PAWHUSKA HOSPITAL INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: PAWHUSKA HOSPITAL INC (EIN 23-7169376)
Tax period: 2012-10-01 to 2013-09-30
Filed: 2014-08-15
IRS object ID: 201422279349304832
Schema version: 2012v2.1
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 D
Schedule H
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-08-15T17:35:00-05:00	Timestamp
Tax Period End Date	2013-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	STOTTS BARCLAY PETTUS WHIPPLE LITTLETON	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	RUEF PC 7645 EAST 63RD ST STE	AddressLine1
City	TULSA	City
State	OK	State
ZIP Code	74133	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	237169376	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	PAWHUSKA HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	PAWH	NameControl
Phone	9182873232	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1101 EAST 15TH STREET	AddressLine1
City	PAWHUSKA	City
State	OK	State
ZIP Code	740561920	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	JASON MCCAULEY	Name
Title	ADMINISTRATOR	Title
Phone	9182873232	Phone
Date Signed	2014-08-15	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	GARY L PETTUS	Name
Phone	9182540433	Phone
Date Prepared	2014-08-15	DatePrepared

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	JASON MCCAULEY	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1101 EAST 15TH STREET	AddressLine1
City	PAWHUSKA	City
State	OK	State
ZIP Code	740561920	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	4607974	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.PAWHUSKAHOSPITAL.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1972	YearFormation
State Legal Domicile	OK	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE CARE FOR PERSONS SUFFERING FROM ILLNESSES OR DISABILITIES WHICH REQUIRE IN OR OUT PATIENT HOSPITAL CARE. TO CARRY ON EDUCATION ACTIVITIES AND SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED AND TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	5	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	5	NbrIndependentVotingMembers
Total Nbr Employees	69	TotalNbrEmployees
Total Nbr Volunteers	25	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	177043	ContributionsGrantsPriorYear
Contributions Grants Current Year	130997	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	4656150	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4471123	ProgramServiceRevenueCY
Investment Income Prior Year	9212	InvestmentIncomePriorYear
Investment Income Current Year	5854	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	4842405	TotalRevenuePriorYear
Total Revenue Current Year	4607974	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	2674491	SalariesEtcPriorYear
Salaries Etc Current Year	2566250	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1641676	OtherExpensePriorYear
Other Expenses Current Year	1883438	OtherExpensesCurrentYear
Total Expenses Prior Year	4316167	TotalExpensesPriorYear
Total Expenses Current Year	4449688	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	526238	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	158286	RevenuesLessExpensesCY
Total Assets BOY	3668760	TotalAssetsBOY
Total Assets EOY	4376918	TotalAssetsEOY
Total Liabilities BOY	921766	TotalLiabilitiesBOY
Total Liabilities EOY	1471638	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2746994	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	2905280	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE CARE FOR PERSONS SUFFERING FROM ILLNESSES OR DISABILITIES WHICH REQUIRE IN OR OUT PATIENT HOSPITAL CARE. TO CARRY ON EDUCATION ACTIVITIES AND SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED AND TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	3926728	Expense
Revenue	4471123	Revenue
Description	PAWHUSKA HOSPITAL, INC. IS A 25-BED CRITICAL ACCESS HOSPITAL THAT ACCEPTS PATIENTS REGARDLESS OF ABILITY TO PAY. CHARITY CARE FOR THE YEAR ENDED SEPTEMBER 30, 2013, WAS 156,150.	Description
Total Program Service Expense	3926728	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	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	false	ReportOtherLiabilities
Report Fin48 Footnote	true	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	false	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	4	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	69	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
Form8899 Filed	false	Form8899Filed
Form1098 C Filed	false	Form1098CFiled
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	5	NbrVotingGoverningBodyMembers
Number Independent Voting Members	5	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	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
Other Explain In Sch O	X	OtherExplainInSchO

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	JASON MCCAULEY	NamePerson
Telephone Number	9182873232	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1101 EAST 15TH STREET	AddressLine1
City	PAWHUSKA	City
State	OK	State
ZIP Code	740561920	ZIPCode

Field	Value	IRS element (for citing)
No Listed Persons Compensated	X	NoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
JAMES HAGER
CHAIRMAN	1.00	X	X	0	0	0
TOBY BIGHORSE
SECRETARY	1.00	X	X	0	0	0
BOB ROBERTS
TRUSTEE	1.00	X		0	0	0
FRANCIS ALTAFFER
TRUSTEE	1.00	X		0	0	0
NANCY WOODYARD
TRUSTEE	1.00	X		0	0	0
JOHN HAM PA
PA	52.00			168020	0	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	168020	TotalReportableCompFromOrg
Number Individuals GT100 K	1	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Government Grants	109948	GovernmentGrants
All Other Contributions	21049	AllOtherContributions
Total Contributions	130997	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE	900099	4464476	4464476
DIETARY REVENUE	900099	6315	6315
MISCELLANEOUS REVENUE	900099	332	332

Field	Value	IRS element (for citing)
Total Program Service Revenue	4471123	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5854	TotalRevenueColumn
Exclusion	$5,854	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4607974	TotalRevenueColumn
Related Or Exempt Function Income	4471123	RelatedOrExemptFunctionIncome
Exclusion	$5,854	ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2015415	Total
Program Services	1672559	ProgramServices
Management And General	342856	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	251176	Total
Program Services	208447	ProgramServices
Management And General	42729	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	299659	Total
Program Services	248681	ProgramServices
Management And General	50978	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	928851	Total
Program Services	928851	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	66149	Total
Program Services	66149	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1245	Total
Program Services	1245	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	14124	Total
Program Services	11717	ProgramServices
Management And General	2407	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	50054	Total
Program Services	22564	ProgramServices
Management And General	27490	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	15230	Total
Program Services	5035	ProgramServices
Management And General	10195	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	15293	Total
Program Services	15293	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	251427	Total
Program Services	251427	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	49066	Total
Program Services	49066	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	191952	191952
REPAIRS AND MAINTENANCE	143615	139938	3677
OTHER SUPPLIES & EXPENSES	88217	52786	35431
UTILITIES	59344	59344

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	8871	Total
Program Services	1674	ProgramServices
Management And General	7197	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	4449688	Total
Program Services	3926728	ProgramServices
Management And General	522960	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	403723	BOY
EOY	26106	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1438849	BOY
EOY	719817	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	461000	BOY
EOY	428159	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	28467	BOY
EOY	1106583	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	130028	BOY
EOY	101382	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	36398	BOY
EOY	11314	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4646876	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	2663319	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	1170295	BOY
EOY	1983557	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	3668760	BOY
EOY	4376918	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	405319	BOY
EOY	413392	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	408355	BOY
EOY	1058246	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	108092	BOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	921766	BOY
EOY	1471638	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2746994	BOY
EOY	2905280	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2746994	BOY
EOY	2905280	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3668760	BOY
EOY	4376918	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	158286	ReconcilationRevenueExpenses
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
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 D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	34360	OtherCostOrOtherBasis
Book Value	34360	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1043701	OtherCostOrOtherBasis
Depreciation	691883	Depreciation
Book Value	351818	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	35979	OtherCostOrOtherBasis
Depreciation	30956	Depreciation
Book Value	5023	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3128776	OtherCostOrOtherBasis
Depreciation	1940480	Depreciation
Book Value	1188296	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	404060	OtherCostOrOtherBasis
Book Value	404060	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	1983557	TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt	4607974	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	4607974	RevenueSubtotal
Total Revenue Per Form990	4607974	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	4449688	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	4449688	ExpensesSubtotal
Total Expenses Per Form990	4449688	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	LIABILITY UNDER FIN 48 FOOTNOTE	Identifier
Return Reference	SCHEDULE D, PAGE 3, PART X	ReturnReference
Explanation	THE HOSPITAL IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC") AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL HAD NO UNRELATED BUSINESS TAXABLE INCOME DURING THE YEARS ENDED SEPTEMBER 30, 2013 AND 2012. INCOME TAX BENEFITS ARE RECOGNIZED FOR INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, ONLY WHEN IT IS DETERMINED THAT THE INCOME TAX POSITION WILL MORE-LIKELY-THAN-NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. THE HOSPITAL HAS ANALYZED THE TAX POSITIONS TAKEN IN ITS FILINGS WITH THE INTERNAL REVENUE SERVICE ("IRS") AND STATE JURISDICTIONS WHERE IT OPERATES. THE HOSPITAL BELIEVES THAT ITS INCOME TAX FILING POSITIONS WILL BE SUSTAINED UPON EXAMINATION AND DOES NOT ANTICIPATE ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL ADVERSE EFFECT ON THE HOSPITAL'S FINANCIAL CONDITION, RESULTS OF OPERATIONS, OR CASH FLOWS. ACCORDINGLY, THE HOSPITAL HAS NOT RECORDED ANY RESERVES OR RELATED ACCRUALS FOR INTEREST AND PENALTIES RELATING TO UNCERTAIN TAX POSITIONS AT SEPTEMBER 30, 2013 AND 2012. THE HOSPITAL FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF OKLAHOMA. THE STATUTE OF LIMITATIONS FOR BOTH FEDERAL AND OKLAHOMA TAX RETURNS IS THREE YEARS; THEREFORE ALL TAX RETURNS FILED THREE YEARS AGO ARE NO LONGER SUBJECT TO EXAMINATION.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	false	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	144096	TotalCommunityBenefitExpense
Net Community Benefit Expense	144096	NetCommunityBenefitExpense
Percent Of Total Expense	0.03240	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	782754	TotalCommunityBenefitExpense
Direct Offsetting Revenue	506387	DirectOffsettingRevenue
Net Community Benefit Expense	276367	NetCommunityBenefitExpense
Percent Of Total Expense	0.06210	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	23070	TotalCommunityBenefitExpense
Direct Offsetting Revenue	22080	DirectOffsettingRevenue
Net Community Benefit Expense	990	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	949920	TotalCommunityBenefitExpense
Direct Offsetting Revenue	528467	DirectOffsettingRevenue
Net Community Benefit Expense	421453	NetCommunityBenefitExpense
Percent Of Total Expense	0.09470	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	949920	TotalCommunityBenefitExpense
Direct Offsetting Revenue	528467	DirectOffsettingRevenue
Net Community Benefit Expense	421453	NetCommunityBenefitExpense
Percent Of Total Expense	0.09470	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$683,658	BadDebtExpenseAmount
Amount Attributable To	34183	AmountAttributableTo
Amount Reimbursed By Medicare	2986067	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	60968	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	2925099	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

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	PAWHUSKA HOSPITAL INC	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	1101 EAST 15TH STREET	AddressLine1
City	PAWHUSKA	City
State	OK	State
ZIP Code	740561920	ZIPCode

Field	Value	IRS element (for citing)
Website Address	WWWPAWHUSKAHOSPITALORG	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	PAWHUSKA HOSPITAL INC	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
Other	X	Other
Take Into Account	true	TakeIntoAccount
Other Facilities	false	OtherFacilities
CHNA Widely Available	true	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Other Method	X	OtherMethod
Adopt Implement Strategy	X	AdoptImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
Other Needs Addressed	X	OtherNeedsAddressed
All Needs Addressed	false	AllNeedsAddressed
Organization Incur Excise Tax	false	OrganizationIncurExciseTax
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	100.0	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	200.0	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
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
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Medicare Rate	X	MedicareRate
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE	PART I LINE 3C	PAWHUSKA HOSPITAL INC PROVIDES ITS SERVICES WITHOUT REGARD TO A PATIENTS ABILITY TO PAY PAWHUSKA HOSPITAL INC PROVIDES A DISCOUNT OF AT LEAST 25 OF BILLED CHARGES TO ALL UNINSURED PATIENTS UNINSURED PATIENTS ALSO MAY QUALIFY FOR AN ADDITIONAL 10 PROMPT PAY DISCOUNT IN ADDITION TO THESE AUTOMATIC DISCOUNTS PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE INCLUDING FREE AND DISCOUNTED CARE THE DETERMINATION OF THE PATIENTS QUALIFICATION FOR FINANCIAL ASSISTANCE IS BASED ON AN OBJECTIVE DETERMINATION OF THE PATIENTS FINANCIAL RESOURCES AND ABILITY TO PAY IN GENERAL ALL UNINSURED PATIENTS WITH HOUSEHOLD INCOME OF LESS THAN 100 OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR FREE CARE PATIENTS WITH HOUSEHOLD INCOMES LESS THAN 200 OF FEDERAL POVERTY GUIDELINES QUALIFY FOR SLIDING SCALE DISCOUNTS THAT ARE IN ADDITION TO THE AUTOMATIC DISCOUNT PROVIDED TO ALL UNINSURED PATIENTS
COSTING METHODOLOGY EXPLANATION	PART I LINE 7	CHARITY CARE UNREIMBURSED MEDICAID AND UNREIMBURSED COSTSOTHER MEANS TESTED GOVERNMENT PROGRAMS WERE CALCULATED AT COST USING THE COSTTOCHARGE RATIO DERIVED FROM WORKSHEET 2
COMMUNITY BUILDING ACTIVITIES	PART II	PART II CURRENTLY PAWHUSKA HOSPITAL INC DOES NOT HAVE A COMMUNITY BUILDING ACTIVITY IN PLACE BUT IS WORKING TO DEVELOP ONE
BAD DEBT EXPENSE EXPLANATION	PART III LINE 4	PAWHUSKA HOSPITAL INCS BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE EXPENSE REPORTED ON THE FINANCIAL STATEMENTS AND APPLYING AN OVERALL COST TOCHARGE RATIO CALCULATED FROM WORKSHEET 2 THE ESTIMATED AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE IS 5 THIS IS AN ESTIMATION FROM NOTIFICATIONS OF CHARITY CARE POLICIES SENT TO PATIENTS AND THE NUMBER COMPLETED AND RETURNED TO THE HOSPITAL THE MAJORITY OF THE POPULATION SERVED WOULD QUALIFY FOR GOVERNMENT ASSISTANCE OR MEET THE FEDERAL POVERTY GUIDELINES THEREFORE IF PATIENTS WOULD HAVE APPLIED FOR FINANCIAL ASSISTANCE THE MAJORITY OF THE BAD DEBT WOULD HAVE BEEN CLASSIFIED AS CHARITY CARE PAWHUSKA HOSPITAL INC CONSIDERS CARE FOR THE POOR TO BE AN ESSENTIAL PART OF ITS MISSION OF SERVICE TO THE COMMUNITY BAD DEBT IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR FINANCIAL STATEMENT NOTE THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENTS ESTIMATES OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRDPARTY PAYORS MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS MANAGEMENT CONSIDERS HISTORICAL WRITEOFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION
MEDICARE EXPLANATION	PART III LINE 8	MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS
COLLECTION PRACTICES EXPLANATION	PART III LINE 9B	THE COLLECTION POLICY IS SUCH THAT ALL COLLECTION ACTIVITY CEASES FOR EACH PATIENTS AMOUNT DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE FOR EXAMPLE IF IT IS DETERMINED THAT A PATIENT IS ELIGIBLE FOR FREE CARE ALL COLLECTION EFFORTS STOP IF A PATIENT IS ELIGIBLE FOR DISCOUNT CARE NORMAL COLLECTION EFFORTS CONTINUE ONLY ON THE PORTION DETERMINED TO STILL BE OWED BY THE PATIENT DURING THE FISCAL YEAR ALL UNINSURED PATIENTS WERE ELIGIBLE FOR AN UPFRONT DISCOUNT OF AT LEAST 25 DURING THE FISCAL YEAR ALL PATIENTS WITH A FAMILY INCOME LESS THAN OR EQUAL TO 200 OF THE FEDERAL POVERTY GUIDELINES WERE ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE OF FREE OR DISCOUNTED CARE
NEEDS ASSESSMENT	PART VI	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 IN CONJUNCTION WITH THE OKLAHOMA OFFICE OF RURAL HEALTH PAWHUSKA HOSPITAL INC DEVELOPED A COMMUNITY NEEDS ASSESSMENT DURING TAX YEAR 2012 GOING FORWARD PAWHUSKA HOSPITAL INC WILL IMPLEMENT STRATEGIES FOR EACH HEALTH PRIORITY IDENTIFIED THROUGH THE ASSESSMENT PROCESS IN ADDITION WHEN LOOKING AT THE POTENTIAL OF ADDING NEW SERVICES AN INTEGRAL PART OF THAT RESEARCH REVOLVES AROUND HOW SUCH SERVICES WILL MEET AND ADDRESS THE DIFFERENT NEEDS OF THE COMMUNITY WE ARE PLANNING ON DEVELOPING FUTURE PROGRAMS THAT WILL ALLOW US THE OPPORTUNITY TO GATHER A LARGER COMMUNITY AUDIENCE THAT CAN INFORM US AS TO THE ISSUES THAT ARE IMPORTANT TO THE COMMUNITY AND TO GATHER SUGGESTIONS FROM THOSE INVOLVED PROGRAMS SUCH AS THE USE OF FOCUS GROUPS WILL ENABLE US TO BE FURTHER EDUCATED TO MEET THE NEEDS OF OUR COMMUNITY AND TO DEVELOP PROGRAMS TO MEET THOSE NEEDS
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	PAWHUSKA HOSPITAL INC PROVIDES A LETTER TO PATIENTS UPON ADMISSION THAT STATES THAT OUR HOSPITAL PROVIDES ASSISTANCE TO THOSE PATIENTS WHO HAVE 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 OUR CHARITY CARE POLICY AND NOTES THAT MEDICARE AND OTHER STATE PROGRAMS ARE ALSO AVAILABLE TO PATIENTS THAT MEET INCOME REQUIREMENTS OUR STAFF IS AVAILABLE TO OFFER PATIENTS ASSISTANCE IN COMPLETING THE CHARITY CARE AND MEDICAID APPLICATIONS IF NEEDED
COMMUNITY INFORMATION	PART VI	PAWHUSKA HOSPITAL INC PRIMARILY SERVIES THE CITIZENS OF THE COMMUNITY OF PAWHUSKA OKLAHOMA AND THE SURROUNDING AREA PAWHUSKA SERVES AS THE COUNTY SEAT OF THE 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 LOCATED IN A RURAL AREA WIHT THE CITYS POPULATION BEING 3589 2010 CENSUS AND THE OVERALL COUNTY POPULATION OF 47472 THE PER CAPITA INCOME FOR THE CITY WAS 13916 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 AGE 65 OR OVER THE HOSPITAL IS LOCATED WITHIN FEDERALLYDESIGNATED UNDERSERVED AREAS FOR PRIMARY CARE HEALTH PROFESSIONALS MENTAL HEALTH PROFESSIONALS DENTAL CARE HEALTH PROFESSIONALS AND IS LOCATED IN A MEDICALLY UNDERSERVED AREA POPULATION THE ENTIRE COUNTY FALLS INTO TWO MEDICALLY UNDERSERVED AREAS OSAGE SERVICE AREA AND WEST OSAGE SERVICE AREA
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	PAWHUSKA HOSPITAL INCS 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 IS PLANNING AN OPEN HOUSE NEXT JANUARY AND WILL BE OFFERING FREE HEALTH SCREENINGS TO THE COMMUNITY WE PLAN TO INVITE OTHER LOCAL HEALTHCARE ENTITIES TO PARTICIPATE IN THE OPEN HOUSE WITH OUR HOSPITAL
PAWHUSKA HOSPITAL INC LINE NUMBER 1 PART V LINE 1J	PART V LINE 1J	NO ADDITIONAL ITEMS NOTED
PAWHUSKA HOSPITAL INC LINE NUMBER 1 PART V LINE 3	PART V LINE 3	PAWHUSKA HOSPITAL INC IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS THE GEOGRAPHIC AREA OF THE DEFINED COMMUNITY BASED ON THE IDENTIFIED ZIP CODES FOR THE COMMUNITY COVERS THE CITIY OF PAWHUSKA AND THE SURROUNDING COMMUNITIES IN OSAGE COUNTY 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 HEALTH INDICATORS HEALTH EQUITY AND MORTALITY INFORMATION GATHERED WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF UNINSURED PERSONS LOWINCOME PERSONS AND MINORITY GROUPS AND THE COMMUNITY AS A WHOLE HEALTH NEEDS WERE RANKED UTILIZING WEIGHTING METHODS THAT WEIGHED 1 SIZE OF THE PROBLEM 2 SERIOUSNESS OF THE PROBLEM 3 THE PREVALENCE OF COMMON THEMES 4 THE IMPACT OF THE PROBLEM ON VULNERABLE POPULATIONS 5 HOW IMPORTANT THE PROBLEM IS TO THE COMMUNITY AND 6 WHETHER OR NOT PAWHUSKA HOSPITAL INC HAS EXISTING PROGRAMS WHICH RESPOND TO THE IDENTIFIED NEED SUBSEQUENTLY PAWHUSKA HOSPITAL INC LEADERSHIP DISCUSSED THE RESULTS OF THE EVALUATION AND SELECTED HEALTH PRIORITIES AFTER CONSIDERING THE COMMUNITY HEALTH NEEDS AND IN LIGHT OF PAWHUSKA HOSPITAL INCS SCOPE OF EXPERTISE AND RESOURCES PAWHUSKA HOSPITAL INC SELECTED TO ADDRESS THREE PRIORITY HEALTH ISSUES IN ITS SERVICE REGION 1 COMMUNITY INVOLVEMENT 2 PHYSICIAN RECRUITMENT 3 EDUCATION AND COORDINATION REGARDING AVAILABLE RESOURCES WITHIN THE COMMUNITY
