2013-05-08T13:49:41-05:00 2012-06-30 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2011-07-01 730579295 FARMERS UNION HOSPITAL ASSOCIATION D/B/A GREAT PLAINS REGIONAL MEDICAL CTR FARM 5802252511 1801 WEST THIRD LINCOLN BOX 2339 ELK CITY OK 73648 DON IKNER CEO 5802252511 2013-05-08 1 JONATHAN PHILLIPS P01605460 8067911591 2011 2016-02-25 16:41:14Z GREAT PLAINS REGIONAL MEDICAL CENTER DON IKNER 1801 WEST THIRD LINCOLN BOX 2339 ELK CITY OK 73648 41146854 0 X WWW.GPRMC-OK.COM X 1929 OK PROVIDE QUALITY HEALTHCARE 10 8 519 40 0 0 200000 125685 46521230 39896507 422971 510321 295114 379718 47439315 40912231 1225 140 0 0 20709914 20599036 0 0 0 29442121 23834528 50153260 44433704 -2713945 -3521473 98650598 94318349 41061161 40250385 57589437 54067964 X GREAT PLAINS REGIONAL MEDICAL CENTER WILL DISTINGUISH ITSELF AS THE LEADER IN WESTERN OKLAHOMA & EASTERN TEXAS PANHANDLE FOR COMPREHENSIVE, COST EFFECTIVE, HIGH-QUALITY HEALTHCARE. WE WILL MEET THE HEALTHCARE NEEDS OF PATIENTS IN OUR SERVICE AREA WHILE ACHIEVING COST EFFECTIVE, QUALITY OUTCOMES. WE WILL MAINTAIN AND ENHANCE COLLABORATIVE RELATIONSHIPS WITH PHYSICIANS TO BETTER SERVE THE HEALTHCARE NEEDS OF OUR SERVICE AREA. WE WILL MAINTAIN AND CONTINUALLY ENHANCE HEALTH PROMOTION, PATIENT EDUCATION AND DISEASE PREVENTION FOR PATIENTS IN OUR SERVICE AREA. 0 0 39622557 39896507 FARMERS UNION HOSPITAL ASSOCIATION DBA. GREAT PLAINS REGIONAL MEDICAL CENTER IN ELK CITY, OKLAHOMA (HEREINAFTER REFERRED TO AS GPRMC) PROVIDES QUALITY HEALTH CARE REGARDLESS OF RACE, RELIGION, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF GPRMC, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING THIS HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT BELOW COST, AND HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHETHER THE NEED AND/OR INDIVIDUALS INABILITY TO PAY COEXISTS. THESE ACTIVITIES INCLUDED WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS,SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, & MEDICALLY UNDER-SERVED, AND OTHER BROAD COMMUNITY SUPPORT ACTIVITIES.GPRMC SERVED OVER 2,348 PATIENTS WITH MORE THAN 8,482 PATIENT DAYS ON AN INPATIENT BASIS. WE ALSO HAD OVER 58,150 OUTPATIENT ENCOUNTERS WITH PATIENTS DURING THE YEAR. WE TREATED 11,942 PATIENTS IN THE EMERGENCY DEPARTMENT. OUR SURGICAL TEAMS PERFORMED 3,476 SURGERIES DURING THE YEAR.GPRMC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL AND OTHER PROGRAMS AS PART OF ITS MISSION TO THE COMMUNITY. THESE PROGRAMS MAY NOT PAY FULL CHARGES. TO THE EXTENT REIMBURSEMENT IS BELOW FULL CHARGES, GPRMC RECOGNIZES THESE AMOUNTS AS CONTRACTUAL ADJUSTMENTS IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. ALSO, IN RECOGNIZING ITS MISSION TO THE