PAWHUSKA HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- PAWHUSKA HOSPITAL INC (EIN 23-7169376)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-08
- IRS object ID
- 201222219349301192
- Schema version
- 2010v3.4
- 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) |
|---|---|---|
| Timestamp | 2012-08-08T16:48:59-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 NW EXPRESSWAY SUITE 1900 | AddressLine1 |
| City | OKLAHOMA CITY | City |
| State | OK | State |
| ZIP Code | 73118 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237169376 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawhuska Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PAWH | NameControl |
| Phone | 9182873232 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 East 15th Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Karen Arrowsmith | Name |
| Title | Administrator | Title |
| Phone | 9182873232 | Phone |
| Date Signed | 2012-08-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carolyn Levings | Name |
| Phone | 4054783334 | Phone |
| Date Prepared | 2012-08-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Karen Arrowsmith | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 East 15th Street | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3949448 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1972 | YearFormation |
| State Legal Domicile | OK | StateLegalDomicile |
| Activity Or Mission Description | HEALTH CARE SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 69 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 143846 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 142416 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2920936 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3798889 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 9526 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8143 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3074308 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3949448 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2290633 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2468521 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 962139 | OtherExpensePriorYear |
| Other Expenses Current Year | 1332801 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3252772 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3801322 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -178464 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 148126 | RevenuesLessExpensesCY |
| Total Assets BOY | 2416007 | TotalAssetsBOY |
| Total Assets EOY | 3700829 | TotalAssetsEOY |
| Total Liabilities BOY | 343377 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1480073 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2072630 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2220756 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | To provide care for persons suffering from illnesses or disabilities which require in or out patient hospital care. To carry on education activities and scientific research related to the care of the sick and injured and to promote the general health of the community. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3281622 | Expense |
| Revenue | 3798889 | Revenue |
| Description | Pawhuska Hospital is a 25-bed critical access hospital that accepts patients regardless of ability to pay. Charity care for the year ended September 30, 2011 was $106,667. | Description |
| Total Program Service Expense | 3281622 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 69 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OK | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Karen Arrowsmith | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9182873232 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 East 15th Street | AddressLine1 |
| City | PAWHUSKA | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| James Hager | |||||||
| Chariman of Board of Direc | 1.00 | X | X | 0 | 0 | 0 | |
| Bob Roberts | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Toby Bighorse | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Francis Altaffer | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Nancy Woodyard | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Karen Arrowsmith | |||||||
| Administrator | 50.00 | X | 86306 | 0 | 0 | ||
| John Ham | |||||||
| Physicians Assistant-C | 52.00 | 129311 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 215617 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 142416 | AllOtherContributions |
| Total Contributions | 142416 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient Revenue | 900099 | 3793466 | 3793466 |
| Dietary Revenue | 900099 | 5139 | 5139 |
| Miscellaneous Revenue | 900099 | 284 | 284 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3798889 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8143 | TotalRevenueColumn |
| Exclusion | $8,143 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3949448 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3798889 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $8,143 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89781 | Total |
| Management And General | 89781 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1850821 | Total |
| Program Services | 1650375 | ProgramServices |
| Management And General | 200446 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 289995 | Total |
| Program Services | 210949 | ProgramServices |
| Management And General | 79046 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 237924 | Total |
| Program Services | 237924 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 455167 | Total |
| Program Services | 455167 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73126 | Total |
| Management And General | 73126 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2808 | Total |
| Program Services | 280 | ProgramServices |
| Management And General | 2528 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 498460 | Total |
| Program Services | 429545 | ProgramServices |
| Management And General | 68915 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65144 | Total |
| Program Services | 61710 | ProgramServices |
| Management And General | 3434 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7906 | Total |
| Program Services | 5482 | ProgramServices |
| Management And General | 2424 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19308 | Total |
