2014-05-15T09:10:43-05:00 2013-06-30 450250958 EIDE BAILLY LLP 1601 NW EXPRESSWAY SUITE 1900 OKLAHOMA CITY OK 73118 990 2012-07-01 736617937 McCurtain Memorial Medical Management Inc MCCU 5802867623 1301 East Lincoln Rd Idabel OK 74745 Ray B Whitmore Jr 5802867623 2014-05-07 1 Carolyn Levings P01083874 4054783334 2014-05-07 2012 2015-11-30 17:44:51Z Ray B Whitmore Jr 1301 East Lincoln Rd Idabel OK 74745 22217890 0 X www.mmhok.com X 1975 OK Hospital care 7 6 368 27 0 0 1898261 2011825 20964928 20147432 9865 -449198 55679 55575 22928733 21765634 2035 361 0 0 12388200 12824995 0 0 0 10398155 10553671 22788390 23379027 140343 -1613393 8306037 6912672 5011738 5231766 3294299 1680906 X McCurtain 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. 1 1 21335071 361 20119061 We 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. 85571 28371 Wellness 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. 13559 The 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. 21434201 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 1 1 1 1 0 0 0 0 0 1 1 0 0 0 1 70 0 1 368 1 0 0 0 0 0 0 0 1 1 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 OK X Ray B Whitmore Jr 5802083104 1301 E Lincoln Rd Idabel OK 74745 Billie Tomlinson 1.00 X X 0 0 0 Irvin C Jones 1.00 X X 0 0 0 Thomas Salyer DO 1.00 X X 0 0 0 Desmond Brown 1.00 X 0 0 0 Robert P Hessenlopp 1.00 X 0 0 0 David White 1.00 X 0 0 0 George Freeman DO 1.00 X 0 0 0 John M Migliaccio MD 40.00 X 511451 0 15726 Bristol Messer 40.00 X 172965 0 20097 Ray B Whitmore Jr 40.00 X 91496 0 18088 Jeffrey Martin 40.00 X 298879 0 13548 Raymond Smith 40.00 X 395525 0 15932 John Oglesbee 40.00 X 201588 0 15726 Stephen Katz 40.00 X 323258 0 9182 Michael Freeman 40.00 X 200548 0 15835 Michael West-Current Employee 40.00 X 198648 0 15726 2394358 0 139860 8 1 1 0 Denny Parton PO Box 522 Shawnee OK 74802 ER Physician 352883 Create A Storehouse 1970 Marie Dr Durant OK 74701 ER Physician 263933 On Assignment Inc File 50730 Los Angeles CA 90074 Locum Tenen Nurse Agency 236893 Emcare Inc 7032 Collection Ctr Dr Chicago IL 60693 ER Physician Agency 148238 Bhupinder Sangha 232 Harders Crossing Shreveport LA 71106 Hospitalist Services 119200 7 X 1564898 446927 2011825 Net Patient Serv Rev 900099 20106199 20106199 Other Rev 900099 41233 41233 20147432 2313 2313 55575 0 55575 55575 55575 745 452256 -451511 -451511 -451511 21765634 20147432 0 -393623 361 361 996995 621528 375467 10127046 9598614 528432 93684 75308 18376 850121 661082 189039 757149 567862 189287 17097 17097 60947 60947 2112849 1891974 220875 25819 18416 7403 754378 703808 50570 779600 774019 5581 58469 52117 6352 109837 109837 963471 722603 240868 903483 903483 Provision for Bad Debts 2860071 2860071 Medical Supplies 1511020 1511020 Miscellaneous 219106 184574 34532 Physician Recruitment 177524 177524 23379027 21434201 1944826 0 375583 286321 2554810 1893336 122500 129837 191486 402712 426865 305336 293575 16791873 13980897 3366087 2810976 987523 1071762 8306037 6912672 3785296 4298368 947528 507452 278914 425946 5011738 5231766 X 3294299 1680906 3294299 1680906 8306037 6912672 -1613393 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 37450 37450 8429123 6870066 1559057 335731 268568 67163 7969303 6842263 1127040 20266 20266 2810976 Bond Origination Costs, Net 410 Advances to Related party 39623 Malpractice Insurance Receivable 1031729 1071762 Due to Third-Party Payor 425946 425946 X 18458641 -2860071 -2860071 21318712 446922 446922 21765634 20518956 0 20518956 2860071 2860071 23379027 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 171000 10485 160515 0.00780 171000 10485 160515 0.00780 103937 28371 75566 0.00370 7242 1635 5607 0.00030 5649597 2791760 2857837 0.13930 508 508 0.00000 5761284 2821766 2939518 0.14330 5932284 2832251 3100033 0.15110 897 897 0.00000 2971 2971 0.00010 1163 1163 0.00010 709 709 0.00000 187529 187529 0.00910 193269 193269 0.00930 0 2860071 715018 4719831 5152688 -432857 X 1 1 1 1 McCurtain Memorial Medical Management

1301 East Lincoln Rd Idabel OK 74745

X X X McCurtain Memorial Medical ManagmentInc 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 1 0 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 8 Idabel Primary Care Clinic

1425 E Lincoln Road Suite B-4 Idabel OK 74745

Physician Clinic (closed 9/14/12) Memorial North Health Center

510 South Park Drive Broken Bow OK 74728

Physician Clinic McCurtain Memorial Home Health

1301 E Lincoln Road Idabel OK 74745

Home Health office on Hospital premises Southeast Oklahoma Surgical Services

1425 E Lincoln Road Suite A-6 Idabel OK 74745

Physician Clinic Valliant Healthcare Center

101 Terry Drive Valliant OK 74764

Physician Clinic (opened 3/18/13) MedFast

1425 E Lincoln Road Suite B-4 Idabel OK 74745

Walk-in Clinic staffed with Nurse Practitioners (closed 3/10/13) Southeast Regional Psychiatric Services

1425 E Lincoln Road Suite A-2 Idabel OK 74745

Physician Clinic Women and Health Clinic

1425 E Lincoln Road Suite B-3 Idabel OK 74745

Physician Clinic 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. McCurtain Memorial Medical Managment,Inc 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. 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. X X X X 0 0 0 0 0 0 0 0 0 John M Migliaccio MD 511451 0 0 0 0 0 0 0 15726 0 527177 0 0 0 Bristol Messer 167378 0 0 0 5587 0 4371 0 16025 0 193361 0 0 0 Jeffrey Martin 298879 0 0 0 0 0 6250 0 7896 0 313025 0 0 0 Raymond Smith 395525 0 0 0 0 0 0 0 15972 0 411497 0 0 0 John Oglesbee 201588 0 0 0 0 0 0 0 15726 0 217314 0 0 0 Stephen Katz 323258 0 0 0 0 0 1875 0 7606 0 332739 0 0 0 Michael Freeman 200548 0 0 0 0 0 0 0 16284 0 216832 0 0 0 Michael West-Current Employee 198648 0 0 0 0 0 0 0 16324 0 214972 0 0 0 Good Honest Medicine - Michael West Agreement to pay physician recruitment fees for physician practice X 122500 122500 1 1 1 John Migliaccio MD To assist in payment of mal-practice liability insurance premiums X 6247 7337 1 1 1 129837 John Migliaccio Employed Physician and Board Member 22628 Physician subsidy for insurance premiums Michael West Employed Physician 198648 Payment for professional services rendered 0 John Migliaccio Employed Physician, Independent Contractor, Board Member 511451 Payment for professional services rendered and management fees for ER medical directorship and Chief of Medical Staff 0 New Program Services Form 990, Part III, line 2 Physician from Idabel Primary Care Clinic moved to Hospitalist position at the Hospital September 17, 2012. Changes in Program Services Form 990, Part III, line 3 Idabel 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 11 The 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 12c All 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 15a The 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 19 Form 990, Part VI, Section C, Line 19: These documents are available upon request during normal business hours. Sch B and Part VIII Sch 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. McCurtain Memorial Hospital Foundation 1301 Lincoln Rd Idabel OK 74745 731455422 Fundraising OK 501(C)(3) 11a N/A 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 1 0 1 0 1 McCurtain Memorial Hospital Foundation K 203600 Book McCurtain Memorial Hospital Foundation E 115212 Book McCurtain Memorial Hospital Foundation E 200000 Book McCurtain Memorial Hospital Foundation O 50542 Book