2015-05-15T14:26:58-05:00 2014-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-07-01 731023826 SAYRE MEMORIAL HOSPITAL % DON BATES SAYR 5809285541 911 HOSPITAL DRIVE Suite SAYRE OK 73662 DON BATES CEO 5809285541 2015-05-15 true Kevin Ensminger CPA P01310558 5809285541 2013 2016-04-25 22:37:26Z DON BATES 911 HOSITAL DRIVE SAYRE OK 73662 8835999 false X WWW.SAYREHOSPITAL.ORG X 1977 OK TO PROVIDE COST-EFFECTIVE, QUALITY MEDICAL CARE FOR SAYRE AND SURROUNDING COMMUNITIES TO ACHIEVE LIFE ENRICHMENT FOR THE COMMUNITY THROUGH LOCAL ACCESS TO QUALITY CARE. 6 6 130 10 0 0 546878 1400133 5404542 7077125 2468 55 1117659 258340 7071547 8735653 750 100 0 0 3619378 4149378 0 0 0 5559587 7354715 9179715 11504193 -2108168 -2768540 15002315 12015451 13535353 13041875 1466962 -1026424 TO PROVIDE COST-EFFECTIVE, QUALITY MEDICAL CARE FOR SAYRE AND THE SURROUNDING COMMUNITIES IN ORDER TO ACHIEVE LIFE ENRICHMENT FOR THE COMMUNITY THROUGH LOCAL ACCESS TO QUALITY CARE. false false 9577828 100 7290968 RURAL HOSPITAL PROVIDING MEDICAL CARE ON BOTH AN INPATIENT AND OUTPATIENT BASIS TO AREA RESIDENTS. CARE PROVIDED INCLUDES EMERGENCY, OBSTETRICS, SURGICAL AND PHYSICAL REHABILITATION. CARE IS PROVIDED REGARDLESS OF RACE, CREED, COLOR OR ABILITY TO PAY. 9577828 true true false true false false false false false false true false false false false false true false false false false false false false false false true true false false false false false false false false false false false false false false false false true false false false true 22 0 true 130 true false false false false false false false false false false X 6 6 false true false false false true false true true false false true true true true true true true true false OK X DON BATES 5809285541 501 E WASHINGTON ST SAYRE OK 73662 ROBERTA OLDFIELD SECRETARY/TREAS. 10.0 X X EDDIE TOM LAKEY CHAIRMAN 10.0 X X LEON WILLSIE VICE-CHAIRMAN 10.0 X X WAYNE ROBINSON TRUSTEE 10.0 X EMIL CORNELS TRUSTEE 10.0 X KEITH RIPLEY TRUSTEE 10.0 X MICHAEL BLEVINS CHAIRMAN 10.0 X X SHERRON MANNING SECRETARY/TREAS. 10.0 X X JAY RAY LAXTON VICE-CHAIRMAN 10.0 X X DONNA GAIL ROBISON CEO 40.0 X 83797 0 0 JERRY HOWELL INTERIM CEO 40.0 X 10417 MARCIA ARANDA CNO 40.0 X 66498 160712 0 0 0 false false false CPSI COMPUTER SUPPORT 253036 NP CARE INC NURSE PRACTIONER 109410 RCHA BILLING SERVICES 400000 CONTEMPORARY HEALTHCARE SERVICES NURSE PRACTIONER 181035 4 0 1400133 0 0 1400133 NET PATIENT SERVICE REVENUE 621300 7077125 7077125 7077125 625 625 0 0 0 0 0 99776 100346 -570 -570 -570 0 0 0 CAFETERIA 722210 41598 41598 MEDICAL RECORDS 900099 2899 2899 OTHER RELATED INCOME 900099 213843 213843 258340 8735653 7290968 44552 0 100 100 0 0 73932 73932 0 3420223 2757023 663200 0 389229 307117 82112 265994 209880 56114 477470 477470 2709 2709 75424 75424 1669 1669 0 0 85495 67459 18036 4683 3695 988 57605 45459 12146 201813 159238 42575 0 263411 207841 55570 72530 57229 15301 0 0 848092 848092 0 1172069 1172069 181959 181959 BAD DEBT EXPENSE 2109868 2109868 MEDICAL PURCHASED SERVICES 507345 507345 PHARMACY 191669 191669 MEDICAL SUPPLIES 403242 403242 697662 530502 167160 11504193 9577828 1926365 0 115539 24513 