2014-05-14T15:42:48-05:00 2013-06-30 BKD LLP 6120 S Yale 1400 Tulsa OK 741364223 990 2012-07-01 730618679 KINGFISHER REGIONAL HOSPITAL % CFO KING 4053753141 1000 KINGFISHER REGIONAL HOSP DRIVE Suite KINGFISHER OK 73750 J JUAN JECH 4053753141 2014-05-14 true 9185842900 2012 2015-11-30 17:44:51Z J JUAN JECH 1000 KINGFISHER REGIONAL HOSP KINGFISHER OK 73750 15944897 false X N/A X 1950 OK TO SERVE THE HEALTHCARE NEEDS OF OUR COMMUNITIES WITH EXCELLENCE, COMPASSION AND COMMITMENT 9 8 147 31 0 0 69254 25691 13989777 15143071 294675 35997 112860 740138 14466566 15944897 550 570 0 0 5998645 6091581 0 0 0 11148069 10976389 17147264 17068540 -2680698 -1123643 28825377 28003895 27512671 27814832 1312706 189063 X OUR MISSION IS TO SERVE THE HEALTHCARE NEEDS OF OUR COMMUNITIES WITH EXCELLENCE, COMPASSION AND COMMITMENT false false 11670206 570 15836242 KINGFISHER REGIONAL HOSPITAL PROVIDES QUALITY HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZAED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. FURTHERMORE, OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH THIS HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY: FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST, HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE SURROUNDING COMMUNITY WILL BE CONSIDERED WHERE THE NEED EXISTS. 11670206 true false false false false false false false false false true false false false true false false false false false false false false false false false true true false false true true false false false false false false false false false true false false false false false true true false false false true 21 0 true 147 true false false false false false false false false false false X 9 8 false true false false true true true true true false false true true true true true true true false false OK X CFO 4053757951 1000 KINGFISHER REGIONAL HOSPITAL D KINGFISHER OK 73750 J Juan Jech 2.0 X X Jerry Kadavy 2.0 X X Jim Lemon 2.0 X Max Thomas 2.0 X Kurt Bollenbach 2.0 X Heath Myers 2.0 X Jack Stuteville 2.0 X Kim Grellner 2.0 X Brenda Walta 2.0 X Nancy Schmid 40.0 X 209462 0 0 John Parigi 40.0 X 282600 0 0 Deborah Day 40.0 X 172592 0 0 664654 0 0 3 false true false Stephen R Arthurs MD Medical Professional 504196 CPP Wound Care LLC 1401 E Broadway St MORRILTON AR 72110 Wound Care 260650 Matson Enterproses Medical professional 291964 McAfee and Taft Legal fees 207247 Imaging Solutions Inc Radiologist 258727 8 25691 25691 NET PATIENT SERVICE REVENUE 900099 14208674 14208674 SALES TAX REVENUE 900099 934397 934397 15143071 2997 2997 0 0 46967 46967 0 46967 46967 33000 33000 33000 33000 0 0 0 OTHER INCOME 900099 693171 693171 693171 15944897 15836242 82964 570 570 0 0 0 492062 492062 0 4274197 2951032 1323165 0 0 955181 659485 295696 370141 255556 114585 0 581732 581732 8481 8481 0 0 0 2067233 1427279 639954 12974 8958 4016 428994 296190 132804 0 0 1139864 786996 352868 102575 70821 31754 0 0 1743430 1203716 539714 0 2449774 1691397 758377 187394 129382 58012 BAD DEBTS 1470032 1470032 PHARMACY 150478 150478 DIETARY 232625 191605 41020 DEPARTMENTAL SUPPLIES 176017 176017 224786 200692 24094 17068540 11670206 5398334 0 1248122 3183824 1019378 981687 0 0 1711620 1459518 0 0 0 0 32523 29366 104478 196663 56437 97881 31243982 10248590 22775225 20995392 1436990 554294 0 0 0 0 0 0 440604 505270 28825377 28003895 1396314 1678733 0 0 0 0 24557698 24556078 0 0 0 0 1554754 1576116 0 0 3905 3905 27512671 27814832 X 1307706 184063 5000 5000 0 0 1312706 189063 28825377 28003895 -1123643 X false true X true false X 730215 730215 24728266 6786424 17941842 112703 30565 82138 5300440 3370886 1929554 372358 60715 311643 20995392 0 DUE TO FOUNDATION 3905 3905 1 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. true true true X true X true true false true false 294363 294363 0.01890 1395646 834969 560677 0.03590 1690009 834969 855040 0.05480 1690009 834969 855040 0.05480 true 1470032 6274011 5880130 393881 X true true 1 1 Kingfisher Regional Hospital

1000 Kingfisher Regional Hospital D Kingfisher OK 73750

