2023-11-15T12:24:51-06:00 2022-12-31 621199757 LBMC PC PO BOX 1869 BRENTWOOD TN 370241869 990 2022-01-01 610601267 MARSHALL COUNTY HOSPITAL DISTRICT MARS 2705274800 615 OLD SYMSONIA ROAD BENTON KY 42025 DAVID G FUQUA CEO 2705274800 2023-11-14 1 DAVID FUQUA 999009999 1 MAYUMI STELLA P00970938 6153774600 2023-11-14 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID G FUQUA 615 OLD SYMSONIA ROAD BENTON KY 42025 25635244 0 X WWW. MARSHALLCOUNTYHOSPITAL. ORG X 1974 KY TO PROVIDE MEDICAL CARE TO PEOPLE IN MARSHALL AND SURROUNDING COUNTIES 5 5 339 10 0 0 2252092 1363922 24443335 22826892 116323 194388 1309513 1248660 28121263 25633862 0 0 0 0 13148065 13638339 0 0 0 13447887 13662641 26595952 27300980 1525311 -1667118 42667411 39357496 24467474 20003879 18199937 19353617 TO PROVIDE MEDICAL CARE TO THE PEOPLE IN MARSHALL AND SURROUNDING COUNTIES. 0 0 22607912 24075552 MARSHALL COUNTY HOSPITAL DISTRICT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN MARSHALL COUNTY AND SURROUNDING COUNTIES IN KENTUCKY. IN 2022, THE HOSPITAL HAD 1,103 ACUTE DAYS, 367 ICU DAYS, AND 194 SWING DAYS. 22607912 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 32 0 1 339 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X THE ORGANIZATION 2705274800 615 OLD SYMSONIA ROAD BENTON KY 42025 JEFF SMITH CHAIRMAN 1.00 1.00 X 0 0 0 BLAKE WISEMAN SECRETARY 1.00 1.00 X 0 0 0 PAMELA SIRLS TREASURER 1.00 1.00 X 0 0 0 JERRY SELLS DIRECTOR 1.00 1.00 X 0 0 0 LAUREN MANN DIRECTOR 1.00 1.00 X 0 0 0 DAVID G FUQUA CEO 40.00 0.00 X 268518 0 50489 JANICE KELLEY CFO 40.00 0.00 X 141372 0 36524 TIFFANY N TUBBS CCO 40.00 0.00 X 91486 0 31957 BENNIE M FULBRIGHT PHYSICIAN 40.00 0.00 X 501763 0 40523 JULIA T LYLES PHYSICIAN 40.00 0.00 X 244204 0 43185 CHRISTINA M BROWN PHYSICIAN 40.00 0.00 X 240031 0 14399 WILLIAM T POWELL PHYSICIAN 26.00 0.00 X 168909 0 33614 DIANE KOLENICH PHYSICIAN 40.00 0.00 X 121170 0 48749 1777453 0 299440 11 0 1 0 MD PARTNERS PLLC 83 GERALDINE LANE GILBERTSVILLE KY 42044 ER PHYSICIANS 1182170 EVIDENT DEPT #6448 PO BOX 11407 BIRMINGHAM AL 352466448 IT SERVICES 271227 BRUCE DAVID 272 W 24TH ST BENTON KY 42025 ANESTHESIOLOGY 216667 LEONARD HOHLBEIN 1008 W STATELINE FULTON KY 42041 ANESTHESIOLOGY 216667 AYA HEALTHCARE INC PO BOX 123519 DALLAS TX 753123519 TRAVEL NURSES & LAB TECHS 194938 12 20245 1343677 1363922 NET PATIENT REVENUE 621400 22623564 22623564 AMBULANCE SERVICES MGT FEES 621910 203328 203328 22826892 195770 195770 1382 -1382 -1382 -1382 AD VALOREM TAXES 900099 1154791 1154791 CAFETERIA 722210 89186 89186 MISC 900099 2376 2376 2307 2307 1248660 25633862 24075552 0 194388 X 620346 310173 310173 10347414 9512554 834860 61177 61177 1848417 1690184 158233 760985 684840 76145 29553 29553 91188 91188 3033703 2809164 224539 85368 78638 6730 276820 173924 102896 181876 584 181292 728644 258431 470213 14810 12476 2334 794156 776526 17630 1499244 1457511 41733 453079 453079 SUPPLIES 2061233 2061233 COVID COSTS 1763155 225 1762930 REPAIRS & MAINTENANCE 1197481 1166630 30851 MEDICAL SUPPLIES 982004 982004 470327 118559 351768 27300980 22607912 4693068 0 5748021 5872402 13526943 7286041 2712804 2629264 542540 595471 587928 336854 49154852 30594074 19496105 18560778 0 3890923 0 53070 53070 132693 42667411 39357496 1823837 2647094 17290000 16045000 1190000 1245000 4163637 66785 24467474 20003879 X 18199937 19353617 18199937 19353617 42667411 39357496 X -1667118 2820798 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25312 25312 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE KENTUCKY HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. A PERCENTAGE OF THE MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS ARE USED FOR LOBBYING PURPOSES. THE HOSPITAL PAID DUES OF $25,312 TO THE KENTUCKY HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION OF WHICH AN AVERAGE OF 11.9% WAS FOR LOBBYING PURPOSES. 3234612 3234612 28793775 15789625 13004150 13691732 11483795 2207937 3434733 3320654 114079 18560778 OTHER LIABILITIES 66785 66785 X PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. MANAGEMENT BELIEVES THEY DO NOT HAVE ANY UNRELATED BUSINESS TAXABLE INCOME. THE FOUNDATION HAS ALSO BEEN RECOGNIZED AS TAX EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3) OF THE IRC. 1 1 1 X 0 1 1 0 1 1 11074 11074 0.00040 4928727 4343262 585465 0.02140 4939801 4343262 596539 0.02180 1000 1000 0.00000 1000 1000 0.00000 4940801 4343262 597539 0.02180 1 1276609 7306140 7344980 -38840 X 1 0 1 1 MARSHALL COUNTY HOSPITAL 615 OLD SYMSONIA ROAD BENTON KY 42025 X X X X MARSHALL COUNTY HOSPITAL DISTRICT 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X WWW. MARSHALLCOUNTYHOSPITAL. ORG 1 22 1 WWW. MARSHALLCOUNTYHOSPITAL. ORG 0 1 X 100.000000000000 X 1 1 X X X X 1 X WWW. MARSHALLCOUNTYHOSPITAL. ORG X WWW. MARSHALLCOUNTYHOSPITAL. ORG X SEE PART V, PAGE 8 X X X X X 1 0 X X X 1 X 0 0 PART V, SECTION B, LINE 5: THE MARSHALL COUNTY HOSPITAL AND THE MARSHALL COUNTY HEALTH DEPARTMENT JOINT-VENTURED AND UTILIZED A COMMUNITY HEALTH ASSESSMENT PROCESS BASED ON MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). MAPP IS A COMMUNITY-DRIVEN STRATEGIC PLANNING PROCESS WHICH HELPS COMMUNITIES APPLY STRATEGIC THINKING TO PRIORITIZE PUBLIC HEALTH ISSUES AND IDENTIFY RESOURCES TO ADDRESS THEM. MAPP IS NOT AN AGENCY-FOCUSED ASSESSMENT PROCESS; RATHER, IT IS AN INTERACTIVE PROCESS THAT CAN IMPROVE THE EFFICIENCY, EFFECTIVENESS, AND ULTIMATELY THE PERFORMANCE OF LOCAL PUBLIC HEALTH SYSTEMS. THE ASSESSMENTS USED IN THE MAPP PROCESS INCLUDE COMMUNITY HEALTH STATUS ASSESSMENT, COMMUNITY STRENGTHS AND RISKS ASSESSMENT, FORCES OF CHANGE ASSESSMENT, AND THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT. THE MARSHALL COUNTY HEALTH DEPARTMENT AUGMENTED THE MAPP PROCESS WITH A THREE PERSPECTIVE APPROACH TO GATHERING INFORMATION. DATA GATHERED IN CONJUNCTION WITH THE COMMUNITY HEALTH STATUS ASSESSMENT PROVIDED A DATA PERSPECTIVE ON THE HEALTH OF EACH COMMUNITY. INFORMATION GATHERED DURING COMMUNITY FORUMS, PRIMARILY ATTENDED BY REPRESENTATIVES OF COMMUNITY PARTNER ORGANIZATIONS, PROVIDED THE ORGANIZATIONAL PERSPECTIVE. IN AN EFFORT TO ADD THE PERSPECTIVE OF INDIVIDUAL CITIZENS OF EACH COUNTY, BOTH PAPER AND ELECTRONIC SURVEYS WERE DISTRIBUTED. INFORMATION FROM THESE SURVEYS PROVIDED THE INDIVIDUAL PERSPECTIVE. IN ADDITION, THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT WAS COMPLETED UTILIZING AN ASSET MAPPING APPROACH. THE MARSHALL COUNTY HEALTH COALITION HELD A COMMUNITY FORUM FOR THE PURPOSE OF VISION STATEMENT DISCUSSION, COALITION ACCOMPLISHMENT CELEBRATION AND COMMUNITY HEALTH ASSESSMENT DATA UPDATES. THESE DISCUSSIONS PROVIDED THE FOUNDATION FOR THE 2019-2022 COMMUNITY HEALTH IMPROVEMENT PLAN. AREA BUSINESS LEADERS, COUNTY AND CITY OFFICIALS, LAW ENFORCEMENT, INTERESTED CITIZENS, FAITH-BASED ORGANIZATIONS, HEALTHCARE PROVIDERS AND THE GENERAL PUBLIC WERE INVITED TO PARTICIPATE. IT WAS ARRANGED FOR A FACILITATOR FROM THE UNIVERSITY OF KENTUCKY, DR. ANGIE CARMAN TO LEAD THE GROUP IN DISCUSSING HEALTH CONCERNS FOR MARSHALL COUNTY CITIZENS. MARSHALL COUNTY HOSPITAL DISTRICT: PART V, SECTION B, LINE 6B: THE HOSPITAL PARTNERED WITH MARSHALL COUNTY HEALTH DEPARTMENT TO CONDUCT THE CHNA. SEE ADDITIONAL INFORMATION UNDER LINE 5 ABOVE. MARSHALL COUNTY HOSPITAL DISTRICT: PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, EXECUTION OF THE IMPLEMENTATION STRATEGY, PARTICIPATION IN THE EXECUTION OF A COMMUNITY-WIDE PLAN, ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA, PRIORITIZATION OF HEALTH NEEDS IN THE COMMUNITY, AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN THE COMMUNITY. MARSHALL COUNTY HOSPITAL DISTRICT PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: WWW.MARSHALLCOUNTYHOSPITAL.ORG PART V, SECTION B INDIVIDUALS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY ARE NOT CHARGED ANYTHING. 1 1 - MARSHALL COUNTY SURGICAL & MEDICAL GRO 617 OLD SYMSONIA ROAD BENTON KY 42025 RURAL HEALTH CLINIC-PROVIDER BASED PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION DOES NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES TO REPORT. PART III, LINE 2: THE HOSPITAL HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE HOSPITAL UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE BY PAYOR, REVENUE TRENDS BY PAYOR CLASSIFICATION AND AGED ACCOUNTS FROM DATE OF SERVICE BY PAYOR. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES. PART III, LINE 3: THE HOSPITAL DOES NOT HAVE BAD DEBT EXPENSES RELATED TO THE PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY.PART III, LINE 4:THE AMOUNTS REPRESENT UNPAID MEDICARE DEDUCTIBLES AND COINSURANCE AND ALL SELF-PAY ACCOUNTS THAT WERE UNPAID. THE HOSPITAL HAS BOTH INTERNAL AND EXTERNAL COLLECTION EFFORTS. BAD DEBT TREATMENT IS COVERED IN FOOTNOTE 4 OF THE FINANCIAL STATEMENTS. PART III LINE 8: THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL, LINE 6 COSTS REPRESENT MEDICARE CHARGES MULTIPLIED BY A CALCULATED COST-TO-CHARGE RATIO FOR ANCILLARY SERVICES AND MEDICARE DAYS MULTIPLIED BY A CALCULATED PER DIEM AMOUNT FOR ROUTINE SERVICES, LINE 5 REVENUES REPRESENT 101% OF MEDICARE COSTS, LESS 2% SEQUESTRATION, WHICH IS MEDICARE'S REIMBURSEMENT METHODOLOGY FOR CRITICAL ACCESS HOSPITALS, CMS ELIMINATED THE SEQUESTRATION ADJUSTMENT DURING THE COVID PANDEMIC AND IT IS CURRENTLY STILL ELIMINATED THROUGH MARCH 31, 2022. PART III, LINE 9B: AT ADMISSION, ALL PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE FILL OUT A DISPROPORTIONATE SHARE HOSPITAL (DSH) FORM, WHICH IS MAILED BI-WEEKLY TO THE DISABILITY MEDICAL CONSULTANTS (DMC). A PATIENT WHO APPLIES FOR FREE CARE COVERAGE (DSH) OF HIS/HER HOSPITAL SERVICES WILL, UPON REQUEST, RECEIVE A WRITTEN NOTICE OF THE HOSPITAL'S DECISION ON THE REQUEST WITHIN TWO MONTHS OF SUBMISSION OF A COMPLETED APPLICATION AND OTHER REQUIRED INFORMATION. DETERMINATION FOR FREE CARE IS MADE ON AN ACCOUNT BY ACCOUNT BASIS. WITHIN 180 DAYS OF THE DETERMINATION OF THE PATIENT'S INABILITY TO PAY FOR SERVICES, THE HOSPITAL WILL SEND THE PATIENT, HIS/HER GUARANTOR OR OTHER FINANCIALLY RESPONSIBLE PARTY AN INITIAL STATEMENT OF CHARGES CLEARLY STATING THE AMOUNT FOR WHICH THE PATIENT, GUARANTOR OR OTHER FIANCIALLY RESPONSIBLE PARTY IS RESPONSIBLE. AN ITEMIZED BILL WILL BE SENT UPON REQUEST OF THE PATIENT, AND IF NO RESPONSE, A SECOND AND THIRD STATEMENT WILL BE SENT TO THE RESPONSIBLE PARTY. FINALLY, A LETTER IS SENT STATING THAT COLLECTION AGENCY ACTION WILL BE TAKEN. THEREAFTER, IF THE ACCOUNT IS EQUAL TO OR EXCEEDS $1,000, THE HOSPITAL WILL AGAIN INVESTIGATE ALL POTENTIAL PAYMENT SOURCES BEFORE TURNING THE ACCOUNT OVER TO COLLECTIONS. THIS INCLUDES SENDING ANOTHER LETTER THROUGH THE DSH PROGRAM. IF THE AMOUNT IS LESS THAN $1,000 THE HOSPITAL WILL WRITE THE ACCOUNT OFF TO BAO DEBT AND SEND TO A COLLECTION AGENCY. PART VI LINE 2: THE HOSPITAL CONTINUES TO BE PART OF THE MARSHALL COUNTY HEALTH COALITION, MADE UP OF BUSINESS LEADERS, OFFICIALS, LAW ENFORCEMENT, INTERESTED CITIZENS, FAITH-BASED ORGANIZATIONS, AND OTHER HEALTHCARE PROVIDERS, THE COMMITTEE ASSESSES THE NEEDS OF MARSHALL COUNTY RESIDENTS REGARDING HEALTH CARE, SECURITY, AND BOTH ENVIRONMENTAL AND EDUCATIONAL CONCERNS. MARSHALL COUNTY HOSPITAL ASSISTED THE LOCAL HEALTH DEPARTMENT AND OTHER MEMBERS OF THE COALITION IN THE COMPLETION OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THE MAPP PROCESS WAS UTILIZED, WITH A THREE-PERSPECTIVE APPROACH TO GATHERING INFORMATION (DATA PERSPECTIVE, ORGANIZATIONAL PERSPECTIVE, AND INDIVIDUAL PERSPECTIVE). COMPLETION OF THE 2022 NEEDS ASSESSMENT RESULTED IN THE MCH COMMUNITY HEALTH NEEDS ASSESSMENT IMPROVEMENT PLAN, ADDRESSING THOSE CONCERNS IDENTIFIED. PART VI, LINE 3: DURING THE ADMISSIONS PROCESS, THE ADMISSIONS CLERK INFORMS ANY PATIENTS WITHOUT INSURANCE COVERAGE ABOUT THE AVAILABLITY OF FREE CARE COVERAGE UNDER THE DISPROPORTIONATE SHARE HOSPITAL PROGRAM (DSH) AND PROVIDES THEM WITH THE FORM TO DETERMINE ELIGIBILTY FOR BOTH THE DSH PROGRAM AND MEDICAID, THE HOSPITAL WILL PROVIDE REASONABLE ASSISTANCE IN COMPLETING THIS FORM, THE HOSPITAL WILL ALSO ADVISE PATIENTS ABOUT ELIGIBILITY FOR AND OBTAINING PUBLIC ASSISTANCE. THE COMPLETED FORM IS MAILED OUT BI-WEEKLY TO DISABILITY MEDICAL CONSULTANTS (DMC), WHO DETERMINE THOSE ELIGIBLE FOR THE DSH PROGRAM, IN ADDITION, THE FINANCIAL COUNSELOR WILL PERSONALLY SPEAK WITH ALL UNINSURED INPATIENTS WHEN FEASIBLE. UPON REQUEST, THE PATIENT WILL RECEIVE WRITTEN NOTICE OF HIS ELIGIBILITY FOR THE DSH PROGRAM WITHIN TWO MONTHS OF SUBMITTING THE COMPLETED APPLICATION AND ANY OTHER REQUIRED INFORMATION. IF THE PATIENT IS A RESIDENT OF KENTUCKY, DOES NOT HAVE HEALTH INSURANCE, MEETS THE INCOME GUIDELINES AND HAS BEEN DENIED MEDICAL CARE BY MEDICAID, THE PATIENT'S BILL WILL BE COVERED UNDER THIS PROGRAM.PART VI, LINE 4: MARSHALL COUNTY, NESTLED ON THE SHORES OF ONE OF THE LARGEST MANMADE LAKES IN THE EASTERN UNITED STATES, HAS AN UNSURPASSED QUALITY OF LIFE. THE SMALL TOWN ATMOSPHERE, COMBINED WITH THE ACCESS TO LARGER METROPOLITAN AREAS, THE LAND BETWEEN THE LAKES NATIONAL RECREATION AREA, THE HIGHLY RATED SCHOOL SYSTEM, AND ABUNDANCE OF JOB OPPORTUNITIES, MAKES THIS AN IDEAL PLACE TO LIVE, WORK AND SUCCEED, MARSHALL COUNTY HAS A POPULATION OF APPROXIMATELY 31,777 PEOPLE WITH A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $58,989. PER THE 2022 CENSUS, THE COUNTY IS COMPRISED OF 50.1% FEMALE AND 49.9% MALE AND IS APPROXIMATELY 97.5% CAUCASIAN, THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IS APPROXIMATELY 13.7%. APPROXIMATELY 2% OF THE EMPLOYED POPULATION RECEIVES PUBLIC ASSISTANCE INCOME. APPROXIMATELY 54% OF THE HOSPITAL'S NET PATIENT SERVICE REVENUE IS COMPRISED OF PARTICIPANTS IN MEDICARE AND MEDICAID PROGRAMS. PART VI, LINE 5: MARSHALL COUNTY HOSPITAL IS ACTIVE IN EDUCATING THE COMMUNITY. THE HOSPITAL HAS VISITED SENIOR CITIZENS, RESIDENTS OF THE LOCAL ASSISTED LIVING FACILITY, HOSTED NUMEROUS "LUNCH AND LEARNS" WITH VARIOUS SPEAKERS, AND REPRESENTED THE HOSPITAL AT ALL AREA FAIRS WITH EDUCATIONALINFORMATION, AS WELL AS FREE SCREENINGS TO THE PUBLIC. THE HOSPITAL ALSO PUBLISHES EDUCATIONAL MATERIAL IN THE LOCAL NEWSPAPERS, RADIO, ON-LINE PRODUCTIONS AND THE EMPLOYEE NEWSLETTER.PART VI LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 0 0 BENNIE M FULBRIGHT PHYSICIAN 500763 0 1000 0 0 0 17458 0 23065 0 542286 0 0 0 DAVID G FUQUA CEO 267518 0 1000 0 0 0 26967 0 23522 0 319007 0 0 0 JULIA T LYLES PHYSICIAN 235704 0 1000 0 7500 0 20500 0 22685 0 287389 0 0 0 CHRISTINA M BROWN PHYSICIAN 239031 0 1000 0 0 0 14399 0 0 0 254430 0 0 0 WILLIAM T POWELL PHYSICIAN 165742 0 500 0 2667 0 13765 0 19849 0 202523 0 0 0 JANICE KELLEY CFO 140372 0 1000 0 0 0 23244 0 13280 0 177896 0 0 0 DIANE KOLENICH PHYSICIAN 120170 0 1000 0 0 0 20800 0 27949 0 169919 0 0 0 A CHRISTIAN COUNTY KENTUCKY 616000824 999999999 2008-04-28 30000000 ACQUISITION, CONSTRUCTION, & 0 0 0 A 12710000 30000000 655119 30042765 2008 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 1 US BANK NATIONAL AS 25.000000000000 0 0 0 0 0 A 0 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: CHRISTIAN COUNTY KENTUCKY (F) DESCRIPTION OF PURPOSE: ACQUISITION, CONSTRUCTION, & EQUIPPING OF NEW ACUTE CARE HOSPITAL SCHEDULE K ADDENDUM: THE HOSPITAL HAS A LEASE WITH KACO LEASING TRUST AND FILES SCHEDULE K TO PROVIDE COMPLETE REPORTING RELATING TO THIS LEASE. AS A RESULT SOME QUESTIONS APPLICABLE TO BOND COMPLIANCE DO NOT APPLY. FORM 990, PART VI, SECTION B, LINE 11B AN OFFICER OF THE BOARD REVIEWS THE 990 ON BEHALF OF THE BOARD OF DIRECTORS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL PROVIDES THE CONFLICT OF INTEREST POLICY TO THE BOARD AND EMPLOYEES. BOARD MEMBERS FILL OUT THE CONFLICT OF INTEREST POLICY ANNUALLY. THE HOSPITAL'S COMPLIANCE MANUAL HAS A SECTION ON CONFLICTS OF INTEREST AND DEPARTMENT DIRECTORS ARE REQUIRED TO SIGN THAT THEY HAVE READ AND WILL ABIDE BY IT. IF A CONFLICT ARISES, THOSE INVOLVED ARE RECUSED FROM THE DISCUSSION AND ANY VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL PARTICIPATES IN THE KENTUCKY HOSPITAL ASSOCIATION'S SALARY SURVEY IN ORDER TO HAVE ACCESS TO STATE WIDE COMPARABLE SALARY DATA, COMPENSATION IS DOCUMENTED AND APPROVED BY AN INDEPENDENT BODY PRIOR TO SETTING. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE DISCRETION OF THE BOARD OF DIRECTORS AND MANAGEMENT. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,809,164. MANAGEMENT AND GENERAL EXPENSES 224,539. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,033,703. FORM 990, PART XI, LINE 9: PROVIDER RELIEF FUNDING RECOGNIZED AS REVENUE IN PY, RECLASS FROM LIABILITY 2,820,798. FORM 990, PART XII, LINE 2C THE HOSPITAL'S BOARD AND SENIOR MANAGEMENT ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MARSHALL COUNTY HOSPITAL & HEALTHCARE 615 OLD SYMSONIA ROAD BENTON KY 42025 611157518 SOLICIT CHARITABLE CONTRIBUTIONS FOR THE BENEFIT OF MARSHALL COUNTY KENTUCKY KY 501(C)(3) LINE 12A, I MARSHALL COUNTY HOSPITAL DISTRICT 1 MARSHALL COUNTY MRI LLC 615 OLD SYMSONIA ROAD BENTON KY 42025 465453921 L FACILITY KY MARSHALL COUNTY HOSPITAL DISTRICT RELATED 42466 537931 0 0 0.50000 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 MARSHALL COUNTY HOSPITAL & HEALTHCARE FOUNDATION INC C 20245 FMV