2023-08-15T10:48:42-05:00 2022-09-30 FORVIS LLP 1222 Demonbreun Street Suite 950 Nashville TN 372033357 990 2021-10-01 610510934 JAMES B HAGGIN MEMORIAL HOSPITAL INC % AMANDA KINMAN JAME 8592392424 464 LINDEN AVENUE HARRODSBURG KY 40330 AMANDA KINMAN CFO 8597345441 2023-08-15 true AMANDA KINMAN 999009999 JEFF SMITH P00289876 6159883600 2 2021 2023-04-26 12:10:37Z DANIEL MCKAY 217 SOUTH THIRD STREET DANVILLE KY 40422 42138568 false X WWW.EMHEALTH.ORG X 1913 KY TO PROVIDE ACUTE HOSPITAL CARE TO INDIVIDUALS RESIDING WITHIN A PRIMARY SERVICE AREA OF MERCER AND SURROUNDING COUNTIES. 12 10 154 3 5111 0 2480790 1508402 31200536 40471631 2426 18685 60928 113085 33744680 42111803 0 0 0 0 13617324 14894632 0 0 0 17672961 22168194 31290285 37062826 2454395 5048977 14539377 13795525 19701815 13908986 -5162438 -113461 X THE JAMES B HAGGIN MEMORIAL HOSPITAL WILL MAINTAIN A LEADERSHIP POSITION IN EFFICIENTLY PROVIDING QUALITY MEDICAL CARE AND HEALTH CARE SERVICES TO THE RESIDENTS OF MERCER AND SURROUNDING COUNTIES. SEE SCHEDULE O FOR CONTINUATION. false false 33558964 40471631 Ephraim McDowell James B. Haggin Hospital (EMJBHH), located in Harrodsburg, Kentucky, is a 25-bed critical access hospital. The hospital offers a full array of health care services ranging from surgery to diagnostic imaging. The hospital's Emergency Department is also recognized as a Level IV Trauma Center and the hospital now has Pediatric Ready Designation and Acute Stroke Ready Designation. The facility is Joint Commission accredited. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 33558964 true true false true false false false false false true false false false true false false 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 true true false false true X 16 0 true 154 true true true false false false false false false false false false false false false X 12 10 false false false false true true true true true false false true true true true true true false false false KY X AMANDA KINMAN 8592392424 217 SOUTH THIRD STREET DANVILLE KY 40422 DANIEL MCKAY PRESIDENT & CEO 2.5 57.5 X X 0 743668 58392 WILLIAM SNAPP III VP & CFO UNTIL 06/30/21 0.0 60.0 X 0 531045 41480 GARY BUNCH CMO 1.0 59.0 X 0 328626 33578 TAMMY ENSSLIN LEGAL COUNSEL 2.5 57.5 X 0 296516 56123 LYNNE WARNER-LYNN HOSPITAL ADMINISTRATOR 20.0 20.0 X X 135895 135895 51768 BUDDY L HURT DO BOARD MEMBER 4.5 40.0 X 0 224502 44348 AMANDA KINMAN CFO 2.5 57.5 X 0 201877 47593 JOAN DELAHOUSEY CRNA 40.0 0.0 X 201466 0 35434 STACEY RIDER PHARMACIST 40.0 0.0 X 151088 0 21097 SUSAN WHEELER PHARMACIST 40.0 0.0 X 132840 0 28728 LYDIA TIMS CHIEF NURSING OFFICER 40.0 0.0 X 139531 0 21558 PAULA TAYLOR HOUSE SUPERVISOR 40.0 0.0 X 91714 0 37434 TONYA SUTTON OT 40.0 0.0 X 99129 0 28206 JOETTA WICKLIFFE CHAIR 7.5 0.0 X X 6150 0 0 JAMES W DUNN BOARD MEMBER 4.5 0.0 X 6150 0 0 GREG COBETTO VICE-CHAIR 7.5 0.0 X X 1800 0 0 ALVIS JOHNSON BOARD MEMBER 4.5 0.0 X 1800 0 0 DENNIS DAVIS BOARD MEMBER 4.5 0.0 X 1650 0 0 KAY RICHARDSON SECRETARY-TREASURER 7.5 0.0 X X 1650 0 0 JEREMIAH PHELPS MD BOARD MEMBER 4.5 0.0 X 1650 0 0 SHAWN MARKHAM BOARD MEMBER 4.5 0.0 X 1650 0 0 JOHN SETTLES BOARD MEMBER 4.5 0.0 X 1350 0 0 975513 2462129 505739 7 true true false QUALIVIS DEPT 3847 PO BOX 12387 DALLAS TX 75312 TEMP AGENCY 659773 MESSER CONSTRUCTION 854 WEST MAIN STREET LEXINGTON KY 40508 CONSTRUCTION 173000 2 1222381 286021 1508402 PATIENT SERVICES 621400 38941200 38936089 5111 PHARMACY REVENUE 446110 1530431 1530431 40471631 18685 18685 0 0 17339 26765 -9426 0 -9426 -9426 0 0 0 0 0 0 0 0 0 0 CAFETERIA 722210 61679 61679 MISCELLANEOUS REVENUES 900099 60832 60832 122511 42111803 40466520 5111 131770 0 0 0 0 1255537 1255537 0 11262593 10090903 1171690 483869 438579 45290 1043703 946013 97690 848930 774499 74431 0 32 32 60710 60710 0 0 0 8427288 7773485 653803 8002 6730 1272 1160721 1006813 153908 0 0 672361 171958 500403 38097 38089 8 0 43014 43014 144046 144046 0 1190987 1190987 152172 -16018 168190 MEDICAL SUPPLIES 6040847 6037743 3104 REPAIR & MAINTENANCE 759252 575740 183512 PROVIDER TAXES 340524 340524 SHARED RESOURCE ALLOCATION 3026052 3026052 104089 54794 49295 37062826 33558964 3503862 0 327392 499750 0 0 0 0 5199103 4554662 0 0 0 0 0 0 1025170 1037798 111977 150162 14802483 7249330 7875735 7553153 0 0 0 0 0 0 0 0 0 0 14539377 13795525 2604408 2590044 0 0 0 0 0 0 0 0 0 0 3384481 3092073 0 0 13712926 8226869 19701815 13908986 X -5162438 -113461 0 0 -5162438 -113461 14539377 13795525 5048977 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1358 1358 false false SCHEDULE C, PART 11-B, LINE 1 LOBBYING EXPENDITURES ---------------------- A PORTION OF DUES PAID TO THE KENTUCKY HOSPITAL ASSOCIATION (KHA) ARE USED FOR LOBBYING. 826709 826709 7313878 2838474 4475404 67434 52896 14538 6450553 4274246 2176307 143909 83714 60195 7553153 0 DUE TO RELATED PARTY 2378303 THIRD PARTY 5848566 8226869 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 FIN 48 (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 125. true X true true false true true 322089 322089 0.00870 8381947 6547694 1834253 0.04950 8704036 6547694 2156342 0.05820 8704036 6547694 2156342 0.05820 true 2781454 1020600 9274047 8133963 1140084 X true true 1 1 THE JAMES B HAGGIN MEMORIAL HOSPITAL 464 LINDEN AVENUE HARRODSBURG KY 40330 WWW.EMHEALTH.ORG 600053 X X X X THE JAMES B HAGGIN MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 20 true false false true X SEE PART V, SECTION C X true 20 true SEE PART V, SECTION C false true X 125. 300. X X X X X true true X 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 true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT ---------------- THROUGH THE FOCUS GROUP AND ONLINE SURVEY, PARTICIPATION AND INPUT WAS GATHERED FROM REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY (INCLUDING HISPANIC, AFRICAN AMERICAN), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (SPECIFICALLY, THE ELDERLY, DISABLED, YOUNG ADULTS, LGBT COMMUNITY, THE MENTALLY ILL, INMATES, HEARING IMPAIRED, MEDICAID RECIPIENTS, AND THE UNINSURED). HISPANIC, AFRICAN AMERICAN), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (SPECIFICALLY, THE ELDERLY, DISABLED, YOUNG ADULTS, LGBT COMMUNITY, THE MENTALLY ILL, INMATES, HEARING IMPAIRED, MEDICAID RECIPIENTS, AND THE UNINSURED). SCHEDULE H, PART V, SECTION B, LINE 7 AND 10 CHNA REPORT & IMPLEMENTATION STRATEGY -------------------------------------- THE HOSPITAL'S CHNA REPORT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.EMHEALTH.ORG/SERVICES/COMMUNITY-HEALTH SCHEDULE H, PART V, SECTION B, LINE 11 ASSESSING THE NEEDS OF THE COMMUNITY ------------------------------------- THE INTERNAL STAKEHOLDERS OF JAMES B. HAGGIN MEMORIAL HOSPITAL DETERMINED THE FOLLOWING TO BE THE TOP HEALTH PRIORITIES FOR THE HOSPITAL TO ADDRESS IN THE COMMUNITY FOR THE COMING YEARS: - DIABETES - ACCESS TO THE HEALTHCARE SERVICES - CANCER - EARLY DETECTION AND PREVENTION - CARDIOVASCULAR DISEASE & RELATED RISK FACTORS - NUTRITION, PHYSICIAL ACTIVITY, & WEIGHT - INJURY & VIOLENCE - SUBSTANCE ABUSE THESE PRIORITY AREAS, AND PLANS TO ADDRESS THESE, WILL BE INTEGRATED INTO THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE RATIONALE FOR SELECTING THESE AREAS IN AN UNDERSTANDING THAT IMPACTING THESE WOULD ALSO IMPACT MANY OTHER AREAS OF NEED IDENTIFIED IN THE ASSESSMENT, SUCH AS DEMENTIA, MENTAL HEALTH, SEXUALLY TRANSMITTED DISEASES, & HIV/AIDS, ORAL HEALTH, INFANT HEALTH & FAMILY PLANNING, RESPIRATORY DISEASES, TOBACCO USE, AND CHRONIC KIDNEY DISEASE. THESE AREAS ALSO REPRESENT A CONTINUATION OF EXISTING WORK AND ALLOW THE HOSPITAL TO BUILD ON PAST SUCCESSES. NEEDS NOT ADDRESSED --------------------- THERE ARE ADDITIONAL NEEDS IDENTIFIED WITHIN THE CHNA REPORT THAT ARE NOT SPECIFICALLY ADDRESSED BY THE HOSPITAL, DUE TO NO EXPERTISE OR LIMITED RESOURCES, BUT ARE BEING ADDRESSED BY OTHER AGENCIES WITHIN THE COMMUNITY. SOME OF THESE INCLUDE: ** SUBSTANCE ABUSE IS AN ISSUE IN THE STATE AND REGION. ADDICTION SERVICES ARE OFFERED BY PRIVATE PROVIDERS, COMPREHENSIVE CARE, AND SELF-REFINED IN THE REGION. THERE IS AN ACTIVE ALCOHOLICS ANONYMOUS CHAPTER. CELEBRATE RECOVERY IS OFFERED AT VARIOUS SITES IN THE SERVICE AREA. SUBSTANCE ABUSE TASK FORCE RESOURCES AND COMMITTEES ARE IN THE SURROUNDING SERVICE AREA, AND COLLABORATION OCCURS AS NEEDED. DUE TO LACK OF EXPERTISE AND RESOURCES, ADDICTION IS DEFERRED AS PART OF THE WORK PLAN. ** CHRONIC KIDNEY DISEASE AND END STAGE RENAL FAILURE LINKS TO DIABETES. FREE SCREENINGS WILL PROVIDE EARLY DETECTION AND POSSIBLY PREVENTION WHEN ADDRESSING NUTRITION, BODY MASS INDEX, AND EXERCISE. SOME FAITH COMMUNITY NURSES IN CONGREGRATIONS ASSESS BLOOD PRESSURES AND MEDICATION ADHERENCE AS WELL AS PROVIDE EDUCATION. RENAL SPECIALISTS AND DIALYSIS CENTERS SERVE THIS POPULATION AS WELL. ** DEMENTIA LINKS TO CV HEALTH AND STROKE INCIDENCE AND VASCULAR ISSUES. IT ALSO LINKS TO THE AGING OF THE POPULATIONS IN THE REGION. THERE IS AN ALZHEIMER'S SUPPORTS GROUP IN BOYLE AND MERCER COUNTIES. ALSO, MENTAL EVALUATION AND MEDICATION MANAGEMENT IS AVAILABLE BY A PSYCHIATRIST AT THE MEDICAL CENTER. DANVILLE HEALTH & REHABILITATION CENTER AS WELL AS MORNING POINT HAS AN ALZHEIMER'S LONG TERM CARE UNIT. THE SANDERS BROWN CENTER AT THE UNIVERSITY OF KENTUCKY HAS ON-GOING ALZHEIMER'S RELATED RESEARCH AND SERVES AS A REFERRAL CENTER FOR THE REGION. ** Births to teenagers and unwed mothers, and low birth-weight births are being addressed by the health departments and the school health COALITIONS. ** CHRONIC LUNG/RESPIRATORY DISEASE IS BEING ADDRESSED WITH TOBACCO EDUCATION, STOP SMOKING CLASSES AT THE HEALTH DEPARTMENTS, PULMONARY REHAB AT EPHRAIM MCDOWELL SPECIALTY CENTER AND THROUGH PUBLIC POLICY. ** IN THE AREAS OF INFECTIOUS DISEASE, THE COUNTY HEALTH DEPARTMENTS WILL CONTINUE TO ADDRESS HIV EDUCATION AND TESTING. HEPATITIS C VACCINE IS AVAILABLE AT THE HEALTH DEPARTMENTS. EPHRAIM WILL DEFER DUE TO RESOURCE ALLOCATIONS - BOTH PERSONNEL AND TIME. ** INJURY AND VIOLENCE EDUCATION IS IN THE HEALTH DEPARTMENTS, COUNTY EXTENSION OFFICES, SCHOOL RESOURCE CENTERS, FAMILY COURT, AND LAW ENFORCEMENT IN ALL COUNTIES. EPHRAIM WILL DEFER FOCUS ON INJURY AND VIOLENCE AT THIS TIME DUE TO OTHER AGENCIES COVERING ALL ASPECTS, HAVING GREATER EXPERTISE AND DEPARTMENTAL RESOURCE LIMITATIONS. ** ORAL HEALTH, INCLUDING REGULAR DENTAL CARE AND DENTAL INSURANCE, IS A REGIONAL ISSUE. EPHRAIM BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, AND 16C FINANCIAL ASSISTANCE POLICY WEBSITE ------------------------------------ THE HOSPITAL'S FAP, FAP APPLICATION FORM, AND PLAIN LANGAUGE SUMMARY ARE AVAILABLE AT: HTTP://WWW.EMHEALTH.ORG/FOR-PATIENTS/GOING-HOME/BILLING-INSURANCE/ 6 EPHRAIM MCDOWELL DEDMAN PRIMARY CARE 466 LINDEN AVENUE SUITE A HARRODSBURG KY 40330 PRIMARY CARE CLINIC EPHRAIM MCDOWELL MERCER PEDIATRICS 466 LINDEN AVENUE SUITE B HARRODSBURG KY 40330 PEDIATRIC CLINIC HARRODSBURG FAMILY MEDICAL CENTER 1509 LOUISVILLE ROAD HARRODSBURG KY 40330 PRIMARY CARE CLINIC EM SPRINGFIELD FAMILY MEDICAL CENTER 280 LINCOLN DRIVE SPRINGFIELD KY 40069 PRIMARY CARE CLINIC EM WALK IN AND PRIMARY CARE 1541 LEBANON ROAD SUITE 1 DANVILLE KY 40422 PRIMARY CARE CLINIC EM FAMILY AND INTERNAL MEDICINE 105 PONDER COURT SUITE 104 DANVILLE KY 40422 PRIMARY CARE CLINIC 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 WORKSHEET 1. COST COMPUTED ON IRS WORKSHEET 3 WAS COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS. 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 ----------------------------------------- HOSPITAL LEADERS AND STAFF ARE ENGAGED IN LEADERSHIP POSITIONS WITHIN SEVERAL ORGANIZATIONS IN THE LOCAL COMMUNITY. THEY ALSO VOLUNTEER ON LOCAL, REGIONAL AND STATE PROJECTS TO IMPROVE HEALTH, EDUCATION, AND THE GENERAL WELFARE OF THE CITIZENS OF THE REGION. SOME OF THESE ACTIVITIES INCLUDE: ** RINGING THE BELL FOR THE SALVATION ARMY DURING THE CHRISTMAS HOLIDAY SEASON, SUPPORTING SALVATION ARMY'S GOAL OF FEEDING THE HUNGRY AND PROVIDING CHRISTMAS FOR NEEDY FAMILIES. LEADERS AND STAFF ALSO PARTICIPATED IN THE SALVATION ARMY'S KETTLE DRIVE. ** PARTICIPATED IN THE UNITED WAY DAY OF CARING AND DAY OF ACTION TO IMPROVE OUR COMMUNITY THROUGH SERVICE PROJECTS ** PARTICIPATION IN THE SOUTHERN KY AHEC (AREA HEALTH EDUCATION CENTER) FUTURE DOCS PROGRAM. THIS PROGRAM GIVES A BOOST TO PRE-MED STUDENTS IN THE REGION TO LEARN MORE ABOUT THE MEDICAL SCHOOL APPLICATION PROCESS, PRACTICE INTERVIEW SKILLS, & INTERACT WITH MEDICAL STUDENTS AND PHYSICIANS. ** PARTICIPATION AND ATTENDANCE WITH THE HARRODSBURG ROTARY CLUB. ** PARTICIPATION WITH LOCAL EMERGENCY MANAGEMENT AND BLUEGRASS HEALTHCARE COALITION. ** PARTICIPATION IN THE MERCER COUNTY YOUTH LEADERSHIP PROGRAM, PROVIDING HOSPITAL TOURS AND EDUCATION ABOUT DIFFERENT CAREER OPPORTUNITIES IN HEALTHCARE. ** PARTICIPATION WITH THE MERCER COUNTY LEADERSHIP PROGRAM. ** PARTICIPATION IN THE MERCER COUNTY PIONEER DAYS EVENT BY PROVIDING HEALTH SERVICES AT THE EVENT. 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 SEPTEMBER 30, 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. THIS AMOUNT IS DIRECTLY FROM THE FINANCIAL STATEMENTS AND INCLUDES ESTIMATES AND ACCRUALS OF BAD DEBT EXPENSE AND DOES NOT NECESSARILY REFLECT ACTUAL WRITE-OFFS DURING THE PERIOD. SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE ----------------------------------------------- BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS REPORTED PER THE MEDICARE COST REPORT WORKSHEET S-10. 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 ----------------------------- AMOUNTS REPORTED ON LINES 5 AND 6 WERE BASED ON THE CORPORATION'S MEDICARE COST REPORT. SCHEDULE H, PART III, LINE 9B WRITTEN DEBT COLLECTION POLICY AND FINANCIAL ASSISTANCE -------------------------------------------------------- IF IT IS DETERMINED THAT A PATIENT OR RESPONSIBLE PARTY IS ELIGIBLE FOR FINANCIAL ASSISTANCE, EMH WILL: - SEND WRITTEN NOTIFICATION TO THE RESPONSIBLE INDIVIDUAL OF THE ASSISTANCE DETERMINATION AND - IF THE DISCOUNT IS LESS THAN 100%, EMH WILL: * PROVIDE THE RESPONSIBLE INDIVIDUAL WITH A BILLING STATEMENT SHOWING THE AMOUNT OWED, HOW THE AMOUNT WAS DETERMINED, AND DESCRIBE HOW THE INDIVIDUAL CAN LEARN MORE ABOUT HOW THE HOSPITAL CALCULATES AGB; * ISSUE REFUNDS TO THE RESPONSIBLE INDIVIDUAL IF HE OR SHE PREVIOUSLY PAID AN AMOUNT TO EMH EXCEEDING WHAT HE OR SHE IS PERSONALLY RESPONSIBLE TO PAY; AND * TAKE ALL REASONABLE MEASURES TO REVERSE ANY ECAS (WITH THE EXCEPTION OF A SALE OF A DEBT OR DEFERRING OR DENYING CARE FOR NON-PAYMENT OF AMOUNTS FOR PREVIOUS CARE) TAKEN AGAINST THE RESPONSIBLE INDIVIDUAL TO THE EXTENT POSSIBLE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT ------------------ IN 2020, PROFESSIONAL RESEARCH CONSULTANTS (PRC) WAS ENGAGED TO CONDUCT A NEEDS ASSESSMENT OF EMJBH'S COMMUNITY, WHICH IS DEFINED AS THE PRINCIPAL RESIDENTIAL ZIP CODES IN BOYLE, GARRARD, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY. A SURVEY AND A COMMUNITY FOCUS GROUP WERE COMPLETED TO OBTAIN PRIMARY DATA FROM INDIVIDUALS WITHIN THE COMMUNITY. THE FOCUS GROUP WAS COMPRISED OF REPRESENTATIVES FROM PUBLIC HEALTH, SOCIAL SERVICES PROVIDERS, EMPLOYERS, AND OTHER COMMUNITY LEADERS, SELF REPORT DATA, MORTALITY, MORBIDITY, LIFESTYLE, INCIDENCE OF CHRONIC DISEASE, INJURY DATA AND DISABILITY DATA ARE PART OF THE ASSESSMENT PROCESS. THE BENCH MARK IS ESTABLISHED USING HEALTHY PEOPLE 2020 DATA. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ------------------------------------------------- THE HOSPITAL'S CHARITY CARE POLICY IS POSTED ON THE WWW.EMHEALTH.ORG WEBSITE. AT REGISTRATION OF SELF-PAY CLIENTS, INFORMATION IS GIVEN ON A REDUCED FEE, CHARITY APPLICATION, AND A REFERRAL TO A FINANCIAL COUNSELOR. THE FREE COMMUNITY SCREENINGS ARE POSTED ON THE WEBSITE AND IN AREA NEWSPAPERS IF THE HOSTING ORGANIZATION INVITES COMMUNITY PARTICIPATION. SOME EVENTS ARE DISCUSSED ON LOCAL RADIO. INFORMATION REGARDING THE FREE CLINIC IS ALSO GIVEN BY HEALTHCARE PROVIDERS, FAITH COMMUNITY NURSES, CASE WORKERS, AND OTHER MEDICAL PROFESSIONALS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION ----------------------- THE COMMUNITY DEFINED FOR THE CHNA REPORT INCLUDES THE PRINCIPAL RESIDENTIAL ZIP CODES IN BOYLE, GARRARD, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY, COMPRISING THE HOSPITAL'S SERVICE AREA. THE HEALTH SYSTEM SERVES BOYLE, MERCER, CASEY, LINCOLN, GARRARD, AND WASHINGTON COUNTIES, WHICH HAVE A RURAL POPULATION OF APPROXIMATELY 124,000. ACCESS IS AN ISSUE, DUE TO TRAVEL BARRIERS SUCH AS AN OUT-OF-DATE HIGHWAYS AND LACK OF PUBLIC TRANSPORTATION. THESE ACCESS ISSUES INFLUENCED THE DECISION TO SERVE WITH FREE SCREENINGS AT KEY GATHERING PLACES SUCH AS CHURCHES AND SCHOOLS, ETC. INSURANCE COVERAGE IS ANOTHER ISSUE. THE NUMBERS OF UNINSURED CONTINUES TO EXCEED THE NATIONAL AVERAGE AND THE UNDERINSURED IN THIS SERVICE AREA CONTINUES TO EXCEED POST ACA. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH --------------------------------- OFFICERS AND STAFF OF THE HOSPITAL ARE ENGAGED IN LEADERSHIP POSITIONS WITHIN SEVERAL ORGANIZATIONS IN THE LOCAL COMMUNITY. THE HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL OPERATING IN MERCER COUNTY AND PROVIDES EMERGENCY TREATMENT TO LOCAL RESIDENTS WHO WOULD OTHERWISE HAVE TO TRAVEL OUT OF THE COUNTY TO RECEIVE EMERGENCY MEDICAL TREATMENT. THE HOSPITAL ALSO PROVIDES A WEEKEND AND AFTER HOURS WALK-IN CLINIC TO PROVIDE A BETTER (MORE APPROPRIATE) OPTION THAN THE ER TO OUR RESIDENTS WHO REQUIRE BASIC HEALTHCARE NEEDS AFTER HOURS AND ON THE WEEKEND. THE HOSPITAL, ALONG WITH THE LOCAL HEALTH DEPARTMENT, IS RESPONSIBLE FOR EDUCATION AND PROVIDING THE MEDICAL CARE TO ITS LOCAL AND SURROUNDING RESIDENTS. THE HOSPITAL PROVIDES FREE COMMUNITY HEALTH FORUMS MONTHLY TO THE COMMUNITY AT THE PUBLIC LIBRARY EDUCATING THEM ON HEALTH RELATED ISSUES (HOW TO IMPROVE THEIR MENTAL HEALTH, HOW TO KEEP UP WITH THEIR MEDICATIONS, BIKE SAFETY, HOW TO MAINTAIN A WALKING PROGRAM, HEALTHY EATING, BREAST SCREENING AND EARLY DETECTION EDUCATION). WE ALSO PROVIDE NUMEROUS HEALTH FAIRS TO LOCAL COMPANIES FOR A NOMINAL CHARGE. STAFF HAS ALSO GIVEN TESTIMONY AT LOCAL, STATE, AND FEDERAL LEVELS RELATED TO OUR SERVICE AREA'S HEALTH, EDUCATION AND ECONOMIC ISSUES. THE HOSPITAL'S BOARD AND EPHRAIM MCDOWELL HEALTH'S BOARD IS COMPRISED OF COMMUNITY MEMBERS WITH REPRESENTATION FROM MEDICAL STAFF AND SENIOR LEADERSHIP. THE GOVERNING BOARD APPROVED THE ESTABLISHMENT AND FUNDING OF THE COMMUNITY SERVICE DEPARTMENT AND THE FUNDING OF THE HEALTH RISK BEHAVIOR ASSESSMENT OF BOYLE COUNTY. THEY ALSO APPROVED THE CHARITY CARE POLICY. THERE IS NEVER A FEE FOR SERVICES PROVIDED BY THE COMMUNITY SERVICE DEPARTMENT. WE ALSO APPROACHED CHURCHES IN THE SIX-COUNTY AREA WITH HEALTH SCREENINGS. PREVENTATIVE CARE, SUCH AS FLU SHOTS, ARE TAKEN TO THE COMMUNITY. SO, TOO, ARE ANNUAL SKIN CANCER CHECKS, MONTHLY BLOOD PRESSURE CHECKS, SEMIANNUAL GLUCOSE AND CHOLESTEROL CHECKS, ALONG WITH NURSE CONSULTS. SUCH SERVICES ARE OFFERED IN SCHOOLS, CHURCHES, AND OTHER PUBLIC ENTITIES IN THE REGION. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM -------------------------------- JAMES B. HAGGIN MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN MERCER COUNTY. ON DECEMBER 1, 2017, THE HOSPITAL WAS ACQUIRED BY EPHRAIM MCDOWELL HEALTH (EMH). EMH IS A COMPREHENSIVE, INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES 124,000 RESIDENTS FROM SIX COUNTIES IN SOUTH CENTRAL KENTUCKY. THE EMH BOARD IS COMPRISED OF COMMUNITY MEMBERS AND REPRESENTATION FROM FT LOGAN HOSPITAL, JAMES B. HAGGIN MEMORIAL HOSPITAL, MEDICAL STAFF, AND EMRMC LEADERSHIP. FT LOGAN HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN LINCOLN COUNTY. HEALTH RESOURCE IS COMPRISED OF CLINICS, A WELLNESS CENTER, ASSISTED LIVING FACULTY, AND DURABLE MEDICAL EQUIPMENT OUTLETS. THERE ARE REPRESENTATIVES FROM OUR SIX COUNTIES, MEDICAL STAFF, AND LEADERSHIP ON THE COMMUNITY BOARD THAT OVERSEES AND COORDINATES THE SERVICES OF EPHRAIM MCDOWELL HEALTH. true false false false false false true false false JOAN DELAHOUSEY CRNA 198627 1500 1339 16163 19271 236900 0 BUDDY L HURT DO BOARD MEMBER 204791 6250 13461 15025 29323 268850 0 DANIEL MCKAY PRESIDENT & CEO 587012 140712 15944 23200 35192 802060 0 LYNNE WARNER-LYNN HOSPITAL ADMINISTRATOR 105924 105924 18771 18771 11200 11200 8830 8830 17054 17054 161779 161779 0 0 AMANDA KINMAN CFO 178573 14929 8375 16889 30704 249470 0 GARY BUNCH CMO 307385 1500 19741 23200 10378 362204 0 TAMMY ENSSLIN LEGAL COUNSEL 241146 39433 15937 23200 32923 352639 0 WILLIAM SNAPP III VP & CFO UNTIL 06/30/21 261472 96143 173430 21707 19773 572525 0 STACEY RIDER PHARMACIST 149418 1500 170 11876 9221 172185 0 SUSAN WHEELER PHARMACIST 129932 1500 1408 10785 17943 161568 0 LYDIA TIMS CHIEF NURSING OFFICER 116787 21606 1138 11026 10532 161089 SCHEDULE J, PART I, LINE 3 ESTABLISHING CEO COMPENSATION ------------------------------ THE CEO IS COMPENSATED BY EPHRAIM MCDOWELL HEALTH, INC. (EMH), A RELATED ORGANIZATION. EMH 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 4A SEVERANCE PAYMENTS ------------------- WILLIAM SNAPP LEFT EPHRAIM MCDOWELL IN JULY 2021. HIS SEVERANCE OF $157,868 WAS REPORTED IN HIS W-2. SCHEDULE J, PART 1, LINE 6B MANAGEMENT INCENTIVE PLAN --------------------------- EPHRAIM MCDOWELL HEALTH, INC. AND ITS AFFILIATES HAVE MANAGEMENT INCENTIVE PLANS FOR CORPORATE OFFICERS, SENIOR VICE PRESIDENTS, VICE-PRESIDENTS, AND DIRECTORS. ANNUAL PAYOUTS RELATED TO THESE INCENTIVE PLANS HAVE TWO COMPONENTS. 30% OF THE ANNUAL PAYOUT IS BASED ON NET OPERATING INCOME GOALS COMPARED TO BUDGET. THE OTHER 70% IS BASED ON QUALITY MEASURES, PATIENT SATISFACTION GOALS, ASSOCIATE SATISFACTION GOALS, AND SAFETY MEASURES. FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION ------------------------------- SERVICES WILL MEET IDENTIFIED COMMUNITY NEEDS AND SHALL BE PROVIDED WITH THE HIGHEST CONCERN FOR OUR PATIENTS AND THEIR FAMILIES. THESE SERVICES WILL BE PROVIDED AT THE LOWEST POSSIBLE COST. THE HOSPTIAL WILL PROVIDE ADEQUATE FACILITIES, MODERN EQUIPMENT, A PROFESSIONALLY TRAINED STAFF, AND A QUALIFIED MEDICAL STAFF. THE HEALTH CARE SERVICES MAY INCLUDE ACUTE MEDICAL AND SURGICAL INPATIENT, OUTPATIENT, EMERGENCY, HEALTH EDUCATION, HEALTH SCREENING, WELLNESS, AND REHABILITATION. ALL SERVICES WILL BE PROVIDED WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, AGE, SEX, DISABILITY, SOCIAL, OR ECONOMIC STATUS. FORM 990, PART III, LINE 4 PROGRAM SERVICE ACCOMPLISHMENTS --------------------------------- The hospital serves the citizens of Mercer County, while patients from surrounding counties also rely on the Hospital for their health care needs. Although small, the Hospital maintains the same standards of excellence in care and customer service that patients will find at all Ephraim McDowell Health facilities. The Hospital offers a variety of Ephraim McDowell Health system services locally through the facility, including Cardiopulmonary, Diagnostic, Dietary, Swing Beds, Laboratory, Rehabilitation, Surgical Services, Wound Care Clinic, 24-hour emergency care, and Durable Medical Equipment. In fiscal year 2022, outpatient registrations were 51,752 and emergency room services were provided for 7,576 visits. There were 744 surgical procedures, 501 admissions (including swing), and the facility recorded 5,917 total patient days (including observation and swing). In FY 2022, the Hospital invested $2,156,342 in community benefits including financial assistance and means-tested programs. This is above and beyond the hours of volunteer time in leadership roles by EMJBHH staff at the local, regional, state and national level. FORM 990, PART V, LINE 2A COMMON PAYMASTER ----------------- EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER IS THE COMMON PAYMASTER FOR JAMES B. HAGGIN MEMORIAL HOSPITAL, INC. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 61-0492356. FORM 990, PART VI, SECTION A, LINE 6, 7A, AND 7B MEMBERS OF THE ORGANIZATION ----------------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF JAMES B. HAGGIN MEMORIAL HOSPITAL. EPHRIAM MCDOWELL HEALTH, INC., A RELATED 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTCARE DELIVERY SYSTEM. EPHRAIM MCDOWELL HEALTH, INC. ELECTS BOARD MEMBERS OF JAMES B. HAGGIN MEMORIAL HOSPITAL ON AN ANNUAL BASIS. THE BYLAWS OF JAMES B. HAGGIN MEMORIAL HOSPITAL REQUIRE APPROVAL OF CERTAIN TRANSACTIONS BY ITS SOLE CORPORATE MEMBER, EPHRAIM MCDOWELL HEALTH, INC. FORM 990, PART VI, SECTION B, LINE 11 PROCESS TO REVIEW FORM 990 ----------------------------------- COPIES OF THE FORM 990 ARE SUBMITTED TO THE FULL BOARD VIA EMAIL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12 MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ ANNUALLY, BOARD OF DIRECTORS, SENIOR LEADERSHIP, AND MEDICAL STAFF LEADERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. COMPLETION OF THE ANNUAL QUESTIONNAIRE IS COORDINATED BY GENERAL COUNSEL AND EPHRAIM MCDOWELL'S CORPORATE COMPLIANCE OFFICER. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE SENIOR LEADERSHIP AND THE CORPORATE COMPLIANCE OFFICER. THE CHAIRMAN OF THE BOARD OF DIRECTORS IS MADE AWARE OF CONFLICTS WHICH HAVE BEEN DISCLOSED ON ANNUAL STATEMENTS. IF CONFLICTS EXIST, THE CONFLICT IS DISCLOSED AND THE INDIVIDUAL WITH THE CONFLICT DOES NOT PARTICIPATE OR VOTE ON ACTIVITIES WHERE A CONFLICT OF INTEREST IS PRESENT. FORM 990, PART VI, SECTION C, LINE 15 PROCESS FOR DETERMINING COMPENSATION ------------------------------------------ JAMES B. HAGGIN MEMORIAL HOSPITAL IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS EPHRAIM MCDOWELL HEALTH, INC. COMPENSATION FOR ALL AFFILIATES IS OVERSEEN AND COORDINATED THROUGH EPHRAIM MCDOWELL HEALTH, INC. THE MERCER GROUP, INDEPENDENT CONSULTANTS, CONDUCTED A REVIEW AND PROVIDED MARKET DATA IN 2018 FOR ESTABLISHING REASONABLE COMPENSATION OF THE CEO. FOR OTHER OFFICERS AND KEY EMPLOYEES FOR THE SYSTEM, THE ORGANIZATION ALSO UTILIZED COMPENSATION STUDIES. THE COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE EPHRAIM MCDOWELL HEALTH, INC. BOARD OF DIRECTORS. THE DECISION AND PROCESS IS DOCUMENTED BY THE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 19 MAKING FORMS AVAILABLE TO THE PUBLIC ---------------------------------------- THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. HAGGIN MEMORIAL HOSPITAL FOUNDATION INC 464 LINDEN AVENUE HARRODSBURG KY 40330 310995840 SUPPORT KY 501(C)(3) 12B-11 JAMES B HAGG true EMHFL INC 217 SOUTH THIRD STREET DANVILLE KY 40422 611388556 CRITICAL HOSP KY 501(C)(3) 3 EM HEALTH false EPHRAIM MCDOWELL HEALTH RESOURCE INC 217 SOUTH THIRD STREET DANVILLE KY 40422 311545520 HEALTHCARE KY 501(C)(3) 3 EM HEALTH false EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER 217 SOUTH THIRD STREET DANVILLE KY 40422 610492356 ACUTE HOSP KY 501(C)(3) 3 EM HEALTH false EPHRAIM MCDOWELL HEALTH INC 217 SOUTH THIRD STREET DANVILLE KY 40422 611324736 MGT SERVICES KY 501(C)(3) 12B-II NA false MCDOWELL HOME HEALTH AGENCY INC 217 SOUTH THIRD STREET DANVILLE KY 40422 610715227 HOME HEALTH KY 501(C)(3) 3 EM HEALTH false EPHRAIM MCDOWELL HEALTH CARE FOUNDATION 217 SOUTH THIRD STREET DANVILLE KY 40422 611229333 FUNDRAISING KY 501(C)(3) 12B-II EM HEALTH false COOPERATIVE CARE INC 217 SOUTH THIRD STREET DANVILLE KY 40422 611265715 CONTRACTING SVCS KY NA C 0 0 0.00000 false false false false false false false false false false false false false false false false false false true true