0 89279 1406785 0 1494990 1161435 0 0 0 0 0 0 135905 133329 65767 63888 21580339 11037332 11783329 10543007 0 0 0 0 0 0 0 0 0 0 15002315 12015451 885770 1137444 0 0 0 0 0 0 0 0 0 0 0 0 12149583 11904431 500000 0 13535353 13041875 X 60177 -1026424 1406785 0 0 0 1466962 -1026424 15002315 12015451 X -2768540 555099 -279945 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1669 false false false 1669 false SCHEDULE C, PART II-B, LINE 1F THE ORGANIZATION PAYS DUES TO OHA AND A PORTION OF THE DUES PAID IS ATTRIBUTABLE TO LOBBYING EXPENSE. 218226 218226 14442532 5171701 9270831 1164567 593331 571236 5649849 5272300 377549 105165 105165 10543007 X 6626355 570 570 6625785 2109868 2109868 8735653 9394895 570 570 9394325 2109868 2109868 11504193 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D LOSS ON SALE OF PROPERTY AND EQUIPMENT $570 SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSE $2,109,868 SCHEDULE D, PART XII, LINE 2D LOSS ON SALE OF PROPERTY AND EQUIPMENT $570 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $2,109,868 true true true X 300. true X true true true false false 30916 30916 0.00330 1044303 439084 605219 0.06440 1075219 439084 636135 0.06770 1075219 439084 636135 0.06770 false 2109868 1420549 1948475 -527926 X true true 1 1 SAYRE MEMORIAL HOSPITAL 911 HOSPITAL DRIVE SAYRE OK 73662 WWW.SAYREHOSPITAL.ORG 2207 X X X SAYRE MEMORIAL HOSPITAL 1 true X X X X X X X X X 12 true false true X WWW.SAYREHOSPITAL.ORG X X X X true false true true 300. true 300. true X X X true true X X true false X X X X true X X false false SCHEDULE H, PART V, SECTION B, LINE 3 CITIZENS OF THE COMMUNITY WERE INVOLVED IN A COMMUNITY SURVEY CONDUCTED BY THE TURNING POINT COALITION, OKLAHOMA UNIFIED RESOURCES. LEADERSHIP FROM THE SAYRE MEMORIAL HOSPITAL ARE ACTIVE MEMBERS OF THE OKLAHOMA UNITED RESOURCES TURNING POINT COALITION. THOSE THAT SERVE IN LEADERSHIP AT SAYRE MEMORIAL HOSPITAL HAVE SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH. SCHEDULE H, PART V, SECTION B, LINE 20D MAX CHARGE EQUALS 60% OF GROSS CHARGES (40% DISCOUNT). SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,109,868. SCHEDULE H, PART III, LINE 2 THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF EACH TYPE OF PAYOR. THE HOSPITAL'S BAD DEBT AT COST WAS DETERMINED BY APPLYING AN OVERALL RATIO OF COST TO CHARGES. SCHEDULE H, PART III, LINE 4 THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. COST OF PROVIDING CARE FOR THESE PATIENTS AND THAT SHORTFALL OF $527,926 SHOULD BE COUNTED AS COMMUNITY BENEFIT. THE COST TO CHARGE METHOD WAS USED. SCHEDULE H, PART III, LINE 9B IF A PATIENT IS DETERMINED TO BE FINANCIALLY INDIGENT, PATIENT FINANCIAL SERVICES WILL ASSIST THE PATIENT/GUARANTOR IN APPLYING FOR FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE HEATH CARE CENTER WILL REVIEW THE ACCOUNT FOR CHARITY ALLOWANCE. SCHEDULE H, PART VI, LINE 2 SAYRE MEMORIAL HOSPITAL IS VERY INVOLVED IN EVERY ASPECT OF THE COMMUNITY AND THROUGH THAT INVOLVEMENT AND THE ANNUAL HEALTH FAIR THAT WE ARE ABLE TO PROVIDE FOR THE COMMUNITY, WE TAKE TIME TO LISTEN TO THE HEALTH CARE WANTS AND NEEDS OF OUR CITIZENS. WE UNDERSTAND THAT A GOOD SHARE OF OUR POPULATION IS ELDERLY AND THEY HAVE LIMITED MEANS OF TRAVEL TO A LARGE AREA FOR HEALTH CARE. THEREFORE, WE STRIVE TO PROVIDE A WIDE DIVERSITY OF SERVICES TO MEET AS MANY OF THEIR NEEDS LOCALLY AS WE ARE FISCALLY ABLE TO DO SO. SCHEDULE H, PART VI, LINE 3 UNINSURED INDIVIDUALS ARE PROVIDED COMPUTER ACCESS TO THE MEDICAID SYSTEM TO APPLY FOR ASSISTANCE AT THE TIME OF ADMISSION. WE ALSO PROVIDE A PATIENT ACCOUNT MANAGER WHO INFORMS THE PATIENT OF THE ORGANIZATION'S CHARITY CARE POLICY. SCHEDULE H, PART VI, LINE 4 SAYRE MEMORIAL HOSPITAL PROVIDES CARE TO THE RURAL COMMUNITIES OF SAYRE, ERICK, CHEYENNE, SWEETWATER, CARTER, MANGUM, AND DELHI. OUR PATIENTS ARE 60% MEDICARE, 8% MEDICAID, 22% COMMERCIAL INSURANCE, AND 10% UNINSURED. SCHEDULE H, PART VI, LINE 5 GOVERNING BOARD MEMBERSHIP IS OPEN TO ANYONE OVER THE AGE OF 18 YEARS WHO IS DULY ELECTED. ALL MEMBERS IN GOOD STANDING ARE ENTITLED TO ONE VOTE IN ANY REGULAR OR SPECIAL MEETING AND TO EXERCISE ALL OTHER PRIVILEGES OF MEMBERSHIP. THE MEMBERS HAVE THE POWER, BY MAJORITY VOTE, AT REGULAR, SPECIAL CALLED, OR ANNUAL MEETINGS, TO REMOVE ANY DIRECTOR OR OFFICER FROM OFFICE. THERE IS AN ANNUAL MEETING HELD TO ELECT THE BOARD OF DIRECTORS AND OFFICERS AND TO TRANSACT ANY BUSINESS THAT MAY COME BEFORE THE MEETING. OUR MEDICAL STAFF IS OPEN TO ANY LICENSED PHYSICIAN. USE OF SURPLUS FUNDS ARE INVESTED BACK INTO THE HOSPITAL FOR FURTHER CONTINUATION OF SERVICE. Form 990, Part VI, Line 3 THE ORGANIZATION DELEGATED MANAGEMENT DUTIES TO RURAL COMMUNITY HOSPITALS OF AMERICA, LLC. Form 990, Part VI, Line 7a Membership is open to any person over the age of 18 years who is duly elected. All members in good standing are entitled to one vote in any regular or special meeting, and to exercise all other privileges of membership. The members have the power, by a majority vote, at any regular, special called, or annual meeting, to remove any director or officer from office. There is an annual meeting held to elect the Board of Directors and officers and to transact any business that may come before the meeting. Form 990, Part VI, Line 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY MANAGEMENT. ANY QUESTIONS OR CONCERNS MANAGEMENT HAS ARE ADDRESSED AND ANY CLARIFICATIONS OR CORRECTIONS THAT NEEED TO BE MARE ARE MADE. The Board of Directors will review the Form 990 prior to filing the return with the IRS. The review will be documented in the board minutes. Form 990, Part VI, Line 12c Officers and trustees are required to disclose annually interests that could give rise to conflicts. Form 990, Part VI, Line 15 The CEO is not an employee of the organization and is compensated by quorum health resources, an unrelated organization. The CFO's compensation is reviewed and approved by the board. Form 990, Part VI, Line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. FORM 990, PART XI, LINE 9 CHANGE IN INTEREST IN FOUNDATION $(279,945) SAYRE MEMORIAL HOSPITAL FOUNDATION 911 HOSPITAL DR SAYRE OK 73662 320177689 SUPPORT HOSP. OK 501(C)(3) 9 NA false false false true false false false false false false false false false false false false false false false false