2014-11-14T09:06:23-06:00 2013-12-31 BKD LLP 6120 S Yale 1400 Tulsa OK 741364223 990 2013-01-01 730570773 NEWMAN MEMORIAL HOSPITAL INC % NEWMAN MEMORIAL HOSPITAL NEWM 5809382551 905 SOUTH MAIN Suite SHATTUCK OK 73858 JEFFREY D SHELTON OFFICER 5809382551 2014-11-13 true Anne M Adams P00887943 5809382551 2013 2015-11-30 17:44:51Z JEFFREY D SHELTON 905 SOUTH MAIN SHATTUCK OK 73858 10542348 false X WWW.NEWMANMEMORIALHOSPITAL.ORG X 1907 OK NEWMAN MEMORIAL HOSPITAL'S MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICE AND HEALTHCARE EDUCATION. 13 13 121 14 0 1719966 1624639 9537601 7796793 12640 1600 175484 1119316 11445691 10542348 0 0 0 0 4592553 4015760 0 0 0 6973749 7196818 11566302 11212578 -120611 -670230 14067988 14244579 7039682 7909038 7028306 6335541 X PROVIDE THE COMMUNITY WITH HEALTHCARE SERVICE AND HEALTHCHARE EDUCATION. false false 8220073 8886024 Newman Memorial Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, disability, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Newman Memorial Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Our mission is to serve the community with respect to providing healthcare services and healthcare 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 governmental programs at below cost, health activities and programs to support the community will be considered where the need and/or an individual's inability to pay coexists. These activities include wellness programs, community education programs, special programs for the elderly, disabled, medically underserved, and a variety of broad community support activities. Newman Memorial Hospital serviced 455 inpatients and provided over 4,000 home health visits during 2013. In addition, Newman Memorial Hospital provided emergency room care for over 2,555 patients. Newman Memorial Hospital provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to Medicare and Medicaid patients. To the extent reimbursement is below cost, Newman Memorial Hospital recognizes these amounts as charity care in meeting its mission to the entire community. Charity care is also provided through many reduced price services and free programs offered throughout the year based upon activities and services which Newman Memorial Hospital believes will serve a bona fide community health need. These include: - Provided additional charity care to the community of $313,912 during 2013. - Being called upon to speak before community organizations on a variety of healthcare topics. - Providing assistance to educators through our work with student nurses. - Providing meeting facilities for the Ministerial Alliance. Facilities are used for this purpose once a month. - During 2013 the Newman Hospital Auxiliary contributed over 3,800 volunteer hours toward the purpose of servicing the health care of the community. - Provided nursing scholarship to area students. - Provided free finger blood stick sugars and blood pressure checks to area senior citizens centers. - Provided over 250 WIC service visits for the area. - Provided influenza clinics in the four surrounding towns which served over 190 people. - Provided over 217 immunizations at the hospital. - Provided over 217 immunizations at the hospital. 8220073 true true false false false false false false false false true false false false false false true false false false false false false false false false true true false false true false false false false false false true false false false false false false false false false false true 26 0 true 121 true false false false false false false false false false false X 13 13 true false false false false false false true true false false true true true true true true true false false OK X NEWMAN MEMORIAL HOSPITAL 5809382551 905 SOUTH MAIN SHATTUCK OK 73858 MATTHEW SCOTT OD PRESIDENT 0.5 X X 0 0 0 GREG HUENERGARDT VICE PRESIDENT/PRESIDENT 0.5 X X 0 0 0 ANGELA PRATHER SECRETARY 0.5 X X 0 0 0 DANNA STUART MD DIRECTOR 0.5 X 0 0 0 BRENDA HUENERGARDT MD DIRECTOR 0.5 X 0 0 0 DAVID DERSCH DIRECTOR 0.5 X 0 0 0 TODD COOK DIRECTOR 0.5 X 0 0 0 THERESA WHEELER DIRECTOR 0.5 X 0 0 0 TED MILLER VICE PRESIDENT 0.5 X X 0 0 0 RICHARD ROYAL DIRECTOR 0.5 X 0 0 0 KYLE NONDORF DIRECTOR 0.5 X 0 0 0 BRIDGET COSBY DIRECTOR 0.5 X 0 0 0 RHONDA WAYLAND DIRECTOR 0.5 X 0 0 0 KEVIN O'BRIEN COO 50.0 X 134584 0 6475 DENISA KETTERMAN CNO 40.0 X 53477 0 2755 JEFFREY SHELTON CEO 50.0 X 105587 0 2823 RILEY CASPER DIRECTOR OF NURSING 50.0 X 51492 0 782 345140 0 12835 2 false false true ANESTHESIA LLC PO BOX 429 SHATTUCK OK 73858 ANESTHESIA 353000 ACCOUNTABLE HEALTHCARE PO BOX 203820 DALLAS TX 75320 NURSING SERVICES 168244 CONCORD MEDICAL GROUP 3004 50TH STREET SUITE D LUBBOCK TX 79413 ER PHYSICIANS 425428 ST ANTHONY HOSPITAL PO BOX 205 OKLAHOMA CITY OK 73101 CLINICAL RESOURCES 118517 4 1600553 24086 1624639 PATIENT SERVICE REVENUE 621300 7796793 7796793 7796793 1600 1600 0 0 30085 30085 0 30085 30085 0 0 0 0 MEDICAL RECORD SALES 900099 979619 979619 CAFETERIA MEALS 722210 48187 48187 VENDING SALES 900099 3033 3033 58392 58392 1089231 10542348 8886024 31685 0 0 0 0 357974 357974 0 3059945 2397390 662555 29349 22994 6355 325576 255081 70495 242916 190319 52597 0 17843 17843 75604 75604 0 0 0 0 24300 8057 16243 50705 39726 10979 0 0 200206 200206 68289 53503 14786 0 0 281942 281942 0 810812 810812 184639 184639 BAD DEBT EXPENSE 1767560 1767560 CONTRACTUAL SALARIES 1825219 1825219 SUPPLIES 923253 723346 199907 EQUIPMENT RENTAL & MAINTENANCE 497656 389901 107755 468790 362338 106452 11212578 8220073 2992505 0 1675452 1796131 406687 407913 0 0 1613393 1321469 0 0 0 0 0 0 191977 172498 155100 106842 23013546 12573820 10025379 10439726 0 0 0 0 0 0 0 0 0 0 14067988 14244579 816796 832354 0 0 0 0 0 0 0 0 0 0 6222886 7076684 0 0 0 0 7039682 7909038 X 6448262 5651904 580044 683637 0 0 7028306 6335541 14067988 14244579 -670230 -22535 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 41025 41025 11249170 6167543 5081627 11684606 6406277 5278329 38745 38745 10439726 X 10542348 10542348 10542348 11212578 11212578 11212578 Schedule D, Part XIII As a govenmental entity, the Hospital is generally exempt from federal and state income taxes under Section 115 of the Internal Revenue Code and a similar provision of state law. However, the Hospital is subject to federal income tax on any unrelated business taxable income. true true X true X 180. true X true true true false false 269136 269136 0.02400 592020 287916 304104 0.02710 861156 287916 573240 0.05110 861156 287916 573240 0.05110 false 1767560 1423241 2314852 -891611 X true true NA 1 1 NEWMAN MEMORIAL HOSPITAL 905 SOUTH MAIN SHATTUCK OK 73858 X X X NEWMAN MEMORIAL HOSPITAL 1 true X X X X X X X X X 13 true false true X www.newmanmemorial.org X X X X X X X false false true true 180. true 300. true X X X X X X X X true true X X X X X X true false X X X X true X false false Schedule H, Part V, Section B, Line 3 A survey was designated to gauge hospital usage, satisfaction and community health needs. The surveys were distributed at the hospital and during the first community meeting on August 21, 2013. Community members present at the hospital each took a survey. THE HOSPITAL ALSO HOSTED FOUR COMMUNITY MEETINGS FROM AUGUST 21, 2013 THRU OCTOBER 24, 2013. THESE MEETINGS WERE ATTENDED BY COMMUNITY MEMBERS AND THOSE WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. THE MEETINGS ALLOWED THOSE IN ATTENDANCE TO DISCUSS THE HEALTH NEEDS OF THE HOSPITAL'S COMMUNITY. Schedule H, Part V, Line 7 THERE WERE SEVERAL HEALTH NEEDS IDENTIFIED THRU THE SURVEY PROCESS AND THE COMMUNITY MEETINGS. WHILE ALL OF THESE NEEDS ARE LISTED IN THE CHNA, THE TOP HEALTH NEEDS WERE SPECIFICALLY IDENTIFIED WITH SPECIFIC EXAMPLES. THE IMPLEMENTATION STRATEGY ADDRESSES THE TOP HEALTH NEEDS OF THE COMMUNITY. Schedule H, Part V, Section B, Line 6a The implementation strategy can be found on the hospital's website at www.newmanmemorial.org in the community health needs assessment. SCHEDULE H, PART V, LINE 20D 100% OF BILLED CHARGES ARE WRITTEN OFF FROM 0-180%; 90% OF CHARGES ARE WRITTEN OFF FROM 181%-200%; 80% FROM 201-220%; 221-300% IS CASE BY CASE DEPENDING ON THE FINANCIAL STATUS OF THE PATIENT, ASSETS, ETC. SCHEDULE H, PART III, LINE 4A The Hospital has agreements with third-party payers that provide for payments to the Hospital at amounts different from its established rates. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payers and others for services rendered and includes estimated retroactive revenue adjustments and a provision for uncollectible accounts. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered and such estimated amounts are revised in future periods as adjustments become known. SCHEDULE H, PART III, LINE 4B THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS DUE FROM PATIENTS, THIRD-PARTY AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. SCHEDULE H, PART III, LINE 8 and 8a THE ORGANIZATION USES MEDICARE COST REPORT METHODOLOGY TO DETERMINE THE AMOUNT REPORTED ON LINE 6. THE SHORTFALL ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED WITHOUT PAYMENT TO PATIENTS. SCHEDULE H, PART III, LINE 9B THE HOSPITAL NOTIFIES PATIENTS OF THE CHARITY CARE POLICY WHEN THEY ARE ATTEMPTING TO COLLECT PAYMENT FOR THE SERVICES OR SETTING UP PAYMENT ARRANGEMENTS. SCHEDULE H, PART VI, LINE 2 THE MEDICAL STAFF, HOSPITAL BOARD AND MANAGEMENT OF THE HOSPITAL DECIDE COMMUNITY NEEDS BASED UPON WHAT THEY READ AND SEE IN OTHER COMMUNITIES OR INPUT FROM PEOPLE IN THE COMMUNITY. SCHEDULE H, PART VI, LINE 3 ALL INPATIENTS THAT ARE ADMITTED TO THE HOSPITAL RECEIVE AN INFORMATION PACKET ABOUT SERVICES AND PROGRAMS THE HOSPITAL OFFERS. ONE BROCHURE IS AN APPLICATION FOR CHARITY CARE FOR PATIENTS TO FILL OUT. THE COLLECTION CLERK ALSO CONTACTS ALL SELF-PAY PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF THE PATIENT FEELS THEY CAN NOT PAY, THEY ARE ADVISED OF THE HOSPITAL CHARITY CARE AND APPLICATIONS ARE MAILED AT THAT TIME. SCHEDULE H, PART VI, LINE 4 THE HOSPITAL PROVIDES COMPETENT HIGH-QUALITY SERVICES MEETING THE PREVENTATIVE, ACUTE, EMERGENCY, AMBULATORY, REHABILITATIVE AND HOME HEALTH CARE NEEDS OF ALL INDIVIDUALS RESIDING IN THE IMMEDIATE AND ADJACENT COMMUNITIES. NO INDIVIDUAL WILL BE DEPRIVED OF EMERGENCY OR CRITICAL CARE BECAUSE OF THEIR INABILITY TO PAY; HOWEVER, EVERY EFFORT WILL BE MADE TO COLLECT FUNDS OWED TO THE HOSPITAL FOR ELECTIVE CARE SINCE THE ABILITY TO CONTINUE TO PROVIDE AND IMPROVE SERVICES TO THE COMMUNITIES SERVED DEPENDS ON FINANCIAL STABILITY. X X X X false false false false false false false false false DENISA KETTERMAN CNO 53477 0 0 0 0 0 0 0 2755 0 56232 0 0 0 SEE PART V 1 SCHEDULE L, PART IV 1. NAME: KASANDRA WATSON; FAMILY MEMBER OF COO - KEVIN O'BRIEN; AMOUNT OF TRANSACTION: $19,708; TRANSACTION: EMPLOYMENT, NO SHARING OF ORGANIZATION REVENUES. 2. NAME: JIMMY KETTERMAN; FAMILY MEMBER OF CNO - DENISA KETTERMAN; AMOUNT OF TRANSACTION: $353,000; TRANSACTION: CONTRACT LABOR, NO SHARING OF ORGANIZATION REVENUES. FORM 990, PART VI, LINE 12C A CONFLICT OF INTEREST POLICY IS REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS ANNUALLY. FORM 990, PART VI, LINE 15 IN SEPTEMBER 2013, THE EXECUTIVE COMMITTEE MET AND DETERMINED THE COMPENSATION OF THE CEO OF THE HOSPITAL. THE MEETING WAS DOCUMENTED IN THE BOARD OF DIRECTORS' MEETING MINUTES. FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAIALBLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, LINE 11 THE 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED INTERNALLY BY MANAGEMENT. THE RETURN WAS THEN REVIEWED AND APPROVED BY THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, LINE 2 THE FOLLOWING RELATIONSHIPS EXIST BETWEEN OFFICERS, DIRECTORS, TRUSTEES, AND OTHER KEY EMPLOYEES: DAVID DERSCH AND DANNA STUART FAMILY RELATIONSHIP. GREG HUENERGARDT AND BRENDA HUENERGARDT FAMILY RELATIONSHIP.