ADAIR COUNTY HEALTH CENTER INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ADAIR COUNTY HEALTH CENTER INC (EIN 73-0977997)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-02-17
- IRS object ID
- 201540489349301294
- Schema version
- 2013v4.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-02-17T14:44:06-06:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAUSON & WESTHOFF CPA'S | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 W 6th St Ste 2310 | AddressLine1 |
| City | TULSA | City |
| State | OK | State |
| ZIP Code | 74119 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 730977997 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADAIR COUNTY HEALTH CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % STILWELL MEMORIAL HOSPITAL | InCareOfNm |
| Business Name Control | ADAI | BusinessNameControlTxt |
| Phone | 9186963101 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 272 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | STILWELL | City |
| State | OK | State |
| ZIP Code | 74960 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALAN L ADAMS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9186963101 | PhoneNum |
| Signature | 2015-02-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES W CAUSON | PreparerPersonNm |
| PTIN | P00966107 | PTIN |
| Phone | 9186963101 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALAN L ADAMS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 W LOCUST | AddressLine1 |
| City | STILWELL | City |
| State | OK | State |
| ZIP Code | 74960 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $32,970,672 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1975 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | To serve the community with respect to providing health care services and health care education. | ActivityOrMissionDesc |
| Voting Members Governing Body | 2 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 333 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $200,511 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,388 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,493,226 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $32,965,965 | CYProgramServiceRevenueAmt |
| PY Investment Income | $564 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,319 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $31,694,301 | PYTotalRevenueAmt |
| CY Total Revenue | $32,970,672 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,585,830 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,852,299 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,211,617 | PYOtherExpensesAmt |
| CY Other Expenses | $19,424,486 | CYOtherExpensesAmt |
| PY Total Expenses | $31,797,447 | PYTotalExpensesAmt |
| CY Total Expenses | $33,276,785 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$103,146 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$306,113 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,471,878 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,156,409 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,932,973 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,923,617 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,538,905 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,232,792 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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 | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $31,683,383 | ExpenseAmt |
| Revenue | $32,965,965 | RevenueAmt |
| Desc | 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 7,600 emergency room visits, 6,500 home health care visits, and provided the equivalent of more than 14,000 patient days during the year ended June 30, 2014. 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 $11,876,760. 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 $1,863,167, of this $911,631 is identified as charity care and $911,631 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 75 food baskets to needy families, impacting the lives of nearly 300 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 $13,000 for the fiscal year ended June 30, 2014. Other areas of participation include DHS Foster Children Fund and the Angel Tree Fund. | Desc |
| Total Program Service Expenses | $31,683,383 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | 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 With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 | false | 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 | 20 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 333 | 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 |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 2 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | 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 | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | 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 | STILWELL MEMORIAL HOSPITAL | PersonNm |
| Phone | 9186963101 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 272 | AddressLine1 |
| City | STILWELL | City |
| State | OK | State |
| ZIP Code | 74960 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JIM F CARSON | |||||||
| CHAIRMAN | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| ALAN L ADAMS | |||||||
| PRESIDENT | 50.0 | $174,521 | $0 | $0 | Yes (X) | ||
| DR WOJCIECH DULOWSKI | |||||||
| PHYSICIAN | 60.0 | $896,338 | $0 | $0 | Yes (X) | ||
| DR JEFFREY JENKINS | |||||||
| PHYSICIAN | 50.0 | $389,818 | $0 | $0 | Yes (X) | ||
| DR NICHOLAS BENTLEY | |||||||
| PHYSICIAN | 50.0 | $486,002 | $0 | $0 | Yes (X) | ||
| WANDA F BUTLER | |||||||
| NURSE PRACTITIONER | 50.0 | $327,160 | $0 | $0 | Yes (X) | ||
| DR ALBERTO DEL CORRO | |||||||
| PHYSICIAN | 50.0 | $321,171 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,595,010 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MEDSPHERE SYSTEMS CORPORATION | |||||
| 1903 WRIGHT PLACE STE 120 | CARLSBAD | CA | 92008 | EMR | $173,623 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| FILE 55826 | LOS ANGELES | CA | 90074 | MRI | $164,261 |
| CUSTOM MEDICAL SCRIBE | |||||
| 6506 S LEWIS AVE 149 | TULSA | OK | 74136 | TRANSCRIPTION | $171,384 |
| TULSA MEDICAL LEASING LLC | |||||
| PO BOX 312 | STILWELL | OK | 74960 | EQUIPMENT RENTAL | $171,218 |
| STOCKELL HEALTHCARE SYSTEMS | |||||
| 15400 SOUTH OUTER FORTY | CHESTERFIELD | MO | 63017 | EMR ADT SYSTEM | $184,760 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $3,388 | AllOtherContributionsAmt |
| Total Contributions | $3,388 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT SVC REV. | $29,837,492 | $29,837,492 |
| MEDICAL REC. FEES | $3,374 | $3,374 |
| SUPPLEMENTAL HOSPIAL OFFSET PAYMENT PROGRAM | $1,094,051 | $1,094,051 |
| MEDICARE/MEDICAID EHR INCENTIVE PAYMENTS | $1,922,533 | $1,922,533 |
| MISCELLANEOUS | $108,515 | $108,515 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $32,965,965 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,319 | TotalRevenueColumnAmt |
| Exclusion | $1,319 | ExclusionAmt |
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 |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,970,672 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,965,965 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $1,319 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
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 | $174,521 | TotalAmt |
| Management And General | $174,521 | 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 | $11,454,690 | TotalAmt |
| Program Services | $10,989,230 | ProgramServicesAmt |
| Management And General | $465,460 | 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 | $1,473,697 | TotalAmt |
| Program Services | $1,392,596 | ProgramServicesAmt |
| Management And General | $81,101 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $749,391 | TotalAmt |
| Program Services | $708,150 | ProgramServicesAmt |
| Management And General | $41,241 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,420 | TotalAmt |
| Management And General | $45,420 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,394 | TotalAmt |
| Management And General | $103,394 | 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 | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,129 | TotalAmt |
| Program Services | $55,129 | 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 | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,230 | TotalAmt |
| Program Services | $24,230 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $848,400 | TotalAmt |
| Program Services | $848,400 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| GOVERNMENTAL CONTRACTUAL ADJ. | $8,688,215 | $8,688,215 | |
| OTHER CONTRACTUAL ADJUSTMENTS | $3,188,545 | $3,188,545 | |
| SUPPLIES | $4,381,927 | $3,699,662 | $682,265 |
| PROVISION FOR BAD DEBT | $911,631 | $911,631 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,177,595 | TotalAmt |
| Program Services | $1,177,595 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,276,785 | TotalAmt |
| Program Services | $31,683,383 | ProgramServicesAmt |
| Management And General | $1,593,402 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,749,045 | BOYAmt |
| EOY | $668,826 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,523,871 | BOYAmt |
| EOY | $2,123,871 | 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 | $2,357,554 | BOYAmt |
| EOY | $2,958,216 | 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 | $682,881 | BOYAmt |
| EOY | $539,026 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,253 | BOYAmt |
| EOY | $80,253 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,727,523 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,764,606 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,254,974 | BOYAmt |
| EOY | $7,962,917 | 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 | $823,300 | BOYAmt |
| EOY | $823,300 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,471,878 | BOYAmt |
| EOY | $15,156,409 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,132,973 | BOYAmt |
| EOY | $1,123,617 | 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 | $0 | 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 | $800,000 | BOYAmt |
| EOY | $800,000 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,932,973 | BOYAmt |
| EOY | $1,923,617 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,538,905 | BOYAmt |
| EOY | $13,232,792 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| 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 | $13,538,905 | BOYAmt |
| EOY | $13,232,792 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,471,878 | BOYAmt |
| EOY | $15,156,409 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$306,113 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
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 | $72,150 | OtherCostOrOtherBasisAmt |
| Book Value | $72,150 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,837,828 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,994,324 | DepreciationAmt |
| Book Value | $4,843,504 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,496,678 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,635,821 | DepreciationAmt |
| Book Value | $2,860,857 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $320,867 | OtherCostOrOtherBasisAmt |
| Depreciation | $134,461 | DepreciationAmt |
| Book Value | $186,406 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,962,917 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER ASSETS AT COST | $523,300 |
| DUE FROM MEDICARE | $300,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $823,300 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $21,093,912 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $21,093,912 | RevenueSubtotalAmt |
| Other Revenues Not Included | $11,876,760 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $11,876,760 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $32,970,672 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $21,400,025 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $21,400,025 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $11,876,760 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $11,876,760 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $33,276,785 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | CONTRACTUAL ALLOWANCES $ 11,876,760 | FormAndLineReferenceDesc |
| Explanation | CONTRACTUAL ALLOWANCES $ 11,876,760 | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| 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 | $881,314 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $881,314 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,768,869 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,768,869 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05310 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,650,183 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,650,183 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07960 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,368,202 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,368,202 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,368,202 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,368,202 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07120 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,018,385 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,018,385 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15080 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,725,665 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $6,068,753 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,785,336 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$10,716,583 | 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 | MEMORIAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 W LOCUST | AddressLine1 |
| City | STILWELL | City |
| State | OK | State |
| ZIP Code | 74960 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PHYSICIANS CLINIC HOME HLTH/GERAL PSYC PHYSICAL THERAPY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 350. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Lawsuit | Yes (X) | PermitLawsuitInd |
| Permit Body Attachments | Yes (X) | PermitBodyAttachmentsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Lawsuit | Yes (X) | LawsuitInd |
| Body Attachments | Yes (X) | BodyAttachmentsInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|
| ALAN L ADAMS | |||||
| PRESIDENT | $174,521 | $0 | $0 | $174,521 | $0 |
| DR WOJCIECH DULOWSKI | |||||
| PHYSICIAN | $190,000 | $0 | $706,338 | $896,338 | $0 |
| DR JEFFREY JENKINS | |||||
| PHYSICIAN | $190,000 | $0 | $199,818 | $389,818 | $0 |
| DR NICHOLAS BENTLEY | |||||
| PHYSICIAN | $200,000 | $0 | $286,002 | $486,002 | $0 |
| WANDA F BUTLER | |||||
| NURSE PRACTITIONER | $68,000 | $0 | $259,160 | $327,160 | $0 |
| DR ALBERTO DEL CORRO | |||||
| PHYSICIAN | $321,171 | $0 | $0 | $321,171 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990 PART VI SECTION C DISCLOSURE | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |