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Okmulgee Memorial Hospital Inc: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
Okmulgee Memorial Hospital Inc (EIN 73-1279909)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-27
IRS object ID
201123009349300217
Schema version
2010v3.4
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)
Timestamp2011-10-27T12:56:43-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

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 ExpresswayAddressLine1
CityOklahoma CityCity
StateOKState
ZIP Code73118ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN731279909EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Okmulgee Memorial Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlOKMUNameControl
Phone9187564233Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11401 Morris DriveAddressLine1
CityOkmulgeeCity
StateOKState
ZIP Code74447ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePaul ErvinName
TitleChief Financial OfficerTitle
Phone9187564233Phone
Date Signed2011-10-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCarolyn LevingsName
Phone4054783334Phone
Date Prepared2011-10-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPaul ErvinNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11401 Morris DriveAddressLine1
CityOkmulgeeCity
StateOKState
ZIP Code74447ZIPCode
FieldValueIRS element (for citing)
Gross Receipts20444985GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitehttp://www.okmulgeehospital.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1967YearFormation
State Legal DomicileOKStateLegalDomicile
Activity Or Mission DescriptionHEALTH CARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees324TotalNbrEmployees
Total Nbr Volunteers85TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year200529ContributionsGrantsCurrentYear
Program Service Revenue Prior Year19271373ProgramServiceRevenuePriorYear
Program Service Revenue CY20243573ProgramServiceRevenueCY
Investment Income Prior Year1482InvestmentIncomePriorYear
Investment Income Current Year883InvestmentIncomeCurrentYear
Other Revenue Prior Year422478OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year19695333TotalRevenuePriorYear
Total Revenue Current Year20444985TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10022031SalariesEtcPriorYear
Salaries Etc Current Year10494101SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10356110OtherExpensePriorYear
Other Expenses Current Year10957572OtherExpensesCurrentYear
Total Expenses Prior Year20378141TotalExpensesPriorYear
Total Expenses Current Year21451673TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-682808RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1006688RevenuesLessExpensesCY
Total Assets BOY5172011TotalAssetsBOY
Total Assets EOY5373192TotalAssetsEOY
Total Liabilities BOY3253482TotalLiabilitiesBOY
Total Liabilities EOY4461351TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1918529NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY911841NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOkmulgee Memorial Hospital's mission is to put our patients and customers first and to provide quality health care in an efficient manner.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense17513828Expense
Revenue20243573Revenue
DescriptionOkmulgee Hospital is a 66 bed hospital facility providing such services as, but not limited to, Inpatient, Outpatient, Psychiatric, Home Health and Emergency Care services to the general public regardless of ability to pay.The Hospital provided $255,933 of charity care in 2010.Description
Total Program Service Expense17513828TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Assets0ReportOtherAssets
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 Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109618NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees324NumberOfEmployees
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
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
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 Committees0MinutesOfCommittees
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 Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
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 Line1Paul ErvinBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9187583102TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11401 Morris DriveAddressLine1
CityOkmulgeeCity
StateOKState
ZIP Code74447ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
John Fidler
President1.00XX000
Nevyle Cable
President-Elect1.00XX000
Barbara Osborn
Secretary1.00XX000
Greg Marriott
Treasurer1.00XX000
Tracy Sanford
Trustee1.00X000
Timothy Sandford
Trustee1.00X000
Linda Janzen
Trustee1.00X000
Walter McGown
Trustee1.00X000
Jason Winters
Trustee1.00X000
Stanley White MD
Trustee1.00X000
John Crawford
CFO40.00X12835002871
Rex Jones-Mgmt Company
CEO40.00X159000058880
Jason Bruce MD
Director Anesthesia40.00293251018463X
Benjamin Kamp DO
Surgeon40.0017136404071X
FieldValueIRS element (for citing)
Total Reportable Comp From Org751965TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation84285TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
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
Cardinal Health
PO Box 847384DallasTX75284Supplies/Med & Pharmacy675061
Horizon Health
PO Box 840839DallasTX75284Mental Health486129
Quorum Health Resources
105 Continental PlBrentwoodTN37027ER Physicians417655
Total Medical
PO Box 26243Oklahoma CityOK73126Hospital Mgmt340359
Okmulgee ER Services
PO Box 1038OkmulgeeOK74447Contract Nursing255292
FieldValueIRS element (for citing)
Number Of Contractors GT100 K18NumberOfContractorsGT100K
All Other Contributions200529AllOtherContributions
Noncash Contributions200529NoncashContributions
Total Contributions200529TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Serv. Rev.6241002006212320062123
Dietary9000998796087960
Maint. & Janitorial9000994816148161
Miscellaneous Revenue9000993534435344
Security Services90009999859985
FieldValueIRS element (for citing)
Total Program Service Revenue20243573TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column883TotalRevenueColumn
Exclusion$883ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20444985TotalRevenueColumn
Related Or Exempt Function Income20243573RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$883ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total677110Total
Program Services315980ProgramServices
Management And General361130ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7206884Total
Program Services5824260ProgramServices
Management And General1382624ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total99044Total
Program Services74692ProgramServices
Management And General24352ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1881603Total
Program Services1418982ProgramServices
Management And General462621ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total629460Total
Program Services474697ProgramServices
Management And General154763ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24445Total
Management And General24445ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total62540Total
Management And General62540ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2378258Total
Program Services1982449ProgramServices
Management And General395809ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total86865Total
Program Services60000ProgramServices
Management And General26865ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3349581Total
Program Services2537684ProgramServices
Management And General811897ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total18546Total
Program Services6689ProgramServices
Management And General11857ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2331Total
Program Services1461ProgramServices
Management And General870ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total68921Total
Program Services46798ProgramServices
Management And General22123ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total124724Total
Program Services124724ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total624599Total
Program Services468449ProgramServices
Management And General156150ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total246774Total
Program Services209830ProgramServices
Management And General36944ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad debt expense39075823907582
Dues & Subscriptions62406595512855

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21451673Total
Program Services17513828ProgramServices
Management And General3937845ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY22892BOY
EOY14718EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2243759BOY
EOY2103925EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY829016BOY
EOY787769EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY83692BOY
EOY233876EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12502961LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10270057LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1992652BOY
EOY2232904EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5172011BOY
EOY5373192EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1619256BOY
EOY2360125EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY1634226BOY
EOY2020985EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY80241EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3253482BOY
EOY4461351EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1918529BOY
EOY911841EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1918529BOY
EOY911841EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5172011BOY
EOY5373192EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1006688ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Basis22716OtherCostOrOtherBasis
Book Value22716BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5367013OtherCostOrOtherBasis
Depreciation4738299Depreciation
Book Value628714BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis102260OtherCostOrOtherBasis
Depreciation102260Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7010972OtherCostOrOtherBasis
Depreciation5429498Depreciation
Book Value1581474BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2232904TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionEstimated Third Party SettlementsDescription
Amount$80,241Amount
FieldValueIRS element (for citing)
Total Of Amounts80241TotalOfAmounts
Total Revenue20444985TotalRevenue
Total Expenses21451673TotalExpenses
Excess Or Deficit For Year-1006688ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-1006688ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt20244456TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal20244456RevenueSubtotal
Other Revenues Not Included200529OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt200529RevenueNotRptdOnFinStmt
Total Revenue Per Form99020444985TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt21451673TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal21451673ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99021451673TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X:The Hospital undergoes an annual analysis of its various tax positions assessing the likelihood of these positions being upheld upon examination with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. (GAAP). The Hospital believes that they are compliant with all IRS tax regulations and as of December 31, 2010 have not recorded any unrecognized tax benefit or liabilities for income taxes.
Part XII, Line 4b - Other Adjustments:Capital Contributions Not included in Total Revenue

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense105462TotalCommunityBenefitExpense
Net Community Benefit Expense105462NetCommunityBenefitExpense
Percent Of Total Expense0.00600PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3511376TotalCommunityBenefitExpense
Direct Offsetting Revenue2544844DirectOffsettingRevenue
Net Community Benefit Expense966532NetCommunityBenefitExpense
Percent Of Total Expense0.05510PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3616838TotalCommunityBenefitExpense
Direct Offsetting Revenue2544844DirectOffsettingRevenue
Net Community Benefit Expense1071994NetCommunityBenefitExpense
Percent Of Total Expense0.06110PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense60800TotalCommunityBenefitExpense
Net Community Benefit Expense60800NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense60800TotalCommunityBenefitExpense
Net Community Benefit Expense60800NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3677638TotalCommunityBenefitExpense
Direct Offsetting Revenue2544844DirectOffsettingRevenue
Net Community Benefit Expense1132794NetCommunityBenefitExpense
Percent Of Total Expense0.06460PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,615,779BadDebtExpenseAmount
Amount Attributable To9840AmountAttributableTo
Amount Reimbursed By Medicare8993621AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8766519CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall227102MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
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 Line1Okmulgee Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11401 Morris DriveAddressLine1
CityOkmulgeeCity
StateOKState
ZIP Code74447ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherPsych-16 BedsOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Okmulgee Memorial Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Home Health Agency
1401 Morris DriveOkmulgeeOK744476419In-Home Care Service
Benjamin A Kamp DO
1201 S Belmont Ste 207OkmulgeeOK744476419Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanation
Part I, Line 7: Charity care was converted to cost using a cost-to charge ratio calculated from Worksheet 2.Unreimbursed Medicaid was calculated using the cost-to-charge ratio derived from Worksheet 2.
Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $3,907,582.
Part III, Line 4: Bad debt expense was converted to cost using the cost-to-charge ratio derived from Worksheet 2.Bad debt is determined by our bad debt policy considering actual patient care charges. Charges become bad debt once a reasonable opportunity has been made by the hospital to collect an open account and the responsible party has been contacted regarding the unpaid balance. After policy based collection attempts have been exhausted, the account is written off to bad debt.All payments and contractual are applied to the account before it is written off to bad debt. If any payments are received for bad debts that have been written off, they are applied to the current year bad debt expense.The estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy is calculated based on an estimate of charges foregone to gross patient charges.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.
Part III, Line 8: The costs associated with Medicare were taken from the Medicare Cost Report.
Part III, Line 9b: The hospital has a charity care policy and patients must meet certain established criteria for charity service consistent with OHM's mission. The policy does not specifically state the collection procedures for those who qualify for other financial assistance which most would be Medicaid. The hospital does have provisions but they are not specifically written in the policy.
Part VI, Line 2: Okmulgee Memorial Hospital has a strategic plan and looks at information provided by the state, county and Medicare. The hospital looks at discharges, hospitalization and utilization of different categories of patients. The information is used to assess physician needs as well as the purchasing of capital equipment. The hospital also participates in the County Wellness Coalition. Information from surveys are used in the needs asssessment for the hospital.
Part VI, Line 3: The hospital uses an electronic program at admission to determine if a patient is eligible for assistance. If a patient is determined to be eligible, then the patient is referred to a financial counselor. The financial counselor works with the patient to determine if the patient is eligible for Medicare. If the patient is not eligible for Medicare, the hospital then works with the patient to determine if the patient is eligible for charity care. The Financial Counselor contact information is included in the patient billing statements if further assistance is needed.
Part VI, Line 4: Okmulgee Memorial Hospital is an acute care hospital located in Okmulgee, which is in Okmulgee County, Oklahoma. Okmulgee County is a federally underserved area according to the Health Resources and Services Administration. Okmulgee is a small community of about 13,000 residents. There are two other hospitals in the county with one about twenty miles from Okmulgee Memorial Hospital. The median household income is $35,615 and 19.2% of families and 21.4% of individuals of the population are below the poverty line.
Part VI, Line 6: The organization has a volunteer board comprised of members of the community. Medical staff privileges are extended to all qualified physicians in the community and to those who wish to render services at OMH. Any surplus funds, if available, are reinvested in the facilities to improve patient care.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 (3 entries)

Base 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
Rex Jones-Mgmt Company
1590000000000588800217880000
Jason Bruce MD
293251000009147093160311714000
Benjamin Kamp DO
171364000000040710175435000

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990
XVITEK MACHINE157700
XBOILERS1142829
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMethod for Determining Number of Contributors:Identifier
Return ReferencePart I, Column (b):ReturnReference
ExplanationThe machine and boilers were donated from the Okmulgee Medical Foundation, Inc. to the Hospital. Various contributions were made to the Foundation and the equipment was donated to the Hospital.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
New Program ServicesForm 990, Part III, line 2In 2010 we expanded the clinic program including prenatal and cardiology. We also employed a physician/surgeon.
Form 990, Part VI, Section A, line 2Tracy & Timothy Sanford (Trustees) - family relationship
Form 990, Part VI, Section A, line 3Management duties include planning and executing financial operations. Quorem Health Resources manages the hospital.
Form 990, Part VI, Section A, line 8bThe organization does not have a committee with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11The Form 990 is prepared by an outside accounting firm and is reviewed internally by the CEO and the Finance Committee prior to filing with the IRS. The Board of Directors is provided a copy.
Form 990, Part VI, Section B, line 12cWe also have a conflict of interest policy which is applicable to all employees of OMH. Once a potential conflict is identified, Compliance and administration determine the level and risk of the conflict. Depending on the severity of conflict an employee may be asked to refrain involvement. If there is a known conflict that is not disclosed by an employee, they will be subject to the disciplinary action policy.
Form 990, Part VI, Section B, line 15The Board of Directors reviews and approves salaries of top management positions. Salary determination is based on comparability data from industry standards. CEO compensation is recommended by Quorem Health Resources and Board approved.
Form 990, Part VI, Section C, line 19The organization makes its governing documents, conflict of interest policy, and financial statemsnts available to the public upon request.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Okmulgee Medical Foundation IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 1038AddressLine1
CityOkmulgeeCity
StateOKState
ZIP Code74447ZIPCode
FieldValueIRS element (for citing)
EIN730766656EIN
Primary ActivitiesOffice building and manages tax deductible contributionsPrimaryActivities
Legal Domicile StateOKLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity Status509(a)(1)PublicCharityStatus
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 Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Okmulgee Medical Foundation
I56000FMV
Okmulgee Medical Foundation
R200529FMV