2013-05-14T08:38:12-05:00 2012-06-30 BKD LLP 6120 S Yale 1400 Tulsa OK 741364223 990 2011-07-01 731023826 SAYRE MEMORIAL HOSPITAL % SAYRE MEMORIAL HOSPITAL SAYR 5809285541 911 Hospital Drive SAYRE OK 73662 John Lampert 2013-05-13 true Anne M Adams 9185842900 2011 2016-02-25 16:41:14Z X John Lampert 911 Hospital Drive Sayre OK 73662 8569220 false X WWW.SAYREHOSPITAL.ORG X 1977 OK TO PROVIDE COST-EFFECTIVE, QUALITY MEDICAL CARE FOR SAYRE AND THE SURROUNDING COMMUNITIES IN ORDER TO ACHIEVE LIFE ENRICHMENT FOR THE COMMUNITY THROUGH LOCAL ACCESS TO QUALITY CARE. 6 6 226 12 0 0 421382 499160 9238646 7256878 39716 14395 122112 798787 9821856 8569220 0 5500 0 0 5419972 5171628 0 0 0 5184898 5798162 10604870 10975290 -783014 -2406070 20147160 17402154 13762956 13378847 6384204 4023307 TO PROVIDE COST-EFFECTIVE, QUALITY MEDICAL CARE FOR SAYRE AND THE SURROUNDING COMMUNITIES IN ORDER TO ACHIEVE LIFE ENRICHMENT FOR THE COMMUNITY THROUGH LOCAL ACCESS TO QUALITY CARE. false false 8412948 7256878 RURAL HOSPITAL PROVIDING MEDICAL CARE ON BOTH AN IN AND OUTPATIENT BASIS TO AREA RESIDENTS. CARE PROVIDED INCLUDES EMERGENCY, OBSTETRICS, SURGICAL AND PHYSICAL REHABILITATION. CARE IS PROVIDED REGARDLESS OF RACE, CREED, COLOR OR ABILITY TO PAY. 8412948 true true false true false false false false false false true false false false true false true false false false false false false false false false true true false true true false false false false false false true false false false false false false true false false false false true 40 0 true 226 true false false false false false false false false false false false false false X 6 6 false true false false true true false true true false false true true true true true true true true false OK X SAYRE MEMORIAL HOSPITAL 5809285541 911 HOSPITAL DRIVE SAYRE OK 73662 ROBERTA OLDFIELD 10.0 X X 0 0 0 ROBERT LAKEY 10.0 X LEON WILLSIE 10.0 X X KENNETH WHINERY MD 10.0 X GENE MOSES 10.0 X MICHAEL BLEVINS 10.0 X X WALLACE BOYD 40.0 X 108194 7221 BRENDA DOYEL 40.0 X 79629 5766 CAROLE JACKSON 40.0 X 69750 5328 MISTY CARTER 40.0 X 49366 2001 JIM GROCHOLSKI 40.0 X RON VESTAL 40.0 X 65211 4044 MICHAEL ROBINSON DO 40.0 X 171536 2000 TREVA GRAHAM MD 40.0 X 199805 969 JESSICA L KENNEMER 40.0 X 119574 5291 863065 0 32620 4 false true false CPSI PO BOX 850309 MOBILE AL 36685 COMPUTER SUPPORT 404912 NP Resources 11100 Kinsgate OKLAHOMA CITY OK 74170 ER COVERAGE 174728 CINCO NO NOMBRE 13985 COUNTY RD 1556 ADA OK 74820 DETOX PROGRAM 144000 NEWLIGHT HEALTHCARE LLC 1103 CORBETT RD MONKTON MD 21111 MGMT & INT CEO 139410 4 15765 479477 3918 499160 Net Patient Service Revenue 621300 7256878 7256878 7256878 14395 14395 0 0 0 0 0 0 Cafeteria 722210 41635 41635 Medical Records 900099 1186 1186 Other Related Income 900099 755966 755966 798787 8569220 8012844 57216 0 5500 5500 0 0 372231 259871 112360 0 4059475 2834105 1225370 0 388671 271349 117322 351251 245224 106027 124303 124303 0 120776 120776 0 0 0 207230 144677 62553 16586 11579 5007 71935 50300 21635 187736 131067 56669 0 359925 251280 108645 88366 61692 26674 0 0 858821 858821 0 1269164 1269164 204253 204253 Medical Purchased Services 925706 925706 Pharmacy 178912 178912 Medical Supplies 375755 375755 Repairs & Maintenance 232348 162213 70135 0 576346 375733 200613 10975290 8412948 2562342 0 251008 510651 1381587 2771 1511950 1406785 2770568 1931988 0 0 0 0 0 0 131966 153228 79876 74928 21465612 8591986 13617201 12873626 0 0 0 0 403004 448177 0 0 0 0 20147160 17402154 1114879 808528 0 0 33743 0 0 0 0 0 0 0 0 0 12614334 12414410 0 155909 13762956 13378847 X 4469250 2168345 1914954 1854962 0 0 6384204 4023307 20147160 17402154 X -2406070 45173 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 741 false false false 741 false 240902 240902 14441285 1887301 12553984 722905 472591 250314 4921669 3759753 1161916 14207116 0 DUE TO AFFILIATE 155909 155909 8569220 10975290 -2406070 -2406070 8554825 8554825 14395 14395 8569220 10975290 10975290 10975290 1 Schedule D, Part XII, Line 4b Investment Income $14,395. true true true X 300. true X true true true false false 3161 3161 0.00030 1116692 202075 914617 0.08330 1119853 202075 917778 0.08360 1119853 202075 917778 0.08360 false 1017399 2341646 3237728 -896082 X true true 1 1 SAYRE MEMORIAL HOSPITAL

911 HOSPITAL DRIVE SAYRE OK 73662

X X X MEDICARE DEPENDENT SAYRE MEMORIAL HOSPITAL 1 true true 300. true 300. true X X X true true X X true false X X true X X false true 1 SCHEDULE H, PART III, LINE 9B IF A PATIENT IS DETERMINED TO BE FINANCIAL INDIGENT, PATIENT FINANCIAL SERVICES WILL ASSIST THE PATIENT/GUARANTOR IN APPLYING FOR FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVALIABLE, THE HEATH CARE CENTER WILL REVIEW THE ACCOUNT FOR CHARITY ALLOWANCE. 2 SCHEDULE H, PART VI, LINE 2 SAYRE MEMORIAL HOSPITAL IS VERY INVOLVED IN EVERY ASPECT OF THE COMMUNITY AND THROUGH THAT INVOLVEMENT AND THE ANNUAL HEALTH FAIR THAT WE ARE ABLE TO PROVIDE FOR THE COMMUNITY, WE TAKE TIME TO LISTEN TO THE HEALTH CARE WANTS AND NEEDS OF OUR CITIZENS. WE UNDERSTAND THAT A GOOD SHARE OF OUR POPULATION IS ELDERLY AND THEY HAVE LIMITED MEANS OF TRAVEL TO A LARGE AREA FOR HEALTH CARE. THEREFORE, WE STRIVE TO PROVIDE A WIDE DIVERSITY OF SERVICES TO MEET AS MANY OF THEIR NEEDS LOCALLY AS WE ARE FISCALLY ABLE TO DO SO. 3 SCHEDULE H, PART VI, LINE 3 UNINSURED INVDIVIDUALS ARE PROVIDED COMPUTER ACCESS TO THE MEDICAID SYSTEM TO APPLY FOR ASSISTANCE AT THE TIME OF ADMISSION. WE ALSO PROVIDE A PATIENT ACCOUNT MANAGER WHO INFORMS THE PATIENT OF THE ORGANIZATION'S CHARITY CARE POLICY. 4 SCHEDULE H, PART VI, LINE 4 SAYRE MEMORIAL HOSPITAL PROVIDES CARE TO THE RURAL COMMUNITIES OF SAYRE, ERICK, CHEYENNE, SWEETWATER, CARTER, MANGUM, AND DELHI. OUR PATIENTS ARE 60% MEDICARE, 8% MEDICAID, 22% COMMERCIAL INSURANCE, AND 10% UNINSURED. 5 SCHEDULE H, PART VI, LINE 5 GOVERNING BOARD MEMBERSHIP IS OPEN TO ANYONE OVER THE AGE OF 18 YEARS WHO IS DULY ELECTED. ALL MEMBERS IN GOOD STANDING ARE ENTITLED TO ONE VOTE IN ANY REGULAR OR SPECIAL MEETING AND TO EXERCISE ALL OTHER PRIVILEGES OF MEMBERSHIP. THE MEMBER HAVE THE POWER, BY MAJORIY VOTE, AT REGULAR, SPECIAL CALLED, OR ANNUAL MEETINGS, TO REMOVE ANY DIRECTOR OR OFFICER FROM OFFICE. THERE IS AN ANNUAL MEETING HELD TO ELECT THE BOARD OF DIRECTORS AND OFFICERS AND TO TRANSACT ANY BUSINESS THAT MAY COME BEFORE THE MEETING. OUR MEDICAL STAFF IS OPEN TO ANY LICENSED PHYSICIAN. USE OF SURPLUS FUNDS ARE INVESTED BACK INTO THE HOSPITAL FOR FURTHER CONTINUATION OF SERVICE. 6 Schedule H, Part V, Section B, Line 19d Max charge equals 60% of gross charges (40% discount). 7 Schedule H, Part V, Line 21 Gross charges are identical for FAP-eligible patients vs. non-FAP eligible patients. Once an FAP-eligible patient is determined to meet the criteria for financial assistance, the discounts are then applied. true Nursing Scholarship 1 5500 1 Schedule I, Part IV The organization gave nursing scholarships during the fiscal year. X false false false false false false false false false MICHAEL ROBINSON DO 171536 0 0 0 0 171536 0 TREVA GRAHAM MD 199805 0 0 0 0 199805 0 DON DOYEL RELATIVE OF BRENDA DOYEL 42448 EMPLOYMENT false 1 Form 990, Part VI, Lines 6 and 7a Membership is open to any person over the age of 18 years who is duly elected. All members in good standing are entitled to one vote in any regular or special meeting, and to exercise all other privileges of membership. The members have the power, by a majority vote, at any regular, special called, or annual meeting, to remove any director or officer from office. There is an annual meeting held to elect the Board of Directors and officers and to transact any business that may come before the meeting. 2 Form 990, Part VI, Line 10 The Board of Directors will review the Form 990 prior to filing the return with the IRS. The review will be documented in the board minutes. 3 Form 990, Part VI, Line 12c Officers and trustees are required to disclose annually interests that could give rise to conflicts. 4 Form 990, Part VI, Line 15 The CEO is not an employee of the organization and is compensated by an unrelated organization. The CFO's compensation is reviewed and approved by the board. 5 Form 990, Part VI, Line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. 6 Form 990, Part XI, Line 5 CHANGE IN NET ASSETS OF FOUNDATION $45,173 SAYRE MEMORIAL HOSPITAL FOUNDATION 911 HOSPITAL DR SAYRE OK 73662 320177689 SUPPORT HOSP. OK 501(C)(3) 9 NA false false false true false false false false false false false false false false false false false false