2017-05-08T13:02:48-05:00 2016-06-30 450250958 EIDE BAILLY LLP 1601 NW EXPRESSWAY SUITE 1900 OKLAHOMA CITY OK 73118 990 2015-07-01 730579295 Farmers Union Hospital Association FARM 5802252511 1801 W 3rd Street Elk City OK 73644 Corey Lively CEO 5802252511 2017-05-01 1 Kim Hunwardsen P00484560 4054783334 2017-05-01 2015 2021-01-29 14:40:06Z Great Plains Regional Medical Center Corey Lively 1801 W 3rd Street Elk City OK 73644 56924851 0 X www.gprmc-ok.com X 1938 OK To provide comprehensive, cost-effective, high quality healthcare to our communities. 10 9 537 35 57957 -2009 48965 84419 51498824 48635930 562658 308287 479808 285103 52590255 49313739 3100 6035 0 0 21208812 22291152 0 0 0 33083682 32264716 54295594 54561903 -1705339 -5248164 83283661 77079947 38868711 37704447 44414950 39375500 X Great Plains Regional Medical Center will distinguish itself as the leader in Western Oklahoma and the Eastern Texas Panhandle for comprehensive, cost effective, high quality healthcare. We will meet the healthcare needs of patients in our service area while achieving cost effective quality outcomes. We will maintain and enhance collaborative relationships with physicians to better serve the healthcare needs of our service area. We will maintain and continually enhance health promotion, patient education and disease prevention for patients in our service area. 0 0 48369115 6035 48577973 Farmers Union Hospital Association, DBA Great Plains Regional Medical Center in Elk City, Oklahoma (hereinafter referred to as GPRMC) provides quality health care regardless of race, religion, creed, sex, national origin, handicap, age or ability to pay. Reimbursement for services rendered is critical to the operation and stability of GPRMC, it is recognized that not all individuals possess the ability to purchase essential medical services. In keeping with the 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 whether the need and/or individual's inability to pay exists. GPRMC served over 2,204 patients with more than 6,677 patient days on an inpatient basis. We also had 60,567 outpatient encounters. During the year we treated 13,742 patients in the Emergency Department. Our Surgical teams performed 2,535 outpatient surgeries. GPRMC provides care to persons covered by governmental and other programs as part of its mission to the community. These programs may not pay full charges to the extent reimbursement is below full charges. GPRMC recognized these amounts as contractual adjustments in meeting its mission to the entire community. Also, in recognizing its mission to the community, GPRMC provides services for those unable to pay. Additionally, GPRMC has provided services to others who are either unwilling or unable to qualify for charity care guidelines but who are still unable to pay. Community benefit is also provided by GPRMC by providing reduced price services, free programs offered throughout the year which GPRMC believes will serve a bona fide community health need. See Schedule H for more information regarding these activities.The Hospital provides health care services to patients who meet certain criteria under its charity policy without charge or amounts less than established rates. Because the Hospital does not pursue collection amounts determined to qualify as charity care, they are not recorded as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $1,634,224 in 2016. Total direct and indirect cost related to these foregone charges were $568,000 at June 30, 2016, based on an average ratios of cost to gross charges. 48369115 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 78 0 1 537 1 1 1 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 OK X Janet Miller 5808215302 1801 W 3rd Street Elk City OK 73544 Paul Kumpf Chair 1.00 0.10 X X 0 0 0 Edward Albert Vice Chair 1.00 0.00 X X 0 0 0 Jack Morrison DDS Secretary 1.00 0.00 X X 0 0 0 Joe Coker MD Chief of Staff 41.00 0.00 X 90000 0 0 Francis Abraham MD- Vice Chief of Staff (July - Dec 2015) 41.00 0.00 X 376486 0 2887 Alan Stone MD Vice Chief of Staff 1.00 0.00 X 0 0 0 J Coffey MD Member/Family Practice Physician 1.00 0.00 X 0 0 0 Emory Thomas Member 1.00 0.00 X 0 0 0 Bill Gwartney Member 1.00 0.00 X 0 0 0 Danny Sprowls Member 1.00 0.00 X 0 0 0 Jeff Jackson Member 1.00 0.00 X 0 0 0 Gene Smith Member (July-Oct 2015) 1.00 0.00 X 0 0 0 Corey Lively CEO 40.00 0.10 X 329304 0 27832 Monica Scott CFO 40.00 0.00 X 134868 0 21171 Lindsey Pena MD Surgery 40.00 0.00 X 375591 0 19671 Tiffany Dupree DO Obstetrics & Gynecology 40.00 0.00 X 299613 0 17232 Jeffery Lester MD Family Practice 40.00 0.00 X 308286 0 19789 Brad Whinery MD Family Practice 40.00 0.00 X 284011 0 26792 Robert Keith MD Obstetrics & Gynecology 40.00 0.00 X 284470 0 20049 2482629 0 155423 19 0 1 0 Premier Physician Staffing 19992 W Woodhaven Road Owasso OK 74055 Physician ER Coverage 2715134 Nightrays PA 10901 W Toller Dr Suite 105 Littleton CO 80124 Radiologist Services 836262 Prime Physician Staffing PLLC 19992 W Woodhaven Road Owasso OK 74055 Hospitalist Physician Coverage 532098 Medical Solutions 1010 N 102nd