COMMUNITY, GPRMC PROVIDES SERVICES FOR THOSE UNABLE TO PAY. ADDITIONALLY, GPRMC HAS PROVIDED SERVICES TO OTHERS WHO ARE EITHER UNWILLING OR UNABLE TO QUALIFY FOR CHARITY CARE GUIDELINES BUT WHO ARE STILL UNABLE TO PAY. COMMUNITY BENEFIT IS ALSO PROVIDED BY GPRMC BY ITS PROVIDING REDUCED PRICE SERVICES, FREE PROGRAMS OFFERED THROUGHOUT THE YEAR, AND INITIATIVES WHICH GPRMC BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. SEE SCHEDULE H FOR MORE INFORMATION REGARDING THESE ACTIVITIES. 39622557 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 585 0 1 519 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OK X JANET MILLER EXECUTIVE ASSISTANT 5808215302 PO BOX 2339 ELK CITY OK 73648 DANNY L SPROWLS CPA 2.00 X 0 0 0 PAUL KUMPF 2.00 X 0 0 0 EDWARD ALBERT 2.00 X 0 0 0 J COFFEY MD 2.00 X 0 0 0 BILL GWARTNEY 2.00 X 0 0 0 JACK MORRISON DDS 2.00 X 0 0 0 GENE SMITH 2.00 X 0 0 0 EMORY THOMAS 2.00 X 0 0 0 EDDIE MOORE 2.00 X 0 0 0 DAVID BANK MD 2.00 X 0 0 0 CRAIG PHELPS MD 2.00 X 47150 0 0 SCOTT WILLIAMS DO 40.00 X 10500 0 0 ROY IKNER 40.00 X 299305 0 928 STEVE STEWART 40.00 X 0 0 0 RICHARD H HOGAN 40.00 X 109158 0 0 LAURA L KURZENDOERFER 40.00 X 178862 0 0 HETLEVIA R VILAR-JENSEN MD 40.00 X 176857 0 0 LELAND W DENNIS MD 40.00 X 175780 0 0 LINDSAY J PENA MD 40.00 X 121204 0 0 FRANCIS ABRAHAM MD 40.00 X 358173 0 754 HUGH M LEAVENS MD 40.00 X 441618 0 0 PREMAL A KHETIA MD 40.00 X 135820 0 0 2054427 0 1682 9 0 1 0 EM CARE PHYSICIAN SERVICES INC 13737 NOEL ROAD SUITE 1600 DALLAS TX 75240 PHYSICIAN ER COVERAGE 1244956 RAYS ILLUMINATE 10901 W TOLLER DR SUITE 105 LITTLETON CO 80127 RADIOLOGIST COVERAGE 797271 HOSPITAL CARE CONSULTANTS INC 17304 PRESTON ROAD SUITE 510 DALLAS TX 75252 HOSPITALIST 578400 WATERSTONE BENEFIT ADMINISTRATORS 4013 NORTHWEST EXPRESSWAY SUITE 575 OKLAHOMA CITY OK 73116 INSURANCE MANAGEMENT 474981 WEATHERBY LOCUMS INC 6451 N FEDERAL HIGHWAY SUITE 800 FORT LAUDERDALE FL 33308 ORTHOPEDIC SURGEON COVERAGE 421505 12 875 100000 18042 6768 125685 NET PATIENT REVENUE 621990 37680038 37680038 MEDICAID INCENTIVE PAY 900099 1487207 1487207 CAFETERIA SALES 900099 446163 446163 OTHER SERVICE REVENUE 900099 140310 140310 DAYCARE CENTER REVENUE 900099 136114 136114 6675 6675 39896507 449735 449735 110618 110618 269100 0 269100 269100 269100 295209 232000 2623 63209 -2623 60586 60586 0 875 0 0 40912231 39896507 0 890039 140 140 691676 191325 500351 15387515 14603016 784499 3401714 3401714 1118131 1040444 77687 157627 157627 280429 280429 51945 51945 94936 89499 5437 105337 92873 12464 147243 147243 74074 74074 88863 82040 6823 110800 72485 38315 1914898 18625 1896273 4997852 4991959 5893 470034 470034 SUPPLIES EXPENSE 5975457 5940841 34616 CONTRACT SERVICES 4787941 