PAWHUSKA HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PAWHUSKA HOSPITAL INC (EIN 23-7169376)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-16
- IRS object ID
- 202242289349301529
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-16T15:20:17-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14241 DALLAS PARKWAY SUITE 1100 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237169376 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawhuska Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JASON MCBRIDE | InCareOfNm |
| Business Name Control | PAWH | BusinessNameControlTxt |
| Phone | 9182873232 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 East 15th Street | AddressLine1Txt |
| City | Pawhuska | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74056 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JASON MCBRIDE | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 9182873232 | PhoneNum |
| Signature | 2022-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JASON | PersonFirstNm |
| Person Last | MCBRIDE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeanette Verrelli | PreparerPersonNm |
| PTIN | P00742631 | PTIN |
| Phone | 9727028262 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JASON MCBRIDE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 EAST 15TH STREET | AddressLine1Txt |
| City | PAWHUSKA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 740561920 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,549,601 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PAWHUSKAHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | PAWHUSKA HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH AND LIVES IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 148 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,480,630 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,681,229 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,833,525 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,857,174 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,829 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,000 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$459,750 | PYOtherRevenueAmt |
| CY Other Revenue | $10,198 | CYOtherRevenueAmt |
| PY Total Revenue | $15,864,234 | PYTotalRevenueAmt |
| CY Total Revenue | $21,549,601 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,350 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,160 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,034,969 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,822,425 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,349,457 | PYOtherExpensesAmt |
| CY Other Expenses | $11,373,627 | CYOtherExpensesAmt |
| PY Total Expenses | $17,385,776 | PYTotalExpensesAmt |
| CY Total Expenses | $18,201,212 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,521,542 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,348,389 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,467,479 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,271,887 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,217,541 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,673,560 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$7,750,062 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$4,401,673 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE, THE PHYSICIANS, STAFF, AND GOVERNING BOARD OF PAWHUSKA HOSPITAL, INC. ARE COMMITTED TO PROVIDING THE HIGHEST LEVEL OF HEALTHCARE POSSIBLE FOR OUR FACILITY. RECOGNIZING THE HEALTH NEEDS OF OUR COMMUNITY AND SURROUNDING AREA, WE PLEDGE TO PROVIDE, IN A COST-EFFECTIVE MANNER, THE SERVICES NECESSARY TO ENHANCE THE QUALITY OF LIFE. UNDERSTANDING THE CONSTANT AND DRAMATIC CHANGES IN THE HEALTHCARE INDUSTRY, WE WILL STRIVE TO ACHIEVE EXCELLENCE AND CONTINUE OUR SUPPORT OF THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $14,431,013 | ExpenseAmt |
| Grant | $5,160 | GrantAmt |
| Revenue | $15,863,200 | RevenueAmt |
