2011-05-12T16:42:11-05:00 2010-06-30 EIDE BAILLY LLP 2424 E 21st ST SUITE 200 TULSA OK 74114 990 2009-07-01 730579295 Farmers Union Hospital Association DBA Great Plains Regional Medical Ctr FARM 5802252511 1801 West Third Lincoln Box 2339 Elk City OK 73648 Roy L Ikner 5802252511 2011-05-11 1 Carolyn Levings 9187485000 2011-05-11 2009 2016-02-24 21:20:13Z Great Plains Regional Medical Center Don Ikner 1801 West Third Lincoln Box 2339 Elk City OK 73648 51521281 0 X N/A X 1929 OK Provide quality healthcare 10 8 532 40 0 0 797535 350000 46274097 50335525 637433 393146 287057 315761 47996122 51394432 78877 52000 0 20855505 23688810 0 0 22242307 28683665 43176689 52424475 4819433 -1030043 105066937 103978055 43733583 43674673 61333354 60303382 Great Plains Regional Medical Center will distinguish itself as the leader in western Oklahoma & eastern Texas panhandle for comprehensive, cost effective, high-quality healthcare. We will meet the healthcare needs of patients in our service area while achieving cost effective, quality outcomes. We will maintain and enhance collaborative relationships with physicians to better serve the healthcare needs of our service area. We will maintain and continually enhance health promotion, patient education and disease prevention for patients in our service area. 1 0 47228759 50335525 Farmers Union Hospital Association DBA. Great Plains Regional Medical Center in Elk City, Oklahoma (hereinafter referred to as GPRMC) provides quality health care regardless of race, religion, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of GPRMC, 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 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 whether the need and/or individuals inability to pay coexists. These activities included wellness programs, community education programs,Special programs for the elderly, handicapped, & medically under-served, and other broad community support activities.GPRMC served over 3,191 patients with more than 10,807 patient days on an inpatient basis. We also had over 57,000 outpatient encounters with patients during the year. We treated 10,400 patients in the emergency department. Our surgical teams performed 4,368 surgeries during the year.GPRMC provides care to persons covered by governmental and other programs as part of its mission to the community. These programs may not pay full charges. To the extent reimbursement is below full charges, GPRMC recognizes these amounts as contractual adjustments in meeting its mission to the entire community. Also, in recognizing its mission to the community, GPRMC provides services for those unable to pay. Additionally, GPRMC has provided services to others who are either unwilling or unable to qualify for charity care guidelines but who are still unable to pay. Community benefit is also provided by GPRMC by its providing reduced price services, free programs offered throughout the year, and initiatives which GPRMC believes will serve a bona fide community health need. See Schedule H for more information regarding these activities. 47228759 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 45 0 1 532 1 0 0 0 0 0 0 0 0 0 10 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 0 1 1 1 0 1 1 OK X Janet Miller Executive Assistant 5808215302 PO Box 2339 Elk City OK 73648 Emory Thomas 2.00 X 0 0 0 Gene Smith 2.00 X X 0 0 0 Paul Kumpf 2.00 X X 0 0 0 David Bank MD 2.00 X 0 0 0 Craig Phelps MD 2.00 X 15600 0 0 Eddie Moore 2.00 X 0 0 0 Danny L Sprowls CPA 2.00 X X 0 0 0 Jack Morrison DDS 2.00 X 0 0 0 Edward Albert 2.00 X 0 0 0 Francis Abraham MD 40.00 X 429160 0 2343 Robin E Lake 40.00 X 479548 0 2322 Don Ikner 40.00 X 235822 0 1362 Richard K McBryde 40.00 X 214925 0 0 Laura Kurzendoerfer 40.00 X 140436 0 0 James L Johnson 40.00 X 243208 0 1324 Robert Keith 40.00 X 247231 0 0 David G Purdom 40.00 X 354583 0 0 John W Flynn 40.00 X 222516 0 0 2583029 0 7351 18 0 1 0 Flintco Inc PO Box 490 Tulsa OK 74101 Construction management 5512998 Hospital Care Consultants Inc 17304 Preston Rd Suite 555 Dallas TX 75252 Hospitalist 588000 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Physician/nurse coverage 268271 EMCARE Physician Services 7032 Collection Center Drive Chicago IL 60693 Physician coverage 265319 Navigant Consulting Inc 4511 Paysphere Circle Chicago IL 60674 Consulting 127512 9 350000 350000 Net Patient Revenue 621990 49073908 49073908 Other Service Revenue 900099 628309 628309 Cafeteria Sales 900099 380168 380168 Daycare Center Revenue 900099 151299 151299 Vending Income 900099 24680 24680 77161 77161 50335525 431737 431737 17457 17457 298304 298304 298304 298304 88258 126849 -38591 -38591 -38591 51394432 50335525 0 708907 50000 50000 2000 2000 1302713 377152 925561 16626001 15823258 802743 156036 149046 6990 4405051 4207721 197330 1199009 1167636 31373 96634 96634 45574 45574 3684248 2628679 1055569 72676 72676 7346353 7319693 26660 113208 113208 1588991 1586038 2953 81900 80724 1176 101286 81977 19309 1966316 33814 1932502 5024778 5016492 8286 236938 236938 Bad Debt Expense 6489056 6489056 Equipment Rental 1197143 1196693 450 Patient Acct. Collect. 353273 353273 Miscellaneous 211833 210457 1376 Dues & License 73458 32228 41230 52424475 47228759 5195716 0 10199604 5670034 2671329 7771865 10583701 9799043 196435 1133980 1341576 594995 915004 81230280 16686346 60024877 64543934 16432860 10379006 379894 873596 2849262 2683997 105066937 103978055 3382109 3975008 39325000 38625000 931158 983854 95316 90811 43733583 43674673 X 61195524 60303382 137830 0 61333354 60303382 105066937 103978055 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 748759 748759 59073184 5186755 53886429 1653453 291782 1361671 19516591 11207809 8308782 238293 238293 64543934 Part X: Description of Uncertain Tax Positions Under FIN 48: The Medical Center has adopted provisions of FASB Accounting Standards Codification Topic ASC 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes), on January 1, 2009. The implementation of this standard had no impact on the financial statements. The Medical Center evaluates its status as an exempt organization annually to determine any potential risks. As of June 30, 2010, no provision has been made for tax concerns. 1 1 X 1 X 0 0 1 0 404477 404477 0.00880 5220727 3889349 1331378 0.02900 5625204 3889349 1735855 0.03780 737 27964 27964 0.00060 41 58162 58162 0.00130 50000 50000 0.00110 778 136126 136126 0.00300 778 5761330 3889349 1871981 0.04080 0 1974133 690947 12428824 15433099 -3004275 X 1 1 Plains Diagnostic Imaging Radiology Services 0.72000 0.00000 0.28000 Great Plains Regional Medical Center

PO BOX 2339 1801 W Third Elk City OK 73648

X X X Part I, Line 3c: The hospital provides a 15% discount to all self-pay (no insurance) patients. There is no asset test to qualify for this discount. There is an asset test to qualify for charity care. Household resources are determined by the guidelines set forth by the Department of Human Services. Part I, Line 7: Amounts on line 7a and 7b were calculated using the cost to charge ratio in IRS worksheet 2. Amounts on lines 7e,f and g are based on actual cost recorded in the general ledger and hours at average rates. Part I, Line 7f: Bad debt expense of $6,489,056 was backed out of the numerator to determine community benefit percentage. Part III, Line 4: Bad debt at cost was determined using cost to charge ratio in IRS worksheet 2.Financial Statement Footnote:The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.Bad debts are written-off at gross charges, after payments made on the accounts reduce the balance due. Discounts are not applied to the account and then the balance written-off.The amount estimated to be charity care is an estimate based upon our experience with patients who qualify and receive the proper application and subsequently do not follow-up with our business office staff for charity care write-off. Part III, Line 8: GPRMC provides services to Medicare patients understanding there will be write-offs and knowing the organization will not recover the costs of the services provided. Providing these services is essential to the community and therefore increases access to helathcare services, which is a community benefit. Part III, Line 9b: The patients are pre-screened prior to testing for charitable services and a determination is made as to the financial ability to pay. If patients are pre-qualified for services, the collection process is ceased. Part VI, Line 2: The organization relies on input from physicians, other healthcare providers, community leaders, the Board of Directors, citizens, etc. in the community. We look at out-migration studies to determine what services people from our community are seeking and receiving from outside locations. They also consider comparisons of the volume of physician specialties in our area to nationally recognized data. These factors are all considered in addition to feedback from patients in the community to determine shortage of care areas. Part VI, Line 3: Assistance is discussed with patients as part of the intake process. We try to assist people in qualifying for some type of medical assistance whether it be Medicare, Medicaid, disability, charity care, etc. Part VI, Line 4: The Corporation provides a comprehensive range of general, acute and specialized care, as well as outpatient and ancillary services, to residents in its primary and secondary service areas covering ten counties. Estimated primary and secondary service area population exceeds 100,000 people, Part VI, Line 5: GPRMC provides community building activities within the community, but has not tracked the expenses related to these activities. The hospital provides support to the community in the following ways:-GPRMC employees provide many hours of volunteer service to civic and other community benefit clubs in the area. We provide various donations to these clubs, local school systems, and various non-profit foundations & organizations.-Aware of the shortage of physicians in the Elk City area, GPRMC has worked diligently to attract additional physicians to the community. These physicians range from family practice to a variety of specialty areas. Patients will be able to access their healthcare needs locally instead of driving great distances to see a specialist. Part VI, Line 6: Our Board of Directors is made up of citizens from the community, from business owners to retired individuals. This broadly based group provides us with a broad perspective on the needs of the community.As quantified in Part II, question 7 e,f and i community benefit is provided by GPRMC through free programs offered throughout the year and initiatives which GPRMC believes serve a bona fide community health need. Some of these activities are as follows: -Notices are published in area newspapers, regarding new physicians or medical services. According to estimated newspaper circulation, these ads reach from 8,000 to 10,000 homes in the area.-The hospital offers a special reduced rate for mammogram screenings each year. -GPRMC provided flu shots for the office personnel of the physicians in the community. -GPRMC provides breast self-exam, CPR and pre-natal education to community members.-Medical professionals who work for GPRMC provide mini health fairs for the local communities and businesses.-GPRMC is one of two designated donor locations for the community-wide blood drive held five times per year.-GPRMC has a shuttle service for patients without transportation to the physician's offices, clinics and the hospital. The free shuttle travels in elk City and area communities.-GPRMC sponsors healthcare education initiatives for the community. Some of these include diabetes self-management classes for patients with new or uncontrolled diabetes and education to local nursing home staff regarding care of patients with dementia and other types of behavioral disorders.-Due to the shortage of nurses, scholarships are awarded to students wishing to pursue degrees in the medical field. -Representatives from GPRMC present education programs at the local adult learning center relative to education needed to fulfill the requirements for employment in a hospital setting. We also participate in several career fairs for different schools in our area.-GPRMC works in cooperation with educators by providing a clinical rotation training environment for students of various fields including physician, nursing, pharmacy, lab, radiology and medical records.-We participate with area high schools in the 'job shadow program'. Students interested in health careers may observe our staff in the work setting and obtain a first hand experience.-GPRMC has developed a collaboration with western Oklahoma State College to provide distance learning classes for those in the community wishing to pursue nursing degrees. GPRMC's part of the collaborative included a donation of $ 50,000 in 2009 to operate the program and provide a classroom in the local community. Additionally, in-kind services are provided to western Oklahoma State College. This is vital to those prospective students pursuing nursing degrees that would not have been able to drive the long distance to the college. 1 Western Oklahoma State College 2801 North Main Altus OK 73521 237409802 Government 50000 N/A N/A Nursing Education 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: We monitor this in multiple ways. The grants/scholarships to individual recipients are on a reimbursement basis. The recipients must submit receipts for school related expenses in order to qualify for reimbursement. We require a letter of acceptance to Nursing School and a copy of the transcript. The student is monitored each semester through the documentation they submit from the school. At the end of the educational period each recipient takes the Oklahoma Nursing Exam. Once those exam results are posted online we verify them as a primary source and proof of accomplishment for each recipient. The grant to the school is monitored by the participation of our employees as mentors and preceptors. We also know how well the education process is working since