CUMBERLAND COUNTY HOSPITAL ASSOCIATION INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CUMBERLAND COUNTY HOSPITAL ASSOCIATION INC (EIN 61-0624096)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201701359349305310
- Schema version
- 2015v3.0
- 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 K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T11:57:23-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610624096 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND COUNTY HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CUMB | BusinessNameControlTxt |
| Phone | 2708642511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 280 | AddressLine1Txt |
| City | BURKESVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42717 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICK CAPPS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2708642511 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CARRIE A MERRILL CPA | PreparerPersonNm |
| PTIN | P00832283 | PTIN |
| Phone | 5029923500 | PhoneNum |
| Preparation | 2017-05-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICK CAPPS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 280 | AddressLine1Txt |
| City | BURKESVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42717 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,209,708 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CCHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1964 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | CUMBERLAND COUNTY HOSPITAL SEEKS TO BECOME THE NETWORK LEADER IN PROVIDING, COORDINATING, AND CONTRACTING THE FULL CONTINUUM OF HEALTH CARE SERVICES REQUIRED BY RESIDENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 237 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $72,000 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $20,051 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $231,833 | PYContributionsGrantsAmt |
| CY Contributions Grants | $20,035 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,186,746 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,737,127 | CYProgramServiceRevenueAmt |
| PY Investment Income | $11,211 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,985 | CYInvestmentIncomeAmt |
| PY Other Revenue | $376,277 | PYOtherRevenueAmt |
| CY Other Revenue | $444,561 | CYOtherRevenueAmt |
| PY Total Revenue | $17,806,067 | PYTotalRevenueAmt |
| CY Total Revenue | $16,209,708 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,149,757 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,366,088 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,988,322 | PYOtherExpensesAmt |
| CY Other Expenses | $7,651,147 | CYOtherExpensesAmt |
| PY Total Expenses | $18,138,079 | PYTotalExpensesAmt |
| CY Total Expenses | $17,017,235 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$332,012 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$807,527 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,775,689 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,506,619 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,935,811 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,474,268 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,839,878 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,032,351 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CUMBERLAND COUNTY HOSPITAL SEEKS TO BECOME THE NETWORK LEADER IN PROVIDING, COORDINATING, AND CONTRACTING THE FULL CONTINUUM OF HEALTH CARE SERVICES REQUIRED BY RESIDENTS OF CUMBERLAND COUNTY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,902,873 | ExpenseAmt |
| Revenue | $15,737,127 | RevenueAmt |
| Desc | CUMBERLAND COUNTY HOSPITAL, IN PARTNERSHIP WITH ITS MEDICAL STAFF, EMPLOYEES, AND OTHER PROVIDERS, STRIVES TO BE RECOGNIZED FOR HIGH QUALITY, COST-EFFECTIVE CARE RESULTING IN COMMUNITY PRIDE, CONFIDENCE, AND SUPPORT. THE HOSPITAL ACKNOWLEDGES THE PARTNERSHIPS REQUIRED WITH ITS MEDICAL STAFF, ITS EMPLOYEES, AND OTHER PROVIDERS TO ACHIEVE THIS VISION. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN CUMBERLAND COUNTY, KY AND SURROUNDING COUNTIES. THE HOSPITAL PROVIDED APPROXIMATELY $110,000 IN CHARITY CARE DURING THE YEAR ENDED JUNE 30, 2016. | Desc |
| Total Program Service Expenses | $13,902,873 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 61 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 237 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | RICK NEIKIRK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2708642511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 280 | AddressLine1Txt |
| City | BURKESVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42717 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DOUGLAS BUTLER | ||||||||
| CHAIRMAN OF THE BOARD | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOE DAVID BROWN | ||||||||
| VICE CHAIRMAN OF BOARD | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH NORRIS | ||||||||
| SECRETARY/TREASURER OF BOARD | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DR ROBERT FLOWERS SR | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | Yes (X) | $605,205 | $0 | $14,365 | |||
| JOHN HURT | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES LONG | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID T LONG | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TODD MORGAN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| VICKIE WELLS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| STEVE BURNS | ||||||||
| COO | 40.00 | Yes (X) | Yes (X) | $90,309 | $0 | $8,755 | ||
| RICHARD NEIKIRK | ||||||||
| CEO | 40.00 | Yes (X) | $185,222 | $0 | $11,603 | |||
| RICHIE CAPPS | ||||||||
| CFO | 40.00 | Yes (X) | $132,212 | $0 | $10,012 | |||
| DR SAMUEL RICE | ||||||||
| DIRECTOR OF INPATIENT SERVICES | 40.00 | $442,923 | $0 | $6,046 | Yes (X) | |||
| DR ROBERT FLOWERS JR | ||||||||
| PHYSICIAN | 40.00 | $396,423 | $0 | $9,360 | Yes (X) | |||
| DR CHRISTIAN KONSAVAGE | ||||||||
| PHYSICIAN/ MEDICAL STAFF DIR. | 40.00 | $187,870 | $0 | $6,046 | Yes (X) | |||
| VICTORIA KINGREY | ||||||||
| APRN/OFFICE DIRECTOR | 40.00 | $130,919 | $0 | $9,974 | Yes (X) | |||
| MEGAN SELLS | ||||||||
| PHARMACIST | 40.00 | $127,308 | $0 | $9,229 | Yes (X) | |||
| PEGGY FLOWERS | ||||||||
| DIRECTOR OF FRHC/RN | 40.00 | $122,844 | $0 | $9,731 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,421,235 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $95,121 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| QUEST DIAGNOSTICS | |||||
| PO BOX 530458 | ATLANTA | GA | 30374 | OUTSOURCE LAB TEST | $170,776 |
| INSPIRE MEDICAL | |||||
| 2323 LIME KILN LANE | LOUISVILLE | KY | 40222 | ER COVERAGE | $140,561 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $20,035 | AllOtherContributionsAmt |
| Total Contributions | $20,035 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HOSPITAL SERVICES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $15,737,127 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,737,127 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,737,127 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,985 | TotalRevenueColumnAmt |
| Exclusion | $7,985 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $119,480 | 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 | $119,480 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $119,480 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $72,000 | UnrelatedBusinessRevenueAmt |
| Exclusion | $47,480 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 722514 | $49,785 | $49,785 |
| EHR INCENTIVES | 900099 | $17,000 | $17,000 |
| REBATES | 900099 | $3,607 | $3,607 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $254,689 | TotalRevenueColumnAmt |
| Exclusion | $254,689 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $325,081 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,209,708 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,737,127 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $72,000 | UnrelatedBusinessRevenueAmt |
| Exclusion | $380,546 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,015,838 | TotalAmt |
| Program Services | $772,037 | ProgramServicesAmt |
| Management And General | $243,801 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,924,312 | TotalAmt |
| Program Services | $5,254,112 | ProgramServicesAmt |
| Management And General | $1,670,200 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $191,112 | TotalAmt |
| Program Services | $145,014 | ProgramServicesAmt |
| Management And General | $46,098 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $627,404 | TotalAmt |
| Program Services | $476,069 | ProgramServicesAmt |
| Management And General | $151,335 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $607,422 | TotalAmt |
| Program Services | $461,641 | ProgramServicesAmt |
| Management And General | $145,781 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,273 | TotalAmt |
| Program Services | $18,418 | ProgramServicesAmt |
| Management And General | $5,855 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,108 | TotalAmt |
| Program Services | $23,605 | ProgramServicesAmt |
| Management And General | $7,503 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,050,460 | TotalAmt |
| Program Services | $1,555,872 | ProgramServicesAmt |
| Management And General | $494,588 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,773 | TotalAmt |
| Program Services | $10,451 | ProgramServicesAmt |
| Management And General | $3,322 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,315 | TotalAmt |
| Program Services | $408,469 | ProgramServicesAmt |
| Management And General | $129,846 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $293,988 | TotalAmt |
| Program Services | $223,076 | ProgramServicesAmt |
| Management And General | $70,912 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,240 | TotalAmt |
| Program Services | $55,574 | ProgramServicesAmt |
| Management And General | $17,666 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $385,019 | TotalAmt |
| Program Services | $385,019 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $927,816 | TotalAmt |
| Program Services | $927,816 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,357 | TotalAmt |
| Program Services | $150,512 | ProgramServicesAmt |
| Management And General | $47,845 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,604,293 | $2,604,293 | |
| PROVIDER TAX | $180,458 | $180,458 | |
| DUES & SUBSCRIPTIONS | $46,300 | $35,132 | $11,168 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,747 | TotalAmt |
| Program Services | $215,305 | ProgramServicesAmt |
| Management And General | $68,442 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,017,235 | TotalAmt |
| Program Services | $13,902,873 | ProgramServicesAmt |
| Management And General | $3,114,362 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $436,666 | BOYAmt |
| EOY | $588,795 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $5,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,780,402 | BOYAmt |
| EOY | $2,614,064 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $410,450 | BOYAmt |
| EOY | $452,839 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,257 | BOYAmt |
| EOY | $49,529 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,027,017 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,311,207 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,303,993 | BOYAmt |
| EOY | $9,715,810 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,764,921 | BOYAmt |
| EOY | $2,080,582 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,775,689 | BOYAmt |
| EOY | $15,506,619 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,623,655 | BOYAmt |
| EOY | $1,478,033 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,312,156 | BOYAmt |
| EOY | $9,194,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $802,235 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,935,811 | BOYAmt |
| EOY | $11,474,268 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,839,878 | BOYAmt |
| EOY | $4,032,351 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,839,878 | BOYAmt |
| EOY | $4,032,351 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,775,689 | BOYAmt |
| EOY | $15,506,619 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$807,527 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | 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 | $1,437 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,437 | 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 | A PERCENTAGE OF DUES PAID TO THE KENTUCKY HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. FOR FY16, THIS PERCENTAGE WAS 15.1%. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $547,269 | OtherCostOrOtherBasisAmt |
| Book Value | $547,269 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,557,191 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,850,507 | DepreciationAmt |
| Book Value | $6,706,684 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,253,866 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,166,793 | DepreciationAmt |
| Book Value | $2,087,073 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $668,691 | OtherCostOrOtherBasisAmt |
| Depreciation | $293,907 | DepreciationAmt |
| Book Value | $374,784 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,715,810 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $835,110 |
| RESTRICTED FUNDS | $821,886 |
| INTERNALLY DESIGNATED ASSETS | $4,994 |
| DUE FROM THIRD PARTIES | $418,592 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,080,582 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION 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 HOSPITAL, AND HAS CONCLUDED THAT AS OF JUNE 30, 2016 AND 2015, 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 HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | 0 | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $141,523 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $186,024 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$44,501 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,471,975 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,365,160 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,106,815 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,613,498 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,551,184 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,062,314 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,200 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $575 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $85,977 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,459 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $68,518 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $87,177 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,034 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $69,143 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,700,675 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,569,218 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,131,457 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06900 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 80 | PersonsServedCnt |
| Total Community Benefit Expns | $1,360 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,200 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 80 | PersonsServedCnt |
| Total Community Benefit Expns | $1,360 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,200 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $160 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $743,340 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $213,645 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,369,807 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,644,429 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$274,622 | 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 | 0 | 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 | CUMBERLAND COUNTY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 299 GLASGOW ROAD | AddressLine1Txt |
| City | BURKESVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42717 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND COUNTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CCHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.CCHOSPITAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 | HTTP://WWW.CCHOSPITAL.ORG/FINANCIALASSISTANCE.HTML | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.CCHOSPITAL.ORG/FINANCIALASSISTANCE.HTML | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CUMBERLAND COUNTY HOSPITAL | PART V, SECTION B, LINE 5: CUMBERLAND COUNTY HOSPITAL INTERVIEWED SEVEN KEY INFORMANTS FROM THE COMMUNITY IN ORDER TO ASSESS PUBLIC PERCEPTIONS OF THE COUNTY'S HEALTH STATUS AND UNMET NEEDS. THE INTERVIEWEES WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, THEIR AFFILIATION WITH THE LOCAL GOVERNMENT, FROM THE SCHOOLS OR INDUSTRY AND THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. THE KEY INFORMANTS WERE: A MEMBER FROM THE LAKE CUMBERLAND HEALTH DEPARTMENT, AN EMPLOYEE FROM THE CUMBERLAND COUNTY HOSPITAL, ADMINISTRATION FROM THE CUMBERLAND VALLEY MANOR (NURSING HOME), THE CITY MAYOR, EMERGENCY MANAGEMENT SERVICES DIRECTOR, A DIRECTOR FROM CUMBERLAND COUNTY SCHOOLS, AND DIRECTOR OF BURKESVILLE HOUSING AUTHORITY. |
| CUMBERLAND COUNTY HOSPITAL | PART V, SECTION B, LINE 11: CUMBERLAND COUNTY HOSPITAL IDENTIFIED COMMUNITY HEALTH NEEDS BY CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT DURING ITS FISCAL YEAR ENDING JUNE 30, 2016. PRIMARY DATA WAS OBTAINED BY CONDUCTING KEY INFORMANT INTERVIEWS. IN ADDITION, SECONDARY DATA WAS COMPILED FROM DEMOGRAPHIC AND SOCIOECONOMIC SOURCES AS WELL AS NATIONAL, STATE AND LOCAL SOURCES OF INFORMATION ON DISEASE PREVALENCE, HEALTH INDICATORS, AND MORTALITY. DATA WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF VULNERABLE POPULATIONS AND THE COMMUNITY AS A WHOLE. HEALTH NEEDS WERE PRIORITIZED UTILIZING A METHOD THAT WEIGHS: 1) THE SIZE OF THE PROBLEM; 2) THE SERIOUSNESS OF THE PROBLEM; 3) THE IMPACT OF THE ISSUE ON VULNERABLE POPULATIONS; 4) HOW IMPORTANT THE ISSUE IS TO THE COMMUNITY; AND 5) WHETHER OR NOT THE HOSPITAL HAS EXISTING PROGRAMS TO RESPOND TO THE IDENTIFIED NEED.SUBSEQUENTLY, CUMBERLAND COUNTY HOSPITAL'S LEADERSHIP ENTERED IN TO A DIALOGUE TO DISCUSS THE RESULTS OF THE EVALUATION AND SELECT HEALTH PRIORITIES. AS A RESULT OF THE ANALYSIS, THE FOLLOWING AREAS WERE IDENTIFIED AS PRIORITY AREAS ON WHICH WE WILL FOCUS OVER THE NEXT THREE YEARS:-PREVENTION AND MANAGEMENT OF CHRONIC DISEASES: HEART DISEASE AND CANCER-ACCESS TO CARE: UNINSURED ADULTS, PREVENTATIVE CARE FOR ELDERLY, TRANSPORTATION, SHORTAGE OF PRIMARY CARE PHYSICIANS-HEALTHY LIVING: ADULT OBESITY AND PHYSICAL INACTIVITY, DRUG ABUSE, TOBACCO USE |
| CUMBERLAND COUNTY HOSPITAL | PART V, SECTION B, LINE 13B: DETERMINING FREE CARE: STATE GUIDELINES ARE FOLLOWED FOR ELIGIBILITY REQUIREMENTS AS SET FORTH BY DMS FOR DISPROPORTIONATE SHARE HOSPITAL PROGRAMS FOR THE CURRENT YEAR. UPON COMPLETION OF THE APPLICATION, IT CAN BE DETERMINED WHETHER THE PATIENT IS ELIGIBLE FOR CHARITY. IF THE PATIENT IS ELIGIBLE 100% WILL BE ADJUSTED. THE INCOME LIMITS ARE FOR A HOUSEHOLD SIZE OF ONE, AN ANNUAL INCOME OF $13,520 OR LOWER QUALIFIES. FOR EACH ADDITIONAL PERSON IN THE HOUSEHOLD THE INCOME LIMIT IS INCREASED $4,680.DETERMINING DISCOUNTED CARE: ALL PATIENTS WITH A PRIVATE PAY BALANCE OF ANY FORM (DEDUCTIBLE, ALL CHARGES ETC.) QUALIFY FOR A 40% DISCOUNT IMMEDIATELY WITH A PROMPT PAYMENT OR PROMPT REPAYMENT PLAN. |
| CUMBERLAND COUNTY HOSPITAL | PART V, SECTION B, LINE 22D: DETERMINATION OF CHARGES TO FAP-ELIGIBLE INDIVIDUALS: IF A PATIENT COMPLETES THE FAP APPLICATION FOR CHARITY CARE AND IT IS DETERMINED THAT HE/SHE QUALIFIES, 100% OF THE CHARGES ARE DISCOUNTED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - BF TAYLOR CLINIC | ||||
| 299A GLASGOW ROAD | BURKESVILLE | KY | 42717 | RURAL HEALTH CLINIC |
| 2 - FLOWERS RURAL HEALTH CLINIC | ||||
| 333 KEEN STREET | BURKESVILLE | KY | 42717 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | DETERMINE FREE CARE: STATE GUIDELINES ARE FOLLOWED FOR ELIGIBILITY REQUIREMENTS AS SET FORTH BY DMS FOR DISPROPORTIONATE SHARE HOSPITAL PROGRAMS FOR THE CURRENT YEAR. UPON COMPLETION OF THE APPLICATION, IT CAN BE DETERMINED WHETHER THE PATIENT IS ELIGIBLE FOR CHARITY. IF THE PATIENT IS ELIGIBLE 100% WILL BE ADJUSTED. THE INCOME LIMITS ARE FOR A HOUSEHOLD SIZE OF ONE AN ANNUAL INCOME OF $13,520 OR LOWER QUALIFIES. FOR EACH ADDITIONAL PERSON IN THE HOUSEHOLD THE INCOME LIMIT IS INCREASED $4,680. DETERMINIE DISCOUNTED CARE: ALL PATIENTS WITH A PRIVATE PAY BALANCE OF ANY FORM (DEDUCTIBLE, ALL CHARGES ETC.) QUALIFY FOR A 25% DISCOUNT IMMEDIATELY WITH A PROMPT PAYMENT OR PROMPT REPAYMENT PLAN. |