Street Suite 300 Omaha NE 68114 Contract Nursing 379607 Hospital Care Consultants 17304 Preston Road Suite 1400 Dallas TX 75252 Hospitalist Physician Coverage 341090 10 38271 46148 84419 Net patient service 621990 47172402 47172402 Cafeteria 722210 543555 485598 57957 EHR incentives 900099 367383 367383 Income from Plains Diagnostic Ima 900099 299926 299926 Daycare center 624410 138966 138966 113698 113698 48635930 491807 491807 142156 142156 142947 0 142947 142947 142947 7424407 3185 7610406 706 -185999 2479 -183520 -183520 49313739 48577973 57957 593390 X 6035 6035 933199 418082 515117 17075867 15001256 2074611 32069 24349 7720 3027829 2593600 434229 1222188 885800 336388 94248 94248 44472 44472 9217667 7993018 1224649 138498 2573 135925 1238440 966932 271508 280737 102834 177903 895413 888558 6855 86837 83234 3603 55312 42549 12763 1740025 1454856 285169 3997865 3779018 218847 833158 632791 200367 Bad debt expense 6644317 6644317 Medical supplies 6026286 6026286 Food 606383 606383 Dues & subscriptions 234708 149675 85033 130350 66969 63381 54561903 48369115 6192788 0 2825 2959 8328116 7059077 6271464 5765352 1433641 1409877 1121362 1210949 86301012 43476929 46352972 42824083 17069320 16617994 1397738 1547058 44362 55117 1261861 587481 83283661 77079947 4482697 4210479 34306547 33426709 79467 67259 38868711 37704447 X 44414950 39375500 44414950 39375500 83283661 77079947 X -5248164 208712 2 X 0 1 X 1 0 X 748759 748759 59310836 21849281 37461555 24517222 20635053 3882169 1724195 992595 731600 42824083 Payable to related party 67000 Estimated third-party payor settlements 259 67259 X Part X, Line 2: 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 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 consolidated 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. 1 1 X 1 X 1 X 1 1 0 1 1 568000 568000 0.01190 568000 568000 0.01190 12654 12654 0.00030 4704126 3772251 931875 0.01940 4716780 3772251 944529 0.01970 5284780 3772251 1512529 0.03160 7570 7570 0.00020 7570 7570 0.00020 1 6644317 1063091 11610288 15313602 -3703314 X 1 1 1 Plains Diagnostic Imaging LLC Radiology services 0.84550 0.03640 0.11810 1 1 Great Plains Regional Medical Center 1801 W 3rd Street Elk City OK 73644 www.gprmc-ok.com 2210 X X X Great Plains Regional Medical Center 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.gprmc-ok.com/about/chna X osururalhealth.blogspot.com/p/chna.html#beckham X 1 15 1 osururalhealth.blogspot.com/p/chna.html#beckham 0 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X www.gprmc-ok.com/patient/assistance X www.gprmc-ok.com/patient/assistance X www.gprmc-ok.com/patient/assistance X X X X 1 X 0 X X X X 1 X 0 0 Great Plains Regional Medical Center Part V, Section B, Line 5: Great Plains Regional Medical Center hosted five community meetings between March - May 2016. Average attendance at the community meetings was 20-25 community members consisting of retired individuals, local business owners, city government, local bank employees/officers, local volunteer organizations, Great Plains Regional Medical Center representatives and individuals from the County Cooperative Extension office. Great Plains Regional Medical Center Part V, Section B, Line 11: The Implementation Strategy addressed:Insurance and uninsured individualsThis priority was identified as a barrier for community members in terms of accessing care. There are community members who do have insurance coverage with high deductibles and out of pocket costs that limit them from accessing needed care, and there are also individuals who cannot afford coverage but do not meet the requirements for Medicaid. * The hospital and local providers collaborate with the Hope Clinic in terms of providing physician services and staffing. The hospital also has a financial assistance policy in place to assist uninsured patients. * The community members present noted that ideally a free clinic offered once per week or month could further assist those needing assistance. Preventative careThis item was mentioned as a need that went along with the previous priority of accessing care. It was also noted the need for prevention or at least education to decrease the rate of teen pregnancy and sexually transmitted infections in the county. It was noted in the data presented in the second community meeting that these are two areas for Beckham County to take a closer look. It was also noted that prevention strategies, including adding and passing policies in the workplace and government, are not necessarily a top focus at this time. With the current economic climate, businesses and individuals have further stressors and items that take a current priority. * The physician offices are increasing case management and insurance plans have case managers to assist patients. In the area of teen pregnancy and sexually transmitted infections, the county health department does provide free condoms, and they employ a health educator who goes to the schools to teach students about sexual health. * In terms of outreach and programs the community would like to see, it was noted the hospital and physician offices could take a larger focus on case management and increase the number of preventative exams, maximize smoking cessation, and counseling. * The hospital will provide free room space for smoking cessation classes offered to community members * The hospital already hosts an annual health fair. It was noted to maybe transform the health fair into a life coaching event to expand beyond health. There could be providers present to assist community members in signing up for assistance with utilities, show how to cook healthy, have vaccines available, and how to manager stressors. Student could be invited to attend for the educational opportunity. * It was also mentioned to have a community center for resources. The community currently has the Lincoln Teen Center which provides after school programs and will bus youth to the facility. Substance abuse/Drug abuseThis priority was mentioned at more than one community meeting. It was noted as an increasing concern from law enforcement and healthcare providers. One provider noted the substantial increase in deliveries that the mother used drugs during the pregnancy. * In terms of current programs, there is a female recovery center located in Sayre. There is also a grant for middle school students to prevent the use of e-cigarettes and tobacco. There is also the 1-800 quit line available for assistance with decreasing tobacco use. * The DARE program was previously successful in educating youth. It was also noted that there is a lack of knowledge of existing resources and partners in this area to refer patients for help. * The hospital does note that this is a concern in the community; however, it is largely beyond the scope of services provided by this facility. This priority cannot be addressed at this time outside of provide space for smoking cessation education. Great Plains Regional Medical Center Part V, Section B, Line 13b: If the patients' medical expenses are 30% of their income then they can also qualify for assistance. Great Plains Regional Medical Center Part V, Section B, Line 22d: Great Plains Regional Medical Center uses the Look Back Method to determine the maximum amounts that can be charged to financial assistance eligible patients. All claims paid by Medicare fee-for-service and private health insurers over the last 12 months are used in the calculation. For these claims, the sum of all allowable reimbursement amounts is divided by the sum of the associated gross charges. The calculation is completed each fiscal year with implementation not more than one hundred twenty days after the end of the twelve month period. Part I, Line 3c: If the patient's medical expenses are 30% of their income then they can also qualify for assistance. Part I, Line 6a: The organization's community benefit report can be found on its website at http://www.gprmc-ok.com/about/chna/ Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, line 7e, was compiled using actual costs recorded in the general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the community benefit percentage was $6,644,317. Part II, Community Building Activities: Great Plains Regional Medical Center's involvement in community building activities extends through programs such as Meals on Wheels, which delivers meals to the homebound. The Medical Center uses a taxi service for patients that need to be transported to their home after a visit at the hospital or one of the physician clinics. The taxi service is free to patients. Part III, Line 2: All forms of payment, including self-pay, insurance, contractual allowances, and discounts, are applied to the patient's account before the account is classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Great Plains Regional Medical Center does not refuse services to patients that generate bad debt.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: A reasonable estimate of the Organization's bad debt expense attributable to patients under the Organization's financial assistance policy is 16% of bad debt expense. This is based on the percentage of individuals in the county under the federal poverty level. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 8 and 9 of the attached audited financial statements. Part III, Line 8: Great Plains Regional Medical Center provides services to Medicare patients understanding there will be write-offs and knowing the Organization will not recover the costs of the services provided. Providing these services is essential to the community and therefore increases access to healthcare services, which is a community benefit. Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: Patients are pre-screened for charitable services before receiving tests and a determination is made as to the financial ability to pay. If patients are pre-qualified for services, the collection process is ceased.For patients who qualify for charity care and who are cooperating in good faith to resolve their discounted hospital bills, Great Plains Regional Medical Center may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. Great Plains Regional Medical Center will not impose extraordinary collections actions such as wage garnishments; liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for charity care under this financial assistance policy. Reasonable efforts shall include:1. Validating that the patient owes the unpaid bills and that all sources of third-party payments have been identified and billed by the hospital; 2. Documentation that Great Plains Regional Medical Center has or has attempted to offer the patient the opportunity to apply for charity care pursuant to this policy and that the patient has not complied with the hospital's application requirements; 3. Documentation that the patient has been offered a payment plan but has not honored the terms of that plan Part VI, Line 2: The Organization relies on input from physicians, other healthcare providers, community leaders, the Board of Directors and citizens in the community. We look at out-migration studies to determine what services individuals from the community are seeking and receiving from outside locations. We also consider comparisons of the volume of physician specialties in our area to nationally recognized data. The factors are all considered in addition to feedback from patients in the community to determine shortages of care areas. Part VI, Line 3: Assistance is discussed with patients as part of the intake process. Patients are screened at registration to determine need for financial assistance and then are given copies of the financial assistance policy. Upon request, we try to assist patients with paperwork for medical assistance such as Medicare, Medicaid, disability or financial assistance. Part VI, Line 4: Great Plains Regional Medical Center is an acute care hospital located in Elk City, Oklahoma in Beckham County. The Medical Center provides a comprehensive range of general, acute and specialized care, as well as outpatient and ancillary services to residents in its primary and secondary service areas covering eight counties. The estimated primary and secondary service area population exceeds 93,146. The median household income in Beckham County is $43,642 and 16% of the county is below poverty level. Part VI, Line 5: Our Board of Directors is comprised of citizens from the community, from business owners to retired individuals. This broadly based group provides us with a broad perspective on the needs of the community. GPRMC extends medical privileges to area physicians. They must apply for privileges and be approved by the medical staff and Board of Director. Surplus funds are reinvested into facility and equipment upgrades and free programs throughout the year.GPRMC publishes notices in the area newspapers reaching 8,000 to 10,000 homes. The notices provide information on new physicians and medical services.GPRMC provides breast self-exam, CPR and pre-natal education to community members. The Medical Center is one of two designated donor locations for the communitywide blood drive held five times per year.Great Plains Regional Medical Center sponsors healthcare initiatives for the community. Some of these include diabetes self-management classes for patients with new or uncontrolled diabetes and education to local nursing home staff regarding care of patients with dementia and other types of behavioral disorders. Due to the shortage of nurses in the area, scholarships are awarded to students wishing to pursue degrees in the medical field. Education programs are presented at the local adult learning center discussing education needed to fulfill the requirements for employment in a hospital setting. We also participate in several career fairs for different schools in our area. GPRMC works in cooperation with educators by providing a clinical rotation training environment for students of various fields including physician, nursing, pharmacy, lab, radiology and medical records. We participate with area high schools in the job shadow program. Students interested in health careers may observe our staff in the work setting and obtain a first-hand experience. The Medical Center developed a collaboration with Western Oklahoma State College to provide distance learning classes for those in the community wishing to pursue nursing degrees. GPRMC provides a classroom in the local community. Additionally, in-kind services are provided to Western Oklahoma State College. This is vital to prospective students pursuing nursing degrees that would not have been able to drive the long distance to the College. X X X X 0 0 0 0 0 0 0 0 0 Francis Abraham MD- Vice Chief of Staff (July - Dec 2015) 335486 0 0 0 41000 0 442 0 3681 0 380609 0 0 0 Corey Lively CEO 329304 0 0 0 0 0 0 0 28131 0 357435 0 0 0 Monica Scott CFO 134760 0 0 0 108 0 700 0 20719 0 156287 0 0 0 Lindsey Pena MD Surgery 358091 0 0 0 17500 0 1750 0 18245 0 395586 0 0 0 Tiffany Dupree DO Obstetrics & Gynecology 299613 0 0 0 0 0 0 0 17455 0 317068 0 0 0 Jeffery Lester MD Family Practice 299076 0 0 0 9210 0 1499 0 24445 0 334230 0 0 0 Brad Whinery MD Family Practice 284011 0 0 0 0 0 0 0 27061 0 311072 0 0 0 Robert Keith MD Obstetrics & Gynecology 261393 0 0 0 23077 0 1500 0 20521 0 306491 0 0 0 A The Oklahoma Development Finance Committee 731083741 678910DB3 2007-06-26 40000000 Construct and furnish a 62-bed hospital 0 0 0 A 6022228 39448937 2653544 562777 36232616 2009 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 Form 990, Schedule K, Part II, Line 3: The total issue price of $40,000,000 reported on Part I, Line A, Column (e) less the Original Issue Discount of $551,063 is the amount reported on Part II, Line 3. Form 990, Part VI, Section A, line 1 The Executive Committee is composed of the officers of the Board; President, Vice President, Secretary and Treasurer. The Hospital's Board President serves as the Chair of the Executive Committee. Other members may be added if advisable. The Executive Committee directly represents the Board and possesses the power to act for the Board within limits set for it by the Board, on matters needing immediate attention, prior to regular board meetings, and such other powers as delegated to it by the Board. The Executive Committee reports to the Board of Directors at the next regular or at the next special meeting called for that purpose. Form 990, Part VI, Section A, line 6 Members are individuals who have voting shares in Great Plains Regional Medical Center. Membership is obtained through transfers of existing memberships. Transfers normally result either through voluntary surrender of a membership from a current member who is no longer interested in retaining their membership or through the death of a member who has no immediate family interested in retaining the membership. Each individual is allowed only one membership and there is only one vote allowed per membership. Form 990, Part VI, Section A, line 7a Governing Board members are appointed through nomination and a majority vote election by the membership at annual meetings. Form 990, Part VI, Section A, line 7b Any amendments to the Governing Board Bylaws and Rules & Regulations have to be approved by a majority vote of the membership. Per the Organization's Bylaws, the members are the supreme authority of the Association in all its affairs. Form 990, Part VI, Section B, line 11 The Form 990 is presented and reviewed at the governing Board's monthly meeting. The 990 is also posted on the governing Board's website prior to the meeting. Form 990, Part VI, Section B, line 12c All members of the governing board, officers and key employees receive a copy of the Conflict of Interest Policy on an annual basis. The individuals are required to review the policy and complete and sign the questionnaire attesting to their understanding of the policy and that their answers are true and accurate. The board as a whole reviews the conflict of interest statements. Any potential conflicts are discussed and depending on the conflict the board decides the appropriate action to take. Form 990, Part VI, Section B, line 15a Human Resources conducts a comparative analysis using state, multi-state, regional, and national compensation (by position). Data is culled into bed-size, revenue, and similar area comparatives. Human Resources submits a report to the Executive Committee of the Board of Directors annually. The Executive Committee reviews the data, confirms the data with an out-of-house auditor, and recommends appropriate CEO compensation to the Board of Directors as a whole. All other positions are reviewed annually by Human Resources and approved by the CEO. Form 990, Part VI, Section C, line 19 GPRMC makes its Forms 1023, 990, and 990-T available to the public upon request. A copy of the requested document is provided when practical. Otherwise, an appointment for an on-site review of the requested document is made, with the day and time of the appointment determined by the person(s) who has made the request, according to their schedule and convenience. Form 990, Part IX, line 11g Repairs and maintenance: Program service expenses 190,366. Management and general expenses 7,901. Fundraising expenses 0. Total expenses 198,267. Consulting: Program service expenses 3,018,021. Management and general expenses 266,261. Fundraising expenses 0. Total expenses 3,284,282. Service contracts: Program service expenses 878,739. Management and general expenses 242,979. Fundraising expenses 0. Total expenses 1,121,718. Contract labor: Program service expenses 3,802,700. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,802,700. Purchased services: Program service expenses 103,192. Management and general expenses 707,508. Fundraising expenses 0. Total expenses 810,700. Form 990, Part XI, line 9: Adjustment to balance to end of year net assets 2. Plains Diagnostic Imaging LLC 1705 W 2nd St Elk City OK 73644 261530951 Radiology services and equipment rental OK Great Plains Regional Medical Center Related 299927 572259 0 1 0.84550 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 Plains Diagnostic Imaging LLC K 804000 General ledger Plains Diagnostic Imaging LLC S 299590 Amount from K-1 Plains Diagnostic Imaging LLC A 337 Amount from K-1