several of our "employees" are students as well. The feedback and intercommunication between our nursing leaders and their employees in multiple roles assures us these students are receiving an appropriate education and our funds are being utilized for the intended purpose. X X X X X 1 0 0 0 0 0 0 0 0 Francis Abraham MD 385415 0 40872 0 2873 0 2343 0 0 0 431503 0 0 0 Robin E Lake 384985 0 15050 0 79513 0 2322 0 0 0 481870 0 0 0 Don Ikner 216562 0 19260 0 0 0 1362 0 0 0 237184 0 0 0 Richard K McBryde 210204 0 4100 0 621 0 0 0 0 0 214925 0 0 0 James L Johnson 242055 0 100 0 1053 0 1324 0 0 0 244532 0 0 0 Robert Keith 247131 0 100 0 0 0 0 0 0 0 247231 0 0 0 David G Purdom 316081 0 38502 0 0 0 0 0 0 0 354583 0 0 0 John W Flynn 221093 0 100 0 1323 0 0 0 0 0 222516 0 0 0 Part I, Line 4a Rob Lake, CEO $344,866 nine months severance pay based upon prior salary and service period The Oklahoma Development Finance Authority 731083741 678910DB3 2007-06-26 39448937 Great Plains Regional Medical Center-Construct & Furnish 62 Bed Hospital 0 0 36232616 2653544 562777 2009 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 Form 990, Part III, line 2 New Program Services In FYE June, 2010, GPRMC added an ENT (November 2009), psychiatrist (July 2009), and gastroenterologist (July 2009) to the Elk City Community. Our ENT services were limited because we only had one ENT serving Elk City and the surrounding areas. We did not have a psychiatrist with an office in Elk City. The psychiatrist serves the community in addition to our Senior Care Wing at the hospital. The addition of a gastroenterologist not only gives us expertise in that medical field; it enables us to offer more procedures on a timely basis. Form 990, Part VI, Section A, line 6 Members are individuals who have voting shares in the organization. Membership is obtained through transfers of existing memberships. Transfers normally result either through voluntary surrender of a membership from a current member who is no longer interested in retaining their membership or through the death of a member who has no immediate family interested in retaining the membership. Each individual is allowed only one membership and there is only one vote allowed per membership. Form 990, Part VI, Section A, line 7a Governing Board members are appointed through nomination and a majority vote election by the membership at annual meetings. Form 990, Part VI, Section A, line 7b Any edits to the Governing Board Bylaws, Rules & Regulations have to be approved by a majority vote of the membership. Per the organizations bylaws, the members are the supreme authority of the Association in all its affairs. Form 990, Part VI, Section B, line 11 Form 990 will be presented and reviewed at one of the Governing Board's monthly meetings. The Form 990 will also have been posted on the Governing Board's website in the days preceding the monthly meeting. Form 990, Part VI, Section B, line 12 On an annual basis, all members of the Governing Body and key employees receive a copy of the organization's conflict of interest policy. They are required to review the policy, complete a conflict of interest questionnaire and sign the questionnaire, attesting to their understanding of the policy and that their answers on the questionnaire are true and accurate. Form 990, Part VI, Section B, line 15a HR conducts a comparative analysis using state, multi-state, regional, and national compensation (by-position) data. Data is culled into bed-size, revenue, and similar area comparatives. HR submits a report to the Executive Committee of the Board of Directors annually. The Executive Committee reviews the data, confirms the data with an out of house auditor, and recommends appropriate CEO compensation to the Board of Directors as a whole. All other positions are reviewed annually by HR and approved by the CEO. Form 990, Part VI, Section C, line 19 Those documents are available to the public upon request. A copy of the requested document is provided when practical. Otherwise, an appointment for an on-site review of the requested documents is made, with the day and time of the appointment determined by the person(s) who has made the request, according to their schedule and convenience. Foundation Board of Great Plains Regional Medical Center PO BOX 2339 Elk City OK 736482339 730479295 Providing support for Healthcare OK 501(C)3 N/A Plains Diagnostic Imaging LLC PO BOX 2339 Elk City OK 73648 261530951 Radiology Services OK N/A Equipment Rental 10017 1839765 0 1 0 0 1 1 1 0 0 0 0 1 0 0 0 0 0 0 1 1 Plains Diagnostic Imaging LLC Q 90811 Plains Diagnostic Imaging LLC R 42356 Plains Diagnostic Imaging LLC J 997443 Foundation Board of Great Plains C 350000