Okmulgee Memorial Hospital Inc: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- Okmulgee Memorial Hospital Inc (EIN 73-1279909)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201433189349300323
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-14T07:28:20-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 NW Expressway | AddressLine1 |
| City | Oklahoma City | City |
| State | OK | State |
| ZIP Code | 73118 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 731279909 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Okmulgee Memorial Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OKMU | BusinessNameControlTxt |
| Phone | 9187564233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 Morris Drive | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 74447 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Sheridan Pickering | PersonNm |
| Person Title | Administrator | PersonTitleTxt |
| Phone | 9187564233 | PhoneNum |
| Signature | 2014-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carolyn Levings | PreparerPersonNm |
| PTIN | P01083874 | PTIN |
| Phone | 4054783334 | PhoneNum |
| Preparation | 2014-11-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Sheridan Pickering | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 Morris Drive | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 74447 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,188,782 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.creekhealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1967 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | Provide quality health care services | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 286 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,000 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,611,517 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,077,691 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,996 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,150,556 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $1,475 | CYOtherRevenueAmt |
| PY Total Revenue | $19,613,513 | PYTotalRevenueAmt |
| CY Total Revenue | $20,230,722 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,379,723 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,549,579 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,188,705 | PYOtherExpensesAmt |
| CY Other Expenses | $10,107,202 | CYOtherExpensesAmt |
| PY Total Expenses | $20,568,428 | PYTotalExpensesAmt |
| CY Total Expenses | $19,656,781 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$954,915 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $573,941 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,658,007 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,231,948 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$573,941 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Okmulgee Memorial Hospital's mission is to put our patients and customers first and to provide quality health care in an efficient manner. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $16,285,153 | ExpenseAmt |
| Revenue | $17,077,691 | RevenueAmt |
| Desc | Okmulgee Memorial Hospital, Inc. is a 66-bed acute care hospital located in Okmulgee, Oklahoma. It also operates a home health agency in the same geographic area. Emergency Care services are provided to the general public regardless of ability to pay.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $326,000 for the period and year ended December 30, 2013. Total direct and indirect costs related to these foregone charges were $132,000 for the period and year ended December 31, 2013, based on an average ratio of cost to gross charges. | Desc |
| Total Program Service Expenses | $16,285,153 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 286 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sheridan Pickering | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9187583102 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 Morris Drive | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 74447 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Nevyle Cable | ||||||||
| President | 1.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Fidler | ||||||||
| President-Elect | 1.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Greg Marriott | ||||||||
| Treasurer | 1.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Barbara Osborn | ||||||||
| Secretary | 1.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Kim Gage MD | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Linda Janzen | ||||||||
| Trustee | 1.00 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Walter McGown OD | ||||||||
| Trustee | 1.00 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Timothy Sanford DO | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Jason Winters | ||||||||
| Trustee | 1.00 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| George Miller-Mgmt Company | ||||||||
| CEO until August 2013 | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Roshanda Gray | ||||||||
| Interim CEO Aug-Dec 2013 | 40.00 | 0.00 | Yes (X) | $69,413 | $0 | $6,966 | ||
| Doran Hammett-Mgmt Company | ||||||||
| CFO | 40.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| Benjamin Kamp DO | ||||||||
| Surgeon | 40.00 | 0.00 | $180,634 | $0 | $9,969 | Yes (X) | ||
| Jason Bruce CRNA | ||||||||
| Nurse Anesthesiologist | 40.00 | 0.00 | $220,142 | $0 | $8,687 | Yes (X) | ||
| Brent Galloway MD | ||||||||
| Family Practitioner | 40.00 | 0.00 | $180,270 | $0 | $0 | Yes (X) | ||
| Ben Bradley | ||||||||
| Chief Nursing Officer | 40.00 | 0.00 | $134,922 | $0 | $0 | Yes (X) | ||
| Ahmad Masood MD | ||||||||
| Psychiatrist | 40.00 | 0.00 | $191,550 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $976,931 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $25,622 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Okmulgee Emergency PLCC | |||||
| 607 South Broadway | Coweta | OK | 74429 | Emergency Room Physician Services | $278,500 |
| Quorum Health Resources | |||||
| 105 Continental Pl | Brentwood | TN | 37027 | Management Services | $273,595 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36695 | Internet & Computer Serv. | $246,065 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,000 | AllOtherContributionsAmt |
| Total Contributions | $1,000 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $16,052,561 | $16,052,561 |
| EHR incentive | 900099 | $833,706 | $833,706 |
| Supporting revenue | 900099 | $78,919 | $78,919 |
| Dietary | 900099 | $65,572 | $65,572 |
| Maintenance/Janitorial | 561720 | $46,933 | $46,933 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,077,691 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $109 | TotalRevenueColumnAmt |
| Exclusion | $109 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,475 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,475 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,475 | TotalRevenueColumnAmt |
| Exclusion | $1,475 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,108,507 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$1,041,940 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,150,447 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,150,447 | TotalRevenueColumnAmt |
| Exclusion | $3,150,447 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,230,722 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,077,691 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,152,031 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,379 | TotalAmt |
| Management And General | $76,379 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,456,545 | TotalAmt |
| Program Services | $6,003,432 | ProgramServicesAmt |
| Management And General | $1,453,113 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,635 | TotalAmt |
| Program Services | $64,322 | ProgramServicesAmt |
| Management And General | $16,313 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,345,546 | TotalAmt |
| Program Services | $1,078,894 | ProgramServicesAmt |
| Management And General | $266,652 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $590,474 | TotalAmt |
| Program Services | $471,019 | ProgramServicesAmt |
| Management And General | $119,455 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,595 | TotalAmt |
| Management And General | $273,595 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,577 | TotalAmt |
| Management And General | $74,577 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,439 | TotalAmt |
| Management And General | $94,439 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,600,421 | TotalAmt |
| Program Services | $2,202,385 | ProgramServicesAmt |
| Management And General | $398,036 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $792,042 | TotalAmt |
| Program Services | $320,849 | ProgramServicesAmt |
| Management And General | $471,193 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,829 | TotalAmt |
| Management And General | $6,829 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $309,984 | TotalAmt |
| Program Services | $282,668 | ProgramServicesAmt |
| Management And General | $27,316 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,862 | TotalAmt |
| Program Services | $64,839 | ProgramServicesAmt |
| Management And General | $18,023 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,456 | TotalAmt |
| Program Services | $102,456 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $603,856 | TotalAmt |
| Program Services | $603,856 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $298,424 | TotalAmt |
| Program Services | $223,440 | ProgramServicesAmt |
| Management And General | $74,984 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad debt expense | $3,447,745 | $3,447,745 | |
| Medical supplies | $954,483 | $954,483 | |
| Government programs | $401,441 | $401,441 | |
| Dues & Subscriptions | $64,048 | $63,324 | $724 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,656,781 | TotalAmt |
| Program Services | $16,285,153 | ProgramServicesAmt |
| Management And General | $3,371,628 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,043 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,811,226 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $591,105 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $529,713 | BOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,709,920 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,658,007 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,317,478 | BOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,206 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,438,439 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $472,825 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,231,948 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$573,941 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$573,941 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,658,007 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $573,941 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,632,530 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$3,447,745 | OtherRevenueAmt |
| Revenue Not Reported | -$3,447,745 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,080,275 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,150,447 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,150,447 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $20,230,722 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,209,036 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $16,209,036 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,447,745 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,447,745 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $19,656,781 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital is organized as an Oklahoma nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Bad debt expense reported in revenue for the financial statements -3,447,745. |
| Part XI, Line 4b - Other Adjustments: | Gain on sale of Hospital included in revenue for Form 990 3,150,447. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense reported in revenue for the financial statements 3,447,745. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $132,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $132,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00810 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,807,072 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,327,974 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $479,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02960 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,939,072 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,327,974 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $611,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,939,072 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,327,974 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $611,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03770 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,447,745 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $29,995 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,331,163 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,792,078 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$460,915 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Okmulgee Memorial Hospital Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 Morris Drive | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 74447 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.creekhealth.org | WebsiteAddressTxt |
| State License | 2165 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Psych-16 Beds | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Okmulgee Memorial Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.creekhealth.org | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Okmulgee Memorial Hospital, Inc. | Part V, Section B, Line 3: A 17 question survey was distributed to persons within the City of Okmulgee water service. 522 completed surveys were returned to the Oklahoma County Wellness Coalition and analyzed by the Oklahoma State Department of Health. |
| Okmulgee Memorial Hospital, Inc. | Part V, Section B, Line 6i: Okmulgee Memorial Hospital did not formally complete an implementation strategy because the Hospital assets were purchased by Muscogee (Creek) Nation as of 12/31/2013. In 2014, the Hospital will no longer be required to comply with 501(r) as it no longer operates a hospital. The needs identified in the community health needs assessment were informally discussed and it was determined that other organizations in the community would be able to address the needs. |
| Okmulgee Memorial Hospital, Inc. | Part V, Section B, Line 7: No actions were taken as of December 31, 2013 on the needs identified in the community health needs assessment as the Hospital assets were purchased by Muscogee (Creek) Nation. The current entity will not be subject to 501(r) in 2014. The needs identified in the community health needs assessment were informally discussed and it was determined that other organizations in the community would be able to address the needs. |
| Okmulgee Memorial Hospital, Inc. | Part V, Section B, Line 14g: The financial assistance policy is available from the patient Financial Counselor and is also included on patient billing statements. Summary of financial assistance is available in the waiting rooms, emergency room, and outpatient areas of the Hospital. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OMH Home Health | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 Morris Drive | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 744476419 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Home health agency | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Patients may qualify for financial assistance at three different levels. Approval is contingent upon income, expenses, and documentation:1. Income and family size at or below 200% of the Federal Poverty Guidelines may qualify for 100% financial assistance.2. Income and family size at or below 250% but greater than 200% of the Federal Poverty Guidelines may qualify for 75% financial assistance, resulting in expectation that the patient will pay 25% of the charges for services rendered.3. Income and family size at or below 300% but greater than 250% of the Federal Poverty Guidelines may qualify for 50% financial assistance, resulting in expectation that the patient will pay 50% of the charges for services rendered.4. Income and family size greater than 300% of the Federal Poverty Guidelines will be denied financial assistance, unless and exception is granted by the CFO or CEO.Financial assistance may be extended when income is greater than described in the Federal Poverty Guidelines when there is a clear and overwhelming circumstance documented, i.e. catastrophic illness and/or event. This determination can only be made by the Chief Financial Officer or Chief Executive Officer. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $3,447,745. |
| Part III, Line 2: | Bad debt is determined by our bad debt policy considering actual patient care charges. Charges become bad debt once a reasonable opportunity has been made by the Hospital to collect an open account and the responsible party has been contacted regarding the unpaid balance. After policy based collection attempts have been exhausted, the account is written off to bad debt.All payments and contractual are applied to the account before it is written off to bad debt. If any payments are received for bad debts that have been written off, they are applied to the current year bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on an estimate of charges foregone to gross patient charges. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 7 of the attached audited financial statements. |
| Part III, Line 8: | Okmulgee Memorial Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.The costs associated with Medicare were taken from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | The Hospital has a charity care policy and patients must meet certain established criteria for charity service consistent with Okmulgee Memorial Hospital's mission. No collections actions are filed while an application is in review, any personal portion due after a determination of assistance would follow normal collections practices. |
| Part VI, Line 2: | The Oklahoma County Wellness Coalition conducted a Community Health Needs Assessment. The Okmulgee County Wellness Coalition was created in 2006 by a concerned group of individuals from four different agencies, Okmulgee County Health Department, Anne Moroney Youth Services, Okmulgee Memorial Hospital, and Area Prevention Resource Center, who were interested in improving the health status of Okmulgee County. Since then, the coalition has brought together a wide circle of community agencies and partners, coordinating efforts and resources to more effectively improve the wellness of the people of Okmulgee County.The purpose of the Community Health Needs Assessment was to understand the current needs and health status of Okmulgee County residents. Health problems reported were high blood pressure, dental problems, high cholesterol, arthritis, hearing/vision loss, stress/depression, diabetes, obesity, lung/respiratory disease and heart disease. The full needs assessment can be accessed at http://creekhealth.org/index.php/facilities/medical-centers. |
| Part VI, Line 3: | The Hospital uses an electronic program during admissions to determine if a patient is eligible for assistance. If a patient is determined to be eligible, then the patient is referred to a financial counselor. The financial counselor works with the patient to determine if the patient is eligible for Medicaid. If the patient is not eligible for Medicaid, the Hospital then works with the patient to determine if the patient is eligible for charity care. The Financial Counselor contact information is included in the patient billing statements if further assistance is needed. Summary of financial assistance is available in the waiting rooms, emergency room, and outpatient areas of the Hospital. |
| Part VI, Line 4: | Okmulgee Memorial Hospital is an acute care hospital located in Okmulgee, which is in Okmulgee County, Oklahoma. Okmulgee County is a federally underserved area according to the Health Resources and Services Administration. Okmulgee is a small community of about 13,000 residents. There are two other hospitals in the county with one about twenty miles from Okmulgee Memorial Hospital. The median household income is $35,615 and 19.2% of families and 21.4% of individuals of the population are below the poverty line. |
| Part VI, Line 5: | The Organization has a volunteer board comprised of members of the community. Medical staff privileges are extended to all qualified physicians in the community and to those who wish to render services at Okmulgee Memorial Hospital. Any surplus funds, if available, are reinvested in the facilities to improve patient care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Benjamin Kamp DO | ||||||||||||||
| Surgeon | $180,634 | $0 | $0 | $0 | $0 | $0 | $9,969 | $0 | $0 | $0 | $190,603 | $0 | $0 | $0 |
| Jason Bruce CRNA | ||||||||||||||
| Nurse Anesthesiologist | $220,142 | $0 | $0 | $0 | $0 | $0 | $8,687 | $0 | $0 | $0 | $228,829 | $0 | $0 | $0 |
| Brent Galloway MD | ||||||||||||||
| Family Practitioner | $180,270 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $180,270 | $0 | $0 | $0 |
| Ahmad Masood MD | ||||||||||||||
| Psychiatrist | $191,550 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $191,550 | $0 | $0 | $0 |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | Okmulgee Memorial Hospital, Inc. entered into an asset purchase agreement to sell all of the assets of the Hospital as of December 30, 2013 to the Muscogee (Creek) Nation. The Muscogee (Creek) Nation purchased the assets and assumed the debt and liabilities of the Hospital. | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2013-12-31 | DistributionDt |
| Fair Market Value Of Asset | -$1,041,940 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | The FMV is the book value of the assets at the time of the transfer. | MethodOfFMVDeterminationTxt |
| EIN | 731357965 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Muscogee (Creek) Nation | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Hwy 75 Loop 56 | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 74447 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | Government | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | Yes (1) | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | Yes (1) | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II, Line 2e: | FormAndLineReferenceDesc |
| Explanation | Person(s) Involved: Nevyle Cable, John Fidler, Greg Marriott, Barbara Osborn, Kim Gage, MD, Linda Janzen, Walter McGown, O.D., Timothy Sanford, D.O., and Jason Winters became the board members for the successor hospital, Muscogee (Creek) Nation Medical Center. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 3 | On December 30, 2013, Okmulgee Memorial Hospital Authority entered into an asset purchase agreement with Muskogee (Creek) Nation who purchased the assets and assumed the liabilities of the Hospital. Muskogee (Creek) Nation began operations of the Hospital December 31, 2013. |
| Form 990, Part VI, Section A, line 1 | Seven Directors serve on the Executive Committee of the Board. The Executive Committee consists of the President, Vice President and Treasurer of the Corporation and four other Directors. Two of the Directors selected by St. Francis Hospital, Inc. serve on the Executive Committee. The Board delegates full operational authority of the Corporation to the Executive Committee, subject to control and ratification by the Board. All elections and designations to the Executive Committee will be made at the annual meeting of the Board. The Executive Committee keeps regular minutes of its proceedings and reports the same to the Board. Elected members of the Executive Committee serve only until expiration of their term, or if succession is delayed, until their successors are duly elected and qualified. A quorum of the Executive Committee consists of not less than four members of the Executive Committee present in person. Less than a quorum may vote to adjourn the meeting until another time. At any meeting of the Executive Committee, a majority vote of its members present in person is required to pass any measure coming before the meeting. |
| Form 990, Part VI, Section A, line 3 | George Miller, CEO until August 2013, and Doran Hammett, CFO, are common law employees of Quorum Health Resources, an unrelated management company. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. George Miller was compensated $18,704 for services to Okmulgee Memorial Hospital, Inc. Doran Hammett was compensated $16,000 for services to Okmulgee Memorial Hospital. |
| Form 990, Part VI, Section A, line 7a | At least three Directors are selected by St. Francis Hospital, Inc. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared by an outside accounting firm and is reviewed internally by the CEO and the Finance Committee prior to filing with the IRS. The Board of Directors is also provided a copy prior to filing. |
| Form 990, Part VI, Section B, line 12c | The Organization has a conflict of interest policy which is applicable to all employees of Okmulgee Memorial Hospital. Once a potential conflict is identified, Compliance and administration determine the level and risk of the conflict. Depending on the severity of conflict an employee may be asked to refrain involvement. If there is a known conflict that is not disclosed by an employee, they will be subject to the disciplinary action policy. |
| Form 990, Part VI, Section B, line 15 | The Board of Directors reviews and approves salaries of top management positions, including the interim CEO, annually. Salary determination is based on comparability data from industry standards. During the period when Quorum Health Resources provided management services the CEO and CFO compensation was recommended by Quorum Health Resources and Board approved. The process and determination was documented in the Board minutes and management contract with Quorum Health Resources. |
| 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. |
| Form 990, Part IX, line 11g | Contract labor: Program service expenses 1,258,386. Management and general expenses 31,632. Fundraising expenses 0. Total expenses 1,290,018. Maintenance and repairs: Program service expenses 335,279. Management and general expenses 72,525. Fundraising expenses 0. Total expenses 407,804. Professional fees: Program service expenses 608,720. Management and general expenses 54,344. Fundraising expenses 0. Total expenses 663,064. Recruitment expense: Program service expenses 0. Management and general expenses 19,328. Fundraising expenses 0. Total expenses 19,328. Collection fees: Program service expenses 0. Management and general expenses 220,207. Fundraising expenses 0. Total expenses 220,207. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Okmulgee Medical Foundation Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1038 | AddressLine1 |
| City | Okmulgee | City |
| State | OK | State |
| ZIP Code | 74447 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 730766656 | EIN |
| Primary Activities | Support Okmulgee Memorial Hospital, Inc. | PrimaryActivitiesTxt |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | PF | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |