DELTA MEMORIAL HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: DELTA MEMORIAL HOSPITAL (EIN 71-0276839)
Tax period: 2009-07-01 to 2010-06-30
Filed: 2011-05-16
IRS object ID: 201101369349303150
Schema version: 2009v1.7
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)
Timestamp	2011-05-16T11:09:05-05:00	Timestamp
Tax Period End Date	2010-06-30	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	2009-07-01	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	Cris Bolin	Name
Title	Administrator	Title
Phone	8703824303	Phone
Date Signed	2011-05-13	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Richard Ruvelson	Name
Phone	9525483400	Phone
Date Prepared	2011-05-13	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2009	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	17390241	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c	X	Organization501c
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	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	4	NbrIndependentVotingMembers
Total Nbr Employees	199	TotalNbrEmployees
Total Nbr Volunteers	25	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	111998	ContributionsGrantsPriorYear
Contributions Grants Current Year	84860	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	13093376	ProgramServiceRevenuePriorYear
Program Service Revenue CY	17181214	ProgramServiceRevenueCY
Investment Income Prior Year	17036	InvestmentIncomePriorYear
Investment Income Current Year	2924	InvestmentIncomeCurrentYear
Other Revenue Prior Year	61510	OtherRevenuePriorYear
Other Revenue Current Year	90311	OtherRevenueCurrentYear
Total Revenue Prior Year	13283920	TotalRevenuePriorYear
Total Revenue Current Year	17359309	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	5717327	SalariesEtcPriorYear
Salaries Etc Current Year	7528112	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	9019891	OtherExpensePriorYear
Other Expenses Current Year	9092265	OtherExpensesCurrentYear
Total Expenses Prior Year	14737218	TotalExpensesPriorYear
Total Expenses Current Year	16620377	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-1453298	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	738932	RevenuesLessExpensesCY
Total Assets BOY	15373386	TotalAssetsBOY
Total Assets EOY	15350822	TotalAssetsEOY
Total Liabilities BOY	6794979	TotalLiabilitiesBOY
Total Liabilities EOY	6033483	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	8578407	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	9317339	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	14863903	Expense
Revenue	17181214	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 3568 inpatient days during the fiscal year. The organization had 10,506 clinic visits and Home Health served 15,080 individuals.	Description
Total Program Service Expense	14863903	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
Balance Sheet Amounts Reported	1	BalanceSheetAmountsReported
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
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	1	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	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
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	26	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	199	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
Nbr Voting Governing Body Members	7	NbrVotingGoverningBodyMembers
Number Independent Voting Members	4	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	1	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 (11 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
Cobra Shanley DO
Director	1.00	X	61000	0	0
Bruce Gasaway
director	1.00	X	0	0	0
Dr Thomas Lewellen
director	1.00	X	248500	0	0
Cris Bolin
Administrator	40.00		92626	0	10324	X
Dr F David Chambers
Physician	40.00		808192	0	14390		X
Dr Peter Go
Physician	40.00		627821	0	8907		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1838139	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	33621	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
Tree Frog Industries Inc
2840 Hwy 95 Alt South 7	Silver Springs	NV	89429	ER Physician Services	971400
Ballard Ishee Corporation
125 Carlton Dr	Dumas	AR	71639	Professional Services	536700
Therex Inc
Dept AT 952740	Atlanta	GA	31192	Physical Therapy Services	532907
CPP Wound Care
3017 N Causeway Blvd	Metairie	LA	70002	Professional Services	231840
Quality Health Network
334 E Farrell Rd	Lafayette	LA	70508	Administrative Management	177594

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
Fundraising Events	7450	FundraisingEvents
All Other Contributions	77410	AllOtherContributions
Total Contributions	84860	TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenu	621990	16075289	16075289
Arkansas State Assessm	621990	1098871	1098871
Medical Records Revenu	900099	5254	5254
Clinic Rents	531120	1800	1800

Field	Value	IRS element (for citing)
Total Program Service Revenue	17181214	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	25005	TotalRevenueColumn
Exclusion	$25,005	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	4848	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	26929	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	-22081	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-22081	TotalRevenueColumn
Exclusion	-$22,081	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	3797	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	7450	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	4003	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	-206	TotalRevenueColumn
Exclusion	-$206	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
Meal and Vending Reven	900099	56468	$56,468
County Tax Millage	900099	34049	$34,049

