Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2011 and ending 09-30-2012
BCheck if applicable:
CName of organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3500 E FRANK PHILLIPS BLVD
 
Room/suite
City or town, state or country, and ZIP + 4
BARTLESVILLE, OK74006
D Employer identification number

73-0606129
E Telephone number

G Gross receipts $ 115,052,649
F Name and address of principal officer:
DAVID STIRE
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.JPMC.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1950
M State of legal domicile: OK
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY PROVIDING MEDICAL EXCELLENCE AND COMPASSIONATE CARE TO ALL WHO NEED IT WITH A SPECIAL EMPHASIS FOR THE POOR AND POWERLESS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 17
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 984
6 Total number of volunteers (estimate if necessary) .... 6 168
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 215,409 631,883
9 Program service revenue (Part VIII, line 2g) ......... 103,484,342 111,755,762
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 285,969 87,931
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 103,985,720 112,475,576
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 87,150
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 49,707,899 49,574,331
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 49,001,948 51,862,565
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 98,709,847 101,524,046
19 Revenue less expenses. Subtract line 18 from line 12....... 5,275,873 10,951,530
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 81,303,129 86,384,523
21 Total liabilities (Part X, line 26)............. 17,446,857 17,910,360
22 Net assets or fund balances. Subtract line 21 from line 20..... 63,856,272 68,474,163
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: NONE. SEE SCHEDULE O - GENERAL STATEMENT 1
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe 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 and section 4947(a)(1) trusts 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 (Code:   ) (Expenses $ 79,146,652 including grants of $ 87,150 ) (Revenue $ 111,755,762 )
SEE SCHEDULE O, GENERAL STATEMENTS 2 AND 3
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 79,146,652
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
113
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
984
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
19
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
17
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
OK
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
LYNNE GARRETT
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
(918) 331-1550
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) ROBERT J LAFORTUNE
DIRECTOR
 1.0 X           0 0 0
(2) DONALD DOTY
DIRECTOR
 1.0 X           0 0 0
(3) SR M THERESE GOTTSCHALK
DIRECTOR
 1.0 X           0 99,996 0
(4) DAVID J PYNN
CEO SJHS
 1.0 X           0 815,682 114,156
(5) GLENN BONNER
CHAIRPERSON
 1.0 X   X       0 0 0
(6) JOHN B KANE
VICE CHAIRMAN
 1.0 X   X       0   0
(7) CHARLES BOWERMAN
SECRETARY
 1.0 X   X       0 0 0
(8) ROBERT BAUGHMAN
DIRECTOR
 1.0 X           0 0 0
(9) BILL BEIERSCHMITT
DIRECTOR
 1.0 X           0 0 0
(10) JEAN BLOOMFIELD
DIRECTOR
 1.0 X           0 0 0
(11) STAN DEFEHR MD
DIRECTOR
 1.0 X           0 0 0
(12) FRANCES HORN DO
DIRECTOR
 1.0 X           0 0 0
(13) ROBERT KANE
DIRECTOR
 1.0 X           0 0 0
(14) JOE LEBLANC MD
DIRECTOR
 1.0 X           0 0 0
(15) MIKE MAY
DIRECTOR
 1.0 X           0 0 0
(16) MARK ROBERTSON MD
DIRECTOR
 1.0 X           0 0 0
(17) DAVID SIGMON
DIRECTOR
 1.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) SCOTT WILLIAMS MD
DIRECTOR
 1.0 X           0 0 0
(19) DAVID STIRE
CEO/PRESIDENT
 36.0 X   X       365,696 0 59,610
(20) MICHAEL MOORE
CFO
 40.0     X       177,275 0 37,014
(21) SCOTT PHILLIPS
VP
 20.0     X       92,603 88,971 23,993
(22) SAMUEL GUILD
VP
 39.0     X       166,893 0 42,140
(23) SUSAN HERRON
VP
 40.0     X       167,421 0 19,526
(24) ROBERT POOLE
CIO
 40.0       X     153,921 0 11,794
(25) ERIN CLAIBORNE
PHARMACY MANAGER
 40.0         X   128,849 0 11,794
(26) DAVID SETTLE
PHYSICAL THERAPIST
 40.0         X   161,663 0 11,698
(27) LAUREN GARRETT
DIRECTOR OF QUALITY
 40.0         X   123,961 0 5,032
(28) SUSAN WESSON
PHARMACIST
 40.0         X   133,214 0 4,938
(29) JERUSHA COWARD
PHARMACIST
 40.0         X   118,822 0 4,822


1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,790,318 1,004,649 346,517
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet12
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SEE SCHEDULE O GENERAL STATEMENT 1
 
  		  9,897,788
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet14
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 580,000
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		51,883
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 631,883
Program Service Revenue Business Code
2a NET PATIENT REVENUE 621,990 108,810,845 108,745,850   64,995
b CAFETERIA SALES 900,099 901,689     901,689
c RENTAL INCOME 532,000 297,695     297,695
d WELLNESS MEMBER COMMUNITY 900,099 203,026 203,026    
e ELECTRONIC MEDICAL RECORDS PAYMENT 900,099 666,728     666,728
f All other program service revenue . 875,779 875,779    
g Total. Add lines 2a–2f........MediumBullet 111,755,762
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 320,192     320,192
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,925,661 419,151
b Less: cost or other basis and sales expenses 1,907,179 669,894
c Gain or (loss) 18,482 -250,743
d Net gain or (loss)..........MediumBullet -232,261     -232,261
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 112,475,576 109,824,655   2,019,038
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 87,150 87,150
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,029,325 1,029,325    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 37,436,670 30,253,436 7,183,234  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,138,011 3,138,011    
9 Other employee benefits ....... 5,293,992 3,324,427 1,969,565  
10 Payroll taxes ........... 2,676,333 2,194,490 481,843  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 329,164 329,164    
c Accounting ........... 53,556 53,556    
d Lobbying ........... 3,829 3,829    
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 15,428,885 11,692,641 3,736,244  
12 Advertising and promotion .... 225,614 8,518 217,096  
13 Office expenses ....... 17,947,812 17,373,120 574,692  
14 Information technology ...... 1,758,514 448,608 1,309,906  
15 Royalties .. 0      
16 Occupancy ........... 2,165,090 2,165,090    
17 Travel ............ 160,962 108,936 52,026  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 52,933 13,716 39,217  
20 Interest ........... 318,791   318,791  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 5,186,306 3,287,827 1,898,479  
23 Insurance .............. 341,776   341,776  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a SHOPP ASSESSMENT FEE 3,003,798   3,003,798  
b REPAIRS 2,906,153 2,216,421 689,732  
c FOOD 1,043,612 936,084 107,528  
d SALES & USE TAX 204,225 151,500 52,725  
e
f All other expenses 731,545 330,803 400,742  
25 Total functional expenses. Add lines 1 through 24f 101,524,046 79,146,652 22,377,394 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,700 1 2,700
2 Savings and temporary cash investments ....... 7,886,387 2 10,182,768
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 22,964,016 4 26,890,613
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 1,125,539 8 1,113,570
9 Prepaid expenses and deferred charges ............ 848,487 9 1,008,121
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 136,307,517
b Less: accumulated depreciation. ..... 10b 101,815,935 37,876,594 10c 34,491,582
11 Investments—publicly traded securities .......... 9,667,181 11 11,476,577
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 302,174 14 302,174
15 Other assets. See Part IV, line 11 ........... 630,051 15 916,418
16 Total assets. Add lines 1 through 15 (must equal line 34)... 81,303,129 16 86,384,523
Liabilities 17 Accounts payable and accrued expenses . 7,711,049 17 8,026,775
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 7,883,784 20 7,957,811
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 179,553 23 55,184
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 1,672,471 25 1,870,590
26 Total liabilities. Add lines 17 through 25..... 17,446,857 26 17,910,360
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 63,856,272 27 68,474,163
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 63,856,272 33 68,474,163
34 Total liabilities and net assets/fund balances ..... 81,303,129 34 86,384,523
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
112,475,576
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
101,524,046
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
10,951,530
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
63,856,272
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-6,333,639
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
68,474,163
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
  		Employer identification number

73-0606129
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
  		Employer identification number

73-0606129
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
  		Employer identification number

73-0606129
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
3,829
j
Total. Add lines 1c through 1i ...............................
3,829
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION 1 SCHEDULE C, PART II-B: QUESTION 1I: OTHER ACTIVITIES - AHA FEES ATTRIBUTABLE TO LOBBYING.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   811,165 811,165
b Buildings ................   33,747,933 19,439,850 14,308,083
c Leasehold improvements ............        
d Equipment ................   95,451,137 79,747,406 15,703,731
e Other .................   6,297,282 2,628,679 3,668,603
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 34,491,582
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
ACCRUED PENSION 856,031
OTHER LONG TERM LIABILITIES 78,655
ARO ASSET RETIREMENT OBLIGATION 677,794
ESTIMATED NET AMTS DUE TO MEDICARE 203,946
LEASE LIABILITY 54,164




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,870,590
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    4,508,569 0 4,508,569 4.400 %
b Medicaid (from Worksheet 3, column a) .....     13,039,481 13,403,146 -363,665  
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    17,548,050 13,403,146 4,144,904 4.400 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    34,110 5,420 28,690  
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		    4,091 0 4,091  
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....            
jTotal Other Benefits ...     38,201 5,420 32,781  
kTotal. Add lines 7d and 7j. ..     17,586,251 13,408,566 4,177,685 4.400 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
7,836,149
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
47,453,050
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
47,902,902
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-449,852
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 JANE PHILLIPS MEMORIAL MEDICAL CENTER
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
JANE PHILLIPS MEMORIAL MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
SUPPLEMENTAL INFORMATION 1 PART I, LINE 3C: N/A FOR ADDITIONAL INFORMATION
SUPPLEMENTAL INFORMATION 2 PART I, LINE 6A: THE HOSPITAL IS A WHOLLY-OWNED (WHOLLY-SPONSORED) SUBSIDIARY OF ST. JOHN HEALTH SYSTEM, INC. - EIN 73-1215174 - (SJHS). SJHS PREPARED A CONSOLIDATED COMMUNITY BENEFIT REPORT FOR THE CONSOLIDATED ORGANIZATION FOR THIS TAX YEAR. THE REPORT IS MADE AVAILABLE ON DEMAND AND IS REFERENCED BY THE ORGANIZATION IN A NUMBER OF PUBLIC MEETINGS AND COMMUNITY OUTREACH ACTIVITIES. SJHS HAS CHOSEN NOT TO POST THE SUMMARIZED INFORMATION ON ITS WEB SITE OR DO MASS MAILINGS OR MASS ADVERTISING TO COMMUNICATE THE SUBSTANTIAL COMMUNITY BENEFIT PROVIDED EACH YEAR BY SJHS.
SUPPLEMENTAL INFORMATION 3 PART I, LINE 7: COSTS WERE DETERMINED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, PATIENT CARE COST-TO CHARGES.
SUPPLEMENTAL INFORMATION 4 PART II: COMMUNITY BUILDING ACTIVITIES N/A FOR ADDITIONAL INFORMATION
SUPPLEMENTAL INFORMATION 5 PART III, SECTION A, LINE 4: THE HOSPITAL DOES NOT PUBLISH SEPARATELY AUDITED FINANCIAL STATEMENTS, BUT IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENT OF SJHS. SEE 2012 CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF SJHS. COSTS WERE DETERMINED USING A RATIO OF COST TO CHARGES METHODOLOGY CONSISTENT WITH THE DETERMINATION OF THE COST OF CHARITY CARE AND THE COST OF UNCOMPENSATED MEDICAID. THE HOSPITAL DOES NOT CONSIDER ANY AMOUNTS CHARGED TO BAD DEBT TO BE, AND HAS NOT INCLUDED ANY SUCH AMOUNTS IN ITS MEASURE OF, COMMUNITY BENEFIT.
SUPPLEMENTAL INFORMATION 6 PART III, SECTION A, LINE 8 THE COSTS OF SERVICES PROVIDED TO MEDICARE BENEFICIARIES WERE DETERMINED USING A RATIO OF COST TO CHARGES METHODOLOGY CONSISTENT WITH THE DETERMINATION OF THE COST OF CHARITY CARE AND THE COST OF UNCOMPENSATED MEDICAID. THE HOSPITAL DOES NOT CONSIDER ANY AMOUNTS RELATED TO THE SHORTFALL (IF ANY) OF REIMBURSEMENT LESS THE COST OF SERVICE TO MEDICARE BENEFICIARIES TO BE CHARITY CARE OR COMMUNITY BENEFIT AND HAS NOT INCLUDED ANY SUCH AMOUNTS IN ITS MEASURE OF COMMUNITY BENEFIT.
SUPPLEMENTAL INFORMATION 7 PART III, SECTION A, 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 CEASE. 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 FY 2012, ALL UNINSURED PATIENTS WERE ELIGIBLE FOR AUTOMATIC DISCOUNTS OF AT LEAST 30% AND UP TO 45%. IN FY 2012, ALL PATIENTS WITH FAMILY INCOME LESS THAN OR EQUAL TO 300% OF FEDERAL POVERTY GUIDELINES WERE ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE OF FREE OR DISCOUNTED CARE.
SUPPLEMENTAL INFORMATION 8 PART VI, LINE 2: NEEDS ASSESSMENT THE HOSPITAL CONDUCTED A COMMUNITY NEEDS ASSESSMENT JOINTLY WITH ITS PARENT ENTITY - SJHS. SJHS PARTICIPATES IN ONGOING COMMUNITY-BASED NEEDS ASSESSMENTS. SOME OF THE MOST SIGNIFICANT RECENT ACTIVITY INCLUDES COMMISSIONING OF A COMMUNITY NEEDS ASSESSMENT AND PLAN FOR IMPROVING COMMUNITY HEALTH CARE CONDUCTED BY TULSA COUNTY HEALTH DEPARTMENT AND RELEASED IN 2013, AND THE LEWIN CONSULTING GROUP IN 2007. THIS LEWIN STUDY INCLUDED PARTICIPATION OF ST. JOHN HEALTH SYSTEM, THE GEORGE KAISER FAMILY FOUNDATION, TRUSTEES OF THE CHAPMAN TRUSTS, ST. FRANCIS HEALTH SYSTEM, THE UNIVERSITY OF OKLAHOMA TULSA SCHOOL OF COMMUNITY MEDICINE, MANY OF THE LOCAL AND REGIONAL SAFETY NET PROVIDER ORGANIZATIONS, INCLUDING LOCAL FCHC'S AND MANY OTHERS. THIS LEWIN STUDY AND REPORT WAS FOLLOWED IN 2009 BY A COMMUNITY-BASED NEEDS ASSESSMENT AND PLANNING PROCESS OPEN TO EVERYONE IN THE COMMUNITY AND LEAD BY THE TULSA COUNTY HEALTH DEPARTMENT AND THE RECENT 2012/2013 COMMUNITY NEEDS ASSESSMENT ALSO LEAD BY TULSA COUNTY HEALTH DEPARTMENT. THE 2013 ASSESSMENT HAS BEEN POSTED TO THE HOSPITAL AND HEALTH SYSTEM WEBSITES. MANY MAJOR COMMUNITY HEALTH CARE SERVICE ORGANIZATIONS PARTICIPATED IN THESE STUDIES. IN ADDITION TO THE ABOVE, SJHS THROUGH, ITS SUBSIDIARY ST. JOHN MEDICAL CENTER, HAS ESTABLISHED A MEDICAL ACCESS PROGRAM (MAP) THAT IS ATTEMPTING TO IMPROVE AND EXPAND ACCESS TO HEALTH CARE SERVICES TO THE MOST VULNERABLE MEMBERS OF THE TULSA COMMUNITY. ALL SJHS TULSA HOSPITALS PARTICIPATE IN THIS INITIATIVE. THIS PROGRAM IS OVERSEEN BY REPRESENTATIVES OF ST. JOHN, THE GEORGE KAISER FAMILY FOUNDATION, TRUSTEES OF THE CHAPMAN TRUSTS AND THE UNIVERSITY OF OKLAHOMA TULSA SCHOOL OF COMMUNITY MEDICINE. THE MAP PROGRAM INCLUDES PARTICIPATION OF OTHER HEALTH CARE PROVIDERS INCLUDING GOOD SAMARITAN CLINICS, DAY CENTER FOR THE HOMELESS, COMMUNITY HEALTH CONNECTIONS FQHC AND A NETWORK OF VOLUNTEER PHYSICIAN PROVIDERS AND OTHER ORGANIZATIONS. THE MAP PROGRAM REGULARLY RECEIVES INPUT FROM ALL THESE ORGANIZATIONS ON NEEDED SERVICES IN THE COMMUNITY WHICH HELPS TO PRIORITIZE THE LIMITED RESOURCES AVAILABLE TO ADDRESS COMMUNITY NEEDS.
SUPPLEMENTAL INFORMATION 9 PART VI, LINE 3: PATIENT EDUCATION - ELIGIBILITY ASSISTANCE THE HOSPITAL HAS A TEAM OF FINANCIAL COUNSELORS WHO, PRIOR TO DISCHARGE, ATTEMPT TO VISIT IN PERSON WITH ALL UNINSURED INPATIENTS AND ALL INPATIENTS LIKELY TO QUALIFY FOR MEDICAL INDIGENCY TO EXPLAIN OUR FINANCIAL ASSISTANCE POLICIES AND HELP GUIDE THEM THROUGH THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. WE ALSO ATTEMPT TO MEET WITH ALL THE FAMILIES OF ALL MEDICAID BENEFICIARIES OR INDIVIDUALS WHO WE BELIEVE COULD POTENTIALLY QUALIFY FOR MEDICAID TO HELP THEM APPLY FOR COVERAGE. THE HOSPITAL MENTIONS THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY AND PROVIDES A PHONE NUMBER TO CALL: ON ITS WEBSITE, IN ADMITTING MATERIALS, ON ALL INVOICES FOR SERVICES SENT TO PATIENTS AND IN OTHER WAYS.
SUPPLEMENTAL INFORMATION 10 PART VI, LINE 4: COMMUNITY INFORMATION AS DESCRIBED ABOVE THE HOSPITAL IS PART OF THE ST. JOHN HEALTH SYSTEM (SJHS). ALTHOUGH SJHS PROVIDES A FULL SPECTRUM OF HEALTH RELATED SERVICES THROUGHOUT NORTHEASTERN OKLAHOMA, ITS TERTIARY OPERATIONS AND A LARGE PART OF ITS OTHER SERVICES ARE CONCENTRATED IN THE TULSA METROPOLITAN STATISTICAL AREA (THE "TULSA MSA"). ACCORDING TO THE 2010 CENSUS, THE STATE OF OKLAHOMA HAD A RESIDENT POPULATION OF 3,751,351 PERSONS COMPARED TO 3,450,654 PERSONS IN 2000. THIS IS AN 8.7% INCREASE. THE U. S. CENSUS BUREAU ESTIMATED THAT IN 2009 13.5% OF THE OKLAHOMA RESIDENT POPULATION WAS ELIGIBLE FOR MEDICARE, COMPARED TO 14.7% IN 2000. TULSA COUNTY, OKLAHOMA AND THE COUNTIES THAT MAKE UP THE TULSA MSA, ACCORDING TO THE 2010 CENSUS, HAD POPULATIONS OF 603,403 AND 1,008,460, RESPECTIVELY. THIS COMPARES TO POPULATIONS OF 563,299 AND 803,235 PERSONS, RESPECTIVELY IN 2000 AND REPRESENTS POPULATION GROWTH OF 7.1% AND 25.5%, RESPECTIVELY. THE DATA SHOW THAT THE COUNTIES IN THE TULSA MSA THAT SURROUND TULSA COUNTY GREW MUCH FASTER FROM 2000 TO 2010. AT THE SAME TIME THE POPULATION WITHIN TULSA COUNTY SHIFTED AWAY FROM THE CITY OF TULSA AND TO SUBURBS SUCH AS OWASSO AND BROKEN ARROW. THE CITIES OF BROKEN ARROW AND OWASSO WERE TWO OF THE FASTEST GROWING COMMUNITIES IN OKLAHOMA BETWEEN 2000 AND 2010. THE POPULATION OF THE CITY OF OWASSO GREW 56% TO 28,915 FROM 2000 TO 2010 AND THE POPULATION OF THE CITY OF BROKEN ARROW GREW 32% TO 98,850 FROM 2000 TO 2010. WAGONER COUNTY (SOUTHEAST OF TULSA) AND ROGERS COUNTY (NORTHEAST OF TULSA) SHOWED THE TWO HIGHEST POPULATION GROWTH RATES FROM 2000 TO 2010. EVERY COUNTY IN THE 8 COUNTY TULSA MSA EXCEPT PAWNEE COUNTY GREW IN POPULATION FROM 2000 TO 2010. WASHINGTON COUNTY, DIRECTLY NORTH OF TULSA COUNTY AND WHICH INCLUDES THE CITY OF BARTLESVILLE (AND JANE PHILLIPS MEDICAL CENTER), ALSO GREW IN POPULATION FROM 2000 TO 2010. WHEN THE POPULATION OF WASHINGTON COUNTY IS ADDED TO THE POPULATION OF THE TULSA COUNTY, THE 2010 COMBINED POPULATION WAS 1,059,436. THERE IS SIGNIFICANT DISPARITY IN THE GENERAL HEALTH OF POPULATIONS WITHIN THE SERVICE AREA DEPENDING UPON WHERE AN INDIVIDUAL LIVES AND TO WHAT SOCIO ECONOMIC AND ETHNIC GROUP THEY BELONG. CITIZENS WHO RESIDE IN "NORTH TULSA" AND IN SOME AREAS OF "EAST" AND "WEST" TULSA GENERALLY HAVE POORER HEALTH AND SHORTER LIFE SPANS THAN INDIVIDUALS WHO LIVE IN "SOUTH" TULSA. MEMBERS OF MINORITY GROUPS (MANY OF WHOM RESIDE IN THE GEOGRAPHIC AREAS DESCRIBED ABOVE) SHARE THESE SAME HEALTH CHARACTERISTICS. IT HAS BEEN DEMONSTRATED THAT THESE INDIVIDUALS HAVE LESS ACCESS TO REGULAR HEALTH CARE SERVICES, INCLUDING SPECIALTY CARE AND MANY SEEK EVEN THEIR PRIMARY CARE IN HOSPITAL EMERGENCY ROOMS, INCLUDING ALL OF THE SJHS HOSPITALS. SOME SIGNIFICANT MINORITY GROUPS IN THE HOSPITAL'S AND SJHS'S PRINCIPAL SERVICE AREA INCLUDE NATIVE AMERICANS, HISPANICS AND AFRICAN AMERICANS. EACH OF THESE GROUPS SHARE COMMON SOCIO ECONOMIC CHALLENGES MAKING THEM MORE LIKELY TO BE POOR AND BE UNINSURED FOR HEALTH CARE. EACH OF THESE GROUPS HAVE UNIQUE ETHNIC HEALTH RISK FACTORS THAT CONTRIBUTE TO HEALTH STATUS THAT IS GENERALLY POORER THAN THEIR WHITE COUNTERPARTS. HOWEVER, EVEN AMONG THE WHITE POPULATION IN THE HOSPITAL'S SERVICE AREA THERE IS SIGNIFICANT ADVERSE HEALTH CARE STATUS. IN GENERAL OKLAHOMA (INCLUDING THE HOSPITAL'S SERVICE AREA) RANKS NEAR THE BOTTOM IN MANY IF NOT MOST MEASURES OF HEALTH STATUS IN THE U.S. IN GENERAL, THERE ARE HIGH RATES OF SMOKING, DIABETES, OBESITY, UPPER RESPIRATORY ILLNESS, CHRONIC HEART CONDITIONS AND MANY OTHER FACTORS. IN GENERAL THERE ARE HIGH RATES OF UNINSURED AND UNDERINSURED INDIVIDUALS AND FAMILIES IN THE COMMUNITIES AND GEOGRAPHIES SERVED BY THE HOSPITAL WHICH CREATE MANY CHALLENGES IN MEETING THE DEMAND FOR BASIC SERVICES AND IN IMPROVING THE HEALTH STATUS OF THE POPULATION.
SUPPLEMENTAL INFORMATION 11 PART VI, LN 5:PROMOTION OF COMMUNITY HEALTH & LN 6:AFFILIATED HEALTH CARE ANSWERS TO THESE TWO QUESTIONS ARE COMBINED BELOW. AS PREVIOUSLY DISCUSSED THE HOSPITAL IS PART OF ST. JOHN HEALTH SYSTEM (ST. JOHN). ST. JOHN IS A GROWING INTEGRATED DELIVERY SYSTEM THAT SERVES NORTHEASTERN OKLAHOMA AND THE SURROUNDING AREA. IT HAS GROWN SIGNIFICANTLY IN RECENT YEARS, WITH INCREASING REVENUES FROM OUTPATIENT AND PHYSICIAN PROFESSIONAL SERVICES AS WELL AS OTHER POST-ACUTE SERVICES. ACUTE CARE SERVICES ARE PROVIDED ON FIVE MAJOR HOSPITAL CAMPUSES THAT ARE OWNED BY ST. JOHN. THE OWNED HOSPITALS ARE ST. JOHN MEDICAL CENTER (THE TERTIARY CENTER IN TULSA, OKLAHOMA), JANE PHILLIPS MEDICAL CENTER IN BARTLESVILLE, ST. JOHN OWASSO IN OWASSO OKLAHOMA, ST. JOHN BROKEN ARROW, AND ST. JOHN SAPULPA, A CRITICAL ACCESS HOSPITAL IN SAPULPA, OKLAHOMA. ACUTE CARE SERVICES ARE ALSO PROVIDED AT THREE ADDITIONAL RURAL CRITICAL ACCESS HOSPITALS WHICH ARE OWNED OR MANAGED BY JANE PHILLIPS AND AT OSUMC WHICH IS MANAGED BY ST. JOHN. DIAGNOSTIC SERVICES AND CERTAIN ACUTE CARE SERVICES ARE ALSO PROVIDED IN A VARIETY OF FREE STANDING (INCLUDING HOSPITAL-BASED) SETTINGS. THE ST. JOHN SYSTEM NOW INCLUDES MORE THAN 400 EMPLOYED PHYSICIANS AND "MID-LEVEL PROVIDERS", AND SEVERAL URGENT CARE CLINICS, AS WELL AS RETIREMENT AND SKILLED NURSING FACILITIES INCLUDING SOME TARGETED SPECIFICALLY TO SERVE LOW-INCOME AND PHYSICALLY DISABLED INDIVIDUALS) AND OTHER HEALTH CARE PROVIDERS. ST. JOHN IS ATTEMPTING TO PROMOTE COMMUNITY HEALTH IN SEVERAL WAYS. MOST OF THE AFFILIATED PRIMARY CARE PHYSICIANS HAVE OR ARE ESTABLISHING "MEDICAL HOME" MODELS OF CARE THAT ARE ATTEMPTING TO IMPROVE HEALTH STATUS OF THEIR PATIENTS BY BETTER EMPHASIZING PREVENTIVE CARE AND HEALTH SCREENING AND BY BETTER MANAGEMENT OF CHRONIC DISEASE. THE AFFILIATED PRIMARY CARE PHYSICIANS UTILIZE A SOPHISTICATED ELECTRONIC MEDICAL RECORD THAT HELPS PROVIDE REAL TIME INFORMATION TO MAKE IT EASIER TO MANAGE PATIENTS' CARE. THE HOSPITAL AND THE OTHER HOSPITALS IN THE SYSTEM HAVE INVESTED HEAVILY IN CLINICAL INFORMATION SYSTEMS AND ELECTRONIC MEDICAL RECORDS TO BETTER MANAGE PATIENT CARE DURING EACH EPISODE OF ACUTE CARE. ST. JOHN IS INVESTING IN NEW SYSTEMS OF CARE TO PROVIDE BETTER COORDINATION OF CARE BETWEEN ALL THE DIFFERENT PROVIDERS RESPONSIBLE FOR PORTIONS OF EACH PATIENT'S CARE WITH AN EMPHASIS ON PREVENTION, SCREENING AND COORDINATION OF CHRONIC CARE. THE HOSPITAL AND SJHS HAVE INVESTED IN TERTIARY SERVICES THAT ARE NEEDED BY THE COMMUNITY. EXAMPLES OF WHICH INCLUDE DEVELOPMENT OF OKLAHOMA'S ONLY ACS LEVEL II TRAUMA CENTER (THE HIGHEST ACCREDITED CENTER IN TULSA), NORTHEASTERN OKLAHOMA'S ONLY JCAHO-ACCREDITED STROKE CENTER, NEONATAL INTENSIVE CARE, SOPHISTICATED MEDICAL TECHNOLOGY INCLUDING ALL-DIGITAL DIAGNOSTIC RADIOLOGY, CYBERKNIFE AND OTHER FORMS OF RADIATION THERAPY, DAVINCI ROBOTIC SURGERY, AN ENDOVASCULAR OPERATING SUITE, ORTHOPEDIC AND NEURO SURGICAL CENTERS OF EXCELLENCE, SOPHISTICATED CARDIOVASCULAR CARE THAT EMPHASIZED RAPID AND EFFECTIVE INTERVENTION FOR HEART ATTACK VICTIMS AND PREVENTIVE CARE FOR THOSE WITH CHRONIC HEART CONDITIONS. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND HAS COMMUNITY, RELIGIOUS AND PHYSICIAN REPRESENTATIVES SERVING ON ITS BOARD. SJHS HAS CREATED AND IS CONTINUING TO CREATE SYSTEMS AND POLICIES TO PROMOTE BETTER COORDINATION OF CARE AND ALLOCATION OF RESOURCES THROUGHOUT THE SYSTEM. THE HOSPITAL PARTICIPATES IN MANY COMMUNITY-WIDE HEALTH SCREENING AND HEALTH EDUCATION EVENTS AS WELL AS HOSTING MANY SUCH EVENTS THAT ARE OPEN TO THE PUBLIC. THE HOSPITAL AND SJHS CONTINUE TO INVEST IN MEDICAL EDUCATION TO SUPPORT THE EXPANSION OF PHYSICIANS, NURSES AND ALLIED HEALTH PROFESSIONALS THAT WILL SERVE THE CURRENT AND FUTURE GENERATIONS OF PATIENTS IN THE SERVICE AREA. THE HOSPITAL PARTICIPATES IN SJHS'S COORDINATED EFFORT TO ASSESS COMMUNITY NEED COLLABORATIVELY WITH OTHER INTERESTED PARTIES IN THE COMMUNITY AND TO ALLOCATE CAPITAL AND HUMAN RESOURCES TO ADDRESS THE NEEDS OF THE ENTIRE SERVICE AREA. FINALLY AS ONE OF ONLY TWO MAJOR TAX-EXEMPT HEALTH SYSTEMS IN OUR SERVICE AREA, ST. JOHN REINVESTS 100% OF ANY PROFITS GENERATED INTO NEW OR EXPANDED SERVICES FOR THE COMMUNITY. THE INVESTOR-OWNED COUNTERPARTS IN THE SERVICE AREA ARE MOTIVATED TO LIMIT SERVICES TO THE UNDERSERVED AND UNINSURED SO THAT THEY CAN GENERATE HIGHER PROFITS TO RETURN AT LEAST A SUBSTANTIAL PORTION OF THOSE PROFITS TO THEIR INVESTORS. SOME OF PHYSICIAN AND INVESTOR-OWNED FACILITIES IN THE SERVICE AREA PROVIDE LITTLE OR NO SERVICES TO MEDICAID BENEFICIARIES AND TO THE UNINSURED, BUT AGGRESSIVELY COMPETE FOR COMMERCIALLY-INSURED PATIENTS FROM WHICH THE ST. JOHN AND THE OTHER TAX-EXEMPT PROVIDERS DERIVE MOST OF THE PROFITS THAT ALLOW FOR OUR INVESTMENT IN SERVICES TO THE COMMUNITY.
SUPPLEMENTAL INFORMATION 12 PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT THE HOSPITAL DOES NOT OPERATE IN ANY STATES REQUIRING A COMMUNITY BENEFIT REPORT TO BE FILED.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number
73-0606129
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) ROGERS STATE UNIVERSITY1701 W WILL ROGERS BLVD
CLAREMORE,OK74017 		73-6017987 PUBLIC UNIVSTY. 80,000       EDUCATION SUPPORT






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION 1 SCHEDULE I, PART I, LINE 2 IN LINE WITH ITS EXEMPT PURPOSE, JANE PHILLIPS MEMORIAL MEDICAL CENTER (JPMMC) PROVIDES FUNDS TO ROGERS STATE UNIVERSITY TO SUPPORT THEIR EDUCATIONAL PROGRAMS. JPMMC DETERMINES THE AMOUNT OF THE FUNDS PROVIDED ON AN ANNUAL BASIS.
Schedule I (Form 990) 2011


Additional Data


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DAVID J PYNN (i)
(ii)		 0
718,611 		0
60,775 		0
36,296 		0
97,673 		0
16,483 		0
929,838 		0
0
(2) DAVID STIRE (i)
(ii)		 336,376
0 		29,320
0 		0
0 		46,812
0 		12,798
0 		425,306
0 		0
0
(3) MICHAEL MOORE (i)
(ii)		 161,255
0 		16,020
0 		0
0 		22,928
0 		14,086
0 		214,289
0 		0
0
(4) SCOTT PHILLIPS (i)
(ii)		 84,509
81,195 		8,094
7,776 		0
0 		6,880
6,611 		5,356
5,146 		104,839
100,728 		0
0
(5) SAMUEL GUILD (i)
(ii)		 151,963
0 		14,930
0 		0
0 		30,095
0 		12,045
0 		209,033
0 		0
0
(6) SUSAN HERRON (i)
(ii)		 153,831
0 		13,590
0 		0
0 		14,283
0 		5,243
0 		186,947
0 		0
0
(7) ROBERT POOLE (i)
(ii)		 153,921
0 		0
0 		0
0 		0
0 		11,794
0 		165,715
0 		0
0
(8) DAVID SETTLE (i)
(ii)		 161,663
0 		0
0 		0
0 		0
0 		11,698
0 		173,361
0 		0
0








Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION 1 SCHEDULE J, PART I, LINE 3 JANE PHILLIPS MEMORIAL MEDICAL CENTER IS AN AFFILIATE OF ST. JOHN HEALTH SYSTEM (SJHS). COMPENSATION FOR ALL EXECUTIVES WITHIN THE SYSTEM IS ESTABLISHED BY SJHS USING THE FOLLOWING METHODS, LISTED ON SCHEDULE J, PART I, LINE 3: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
SUPPLEMENTAL INFORMATION 2 SCHEDULE J, PART I, LINE 4B ST. JOHN HEALTH SYSTEM, INC. IS THE CONTROLLING MEMBER ORGANIZATION OF AN INTEGRATED HEALTHCARE SYSTEM (SYSTEM). THE SYSTEM PROVIDES A VOLUNTARY SECTION 457(B) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO CERTAIN EXECUTIVES. UNDER THIS PLAN, THE EXECUTIVES MAY ELECT TO DEFER A PORTION OF THEIR INCOME UNTIL RETIREMENT. THE CONTRIBUTIONS, ALONG WITH ANY EARNINGS, ARE TAXED UPON WITHDRAWAL. THE SYSTEM ALSO PROVIDES A SECTION 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO CERTAIN EXECUTIVES. THE PLAN PROVIDES A DEFERRED COMPENSATION CONTRIBUTION, MADE BY THE SYSTEM, OF 9% OF BASE PAY, FUNDED AT THE CONCLUSION OF THE FISCAL YEAR. EACH CONTRIBUTION, ALONG WITH ANY EARNINGS, WILL BE HELD BY IN TRUST FOR TWO YEARS, AT WHICH POINT THE CONTRIBUTION WILL VEST AND WILL BE PAID OUT AS A TAXABLE LUMP SUM CASH PAYMENT. VESTING WILL ALSO OCCUR UPON DEATH, INVOLUNTARY TERMINATION WITHOUT CAUSE, VOLUNTARY TERMINATION FOR GOOD REASON, OR PLAN TERMINATION. THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII PARTICIPATED IN THIS PLAN: DAVID STIRE SAMUEL GUILD MICHAEL MOORE SUSAN HERRON SCOTT PHILLIPS DAVID J. PYNN
SUPPLEMENTAL INFORMATION 3 SCHEDULE J, PART I, LINE 7 ST. JOHN HEALTH SYSTEM, INC. IS THE CONTROLLING MEMBER ORGANIZATION OF AN INTEGRATED HEALTHCARE SYSTEM (SYSTEM). THE SYSTEM HAS ESTABLISHED AN EXECUTIVE ACCOUNTABILITY AND FINANCIAL INCENTIVE PLAN THAT ENCOURAGES THE EXECUTIVES' PARTICIPATION IN THE SIGNIFICANT IMPROVEMENTS OF THE QUALITY, FINANCIAL, GROWTH, AND HUMAN RESOURCE RELATED OPERATIONS OF THE ORGANIZATION. ELIGIBILITY IS TRIGGERED WHEN THE SYSTEM MEETS CERTAIN EARNINGS AND COMMUNITY BENEFITS TARGETS; HOWEVER PAYMENTS RECEIVED UNDER THE PLAN ARE NOT BASED ON THE EARNINGS OF THE ORGANIZATION. EXECUTIVES RECEIVE POINTS UNDER A PLAN SCORING SYSTEM FOR MEETING THEIR PREDETERMINED GOALS. THE POINTS ARE THEN ENTERED INTO THE PLAN FORMULA TO DETERMINE THE EXECUTIVES' INCENTIVE COMPENSATION. MAXIMUM PAYMENTS UNDER THE FINANCIAL INCENTIVE PLAN ARE TWENTY PERCENT OF BASE PAY FOR MOST EXECUTIVES AND 25% OF BASE PAY FOR THE SYSTEM CEO. THERE IS A SMALL DISCRETIONARY ELEMENT TO THE PLAN, GENERALLY EQUAL UP TO 6.0% OF BASE PAY (UP TO 30% OF THE TOTAL PLAN PAY OUT).
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Identifier Return Reference Explanation
GENERAL STATEMENT 1 PART III: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS PART III: QUESTION 1 - JANE PHILLIPS MEMORIAL MEDICAL CENTER IS PART OF THE JANE PHILLIPS HEALTH SYSTEM. IT IS THE MISSION OF JANE PHILLIPS HEALTH SYSTEM TO PROVIDE HEALTHCARE AND RELATED MINISTRIES FOR THE PEOPLE SERVED, ESPECIALLY THE SICK, THE POOR, AND THE POWERLESS. JANE PHILLIPS MEMORIAL MEDICAL CENTER IS ALSO PART OF THE ST. JOHN HEALTH SYSTEM. ST. JOHN HEALTH SYSTEM'S MISSION IS TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST BY PROVIDING MEDICAL EXCELLENCE AND COMPASSIONATE CARE TO ALL WHO NEED IT WITH A SPECIAL EMPHASIS FOR THE POOR AND POWERLESS.
GENERAL STATEMENT 2 PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ST. JOHN HEALTH SYSTEM, INC. ("ST. JOHN"), AND AFFILIATES, OWN AND OPERATE A COMPREHENSIVE TERTIARY HEALTH CARE DELIVERY SYSTEM WHICH PROVIDES A FULL SPECTRUM OF HEALTH-RELATED SERVICES THROUGHOUT NORTHEASTERN OKLAHOMA. ST. JOHN, HEADQUARTERED IN TULSA, OKLAHOMA, CONDUCTS ITS OPERATIONS THROUGH TEN PRINCIPAL WHOLLY-OWNED OR WHOLLY-CONTROLLED SUBSIDIARIES: ST. JOHN MEDICAL CENTER, INC. (THE "MEDICAL CENTER"), ST. JOHN SAPULPA, INC. ("ST. JOHN SAPULPA"), JANE PHILLIPS HEALTH CORPORATION ("JANE PHILLIPS"), UTICA SERVICES, INC. ("UTICA"), ST. JOHN VILLAS, INC. ("ST. JOHN VILLAS"), ST. JOHN MANAGEMENT SERVICES, INC., ("SJMS"), OWASSO MEDICAL FACILITY, INC. ("ST. JOHN OWASSO"), ST. JOHN HEALTH SYSTEM FOUNDATION, INC. (FORMERLY ST. JOHN MEDICAL CENTER FOUNDATION, INC.) ("ST. JOHN FOUNDATION"), ST. JOHN BUILDING CORPORATION (SJBC), AND ST. JOHN BROKEN ARROW, INC. (ST. JOHN BROKEN ARROW). ST. JOHN, THESE SUBSIDIARIES, AND ALL OTHER SUBSIDIARIES UNDER ST. JOHN'S DIRECT OR INDIRECT CONTROL OR OWNERSHIP ARE REFERRED TO HEREIN AS "THE ST. JOHN SYSTEM". JANE PHILLIPS HEALTH CORPORATION (JPHC) AND ITS AFFILIATES OPERATE A FULL-SERVICE HEALTHCARE DELIVERY SYSTEM WHICH PROVIDES A BROAD RANGE OF IN-PATIENT AND OUT-PATIENT HEALTH CARE SERVICES TO THE RESIDENTS OF NORTHEASTERN OKLAHOMA AND THE SURROUNDING REGION. JPHC INCLUDES JANE PHILLIPS MEMORIAL MEDICAL CENTER (THE MEDICAL CENTER) IN BARTLESVILLE OKLAHOMA. THE MEDICAL CENTER IS LICENSED FOR 140 BEDS AND OPERATES 114 BEDS. THE MEDICAL CENTER MAINTAINS A 24 HOUR EMERGENCY ROOM, AN ADULT INTENSIVE CARE UNIT, COMPREHENSIVE DIAGNOSTIC TESTING FACILITIES AND CAPABILITIES, INPATIENT PSYCHIATRIC FACILITIES, COMPREHENSIVE WOMEN'S SERVICES, CARDIOVASCULAR SERVICES, CANCER SERVICES, SURGICAL SERVICES AND MANY OTHER SERVICES. MISSION AND VALUES AS A CATHOLIC HEALTHCARE INSTITUTION, THE MEDICAL CENTER CARRIES ON THE MISSION OF ITS SPONSORS; THAT OF CONTINUING THE HEALING MINISTRY OF JESUS CHRIST. IT OPERATES IN CONFORMANCE WITH "THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH FACILITIES". FAITHFUL TO THE SPONSORSHIP MISSION, PHILOSOPHY AND VALUES, THE MEDICAL CENTER'S MISSION IS TO: PROVIDE HIGH QUALITY HEALTHCARE, CONTRIBUTE TO THE CONTINUING IMPROVEMENT OF THE OVERALL HEALTH STATUS, AND PROMOTE THE WELL-BEING OF PEOPLE IN BARTLESVILLE AND THE SURROUNDING COMMUNITIES WE SERVE, BEING ESPECIALLY SENSITIVE TO THE DIGNITY AND NEEDS OF THE SICK, THE POOR AND THE POWERLESS. THE CATCH PHRASE TO CAPTURE THIS MISSION OF SERVICE IS "MEDICAL EXCELLENCE - COMPASSIONATE CARE". THE BOARD OF DIRECTORS, MANAGEMENT AND EMPLOYEES OF THE MEDICAL CENTER ARE GUIDED IN THEIR DAY-TO-DAY ACTIONS AND INTERACTIONS WITH THOSE WHO SERVE AND WHO ARE SERVED BY THE CORE VALUES OF SERVICE, HUMAN DIGNITY, PRESENCE AND WISDOM. JANE PHILLIPS AND THE MEDICAL CENTER COLLABORATE WITH OTHER INDIVIDUALS AND INSTITUTIONS IN THE COMMUNITY TO ASCERTAIN COMMUNITY NEEDS AND PROVIDE A BROAD RANGE OF SERVICES ALONG THE HEALTHCARE CONTINUUM TO HELP MEET THOSE NEEDS. PROGRAMS AND SERVICES INCLUDE PREVENTIVE, DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE PROGRAMS, INCLUDING EMPHASIS ON HEALTH PROMOTION AND DISEASE PREVENTION. JANE PHILLIPS ALSO ADVOCATES FOR PUBLIC POLICIES WHICH ADVANCE A HEALTHY AND JUST SOCIETY. JANE PHILLIPS HEALTH CORPORATION WORKS WITH LOCAL, STATE AND NATIONAL LEADERS AND ORGANIZATIONS TO BRING ABOUT A HEALTHCARE DELIVERY SYSTEM THAT PROVIDES DIGNIFIED ACCESS TO AND AFFORDABLE HEALTHCARE FOR ALL PERSONS. COMMUNITY NEEDS ASSESSMENT THE MEDICAL CENTER HAS COMPLETED A COMMUNITY NEEDS ASSESSMENT AND THAT ASSESSMENT HAS BEEN POSTED TO BOTH THE JANE PHILLIPS AND ST. JOHN SYSTEM WEB SITES. GOVERNANCE THE ADMINISTRATIVE POWERS OF THE MEDICAL CENTER ARE VESTED IN ITS BOARD OF DIRECTORS, WHICH CONTROLS AND MANAGES THE PROPERTIES, AFFAIRS AND FUNDS OF THE MEDICAL CENTER, SUBJECT TO RESERVATION OF CERTAIN POWERS AND OVERSIGHT BY JPHC AND ST. JOHN. THE BOARD MEETS ON A REGULAR BASIS. THE MEDICAL CENTER BOARD WORKS IN CONCERT WITH AND, WHEN APPROPRIATE, UNDER THE DIRECTION OF THE JPHC AND THE ST. JOHN BOARDS. COMMUNITY BENEFIT THE MEDICAL CENTER IS AN INTEGRAL PART OF THE MISSION OF SERVICE AND THE CONTINUUM OF MEDICAL CARE PROVIDED BY THE ST. JOHN SYSTEM. IN MEASURING AND REPORTING QUANTIFIABLE COMMUNITY BENEFIT, THE ST. JOHN SYSTEM FOLLOWS GUIDELINES PROMULGATED BY THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES AND ENDORSED BY OTHER ORGANIZATIONS. UNCOMPENSATED CARE AND OTHER ELEMENTS OF COMMUNITY BENEFIT ARE MEASURED AT THE UNREIMBURSED ESTIMATED COST OF SERVICES OR RESOURCES PROVIDED.
GENERAL STATEMENT 3 PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS (CONT'D) THE ST. JOHN SYSTEM HOSPITALS, INCLUDING THE MEDICAL CENTER SERVE AS IMPORTANT SAFETY NET PROVIDERS OF A BROAD CONTINUUM OF HEALTH CARE SERVICES TO THE CITIZENS OF NORTHEASTERN OKLAHOMA AND THE SURROUNDING REGION. THE ST. JOHN MEDICAL CENTER OPERATES A FULL-SERVICE, 24-HOUR, 365-DAY TRAUMA CENTER AND EMERGENCY ROOM PROVIDING BOTH URGENT AND EMERGENCY CARE TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. THE ST. JOHN MEDICAL CENTER SERVES AS ONE OF ONLY THREE ADVANCED TRAUMA REFERRAL CENTERS FOR THE ENTIRE STATE OF OKLAHOMA AND TULSA'S ONLY ACCREDITED STROKE CENTER. IT ALSO SERVES AS THE HOST HOSPITAL FOR THE MEDICAL RESIDENCY PROGRAMS FOR INTERNAL MEDICINE AND GENERAL SURGERY FOR THE UNIVERSITY OF OKLAHOMA'S TULSA SCHOOL OF COMMUNITY MEDICINE. IT ALSO SERVES AS THE PRIMARY TEACHING HOSPITAL FOR THE IN HIS IMAGE FAMILY MEDICINE RESIDENCY PROGRAM. JANE PHILLIPS MEMORIAL MEDICAL CENTER ALSO OPERATES A FULL-SERVICE 24 HOUR/365 DAY PER YEAR EMERGENCY DEPARTMENT THAT PROVIDES MUCH NEEDED CARE TO THE LOCAL COMMUNITY AND ALSO ARRANGES TO TRANSFER ADVANCED OR MORE COMPLEX CASES DIRECTLY TO ST. JOHN MEDICAL CENTER OR TO OTHER PROVIDERS WHENEVER NEEDED. THE JANE PHILLIPS MEMORIAL MEDICAL CENTER ALSO PARTICIPATES IN RURAL FAMILY MEDICINE TRAINING PROGRAMS OF THE UNIVERSITY OF OKLAHOMA'S TULSA SCHOOL OF COMMUNITY MEDICINE. THE ST. JOHN SYSTEM CONSIDERS CARE FOR THE POOR TO BE AN ESSENTIAL PART OF ITS MISSION OF SERVICE TO THE COMMUNITY. THE TOTAL COST OF CARE FOR THE POOR INCLUDES THE COST OF CHARITY CARE, THE UNREIMBURSED COST OF SERVICES TO MEDICAID BENEFICIARIES (TOGETHER REFERRED TO AS "UNCOMPENSATED CARE FOR THE POOR") AND THE COST OF SPECIAL PROGRAMS OR OTHER ACTIVITIES SPECIFICALLY TARGETED TO INCREASE ACCESS TO CARE OR PROVIDE OTHER SERVICES TO THE POOR. "CARE FOR THE POOR" INCLUDES THE ESTIMATED COST OF CARE CLASSIFIED AS CHARITY CARE PLUS THE ESTIMATED EXCESS OF THE COST OF SERVICES PROVIDED TO MEDICAID BENEFICIARIES OVER THE PAYMENTS RECEIVED FROM MEDICAID. "CARE FOR THE POOR" DOES NOT INCLUDE THE COST OF SERVICES CLASSIFIED AND WRITTEN OFF AS BAD DEBTS OR THE EXCESS OF THE COST OF SERVICES PROVIDED TO MEDICARE BENEFICIARIES OVER THE PAYMENTS RECEIVED FROM MEDICARE. CHARITY AND UNCOMPENSATED CARE THE MEDICAL CENTER PROVIDES ITS SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. IN 2012, THE MEDICAL CENTER PROVIDED A DISCOUNT OF AT LEAST 30% OF BILLED CHARGES TO ALL UNINSURED PATIENTS. UNINSURED PATIENTS ALSO COULD QUALIFY FOR AN ADDITIONAL 15% PROMPT PAY DISCOUNT. IN ADDITION TO THESE AUTOMATIC DISCOUNTS, PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE UP TO AND INCLUDING FREE 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 300% OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR FREE OR SUBSTANTIALLY DISCOUNTED CARE. MANAGEMENT BELIEVES THAT ALL OF ITS BILLING AND COLLECTION POLICIES AND PROCEDURES COMPLY WITH IRS GUIDELINES AND DIRECTIVES. OTHER PROGRAM SERVICE ACCOMPLISHMENTS AS PREVIOUSLY DISCUSSED, THE ST. JOHN SYSTEM IS ORGANIZED AND OPERATED TO PROVIDE MEDICAL EXCELLENCE AND COMPASSIONATE CARE TO THE CITIZENS OF NORTHEASTERN OKLAHOMA, WITH A SPECIAL PREFERENCE FOR THE POOR AND DISADVANTAGED. TO THAT END, THE MEDICAL CENTER PROVIDED A BROAD CONTINUUM OF SERVICES IN THE YEAR ENDED SEPTEMBER 30, 2012, INCLUDING: TOTAL COMBINED HOSPITAL ADMISSIONS AND OBSERVATION PATIENTS - 8,641; TOTAL COMBINED HOSPITAL EMERGENCY ROOM VISITS - 36,821; TOTAL COMBINED SURGICAL CASES - 4,039; AND TOTAL COMBINED OUTPATIENT AND DIAGNOSTIC REGISTRATIONS - 83,901. MEDICAL EDUCATION THE MEDICAL CENTER PARTICIPATES IN A RESIDENT TRAINING PROGRAM ADMINISTERED BY THE UNIVERSITY OF OKLAHOMA'S TULSA COLLEGE OF COMMUNITY MEDICINE. THE MEDICAL CENTER ALSO SUPPORTS A VARIETY OF INITIATIVES OF THE TULSA HOSPITAL COUNCIL AND OTHERS TO PROVIDE FINANCIAL SUPPORT TO EXPAND ENROLLMENTS IN AREA ALLIED HEALTH AND NURSING EDUCATIONAL PROGRAMS. THE MEDICAL CENTER MAINTAINS AFFILIATIONS WITH A NUMBER OF AREA MEDICAL EDUCATION FACILITIES AND ORGANIZATIONS TO PROMOTE THE OFFERING AND ENHANCEMENT OF BASIC AND CONTINUING MEDICAL, NURSING AND ALLIED HEALTH EDUCATION. THE MEDICAL CENTER MAINTAINS A CONTINUING EDUCATION PROGRAM WHICH IS ACCREDITED TO AWARD CATEGORY I EDUCATION CREDITS TO PARTICIPATING PHYSICIANS. OTHER COMMUNITY BENEFIT AND OUTREACH ACTIVITIES JANE PHILLIPS HEALTH CORPORATION AND THE MEDICAL CENTER PROVIDE ANNUAL FINANCIAL SUPPORT TO ROGERS STATE UNIVERSITY. THESE PAYMENTS HELP TO PROVIDE SUPPORT FOR THEIR NURSING EDUCATION PROGRAM IN OUR COMMUNITY. THE MEDICAL CENTER PROVIDES OTHER FORMS OF COMMUNITY BENEFIT IN THE FORM OF FREE, OR REDUCED-CHARGE EDUCATIONAL SEMINARS FOR THE GENERAL PUBLIC ON WIDE RANGING TOPICS FROM PRENATAL CARE TO CHRONIC DISEASE MANAGEMENT. IT PARTICIPATES IN COMMUNITY-WIDE HEALTH SCREENING EVENTS, BLOOD DONATION DRIVES, AND A NUMBER OF OTHER OUTREACH ACTIVITIES TO IMPROVE THE HEALTH STATUS OF THE RESIDENTS OF NORTHEASTERN OKLAHOMA AND THE SURROUNDING AREA.
GENERAL STATEMENT 4 PART V: STATEMENTS REGARDING OTHER IRS FILINGS AND TAX COMPLIANCE PART V: QUESTION 1A AND 2A - JANE PHILLIPS MEMORIAL MEDCIAL CENTER (JPMMC) AND ITS RELATED JANE PHILLIPS ORGANIZATIONS (THE JP GROUP) REPORTED THE NUMBER OF INDEPENDENT CONTRACTORS COMPENSATED IN CALENDAR YEAR 2011 ON FORM 990, PART V, LINE 1A, OF THE RESPECTIVE ORGANIZATIONS. HOWEVER, ALL OF THE INDEPENDENT CONTRACTORS OF THE JP GROUP ARE REPORTED ON FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF THE U.S. INFORMATION RETURNS, OF JANE PHILLIPS MEMORIAL MEDICAL CENTER, FEIN 73-0606129. EXPENSES ARE ALLOCATED TO AND REIMBURSED TO JPMMC BY THE RESPECTIVE JANE PHILLIPS ORGANIZATIONS, AND REPORTED ON THEIR RESPECTIVE FORMS 990, PART VII, SECTION B AND PART IX AS APPROPRIATE. JANE PHILLIPS MEMORIAL MEDICAL CENTER AND ITS RELATED JANE PHILLIPS ORGANIZATIONS (THE JP GROUP) REPORTED THE NUMBER OF EMPLOYEES EMPLOYED IN CALENDAR YEAR 2011 ON FORM 990, PART V, LINE 2A, OF THE RESPECTIVE ORGANIZATIONS. HOWEVER, ALL OF THE EMPLOYEES OF THE JP GROUP ARE REPORTED ON FORM W-3 AND FORM 941, EMPLOYER'S QUARTERLY FEDERAL TAX RETURN, OF JANE PHILLIPS MEMORIAL MEDICAL CENTER, FEIN 73-0606129. THE SALARIES ARE REIMBURSED TO JPMMC BY THE RESPECTIVE JANE PHILLIPS ORGANIZATIONS, AND REPORTED ON THEIR RESPECTIVE FORMS 990 PARTS VII, IX, AND SCHEDULE J AS APPROPRIATE.
GENERAL STATEMENT 5 PART VI: SECTION A. GOVERNING BODY AND MANAGEMENT PART VI: QUESTION 2 JOHN B. KANE AND ROBERT KANE HAVE A FAMILY RELATIONSHIP.
GENERAL STATEMENT 6 PART VI: SECTION A. GOVERNING BODY AND MANAGEMENT PART VI: QUESTIONS 6, 7A AND 7B - JANE PHILLIPS HEALTH CORPORATION IS THE SOLE MEMBER OF JANE PHILLIPS MEMORIAL MEDICAL CENTER. AS SUCH IT HAS THE POWER (1) TO DEFINE THE PURPOSE, PHILOSOPHY AND MISSION AND ESTABLISH THE GOALS AND OBJECTIVES, (2) TO INITIATE AND/OR APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS, (3) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS, SANCTION VACANCIES, AND DETERMINE THE NUMBER OF DIRECTORS, (4) TO APPROVE THE BUDGET AND OTHER SIGNIFICANT FINANCIAL TRANSACTIONS, AND (5) TO INITIATE AND/OR APPROVE VARIOUS OTHER ACTIONS AND POLICIES AS ENUMERATED IN JANE PHILLIPS MEMORIAL MEDICAL CENTER'S CERTIFICATE OF INCORPORATION AND BYLAWS, AND AS REQUIRED BY STATE LAW.
GENERAL STATEMENT 7 PART VI: SECTION B. POLICIES PART VI: QUESTION 11B - JANE PHILLIPS MEMORIAL MEDICAL CENTER (JPMMC) IS AN AFFILIATE OF THE ST. JOHN HEALTH SYSTEM (SJHS). SJHS HAS HIRED A THIRD PARTY PREPARER EXPERIENCED IN THE PREPARATION OF FORM 990 TO ASSIST IN THE PREPARATION OF THE RETURN. THE EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER AND CONTROLLER OF SJHS WILL WORK CLOSELY WITH THE PAID PREPARER IN GATHERING THE INFORMATION FOR THE RETURN AND WILL PERFORM THE INITIAL DETAILED REVIEW OF THE RETURN. THE RETURN WILL THEN BE REVIEWED BY THE SJHS SYSTEM AUDIT COMMITTEE (AS DELEGATED BY THE BOARD OF THE FILING ORGANIZATION). A COPY OF THE RETURN WILL BE PROVIDED TO ALL VOTING BOARD MEMBERS OF THE FILING ORGANIZATION PRIOR TO FILING.
GENERAL STATEMENT 8 PART VI: SECTION B. POLICIES PART VI: QUESTION 12C - AT EVERY FISCAL YEAR END, ST. JOHN HEALTH SYSTEM (SJHS) DISTRIBUTES A COPY OF THE CURRENT CONFLICT OF INTEREST POLICY AND PROCEDURE BULLETIN, TOGETHER WITH AN EXPLANATION AND QUESTIONNAIRE TO THE MEMBERS OF THE BOARD OF DIRECTORS, ADMINISTRATIVE OFFICERS AND KEY EMPLOYEES OF SJHS, ITS SUBSIDIARIES AND AFFILIATES, INCLUDING JANE PHILLIPS MEMORIAL MEDICAL CENTER. THE BOARD MEMBERS, ADMINISTRATIVE OFFICERS AND KEY EMPLOYEES OF SJHS, ITS SUBSIDIARIES AND AFFILIATES MUST COMPLETE THE QUESTIONNAIRE AND RETURN IT TO THE DESIGNATED SJHS OFFICIAL WITHIN TWO WEEKS OF RECEIPT. COMPLETED QUESTIONNAIRES ARE REVIEWED AND SUMMARIZED BY THE VICE PRESIDENT, CORPORATE COMPLIANCE AND INTEGRITY, OR HIS/HER DESIGNEE. THAT INDIVIDUAL THEN PRESENTS THE QUESTIONNAIRE RESULTS TO THE HEADS OF EACH HOSPITAL FOR FURTHER PROVISION TO THE VARIOUS BOARDS' AUDIT AND COMPLIANCE COMMITTEES. THE AUDIT AND COMPLIANCE COMMITTEES, AS APPROPRIATE, SUBMIT A CONFIDENTIAL REPORT TO THEIR BOARD CHAIRMAN SUMMARIZING THE QUESTIONNAIRE RESULTS. THE BOARD CHAIRMAN, AS APPROPRIATE, MAY REVIEW WITH THE EXECUTIVE COMMITTEE THE RESPONSES TO THE QUESTIONNAIRE RESULTS.
GENERAL STATEMENT 9 PART VI: SECTION B. POLICIES PART VI: QUESTION 15A AND 15B - COMPENSATION FOR ALL EXECUTIVES IN ST. JOHN HEALTH SYSTEM (SJHS) OF WHICH JANE PHILLIPS MEMORIAL MEDICAL CENTER IS A PART, IS ANALYZED BY AN INDEPENDENT HEALTH CARE CONSULTING FIRM. THE ANALYSIS INCLUDES A FAIR MARKET VALUE ASSESSMENT AND ESTABLISHMENT OF A RANGE FOR EACH POSITION BASED ON RESEARCH OF COMPARABLE HEALTH CARE SYSTEMS OF SIMILAR SIZE. THE REPORT AND RECOMMENDED COMPENSATION LEVELS FOR EACH EXECUTIVE MANAGEMENT POSITION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE SJHS BOARD OF DIRECTORS.
GENERAL STATEMENT 10 PART VI: SECTION C. DISCLOSURE PART VI: QUESTION 19 - ONLY THE CONSOLIDATED FINANCIAL STATEMENTS OF THE ST. JOHN HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC. THESE CONSOLIDATED FINANCIAL STATEMENTS, OF WHICH JANE PHILLIPS MEMORIAL MEDICAL CENTER IS A PART, ARE AVAILABLE THROUGH THE QUARTERLY CONTINUING DISCLOSURE FILING AS REQUIRED IN CONNECTION WITH THE TAX EXEMPT BOND FILINGS.
GENERAL STATEMENT 11 PART VII: SECTION B. INDEPENDENT CONTRACTORS JANE PHILLIPS MEMORIAL MEDICAL CENTER'S FIVE HIGHEST PAID INDEPENDENT CONTRACTORS FOR THE YEAR ENDED SEPTEMBER 30, 2012 ARE AS FOLLOWS: (1)ARAMARK P.O. BOX 651009; CHARLOTTE, NC 28625, FOOD/HOUSEKEEPING SERVICE, $3,863,214, (2) BLUESTEM EMERGENCY MEDICINE 10510 NORTH 3980 ROAD; DEWEY, OK 74029, ER PHYSICIANS, $3,542,649, (3) FENIX CONSTRUCTION INC. P.O. BOX 2480; ARDMORE, OK, CONTRACTOR, $1,376,814, (4) BAP, LLP P.O. BOX 3456; BARTLESVILLE, OK, ANESTHESIOLOGY, $666,671, (5) DMS IMAGING 26273 NETWORK PLACE; CHICAGO IL, PREAD PET SCANS, $448,440.
GENERAL STATEMENT 12 PART X: BALANCE SHEET LINE 20 - JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC. HAS REPORTED A LIABILITY FOR TAX EXEMPT BONDS IN PART X, LINE 20 BECAUSE IT IS A MEMBER OF AN OBLIGATED GROUP OF RELATED ORGANIZATIONS RESPONSIBLE FOR REPAYMENT OF CERTAIN BONDS. THE DETAIL FOR THESE BONDS ARE REPORTED ON THE FORM 990, SCHEDULE K OF ST.JOHN HEALTH SYSTEM, INC., (EIN: 73-1215174). THE AMOUNTS REPORTED IN PART X REPRESENT JANE PHILLIPS MEMORIAL MEDICAL CENTER'S ALLOCATED SHARE OF THOSE BONDS.
GENERAL STATEMENT 13 PART XI: RECONCILIATION OF NET ASSETS, LINE 5 UNREALIZED GAIN ON INVESTMENTS 1,119,041 TRANSFERS FROM AFFILITATES 2,341,558 TRANSFERS TO AFFILIATES <9,554,630> ADJUSTMENT TO DIVIDEND INCOME <239,608> ============= TOTAL <$6,333,639>
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT J. LAFORTUNE TITLE:DIRECTOR HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONALD DOTY TITLE:DIRECTOR HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SR. M. THERESE GOTTSCHALK TITLE:DIRECTOR HOURS:39
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID J. PYNN TITLE:CEO SJHS HOURS:39
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GLENN BONNER TITLE:CHAIRPERSON HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN B. KANE TITLE:VICE CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES BOWERMAN TITLE:SECRETARY HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT BAUGHMAN TITLE:DIRECTOR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BILL BEIERSCHMITT TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEAN BLOOMFIELD TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STAN DEFEHR, M.D. TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANCES HORN, D.O. TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT KANE TITLE:DIRECTOR HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOE LEBLANC, M.D. TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIKE MAY TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK ROBERTSON, M.D. TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID SIGMON TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT WILLIAMS, M.D. TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID STIRE TITLE:CEO/PRESIDENT HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT PHILLIPS TITLE:VP HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SAMUEL GUILD TITLE:VP HOURS:1
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
JANE PHILLIPS MEMORIAL MEDICAL CENTER
 
Employer identification number

73-0606129
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) CRAIG COUNTY MEDICAL SERVICES CORP

1923 S UTICA AVE

TULSA,OK74104
73-1487478 		HEALTH CARE OK 501(C)(3) LINE 9 SJHS
 
 
No
(2) ST JOHN SAPULPA INC

1923 S UTICA AVE

TULSA,OK74104
73-0662663 		HEALTH CARE OK 501(C)(3) LINE 3 SJHS
 
 
No
(3) JANE PHILLIPS HEALTHCARE FOUNDATION

3500 E FRANK PHILLIPS BLVD

BARTLESVILLE,OK74006
73-1250611 		HEALTH CARE OK 501(C)(3) LINE 3 JPMMC
 
Yes
 
(4) BARTLETT HOMES INC

1008 E CLEVELAND

SAPULPA,OK74066
73-1301822 		HUD HOUSING OK 501(C)(3) LINE 7 SJS
 
 
No
(5) BETHEL MANOR INC

619 S DIVISION

SAPULPA,OK74066
73-1216617 		HUD HOUSING OK 501(C)(3) LINE 7 SJS
 
 
No
(6) BLUESTEM REG MED DEVELOPMENT FDNINC

3500 E FRANK PHILLIPS BLVD

BARTLESVILLE,OK74066
73-1081013 		FUNDRAISING OK 501(C)(3) LINE 9 BMC
 
 
No
(7) JANE PHILLIPS NOWATA HOSPITAL INC

237 SOUTH LOCUST

NOWATA,OK74048
73-1440267 		HEALTH CARE OK 501(C)(3) LINE 3 JPHC
 
Yes
 
(8) BARTLESVILLE MEDICAL CORPORATION

3500 E FRANK PHILLIPS BLVD

BARTLESVILLE,OK74006
73-1492080 		HEALTH CARE OK 501(C)(3) LINE 11B JPMMC
 
Yes
 
(9) ST JOHN BUILDING CORPORATION

1923 S UTICA AVE

TULSA,OK74104
61-1659782 		REAL ESTATE OK 501(C)(2)   SJHS
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) COMMUNITY CARE

1923 S UTICA AVE
TULSA,OK74104
73-1464144 		DORMANT OK NA
  		N/A                
(2) SJMC PHYS BUILDING

1923 S UTICA AVE
TULSA,OK74104
73-1181714 		MED. OFFICE BLDG. OK NA
  		N/A                
(3) SFSJ VENTURES LLC

6600 S YALE AVE STE 400
TULSA,OK74136
73-1563876 		HEALTH CARE OK NA
  		N/A                
(4) PLATINUM FITNESS

4808 S 109TH EAST AVE
TULSA,OK74146
20-1879493 		HEALTH CLUB OK NA
  		N/A                
(5) TULSA HAND SURGERY

1923 S UTICA AVE
TULSA,OK74104
73-1572055 		OPERATE SURG. OK NA
  		N/A                
(6) MEMORIAL SURGERY

1923 S UTICA AVE
TULSA,OK74104
20-1167151 		OPERATE ASC OK NA
  		N/A                
(7) BROKEN ARROW DEV

PO Box 7712
EDMOND,OK73083
26-0748994 		COMM'L RE DEVELOP OK NA
  		N/A                
(8) ALL SAINTS HOME

4808 S 109TH EAST AVE
TULSA,OK74146
73-1558644 		DME OK NA
  		N/A                
(9) UNION PINES SURGERY

4808 S 109TH EAST AVE
TULSA,OK74146
73-1622427 		OPERATE ASC OK NA
  		N/A                
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) REGIONAL MEDICAL LABINC
1923 SOUTH UTICA
TULSA,OK74104
73-1131608 		MEDICAL SERVICES OK NA
  		C      
(2) ST JOHN PHYSICIANS INC
1923 SOUTH UTICA
TULSA,OK74104
73-1321032 		MEDICAL SERVICES OK NA
  		C      
(3) PHYSICIAN SUPPORT SERVINC
1923 SOUTH UTICA
TULSA,OK74104
73-1437252 		MEDICAL SERVICES OK NA
  		C      
(4) OMNI MEDICAL GROUP INC
1923 SOUTH UTICA
TULSA,OK74104
73-1335536 		MEDICAL SERVICES OK NA
  		C      
(5) ST JOHN ASC MGMTCOINC
1923 SOUTH UTICA
TULSA,OK74104
20-2411172 		MEDICAL SERVICES OK NA
  		C      
(6) ST JOHN EMERGENCY PHYSICIANS
1923 SOUTH UTICA
TULSA,OK74104
20-2099141 		MEDICAL SERVICES OK NA
  		C      
(7) SJ URGENT CARE CLINIC INC
1923 SOUTH UTICA
TULSA,OK74104
20-4990275 		MEDICAL SERVICES OK NA
  		C      
(8) SJ CARDIOVASCULAR SERVINC
1923 SOUTH UTICA
TULSA,OK74104
20-3912018 		MEDICAL SERVICES OK NA
  		C      
(9) SJ CARDIOVASCULAR MEDINC
1923 SOUTH UTICA
TULSA,OK74104
20-3912076 		MEDICAL SERVICES OK NA
  		C      
(10) SJ ANESTHESIA SERVICESINC
1923 SOUTH UTICA
TULSA,OK74104
20-3690446 		MEDICAL SERVICES OK NA
  		C      
(11) MAGNUM HEALTHCARE INC
1923 SOUTH UTICA
TULSA,OK74104
20-4827780 		MEDICAL SERVICES OK NA
  		C      
(12) UTICA SERVICES INC
1923 SOUTH UTICA
TULSA,OK74104
73-1057650 		MEDICAL SERVICES OK NA
  		C      
(13) PROFESSIONAL MED INS RISK
201 MERCHANT STSUITE 2400
HONOLULU,HI96813
73-1525831 		INSURANCE HI NA
  		C      
(14) JP SUPPORT SERVINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-1530296 		MEDICAL SERVICES OK NA
  		C      
(15) MEDICAL MANAGEMENT SERVINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-1531974 		HOLDING CO. OK NA
  		C      
(16) JP SPECIALITY PHYSICIANSINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
01-0879962 		MEDICAL SERVICES OK NA
  		C      
(17) GEMINI MEDICAL GROUP INC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-1503529 		MEDICAL SERVICES OK NA
  		C      
(18) CERES MEDPRACTICE MGMTINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-1522656 		MEDICAL SERVICES OK NA
  		C      
(19) GEMINI AFTER HRSCLINICINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
30-0375407 		MEDICAL SERVICES OK NA
  		C      
(20) SYNERGY HOSPITALIST GRPINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
30-0375404 		MEDICAL SERVICES OK NA
  		C      
(21) PROFCREDIT RECOVINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-1057187 		COLLECTIONS SERV. OK NA
  		C      
(22) DRSBLDGOF BARTLESVILLEINC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-0759185 		BLDG. RENTAL OK NA
  		C      
(23) JP ENTERPRISES INC
3500 E FRANK PHILLIPS BLVD
BARTLESVILLE,OK74006
73-1530246 		HOLDING CO. OK NA
  		C      
(24) COMMUNITYCARE MANAGED HEALTH
218 W 6TH ST
TULSA,OK74119
73-1513383 		HEALTH INSURANCE OK NA
  		C      
(25) BLUESTEM MEDICAL CLINICINC
1923 SOUTH UTICA
TULSA,OK74104
73-1481016 		MEDICAL SERVICES OK NA
  		C      
(26) OUTBOUND MEDICAL NETWORKINC
1923 SOUTH UTICA
TULSA,OK74104
73-1255463 		MEDICAL SERVICES OK NA
  		C      
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CERES MEDICAL PRACTICE MANAGEMENT INC

 A 50,000 FMV
(2) GEMINI MEDICAL GROUP INC

 A 57,834 FMV
(3) JANE PHILLIPS SUPPORT SERVICES INC

 C 200,380 FMV
(4) BLUESTEM REG MED DEVELOPMENT FDN INC

 C 778,887 FMV
(5) PROFESSIONAL CREDIT RECOVERY INC

 C 172,720 FMV
(6) PROFESSIONAL CREDIT RECOVERY INC

 O 555,825 FMV
(7) JANE PHILLIPS NOWATA HOSPITAL INC

 P 3,445,000 FMV
(8) JANE PHILLIPS HEALTH CARE FOUNDATION INC

 P 740,000 FMV
(9) PROFESSIONAL CREDIT RECOVERY INC

 P 1,475,000 FMV
(10) DOCTORS BUILDING OF BARTLESVILLE

 P 120,000 FMV
(11) GEMINI MEDICAL GROUP INC

 P 7,855,000 FMV
(12) CERES MEDICAL PRACTICE MANAGEMENT INC

 P 539,000 FMV
(13) JANE PHILLIPS SUPPORT SERVICES INC

 P 830,000 FMV
(14) SYNERGY HOSPITALIST GROUP INC

 P 750,000 FMV
(15) JP SPECIALTY PHYSICIANS INC

 P 7,690,000 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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