2014-04-08T12:42:38-07:00 2013-06-30 Hughes Welch & MilliganCPASLTD PO Box 2094 Batesville AR 725032094 990 2012-07-01 710276839 DELTA MEMORIAL HOSPITAL DELT 8703824303 811 HWY 65 S DUMAS AR 71639 DON LIVINGSTON 2014-04-08 true WILLIAM T COUCH P00183609 8707935231 2012 2015-11-30 17:44:51Z 17907545 false false X WWW.DELTAMEM.ORG X 1975 AR DELTA MEMORIAL HOSPITAL IS COMMITTED TO AID HEALING AND PROMOTE WELLNESS FOR SOUTHEAST ARKANSAS 6 6 213 32 0 70604 280210 16024521 15410977 -31670 -2250291 540395 1016185 16603850 14457081 0 0 7981664 7241764 0 0 9629751 9170655 17611415 16412419 -1007565 -1955338 16454428 15137426 7602240 8240576 8852188 6896850 DELTA MEMORIAL HOSPITAL IS COMMITTED TO AID HEALING AND PROMOTE WELLNESS FOR SOUTHEAST ARKANSAS false false 13306030 DELTA MEMORIAL HOSPITAL PROVIDES MEDICAL HEALTH CARE SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR ABILITY TO PAY. 13306030 true true false false false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false false false false false false 18 0 false 213 true false false false false false false false false 0 false false false false false false false false false false X 6 6 false false false false false false false true false false false true true true true true true false false false X CRIS BOLIN 8703924303 811 HWY 65 S DUMAS AR 71639 SHIRLEY TEETER 1.00 0.00 X 0 0 0 ROBIN SHEA 1.00 0.00 X 0 0 0 DR DAVID CHAMBERS 40.00 0.00 X 587650 0 0 GLENN CROW 1.00 0.00 X 0 0 0 TIMOTHY JONES 1.00 0.00 X 0 0 0 HEATH MONICRIEF 1.00 0.00 X 0 0 0 DON LIVINGSTON 1.00 0.00 X 0 0 0 CRIS BOLIN 40.00 0.00 X 127319 0 0 ROGER MASON 40.00 0.00 X 292311 0 0 RALPH MAXWELL 40.00 0.00 X 505250 0 0 1512530 4 false true false MARGARET ISHEE 5120 LODS FIELD RD GRAND BAY AL 36541 CRNA 267813 LEWIS NELSON BALLARD III 100 RAVENWOOD PLACE HOT SPRINGS AR 71901 CRNA 267813 DELTA SURGERY PA PO BOX 399 DUMAS AR 71639 ER PHYSICAN 146300 DELTA MEDICAL SERVICES LLC 130 DAY DR MONTICELLO AR 71655 BILLINGS 175953 CPP WOUND CARE 3017 N CAUSEWAY BLVD METAIRE LA 70002 WOUND CARE 152925 5 34836 245374 280210 STATE ASSESSMENT REVENUE 1025300 1025300 PATIENT SERVICE REVENUE 14385677 14385677 15410977 173 173 0 0 0 1200000 3450464 -2250464 -2250464 -2250464 0 0 0 MISCELLANEOUS 900099 132825 132825 GUEST AND EMPLOYEE MEALS 900099 33080 33080 ELECTRONIC HEALTH RECORDS 900099 840656 840656 9624 9624 1016185 14457081 14176698 173 0 0 0 0 714969 587650 127319 0 5558837 4911383 647454 15966 12453 3513 523202 408098 115104 428790 334456 94334 0 95880 95880 27487 27487 0 0 0 0 0 0 0 0 270917 26697 244220 69451 63243 6208 0 0 164001 164001 0 1093086 1093086 261629 261629 REPAIRS & MAINTENANCE 224623 89461 135162 SUPPLIES & OTHER 1275928 697269 578659 PURCHASED SERVICES 2466661 1992389 474272 PROVISION FOR BAD DEBTS 2996600 2996600 224392 93245 131147 16412419 13306030 3106389 0 3435 2697 0 0 4833638 3934210 0 0 0 204178 236039 217884 233080 17763719 7199373 11028239 10564346 0 0 0 0 167054 167054 16454428 15137426 2825770 2641386 3972503 5369580 594164 84094 209803 145516 7602240 8240576 X 1375616 -185354 7476572 7082204 8852188 6896850 16454428 15137426 -1955338 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 105910 105910 12407371 4209328 8198043 5250438 2990045 2260393 10564346 DELINQUENT PAYROLL TAXES PAYABLE 145516 145516 X 11460481 11460481 2996600 2996600 14457081 13415819 13415819 2996600 2996600 16412419 Part XII, Line 4b Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S BAD DEBTS $2996600 Part XI, Line 4b Part XI, Line 4b: Other revenue amounts included on 990 but not included in F/S BAD DEBTS $2996600 Part X 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. true true true X true X true true false false true true 90884 90884 0.00550 90884 90884 0.00550 90884 90884 0.00550 true 2996600 1543467 4492500 4289479 203021 true false 1 1 DELTA MEMORIAL HOSPITAL

811 HWY 65 S DUMAS AR 71639

X X DELTA MEMORIAL HOSPITAL 1 true X X X X X X X X 12 true false true X X true false false true true 100.0000 true 200.0000 true X X X X true true X X X X true X X true X X X X X true X false true Part VI - Explanation Of How Organization Furthers Its Exempt Purpose PROVIDES DUMAS SCHOOL ATHLETES PHYSICALS FREE OF CHARGE, PARTICIPATES IN NUMEROUS COMMUNITY HEALTH FAIRS AND PROVIDES HEALTH SCREENINGS, NEW MOM/BIRTHING CLASSES, CAR SEAT SAFETY TRAINING, BABYSITTING TRAINING CLASSES,AND MEALS FOR COMMUNITY EVENTS Part VI - Community Information RURAL SETTING, PREDOMINANTLY AGRICULTURAL BASE. AVERAGE INCOME AT OR BELOW FEDERAL POVERTY GUIDELINES. PREDOMINANTLY CAUCASIAN, HIGH SCHOOL EDUCATED AND GERIATRIC IN NATURE. Part VI - Patient Education of Eligibility for Assistance INFORMS PATIENTS UPON ADMISSION AND POSTS NOTICES IN CONSPICUOUS AREAS. Part VI - Needs Assessment UTILIZES ANNUAL STATISTICAL REPORT WITH DEMOGRAPHIC INFORMATION FORM DHS AS WELL AS REPORTS SHOWING PERCENT OF ACTIVITY OF COMMUNITY BY PAYOR SOURCE. Number of Hospital Faciltiy - 1 Part V, Line 22 - Charge Patients Amount Equal Gross Charge for Services THE HOSPITAL CHARGES EVERY PATIENT THE SAME AMOUNT FOR EVERY SERVICE. THEY APPLY DISCOUNTS AS DETERMINED BASED ON THE FINANCIAL ASSISTANCE APPLICIATIONS. Number of Hospital Faciltiy - 1 Part V, Line 20d - Other Billing Determination of Individuals Without Insurance CHARGE EVERY PATIENT THE SAME AMOUNT FOR EVERY SERVICE Number of Hospital Faciltiy - 1 Part V, Line 3 - Account Input from Person Who Represent the Community DEVELOPED A STEERING COMMITTEE AND HELD COMMUNITY MEETINGS THAT PRESENTED SURVEYS TO COMMITTEE MEMEBERS FOR INPUT false false false false false false false false false false ROGER MASON 292311 292311 RALPH MAXWELL 505250 505250 DR DAVID CHAMBERS 587650 587650 Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available No documents available to the public. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts ANNUAL CONFLICT OF INTEREST FORM COMPLETED BY EACH BOARD MEMBER Form 990, Part VI, Line 11b Form 990, Part VI, Line 11b: Form 990 Review Process No review was or will be conducted.