4602501 185440 MISCELLANEOUS 1398861 695924 702937 LEASE/RENT EXPENSE 1264945 1263669 1276 1913286 1844151 69135 44433704 39622557 4811147 0 2834447 2045847 17830740 15783589 8467650 8665632 1348231 1184656 786762 537495 83735945 26224735 61499689 57511210 4255347 6692976 1627732 1896944 98650598 94318349 2236103 2318299 37895000 37130000 930058 802086 41061161 40250385 X 57589437 54067964 57589437 54067964 98650598 94318349 -3521473 0 X X 1 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 748759 748759 59269955 10960588 48309367 1690799 551321 1139478 21948646 14712826 7235820 77786 77786 57511210 INVESTMENT IN JOINT VENTURE 368145 C INVESTMENT IN HEARTLAND HEALTHCARE RRG 476835 C BOND FUND 722673 C RESERVE FUND 2665038 C LONG TERM INVESTMENTS 2460285 C 6692976 40912231 44433704 -3521473 -3521473 40820428 0 40820428 91803 91803 40912231 44316833 0 44316833 116871 116871 44433704 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL EVALUATES AND ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (FORMERLY FASB INTERPRETATION 48 (FIN 48) ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES). THIS STANDARD REQUIRES CERTAIN DISCLOSURES ABOUT UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL EVALUATES ANY UNCERTAIN TAX POSITIONS USING THE PROVISIONS OF ASC 450, CONTINGENCIES. AS A RESULT, MANAGEMENT DOES NOT BELIEVE THAT ANY UNCERTAIN TAX POSITIONS CURRENTLY EXIST AND NO LOSS CONTINGENCY HAS BEEN RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS FILED ALL APPLICABLE TAX RETURNS. PART XII, LINE 4B - OTHER ADJUSTMENTS: NONCONTROLLING INTEREST IN JOINT VENTURE 91,803. PART XIII, LINE 4B - OTHER ADJUSTMENTS: NONCONTROLLING INTEREST IN JOINT VENTURE 116,871. 1 1 X 1 X 0 1 1 0 0 311580 311580 0.00700 4966800 3989910 976890 0.02200 5278380 3989910 1288470 0.02900 18880 18880 0.00040 81889 81889 0.00180 140 140 0.00000 100909 100909 0.00220 5379289 3989910 1389379 0.03120 259 259 0.00000 12258 12258 0.00030 668403 668403 0.01500 680920 680920 0.01530 0 2314520 311580 9497509 9645765 -148256 X 1 1 1 PLAINS DIAGNOSTIC IMAGING LLC EQUIPMENT RENTAL 0.79490 0.20510 1 1 GREAT PLAINS REGIONAL MEDICAL CENTER

PO BOX 2339 1801 W THIRD ELK CITY OK 73648

X X X GREAT PLAINS REGIONAL MEDICAL CENTER 1 0 1 1 200.000000000000 0 1 X X X X X X X 1 0 1 X 1 X X X X X 1 X 0 0 PART I, LINE 7: AMOUNTS ON LINE 7A AND 7B WERE CALCULATED USING THE COST TO CHARGE RATIO IN IRS WORKSHEET 2. AMOUNTS ON LINES 7E, F, AND I ARE BASED ON ACTUAL COST RECORDED IN THE GENERAL LEDGER AND HOURS AT AVERAGE RATES. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE COMMUNITY BENEFIT PERCENTAGE WAS $6,444,337. PART II: GPRMC PROVIDES COMMUNITY BUILDING ACTIVITIES WITHIN THE COMMUNITY, BUT HAS NOT TRACKED THE EXPENSES RELATED TO THESE ACTIVITIES. THE HOSPITAL PROVIDES SUPPORT TO THE COMMUNITY IN THE FOLLOWING WAYS:-GPRMC EMPLOYEES PROVIDE MANY HOURS OF VOLUNTEER SERVICE TO CIVIC AND OTHER COMMUNITY BENEFIT CLUBS IN THE AREA. WE PROVIDE VARIOUS DONATIONS TO THESE CLUBS, LOCAL SCHOOL SYSTEMS, AND VARIOUS NON-PROFIT FOUNDATIONS & ORGANIZATIONS.-AWARE OF THE SHORTAGE OF PHYSICIANS IN THE ELK CITY AREA, GPRMC HAS WORKED DILIGENTLY TO ATTRACT ADDITIONAL PHYSICIANS TO THE COMMUNITY. THESE PHYSICIANS RANGE FROM FAMILY PRACTICE TO A VARIETY OF SPECIALTY AREAS. PATIENTS WILL BE ABLE TO ACCESS THEIR HEALTHCARE NEEDS LOCALLY INSTEAD OF DRIVING GREAT DISTANCES TO SEE A SPECIALIST.-GPRMC INVOLVEMENT IN COMMUNITY BUILDING ACTIVITIES ALSO EXTENDS THROUGH OTHER PROGRAMS SUCH AS MEALS ON WHEELS WHICH DELIVERS MEALS TO THE HOMEBOUND; DONATING ATHLETIC TRAINER SERVICES TO LOCAL SCHOOLS; AND WORKING WITH THE LOCAL FOODBANK.-GPRMC HAS A SHUTTLE SERVICE FOR PATIENTS WITHOUT TRANSPORTATION TO THE PHYSICIAN'S OFFICES, CLINICS AND THE HOSPITAL. THE FREE SHUTTLE TRAVELS IN ELK CITY AND AREA COMMUNITIES.-GPRMC IS COMMITTED TO COALITION BUILDING THROUGH THE MARCH OF DIMES PROGRAM. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE EXPENSE REPORTED ON THE FINANCIAL STATEMENTS AND APPLYING AN OVERALL COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2. BAD DEBT EXPENSE IS REPORTED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS. ALL DISCOUNTS AND PAYMENTS ARE APPLIED BEFORE WRITTEN OFF TO BAD DEBT. A PAYMENT ON AN ACCOUNT THAT WAS PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED BY APPLYING A PERCENTAGE OF THE POPULATION BELOW FEDERAL POVERTY GUIDELINES TO BAD DEBT AT COST.FINANCIAL STATEMENT FOOTNOTE: THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENTS BEST 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 HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. PART III, LINE 8: GPRMC PROVIDES SERVICES TO MEDICARE PATIENTS UNDERSTANDING THERE WILL BE WRITE-OFFS AND KNOWING THE ORGANIZATION WILL NOT RECOVER THE COSTS OF THE SERVICES PROVIDED. PROVIDING THESE SERVICES IS ESSENTIAL TO THE COMMUNITY AND THEREFORE INCREASES ACCESS TO HEALTHCARE SERVICES, WHICH IS A COMMUNITY BENEFIT.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. PART III, LINE 9B: THE PATIENTS ARE PRE-SCREENED PRIOR TO TESTING FOR CHARITABLE SERVICES AND A DETERMINATION IS MADE AS TO THE FINANCIAL ABILITY TO PAY. IF PATIENTS ARE PRE-QUALIFIED FOR SERVICES, THE COLLECTION PROCESS IS CEASED. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11H: PATIENTS, THEIR FAMILIES, OR THEIR REPRESENTATIVES MUST REQUEST CHARITY CARE AND COMPLETE THE APPLICATION WITHIN SIXTY (60) DAYS AFTER BEING DENIED COVERAGE DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID OR ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT. APPLICATIONS SUBMITTED MUST INCLUDE PROOF OF INCOME BY INCLUDING A PERSONAL FINANCIAL STATEMENT, PREVIOUS YEAR'S TAX RETURN, RELEASE OF INFORMATION FROM EMPLOYERS, AND CHECK STUBS FROM THE EMPLOYER. ADDITIONALLY, THE HOSPITAL PROVIDES A 35% DISCOUNT TO ALL SELF-PAY (NO INSURANCE) PATIENTS. THERE IS AN ASSET TEST TO QUALIFY FOR CHARITY CARE. HOUSEHOLD RESOURCES ARE DETERMINED BY THE GUIDELINES SET FORTH BY THE DEPARTMENT OF HUMAN SERVICES. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 15E: DURING THIS YEAR, THE ORGANIZATION'S POLICY WAS TO PROVIDE A 100% DISCOUNT TO QUALIFIED PATIENTS UNDER THE CHARITY CARE POLICY. BECAUSE OF THIS DISCOUNT, AFTER A PATIENT HAS BEEN FOUND TO MEET THE CRITERIA FOR CHARITY CARE NO OTHER COLLECTION ACTIONS ARE REQUIRED. NO OTHER FINANCIAL ASSISTANCE POLICY EXISTED. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16E: AS EXPLAINED IN PART V, LINE 15E THE ORGANIZATION APPROVED A 100% DISCOUNT FOR QUALIFIED CHARITY CARE PATIENTS. APPLICANTS HAVE SIXTY (60) DAYS AFTER BEING DENIED COVERAGE DUE TO PROGRAM ELIGIBILITY IN WHOLE OR PART BY MEDICAID OR ANY OTHER PROGRAM THE HOSPITAL CONSIDERS TO BE AN ALTERNATIVE SOURCE OF PAYMENT TO SUBMIT THEIR APPLICATION FOR CARITY CARE. DETERMINATION FOR APPLICANTS REQUESTING CHARITY CARE IS TO BE MADE BY GPRMC WITHIN THIRTY (30) DAYS AFTER A COMPLETE APPLICATION HAS BEEN SUBMITTED. NO AMOUNTS PAID PRIOR TO RECEIVEING CHARITY CARE WILL BE REIMBURSED. GREAT PLAINS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: GPRMC PROVIDES A 100% DISCOUNT TO QUALIFIED INDIVIDUALS UNDER THEIR CHARITY CARE POLICY. THE AMOUNT THAT IS CHARGED IS DETERMINED BY THE CHARGEMASTER AT THE FULL RATE AMOUNT. PART VI, LINE 2: THE ORGANIZATION RELIES ON INPUT FROM PHYSICIANS, OTHER HEALTHCARE PROVIDERS, COMMUNITY LEADERS, THE BOARD OF DIRECTORS, CITIZENS, ETC. IN THE COMMUNITY. WE LOOK AT OUT-MIGRATION STUDIES TO DETERMINE WHAT SERVICES PEOPLE FROM OUR COMMUNITY ARE SEEKING AND RECEIVING FROM OUTSIDE LOCATIONS. WE ALSO CONSIDER COMPARISONS OF THE VOLUME OF PHYSICIAN SPECIALTIES IN OUR AREA TO NATIONALLY RECOGNIZED DATA. THESE FACTORS ARE ALL CONSIDERED IN ADDITION TO FEEDBACK FROM PATIENTS IN THE COMMUNITY TO DETERMINE SHORTAGE OF CARE AREAS. PART VI, LINE 3: ASSISTANCE IS DISCUSSED WITH PATIENTS AS PART OF THE INTAKE PROCESS. THEY ARE SCREENED AT REGISTRATION FOR NEED FOR FINANCIAL ASSISTANCE AND THEN ARE GIVEN COPIES OF CHARITY CARE POLICY/FINANCIAL POLICY UPON REQUEST. WE TRY TO ASSIST PEOPLE IN QUALIFYING FOR SOME TYPE OF MEDICAL ASSISTANCE WHETHER IT BE MEDICARE, MEDICAID, DISABILITY OR CHARITY CARE. PART VI, LINE 4: GREAT PLAINS REGIONAL MEDICAL CENTER IS A SIXTY-TWO LICENSED BED ACUTE CARE HOSPITAL LOCATED IN ELK CITY, OKLAHOMA IN BECKMAN COUNTY. THE CORPORATION PROVIDES A COMPREHENSIVE RANGE OF GENERAL, ACUTE AND SPECIALIZED CARE, AS WELL AS OUTPATIENT AND ANCILLARY SERVICES, TO RESIDENTS IN ITS PRIMARY AND SECONDARY SERVICE AREAS COVERING TEN COUNTIES. ESTIMATED PRIMARY AND SECONDARY SERVICE AREA POPULATION EXCEEDS 100,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IN BECKAM COUNTY IS $43,642 AND 16% OF THE COUNTY IS BELOW POVERTY LEVEL. PART VI, LINE 5: OUR BOARD OF DIRECTORS IS MADE UP OF CITIZENS FROM THE COMMUNITY, FROM BUSINESS OWNERS TO RETIRED INDIVIDUALS. THIS BROADLY BASED GROUP PROVIDES US WITH A BROAD PERSPECTIVE ON THE NEEDS OF THE COMMUNITY.GPRMC EXTENDS MEDICAL PRIVILEGES TO AREA PHYSICIANS. THEY MUST APPLY FOR PRIVILEGES AND THEN BE APPROVED BY THE MEDICAL STAFF AND THEN BY THE BOARD OF DIRECTORS.IF GPRMC HAS A SURPLUS OF FUNDS, THEN THEY ARE USED BY THE ORGANIZATION TO FULFILL OUR MISSION,, VISION, AND VALUES.AS QUANTIFIED IN PART II, QUESTION 7 E, F AND I COMMUNITY BENEFIT IS PROVIDED BY GPRMC THROUGH FREE PROGRAMS OFFERED THROUGHOUT THE YEAR AND INITIATIVES WHICH GPRMC BELIEVES SERVE A BONA FIDE COMMUNITY HEALTH NEED. SOME OF THESE ACTIVITIES ARE AS FOLLOWS: -NOTICES ARE PUBLISHED IN AREA NEWSPAPERS, REGARDING NEW PHYSICIANS OR MEDICAL SERVICES. ACCORDING TO ESTIMATED NEWSPAPER CIRCULATION, THESE ADS REACH FROM 8,000 TO 10,000 HOMES IN THE AREA.-GPRMC PROVIDED FLU SHOTS FOR THE OFFICE PERSONNEL OF THE PHYSICIANS IN THE COMMUNITY. -GPRMC PROVIDES BREAST SELF-EXAM, CPR AND PRE-NATAL EDUCATION TO COMMUNITY MEMBERS.-GPRMC IS ONE OF TWO DESIGNATED DONOR LOCATIONS FOR THE COMMUNITY-WIDE BLOOD DRIVE HELD FIVE TIMES PER YEAR.-GPRMC HAS A SHUTTLE SERVICE FOR PATIENTS WITHOUT TRANSPORTATION TO THE PHYSICIAN'S OFFICES, CLINICS AND THE HOSPITAL. THE FREE SHUTTLE TRAVELS IN ELK CITY AND AREA COMMUNITIES.-GPRMC SPONSORS HEALTHCARE EDUCATION INITIATIVES FOR THE COMMUNITY. SOME OF THESE INCLUDE DIABETES SELF-MANAGEMENT CLASSES FOR PATIENTS WITH NEW OR UNCONTROLLED DIABETES AND EDUCATION TO LOCAL NURSING HOME STAFF REGARDING CARE OF PATIENTS WITH DEMENTIA AND OTHER TYPES OF BEHAVIORAL DISORDERS.-DUE TO THE SHORTAGE OF NURSES, SCHOLARSHIPS ARE AWARDED TO STUDENTS WISHING TO PURSUE DEGREES IN THE MEDICAL FIELD. -REPRESENTATIVES FROM GPRMC PRESENT EDUCATION PROGRAMS AT THE LOCAL ADULT LEARNING CENTER RELATIVE TO EDUCATION NEEDED TO FULFILL THE REQUIREMENTS FOR EMPLOYMENT IN A HOSPITAL SETTING. WE ALSO PARTICIPATE IN SEVERAL CAREER FAIRS FOR DIFFERENT SCHOOLS IN OUR AREA.-GPRMC WORKS IN COOPERATION WITH EDUCATORS BY PROVIDING A CLINICAL ROTATION TRAINING ENVIRONMENT FOR STUDENTS OF VARIOUS FIELDS INCLUDING PHYSICIAN, NURSING, PHARMACY, LAB, RADIOLOGY AND MEDICAL RECORDS.-WE PARTICIPATE WITH AREA HIGH SCHOOLS IN THE 'JOB SHADOW PROGRAM'. STUDENTS INTERESTED IN HEALTH CAREERS MAY OBSERVE OUR STAFF IN THE WORK SETTING AND OBTAIN A FIRST-HAND EXPERIENCE.-GPRMC HAS DEVELOPED A COLLABORATION WITH WESTERN OKLAHOMA STATE COLLEGE TO PROVIDE DISTANCE LEARNING CLASSES FOR THOSE IN THE COMMUNITY WISHING TO PURSUE NURSING DEGREES. GPRMC'S PART OF THE COLLABORATIVE IS TO PROVIDE A CLASSROOM IN THE LOCAL COMMUNITY. ADDITIONALLY, IN-KIND SERVICES ARE PROVIDED TO WESTERN OKLAHOMA STATE COLLEGE. THIS IS VITAL TO THOSE PROSPECTIVE STUDENTS PURSUING NURSING DEGREES THAT WOULD NOT HAVE BEEN ABLE TO DRIVE THE LONG DISTANCE TO THE COLLEGE. X X X X 0 0 0 0 0 0 0 0 0 ROY IKNER 299305 0 0 0 0 0 0 0 928 0 300233 0 0 0 LAURA L KURZENDOERFER 178862 0 0 0 0 0 0 0 0 0 178862 0 0 0 HETLEVIA R VILAR-JENSEN MD 176857 0 0 0 0 0 0 0 0 0 176857 0 0 0 LELAND W DENNIS MD 175780 0 0 0 0 0 0 0 0 0 175780 0 0 0 FRANCIS ABRAHAM MD 358173 0 0 0 0 0 0 0 754 0 358927 0 0 0 HUGH M LEAVENS MD 441618 0 0 0 0 0 0 0 0 0 441618 0 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS ESTABLISHED BY GPRMC THROUGH A COMPENSATION COMMITTEE WHICH USES COMPARATIVE COMPENSATION STUDIES. THE BOARD THEN REVIEWS AND APPROVES THE CEO'S COMPENSATION AND SIGNS A WRITTEN EMPLOYMENT CONTRACT WITH THE CEO. SUPPLEMENTAL INFORMATION PART III PART II, LINE 5A: FRANCIS ABRAHAM, MD IS STILL AN EMPLOYEE OF GPRMC, BUT NO LONGER THE VICE CHIEF OF STAFF TO THE BOARD OF DIRECTORS AS LISTED ON FORM 990 PART VII. THE OKLAHOMA DEVELOPMENT FINANCE AUTHORITY 731083741 678910DB3 2007-06-26 39448937 GREAT PLAINS REGIONAL MEDICAL CENTER - CONSTRUCT & FURNISH 62 BED HOSPITAL 0 0 0 36232616 2653544 562777 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 JOHN MARK PHELPS FAMILY MEMBER OF CRAIG PHELPS, BOARD MEMBER & CHIEF OF STAFF 49228 EMPLOYMENT 0 SARAH G PHELPS FAMILY MEMBER OF CRAIG PHELPS, BOARD MEMBER & CHIEF OF STAFF 81564 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS ARE INDIVIDUALS WHO HAVE VOTING SHARES IN THE ORGANIZATION. MEMBERSHIP IS OBTAINED THROUGH TRANSFERS OF EXISTING MEMBERSHIPS. TRANSFERS NORMALLY RESULT EITHER THROUGH VOLUNTARY SURRENDER OF A MEMBERSHIP FROM A CURRENT MEMBER WHO IS NO LONGER INTERESTED IN RETAINING THEIR MEMBERSHIP OR THROUGH THE DEATH OF A MEMBER WHO HAS NO IMMEDIATE FAMILY INTERESTED IN RETAINING THE MEMBERSHIP. EACH INDIVIDUAL IS ALLOWED ONLY ONE MEMBERSHIP AND THERE IS ONLY ONE VOTE ALLOWED PER MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A GOVERNING BOARD MEMBERS ARE APPOINTED THROUGH NOMINATION AND A MAJORITY VOTE ELECTION BY THE MEMBERSHIP AT ANNUAL MEETINGS. FORM 990, PART VI, SECTION A, LINE 7B ANY EDITS TO THE GOVERNING BOARD BYLAWS, RULES & REGULATIONS HAVE TO BE APPROVED BY A MAJORITY VOTE OF THE MEMBERSHIP. PER THE ORGANIZATIONS BYLAWS, THE MEMBERS ARE THE SUPREME AUTHORITY OF THE ASSOCIATION IN ALL ITS AFFAIRS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WILL BE PRESENTED AND REVIEWED AT ONE OF THE GOVERNING BOARD'S MONTHLY MEETINGS. THE FORM 990 WILL ALSO HAVE BEEN POSTED ON THE GOVERNING BOARD'S WEBSITE IN THE DAYS PRECEDING THE MONTHLY MEETING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL MEMBERS OF THE GOVERNING BODY AND KEY EMPLOYEES RECEIVE A COPY OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. THEY ARE REQUIRED TO REVIEW THE POLICY, COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AND SIGN THE QUESTIONNAIRE, ATTESTING TO THEIR UNDERSTANDING OF THE POLICY AND THAT THEIR ANSWERS ON THE QUESTIONNAIRE ARE TRUE AND ACCURATE. FORM 990, PART VI, SECTION B, LINE 15 HR CONDUCTS A COMPARATIVE ANALYSIS USING STATE, MULTI-STATE, REGIONAL, AND NATIONAL COMPENSATION (BY-POSITION) DATA. DATA IS CULLED INTO BED-SIZE, REVENUE, AND SIMILAR AREA COMPARATIVES. HR SUBMITS A REPORT TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS ANNUALLY ON THE CEO. THE EXECUTIVE COMMITTEE REVIEWS THE DATA, CONFIRMS THE DATA WITH AN OUT OF HOUSE AUDITOR, AND RECOMMENDS APPROPRIATE CEO COMPENSATION TO THE BOARD OF DIRECTORS AS A WHOLE. ALL OTHER POSITIONS ARE REVIEWED ANNUALLY BY HR AND APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 18 THOSE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WHEN PRACTICAL. OTHERWISE, AN APPOINTMENT FOR AN ON-SITE REVIEW OF THE REQUESTED DOCUMENT IS MADE, WITH THE DAY AND TIME OF THE APPOINTMENT DETERMINED BY THE PERSON(S) WHO HAS MADE THE REQUEST, ACCORDING TO THEIR SCHEDULE AND CONVENIENCE. FORM 990, PART VI, SECTION C, LINE 19 THOSE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WHEN PRACTICAL. OTHERWISE, AN APPOINTMENT FOR AN ON-SITE REVIEW OF THE REQUESTED DOCUMENT IS MADE, WITH THE DAY AND TIME OF THE APPOINTMENT DETERMINED BY THE PERSON(S) WHO HAS MADE THE REQUEST, ACCORDING TO THEIR SCHEDULE AND CONVENIENCE. THE PROCESS IS THE SAME AS IT WAS IN THE PRIOR YEAR. FOUNDATION BOARD OF GREAT PLAINS REGIONAL MEDICAL CENTER PO BOX 2339 ELK CITY OK 736482339 730479295 PROVIDING SUPPORT FOR HEALTHCARE OK 501(C)(3) N/A 0 PLAINS DIAGNOSTIC IMAGING LLC PO BOX 2339 ELK CITY OK 73648 261530951 EQUIPMENT RENTAL OK N/A EQUIPMENT RENTAL 170093 1168569 0 1 0.79487 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 FOUNDATION BOARD OF GREAT PLAINS C 100000 BOOK PLAINS DIAGNOSTIC IMAGING LLC J 1089726 BOOK