2013-04-26T15:00:18-05:00 2012-06-30 450250958 EIDE BAILLY LLP 1601 NW EXPRESSWAY SUITE 1900 OKLAHOMA CITY OK 73118 990 2011-07-01 736617937 McCurtain Memorial Medical Management Inc MCCU 5802867623 1301 East Lincoln Rd Idabel OK 74745 Ray Whitmore 5802867623 2013-04-23 1 Carolyn Levings P01083874 4054783334 2013-04-23 2011 2016-02-25 16:41:14Z Ray B Whitmore Jr 1301 East Lincoln Rd Idabel OK 74745 22929042 0 X www.mmhok.com X 1975 OK Hospital care 7 6 342 34 0 0 978542 1898261 21587861 20964928 -83156 9865 66346 55679 22549593 22928733 1029 2035 0 0 11661828 12388200 0 0 0 11312479 10398155 22975336 22788390 -425743 140343 6974617 8306037 3820661 5011738 3153956 3294299 X McCurtain Memorial Hospital exists to provide appropriate, cost effective healthcare to our patients in a safe, healing environment while striving to be the healthcare leader of choice in our community. 1 0 20819336 20935825 We continue to provide quality health care to McCurtain County, Oklahoma and its surrounding areas. In addition, we endeavor to serve the public through such activities as wellness programs, community education programs, special programs for the elderly, handicapped and medically underserved and a variety of broad community support activities. To fulfill our mission of community service, we provide care to patients who meet certain criteria under our charity care policy without charge or at amounts less than our established rates. We maintain records to identify and monitor the level of charity care we provide. These records include the amount of charges foregone for services and supplies furnished under our charity care policy and equivalent service statistics. The amount of charges forgone, based on established rates were approximately $383,000 for the year ended June 30, 2012. 87518 29103 The Wellness Center is an exercise area that community members can subscribe to and use the exercise equipment as well as receive personal training and wellness assessments on a regular basis. There are personnel available to assist them. This program is available to community members in order to help advocate healthy lifestyles in addition to the walking track. Expenses include the cost of depreciation for equipment. 24437 The Garden Meadows Walking Trail located at the Hospital is open to the public, in addition to employees, 24 hours a day, 7 days a week at no charge and is intended to promote physical activity for healthier lifestyles. Hospital expense to maintain the walking track includes water, electricity, and depreciation. 20931291 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 60 0 1 342 1 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 0 0 OK X Ray B Whitmore Jr 5802083104 1301 E Lincoln Rd Idabel OK 74745 Billie Tomlinson 1.00 X X 0 0 0 Thomas Salyer DO 1.00 X X 650 0 0 Irvin C Jones 1.00 X X 0 0 0 Desmond Brown 1.00 X 0 0 0 David White 1.00 X 0 0 0 Robert P Hossenlopp 2.00 X 0 0 0 Nancy Woodruff MD 1.00 X 12600 0 0 George Freeman DO 1.00 X 0 0 0 Bristol Messer 40.00 X 171809 0 19981 Ray B Whitmore Jr 40.00 X 89079 0 18026 Jeffrey Martin 40.00 X 298979 0 13431 Raymond Smith 40.00 X 394904 0 15950 John Oglesbee 40.00 X 196204 0 15726 Michael West 40.00 X 107692 0 0 1271917 0 83114 5 0 1 0 Emcare Inc 7032 Collections Center Dr Chicago IL 60693 ER Physicians 211166 Reimbursement Technologies 1000 River Road Suite 100 Conshohocken PA 19428 ER Billing Service 181228 Delta Healthcare PO Box 202940 Dallas TX 75234 Physician Recruitment 140250 Jeff McIlroy 224 Deer Valley Dr Catoosa OK 74015 Psychiatric Physician 117450 4 1228755 669506 1898261 Net Patient Serv. Rev 900099 20930511 20930511 Other Revenue 900099 34417 34417 20964928 6212 6212 55679 0 55679 55679 55679 3962 309 3653 3653 3653 22928733 20964928 0 65544 2035 2035 331655 1247 330408 10306704 9773791 532913 71978 68123 3855 935247 725979 209268 742616 556962 185654 8364 8364 39938 39938 1902636 1700471 202165 25081 21193 3888 753866 704476 49390 690500 684758 5742 70938 66221 4717 69985 69985 979996 734997 244999 1060031 1060031 Bad Debt Expense 2502151 2502151 Medical Supplies 1794850 1794850 Miscellaneous 277476 241678 35798 Physician Recruitment 222343 222343 22788390 20931291 1857099 0 309797 375583 2353823 2554810 122500 122500 238320 191486 401683 402712 247632 305336 17224813 13858726 3235873 3366087 64989 987523 6974617 8306037 2513817 3785296 1011973 947528 294871 278914 3820661 5011738 X 3153956 3294299 3153956 3294299 6974617 8306037 140343 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 37450 37450 8383997 6642178 1741819 334350 260314 74036 7953851 6956234 997617 515165 515165 3366087 Bond Origination Costs, Net 2173 Advances to Related Party 57637 Malpractice Insurance Receivable 927713 987523 Due to Third-Party Payor 278914 278914 22928733 22788390 140343 140343 22277477 0 22277477 651256 651256 22928733 22788390 0 22788390 0 22788390 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 XII, Line 4b - Other Adjustments: Capital Transfers Stated Separately on Financial Statements 549,187. Capital Contributions Stated Separately on Financial Statements 102,069. 1 1 X 1 X 1 X 1 1 1 0 0 185000 35636 149364 0.00740 185000 35636 149364 0.00740 112198 29103 83095 0.00410 7476 1876 5600 0.00030 2179 2179 0.00010 121853 30979 90874 0.00450 306853 66615 240238 0.01190 1042 1042 0.00010 2849 2849 0.00010 882 882 0.00000 334 334 0.00000 273827 273827 0.01350 278934 278934 0.01370 2502151 625538 7923600 7771342 152258 X 1 1 1 1 McCurtain Memorial Medical Management

1301 East Lincoln Rd Idabel OK 74745

X X X McCurtain Memorial Medical ManagmentInc 1 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 7 Idabel Primary Care Clinic

1425 E Lincoln Road Suite B-4 Idabel OK 74745

Physician Clinic Memorial North Health Center

510 South Park Drive Broken Bow OK 74728

Physician Clinic McCurtain Memorial Home Health

1301 E Lincoln Road Idabel OK 74745

Home Health office on Hospital premises Southeast Oklahoma Surgical Services

1425 E Lincoln Road Suite A-6 Idabel OK 74745

Physician Clinic MedFast

1425 E Lincoln Road Suite B-2 Idabel OK 74745

Walk-in Clinic staffed with Nurse Practitioners Southeast Regional Psychiatric Services

1425 E Lincoln Road Suite A Idabel OK 74745

Physician Clinic Women and Health Clinic

1401 S Lynn lane Idabel OK 74745

Physician Clinic Part I, Line 7: Charity care at cost on line 7a was calculated based on an overall cost-to-charge ratio addressing all patient segments. Amounts on line 7e, 7f and 7i were determined based on actual costs from the general ledger. Part I, L7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $2,502,151. Part II: The Hospital is a member of the Chambers of Commerce and Main Street programs in the communities of its service area which promote community and economic development. The Hospital actively recruits physicians and Allied Health professionals (nurse practitioners) to serve the citizens of its service area and increase the availability of providers. The Hospital is also involved in helping to prevent domestic violence in its community by providing leadership and participation to the McCurtain County Child Abuse Awareness Team as well as the Domestic Violence Task Force. In addition, the Hospital also participates in the McCurtain County Coalition for Change Program - Turning Point. Part III, Line 4: Accounts are not written off to bad debt until all payments, discounts and contractual allowances are applied and internal collection efforts have been exhausted. When a payment is received on an account previously written off to bad debt, the payment reduces the current year's bad debt expense.The amount of bad debt estimated to be attributable to patients under the organization's charity care policy is determined by using the percentage of the population in the service area that is under the federal poverty guideline established for charity care.Footnote from Financial Statements: The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients and third-party 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 the aging analysis in determining the estimated bad debt provision. Part III, Line 8: Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported 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: Self-pay patients are notified of the Financial Assistance Program upon registration during face-to-face interviews if at all possible. First time billing statements will be mailed to the responsible party of all self-pay patients within approximately 15 days of discharge. The message on this statement indicates the patient may be eligible for a discount and provides information on applying for discounts. If eligibility is established, the discounted amount is written off as charity care and no further collection will occur. If the individual does not provide the required information or the application is denied, normal collection procedures will commence. The Hospital is currently in the process of codifying its policies for compliance with new 501(r) requirements. McCurtain Memorial Medical Managment,Inc Part V, Section B, Line 13g: The Hospital posts its charity care policy summary with financial assistance contact information in the financial services office. Summary information is also printed in pamphlets provided in the ER waiting room. Financial Assistance information is provided in "first-time" statements of patient bills. The entire Financial Assistance Policy is available upon request. Part VI, Line 2: The Hospital holds an annual Strategic Planning Meeting in which the needs of the community are evaluated with an environmental assessment identifying internal and external issues that affect the organization and its ability to meet the needs of the community it serves. Part VI, Line 3: The Hospital posts its charity care policy summary with financial assistance contact information in the financial services office. Information is also printed in pamphlets provided in the ER waiting room. Financial Assistance guidance and information is provided to patients upon completion of medical evaluation and screening at which time potentially eligible patients are counseled by Financial Services. Financial Assistance information is not provided with discharge materials. Financial Assistance information is provided in "first-time" statements of patient bills. Financial Services counsels all patients who are potentially eligible for financial assistance by providing guidance in applying for assistance through federal, state and county programs. Part VI, Line 4: McCurtain Memorial Hospital is the only hospital located in McCurtain County, which is the 3rd largest county in the state. The entire county is designated as a Medically Underserved Area with portions of the county designated as Health Professional Shortage Areas due to geographical area, census tracts, and/or a Native American tribal population. According to 2010 census files of the U.S. Census Bureau, families below poverty level from 2007-2011 represent approximately 27.6% of the county's population in comparison to 16.3% for the State of Oklahoma. Approximately 30% of the people in McCurtain County are covered by Medicaid and the unemployment rate usually ranks in the top five of the state. The primary service area is approximately a 35-mile radius around Idabel. The 2010 US Census Bureau population count for McCurtain County is 33,151. With the exception of McCurtain Memorial Hospital there are no other major hospitals located within the county. McCurtain County has major employers such as Weyerhaeuser (now International Paper, IP), Tyson Foods, Hagale Industries, Huber Paper, Georgia Pacific and Pan Pacific Products. Unemployment rates in McCurtain County have improved during the second quarter of 2012, however, the county continues to have one of the highest unemployment rates in the state at 8.5%, well above the state rate of 4.7% as of June 2012. Part VI, Line 5: The McCurtain Memorial Hospital Board of Directors is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization, nor family members thereof. Five of the board members are non-physician and two members are physicians on the medical staff of the hospital.The Hospital extends medical staff privileges to all qualified physicians in its community for all of its departments. The Hospital applies surplus funds to improvements in patient care and medical education. The Hospital continuously evaluates and monitors quality control initiatives. The hospital's emergency room is available to all regardless of ability to pay. Continuing education and seminars are provided to personnel on a regular basis including EKG monitoring classes, Venous Thrombo-embolism Prevention and Prophylaxis, ACLS, PALS, CPI, CPR, Medicare Workshops, Credentialing Updates in addition to allowances provided to employed physicians and CRNA for continuing medical education workshops and seminars. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Bristol Messer 162534 0 0 0 9275 0 4255 0 16025 0 192089 0 0 0 Jeffrey Martin 298979 0 0 0 0 0 6125 0 7903 0 313007 0 0 0 Raymond Smith 394904 0 0 0 0 0 0 0 15990 0 410894 0 0 0 John Oglesbee 196204 0 0 0 0 0 0 0 15726 0 211930 0 0 0 Part I, Line 1a Rent and utilities paid by hospital for housing of CEO that is not on the business premises. However, beginning in FY2012, payment for these expenses were withheld from CEO salary through payroll deduction. As of end of fiscal year, June 30, 2012, CEO no longer resides in Hospital paid premises. Part I, Line 1b The board approved such expenditures at the beginning of the CEO's employment with the hospital and the hospital has continued to pay for those expenses since that time. However, beginning in FY2012, payment for these expenses were withheld from CEO salary through payroll deduction. As of end of fiscal year, June 30, 2012, CEO no longer resides in Hospital paid premises. Good Honest Medicine - Michael West agreement to pay physician recruitment fees for physician practice X 122500 122500 1 1 1 122500 New Program Services Form 990, Part III, line 2 Southeast Oklahoma Surgical Services reopened September 19, 2011 with addition of surgeon to medical staff. Southeast Regional Psychiatric Services reopened May 21, 2012 with addition of nurse practitioner to medical staff. Women's and Health Clinic opened June 1, 2012 Wound Care Clinic opened week of July 18, 2011. Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO prior to filing and is also presented to the Board of Directors as available for review at last board meeting prior to filing deadline. If Form 990 is available in electronic format prior to meeting date, it may be emailed to board members for comments prior to board meeting date. Form 990, Part VI, Section B, line 12c All officers, directors, and key employees fill out a conflict of interest disclosure annually. The disclosure forms are reviewed initially by the CEO and CFO for potential conflicts. Any actual conflicts are reviewed by the Board of Directors. A person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15a The CEO compensation is determined by the Board of Directors based on comparability data and an annual evaluation. The CFO compensation is determined by the CEO based on an annual evaluation. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19: These documents are available upon request during normal business hours. McCurtain Memorial Hospital Foundation 1301 Lincoln Rd Idabel OK 74745 731455422 Fundraising OK 501(C)(3) 11a N/A 0 0 0 1 0 1 0 0 0 0 1 0 1 1 1 0 1 0 0 McCurtain Memorial Hospital Foundation J 134400 Book McCurtain Memorial Hospital Foundation J 54544 Book McCurtain Memorial Hospital Foundation E 200000 Book