X X X X Kingfisher Regional Hospital 1 true X X X X X X X X X 12 true true true X X X X X true false true true 400. true true X true true X X X X true false X X X X true X false false 1 Schedule H, Part III, Section A, Line 4a Accounts are written off to bad debt when they are returned from Revenue Cycle Solutions as noncollectible. All collection efforts are discontinued. 2 Schedule H, Part III, Section A, Line 4b Amount on line 2 was derived by taking the cost to charge ratio and applying it to the bad debt expense. 3 Schedule H, Part III, Section C, Line 9b The hospital will treat a patient regardless of their ability to pay. If a patient is unable to pay, the hospital will provide uncompensated services, assist in third party billing, or bill the patient depending on the need and resources of the patient. An alpha census is reviewed by patient account representatives every week. Through review all uninsured patients are identified and patients that will owe a copay/deductible. The registration staff will visit the patient's room to make financial arrangements with the patient and/or guarantor. The PFS collectors are making daily visits to the patient's room to notify them of any copay/deductible that are due and to make sure of the uncompensated services policy available if they have not filled out an affidavit yet. If the patient indicates a need for financial assistance, the patient account representative will discuss the various payment plans and other options available. These options may include the medicaid program. If medicaid assistance might be available, this must be looked at first. The registration staff will send (and fax) a MSMA-5 to the appropriate DHS county office. If the patient does not qualify for medicaid assistance, we will ask the patient to provide us with the financial information needed (after discharge) in a timely manner to calculate the uncompensated services that will apply. Assistance will be provided by the hospital in any of the above areas if necessary. 4 Needs Assessment The hospital uses a variety of resources to assess the health care needs of the communities it serves. Those resources include the following: 3-year strategic business plan and market assessment of current and potential service areas utilizing consultants from Quorum Health Resources. Health assessments in conjuction with offices of the Oklahoma State Department of Health and Oklahoma State University Economic Development. 5 Patient Education of Eligibility for Assistance Information regarding charity care is available in the admission are and the emergency room. A copy of the charity care policy is given to patients when they come to register. The hospital also discusses with patients the availability of medicaid and assists them with the qualification of such programs. They will also inform them of other discounts that may be available to them. 6 Community Information The county of Kingfisher is a rural community with a county population of 10,397. The average household income is $32,471 with 10.4% of population under the poverty level as reported in the year 2005, our latest current data. Kingfisher County has an unemployment rate of 2.7% as of January, 2008. Based on the Bureau of Economic Analysis Data, the 2006 per capita is slightly higher than the state of Oklahoma's average, but lower than the United States average. Medical payments for the county included public assist medical care at a 11.6% rate with additional family assistance at .4% and food stamps at 1.2%. The hospital is the only hospital in this county. The Kingfisher Health Department also serves this county as well as DHS. 7 Promotion of community health The hospital sponsors a student governing body where area high school students participate on the board. The hospital provides employees to oversee the meeting, provide lunch and provide a speaker. The students learn about healthcare and related healthcare occupations. Once a year, the students work on a project related to health care. This provides students an opportunity to learn about the industry and make a difference in the community. The 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 ability to pay. The hospital serves a major role in the education of the population of the Kingfisher County. The hospital provides