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MCCURTAIN MEMORIAL MEDICAL MANAGEMENT INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT INC (EIN 73-6617937)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-15
IRS object ID
201401359349302335
Schema version
2012v2.1
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

FieldValueIRS element (for citing)
Timestamp2014-05-15T09:10:43-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11601 NW EXPRESSWAY SUITE 1900AddressLine1
CityOKLAHOMA CITYCity
StateOKState
ZIP Code73118ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN736617937EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1McCurtain Memorial Medical Management IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMCCUNameControl
Phone5802867623Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 East Lincoln RdAddressLine1
CityIdabelCity
StateOKState
ZIP Code74745ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRay B Whitmore JrName
TitleCFOTitle
Phone5802867623Phone
Date Signed2014-05-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCarolyn LevingsName
PTINP01083874PTIN
Phone4054783334Phone
Date Prepared2014-05-07DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRay B Whitmore JrNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11301 East Lincoln RdAddressLine1
CityIdabelCity
StateOKState
ZIP Code74745ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22217890GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mmhok.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1975YearFormation
State Legal DomicileOKStateLegalDomicile
Activity Or Mission DescriptionHospital careActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees368TotalNbrEmployees
Total Nbr Volunteers27TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1898261ContributionsGrantsPriorYear
Contributions Grants Current Year2011825ContributionsGrantsCurrentYear
Program Service Revenue Prior Year20964928ProgramServiceRevenuePriorYear
Program Service Revenue CY20147432ProgramServiceRevenueCY
Investment Income Prior Year9865InvestmentIncomePriorYear
Investment Income Current Year-449198InvestmentIncomeCurrentYear
Other Revenue Prior Year55679OtherRevenuePriorYear
Other Revenue Current Year55575OtherRevenueCurrentYear
Total Revenue Prior Year22928733TotalRevenuePriorYear
Total Revenue Current Year21765634TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2035GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY361GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12388200SalariesEtcPriorYear
Salaries Etc Current Year12824995SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10398155OtherExpensePriorYear
Other Expenses Current Year10553671OtherExpensesCurrentYear
Total Expenses Prior Year22788390TotalExpensesPriorYear
Total Expenses Current Year23379027TotalExpensesCurrentYear
Revenues Less Expenses Prior Year140343RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1613393RevenuesLessExpensesCY
Total Assets BOY8306037TotalAssetsBOY
Total Assets EOY6912672TotalAssetsEOY
Total Liabilities BOY5011738TotalLiabilitiesBOY
Total Liabilities EOY5231766TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3294299NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1680906NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMcCurtain Memorial Hospital exists to provide appropriate, cost effective healthcare to our patients in a safe, healing environment while striving to be the healthcare leader of choice in our community.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change1SignificantChange
Expense21335071Expense
Grants361Grants
Revenue20119061Revenue
DescriptionWe continue to provide quality health care to McCurtain County, Oklahoma and its surrounding areas. In addition, we endeavor to serve the public through such activities as wellness programs, community education programs, special programs for the elderly, handicapped and medically underserved and a variety of broad community support activities. To fulfill our mission of community service, we provide care to patients who meet certain criteria under our charity care policy without charge or at amounts less than our established rates. We maintain records to identify and monitor the level of charity care we provide. These records include the amount of charges foregone for services and supplies furnished under our charity care policy and equivalent service statistics. The amount of charges forgone, based on established rates were approximately $355,500 for the year ended June 30, 2013.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense85571Expense
Revenue28371Revenue
DescriptionWellness Center-exercise area that community members can subscribe to and use the exercise equipment as well as receive personal training and wellness assessments on a regular basis. There are personnel available to assist them. This program is available to all community members at a low cost with discounted rates for seniors and is free to employees (after initial charge for first wellness assessment) in order to help advocate healthy lifestyles. Expenses include the cost of depreciation for equipment.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense13559Expense
DescriptionThe Garden Meadows Walking Trail located at the Hospital is open to the public, in addition to employees, 24 hours a day, 7 days a week at no charge and is intended to promote physical activity for healthier lifestyles. Hospital expenses to maintain the walking track includes water, electricity, and depreciation.Description
FieldValueIRS element (for citing)
Total Program Service Expense21434201TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person1GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109670NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees368NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums1FundsToPayPremiums
Premiums Paid1PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOKStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Ray B Whitmore JrBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5802083104TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11301 E Lincoln RdAddressLine1
CityIdabelCity
StateOKState
ZIP Code74745ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Billie Tomlinson
President1.00XX000
Irvin C Jones
Vice President1.00XX000
Thomas Salyer DO
Secretary/Treasurer1.00XX000
Desmond Brown
Board Member1.00X000
Robert P Hessenlopp
Board Member1.00X000
David White
Board Member1.00X000
George Freeman DO
Bd Member, Chief of Staff1.00X000
John M Migliaccio MD
Chief of Staff40.00X511451015726
Bristol Messer
CEO40.00X172965020097
Ray B Whitmore Jr
CFO40.00X91496018088
Jeffrey Martin
CRNA40.00298879013548X
Raymond Smith
Physician40.00395525015932X
John Oglesbee
Physician40.00201588015726X
Stephen Katz
Physician40.0032325809182X
Michael Freeman
Physician40.00200548015835X
Michael West-Current Employee
Former BOD) - Physician40.00198648015726X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2394358TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation139860TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Denny Parton