PAWHUSKA HOSPITAL INC LINE NUMBER 1 PART V LINE 5C	PART V LINE 5C	NO ADDITIONAL ITEMS NOTED
PAWHUSKA HOSPITAL INC LINE NUMBER 1 PART V LINE 6I	PART V LINE 6I	NO ADDITIONAL ITEMS NOTED
PAWHUSKA HOSPITAL INC LINE NUMBER 1 PART V LINE 7	PART V LINE 7	WHILE THE INITIAL COMMUNITY NEEDS ASSESSMENTS HAVE BEEN COMPLETED WORK IS ONGOING TO FORMULATE SUSTAINABLE RESPONSES TO THE OVERWHELMING COMMUNITY NEEDS THE MOST RECENT COMMUNITY NEEDS ASSESSMENTS CONFIRM WHAT WE ALREADY KNOW THE COMMUNITIES SERVED BY PAWHUSKA HOSPITAL INC STRUGGLE WITH THE HEALTH CHALLENGES ARISING FROM MANY SOCIOECONOMIC FACTORS INCLUDING RELATIVELY LARGE NUMBER OF INDIVIDUALS LIVING IN HOUSEHOLDS WITH INCOMES NEAR OR BELOW FEDERAL POVERTY LEVELS RELATIVELY LARGE NUMBERS OF INDIVIDUALS WITH NO OR POOR HEALTH INSURANCE COVERAGE RELATIVELY LARGE NUMBERS OF INDIVIDUALS WITH OVERALL POOR HEALTH STATUS AND CHRONIC HEALTH PROBLEMS INCLUDING MENTAL HEALTH ISSUES A SHORTAGE OF HEALTH CARE RESOURCES AND PROVIDERS AVAILABLE TO PROVIDE SERVICES TO THE UNDERSERVED PARTS OF OUR COMMUNITIES AND A DISPARATE SAFETY NET SYSTEM THAT SUFFERS FROM LACK OF RESOURCES AND LARGELY UNCOORDINATED EFFORTS TO ADDRESS COMMUNITY NEEDS THE UNFORTUNATE REALITY IS THAT THERE ARE SIMPLY NOT ENOUGH PRIVATE RESOURCES TO EFFECTIVELY ADDRESS ALL OF THE COMMUNITY NEEDS IDENTIFIED IN PARTICULAR PAWHUSKA HOSPITAL INC PROVIDES ANNUALLY OVER ONE MILLION DOLLARS EACH YEAR IN UNCOMPENSATED CARE TO THE POOR IN THE FORM OF FREE OR DISCOUNTED CARE TO THE UNINSURED THE UNDERINSURED AND TO MEDICAID BENEFICIARIES A MORE SUSTAINABLE PUBLIC PRIVATE PARTNERSHIP IS NEEDED TO PROVIDE ADEQUATE RESOURCES TO ADDRESS THE COMMUNITY NEEDS IN A MORE EFFECTIVE AND MORE FINANCIALLY SUSTAINABLE WAY PAWHUSKA HOSPITAL INC WILL CONTINUE TO WORK WITH STATE AND LOCAL POLICY AND POLITICAL LEADERS SAFETY NET PROVIDERS AND COMMUNITY LEADERS AND ADVOCATES TO BUILD SUSTAINABLE PARTNERSHIPS TO BETTER ADDRESS THE COMMUNITY NEEDS AS WE WORK TO IMPROVE HEALTH CARE DELIVERY IN PAWHUSKA AND OSAGE COUNTY PAWHUSKA HOSPITAL INC WILL CONTINUE TO ADVOCATE FOR THE POOR THE VULNERABLE AND THE UNDERSERVED

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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	JOHN HAM PA	NamePerson
Title	PA	Title
Base Compensation Filing Org	168020	BaseCompensationFilingOrg
Total Compensation Filing Org	168020	TotalCompensationFilingOrg

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S MISSION	FORM 990 - ORGANIZATION'S MISSION	TO PROVIDE CARE FOR PERSONS SUFFERING FROM ILLNESSES OR DISABILITIES WHICH REQUIRE IN OR OUT PATIENT HOSPITAL CARE. TO CARRY ON EDUCATION ACTIVITIES AND SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED AND TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE FORM 990 IS PRESENTED TO THE ADMINISTRATOR FOR REVIEW AND THEN PRESENTED TO THE BOARD OF DIRECTORS. THE FORM 990 IS FILED AFTER REVIEW BY THE BOARD OF DIRECTORS.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, 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.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	PAWHUSKA HOSPITAL, INC. FOLLOWS THE PAY GUIDELINES PER OUR MANAGING COMPANY, JANE PHILLIPS MEDICAL CENTER.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	PAWHUSKA HOSPITAL, INC. FOLLOWS THE PAY GUIDELINES PER OUR MANAGING COMPANY, JANE PHILLIPS MEDICAL CENTER.
NO PUBLIC DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 18	DOCUMENTS ARE AVAILABLE UPON REQUEST.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	DOCUMENTS ARE AVAILABLE UPON REQUEST.
CHANGE IN FINANCIAL REVIEW PROCESS	FORM 990, PAGE 12, PART XII, LINE 2C	PROCESS HAS NOT CHANGED FROM THE PRIOR FISCAL YEAR.