ADAIR COUNTY HEALTH CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ADAIR COUNTY HEALTH CENTER INC (EIN 73-0977997)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-16
- IRS object ID
- 201400479349300210
- Schema version
- 2012v2.3
- 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) |
|---|---|---|
| Timestamp | 2014-02-16T18:42:08-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAUSON & WESTHOFF CPA'S | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 730977997 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADAIR COUNTY HEALTH CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % STILWELL MEMORIAL HOSPITAL | InCareOfName |
| Name Control | ADAI | NameControl |
| Phone | 9186963101 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALAN L ADAMS | Name |
| Title | CEO | Title |
| Phone | 9186963101 | Phone |
| Date Signed | 2014-02-16 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9183827000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ALAN L ADAMS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 31694301 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1975 | YearFormation |
| State Legal Domicile | OK | StateLegalDomicile |
| Activity Or Mission Description | To serve the community with respect to providing health care services and health care education. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 2 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 315 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 992 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 200511 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 34966884 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 31493226 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5215 | InvestmentIncomePriorYear |
| Investment Income Current Year | 564 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 34973091 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31694301 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12416144 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12585830 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 21486363 | OtherExpensePriorYear |
| Other Expenses Current Year | 19211617 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 33902507 | TotalExpensesPriorYear |
| Total Expenses Current Year | 31797447 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1070584 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -103146 | RevenuesLessExpensesCY |
| Total Assets BOY | 14689471 | TotalAssetsBOY |
| Total Assets EOY | 15471878 | TotalAssetsEOY |
| Total Liabilities BOY | 1047420 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1932973 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 13642051 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13538905 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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 | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 30327545 | Expense |
| Revenue | 31493226 | Revenue |
| Description | 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 1,700 patients, over 9,000 emergency room visits, 6,000 home health care visits, and provided the equivalent of more than 12,000 patient days during the year ended June 30, 2013. 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 $11,311,041. 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 $1,877,901, of this $916,231 is identified as charity care and $961,670 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 85 food baskets to needy families, impacting the lives of nearly 330 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. The Hospital gives infant car seats to mothers after the birth of their child. The seat is provided at no cost to the patient as an attempt on the part of the Hospital to encourage parents to buckle up their children and save lives. For the fiscal year ending June 30, 2013, the Hospital provided 18 infant car seats. 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 $15,000 for the fiscal year ended June 30, 2013. Other areas of participation include DHS Foster Children Fund and the Angel Tree Fund. | Description |
| Total Program Service Expense | 30327545 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 23 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 315 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 2 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicy |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OK | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | STILWELL MEMORIAL HOSPITAL | NamePerson |
| Telephone Number | 9186963101 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JIM F CARSON | |||||||
| CHAIRMAN | 1.0 | X | 0 | 0 | 0 | ||
| ALAN L ADAMS | |||||||
| PRESIDENT | 50.0 | 175695 | 0 | 0 | X | ||
| DR WOJCIECH DULOWSKI | |||||||
| PHYSICIAN | 60.0 | 729344 | 0 | 0 | X | ||
| DR JEFFREY JENKINS | |||||||
| PHYSICIAN | 50.0 | 363124 | 0 | 0 | X | ||
| DR NICHOLAS BENTLEY | |||||||
| PHYSICIAN | 50.0 | 420532 | 0 | 0 | X | ||
| DR NIHAT GURKAN | |||||||
| PHYSICIAN | 50.0 | 365751 | 0 | 0 | X | ||
| DR EMMANUEL MACARAEG | |||||||
| PHYSICIAN | 40.0 | 296379 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2350825 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 18 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MEDSPHERE SYSTEMS CORPORATION | |||||
| 1903 WRIGHT PLACE STE 120 | CARLSBAD | CA | 92008 | EMR | 212750 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| FILE 55826 | LOS ANGELES | CA | 90074 | MRI | 173128 |
| CUSTOM MEDICAL SCRIBE | |||||
| 6506 S LEWIS AVE 149 | TULSA | OK | 74136 | TRANSCRIPTION | 179251 |
| TULSA MEDICAL LEASING LLC | |||||
| PO BOX 312 | STILWELL | OK | 74960 | EQUIPMENT RENTAL | 171218 |
| STOCKEL HEALTHCARE SYSTEMS | |||||
| 15400 SOUTH OUTER FORTY | CHESTERFIELD | MO | 63017 | EMR ADT SYSTEM | 170813 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| All Other Contributions | 200511 | AllOtherContributions |
| Total Contributions | 200511 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| PATIENT SVC REV. | 30359521 | 30359521 |
| MEDICAL REC. FEES | 4819 | 4819 |
| SUPPLEMENTAL HOSPIAL OFFSET PAYMENT PROGRAM | 1006864 | 1006864 |
| MISCELLANEOUS | 122022 | 122022 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 31493226 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 564 | TotalRevenueColumn |
| Exclusion | $564 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31694301 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31493226 | RelatedOrExemptFunctionIncome |
| Exclusion | $564 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175695 | Total |
| Management And General | 175695 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10351833 | Total |
| Program Services | 9892924 | ProgramServices |
| Management And General | 458909 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1376064 | Total |
| Program Services | 1293114 | ProgramServices |
| Management And General | 82950 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 682238 | Total |
| Program Services | 641112 | ProgramServices |
| Management And General | 41126 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74701 | Total |
| Management And General | 74701 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 148500 | Total |
