Sayre Memorial Hospital: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- Sayre Memorial Hospital (EIN 73-1023826)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201401359349306020
- Schema version
- 2012v2.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T12:54:22-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6120 S Yale 1400 | AddressLine1 |
| City | Tulsa | City |
| State | OK | State |
| ZIP Code | 741364223 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 731023826 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAYRE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % SAYRE MEMORIAL HOSPITAL | InCareOfName |
| Name Control | SAYR | NameControl |
| Phone | 5809285541 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 911 Hospital Drive | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | SAYRE | City |
| State | OK | State |
| ZIP Code | 73662 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DONNA GAIL ROBISON | Name |
| Title | INTERIM CEO | Title |
| Phone | 5809285541 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9185842900 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DONNA GAIL ROBISON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 911 Hospital Drive | AddressLine1 |
| City | Sayre | City |
| State | OK | State |
| ZIP Code | 73662 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 7071547 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAYREHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | OK | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 169 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 499160 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 546878 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7256878 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5404542 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 14395 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2468 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 798787 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1117659 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 8569220 | TotalRevenuePriorYear |
| Total Revenue Current Year | 7071547 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 750 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5171628 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3619378 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5798162 | OtherExpensePriorYear |
| Other Expenses Current Year | 5559587 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10975290 | TotalExpensesPriorYear |
| Total Expenses Current Year | 9179715 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2406070 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2108168 | RevenuesLessExpensesCY |
| Total Assets BOY | 17402154 | TotalAssetsBOY |
| Total Assets EOY | 15002315 | TotalAssetsEOY |
| Total Liabilities BOY | 13378847 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13535353 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4023307 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1466962 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 7055477 | Expense |
| Revenue | 7071547 | Revenue |
| Description | RURAL HOSPITAL PROVIDING MEDICAL CARE ON BOTH AN IN 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. | Description |
| Total Program Service Expense | 7055477 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 47 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 169 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OK | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SAYRE MEMORIAL HOSPITAL | NamePerson |
| Telephone Number | 5809285541 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 911 HOSPITAL DRIVE | AddressLine1 |
| City | SAYRE | City |
| State | OK | State |
| ZIP Code | 73662 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Other CompensationOtherCompensation | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ROBERTA OLDFIELD | |||||||
| SECRETARY/TREAS. | 10.0 | X | X | 0 | 0 | ||
| ROBERT LAKEY | |||||||
| TRUSTEE | 10.0 | X | 0 | ||||
| LEON WILLSIE | |||||||
| VICE-CHAIRMAN | 10.0 | X | X | ||||
| KENNETH WHINERY MD | |||||||
| TRUSTEE | 10.0 | X | |||||
| GENE MOSES | |||||||
| TRUSTEE | 10.0 | X | |||||
| MICHAEL BLEVINS | |||||||
| CHAIRMAN | 10.0 | X | X | ||||
| WALLACE BOYD | |||||||
| CEO | 40.0 | X | 33957 | 3016 | |||
| CAROLE JACKSON | |||||||
| CNO | 40.0 | X | 28584 | 606 | 0 | ||
| MISTY CARTER | |||||||
| INTERIM CEO | 40.0 | X | 24410 | 1231 | 0 | ||
| JIM GROCHOLSKI | |||||||
| CEO | 40.0 | X | 0 | 0 | |||
| RON VESTAL | |||||||
| CNO | 40.0 | X | 76356 | 5514 | 0 | ||
| BRIAN DENTON | |||||||
| CEO | 40.0 | X | |||||
| TREVA GRAHAM MD | |||||||
| PHYSICIAN | 40.0 | 103846 | 2068 | 0 | X | ||
| DR MICHAEL ROBINSON | |||||||
| PHYSICIAN | 40.0 | 280501 | 5038 | 0 | X | ||
| JESSICA L KENNEMER | |||||||
| ARNP | 40.0 | 64425 | 3106 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 612079 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 20579 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | COMPUTER SUPPORT | 363478 |
| NP Care Inc | |||||
| 2220 Cherrybrook St | DUNCAN | OK | 73533 | Nurse Practioner | 184278 |
| MERCY SPECIALIZED BILLING SVCS | |||||
| PO BOX 505125 | ST LOUIS | MO | 63150 | BILLING SERVICES | 139533 |
| BENISH ASSOCIATES | |||||
| 1716 RIDGEMONT DRIVE | WICHITA FALLS | TX | 76309 | PHYSICIAN ASSISTANTS | 187986 |
| GE Medical Systems | |||||
| PO Box 843553 | DALLAS | TX | 75284 | Info Technology | 121356 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Government Grants | 533276 | GovernmentGrants |
| All Other Contributions | 13602 | AllOtherContributions |