| Program Services | 19308 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 164198 | Total |
| Program Services | 164198 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46374 | Total |
| Program Services | 46374 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Sales & Use Tax | Description |
| Total | 310 | Total |
| Program Services | 310 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3801322 | Total |
| Program Services | 3281622 | ProgramServices |
| Management And General | 519700 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1050231 | BOY |
| EOY | 1528452 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 374747 | BOY |
| EOY | 673445 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12428 | BOY |
| EOY | 8852 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109865 | BOY |
| EOY | 136334 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15080 | BOY |
| EOY | 18453 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3521090 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2185797 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 853656 | BOY |
| EOY | 1335293 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2416007 | BOY |
| EOY | 3700829 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 272832 | BOY |
| EOY | 820397 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 513472 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70545 | BOY |
| EOY | 146204 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 343377 | BOY |
| EOY | 1480073 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2072630 | BOY |
| EOY | 2220756 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2072630 | BOY |
| EOY | 2220756 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2416007 | BOY |
| EOY | 3700829 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 148126 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 34360 | OtherCostOrOtherBasis |
| Book Value | 34360 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 973428 | OtherCostOrOtherBasis |
| Depreciation | 617692 | Depreciation |
| Book Value | 355736 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 35979 | OtherCostOrOtherBasis |
| Depreciation | 28988 | Depreciation |
| Book Value | 6991 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2477323 | OtherCostOrOtherBasis |
| Depreciation | 1539117 | Depreciation |
| Book Value | 938206 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1335293 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Third Party Settlements | Description |
| Amount | $146,204 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 146204 | TotalOfAmounts |
| Total Revenue | 3949448 | TotalRevenue |
| Total Expenses | 3801322 | TotalExpenses |
| Excess Or Deficit For Year | 148126 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 148126 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 3930140 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -19308 | OtherRevenues |
| Revenue Not Rptd F990 | -19308 | RevenueNotRptdF990 |
| Revenue Subtotal | 3949448 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 3949448 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3782014 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 3782014 | ExpensesSubtotal |
| Other Expenses Not Included | 19308 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 19308 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3801322 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | 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 2d - Other Adjustments: | Interest expenses included in Revenue on financial statements -19,308. | |
| Part XIII, Line 4b - Other Adjustments: | Interest expenses included in Revenue on financial statements 19,308. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 705 | PersonsServed |
| Total Community Benefit Expense | 95038 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 95038 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02500 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 448805 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 184139 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 264666 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06960 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 28471 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 27256 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 705 | PersonsServed |
| Total Community Benefit Expense | 572314 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 211395 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 360919 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09490 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 705 | PersonsServed |
| Total Community Benefit Expense | 572314 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 211395 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 360919 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09490 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $430,586 | BadDebtExpenseAmount |
| Amount Attributable To | 21529 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2961198 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2931879 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 29319 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawhuska Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 E 15th St | AddressLine1 |
| City | Pawhuska | City |
| State | OK | State |
| ZIP Code | 740561920 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Not Required | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation |
|---|
| Part I, Line 3c: The Medical Center provides its services without regard to a patient's ability to pay. The Medical Center provides a discount of at least 25% of billed charges to all uninsured patients. Uninsured patients also may qualify for an additional 10% prompt pay discount. In addition to these automatic discounts, patients can apply for financial assistance including free and discounted care. The determination of the patient's qualification for financial assistance is based on an objective determination of the patient's financial resources and ability to pay. In general, all uninsured patients with household incomes of less than 150% of the Federal poverty guidelines qualify for free care. Patients with household incomes less than 300% of Federal Poverty Guidelines qualify for sliding scale discounts that are in addition to the automatic discount provided to all uninsured patients. |
| Part I, Line 7: Charity care, unreimbursed Medicaid and unreimbursed costs-other means-tested government programs were calculated at cost using the cost-to-charge ratio derived from Worksheet 2. |
| Part II: Currently, Pawhuska Hospital, Inc. does not have a Community Building Activity in place but is working to develop one. |
| 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. The estimated amount of bad debt attributable to charity care is 5%. This is an estimation from notifications of charity care policies sent to patients and the number completed and returned to the hospital. The majority of the population served would qualify for government assistance or meet the federal poverty guidelines therefore if patients would have applied for financial assistance, the majority of the bad debt would have been classified as charity care.Pawhuska Hospital, Inc. considers care for the poor to be an essential part of its mission of service to the community.Bad debt is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Financial Statement Note:The carrying amount of patient receivables is reduced by a valuation allowance that reflects 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 historical write-off and recovery information in determining the estimated bad debt provision. |
| Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. |
| Part III, Line 9b: The collection policy is such that all collection activity ceases for each patient's amount determined to be eligible for financial assistance. For example, if it is determined that a patient is eligible for free care, all collection efforts stop. If a patient is eligible for discounted care, normal collection efforts continue only on the portion determined to still be owed by the patient. In FY11, all uninsured patients were eligible for an upfront discount of at least 25%. In FY11, all patients with a family income less than or equal to 300% of the federal poverty guidelines were eligible to receive financial assistance of free or discounted care. |
| Part VI, Line 2: Administration, medical staff and the Board regularly discuss the health care needs of the local community during board meetings, as well as in the bi-monthly meetings of the medical staff. Administration is currently working with the Oklahoma Office of Rural Health to develop and implement a community needs assessment. In addition, when looking at the potential of adding new services, an integral part of that research revolves around how such services will meet and address the different needs of our community. We are planning on developing future programs that will allow us the opportunity to gather a larger community audience that can inform us as to the issues that are important to the community and to gather suggestions from those involved. Programs such as the use of focus groups will enable us to be further educated to meet the needs of our community, and to develop programs to meet those needs. |
| Part VI, Line 3: Pawhuska Hospital, Inc. provides a letter to patients upon admission that states our Hospital provides assistance to those patients who have limited income to help pay for hospital expenses. The letter indicates that Charity Care applications are available to all patients and can be picked up at the time of service or at a later date. The Charity Care application gives an overview of our Charity Care policy and notes that Medicaid and other State programs are also available to patients that meet income requirements. Our staff is available to offer patients assistance in completing the charity care and Medicaid applications if needed. |
| Part VI, Line 4: Pawhuska Hospital, Inc. primarily serves the citizens of the community of Pawhuska, Oklahoma and the surrounding area. Pawhuska serves as the county seat of Osage County, Oklahoma and is also the capital of the Osage Nation. The Hospital is one of two facilities located in Osage County. Pawhuska is located in a rural area, with the city's population being 3,584 and the overall county population of 47,472 (2010 Census). The per capita income for the city was $13,916. About 13.7% of families and 17.5% of the population were below the poverty line, including 22.3% of those under age 18 and 14.9% of those age 65 or over. The Hospital is located within federally-designated underserved areas for primary care health professionals, mental health professionals, dental care health professionals and is located in a medically underserved area/population. The entire county falls into two medically underserved areas: Osage Service Area and West Osage Service Area. |
| Part VI, Line 6: The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The Hospital operates an emergency room that is available to all, regardless of ability to pay. The Hospital is planning an open house next January and will be offering to the community free health screenings. We plan to invite other local healthcare entities to participate in the open house with our Hospital. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| New Program Services | Form 990, Part III, line 2 | Pawhuska Hospital, as of June 2011, began offering CT's to patients. This service allows for our community to have a more comprehensive diagnostic screening to diagnose and treat patients in a timelier manner without the need to transport them to a larger facility for the same services. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is presented to the Administrator for review and then presented to the Board of Directors. The Form 990 is filed after review by the Board of Directors. | |
| Form 990, Part VI, Section B, line 12c | All employees, board members, and contract employees are covered in our policies. The employee and contract employee determinations are made by Administration and any board determinations are made by the Governing Board. The employee will be asked to remedy the situation and the board member will be asked to leave after presenting their conflict and the remainder of the Governing Board will discuss and then vote. Copies of both policies can be provided upon request. | |
| Form 990, Part VI, Section B, line 15b | Pawhuska Hospital follows the pay guidelines per our mananaging company, Jane Phillips Medical Center. | |
| Form 990, Part VI, Section C, line 19 | Documents are available upon request. |