PO Box 522ShawneeOK74802ER Physician352883
Create A Storehouse
1970 Marie DrDurantOK74701ER Physician263933
On Assignment Inc
File 50730Los AngelesCA90074Locum Tenen Nurse Agency236893
Emcare Inc
7032 Collection Ctr DrChicagoIL60693ER Physician Agency148238
Bhupinder Sangha
232 Harders CrossingShreveportLA71106Hospitalist Services119200
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Info In Schedule O Part VIIIXInfoInScheduleOPartVIII
Government Grants1564898GovernmentGrants
All Other Contributions446927AllOtherContributions
Total Contributions2011825TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Serv Rev9000992010619920106199
Other Rev9000994123341233
FieldValueIRS element (for citing)
Total Program Service Revenue20147432TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2313TotalRevenueColumn
Exclusion$2,313ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real55575Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real55575Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column55575TotalRevenueColumn
Exclusion$55,575ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other745Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other452256Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-451511Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-451511TotalRevenueColumn
Exclusion-$451,511ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column21765634TotalRevenueColumn
Related Or Exempt Function Income20147432RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$393,623ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total361Total
Program Services361ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total996995Total
Program Services621528ProgramServices
Management And General375467ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10127046Total
Program Services9598614ProgramServices
Management And General528432ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total93684Total
Program Services75308ProgramServices
Management And General18376ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total850121Total
Program Services661082ProgramServices
Management And General189039ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total757149Total
Program Services567862ProgramServices
Management And General189287ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total17097Total
Management And General17097ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total60947Total
Management And General60947ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total2112849Total
Program Services1891974ProgramServices
Management And General220875ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total25819Total
Program Services18416ProgramServices
Management And General7403ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total754378Total
Program Services703808ProgramServices
Management And General50570ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total779600Total
Program Services774019ProgramServices
Management And General5581ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total58469Total
Program Services52117ProgramServices
Management And General6352ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total109837Total
Program Services109837ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total963471Total
Program Services722603ProgramServices
Management And General240868ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total903483Total
Program Services903483ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Provision for Bad Debts28600712860071
Medical Supplies15110201511020
Miscellaneous21910618457434532
Physician Recruitment177524177524

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23379027Total
Program Services21434201ProgramServices
Management And General1944826ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY375583BOY
EOY286321EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2554810BOY
EOY1893336EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY122500BOY
EOY129837EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY191486BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY402712BOY
EOY426865EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY305336BOY
EOY293575EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16791873LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec13980897LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3366087BOY
EOY2810976EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY987523BOY
EOY1071762EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8306037BOY
EOY6912672EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3785296BOY
EOY4298368EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY947528BOY
EOY507452EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY278914BOY
EOY425946EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5011738BOY
EOY5231766EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3294299BOY
EOY1680906EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3294299BOY
EOY1680906EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8306037BOY
EOY6912672EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1613393ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis37450OtherCostOrOtherBasis
Book Value37450BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8429123OtherCostOrOtherBasis
Depreciation6870066Depreciation
Book Value1559057BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis335731OtherCostOrOtherBasis
Depreciation268568Depreciation
Book Value67163BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7969303OtherCostOrOtherBasis
Depreciation6842263Depreciation
Book Value1127040BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis20266OtherCostOrOtherBasis
Book Value20266BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2810976TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Bond Origination Costs, Net410
Advances to Related party39623
Malpractice Insurance Receivable1031729
FieldValueIRS element (for citing)
Total Book Value Other Assets1071762TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue to Third-Party PayorDescription
Amount$425,946Amount
FieldValueIRS element (for citing)
Total Of Amounts425946TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt18458641TotRevenueEtcAuditedFinclStmt
Other Revenues-2860071OtherRevenues
Revenue Not Rptd F990-2860071RevenueNotRptdF990
Revenue Subtotal21318712RevenueSubtotal
Other Revenues Not Included446922OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt446922RevenueNotRptdOnFinStmt
Total Revenue Per Form99021765634TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt20518956TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal20518956ExpensesSubtotal
Other Expenses Not Included2860071OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt2860071ExpensesNotRptdOnFinStmt
Total Expenses Per Form99023379027TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X, Line 2:The Hospital is organized as an Oklahoma nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred.
Part XI, Line 2d - Other Adjustments:Provision for Bad Debts -2,860,071.
Part XI, Line 4b - Other Adjustments:Capital Transfers Stated Separately on Financial Statements 17,872. Capital Contributions Stated Separately on Financial Statements 429,050.
Part XII, Line 4b - Other Adjustments:Provision for Bad Debts 2,860,071.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense171000TotalCommunityBenefitExpense
Direct Offsetting Revenue10485DirectOffsettingRevenue
Net Community Benefit Expense160515NetCommunityBenefitExpense
Percent Of Total Expense0.00780PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense171000TotalCommunityBenefitExpense
Direct Offsetting Revenue10485DirectOffsettingRevenue
Net Community Benefit Expense160515NetCommunityBenefitExpense
Percent Of Total Expense0.00780PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense103937TotalCommunityBenefitExpense
Direct Offsetting Revenue28371DirectOffsettingRevenue
Net Community Benefit Expense75566NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense7242TotalCommunityBenefitExpense
Direct Offsetting Revenue1635DirectOffsettingRevenue
Net Community Benefit Expense5607NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense5649597TotalCommunityBenefitExpense
Direct Offsetting Revenue2791760DirectOffsettingRevenue
Net Community Benefit Expense2857837NetCommunityBenefitExpense
Percent Of Total Expense0.13930PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense508TotalCommunityBenefitExpense
Net Community Benefit Expense508NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5761284TotalCommunityBenefitExpense
Direct Offsetting Revenue2821766DirectOffsettingRevenue
Net Community Benefit Expense2939518NetCommunityBenefitExpense
Percent Of Total Expense0.14330PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5932284TotalCommunityBenefitExpense
Direct Offsetting Revenue2832251DirectOffsettingRevenue
Net Community Benefit Expense3100033NetCommunityBenefitExpense
Percent Of Total Expense0.15110PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense897TotalCommunityBuildingExpense
Net Community Building Expense897NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense2971TotalCommunityBuildingExpense
Net Community Building Expense2971NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense1163TotalCommunityBuildingExpense
Net Community Building Expense1163NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense709TotalCommunityBuildingExpense
Net Community Building Expense709NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense187529TotalCommunityBuildingExpense
Net Community Building Expense187529NetCommunityBuildingExpense
Percent Of Total Expense0.00910PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense193269TotalCommunityBuildingExpense
Net Community Building Expense193269NetCommunityBuildingExpense
Percent Of Total Expense0.00930PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$2,860,071BadDebtExpenseAmount
Amount Attributable To715018AmountAttributableTo
Amount Reimbursed By Medicare4719831AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5152688CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-432857MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1McCurtain Memorial Medical ManagementBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11301 East Lincoln RdAddressLine1
CityIdabelCity
StateOKState
ZIP Code74745ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1McCurtain Memorial Medical ManagmentIncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
Other Needs AddressedXOtherNeedsAddressed
All Needs Addressed1AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities8NumberOfOtherFacilities

Other Facilities OtherFacilities (8 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Idabel Primary Care Clinic
1425 E Lincoln Road Suite B-4IdabelOK74745Physician Clinic (closed 9/14/12)
Memorial North Health Center
510 South Park DriveBroken BowOK74728Physician Clinic
McCurtain Memorial Home Health
1301 E Lincoln RoadIdabelOK74745Home Health office on Hospital premises
Southeast Oklahoma Surgical Services
1425 E Lincoln Road Suite A-6IdabelOK74745Physician Clinic
Valliant Healthcare Center
101 Terry DriveValliantOK74764Physician Clinic (opened 3/18/13)
MedFast
1425 E Lincoln Road Suite B-4IdabelOK74745Walk-in Clinic staffed with Nurse Practitioners (closed 3/10/13)
Southeast Regional Psychiatric Services
1425 E Lincoln Road Suite A-2IdabelOK74745Physician Clinic
Women and Health Clinic
1425 E Lincoln Road Suite B-3IdabelOK74745Physician Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationIdentifierIdentifier
Part I, Line 6a: The organization's community benefit report can be found on its website at www.mmhok.com
Part I, Line 7: Charity care at cost on line 7a was calculated using the cost-to-charge ratio derived from Worksheet 2. Amounts on line 7e, 7f and 7i were determined based on actual costs from the general ledger. Subsidized health services, line 7g, were determined using the Medicare Cost Report.
Part I, Line 7g: The physician clinics listed in Sch H, Part V, Page 7 are subsidized. The direct and indirect costs associated with the physician clinics were $2,610,251.
Part I, L7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $2,860,071.
Part II: Hospital is a member of the Chambers of Commerce and Main Street programs in the communities of its service area which promote community and economic development. The Hospital actively recruits physicians and Allied Health professionals (nurse practitioners) to serve the citizens of its service area and increase the availability of providers. The Hospital is also involved in helping to prevent domestic violence in its community by providing leadership and participation to the McCurtain County Child Abuse Awareness Team as well as the Domestic Violence Task Force. In addition, the Hospital also participates in the McCurtain County Coalition for Change Program - Turning Point.
Part III, Line 4: Accounts are not written off to bad debt until all payments, discounts and contractual allowances are applied and internal collection efforts have been exhausted. When a payment is received on an account previously written off to bad debt, the payment reduces the current year's bad debt expense.The amount of bad debt estimated to be attributable to patients under the organization's charity care policy is determined by using the percentage of the population in the service area that is under the federal poverty guideline established for charity care.The footnote to the Organization's finanical statements can be found on page 8 of the attached audited financial statements.
Part III, Line 8: Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.McCurtain Memorial Medical Management, Inc. provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.
Part III, Line 9b: Self-pay patients are notified of the Financial Assistance Program upon registration during face-to-face interviews if at all possible. First time billing statements will be mailed to the responsible party of all self-pay patients within approximately 15 days of discharge. The message on this statement indicates the patient may be eligible for a discount and provides information on applying for discounts. If eligibility is established, the discounted amount is written off as charity care and no further collection will occur. If the individual does not provide the required information or the application is denied, normal collection procedures will commence. The Hospital is currently in the process of codifying its policies for compliance with new 501(r) requirements.
Part V, Section B, Line 3: From the Community Health Needs Assessment Final Report, page 2, Section Title: Participation with Community Stakeholders- "In order to achieve wide-spread community involvement and ownership of the results of the Community Health Needs Assessment the McCurtain Memorial Hospital's HealthCare Foundation sponsored luncheon presentations upon completion of each of the studies and reports compiled by OSU Rural Health. A diverse group of individuals participated in the luncheon presentations which were held at the Mary Herron Conference Center in Idabel. Additionally public participation at the presentations was encouraged through public newspaper announcements of the presentations. Each of the presentations was well attended by an assorted group, including educators, health-related professionals, media representatives, local government officials, health and human service organizations, institutes of higher learning, religious institutions, local civic groups, and other individuals from the community. At the conclusion of each presentation, the luncheon guests were invited to offer comments and suggestions on the topic of the presentation. Many discussions among individuals and groups resulted from the material presented at the various luncheon meetings."McCurtain Memorial Medical Managment,Inc
Part V, Section B, Line 5c: The Community Health Needs Assessment Final Report as of November 1, 2012 is posted on the hospital's website at www.mmhok.com.McCurtain Memorial Medical Managment,Inc
Part V, Section B, Line 6i: The Community Health Needs Assessment Implementation Strategy is posted on the hospital's website at www.mmhok.com.McCurtain Memorial Medical Managment,Inc
Part V, Section B, Line 14g: The Hospital posts its charity care policy summary with financial assistance contact information in the financial services office. Summary information is also printed in pamphlets provided in the ER waiting room. Financial Assistance information is provided in "first-time" statements of patient bills. The entire Financial Assistance Policy is available upon request.McCurtain Memorial Medical Managment,Inc
Part VI, Line 2: The Hospital holds an annual Strategic Planning Meeting in which the needs of the community are evaluated within an environmental assessment which also identifies internal and external issues that affect the organization and its ability to meet the needs of the community it serves.
Part VI, Line 3: The Hospital posts its charity care policy summary with financial assistance contact information in the financial services office. Information is also printed in pamphlets provided in the ER waiting room. Financial Assistance guidance and information is provided to patients upon completion of medical evaluation and screening at which time potentially eligible patients are counseled by Financial Services. Financial Assistance information is not provided with discharge materials. Financial Assistance information is provided in "first-time" statements of patient bills. Financial Services counsels all patients who are potentially eligible for financial assistance by providing guidance in applying for assistance through federal, state and county programs. Should a patient not qualify for one of these programs and is not eligible for nor enrolled in private or public insurance plans, he/she may still be eligible for financial assistance through the Hospital's Financial Assistance Program upon meeting the criteria outlined in the policy (78-06-20).
Part VI, Line 4: McCurtain Memorial Hospital is the only hospital located in McCurtain County, which is the third largest county in the state. The entire county is designated as a Medically Underserved Area with portions of the county designated as Health Professional Shortage Areas due to geographical area, census tracts, and/or a Native American tribal population. According to the U.S. Census Bureau 2008-2012 American Community Survey, there were 27.1% of individuals whose income was below poverty level in the prior twelve months of the survey. Of the estimated population for 2008-2012, there were 23.7% without insurance coverage. Approximately 30% of the people in McCurtain County are covered by Medicaid and the unemployment rate usually ranks in the top five of the state. The primary service area is approximately a 35-mile radius around Idabel. The 2010 US Census Bureau population count for McCurtain County was 33,151 with 15.6% of those in the age group 65 and older and 28.7% under the age of 20.With the exception of McCurtain Memorial Hospital there are no other major hospitals located within the county. McCurtain County has major employers such as International Paper (IP), Tyson Foods, Hagale Industries, Huber Paper, Georgia Pacific and Pan Pacific Products. Unemployment rates in McCurtain County rose during the second quarter of 2013, and the county continues to have one of the highest unemployment rates in the state at 8.9%, well above the state rate of 5.2% as of June 2013.
Part VI, Line 5: The McCurtain Memorial Hospital is a sole community provider with a Board of Directors comprised of persons who reside in the organization's primary service area who are neither employees (except the Chief of Staff position) nor contractors of the organization, nor family members thereof. The Hospital extends medical staff privileges to all qualified physicians in its community for all of its departments. The Hospital applies surplus funds to improvements in patient care and medical education. The Hospital continuously evaluates and monitors quality control initiatives. The hospital's emergency room is available to all regardless of ability to pay. Continuing education and seminars are provided to personnel on a regular basis including EKG monitoring classes, Venous Thrombo-embolism Prevention and Prophylaxis, ACLS, PALS, CPI, CPR, Medicare Workshops, Credentialing Updates in addition to allowances provided to employed physicians and CRNA for continuing medical education workshops and seminars. The organization provides Geriatric Psychiatric inpatient services not otherwise available within the county and also Emergency services available to all regardless of ability to pay. The organization is an active member of the Chambers of Commerce within the county and participates in community events such as health fairs, seasonal festivals, county fairs, etc. with the purpose of educating people of the community in health wellness, disease and illness prevention. Pamphlets and other useful information are provided as well as free blood pressure checks and glucose screenings.McCurtain Memorial Hospital is also a sponsor of Kids Safe Saturday and the Great American Smoke-Out. These events are organized by community advocacy groups to help raise awareness of domestic/child abuse and teen drug and tobacco abuse. The organization participates in these planning meetings as well as the events.The Hospital is a participant in the McCurtain County Coalition for Change as well as several community steering committees initiated with the purpose of addressing health needs of the community, including obesity, teen health, substance abuse/mental health, socio-economic factors, access to healthcare and issues of fragmented healthcare. The organization sponsored Lunch and Learn sessions during the tax year aimed at raising public awareness in the areas of diabetes, healthy eating, and mental health.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
John M Migliaccio MD
Chief of Staff5114510000000157260527177000
Bristol Messer
CEO1673780005587043710160250193361000
Jeffrey Martin
CRNA298879000006250078960313025000
Raymond Smith
Physician3955250000000159720411497000
John Oglesbee
Physician2015880000000157260217314000
Stephen Katz
Physician323258000001875076060332739000
Michael Freeman
Physician2005480000000162840216832000
Michael West-Current Employee
Former BOD) - Physician1986480000000163240214972000

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
Good Honest Medicine - Michael West
Agreement to pay physician recruitment fees for physician practiceX$122,500122500111
John Migliaccio MD
To assist in payment of mal-practice liability insurance premiumsX$6,2477337111
FieldValueIRS element (for citing)
Total Balance Due129837TotalBalanceDue

Form990 Schedule L Part III Form990ScheduleLPartIII

FieldValueIRS element (for citing)
Name Of Interested PersonJohn MigliaccioNameOfInterestedPerson
Relationship With OrganizationEmployed Physician and Board MemberRelationshipWithOrganization
Amount Of Grant22628AmountOfGrant
Type Of AssistancePhysician subsidy for insurance premiumsTypeOfAssistance

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Michael West
Employed Physician198648Payment for professional services rendered0
John Migliaccio
Employed Physician, Independent Contractor, Board Member511451Payment for professional services rendered and management fees for ER medical directorship and Chief of Medical Staff0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
New Program ServicesForm 990, Part III, line 2Physician from Idabel Primary Care Clinic moved to Hospitalist position at the Hospital September 17, 2012.
Changes in Program ServicesForm 990, Part III, line 3Idabel Primary Care Clinic closed September 17, 2012. Medfast Walk-In Clinic closed March 10, 2013. Speech Therapy services discontinued with resignation of Speech Pathologist April 10, 2013.
Form 990, Part VI, Section B, line 11The return will be emailed to all board members for review prior to the filing deadline. It is also reviewed by the CFO prior to filing.
Form 990, Part VI, Section B, line 12cAll officers, directors, and key employees fill out a conflict of interest disclosure annually. The disclosure forms are reviewed initially by the CEO and CFO for potential conflicts. Any actual conflicts are reviewed by the Board of Directors. A person with a conflict is restricted from voting on related matters.
Form 990, Part VI, Section B, line 15aThe CEO compensation is determined by the Board of Directors based on comparability data and an annual evaluation. The CFO compensation is determined by the CEO based on an annual evaluation.
Form 990, Part VI, Section C, line 19Form 990, Part VI, Section C, Line 19: These documents are available upon request during normal business hours.
Sch B and Part VIIISch B has more contributions than listed on Part VIII. Grants on Schedule B are listed as full amounts received. Per the audited Financial Statments, an adjustment to Grant Revenue was made for $64,160 which is reflected in the total on Part VIII, Line 1e.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1McCurtain Memorial Hospital FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11301 Lincoln RdAddressLine1
CityIdabelCity
StateOKState
ZIP Code74745ZIPCode
FieldValueIRS element (for citing)
EIN731455422EIN
Primary ActivitiesFundraisingPrimaryActivities
Legal Domicile StateOKLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11aPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
McCurtain Memorial Hospital Foundation
K203600Book
McCurtain Memorial Hospital Foundation
E115212Book
McCurtain Memorial Hospital Foundation
E200000Book
McCurtain Memorial Hospital Foundation
O50542Book