2016-05-10T09:52:20-05:00 2015-06-30 450250958 EIDE BAILLY LLP 1601 NW EXPRESSWAY SUITE 1900 OKLAHOMA CITY OK 73118 990 2014-07-01 730579295 Farmers Union Hospital Association FARM 5802252511 1801 W 3rd Street Elk City OK 73648 Corey Lively CEO 5802252511 2016-05-04 1 Kim Hunwardsen CPA P00484560 4054783334 2016-05-04 2014 2016-08-17 19:52:53Z Great Plains Regional Medical Center Corey Lively 1801 W 3rd Street Elk City OK 73648 65286778 0 X www.gprmc-ok.com X 1938 OK To provide comprehensive, cost-effective, high quality healthcare to our communities. 10 8 509 39 77072 -1765 87134 48965 46946279 51498824 670031 562658 1245542 479808 48948986 52590255 4342 3100 0 0 20271705 21208812 0 0 0 31366434 33083682 51642481 54295594 -2693495 -1705339 85483381 83283661 39049687 38868711 46433694 44414950 X Great Plains Regional Medical Center will distinguish itself as the leader in Western Oklahoma and the 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. 0 0 47272457 3100 51421752 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. 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. In keeping with the 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 individual's inability to pay exists. GPRMC served over 1,895 patients with more than 6.978 patient days on an inpatient basis. We also had 56,023 outpatient encounters. During the year we treated 13,260 patients in the Emergency Department. Our Surgical teams performed 2,750 outpatient surgeries. 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 recognized 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 providing reduced price services, free programs offered throughout the year which GPRMC believes will serve a bona fide community health need. See Schedule H for more information regarding these activities. 47272457 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 81 0 1 509 1 1 1 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 OK X Janet Miller 5808215302 1801 W 3rd Street Elk City OK 73648 Paul Kumpf Chairman 1.00 X X 0 0 0 Edward Albert Vice Chairman 1.00 X X 0 0 0 Jack Morrison DDS Secretary 1.00 X X 0 0 0 Jean Forsberg MD Chief of Staff - Through Feb. 2015 1.00 X X 0 0 0 Joe Coker MD Chief of Staff - Commenced Feb. 2015 1.00 X X 12115 0 0 Francis Abraham MD Vice Chief of Staff 1.00 X X 378624 0 4414 J Coffey MD Member 1.00 X 0 0 0 Emory Thomas Member 1.00 X 0 0 0 Gene Smith Member 1.00 X 0 0 0 Bill Gwartney Member 1.00 X 0 0 0 Danny Sprowls Member 1.00 X 0 0 0 Corey Lively CEO 40.00 X 265383 0 0 Monica Scott CFO 40.00 X 134901 0 4810 Laura Kurzendoerfer CNO - Through 3/20/2015 40.00 X 198282 0 791 Lindsey Pena Physician 40.00 X 365290 0 0 Tiffany Dupree Physician 40.00 X 299421 0 791 Jeffrey Lester Physician 40.00 X 234230 0 0 Janice Witt Physician 40.00 X 149998 0 0 Misty Carter COO 40.00 X 129015 0 2048 2167259 0 12854 14 0 1 0 Premier Physician Staffing 19992 W Woodhaven Road Owasso OK 74055 Physician ER coverage 1725893 Nightrays PA PO Box 204367 Dallas TX 75230 Radiologist services 920308 EM Care Physician Services Inc 13737 Noel Road Suite 1600 Dallas TX 75240 Physician ER coverage 797727 Hospital Care Consultants Inc 17304 Preston Road Suite 510 Dallas TX 75252 Hospitalist 588000 Cronin Enterprises 8270 College Parkway Suite 101 Fort Myers FL 33919 Outside coding services 183362 6 7956 41009 48965 Net Patient Service 621990 49703605 49703605 Cafeteria 722210 550853 473781 77072 EHR Incentives 900099 540978 540978 Income from Plains Diagnostic Ima 900099 410656 410656 Daycare Center Revenue 624410 111438 111438 181294 181294 51498824 540188 540188 217213 217213 262595 0 262595 262595 262595 12718993 12696523 22470 22470 22470 52590255 51421752 77072 1042466 X 3100 3100 919454 479451 440003 15172726 13156417 2016309 4005764 3394324 611440 1110868 941305 169563 460676 460676 43624 43624 9338628 7730325 1608303 86129 2864 83265 5518165 5378531 139634 207492 51304 156188 775437 775437 100462 84032 16430 48058 37822 10236 1779337 1506945 272392 4100234 3869830 230404 712503 139790 572713 Bad Debt Expense 5819307 5819307 Medical Supplies/Food 2356853 2339601 17252 Lease and Rental 1337495 1328821 8674 Dues & Subscriptions 223298 173779 49519 175984 59472 116512 54295594 47272457 7023137 0 3918932 2825 18161825 8328116 5749921 6271464 1284175 1433641 603957 1121362 85928681 39575709 49134242 46352972 4592913 17069320 1257900 1397738 44362 779516 1261861 85483381 83283661 2550186 4482697 35505000 34306547 399501 0 595000 79467 39049687 38868711 X 46433694 44414950 46433694 44414950 85483381 83283661 -1705339 -313405 0 X 0 1 X 1 0 X 748759 748759 59310836 19223193 40087643 24211416 19474084 4737332 1657670 878432 779238 46352972 Payable to Related Party 67000 Estimated third-party payor settlements 12467 79467 X 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 consolidated 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. 1 1 X 1 X 135.000000000000 1 X 1 1 0 1 1 564000 564000 0.01160 564000 564000 0.01160 11443 11443 0.00020 5696788 4945885 750903 0.01550 5708231 4945885 762346 0.01570 6272231 4945885 1326346 0.02730 4126 4126 0.00010 4126 4126 0.00010 0 5819307 931089 10928166 15288805 -4360639 X 1 1 1 Plains Diagnostic Imaging LLC Radiology services 0.80170 0.00000 0.19830 1 1 Great Plains Regional Medical Center 1801 W 3rd Street Elk City OK 73644 www.gprmc-ok.com 2210 X X X Great Plains Regional Medical Center 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X www.gprmc-ok.com/about/ X www.okruralhealthworks.org X 1 12 1 www.gprmc-ok.com/about/ 0 0 1 X 135.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X X X X 1 X 0 X X X X 1 X 0 1 Great Plains Regional Medical Center Part V, Section B, Line 5: Great Plains Regional Medical Center hosted five community meetings between July 27, 2011 and March 13, 2013. Average attendance at the community meetings was 20-25 community members consisting of retired individuals, local business owners, city government, local bank employees/officers, local volunteer organizations, Great Plains Regional Medical Center representatives and individuals from the County Cooperative Extension office. Great Plains Regional Medical Center Part V, Section B, Line 11: Mental HealthAfter examining the availability and access of mental health services, community members present noted the lack or strict definition of services available. However, these services are very specific and accessible via inpatient services. The hospital is currently exploring available options.Temporary Assistance for Needy Families (TANF) casesCommunity members present noted the high number of local TANF cases and the large number of students at school that receive backpacks of food/supplies.This health concern is beyond the scope of services the hospital provides. Great Plains Regional Medical Center Part V, Section B, Line 13b: If the patients' medical expenses are 30% of their income then they can also qualify for assistance.There are instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to a lack of supporting documentation. Often there is adequate information provided by the patient or through other sources, which could provide sufficient evidence to provide the patient with charity care assistance. In the event there is no evidence to support a patient's eligibility for charity care, Great Plains Regional Medical Center could use outside agencies in determining estimate income amounts for the basis of determining charity care eligibility and potential discount amounts. Great Plains Regional Medical Center Part V, Section B, Line 24: Great Plains Regional Medical Center provides financial assistance to qualifying patients for medically necessary services, non-elective services provided in response to life-threatening circumstances in a non-emergency room setting and services for a condition in which, if not promptly treated, would lead to an adverse change in the health status of the patient. Elective services are not eligible for financial assistance, therefore some financial assistance eligible patients may have been billed gross charges for elective services. Part I, Line 3c: If the patients' medical expenses are 30% of their income then they can also qualify for assistance.There are instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to a lack of supporting documentation. Often there is adequate information provided by the patient or through other sources, which could provide sufficient evidence to provide the patient with charity care assistance. In the event there is no evidence to support a patient's eligibility for charity care, Great Plains Regional Medical Center could use outside agencies in determining estimate income amounts for the basis of determining charity care eligibility and potential discount amounts. Part I, Line 6a: The Organization's community benefit report can be found on its website at http://www.gprmc-ok.com/about/chna. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, line 7e, was compiled using actual costs recorded in the general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the community benefit percentage was $5,819,307. Part II, Community Building Activities: Great Plains Regional Medical Center's involvement in community building activities extends through programs such as Meals on Wheels, which delivers meals to the homebound. The Medical Center has a taxi service for patients that need to be transported to their home after a visit at the hospital or one of the physician clinics. The taxi service is free to patients. Part III, Line 2: All forms of payment, including self-pay, insurance, contractual allowances, and discounts, are applied to the patient's account before the account is classified as bad debt. A payment received on an account previously written off as bad debt reduces bad debt expense. Great Plains Regional Medical Center does not refuse services to patients that generate bad debt.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: A reasonable estimate of the Organization's bad debt expense attributable to patients under the Organization's financial assistance policy is 16% of bad debt expense. This is based on the percentage of individuals in the county under the federal poverty level. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 8 and 9 of the attached audited financial statements. Part III, Line 8: Great Plains Regional Medical Center provides services to Medicare patients understaning 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 healthcare services, which is a community benefit. 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 the Centers for Medicare and Medicaid Services. Part III, Line 9b: Patients are pre-screened for charitable services before receiving tests and a determination is made as to the financial ability to pay. If patients are pre-qualified for services, the collection process is ceased.For patients who qualify for charity care and who are cooperating in good faith to resolve their discounted hospital bills, Great Plains Regional Medical Center may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. Great Plains Regional Medical Center will not impose extraordinary collections actions such as wage garnishments; liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for charity care under this financial assistance policy. Reasonable efforts shall include:1. Validating that the patient owes the unpaid bills and that all sources of third-party payments have been identified and billed by the hospital; 2. Documentation that Great Plains Regional Medical Center has or has attempted to offer the patient the opportunity to apply for charity care pursuant to this policy and that the patient has not complied with the hospital's application requirements; 3. Documentation that the patient has been offered a payment plan but has not honored the terms of that plan Part VI, Line 2: The Organization relies on input from physicians, other healthcare providers, community leaders, the Board of Directors and citizens in the community. We look at out-migration studies to determine what services individuals from the community are seeking and receiving from outside locations. We also consider comparisons of the volume of physician specialties in our area to nationally recognized data. The factors are all considered in addition to feedback from patients in the community to determine shortages of care areas. Part VI, Line 3: Assistance is discussed with patients as part of the intake process. Patients are screened at registration to determine need for financial assistance and then are given copies of the financial assistance policy. Upon request, we try to assist patients with paperwork for medical assistance such as Medicare, Medicaid, disability or financial assistance. Part VI, Line 4: Great Plains Regional Medical Center is an acute care hospital located in Elk City, Oklahoma in Beckham County. The Medical Center 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. The estimated primary and secondary service area population exceeds 100,000. The median household income in Beckham County is $43,642 and 16% of the county is below poverty level. Part VI, Line 5: Our Board of Directors is comprised 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. GPRMC extends medical privileges to area physicians. Physicians must apply for privileges and be approved by the medical staff and Board of Directors. Surplus funds are reinvested into facility and equipment upgrades and free programs throughout the year.GPRMC publishes notices in the area newspapers reaching 8,000 to 10,000 homes. The notices provide information on new physicians and medical services.GPRMC provides breast self-exam, CPR and pre-natal education to community members. The Medical Center is one of two designated donor locations for the communitywide blood drive held five times per year.Great Plains Regional Medical Center sponsors healthcare 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 in the area, scholarships are awarded to students wishing to pursue degrees in the medical field. Education programs are presented at the local adult learning center discussing 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. The Medical Center developed a collaboration with Western Oklahoma State College to provide distance learning classes for those in the community wishing to pursue nursing degrees. GPRMC provides a classroom in the local community. Additionally, in-kind services are provided to Western Oklahoma State College. This is vital to prospective students pursuing nursing degrees that would not have been able to drive the long distance to the College. X X X X 0 0 0 0 0 0 0 0 0 Francis Abraham MD Vice Chief of Staff 370590 0 0 0 8034 0 0 0 4414 0 383038 0 0 0 Corey Lively CEO 265383 0 0 0 0 0 0 0 0 0 265383 0 0 0 Laura Kurzendoerfer CNO - Through 3/20/2015 190290 0 6923 0 1069 0 0 0 791 0 199073 0 0 0 Lindsey Pena Physician 365002 0 0 0 288 0 0 0 0 0 365290 0 0 0 Tiffany Dupree Physician 274206 0 25000 0 215 0 0 0 791 0 300212 0 0 0 Jeffrey Lester Physician 234230 0 0 0 0 0 0 0 0 0 234230 0 0 0 A The Oklahoma Development Finance Committee 731083741 678910DB3 2007-06-01 39448937 Construct and furnish a 62-bed hospital 0 0 0 A 5142390 39448937 2653544 562777 36232616 2008 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: The Oklahoma Development Finance Committee Date the Rebate Computation was Performed: 09/04/2012 Form 990, Schedule K, Part II, Line 3: The total issue price of $40,000,000 reported on Part I, Line A, Column (e) less the Original Issue Discount of $551,063 is the amount reported on Part II, Line 3. Form 990, Part VI, Section A, line 1 The Executive Committee is composed of the officers of the Board; President, Vice President, Secretary and Treasurer. The Hospital's Board President serves as the Chair of the Executive Committee. Other members may be added if advisable. The Executive Committee directly represents the Board and possesses the power to act for the Board within limits set for it by the Board, on matters needing immediate attention, prior to regular board meetings, and such other powers as delegated to it by the Board. The Executive Committee reports to the Board of Directors at the next regular or at the next special meeting called for that purpose. Form 990, Part VI, Section A, line 6 Members are individuals who have voting shares in Great Plains Regional Medical Center. 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 amendments to the Governing Board Bylaws and Rules & Regulations have to be approved by a majority vote of the membership. Per the Organization's Bylaws, the members are the supreme authority of the Association in all its affairs. Form 990, Part VI, Section B, line 11 The Form 990 is presented and reviewed at the governing Board's monthly meeting. The 990 is also posted on the governing Board's website prior to the meeting. Form 990, Part VI, Section B, line 12c All members of the governing board, officers and key employees receive a copy of the Conflict of Interest Policy on an annual basis. The individuals are required to review the policy and complete and sign the questionnaire attesting to their understanding of the policy and that their answers are true and accurate. The board as a whole reviews the conflict of interest statements. Any potential conflicts are discussed and depending on the conflict the board decides the appropriate action to take. Form 990, Part VI, Section B, line 15a Human Resources conducts a comparative analysis using state, multi-state, regional, and national compensation (by position). Data is culled into bed-size, revenue, and similar area comparatives. Human Resources 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 Human Resources and approved by the CEO. Form 990, Part VI, Section C, line 19 GPRMC makes its Forms 1023, 990, and 990-T 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 document 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. Form 990, Part IX, line 11g Repairs: Program service expenses 196,660. Management and general expenses 6,503. Fundraising expenses 0. Total expenses 203,163. Consulting: Program service expenses 1,850,719. Management and general expenses 1,376,241. Fundraising expenses 0. Total expenses 3,226,960. Service Contracts: Program service expenses 897,412. Management and general expenses 225,559. Fundraising expenses 0. Total expenses 1,122,971. Contract Labor: Program service expenses 4,515,988. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,515,988. Purchased Services: Program service expenses 269,546. Management and general expenses 0. Fundraising expenses 0. Total expenses 269,546. Plains Diagnostic Imaging LLC 1705 W 2nd St Elk City OK 73644 261530951 Radiology services and equipment rental OK Great Plains Regional Medical Center Related 412398 569688 0 1 0.82300 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 Plains Diagnostic Imaging LLC K 804000 General Ledger Plains Diagnostic Imaging LLC S 410656 General Ledger