2018-05-15T20:47:26-05:00 2017-06-30 CAUSON & WESTHOFF CPA'S 15 W 6th St Ste 2310 TULSA OK 74119 990 2016-07-01 730977997 ADAIR COUNTY HEALTH CENTER INC % STILWELL MEMORIAL HOSPITAL ADAI 9186963101 PO BOX 272 STILWELL OK 74960 ALAN L ADAMS PRESIDENT & CEO 9186963101 2018-05-15 2016 2022-09-23 18:48:47Z STILWELL MEMORIAL HOSPITAL ALAN L ADAMS 1401 W LOCUST STILWELL OK 74960 36364176 false X N/A X 1975 OK To serve the community with respect to providing health care services and health care education. 2 0 337 0 10 0 36521414 36363985 35 191 0 0 36521459 36364176 0 0 0 0 14059740 13690653 0 0 0 22841848 23615951 36901588 37306604 -380129 -942428 14340373 13323443 1899886 1825384 12440487 11498059 TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION THROUGH THE OPERATION OF HOSPITAL(S), CLINIC(S) AND OTHER SUCH FACILITIES AS ARE NECESSARY AND USEFUL IN PROVIDING CARE, TREATMENT AND REHABILITATION FOR THE SICK, INJURED, AGED AND INFIRM WITHOUT REGARD TO RACE, COLOR, NATIONAL ORIGIN OR FINANCIAL STATUS. STILWELL MEMORIAL HOSPITAL PROVIDES QUALITY HEALTH CARE REGARDLESS OF RACE, CREED, SEX NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF STILWELL MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THIS HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY: * FREE CARE AND/OR SUBSIDIZED CARE, * CARE PROVIDED TO PERSONS COVER false false 35695736 36364176 Stilwell Memorial Hospital provides quality health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Stilwell Memorial Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services and further that our mission is to serve the community with respect to providing health care services and health care education. Therefore, in keeping with this Hospital's commitment to serve all members of its community: * Free care and/or subsidized care, * Care provided to persons covered by government programs at below cost, and * Health care activities and programs to support the community will be considered where the need and/or and individual's inability to pay coexists. These activities will include wellness programs, community education programs, special programs for the elderly, handicapped, medically underserved, and a variety of broad community support activities. Stilwell Memorial Hospital served over 1,500 patients, over 7,000 emergency room visits, 4,700 home health care visits, and provided the equivalent of more than 12,190 patient days during the year ended June 30, 2017. Stilwell Memorial Hospital provides care to persons covered by governmental programs at below cost, recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. To the extent reimbursement is below cost, Stilwell Memorial Hospital recognizes these amounts as charity care in meeting its mission to the entire community. The unreimbursed value of providing care to these patients is $15,899,999. Also, in recognizing its mission to the community, Stilwell Memorial Hospital provides services for those unable to pay. These services are unreimbursed to the Hospital and the unreimbursed value of providing care to these patients is $1,868,664, of this $1,083,677 is identified as charity care and $784,987 is specified as bad debts. Charity care is also provided through many reduced price services and free programs throughout the year. These programs and services are chosen to meet legitimate community health center needs. The following listing of activities provides a sample of the types of programs and services offered to our community. Home health and Hospital employees donated and collected enough perishable and nonperishable food items to fill and distribute approximately 88 food baskets to needy families, impacting the lives of nearly 315 individuals. The home health care department has also performed complimentary assessments and free visits as a part of their mission to the community. Free assistance is offered to patients by the business office employees, so patients may complete billing forms accurately. The Hospital participates in a providing various tests and procedures at reduced prices or at no cost to the public. Such tests include, but are not limited to, prostate exams, colorectal exams, cholesterol and blood pressure checks. Hospital employees speak publicly to various groups regarding a variety of health care topics. Others are members of local civic groups and participate in community activities thereby helping to promote proper health care throughout the community. Hospital employees annually give of their time and expertise to organize and coordinate reduced cost physicals for local youths, so they may participate in athletic events. Hospital employees have adopted a section of State Highway 100 West and regularly participate in the Oklahoma Department of Transportation's "Adopt-A-Highway" program which contributes toward the effort of maintaining litter-free Oklahoma highways. Other community services in which Hospital employees participate are: the American Cancer Society's Relay for Life, which through various fund raising events employees raised and contributed more than $10,600 for the fiscal year ended June 30, 2017. Other areas of participation include DHS Foster Children Fund and the Angel Tree Fund. 35695736 true false false false false false false false false true false false true false false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 17 0 true 337 true false false false false false false false false false false false false false X 2 0 false false false false false false false true true false false false false false false false false false OK X STILWELL MEMORIAL HOSPITAL 9186963101 PO BOX 272 STILWELL OK 74960 JIM F CARSON CHAIRMAN 1.0 0.0 X 0 0 0 ALAN L ADAMS PRESIDENT 50.0 0.0 X 178220 0 0 DR WOJCIECH DULOWSKI PHYSICIAN 60.0 0.0 X 843781 0 0 DR JEFFREY JENKINS PHYSICIAN 50.0 0.0 X 415436 0 0 DR NICHOLAS BENTLEY PHYSICIAN 50.0 0.0 X 427604 0 0 VIKRANT L LANDGE PHYSICIAN 50.0 0.0 X 429238 0 0 DR MARTIN NEE PHYSICIAN 50.0 0.0 X 401085 0 0 2695364 0 0 14 false true false MEDSPHERE SYSTEMS CORPORATION 1903 WRIGHT PLACE STE 120 CARLSBAD CA 92008 EMR 178419 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 90074 MRI 190354 CUSTOM MEDICAL SCRIBE 6506 S LEWIS AVE 149 TULSA OK 74136 TRANSCRIPTION 181989 DR THOMAS TODD MD 2530 E 26TH ST TULSA OK 74114 ER SERVICES 161325 STOCKELL HEALTHCARE SYSTEMS 15400 SOUTH OUTER FORTY CHESTERFIELD MO 63017 EMR ADT SYSTEM 265300 6 0 0 PATIENT SVC REV. 33397843 33397843 MEDICAL REC. FEES 3325 3325 SUPPLEMENTAL HOSPIAL OFFSET PAYMENT PROGRAM 963563 963563 MEDICARE/MEDICAID EHR PAYMENTS AND 340B 1896378 1896378 MISCELLANEOUS 102876 102876 36363985 191 191 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36364176 36363985 191 0 0 0 0 178220 178220 0 12159815 11676527 483288 0 617025 583943 33082 735593 696154 39439 0 50636 50636 172049 172049 0 0 0 0 0 0 0 0 0 49525 39152 10373 0 0 5943 5943 0 848400 848400 0 GOVERNMENTAL CONTRACTUAL ADJ. 12507567 12507567 OTHER CONTRACTUAL ADJUSTMENTS 3382432 3382432 SUPPLIES 3919592 3275811 643781 PROVISION FOR BAD DEBT 784987 784987 1894820 1894820 37306604 35695736 1610868 0 106961 171062 2122270 1000182 0 0 3170214 3341962 0 0 0 0 0 0 616299 622855 74267 74267 18809621 11309806 7177062 7499815 0 0 0 0 0 0 0 0 1073300 613300 14340373 13323443 1099886 1272530 0 0 0 0 0 0 0 0 0 0 800000 552854 0 0 0 0 1899886 1825384 X 12440487 