON THE PERIODIZATION OF RESISTANCE TRAINING, SOUND NUTRITION, AND CARDIOVASCULAR TRAINING. THIS IS KNOWN AS OUR TRIANGLE OF SUCCESS.THE NEA BAPTIST WELLNESS CENTER IS A SILVER SNEAKER CERTIFIED FACILITY. ANYONE WHO HAS SILVER SNEAKERS AS A BENEFIT ON THEIR MEDICAL INSURANCE CAN COME TO THE WELLNESS CENTER FREE OF CHARGE.WE OFFER VARIOUS CLASSES SUCH AS AAA WATER AEROBICS, LATIN BOOTCAMP, SILVERSPLASH SILVER SNEAKERS, AB WORKOUTS, LATIN FIT, YOGASTRETCH SILVER SNEAKERS, CARDIO CIRCUIT SILVER SNEAKERS, MSROM SILVER SNEAKERS, AND ZUMBA, JUST TO NAME A FEW. 81870189 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 1 X 117 0 1 769 1 1 1 0 0 0 0 0 0 0 0 0 X 17 0 0 1 0 0 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 X The Organization 8709345119 4802 EAST JOHNSON AVE JONESBORO AR 72401 X RANDY J KING DIRECTOR 0.80 39.20 X 0 489106 67188 JAMES W BOSWELL DIRECTOR 0.20 39.80 X 0 619884 71074 BRAD H PARSONS DIRECTOR 0.20 39.80 X 0 234917 46616 ROBERT TAYLOR MD PRESIDENT 0.20 39.80 X X 237082 0 23000 JASON BRANDT MD DIRECTOR/EMPLOYEE 40.00 0.00 X 711758 0 17500 ROBERT ABRAHAM MD DIRECTOR/EMPLOYEE 40.00 0.00 X 438677 0 23000 MICHAEL MACKEY MD DIRECTOR/EMPLOYEE 40.00 0.00 X 410650 0 12396 JAMES AMEIKA MD DIRECTOR/EMPLOYEE 40.00 0.00 X 413700 0 23000 NORBERT DELACEY MD DIRECTOR/EMPLOYEE 40.00 0.00 X 358060 0 17500 KENNETH JONES MD DIRECTOR/EMPLOYEE 40.00 0.00 X 348462 0 23000 MICHAEL ISAACSON MD DIRECTOR/EMPLOYEE 40.00 0.00 X 224877 0 0 DOUGLAS MAGLOTHIN MD DIRECTOR/EMPLOYEE 40.00 0.00 X 212654 0 23000 RAY HALL JR MD DIRECTOR/EMPLOYEE 40.00 0.00 X 199947 0 5500 WILLIAM HUBBARD MD DIRECTOR/EMPLOYEE 40.00 0.00 X 26595 0 0 NATHAN TURNEY MD DIRECTOR/EMPLOYEE 40.00 0.00 X 252917 0 0 BROCK HARRIS MD DIRECTOR/EMPLOYEE 40.00 0.00 X 208953 0 17500 GREGORY M DUCKETT SECRETARY 0.10 39.90 X 0 582127 65914 STEPHEN WOODRUFFMD TREASURER 0.20 39.80 X 259667 0 -6558 DARRELL KING CEO 40.00 0.00 X 253457 0 22450 ANGIE CARLTON CFO 40.00 0.00 X 155956 0 8113 LEXINE HORTON COO 40.00 0.00 X 145225 0 1915 BEATA MAJEWSKIMD PHYSICIAN 40.00 0.00 X 634038 0 17500 MARK WENDEL MD PHYSICIAN 40.00 0.00 X 595284 0 25552 RONALD SCHECHTER MD PHYSICIAN 40.00 0.00 X 593937 0 10250 JEFFREY MULLEN MD PHYSICIAN 40.00 0.00 X 577462 0 17500 DHARMENDRA PATEL MD PHYSICIAN 40.00 0.00 X 519498 0 0 7778856 1926034 532910 97 0 1 0 SOUTHERN EMERGENCY SERVICES 1001 COUNTY RD 759 JONESBORO AR 72401 MEDICAL SERVICES 850777 EXPRESS PERSONNEL SERVICES PO BOX 203901 DALLAS TX 752841634 TEMP SERVICES 767367 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 606731246 EMR CONSULTING 676330 SG 360 INTERNATIONAL LLC