2023-02-15T10:07:33-06:00 2022-03-31 FORVIS LLP 3102 WEST END AVENUE SUITE 800 NASHVILLE TN 372031382 990 2021-04-01 811312058 THE MEDICAL CENTER AT CLINTON COUNTY INC % JENNY GREENWELL MEDI 2707451551 800 PARK STREET BOWLING GREEN KY 42101 MICHELE LAWLESS EVP - CFO 2707451551 2023-02-15 true MICHELE LAWLESS 999009999 JEFF SMITH P00289876 6159883600 2023-02-15 2 2021 2023-03-07 01:45:13Z THE MEDICAL CENTER AT ALBANY CONNIE D SMITH 800 PARK STREET BOWLING GREEN KY 42101 13579488 false X HTTPS://MEDCENTERHEALTH.ORG/LOCATIONS/ X 2016 KY PROVIDES INPATIENT AND OUTPATIENT ACUTE CARE SERVICES BY OR UNDER THE SUPERVISION OF PHYSICIANS IN ALBANY, KENTUCKY AND IN THE SURROUNDING COUNTIES. 5 4 113 4 0 0 5185784 388534 12576538 12554667 10489 131455 444350 504832 18217161 13579488 0 0 0 0 5340989 6051784 0 0 0 7931417 8798466 13272406 14850250 4944755 -1270762 14863955 13891924 4396644 4695375 10467311 9196549 X DEDICATED TO PROVIDING THE HIGHEST QUALITY CARE POSSIBLE IN A SAFE AND SECURE ENVIRONMENT; COMMITTED TO THE PROMOTION OF WELLNESS AND RESTORATION OF HEALTH IN A COST-EFFECTIVE MANNER; CONTINUOUSLY STRIVE TO IMPROVE THE QUALITY OF HEALTH IN THE COMMUNITIES WE SERVE. false false 10616380 10456358 OUTPATIENT SERVICES: THE MEDICAL CENTER AT CLINTON COUNTY D/B/A THE MEDICAL CENTER AT ALBANY (MCA) IS RECOGNIZED BY MEDICARE AS AN ACUTE CARE HOSPITAL. THE HOSPITAL SERVES THE COMMUNITY BY PROVIDING CERTAIN OUTPATIENT SERVICES, INCLUDING AN EMERGENCY DEPARTMENT, BY OR UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC AND THERAPEUTIC SERVICES FOR MEDICAL DIAGNOSIS, TREATMENT, CARE, OR REHABILITATION OF INJURED, DISABLED, OR SICK PERSONS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 2130421 2098309 INPATIENT SERVICES: MCA IS A 42-BED ACUTE CARE HOSPITAL ENGAGED IN PROVIDING INPATIENT SERVICES, BY OR UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC, AND THERAPEUTIC SERVICES FOR MEDICAL DIAGNOSIS, TREATMENT, CARE, OR REHABILITATION OF INJURED, DISABLED, OR SICK PERSONS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 12746801 true true false false false false false false false false true false true false true false true true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 41 0 true 113 true false false false false false false false false false false false false X 5 4 false false false false true true true true true false false true true true true true true false false false KY X JENNY GREENWELL 2707451551 800 PARK STREET BOWLING GREEN KY 42101 MS CONNIE D SMITH PRESIDENT / CEO 2.0 52.0 X X 0 1333801 20856 MR WADE STONE EXECUTIVE VICE PRESIDENT 2.0 48.0 X 0 434345 29943 MR DAVID GRAY EXECUTIVE VICE PRESIDENT 2.0 48.0 X 0 374445 43440 MS MICHELE W LAWLESS EXECUTIVE VICE PRESIDENT/CFO 2.0 48.0 X 0 371796 3505 MR ERIC HAGAN VP OF RURAL HOSPITALS 4.0 36.0 X 28878 259906 20046 MR RONALD G SOWELL EXEC VP - RETIRED 3/31/21 2.0 48.0 X 0 270499 5145 MS LAURA BELCHER VICE PRESIDENT/ADMINISTRATOR 40.0 0.0 X 165512 0 39994 MS JILL PAYNE EVP/CNO - RESIGNED 6/25/21 0.0 40.0 X 0 166490 6935 MS SHEILA KINGRY PHARMACY MANAGER 40.0 0.0 X 140888 0 10428 LORI POINDEXTER APRN 40.0 0.0 X 103282 0 32573 AMY CLABORN DIRECTOR OF PATIENT CARE SVCS 40.0 0.0 X 108076 0 12076 LISA THOMPSON DIRECTOR OF PATIENT CARE SVCS 40.0 0.0 X 114478 0 680 DR PAUL COOK CHAIR 2.0 2.0 X X 0 0 0 DR DONNA BLACKBURN VICE CHAIR 2.0 4.0 X X 0 0 0 MR TOMMY LOVING SECRETARY 2.0 4.0 X X 0 0 0 DR KAL SAHETYA DIRECTOR 2.0 2.0 X 0 0 0 661114 3211282 225621 5 true true false DIAGNOSTIC SHARED SERVICES 2650 EASTPOINT PARKWAY STE 300 LOUISVILLE KY 40223 CLINICAL SERVICES 116325 SOUTHEASTERN EMERGENCY PHYSICIANS PO BOX 634850 CINCINNATI OH 452634850 ER PHYSICIAN SVCS 944060 HEARTCARE IMAGING INC 760 NORTH US HWY ONE TEQUESTA FL 33469 CLINICAL SERVICES 177220 QUALIVIS LLC DEPARTMENT 3847 PO BOX 123847 DALLAS TX 75312 STAFFING SERVICES 325654 4 3564 384970 388534 OUTPATIENT SERVICES 621400 10456358 10456358 INPATIENT ROUTINE AND ANCILLARY SERVICES 621110 2098309 2098309 12554667 65341 65341 0 0 19527 19527 0 19527 19527 66114 0 66114 66114 66114 0 0 0 0 0 0 0 0 0 CONTRACT LABOR 900099 306554 306554 CAFETERIA/FOOD SERVICE 722514 12604 12604 OTHER MISCELLANEOUS REVENUE 900099 166147 166147 485305 13579488 12554667 0 636287 0 0 0 0 241743 241743 0 4434622 4360342 74280 149577 139469 10108 874918 815893 59025 350924 327056 23868 1018400 176000 842400 22151 22151 33834 33834 0 0 0 2826843 2490537 336306 26647 2518 24129 1000835 606100 394735 288418 288418 0 453770 453770 9335 6844 2491 0 0 0 0 432155 412497 19658 97391 94074 3317 MEDICAL SUPPLIES 1618466 1618466 PHYSICIAN PRACTICE EXPENSE 439699 439699 OTHER TAXES & LICENSES 513430 511365 2065 RECRUITING FEES 11934 3331 8603 5158 422 4736 14850250 12746801 2103449 0 1858694 302980 0 0 0 0 1322200 1178256 0 0 0 0 0 0 576836 560287 90982 152565 10655914 2288820 7015744 8367094 98640 64910 0 0 3857586 3265832 0 0 43273 0 14863955 13891924 3318678 4166025 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1077966 529350 4396644 4695375 X 10467311 9196549 0 0 10467311 9196549 14863955 13891924 -1270762 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 200200 200200 8106538 1903220 6203318 1464315 385600 1078715 884861 884861 8367094 0 0 PAYABLE TO AFFILIATES 529350 ADVANCED MEDICARE PAYMENTS 0 529350 13579488 13579488 13579488 14850250 14850250 14850250 SCHEDULE D, PART X, LINE 2: INCOME TAXES --------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE THAT ADDRESSED THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN48 (ASC 740). MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X false true true false true true 292963 292963 0.02030 292963 292963 0.02030 13 280 2615 2615 0.00020 13 280 2615 2615 0.00020 13 280 295578 295578 0.02050 true 660752 0 4380468 6830943 -2450475 X true true 1 1 THE MEDICAL CENTER AT CLINTON COUNTY 723 BURKESVILLE ROAD ALBANY KY 42602 HTTPS://MEDCENTERHEALTH.ORG/LOCATIONS/ 100078 X X X THE MEDICAL CENTER AT CLINTON COUNTY 1 false false true X X X X X X X X X 22 true false true true X SEE PART V, SECTION C X true 22 true SEE PART V, SECTION C false true X 200. 0. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT ---------------- THE MEDICAL CENTER AT CLINTON COUNTY D/B/A THE MEDICAL CENTER AT ALBANY (MCA) CONTRACTED WITH THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK) IN THE FALL OF 2020 TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE HOSPITAL. THE ASSESSMENT PROCESS INCLUDED COLLECTING SECONDARY DATA RELATED TO THE HEALTH OF THE COMMUNITY. SOCIAL AND ECONOMIC DATA AS WELL AS HEALTH OUTCOMES AND PROVIDERS DATA WERE COLLECTED FROM SECONDARY SOURCES TO HELP PROVIDE DEMOGRAPHIC CONTEXT FOR THE COMMUNITY. IN ADDITION, CEDIK COMPILED HOSPITAL UTILIZATION DATA TO BETTER UNDERSTAND WHO WAS USING THE FACILITY AND FOR WHAT SERVICES. FINALLY, WITH THE ASSISTANCE OF THE STEERING COMMITTEE, INPUT FROM THE COMMUNITY WAS COLLECTED THROUGH KEY INFORMATION INTERVIEWS AND SURVEYS. TO FORM A STEERING COMMITTEE, CEDIK PROVIDED A LIST OF COMMUNITY LEADERS, AGENCIES AND ORGANIZATIONS TO ASSIST MCA IN THE RECRUITMENT OF MEMBERS THAT WOULD FACILITATE BROAD COMMUNITY INPUT. THESE COMMITTEE MEMBERS REPRESENT ORGANIZATIONS AND AGENCIES THAT SERVE THE CLINTON COUNTY POPULATION IN A VARIETY OF AREAS THAT RELATE TO A POPULATIONS HEALTH. BY VOLUNTEERING THEIR TIME, THE COMMITTEE MEMBERS ENABLED THE HOSPITAL TO ACQUIRE INPUT FROM RESIDENTS THAT ARE OFTEN NOT ENGAGED IN CONVERSATIONS ABOUT THEIR HEALTH NEEDS. THE STEERING COMMITTEE PROVIDED BOTH AN EXPERT VIEW OF THE NEEDS THEY SEE WHILE WORKING WITH THE PEOPLE AND CLIENTS THEY SERVE AND IN EXTENSIVE DISTRIBUTION OF THE COMMUNITY SURVEY. IN JANUARY 2021, ELEVEN MEMBERS OF THE CLINTON COUNTY HEALTH COALITION PARTICIPATED IN A FOCUS GROUP FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE COALITION MEMBERSHIP INCLUDES REPRESENTATION FROM THE HEALTH DEPARTMENT, BEHAVIORAL HEALTH, PUBLIC SCHOOLS, FAMILY RESOURCE CENTERS, COOPERATIVE EXTENSION AND COMMUNITY BASED SERVICES. THE COALITION MEMBERS BRING KNOWLEDGE AND EXPERTISE RELATED TO HEALTH NEEDS OF THE POPULATIONS THEY SERVE. IN ADDITION, A TOTAL OF EIGHT KEY INFORMANT INTERVIEWS WITH STEERING COMMITTEE MEMBERS WERE COMPLETED IN THE FALL OF 2020 AND EARLY JANUARY 2021. RESPONSES FROM THE INTERVIEWS HELPED IDENTIFY STRENGTHS OF THE COMMUNITY AND THE HEALTHCARE SYSTEM, CHALLENGES/BARRIERS IN THE BROADER HEALTHCARE SYSTEM AND OPPORTUNITIES FOR IMPROVING THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 6B OTHER ORGANIZATION ---------------------- THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY WAS PREPARED FOR THE MEDICAL CENTER AT ALBANY, CLINTON COUNTY, KENTUCKY BY THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK) AT THE UNIVERSITY OF KENTUCKY. THE CHNA WAS NOT CONDUCTED WITH OTHER HOSPITAL FACILITIES. SCHEDULE H, PART V, SECTION B, LINE 7A & 10A AVAILABILITY TO THE PUBLIC ------------------------------------- A COPY OF THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND STRATEGIC IMPLEMENTATION PLAN CAN BE FOUND AT: HTTPS://MEDCENTERHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING NEEDS ----------------- THE CHNA STEERING COMMITTEE MET TO REVIEW FINDINGS FROM THE COMMUNITY SURVEYS, KEY INFORMANT INTERVIEWS, FOCUS GROUPS AND HEALTH DATA. THE PROCESS OF PRIORITY SELECTION CONSIDERED THE FOLLOWING FACTORS: 1) THE ABILITY OF MCA TO EVALUATE AND MEASURE OUTCOMES 2) THE NUMBER OF PEOPLE AFFECTED BY THE ISSUE OR SIZE OF THE ISSUE 3) THE CONSEQUENCES OF NOT ADDRESSING THIS PROBLEM 4) PREVALENCE OF COMMON THEMES 5) THE EXISTENCE OF HOSPITAL PROGRAMS WHICH RESPOND TO THE IDENTIFIED NEED. NEEDS NOT ADDRESSED --------------------- MENTAL HEALTH SERVICES ARE OUTSIDE OF THE RESOURCES THAT MCA IS ABLE TO PROVIDE WITH THE RESOURCES AVAILABLE. MCA WILL CONTINUE TO MAINTAIN EXISTING AND ESTABLISH NEW RELATIONSHIPS WITH ENTITIES PROVIDING BEHAVIORAL HEALTH TREATMENT THAT BENEFIT THE PLACEMENT AND REFERRAL FOR MCA PATIENTS AND FAMILIES. MCA WILL KICK OFF THE IMPLEMENTATION STRATEGY BY INITIATING COLLABORATIVE EFFORTS WITH COMMUNITY LEADERS TO ADDRESS EACH HEALTH PRIORITY IDENTIFIED THROUGH THE ASSESSMENT PROCESS. PERIODIC EVALUATION OF GOALS/OBJECTIVES FOR EACH IDENTIFIED PRIORITY WILL BE CONDUCTED. SCHEDULE H, PART V, SECTION B, LINE 13B & 13H LINE 13B: ELIGIBILITY CRITERIA - INCOME OTHER THAN FPG ---------------------------------------------- BECAUSE THERE MAY BE CIRCUMSTANCES WHERE A PATIENT/GUARANTOR MAY END UP OWING AN AMOUNT THAT IS LARGE IN RELATION TO HIS INCOME, BUT STILL NOT MEET OUR STANDARD FINANCIAL ASSISTANCE (CHARITY CARE) GUIDELINES, AND BECAUSE WE DO NOT WANT TO CREATE WHAT IS COMMONLY KNOWN AS "MEDICAL INDIGENCY," WE WILL ALSO APPLY THE FOLLOWING GUIDELINES TO FINANCIAL ASSISTANCE APPLICATIONS: 1) ONLY PERSONS OR FAMILIES WHO MAKE LESS THAN 20 TIMES (2000%) OF THE SINGLE PERSON FPL ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE. THE PURPOSE OF THIS REQUIREMENT IS TO LIMIT THE INCENTIVE TO NOT PURCHASE HEALTH INSURANCE IF A PERSON CAN AFFORD IT. 2) A SELF-PAY PORTION OF A BILL GREATER THAN 20% OF ANNUAL INCOME QUALIFIES A PERSON FOR CATASTROPHIC FINANCIAL ASSISTANCE. 3) ALSO, THE AMOUNT DUE FROM CATASTROPHIC FINANCIAL ASSISTANCE APPLICANTS IS CAPPED AT 50% OF THEIR DOCUMENTED AND VERIFIED ANNUAL INCOME PLUS THE AMOUNT THE PATIENT'S LIQUID ASSETS EXCEED THEIR IMMEDIATE NEEDS AS PER THE ASSET TEST ABOVE. 4) WE ALLOW PAYMENT OF THIS CAPPED AMOUNT OVER A PERIOD OF UP TO 10 YEARS, WITH UP TO 15 YEARS AVAILABLE WITH THE APPROVAL OF THE DIRECTOR OF COMMONWEALTH FINANCIAL RESOURCES (CFR). 5) THE PAYMENTS ARE TREATED AS LONG-TERM PAY, I.E. THEY REQUIRE A WRITTEN AGREEMENT, AND THE PAYMENTS ARE INTEREST FREE FOR THE REMAINING PORTION OF THE BALANCE DUE. LINE 13H: ELIGIBILITY CRITERIA - OTHER -------------------------------- PERSONS OR FAMILIES THAT QUALIFY FOR MEDICAID, FOOD STAMPS, AND OTHER INDIGENT CARE PROGRAMS THAT CAN BE AND ARE INDEPENDENTLY VERIFIED ARE DEEMED TO MEET THE FINANCIAL ASSISTANCE GUIDELINES, AS WILL ACCOUNTS IDENTIFIED THROUGH TOOLS OR PROGRAMS WHICH PROVIDE REASONABLE ASSURANCE THAT THE ACCOUNT MEETS OUR FINANCIAL ASSISTANCE GUIDELINES. PATIENT ACCOUNTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENT HAS HAD MEDICAID WITHIN 60 DAYS BEFORE OR AFTER THE DISCHARGE DATE/DATE OF SERVICE. SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, & 16C FAP WEBSITE -------------- A COPY OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP CAN BE FOUND AT: HTTPS://MEDCENTERHEALTH.ORG/CFR/BILLING-POLICIES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART I, LINE 3C DETERMINING ELIGIBILITY ------------------------------ THE INCOME LIMIT FOR FINANCIAL ASSISTANCE IS 200% OF THE FEDERAL POVERTY LEVEL. DISCOUNTS ARE PROVIDED TO ALL PATIENTS WHO ARE UNINSURED WHOSE INCOME EXCEEDS THE LIMITS TO QUALIFY FOR FINANCIAL ASSISTANCE. SELF-PAY DISCOUNTS ARE NOT LIMITED BASED ON INCOME. THE HOSPITAL ALSO PROVIDES PAYMENT PLANS FOR SELF-PAY PATIENTS. THE ORGANIZATION ALSO USES ASSET LEVELS, UNINSURED, UNDERINSURED, MEDICAID ELIGIBILITY, FOOD STAMP ELIGIBILITY, AND PROVIDES FOR CATASTROPHIC DISCOUNTS. SEE THE NARRATIVES FOR LINES 13B AND 13H FOR MORE DETAIL. SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT ------------------------- THE ANNUAL REPORT TO THE COMMUNITY IS MADE AVAILABLE TO THE PUBLIC VIA NEWSPAPER INSERTS, DIRECT MAILINGS, AND IS POSTED ON THE COMMONWEALTH HEALTH CORPORATION'S WEBSITE AT: HTTPS://MEDCENTERHEALTH.ORG/ABOUT-US/ SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY ---------------------------- THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. THE COSTS RELATED TO MEDICAID PATIENTS WERE ALSO DETERMINED USING A RATIO OF COST TO CHARGE. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE --------------------------- TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES ------------------------------ COMMUNITY BUILDING ACTIVITIES INCLUDE PARTICIPATION IN CHAMBER OF COMMERCE AND INDUSTRIAL AUTHORITY. SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE -------------------- THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED MARCH 31, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, LINE 3 BAD DEBTS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE --------------------------------------------------------------- THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN FINANCIAL ASSISTANCE, CANDIDATES MUST COOPERATE FULLY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THESE REASONS, THE HOSPITAL BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, AND THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS NEGLIGIBLE. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE FOOTNOTE --------------------------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE HOSPITAL ELECTED TO EARLY ADOPT ASU 2011-07 ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AN OPERATING EXPENSE FOR FINANCIAL REPORTING PURPOSES. SCHEDULE H, PART III, LINE 8 MEDICARE SURPLUS/(SHORTFALL) -------------------------------- COSTS REPORTED ON LINE 6 ARE OBTAINED FROM THE MEDICARE COST REPORT WHICH ARE BASED ON A COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 9B DEBT COLLECTION PRACTICES --------------------------------- MCA PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE MCA DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FINANCIAL ASSISTANCE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. MCA MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF FINANCIAL ASSISTANCE THEY PROVIDE. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THEIR FINANCIAL ASSISTANCE POLICY. OTHER COMPENSATED CARE RELATES PRINCIPALLY TO CONTRACTUAL ALLOWANCES FOR GOVERNMENT PAYERS, DISCOUNTS TAKEN BY COMMERCIAL PAYERS AND BAD DEBTS. BENEFITS FOR THE POOR INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES OR WHO ARE UNINSURED. THIS INCLUDES TRADITIONAL FINANCIAL ASSISTANCE AT STANDARD BILLING RATES AND THE COSTS OF TREATING MEDICAID BENEFICIARIES IN EXCESS OF GOVERNMENT PAYMENTS. MCA DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO BE TRADITIONAL FINANCIAL ASSISTANCE. THEREFORE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT ------------------------------ MCA IS BUILT UPON THE FOUNDATION OF SERVING OUR COMMUNITY, DAY IN AND DAY OUT, WITH QUALITY DEPENDABLE HEALTHCARE. MCA'S CHNA IS POSTED AT: HTTPS://MEDCENTERHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ---------------------------------------------------- UPON REGISTRATION, PATIENTS ARE PROVIDED A PATIENT HANDBOOK WHICH CONTAINS INFORMATION REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, SIGNAGE AND BROCHURES DESCRIBING FINANCIAL ASSISTANCE POLICIES ARE AVAILABLE AT ADMISSIONS AREAS. EACH PATIENT WILL RECEIVE A STATEMENT REFERRED TO AS A FIRST NOTICE. THE FIRST NOTICE STATES THAT IT IS NOT A BILL, BUT IT IS A SUMMARY OF THE PATIENT'S CHARGES. THIS NOTICE AND EACH SUBSEQUENT STATEMENT CONTAINS INFORMATION CONCERNING FINANCIAL ASSISTANCE AS WELL AS CONTACT INFORMATION FOR QUESTIONS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION ---------------------- THE MEDICAL CENTER AT ALBANY SERVES THE NEEDS OF PATIENTS AND PHYSICIANS OF CLINTON COUNTY, KY AND SURROUNDING COUNTIES. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH ---------------------------------- AS PART OF COMMONWEALTH HEALTH CORPORATION, THE MEDICAL CENTER AT ALBANY IS PATIENT-FOCUSED, QUALITY-DRIVEN AND MISSION-LED. OUR MISSION IS TO CARE FOR PEOPLE AND IMPROVE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. WE COMBINE STATE-OF-THE-ART TECHNOLOGY, UNSURPASSED PERSONAL CARE, AND THE FINEST HEALTHCARE PROFESSIONALS TO ENSURE EACH VISIT IS THE VERY BEST IT CAN BE. MCA OFFERS FREE STROKE SCREENINGS AT COMMUNITY EVENTS, WORKSITES AND HEALTH FAIRS AND PROVIDES EARLY HEART ATTACK CARE (EHAC) EDUCATION AT LOCAL HEALTH FAIRS. MCA INCREASES COMMUNITY AWARENESS AND KNOWLEDGE OF THE OPIOID EPIDEMIC THROUGH "THE CHOICE IS YOURS" ENRICHMENT EVENT HELD FOR HIGH SCHOOL JUNIORS AND SENIORS. MCA PROVIDES CANCER PREVENTION INFORMATION AT LOCAL FESTIVALS AND FAIRS, DISTRIBUTING EDUCATIONAL MATERIALS AND PROMOTIONAL ITEMS PROMOTING AWARENESS AND PREVENTATIVE SCREENINGS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM ------------------------------ THE MEDICAL CENTER AT CLINTON COUNTY D/B/A THE MEDICAL CENTER AT ALBANY (MCA) IS OWNED AND CONTROLLED BY COMMONWEALTH HEALTH CORPORATION, A RELATED 501(C)(3) ORGANIZATION. COMMONWEALTH HEALTH CORPORATION (CHC) IS A HOLDING COMPANY FOR A TOTAL OF TWELVE FOR-PROFIT AND NONPROFIT CORPORATIONS AND PARTNERSHIPS (COLLECTIVELY, THE "AFFILIATES") ENGAGED IN VARIOUS ASPECTS OF THE HEALTH CARE INDUSTRY. CHC OWNS AND OPERATES MULTIPLE PHYSICIAN PRACTICES, WHICH ARE ACQUIRED TO ATTRACT AND RETAIN HIGHLY SKILLED PHYSICIANS IN SPECIALTIES THAT SUPPORT THE MISSION OF CHC AND ITS AFFILIATES. IN ADDITION, CHC OPERATES AND PROVIDES VARIOUS CORPORATE SUPPORT SERVICES INCLUDING PATIENT BILLING, COLLECTIONS, ACCOUNTING, MATERIALS MANAGEMENT, ENGINEERING, SECURITY, HUMAN RESOURCES, INFORMATION SYSTEMS, AND ADMINISTRATIVE SUPPORT TO ITS AFFILIATES. CHC HAS ESTABLISHED VARIOUS DIVISIONS FOR ITS OPERATIONS, INCLUDING THE NONPROFIT ORGANIZATIONS DESCRIBED BELOW (IN ADDITION TO THE MEDICAL CENTER AT ALBANY) AND OTHER NONPROFIT AND FOR-PROFIT CORPORATIONS AND PARTNERSHIPS. BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION ("THE MEDICAL CENTER"): ----------------- BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION ("THE MEDICAL CENTER") IS A NONPROFIT KENTUCKY CORPORATION THAT OPERATES A 337-BED HOSPITAL FACILITY IN BOWLING GREEN, KENTUCKY UNDER THE NAME "THE MEDICAL CENTER AT BOWLING GREENSINCE OCTOBER 1996, A 25-BED CRITICAL ACCESS HOSPITAL AND 110-BED NURSING HOME FACILITY IN SCOTTSVILLE, KENTUCKY, UNDER THE NAME "THE MEDICAL CENTER AT SCOTTSVILLE." IN ADDITION, SINCE JANUARY 2016, THE CORPORATION HAS OPERATED A 25-BED CRITICAL ACCESS ACUTE CARE HOSPITAL IN HORSE CAVE, KENTUCKY UNDER THE NAME "THE MEDICAL CENTER AT CAVERNA." THE THREE FACILITIES ARE PART OF ONE CORPORATION BUT ARE SEPARATELY LICENSED BY THE STATE OF KENTUCKY. THE MEDICAL CENTER IS THE SOLE MEMBER OF MEDICAL CENTER EMS, LLC (EMS), MEDICAL CENTER PHARMACY OF BOWLING GREEN, LLC (RIVERSIDE PHARMACY) AND ENSPIRE QUALITY PARTNERS, LLC (MED CENTER HEALTH PARTNERS). EMS PROVIDES AMBULANCE SERVICES IN WARREN COUNTY, KENTUCKY. RIVERSIDE OFFERS RETAIL PHARMACY SERVICES IN BOWLING GREEN, KY. MED CENTER HEALTH PARTNERS IS A CLINICALLY INTEGRATED NETWORK OF HEALTHCARE PROVIDERS, WORKING TOGETHER UNDER A PHYSICIAN-LED STRUCTURE TO IMPROVE POPULATION HEALTH, IMPROVE PATIENT EXPERIENCE AND REDUCE THE COST OF HEALTHCARE. THE CORPORATION IS BOTH THE LIMITED PARTNER AND A GENERAL PARTNER IN THE MEDICAL PLAZA PARTNERS, LLP WHICH PROVIDES ON-CAMPUS SPACE FOR HOSPITAL DEPARTMENTS AND OTHER NON-AFFILIATE MEDICAL-RELATED SERVICES. TOGETHER WITH ANOTHER AREA NON-PROFIT ACUTE CARE HOSPITAL CORPORATION, TMC IS AN EQUAL OWNER OF THE BARREN RIVER REGIONAL CANCER CENTER, INC., AN OUTPATIENT RADIATION THERAPY CARE SERVICE LOCATED IN GLASGOW, KENTUCKY. THE MEDICAL CENTER AT SCOTTSVILLE OPERATES TWO RURAL HEALTH CLINICS, ONE IN SCOTTSVILLE, KY AND ONE IN FOUNTAIN RUN, KY. THE MEDICAL CENTER AT CAVERNA OPERATES TWO RURAL HEALTH CLINICS, ONE IN MUNFORDVILLE, KY AND ONE IN HORSE CAVE, KY. COMMONWEALTH HEALTH FREE CLINIC, INC.: -------------------- COMMONWEALTH HEALTH FREE CLINIC, INC. ("CHFC") WAS ORGANIZED TO OPERATE A CLINIC, WHICH PROVIDES BASIC MEDICAL AND DENTAL DIAGNOSTIC AND TREATMENT SERVICES FOR CHARITABLE PURPOSES FOR THE UNINSURED AND UNDERINSURED OF SOUTH-CENTRAL KENTUCKY AND ALSO SERVES INDIVIDUALS WHO MAY BE COVERED BY SOME FORM OF INSURANCE, BUT WHO ARE UNABLE TO ACCESS A PROVIDER FOR ACUTE OR CHRONIC HEALTHCARE ISSUES. THE CLINIC OFFERS SERVICES INCLUDING NON-EMERGENCY CLINICAL SERVICES, DENTISTRY, COMMUNITY HEALTH EDUCATION AND COUNSELING, DISEASE/CONDITION SPECIFIC EDUCATION AND COUNSELING, AND ACCESS TO PHARMACEUTICALS. COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC: --------------------- COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC IS A LONG-TERM ACUTE CARE HOSPITAL THAT OPERATES AS A HOSPITAL WITHIN A HOSPITAL BY LEASING BEDS FROM THE MEDICAL CENTER ON ITS BOWLING GREEN CAMPUS. IT IS AN ACUTE CARE HOSPITAL FOR THOSE PATIENTS REQUIRING AN EXTENDED HOSPITAL STAY (ANTICIPATED LENGTH OF STAY BETWEEN 18-35 DAYS) AND GENERALLY HAVING COMPLEX OR CHRONIC MEDICAL CONDITIONS. THE MEDICAL CENTER AT FRANKLIN, INC.: --------------------- THE MEDICAL CENTER AT FRANKLIN, INC. (MCF) OPERATES A HOSPITAL IN THE COMMUNITY OF FRANKLIN, SIMPSON COUNTY, KENTUCKY. THIS LOCATION IS JUST 20 MILES FROM THE MEDICAL CENTER'S BOWLING GREEN CAMPUS. MCF IS A MEDICARE DESIGNATED CRITICAL ACCESS HOSPITAL OFFERING ACUTE CARE INPATIENT AND OUTPATIENT PROGRAMS IN ITS 25 BED ACUTE CARE FACILITY. THE MEDICAL CENTER AT FRANKLIN, INC. OPERATES A RURAL HEALTH CLINIC IN FRANKLIN, KENTUCKY. COMMONWEALTH HEALTH FOUNDATION: ------------------------ CHC ENDORSED THE ESTABLISHMENT OF COMMONWEALTH HEALTH FOUNDATION ("THE FOUNDATION") FOR THE PURPOSE OF FOSTERING, SUPPORTING AND INITIATING ACTIVITIES FOR THE AFFILIATED NON-PROFIT 501(C)(3) ORGANIZATIONS. THE FOUNDATION BUILDS RELATIONSHIPS THAT INSPIRE CHARITABLE GIVING IN SUPPORT OF CHC'S MISSION TO CARE FOR PEOPLE AND IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. BLUEGRASS OUTPATIENT CENTER: --------------------------- SINCE 2008, CHC HAS BEEN THE SOLE OWNER OF BLUEGRASS OUTPATIENT CENTER OF BOWLING GREEN, LLC ("BLUEGRASS"). BLUEGRASS PROVIDES COMPREHENSIVE OUTPATIENT REHABILITATION THERAPY SERVICES. false true false false false false false false false MS LAURA BELCHER VICE PRESIDENT/ADMINISTRATOR 161900 0 0 0 3612 0 4971 0 35023 0 205506 0 0 0 MR DAVID GRAY EXECUTIVE VICE PRESIDENT 0 366071 0 0 0 8374 0 8700 0 34740 0 417885 0 0 MR ERIC HAGAN VP OF RURAL HOSPITALS 28209 253883 0 0 669 6023 0 0 2005 18041 30883 277947 0 0 MS SHEILA KINGRY PHARMACY MANAGER 137479 0 0 0 3409 0 1131 0 9297 0 151316 0 0 0 MS MICHELE W LAWLESS EXECUTIVE VICE PRESIDENT/CFO 0 365764 0 0 0 6032 0 0 0 3505 0 375301 0 0 MS JILL PAYNE EVP/CNO - RESIGNED 6/25/21 0 162535 0 0 0 3955 0 2381 0 4554 0 173425 0 0 MS CONNIE D SMITH PRESIDENT / CEO 0 949706 0 0 0 384095 0 0 0 20856 0 1354657 0 0 MR RONALD G SOWELL EXEC VP - RETIRED 3/31/21 0 260389 0 0 0 10110 0 0 0 5145 0 275644 0 0 MR WADE STONE EXECUTIVE VICE PRESIDENT 0 381149 0 0 0 53196 0 0 0 29943 0 464288 0 0 SCHEDULE J, PART I, LINE 3: ---------------------------- THE CEO IS COMPENSATED BY COMMONWEALTH HEALTH CORPORATION (CHC), A RELATED ORGANIZATION. CHC USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART I, LINE 4B: ------------------------------- CERTAIN EXECUTIVES OF COMMONWEALTH HEALTH CORPORATION PARTICIPATED IN A SUPPLEMENTAL RETIREMENT PLAN. THE CURRENT YEAR INCREASE IN THE ACCRUED BENEFIT, AS ACTUARIALLY DETERMINED, IS REPORTED AS COMPENSATION. THE FOLLOWING ARE THE INDIVIDUALS PARTICIPATING IN THE PLAN AND THE CURRENT YEAR INCREASES REPORTED AS COMPENSATION: CONNIE SMITH $365,712 WADE STONE $ 50,987 FORM 990, PART III, LINE 4A & 4B PROGRAM SERVICE NARRATIVE -------------------------- DURING 2016, COMMONWEALTH HEALTH CORPORATION (CHC) ASSUMED MANAGEMENT OF CLINTON COUNTY HOSPITAL. CLINTON COUNTY HOSPITAL JOINED CHC AND BECAME THE MEDICAL CENTER AT CLINTON COUNTY D/B/A THE MEDICAL CENTER AT ALBANY. THE HOSPITAL'S PROFESSIONAL STAFF INCLUDES PHYSICIANS WHO ARE ENGAGED IN THE PRACTICE OF MEDICINE AND WHO REPRESENT MULTIPLE SPECIALTIES, INCLUDING FAMILY PRACTICE AND EMERGENCY CARE. THE STAFF ALSO INCLUDES NURSES, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPISTS, PSYCHOLOGISTS, RESPIRATORY THERAPISTS, NUTRITIONISTS AND OTHERS. USING AN INTERDISCIPLINARY TEAM APPROACH, THE STAFF WORKS COLLABORATIVELY TO PROVIDE PRIMARY OUTPATIENT CARE, RENDERED IN AN EMERGENCY ROOM AND OUTPATIENT SETTING, AND SECONDARY CARE CONSISTING OF INPATIENT SERVICES OF A GENERAL AND SPECIALIZED NATURE. SERVICES INCLUDE: - Cardiology - Cardiopulmonary Rehabilitation - Computed Tomography (CT) - Diagnostic Imaging - Digital Mammography - Emergency Department - Infectious Disease - Laboratory Services - Magnetic Resonance Imaging (MRI) - Nuclear Medicine - Oncology - Orthopaedics - Physical Rehabilitation - Respiratory Care - Telehealth THE COVID-19 PANDEMIC HAS BEEN A HEALTHCARE PRIORITY FOR OUR COMMUNITY, AS IT HAS FOR MANY COMMUNITIES ACROSS KENTUCKY. THE PANDEMIC HAS DEMANDED OUR FOCUS AND RESOURCES BE ALLOCATED TO COVID-19 TESTING, TREATMENT, INCREASED ACUTE CARE HOSPITALIZATIONS AND VACCINATIONS. MCA, WITH THE SUPPORT OF THE LAKE CUMBERLAND DISTRICT HEATH DEPARTMENT, HAS BEEN AVAILABLE AND READY TO MEET THE CHALLENGE AND IT IS OUR HOPE TO CONTINUE TO FIGHT THE PANDEMIC AS WELL AS GET BACK TO PRIORITIZING THE OTHER HEALTHCARE CONCERNS WITHIN OUR COMMUNITY AS WE MOVE FORWARD. DURING FISCAL YEAR 2022 THE HOSPITAL PROVIDED THE FOLLOWING DAYS OF CARE: 1,160 ACUTE PATIENT DAYS, 916 SWING PATIENT DAYS, AND 1,129 OBSERVATION DAYS. FORM 990, PART V, LINE 2A MANAGEMENT SERVICES AGREEMENT --------------------------------- COMMONWEALTH HEALTH CORPORATION HAS A MANAGEMENT SERVICES AGREEMENT FOR THE FOLLOWING RELATED ORGANIZATIONS: BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION, THE MEDICAL CENTER AT FRANKLIN, INC., THE MEDICAL CENTER AT CLINTON COUNTY, INC., AND COMMONWEALTH REGIONAL SPECIALTY HOSPITAL. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 31-1118087. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS ----------- THE CORPORATION'S ARTICLES OF INCORPORATION SPECIFY THE CORPORATION SHALL HAVE ONE (1) MEMBER. THE MEMBER SHALL BE COMMONWEALTH HEALTH CORPORATION, INC. FORM 990, PART VI, SECTION A, LINE 7A & 7B POWER OF MEMBERS ------------------- LINE 7A: BYLAWS OF THE CORPORATION SPECIFY THAT THE SOLE MEMBER SHALL APPOINT A NOMINATING COMMITTEE WHICH SHALL MEET AND DESIGNATE NOMINEES FOR BOARD DIRECTORSHIPS. LINE 7B: THE BYLAWS MAY BE REVISED OR AMENDED BY AFFIRMATIVE VOTE OF TWO-THIRDS(2/3) OF THE BOARD, SUBJECT TO APPROVAL OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990 ---------------------------- FORM 990 IS PLACED ELECTRONICALLY ON A COMPANY WEBSITE USED TO SHARE INFORMATION WITH BOARD MEMBERS. EACH BOARD MEMBER IS PROVIDED ACCESS TO THE WEBSITE AND IS ASKED TO REVIEW FORM 990 PRIOR TO A DESIGNATED DATE ON WHICH THE RETURN WILL BE FILED. ADVANCE NOTICE IS GIVEN TO BOARD MEMBERS SO THEY MAY REVIEW THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ THE COMMONWEALTH HEALTH CORPORATION (CHC) (APPLICABLE TO THE CORPORATION AND/OR ITS AFFILIATES) CODE OF CONDUCT EXPLICITLY STATES MEMBERS OF THE BOARD, ADMINISTRATION, THE MEDICAL STAFF AND ALL EMPLOYEES ARE EXPECTED TO AVOID CONFLICTS OF POLICY INTEREST. FURTHER, IT REQUIRES DISCLOSURE OF ANY POTENTIAL CONFLICTS OF INTEREST IN A TIMELY MANNER. ALL INDIVIDUALS SIGN AN ACKNOWLEDGEMENT UPON EMPLOYMENT THAT THEY HAVE RECEIVED A COPY OF THE CODE OF CONDUCT, ARE FAMILIAR WITH ITS CONTENT AND UNDERSTAND THEIR RESPONSIBILITIES TO AVOID NON-COMPLIANT ACTIVITY. CHC'S REGULATORY COMPLIANCE COMMITTEE (RCC) REVIEWS AND APPROVES ALL CONTRACTS BETWEEN CHC AND/OR ITS AFFILIATES AND DISQUALIFIED ENTITIES. THE REVIEW IS DESIGNED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST BY BOARD MEMBERS AND/OR OFFICERS. RCC MEMBERS ARE PROHIBITED FROM TAKING PART IN DECISIONS REGARDING TRANSACTIONS WITH WHICH HE/SHE HAS A CONFLICT OF INTEREST. ANNUALLY, WRITTEN INQUIRY IS MADE - BY QUESTIONNAIRE - OF BOARD MEMBERS AND OFFICERS SEEKING DISCLOSURE OF CONFLICTS OF INTEREST OR INFORMATION THAT RELATES TO FAMILY MEMBERS. TRANSACTIONS ARISING ARE REVIEWED BY MANAGEMENT AS THEY OCCUR. FORM 990, PART VI, SECTION B, LINE 15A & 15B DETERMINING COMPENSATION --------------------------- MEDICAL CENTER AT CLINTON COUNTY IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS COMMONWEALTH HEALTH CORPORATION, INC. COMPENSATION FOR ALL AFFILIATES IS OVERSEEN AND COORDINATED THROUGH COMMONWEALTH HEALTH CORPORATION, INC. CHC USES INDEPENDENT CONSULTANTS TO ANNUALLY REVIEW COMPENSATION. COMPENSATION-RELATED DETERMINATIONS ARE CONDUCTED IN ACCORDANCE WITH APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE AND REGULATIONS TO QUALIFY FOR THE PRESUMPTION THAT THE COMPENSATION IS REASONABLE, INCLUDING BUT NOT LIMITED TO APPROVAL BY AN AUTHORIZED COMMITTEE OF THE BOARD OF DIRECTORS WHO DO NOT HAVE A CONFLICT OF INTEREST, OBTAINING AND RELYING ON APPROPRIATE DATA AS TO COMPARABILITY, AND CONCURRENT DOCUMENTATION OF THE BASIS FOR THE COMPENSATION DETERMINATIONS. FORM 990, PART VI, SECTION C, LINE 19 MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ------------------------------------------ GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ONLY MADE AVAILABLE IF REQUESTED, AND IN THE MANNER REQUIRED, BY A GOVERNING AGENCY. FORM 990, PART XII, LINE 2C OVERSIGHT PROCESS --------------------- THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION AGENCY FEES TOTAL FEES:97078 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL CONSULTING FEES TOTAL FEES:967170 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:746179 FORM 990 PART IX LINE 11G DESCRIPTION:LAB FEES TOTAL FEES:3049 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT FEES TOTAL FEES:312244 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING FEES TOTAL FEES:239228 FORM 990 PART IX LINE 11G DESCRIPTION:AGENCY NURSING FEES TOTAL FEES:460611 FORM 990 PART IX LINE 11G DESCRIPTION:EMPLOYEE SUPPORT FEES TOTAL FEES:1284 BOWLING GREEN-WARREN CTY COMM HOSP CORP 800 PARK STREET BOWLING GREEN KY 42101 610920842 HOSPITAL KY 501(C)(3) 3 CHC INC false THE MEDICAL CENTER AT FRANKLIN 800 PARK STREET BOWLING GREEN KY 42101 611362001 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH REGIONAL SPECIALTY HOSPITAL 800 PARK STREET BOWLING GREEN KY 42101 542142034 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH FREE CLINIC 800 PARK STREET BOWLING GREEN KY 42101 611292739 HEALTHCARE KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH FOUNDATION INC 800 PARK STREET BOWLING GREEN KY 42101 611362000 SUPPORT KY 501(C)(3) 7 CHC INC false COMMONWEALTH HEALTH CORPORATION 800 PARK STREET BOWLING GREEN KY 42101 311118087 SUPPORT KY 501(C)(3) 10 NA false MEDICAL PLAZA PARTNERS 800 PARK STREET BOWLING GREEN KY 42101 611080340 REAL ESTATE KY NA false 0 false false false false false false false false false true false false true false true true true false false