11498059 0 0 0 0 12440487 11498059 14340373 13323443 -942428 X false true X true false X 72150 72150 7838728 3498325 4340403 10577876 7652911 2924965 320867 158570 162297 7499815 20474177 20474177 15889999 15889999 36364176 21416605 21416605 15889999 15889999 37306604 CONTRACTUAL ALLOWANCES $ 15,889,999 CONTRACTUAL ALLOWANCES $ 15,889,999 true true true X true X true false false 921323 921323 0.02470 2234651 2234651 0.05990 3155974 3155974 0.08460 1755153 1755153 0.04700 1755153 1755153 0.04700 4911127 4911127 0.13160 23709 23709 0.00060 23709 23709 0.00060 true 1749483 5950471 16668701 -10718230 X true true 1 1 MEMORIAL HOSPITAL 1401 W LOCUST STILWELL OK 74960 X X X PHYSICIANS CLINIC HOME HLTH/GERAL PSYC PHYSICAL THERAPY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 15 true false true true X osururalhealth.blogspot.com X true 15 true osururalhealth.blogspot.com false true X 200. 350. X X X X true true X X X true X X X X true X false X X X X true X false true SCHEDULE H, SECTION B, LINE 6b OKLAHOMA STATE UNIVERSITY CENTER FOR HEALTH SCIENCES OKLAHOMA STATE UNIVERSITY CENTER FOR RURAL HEALTH PART III, LINE 4: THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE AMOUNT REPORTED ON LINE 2 WAS CALCULATED USING IRS WORKSHEET 2 'RATIO OF PATIENT CARE COST TO CHARGES' TO CALCULATE THE COST TO CHARGE RATIO FOR THE HOSPITAL. THIS RATIO WAS THEN APPLIED AGAINST THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS USING IRS WORKSHEET A TO ARRIVE AT THE BAD DEBT EXPENSE AT COST REPORTED ON LINE 2. THE AMOUNT ON LINE 3 IS $0 DUE TO THE WAY IN WHICH THE HOSPITAL IDENTIFIED AND ACCOUNTS FOR BOTH CHARITY CARE AND BAD DEBT. PART III, LINE 8: THE HOSPITAL BELIEVES THE ENTIRE AMOUNT OF THE MEDICARE SHORTFALL REPORTED ON LINE 7 ABOVE SHOULD BE TREATED AS COMMUNITY BENEFIT, MORE SPECIFICALLY, AS CHARITY CARE. THIS IS BECAUSE THE ELDERLY CONSTITUTE A CLEARLY-RECOGNIZED CHARITABLE CLASS, AND MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR AND THUS WOULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE PROGRAM OR MEDICAID IN ADDITION TO MEDICARE. IF THESE PATIENTS HAD BEEN TREATED AS CHARITY CARE, THE ENTIRE COST OF MEDICAL CARE WOULD HAVE BEEN CONSIDERED COMMUNITY BENEFIT UNDER PART I. AMOUNTS ON LINE 6 WERE CALCULATED USING IRS WORKSHEET B 'TOTAL MEDICARE ALLOWABLE COSTS.' THE MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE MEDICARE COST REPORT AND THEN REDUCED BY ANY AMOUNTS ALREADY CAPTURED IN COMMUNITY BENEFIT EXPENSE IN PART I ABOVE. PART III, LINE 9B: AFTER THE PATIENT MEETS THE QUALIFICATIONS FOR FINANCIAL ASSISTANCE, THE ACCOUNT BALANCE IS PARTIALLY OR ENTIRELY WRITTEN OFF, AS APPROPRIATE. ANY REMAINING BALANCE, IF ANY, WOULD BE COLLECTED UNDER THE NORMAL DEBT COLLECTION POLICY. PART V, LINE 19: THE FACILITY BILLS ITS SERVICES AT GROSS CHARGES TO INDIVIDUALS WHO DO NOT HAVE INSURANCE COVERAGE FOR ITS SERVICES. HOWEVER, CERTAIN PATIENTS ARE ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICY. PART V, LINE 21: THE FACILITY BILLS ITS SERVICES AT GROSS CHARGES UNLESS THE INDIVIDUAL IS COVERED BY INSURANCE OR OTHER PROGRAM OR POLICY WHICH PROVIDES THAT SERVICES ARE BILLED AT LESS THAN GROSS CHARGES. CERTAIN PATIENTS ARE ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICY. NEEDS ASSESSMENT: ADAIR COUNTY HEALTH CENTER CONTINUALLY WORKS WITH COMMUNITY PARTNERS IN EASTERN OKLAHOMA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. SPECIFICALLY, THE HOSPITAL ADMINISTRATION IS ACTIVELY ENGAGED IN LOCAL, REGIONAL AND STATEWIDE HEALTHCARE COUNCILS, BOARDS AND EMERGENCY/HEALTHCARE SERVICE ORGANIZATIONS. THESE VARIOUS ORGANIZATIONS WORK TO ASSESS, ADDRESS AND MONITOR THE HEALTH NEEDS OF ADAIR COUNTY AND NORTHEASTERN OKLAHOMA. THE HOSPITAL USES ITS RELATIONSHIPS WITH LARGE LOCAL EMPLOYERS TO ALSO HELP ASSESS COMMUNITY NEEDS AND HELP TO ENGAGE IN AREAS OF SERVICE TO THE COMMUNITY WHICH ARE SPECIFIC IN NEED TO THE LOCAL AREA. INDIVIDUAL DEPARTMENTS OFTEN WORK TO IDENTIFY SPECIFIC NEEDS RELATED TO THEIR SERVICES AND THE POPULATION THEY IMPACT. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ADAIR COUNTY HEALTH CENTER PERFORMS THE FOLLOWING ACTIVITIES TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE TO ALL PATIENTS: 1) PLACES SIGNAGE, INFORMATION, AND/OR BROCHURES IN APPROPRIATE AREAS OF THE FACILITY (E.G., THE EMERGENCY DEPARTMENT; REGISTRATION AND CHECK-OUT/CASHIER AREAS) STATING THE PROVIDER OFFERS CHARITY CARE AND DESCRIBES HOW TO OBTAIN MORE INFORMATION ABOUT FINANCIAL ASSISTANCE, 2) PLACES A NOTE ON THE HEALTH-CARE BILL AND STATEMENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE, 3) DESIGNATES INDIVIDUALS WHO CAN EXPLAIN THE PROVIDER'S CHARITY CARE POLICY, AND 4) INSTRUCTS STAFF WHO INTERACT WITH PATIENTS TO DIRECT QUESTIONS REGARDING THE CHARITY CARE POLICY TO THE PROPER PROVIDER REPRESENTATIVE. COMMUNITY INFORMATION: ADAIR COUNTY HEALTH CENTER IS A LICENSED 57 BED RURAL HOSPITAL LOCATED IN ADAIR COUNTY IN EASTERN OKLAHOMA. THE HOSPITAL IS NONDENOMINATIONAL AND SERVES ALL WHO COME, REGARDLESS OF REASON OR CIRCUMSTANCE. AS OF THE CENSUS OF 2000, ADAIR COUNTY HAD A POPULATION OF APPROX 22,000 PEOPLE, ALMOST HALF OF WHICH (42.49%) ARE NATIVE AMERICAN. THE MEDIAN AGE OF THE POPULATION WAS 33 YEARS OLD AND NEARLY TWO-THIRDS OF THE COUNTY'S POPULATION WERE EITHER UNDER THE AGE OF 18 (30.3%) OR BETWEEN 25 TO 44 (27.2%). POPULATION OVER 65 YEARS IS 12%. THE MEDIAN INCOME PER HOSEHOLD IN THE COUNTY WAS $24,881. ABOUT 19.4 PERCENT OF FAMILIES AND 23.2 PERCENT OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 28.2% OF THOSE UNDER AGE 18 AND 23.7% OF THOSE AGE 65 OR OVER. PROMOTION OF COMMUNITY HEALTH: ADAIR COUNTY HEALTH CENTER CONTINUALLY RECRUITS PHYSICIANS TO HELP FULFILL THE NEEDS OF THE MEDICALLY UNDERSERVED AREA IN WHICH IT OPERATES. HOSPITAL EMPLOYEES ARE ACTIVE IN EDUCATING PARTNERS THROUGHOUT THE COMMUNITY THROUGH THEIR MEMBERSHIPS ON VOLUNTARY ORGANIZATIONS TO PROMOTE HEALTH ISSUES WITHIN THE COMMUNITY AND TO HELP EDUCATE ON THE AVAILABLITY OF HEALTH SERVICES. OTHER INFORMATION: PART VI, LINE 5: ADAIR COUNTY HEALTH CENTER IS ORGANIZED AND OPERTATED TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THE HOSPITAL SUPPORTS THIS MISSION WITH A BOARD COMPOSED OF CIVIC LEADERS IN THE COMMUNITY, OPEN MEDICAL STAFF AND AN EMERGENCY ROOM AVAILABLE TO PATIENTS REGARDLESS OF ABILITY TO PAY. THE BOARD ACTIVELY DEBATES AND SETS POLICIES AND STRATEGIC DIRECTION FOR THE HOSPITAL BUT DOES NOT GET INVOLVED IN ISSUES RELATES TO THE DIRECT OPERATION OF THE HOSPITAL. THE BOARD TAKES A BALANCED APPROACH WHEN ADDRESSING COMMUNITY AND BUSINESS/FINANCIAL CONCERNS. THE BOARD IS ALSO THE PRIMARY GROUP FOR DETERMINING THE USE OF HOSPITAL SURPLUS FUNDS WHICH ARE ALL USED TO FURTHER ITS CHARITABLE PURPOSE. X false false false false false false false false false ALAN L ADAMS PRESIDENT 178220 0 0 0 0 0 178220 0 DR WOJCIECH DULOWSKI PHYSICIAN 190000 0 653781 0 0 0 843781 0 DR JEFFREY JENKINS PHYSICIAN 190000 0 225436 0 0 0 415436 0 DR NICHOLAS BENTLEY PHYSICIAN 200000 0 227604 0 0 0 427604 0 VIKRANT L LANDGE PHYSICIAN 429238 0 0 0 0 0 429238 0 DR MARTIN NEE PHYSICIAN 401085 0 0 0 0 0 401085 0 1 THE ORGANIZATION DOES NOT MAKE GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION DOES MAKE FORM 990 AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE ADMINISTRATIVE OFFICES LOCATED AT 1401 W. LOCUST, STILWELL, OK 74960.