2020-11-13T07:24:58-06:00 2019-12-31 271235638 MCM CPAS & ADVISORS LLP 462 S FOURTH ST SUITE 2600 LOUISVILLE KY 402023445 990 2019-01-01 610525158 BRECKINRIDGE HEALTH INC BREC 2707567000 1011 OLD HIGHWAY 60 EAST HARDINSBURG KY 40143 ANGELA PORTMAN CHIEF EXECUTIVE OFFICER 2707567000 2020-11-05 1 ELEANOR A LIVINGSTON CPA MST P00226461 5027491900 2020-10-27 69.135.99.226 2020-11-05 18:12:36 ES P A9E73B062129935174CB771FC93B1B2751F22327 BE8E94C025C46DAA2232A80A473E80B0CC3532C5 2019 2021-01-29 14:40:06Z ANGELA PORTMAN 1011 OLD HIGHWAY 60 EAST HARDINSBURG KY 40143 23195737 0 X WWW.BRECKHEALTH.ORG X 1947 KY THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF ITS COMMUNITIES. 12 11 372 11 0 0 62133 1970 20062770 20202328 7616 3108 2087192 2988331 22219711 23195737 0 0 0 0 11877055 11875687 0 0 0 10829172 10617151 22706227 22492838 -486516 702899 11615787 11450538 11905717 11037569 -289930 412969 X THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF ITS COMMUNITIES. 0 0 19110539 23140513 BRECKENRIDGE HEALTH IS A 25 BED CRITICAL ACCESS HOSPITAL, PLUS 18 BED NURSING FACILITY, AND ALSO HAS 3 RURAL HEALTH CLINICS.IN 2002 BRECKINRIDGE MEMORIAL HOSPITAL, INC. BECAME BRECKINRIDGE HEALTH, INC. IN ORDER TO DESCRIBE ALL OF ITS DIVISIONS. BRECKINRIGE HEALTH, INC. INCLUDES BRECKINRIDGE MEMORIAL HOSPITAL, BRECKINRIDGE MEMORIAL NURSING FACILITY, THE CLOVERPORT HEALTH CLINIC, MCDANIELS HEALTH CLINIC, AND BRECKINRIDGE PRIMARY CARE.BRECKINRIDGE HEALTH, INC. IS ACCREDITED BY JOINT COMMISSION FOR HEALTHCARE ORGANIZATIONS, CERTIFIED FOR MEDICARE AND MEDICAID, LICENSED BY THE KENTUCKY DIVISION OF LICENSING AND REGULATION.BRECKINRIDGE HEALTH IS ALSO A MEMBER OF THE FOLLOWING ORGANIZATIONS: AMERICAN HOSPITAL ASSOCIATION, KENTUCKY HOSPITAL ASSOCIATION, KENTUCKY ASSOCIATION OF NOT-FOR-PROFIT HOMES AND SERVICES FOR THE AGING 19110539 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 0 0 1 30 0 1 372 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X ANGELA PORTMAN 2707567000 1011 OLD HIGHWAY 60 EAST HARDINSBURG KY 40143 DR BENJAMIN SMITH PHYSICIAN 50.00 X 402893 0 5312 DAVID FABER SURGEON 50.00 X 365000 0 2808 BRIAN T O'DONOGHUE PHYSICIAN 50.00 X 282345 0 4811 ANGELA PORTMAN CHIEF EXECUTIVE OFFICER 40.00 X X 180200 0 19398 JOHN ROE CRNA 40.00 X 178530 0 0 HARRY MATTINGLY PHARMACY DIRECTOR 45.00 X 142836 0 2694 TIMOTHY D CROCKETT CHIEF FINANCIAL OFFICER 40.00 X 99234 0 13184 FAYE DOWELL TREASURER 2.00 X X 0 0 0 LAYMAN LUCAS CHAIR 2.00 X X 0 0 0 DOTTIE WATSON SECRETARY 1.00 X X 0 0 0 KIM FLOOD VICE CHAIR 1.00 X X 0 0 0 MITCH JACKSON TRUSTEE 1.00 X 0 0 0 HOLLY GREGORY TRUSTEE 1.00 X 0 0 0 TOM LOUGHRAN TRUSTEE 1.00 X 0 0 0 GRAYANNE JACKSON TRUSTEE 1.00 X 0 0 0 JEFF ROBBINS TRUSTEE 1.00 X 0 0 0 JANICE ELDER TRUSTEE 1.00 X 0 0 0 MANDY BUTLER MEDICAL STAFF ADVOCATE 1.00 X 0 0 0 KERRY KASEY TRUSTEE 1.00 X 0 0 0 1651038 0 48207 6 0 1 0 CONCORD MEDICAL GROUP OF KENTUCKY 1602 AVENUE Q LUBBOCK TX 79401 EMERGENCY ROOM SERVICES 904791 ALLIANT MANAGEMENT SERVICES 12800 N MERIDIAN ST CARMEL IN 46032 HOSPITAL MGT SERVICES 748898 ATHENAHEALTH INC PO BOX 415615 BOSTON MA 02241 EMERGENCY ROOM SERVICES 671178 DIAGNOSTIC SHARED SERVICES 2650 EASTPOINT PKWY STE 300 LOUISVILLE KY 40223 MOBILE MRI 242028 NUMED INC PO BOX 1098 DENTON TX 76202 MED. IMAGING SERVICES 133000 8 1970 1970 PATIENT SERVICES 621990 20202328 20202328 20202328 3054 3054 54 0 54 54 54 340B REVENUE 900099 2332543 2332543 DISPROPORTIONATE SHARE REBATE PRO 900099 539590 539590 MISCELLANEOUS REVENUE 900099 66052 66052 50146 50146 2988331 23195737 23140513 0 53254 X 300946 300946 9053958 7480900 1573058 82938 65522 17416 1772299 1400116 372183 665546 525781 139765 178636 178636 382 382 58782 58782 3585577 3585577 70688 63620 7068 611843 565656 46187 1189717 951774 237943 79339 56345 22994 312697 212634 100063 568082 386296 181786 337756 307358 30398 MEDICAL AND OTHER SUPPL 1995558 1938206 57352 BAD DEBT EXPENSE 1258661 1258661 TAXES AND LICENSES 299752 294670 5082 DUES AND SUBSCRIPTIONS 69681 17423 52258 22492838 19110539 3382299 0 102060 391755 527054 886982 3117861 2582274 411394 467682 114794 153394 23985649 17056489 7284333 6929160 26291 26291 32000 13000 11615787 11450538 3687847 2856145 303750 209604 6560000 6344000 1107971 656738 246149 971082 11905717 11037569 X -289930 412969 -289930 412969 11615787 11450538 702899 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1738 1738 0 PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE KENTUCKY HOSPITAL ASSOCIATION. TOTAL DUES PAID TO THE ORGANIZATION ATTRIBUTABLE TO LOBBYING EXPENSES FOR 2019 AMOUNT TO $1,738. 0 66140 66140 10334655 4435139 5899516 13083472 12204407 879065 501382 416943 84439 6929160 THIRD PARTY PAYOR SETTLEMENTS 971082 971082 X 21937076 0 21937076 1258661 1258661 23195737 21234177 0 21234177 1258661 1258661 22492838 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECOGNIZES UNCERTAIN INCOME TAX POSITIONS USING A "MORE-LIKELY-THAN-NOT" APPROACH AS DEFINED IN THE ASC. NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,258,661. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,258,661. 1 1 X 1 X 1 X 1 1 1 0 1 1 55602 55602 0.00250 4748003 4434953 313050 0.01390 4803605 4434953 368652 0.01640 19900 19900 0.00090 19900 19900 0.00090 4823505 4434953 388552 0.01730 1 1258661 63119 X 1 1 1 1 BRECKINRIDGE MEMORIAL HOSPITAL 1011 OLD HIGHWAY 60 HARDINSBURG KY 40143 WWW.BRECKINRIDGEHEALTH.ORG 600070 X X X X BRECKINRIDGE MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 19 1 0 1 1 X WWW.BRECKINRIDGEHEALTH.ORG X 1 19 1 WWW.BRECKINRIDGEHEALTH.ORG 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X WWW.BRECKINRIDGEHEALTH.ORG X WWW.BRECKINRIDGEHEALTH.ORG X WWW.BRECKINRIDGEHEALTH.ORG X X X X 1 X X 1 X X X 1 X 0 0 BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL MET WITH HEALTH DEPARTMENT, OTHER LOCAL HEALTH PROVIDERS, LOCAL MINISTERS HOSPITAL BOARD, FOUNDATION BOARD AND COMMUNITY LEADERS. BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: RURAL HEALTH CLINICS, ALL LOCAL PHYSICIANS AND OTHER COMMUNITY MEMBERS BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: RURAL HEALTH CLINICS, ALL LOCAL PHYSICIANS AND OTHER COMMUNITY MEMBERS BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: FOR EACH OF THE PRIORITY AREAS IN THE MOST RECENT CHNA THE HOSPITAL WILL WORK WITH THE PHYSICIANS AND COMMUNITY TO: IDENTIFY ANY RELATED ACTIVITIES BEING CONDUCTED BY OTHERS IN THE COMMUNITY THAT COULD BE BUILT UPON; DEVELOP MEASUREABLE GOALS AND OBJECTIVES TO BE EFFECTIVE IN MEASURING THEIR EFFORTS; BUILD SUPPORT FOR THE INITIATIVES WITHIN THE COMMUNITY AND AMONG OTHER HEALTH CARE PROVIDERS. DEVELOP DETAILED WORK PLANS. THOSE ITEMS NOT ADDRESSED MAY BE ACTIVELY ADDRESSED BY ANOTHER COMMUNITY ORGANIZATION OR NOT BUDGETARY FEASIBLE AT THIS TIME. BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: THE FINANCIAL COUNSELOR FOLLOWS UP WITH EACH AND EVERY UNINSURED INDIVIDUAL AND DOCUMENTS EACH DATE OF SERVICE INCURRED. INDIVIDUALS ARE NOTIFIED OF OUR FINANCIAL AID POLICY. DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IS DOCUMENTED. WE HAVE AN EARLY OUT VENDOR THAT CALLS ON ALL BALANCES (UNINSURED AND AFTER INSURANCE SELF-PAY). WE ALSO MEET ALL REQUIREMENTS SET FORTH BY 501(R). ALL STATEMENTS INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FAP. THE THIRD STATEMENT HAS THE "ECA NOTICE THAT EXPLAINS THE BALANCE WILL BE PLACED WITH A COLLECTOR. 4 1 - CLOVERPORT CLINIC 209 ELM ST CLOVERPORT KY 40111 CLINIC 2 - MCDANIELS' CLINIC 9798 KY-259 MCDANIELS KY 40152 CLINIC 3 - BRECKENRIDGE PRIMARY CARE 107 OLD HWY 60 HARDENSBURG KY 40143 CLINIC 4 - BRECKENRIDGE NURSING FACILITY 1011 OLD HWY 60 HARDENSBURG KY 40143 ELDER CARE PART I, LINE 7: BRECKINRIDGE HEALTH UTILIZES A COST ACCOUNTING SYSTEM THAT IDENTIFIES THE COST OF DELIVERING CARE AT THE INDIVIDUAL PROCEDURE AND SUPPLY LEVEL FOR DIRECT COSTS AND THEN ALLOCATES OVERHEAD COSTS. COSTS ARE DETERMINED FOR EACH PATIENT BASED UPON THE SPECIFIC PROCEDURES PERFORMED AND SUPPLIES USED FOR EACH PATIENT. PART I, LN 7 COL(F): A SEPARATE FOOTNOTE FOR BAD DEBT EXPENSE IS NOT INCLUDED IN THE AUDITEDFINANCIAL STATEMENTS. BAD DEBT IS DETERMINED BY REVIEWING ACCOUNTS OWED AND REVIEWING WHICH PROGRAMS ARE AVAILABLE TO THOSE PATIENTS WHO CANNOT PAY THEIR BILL. ONCE A REVIEW IS COMPLETED AND PATIENTS WHO ARE NOT ELIGIBLE FOR OTHER PROGRAMS ARE IDENTIFIED THE FACILITY ATTEMPTS TO COLLECT THE UNPAID BALANCE. ONCE ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED THE FACILITY DETERMINES THE AMOUNTS THAT ARE UNCOLLECTIBLE AND WRITES THOSE BALANCES OFF. PART III, LINE 2: BAD DEBT IS DETERMINED TO BE 90% OF THE SELF-PAY ACCOUNTS RECEIVABLE. THIS IS BASED UPON HISTORIC TRENDS. PART III, LINE 3: THE FINANCIAL COUNSELOR FOLLOWS UP WITH EACH AND EVERY UNINSURED INDIVIDUAL TO ASSIST WITH DETERMINING MEDICAID AND FINANCIAL ASSISTANCE ELIGIBILITY. IN SOME INSTANCES, THE PATIENT IS NONCOMPLIANT WITH PROVIDING THE NEEDED DOCUMENTATION. ALSO, WHEN PATIENTS GO THROUGH THE ER AFTER HOURS, THE FINANCIAL COUNSELOR IS NOT ABLE TO MEET WITH THE PATIENT AT THAT TIME. SHE DOES FOLLOW UP AFTER THE ER VISIT TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, BUT SINCE IT IS AFTER THE FACT SOME COULD SLIP THROUGH THE CRACKS. WE ARE CONSTANTLY TRYING TO IMPROVE OUR PROCESS WITH THE GOAL OF CAPTURING 100% ELIGIBILITY. BASED ON DEMOGRAPHICS AND INCOME LEVELS, $62,000 IS THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: THE MEDICARE SHORTFALL REPRESENTS AN UNDERPAYMENT OF OUR COST FOR PROVIDING SERVICES TO TRADITIONAL MEDICARE PATIENTS. WE USE THE MEDICARE COST REPORT FOR COSTING METHODOLOGY FOR CALCULATING THE MEDICARE SHORTFALL. PART III, LINE 9B: COLLECTION PRACTICES ARE THE SAME FOR THOSE WHO QUALIFY FOR ASSISTANCE AS FOR THOSE WHO DO NOT. THE FINANCIAL COUNSELOR FOLLOWS UP WITH EACH AND EVERY UNINSURED INDIVIDUAL TO ASSIST WITH DETERMINING MEDICAID AND FINANCIAL ASSISTANCE ELIGIBILITY. BEFORE ANY ACCOUNT IS SENT TO COLLECTIONS, IT IS REVIEWED FOR DSH FUNDS AND CHARITY CARE. PART VI, LINE 2: EVERY THREE YEARS THE HOSPITAL DOES A COMMUNITY SURVEY. WE CONTACT RESIDENTS OF OUR SERVICE AREA TO GET THEIR FEELING ABOUT THE HOSPITAL AND WHAT IS NEEDED IN OUR COMMUNITY. OUR BOARD AND EMPLOYEES ALSO RELAY TO THE FACILITY WHAT IS NEEDED. THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF THIS COMMMUNITY. PART VI, LINE 3: AT TIME OF REGISTRATION THE FACILITY ADMISSIONS PERSONNEL DISCUSS WITH THE PATIENTS COVERAGE THEY MAY HAVE. FOR THOSE PATIENTS WHO DO NOT HAVE 3RD PARTY COVERAGE, THE POTENTIAL PROGRAMS ARE DISCUSSED. FACILITY COLLECTS INFORMATION AND THEN ASSISTS PATIENTS IN APPLYING FOR ASSISTANCE. ALL PRIVATE PATIENTS ARE ALSO SCREENED FOR STATE PROGRAMS. PART VI, LINE 4: BRECKINRIDGE HEALTH IS A CRITICAL ACCESS HOSPITAL LOCATED IN HARDINSBURG, KENTUCKY. THE FACILITY HAS 25 MEDICAL/SURGICAL BEDS AND 18 EXTENDED CARE/SKILLED NURSING BEDS. THE HOSPITAL SERVES BRECKINRIDGE COUNTY AND PORTIONS OF OHIO, MEADE, GRAYSON AND HANCOCK COUNTIES. THE HOSPITAL WAS FOUNDED IN 1947. PART VI, LINE 5: THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF THIS COMMUNITY. THE BOARD OF DIRECTORS IS COMPRISED OFCOMMUNITY MEMBERS WHO REPRESENT THE WHOLE COMMUNITY. THIS GROUP ALONG WITH HOSPITAL MANAGEMENT, EMPLOYEES, AND PHYSICIANS UNDERSTANDS THE COMMUNITY EXPECTS THE ORGANIZATION TO PROVIDE HIGH QUALITY HEALTHCARE. ALL OF THE PARTIES UNDERSTAND THAT A DELICATE BALANCE IS REQUIRED TO MEET FISCAL NEEDS OF THE COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL MEMBERS OF THE COMMUNITY. THE GROUP STRIVES CONSTANTLY TO MEET BOTH RESPONSIBILITIES. BRECKINRIDGE HEALTH OFFERS MANY EDUCATIONAL PROGRAMS ON DIABETES AWARENESS AND MANAGEMENT, HEALTHY HABITS, NUTRITION, CPR, SPORTS INJURY PREVENTION, FLU PREVENTION, ETC. OUR TRANQUILITY DEPARTMENT ALSO HOSTED SEVERAL LUNCH AND LEARNS WHERE WE EDUCATED THE COMMUNITY ABOUT SEVERAL TOPICS SUCH AS SOCIAL MEDIA AND YOUR WELL-BEING, NUTRITION, AND WEIGHT LOSS. WE ACTIVELY SUPPORT POCKETFUL OF HOPE (LOCAL CANCER CHARITY) AND COWBOYS FOR KIDS (CHILDREN'S CANCER CHARITY). ANNUALLY, WE HOLD A BACK 2 SCHOOL SUPPLY DRIVE TO ASSIST LOW INCOME CHILDREN AND THE SCHOOL SYSTEM WITH MUCH NEEDED SCHOOL SUPPLIES. WE DONATE FIRST AID KITS FOR ALL OF THE LOCAL SCHOOL FESTIVALS. WE PARTICIPATED IN THE ENGAGE AT EVERY AGE WITH THE LOCAL LIBRARY TO ENCOURAGE ACTIVE PARTICIPATION IN THE LIVES OF YOUNG CHILDREN. WE ALSO PARTICIPATED IN THE BRECKINRIDGE COUNTY COMMUNITY-WIDE BABY SHOWER TO PROVIDE BABY SUPPLIES TO EXPECTING MOMS. WE ALSO PARTNERED WITH A LOCAL GYM TO START A WALKING GROUP TO ENCOURAGE EXERCISE AND HEALTHY HABITS. WE ASSIST OUR LOCAL SCHOOL TEAMS BY MAKING OUR DIRECTOR OF PHYSICAL THERAPY AVAILABLE TO THEM AS WELL AS PROVIDING FREE SPORTS PHYSICALS. WE REGULARLY PUBLISH ARTICLES ON FACEBOOK TO EDUCATE THE COMMUNITY ON HEALTH AND WELLNESS. WE PARTICIPATE IN THE COMMUNITY CARE COORDINATION TASK FORCE, MONTHLY DIABETES SUPPORT GROUP, BRECKINRIDGE COUNTY COALITION, CHAMBER OF COMMERCE, CAREER FAIRS AT THE LOCAL SCHOOLS, AND THE PHANTOM PROJECT, WHICH REACHED OVER 100,000 PEOPLE ACROSS THE COUNTRY. THE PHANTOM PROJECT EDUCATED THE COMMUNITY ON THE DANGERS OF DISTRACTED DRIVING. BRECKINRIDGE HEALTH ALSO STARTED A YOUTUBE CHANNEL TO SPOTLIGHT SEVERAL SERVICES WE OFFER AND TO EDUCATE THE COMMUNITY. WE PROVIDE HEALTH INFORMATION AND BLOOD PRESSURE CHECKS AT LOCAL 5KS, COMMUNITY APPRECIATION EVENTS, THE COUNTY FAIR, AND THE LOCAL HOE DOWN DAY. WE PROVIDE GUEST SPEAKERS TO LOCAL EVENTS AS WELL. X X 0 0 0 0 0 0 0 1 0 DR BENJAMIN SMITH PHYSICIAN 402893 0 0 0 0 0 0 0 0 0 402893 0 0 0 DAVID FABER SURGEON 365000 0 0 0 0 0 0 0 0 0 365000 0 0 0 BRIAN T O'DONOGHUE PHYSICIAN 282345 0 0 0 0 0 0 0 0 0 282345 0 0 0 ANGELA PORTMAN CHIEF EXECUTIVE OFFICER 155000 0 0 0 25200 0 5420 0 13978 0 199598 0 0 0 JOHN ROE CRNA 178530 0 0 0 0 0 0 0 0 0 178530 0 0 0 PART I, LINE 7 PROVIDERS HAVE A WORK RELATIVE VALUE UNIT (WRVU) INCENTIVE GOAL AND BONUS PLAN ENCOURAGES CLINICAL PRODUCTIVITY. PHYSICIANS, NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS ARE ELIGIBLE TO RECEIVE A BONUS FOR ABOVE MEDICAL GROUP MANAGMENT ASSOCIATION MEDIAN PRODUCTIVITY (SPECIALTY SPECIFIC). A BRECKINRIDGE COUNTY BUILDINGS COMMISSION 300306470 2009-10-16 6100000 HOSPITAL EXPANSION FINANCING SERIES A BOND ISSUE 0 0 0 B BRECKINRIDGE COUNTY BUILDINGS COMMISSION 300306470 2009-10-16 1900000 HOSPITAL EXPANSION FINANCING SERIES A BOND ISSUE 0 0 0 A 1276000 6100000 18000 6082000 2010 0 0 1 1 B 380000 1900000 11000 1889000 2010 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 3 BRECKINRIDGE HEALTH INC. (BHI) CONTRACTS WITH ALLIANT MANAGEMENT SERVICES (ALLIANT) TO PROVIDE MANAGEMENT SERVICES FOR BHI. ALLIANT PREPARES COST REPORTS FOR THIRD-PARTY PAYORS; PROVIDES TECHNICAL AND CONSULTING ASSISTANCE; AND PROVIDES THE CEO AND CFO POSITIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY THE ORGANIZATION'S AUDITORS AND REVIEWED BY THE CHIEF EXECUTIVE AND CHIEF FINANCIAL OFFICERS. FORM 990, PART VI, SECTION B, LINE 12C ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER IS REQUIRED TO BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORDS, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION; ANY GOVERNING BOARD MEMBER HAVING DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER IS PROHIBITED TO VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER,EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSENTATION FROM VOTING AND THE QUORUM SITUATION. THIS POLICY IS REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF GOVERNING BOARD MEMBERS AND ANY NEW MEMBERS ADVISED OF THE POLICY UPON ENTERING ON THE DUTIES OF THE OFFICE. FORM 990, PART VI, SECTION B, LINE 15 AS PART OF THE AGREEMENT WITH ALLIANT MANAGEMENT SERVICES, INC., THE BOARD IS PROVIDED WITH COMPENSATION SURVEYS FOR SENIOR LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION'S MEETINGS ARE OPEN TO THE PUBLIC AND SIGNIFICANT ACTIONS ARE AVAILABLE TO LOCAL MEDIA. ANY REQUEST FOR DOCUMENTS WOULD BE PRESENTED TO THE BOARD AND WOULD BE PROVIDED TO THE REQUESTING PARTY UNLESS THERE WAS A REASON NOT TO HONOR THEIR REQUEST. FORM 990, PART VI, SECTION B, LINE 15: THE ORGANIZATION USES ALLIANT MANAGEMENT TO PROVIDE ITS CEO AND CFO; THEREFORE, THE ORGANIZATION DOES NOT PAY COMPENSATION DIRECTLY TO THESE INDIVIDUALS. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 3,585,577. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,585,577. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. THE ORGANIZATION HAS A FINANCE COMMITTEE THAT OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE INDEPENDENT AUDITOR MEETS WITH THE FINANCE COMMITTEE AT THE CONCLUSION OF THE AUDIT.