2012-03-27T16:05:11-05:00 2011-06-30 EIDE BAILLY LLP 1601 NW EXPRESSWAY SUITE 1900 OKLAHOMA CITY OK 73118 990 2010-07-01 736617937 McCurtain Memorial Medical Management Inc MCCU 5802867623 1301 East Lincoln Rd Idabel OK 74745 Ray Whitmore 5802867623 2012-03-23 1 Carolyn Levings 4054783334 2012-03-23 2010 2016-02-24 21:20:13Z Ray Whitmore 1301 East Lincoln Rd Idabel OK 74745 22635303 0 X www.mmhok.com X 1975 OK Hospital care 6 5 326 33 0 0 70 978542 22283596 21587861 3376 -83156 96467 66346 22383509 22549593 1260 1029 0 0 11285550 11661828 0 0 0 11951548 11312479 23238358 22975336 -854849 -425743 8231824 6974617 4652125 3820661 3579699 3153956 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 1 21555706 1029 21565567 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 $343,248 for the year ended June 30, 2011. 47021 22294 Jan. 3, 2011 - Opened Wellness Center - 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 is 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. 22706 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. Total estimated expense to maintain the walking trail, including depreciation, is $22,705.99 per year. 21625433 1 1 0 0 0 0 0 0 0 1 0 0 0 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 0 0 0 1 49 0 1 326 1 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 0 0 OK X Ray Whitmore 5802083100 1301 E Lincoln Rd Idabel OK 74745 Billie Tomlinson 1.00 X X 0 0 0 Thomas Salyer DO 1.00 X X 0 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 Thomas A Jones MD 2.00 X 5000 0 0 Nancy Woodruff MD 2.00 X 5000 0 0 Bristol Messer 40.00 X 165106 0 19355 Ray Whitmore 40.00 X 88373 0 17376 Jeffrey Martin 40.00 X 299364 0 12758 Raman Talwar 40.00 X 198471 0 15226 Jose Gomez 40.00 X 195703 0 15100 Raymond Smith 40.00 X 197183 0 15135 John Oglesbee 40.00 X 180450 0 15100 1334650 0 110050 6 0 1 0 John H Migliaccio MD PC 1401 S Lynn Lane Idabel OK 74745 ER Physician 442464 Locumtenenscom LLC PO Box 532869 Atlanta GA 30353 Radiologist Physicians 355681 CompHealth Inc PO Box 972651 Dallas TX 753972651 ER Physician 311513 Gerard Enterprise Inc 303 Summit Circle Durant OK 74701 ER Physician 205575 Create A Storehouse Inc 1970 marie Drive Durant OK 74701 ER Physician 167040 10 926818 51724 978542 Net Patient Serv. Rev 900099 21550137 21550137 Other Revenue 900099 37724 37724 21587861 875 875 66346 66346 66346 66346 1679 85710 -84031 -84031 -84031 22549593 21587861 0 -16810 1029 1029 310945 310945 9399113 8846745 552368 76958 71552 5406 1201113 1125729 75384 673699 617680 56019 2872 2872 60213 60213 2071749 1871480 200269 15801 13505 2296 1012744 973313 39431 746887 741428 5459 61046 56361 4685 109916 109916 636920 636920 755323 755323 Bad Debt Expense 4259468 4259468 Medical Supplies 1238756 1238756 Miscellaneous 340784 306228 34556 22975336 21625433 1349903 0 155008 309797 3400648 2353823 122500 122500 200317 238320 371279 401683 229277 247632 16776866 13540993 3671493 3235873 81302 64989 8231824 6974617 2825034 2513817 1379177 1011973 447914 294871 4652125 3820661 X 3579699 3153956 3579699 3153956 8231824 6974617 -425743 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 37450 37450 8093281 6413377 1679904 333627 251386 82241 7825428 6876230 949198 487080 487080 3235873 Due to Third-Party Payor 294871 294871 22549593 22975336 -425743 0 -425743 21705931 0 21705931 843662 843662 22549593 23365991 0 23365991 -390655 -390655 22975336 Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital undergoes an annual analysis of its various tax positions assessing the likelihood of these positions being upheld upon examination with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. The Hospital believes that they are in substantial compliance with all IRS tax regulations and as of June 30, 2011, and have not recorded any unrecognized tax benefit or liabilities for income taxes. Part XII, Line 4b - Other Adjustments: Other Income Stated Separately on Financial Statement 649,494. Contributions for Long-live Assets Stated Separately on Financial Stmt 194,168. Capital Transfers Stated Separately on Financial Statements Part XIII, Line 4b - Other Adjustments: Depreciation Transfer Reported in Financial Statements as Capital Transfer -390,655. 1 1 X 1 X 1 X 1 1 1 0 0 160924 20857 140067 0.00750 4363549 4268298 95251 0.00510 4524473 4289155 235318 0.01260 48332 22294 26038 0.00140 7476 1387 6089 0.00030 1023 1023 0.00010 56831 23681 33150 0.00180 4581304 4312836 268468 0.01440 1037 1037 0.00010 557 557 0.00000 882 882 0.00000 144109 144109 0.00770 146585 146585 0.00780 0 1998399 539568 7528726 7087012 441714 X 1 1 1 1 McCurtain Memorial Medical Management

1301 East Lincoln Rd Idabel OK 74745

X X X Not Required 1 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 Hospitalist Services Dr Nia

1425 E Lincoln Road Suite B-2 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-2 Idabel OK 74745

Physician Clinic Part I, Line 7: Amounts on lines 7 a and b were determined using the cost to charge ratio in Worksheet 2. Amounts on line 7e and f 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 $4,259,468. Part II: McCurtain Memorial Hospital is a facility dedicated to promoting the health of the community. The Hospital is a member of the Chambers of Commerce and Main Street programs in the communities in our service area, which promote our community and economic development. The Hospital expended $114,109 to recruit and retain physicians to serve the citizens of our service area and increase the availability of providers. The Hospital is also involved in helping to prevent domestic violence in our 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: The organization's bad debt expense at cost was calculated using the expense reported on the financial statements and applying the cost to charge ratio derived from Worksheet 2.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: Medicare costs were determined using the organization's Medicare Cost Report. 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. Part VI, Line 2: The Hospital holds an annual Strategic Planning Meeting in which the needs of the community are evaluated within an environmental assessment which also identifies 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 a hospital facility owned by McCurtain County, Oklahoma. It 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 QuickFacts of the U.S. Census Bureau, persons below poverty level represent approximately 27.0% of the county's population in comparison to 16.1% 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 census count for McCurtain County is 33,151. The nearest major hospital from McCurtain Memorial Hospital is located in Paris, TX, approximately 60 minutes away. The next nearest hospital is located in Texarkana, TX approximately 75 minutes away.McCurtain County consistently has one of the highest unemployment rates in the state, with the twelve month rolling average rate from July 2010 through June 2011 at 10.2%. Part VI, Line 6: The Hospital's Board 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-physicians and two members are local physicians, one of which serves as Chief of Medical Staff.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. 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.The Hospital provides a 24-hour emergency room and a walk-in clinic (MedFast) operating after regular business hours (M-Th 6pm-11pm, Fri 6pm-12am, Sat 10am-11pm, Sun 12pm-11pm). The Hospital has also become a certified stroke center through the ER with real-time stroke assessment and treatment through the use of two-way interactive videoconferencing. Emergency medical staff and nurses have undergone extensive training to learn the signs and symptoms of stroke to determine the level of stroke according to the NIH Stroke Scale. The Hospital actively advocates for healthy lifestyles and improved public health by opening to the public a Wellness Center complete with gym access, fitness assessment and individual training session with a certified licensed athletic trainer. Also available to the public is an outdoor, lighted walking track. The Hospital regularly participates in the various health fairs at surrounding communities, schools and workplaces. The Hospital is a strong advocate of Relay for Life, a program of the American Cancer Society.The Hospital provides the meeting room and regularly attends meetings for the McCurtain County Coalition for Change - Turning Point. The Hospital also developed and sponsored the Domestic Violence Task Force and the McCurtain County Child Abuse Awareness Team providing leadership and a monthly meeting location for both groups. The Hospital is a partner with the Eastern Oklahoma State College Nursing Program and the EOSC Medical Laboratory Tech Program. Students from these programs use the Hospital as a clinical rotation site. Hospital staff was provided for mock interviews for Kiamichi Technology Center Nursing Students. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Bristol Messer 161662 0 0 0 3444 0 4255 0 21868 0 191229 0 0 0 Jeffrey Martin 299364 0 0 0 0 0 6125 0 7389 0 312878 0 0 0 Raman Talwar 198471 0 0 0 0 0 0 0 15289 0 213760 0 0 0 Jose Gomez 195703 0 0 0 0 0 0 0 15100 0 210803 0 0 0 Raymond Smith 197183 0 0 0 0 0 0 0 15135 0 212318 0 0 0 John Oglesbee 180450 0 0 0 0 0 0 0 15100 0 195550 0 0 0 Part I, Line 1a Rent and utilities paid by hospital for housing of CEO that was not on the business 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. 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 Jan. 3, 2011 - Opened Wellness Center - exercise area that community members can subscribe to and use the exercise equipment. There is personnel available to assist them. Oct. 19, 2010 - Have been certified by the Oklahoma State Dept of Health as a Primary Stroke Center through the existing ER services. June 1, 2011 - Inpatient physical therapy services once again became available after a turnover of personnel in physical therapy dept. It had been discontinued in Mar. 2010 Implementation of Electronic health record - EHR - qualified for both Medicare and Medicaid financial incentives Changes in Program Services Form 990, Part III, line 3 The newsletter "Landscapes and Portraits" has been phased out and discontinued and it is being considered for other versions Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO prior to filing. 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 53700 Book McCurtain Memorial Hospital Foundation J 134400 Book McCurtain Memorial Hospital Foundation E 50250 Book