| Management And General | 148500 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42469 | Total |
| Program Services | 42469 | ProgramServices |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 848400 | Total |
| Program Services | 848400 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| GOVERNMENTAL CONTRACTUAL ADJ. | 7527649 | 7527649 | |
| OTHER CONTRACTUAL ADJUSTMENTS | 3783392 | 3783392 | |
| SUPPLIES | 3841142 | 3353121 | 488021 |
| PROVISION FOR BAD DEBT | 961671 | 961671 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1983693 | Total |
| Program Services | 1983693 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31797447 | Total |
| Program Services | 30327545 | ProgramServices |
| Management And General | 1469902 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2673690 | BOY |
| EOY | 1749045 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3121871 | BOY |
| EOY | 2523871 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2751568 | BOY |
| EOY | 2357554 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 661891 | BOY |
| EOY | 682881 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130532 | BOY |
| EOY | 80253 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15171180 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7916206 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4546619 | BOY |
| EOY | 7254974 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 803300 | BOY |
| EOY | 823300 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14689471 | BOY |
| EOY | 15471878 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1047420 | BOY |
| EOY | 1132973 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 800000 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1047420 | BOY |
| EOY | 1932973 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13642051 | BOY |
| EOY | 13538905 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13642051 | BOY |
| EOY | 13538905 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14689471 | BOY |
| EOY | 15471878 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -103146 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 72150 | OtherCostOrOtherBasis |
| Book Value | 72150 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7504788 | OtherCostOrOtherBasis |
| Depreciation | 2826324 | Depreciation |
| Book Value | 4678464 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7273375 | OtherCostOrOtherBasis |
| Depreciation | 4963821 | Depreciation |
| Book Value | 2309554 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 320867 | OtherCostOrOtherBasis |
| Depreciation | 126061 | Depreciation |
| Book Value | 194806 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7254974 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER ASSETS AT COST | 523300 |
| DUE FROM MEDICARE | 300000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 823300 | TotalBookValueOtherAssets |
| Tot Revenue Etc Audited Fincl Stmt | 20383260 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 20383260 | RevenueSubtotal |
| Other Revenues Not Included | 11311041 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 11311041 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31694301 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20486406 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 20486406 | ExpensesSubtotal |
| Other Expenses Not Included | 11311041 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 11311041 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 31797447 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | CONTRACTUAL ALLOWANCES $ 11,311,041 | Identifier |
| Explanation | CONTRACTUAL ALLOWANCES $ 11,311,041 | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 844673 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 844673 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02660 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1782594 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1782594 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05610 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2627267 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2627267 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08270 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2515396 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2515396 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07910 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2515396 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2515396 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07910 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5142663 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5142663 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16180 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 36000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 36000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,714,336 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 6075245 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14393395 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -8318150 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| 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 | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | PHYSICIANS CLINIC HOME HLTH/GERAL PSYC PHYSICAL THERAPY | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 350. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Body Attachment | X | PermitBodyAttachment |
| Collection Activities | true | CollectionActivities |
| Lawsuit | X | Lawsuit |
| Body Attachment | X | BodyAttachment |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PART III, LINE 4: | 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: | 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: | 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: | 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: | 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: | 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: | 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: | COMMUNITY INFORMATION: | ADAIR COUNTY HEALTH CENTER IS A LICENSED 34 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: | PROMOTION OF COMMUNITY HEALTH: | ADAIR COUNTY HEALTH CENTER CONTINUALLY RECRUITS PHYSICIANS TO HELP FUFILL 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: | 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 | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Bonus Filing OrgBonusFilingOrg |
|---|---|---|---|---|---|
| ALAN L ADAMS | |||||
| PRESIDENT | 175695 | 0 | 175695 | 0 | |
| DR WOJCIECH DULOWSKI | |||||
| PHYSICIAN | 190000 | 0 | 729344 | 0 | 539344 |
| DR JEFFREY JENKINS | |||||
| PHYSICIAN | 190000 | 0 | 363124 | 0 | 173124 |
| DR NICHOLAS BENTLEY | |||||
| PHYSICIAN | 200000 | 0 | 420532 | 0 | 220532 |
| DR NIHAT GURKAN | |||||
| PHYSICIAN | 350000 | 0 | 365751 | 0 | 15751 |
| DR EMMANUEL MACARAEG | |||||
| PHYSICIAN | 296379 | 0 | 296379 | 0 | |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | 1 | Identifier |
| Return Reference | FORM 990 PART VI SECTION C DISCLOSURE | ReturnReference |
| 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. | Explanation |