| Total Contributions | 546878 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net Patient Service Revenue | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 5404542 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5404542 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5404542 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2468 | TotalRevenueColumn |
| Exclusion | $2,468 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| Cafeteria | 722210 | 33945 | $33,945 | |
| Medical Records | 900099 | 969 | $969 | |
| Other Related Income | 900099 | 1082745 | $5 | 1082740 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1117659 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7071547 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6487282 | RelatedOrExemptFunctionIncome |
| Exclusion | $37,387 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 750 | Total |
| Program Services | 750 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 349487 | Total |
| Program Services | 243993 | ProgramServices |
| Management And General | 105494 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2727444 | Total |
| Program Services | 1904153 | ProgramServices |
| Management And General | 823291 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 286200 | Total |
| Program Services | 199809 | ProgramServices |
| Management And General | 86391 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256247 | Total |
| Program Services | 178898 | ProgramServices |
| Management And General | 77349 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97250 | Total |
| Management And General | 97250 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90645 | Total |
| Management And General | 90645 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 196657 | Total |
| Program Services | 137295 | ProgramServices |
| Management And General | 59362 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9130 | Total |
| Program Services | 6374 | ProgramServices |
| Management And General | 2756 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66082 | Total |
| Program Services | 46300 | ProgramServices |
| Management And General | 19782 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 163270 | Total |
| Program Services | 113986 | ProgramServices |
| Management And General | 49284 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259999 | Total |
| Program Services | 181517 | ProgramServices |
| Management And General | 78482 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69934 | Total |
| Program Services | 48824 | ProgramServices |
| Management And General | 21110 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 840349 | Total |
| Program Services | 840349 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1284114 | Total |
| Program Services | 1284114 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 188461 | Total |
| Management And General | 188461 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Purchased Services | 806542 | 806542 | |
| Pharmacy | 166614 | 166614 | |
| Medical Supplies | 376182 | 376182 | |
| Repairs & Maintenance | 252037 | 175959 | 76078 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 692321 | Total |
| Program Services | 343818 | ProgramServices |
| Management And General | 348503 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9179715 | Total |
| Program Services | 7055477 | ProgramServices |
| Management And General | 2124238 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 510651 | BOY |
| EOY | 115539 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2771 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1406785 | BOY |
| EOY | 1406785 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1931988 | BOY |
| EOY | 1494990 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153228 | BOY |
| EOY | 135905 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74928 | BOY |
| EOY | 65767 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 21655757 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9872428 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12873626 | BOY |
| EOY | 11783329 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 448177 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17402154 | BOY |
| EOY | 15002315 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 808528 | BOY |
| EOY | 885770 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12414410 | BOY |
| EOY | 12149583 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155909 | BOY |
| EOY | 500000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13378847 | BOY |
| EOY | 13535353 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2168345 | BOY |
| EOY | 60177 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1854962 | BOY |
| EOY | 1406785 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4023307 | BOY |
| EOY | 1466962 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17402154 | BOY |
| EOY | 15002315 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2108168 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -448177 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | false | FSAudited |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $7,323 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 7323 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | 1 | Identifier |
| Return Reference | Line 1f | ReturnReference |
| Explanation | The organization pays dues to AHA and OHA and a portion of the dues paid is attributable to lobbying expense. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 143835 | OtherCostOrOtherBasis |
| Book Value | 143835 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14442532 | OtherCostOrOtherBasis |
| Depreciation | 4370057 | Depreciation |
