2019-11-14T08:27:34-06:00 2018-12-31 271235638 MCM CPAS & ADVISORS LLP 462 S FOURTH ST SUITE 2600 LOUISVILLE KY 402023445 990 2018-01-01 611297707 CCMH CORPORATION CCMH 5027323200 309 ELEVENTH ST CARROLLTON KY 41008 KIM HAVERLY CFO 5027323200 2019-11-13 1 BOB MORELAND CPA P00418596 5027491900 2019-11-13 69.135.99.226 2019-11-13 10:48:50 ES P 193324A7991F95C1001CD4AAC29DB97B1EA03185 3FB7F03DEE2B8C3C6C241D6399512DBD7EB5CDF8 2018 2020-03-31 21:24:44Z KIM HAVERLY 309 ELEVENTH ST CARROLLTON KY 41008 19941451 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. 12 12 243 20 0 0 159194 89513 17547858 17529715 1736 11296 1926504 2310927 19635292 19941451 0 0 0 0 10463674 10690163 0 0 0 9606880 9100934 20070554 19791097 -435262 150354 6975846 10498620 5786141 9158561 1189705 1340059 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 18024312 19725217 SERVICED 64,970 PATIENTS THIS YEAR. APPROXIMATELY 8,513 PATIENTS WERE SERVICED IN EMERGENCY ROOMS. ALSO HAD 25,753 PHYSICIAN CLAIMS.PROVIDED MEDICAL CARE FOR THOSE UNABLE TO PAY.PROVIDED RURAL HEALTH CLINIC TO SERVE THE INDIGENT OF THE COMMUNITY. 18024312 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 64 0 1 243 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 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 DENNIS RAISOR PRESIDENT 1.00 X X 0 0 0 JAMES STEVENSON SECRETARY 1.00 X X 0 0 0 DONNA BURNS TRUSTEE 1.00 X 0 0 0 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 GEORGIA HEISE TRUSTEE 1.00 X 0 0 0 HAROLD TOMLINSON 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 VICKY RAND TRUSTEE 1.00 X 0 0 0 JOHN WRIGHT TRUSTEE 1.00 X 0 0 0 AMANDA KINMAN CFO 40.00 X 81831 0 6875 HARRY HAYS CEO 40.00 X 181480 0 0 FAROOQ MIRZA PHYSICIAN 40.00 X 329812 0 27210 SHERRELL NUNNELLEY PHYSICIAN 40.00 X 277558 0 25146 WINSTON YAP PHYSICIAN 40.00 X 213160 0 20269 CHRISTINA JOHNSON PHYSICIAN 40.00 X 175226 0 15759 JESSICA EASTERLING PHYSICIAN 40.00 X 185798 0 24588 THOMAS SLONE CRNA 40.00 X 174209 0 24483 RANJHAN GOPANG PHYSICIAN 40.00 X 374242 0 36211 SAMER HUSSEIN PHYSICIAN 40.00 X 272159 0 31823 RHONDA MOORE NURSE PRACTITIONER 40.00 X 100059 0 3282 MARY BLATTMAN NURSE PRACTITIONER 40.00 X 103097 0 6147 2468631 0 221793 11 0 1 0 MORELS CONSTRUCTION 627 W MAIN STREET LOUISVILLE KY 40202 CONSTRUCTION 3188729 EMCARE PHYSICIAN SERVICES 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 EMERGENCY ROOM PHYSICIANS 829101 NUMED INC PO BOX 1098 DENTON TX 76202 IMAGING SERVICES 383650 ACCORDIAS HEALTHCARE SERVICES 1161 MURFREESBORO PIKE SUITE 100 NASHVILLE TN 37217 BILLING SERVICES 307813 ISALUS 1 VIRGINIA AVE SUITE 500 INDIANAPOLIS IN 46204 EMR SYSTEMS 145011 12 70413 19100 89513 PATIENT SERVICE REVENUE 621110 17529715 17529715 17529715 11296 11296 81016 0 81016 81016 81016 340B PROGRAM 900099 1936105 1936105 MISCELLANEOUS 900099 174397 174397 MEDICAID EMR INCENTIVES 900099 85000 85000 34409 34409 2229911 19941451 19725217 0 126721 X 270186 181480 88706 8749082 8574100 174982 1071006 1060296 10710 599889 569895 29994 182711 182711 13620 13620 79015 79015 3244312 2076359 1167953 14072 5770 8302 51739 51222 517 957711 957711 17758 15272 2486 27650 27650 233793 233793 271987 271987 MEDICAL SUPPLIES AND DR 1972934 1972934 BAD DEBT 1542358 1542358 PROVIDER TAX 301890 301890 RAW FOOD 86977 86977 102407 94618 7789 19791097 18024312 1766785 0 640765 797858 21800 21849 2173197 1870984 144725 104707 270933 441852 20199291 13598761 3063586 6600530 660840 660840 6975846 10498620 4148325 7758582 879828 723075 757988 676904 5786141 9158561 X 1163661 1340059 26044 0 1189705 1340059 6975846 10498620 150354 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 376450 376450 5675915 4760771 915144 9453292 8775450 677842 4693634 62540 4631094 6600530 CERTIFICATE OF NEED 660840 660840 ESTIMATED THIRD PARTY SETTLEMENTS 676904 676904 X 18399093 0 18399093 1542358 1542358 19941451 18248739 0 18248739 1542358 1542358 19791097 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 ACCOUNTING STANDARDS CODIFICATION. NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,542,358. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,542,358. 1 1 X 1 X 1 X 1 1 0 1 1 2840579 648991 2191588 0.11070 5042486 4583349 459137 0.02320 7883065 5232340 2650725 0.13390 7883065 5232340 2650725 0.13390 1 1542358 308000 4583349 5062486 -479137 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 16 1 0 0 1 X HTTP://WWW.CCMHOSP.COM/?S=COMMUNITY+HEALTH+NEEDS&X=23&Y=7 X 1 16 1 HTTP://WWW.CCMHOSP.COM/?S=COMMUNITY+HEALTH+NEEDS&X=23&Y=7 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 THE HOSPITAL REPRESENTATIVES NOT BE PRESENT DURING ANY FOCUS GROUP DISCUSSIONS OR DEBRIEFING WITH THE COMMUNITY STEERING COMMITTEE.COMMUNITY STEERING COMITTEE MEMBERS:FLOYD BOWLING OF MAGISTRATERAY CLEM OF HOUSING AUTHORITYGREG GOFF OF FIRST NATIONAL BANKBILL HOGAN OF CARROLL COUNTY SCHOOOL SYSTEMTRACY MILES OF GALLATIN COUNTY CLERK'S OFFICEJEFF MOORE OF NEWS DEMOCRATSDANA NEW OF INTERIM HOME HEALTHVICKY RAND OF ALL STATE INSURANCE AGENCYBECKY WILSON OF THREE RIVERS DISTRICT HEALTH DEPARTMENT CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PHYSICIAN BEDSIDE MANNER - WE CURRENTY HAVE A PROCESS IN PLACE TO FOLLOW-UP AND ADDRESS NEGATIVE SURVEYS AND COMPLAINTS IN REGARDS TO ER PHYSICIANS. WE ARE IN CONSTANT COMMUNICATION WITH THE ER PHYSICIAN GROUP ABOUT CONCERNS. A MAJORITY OF OUR PATIENT SATISFACTION SURVEYS ARE FROM THE ER AND WE HAVE ABOUT 99% APPROVAL RATE.EMERGENCY ROOM WAIT TIME - WE WILL CONTINUE TO MONITOR WAIT TIMES, CURRENTLY CCMH ER WAIT TIMES ARE AVERAGING BETWEEN 71-76 MINUTES, WHICH IS BELOW THE NATIONAL AVERAGE OF 91-134 MINUTES.PATIENT CHECKLIST - WE WILL BETTER INFORM THE COMMUNITY OF WHAT PROCESSES ARE CURRENTLY IN PLACE. EXAMPLE: EACH PATIENT IS GIVEN DISCHARGE INSTRUCTIONS THAT ARE DISCUSSED WITH THE PATIENT/FAMILY; STAFF CALLS THE PATIENT 24-72 HOURS AFTER DISCHARGE TO MAKE SURE THE PATIENT DOESN'T HAVE ANY QUESTIONS; EACH PATIENT'S FOLLOW UP APPOINTMENT WITH ANY PHYSICIAN IS MADE BEFORE THE PATIENT IS DISCHARGED UNLESS REFUSED BY THE PATIENT. 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 28%. 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 28%. 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. CEO IS 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.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 HARRY HAYS CEO 181480 0 0 0 0 0 0 0 0 0 181480 0 0 0 FAROOQ MIRZA PHYSICIAN 329812 0 0 0 0 0 24000 0 3210 0 357022 0 0 0 SHERRELL NUNNELLEY PHYSICIAN 257866 0 0 0 19692 0 24500 0 646 0 302704 0 0 0 WINSTON YAP PHYSICIAN 213160 0 0 0 0 0 18500 0 1769 0 233429 0 0 0 CHRISTINA JOHNSON PHYSICIAN 175226 0 0 0 0 0 12642 0 3117 0 190985 0 0 0 JESSICA EASTERLING PHYSICIAN 185798 0 0 0 0 0 18500 0 6088 0 210386 0 0 0 THOMAS SLONE CRNA 174209 0 0 0 0 0 21940 0 2543 0 198692 0 0 0 RANJHAN GOPANG PHYSICIAN 374242 0 0 0 0 0 24500 0 11711 0 410453 0 0 0 SAMER HUSSEIN PHYSICIAN 272159 0 0 0 0 0 24500 0 7323 0 303982 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR BONUSES BASED ON PRODUCTIVITY (RVU'S). FORM 990, PART VI, SECTION A, LINE 3 ALLIANT MANAGEMENT SERVICES PROVIDES MANAGEMENT GUIDANCE. 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 TWO YEARS. COMPENSATION FOR THE CFO, CNO, 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 1,539,764. MANAGEMENT AND GENERAL EXPENSES 866,118. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,405,882. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 511,371. MANAGEMENT AND GENERAL EXPENSES 287,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 799,017. COLLECTION FEES: PROGRAM SERVICE EXPENSES 25,224. MANAGEMENT AND GENERAL EXPENSES 14,189. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,413. 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.