2018-03-15T15:43:49-05:00 2017-04-30 351178661 Blue & Co LLC 2650 Eastpoint Pkwy Suite 300 Louisville KY 40223 990 2016-05-01 610471581 Trigg County Hospital TRIG 2702063601 254 Main Street Cadiz KY 42211 John Sumner CEO 2702063601 2018-03-15 1 Carrie A Merrill CPA P00832283 5029923500 2018-03-15 38.109.186.2 2018-03-15 15:13:07 ED P B19D0506B86ED19F1A0FD2AFEEB91090E576B51F CEC041C7A28BF02AF1651001FA3B4F793CABA0CE 2016 2021-01-29 14:40:06Z John Sumner 254 Main Street Cadiz KY 42211 16997880 0 X www.trigghospital.org X 1952 KY To provide quality healthcare services in a caring and cost-effective manner. We pledge to meet standards of excellence and improve the value of our service. 12 12 263 50 0 0 2508312 396835 16148134 16518831 4207 6910 99021 75304 18759674 16997880 0 0 0 0 8129404 7221345 0 0 0 8499349 9337829 16628753 16559174 2130921 438706 14973912 17216692 10541125 13084136 4432787 4132556 To provide quality healthcare services in a caring and cost-effective manner. In achieving our mission, we pledge to meet standards of excellence while continuously improving the value of our service. 0 0 15562297 0 16524268 Our mission is to provide quality healthcare services in a caring and cost-effective manner. In achieving our mission, we pledge to meet standards of excellence while continuously improving the value of our service. The hospital provides inpatient, outpatient, and emergency care services to patients in the Trigg County, Kentucky area. 15562297 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 27 0 1 263 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X Nacy Butts 2702063601 254 Main Street Cadiz KY 42211 Michael Gross Chairman 1.00 0.00 X X 0 0 0 Stephanie Perry Vice Chairman 1.00 0.00 X X 0 0 0 George Radford Secretary/Treasurer 1.00 0.00 X X 0 0 0 William Anderson Board Member 1.00 0.00 X 0 0 0 Craig Fowler board Member 1.00 0.00 X 0 0 0 Melissa Hale board Member 1.00 0.00 X 0 0 0 Clara Beth Hyde board Member 1.00 0.00 X 0 0 0 Joe Nichols board Member 1.00 0.00 X 0 0 0 Bob Noel board Member 1.00 0.00 X 0 0 0 Christy Oliphant board Member 1.00 0.00 X 0 0 0 Joe Powell board Member 1.00 0.00 X 0 0 0 Mike Wright board Member 1.00 0.00 X 0 0 0 John Sumner CEO 40.00 0.00 X 134726 0 363 Nacy Butts CFO 40.00 0.00 X 14593 0 117 David Rutland Pharmacist 40.00 0.00 X 132246 0 34640 Holly McCormick Nurse Practitioner 40.00 0.00 X 105940 0 0 Callie Wells APRN 40.00 0.00 X 100292 0 14184 487797 0 49304 4 0 1 0 Align MD 5121 Maryland Way Suite 300 Brentwood TN 37027 ER Physician 1619040 Therapy Staffing Specialists 755 Everett Lane Hopkinsville KY 42240 Physical/Occupational/Speech 867123 cpsi iNC 6600 Wall street mobile AL 36695 Software & Billing 661928 Diamond Healthcare Corporation PO Box 85050 Richmond VA 23285 Behavioral & CP Cons 276701 ARAMARK UNIFORM SERVICES PO BOX 731676 DALLAS TX 75373 UNIFORM SERVICE 229309 9 355000 41835 396835 Service Revenue 621110 16079949 16079949 340B Program Revenue 621110 436185 436185 Charity Care 900099 2697 2697 16518831 6910 6910 38664 0 38664 38664 38664 Cafeteria 722210 29964 29964 Life Line 900099 5437 5437 1239 1239 36640 16997880 16524268 0 76777 X 149799 149799 5959946 5812824 147122 3678 3411 267 659112 611257 47855 448810 416224 32586 5078 5078 30213 30213 5076077 4971777 104300 53035 53035 681850 659937 21913 735625 707147 28478 18591 4591 14000 315593 315593 889337 889337 164720 164720 Medical Supplies 735548 728964 6584 Provider Tax 132718 132718 Collection Fees 124452 124452 Dues & Sub. 29977 20423 9554 345015 235059 109956 16559174 15562297 996877 0 56716 96582 445000 675050 2869079 4720754 2364 2059 151845 184700 120602 316412 21252668 10031533 10781621 11221135 546685 0 14973912 17216692 1779721 1968874 8761404 10713056 0 402206 10541125 13084136 X 4118354 3907739 314433 224817 4432787 4132556 14973912 17216692 X 438706 -649321 -89616 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1447 1447 0 Part II-B, Line 1: A portion of the organization's KHA & AHA dues are used for lobbying activities. Approximately 14.9% of dues is for lobbying. Total dues $9,713. 66000 66000 14848830 4578227 10270603 6337838 5453306 884532 11221135 Third Party Payable 402206 402206 1 1 1 X 1 X 100.000000000000 1 1 1 0 0 33991 33991 0.00210 2942621 2452535 490086 0.02960 2976612 2452535 524077 0.03170 2976612 2452535 524077 0.03170 1 204523 0 6044343 6080555 -36212 X 1 1 1 1 Trigg County Hospital Inc 254 Main Street Cadiz KY 42211 www.trigghospital.org 600055 X X X Trigg County Hospital Inc 1 0 0 1 X X X X X X X X X 16 1 0 0 1 http://www.trigghospital.org X 1 16 1 http://www.trigghospital.org 0 1 X 100.000000000000 100.000000000000 X X 1 1 X 1 X http://www.trigghospital.org/getpage.php?name=Patient_Finacial_Information& X http://www.trigghospital.org/getpage.php?name=Patient_Finacial_Information& X X X 1 X 0 X 1 0 0 Part I, Line 7: Trigg County Hospital is a critical access hospital and is reimbursed from medicare at 101% of cost related to caring for medicare patients. Medicare revenues and costs reported on lines 5 and 6 are based on the medicare cost report. Part III, Line 4: Financial Statement Footnote: Net patient service revenue is reported at estimated retroactive revenue adjustments and a provision for uncollectible accounts. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered and such estimated amounts are revised in future periods as adjustments become known. Part III, Line 8: The source used to determine the amount of Medicare allowable costs reported for Part III, Section B, Medicare has been provided from the year ended April 30, 2017: Hospital Statement of Reimbursable Cost. Part III, Line 9b: The hospital does not pursue collection of amounts determined to qualify as charity care or financial assistance. Part VI, Line 2: Needs Assessed:In addition to completing a CHNA every three years, the Hospital is always willing and available to meet the needs of the community as they arise. The Hospital assists other agencies, as needed, to meet the health and welfare needs of the community. Part VI, Line 3: Patient Education:Uninsured and underinsured patients are provided with information about the charity care program. The hospital contracts with disability medical consultants to contact each of these identified patients and provides them with information on how to get qualified for Medicaid or how to enroll in insurance programs available through the affordable care act. Part VI, Line 4: Community Information:The Hospital is a rural community located in western kentucky with an estimated population of 14,142. Approximately, 21% of the county residents are age 65 and older. Trigg County has been designed as a health professional shortage area and medically underserved area. The median household income is right around $45,000 and about 21% of the county population is uninsured. 0 0 0 0 0 0 0 0 0 David Rutland Pharmacist 132246 0 0 0 0 0 0 0 34640 0 166886 0 0 0 Form 990, Part VI, Section B, line 11b A copy of the form 990 was not provided to the board before filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy is reviewed annually. All employees, staff, officers, and board members are covered by this policy. Each year, the board members are asked to sign a conflict of interest statement. The hospital has policies and procedures in place that will be followed should a conflict of interest arise. A record of the proceedings where conflicts are addressed is kept on file once reviewed. Form 990, Part VI, Section B, line 15 The board of directors reviews the CEO compensation annually. The reviews of employees are done annually by their supervisor or upper management. The date of the completion depends on the employees' anniversary date. Form 990, Part VI, Section C, line 19 A legal ad is published annually to advise of the availability of audited financial statements at the hospital. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,971,777. Management and general expenses 104,300. Fundraising expenses 0. Total expenses 5,076,077. Form 990, Part XI, line 9: Change in Restricted Net Assets -89,616. Trigg County Hospital Foundation Inc 254 Main Street Cadiz KY 42211 061805018 education KY 501(c)(3) Line 7 N/A 0 Trigg County Public Hospital Corporation PO Box 672 Cadiz KY 42211 611336530 Gov't Unit KY 501(a) n/a N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0