Community Benefit Insight - Tax-exempt hospital

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Farmers Union Hospital Association

Great Plains Regional Medical Center

West Third And Lincoln
Elk City, OK 73648

Bed count	62	Medicare provider number	370019	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 730579295

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

3.7%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 58,000 0.10 %
Medicaid as % of operating expenses	$ 381,578 0.63 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 1,801,478 2.97 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 4,689,009 7.74 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 520,480 11.10 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 46004044 including grants of $ 22577) (Revenue $ 55208773)
Farmers Union Hospital Association, DBA Great Plains Regional Medical Center in Elk City, Oklahoma (hereinafter referred to as GPRMC) is a 62-bed hospital that provides quality health care regardless of race, religion, creed, sex, national origin, handicap, age or ability to pay. 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. In keeping with the 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 individual's inability to pay exists.GPRMC served over 1,882 Inpatients that include, Medical, Intensive Care, Inpatient Rehabilitation, Newborns, Swing Bed and Senior Care. These services produced more than 9,100 Inpatient days. During the year we treated 13,076 patients in the Emergency Department. Our Surgical teams performed 3,274 surgeries. 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 recognized 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 providing reduced price services, free programs offered throughout the year which GPRMC believes will serve a bona fide community health need. See Schedule H for more information regarding these activities.The Hospital provides health care services to patients who meet certain criteria under its charity policy without charge or amounts less than established rates. Because the Hospital does not pursue collection amounts determined to qualify as charity care, they are not recorded as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $185,000 in 2022. Total direct and indirect cost related to these foregone charges were $58,000, based on an average ratio of cost to gross charges.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Great Plains Regional Medical Center
Part V, Section B, Line 5: Due to the unprecedented Covid-19 pandemic, Great Plains Regional Medical Center was not able to host three community meetings as they have in the past to seek feedback from key stakeholders. In an effort to promote social distancing and following recommendations outlined the CDC's website, the hospital hosted one single community meeting to gather community feedback. The meeting was held on March 23, 2022. All stakeholders received primary and secondary data prior to the meeting.Community members invited to the community meeting included representatives from Great Plains Regional Medical Center, City of Elk City, Elk City Fire Department, Elk City Chamber of Commerce, Area Agency on Aging, Hospital Foundation, Elk City Public Schools and Vocational Technology Schools. Community members received a phone invitation and/or an email invitation from the hospital. Those invited included: board members, foundation members, Elk City and Western Oklahoma Wellness Initiatives coordinator, AirEvac, City of Elk City Farmers Union Hospital Association officials, Beckham County Health Department, and GPRMC department directors. The director of Western Oklahoma Family Care Center was invited because of the low-income population served. Therefore, a significant effort was placed on including representatives from the public health sector and those who serve the underserved, low-income or racially diverse populations to gain their perspective of needs in the community.

Great Plains Regional Medical Center
"Part V, Section B, Line 11: The community health needs assessment (CHNA) was completed in fiscal year 2022. The following needs were identified and due to the timing of the completion of the CHNA will be addressed over the next 3 years.Mental Health including services for youth and adolescents Drug, alcohol, and tobacco abuse Lack of OBGYN care Limited outdoor youth activities Mental Health including services for youth and adolescents Great Plains Regional Medical Center currently offers a geropsychiatry program. There are plans to grow the program through greater marketing of services and care available. The Medical Center also screens each outpatient and emergency room patient for the need for mental health services (e.g. depression, suicide). When a patient screens as needing additional services, resources are then identified for the patient. The Medical Center plans to continue these screenings and continue to search for additional services and resources.Drug, alcohol, and tobacco abuseThe Medical Center plans to address the increasing drug, alcohol, and tobacco abuse. Counselors are present in Elk City and Red Rock.Lack of OB/GYN careGreat Plains Regional Medical Center in collaboration and support of local providers will increase access to additional OB/GYN services. The facility strives to maintain patient access to current inpatient and outpatient resources. The Medical Center will ensure increased access for the Medicaid population for Obstetrics and Gynecology services. Limited outdoor youth activitiesAn activity center is being built and is estimated to open mid-summer 2022. A new aquatic center in process.The following are the needs addressed in FY2022 in regards to the Community Health Needs Assessment (CHNA) completed in FY2019:Insurance and uninsured individuals with the aging population having trouble accessing physicians that accept Medicaid.Great Plains Regional Medical Center (GPRMC) and local providers are continuing to collaborate in terms of providing physician services and staffing. The hospital has a financial assistance policy in place to assist uninsured patients. Telehealth services (or telemedicine) was added and video conferencing, which is used for real-time patient-provider consultations, provider-to-provider discussions in clinics, GeriPsych, Dialysis, and other service areas. To date, there have been 900 telehealth visits completed. GPRMC added two Nurse Practitioners to increase access of care especially to the Medicaid population. Both nurse practitioners are contracted providers with the Oklahoma Healthcare Authority and accept Medicaid. To date, they have collectively seen over 4,000 patients.Preventative careGPRMC hosted a Health and Wellness Fair with the theme ""Spring Into Health"". The event connected and served our local community, and provided a means of awareness as to the services that are available to assist them in their day to day lives. This event provided the opportunity to introduce each department's services to the local community and connect with them on an individual basis. We brought in individuals from different facets of the community and others seeking to gain knowledge as to what is offered here at Great Plains Regional Medical Center. The hospital also continued to make smoking cessation pamplets and information available to community members. Substance Abuse/Drug AbuseGPRMC successfully recruited an Orthopedic Surgeon who is trained to use Robotic Assisted Joint Replacement in Surgery. To date over 600 procedures have been completed with over 2,100 patient visits to the clinic. This availability helps alleviate travel burdens. An experienced Gastroenterologist was also recruited to ensure a Specialist in our area was local to diagnosis and treat digestive disorders. This provider has performed over 100 surgeries and seen over 220 patients in the clinic setting.GPRMC CEO served on the Board for Project AWARE. This grant was used in our community and surrounding service areas to gain access to behavioral health. This grant promoted youth mental health awareness among schools and communities and improved connections to services for school-age youth in Western Oklahoma. Over 2,100 students in the Elk City School System have benefited from this program."

Great Plains Regional Medical Center
Part V, Section B, Line 13h: Great Plains Regional Medical Center (GPRMC) provides 100% financial assistance for non-elective services under the presumptive guidelines if the patient/responsible party meets any of the below listed criteria:a. Is uninsured and has an estimated family income of less than 200% FPL, and a Health Care Credit score of less than 620 as determined by externally available data sources such as credit agenciesb. Is Homeless or received care from a homeless clinicc. Is deceased with no known estate or living spouse

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
Great Plains Regional Medical Center (GPRMC) provides 100% financial assistance for non-elective services under the presumptive guidelines if the patient/responsible party meets any of the below listed criteria:a. Is uninsured and has an estimated family income of less than 200% FPL, and a Health Care Credit score of less than 620 as determined by externally available data sources such as credit agenciesb. Is Homeless or received care from a homeless clinicc. Is deceased with no known estate or living spouse

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost report. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.

Part III, Line 2:
The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
An estimated 11.1% of implicit price concession in 2021 are attributable to patients potentially eligible for financial assistance. This is based on the percentage of individuals in the county under the federal poverty level.

Part III, Line 4:
The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 10 and 11.

Part III, Line 8:
Great Plains Regional Medical Center 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. 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 the Centers for Medicare and Medicaid Services.

Part III, Line 9b:
GPRMC patients who qualify for charity care and who are cooperating in good faith to resolve their discounted hospital bills, are offered extended payment plans. During this time GPRMC will not send unpaid bills to outside collection agencies, and will cease all collection efforts. Great Plains Regional Medical Center will not impose extraordinary collections actions such as wage garnishments; liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for charity care under the financial assistance policy. Patients have 120-days from their first statement to apply for charity care with no extraordinary collection actions.Patients are pre-screened for charitable services before receiving tests and a determination is made as to the financial ability to pay. If patients are pre-qualified for services, the collection process is ceased.

Part VI, Line 2:
GPRMC relies on input from physicians, other healthcare providers, community leaders, the Board of Directors and citizens in the community to assess the needs of the community. We look at out-migration studies to determine what services individuals from the 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. The factors are all considered in addition to feedback from patients in the community to determine shortages of care areas.

Part VI, Line 3:
Assistance is discussed with patients as part of the intake process. Patients are screened at registration to determine need for financial assistance and then are given copies of the financial assistance policy. Upon request, we try to assist patients with paperwork for medical assistance such as Medicare, Medicaid, disability, or financial assistance.Notification about financial assistance is disseminated from Great Plains Regional Medical Center through various means. This includes notice in patient bills and the Conditions of Admissions form. In addition, information is posted in emergency rooms, the admitting and registration departments and the hospital business offices. A request for financial assistance may be made by the patient, patient family member, close friend, or any associate of the patient, subject to applicable privacy laws.

Part VI, Line 4:
Great Plains Regional Medical Center is a 62-bed acute care facility located in Beckham County. The hospital provides 24-hour emergency department, acute inpatient services, hospitalist services, laboratory, diagnostic radiology (CT, ultrasound, MRI, nuclear medicine, echocardiograms, mammography, and cardiac catheterization), intensive care, and cancer treatment center (prostate, breast, and head and neck cancers).The primary medical service area of Great Plains Regional Medical Center includes the zip code areas of Elk City, Sayre, Erick, Hammon, Cheyenne, Cordell, Canute, Mangum, Sentinel and Clinton. The primary medical service area experienced a population increase of 7.3 percent from the 2000 Census to the 2010 Census. This same service area experienced a population decrease of 1.0 percent from the 2010 Census to the latest available, 2016-2020, American Community Survey. The secondary medical services area is comprised of the zip code areas of Burns Flat, Carter, Weatherford, Sweetwater, Reydon, Arnett, Lone Wolf, Durham, Butler, Leedey, Foss, Dill City, Hobart, Granite, Hollis, and Altus. The secondary medical service area experienced an increase in population of 25.4 percent from 2000 to 2010 followed by a population decrease of 4 percent from 2010 to the 2016-2020 American Community Survey.The 2020 annual unemployment rate for Beckham County was 7.5 percent. This rate is higher than the state (6.1%) but lower the national (8.1%). All of these rates are non-seasonally adjusted. The most recent monthly estimates show Beckham County to be lower than 2020 with a 2 percent rate. This is slightly higher than the state (1.8%) but lower than the national (3.7%) rates. The share of individuals below the poverty threshold for income and household size is calculated by the U.S. Census Bureau. In 2020, the poverty rate for all ages in Beckham County was 18.8 percent. This is higher than the state and national rates. The poverty rate for children, or those under the age of 18, is higher than both the state and national rates.

Part VI, Line 5:
Our Board of Directors is comprised 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 local and area physicians. They must apply for privileges and be approved by the medical staff and Board of Director. Surplus funds are reinvested into facility and equipment upgrades and free programs throughout the year.GPRMC publishes notices in the area newspapers reaching 8,000 to 10,000 homes. The notices provide information on new physicians and medical services.GPRMC provides education to community on CPR, pre-natal education and Heart Disease Prevention. The Medical Center is one of two designated donor locations for the community wide blood drive held several times per year.Great Plains Regional Medical Center sponsors healthcare 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 in the area, scholarships are awarded to students wishing to pursue degrees in the medical field. Education programs are presented at the local adult learning center discussing 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. The Medical Center developed a collaboration with Western Oklahoma State College to provide distance learning classes for those in the community wishing to pursue nursing degrees. GPRMC provides a classroom in the local community. Additionally, in-kind services are provided to Western Oklahoma State College. This is vital to prospective students pursuing nursing degrees that would not have been able to drive the long distance to the College.In-kind services are also provided to Southwestern Oklahoma State University for college classes. The Hospital provides a room, Monday - Friday for teaching general education classes in both fall and spring semesters.

Operating expenses	$ 60,585,201
Total amount spent on community benefits as % of operating expenses	$ 2,241,056 3.70 %