2024-05-08T12:45:54-05:00 2023-06-30 FORVIS LLP PO BOX 3667 LITTLE ROCK AR 722033667 990 2022-07-01 716044543 JOHN ED CHAMBERS MEMORIAL HOSPITAL INC % MICHAELLE CORNWELL JOHN 4794952241 PO BOX 639 DANVILLE AR 728330639 SCOTT PEEK CEO 4794952241 2024-05-06 true SCOTT PEEK 000000000 AMBER SHERRILL P00748683 5013721040 2 2022 2023-04-26 12:10:37Z SCOTT PEEK PO BOX 639 DANVILLE AR 728330639 22561288 false X WWW.CHAMBERSHOSPITAL.COM X 1998 AR IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS & EXPECTATIONS OF PATIENTS & COMMUNITIES. 7 7 326 7 0 0 1997552 256278 24136940 21772843 122743 167631 228342 297659 26485577 22494411 0 0 0 0 13104848 13385514 0 0 0 10704578 9921774 23809426 23307288 2676151 -812877 36542308 34664869 9580879 8516317 26961429 26148552 IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEEDS AND EXPECTATIONS OF PATIENTS AND THE COMMUNITIES SERVED. false false 19122472 0 21772843 IT IS THE GOAL OF CHAMBERS MEMORIAL HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES IN A COST EFFECTIVE MANNER THAT MEETS THE NEED AND EXPECTATIONS OF PATIENTS AND THE COMMUNITIES SERVED. 19122472 true true false true false false false false false false true false false false true false true false false false false false false false true false true true false false true true false false false false false false false false false false false false false false false false false false false true 42 0 true 326 true false false false false false false false false false false false false X 7 7 false false false false false false false true true false false true true true true false true true true false AR X MICHAELLE CORNWELL 4794956219 719 DETROIT AVENUE DANVILLE AR 728330639 X FREDERICK PERKINS JR PHYSICIAN - SURGEON 40.0 0.0 X 361191 0 16006 SCOTT PEEK CEO 40.0 0.0 X 341303 0 29348 WILLIAM L BERRY PHYSICIAN 32.0 0.0 X 188720 0 22852 JOHN WESTWOOD PHYSICIAN 32.0 0.0 X 172414 0 8135 KARL SANDBERG PHYSICIAN 32.0 0.0 X 158620 0 8489 JOSHUA MANATT PHYSICIANS ASSISTANT 36.0 0.0 X 159862 0 6913 MICHAELLE CORNWELL CFO 40.0 0.0 X 98357 0 13907 DAVID FISHER VICE CHAIRMAN 1.0 0.0 X X 0 0 0 JOHNNY CHAMBERS CHAIRMAN 1.0 0.0 X X 0 0 0 PHILLIP ALEXANDER DIRECTOR 1.0 0.0 X 0 0 0 RITCHIE TIPPIN DIRECTOR 1.0 0.0 X 0 0 0 ROBERT REDFERN SECRETARY 1.0 0.0 X X 0 0 0 TODD SANDERS DIRECTOR 1.0 0.0 X 0 0 0 TOMMY PAPASAN DIRECTOR 1.0 0.0 X 0 0 0 1480467 0 105650 21 false true false EMERGENCY STAFFING SOLUTIONS 17304 PRESTON RD SUITE 1400 DALLAS TX 75252 PHYSICIAN STAFFING 1454400 SIGNET PO BOX 670697 DALLAS TX 75267 BHU HEALTH MGMT 527072 RIVER RIDGE RX PO BOX 394 DANVILLE AR 72833 PHARMACY SERVICES 324250 RURAL ANESTHESIA 1100 S VANCOUVER AVE RUSSELLVILLE AR 72801 