2015-04-30T09:09:38-05:00 2014-06-30 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2013-07-01 730579295 FARMERS UNION HOSPITAL ASSOCIATION D/B/A GREAT PLAINS REGIONAL MEDICAL CTR FARM 5802252511 1801 WEST THIRD LINCOLN BOX 2339 ELK CITY OK 73648 MONICA SCOTT CFO 5802252511 2015-04-30 GAYLE DE HAAS P01774581 8067911591 2015-04-30 2013 2016-03-07 17:11:31Z MONICA SCOTT 1801 WEST THIRD LINCOLN BOX 2339 ELK CITY OK 73648 49193851 0 X WWW.GPRMC-OK.COM X 1929 OK GREAT PLAINS REGIONAL MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION ORGANIZED UNDER THE STATE LAWS OF OKLAHOMA FOR THE SOLE PURPOSE OF PROVIDING COMPREHENSIVE, COST-EFFECTIVE, HIGH QUALITY HEALTHCARE TO OUR COMMUNITIES. 10 8 504 40 14497 -13777 24008 87134 46544365 46946279 1016818 670031 882532 1245542 48467723 48948986 1550 4342 0 0 20747406 20271705 0 0 0 30609542 31366434 51358498 51642481 -2890775 -2693495 88590448 85483381 39463259 39049687 49127189 46433694 X GREAT PLAINS REGIONAL MEDICAL CENTER WILL DISTINGUISH ITSELF AS THE LEADER IN WESTERN OKLAHOMA & 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 47822702 4342 47808983 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. ALTHOUGH 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 AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING 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 WHETHER THE NEED AND/OR INDIVIDUALS INABILITY TO PAY COEXISTS. THESE ACTIVITIES INCLUDED WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS,SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, & MEDICALLY UNDER-SERVED, AND OTHER BROAD COMMUNITY SUPPORT ACTIVITIES.GPRMC SERVED OVER 2,170 PATIENTS WITH MORE THAN 7,770 PATIENT DAYS ON AN INPATIENT BASIS. WE ALSO HAD 60,567 OUTPATIENT ENCOUNTERS WITH PATIENTS DURING THE YEAR. WE TREATED 14,260 PATIENTS IN THE EMERGENCY DEPARTMENT. OUR SURGICAL TEAMS PERFORMED 1,852 OUTPATIENT SURGERIES DURING THE YEAR.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 RECOGNIZES 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 ITS PROVIDING REDUCED PRICE SERVICES, FREE PROGRAMS OFFERED THROUGHOUT THE YEAR, AND INITIATIVES WHICH GPRMC BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. SEE SCHEDULE H FOR MORE INFORMATION REGARDING THESE ACTIVITIES. 47822702 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 1 0 0 0 0 0 0 1 1 1 0 0 1 276 0 1 504 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OK X X JANET MILLER EXECUTIVE ASSISTANT 5808215302 PO BOX 2339 ELK CITY OK 73648 PAUL KUMPF CHAIRMAN 1.00 X 0 0 0 EDWARD ALBERT VICE CHAIRMAN 1.00 X 0 0 0 JACK MORRISON DDS SECRETARY 1.00 X 0 0 0 SCOTT WILLIAMS DO CHIEF OF STAFF (FORMER) 1.00 X X 0 0 0 J COFFEY MD MEMBER 1.00 X 0 0 0 JEAN FORSBERG MD CHIEF OF STAFF 1.00 X X 0 0 0 EMORY THOMAS MEMBER 1.00 X 0 