2025-11-04T10:15:49-06:00 2024-06-30 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2023-07-01 843196350 U OF L HEALTH - SHELBYVILLE INC UOFL 5025617213 530 S JACKSON STREET LOUISVILLE KY 40202 KIRK STRACK CFO 5025623621 2025-11-03 1 1 EMILIE M KNIERIEM CPA P01330194 5029923500 2025-11-03 2023 2025-03-06 01:10:19Z X KIRK STRACK 530 S JACKSON STREET LOUISVILLE KY 40202 36933052 0 X HTTPS://WWW.UOFLHEALTHNETWORK.ORG/SHELBYVILLE-HOS X 2019 KY TO OPERATE AND MAINTAIN A HOSPITAL AFFILIATED WITH THE UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE AND TO PROVIDE CARE FOR THE PEOPLE WHO ARE IN NEED OF THOSE, OR RELATED, MEDICAL SERVICES. 12 10 0 10 0 0 2164093 0 33548830 36738602 0 0 212218 194450 35925141 36933052 18123 43758 0 0 17181243 18545514 0 0 0 20780559 23967344 37979925 42556616 -2054784 -5623564 15415943 14790348 6845171 6997578 8570772 7792770 X TO OPERATE AND MAINTAIN A HOSPITAL AFFILIATED WITH THE UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE AND TO PROVIDE CARE FOR THE PEOPLE WHO ARE IN NEED OF THOSE, OR RELATED, MEDICAL SERVICES. 0 0 34791206 43758 36823829 U OF L HEALTH - SHELBYVILLE, INC. OWNS AND OPERATES A 70-BED HOSPITAL LOCATED AT 727 HOSPITAL DRIVE IN SHELBYVILLE, KENTUCKY. FOR MORE THAN A CENTURY, SHELBYVILLE HOSPITAL HAS SERVED THE PEOPLE OF SHELBY AND SURROUNDING COUNTIES WITH HIGH-QUALITY HEALTH CARE. THE HOSPITAL SERVES RESIDENTS OF SHELBY, HENRY, AND SPENCER COUNTIES. THE HOSPITAL OFFERS A FULL COMPLEMENT OF INPATIENT AND OUTPATIENT CARE, INCLUDING: 24/7 EMERGENCY CARE, INTENSIVE CARE UNIT, INPATIENT CARE (MEDICAL/SURGICAL), DIAGNOSTIC IMAGING: MRI, CT, PET/CT, NUCLEAR CARDIOLOGY, ULTRASOUND, 3D MAMMOGRAPHY, BONE DENSITY, GENERAL AND SPECIALIZED SURGERY: ENDOSCOPY, ENT GASTROENTEROLOGY, ORTHOPEDICS, PODIATRY, UROLOGY, VASCULAR SURGERY, PAIN MANAGEMENT, CARDIOLOGY, CARDIAC REHAB/HEALTHY LIFESTYLE CENTER, SLEEP MEDICINE, FRAZIER REHAB INSTITUTE - PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, DIABETES AND NUTRITION COUNSELING, OUTPATIENT INFUSION SERVICES, CLINICAL LABORATORY AND PHARMACY. 34791206 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 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 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X THE ORGANIZATION 5025617213 530 S JACKSON STREET LOUISVILLE KY 40202 X THOMAS D MILLER CEO UOFL HEALTH/SECRETARY 2.00 44.00 X X 0 1708193 42014 KEN MARSHALL COO UOFL HEALTH 2.00 44.00 X 0 999858 44434 ANDREW DUFFEE MD VICE CHAIR 1.00 40.00 X X 0 753742 43703 MICHAEL DOUZUK JR CFO UOFL HEALTH (END 2023) 2.00 44.00 X 0 705824 26123 KIRK STRACK CFO UOFL HEALTH 2.00 44.00 X 0 611197 58071 TIMOTHY AARON GAROFOLA CEO SHELBYVILLE HOSPITAL 40.00 X 0 471377 42180 VALERIE BRIONES-PRYOR MD BOARD MEMBER 1.00 40.00 X 0 387015 42286 GREG PFISTER MD MEMBER 1.00 40.00 X 0 361368 21449 ANNESSA BAKER COO/CNO 40.00 X 0 214845 19523 KENNETH GARDNER MD MEMBER 1.00 40.00 X 0 189638 31346 JAMES BOSE DIRECTOR - IMAGING SERVICES 40.00 X 0 148700 30463 KELLY NOLAN DIRECTOR - NURSING 40.00 X 0 161224 14944 AMY CAPPS DIRECTOR - NURSING 40.00 X 0 134318 31826 MICHELLE H LEDGER DIRECTOR - LABRATORY 40.00 X 0 123472 28555 EMILY MIRACLE DIRECTOR - QUALITY PATIENT SAFETY 40.00 X 0 110106 11412 PAT HARGADON CHAIR 1.00 X X 0 0 0 RON CAUGHRON MEMBER 1.00 X 0 0 0 RAY LEATHERS MEMBER 1.00 X 0 0 0 GARY WALLS MEMBER 1.00 X 0 0 0 JANICE HARRIS MEMBER 1.00 X 0 0 0 STEVE MEADOR MEMBER 1.00 X 0 0 0 TROY RAWLINS MEMBER 1.00 X 0 0 0 0 7080877 488329 0 0 1 0 METZ CULINARY MANAGEMENT TWO WOODLANDS DRIVE DALLAS PA 18612 FOOD/ENVIRONMENTAL SERVICES 1036323 ALLIED UNIVERSAL SECURITY SERVICES PO BOX 277469 ATLANTA GA 30384 SECURITY SERVICES 283628 MEDICAL CENTER LAUNDRY 1400 STORY AVENUE LOUISVILLE KY 40206 LAUNDRY SERVICES 155813 VASCULAR ACCESS INC PO BOX 444 GEORGETOWN IN 47122 PROFESSIONAL SERVICES 155245 BRIGHTVIEW LANDSCAPE SERVICES INC 4510 POPLAR LEVEL ROAD LOUISVILLE KY 40213 LANDSCAPE SERVICES 128322 6 NET PATIENT REVENUE 621999 36738602 36738602 36738602 90175 0 90175 90175 90175 3925 0 3925 3925 GENERAL PRODUCT SAFETY REG REVENU 900099 68826 68826 EARNINGS IN KMRRRG 900099 15123 15123 CONTRACTED SERVICES 900099 2464 2464 13937 13937 100350 36933052 36823829 0 109223 X 43758 43758 15133272 12914206 2219066 569858 320919 248939 1822093 1026123 795970 1020291 574583 445708 900 900 519 519 9194093 7094373 2099720 9680 2706 6974 353301 351983 1318 482810 189672 293138 6959 1945 5014 3769 1054 2715 1587673 954493 633180 392013 109578 282435 MEDICAL SUPPLIES 5812031 5812031 CORPORATE ALLOCATION EX 3463334 3463334 REPAIRS & MAINTENANCE 1391640 827318 564322 PROVIDER TAX 1038923 1038923 229699 64207 165492 42556616 34791206 7765410 0 5592052 5399130 779900 793436 22575 47652 12397768 4997485 7767234 7400283 1254182 1149847 15415943 14790348 3117081 4257793 2505908 2505908 1222182 233877 6845171 6997578 X 8570772 7792770 8570772 7792770 15415943 14790348 X -5623564 4845562 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 1357 1357 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO AMERICAN HOSPITAL ASSOCIATION (AHA) AND KENTUCKY HOSPITAL ASSOCIATION (KHA), OF WHICH 11.2% IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 1000000 1000000 2306161 1152165 1153996 8790566 3748483 5042083 301041 96837 204204 7400283 HRIP RECEIVABLE 1149847 1149847 THIRD PARTY SETTLEMENTS 222977 RELATED PARTY PAYABLE 10900 233877 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2024 AND 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION HAS FILED ITS FEDERAL AND STATE INCOME TAX RETURNS FOR THE PERIODS THROUGH JUNE 30, 2023 AND IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. HOWEVER, AS OF THE DATE THE CONSOLIDATED FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 1433668 1433668 0.03370 8938439 18082282 0 0.00000 10372107 18082282 1433668 0.03370 4 293 48967 48967 0.00120 2 10 111919 111919 0.00260 8513 8513 0.00020 6 303 169399 169399 0.00400 6 303 10541506 18082282 1603067 0.03770 1 29120 29120 0.00070 1 5376 5376 0.00010 1 4793 4793 0.00010 3 39289 39289 0.00090 1 3405026 0 6567401 6755771 -188370 X 1 1 1 1 U OF L HEALTH - SHELBYVILLE INC 727 HOSPITAL DRIVE SHELBYVILLE KY 40065 100385 X X X U OF L HEALTH - SHELBYVILLE INC 1 0 0 1 X X X X X X X X X 22 1 1 0 1 X HTTPS://UOFLHEALTH.ORG/WP-CONTENT/UPLOADS/2022/06/6.22.2022-SHELBYVILLE-CHN X X 1 22 1 HTTPS://UOFLHEALTH.ORG/WP-CONTENT/UPLOADS/2022/06/6.22.2022-SHELBYVILLE-CHN 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTPS://UOFLHEALTH.ORG/FINANCIAL-ASSISTANCE/ X HTTPS://UOFLHEALTH.ORG/FINANCIAL-ASSISTANCE/ X HTTPS://UOFLHEALTH.ORG/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 U OF L HEALTH - SHELBYVILLE INC. PART V, SECTION B, LINE 5: U OF L HEALTH CONTRACTED WITH BLUE AND CO., LLC TO CONDUCT THE MOST RECENT CHNA IN THE SPRING OF 2022. DURING DATA COLLECTION FROM APRIL 2022-MAY 2022, BLUE AND CO. INTERVIEWED MEMBERS OF THE COMMUNITY FROM ACROSS THE HOSPITAL'S SERVICE AREA. THESE INCLUDED REPRESENTATIVES FROM GOVERNMENT, PUBLIC HEALTH, MEDICAL PROVIDERS, NONPROFIT LEADERS, FAITH-BASED INSTITUTIONS, ELECTED OFFICIALS, AND LAW ENFORCEMENT. ONLINE SURVEYS WERE ALSO DISTRIBUTED THROUGHOUT THE SERVICE AREA, MANY THROUGH THE COMMUNICATION CHANNELS OF THESE REPRESENTATIVES. DATA FROM THE INTERVIEWS AND SURVEYS INFORMED THE RESULTS AND ASSISTED THE HOSPITAL IN IDENTIFYING PRIORITY AREAS. MEMBERS FROM THESE COMMUNITY GROUPS ALSO PARTICIPATED IN AN ADVISORY GROUP TO DETERMINE IMPLEMENTATION STRATEGIES FOR EACH OF THE PRIORITY NEEDS IDENTIFIED. FOR FEEDBACK ON PREVIOUS CHNAS, AN ONLINE FEEDBACK FORM WAS MADE AVAILABLE ON THE UOFL HEALTH WEBSITE AT <HTTPS://UOFLHEALTH.ORG/ABOUT/COMMUNITY-ENGAGEMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FEEDBACK/>. ANY COMMENTS COLLECTED THROUGH THE FORM WERE INCLUDED IN THE CHNA PROCESS. U OF L HEALTH - SHELBYVILLE INC. PART V, SECTION B, LINE 6A: U OF L HEALTH, AS A HEALTH CARE SYSTEM, CONTRACTED WITH BLUE AND CO., LLC TO CONDUCT THE MOST RECENT CHNA IN THE SPRING OF 2022. THE OTHER FIVE HOSPITALS INCLUDED IN THE SYSTEM FELL INTO THE SAME CHNA TIMELINE AS SHELBYVILLE. THEREFORE, BLUE AND CO. COLLECTED PRIMARY AND SECONDARY FOR ALL HOSPITALS AT THE SAME TIME. THE SAME SURVEY TOOL WAS USED FOR ALL HOSPITALS. THESE INCLUDED: JEWISH HOSPITAL, PEACE HOSPITAL, MARY AND ELIZABETH HOSPITAL, UOFL HOSPITAL, SHELBYVILLE HOSPITAL, AND FRAZIER REHABILITATION INSTITUTE. U OF L HEALTH - SHELBYVILLE INC. PART V, SECTION B, LINE 7D: HTTPS://UOFLHEALTH.ORG/WP-CONTENT/UPLOADS/2022/06/6.22.2022-SHELBYVILLE-CHNA-FINAL.PDF U OF L HEALTH - SHELBYVILLE INC. PART V, SECTION B, LINE 11: THE CHNA IDENTIFIED THE FOLLOWING OVERALL NEEDS FOR SHELBYVILLE HOSPITAL: ACCESS TO HEALTH CARE, MENTAL HEALTH, SMOKING CESSATION, HEALTH EQUITY AND DISPARITIES, AND OBESITY/INACTIVITY. HOSPITAL LEADERSHIP DETERMINED NOT TO ADDRESS OBESITY/INACTIVITY AS A PRIORITY SINCE IT WAS NOT AN AREA WHERE THE HOSPITAL HAD SERVICE LINES IN PLACE TO ADDRESS IT, NOR COULD THEY MAKE A SIGNIFICANT IMPACT WITH AVAILABLE RESOURCES. HEALTH EQUITY AND DISPARITIES ARE BEING ADDRESSED AS A SYSTEM-WIDE PRIORITY. EACH PRIORITY HAS A GOAL STATEMENT, CATEGORIES OF ACTION, AND SPECIFIC STRATEGIES. ACCESS TO HEALTH CARE WILL BE ADDRESSED THROUGH THE FOLLOWING GOALS AND CATEGORIES OF STRATEGY:- GOAL: INCREASE ACCESS TO HIGH QUALITY, EQUITABLE HEALTH CARE AND COMMUNITY RESOURCES FOR UNDERSERVED INDIVIDUALS AND COMMUNITIESSTRATEGIES:- INCREASE PHYSICIANS, FACILITIES, AND SERVICES- BUILD SUSTAINABLE, MUTUALLY BENEFICIAL PARTNERSHIPS- CONNECT PATIENTS TO RESOURCESMENTAL HEALTH WILL BE ADDRESSED THROUGH THE FOLLOWING GOALS AND CATEGORIES OF STRATEGY:- GOAL: INCREASE PROGRAMMING AND SERVICES THAT FOCUS ON THE TREATMENT & SAFETY OF INDIVIDUALS LIVING WITH MENTAL ILLNESS AND SUBSTANCE USE DISORDERSTRATEGIES:- ENHANCE BEHAVIORAL HEALTH SERVICES- ENSURE THE SAFETY OF PATIENTS LIVING WITH SUBSTANCE USE DISORDERSMOKING WILL BE ADDRESSED THROUGH THE FOLLOWING GOALS AND CATEGORIES OF STRATEGY:- GOAL: INCREASE THE CONNECTION TO SERVICES AND RESOURCES FOR SMOKING, VAPING, AND E-CIGARETTE CESSATION AND PREVENTIONSTRATEGIES:- UTILIZE EXISTING RESOURCES- BUILD SUSTAINABLE, MUTUALLY BENEFICIAL PARTNERSHIPS HEALTH EQUITY AND DISPARITIES WILL BE ADDRESSED THROUGH THE FOLLOWING GOALS AND CATEGORIES OF STRATEGY:- GOAL: INCREASE UOFL HEALTH'S FOCUS ON AND UNDERSTANDING OF HEALTH EQUITY THROUGH DATA ANALYSIS, PLANNING, AND POLICY/PROCEDURE CHANGES TO ADDRESS HEALTH DISPARITIES STRATEGIES:- UTILIZE DATA TO BETTER UNDERSTAND THE NEED- BUILD INTERNAL SYSTEMS TO ADDRESS THE NEED - CONNECT PATIENTS TO RESOURCES TO ADDRESS SOCIAL DETERMINANTS OF HEALTH- FOCUS ON REACHING UNDERSERVED POPULATIONS PART V, SECTION B, LINE 7A HTTPS://UOFLHEALTH.ORG/WP-CONTENT/UPLOADS/2022/06/6.22.2022-SHELBYVILLE-CHNA-FINAL.PDF PART V, SECTION B, LINE 10A HTTPS://UOFLHEALTH.ORG/WP-CONTENT/UPLOADS/2022/06/6.22.2022-SHELBYVILLE-CHNA-FINAL.PDF PART I, LINE 3C: U OF L HEALTH-SHELBYVILLE'S FINANCIAL ASSISTANCE POLICY APPLIES TO PATIENTS WHO COME TO OUR FACILITIES AND ARE UNINSURED/UNDERINSURED, INELIGIBLE FOR GOVERNMENT HEALTH PROGRAMS, OR OTHERWISE WITHOUT ADEQUATE FINANCIAL RESOURCES TO PAY FOR HEALTH CARE SERVICES WHO. THIS POLICY PROVIDES FINANCIAL RELIEF TO PATIENTS WHO QUALIFY BASED ON A COMPARISON OF THEIR FINANCIAL RESOURCES AND/OR INCOME TO FEDERAL POVERTY GUIDELINES. THE PROGRAM IS DESIGNED SPECIFICALLY FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AND PATIENTS WHOSE HOUSEHOLD FINANCIAL RESOURCES AND/OR INCOME ARE AT OR BELOW 300 PERCENT OF THE FEDERAL POVERTY LEVEL.TO QUALIFY FOR ANY ASSISTANCE, PATIENTS WILL BE ASKED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION WHICH INCLUDES INFORMATION RELATING TO HOUSEHOLD INCOME. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO THE INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET NUMBER 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET NUMBER 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET NUMBER 3 WAS USED TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE ORGANIZATION'S COST ACCOUNTING PROGRAM WAS UTILIZED FOR CALCULATING PORTIONS OF THE SUBSIDIZED HEALTH SERVICES. THE ORGANIZATION'S COST ACCOUNTING PROGRAM ENCOMPASSES ALL PATIENT TYPES, SERVICES AND PAYORS. THE COST ASSOCIATED WITH A SERVICE ARE REVIEWED AND UPDATED ANNUALLY TO PROVIDE THE MOST ACCURATE COST POSSIBLE. BOTH DIRECT AND INDIRECT COSTS ARE UTILIZED IN CALCULATING COST. ACTUAL COST OF HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH EDUCATION, RESEARCH PROGRAM, SOME SUBSIDIZED SERVICES AND DONATIONS ARE STATED AT ACTUAL COST. THE COST OF THESE ITEMS ARE TRACKED THROUGHOUT THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE. THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE TO COST-TO-CHARGES FOR LINES 7A AND 7B. LINES 7E, 7F, AND 7G ARE BASED ON ACTUAL COSTS. PART III, LINE 2: THE ORGANIZATION HAS REPORTED BAD DEBT EXPENSE AT GROSS CHARGES WRITTEN OFF. THE ORGANIZATION'S BAD DEBT EXPENSE REPRESENTS AMOUNTS BILLED TO PATIENTS THAT WERE DEEMED UNCOLLECTIBLE AND DOES NOT INCLUDE ANY CHARGES THAT WERE ULTIMATELY REIMBURSED OR DISCOUNTED. PATIENT DISCOUNTS ARE RECORDED IN CONTRACTUAL ALLOWANCE OR FINANCIAL ASSISTANCE, AS APPROPRIATE, AS AN OFFSET TO GROSS REVENUE AND ARE NOT INCLUDED IN BAD DEBT EXPENSE. PART III, LINE 3: U OF L HEALTH - SHELBYVILLE, INC. HAS TAKEN REASONABLE AND PRUDENT STEPS TO ENSURE NO PORTION OF BAD DEBT COULD BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: SEE AUDITED FINANCIAL STATEMENTS PAGES 11-14. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE TAKEN DIRECTLY OFF MEDICARE COST REPORT FILED WITH THE 6/30/24 YEAR END. ANY SHORTFALL SHALL BE TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: U OF L HEALTH - SHELBYVILLE INC.'S DEBT COLLECTION POLICY PROVIDES THAT THE HOSPITAL WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. ALL UNINSURED PATIENTS/GUARANTORS ARE BILLED DIRECTLY AND TIMELY AND WILL RECEIVE A STATEMENT AS PART OF THE NORMAL BILLING PROCESS. ALL PATIENTS/GUARANTORS MAY REQUEST AN ITEMIZED STATEMENT FOR THEIR ACCOUNTS AT ANY TIME. AT LEAST THREE SEPARATE POST-DISCHARGE BILLING STATEMENTS ARE SENT. AN ORAL ATTEMPT TO REACH THE PATIENT IS ALSO MADE BEFORE INITIATION OF ANY ECA. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO THE HOSPITAL FOR APPROPRIATE FOLLOW-UP. U OF L HEALTH - SHELBYVILLE INC. REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: THE CHNAS ARE THE PRIMARY METHOD USED BY THIS FACILITY FOR ASSESSING THE NEEDS OF THE COMMUNITY. HOWEVER, THROUGH HOSPITAL BOARD MEMBERS AND THE INVOLVEMENT OF HOSPITAL LEADERSHIP IN THE COMMUNITY, OTHER NEEDS CAN COME TO LIGHT THAT MAY HAVE ARISEN AFTER THE CHNA WAS COMPLETED. PART VI, LINE 3: NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM UOFL HEALTH ORGANIZATIONS SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO:- CONSPICUOUS PUBLICATION OF NOTICES IN PATIENT BILLS;- NOTICES POSTED IN EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING/REGISTRATION DEPARTMENTS, BUSINESS OFFICES, AND AT OTHER PUBLIC PLACES AS A HOSPITAL FACILITY MAY ELECT; AND- PUBLICATION OF A SUMMARY OF THIS POLICY ON THE HOSPITAL FACILITY'S WEBSITE, <WWW.UOFLHEALTH.ORG> AND AT OTHER PLACES WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL FACILITY AS IT MAY ELECT.SUCH NOTICES AND SUMMARY INFORMATION SHALL INCLUDE A CONTACT NUMBER AND SHALL BE PROVIDED IN ENGLISH, SPANISH, AND OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY AN INDIVIDUAL HOSPITAL FACILITY, AS APPLICABLE. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE UOFL HEALTH ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.UOFL HEALTH ORGANIZATIONS WILL PROVIDE FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR BILLS AND WILL MAKE THE AVAILABILITY OF SUCH COUNSELING KNOWN. IT IS THE RESPONSIBILITY OF THE PATIENT OR THE PATIENT'S GUARANTOR TO SCHEDULE CONSULTATIONS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE WITH A FINANCIAL COUNSELOR. PART VI, LINE 4: SHELBYVILLE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES SHELBY COUNTY WHICH HAS A POPULATION OF APPROXIMATELY 49,611 RESIDENTS AND COVERS ROUGHLY 386 SQUARE MILES, WITH THE LOCAL ECONOMY AND SURROUNDING AREAS FOCUSED ON MANUFACTURING, HEALTH CARE AND SOCIAL ASSISTANCE, AND RETAIL TRADE. THE MEDIAN AGE IN SHELBY COUNTY IS 39.4. THE MEDIAN AGE FOR THE UNITED STATES IS 38.3 YEARS. THE NUMBER OF PERSONS PER HOUSEHOLD IN SHELBY COUNTY IS 2.77. THE U.S. AVERAGE NUMBER OF PERSONS PER HOUSEHOLD IS 2.60. RACE IN SHELBY COUNTY IS AS FOLLOWS: 80.1% NON-HISPANIC WHITE, 6.8% BLACK OR AFRICAN AMERICAN, 1.1% ASIAN, 0.2% NATIVE AMERICAN OR PACIFIC ISLANDER, AND 2.2% FROM TWO OR MORE RACES. 9.6% OF THE POPULATION WERE HISPANIC OR LATINO OF ANY RACE. THE RATIO OF PATIENTS TO PRIMARY CARE PHYSICIANS IN SHELBY COUNTY IS 2,850 PATIENTS TO 1. THE KENTUCKY AVERAGE IS 1,540 TO 1. THE OVERALL HEALTH RANKING FOR SHELBY COUNTY IS 9 OUT OF 120 WITH THE OVERALL STATE RANKING BEING 47TH OUT OF 50 STATES. PART VI, LINE 5: UOFL HEALTH SHELBYVILLE, INC. WORKS TO ENHANCE THE HEALTH OF THE COMMUNITY. MOST COMMUNITY OUTREACH IS OPEN TO THE PUBLIC AND SERVES THE BROADER COMMUNITY. THE FOLLOWING PROVIDES A SNAPSHOT OF THE HOSPITAL'S ENGAGEMENT WITH THE COMMUNITY. - FACILITATION OF HEALTH FAIRS IN THE LOCAL COMMUNITY- PARTNERSHIP WITH THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT- MONITORING HOSPITAL PROVIDE OPIATE PRESCRIBING PRACTICES - INVOLVEMENT OF HOSPITAL LEADERSHIP ON HEALTH-RELATED AND SOCIAL SERVICE BOARDS, COMMITTEES, AND ADVISORY GROUPS- FACILITATING CONVERSATIONS RELATED PATIENTS' EXPERIENCES WITH THE SOCIAL DETERMINANTS OF HEALTH SUCH AS TRANSPORTATION- INVOLVEMENT IN THE EDUCATION OF HEALTH PROFESSIONALS THROUGH CLINICAL ROTATIONS AND CAPSTONES- INVOLVEMENT IN SMOKING CESSATION EFFORTS IN THE COMMUNITY- PARTNERSHIP WITH MERCY MEDICAL CLINIC AND NCDHD ON ACCESS TO CARE- ASSISTING PATIENTS WITH INSURANCE ENROLLMENT- DISCHARGE PLANNING THAT INCLUDES STREAMLINED PRIMARY CARE ACCESS- PARTNER WITH PEACE HOSPITAL TO INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES- AVAILABILITY OF REGISTERED DIETICIAN AND DIABETES EDUCATORS- PARTNERING WITH NURSING HOMES, ASSISTED LIVING FACILITIES, AND HOME HEALTH ORGANIZATIONS TO BETTER UNDERSTAND THE NEEDS AND RESOURCES AVAILABLE- COVID TESTING AND VACCINATIONS PART VI, LINE 6: UOFL HEALTH, INC. IS THE PARENT ORGANIZATION FOR A NUMBER OF TAX-EXEMPT HOSPITALS AND HEALTH CARE ORGANIZATIONS. ITS GENERAL PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, AND TO CARRY OUT THE PURPOSES OF EACH ENTITY DIRECTLY OR INDIRECTLY CONTROLLED BY IT AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)3. UOFL HEALTH, INC. IS SUPERVISED OR CONTROLLED IN CONNECTION WITH ITS SUPPORTED ORGANIZATIONS BECAUSE THE SAME PEOPLE MANAGE UOFL HEALTH, INC. AND THE SUPPORTED ORGANIZATIONS. THE SUPPORTED ORGANIZATIONS INCLUDE UNIVERSITY MEDICAL CENTER, INC., UNIVERSITY OF LOUISVILLE PHYSICIANS, INC, UOFL HEALTH-SHELBYVILLE, INC, AND UOFL HEALTH-LOUISVILLE, INC., ALL OF WHICH ARE KENTUCKY, NONPROFIT CORPORATIONS RECOGNIZED BY THE IRS AS BEING TAX-EXEMPT UNDER SECTION 501(C)3 OF THE CODE. UOFL HEALTH-LOUISVILLE, INC. INCLUDES FIVE HOSPITALS IN THE LOUISVILLE METRO AREA INCLUDING JEWISH HOSPITAL, MARY AND ELIZABETH HOSPITAL, PEACE HOSPITAL, SOUTH HOSPITAL AND FRAZIER REHABILITATION INSTITUTE, AND SHELBYVILLE HOSPITAL LOCATED IN SHELBY COUNTY. UOFL HEALTH IS DEDICATED TO COMMUNITY HEALTH PROMOTION AND IMPROVEMENT, WHICH IS PRESENT THROUGHOUT EACH OF ITS HOSPITALS AND SERVICE LINES. EACH OF THE SUPPORTED ORGANIZATIONS CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AND THE CORRESPONDING HOSPITALS DEVELOP IMPLEMENTATION STRATEGIES TO ADDRESS THOSE NEEDS. BEYOND THE CHNA PROCESS, MANY SERVICE LINES, PROGRAMS, AND FACILITIES THROUGHOUT THE UOFL HEALTH SYSTEM HAVE A COMMUNITY HEALTH COMPONENTS SUCH THAT THEY PROVIDE OUTREACH, HEALTH LITERACY, ACCESS TO CARE FOR UNDERSERVED POPULATIONS, AND CHRONIC DISEASE MANAGEMENT AND PREVENTION. FORM 990, SCHEDULE H, PART VI, LINE 7 A COMMUNITY BENEFIT REPORT IS NOT REQUIRED IN THE STATE OF KENTUCKY. COMMUNITY BENEFIT TOTALS WERE POSTED TO THE ORGANIZATION'S WEBSITE. 0 0 0 0 0 0 0 1 0 THOMAS D MILLER CEO UOFL HEALTH/SECRETARY 0 1124237 0 573288 0 10668 0 19175 0 22839 0 1750207 0 0 KEN MARSHALL COO UOFL HEALTH 0 659253 0 335061 0 5544 0 41675 0 2759 0 1044292 0 0 ANDREW DUFFEE MD VICE CHAIR 0 752482 0 0 0 1260 0 16500 0 27203 0 797445 0 0 MICHAEL DOUZUK JR CFO UOFL HEALTH (END 2023) 0 373024 0 322817 0 9983 0 11021 0 15102 0 731947 0 0 KIRK STRACK CFO UOFL HEALTH 0 425599 0 183714 0 1884 0 41675 0 16396 0 669268 0 0 TIMOTHY AARON GAROFOLA CEO SHELBYVILLE HOSPITAL 0 309691 0 160983 0 703 0 16877 0 25303 0 513557 0 0 VALERIE BRIONES-PRYOR MD BOARD MEMBER 0 386025 0 0 0 990 0 16500 0 25786 0 429301 0 0 GREG PFISTER MD MEMBER 0 360681 0 0 0 687 0 16500 0 4949 0 382817 0 0 ANNESSA BAKER COO/CNO 0 171258 0 42047 0 1540 0 11617 0 7906 0 234368 0 0 KENNETH GARDNER MD MEMBER 0 170094 0 14972 0 4572 0 9486 0 21860 0 220984 0 0 JAMES BOSE DIRECTOR - IMAGING SERVICES 0 128955 0 19517 0 228 0 6558 0 23905 0 179163 0 0 KELLY NOLAN DIRECTOR - NURSING 0 143633 0 17506 0 85 0 8388 0 6556 0 176168 0 0 AMY CAPPS DIRECTOR - NURSING 0 116534 0 17587 0 197 0 8029 0 23797 0 166144 0 0 MICHELLE H LEDGER DIRECTOR - LABRATORY 0 106451 0 16537 0 484 0 7421 0 21134 0 152027 0 0 PART I, LINE 7 THERE IS A SHORT TERM INCENTIVE PLAN THAT ELIGIBLE UOFL HEALTH - SHELBYVILLE INC. EMPLOYEES MAY RECEIVE BASED ON MEETING CERTAIN BENCHMARKS. THE PLAN IS BASED ON MEETING FINANCIAL GOALS, DESIRED PATIENT QUALITY OUTCOMES, PATIENT SATISFACTION SCORES AND IS CONSISTENT WITH MARKET PRACTICES AND THE ORGANIZATION'S COMPENSATION PHILOSOPHY. SCHEDULE H, PART I, LINE 7B AN AMENDED 990 IS BEING FILED TO UPDATE AMOUNTS REPORTED FOR COMMUNITY BENEFIT EXPENSE AND THE CORRESPONDING OFFSETTING REVENUE ON SCHEDULE H, LINE 7B-UNREIMBURSED MEDICAID. FORM 990, PART VI, SECTION A, LINE 6 U OF L HEALTH, INC., A KENTUCKY NONPROFIT CORPORATION, SHALL BE THE HOSPITAL'S SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B AFTER REVIEW AND APPROVAL BY THE ORGANIZATION'S CEO AND CFO, THE CONTRACTED TAX PROFESSIONAL FILES A COPY OF THE FORM 990 WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO AFFECT E-FILING. A COPY IS MADE AVAILABLE TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF THE HOSPITAL THAT AN INTERESTED PERSON WHO KNOWS THAT HE OR SHE HAS AN ACTUAL OR APPARENT CONFLICT OF INTEREST SHALL DISCLOSE IT PROMPTLY AND FULLY TO ALL NECESSARY PARTIES WHENEVER IT OCCURS. INTERESTED PERSONS ARE (A) VOTING MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS AND VOTING MEMBERS OF COMMITTEES THAT EXERCISE BOARD-DELEGATED AUTHORITY, (B) OFFICERS OF THE HOSPITAL ELECTED OR APPROVED BY THE BOARD OF DIRECTORS OR (C) A "CONTROLLED ENTITY" IN WHICH AT LEAST 35% OF THE CONTROL OR BENEFICIAL INTEREST IS HELD BY ANY ONE OR COMBINATION OF INDVIDUALS DESCRIBED IN A AND B. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER KNOWN INTEREST IN A PROPOSED TRANSACTION TO THE DIRECTORS AND MEMBERS OF COMMITTE WITH BOARD DELEGATED POWERS CONSIDERING THE TRANSATION OR ARRANGEMENT WHEN A CONFLICT OF INTEREST IS DECLARED. THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE PROPOSED TRANSACTION. THE INTERESTED PERSON SHALL LEAVE THE MEETING AND THE VOTE ON ANY TRANSACTIONS INVOLVING THE CONFLICT OF INTEREST THE MINUTES OF THE BOARD WILL CONTAIN THE NAMES OF THE PERSONS WHO DISCLOSE OR OTHERWISE WERE FOUND TO HAVE INTEREST IN CONNECTION WITH A CONFLICT OF INTEREST, THE NATURE OF THE INTEREST AND ANY ACTION TAKEN TO DETERMINE THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. THE HOSPITAL USES THE MERCER GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES IS REVIEWED ANNUALLY. THE MERCER GROUP REVIEWS BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO THE HOSPITAL'S COMPENSATION PHILOSOPHY AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW IS DELIVERED BY MERCER GROUP TO THE COMPENSATION COMMITTEE OF THE HOSPITAL'S BOARD OF DIRECTORS ANNUALLY. LINE 15B: FOR ALL EXECUTIVE DIRECTORS, TOP MANAGEMENT OFFICIALS, OFFICERS AND KEY EMPLOYEES, THE FOLLOWING PROCESS IS USED. 1) HUMAN RESOURCES (HR) HAS INDEPENDENT COMPANY DO A COMPARISON OF LIKE POSITIONS WITHIN THE COMMUNITY AND COME UP WITH A RANGE. THEY PREPARE A PROPOSAL THAT IS SUBMITTED TO HR FOR REVIEW 2) A SALARY IS DETERMINED WITHIN THAT RANGE BASED ON YEARS OF SERVICE EDUCATION AND OTHER FACTORS, SUCH AS ADDITIONAL RESPONSIBILITIES. HR PREPARES A PROPOSAL TO SUBMIT TO THE CEO 3)THE PROPOSAL, CONTAINING THE POSITION, RANGE AND FINAL COMPENSATION IS TURNED OVER TO THE CEO FOR REVIEW 4) AFTER REVIEW, THE CEO TAKES THE PROPOSAL INFORMATION AND PRESENTS IT TO THE FINANCE COMMTTEE. 5) THE FINANCE COMMITTEE DECIDES AND VOTES ON THE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION B U OF L HEALTH - SHELBYVILLE, INC. DOES NOT ISSUE ANY 1099S UNDER ITS EIN. ALL INDEPENDENT CONTRACTORS ARE PAID BY RELATED ORGANIZATION UNIVERSITY MEDICAL CENTER UNDER A COMMON PAYMASTER ARRANGEMENT. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,800,401. MANAGEMENT AND GENERAL EXPENSES 1,700,843. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,501,244. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 5,293,972. MANAGEMENT AND GENERAL EXPENSES 398,877. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,692,849. FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES 4,845,562. UNIVERSITY MEDICAL CENTER INC 530 S JACKSON STREET LOUISVILLE KY 40202 611293786 HOSPITAL KY 501(C)(3) LINE 3 U OF L HEALTH INC 0 U OF L HEALTH INC 530 S JACKSON STREET LOUISVILLE KY 40202 843125292 SUPPORTING ORG KY 501(C)(3) LINE 12B, II N/A 0 U OF L HEALTH - LOUISVILLE INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 843178470 HOSPITAL KY 501(C)(3) LINE 3 U OF L HEALTH INC 0 UNIVERSITY OF LOUISVILLE PHYSICIANS LLC 300 EAST MARKET ST 400 LOUISVILLE KY 40202 273645560 MEDICAL SERVICES KY 501(C)(3) LINE 10 U OF L HEALTH INC 0 UNIVERSITY OF LOUISVILLE INC 2301 S 3RD STREET LOUISVILLE KY 40292 611014882 EDUCATION KY 501(C)(3) N/A 0 U OF L HEALTH FOUNDATION INC 530 S JACKSON STREET LOUISVILLE KY 40202 863084814 SUPPORTING ORG KY 501(C)(3) LINE 7 UNIVERSITY MEDICAL CENTER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1