FIVE RIVERS MEDICAL CENTER INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- FIVE RIVERS MEDICAL CENTER INC (EIN 27-3970823)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-05
- IRS object ID
- 201433099349301818
- Schema version
- 2013v3.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-05T14:20:01-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3667 | AddressLine1 |
| City | LITTLE ROCK | City |
| State | AR | State |
| ZIP Code | 722033667 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % FIVE RIVERS MEDICAL CENTER | InCareOfNm |
| Business Name Control | FIVE | BusinessNameControlTxt |
| Phone | 8708926000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | POCAHONTAS | City |
| State | AR | State |
| ZIP Code | 72455 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOEY RADCLIFF | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5013721040 | PhoneNum |
| Signature | 2014-10-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMBER SHERRILL | PreparerPersonNm |
| PTIN | P00748683 | PTIN |
| Phone | 5013721040 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | 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 | AddressLine1 |
| City | POCAHONTAS | City |
| State | AR | State |
| ZIP Code | 72455 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,845,736 | 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 | 217 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $342,274 | PYContributionsGrantsAmt |
| CY Contributions Grants | $78,118 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,096,453 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,689,766 | CYProgramServiceRevenueAmt |
| PY Investment Income | $46,309 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,700 | CYInvestmentIncomeAmt |
| PY Other Revenue | $108,023 | PYOtherRevenueAmt |
| CY Other Revenue | $65,152 | CYOtherRevenueAmt |
| PY Total Revenue | $18,593,059 | PYTotalRevenueAmt |
| CY Total Revenue | $15,840,736 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,438,793 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,233,713 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,234,265 | PYOtherExpensesAmt |
| CY Other Expenses | $9,033,283 | CYOtherExpensesAmt |
| PY Total Expenses | $17,673,058 | PYTotalExpensesAmt |
| CY Total Expenses | $18,266,996 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $920,001 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,426,260 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,930,606 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,488,763 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,957,120 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,941,537 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $973,486 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,452,774 | 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 | $1,690,830 | ExpenseAmt |
| Revenue | $4,793,765 | RevenueAmt |
| Desc | EMERGENCY DEPARTMENT- THE EMERGENCY DEPARTMENT AT FRMC TREATED JUST OVER 5,800 PATIENTS IN 2013 AND IS A LEVEL 4 TRAUMA DESIGNATED ER. THE EMERGENCY DEPARTMENT STRIVES TO CONTINUALLY IMPROVE THE QUALITY OF EMERGENCY MEDICINE THAT IS PROVIDED TO OUR COMMUNITY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,379,628 | ExpenseAmt |
| Revenue | $2,443,667 | RevenueAmt |
| Desc | HOME HEALTH- THE HOME HEALTH DEPARTMENT AT FRMC HAD OVER 22,300 SKILLED NURSING, PHYSICAL THERAPY, AND SPEECH THERAPY VISITS IN 2013. FRMC HOME HEALTH PROVIDES EXCEPTIONAL AT HOME NURSING AND THERAPY TO SEVERAL COUNTIES IN OUR COMMUNITY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,507,400 | ExpenseAmt |
| Revenue | $4,947,910 | RevenueAmt |
| Desc | INPATIENT ACUTE AND BEHAVIORAL HEALTH UNITS- FRMC PROVIDES EXCELLENT ACUTE INPATIENT CARE THROUGH OUR HOSPITALIST PROGRAM. OUR GERIATRIC BEHAVIORAL HEALTH PROGRAM TREATS PATIENTS 65 AND OVER WITH VARYING BEHAVIORAL PROBLEMS. BOTH UNITS COMBINED ADMITTED OVER 750 PATIENTS IN 2013. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,029,467 | ExpenseAmt |
| Revenue | $3,504,424 | RevenueAmt |
| Desc | LABORATORY AND OTHER PROGRAM EXPENSES | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $7,029,467 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $3,504,424 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $12,607,325 | 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 | Yes (true) | 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 | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 217 | 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 |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FIVE RIVERS MEDICAL CENTER | PersonNm |
| Phone | 8708926000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1 |
| City | POCAHONTAS | City |
| State | AR | State |
| ZIP Code | 72455 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
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 | 40.0 | Yes (X) | Yes (X) | $149,845 | $0 | $285 | |
| HAL S BARRE | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| GARY CROCKER | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| JEROL SWAIM | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| TERRY DICKSON | |||||||
| CHAIRMAN | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ALEX BALTZ | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| ANGIE CALDWELL | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| JOEY RADCLIFF | |||||||
| CFO | 40.0 | Yes (X) | $67,320 | $0 | $1,575 | ||
| MANDY DOLLINS | |||||||
| CNO | 40.0 | Yes (X) | $94,655 | $0 | $7,234 | ||
| JANE KUZAS | |||||||
| PHYSICIAN | 40.0 | $369,501 | $0 | $6,895 | Yes (X) | ||
| RITU GOTHWAL | |||||||
| PHYSICIAN | 32.0 | $182,329 | $0 | $0 | Yes (X) | ||
| ROBERT HALL | |||||||
| PHYSICIAN | 36.0 | $160,941 | $0 | $4,239 | Yes (X) | ||
| GINGER BALTZ | |||||||
| NURSE ANEST | 40.0 | $178,774 | $0 | $1,229 | Yes (X) | ||
| SCOTT LEWIS | |||||||
| PHYSICIAN | 40.0 | $241,707 | $0 | $5,877 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,445,072 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $27,334 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DIVERSIFIED CLINICAL SERVICES | |||||
| PO BOX 636981 | CINCINATTI | OH | 45263 | WOUND CARE MGMT | $223,160 |
| APOGEE | |||||
| 2525 E CAMELBACK ROAD STE 1100 | PHOENIX | AZ | 85016 | HOSPITALIST MGMT | $220,552 |
| ROBERT HALL | |||||
| 14808 HWY P | POPLAR BLUFF | MO | 63901 | ER PHYSICIAN | $150,211 |
| BKD LLP | |||||
| PO BOX 3667 | LITTLE ROCK | AR | 72203 | ACCOUNTING SERVICES | $120,389 |
| FRAN DUKE | |||||
| PO BOX 234 | NEWARK | AR | 72562 | ER PHYSICIAN | $114,927 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $78,118 | AllOtherContributionsAmt |
| Total Contributions | $78,118 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $14,879,028 | $14,879,028 |
| OTHER PROGRAM SERVICE REVENUE | 621110 | $810,738 | $810,738 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,689,766 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $12,700 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,000 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,700 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,700 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,700 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 900099 | $26,114 | $26,114 |
| PHARMACY SALES | 900099 | $1,696 | $1,696 |
| MEDICAL RECORDS/ABSTRACT | 900099 | $1,661 | $1,661 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,681 | TotalRevenueColumnAmt |
| Exclusion | $35,681 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $65,152 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,840,736 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,689,766 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $72,852 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,914 | TotalAmt |
| Management And General | $320,914 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,589,783 | TotalAmt |
| Program Services | $5,123,729 | ProgramServicesAmt |
| Management And General | $2,466,054 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $610,096 | TotalAmt |
| Program Services | $411,865 | ProgramServicesAmt |
| Management And General | $198,231 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $712,920 | TotalAmt |
| Program Services | $481,280 | ProgramServicesAmt |
| Management And General | $231,640 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $713,223 | TotalAmt |
| Program Services | $481,484 | ProgramServicesAmt |
| Management And General | $231,739 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,029 | TotalAmt |
| Program Services | $18,922 | ProgramServicesAmt |
| Management And General | $9,107 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,046 | TotalAmt |
| Program Services | $67,539 | ProgramServicesAmt |
| Management And General | $32,507 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,394,650 | TotalAmt |
| Program Services | $941,504 | ProgramServicesAmt |
| Management And General | $453,146 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,800 | TotalAmt |
| Program Services | $7,966 | ProgramServicesAmt |
| Management And General | $3,834 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $849,112 | TotalAmt |
| Program Services | $573,221 | ProgramServicesAmt |
| Management And General | $275,891 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $471,061 | TotalAmt |
| Program Services | $318,005 | ProgramServicesAmt |
| Management And General | $153,056 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,779 | TotalAmt |
| Program Services | $292,837 | ProgramServicesAmt |
| Management And General | $140,942 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,531 | TotalAmt |
| Program Services | $103,646 | ProgramServicesAmt |
| Management And General | $49,885 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $385,598 | TotalAmt |
| Program Services | $260,310 | ProgramServicesAmt |
| Management And General | $125,288 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,074,174 | TotalAmt |
| Program Services | $725,156 | ProgramServicesAmt |
| Management And General | $349,018 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,594 | TotalAmt |
| Program Services | $137,443 | ProgramServicesAmt |
| Management And General | $66,151 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $1,514,972 | $1,514,972 | |
| MEDICAL SUPPLIES | $966,939 | $652,763 | $314,176 |
| REPAIRS & MAINTENANCE | $365,237 | $246,565 | $118,672 |
| EDUCATION AND TRAINING | $28,721 | $19,389 | $9,332 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,817 | TotalAmt |
| Program Services | $228,729 | ProgramServicesAmt |
| Management And General | $110,088 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,266,996 | TotalAmt |
| Program Services | $12,607,325 | ProgramServicesAmt |
| Management And General | $5,659,671 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,225 | BOYAmt |
| EOY | $134,251 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,569,217 | BOYAmt |
| EOY | $1,788,248 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $497,688 | BOYAmt |
| EOY | $471,268 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,524 | BOYAmt |
| EOY | $38,316 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,512,193 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,519,350 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,663,652 | BOYAmt |
| EOY | $7,992,843 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,300 | BOYAmt |
| EOY | $63,837 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,930,606 | BOYAmt |
| EOY | $10,488,763 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,521,909 | BOYAmt |
| EOY | $2,763,516 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,435,211 | BOYAmt |
| EOY | $8,631,123 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $546,898 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,957,120 | BOYAmt |
| EOY | $11,941,537 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $973,486 | BOYAmt |
| EOY | -$1,452,774 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $973,486 | BOYAmt |
| EOY | -$1,452,774 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,930,606 | BOYAmt |
| EOY | $10,488,763 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,426,260 | 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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| 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 | $1,522 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,522 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE C, PART II-B, LINE 1i | FormAndLineReferenceDesc |
| Explanation | FRMC IS A MEMBER OF THE ARKANSAS HOSPITAL ASSOCIATION. THE ORGANIZATION PAID DUES OF $8,953 TO AHA DURING 2013, 17% OF WHICH WAS RELATED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
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 | $5,506,218 | OtherCostOrOtherBasisAmt |
| Depreciation | $741,847 | DepreciationAmt |
| Book Value | $4,764,371 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $310,728 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,085 | DepreciationAmt |
| Book Value | $268,643 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,511,724 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,731,898 | DepreciationAmt |
| Book Value | $2,779,826 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,960 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,520 | DepreciationAmt |
| Book Value | $5,440 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,992,843 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD PARTY PAYERS | Desc |
| Amt | $546,898 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $546,898 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $14,325,764 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $14,325,764 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,514,972 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,514,972 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,840,736 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,752,024 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $16,752,024 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,514,972 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,514,972 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,266,996 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| FORM 990, SCHEDULE D, PART XI, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS $1,514,972 |
| FORM 990, SCHEDULE D, PART XII, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS $1,514,972 |
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 | $416,289 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $416,289 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02490 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,472,734 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $952,678 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $520,056 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03100 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,889,023 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $952,678 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $936,345 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05590 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,109,780 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,279,392 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,830,388 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10930 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,109,780 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,279,392 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,830,388 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10930 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,998,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,232,070 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,766,733 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16520 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,514,972 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $357,563 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,918,992 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,492,291 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,573,299 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2801 MEDICAL CENTER DRIVE | AddressLine1 |
| City | POCAHONTAS | City |
| State | AR | State |
| ZIP Code | 72455 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FIVERIVERSMC.COM | WebsiteAddressTxt |
| State License | AR4720 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIVE RIVER MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.FIVERIVERSMC.COM | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | false | FPGUsedDeterEligFreeCareInd |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | 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 |
|---|---|
| FORM 990, SCHEDULE H, PART V, LINE 10 | THE ORGANIZATION ONLY PROVIDES DISCOUNTED CARE. IT DOES NOT PROVIDE FREE CARE. |
| FORM 990, SCHEDULE H, PART V, LINE 7 | EACH OF THE HEALTH NEEDS LISTED BELOW IS IMPORTANT AND IS BEING ADDRESSED IN PROGRAMS AND INITIATIVES OPERATED BY THIS 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 |
| FORM 990, SCHEDULE H, PART V, LINE 3 | 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. ALL INTERVIEWS WERE CONDUCTED BY BKD PERSONNEL USING A STANDARD QUESTIONNAIRE. A SUMMARY OF THEIR OPINIONS IS REPORTED WITHOUT JUDGING THE TRUTHFULNESS OR ACCURACY 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 HEALTH CARE 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 MEMBERS OF THE MEDICAL CENTER'S BOARD OF DIRECTORS AND MANAGEMENT, AND THE DISCUSSION WAS LED BY BKD PERSONNEL. FOCUS GROUP PARTICIPANTS DISCUSSED THE SAME TOPICS AS THE INTERVIEWEES. BKD PERSONNEL TOOK NOTES DURING THE DISCUSSION AND ANALYZED THE DATA FOR INCLUSION IN THE REPORT. |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE H, PART III, LINE 4 | 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 BAD DEBT WHEN THE RECEIVABLE IS OVER 90 DAYS FROM DISCHARGE. A CONSERVATIVE ESTIMATE OF 25% WAS CALCULATED AS THE BAD DEBT EXPENSE THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. |
| FORM 990, SCHEDULE H, PART VI, LINE 2 | FRMC COLLABORATES WITH OTHER LOCAL HEALTHCARE PROVIDERS TO ASSESS THE NEEDS OF OUR COMMUNITY. WE ALSO PARTICIPATE IN ANNUAL HEALTH FAIRS TO GATHER FEEDBACK REGARDING HEALTH ISSUES. |
| FORM 990, SCHEDULE H, PART VI, LINE 3 | 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 (2) ADDITIONAL LETTERS (AT NO LESS THAN TWENTY (20) 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. |
| FORM 990, SCHEDULE H, PART VI, LINE 4 | THE ORGANIZATION SERVES A SMALL, RURAL, DIVERSE COMMUNITY INCLUDING RANDOLPH COUNTY AND SURROUNDING COUNTIES. |
| FORM 990, SCHEDULE H, PART VI, LINE 5 | FRMC MAINTAINS AN OPEN MEDICAL STAFF AND THE GOVERNING BODY IS MADE UP OF VOLUNTARY LOCAL COMMUNITY MEMBERS ALONG WITH PHYSICIANS. THE ORGANIZATION 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. |
| FORM 990, SCHEDULE H, PART VI, LINE 7 | THE ORGANIZATION DOES NOT FILE A COMMUNITY BENEFIT REPORT. |
| FORM 990, SCHEDULE H, PART III, LINE 9B | THE HOSPITAL WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION EFFORTS 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 CURRENT ADDRESS ON FILE), NOTIFYING 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 (15) 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 (2) ADDITIONAL LETTERS (AT NO LESS THAN TWENTY (20) 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 (20) DAYS AFTER THE SECOND OF THE LETTERS REFERENCED ABOVE DURING THE EARLY OUT PROCESS, 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 (30) 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. LIMITATION ON CHARGES 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 POLICY, "AMOUNTS GENERALLY BILLED" WILL BE DETERMINED BASED ON AVERAGING THE THREE (3) LOWEST NEGOTIATED COMMERCIAL RATES FOR THOSE SERVICES AT THE HOSPITAL. THESE RATES WILL BE REVIEWED ANNUALLY. |
| FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F | BAD DEBT EXPENSE OF $1,514,972 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. |
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 (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LUTHER LEWIS | ||||||||||||||
| CEO | $149,845 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $285 | $0 | $150,130 | $0 | $0 | $0 |
| JANE KUZAS | ||||||||||||||
| PHYSICIAN | $357,351 | $0 | $0 | $0 | $12,150 | $0 | $0 | $0 | $6,895 | $0 | $376,396 | $0 | $0 | $0 |
| RITU GOTHWAL | ||||||||||||||
| PHYSICIAN | $182,329 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $182,329 | $0 | $0 | $0 |
| ROBERT HALL | ||||||||||||||
| PHYSICIAN | $160,941 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,239 | $0 | $165,180 | $0 | $0 | $0 |
| GINGER BALTZ | ||||||||||||||
| NURSE ANEST | $178,774 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,229 | $0 | $180,003 | $0 | $0 | $0 |
| SCOTT LEWIS | ||||||||||||||
| PHYSICIAN | $241,707 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $5,877 | $0 | $247,584 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE J, PART I, LINE 1A | $1,740 IN COUNTRY CLUB DUES TO THE ROLLING HILLS COUNTRY CLUB FOR LUTHER LEWIS. ALL PERSONAL AMOUNTS WERE PAID DIRECTLY BY LUTHER LEWIS. |
| FORM 990, SCHEDULE J, PART I, LINES 5A & 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: CONDITION 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 CONDITION WILL EARN INCENTIVE PAY OF $10,000 AND WILL GIVE MR. LEWIS THE OPPORTUNITY TO EARN ADDITIONAL INCENTIVE PAY. CONDITION 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. CONDITION 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. CONDITION 4: INCREASED NET REVENUES. TRAILING TWELVE MONTH 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 L IRS990ScheduleL
Grnt Asst Bnft Interested Prsn GrntAsstBnftInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Cash GrantCashGrantAmt | Type Of AssistanceTypeOfAssistanceTxt | Assistance PurposeAssistancePurposeTxt |
|---|---|---|---|
| JOEY RADCLIFF | |||
| CFO | $1,367 | EDUCATIONAL ASSISTANCE | TUITION PAYMENTS |
| MANDY DOLLINS | |||
| CNO | $8,868 | EDUCATIONAL ASSISTANCE | TUITION PAYMENTS |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CFO REVIEWS THE FORM 990 BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | THE COMPENSATION FOR THE CEO AND OTHER OFFICERS IS DETERMINED USING COMPARABLE AHA WAGE DATA. THE BOARD OF DIRECTORS APPROVES THE CEO'S SALARY. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR SHALL, AT THEIR FIRST REGULAR MEETING OF THE BOARD OF DIRECTORS OF EACH 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. |