PO BOX 1501 JONESBORO AR 72403 BUILDING REPAIRS 544900 TEAM HEALTH PO BOX 634850 CINCINNATI OH 452634850 ER SERVICES 526107 35 HEALTH CARE SERVICES 541700 94583944 93710386 873558 94583944 32000 32000 0 0 8324 21338 -13014 -13014 -13014 WELLNESS CENTER REV. 900099 397082 166676 230406 397082 94968012 93877062 1103964 -13014 X 86983 86983 4818488 4095715 722773 38543002 32761552 5781450 2551501 2168776 382725 3719226 3161342 557884 2645657 2248808 396849 10709275 9102884 1606391 570799 485179 85620 2830376 2405820 424556 5887911 5004724 883187 375642 319296 56346 127294 108200 19094 7043 5987 1056 2242733 1906323 336410 923275 784784 138491 MEDICAL SUPPLIES 17887428 15204314 2683114 REPAIRS & MAINTENANCE 1167763 992599 175164 GOODWILL IMPAIRMENT CHG 622200 0 622200 TAX & LICENSES 529131 449761 79370 648799 577142 71657 96894526 81870189 15024337 0 11280 13794 18174 18680572 31177324 6030189 7705205 1206217 1762142 14681941 7916805 3478552 6765136 4006219 301249 33431203 47724850 4763802 4170012 619193 23833081 39791322 28596883 44580527 X 4834320 3144323 4834320 3144323 33431203 47724850 X -1926514 236517 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1 1 0 Part II-B, Line 1: NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. BAPTIST MEMORIAL HEALTH CARE CORPORATION, THE SOLE MEMBER OF NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC.,PAYS MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, THE ARKANSAS HOSPITAL ASSOCIATION, THE MISSISSIPPI HOSPITAL ASSOCIATION, AND THE TENNESSEE HOSPITAL ASSOCIATION. A PORTION OF THOSE DUES ARE FOR CONSULTANTS WHO ADVISE AND CONSULT WITH THE ORGANIZATION ON LEGISLATIVE AND REGULATORY MATTERS THAT MAY AFFECT THE ORGANIZATION AND ITS AFFILIATES. THESE CONSULTANTS MAY ADVOCATE POSITIONS WITH THE LEGISLATIVE AND REGULATORY BODIES OF GOVERNMENT AT LOCAL, STATE, AND FEDERAL LEVELS. NORTHEAST ARKANSAS CLINIC FOUNDATION, INC. DID NOT PAY CONSULTANT FEES. "1" HAS BEEN USED SO THE "YES" ANSWER NEXT TO PART II-B, LINE 1i WILL TRANSMITTED WITH THE E-FILED FORM 990. 471340 177853 293487 14210601 7738952 6471649 6765136 DUE TO AFFILIATES 39791322 39791322 X Part X, Line 2: FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENT OF BAPTIST MEMORIAL HEALTH CARE CORPORATION AND SUBSIDIARIES: AS OF SEPTEMBER 30, 2014 AND 2013, BAPTIST MEMORIAL HEALTH CARE CORPORATION HAD NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS UNDER FASB ASC TOPIC 740, INCOME TAXES, REQUIRING ADJUSTMENTS TO ITS COMBINED FINANCIAL STATEMENTS. IN THE EVENT BAPTIST MEMORIAL HEALTH CARE CORPORATION WERE TO RECOGNIZE INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS, IT WOULD BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AS INTEREST EXPENSE. GENERALLY TAX YEARS 2011 THROUGH 2014 ARE OPEN TO EXAMINATION BY THE FEDERAL AND STATE TAXING AUTHORITIES. THERE ARE NO INCOME TAX EXAMINATIONS CURRENTLY IN PROCESS. 1 JONESBORO RADIO GROUP 314 UNION AVE JONESBORO AR 72401 8750 COMMUNITY BREAKFAST AND FREEDOM FEST SPONSORSHIP RED WOLVES SPORTS PROPERTIES PO BOX 25888 WOODBURY MN 55125 14000 ARKANSAS STATE UNIVERSITY RED WOLVES SPONSORSHIP Part I, Line 2: ALL ORGANIZATIONS ARE REQUIRED TO SUBMIT PROOF OF TAX EXEMPT STATUS THAT'S VERIFIED BY THE IRS DATABASE BEFORE THEY CAN PROCEED WITH THEIR REQUEST. THEY MAY USE OUR ONLINE CHARITABLE REQUEST APPLICATION TO SUBMIT A REQUEST. IF THEY ARE NOT A 501 (C)(3) ORGANIZATION, THEY ARE REQUIRED TO SUBMIT A COPY OF THEIR DETERMINATION LETTER FROM THE IRS VALIDATING THEIR EXEMPT STATUS BEFORE WE CAN PROVIDE ANY IN-KIND GIVEAWAYS OR SERVICES. WE ALSO MONITOR THE FUNDS TO ENSURE THEY ARE USED FOR THE PURPOSE GRANTED. WE MAKE EVERY EFFORT TO DIRECT OUR FUNDING TO A PROGRAM FOR A SPECIFIC PURPOSE. ORGANIZATIONS ARE ASKED TO SHOW RESULTS AND DOCUMENTATION ANNUALLY BEFORE THEIR REQUEST CAN BE CONSIDERED FOR FUTURE FUNDING. THE REQUESTS ARE REVIEWED AND APPROVED BY VARIOUS INDIVIDUALS DEPENDING UPON THE TYPE AND AMOUNT OF THE REQUEST. SMALL AMOUNTS MAY BE APPROVED BY THE SYSTEM COORDINATOR, CASH SPONSORSHIPS MAY BE APPROVED BY THE SYSTEM DIRECTOR OF COMMUNICATIONS, ANYTHING OVER $10,000 MAY BE APPROVED BY THE BAPTIST MEMORIAL HEALTH CARE FOUNDATION SENIOR V.P., AND ANYTHING OVER $50,000 NEEDS APPROVAL BY THE CORPORATE PRESIDENT/CEO. FOR MORE INFORMATION ABOUT BAPTIST CHARITABLE GIVING GUIDELINES, PLEASE VISIT HTTP://WWW.BAPTISTONLINE.ORG/SERVICES/COMMUNITY/INVOLVEMENT/GIVING.ASP. X 0 0 X X 0 0 0 0 0 0 0 0 0 RANDY J KING DIRECTOR 0 326338 0 137044 0 25724 0 48500 0 18688 0 556294 0 0 JAMES W BOSWELL DIRECTOR 0 565018 0 26688 0 28178 0 48500 0 22574 0 690958 0 0 BRAD H PARSONS DIRECTOR 0 206058 0 0 0 28859 0 25701 0 20915 0 281533 0 0 ROBERT TAYLOR MD PRESIDENT 237082 0 0 0 0 0 23000 0 0 0 260082 0 0 0 JASON BRANDT MD DIRECTOR/EMPLOYEE 711758 0 0 0 0 0 17500 0 0 0 729258 0 0 0 ROBERT ABRAHAM MD DIRECTOR/EMPLOYEE 438677 0 0 0 0 0 23000 0 0 0 461677 0 0 0 MICHAEL MACKEY MD DIRECTOR/EMPLOYEE 410650 0 0 0 0 0 12396 0 0 0 423046 0 0 0 JAMES AMEIKA MD DIRECTOR/EMPLOYEE 413700 0 0 0 0 0 23000 0 0 0 436700 0 0 0 NORBERT DELACEY MD DIRECTOR/EMPLOYEE 358060 0 0 0 0 0 17500 0 0 0 375560 0 0 0 KENNETH JONES MD DIRECTOR/EMPLOYEE 348462 0 0 0 0 0 23000 0 0 0 371462 0 0 0 MICHAEL ISAACSON MD DIRECTOR/EMPLOYEE 224877 0 0 0 0 0 0 0 0 0 224877 0 0 0 DOUGLAS MAGLOTHIN MD DIRECTOR/EMPLOYEE 212654 0 0 0 0 0 23000 0 0 0 235654 0 0 0 RAY HALL JR MD DIRECTOR/EMPLOYEE 199947 0 0 0 0 0 5500 0 0 0 205447 0 0 0 WILLIAM HUBBARD MD DIRECTOR/EMPLOYEE 26595 0 0 0 0 0 0 0 0 0 26595 0 0 0 NATHAN TURNEY MD DIRECTOR/EMPLOYEE 252917 0 0 0 0 0 0 0 0 0 252917 0 0 0 BROCK HARRIS MD DIRECTOR/EMPLOYEE 208953 0 0 0 0 0 17500 0 0 0 226453 0 0 0 GREGORY M DUCKETT SECRETARY 0 390718 0 138345 0 53064 0 38250 0 27664 0 648041 0 0 STEPHEN WOODRUFFMD TREASURER 259667 0 0 0 0 0 0 0 -6558 0 253109 0 0 0 DARRELL KING CEO 253457 0 0 0 0 0 17500 0 4950 0 275907 0 0 0 ANGIE CARLTON CFO 155956 0 0 0 0 0 6913 0 1200 0 164069 0 0 0 LEXINE HORTON COO 145225 0 0 0 0 0 390 0 1525 0 147140 0 0 0 BEATA MAJEWSKIMD PHYSICIAN 634038 0 0 0 0 0 17500 0 0 0 651538 0 0 0 MARK WENDEL MD PHYSICIAN 595284 0 0 0 0 0 17500 0 8052 0 620836 0 0 0 RONALD SCHECHTER MD PHYSICIAN 593937 0 0 0 0 0 9000 0 1250 0 604187 0 0 0 JEFFREY MULLEN MD PHYSICIAN 577462 0 0 0 0 0 17500 0 0 0 594962 0 0 0 DHARMENDRA PATEL MD PHYSICIAN 519498 0 0 0 0 0 0 0 0 0 519498 0 0 0 Part I, Line 1a THE OFFICERS RECEIVE A PERQUISITE ALLOWANCE WHICH IS INCLUDED IN THEIR SALARIES. Part I, Line 1b THE PRESIDENT, VICE PRESIDENTS, AND ADMINISTRATORS RECEIVE A PERQUISITE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN THEIR SALARIES AND IS TAXABLE TO THEM AS ADDITIONAL INCOME. THE ORGANIZATION ALSO HAS AN ACCOUNTABLE PLAN, BUT A DISCRETIONARY SPENDING ACCOUNT IS NOT PART OF AN ACCOUNTABLE PLAN. IF ANY OF THE OTHER ITEMS LISTED ON SCHEDULE J, PART I, LINE 1a WERE APPLICABLE, THE RECIPIENTS WOULD BE REQUIRED TO FOLLOW THE ORGANIZATION'S WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT. R EDWARD COOPER MD PA DBA ADVANCED ORTHOPAEDICS PC X 62500 37500 0 1 1 PEDIATRIC ASSOCIATES OF JONESBORO PLLC X 145833 85026 0 1 1 ARKANSAS UROLOGY CLINIC LTD X 183333 146667 0 1 1 BROOKLAND MEDICAL CLINIC INC X 125000 100000 0 1 1 FAMILY PRACTICE CLINIC PLLC X 250000 250000 0 1 1 619193 MATTHEW P JACKSON MD CURRENT EMPLOYEE WHO OWNED MORE THAN 5% OF SELLER, A PLLC 474346 ON JANUARY 1, 2014 THE ORGANIZATION PURCHASED ASSETS & ASSUMED CERTAIN LIABILITIES FROM FAMILY PRACTICE CLINIC, PLLC ("SELLER") FOR A PURCHASE PRICE OF $447,315.74 OF WHICH $250,000 WAS REPRESENTED BY A NOTE PAYABLE TO THE SELLER. IN ADDITION, THE SELLER ASSIGNED TO THE ORGANIZATION CERTAIN LEASE AGREEMENTS FOR THE USE OF CERTAIN SPACE PREVIOUSLY UTILIZED BY THE SELLER. 0 RODDY S LOCHALA DO CURRENT EMPLOYEE WHO OWNED MORE THAN 5% OF SELLER, A PLLC ON JANUARY 1, 2014 THE ORGANIZATION PURCHASED ASSETS & ASSUMED CERTAIN LIABILITIES FROM FAMILY PRACTICE CLINIC, PLLC ("SELLER") FOR A PURCHASE PRICE OF $447,315.74 OF WHICH $250,000 WAS REPRESENTED BY A NOTE PAYABLE TO THE SELLER. IN ADDITION, THE SELLER ASSIGNED TO THE ORGANIZATION CERTAIN LEASE AGREEMENTS FOR THE USE OF CERTAIN SPACE PREVIOUSLY UTILIZED BY THE SELLER. 0 PART II: R. EDWARD COOPER, M.D., P.A. D/B/A ADVANCED ORTHOPEDICS, P.C.:LINE 1 COLUMN (b):CERTAIN OFFICERS, DIRECTORS, AND HIGHLY COMPENSATED EMPLOYEES OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. WHO OWN MORE THAN 35 PERCENT OF THE TOTAL COMBINED VOTING POWER OF R. EDWARD COOPER, M.D., P.A. D/B/A ADVANCED ORTHOPEDICS, P.C., THE INTERESTED PERSON.LINE 1 COLUMN (c):NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PURCHASED CERTAIN ASSETS FROM R. EDWARD COOPER, M.D., P.A. D/B/A ADVANCED ORTHOPAEDICS, P.C. ON AUGUST 15, 2012. THE PARTIES AGREED THAT $62,500 OF THE PURCHASE PRICE WOULD BE PAID IN PERIODIC INSTALLMENTS REPRESENTED BY A PROMISSORY NOTE PAYABLE TO R. EDWARD COOPER, M.D., P.A. D/B/A ADVANCED ORTHOPAEDICS, P.C.PEDIATRIC ASSOCIATES OF JONESBORO, PLLC:LINE 2 COLUMN (b):CERTAIN OFFICERS, DIRECTORS, AND HIGHLY COMPENSATED EMPLOYEES OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. WHO OWN MORE THAN 35 PERCENT OF THE TOTAL COMBINED VOTING POWER OF PEDIATRIC ASSOCIATES OF JONESBORO, PLLC, THE INTERESTED PERSONS.LINE 2 COLUMN (c):NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PURCHASED CERTAIN ASSETS FROM PEDIATRIC ASSOCIATES OF JONESBORO, PLLC ON SEPTEMBER 14, 2012. THE PARTIES AGREED THAT $145,833 OF THE PURCHASE PRICE WOULD BE PAID IN PERIODIC INSTALLMENTS REPRESENTED BY A PROMISSORY NOTE PAYABLE TO PEDIATRIC ASSOCIATES OF JONESBORO, PLLC.ARKANSAS UROLOGY CLINIC, LTD:LINE 3 COLUMN (b):CERTAIN OFFICERS, DIRECTORS, AND HIGHLY COMPENSATED EMPLOYEES OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. WHO OWN MORE THAN 35 PERCENT OF THE TOTAL COMBINED VOTING POWER OF ARKANSAS UROLOGY CLINIC, LTD THE INTERESTED PERSONS.LINE 3 COLUMN (c):NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PURCHASED CERTAIN ASSETS FROM ARKANSAS UROLOGY CLINIC, LTD ON APRIL 30, 2013. THE PARTIES AGREED THAT $183,333 OF THE PURCHASE PRICE WOULD BE PAID IN PERIODIC INSTALLMENTS REPRESENTED BY A PROMISSORY NOTE PAYABLE TO ARKANSAS UROLOGY CLINIC, LTD.BROOKLAND MEDICAL CLINIC, INC.:LINE 4 COLUMN (b):CERTAIN OFFICERS, DIRECTORS, AND HIGHLY COMPENSATED EMPLOYEES OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. WHO OWN MORE THAN 35 PERCENT OF THE TOTAL COMBINED VOTING POWER OF BROOKLAND MEDICAL CLINIC, INC. THE INTERESTED PERSONS.LINE 4 COLUMN (c):NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PURCHASED CERTAIN ASSETS FROM BROOKLAND MEDICAL CLINIC, INC. ON JULY 1, 2013. THE PARTIES AGREED THAT $125,000 OF THE PURCHASE PRICE WOULD BE PAID IN PERIODIC INSTALLMENTS REPRESENTED BY A PROMISSORY NOTE PAYABLE TO BROOKLAND MEDICAL CLINIC, INC.FAMILY PRACTICE CLINIC, PLLC:LINE 5 COLUMN (b):CERTAIN OFFICERS, DIRECTORS, AND HIGHLY COMPENSATED EMPLOYEES OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. WHO OWN MORE THAN 35 PERCENT OF THE TOTAL COMBINED VOTING POWER OF FAMILY PRACTICE CLINIC, PLLC THE INTERESTED PERSONS.LINE 5 COLUMN (c):NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. PURCHASED CERTAIN ASSETS FROM FAMILY PRACTICE CLINIC, PLLC ON JANUARY 1, 2014. THE PARTIES AGREED THAT $250,000 OF THE PURCHASE PRICE WOULD BE PAID IN PERIODIC INSTALLMENTS REPRESENTED BY A PROMISSORY NOTE PAYABLE TO FAMILY PRACTICE CLINIC, PLLC. PART V: STATEMENTS REGARDING OTHER IRS FILINGS & TAX COMPLIANCE: LINE 7g: THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY REQUIRING IT TO FILE A FORM 8899. Line 7h: THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES, OR OTHER VEHICLES REQUIRING IT TO FILE A FORM 1098-C. Form 990, Part VI, Section A, line 3 NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. BAPTIST MEMORIAL HEALTH CARE CORPORATION, AS SOLE MEMBER OF NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC., PROVIDES CERTAIN LEGAL, FINANCE, QUALITY, AND PERSONNEL SERVICES PURSUANT TO A SHARED SERVICES AGREEMENT TO NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION,INC. Form 990, Part VI, Section A, line 6 NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. IS A NON-STOCK CORPORATION WHOSE SOLE MEMBER IS NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. Form 990, Part VI, Section A, line 7a NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC., THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC., ELECTS THE BOARD OF DIRECTORS. Form 990, Part VI, Section A, line 7b NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARTIABLE FOUNDATION, INC. BAPTIST MEMORIAL HEALTH CARE CORPORATION, THE SOLE MEMBER OF NORTHEAST ARKANSAS HEALTH SYSTEM, APPROVES THE BOARD OF DIRECTORS ACTIONS. Form 990, Part VI, Section B, line 11 NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. BAPTIST MEMORIAL HEALTH CARE CORPORATION IS THE THE SOLE MEMBER OF NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. THE FORM 990 IS REVIEWED BY BAPTIST MEMORIAL HEALTH CARE CORPORATION'S PRESIDENT/CEO, SR. V.P./CFO, THE V.P. OF CORPORATE FINANCE, AND THE CLINIC CFO. IN ADDITION, THE FORM 990 IS REVIEWED ON A ROTATING BASIS OF EVERY THREE YEARS BY AN OUTSIDE INDEPENDENT ACCOUNTING AND TAX FIRM. THE FORM 990 HAS NOT BEEN REVIEWED BY THE BOARD OF DIRECTORS. HOWEVER, BAPTIST MEMORIAL HEALTH CARE CORPORATION HAS A GOVERNANCE COMMITTEE THAT IS APPOINTED BY ITS BOARD OF DIRECTORS. THE BAPTIST MEMORIAL HEALTH CARE CORPORATION GOVERNANCE COMMITTEE CONSISTS OF THREE OR MORE MEMBERS ALL OF WHICH MAY OR MAY NOT BE MEMBERS OF THE BOARD OF DIRECTORS. THE BAPTIST MEMORIAL HEALTH CARE CORPORATION GOVERNANCE COMMITTEE WILL REVIEW THE FORM 990 AFTER SUBMITTING IT TO THE IRS. Form 990, Part VI, Section B, line 12c NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. BAPTIST MEMORIAL HEALTH CARE CORPORATION, AS SOLE MEMBER OF NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. REQUIRES THAT ALL EMPLOYEES, INCLUDING OFFICERS AND KEY EMPLOYEES, PERIODICALLY COMPLETE A CERTIFICATION AND ACKNOWLEDGEMENT OF THE BAPTIST MEMORIAL HEALTH CARE CORPORATION STANDARDS OF CONDUCT, WHICH INCORPORATES THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS DISCLOSE AND SIGN A CONFLICT OF INTEREST STATEMENT EACH DECEMBER. IN THE EVENT THAT AN EMPLOYEE OR BOARD MEMBER BECOMES AWARE OF A POTENTIAL CONFLICT OF INTEREST, HE/SHE IS REQUIRED TO REPORT IT TO THEIR CHIEF EXECUTIVE OFFICER BEFORE TAKING ANY ACTION. IF HE/SHE IS THE CHIEF EXECUTIVE OFFICER, THEN HE/SHE IS TO REPORT TO THE CHAIRMAN OF THE BOARD OF DIRECTORS. THE SIGNED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE SENIOR V.P. AND CORPORATE COUNSEL, AND ARE MAINTAINED IN THE BAPTIST MEMORIAL HEALTH CARE CORPORATION LEGAL DEPARTMENT. IF A CONFLICT OF INTEREST IS FOUND TO EXIST, IT WILL BE THE RESPONSIBILITY OF THE CEO, WITH THE INVOLVEMENT OF THE BAPTIST MEMORIAL HEALTH CARE CORPORATION LEGAL DEPARTMENT, TO RESOLVE THE ISSUE. Form 990, Part VI, Section B, line 15 BAPTIST MEMORIAL HEALTH CARE CORPORATION'S HUMAN RESOURCE DEPARTMENT, THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS, AND AN INDEPENDENT COMPENSATION CONSULTING FIRM PERFORM ANNUAL REVIEWS EACH DECEMBER AND APPROVE COMPENSATION OF THE CEO AND OTHER TOP MANAGEMENT PERSONNEL. THEY USE COMPARABILITY DATA AND OTHER SOURCES AS NEEDED. THE CEO AND OTHER TOP MANAGEMENT USE THE SAME TYPE OF INFORMATION TO APPROVE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. ON DECEMBER 10, 2012 THE COMPENSATION WAS REVIEWED AND APPROVED FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2013 FOR THE PRESIDENT, THE VICE PRESIDENTS, AND THE CEO/ADMINISTRATOR. Form 990, Part VI, Section C, line 18 NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. MAKES COPIES OF ITS FORMS 1023, 990, AND 990T AVAILABLE FOR PUBLIC INSPECTION TO ANYONE WHO REQUESTS THEM AS REQUIRED BY THE IRS. Form 990, Part VI, Section C, line 19 NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part VII RANDY J. KING - 350 N. HUMPHREYS BLVD., MEMPHIS, TN 38120-2177. GREGORY M. DUCKETT - 350 N. HUMPHREYS BLVD., MEMPHIS, TN 38120-2177. JAMES W. BOSWELL - 350 N. HUMPHREYS BLVD., MEMPHIS, TN 38120-2177. BRAD H. PARSONS - 4800 E. JOHNSON AVE., JONESBORO, AR 72401. Form 990, Part IX, line 11g PHYSICIAN SERVICES: Program service expenses 5,864,150. Management and general expenses 1,034,850. Fundraising expenses 0. Total expenses 6,899,000. OTHER PURCHASED SERVICES: Program service expenses 3,238,734. Management and general expenses 571,541. Fundraising expenses 0. Total expenses 3,810,275. Form 990, Part XI, line 9: EQUITY CONTRIBUTION TO/FROM BAPTIST MEMORIAL MEDICAL GROUP, INC. 236,517. PART XII, LINE 2c: FINANCIAL STATEMENTS AND REPORTING: NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. BAPTIST MEMORIAL HEALTH CARE CORPORATION, AS THE SOLE MEMBER OF NORTHEAST ARKANSAS BAPTIST HEALTH SYSTEM, INC., HAS AN AUDIT COMMITTEE THAT CHOOSES THE AUDIT FIRM, OVERSEES AND REVIEWS THE AUDIT REPORTS, AND THEN FOLLOWS UP ON ANY NECESSARY CHANGES AND RECOMMENDATIONS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. NORTHWEST ARKANSAS BAPTIST MEMORIAL HEALTH CARE LLC 4800 E JOHNSON AVE JONESBORO AR 72401 810572898 OPERATION OF BAPTIST MEMORIAL HOSPITAL-JONESBORO, INC. AR BAPTIST MEMORIAL HOSPITAL-JONESBORO INC NORTHWEST ARKANSAS BAPTIST HEALTH SERVICES GROUP LLC 4800 E JOHNSON AVE JONESBORO AR 72401 271471186 OPATE A PREFERRED PROVIDER ORGANIZATION AR BAPTIST MEMORIAL HOSPITAL-JONESBORO INC BAPTIST MEMORIAL HEALTH CARE SYSTEM INC 350 N HUMPHREYS BLVD MEMPHIS TN 381202177 581456556 CARRY OUT THE HEALTH CARE MISSIONS OF THE BAPTIST CONVENTIONS OF AR, MS, TN TN 501(c)(3) 509(a)(3) N/A 0 BAPTIST MEMORIAL COLLEGE OF HEALTH SCIENCES INC 1003 MONROE MEMPHIS TN 381043110 621599670 EDUCATION OF HEALTH CARE PROFESSIONALS TN 501(c)(3) 509(a)(1) BAPTIST MEMORIAL HOSPITAL INC 0 BAPTIST MEMORIAL HEALTH SERVICES INC 350 N HUMPHREYS BLVD MEMPHIS TN 381202177 621509127 PROVISION OF HEALTH CARE PROVIDERS & HOME INFUSION EQUIPMENT TN 501(c)(3) 509(a)(2) BAPTIST MEMORIAL HEALTH CARE CORPORATION 0 BAPTIST MEMORIAL HOSPITAL INC 350 N HUMPHREYS BLVD MEMPHIS TN 381202177 620123940 HEALTH CARE/HOSPITAL TN 501(c)(3) 509(a)(1) BAPTIST MEMORIAL HEALTH CARE CORPORATION 0 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