| Desc | PAWHUSKA HOSPITAL, INC. IS A 25-BED CRITICAL ACCESS HOSPITAL AND RURAL HEALTH CLINIC LOCATED IN PAWHUSKA, OKLAHOMA, AND PROVIDES MEDICAL SERVICES TO PAWHUSKA AND SURROUNDING AREA. THE HOSPITAL AND CLINIC IS MANAGED THROUGH AN AGREEMENT WITH COHESIVE HEALTHCARE MANAGEMENT AND CONSULTING. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. | Desc |
| Total Program Service Expenses | $14,431,013 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 148 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JASON MCBRIDE | PersonNm |
| Phone | 9182875123 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 EAST 15TH STREET | AddressLine1Txt |
| City | PAWHUSKA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 740561920 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MATTHEW C RUMSEY | ||||||||
| CHIEF MEDICAL OFFICER | 40.0 | 0.0 | Yes (X) | Yes (X) | $484,722 | $0 | $15,278 | |
| RON DUNKLE | ||||||||
| APRN | 40.0 | 0.0 | $330,883 | $0 | $9,857 | Yes (X) | ||
| Adam Helm | ||||||||
| Nurse Practitioner | 40.0 | 0.0 | $201,379 | $0 | $0 | Yes (X) | ||
| HEATHER ARRINGTON | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $171,499 | $0 | $1,986 | Yes (X) | ||
| JOHN CHIAFFITELLI | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $134,711 | $0 | $15,278 | Yes (X) | ||
| DALTON SMITH | ||||||||
| PHYSICAL THERAPIST | 40.0 | 0.0 | $148,617 | $0 | $727 | Yes (X) | ||
| AMANDA BRAY | ||||||||
| COMPLIANCE & RISK OFFICER | 40.0 | 0.0 | Yes (X) | $127,267 | $0 | $883 | ||
| BEN WEST | ||||||||
| SECRETARY | 2.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BEVERLY TOLSON | ||||||||
| TRUSTEE | 2.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH REED | ||||||||
| CHAIRWOMAN | 4.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAM CARPENTER | ||||||||
| TRUSTEE | 2.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Tina Steele | ||||||||
| Finance Director | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| JASON MCBRIDE | ||||||||
| ADMINISTRATOR | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| JILL GRAY | ||||||||
| CCO | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,599,078 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $44,009 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Cohesive Healthcare | |||||
| 2510 Independence St Suite 100 | SHAWNEE | OK | 74804 | MANAGEMENT SERVICES | $1,322,330 |
| COHESIVE REVOPS | |||||
| PO BOX 679227 | DALLAS | TX | 75267 | REVENUE CYCLE SVCS | $1,288,574 |
| COHESIVE STAFFING | |||||
| 2510 INDEPENDENCE ST SUITE 100 | SHAWNEE | OK | 74804 | CONTRACT LABOR STAFF | $843,699 |
| AMERISOURCEBERGEN | |||||
| PO BOX 978526 | DALLAS | TX | 75297 | PHARMACEUTICAL DISTB | $491,759 |
| Cerner Corporation | |||||
| 2800 Rock Creek Pkwy | KANSAS CITY | MO | 64117 | software svcs | $458,887 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,681,229 | GovernmentGrantsAmt |
| All Other Contributions | $0 | AllOtherContributionsAmt |
| Total Contributions | $5,681,229 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| patient service revenue | 621110 | $15,856,936 | $15,856,936 |
| Other Operating Revenue | 900099 | $238 | $238 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,857,174 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,000 | TotalRevenueColumnAmt |
| Exclusion | $1,000 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| medical records | 900099 | $770 | $770 | |
| Pharmacy Rebate | 900099 | $4,641 | $4,641 | |
| Cafeteria Revenue | 722514 | $4,172 | $4,172 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $615 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $615 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $10,198 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,549,601 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,863,200 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $5,172 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,160 | TotalAmt |
| Program Services | $5,160 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $628,151 | TotalAmt |
| Program Services | $533,928 | ProgramServicesAmt |
| Management And General | $94,223 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,265,727 | TotalAmt |
| Program Services | $5,094,018 | ProgramServicesAmt |
| Management And General | $171,709 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $470,544 | TotalAmt |
| Program Services | $429,839 | ProgramServicesAmt |
| Management And General | $40,705 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $458,003 | TotalAmt |
| Program Services | $383,942 | ProgramServicesAmt |
| Management And General | $74,061 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,700,000 | TotalAmt |
| Program Services | $167,965 | ProgramServicesAmt |
| Management And General | $2,532,035 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $486 | TotalAmt |
| Management And General | $486 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,390 | TotalAmt |
| Management And General | $43,390 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,368,026 | TotalAmt |
| Program Services | $4,338,087 | ProgramServicesAmt |
| Management And General | $29,939 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,385 | TotalAmt |
| Program Services | $2,954 | ProgramServicesAmt |
| Management And General | $6,431 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,061 | TotalAmt |
| Program Services | $244,837 | ProgramServicesAmt |
| Management And General | $126,224 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,788 | TotalAmt |
| Program Services | $47,549 | ProgramServicesAmt |
| Management And General | $79,239 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,650 | TotalAmt |
| Program Services | $112,490 | ProgramServicesAmt |
| Management And General | $84,160 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578 | TotalAmt |
| Program Services | $578 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,153 | TotalAmt |
| Program Services | $1,267 | ProgramServicesAmt |
| Management And General | $886 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,463 | TotalAmt |
| Program Services | $19,125 | ProgramServicesAmt |
| Management And General | $108,338 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $229,779 | TotalAmt |
| Program Services | $42,669 | ProgramServicesAmt |
| Management And General | $187,110 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,197 | TotalAmt |
| Management And General | $125,197 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| bad debt expense | $1,359,633 | $1,359,633 | |
| medical supplies | $1,065,049 | $1,065,049 | |
| Equipment | $528,795 | $471,115 | $57,680 |
| food | $109,438 | $109,438 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,756 | TotalAmt |
| Program Services | $1,370 | ProgramServicesAmt |
| Management And General | $8,386 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,201,212 | TotalAmt |
| Program Services | $14,431,013 | ProgramServicesAmt |
| Management And General | $3,770,199 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $587,217 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,358,929 | BOYAmt |
| EOY | $3,305,465 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,507,116 | BOYAmt |
| EOY | $1,764,738 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $333,101 | BOYAmt |
| EOY | $364,340 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,462 | BOYAmt |
| EOY | $46,624 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,955,001 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,164,281 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,664,654 | BOYAmt |
| EOY | $2,790,720 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,467,479 | BOYAmt |
| EOY | $8,271,887 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,883,583 | BOYAmt |
| EOY | $5,134,742 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,642,086 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,764,446 | BOYAmt |
| EOY | $7,188,542 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,927,426 | BOYAmt |
| EOY | $350,276 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,217,541 | BOYAmt |
| EOY | $12,673,560 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$7,750,062 | BOYAmt |
| EOY | -$4,401,673 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$7,750,062 | BOYAmt |
| EOY | -$4,401,673 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,467,479 | BOYAmt |
| EOY | $8,271,887 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,348,389 | ReconcilationRevenueExpnssAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $915 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $915 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1I | FormAndLineReferenceDesc |
| Explanation | OTHER ACTIVITIES: THE HOSPITAL PAID DUES TO THE OKLAHOMA HOSPITAL ASSOCIATION, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $52,140 | OtherCostOrOtherBasisAmt |
| Book Value | $52,140 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,563,745 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,284,778 | DepreciationAmt |
| Book Value | $1,278,967 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,979 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,048 | DepreciationAmt |
| Book Value | $931 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,128,780 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,844,455 | DepreciationAmt |
| Book Value | $1,284,325 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $174,357 | OtherCostOrOtherBasisAmt |
| Book Value | $174,357 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,790,720 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Est 3rd Party Payor Settlement | Desc |
| Amt | $350,276 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $350,276 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | ASC 740 FOOTNOTE: THE HOSPITAL IS ORGANIZED AS AN OKLAHOMA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $147,453 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $147,453 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,039,365 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,080,401 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,186,818 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,080,401 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $147,453 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $375,133 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $375,133 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02230 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $375,133 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $375,133 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02230 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,561,951 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,080,401 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $522,586 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,359,633 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $11,569,292 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,979,924 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $2,589,368 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAWHUSKA HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15TH STREET | AddressLine1Txt |
| City | PAWHUSKA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74056 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PAWHUSKAHOSPITAL.COM | WebsiteAddressTxt |
| State License | 2271 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAWHUSKA HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.PAWHUSKAHOSPITAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.PAWHUSKAHOSPITAL.COM | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | PERSONS WHO REPRESENT THE COMMUNITY: A NEW CHNA WAS PERFORMED FOR THE 2019 FISCAL YEAR. THE HOSPITAL HOSTED FOUR COMMUNITY MEETINGS BETWEEN APRIL AND MAY OF 2019 WITH THE ASSISTANCE OF THE OKLAHOMA OFFICE OF RURAL HEALTH. THE INDIVIDUALS ATTENDING THESE MEETINGS INCLUDED, BUT WERE NOT LIMITED TO, INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS: PAWHUSKA HOSPITAL, PAWHUSKA CHAMBER OF COMMERCE, OSAGE NATION, OKLAHOMA STATE DEPARTMENT OF HEALTH, PAWHUSKA EMS AND PAWHUSKA HOSPITAL BOARD MEMBERS. ADDITIONAL INPUT CAME FROM A COMMUNITY SURVEY THAT HAD A TOTAL OF 104 RESPONSES FROM VARIOUS MEMBERS OF THE COMMUNITY. THE SURVEYS WERE DISTRIBUTED TO THE SCHOOLS, SENIOR HOUSING, OSAGE NATION PROGRAMS AND RESTAURANTS IN THE AREA. |
| SCHEDULE H, PART V, SECTION B, LINE 11 | NEEDS ADDRESSED AND NOT ADDRESSED IN CHNA: Pawhuska Hospital partnered with the Oklahoma Office of Rural Health to complete a CHNA during the 2019 fiscal year. Through this process, secondary data was gathered, a survey was completed, and key community partners including public health were solicited for input. The following identifies each priority, implementation taken, and an evaluation or impact of the implementation. PRIORITY: MENTAL HEALTH AND WELLNESS INCLUDING SUBSTANCE ABUSE AND CHEMICAL DEPENDANCY THE HOSPITAL WILL CONTINUE TO OFFER AND GROW THE SENIOR STRONG PROGRAM AND CONTINUE TO HAVE MONTHLY EDUCATION DISCUSSIONS ABOUT THE TOPIC. THE HOSPITAL PLANS TO PARTNER WITH Grand Lake Mental Health FOR SERVICEs aND PLACEMENT FOR PATIENTS IN NEED. THEY ALSO PLAN TO PARTNER WITH LOCAL LAW ENFORCEMENT TO BETTER RESPOND TO PATIENTS WHO HAVE MENTAL HEALTH AND/OR SUBSTANCE ABUSE ISSUES. PRIORITY: OUTPATIENT DIALYSIS THE HOSPITAL UNDERSTANDS THIS IS A BROAD NEED OF THE COMMUNITY. HOWEVER, THIS IS BEYOND THE SCOPE OF SERVICES, SPACE AND STAFFING OF THE HOSPITAL. THE HOSPITAL WILL CONTINUE TO HELP COORDINATE THIS SERVICE FOR PATIENTS THROUGH OTHER PROVIDERS. PRIORITY: EXPANSION OF CLINIC/HOSPITAL THE HOSPITAL AND CLINIC ARE CONTINUING TO LOOK TO EXPAND SERVICES INCLUDING OFFERING A VARIETY OF SPECIALTY SERVICES OFFERED ON WEEKLY/MONTHLY BASIS TO ALLEVIATE TRANSPORTATION BURDENS OF LOCAL RESIDENTS. THE HOSPITAL RECENTLY ADDED AN INFECTIOUS DISEASE SPECIALIST THAT PROVIDES EDUCATION AND CONSULTS TO THE HOSPITAL AND CLINIC REGARDING ANTIBIOTIC STEWARDSHIP AND EMERGING INFECTIOUS DISEASE TRENDS. THIS PROVIDER WILL ALSO MANAGE THE CARE OF THE PATIENTS WITH COMPLEX INFECTIOUS DISEASE NEEDS WHICH WOULD PREVIOUSLY HAVE BEEN TRANSFERRED. PRIORITY: WELLNESS OPPORTUNITIES AND NEED FOR NUTRITION EDUCATION THE CLINIC HAS STARTED PROVIDING FREE COMMUNITY EDUCATION IN THE AREAS OF DIABETIC, COPD, AND FALL RISK WITH MORE TOPICS TO BE COVERED OVER THE NEXT THREE YEARS. THE HOSPITAL IS ALSO EXPLORING THE OPPORTUNITY TO HOST A HEALTH FAIR IN THE COMMUNITY TO FOCUS ON TOPICS SUCH AS STROKE, SUBSTANCE ABUSE, ETC. |
| SCHEDULE H, PART V, SECTION B, LINE 6B | CHNA CONDUCTED WITH OTHER ORGANIZATIONS: THE HOSPITAL COMPLETED THE CHNA IN PARTNERSHIP WITH THE OKLAHOMA OFFICE OF RURAL HEALTH. THE OFFICE OF RURAL HEALTH ASSISTED WITH GATHERING DATA AND ANALYZING THE LOCAL HEALTH DATA, AS WELL AS ASSISTED WITH DEVELOPING THE IMPLEMENTATION STRATEGY. |
| SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C | FINANCIAL ASSISTANCE POLICY AVAILABILITY: THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: https://pawhuskahospital.com/financial-services/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAWHUSKA FAMILY MEDICAL CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15TH STREET | AddressLine1Txt |
| City | PAWHUSKA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74056 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART III, SECTION A, LINE 2 | BAD DEBT EXPENSE: PATIENTS ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | COSTING METHODOLOGY: THE HOSPITAL USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | COLLECTION POLICY: ALL COLLECTION EFFORTS CEASE WHEN A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. NORMAL COLLECTIONS EFFORTS CONTINUE ON ANY PERSONAL AMOUNT OWED BY THE PATIENT. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT: ADMINISTRATION, MEDICAL STAFF AND THE GOVERNING BOARD REGULARLY DISCUSS THE HEALTH CARE NEEDS OF THE LOCAL COMMUNITY DURING GOVERNING BOARD MEETINGS AS WELL AS IN THE BIMONTHLY MEETINGS OF THE MEDICAL STAFF. THE OKLAHOMA OFFICE OF RURAL HEALTH AND PAWHUSKA HOSPITAL DEVELOPED A COMMUNITY NEEDS ASSESSMENT DURING FISCAL YEAR 2019. PAWHUSKA HOSPITAL IMPLEMENTED STRATEGIES FOR EACH HEALTH PRIORITY IDENTIFIED THROUGH THE NEEDS ASSESSMENT. IN ADDITION, WHEN LOOKING AT THE POTENTIAL OF ADDING NEW SERVICES, THE HOSPITAL RESEARCHES HOW SUCH SERVICES WILL MEET AND ADDRESS THE NEEDS OF THE COMMUNITY. THE HOSPITAL IS PLANNING ON DEVELOPING FUTURE PROGRAMS THAT ALLOW OPPORTUNITIES TO GATHER A LARGER COMMUNITY AUDIENCE THAT CAN EXPRESS THE ISSUES THAT ARE IMPORTANT TO THE COMMUNITY. FOCUS GROUPS WILL ENABLE THE HOSPITAL TO FURTHER EDUCATE TO MEET THE NEEDS OF THE COMMUNITY. THE NEXT CHNA WILL BE COMPLETED IN FY2022. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PAWHUSKA HOSPITAL, INC PROVIDES A LETTER TO PATIENTS UPON ADMISSION THAT STATES THE HOSPITAL PROVIDES ASSISTANCE TO THOSE PATIENTS WITH LIMITED INCOME TO HELP PAY FOR HOSPITAL EXPENSES. THE LETTER INDICATES THAT CHARITY CARE APPLICATIONS ARE AVAILABLE TO ALL PATIENTS AND CAN BE PICKED UP AT THE TIME OF SERVICE OR AT A LATER DATE. THE CHARITY CARE APPLICATION GIVES AN OVERVIEW OF THE CHARITY CARE POLICY AND NOTES THAT MEDICARE AND OTHER STATE PROGRAMS ARE ALSO AVAILABLE TO PATIENTS THAT MEET INCOME REQUIREMENTS. THE HOSPITAL STAFF IS AVAILABLE TO OFFER PATIENTS ASSISTANCE IN COMPLETING THE CHARITY CARE AND MEDICAID APPLICATIONS IF NEEDED. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: PAWHUSKA HOSPITAL, INC. PRIMARILY SERVES THE CITIZENS OF THE COMMUNITY OF PAWHUSKA, OKLAHOMA AND THE SURROUNDING AREA. PAWHUSKA SERVES AS THE COUNTY SEAT OF OSAGE COUNTY, OKLAHOMA AND IS ALSO THE CAPITAL OF THE OSAGE NATION. THE HOSPITAL IS ONE OF TWO FACILITIES LOCATED IN OSAGE COUNTY. PAWHUSKA IS A RURAL AREA WITH A POPULATION OF 3,589 FROM THE 2010 U.S. CENSUS. THE PER CAPITA INCOME FOR THE CITY WAS $13,916. ABOUT 137 OF FAMILIES AND 175 OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 223 OF THOSE UNDER AGE 18 AND 149 OF THOSE AGED 65 OR OVER. THE HOSPITAL IS A FEDERALLY DESIGNATED UNDERSERVED AREA FOR PRIMARY CARE HEALTH PROFESSIONALS, MENTAL HEALTH PROFESSIONALS AND DENTAL CARE HEALTH PROFESSIONALS. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH: PAWHUSKA HOSPITAL'S GOVERNING BODY IS COMPRISED OF VOLUNTEER MEMBERS WHO RESIDE IN THE COMMUNITY. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SURPLUS FUNDS ARE REINVESTED IN FACILITIES TO IMPROVE PATIENT CARE. THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS AVAILABLE TO ALL REGARDLESS OF A PATIENT'S ABILITY TO PAY. |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM: N/A |
| SCHEDULE H, PART VI, LINE 7 | STATE FILING OF COMMUNITY BENEFIT REPORT: not applicable for 2021 fISCAL YEAR |
| SCHEDULE H, PART I, LINE 3C | FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -ASSET LEVEL -MEDICAL INDIGENCY -INSURANCE STATUS -UNDERINSURANCE STATUS |
| SCHEDULE H, PART I, line 7, col (f) | PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $1,359,633. |
| Schedule H, Part III, Section A, Line 4 | BAD DEBT EXPENSE FOOTNOTE: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 10 & PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART I, LINE 7 | COSTING METHODOLOGY FOR COMMUNITY BENEFIT COSTS: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. THE RATIO WAS COMPUTED FROM THE MEDICARE COST REPORT. THE COST COMPUTED ON WORKSHEET 8 WERE FROM THE HOSPITAL'S INCOME STATEMENT AND GRANT SCHEDULE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MATTHEW C RUMSEY | ||||||||||||||
| CHIEF MEDICAL OFFICER | $484,722 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,278 | $0 | $500,000 | $0 | $0 | $0 |
| HEATHER ARRINGTON | ||||||||||||||
| PHYSICIAN | $167,179 | $0 | $4,320 | $0 | $0 | $0 | $0 | $0 | $1,986 | $0 | $173,485 | $0 | $0 | $0 |
| RON DUNKLE | ||||||||||||||
| APRN | $330,883 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,857 | $0 | $340,740 | $0 | $0 | $0 |
| Adam Helm | ||||||||||||||
| Nurse Practitioner | $201,379 | $0 | $0 | $0 | $201,379 | |||||||||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | DELEGATION OF CONTROL OVER MANAGEMENT DUTIES: COHESIVE HEALTHCARE MANAGEMENT AND CONSULTING PROVIDED ADMINISTRATIVE OVERSIGHT FOR DAY-TO-DAY OPERATIONS, ACCOUNTING SERVICES, AND OPERATIONAL CONSULTING SERVICES. JASON MCBRIDE IS THE ADMINISTRATOR AND DENNIS BOYD IS THE CFO ON BEHALF OF COHESIVE HEALTHCARE MANAGEMENT AND CONSULTING. PER IRS GUIDANCE, THE COMPENSATION PAID BY THE MANAGEMENT COMPANY IS NOT SHOWN ON FORM 990, PART VII, FOR THE 2020 CALENDAR YEAR FOR THESE INDIVIDUALS: JILL GRAY $60,677 JASON MCBRIDE $98,817 Tina Steele $118,799 |
| FORM 990, PART VI, SECTION A, LINE 7A | PERSONS WITH POWER TO ELECT OR APPOINT GOVERNING BODY: THERE ARE A TOTAL OF FIVE TRUSTEES. ALL ARE APPOINTED BY THE CITY COUNCIL OF PAWHUSKA BOARD OF INCORPORATORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW FORM 990: THE FORM 990 IS PRESENTED TO THE ADMINISTRATOR FOR REVIEW AND THEN PRESENTED TO THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS TO MONITOR COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL EMPLOYEES, BOARD MEMBERS, AND CONTRACT EMPLOYEES ARE COVERED IN OUR POLICIES. THE EMPLOYEE AND CONTRACT EMPLOYEE DETERMINATIONS ARE MADE BY ADMINISTRATION AND ANY BOARD DETERMINATIONS ARE MADE BY THE GOVERNING BOARD. THE EMPLOYEE WILL BE ASKED TO REMEDY THE SITUATION AND THE BOARD MEMBER WILL BE ASKED TO LEAVE AFTER PRESENTING THEIR CONFLICT AND THE REMAINDER OF THE GOVERNING BOARD WILL DISCUSS AND THEN VOTE. COPIES OF BOTH POLICIES CAN BE PROVIDED UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | COMPENSATION REVIEW: PAWHUSKA HOSPITAL, INC. FOLLOWS THE PAY GUIDELINES OF COHESIVE HEALTHCARE. SALARY DATA IS REVIEWED AGAINST SURVEY DATA FROM THE OKLAHOMA HOSPITAL ASSOCIATION. INCREASES ARE TIED TO AN ANNUAL PERFORMANCE EVALUATION AND APPROVAL FROM THE BOARD OF DIRECTORS. THE PROCESS AND DETERMINATION IS DOCUMENTED IN THE PERSONNEL FILES AND BOARD MINUTES. THE OTHER OFFICERS' COMPENSATION REVIEW IS PERFORMED EVERY YEAR BY THE HR DIRECTOR AND THEN REVIEWED BY THE COHESIVE CFO AND ADMINISTRATOR. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABILITY OF DOCUMENTS: THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IV, LINE 12 & PART XII, LINE 2 | AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION HAS ANSWERED "NO" TO THE QUESTIONS REGARDING AN AUDIT IN PART IV, LINE 12a AND PART XII. THE ORGANIZATION IS IN THE PROCESS OF AN AUDIT OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2021. HOWEVER, AT THE TIME OF FILING THIS RETURN, THE AUDIT IS NOT YET COMPLETE. THE ORGANIZATION HAS ATTACHED A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2020 AND SEPTEMBER 30, 2019 TO THE 990 AND ANSWERED YES TO PART IV, LINE 20B. |
| FORM 990, PART XII, LINE 3B | SINGLE AUDIT: THE ORGANIZATION DID UNDERGO THE REQUIRED SINGLE AUDIT, BUT IT WAS STILL IN PROCESS AT THE TIME OF FILING THE FORM 990. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:2585415 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT STAFF TOTAL FEES:1646229 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAUNDRY TOTAL FEES:89668 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:AMBULANCE SERVICES TOTAL FEES:35008 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMIN CREDENTIALING FEES TOTAL FEES:11706 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF PAWHUSKA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 W MAIN STREET | AddressLine1Txt |
| City | PAWHUSKA | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 74056 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 736005371 | EIN |
| Primary Activities | COMMUNITY SVC | PrimaryActivitiesTxt |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Exempt Code Section | GOVT | ExemptCodeSectionTxt |
| Public Charity Status | N/A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |