Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
STUTTGART REGIONAL MEDICAL CENTER
Employer identification number
71-0564764
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
STUTTGART REGIONAL MEDICAL CENTER
Employer identification number
71-0564764
Identifier
Return Reference
Explanation
ORGANIZATION'S MOST SIGNIFICANT ACTIVITIES
FORM 990, PART I, LINE 1
STUTTGART REGIONAL MEDICAL CENTER PROVIDES COMPREHENSIVE HEALTH CARE SERVICES TO INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. IN KEEPING WITH ITS MISSION, IT PROVIDES FREE AND SUBSIDIZED CARE TO THOSE WHO CANNOT PAY (CHARITY CARE) AND TO THOSE COVERED UNDER GOVERNMENT PROGRAMS (MEDICARE AND MEDICAID) AT REIMBURSEMENT RATES BELOW THOSE PAID BY OTHER THIRD PARTY PAYORS. IN ADDITION TO HEALTH SERVICES, THE MEDICAL CENTER PROVIDED MULTIPLE HEALTH EDUCATION PROGRAMS, HEALTH SCREENINGS, SPONSORED MANY COMMUNITY ACTIVITIES, PROVIDED FREE TRANSPORTATION TO SEVERAL PATIENTS, AND PROVIDED AN AMBULANCE AND CREW FOR SCHOOL SPORTING EVENTS. THE HOSPITAL RECEIVED A GRANT FROM THE ARKANSAS DEPARTMENT OF ECONOMIC DEVELOPMENT TO HELP IN RENOVATING A VACANT HOSPITAL OWNED BUILDING TO BE USED AS A CHILD DEVELOPMENT CENTER. THE CENTER OPENED IN MAY 2004 AND IS BEING OPERATED BY EASTER SEALS. THE HOSPITAL PROVIDED IN-KIND FUNDS TO COVER PART OF THE COST OF RENOVATIONS. THE HOSPITAL HAS ONGOING COSTS IN PROVIDING MAINTENANCE AND OTHER SUPPLIES FOR THE CHILD DEVELOPMENT CENTER. THE CHILD DEVELOPMENT CENTER HAS THE CAPABILITY OF PROVIDING SERVICES TO APPROXIMATELY 85 CHILDREN, THE MAJORITY OF WHICH ARE EITHER DISABLED OR FROM LOW TO MODERATE INCOME FAMILIES. BAPTIST HEALTH HOSPITALS IS PROVIDING THESE SERVICES AND OPERATING THE HOSPITAL THROUGH A LEASE ARRANGEMENT WITH STUTTGART REGIONAL MEDICAL CENTER.
DELEGATION OF MANAGEMENT DUTIES
FORM 990, PART VI, SECTION A, LINE 3
EFFECTIVE JANUARY 1, 2009, THE MEDICAL CENTER ENTERED INTO A LEASING ARRANGEMENT THAT TRANSFERS THE OPERATIONS OF THE MEDICAL CENTER TO BAPTIST HEALTH HOSPITALS OF LITTLE ROCK, ARKANSAS. THE LEASE, WHICH COVERS SUBSTANTIALLY ALL THE ASSETS AND OPERATIONS OF THE MEDICAL CENTER, IS FOR A PERIOD OF 25 YEARS WITH ANNUAL PAYMENTS OF $25 PER YEAR AND INCLUDES TWO OPTIONAL RENEWAL PERIODS OF 25 YEARS EACH AT THE SAME ANNUAL RENTAL. BAPTIST HEALTH HOSPITALS HAS COMMITTED TO PROVIDE ADEQUATE FUNDING TO OPERATE THE MEDICAL CENTER AND WILL MAKE THE REQUIRED DEBT SERVICE PAYMENTS OF ALL LEGAL OBLIGATIONS OF THE MEDICAL CENTER. THE LEASE CAN BE TERMINATED PRIOR TO THE EXPIRATION OF THE LEASE TERM BY BAPTIST HEALTH HOSPITALS OR THE MEDICAL CENTER IN CERTAIN INSTANCES AS DEFINED IN THE AGREEMENT AND WITH PROPER NOTIFICATION. AT THE END OF THE LEASE TERM, ALL ASSETS AND LIABILITIES WILL REVERT BACK TO THE MEDICAL CENTER.
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11B
FORM 990 IS REVIEWED BY THE VICE PRESIDENT OF FINANCE & THE CFO OF BAPTIST HEALTH HOSPITALS WHICH LEASES STUTTGART REGIONAL MEDICAL CENTER.
CONFLICT OF INTEREST POLICY MONITORING PROCEDURES
FORM 990, PART VI, SECTION B, LINE 12C
ALL MEMBERS OF THE BOARD OF DIRECTORS OF STUTTGART REGIONAL MEDICAL CENTER ARE REQUIRED TO REPORT ALL CONFLICTS OF INTERESTS IN WRITING OR BY VERBAL ACKNOWLEDGEMENT DURING A REGULARLY SCHEDULED MONTHLY MEETING OF THE BOARD AT THE BEGINNING OF EACH FISCAL YEAR. ALL STATED CONFLICTS OF INTEREST WILL BE ENTERED INTO THE MINUTES OF RECORD OF SUCH REGULARLY SCHEDULED MONTHLY MEETINGS. MEMBERS OF THE BOARD OF DIRECTORS WILL REFRAIN FROM LOBBYING, OR VOTING WHEN RELATED DIRECTLY TO THE MEMBERS INCOME OR BUSINESS INCOME AND WILL ONLY ACT IN GOOD FAITH AND IN THEIR HONEST BUSINESS JUDGEMENT FOR THE PURPOSES FOR WHICH THE CORPORATION WAS ORGANIZED.
COMPENSATION DETERMINATION PROCEDURES
FORM 990, PART VI, SECTION B, LINES 15A & B
THE ORGANIZATION DID NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES. HOWEVER, WHEN THE ORGANIZATION DOES COMPENSATE OFFICERS OR KEY EMPLOYEES AN INDEPENDENT REVIEW IS PERFORMED USING INDUSTRY COMPARATIVES FOR LIKE SIZE HOSPITALS.
AVAILABILITY OF GOVERNING DOCUMENTS
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
COMPLETION OF SCHEDULE H
FORM 990, PART IV, LINE 20A AND SCHEDULE H
BAPTIST HEALTH HOSPITALS IS PROVIDING THE HEALTHCARE SERVICES AND OPERATING THE HOSPITAL THROUGH A LEASE ARRANGEMENT WITH STUTTGART REGIONAL MEDICAL CENTER. THE HOSPITAL LICENSE IS OWNED BY BAPTIST HEALTH HOSPITALS, THEREFORE, SCHEDULE H IS NOT REQUIRED FOR THIS ENTITY.
OTHER CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
THE $1,631 CHANGE IS FROM THE AMERICAN DATA NETWORK, LLC K-1.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.