DELTA MEMORIAL HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- DELTA MEMORIAL HOSPITAL (EIN 71-0276839)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-15
- IRS object ID
- 201211369349302501
- Schema version
- 2010v3.4
- 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 M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-15T09:41:55-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7601 FRANCE AVENUE SOUTH SUITE 400 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 710276839 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DELT | NameControl |
| Phone | 8703824303 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 811 HWY 65 S | AddressLine1 |
| City | DUMAS | City |
| State | AR | State |
| ZIP Code | 71639 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHRIS BOLIN | Name |
| Title | ADMINISTRATOR | Title |
| Phone | 8703824303 | Phone |
| Date Signed | 2012-05-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RICHARD RUVELSON | Name |
| Phone | 9525483400 | Phone |
| Date Prepared | 2012-05-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CRIS BOLIN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 811 HWY 65 S | AddressLine1 |
| City | DUMAS | City |
| State | AR | State |
| ZIP Code | 71639 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 17340476 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DELTAMEM.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1975 | YearFormation |
| State Legal Domicile | AR | StateLegalDomicile |
| Activity Or Mission Description | AT DELTA MEMORIAL HOSPITAL, WE ARE COMMITTED TO AID HEALING AND PROMOTE WELLNESS FOR SOUTHEAST ARKANSAS IN A COURTEOUS, COST-EFFECTIVE AND CARING MANNER. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 215 | TotalNbrEmployees |
| Total Nbr Volunteers | 32 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 84860 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 329934 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17181214 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16776240 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2924 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3413 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 90311 | OtherRevenuePriorYear |
| Other Revenue Current Year | 230889 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17359309 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17340476 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7528112 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8123428 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9092265 | OtherExpensePriorYear |
| Other Expenses Current Year | 8674634 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 16620377 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16798062 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 738932 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 542414 | RevenuesLessExpensesCY |
| Total Assets BOY | 15350822 | TotalAssetsBOY |
| Total Assets EOY | 15620689 | TotalAssetsEOY |
| Total Liabilities BOY | 6033483 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5760936 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9317339 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9859753 | NetAssetsOrFundBalancesEOY |
| Mission Description | AT DELTA MEMORIAL HOSPITAL, WE ARE COMMITTED TO AID HEALING AND PROMOTE WELLNESS FOR SOUTHEAST ARKANSAS IN A COURTEOUS, COST-EFFECTIVE AND CARING MANNER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14783139 | Expense |
| Revenue | 16776240 | Revenue |
| Description | DELTA MEMORIAL HOSPITAL PROVIDES MEDICAL HEALTH CARE SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR ABILITY TO PAY. DELTA MEMORIAL HOSPITAL HAD 4,248 INPATIENT DAYS DURING THE FISCAL YEAR. THE ORGANIZATION HAD 12,732 CLINIC VISITS AND HOME HEALTH SERVED 15,862 INDIVIDUALS. | Description |
| Total Program Service Expense | 14783139 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 29 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 215 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRIS BOLIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8703824303 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 811 HWY 65 S | AddressLine1 |
| City | DUMAS | City |
| State | AR | State |
| ZIP Code | 71639 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES BERRY | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| TIMOTHY JONES | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| GLENN CROW | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| BENNY ESTES | |||||||
| VICE-CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | |
| DON LIVINGSTON | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | |
| DR THOMAS LEWELLEN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| CRIS BOLIN | |||||||
| ADMINISTRATOR | 40.00 | 115042 | 0 | 14802 | X | ||
| DR F DAVID CHAMBERS | |||||||
| PHYSICIAN | 40.00 | 818449 | 0 | 14802 | X | ||
| DR PETER GO | |||||||
| PHYSICIAN | 40.00 | 482538 | 0 | 11339 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1416029 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 40943 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BALLARD ISHEE CORPORATION | |||||
| 100 RAVENWOOD PLACE | HOT SPRINGS | AR | 71901 | CRNA SERVICES | 547500 |
| THEREX INC | |||||
| DEPT 95270 | ATLANTA | GA | 31192 | PHYSICAL THERAPY SERVICES | 515085 |
| DELTA SURGERY PA | |||||
| PO BOX 399 | DUMAS | AR | 71639 | ER COVERAGE | 208500 |
| THOMAS LEWELLEN PA | |||||
| PO BOX 128 | DUMAS | AR | 71639 | ER COVERAGE | 196600 |
| CPP WOUND CARE | |||||
| 3017 N CAUSEWAY BLVD | METAIRE | LA | 70002 | WOUND CLINIC SERVICES & MGMT | 190100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 25153 | GovernmentGrants |
| All Other Contributions | 304781 | AllOtherContributions |
| Noncash Contributions | 138000 | NoncashContributions |
| Total Contributions | 329934 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621990 | 15998344 | 15998344 |
| ARKANSAS STATE ASSESSM | 621990 | 766699 | 766699 |
| MEDICAL RECORDS REVENU | 900099 | 11197 | 11197 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16776240 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3221 | TotalRevenueColumn |
| Exclusion | $3,221 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 192 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 192 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192 | TotalRevenueColumn |
| Exclusion | $192 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| IRS PENALY REFUND | 900099 | 82126 | $82,126 |
| MEAL AND VENDING REVEN | 900099 | 59366 | $59,366 |
| INSURANCE CASUALTY GAI | 900099 | 43145 | $43,145 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46252 | TotalRevenueColumn |
| Exclusion | $46,252 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 230889 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17340476 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16776240 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $234,302 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129307 | Total |
| Management And General | 129307 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6896982 | Total |
| Program Services | 6054353 | ProgramServices |
| Management And General | 842629 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6247 | Total |
| Program Services | 5484 | ProgramServices |
| Management And General | 763 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 589640 | Total |
| Program Services | 517602 | ProgramServices |
| Management And General | 72038 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 501252 | Total |
| Program Services | 432788 | ProgramServices |
| Management And General | 68464 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31900 | Total |
| Management And General | 31900 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61187 | Total |
| Management And General | 61187 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2644724 | Total |
| Program Services | 2306395 | ProgramServices |
| Management And General | 338329 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12344 | Total |
| Management And General | 12344 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 851635 | Total |
| Program Services | 785685 | ProgramServices |
| Management And General | 65950 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 644325 | Total |
| Program Services | 544539 | ProgramServices |
| Management And General | 99786 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80487 | Total |
| Program Services | 78302 | ProgramServices |
| Management And General | 2185 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 285492 | Total |
| Program Services | 241915 | ProgramServices |
| Management And General | 43577 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 820704 | Total |
| Program Services | 693587 | ProgramServices |
| Management And General | 127117 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 255151 | Total |
| Program Services | 215636 | ProgramServices |
| Management And General | 39515 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 2465038 | 2465038 | |
| PATIENT SERVICES | 346395 | 346395 | |
| OTHER | 155981 | 95420 | 60561 |
| RECRUITMENT MGMT | 19271 | 19271 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16798062 | Total |
| Program Services | 14783139 | ProgramServices |
| Management And General | 2014923 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 211923 | BOY |
| EOY | 51544 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 273172 | BOY |
| EOY | 201477 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3560835 | BOY |
| EOY | 4621448 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 183837 | BOY |
| EOY | 223647 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55813 | BOY |
| EOY | 73508 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 16418458 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6148649 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11023986 | BOY |
| EOY | 10269809 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41256 | BOY |
| EOY | 179256 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15350822 | BOY |
| EOY | 15620689 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2306887 | BOY |
| EOY | 2388607 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2978397 | BOY |
| EOY | 2754338 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 476140 | BOY |
| EOY | 289705 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 272059 | BOY |
| EOY | 328286 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6033483 | BOY |
| EOY | 5760936 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1052031 | BOY |
| EOY | 1988813 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8265308 | BOY |
| EOY | 7870940 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9317339 | BOY |
| EOY | 9859753 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15350822 | BOY |
| EOY | 15620689 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 542414 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,372 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4372 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | A PORTION OF THE DUES PAID TO ARKANSAS HOSPITAL ASSOCIATION IS FOR LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 105910 | OtherCostOrOtherBasis |
| Book Value | 105910 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12407940 | OtherCostOrOtherBasis |
| Depreciation | 3288959 | Depreciation |
| Book Value | 9118981 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3711443 | OtherCostOrOtherBasis |
| Depreciation | 2859690 | Depreciation |
| Book Value | 851753 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 193165 | OtherCostOrOtherBasis |
| Book Value | 193165 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10269809 | TotalOfBookValueLandBuildings |
| Total Revenue | 17340476 | TotalRevenue |
| Total Expenses | 16798062 | TotalExpenses |
| Excess Or Deficit For Year | 542414 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 542414 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 17340476 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 17340476 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 17340476 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 16798062 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 16798062 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 16798062 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. THE ORGANIZATION'S FEDERAL INFORMATIONAL RETURNS FOR TAX YEARS 2007 AND SUBSEQUENT YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 0.0 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 219797 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 219797 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4459127 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3519636 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 939491 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06550 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4678924 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3519636 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1159288 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08080 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 31420 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 31420 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 31420 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 31420 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4710344 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3519636 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1190708 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08300 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,433,162 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5738402 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6269751 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -531349 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 811 HWY 65 S | AddressLine1 |
| City | DUMAS | City |
| State | AR | State |
| ZIP Code | 71639 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELTA MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | Return ReferenceReturnReference |
|---|---|
| PART I, LINE 3C: ELIGIBILITY CRITERIA FOR DISCOUNTED CARE TO LOW INCOME INDIVIDUALS IS AS FOLLOWS: 80% DISCOUNT AT 125% OF FPG, 60% DISCOUNT AT 150% OF FPG, 40% DISCOUNT AT 175% OF FPG, 20% DISCOUNT AT 200% OF FPG. | |
| PART I, LINE 7: PART I, LINE 7: THE ORGANIZATION USES A COST TO CHARGE METHODOLOGY AS DETERMINED BY WORKSHEET 2 OF THE INSTRUCTIONS. | |
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2465038. | |
| AS ALLOWED, THE DENOMINATOR HAS BEEN REDUCED BY $2,465,038, THE AMOUNT OF BAD DEBT REPORTED IN PART IX, LINE 25 OF FORM 990. | FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F |
| PART II: DELTA MEMORIAL HOSPITAL PROVIDES A VARIETY OF PROGRAMS THAT PROMOTE HEALTH WITHIN THE COMMUNITIES IT SERVES. DELTA PROVIDED PHYSICALS TO DUMAS PUBLIC SCHOOLS. DELTA ALSO HAD FAMILY NIGHT OUTREACH WITH 3 RNS AND 3 LPNS WENT OUT INTO THE COMMUNITY. ANOTHER PROGRAM THAT PROMOTES HEALTH IN THE COMMUNITY IS THE PRESCRIPTION ASSISTANCE PROGRAM. | |
| PART III, LINE 4: THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. | |
| PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. | |
| PART III, LINE 9B: PATIENTS THAT QUALIFY FOR CHARITY CARE ARE NOT PUT THROUGH COLLECTION PROCESS FOR THE AMOUNT THAT QUALIFIES FOR CHARITY CARE. | |
| PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH CONTRACTED RESEARCH SERVICES. | |
| PART VI, LINE 3: AT ADMISSIONS CHARITY CARE IS OFFERED. OUR SOCIAL SERVICES COORDINATOR IS AVAILABLE TO WORK WITH OUR BUSINESS OFFICE MANAGER ON OTHER FORMS OF ASSISTANCE. | |
| PART VI, LINE 4: WE ARE A CRITICAL ACCESS HOSPITAL, AND SERVE AN UNDERSERVED POPULATION IN DUMAS, ARKANSAS. DUMAS, ARKANSAS IS LOCATED IN DESHA COUNTY. DESHA COUNTY HAS A MEDIAN INCOME OF $27,555 AS OF 2008 WITH 29% OF PERSONS BELOW THE POVERTY LEVEL. | |
| PART VI, LINE 6: THE BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA. THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY BY ACCOMODATING ANY FINANCIAL CONCERNS THROUGH THE CHARITY CARE PROGRAM. | |
| PART VI, LINE 7: N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR F DAVID CHAMBERS | |||||||||||||
| 588449 | 0 | 57500 | 0 | 172500 | 0 | 0 | 0 | 14802 | 0 | 833251 | 0 | 0 | 0 |
| DR PETER GO | |||||||||||||
| 435708 | 0 | 46830 | 0 | 0 | 0 | 0 | 0 | 11339 | 0 | 493877 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | DR. DAVID CHAMBERS IS PAID A CERTAIN DOLLAR AMOUNT FOR EACH PATIENT SEEN IN THE CLINIC. DR. CHAMBERS ALSO RECEIVES COMPENSATION THROUGH A CONTRACT FOR ER COVERAGE. HE RECEIVED $172,500 FOR HIS ER COVERAGE SERVICES. THE 1099 PAYMENT RECEIVED IS INCLUDED IN OTHER COMPENSATION ABOVE. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCHANT & FARMERS BANK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Purpose Of Loan | CLINIC AND EQUIPMENT FINANCING | PurposeOfLoan |
| Loan To Organization | X | LoanToOrganization |
| Original Principal | $3,000,000 | OriginalPrincipalAmount |
| Balance Due | 2754338 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 2754338 | TotalBalanceDue |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercial
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 138000 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | NO COMMITTEE OF THE GOVERNING BODY HAS AUTHORITY TO ACT WITHOUT BOARD APPROVAL. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL AFTER SUBMISSION. | |
| THE ORGANIZATION REQUIRES DISCLOSURE OF ANY CONFLICTS OF INTEREST ANNUALLY AT THE EMPLOYEE COMPLIANCE MEETINGS AND AT THE ANNUAL BOARD MEETING. | FORM 990, PART VI, SECTION B, LINE 12C | |
| A COMPARISON TO MARKET INFORMATION AVAILABLE THROUGH VARIOUS MEMBERSHIP ASSOCIATIONS IS USED TO DETERMINE COMPENSATION FOR THE ADMINISTRATOR AND OTHER TOP MANAGEMENT. THE COMPARATIVE INFORMATION IS REVIEWED BY THE BOARD OF DIRECTORS AND COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT THE MONTHLY PUBLIC BOARD MEETINGS. | FORM 990, PART VI, SECTION C, LINE 19 | |
| THE BOARD OF DIRECTORS OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. | FORM 990, PART XII, LINE 2C |
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