0 0 GENE SMITH MEMBER 1.00 X 0 0 0 BILL GWARTNEY MEMBER 1.00 X 0 0 0 DANNY SPROWLS MEMBER 1.00 X 0 0 0 COREY LIVELY CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 MONICA SCOTT CHIEF FINANCIAL OFFICER 40.00 X 97203 0 0 MISTY CARTER CHIEF OPERATING OFFICER 40.00 X 94702 0 0 LAURA KURZENDOERFER CHIEF NURSING OFFICER 40.00 X 220658 0 0 DON IKNER CHEIF EXECUTIVE OFFICER (FORMER) 40.00 X 191206 0 0 STEVE STEWART CHIEF FINANCIAL OFFICER (FORMER) 40.00 X 128039 0 0 TRACY BYERS CHIEF OPERATING OFFICER (FORMER) 40.00 X 128114 0 0 FRANCIS ABRAHAM VICE CHIEF OF STAFF/PHYSICIAN 40.00 X 380237 0 0 LINDSEY PENA PHYSICIAN 40.00 X 365705 0 0 TIFFANY DUPREE PHYSICIAN 40.00 X 299413 0 0 JANICE WITT PHYSICIAN 40.00 X 200025 0 0 LELAND DENNIS PHYSICIAN 40.00 X 197437 0 0 JAMIE GORE PHYSICIAN 40.00 X 179170 0 0 THERESA GARNER PHARMACIST 40.00 X 120334 0 0 PATRICIA DROKE REGISTERED NURSE 40.00 X 110716 0 0 DEBRA MORRIS REGISTERED NURSE 40.00 X 108751 0 0 MARSHA BALLEW PHARMACIST 40.00 X 100038 0 0 2921748 0 0 14 0 1 0 EM CARE PHYSICIAN SERVICES INC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 PHYSICIAN ER COVERAGE 1738378 PLAINS DIAGNOSTIC IMAGING LLP PO BOX 2339 ELK CITY OK 73648 RADIOLOGY EQUIPMENT 1089726 NIGHTRAYS PA 10901 WEST TOLLER DRIVE SUITE 100 LITTLETON CO 80127 RADIOLOGIST SERVICES 976476 HOSPITAL CARE CONSULTANTS INC 17304 PRESTON ROAD SUITE 1400 DALLAS TX 75252 HOSPITALIST 573600 CRONIN ENTERPRISES INC 8270 COLLEGE PARKWAY SUITE 101-103 FORT MYERS FL 33919 OUTSIDE CODING SERVICES 224746 11 7416 79718 87134 NET PATIENT SERVICE RE 621990 45931050 45931050 MEDICAID INCENTIVE PAY 900099 806750 806750 DAYCARE CENTER REVENUE 900099 114488 114488 OTHER SERVICE REVENUE 900099 93991 93991 46946279 335127 335127 143474 143474 88355 88355 671274 0 671274 671274 671274 372954 63341 183251 61614 189703 1727 191430 191430 CAFETERIA SALES 722210 458799 458799 CATERING SERVICES 722320 14497 14497 VENDING MACHINES 445100 12617 12617 485913 48948986 47808983 14497 1038372 X 4342 4342 481060 248846 232214 15572073 14670682 901391 3107715 3107715 1110857 1033530 77327 166709 166709 112935 112935 81567 81567 7112336 6864903 247433 253118 218551 34567 2181089 2141097 39992 165889 165889 1230169 1219033 11136 105998 103111 2887 71142 58545 12597 1801176 3045 1798131 4758844 4755772 3072 895552 895552 BAD DEBT EXPENSE 6283389 6283389 MEDICAL SUPPLIES 3842322 3842322 EQUIPMENT LEASE/RENT 1264968 1264843 125 DIETARY EXPENSE 597907 597907 441324 343628 97696 51642481 47822702 3819779 0 3985815 3918932 17057769 18161825 6374179 5749921 1174501 1284175 641371 603957 84750229 35615987 53011273 49134242 4415492 4592913 976905 1257900 953143 779516 88590448 85483381 2597251 2550186 36335000 35505000 531008 399501 0 595000 39463259 39049687 X 49127189 