Field	Value	IRS element (for citing)
Total Other Revenue	90517	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	17359309	TotalRevenueColumn
Related Or Exempt Function Income	17181214	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$93,235	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	112562	Total
Management And General	112562	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	6485142	Total
Program Services	5639873	ProgramServices
Management And General	845269	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	12882	Total
Program Services	11203	ProgramServices
Management And General	1679	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	490280	Total
Program Services	426377	ProgramServices
Management And General	63903	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	427246	Total
Program Services	365586	ProgramServices
Management And General	61660	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	43712	Total
Management And General	43712	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	40661	Total
Management And General	40661	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2975096	Total
Program Services	2905718	ProgramServices
Management And General	69378	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	7627	Total
Management And General	7627	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	982435	Total
Program Services	891006	ProgramServices
Management And General	91429	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	599840	Total
Program Services	506943	ProgramServices
Management And General	92897	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	117442	Total
Program Services	96665	ProgramServices
Management And General	20777	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	277375	Total
Program Services	234418	ProgramServices
Management And General	42957	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	830232	Total
Program Services	701655	ProgramServices
Management And General	128577	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	227757	Total
Program Services	192485	ProgramServices
Management And General	35272	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Bad Debt Expense	2411620	2411620
Patient Service Costs	430287	430287
Other Expense	148181	50067	98114

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	16620377	Total
Program Services	14863903	ProgramServices
Management And General	1756474	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	129586	BOY
EOY	211923	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	320802	BOY
EOY	273172	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2836296	BOY
EOY	3560835	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	183733	BOY
EOY	183837	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	37353	BOY
EOY	55813	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	16351931	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	5327945	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	11824360	BOY
EOY	11023986	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	41256	BOY
EOY	41256	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	15373386	BOY
EOY	15350822	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2605372	BOY
EOY	2306887	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	19451	BOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
EOY	2978397	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	3814839	BOY
EOY	476140	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	355317	BOY
EOY	272059	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	6794979	BOY
EOY	6033483	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	-81269	BOY
EOY	1052031	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	8659676	BOY
EOY	8265308	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	8578407	BOY
EOY	9317339	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	15373386	BOY
EOY	15350822	EOY

Field	Value	IRS element (for citing)
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	$6,105	OtherActivitiesAmount
Total Lobbying Expenditures IIB	6105	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Part II-B, Line 1i:	Identifier
Return Reference	Explanation of Other Lobbying Activities:	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	2800726	Depreciation
Book Value	9607214	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3644173	OtherCostOrOtherBasis
Depreciation	2527219	Depreciation
Book Value	1116954	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	193908	OtherCostOrOtherBasis
Book Value	193908	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	11023986	TotalOfBookValueLandBuildings
Total Revenue	17359309	TotalRevenue
Total Expenses	16620377	TotalExpenses
Excess Or Deficit For Year	738932	ExcessOrDeficitForYear
Total Adjustments	0	TotalAdjustments
Excess Or Deficit Per FS	738932	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	17757680	TotRevenueEtcAuditedFinclStmt
Other Revenues	398371	OtherRevenues
Revenue Not Rptd F990	398371	RevenueNotRptdF990
Revenue Subtotal	17359309	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	17359309	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	16624380	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	4003	OtherExpensesIncluded
Expenses Not Rptd F990	4003	ExpensesNotRptdF990
Expenses Subtotal	16620377	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	16620377	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Part X:	Description of Uncertain Tax Positions Under FIN 48:	The organization recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits. Federal and state returns for 2007 and subsequent years remain subject to examination by major tax jurisdictions.
Part XII, Line 2d - Other Adjustments:		Fundraising Expense: 4003. Net assets released from restrictions - Used for operations: 394368.
Part XIII, Line 2d - Other Adjustments:		Fundraising Expense: 4003.

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

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	253735	TotalCommunityBenefitExpense
Net Community Benefit Expense	253735	NetCommunityBenefitExpense
Percent Of Total Expense	0.01790	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3016942	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2714349	DirectOffsettingRevenue
Net Community Benefit Expense	302593	NetCommunityBenefitExpense
Percent Of Total Expense	0.02130	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3270677	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2714349	DirectOffsettingRevenue
Net Community Benefit Expense	556328	NetCommunityBenefitExpense
Percent Of Total Expense	0.03920	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	191432	TotalCommunityBenefitExpense
Net Community Benefit Expense	191432	NetCommunityBenefitExpense
Percent Of Total Expense	0.01350	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	191432	TotalCommunityBenefitExpense
Net Community Benefit Expense	191432	NetCommunityBenefitExpense
Percent Of Total Expense	0.01350	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3462109	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2714349	DirectOffsettingRevenue
Net Community Benefit Expense	747760	NetCommunityBenefitExpense
Percent Of Total Expense	0.05270	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$2,001,053	BadDebtExpenseAmount
Amount Attributable To	1074582	AmountAttributableTo
Amount Reimbursed By Medicare	5350747	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	5949540	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-598793	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

Form990 Schedule H Part V Form990ScheduleHPartV

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 VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Income Based Criteria	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.	IncomeBasedCriteria
Costing Method Used	Part I, Line 7: Part I, Line 7: The organization uses a cost to charge methodology as determined by worksheet 2 of the instructions.	CostingMethodUsed
Percent Of Total Expense Expln	Part I, Line 7f: PART I, LINE 7, COLUMN F: AS ALLOWED, THE DENOMINATOR HAS BEEN REDUCED BY $2,411,620, THE AMOUNT OF BAD DEBT REPORTED IN PART IX, LINE 25 OF FORM 990.	PercentOfTotalExpenseExpln
Bad Debt Footnote	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.	BadDebtFootnote
Shortfall As Community Benefit	Part III, Line 8: The costing methodology used is cost to charge ratio as required by medicare.	ShortfallAsCommunityBenefit
Debt Collection Policy	Part III, Line 9b: Patients that qualify for charity care are not put through collection process for the amount that qualifies for charity care.	DebtCollectionPolicy
Needs Assessment	Part VI, Line 2: The organization assesses the health care needs of the community it serves through contracted research services.	NeedsAssessment
Patient Education Assistance	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.	PatientEducationAssistance
Community Information	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.	CommunityInformation
Community Building Activities	Part VI, Line 5: 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.	CommunityBuildingActivities
Other Information	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.	OtherInformation
Affiliated Health Care System	Part VI, Line 7: N/A	AffiliatedHealthCareSystem

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (3 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 Thomas Lewellen
0	0	0	0	248500	0	0	0	0	0	248500	0	0	0
Dr F David Chambers
574492	0	0	0	233700	0	0	0	14390	0	822582	0	0	0
Dr Peter Go
372921	0	0	0	254900	0	0	0	8907	0	636728	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 7	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 $135,400 for his ER Coverage services. He does not receive any other compensation from the organization.
Part III	Dr. David Chambers, Dr. Peter Go, DR. Thomas L Lewellen and Dr. Cobra Shanley received wages from a third party vendor named tree frog LLc for emergency room services rendered to delta Memorial Hospital. Dr. Chambers and Dr. Go are also employees of Delta Memorial Hospital. Dr. Lewellen and Dr. Shanley are board members of Delta Memorial Hospital. Dr. Chambers received $98,300, Dr. Go received $106,900, Dr. Lewellen received $103,200 and Dr. Shanley received $45,600.	Supplemental Information

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoan	Loan To OrganizationLoanToOrganization	Original PrincipalOriginalPrincipalAmount	Balance DueBalanceDue	DefaultDefault	Approved By BoardApprovedByBoard	Written AgreementWrittenAgreement
Merchant & Farmers Bank
Line of Credit	X	$750,000	150000	0	0	1
Merchant & Farmers Bank
clinic and equipment financing	X	$3,000,000	2828397	0	0	1

Field	Value	IRS element (for citing)
Total Balance Due	2978397	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	Bruce Gasaway	NamePerson

Field	Value	IRS element (for citing)
Relationship	Board Member of Organizaton and insurance broker of organization	Relationship
Amount Of Transaction	71603	AmountOfTransaction
Description Of Transaction	Insurance purchased through bruce gasaway an insurance broker. In the course of doing business, applications were sent to various insurance carriers and the best available policy was determined.	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	ExplanationExplanation
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.
Form 990, Part VI, Section B, line 12c	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 15	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 C, line 19	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 XI, Line 2c	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 VII	Compensation reported for Cobra Shanley and Thomas L Lewellen, PA is per contract to provide ER coverage and not in their capacity as directors of the organization.