2023-11-10T07:33:50-06:00 2022-12-31 271235638 MCM CPAS & ADVISORS LLP 101 S FIFTH STREET SUITE 2100 LOUISVILLE KY 40202 990 2022-01-01 611297707 CCMH CORPORATION CCMH 5027323200 309 ELEVENTH ST CARROLLTON KY 41008 KIM HAVERLY CEO/CFO 5027323200 2023-11-08 1 KIM HAVERLY XXX-XX-XXXX 0 CHRISTINE KEITH CPA P00963290 5027491900 2023-11-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KIM HAVERLY 309 ELEVENTH ST CARROLLTON KY 41008 22263428 0 X WWW.CCMHOSP.COM X 2007 KY PROVIDE A HEALTHCARE FACILITY OFFERING ACUTE CARE, SKILLED CARE, OUTPATIENT SERVICES, AND EMERGENCY MEDICAL SERVICES TO RESIDENTS OF CARROLL COUNTY, KENTUCKY AND SURROUNDING AREAS. 11 11 240 14 0 0 3263500 467881 16496373 19230731 5454 7167 2526746 2557649 22292073 22263428 0 0 0 0 10761226 12526420 0 0 0 9626555 10499208 20387781 23025628 1904292 -762200 15040154 13268932 9188792 8179770 5851362 5089162 PROVIDE A HEALTHCARE FACILITY OFFERING ACUTE CARE, SKILLED CARE, OUTPATIENT SERVICES, AND EMERGENCY MEDICAL SERVICES TO RESIDENTS OF CARROLL COUNTY, KENTUCKY AND SURROUNDING AREAS. 0 0 21810982 21627131 SERVICED 54,511 PATIENTS THIS YEAR. APPROXIMATELY 7,293 PATIENTS WERE SERVICED IN EMERGENCY ROOMS. ALSO HAD 18,691 PHYSICIAN CLAIMS.PROVIDED MEDICAL CARE FOR THOSE UNABLE TO PAY.PROVIDED RURAL HEALTH CLINIC TO SERVE THE INDIGENT OF THE COMMUNITY. 21810982 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 41 0 1 240 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X KIMBERLY ADAMS 5027323200 309 ELEVENTH ST CARROLLTON KY 41008 VALERIE HINES TRUSTEE 1.00 X 0 0 0 NICK MARSH TRUSTEE 1.00 X 0 0 0 ROBERT YOWLER TRUSTEE 1.00 X 0 0 0 HAROLD TOMLINSON TRUSTEE 1.00 X 0 0 0 JOHN SPIKE WRIGHT TRUSTEE 1.00 X 0 0 0 SCOTT NAB TRUSTEE 1.00 X 0 0 0 LAMAN STARK TRUSTEE 1.00 X 0 0 0 CASEY ELLIS TRUSTEE 1.00 X 0 0 0 VICKY RAND TRUSTEE 1.00 X 0 0 0 JAMES STEVENSON SECRETARY 1.00 X X 0 0 0 DENNIS RAISOR PRESIDENT 1.00 X X 0 0 0 KIMBERLY HAVERLY CEO/CFO 40.00 X 221123 0 21177 RANJHAN GOPANG PHYSICIAN 40.00 X 923878 0 35478 SHERRELL NUNNELLEY PHYSICIAN 40.00 X 256520 0 31944 WINSTON YAP PHYSICIAN 40.00 X 270927 0 38485 KEVIN RICHARDSON PHYSICIAN 40.00 X 106418 0 22369 HERB HUNTER PHARMACIST 40.00 X 141805 0 35457 1920671 0 184910 12 0 1 0 EMCARE PHYSICIAN SERVICES 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 EMERGENCY ROOM PHYSICIANS 205837 NEXIGEN 16 EAST 11TH STREET NEWPORT KY 41071 IT SERVICES 196463 NUMED INC PO BOX 1098 DENTON TX 76202 IMAGING SERVICES 172500 TRISTATE BIOMEDICAL SOLUTIONS 201 INDUSTRIAL DRIVE SUITE A FRANKLIN OH 45005 EQUIPMENT SERVICING 145397 ULTRA GROUP VENTURES LLC 651 EAST 4TH STREET STE 100 CHATTANOOGA TN 37403 MANAGEMENT SERVICES 126000 6 148587 319294 467881 PATIENT SERVICE REVENUE 622110 19230731 19230731 19230731 7167 7167 103123 0 103123 103123 103123 340B PROGRAM 622110 1541936 1541936 MEDICAID HRIP 622110 661027 661027 MISCELLANEOUS 622110 251563 193437 58126 2454526 22263428 21627131 0 168416 X 242300 121150 121150 10252869 10153951 98918 1299499 1283674 15825 731752 695164 36588 19211 19211 49375 49375 2424536 1595598 828938 68295 28001 40294 116311 115208 1103 1051760 1051760 23174 19930 3244 161151 161151 721647 721647 348113 348113 BAD DEBT 2690938 2690938 MEDICAL SUPPLIES AND DR 2271567 2271567 PROVIDER TAX 282586 282586 MISCELLANEOUS 270544 270544 23025628 21810982 1214646 0 5950076 4230395 17491 17517 1463664 1488785 216697 241160 468733 388527 22384862 16256793 6262653 6128069 660840 774479 15040154 13268932 1984439 1755209 6017460 5790700 1186893 633861 9188792 8179770 X 5851362 5089162 5851362 5089162 15040154 13268932 -762200 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 376450 376450 9027576 5741523 3286053 12131083 10211568 1919515 849753 303702 546051 6128069 CERTIFICATE OF NEED 660840 OPERATING LEASE 113639 774479 ESTIMATED THIRD PARTY SETTLEMENTS 520222 OPERATING LEASES 113639 633861 X 19572490 0 19572490 2690938 2690938 22263428 20334690 0 20334690 2690938 2690938 23025628 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS A TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECOGNIZES UNCERTAIN TAX POSITIONS USING THE "MORE LIKELY-THAN-NOT" APPROACH AS DEFINED IN THE ASC. NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,690,938. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,690,938. 1 1 X 1 X 1 X 1 1 0 1 1 2780917 4782275 0 0.00000 9370152 5032866 4337286 0.18840 12151069 9815141 4337286 0.18840 12151069 9815141 4337286 0.18840 1 2690938 7006513 6692251 314262 X 1 1 1 1 CARROLL COUNTY MEMORIAL HOSPITAL 309 ELEVENTH ST CARROLLTON KY 41008 X X X X CARROLL COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X HTTPS://WWW.CCMHOSP.COM/ABOUT-US/HOSPITAL-INFORMATION/ X 1 22 1 HTTPS://WWW.CCMHOSP.COM/ABOUT-US/HOSPITAL-INFORMATION/ 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.CCMHOSP.COM/FINANCIAL-INFORMATION/ 1 X 0 X X X 1 0 0 CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY STEERING COMMITTEE IS A VITAL PART TO THE CHNA PROCESS. THESE INDIVIDUALS REPRESENT ORGANIZATIONS AND AGENCIES FROM THE SERVICE AREA AND IN PARTICULAR, THE INDIVIDUALS WHO WERE WILLING TO VOLUNTEER ENABLED THE HOSPITAL TO GET INPUT FROM POPULATIONS THAT WERE OFTEN NOT ENGAGED IN CONVERSATIONS ABOUT THEIR HEALTH NEEDS. CEDIK PROVIDED A LIST OF POTENTIAL AGENCIES AND ORGANIZATIONS THAT WOULD FACILITATE BROAD INPUT. THE COMMUNITY STEERING COMMITTEE MET TWICE AS A GROUP AND EACH TIME A HOSPITAL REPRESENTATIVE WELCOMED AND THANKED THE INDIVIDUALS FOR ASSISTING IN THE PROCESS AND THEN EXCUSED THEMSELVES IF FOCUS GROUP DISCUSSION WAS BEING CONDUCTED. CEDIK ASKED THAT HOSPITAL REPRESENTATIVES NOT BE PRESENT DURING ANY FOCUS GROUP DISCUSSIONS OR DEBRIEFING WITH THE COMMUNITY STEERING COMMITTEE.COMMUNITY STEERING COMITTEE MEMBERS:HEATHER YOCUM - KCTCS, CARROLLTON CAMPUS SITE DIRECTORMATTHEW ADKINS - KIEDA, DIRECTORLINDA DAVIS - BUSINESS OWNER, COMMUNITY REPRESENTATIVEALYSSA CASPER - DOW CHEMICAL, INDUSTRY REPRESENTATIVEPATRICK CASPER - DOW CHEMICAL, INDUSTRY REPRESENTATIVERUSTY BENNETT - RELEVANT CHURCH, PASTORJAKE THOMPSON - CBKY LAWDENISE HALL - TRIMBLE CARES COALITIONKIMBERLY HAVERLY - CARROLL COUNTY MEMORIAL HOSPITAL CEOJILL GOODMAN - CARROL COUNTY MEMORIAL HOSPITAL DIRECTOR OF ANCILLARY SERVICESSHELIA TOMLINSON - CARROLL COUNTY MEMORIAL HOSPITAL DIRECTOR OF PHYS CLINICSLOGAN MORGAN - CARROLL COUNTY MEMORIAL HOSPITAL EXECUTIVE ASSISTANTASHLEY JOHNSON - CARROLL COUNTY MEMORIAL HOSPITAL HUMAN RESOURSE MGR. CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PROMOTING CURRENT HOSPITAL RESOURCES AVAILABLE: THE CEO AND HR MARKETING MANAGER ARE WORKING CLOSING WITH AFFILIATED ORGANIZATION'S MARKETING DEPARTMENTS TO INCREASE COMMUNITY AWARENESS ON PROGRAMS THE FACILITY OFFERS. OUTSIDE MARKETING FIRMS ARE ALSO BEING REVIEWED TO ASSIST WITH PROMOTING SUBSTANCE ABUSE PROGRAMS THAT CCMH CURRENTLY HAS AVAILABLE. THE COMMUNITIES WE SERVE HAVE DIVERSE DEMOGRAPHICS, SO ADDITIONAL FOCUS IS BEING GIVEN TO PROPER COMMUNICATION STYLES FOR DIFFERING GENERATIONS. CCMH HAS TRANSPORTATION OPTIONS AND OVERALL GOOD QUALITY SCORES, SO ENSURING GENERAL POPULATION AWARENESS OF THESE FACTS AS WELL.EXPANDING MENTAL HEALTH TREATMENT OPTIONS: CCMH IS PURSING POSSIBILITIES IN THIS AREA BY LOOKING TO OFFER INPATIENT TREATMENT OPTIONS, OPTIONS FOR ADOLESCENTS, AS WELL AS HOLDING COMMUNITY EVENTS TO INCREASE EDUCATION ON MENTAL HEALTH. CCMH CURRENTLY OFFERS COUNSELING FOR ADULTS, AND INPATIENT MEDICAL STABILIZATION FOR PEOPLE LOOKING TO ENTER TREATMENT OPTIONS.HEALTH EDUCATION: CCMH IS WORKING WITH MARKETING FIRMS TO INCLUDE PERTINENT INFORMATION ON OUR WEBSITE TO CONNECT PATIENTS WITH PROVIDERS AND PROPER TREATMENT OPTIONS. FOCUS ON HIGHLIGHTING PHYSICIANS AND TREATMENT TYPES AND EDUCATION TO THE GENERAL PUBLIC THROUGH USE OF VARIOUS MARKETING TECHNIQUES. CCMH IS WORKING WITH AFFILIATE AND OUTSIDE MARKETING FIRMS TO IMPROVE AND EXPAND ITS ONLINE PRESENCE. ADDITIONALLY, CCMH WILL CONDUCT COMMUNITY EVENTS ON NUTRITION EDUCATION, GENERAL HYGIENE AND OTHER HEALTH EDUCATION TOPICS.EXPAND SPECIALTY CARE AVAILABILITY: CCMH HAS ENTERED INTO A STRATEGIC PARTNERSHIP WITH UOFL HEALTH IN 2022. ADDITIONAL SPECIALTIES ADDED IN THE LAST 12 MONTHS INCLUDE VASCULAR SURGERY, PODIATRY, ADDITIONAL CARDIOLOGY SERVICES. SERVICES SCHEDULED TO ONBOARD IN 2024 INCLUDE OB/GYN, ENT, AND SPORTS MEDICINE. OTHER SPECIALTIES ARE CURRENTLY BEING EVALUATED. 3 1 - BEDFORD FAMILY PRACTICE 470 HIGHWAY 421 NORTH BEDFORD KY 40006 PROVIDER BASED RURAL HEALTH CLINIC 2 - WARSAW FAMILY PRACTICE 202 FRANKLIN STREET WARSAW KY 41095 PROVIDER BASED RURAL HEALTH CLINIC 3 - CARROLL COUNTY RURAL HEALTH CLINIC 309 ELEVENTH ST CARROLLTON KY 41008 PROVIDER BASED RURAL HEALTH CLINIC PART I, LINE 7: THE ORGANIZATION USED THE MEDICARE COST TO CHARGE RATIO TO COMPLETE PART I, LINE 7. PART III, LINE 2: IN DETERMINING THE AMOUNT OF BAD DEBT AT COST, THE ORGANIZATION USED THE MEDICARE COST REPORT (MCR), COST TO CHARGE RATIO OF 36.8%. PART III, LINE 3: PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS MANAGEMENT'S ESTIMATE BASED UPON HISTORICAL COLLECTION INFORMATION AND OTHER INDUSTRY TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE BILLED UPON DISCHARGE AND ARE OFDINARILY DUE WITHIN 30 DAYS OF BILLING. BALANCES MORE THAN 120 DAYS PAST DUE ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE TURNED OVER TO A COLLECTION AGENCY. PART III, LINE 4: A SEPARATE FOOTNOTE FOR BAD DEBT EXPENSE IS NOT INCLUDED IN THE AUDITED FINANCIAL STATEMENTS.PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS MANAGEMENT'S ESTIMATE BASED UPON HISTORICAL COLLECTION INFORMATION AND OTHER INDUSTRY TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE BILLED UPON DISCHARGE AND ARE ORDINARILY DUE WITHIN 30 DAYS OF BILLING. BALANCES MORE THAN 120 DAYS PAST DUE ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE TURNED OVER TO A COLLECTION AGENCY. IN DETERMINING THE AMOUNT OF BAD DEBT AT COST, THE ORGANIZATION USED THE MEDICARE COST REPORT (MCR), COST TO CHARGE RATIO OF 36.8%. PART III, LINE 9B: THE ORGANIZATION'S COLLECTION POLICY STATES THAT ANY PERSON INDICATING AN INABILITY TO PAY WILL BE SCREENED FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: INPUT FROM COMMUNITY LEADERS, BOARD MEMBERS, EMPLOYEES AND PATIENTS. HOSPITAL ADMINISTRATOR IS A MEMBER OF SEVERAL LOCAL ORGANIZATIONS (ROTARY, ECONOMIC DEVELOPMENT, ETC.). PART VI, LINE 3: FINANCIAL COUNSELORS ASSIST THOSE WITHOUT INSURANCE INCLUDING THOSE WITH INSURANCE THAT EXPRESS A NEED FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: THE ORGANIZATION SERVES A LARGELY RURAL POPULATION. COMMERCE IS CENTERED AROUND THE OHIO RIVER AND INDUSTRIES RELATED TO SUCH. THE POPULATION IS GENERALLY POORER THAN THE STATE AVERAGE WITH HIGHER THAN AVERAGE UNEMPLOYMENT. PART VI, LINE 5: HOSPITAL SPONSORED COMMUNITY HEALTH FAIR OFFERING SCREENINGS, PREVENTATIVE EDUCATION, AND INFORMATION TO PROMOTE GOOD HEALTH. COVID EDUCATION AND BEHAVIORAL HEALTH EDUCATION TO THE COMMUNITY. BOARD OF DIRECTORS REPRESENT THE ENTIRE COMMUNITY AND WORK WITH THE HOSPITAL TO PROMOTE AND PROVIDE HEALTHY COMMUNITY BENEFITS.HOSPITAL WORKS WITH COUNTY HEALTH DEPARTMENT TO PROMOTE HEALTHY LIVING AND PREVENTION. X X 0 0 0 0 0 0 0 1 0 RANJHAN GOPANG PHYSICIAN 654423 0 269455 0 0 0 27000 0 8478 0 959356 0 0 0 WINSTON YAP PHYSICIAN 244177 0 26750 0 0 0 23946 0 14539 0 309412 0 0 0 SHERRELL NUNNELLEY PHYSICIAN 246904 0 0 0 9616 0 27000 0 4944 0 288464 0 0 0 KIMBERLY HAVERLY CEO/CFO 194973 0 26150 0 0 0 20023 0 1154 0 242300 0 0 0 HERB HUNTER PHARMACIST 141805 0 0 0 0 0 4986 0 30471 0 177262 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR BONUSES BASED ON PRODUCTIVITY (RVU'S). FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS THE 990 AND THEN THE 990 IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C CARROLL COUNTY MEMORIAL HOSPITAL'S ADVISORY BOARD; CCMH CORPORATION; OWE A DUTY OF CARE AND A DUTY OF LOYALTY TO CARROLL COUNTY MEMORIAL HOSPITAL, WHICH REQUIRE EACH DIRECTOR TO ACT IN GOOD FAITH, ON AN INFORMED BASIS, AND IN A MANNER THAT THE DIRECTOR HONESTLY BELIEVES TO BE IN THE BEST INTEREST OF CARROLL COUNTY MEMORIAL HOSPITAL. EACH MEMBER OF THE ADVISORY BOARD OF CARROLL COUNTY MEMORIAL HOSPITAL AND ITS AFFILIATED ORGANIZATIONS, CARROLL COUNTY MEMORIAL HOSPITAL OR SUBCOMMITTEES OF THESE BOARDS THAT HAVE BOARD DELEGATED POWERS SHALL FULLY AND ACCURATELY COMPLETE CARROLL COUNTY MEMORIAL HOSPITAL'S CONFLICT OF INTEREST DISCLOSURE FORM. THE FORM IS COMPLETED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CEO IS REVIEWED, DETERMINED AND APPROVED BY THE CCMH BOARD OF DIRECTORS. IT IS PART OF AN EMPLOYMENT CONTRACT FOR THE CEO. COMPARATIVE DATA FOR A HOSPITAL OF THIS SIZE AND IN THIS GEOGRAPHIC AREA ARE USED AMONG OTHER FACTORS. SALARY ADJUSTMENT IS REVIEWED ANNUALLY BY THE BOARD. THE CONTRACT IS REVIEWED EVERY THREE YEARS. COMPENSATION FOR THE DIRECTOR OF FINANCE, D.O.N., D.O.A., DIRECTOR OF CLINICAL SERVICES AND DEPARTMENT MANAGER SALARY AND WAGES ARE BASED ON A SALARY SCALE CONSIDERING YEARS OF EXPERIENCE AND YEARS OF SERVICE AT THE HOSPITAL. ANNUAL INCREASES ARE REVIEWED AND APPROVED BY THE CCMH BOARD AS PART OF THE BUDGETARY PROCESS AND AT THE TIME OF THE SALARY AND WAGE INCREASE. THE SALARY SCALE IS REVIEWED ANNUALLY THROUGH A MARKET ANALYSIS WITH COMPARATIVE DATA FOR HOSPITALS OF THIS SIZE IN THE GEOGRAPHIC AREA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,134,140. MANAGEMENT AND GENERAL EXPENSES 569,367. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,703,507. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 401,062. MANAGEMENT AND GENERAL EXPENSES 225,597. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 626,659. COLLECTION FEES: PROGRAM SERVICE EXPENSES 49,160. MANAGEMENT AND GENERAL EXPENSES 27,652. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,812. RECRUITING FEES: PROGRAM SERVICE EXPENSES 11,236. MANAGEMENT AND GENERAL EXPENSES 6,322. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,558. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. THE BOARD OF DIRECTORS OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE INDEPENDENT AUDITOR MEETS WITH THE BOARD OF DIRECTORS AT THE CONCLUSION OF THE AUDIT.