free health screenings; glucose, blood pressure checks, weight and bmi at various health and wellness fairs; major sponsor of the Kingfisher County life to the max, a healthy fit-lifestyle change weight challenge; women's health fairs; Kingfisher county fair, Kingfisher couny teachers health fair; the 8th grade mini-health conference; student governing board health scholarships; and businesses flu shots. The hospital also provides information out of the primary area and secondary areas by way of a "health scene" magazine flyer and their internet site. 8 Schedule H, Part I, Line 7 The amount of bad debt expense excluded from denominator of total expense = $1,470,032 9 Schedule H, Part VI, Section B, Line 6 The organization is a critical access hospital that receives medicare revenue based on a percentage of its cost. This amount was determined using that ratio. 10 Schedule H, Part V, Section B, Line 3 The hospital hosted community meetings and included local physicians, several hospital representatives, the school nurse and a social worker. 11 Schedule H, Part V, Section B, Line 6 Website address where CHNA and implementation strategy is posted: www.okruralhealthworks.org/pdfweb/AE-13153.pdf X false false false false false false false false false Nancy Schmid 209462 0 0 0 0 0 0 0 0 0 209462 0 0 0 John Parigi 282600 0 0 0 0 0 0 0 0 0 282600 0 0 0 Deborah Day 172592 0 0 0 0 0 0 0 0 0 172592 0 0 0 1 Schedule J, Part II An unrelated organization pays the CEO compensation for services performed for the organization. The unrelated organization is a management company. The management company is an independent contractor. A Kingfisher Hospital Authority 261537909 495713AC3 2007-12-12 25040250 REPLACEMENT FACILITY false true false A 0 0 25040250 1860125 0 0 500805 0 0 22679320 0 0 false false true true A false false false false 0 false false false true A false false false true false false 0 false 0 false true A true 1 Schedule K, Part IV, Line 2c The rebate computation was performed in December 2012. Throckmorton Insurance Agency See 1 Below 146285 Insurance payments false 1 Schedule L, Part IV, Line 1 Board member is a key employee of the company. 1 FORM 990, PART VI, QUESTION 7a Any person may become a member in the Corporation by filing a written application for membership; agreeing to comply with and be bound by the certificate of incorporation and bylaws of the Corporation and any rules and regulations adopted by the Board; paying a membership fee of $100; and acceptance for membership by the Board or the members. The Board of Directors are elected by the members of the corporation. 2 FORM 990, PART VI, QUESTION 7B The members must approve any material changes in the purposes of the Corporation for which it was formed by a 2/3 vote of the members. The members must also approve by a 2/3 vote any amendments, restatements, or repeals to the certificate of incorporation, any voluntary petition in bankruptcy, or for the Corporation to make any assignment for the benefit of creditors. The Corporation must have approval by a majority of the members entitled to vote in order to dissolve. 3 FORM 990, PART VI, QUESTION 11B The CFO coordinates the preparation of the 990 with the tax preparation firm who are also our auditors.The return is then reviewed and approved by the CEO and Board. 4 FORM 990, PART VI, QUESTION 12C We have a fulltime compliance officer, compliance hot line, compliance education, compliance orientation, and complaince meetings and presentations to the Board. 5 FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 6 Form 990, Part VI, Question 3 Quorum Health Resources QHR - Provided a CEO and advisory services to KRH. 7 FORM 990, PART VI, LINE 12; FORM 990, PART IV, LINE 12A THE ORGANIZATION IS CURRENTLY UNDERGOING A FINANCIAL STATEMENT AUDIT; HOWEVER, IT WAS NOT COMPLETED BEFORE THE DUE DATE OF THE RETURN. THEREFORE THE JUNE 30, 2012 AUDIT REPORT HAS BEEN ATTACHED AS REQUIRED. Kingfisher Medical Foundation 1000 Kingfisher Reg Hosp Drive Kingfisher OK 73750 263029117 Foundation OK 501(c)(3) 7 NA true false false false false false false false false false false false true true false false false false false