PAWHUSKA HOSPITAL INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PAWHUSKA HOSPITAL INC (EIN 23-7169376)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-12-15
- IRS object ID
- 201513499349300706
- Schema version
- 2013v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-12-15T08:15:14-06:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 NW EXPRESSWAY SUITE 1900 | AddressLine1 |
| City | OKLAHOMA CITY | City |
| State | OK | State |
| ZIP Code | 73118 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237169376 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawhuska Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PAWH | BusinessNameControlTxt |
| Phone | 9182873232 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15th Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shaun Beggs | PersonNm |
| Person Title | Administrator | PersonTitleTxt |
| Phone | 9182873232 | PhoneNum |
| Signature | 2015-12-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 4054783334 | PhoneNum |
| Preparation | 2015-12-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Shaun Beggs | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15th Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,986,643 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pawhuskahospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | To provide the highest level of healthcare possible, in a cost-effective manner. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 69 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $130,997 | PYContributionsGrantsAmt |
| CY Contributions Grants | $120,064 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,471,123 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,863,970 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,854 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,609 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $4,607,974 | PYTotalRevenueAmt |
| CY Total Revenue | $5,986,643 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,566,250 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,736,456 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,883,438 | PYOtherExpensesAmt |
| CY Other Expenses | $2,783,069 | CYOtherExpensesAmt |
| PY Total Expenses | $4,449,688 | PYTotalExpensesAmt |
| CY Total Expenses | $5,519,525 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $158,286 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $467,118 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,376,918 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,107,774 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,471,638 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,735,378 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,905,280 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,372,396 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | We, the Physicians, Staff, and Governing Board of Pawhuska Hospital, Inc., are committed to providing the highest level of healthcare possible for our facility.Recognizing the health needs of our community and surrounding area, we pledge to provide, in a cost-effective manner, the services necessary to enhance the quality of life. Understanding the constant and dramatic change in the healthcare industry, we will strive to achieve excellence and continue our support of the community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,615,045 | ExpenseAmt |
| Revenue | $5,863,970 | RevenueAmt |
| Desc | Pawhuska Hospital, Inc. is a 25-bed Critical Access Hospital that operates in Pawhuska, Oklahoma. The Hospital is managed through an agreement with Jane Phillips Memorial Medical Center, which is an entity of the St. John Health System. Pawhuska Hospital and the Jane Phillips Health System have had this management relationship for the past 27 years, going back to the initial management agreement that was executed back in 1986.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Continued on Schedule O.Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $122,852 for the year ended September 30, 2014. Total direct and indirect costs related to these foregone charges were approximately $126,000 at September 30, 2014, based on an average ratios of cost to gross charges. | Desc |
| Total Program Service Expenses | $4,615,045 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 8 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 69 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Shaun Beggs | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9182875123 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15th Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Beth Reed | |||||||
| Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ben West | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Beverly Moore | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jerry Mosley | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Nancy Woodyard | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jason McCauley | |||||||
| Regional Administrator | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| Shawn Parkhurst | |||||||
| Regional Controller | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| John Ham PA-C | |||||||
| Emergency room | 48.00 | $167,850 | $0 | $7,467 | Yes (X) | ||
| Theresa Flowerette APN | |||||||
| ER Provider | 60.00 | $118,154 | $0 | $8,331 | Yes (X) | ||
| William Ward | |||||||
| RN | 60.00 | $114,622 | $0 | $10,457 | Yes (X) | ||
| Donna Baxter | |||||||
| Lab Manager | 40.00 | $101,920 | $0 | $0 | Yes (X) | ||
| Mary Dagenais | |||||||
| ER Provider | 40.00 | $124,248 | $0 | $1,027 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $626,794 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $27,282 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| M&L Rehabilitation | |||||
| 18491 N Jamestown | Skiatook | OK | 74002 | Contracted Pysical Therapy | $208,679 |
| Emergency Physician Staffing | |||||
| 2360 Corporate Circle | Henderson | NV | 89074 | Contracted Physician Services | $202,500 |
| Jane Phillips Medical Center | |||||
| 3500 E Frank Phillips Blvd | Bartlesville | OK | 74006 | Management and Accounting | $167,334 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $108,601 | GovernmentGrantsAmt |
| All Other Contributions | $11,463 | AllOtherContributionsAmt |
| Total Contributions | $120,064 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenu | 621110 | $5,213,842 | $5,213,842 |
| EHR incentives | 900099 | $645,098 | $645,098 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,030 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,030 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,863,970 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,609 | TotalRevenueColumnAmt |
| Exclusion | $2,609 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,986,643 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,863,970 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,609 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,158,077 | TotalAmt |
| Program Services | $1,915,212 | ProgramServicesAmt |
| Management And General | $242,865 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,923 | TotalAmt |
| Program Services | $147,314 | ProgramServicesAmt |
| Management And General | $157,609 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,456 | TotalAmt |
| Program Services | $225,925 | ProgramServicesAmt |
| Management And General | $47,531 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,007 | TotalAmt |
| Management And General | $150,007 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,925 | TotalAmt |
| Management And General | $66,925 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $958,462 | TotalAmt |
| Program Services | $890,093 | ProgramServicesAmt |
| Management And General | $68,369 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,652 | TotalAmt |
| Management And General | $5,652 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,709 | TotalAmt |
| Program Services | $44,011 | ProgramServicesAmt |
| Management And General | $79,698 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,360 | TotalAmt |
| Program Services | $76,053 | ProgramServicesAmt |
| Management And General | $10,307 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,343 | TotalAmt |
| Program Services | $5,942 | ProgramServicesAmt |
| Management And General | $6,401 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,218 | TotalAmt |
| Program Services | $53,218 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,001 | TotalAmt |
| Program Services | $346,001 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,976 | TotalAmt |
| Management And General | $49,976 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad Debt | $609,394 | $609,394 | |
| Medical Supplies | $172,997 | $172,997 | |
| Repairs and Maintenance | $103,600 | $100,847 | $2,753 |
| Food | $28,038 | $28,038 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,387 | TotalAmt |
| Management And General | $16,387 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,519,525 | TotalAmt |
| Program Services | $4,615,045 | ProgramServicesAmt |
| Management And General | $904,480 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $745,923 | BOYAmt |
| EOY | $1,471,797 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $437,580 | BOYAmt |
| EOY | $1,144,375 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,382 | BOYAmt |
| EOY | $105,196 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,314 | BOYAmt |
| EOY | $12,212 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,738,418 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,009,322 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,983,557 | BOYAmt |
| EOY | $1,729,096 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,097,162 | BOYAmt |
| EOY | $645,098 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,376,918 | BOYAmt |
| EOY | $5,107,774 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,392 | BOYAmt |
| EOY | $375,039 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,058,246 | BOYAmt |
| EOY | $1,046,942 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $313,397 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,471,638 | BOYAmt |
| EOY | $1,735,378 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,905,280 | BOYAmt |
| EOY | $3,372,396 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,905,280 | BOYAmt |
| EOY | $3,372,396 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,376,918 | BOYAmt |
| EOY | $5,107,774 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $467,118 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$2 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,360 | OtherCostOrOtherBasisAmt |
| Book Value | $34,360 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,248,194 | OtherCostOrOtherBasisAmt |
| Depreciation | $737,618 | DepreciationAmt |
| Book Value | $510,576 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,979 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,941 | DepreciationAmt |
| Book Value | $4,038 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,419,885 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,239,763 | DepreciationAmt |
| Book Value | $1,180,122 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,729,096 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Electronic health record incentives | Desc |
| Book Value | $645,098 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $645,098 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third party payor settlements | Desc |
| Amt | $313,397 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $313,397 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $5,268,648 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$609,394 | OtherRevenueAmt |
| Revenue Not Reported | -$609,394 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,878,042 | RevenueSubtotalAmt |
| Other Revenues Not Included | $108,601 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $108,601 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,986,643 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,910,131 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,910,131 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $609,394 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $609,394 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $5,519,525 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 990-T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for bad debts included in revenue on the Financial Statements -609,394. |
| Part XI, Line 4b - Other Adjustments: | Contribution included in revenue per Form 990 108,601. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts included in Revenue on the Financial Statements 609,394. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $126,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $126,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $126,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $126,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02570 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,236,237 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $830,975 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $405,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08250 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,236,237 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $830,975 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $405,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,362,237 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $830,975 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $531,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10820 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $609,394 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $16,088 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,997,289 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,024,576 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$27,287 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawhuska Hospital Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15th Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 74056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.pawhuskahospital.org | WebsiteAddressTxt |
| State License | 2271 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawhuska Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.pawhuskahospital.org | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | Yes (1) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pawhuska Hospital, Inc. | Part V, Section B, Line 3: Community input was provided through key informant discussions of 20 stakeholders and a community health survey was distributed with a total response of 132 surveys. In addition, secondary data was compiled from demographic and socioeconomic sources as well as national state and local sources of information on disease prevalence. |
| Pawhuska Hospital, Inc. | Part V, Section B, Line 6i: Pawhuska Hospital, Inc. has adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to the Hospital's website at www.pawhuskahospital.org. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. 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 removed from total expenses to determine the percentage was $609,394. |
| Part III, Line 2: | Patient accounts are written off to bad debt after every effort is made to collect the balance and patients are given opportunities to complete charity care applications or set up payment plans. All discounts and contractual adjustments are applied to accounts before they are written off to bad debt. Current payments on accounts previously written off as bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | 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. This portion can reasonably be considered a community benefit as it would have been written off to charity care. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 7 of the attached audited financial statements. |
| Part III, Line 8: | Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered 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: | All collections efforts cease when a patient is determined to be eligible for financial assistance. Normal collections efforts continue on any personal amount owed by the patient. |
| Part VI, Line 2: | Administration, medical staff and the governing board regularly discuss the health care needs of the local community during governing board meetings as well as in the bimonthly meetings of the medical staff. The Oklahoma Office of Rural Health and Pawhuska Hospital developed a Community Needs Assessment during tax year 2012. Pawhuska Hospital implemented strategies for each health priority identified through the needs assessment. In addition, when looking at the potential of adding new services, the Hospital researches how such services will meet and address the needs of the community. The Hospital is planning on developing future programs that allow opportunities to gather a larger community audience that can express the issues that are important to the community. Focus groups will enable the Hospital to further educate to meet the needs of the community. |
| Part VI, Line 3: | Pawhuska Hospital, Inc. provides a letter to patients upon admission that states the Hospital provides assistance to those patients with limited income to help pay for hospital expenses. The letter indicates that Charity Care applications are available to all patients and can be picked up at the time of service or at a later date. The Charity Care application gives an overview of the charity care policy and notes that Medicare and other state programs are also available to patients that meet income requirements. The Hospital staff is available to offer patients assistance in completing the Charity Care and Medicaid applications if needed. |
| Part VI, Line 4: | Pawhuska Hospital, Inc. primarily serves the citizens of the community of Pawhuska, Oklahoma and the surrounding area. Pawhuska serves as the county seat of Osage County, Oklahoma and is also the capital of the Osage Nation. The Hospital is one of two facilities located in Osage County. Pawhuska is a rural area with a population of 3,589 from the 2010 U.S. Census. The per capita income for the city was $13,916. About 137 of families and 175 of the population were below the poverty line, including 223 of those under age 18 and 149 of those aged 65 or over. The Hospital is a federally designated underserved area for primary care health professionals, mental health professionals and dental care health professionals. |
| Part VI, Line 5: | Pawhuska Hospital's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The Hospital operates an emergency room that is available to all regardless of a patient's ability to pay. Free health screenings were offered to the community at an open house in January. Other local healthcare entities were invited to participate. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | John Ham PA-C | PersonNm |
| Title | Emergency room | TitleTxt |
| Base Compensation Filing Org | $166,413 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $1,437 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $7,467 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $175,317 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Question 3: | FormAndLineReferenceDesc |
| Explanation | Pawhuska Hospital, Inc. does not pay compensation to the Regional Administrator directly. The Regional Administrator is compensated by an unrelated organization, Jane Phillips Medical Center. The Hospital's Board of Directors and Jane Phillips Medical Center use the processes described in Part I, Question 3 to determine appropriate compensation for the Regional Administrator. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the Chair of the Board as presiding officer and the Vice Chair of the Board, the Secretary or Treasurer, and the CEO. Other members may be appointed to the Executive Committee as required by the Chair. The primary purpose is to take definitive and immediate action on any matter that might occur between regular meetings that falls outside the scope of the duties and responsibilities of the CEO. Record of action taken by the Executive Committee is made a part of the minutes of the next regular board meeting. |
| Form 990, Part VI, Section A, line 2 | Ben West and Nancy Woodyard have a business relationship. |
| Form 990, Part VI, Section A, line 3 | Jane Phillips Medical Center, a non-profit organization, provides administrative oversight for day-to-day operations, accounting services, and operational consulting services. Jason McCauley was the Regional Administrator and Shawn Parkhurst was the Regional Controller. The amount paid to Jane Phillips Medical Center for services in calendar year 2013 was $167,334. |
| Form 990, Part VI, Section A, line 7a | There are a total of five Trustees. All are appointed by the City Council of Pawhuska Board of Incorporators. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is presented to the Administrator for review and then presented to the Board of Directors. |
| Form 990, Part VI, Section B, line 12c | All employees, board members, and contract employees are covered in our policies. The employee and contract employee determinations are made by Administration and any board determinations are made by the Governing Board. The employee will be asked to remedy the situation and the board member will be asked to leave after presenting their conflict and the remainder of the Governing Board will discuss and then vote. Copies of both policies can be provided upon request. |
| Form 990, Part VI, Section B, line 15a | Pawhuska Hospital, Inc. follows the pay guidelines of Jane Phillips Medical Center. Salary is reviewed against survey data from the Oklahoma Hospital Association. Increases are tied to an annual performance evaluation and approval from the Board of Directors. The process and determination is documented in the personnel file and Board minutes. |
| Form 990, Part VI, Section C, line 19 | The Hospital's governing documents, conflict of interest policy, and financial statements are available to the public upon request. |
| Form 990, Part IX, line 11g | Professional Fees: Program service expenses 871,085. Management and general expenses 68,369. Fundraising expenses 0. Total expenses 939,454. Contracted Services: Program service expenses 19,008. Management and general expenses 0. Fundraising expenses 0. Total expenses 19,008. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Pawhuska | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 W Main Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 74056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 736005371 | EIN |
| Primary Activities | Provide services to the residents of Pawhuska | PrimaryActivitiesTxt |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |