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.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
OZARKS MEDICAL CENTER
Employer identification number
44-6005758
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
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
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.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
OZARKS MEDICAL CENTER
Employer identification number
44-6005758
Return Reference
Explanation
FORM 990, PART I, LINE 1
ORGANIZATION'S MISSION: OUR VISION IS TO BE TRUSTED AS THE BEST PLACE TO GIVE AND RECEIVE HIGH QUALITY, COMPASSIONATE HEALTH CARE. OUR CORE VALUES ARE: RESPECT: HAVING A REGARD FOR LIFE, DIGNITY AND UNIQUENESS OF THOSE SERVED AND SERVING. COMPASSION: EXPRESSING CARE AND CONCERN FOR OTHERS THROUGH OUR ATTITUDES AND ACTIONS. INTEGRITY: MAINTAINING THE HIGHEST STANDARDS OF BEHAVIOR, ENCOMPASSING HONESTY, ETHICAL PRACTICES AND DOING THE RIGHT THINGS FOR THE RIGHT REASONS. SUPERIOR SERVICE: PROVIDING THE HIGHEST QUALITY OF CARE, CONSISTENTLY EXCEEDING OUR CUSTOMERS' EXPECTATIONS. TEAMWORK: HAVING A UNIFIED COMMITMENT TO DEMONSTRATE PRIDE, RESPONSIBILITY, AND ACCOUNTABILITY IN WORKING TOGETHER TO ACHIEVE EXCELLENCE. ENTHUSIASM: INSPIRING OTHERS BY DISPLAYING A POSITIVE ATTITUDE IN ALL WE SAY AND DO.
FORM 990, PART III, LINE 4
PROGRAM SERVICE ACCOMPLISHMENTS: OMC IS COMMITTED TO THE COMMUNITY AND AS PART OF THAT COMMITMENT, HOSTS A NUMBER OF OUTREACH SERVICES AND PROGRAMS EACH YEAR. IN 2013, OMC GAVE COMMUNITY BENEFIT EXPENSE AND CHARITY CARE TO ASSIST THE UNINSURED OR UNDERINSURED AND TO PROVIDE OTHER ASSISTANCE BASED ON NEED. OMC ALSO PROVIDED ACTIVITIES FOR COMMUNITY MEMBERS OF ALL AGES. 493 PEOPLE PARTICIPATED IN THE OMC FUN RUN, RAISING $4,671 TO BENEFIT PATIENTS AT THE CANCER TREATMENT CENTER. DURING THE ANNUAL DOCS VS. JOCKS, OMC REHABILITATION SERVICES RAISED $3,260 FOR THE BOYS AND GIRLS CLUB OF GREATER WEST PLAINS AREA. OMC HOSTED A NUMBER OF FREE SCREENINGS THAT REACHED NEARLY 1,000 PEOPLE. SEE SCHEDULE H FOR MORE INFORMATION REGARDING CHARITY CARE PROVIDED. 2013 YEAR IN REVIEW: 178 CLASSES WERE OFFERED BY OMC EDUCATION SERVICES WITH APPROXIMATELY 969 PARTICIPANTS. CLASSES INCLUDED FIRST AID, BASIC LIFE SUPPORT, ADVANCE CARDIAC LIFE SUPPORT, PEDIATRIC ADVANCE LIFE SUPPORT, NON-VIOLENT CRISIS INTERVENTION, BASIC CARDIAC DYSRHYTHMIA, 12-LEAD AND HEART SAVER CPR.23 STUDENTS IN GRADES 10-12 PARTICIPATED IN OMC'S MEDICAL AND SCIENCE HEALTHCAMP, WHICH PROVIDES HANDS ON EXPERIENCES TO THOSE INTERESTED IN CAREERS IN HEALTH FIELDS. 210 VOLUNTEERS CONTRIBUTED APPROXIMATELY 28,484 HOURS TO OMC, THE EQUIVALENT OF 14 FULL-TIME EMPLOYEES. OMC OFFERED X-RAY, LAB SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH-LANGUAGE PATHOLOGY, MASSAGE THERAPY AND COUNSELING SERVICES IN ITS OUTLYING CLINICS, SAVING TRAVEL FOR MANY PEOPLE LIVING THROUGHOUT THE 11-COUNTY AREA SERVED BY OMC. OMC PROVIDED A TOTAL OF $106,185 IN TUITION REIMBURSEMENTS TO RECIPIENTS WHO ARE FUTURE HEALTHCARE WORKERS, INCLUDING PHYSICIANS. OMC EMPLOYED AN AVERAGE OF 1,263 INDIVIDUALS IN 2013, PROVIDING A TOTAL ECONOMIC IMPACT OF OVER $59 MILLION ANNUAL WAGES FOR THE LOCAL AREA. OMC STATISTICS: 114 BEDS 11-COUNTY SERVICE AREA APPROXIMATELY 90 DOCTORS ON MEDICAL STAFF VOLUME NUMBERS: ADMISSIONS.............................5,326 BIRTHS...................................639 EMERGENCY DEPARTMENT VISITS...........25,343 INPATIENT SURGERIES......................853 OUTPATIENT SURGERIES...................2,000 REHABILITATION SERVICES PROCEDURES...121,543
FORM 990, PART VI, SECTION A, LINE 2
BUSINESS AND FAMILY RELATIONSHIPS: BOARD MEMBERS GIDEON MORRISON, MD AND TRAVIS MORRISON SHARE A FAMILY RELATIONSHIP. GREG BEYKIRCH, KENNETH JOPLIN, ROGER SHAW, III, MARJORIE SLAYTON, AND TRAVIS MORRISON SHARE A BUSINESS RELATIONSHIP. JOHN MCCORMACK, ROBERT MARTIN, AND AARON MILLS SHARE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B
MEMBERS/STOCKHOLDERS: OZARKS MEDICAL CENTER HAS ONE CLASS OF MEMBERSHIP. ALL INTERESTED PARTIES ARE ELIGIBLE FOR MEMBERSHIP UPON PAYMENT OF THE MEMBERSHIP FEES SET BY THE BOARD OF DIRECTORS. MEMBERSHIP IS NOT TRANSFERABLE OR ASSIGNABLE. MEMBERS, AFTER BEING A MEMBER FOR AT LEAST THIRTY DAYS, SHALL BE ELIGIBLE TO VOTE ON ANY BUSINESS OF THE CORPORATION. EACH MEMBER IS ENTITLED TO ONE VOTE. THE BOARD OF DIRECTORS CONSISTS OF 15 DIRECTORS. TEN OF THE CORPORATION'S BOARD MEMBERS, ELECTED FROM OZARKS MEDICAL CENTER'S SERVICE AREA, ARE ELECTED BY THE MEMBERS OF THE CORPORATION. ANY DIRECTOR PREVIOUSLY ELECTED BY THE MEMBERS MAY BE REMOVED FROM OFFICE BY THE MEMBERS AT AN ANNUAL MEETING OR ANY PROPERLY CALLED SPECIAL MEETING, BY THE VOTE OF TWO-THIRDS OF THE MEMBERS PRESENT, IN WHICH EVENT THE MEMBERS PRESENT WILL ELECT A SUCCEEDING DIRECTOR TO SERVE THE UNEXPIRED TERM OF THE REMOVED DIRECTOR. EACH MEMBER HAS ONE VOTE. ANY VACANCY DUE TO DEATH OR RESIGNATION SHALL BE FILLED BY ELECTION BY THE REMAINING MEMBERS OF THE BOARD. TWO DIRECTORS ARE ELECTED BY THE MEDICAL STAFF OF THE ORGANIZATION AND MUST BE A MEDICAL STAFF MEMBER THAT IS ALSO A MEMBER OF THE CORPORATION TO BE ELIGIBLE TO BE ELECTED TO THE BOARD. ANY VACANCIES OF THESE TWO BOARD POSITIONS ARE FILLED BY THE MEDICAL STAFF. THE REMAINING THREE BOARD OF DIRECTORS ARE DESIGNATED BY THEIR POSITION IN THE ORGANIZATION. THE CHIEF OF THE MEDICAL STAFF, THE IMMEDIATE PAST CHIEF OF THE MEDICAL STAFF, AND THE CHIEF ELECT OF THE MEDICAL STAFF ARE ALL BOARD MEMBERS FOR AS LONG AS THEY HOLD THOSE TITLES. THE BYLAWS OF THE CORPORATION MAY BE AMENDED AT AN ANNUAL OR PROPERLY CALLED SPECIAL MEETING OF THE MEMBERS OF THE CORPORATION BY TWO-THIRDS OF THE VOTE CAST OR A MAJORITY OF THE VOTING POWER, WHICHEVER IS LESS. THE BYLAWS MAY ALSO BE AMENDED BY THE BOARD PROVIDED THAT THE AMENDMENT DOES NOT RELATE TO THE NUMBER OF DIRECTORS, THE COMPOSITION OF THE BOARD, THE TERM OF OFFICE OF DIRECTORS, OR THE METHOD OR WAY IN WHICH DIRECTORS ARE ELECTED OR SELECTED, OR PROVIDED THAT THE BASIC PURPOSE OF THE CORPORATION SHALL NOT BE CHANGED OR ALTERED. IF ANY OF THOSE CONDITIONS DOES NOT APPLY, THE AMENDMENT MUST BE VOTED ON BY THE MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B
REVIEW PROCESS FOR FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE BOARD WILL REVIEW THE FORM AND RECORD IN THE MEETING MINUTES THEIR ACCEPTANCE OF THE DRAFT.
FORM 990, PART VI, SECTION B, LINE 12C
COMPLIANCE WITH CONFLICT OF INTEREST POLICY: CONFLICT STATEMENTS ARE REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE TO DETERMINE IF NEW ITEMS WERE DISCLOSED. IF A BOARD MEMBER DID HAVE A CONFLICT OF INTEREST, HE/SHE WOULD ABSTAIN FROM VOTING ON ANY TRANSACTIONS RELATED TO THAT CONFLICT.
FORM 990, PART VI, SECTION B, LINES 15A & 15B
COMPENSATION REVIEW: B.E. SMITH (RECRUITMENT FIRM) WAS HIRED. THEY PERFORMED A REGIONAL SEARCH FOR OMC'S NEW CEO. THEY ALSO PROVIDED MARKET INFORMATION THAT INDICATED THE NEED TO INCREASE THE CEO COMPENSATION, WHICH THE COMPENSATION AND BENEFITS COMMITTEE VALIDATED WITH MISSOURI HOSPITAL ASSOCIATION DATA. THE FINAL COMPENSATION PACKAGE THAT WAS PRESENTED AND ACCEPTED BY THE CURRENT CEO WAS FIRST APPROVED AND REVIEWED BY THE COMPENSATION AND BENEFITS COMMITTEE AND BOARD EXECUTIVE COMMITTEE. ALL BOARD MEMBERS INVOLVED WERE INDEPENDENT BOARD MEMBERS.
FORM 990, PART VI, SECTION C, LINE 19
DOCUMENT DISCLOSURE: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO VIEW UPON WRITTEN REQUEST AT THE ADMINISTRATIVE OFFICE OF THE HOSPITAL DURING REGULAR BUSINESS HOURS.
FORM 990, PART VII, SECTION A
BOARD MEMBER COMPENSATION: BOARD MEMBER CHARLES MORGAN, MD, RECEIVES COMPENSATION FOR HIS ROLE AS A PHYSICIAN. NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DUTIES AS A MEMBER OF THE BOARD OF DIRECTORS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.