46433694 49127189 46433694 88590448 85483381 -2693495 0 X X 1 X 1 X 1 0 X 748759 748759 59247608 16588576 42659032 1657670 763156 894514 23092953 18264255 4828698 3239 3239 49134242 LEGAL ESTIMATE 595000 595000 X 42665597 0 42665597 6283389 6283389 48948986 45359092 0 45359092 6283389 6283389 51642481 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL EVALUATES AND ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (FORMERLY FASB INTERPRETATION 48 (FIN 48) ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THIS STANDARD REQUIRES CERTAIN DISCLOSURES ABOUT UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL EVALUATES ANY UNCERTAIN TAX POSITIONS USING THE PROVISIONS OF ASC 450, CONTINGENCIES. AS A RESULT, MANAGEMENT DOES NOT BELIEVE THAT ANY UNCERTAIN TAX POSITIONS CURRENTLY EXIST AND NO LOSS CONTINGENCY HAS BEEN RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS FILED ALL APPLICABLE TAX RETURNS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1 1 1 X 0 1 1 0 1 1 816336 157238 659098 0.01450 6915858 4473789 2442069 0.05380 7732194 4631027 3101167 0.06830 44512 44512 0.00100 156409 156409 0.00340 4342 4342 0.00010 205263 205263 0.00450 7937457 4631027 3306430 0.07280 2541 -2541 0.00000 13144 -13144 0.00000 210284 -210284 0.00000 225969 -225969 1 2569707 1863549 7708757 11629049 -3920292 X 1 1 1 PLAINS DIAGNOSTIC IMAGING LLP MEDICAL EQUIPMENT LEASING 0.80170 0.19830 1 1 GREAT PLAINS REGIONAL MEDICAL CENTER PO BOX 2339 ELK CITY OK 73648 WWW.GPRMC-OK.COM X X X GREAT PLAINS REGIONAL MEDICAL CENTER 1 1 X X X X X X X X X 12 1 0 1 X WWW.GPRMC-OK.COM X X X X X X X X X 1 0 1 1 200.000000000000 0 1 X X X X X X X 1 1 X X X X 1 X 1 X X X X X 1 X 0 0 GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3: THE ORGANIZATION RELIES ON INPUT FROM PHYSICIANS, OTHER HEALTHCARE PROVIDERS, COMMUNITY LEADERS, THE BOARD OF DIRECTORS, CITIZENS, ETC. IN THE COMMUNITY. WE LOOK AT OUT-MIGRATION STUDIES TO DETERMINE WHAT SERVICES PEOPLE FROM OUR 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. THESE FACTORS ARE ALL CONSIDERED IN ADDITION TO FEEDBACK FROM PATIENTS IN THE COMMUNITY TO DETERMINE SHORTAGE OF CARE AREAS. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 10: GREAT PLAINS REGIONAL MEDICAL CENTER (GPRMC) IS COMMITTED TO PROVIDING CARE BASED ON THE FOLLOWING PRINCIPLES:-TREAT ALL PATIENTS EQUITABLY, WITH DIGNITY, WITH RESPECT AND WITH COMPASSION.-SERVE THE EMERGENT HEALTH CARE NEEDS OF EVERYONE, REGARDLESS OF A PATIENTS' ABILITY TO PAY FOR CARE.-ASSIST PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE.-CAREFUL BALANCE BETWEEN FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH THE NEED FOR FISCAL STEWARDSHIP TO THE COMMUNITY AT LARGE.GPRMC WILL BUDGET AND FUND A REASONABLE AMOUNT OF CHARITY CARE ON AN ANNUAL BASIS TO HELP SUPPORT THE COMMUNITY MEDICAL NEEDS OF THE INDIGENT.CRITERIA:AN APPLICANT MUST MEET EACH OF THE FOLLOWING CRITERIA TO BE ELIGIBLE FOR CHARITY CARE:A. HAVE INCURRED MEDICAL EXPENSES AT GREAT PLAINS REGIONAL MEDICAL CENTER AS A RESULT OF MEDICALLY EMERGENT NON-ELECTIVE SERVICES.B. HAVE NO HEALTH INSURANCE AND APPLY AND BE DENIED DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID AND ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT.DENIAL DUE TO NON-COOPERATION WITH ANY POTENTIAL THIRD PARTY PAYER WILL CONSTITUTE A DENIAL OF CHARITY CARE.C. HAVE INCOME NOT TO EXCEED 200% OF THE CURRENT YEAR FEDERAL POVERTY GUIDELINES. ELIGIBILITY IS BASED UPON THE SIZE OF THE FAMILY UNIT OF THE PATIENT AND THE GROSS FAMILY INCOME FOR THE PRECEDING TWELVE (12) MONTHS. APPLICANTS WILL BE REQUIRED TO FURNISH PROOF OF INCOME FOR THE LAST TWELVE (12) MONTHS WHEN APPLICATION IS MADE. THE INCOME GUIDELINES AND DEFINITION OF FAMILY UNIT ARE DETERMINED BY THE MOST RECENTLY PUBLISHED FEDERAL POVERTY GUIDELINES. APPROVED APPLICANTS WILL RECEIVE A 100% DISCOUNT IN THE MONTH THE APPLICATION IS APPROVED.AN APPROVED APPLICATION WILL REMAIN IN EFFECT FOR TWELVE (12) MONTHS IF THE INDIVIDUAL DOCUMENTS THEY CONTINUE TO MEET THE INCOME GUIDELINES.D. HAVE RESOURCES NOT TO EXCEED $5,000. HOUSEHOLD RESOURCES WILL BE DETERMINED YBY THE GUIDELINES SET FORTH BY THE DEPARTMENT OF HUMAN SERVICES.E. MAKE APPLICATION WITHIN SIXTY (60) DAYS AFTER BEING DENIED COVERAGE DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID OR ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 12I: PATIENTS, THEIR FAMILIES, OR THEIR REPRESENTATIVES MUST REQUEST CHARITY CARE AND COMPLETE THE APPLICATION WITHIN SIXTY (60) DAYS AFTER BEING DENIED COVERAGE DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID OR ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT. APPLICATIONS SUBMITTED MUST INCLUDE PROOF OF INCOME BY INCLUDING A PERSONAL FINANCIAL STATEMENT, PREVIOUS YEAR'S TAX RETURN, RELEASE OF INFORMATION FROM EMPLOYERS, AND CHECK STUBS FROM THE EMPLOYER. ADDITIONALLY, THE HOSPITAL PROVIDES A 35% DISCOUNT TO ALL SELF-PAY (NO INSURANCE) PATIENTS. THERE IS AN ASSET TEST TO QUALIFY FOR CHARITY CARE. HOUSEHOLD RESOURCES ARE DETERMINED BY THE GUIDELINES SET FORTH BY THE DEPARTMENT OF HUMAN SERVICES. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16E: THE ORGANIZATION HAS A 100% DISCOUNT FOR QUALIFIED CHARITY CARE PATIENTS. APPLICANTS HAVE SIXTY (60) DAYS AFTER BEING DENIED COVERAGE DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID OR ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT TO SUBMIT THEIR APPLICATION FOR CHARITY CARE. DETERMINATION FOR APPLICATIONS REQUESTING CHARITY CARE IS TO BE MADE BY GPRMC WITHIN THIRTY (30) DAYS AFTER A COMPLETE APPLICATION HAS BEEN SUBMITTED. NO AMOUNTS PAID PRIOR TO RECEIVING CHARITY CARE WILL BE REIMBURSED. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 17E: THE ORGANIZATION HAS A 100% DISCOUNT FOR QUALIFIED CHARITY CARE PATIENTS. APPLICANTS HAVE SIXTY (60) DAYS AFTER BEING DENIED COVERAGE DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID OR ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT TO SUBMIT THEIR APPLICATION FOR CHARITY CARE. DETERMINATION FOR APPLICATIONS REQUESTING CHARITY CARE IS TO BE MADE BY GPRMC WITHIN THIRTY (30) DAYS AFTER A COMPLETE APPLICATION HAS BEEN SUBMITTED. NO AMOUNTS PAID PRIOR TO RECEIVING CHARITY CARE WILL BE REIMBURSED. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 20D: GPRMC PROVIDES A 100% DISCOUNT TO QUALIFIED INDIVIDUALS UNDER THE CHARITY CARE POLICY. THE AMOUNT THAT IS CHARGED IS BASED OFF OF THE CHARGE MASTER AT THE FULL RATE AMOUNT. PART I, LINE 7: AMOUNTS ON LINE 7A AND 7B WERE CALCULATED USING THE COST TO CHARGE RATIO IN IRS WORKSHEET 2. AMOUNTS ON LINES 7E, F, AND I ARE BASED ON ACTUAL COST RECORDED IN THE GENERAL LEDGER AND HOURS AT AVERAGE RATES. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE COMMUNITY BENEFIT PERCENTAGE WAS $6,283,389. PART II, COMMUNITY BUILDING ACTIVITIES: GPRMC PROVIDES COMMUNITY BUILDING ACTIVITIES WITHIN THE COMMUNITY, BUT HAS NOT TRACKED THE EXPENSES RELATED TO THESE ACTIVITIES. THE HOSPITAL PROVIDES SUPPORT TO THE COMMUNITY IN THE FOLLOWING WAYS:-GPRMC EMPLOYEES PROVIDE MANY HOURS OF VOLUNTEER SERVICE TO CIVIC AND OTHER COMMUNITY BENEFIT CLUBS IN THE AREA. WE PROVIDE VARIOUS DONATIONS TO THESE CLUBS, LOCAL SCHOOL SYSTEMS, AND VARIOUS NON-PROFIT FOUNDATIONS & ORGANIZATIONS.-AWARE OF THE SHORTAGE OF PHYSICIANS IN THE ELK CITY AREA, GPRMC HAS WORKED DILIGENTLY TO ATTRACT ADDITIONAL PHYSICIANS TO THE COMMUNITY. THESE PHYSICIANS RANGE FROM FAMILY PRACTICE TO A VARIETY OF SPECIALTY AREAS. PATIENTS WILL BE ABLE TO ACCESS THEIR HEALTHCARE NEEDS LOCALLY INSTEAD OF DRIVING GREAT DISTANCES TO SEE A SPECIALIST.-GPRMC INVOLVEMENT IN COMMUNITY BUILDING ACTIVITIES ALSO EXTENDS THROUGH OTHER PROGRAMS SUCH AS MEALS ON WHEELS WHICH DELIVERS MEALS TO THE HOMEBOUND; DONATING ATHLETIC TRAINER SERVICES TO LOCAL SCHOOLS; AND WORKING WITH THE LOCAL FOODBANK.-GPRMC HAS A SHUTTLE SERVICE FOR PATIENTS WITHOUT TRANSPORTATION TO THE PHYSICIAN'S OFFICES, CLINICS AND THE HOSPITAL. THE FREE SHUTTLE TRAVELS IN ELK CITY AND AREA COMMUNITIES.-GPRMC IS COMMITTED TO COALITION BUILDING THROUGH THE DREAM LEAGUE SPORTS PROGRAM.-THE HOSPITAL IS ALSO COMMITTED TO COMMUNITY HEALTH IMPROVEMENT ADVOCACY THROUGH PROGRAMS AND EVENTS SUCH AS ATHLETIC TRAINING, BIRTHING CLASSES, HEALTH FAIRS, BLOOD DRIVES, AND PUBLICLY AVAILABLE FLU SHOTS. PART III, LINE 4: PER AUDIT REPORT: "THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE IS MAINTAINED AT A LEVEL WHICH, IN MANAGEMENT'S JUDGMENT, IS ADEQUATE TO ABSORB PATIENT ACCOUNT BALANCE WRITE-OFFS INHERENT IN THE BILLING PROCESS. THE AMOUNT OF THE ALLOWANCE IS BASED ON MANAGEMENT'S EVALUATION OF THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, INCLUDING THE NATURE OF THE ACCOUNTS, CREDIT CONCENTRATIONS, HISTORICAL WRITE-OFF TRENDS, SPECIFIC IMPAIRED ACCOUNTS, AND ECONOMIC CONDITIONS. ALLOWANCES FOR UNCOLLECTIBLE AND CONTRACTUALS ARE GENERALLY DETERMINED BY APPLYING HISTORICAL PERCENTAGES TO FINANCIAL CLASSES WITHIN ACCOUNTS RECEIVABLE. THE ALLOWANCES ARE INCREASED BY A PROVISION FOR BAD DEBT EXPENSES AND CONTRACTUAL ADJUSTMENTS, AND REDUCED BY WRITE-OFFS, NET OF RECOVERIES."THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE EXPENSE REPORTED ON THE FINANCIAL STATEMENTS AND APPLYING AN OVERALL COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2. BAD DEBT EXPENSE IS REPORTED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS. ALL DISCOUNTS AND PAYMENTS ARE APPLIED BEFORE WRITTEN OFF TO BAD DEBT. A PAYMENT ON AN ACCOUNT THAT WAS PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED BY APPLYING A PERCENTAGE OF THE POPULATION BELOW FEDERAL POVERTY GUIDELINES TO BAD DEBT AT COST. PART III, LINE 8: GPRMC 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.TOTAL REVENUE RECEIVED FROM MEDICARE (INCLUDING DSH AND IME) IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT (INCLUDING LSA). BOTH THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THE PATIENTS ARE PRE-SCREENED PRIOR TO TESTING FOR CHARITABLE SERVICES AND A DETERMINATION IS MADE AS TO THE FINANCIAL ABILITY TO PAY. IF PATIENTS ARE PRE-QUALIFIED FOR SERVICES, THE COLLECTION PROCESS IS CEASED. PART VI, LINE 1 ASSISTANCE IS DISCUSSED WITH PATIENTS AS PART OF THE INTAKE PROCESS. THEY ARE SCREENED AT REGISTRATION FOR NEED FOR FINANCIAL ASSISTANCE AND THEN ARE GIVEN COPIES OF CHARITY CARE POLICY/FINANCIAL POLICY UPON REQUEST. WE TRY TO ASSIST PEOPLE IN QUALIFYING FOR SOME TYPE OF MEDICAL ASSISTANCE WHETHER IT BE MEDICARE, MEDICAID, DISABILITY OR CHARITY CARE. PART VI, LINE 2 GREAT PLAINS REGIONAL MEDICAL CENTER IS A SIXTY-TWO LICENSED BED ACUTE CARE HOSPITAL LOCATED IN ELK CITY, OKLAHOMA IN BECKMAN COUNTY. THE CORPORATION 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 TEN COUNTIES. ESTIMATED PRIMARY AND SECONDARY SERVICE AREA POPULATION EXCEEDS 100,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IN BECKAM COUNTY IS $43,642 AND 16% OF THE COUNTY IS BELOW POVERTY LEVEL. PART VI, LINE 3 OUR BOARD OF DIRECTORS IS MADE UP 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 THEN BE APPROVED BY THE MEDICAL STAFF AND THEN BY THE BOARD OF DIRECTORS.IF GPRMC HAS A SURPLUS OF FUNDS, THEN THEY ARE USED BY THE ORGANIZATION TO FULFILL OUR MISSION, VISION, AND VALUES.AS QUANTIFIED IN PART II, QUESTION 7E, F AND I COMMUNITY BENEFIT IS PROVIDED BY GPRMC THROUGH FREE PROGRAMS OFFERED THROUGHOUT THE YEAR AND INITIATIVES WHICH GPRMC BELIEVES SERVE A BONA FIDE COMMUNITY HEALTH NEED. SOME OF THESE ACTIVITIES ARE AS FOLLOWS: -NOTICES ARE PUBLISHED IN AREA NEWSPAPERS, REGARDING NEW PHYSICIANS OR MEDICAL SERVICES. ACCORDING TO ESTIMATED NEWSPAPER CIRCULATION, THESE ADS REACH FROM 8,000 TO 10,000 HOMES IN THE AREA.-GPRMC PROVIDED FLU SHOTS FOR THE OFFICE PERSONNEL OF THE PHYSICIANS IN THE COMMUNITY. -GPRMC PROVIDES BREAST SELF-EXAM, CPR AND PRE-NATAL EDUCATION TO COMMUNITY MEMBERS.-GPRMC IS ONE OF TWO DESIGNATED DONOR LOCATIONS FOR THE COMMUNITY-WIDE BLOOD DRIVE HELD FIVE TIMES PER YEAR.-GPRMC HAS A SHUTTLE SERVICE FOR PATIENTS WITHOUT TRANSPORTATION TO THE PHYSICIAN'S OFFICES, CLINICS AND THE HOSPITAL. THE FREE SHUTTLE TRAVELS IN ELK CITY AND AREA COMMUNITIES.-GPRMC SPONSORS HEALTHCARE EDUCATION 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, SCHOLARSHIPS ARE AWARDED TO STUDENTS WISHING TO PURSUE DEGREES IN THE MEDICAL FIELD. -REPRESENTATIVES FROM GPRMC PRESENT EDUCATION PROGRAMS AT THE LOCAL ADULT LEARNING CENTER RELATIVE TO 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.-GPRMC HAS DEVELOPED COLLABORATION WITH WESTERN OKLAHOMA STATE COLLEGE TO PROVIDE DISTANCE LEARNING CLASSES FOR THOSE IN THE COMMUNITY WISHING TO PURSUE NURSING DEGREES. GPRMC'S PART OF THE COLLABORATIVE IS TO PROVIDE A CLASSROOM IN THE LOCAL COMMUNITY. ADDITIONALLY, IN-KIND SERVICES ARE PROVIDED TO WESTERN OKLAHOMA STATE COLLEGE. THIS IS VITAL TO THOSE PROSPECTIVE STUDENTS PURSUING NURSING DEGREES THAT WOULD NOT HAVE BEEN ABLE TO DRIVE THE LONG DISTANCE TO THE COLLEGE. 1 X X 0 0 1 0 0 0 0 0 0 LAURA KURZENDOERFER CHIEF NURSING OFFICER 220658 0 0 0 0 0 0 0 0 0 220658 0 0 0 DON IKNER CHEIF EXECUTIVE OFFICER (FORMER) 191206 0 0 0 0 0 0 0 0 0 191206 0 0 0 FRANCIS ABRAHAM VICE CHIEF OF STAFF/PHYSICIAN 380237 0 0 0 0 0 0 0 0 0 380237 0 0 0 LINDSEY PENA PHYSICIAN 365705 0 0 0 0 0 0 0 0 0 365705 0 0 0 TIFFANY DUPREE PHYSICIAN 299413 0 0 0 0 0 0 0 0 0 299413 0 0 0 JANICE WITT PHYSICIAN 200025 0 0 0 0 0 0 0 0 0 200025 0 0 0 LELAND DENNIS PHYSICIAN 197437 0 0 0 0 0 0 0 0 0 197437 0 0 0 JAMIE GORE PHYSICIAN 179170 0 0 0 0 0 0 0 0 0 179170 0 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS ESTABLISHED BY GPRMC THROUGH A COMPENSATION COMMITTEE WHICH USES AN INDEPENDENT CONSULTATION CONSULTANT AND A COMPENSATION STUDY. THE BOARD THEN REVIEWS AND APPROVES THE CEO'S COMPENSATION AND SIGNS A WRITTEN EMPLOYMENT CONTRACT WITH THE CEO. PART I, LINE 4C FRANCIS ABRAHAM AND JAMIE GORE ARE PARTNERS IN PLAINS DIAGNOSTIC IMAGING, LLP (A RELATED ORGANIZATION AND JOINT VENTURE). DURING FISCAL YEAR 2014, BOTH RECEIVED LESS THAN THE $10,000 EXCEPTION FOR REPORTING COMPENSATION ON THEIR K-1S, THUS, THESE AMOUNTS WERE EXCLUDED FROM FORM 990 PART VII. A OKLAHOMA DEVELOPMENT FINANCE AUTHORITY 678910DB3 2007-06-01 40000000 CONSTRUCT & FURNISH 62-BED HOSPITAL 0 0 0 A 4495000 40000000 3387711 291418 2036 0 0 0 1 MARK ALBERT BROTHER OF BOARD MEMBER EDWARD ALBERT 18597 ATTORNEY CONTRACTED FOR LEGAL COLLECTIONS, BROTHER OF BOARD MEMBER EDWARD ALBERT. 0 AARON GWARTNEY SON OF BOARD MEMBER BILL GWARTNEY 27988 ATTORNEY CONTRACTED FOR LEGAL COUNSEL, SON OF BOARD MEMBER BILL GWARTNEY. 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS ARE INDIVIDUALS WHO HAVE VOTING SHARES IN THE ORGANIZATION. MEMBERSHIP IS OBTAINED THROUGH TRANSFERS OF EXISTING MEMBERSHIPS. TRANSFERS NORMALLY RESULT EITHER THROUGH VOLUNTARY SURRENDER OF A MEMBERSHIP OF 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 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 EDITS TO THE GOVERNING BOARD BYLAWS, RULES, AND/OR 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 ORGANIZATION IN ALL ITS AFFAIRS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WILL BE PRESENTED AND REVIEWED AT ONE OF THE GOVERNING BOARD'S MONTHLY MEETINGS. THE FORM 990 WILL ALSO HAVE BEEN POSTED ON THE GOVERNING BOARD'S WEBSITE IN THE DAYS PRECEDING THE MONTHLY MEETING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL MEMBERS OF THE GOVERNING BODY AND KEY EMPLOYEES RECEIVE A COPY OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THEY ARE REQUIRED TO REVIEW THE POLICY, COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, AND SIGN THE QUESTIONNAIRE; ATTESTING TO THEIR UNDERSTANDING OF THE POLICY AND THAT THEIR ANSWERS ON THE QUESTIONNAIRE ARE TRUE AND ACCURATE. FORM 990, PART VI, SECTION B, LINE 15 HUMAN RESOURCES CONDUCTS A COMPARATIVE ANALYSIS USING STATE, MULTI-STATE, REGIONAL, AND NATIONAL COMPENSATION (BY POSITION) DATA. DATA IS CULLED INTO BED-SIZE, REVENUE, AND SIMILAR AREA COMPARATIVES. HUMAN RESOURCES THEN 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 18 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 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 HEALTHCARE SERVICES: PROGRAM SERVICE EXPENSES 6,864,903. MANAGEMENT AND GENERAL EXPENSES 247,433. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,112,336. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF GPRMC ENGAGES AN INDEPENDENT THIRD-PARTY ACCOUNTING FIRM TO AUDIT THE ORGANIZATION'S FINANCIAL STATEMENTS ANNUALLY. THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR SELECTING AN INDEPENDENT ACCOUNTANT. MANAGEMENT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, REVIEW, AND COMPILATION OF ITS FINANCIAL STATEMENTS. 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