| Book Value | 10072475 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1377081 | OtherCostOrOtherBasis |
| Depreciation | 559456 | Depreciation |
| Book Value | 817625 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5587144 | OtherCostOrOtherBasis |
| Depreciation | 4942915 | Depreciation |
| Book Value | 644229 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 105165 | OtherCostOrOtherBasis |
| Book Value | 105165 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11783329 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM TAX-EXEMPT AFFILIATE | Description |
| Amount | $500,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 500000 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 300. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 62864 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 62864 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00680 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 823119 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 484733 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 338386 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03690 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 885983 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 484733 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 401250 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04370 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 885983 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 484733 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 401250 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04370 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $1,806,414 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 1667959 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 1776100 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -108141 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAYRE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 911 HOSPITAL DRIVE | AddressLine1 |
| City | SAYRE | City |
| State | OK | State |
| ZIP Code | 73662 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Er24 Hours | X | Er24Hours |
| Er Other | X | ErOther |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAYRE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 300. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Emergency Care Limited | X | EmergencyCareLimited |
| Other Reason | X | OtherReason |
| Medicare Rate | X | MedicareRate |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 1 | 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 AVALIABLE, THE HEATH CARE CENTER WILL REVIEW THE ACCOUNT FOR CHARITY ALLOWANCE. |
| 2 | 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. |
| 3 | 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. |
| 4 | 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. |
| 5 | 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 MEMBER HAVE THE POWER, BY MAJORIY 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. |
| 6 | Schedule H, Part V, Section B, Line 20D | Max charge equals 60% of gross charges (40% discount). |
| 7 | Schedule H, Part V, Line 22 | Gross charges are identical for FAP-eligible patients vs. non-FAP eligible patients. Once an FAP-eligible patient is determined to meet the criteria for financial assistance, the discounts are then applied. |
| 8 | 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. |
| 9 | SCHEDULE H, PART V, SECTION B, LINE 5A | WWW.SAYREHOSPITAL.ORG |
| 10 | 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 $X should be counted as community benefit. |
| 11 | Schedule H, Part V, Section B, Line 7 | There were a couple of needs identified in the community health needs assessment that will not be addressed in the current implementation strategy. The hospital does not have enough resources to address the routine dental care and school health needs in the community. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DR MICHAEL ROBINSON | NamePerson |
| Title | PHYSICIAN | Title |
| Base Compensation Filing Org | 280501 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 5038 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 285539 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 1 | Form 990, Part VI, Lines 6 and 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. |
| 2 | Form 990, Part VI, Line 10 | 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. |
| 3 | Form 990, Part VI, Line 12c | Officers and trustees are required to disclose annually interests that could give rise to conflicts. |
| 4 | Form 990, Part VI, Line 15 | The CEO is not an employee of the organization and is compensated by an unrelated organization. The CFO's compensation is reviewed and approved by the board. |
| 5 | 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. |
| 6 | Form 990, Page 12, Line 9 | Beneficial Interest in SMH Foundation ($448,177) |
| 7 | Form 990, Part IV, line 12a and Form 990 Part XII, Line 2 | The organization is currently undergoing a financial statement audit. However, the organization's audit was not completed by the due date of the tax return. Therefore the June 30, 2012 audited financials have been attached to the return as required. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAYRE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 911 HOSPITAL DR | AddressLine1 |
| City | SAYRE | City |
| State | OK | State |
| ZIP Code | 73662 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320177689 | EIN |
| Primary Activities | SUPPORT HOSP. | PrimaryActivities |
| Legal Domicile State | OK | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 9 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |