THE MEDICAL CENTER AT CLINTON COUNTY INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- THE MEDICAL CENTER AT CLINTON COUNTY INC (EIN 81-1312058)
- Tax period
- 2016-04-01 to 2017-03-31
- Filed
- 2018-02-09
- IRS object ID
- 201800409349301245
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-02-09T14:42:57-06:00 | ReturnTs |
| Tax Period End | 2017-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2650 Eastpoint Pkwy Suite 300 | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40223 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 811312058 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Medical Center at Clinton | BusinessNameLine1Txt |
| Business Name Line2 | County Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEDI | BusinessNameControlTxt |
| Phone | 2707451536 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Park Street | AddressLine1Txt |
| City | Bowling Green | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 421029876 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ron Sowell | PersonNm |
| Person Title | EVP - CFO | PersonTitleTxt |
| Phone | 2707451536 | PhoneNum |
| Signature | 2018-01-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Angela L Zirkelbach CPA | PreparerPersonNm |
| PTIN | P00572603 | PTIN |
| Phone | 5029923500 | PhoneNum |
| Preparation | 2018-01-18 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.109.186.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-01-18 | IPDt |
| IP Tm | 17:13:56 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | CEC041C7A28BF02AF1651001FA3B4F793CABA0CE | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Initial Return | Yes (X) | InitialReturnInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Medical Center at Albany | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Connie Smith | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Park Street | AddressLine1Txt |
| City | Bowling Green | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 421029876 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,500,640 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | http://www.chc.net/services/hospitals/the_medical | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2016 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | Provides inpatient and outpatient acute care services by or under the supervision of physicians in Albany, kentucky and in the surrounding counties. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 153 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| CY Contributions Grants | $9,605 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $10,407,962 | CYProgramServiceRevenueAmt |
| CY Investment Income | -$14,370 | CYInvestmentIncomeAmt |
| CY Other Revenue | $82,174 | CYOtherRevenueAmt |
| CY Total Revenue | $10,485,371 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $5,382,686 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| CY Other Expenses | $7,027,648 | CYOtherExpensesAmt |
| CY Total Expenses | $12,410,334 | CYTotalExpensesAmt |
| CY Revenues Less Expenses | -$1,924,963 | CYRevenuesLessExpensesAmt |
| Total Assets EOY | $11,092,055 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $3,701,849 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | $7,390,206 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The Medical Center at clinton county is dedicated to providing the highest quality care possible in a safe and secure environment. We are committed to the promotion of wellness and restoration of health in a cost-effective manner. We continuously strive to improve the quality of health in the communities we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,655,699 | ExpenseAmt |
| Revenue | $10,407,962 | RevenueAmt |
| Desc | THE MEDICAL CENTER AT CLINTON COUNTY ("MCC") IS RECOGNIZED BY MEDICARE AS AN ACUTE CARE HOSPITAL. MCC IS ENGAGED IN PROVIDING TO INPATIENTS, BY OR UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC AND THERAPEUTIC SERVICES FOR MEDICAL DIAGNOSIS, TREATMENT, AND CARE OF INJURED, DISABLED, OR SICK PERSONS, OR REHABILITATION OF INJURED, DISABLED, OR SICK PERSONS.ORGANIZATION THE MEDICAL CENTER AT CLINTON COUNTY, INC., A KENTUCKY NON-STOCK, NON-PROFIT CORPORATION EXEMPT FROM INCOME TAXES UNDER SECTION 501( C) (3) OF THE INTERNAL REVENUE CODE OF 1986, WAS ESTABLISHED TO ACT AND OPERATE EXCLUSIVELY FOR CHARITABLE PURPOSES SERVING THE LOCAL CITY, COUNTY AND SURROUNDING COUNTIES IN CLINTON COUNTY, KENTUCKY. SERVICES THE HOSPITAL IS PRIMARILY ENGAGED IN PROVIDING TO INPATIENTS, BY OR UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC AND THERAPEUTIC SERVICES FOR MEDICAL DIAGNOSIS, TREATMENT, AND CARE OF INJURED, DISABLED, OR SICK PERSONS, OR REHABILITATION SERVICES FOR THE REHABILITATION OF INJURED, DISABLED, OR SICK PERSONS. AS A HOSPITAL, IT MAINTAINS CLINICAL RECORDS ON ALL PATIENTS AND HAS BYLAWS IN EFFECT CONCERNING ITS STAFF OF PHYSICIANS. IT REQUIRES THAT EVERY PATIENT MUST BE UNDER THE CARE OF A PHYSICIAN AND PROVIDES 24-HOUR NURSING SERVICE BY OR SUPERVISED BY A REGISTERED PROFESSIONAL NURSE, AND HAS A LICENSED PRACTICAL NURSE OR REGISTERED PROFESSIONAL NURSE ON DUTY AT ALL TIMES. IT HAS IN EFFECT A HOSPITAL UTILIZATION REVIEW PLAN AND IS LICENSED OR IS APPROVED BY THE STATE OF KENTUCKY AS MEETING THE STANDARDS ESTABLISHED FOR SUCH LICENSING. IT ALSO MEETS OTHER HEALTH AND SAFETY REQUIREMENTS OF THE SECRETARY OF HEALTH AND HUMAN SERVICES. SERVICES OFFERED INCLUDE: - ACUTE MEDICAL CARE - SKILLED MEDICAL CARE - PHARMACY - REHABILITATION THERAPY - LABORATORY, CLINICAL AND PATHOLOGY - SURGICAL INPATIENT SERVICES - SURGICAL OUTPATIENT SERVICES - EMERGENCY ROOM SERVICES - OUTPATIENT SERVICES - RESPIRATORY THERAPY SERVICES - RADIOLOGY, INCLUDING MAMMOGRAPHY, DIAGNOSTIC X-RAY, CAT SCANNING, ULTRASOUND, CARDIOLOGY, AND MRITHE HOSPITAL'S PROFESSIONAL STAFF INCLUDES PHYSICIANS WHO ARE ENGAGED IN THE PRACTICE OF MEDICINE AND WHO REPRESENT MULTIPLE SPECIALTIES, INCLUDING FAMILY PRACTICE AND EMERGENCY CARE. THE STAFF ALSO INCLUDES NURSES, REHABILITATION THERAPISTS, RESPIRATORY THERAPISTS, NUTRITIONISTS AND OTHERS. USING AN INTERDISCIPLINARY TEAM APPROACH, THE STAFF WORKS COLLABORATIVELY TO PROVIDE PRIMARY OUTPATIENT CARE, RENDERED IN AN EMERGENCY ROOM AND OUTPATIENT SETTING, AND SECONDARY CARE CONSISTING OF INPATIENT SERVICES OF A GENERAL AND SPECIALIZED NATURE. COMMUNITY BENEFIT AND CHARITY AS A HOSPITAL, THE MEDICAL CENTER AT CLINTON COUNTY, INC.: (1) IS ORGANIZED AS A NONPROFIT CHARITABLE ORGANIZATION FOR THE PURPOSE OF OPERATING AS A HOSPITAL FOR THE CARE OF THE SICK, (2) IS OPERATED FOR THE CARE OF ALL PERSONS IN THE COMMUNITY REGARDLESS OF ABILITY TO PAY THE COST THEREOF, EITHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT, (3) WILL NOT RESTRICT USE OF ITS FACILITIES TO A PARTICULAR GROUP OF PHYSICIANS AND SURGEONS TO THE EXCLUSION OF ALL OTHER QUALIFIED DOCTORS, AND (4) WILL NOT PERMIT ANY OF ITS EARNINGS TO INURE DIRECTLY OR INDIRECTLY TO THE BENEFIT OF ANY PRIVATE SHAREHOLDER OR INDIVIDUAL. THE MEDICAL CENTER AT CLINTON COUNTY, INC. PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CHARITY CARE / FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE THE MEDICAL CENTER AT Clinton County DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE/FINANCIAL ASSISTANCE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. THE MEDICAL CENTER AT CLINTON COUNTY, INC. MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE / FINANCIAL ASSISTANCE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE / FINANCIAL ASSISTANCE POLICY. THE MEDICAL CENTER AT CLINTON COUNTY'S ADDITIONAL COMMUNITY BENEFIT EXPENSE MAY BE QUANTIFIED IN TERMS OF UNCOMPENSATED CARE, SERVICES TO THE POOR, AND BENEFITS TO THE BROADER COMMUNITY PROVIDED ON AN ONGOING BASIS: CHARITY CARE / FINANCIAL ASSISTANCE $ 257,217 UNPAID COSTS OF MEDICAID 286,477COMMUNITY HEALTH IMPROVEMENT 1,129HEALTH PROFESSIONALS EDUCATION 12,357BAD DEBTS 1,240,264UNPAID COST OF MEDICARE 632,200 TOTAL MEDICAL CENTER COMMUNITY BENEFITS $ 2,429,644BENEFITS FOR THE POOR INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES OR WHO ARE UNINSURED. THIS INCLUDES TRADITIONAL CHARITY CARE AT STANDARD BILLING RATES AND THE COSTS OF TREATING MEDICAID BENEFICIARIES IN EXCESS OF GOVERNMENT PAYMENTS. THE MEDICAL CENTER AT Clinton County DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO BE TRADITIONAL CHARITY CARE. THEREFORE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. BENEFITS FOR THE BROADER COMMUNITY INCLUDE SERVICES PROVIDED TO OTHER NEEDY INDIVIDUALS THAT MAY NOT QUALIFY AS INDIGENT BUT WHO NEED SPECIAL SERVICES AND SUPPORT. EXAMPLES INCLUDE THE ELDERLY, SUBSTANCE ABUSERS, VICTIMS OF CHILD ABUSE, AND THE DISABLED. THEY ALSO INCLUDE THE COST OF HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND THE UNREIMBURSED COST OF MEDICAL TRAINING, WHICH BENEFIT THE BROADER COMMUNITY. DURING FISCAL YEAR 2017 THE HOSPITAL ADMITTED 679 ACUTE PATIENTS WHO RECEIVED 3,072 PATIENT DAYS OF CARE AND 45 SWING BED PATIENTS WHO RECEIVED 452 DAYS OF CARE. | Desc |
| Total Program Service Expenses | $9,655,699 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 153 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | J Larry Vaughn | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2707451500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Park Street | AddressLine1Txt |
| City | Bowling Green | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42102 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Dr Paul Cook | |||||||
| Chairperson | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| Dr Donna Blackburn | |||||||
| Vice Chairperson | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |
| Tommy Loving | |||||||
| Secretary | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |
| Dr Kal Sahetya | |||||||
| Director | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| Connie Smith | |||||||
| President & CEO/Director | 2.00 | 52.00 | Yes (X) | $0 | $868,646 | $11,764 | Yes (X) |
| Barbara Jean Cherry | |||||||
| Executive Vice President/CIO | 1.00 | 51.00 | $0 | $514,333 | $11,076 | Yes (X) | |
| Ron Sowell | |||||||
| Executive Vice President/CFO | 2.00 | 50.00 | $0 | $524,676 | $10,548 | Yes (X) | |
| Betsy Kullman | |||||||
| Executive Vice President/CNO | 2.00 | 50.00 | $0 | $287,075 | $18,694 | Yes (X) | |
| Eric HAgan | |||||||
| Executive Vice President | 1.00 | 50.00 | $0 | $258,474 | $18,182 | Yes (X) | |
| Wade Stone | |||||||
| Executive Vice President | 1.00 | 50.00 | $0 | $287,329 | $26,818 | Yes (X) | |
| Sarah Moore | |||||||
| EVP (Retired 7/1/16) | 1.00 | 50.00 | $0 | $165,271 | $5,540 | Yes (X) | |
| Laura Belcher | |||||||
| Vice President/Administrator - MCA | 40.00 | 0.00 | $0 | $88,640 | $15,658 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,994,444 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $118,280 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ERX LLC | |||||
| 9724 KINGSTON PIKE SUITE 1300 | Knoxville | TN | 37922 | Emergency Room Physician Services | $681,064 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36685 | Professional Fees | $238,053 |
| Resource Anesthesia PC | |||||
| 12752 KINGSTON PIKE SUITE E 201 | knoxville | TN | 37922 | Professional Fees | $141,345 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $9,605 | AllOtherContributionsAmt |
| Total Contributions | $9,605 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Services Revenue | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $10,407,962 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,407,962 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,407,962 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $899 | TotalRevenueColumnAmt |
| Exclusion | $899 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,557 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,557 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,557 | TotalRevenueColumnAmt |
| Exclusion | $39,557 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,269 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$15,269 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,269 | TotalRevenueColumnAmt |
| Exclusion | -$15,269 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,617 | TotalRevenueColumnAmt |
| Exclusion | $42,617 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $42,617 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,485,371 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,407,962 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $67,804 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,313,335 | TotalAmt |
| Program Services | $3,879,198 | ProgramServicesAmt |
| Management And General | $434,137 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $745,556 | TotalAmt |
| Program Services | $670,516 | ProgramServicesAmt |
| Management And General | $75,040 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $323,795 | TotalAmt |
| Program Services | $170,124 | ProgramServicesAmt |
| Management And General | $153,671 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,079,901 | TotalAmt |
| Program Services | $304,801 | ProgramServicesAmt |
| Management And General | $775,100 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,931 | TotalAmt |
| Management And General | $39,931 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,867 | TotalAmt |
| Management And General | $66,867 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,699,402 | TotalAmt |
| Program Services | $1,699,402 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,850 | TotalAmt |
| Management And General | $3,850 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,661,379 | TotalAmt |
| Program Services | $1,199,923 | ProgramServicesAmt |
| Management And General | $461,456 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,381 | TotalAmt |
| Program Services | $105,381 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $471,521 | TotalAmt |
| Program Services | $471,521 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,104 | TotalAmt |
| Program Services | $10,732 | ProgramServicesAmt |
| Management And General | $3,372 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $595 | TotalAmt |
| Program Services | $128 | ProgramServicesAmt |
| Management And General | $467 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,857 | TotalAmt |
| Program Services | $39,648 | ProgramServicesAmt |
| Management And General | $548,209 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,480 | TotalAmt |
| Management And General | $178,480 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $824,586 | $824,586 | |
| Taxes & Licenses | $279,596 | $279,327 | $269 |
| Dues & Sub. | $13,786 | $13,786 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412 | TotalAmt |
| Program Services | $412 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,410,334 | TotalAmt |
| Program Services | $9,655,699 | ProgramServicesAmt |
| Management And General | $2,754,635 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $499,171 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,361,296 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $13,901 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $425,476 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $55,357 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,667,628 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $930,774 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $7,736,854 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $11,092,055 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,078,335 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $2,623,514 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,701,849 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $7,390,206 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $7,390,206 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $11,092,055 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,924,963 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $9,315,169 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,472 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,472 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | 14.9% of the hospital's annual membership dues of Kentucky Hospital Association are allocated to lobbying expenses. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $200,200 | OtherCostOrOtherBasisAmt |
| Book Value | $200,200 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,264,800 | OtherCostOrOtherBasisAmt |
| Depreciation | $875,717 | DepreciationAmt |
| Book Value | $7,389,083 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $202,628 | OtherCostOrOtherBasisAmt |
| Depreciation | $55,057 | DepreciationAmt |
| Book Value | $147,571 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,736,854 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Capital Lease Obligation | $7,803 |
| Payable to Affiliates | $2,615,711 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,623,514 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $19,800,540 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $9,315,169 | OtherRevenueAmt |
| Revenue Not Reported | $9,315,169 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,485,371 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,485,371 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,410,334 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,410,334 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,410,334 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Medical Center is organized as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code. As such, it is generally exempt from income taxes. However, it is required to file Federal Form 990 - Return of Organization Exempt from Income Tax which is an informational return only. Accordingly, no provision for income taxes has been made in the financial statements. As the Medical Center was acquired on April 1, 2016, no returns have been filed as of March 31, 2017. 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). Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken 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 Medical Center and has concluded that as of March 31, 2017, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying financial statements. The Medical Center is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. |
| Part XI, Line 2d - Other Adjustments: | Excess of assets over liabilities in transfer of Clinton County Hospital 5,181,977. Transfer from affiliate 4,133,192. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $359,347 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $102,130 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $257,217 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 102 | PersonsServedCnt |
| Total Community Benefit Expns | $3,081,749 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,795,272 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $286,477 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02310 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 102 | PersonsServedCnt |
| Total Community Benefit Expns | $3,441,096 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,897,402 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $543,694 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04380 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 621 | PersonsServedCnt |
| Total Community Benefit Expns | $1,128 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,128 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 3 | PersonsServedCnt |
| Total Community Benefit Expns | $12,357 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,357 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 624 | PersonsServedCnt |
| Total Community Benefit Expns | $13,485 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,485 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 726 | PersonsServedCnt |
| Total Community Benefit Expns | $3,454,581 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,897,402 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $557,179 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,240,264 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,517,216 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,149,416 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$632,200 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Medical Center at Clinton County | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Park Street | AddressLine1Txt |
| City | Bowling Green | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.chc.net/services/hospitals/ | WebsiteAddressTxt |
| State License | 100078 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Medical Center at Clinton County | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://cfrbilling.patientcompass.com/RA/General/BillingPolicies/_Financial | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://cfrbilling.patientcompass.com/RA/General/BillingPolicies/_Financial | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://cfrbilling.patientcompass.com/RA/General/BillingPolicies/_Financial | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| The Medical Center at Clinton County | Part V, Section B, Line 2: On December 11, 2015, Commonwealth Health Corporation, Inc. established a wholly owned subsidiary The Medical Center at Clinton County, Inc. dba The Medical Center at Albany (MCC), a not-for-profit. On April 1, 2016, the Medical Center at Clinton County, Inc. acquired the net assets of Clinton County Hospital, Inc. an acute-care facility, in exchange for a commitment to maintain the facility as an acute-care hospital. The Medical Center earns revenue by providing inpatient, outpatient, and emergency care services to patients in Clinton County and surrounding counties in Kentucky.The Medical Center at Clinton County, Inc. (MCC) is filing its initial return therefore the CHNA is not a requirement for the FYE 3.31.17. MCC will comply with section 501(r)(3) and will have the CHNA complete and posted to its website as required. |
| The Medical Center at Clinton County | Part V, Section B, Line 13b: Because there may be circumstances where a patient/guarantor may end up owing an amount that is large in relation to his income, but still not meet our Standard Charity Guidelines, and because we do not want to create what is commonly known as "medical indigency," we will also apply the following guidelines to charity applications:1) Only persons or families who make less than 20 times (2000%) of the single person FPL are eligible for Catastrophic Charity. The purpose of this requirement is to limit the incentive to not purchase health insurance if a person can afford it.2) A self-pay portion of a bill greater than 20% of annual income qualifies a person for Catastrophic Charity.3) Also, the amount due from Catastrophic Charity applicants will be capped at 50% of their documented and verified annual income plus the amount the patient's liquid assets exceed their immediate needs as per the Asset Test above. 4) We will allow payment of this capped amount over a period of up to 10 years, with up to 15 years available with the approval of the Director of CFR.5) The payments will be treated as long-term pay, i.e. they will require a written agreement, and the payments will be interest free for the remaining portion of the balance due. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | THE INCOME LIMIT FOR CHARITY ELIGIBILITY FOR FREE OR discounted CARE IS 200% OF THE FEDERAL POVERTY LEVEL. DISCOUNTS ARE PROVIDED TO ALL PATIENTS WHO ARE uninsured whose income exceeds the limits to QUALIFY FOR CHARITY CARE. SELF-PAY DISCOUNTS ARE NOT LIMITED BASED ON INCOME. THE HOSPITAL ALSo PROVIDES PAYMENT PLANS FOR SELF-PAY PATIENTS. |
| Part I, Line 6a: | THE ANNUAL REPORT TO THE COMMUNITY IS MADE AVAILABLE TO THE PUBLIC VIA NEWSPAPER INSERTS, DIRECT MAILINGS, AND IS POSTED ON THE COMMONWEALTH HEALTH CORPORATION'S WEBSITE AT WWW.CHC.NET. |
| Part I, Line 7: | BAD DEBTS INCLUDED IN PART VIII LINE 2G TOTALED $1,240,264. THIS AMOUNT HAS BEEN REMOVED FROM TOTAL EXPENSES CALCULATED IN COLUMN F ON SCHEDULE H, PART I AND II.COST OF CHARITY CARE WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 2. THE COSTS RELATED TO MEDICAID PATIENTS WERE DETERMINED USING THE HOSPITAL COST ACCOUNTING SYSTEM. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS. |
| Part II, Community Building Activities: | community building activities include participation in chamber of commerce and industrial authority. |
| Part III, Line 2: | This is reported on the financial statements on page 4. |
| Part III, Line 8: | COSTS REPORTED ON LINE 6 ARE OBTAINED FROM THE MEDICARE COST REPORT WHICH are BASED ON A COST TO CHARGE RATIO. |
| Part III, Line 9b: | The Medical Center at CLINTON COUNTY ("MCC") PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE MCC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. MCc MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE THEY PROVIDE. thESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THEIR CHARITY CARE POLICY. OTHER COMPENSATED CARE RELATES PRINCIPALLY TO cONTRACTUAL ALLOWANCES FOR GOVERNMENT PAYERS, DISCOUNTS TAKEN BY COMMERCIAL PAYERS AND BAD DEBTS. BENEFITS FOR THE POOR INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARe because of inadequate resources or who are uninsured. this INCLUDES TRADITIONAL CHARITY CARE AT STANDARD BILLING RATES AND THE COSTS OF tREATING MEDICAID BENEFICIARIES IN EXCESS OF GOVERNMENT PAYMENTS. MCc DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO BE tRADITIONAL CHARITY CARE, THEREFORE, THESE amounts ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE. |
| Part VI, Line 2: | THE MEDICAL CENTER AT Clinton County ("MCc") IS BUILT UPON THE FOUNDATION OF SERVING OUR COMMUNITY, DAY IN AND DAY OUT, WITH QUALITY DEPENDABLE HEALTHCARE. MCc HAS NOT HISTORICALLY COMPLETED FORMAL HEALTH NEEDS ASSESSMENTS, HOWEVER, AS NEEDS ARISE IN THE COMMUNITY AND SURROUNDING COUNTIES, MCc RESPONDS. MCc IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AS DESCRIBED IN QUESTION 6 BELOW. |
| Part VI, Line 3: | UPON REGISTRATION, PATIENTS ARE PROVIDED A PATIENT HANDBook WHICH CONTAINS INFORMATION REGARDING FINANCIAL ASSISTANCE. aDDITIONALLY, SIGNAGE AND BROCHURES DESCRIBING FINANCIAL ASSISTANCE POLICIES ARE AVAILABLE AT aDMISSIONS AREAS. EACH PATIENT WILL RECEIVE A STATEMENT REFERRED TO AS A FIRST NOTICE. THE FIRST NOTICE STATES THAT IT IS NOT A BILL, BUT IT IS SUMMARY OF THE PATIENT'S CHARGES. THIS NOTICE aND EACH SUBSEQUENT STATEMENT CONTAINS INFORMATION CONCERNING FINANCIAL ASSISTANCE AS WELL AS CONTACT INFORMATION FOR QUESTIONS. |
| Part VI, Line 4: | THE MEDICAL CENTER AT Clinton County ("MCc") IS AN ACUTE CARE HOSPITAL WHICH SERVES THE RESIDENTS OF clinton and the surrounding COUNTies. THE COMMUNITY IS GROWING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THE PERCENTAGE OF UNINSURED PERSONS IN THE COMMUNITIES SERVED BY MCc IS HIGHER THAN THE KENTUCKY AVERAGE. |
| Part VI, Line 6: | THE MEDICAL CENTER AT Clinton County ("MCC") IS OWNED AND CONTROLLED BY COMMONWEALTH HEALTH CORPORATION ("CHC"). CHC HAS BEEN DETERMINED TO BE A PUBLICLY SUPPORTED ORGANIZATION DESCRIBED IN SECTION 509(A)(2) OF THE CODE AND A CHARITABLE ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXATION BY VIRTUE OF SECTIONS 501(A) AND 501(C)(3) OF THE CODE. MCC OPERATES A HOSPITAL IN THE COMMUNITY OF Clinton COUNTY, KENTUCKY. MCC IS A HOSPITAL OFFERING ACUTE CARE INPATIENT AND OUTPATIENT PROGRAMS IN ITS 42 BED ACUTE CARE FACILITY.COMMONWEALTH HEALTH CORPORATION: COMMONWEALTH HEALTH CORPORATION (CHC) IS A HOLDING COMPANY FOR A TOTAL OF Twelve FOR PROFIT AND NONPROFIT CORPORATIONS AND PARTNERSHIPS (COLLECTIVELY, THE "AFFILIATES") ENGAGED IN VARIOUS ASPECTS OF THE HEALTHCARE INDUSTRY. CHC HAS ESTABLISHED VARIOUS DIVISIONS FOR ITS OPERATIONS, INCLUDING (1) BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL ("THE MEDICAL CENTER"), (2) COMMONWEALTH HEALTH FREE CLINIC, INC, (3) THE MEDICAL CENTER AT FRANKLIN, INC, (4) COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC, AND (5) VARIOUS other non-profit and FOR-PROFIT CORPORATIONS AND PARTNERSHIPS. CHC OWNS AND OPERATES MULTIPLE PHYSICIAN PRACTICES AND EMPLOYS GENERAL PRACTITIONERS, CARDIAC SURGEONS, VASCULAR SURGEONS, NEUROSURGEONS, NEUROLOGISTS, OBSTETRIC/GYNECOLOGISTS, ORTHOPAEDICS, HOSPITALISTS, OTOLARYNGOLOGISTS, PSYCHIATRISTS, INFECTION DISEASE AND TRAVEL MEDICINE PHYSICIANS, HEMATOLOGY AND ONCOLOGY PHYSICIANS and GENERAL SURGEONS. CHC HAS ACQUIRED THE PHYSICIAN PRACTICES IN ORDER TO ATTRACT AND RETAIN HIGHLY SKILLED PHYSICIANS IN SPECIALTIES THAT SUPPORT THE MISSION OF CHC AND ITS AFFILIATES. IN ADDITION, CHC OPERATES AND PROVIDES VARIOUS CORPORATE SUPPORT SERVICES INCLUDING PATIENT BILLING, COLLECTIONS, ACCOUNTING, MATERIALS MANAGEMENT, ENGINEERING, SECURITY, HUMAN RESOURCES, INFORMATION SYSTEMS, AND ADMINISTRATIVE SUPPORT. SINCE 1990, CHC'S WHOLLY-OWNED CENTER CARE HEALTH BENEFITS PROGRAM ("CENTER CARE"), A PREFERRED PROVIDER ORGANIZATION (PPO), HAS ASSISTED EMPLOYERS IN MANAGING THE RISING COST OF THEIR HEALTHCARE. THE PPO OFFERS EMPLOYER GROUPS IN THIS REGION A COMPREHENSIVE NETWORK OF PHYSICIANS AND FACILITIES WITH GREATER COST SAVINGS POTENTIAL THAN OTHER NATIONAL ORGANIZATIONS. TODAY, CENTER CARE SERVES AS THE STATEWIDE NETWORK FOR MANAGED CARE ORGANIZATIONS PROVIDING MEDICAID MANAGED CARE SERVICE FOR THE STATE OF KENTUCKY. IT ALSO SERVICES OVER 500,000 MEMBERS BY PROVIDING ACCESS TO OVER 20,000 PROVIDERS IN KENTUCKY, TENNESSEE, INDIANA, OHIO, AND ILLINOIS. SINCE 2008, CHC HAS BEEN THE SOLE OWNER OF BLUEGRASS OUTPATIENT CENTER OF BOWLING GREEN, LLC ("BLUEGRASS"). BLUEGRASS PROVIDES COMPREHENSIVE OUTPATIENT REHABILITATION THERAPY SERVICES. BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION: THE BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION IS A NON-STOCK, NONPROFIT KENTUCKY CORPORATION THAT OPERATES A HOSPITAL FACILITY IN BOWLING GREEN, KENTUCKY, UNDER THE NAME "THE MEDICAL CENTER OR "THE MEDICAL CENTER AT BOWLING GREEN AND, SINCE OCTOBER 1996, A HOSPITAL AND NURSING HOME FACILITY IN SCOTTSVILLE, KENTUCKY, UNDER THE NAME "THE MEDICAL CENTER AT SCOTTSVILLE, AND A HOSPITAL IN HORSE CAVE, KENTUCKY, UNDER THE NAME "THE MEDICAL CENTER AT CAVERNA."THE MEDICAL CENTER AT BOWLING GREEN:THE MEDICAL CENTER AT BOWLING GREEN, WARREN COUNTY COMMUNITY HOSPITAL'S BOWLING GREEN FACILITY IS A GENERAL ACUTE CARE HOSPITAL LICENSED FOR 337 BEDS, WITH 333 BEDS IN USE. IN 1980, THE BOWLING GREEN FACILITY MOVED INTO A NEW, SIX STORY, STATE-OF-THE-ART FACILITY, OCCUPYING 298,000 SQUARE FEET ON A 17-ACRE CAMPUS. SINCE 1980, BECAUSE OF AN EXPANDING DEMAND FOR OUTPATIENT SERVICES, SEVERAL ADDITIONS TO THE BOWLING GREEN FACILITY HAVE BEEN MADE AND BOTH CLINICAL AND PATIENT AREAS HAVE BEEN RENOVATED AND MODERNIZED. TODAY, THE CAMPUS INCLUDES 56 ACRES AND THE BUILDINGS ON THE CAMPUS CONTAIN APPROXIMATELY 462,000 SQUARE FEET OF SPACE. IN ADDITION, THE HOSPITAL OPERATES THE WHOLLY OWNED MEDICAL CENTER, EMS, LLC. WHICH PROVIDES THE ONLY EMERGENCY MEDICAL SERVICE IN WARREN COUNTY. THE HOSPITAL IS ALSO A 50% PARTNER WITH ANOTHER NONPROFIT. IN OPERATING THE NON-PROFIT BARREN RIVER REGIONAL CANCER CENTER, INC, AN OUTPATIENT ONCOLOGY CENTER LOCATED IN GLASGOW, KENTUCKY. THE MEDICAL CENTER AT SCOTTSVILLE:TO MORE FULLY SERVE THE HEALTH NEEDS OF SOUTH CENTRAL KENTUCKY, THE MEDICAL CENTER MERGED IN OCTOBER 1996 WITH AN AFFILIATED ENTITY, HEALTH ENDOWMENT PROPERTIES A-C, INC, A KENTUCKY NON-STOCK, NONPROFIT CORPORATION, WHICH OWNED AND OPERATED THE MEDICAL CENTER AT SCOTTSVILLE(THE "SCOTTSVILLE FACILITY"). THE SCOTTSVILLE FACILITY OPENED IN 1996 AND IS COMPRISED OF A 25-BED medicare designated CRITICAL ACCESS HOSPITAL AND 110 NURSING CARE BEDS. THESE BEDS ARE LOCATED IN AN 85,000 SQUARE FOOT BUILDING ON APPROXIMATELY 13 ACRES OF LAND IN ALLEN COUNTY, NEAR SCOTTSVILLE, KENTUCKY.THE MEDICAL CENTER AT CAVERNA:THE MEDICAL CENTER AT CAVERNA, LOCATED IN HORSE CAVE, KENTUCKY, BECAME A PART OF THE BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION ON JANUARY 1, 2016. THE HOSPITAL IS A 25-BED medicare designated CRITICAL ACCESS HOSpITAL AND ALSO OPERATES TWO RURAL HEALTH CLINICS, ONE IN MUNFORDVILLE, KY AND ONE IN HORSE CAVE, KY.THE MEDICAL CENTER AT FRANKLIN, INC.:THE MEDICAL CENTER AT FRANKLIN, INC. ("MCF") OPERATES A HOSPITAL IN THE COMMUNITY OF FRANKLIN, SIMPSON COUNTY, KENTUCKY. THIS LOCATION IS JUST 20 MILES FROM THE MEDICAL CENTER'S BOWLING GREEN CAMPUS. MCF IS A MEDICARE DESIGNATED CRITICAL ACCESS HOSPITAL OFFERING ACUTE CARE INPATIENT AND OUTPATIENT PROGRAMS IN ITS 25 BED ACUTE CARE FACILITY.COMMONWEALTH HEALTH FREE CLINIC, INC.: COMMONWEALTH HEALTH FREE CLINIC, INC. ("CHFC") WAS ORGANIZED TO OPERATE A CLINIC, WHICH PROVIDES BASIC MEDICAL AND DENTAL DIAGNOSTIC AND TREATMENT SERVICES FOR CHARITABLE PURPOSES FOR THE UNINSURED AND UNDERINSURED OF SOUTH-CENTRAL KENTUCKY AND ALSO SERVES INDIVIDUALS WHO MAY BE COVERED BY SOME FORM OF INSURANCE, BUT WHO ARE UNABLE TO ACCESS A PROVIDER FOR ACUTE OR CHRONIC HEALTHCARE ISSUES. THE CLINIC OFFERS SERVICES INCLUDING NON-EMERGENCY CLINICAL SERVICES, DENTISTRY, COMMUNITY HEALTH EDUCATION AND COUNSELING, DISEASE/CONDITION SPECIFIC EDUCATION AND COUNSELING, AND ACCESS TO PHARMACEUTICALS.COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC: COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC IS A LONG-TERM ACUTE CARE HOSPITAL THAT OPERATES AS A HOSPITAL WITHIN A HOSPITAL BY LEASING 28 BEDS FROM THE MEDICAL CENTER ON THE MEDICAL CENTER'S BOWLING GREEN CAMPUS. IT IS AN ACUTE CARE HOSPITAL FOR THOSE PATIENTS REQUIRING AN EXTENDED HOSPITAL STAY (ANTICIPATED LENGTH OF STAY BETWEEN 18-35 DAYS) AND GENERALLY HAVING COMPLEX OR CHRONIC MEDICAL CONDITIONS. COMMONWEALTH HEALTH FOUNDATION: CHC ENDORSED THE ESTABLISHMENT OF COMMONWEALTH HEALTH FOUNDATION ("THE FOUNDATION") FOR THE PURPOSE OF FOSTERING, SUPPORTING AND INITIATING ACTIVITIES FOR THE ADVANCEMENT OF THE HEALTHCARE OBJECTIVES OF CHC AND THE MEDICAL CENTER AND/OR AFFILIATED NON-PROFIT 501(C)(3)ORGANIZATIONS. THE CHAIRMAN OF CHC'S BOARD OF DIRECTORS OR HIS/HER DESIGNEE, CHC'S PRESIDENT AND CEO, AND THE CHIEF FINANCIAL OFFICER OF THE MEDICAL CENTER SERVE AS EX OFFICIO DIRECTORS OF THE FOUNDATION. THEY ALL THREE ARE COUNTED FOR QUORUM PURPOSES AND HAVE THE RIGHTS AND PRIVILEGES OF OTHER DIRECTORS INCLUDING THE RIGHT TO VOTE ON ALL MATTERS PROPERLY BEFORE THE BOARD. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Connie Smith | ||||||||||||||
| President & CEO/Director | $0 | $684,572 | $0 | $0 | $0 | $184,074 | $0 | $0 | $0 | $11,764 | $0 | $880,410 | $0 | $0 |
| Barbara Jean Cherry | ||||||||||||||
| Executive Vice President/CIO | $0 | $432,993 | $0 | $0 | $0 | $81,340 | $0 | $0 | $0 | $11,076 | $0 | $525,409 | $0 | $0 |
| Ron Sowell | ||||||||||||||
| Executive Vice President/CFO | $0 | $433,521 | $0 | $0 | $0 | $91,155 | $0 | $0 | $0 | $10,548 | $0 | $535,224 | $0 | $0 |
| Betsy Kullman | ||||||||||||||
| Executive Vice President/CNO | $0 | $278,417 | $0 | $0 | $0 | $8,658 | $0 | $0 | $0 | $18,694 | $0 | $305,769 | $0 | $0 |
| Eric HAgan | ||||||||||||||
| Executive Vice President | $0 | $250,758 | $0 | $0 | $0 | $7,716 | $0 | $0 | $0 | $18,182 | $0 | $276,656 | $0 | $0 |
| Wade Stone | ||||||||||||||
| Executive Vice President | $0 | $285,421 | $0 | $0 | $0 | $1,908 | $0 | $0 | $0 | $26,818 | $0 | $314,147 | $0 | $0 |
| Sarah Moore | ||||||||||||||
| EVP (Retired 7/1/16) | $0 | $151,083 | $0 | $0 | $0 | $14,188 | $0 | $0 | $0 | $5,540 | $0 | $170,811 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b | FormAndLineReferenceDesc |
| Explanation | CERTAIN EXECUTIVES OF COMMONWEALTH HEATH CORPORATION PARTICIPATE IN A SUPPLEMENTAL RETIREMENT PLAN. THE CURRENT YEAR INCREASE IN THE ACCRUED BENEFIT, AS ACTUARIALLY DETERMINED, IS REPORTED AS COMPENSATION. THE FOLLOWING ARE THE INDIVIDUALS PARTICIPATING IN THE PLAN AND THE CURRENT YEAR INCREASES REPORTED AS COMPENSATION: CONNIE SMITH $171,036 RONALD SOWELL $80,028 JEAN CHERRY $72,099 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The corporation's articles of incorporation specify the corporation shall have one (1) member. The member shall be commonwealth Health Corporation, Inc. |
| Form 990, Part VI, Section A, line 7a | BYLAWS OF THE CORPORATION SPECIFY THAT THE SOLE MEMBER SHALL APPOINT A NOMINATING COMMITTEE WHICH SHALL MEET AND DESIGNATE NOMINEES FOR BOARD DIRECTORSHIPS. |
| Form 990, Part VI, Section B, line 11b | FORM 990 IS PLACED ELECTRONICALLY ON A COMPANY WEBSITE USED TO SHARE INFORMATION WITH BOARD MEMBERS. EACH BOARD MEMBER IS PROVIDED ACCESS TO THE WEBSITE AND IS ASKED TO REVIEW FORM 990 PRIOR TO A DESIGNATED DATE ON WHICH THE RETURN WILL BE FILED. AT LEAST TWO WEEKS OF ADVANCE NOTICE IS GIVEN TO BOARD MEMBERS SO THEY MAY REVIEW THE RETURN. |
| Form 990, Part VI, Section B, line 12c | THE COMMONWEALTH HEALTH CORPORATION (CHC) (APPLICABLE TO THE CORPORATION AND/OR ITS AFFILIATES) CODE OF CONDUCT EXPLICITLY STATES MEMBERS OF THE BOARD, ADMINISTRATION, THE MEDICAL STAFF, AND ALL EMPLOYEES ARE EXPECTED TO AVOID CONFLICTS OF INTEREST IN A TIMELY MANNER. ALL INDIVIDUALS SIGN AN ACKNOWLEDGEMENT UPON EMPLOYMENT THAT THEY HAVE RECEIVED A COPY OF THE CODE OF CONDUCT, ARE FAMILIAR WITH ITS CONTENT, AND UNDERSTAND THEIR RESPONSIBILITIES TO AVOID NON-COMPLIANT ACTIVITY. CHC'S REGULATORY COMPLIANCE COMMITTEE (RCC) REVIEWS AND APPROVES ALL CONTRACTS between CHC and/or its affiliates and disqualified entities. THE REVIEW IS DESIGNED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST BY BOARD MEMBERS AND/OR OFFICERS. RCC MEMBERS ARE PROHIBITED FROM TAKING PART IN DECISIONS REGARDING TRANSACTIONS WITH WHICH HE/SHE HAS A CONFLICT OF INTEREST. ANNUALLY, WRITTEN INQUIRY IS MADE-BY-QUESTIONNAIRE OF BOARD MEMBERS AND OFFICERS SEEKING DISCLOSURE OF CONFLICTS OF INTEREST OR INFORMATION THAT RELATES TO FAMILY MEMBERS. TRANSACTIONS ARISING ARE REVIEWED BY MANAGEMENT AS THEY OCCUR. |
| Form 990, Part VI, Section B, line 15 | EMPLOYEE OFFICERS OF THIS ENTITY ARE EMPLOYEES OF COMMONWEALTH HEALTH CORPORATION WHICH USES INDEPENDENT CONSULTANTS TO ANNUALLY REVIEW COMPENSATION. COMPENSATION-RELATED DETERMINATIONS ARE CONDUCTED IN ACCORDANCE WITH APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE AND REGULATIONS TO QUALIFY FOR THE PRESUMPTION THAT THE COMPENSATION IS REASONABLE, INCLUDING BUT NOT LIMITED TO APPROVAL BY AN AUTHORIZED COMMITTEE OF THE BOARD OF DIRECTORS WHO DO NOT HAVE A CONFLICT OF INTEREST, OBTAINING AND RELYING ON APPROPRIATE DATA AS TO COMPARABILITY AND CONCURRENT DOCUMENTATION OF THE BASIS FOR THE COMPENSATION DETERMINATIONS. |
| Form 990, Part VI, Section C, line 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ONLY MADE AVAILABLE IF REQUIRED, AND IN THE MANNER REQUIRED, BY A GOVERNING AGENCY. |
| Form 990, Part IX, line 11g | Collection Agency Fees: Program service expenses 74,796. Management and general expenses 0. Fundraising expenses 0. Total expenses 74,796. Physician Services: Program service expenses 1,000,764. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,000,764. Other Clinical Fees: Program service expenses 280,383. Management and general expenses 0. Fundraising expenses 0. Total expenses 280,383. Billing Fees: Program service expenses 95,093. Management and general expenses 0. Fundraising expenses 0. Total expenses 95,093. Contract Fees: Program service expenses 222,434. Management and general expenses 0. Fundraising expenses 0. Total expenses 222,434. Lab Fees: Program service expenses 7,323. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,323. Employee Support Fees: Program service expenses 18,609. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,609. |
| Form 990, Part XI, line 9: | Excess of assets over liabilities in transfer of Clinton County Hospital 5,181,977. Transfer from affiliate 4,133,192. |
| Form 990, Part XII, Line 2C | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| BOWLING GREEN WARREN CTY COMM HOSP CORP | ||||||||||
| 800 Park Street | Bowling Green | KY | 42101 | 610920842 | Hospital | KY | 501(c)(3) | Line 3 | N/A | 0 |
| The Medical Center at Franklin | ||||||||||
| 800 Park Street | Bowling Green | KY | 42101 | 611362001 | hospital | KY | 501(c)(3) | Line 3 | N/A | 0 |
| Commonwealth Regional Specialty Hospital | ||||||||||
| 800 Park Street | Bowling Green | KY | 42101 | 542142034 | hospital | KY | 501(c)(3) | Line 3 | N/A | 0 |
| Commonwealth Health Free Clinic | ||||||||||
| 800 Park Street | Bowling Green | KY | 42101 | 611292739 | hospital | KY | 501(c)(3) | Line 3 | N/A | 0 |
| Commonwealth Health Foundation Inc | ||||||||||
| 800 Park Street | Bowling Green | KY | 42101 | 611362000 | Support | KY | 501(c)(3) | Line 3 | N/A | 0 |
| Commonwealth Health Corporation Inc | ||||||||||
| 800 Park Street | Bowling Green | KY | 42101 | 311118087 | Support | KY | 501(c)(3) | Line 3 | N/A | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| URGENTCARE PROPERTIES | |||||||
| 800 Park Street | Bowling Green | KY | 42101 | 611197268 | Real Estate | KY | N/A |
| Medical Plaza Partners | |||||||
| 800 Park Street | Bowling Green | KY | 42101 | 611080340 | Real Estate | KY | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Urgentcare of Bowling Green Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Park Street | AddressLine1Txt |
| City | Bowling Green | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611035393 | EIN |
| Primary Activities | Healthcare | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |