Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| CORE FORM, PART I AND PART X | CORE FORM, PART I; REVENUE AND EXPENSES AND CORE FORM, PART X; BALANCE SHEET, WERE RESTATED TO REFLECT THE AUDITED FINANCIAL STATEMENTS. |
| CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS | THE PHYSICIANS' HOSPITAL IN ANADARKO ORIGINALLY OPENED IN JUNE OF 1978 WITH FINANCING MADE AVAILABLE MOSTLY FROM THE FARMER'S HOME ADMINISTRATION. PATIENT ROOMS WERE FURNISHED BY PRIVATE CITIZENS WHO WANTED QUALITY HEALTHCARE IN THEIR COMMUNITY. THE HOSPITAL WAS OWNED BY THE CITY OF ANADARKO AND CONTINUED TO GROW AND SERVE THE HEALTHCARE NEEDS OF THE COMMUNITY. IN 2002 IT WAS PURCHASED BY A PRIVATE COMPANY. AFTER SEVERAL YEARS OF FINANCIAL DIFFICULTY, AND THE HOSPITAL OWNERSHIP CHANGING SEVERAL TIMES, THE HOSPITAL WAS BOUGHT BY ITS CURRENT OWNER ONE CURA WELLNESS, INC. IN 2011. |
| CORE FORM, PART VI, SECTION A; QUESTION 3 | THE HOSPITAL ENGAGES FIRST PHYSICIAN'S BUSINESS SOLUTIONS, LLC TO BE AN AGENT OF THE HOSPITAL AND DELEGATES CONTROL TO FIRST PHYSICIAN'S BUSINESS SOLUTIONS, LLC IN THE MANAGEMENT AND SUPPORT SERVICES OF THE HOSPITAL. THE HOSPITAL ENGAGES FIRST PHYSICIANS SERVICES, LLC TO BE AN AGENT OF THE HOSPITAL AND DELEGATES CONTROL TO FIRST PHYSICIANS SERVICES, LLC IN THE MANAGEMENT OF FURNISHING INFORMATION TECHNOLOGY, DIAGNOSTIC TESTING SERVICES, ELECTRONIC HEALTH RECORDS SOFTWARE AND SYSTEMS, MANAGEMENT OF PROFESSIONAL SERVICES AND OTHER ANCILLARY SERVICES OF THE HOSPITAL. THE HOSPITAL ENGAGES FIRST PHYSICIANS RESOURCES, LLC TO BE AN AGENT OF THE HOSPITAL AND DELEGATES CONTROL TO FIRST PHYSICIANS RESOURCES, LLC IN THE LEASING OF VARIOUS CLINICAL, ADMINISTRATIVE AND OTHER PERSONNEL, INCLUDING PHYSICIANS AND SENIOR EXECUTIVES, WHO ARE QUALIFIED TO PROVIDE SERVICES TO THE HOSPITAL FOR THE EFFICIENT AND EFFECTIVE OPERATION OF THE HOSPITAL. THE HOSPITAL ENGAGES FIRST PHYSICIANS REALTY GROUP, LLC TO LEASE LAND AND BUILDINGS, INCLUDING THE RIGHT TO USE ALL OF THE PARKING AREAS, DRIVEWAYS, ROADS, ALLEYS, MEANS OF INGRESS AND EGRESS AND OTHER PORTIONS OF THE PREMISES IN THE OPERATION OF THE HOSPITAL. |
| CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 | ONE CURA WELLNESS, INC. ("ONE CURA") IS THE SOLE MEMBER OF THIS ORGANIZATION. ONE CURA HAS THE ULTIMATE AUTHORITY TO APPOINT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF DIRECTORS AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS. |
| CORE FORM, PART VI, SECTION B; QUESTION 11 | THE ORGANIZATION IS AN AFFILIATE IN ONE CURA WELLNESS, INC. AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). ONE CURA WELLNESS, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. FIRST PHYSICIAN SERVICES, LLC, THE MANAGEMENT COMPANY UTILIZED BY THE ORGANIZATION, PERFORMED A REVIEW OF THE FEDERAL FORM 990. THE ONE CURA WELLNESS, INC. BOARD OF DIRECTORS HAS DELEGATED TO THE MANAGEMENT COMPANY THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION, REVIEW AND FILING PROCESS FOR THE TAX-EXEMPT AFFILIATES WITHIN THE SYSTEM. IN ADDITION, THE SYSTEM'S OUTSIDE TAX COUNSEL PERFORMED A DETAILED REVIEW OF THE DRAFT FEDERAL FORM 990. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL AND LEADERSHIP TEAM ("INTERNAL WORKING GROUP") TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S INTERNAL WORKING GROUP FOR REVIEW. THE ORGANIZATION'S INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL PRIOR TO PRESENTATION OF THE FEDERAL FORM 990 TO THE ORGANIZATION'S MANAGEMENT COMPANY. |
| CORE FORM, PART VI, SECTION B; QUESTION 12 | THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH THAT POLICY. THE POLICY REQUIRES THAT A CONFLICT OF INTEREST DISCLOSURE FORM CONSISTENT WITH BEST GOVERNANCE PRACTICES AND INTERNAL REVENUE SERVICE GUIDELINES BE CIRCULATED TO OFFICERS, AND DIRECTORS ANNUALLY. IF AN INDIVIDUAL DISCLOSES AN INTEREST THAT COULD GIVE RISE TO A CONFLICT, THE INDIVIDUAL'S POTENTIAL CONFLICT IS REFERRED TO THE ORGANIZATION'S CEO AND OUTSIDE GENERAL COUNSEL, WHICH EVALUATE THE CONFLICT AND ITS POTENTIAL IMPACT ON THE INDIVIDUAL'S PARTICIPATION ON THE BOARD OR ON CERTAIN ISSUES THAT MAY COME BEFORE THE BOARD. AFTER CONSULTATION WITH THE ORGANIZATION'S OUTSIDE COUNSEL, THE OUTSIDE GENERAL COUNSEL WILL TAKE ACTION, IF APPROPRIATE AND NECESSARY, TO ADDRESS ANY SUCH CONFLICT IN A MANNER CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. |
| CORE FORM, PART VI, SECTION B; QUESTION 15 | THE ORGANIZATION'S CEO IS COMPENSATED BY A RELATED ORGANIZATION, NOT THIS ORGANIZATION. THE INDIVIDUAL'S COMPENSATION IS DETERMINED BY THE RESPECTIVE ORGANIZATION'S BOARD OF DIRECTORS, TAKING INTO ACCOUNT COMPENSATION OF COMPARABLE POSITIONS. THE ORGANIZATION HAS NO OTHER OFFICERS OR KEY EMPLOYEES OTHER THAN THE CEO. |
| CORE FORM, PART VI, SECTION B; QUESTION 19 | THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF OKLAHOMA SECRETARY OF STATE. |
| CORE FORM, PART VII AND SCHEDULE J | PART VII AND SCHEDULE J REFLECTS A BOARD MEMBER/OFFICER RECEIVING COMPENSATION FROM A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS THE HEALTHCARE SYSTEM'S CEO AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF DIRECTORS. |
| CORE FORM, PART VIII, PG 1, PT 1, QUESTION 5 & PG 5, QUESTION 2A | THIS ORGANIZATION HAS NO EMPLOYEES AND ACCORDINGLY ISSUED NO FORMS W-2. PLEASE REFER TO PART VI, QUESTION 3 WORDING WHEREBY THIS ORGANIZATION ENGAGES FIRST PHYSICIAN'S BUSINESS SOLUTIONS, LLC TO BE AN AGENT OF THE HOSPITAL AND DELEGATES CONTROL TO FIRST PHYSICIAN'S BUSINESS SOLUTIONS, LLC IN THE MANAGEMENT AND SUPPORT SERVICES OF THE HOSPITAL. |
| CORE FORM, PART VII, SECTION A, COLUMN B | THE ORGANIZATION IS AN AFFILIATE OF ONE CURA WELLNESS, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM INCLUDES NOT FOR-PROFIT ORGANIZATIONS. CERTAIN BOARD OF DIRECTOR MEMBERS, OFFICERS AND/OR DIRECTORS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM 990 FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENTS THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF OTHER RELATED ORGANIZATIONS IN THE SYSTEM, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY THE SAME AS REFLECTED IN CORE FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990, FOR THE DIRECTOR WHO RECEIVED COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY REFLECTS TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE SYSTEM; NOT SOLELY THIS ORGANIZATION. |
| CORE FORM, PART XII; QUESTION 2 | THE ORGANIZATION IS AN AFFILIATE WITHIN ONE CURA WELLNESS, INC. AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM'S TAX-EXEMPT PARENT ENTITY IS ONE CURA WELLNESS, INC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF ONE CURA WELLNESS, INC. AND ALL AFFILIATES WITHIN THE SYSTEM FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2018, SEPTEMBER 30, 2017 AND SEPTEMBER 30, 2016; RESPECTIVELY AND ISSUED A CONSOLIDATED FINANCIAL STATEMENT WITH CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. ONE CURA WELLNESS' MANAGEMENT COMPANY, FIRST PHYSICIAN'S SERVICES, LLC, ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR. |
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| Software Version: |