ANESTHESIA SERVICES 300000 TRS MANAGED PO BOX 674820 DALLAS TX 75267 NURSE STAFFING 159582 7 20670 83855 151753 256278 PATIENT SERVICES 622110 21251130 21251130 340B REVENUE 622110 284180 284180 MANAGED CARE FEES 622110 229653 229653 MEDICAL OFFICE BUILDING RENT 531120 7880 7880 21772843 167631 167631 0 0 0 0 0 0 22980 20670 26180 -3200 -3200 0 0 0 51304 40697 10607 10607 CAFETERIA REVENUE 722310 148117 148117 SETTLEMENT REVENUE 900099 67454 67454 REBATES 900099 9609 9609 65072 65072 290252 22494411 21772843 465290 X 0 0 0 0 449460 449460 0 10941860 8635810 2306050 303754 239736 64018 895505 706773 188732 794935 627399 167536 0 0 89612 70726 18886 0 0 0 3891504 3812024 79480 0 54912 43339 11573 244171 192711 51460 14653 11565 3088 0 334099 263686 70413 129087 101881 27206 0 0 405913 320365 85548 0 1489598 1175658 313940 332967 262793 70174 OPERATING SUPPLIES 1347613 1347613 REPAIRS & MAINTENANCE 465160 367125 98035 EQUIPMENT EXPENSE 355099 280260 74839 PROVIDER ASSESSMENT TAX 272130 272130 495256 390878 104378 23307288 19122472 4184816 0 3621357 1749814 7545706 9162956 0 0 4019972 4090860 0 0 0 0 0 0 320872 309203 157287 28906 43068780 23813148 20539018 19255632 0 0 0 0 0 0 0 0 338096 67498 36542308 34664869 1621841 1398823 0 0 32000 0 7890677 7043002 0 0 0 0 36361 0 0 0 0 74492 9580879 8516317 X 26961429 26148552 0 0 26961429 26148552 36542308 34664869 -812877 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1822 1822 false false FORM 990, SCHEDULE C, PART II-B, LINE 1I CHAMBERS MEMORIAL HOSPITAL PAID DUES OF $10,716 TO THE ARKANSAS HOSPITAL ASSOCIATION OF WHICH $1,822 (17%) WAS RELATED TO LOBBYING. 1229124 1229124 26234079 16195708 10038371 488821 228297 260524 15116756 7389143 7727613 19255632 0 LEASE LIABILITY 74492 74492 22561288 66877 66877 22494411 22494411 23374165 66877 66877 23307288 23307288 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 INCOME TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. FORM 990, SCHEDULE D, PART XI, LINE 2D FUNDRAISING EXPENSE $26,180 COST OF GOODS SOLD $40,697 ----------------------------------------- TOTAL $66,877 FORM 990, SCHEDULE D, PART XII, LINE 2D FUNDRAISING EXPENSE $26,180 COST OF GOODS SOLD $40,697 ----------------------------------------- TOTAL $66,877 GOLF TOURNAMENT 43650 20670 22980 0 21870 2500 1110 0 700 0 43650 20670 22980 0 21870 2500 1110 0 700 26180 -3200 true true X true X 110. true X true true true false true true 343568 343568 0.01470 2306135 2005085 301050 0.01300 2649703 2005085 644618 0.02770 5033447 4223699 809748 0.03480 5033447 4223699 809748 0.03480 7683150 6228784 1454366 0.06250 true 7324703 5628688 1696015 X true true 1 1 CHAMBERS MEMORIAL HOSPITAL 719 DETROIT AVE DANVILLE AR 728330639 WWW.CHAMBERSHOSPITAL.COM AR4825 X X X CHAMBERS MEMORIAL HOSPITAL false false true X X X X X X X X X 21 true false false true X SEE PART V, SECTION C true 21 true SEE PART V, SECTION C false true X 110. 200. X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 DIALOGUES WITH KEY INTERVIEWEES WERE CONDUCTED NOVEMBER 2021 THROUGH JUNE 2022. INTERVIEWEES WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH OR THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. INTERVIEWS WERE CONDUCTED VIA TELEPHONE, OR THE INTERVIEWEE ANSWERED THE INTERVIEW QUESTIONS VIA EMAIL; WHICHEVER WAS MORE CONVENIENT FOR THE INTERVIEWEE. ALL INTERVIEWS WERE CONDUCTED BY FORVIS PERSONNEL USING A STANDARD QUETIONNAIRE. A COPY OF THE INTERVIEW INSTRUMENT IS INCLUDED IN THE APPENDIX. 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 PRIMARY COMMUNITY -BARRIERS TO IMPROVING HEALTH AND QUALITY OF LIFE FOR RESIDENTS OF THE PRIMARY 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 HEALTHCARE ISSUES OR SERVICES DISCUSSED AND ACTIONS NECESSARY FOR ADDRESSING THOSE ISSUES INTERVIEW DATA WAS INITIALLY RECORDED IN BOTH WRITTEN AND NARRATIVE FORM. THEMES IN THE DATA WERE IDENTIFIED AND REPRESENTATIVE QUOTES HAVE BEEN DRAWN FROM THE DATA TO ILLUSTRATE THE THEMES. INTERVIEWEES WERE ASSURED THAT PEROSAL IDENTIFIERS SUCH AS NAME OR ORGANIZATIONAL AFFILIATIONS WOULD NOT BE CONNECTED IN ANY WAY TO TH EINFORMATION PRESENTED IN THIS REPORT. THIS TECHNIQUE DOES NOT PROVIDE A QUANTITATIVE ANALYSIS OF THE LEADERS' OPINONS BUT REVEALS COMMUNITY INPUT FOR SOME FO THE FACTORS AFFECTING THE VIEWS AND SENTITMENTS ABOUT OVERALL HEALTH AND QUALITY OF LIFE WITHIN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 7A & 10A WWW.CHAMBERSHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ FORM 990, SCHEDULE H, PART V, LINE 11 IN THE MOST CURRENTLY ADOPTED CHNA, THERE WERE FOUR NEEDS CONSISTENTLY RAISED DURING INTERVIEWS. THE FOLLOWING IS CHAMBERS MEMORIAL HOSPITAL'S IMPLEMENTATION PLAN THAT WILL BE USED TO ADRESS THESE PRIORITIZED NEEDS: 1. HEALTH AND WELLNESS EDUCATION -PROVIDE IN-PERSON AGE APPROPRIATE EDUCATION IN LOCAL AREA SCHOOLS. -CONDUCT A COMMUNITY HEALTH FAIR IN THE HOSPITAL. -ESTABLISH A BOOTH AT THE YELL COUNTY FAIR FOR EDUCATION. -PLACE EDUCATIONAL MATERIALS ON THE HOSPITAL'S WEBSITE AND FACEBOOK PAGE. -CREATION OF STRATEGIC ADS IN THE LOCAL NEWSPAPER. AN EXAMPLE WOULD BE TO ADVERTISE: SEPTEMBER IS NATIONAL CHILDHOOD OBESITY AWARENESS MONTH. 2. ACCESS TO PRIMARY AND DENTAL CARE -FOCUS ON RECRUITING PRIMARY CARE PROVIDERS TO OUR AREA BY CONTRACTING WITH CONTINGENCY BASED RECRUITING FIRMS AND ESTABLISHING SPECIFIC PARAMETERS FOR THE SEARCH. -BEGIN SUCCESSION PLANNING FOR OUR CURRENT AGED PROVIDER POPULATION. -BRAINSTORM WITH OUR LOCAL AREA CHAMBER OF COMMERCE REGARDING RECRUITING POSSIBILITIES. -CONTACT "OUT OF THE AREA" DENTIST PRACTICES AND DISCUSS THE VIABILITY OF THEM PROVIDING SERVICES TO OUR AREA EITHER THROUGH PROVIDER PARTNERSHIPS OR DIRECT EMPLOYMENT. 3. MENTAL HEALTH -WILL INVOLVE OUR BEHAVIOR HEALTH MANAGEMENT TEAM IN EVALUATING OPPORTUNITIES FOR CMH TO EXPAND OUR MENTAL HEALTH PLATFORM. -EVALUATE A POSSIBLE PARTNERSHIP WITH A LOCAL OUTPATIENT BEHAVIORAL HEALTH BUSINESS. -VISIT WITH LOCAL SCHOOL ADMINISTRATORS AND EXPLORE POTENTIAL PARTNERSHIPS. 4. SERVICES TO TREAT DRUG AND ALCOHOL ABUSE -PARTNER WITH LOCAL POLICE/SHERIFF'S OFFICES TO PROVIDE IN-PERSON EDUCATION DURING RED RIBBON WEEK AT LOCAL SCHOOLS. -PROMOTE RAAD (RISE ABOVE ALCOHOL AND DRUGS) -EVALUATE THE POTENTIAL INVOLVEMENT WITH LOCAL CHURCHES WITH SUCH PROGRAMS AS ALCOHOLICS ANONYMOUS (AA) AND OTHER RELATED PROGRAMS. -CONNECT WITH LOCAL AGENCIES AND COORDINATE OUR EFFORTS. FORM 990, SCHEDULE H, PART V, LINE 16A, B & C WWW.CHAMBERSHOSPITAL.COM/FINANCIAL-ASSISTANCE/ FORM 990, SCHEDULE H, PART V, LINE 16J ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. FORM 990, SCHEDULE H, PART V, LINE 20E INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY WILL BE PROVIDED ON MONTHLY BILLING STATEMENTS AS WELL AS EFFORTS TO CONTACT THE PATIENT OR RESPONSIBLE PARTY VIA TELEPHONE. CHAMBERS MEMORIAL HOSPITAL WILL PROVIDE PATIENTS OR OTHER PARTIES RESPONSIBLE FOR PAYMENT OF THE ACCOUNT WITH A NOTICE, A MINIMUM OF 30 DAYS IN ADVANCE OF INITIATING ANY EXTRAORDINARY COLLECTION ACTIVITIES. 6 CHAMBERS MEMORIAL CLINIC 719 DETROIT AVENUE DANVILLE AR 72833 FAMILY CLINIC SCENIC 7 MEDICAL CLINIC 402 SOUTH SCENIC 7 DRIVE OLA AR 72853 FAMILY CLINIC WESTERN YELL COUNTY MEDICAL CLINIC 301 WEST BROADWAY HAVANA AR 72842 FAMILY CLINIC PLAINVIEW MEDICAL CLINIC 102 NORTH GARFIELD AVENUE PLAINVIEW AR 72857 FAMILY CLINIC CHAMBERS MEMORIAL HOME HEALTH AGENCY 719 DETROIT AVENUE DANVILLE AR 72833 HOME HEALTH OUTPATIENT INFUSION CENTER 719 DETROIT AVE DANVILLE AR 72833 INFUSION CENTER FORM 990, SCHEDULE H, PART I, LINE 3C PLEASE REFER TO THE FINANCIAL ASSISTANCE POLICY OR SCHEDULE H, PART V, LINES 13 THROUGH 16 FOR ADDITIONAL INFORMATION ON THE FAP. FORM 990, SCHEDULE H, PART I, LINE 7 CHAMBERS MEMORIAL HOSPITAL USES THE MEDICARE COST REPORT COST TO CHARGE RATIO METHODOLOGY. FORM 990, SCHEDULE H, PART III, LINES 2 & 3 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED NCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FORM 990, SCHEDULE H, PART III, LINE 4 PLEASE SEE ATTACHED AUDIT REPORT NOTE 1. FORM 990, SCHEDULE H, PART III, LINE 9B PATIENTS ARE INFORMED OF CHARITY CARE PROGRAM UPON ADMISSION AND DISCHARGE. THE PLAIN LANGUAGE SUMMARY OF THE FAP IS INCLUDED IN THE REGISTRATION PACKET. ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT AND INFORMATION REGARDING THE FAP WILL BE MADE AVAILABLE WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. FORM 990, SCHEDULE H, PART VI, LINE 2 IN ADDITION TO ANY HEALTH NEEDS REPORTED ON PART V, SECTION B, THE HOSPITAL UTILIZES THE 'COUNTY HEALTH RANKINGS' MODEL TO WEIGH THE HEALTH FACTORS NEEDS TO THE COMMUNITIES IT SERVES. THE MODEL PROVIDES A RANKING METHOD THAT RANKS ALL 50 STATES AND THE COUNTIES WITHIN EACH STATE BASED ON TWO TYPES OF HEALTH OUTCOMES FOR EACH COUNTY: MORTALITY AND MORBIDITY. COUNTIES ARE RANKED RELATIVE TO THE HEALTH OF OTHER COUNTIES IN THE STATES. AS PART OF THE ANALYSIS OF THE CHNA FOR THE COMMUNITY, THE RELATIVE HEALTH STATUS FOR YELL COUNTY WILL BE COMPARED TO THE STATE OF ARKANSAS AS WELL AS TO THE NATIONAL BENCHMARK. A BETTER UNDERSTANDING OF THE FACTORS THAT AFFECT THE HEALTH OF THE COMMUNITY WILL ASSIST WITH HOW TO IMPROVE THE COMMUNITY'S HABITS, CULTURE, AND ENVIRONMENT. YELL COUNTY FELL WITHIN THE LOWER 50TH PERCENTILE OF THE 75 COUNTIES IN ARKANSAS. THE HEALTH NEEDS ARE SIMILAR TO THE NEEDS ADDRESSED IN THE CHNA AND VOICED BY THE INTERVIEWS CONDUCTED. FORM 990, SCHEDULE H, PART VI, LINE 3 ALL PATIENTS WILL BE OFFERED, AS PART OF THE REGISTRATION AND/OR DISCHARGE PROCESS, A COPY OF THE PLAIN LANGUAGE SUMMARY OF THIS POLICY. ADDITIONALLY, ALL PATIENTS IDENTIFIED AS POTENTIAL FINANCIAL ASSISTANCE RECIPIENTS OR ANYONE REQUESTING FINANCIAL ASSISTANCE WILL BE OFFERED THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE. IF THIS EVALUATION IS NOT CONDUCTED UNTIL AFTER THE PATIENT LEAVES THE FACILITY, OR IN CASE OF OUTPATIENTS OR EMERGENCY PATIENTS, THE FINANCIAL COUNSELOR WILL MAIL A FINANCIAL ASSISTANCE APPLICATION TO THE PATIENT FOR COMPLETION. IN ADDITION, THE HOSPITAL WILL PROVIDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY TO THE PATIENT WITH ALL BILLING STATEMENTS AND COMMUNICATIONS WITHIN THE FIRST 120 DAYS FOLLOWING THE FIRST BILLING STATEMENT. IN ADDITION, PATIENTS WILL BE CONTACTED VIA TELEPHONE. FORM 990, SCHEDULE H, PART VI, LINE 4 THE COMMUNITY SERVED BY THE HOSPITAL IS A RURAL AREA IN CENTRAL WESTERN ARKANSAS. THE HOSPITAL IS LOCATED IN DANVILLE, ARKANSAS, WHICH IS THE SECOND LARGEST TOWN IN THE COMMUNITY WITH A POPULATION OF AROUND 2,000 PEOPLE. THE POPULATION IS ABOUT 79% CAUCASIAN, MAKING IT MUCH MORE RACIALLY HOMOGENOUS THAN EITHER THE STATE OF ARKANSAS OR THE UNITED STATES AS A WHOLE. MOST OF THE REMAINING POPULATION IS HISPANIC OR LATINO. ACCORDING TO THE U.S. CENSUS BUREAU, ABOUT 18% OF THE COMMUNITY'S POPULATION IS OVER AGE 65, WHICH IS CONSISTENT WITH ARKANSAS (17%) AND HIGHER THAN IN THE UNITED STATES (16%) AS A WHOLE. THIS AGE GROUP USES MORE HEALTH SERVICES THAN ANY OTHER SO THE HOSPITAL SHOULD PREPARE FOR INCREASED PATIENT VOLUME IN THE FUTURE. FACTORS SUCH AS EDUCATIONAL ATTAINMENT, POVERTY LEVEL, UNEMPLOYMENT RATES AND INSURANCE COVERAGE LEVELS CONTRIBUTE SIGNIFICANTLY TO THE HEALTH STATUS OF A COMMUNITY. APPROXIMATELY 13% OF THE COMMUNITY'S POPULATION AGE 25 YEARS OR OLDER HAS OBTAINED A BACHELOR'S DEGREE OR HIGHER, COMPARED TO ABOUT 32% OF THE UNITED STATES. ABOUT 22% OF THE POPULATION DOES NOT HAVE A HIGH SCHOOL DIPOLMA COMPARED TO ABOUT 12% OF THE COUNTRY AS A WHOLE. LOWER LEVELS OF EDUCATIONAL ATTAINMENT HAVE BEEN LINKED TO NEGATIVE HEALTH OUTCOMES, SO THIS IS RELEVANT TO THE CONSIDERATION OF THE HEALTH NEEDS OF THE COMMUNITY. THE INCOME LEVELS OF INDIVIDUALS WITHIN THE COMMUNITY ALSO HAVE A SIGNIFICANT EFFECT ON THEIR ABILITY TO ACCESS HEALTH SERVICES. THE MEDIAN HOUSEHOLD INCOME IN YELL COUNTY IS $43,923, COMPARED TO $47,597 FOR THE STATE OF ARKANSAS AND $62,843 FOR THE UNITED STATES. LOWER THAN MEDIAN HOUSEHOLD INCOME SUGGESTS THAT MANY MEMBERS OF THE COMMUNITY MAY HAVE DIFFICULTY OBTAINING HEALTH CARE, ESPECIALLY PREVENTATIVE CARE. ADDITIONALLY, WHILE SIMILAR TO THE STATE OF ARKANSAS, THE LEVELS OF POVERTY IN YELL COUNTY ARE SIGNIFICANTLY HIGHER THAN THE RATES IN THE UNITED STATES. FORM 990, SCHEDULE H, PART VI, LINE 5 THE HOSPITAL AND OTHER HEALTH CARE FACILITIES FURTHER THEIR EXEMPT PURPOSE BY PROMOTING HEALTH CARE INITIATIVES IN THE COMMUNITIES SERVED. THE HOSPITAL IS INVOLVED WITH LOCAL SCHOOL DISTRICTS, HEALTH DEPARTMENTS, CHURCHES AND FAITH-BASED ORGANIZATIONS, SENIOR CITIZEN CENTERS, AND OTHER ORGANIZATIONS TO HELP PROMOTE HEALTH EDUCATION. A FEW EVENTS IN WHICH THE HOSPITAL IS INVOLVED IN INCLUDES CAR SEAT SAFETY, HEALTH FAIRS, YELL COUNTY FAIR, FARM SAFETY, AND OTHER LOCAL EVENTS THAT WILL HELP THE HOSPITAL DISTRIBUTE HEALTH KNOWLEDGE. X false true X X X false false false false false false false false false SCOTT PEEK CEO 286703 0 45000 0 9600 0 14954 0 14394 0 370651 0 0 0 KARL SANDBERG PHYSICIAN 158620 0 0 0 0 0 7456 0 1033 0 167109 0 0 0 FREDERICK PERKINS JR PHYSICIAN - SURGEON 336191 0 25000 0 0 0 3995 0 12011 0 377197 0 0 0 JOHN WESTWOOD PHYSICIAN 171993 0 0 0 421 0 7285 0 850 0 180549 0 0 0 JOSHUA MANATT PHYSICIANS ASSISTANT 159862 0 0 0 0 0 6405 0 508 0 166775 0 0 0 WILLIAM L BERRY PHYSICIAN 188720 0 0 0 0 0 8986 0 13866 0 211572 0 0 0 SCHEDULE J, PART I, LINE 1A ALL MONTHLY DUES FOR CHAMBERLYNE COUNTRY CLUB ARE PAID FOR THE CEO AND CFO. FOR JOSHUA MANATT, WE PAY HALF AND THEY PAYROLL DEDUCT THE OTHER HALF BASED ON THE TYPE OF MEMBERSHIP THEY HAVE. THE AMOUNTS ARE NOT INCLUDED IN W-2 WAGES AS THE MEMBERSHIP IS ONLY USED FOR BUSINESS PURPOSES AND ANY INCIDENTAL EXPENSES ARE PAID OUT OF POCKET BY THE INDIVIDUAL. A YELL COUNTY ARKANSAS 710420105 98544NAA4 2006-11-14 9900000 CONSTRUCTION & IMPROVEMENT BONDS false false false A 4607020 0 9900000 0 0 0 67850 0 0 0 9773228 58922 2009 false false true true A false false false false 0 false false false false A false false false true false false 0 false 0 false false A false FORM 990, SCHEDULE K, PART IV, LINE 2C FOR BOND SERIES 2006 A&B, THE LAST REBATE COMPUTATION DATE WAS 10/31/2021. FORM 990, SCHEDULE K, PART IV, LINE 2C BOND SERIES 2006 A&B IS COMPLETED ON BOND YEAR OF 10/31/2021. FORM 990, SCHEDULE K, PART III, LINE 9 & PART IV, LINE 7 & PART V THE ORGANIZATION IS IN THE PROCESS OF DRAFTING THESE POLICIES. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE FORM 990 BEFORE IT IS FILED. THE FORM 990 IS EMAILED TO THE BOARD OF DIRECTORS BEFORE FILING. THE BOARD OF DIRECTORS REVIEW THE FORM 990 AT THE FOLLOWING BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS A COMPLIANCE COMMITTEE THAT MONITORS FOR POLICY COMPLIANCE AND RECOMMENDS CHANGES OR NEW POLICIES TO THE CEO FOR APPROVAL. THE HOSPITAL HAS INSTITUTED A NEW POLICY FOR EMPLOYEES THAT WILL BE USED FOR BOARD MEMBERS GOING FORWARD. THE BOARD MEMBERS WILL SIGN THE AGREEMENT AND BE WITHDRAWN FROM VOTING DECISIONS AS CONFLICTS ARISE. FORM 990, PART VI, SECTION B, LINE 15A & 15B THIS REVIEW IS DONE ANNUALLY AT THE CEO'S ANNIVERSARY DATE BY THE BOARD OF DIRECTORS. THIS WOULD HAVE BEEN DONE IN MAY OF 2021. THE CEO PERFORMS EVALUATIONS AND COMPENSATION REVIEWS AT THE ANNIVERSARY DATE OF EACH DEPARTMENT HEAD. THEY ARE PERFORMED YEARLY. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990 PART IX LINE 11G DESCRIPTION:EMERGENCY ROOM SERVICES TOTAL FEES:1455390 FORM 990 PART IX LINE 11G DESCRIPTION:PSYCH TOTAL FEES:613070 FORM 990 PART IX LINE 11G DESCRIPTION:NURSING TOTAL FEES:133928 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:306085 FORM 990 PART IX LINE 11G DESCRIPTION:ANESTHESIOLOGY SERVICES TOTAL FEES:300000 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN & OFFICE SERVICES TOTAL FEES:254008 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:123113 FORM 990 PART IX LINE 11G DESCRIPTION:OCCUPATIONAL THERAPY TOTAL FEES:233348 FORM 990 PART IX LINE 11G DESCRIPTION:SPEECH THERAPY SERVICES TOTAL FEES:196684 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICAL THERAPY TOTAL FEES:161773 FORM 990 PART IX LINE 11G DESCRIPTION:LAB & X-RAY TOTAL FEES:68805 FORM 990 PART IX LINE 11G DESCRIPTION:RESPIRATORY CARE TOTAL FEES:45300