| PART III, LINE 2: | THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT. IN DETERMINING WHAT AMOUNTS SHOULD BE INCLUDED IN BAD DEBT, CCH HAS A BAD DEBT POLICY THAT THEY FOLLOW. THE AMOUNTS WRITTEN OFF TO BAD DEBT ARE THE ACTUAL WRITE OFFS MADE DURING THE YEAR PLUS THE ALLOWANCE FOR BAD DEBTS THAT IS CALCULATED BASED ON PREVIOUS YEARS ACTIVITY THAT IS APPLIED TO CURRENT ACCOUNTS. ALL PAYMENTS THAT ARE MADE ARE APPLIED DIRECTLY TO THE ACCOUNT IN CONJUNCTION WITH AN CONTRACTUAL'S TO INSURANCE COMPANIES OR DISCOUNTS. SEE PAGE 8 AND 9 OF THE AUDITED FINANCIAL STATEMENTS |
| PART III, LINE 3: | THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART VI, LINE 3: | PATIENTS ARE INFORMED OF PATIENT ASSISSTANCE AT TIME OF REGISTRATIONS, BY THE DISCHARGE NURSE, IF INPATIENT, AND ARE MAILED A LETTER. |
| PART VI, LINE 4: | THE POPULATION OF CUMBERLAND COUNTY, KY IS APPROXIMATELY 6,800. CUMBERLAND COUNTY HOSPITAL QUALIFIES FOR A DISPROPORTIONATE SHARE PAYMENT ON THEIR MEDICARE COST REPORT DUE TO THE LARGER THAN NORMAL SHARE OF MEDICAID PATIENT VOLUME SERVED BY THE HOSPITAL. NEARLY 35% OF THE COUNTIES' RESIDENTS ARE ENROLLED IN MEDICAID. |
| PART VI, LINE 5: | THE COMMUNITY HEALTH FAIR IS A HUGE SUCCESS. IT IS AN EXCELLENT WAY FOR THE HOSPITAL TO SHARE IMPORTANT HEALTH INFORMATION WITH THE COMMUNITY. CUMBERLAND COUNTY HOSPTIAL ALSO HAS RADIO SPOTS ON THE LOCAL RADIO STATION TO DISCUSS SPECIFIC HEALTH NEEDS AND TO SHARE HEALTH INFORMATION WITH THE COMMUNITY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR ROBERT FLOWERS SR | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $277,312 | $0 | $0 | $0 | $327,893 | $0 | $8,319 | $0 | $6,046 | $0 | $619,570 | $0 | $0 | $0 |
| RICHARD NEIKIRK | ||||||||||||||
| CEO | $185,222 | $0 | $0 | $0 | $0 | $0 | $5,557 | $0 | $6,046 | $0 | $196,825 | $0 | $0 | $0 |
| DR SAMUEL RICE | ||||||||||||||
| DIRECTOR OF INPATIENT SERVICES | $280,000 | $0 | $0 | $0 | $162,923 | $0 | $0 | $0 | $6,046 | $0 | $448,969 | $0 | $0 | $0 |
| DR ROBERT FLOWERS JR | ||||||||||||||
| PHYSICIAN | $202,787 | $0 | $0 | $0 | $193,636 | $0 | $3,314 | $0 | $6,046 | $0 | $405,783 | $0 | $0 | $0 |
| DR CHRISTIAN KONSAVAGE | ||||||||||||||
| PHYSICIAN/ MEDICAL STAFF DIR. | $187,870 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,046 | $0 | $193,916 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCH J, PART II | FormAndLineReferenceDesc |
| Explanation | DR. ROBERT FLOWERS, DR. SAMUEL RICE AND DR. ROBERT FLOWERS, JR., WERE W-2 EMPLOYEES AT BFT CLINIC AND INDEPENDENT CONTRACTORS FOR ER COVERAGE FOR THE YEAR. DR. ROBERT FLOWERS' TOTAL COMPENSATION OF $619,570 CONSISTS OF $327,893 OF 1099 COMPENSATION AND THE REST WERE W-2 WAGES. DR. RICE'S TOTAL COMPENSATION OF $448,965 CONSISTS OF $162,923 OF 1099 COMPENSATION AND THE REST WERE W-2 WAGES. DR. ROBERT FLOWERS, JR'S TOTAL COMPENSATION OF $405,783 CONSISTS OF $193,636 OF 1099 COMPENSATION AND THE REST WERE W-2 WAGES. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND HEALTH SERVICES CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 611180160 | BondIssuerEIN |
| CUSIP | NONEAVAIL | CUSIPNum |
| Bond Issued | 2012-04-18 | BondIssuedDt |
| Issue Price | $8,500,000 | IssuePriceAmt |
| Purpose | PROCEEDS SPENT TO RENOVATE AND CONSTURCT AN ADDITION TO THE HOSPITAL. | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $8,500,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $38,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $8,462,000 | CapitalExpendituresAmt |
| Substantial Completion | 2014 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd | TransactionTransactionAmt |
|---|---|---|---|
| BOARD MEMBERS | |||
| BOARD MEMBERS | JOE DAVID BROWN, JAMES LONG, TODD MORGAN, AND DAVID LONG ARE ALSO BOARD MEMBERS OF CITIZENS BANK OF CUMBERLAND COUNTY WHERE CUMBERLAND COUNTY HOSPITAL HAS DEBT AND HOLDS AN OPERATING BANK ACCOUNT. | 0 | |
| JOE DAVID BROWN | |||
| BOARD MEMBERS | BOARD MEMBER JOE DAVID BROWN OWNS A LOCAL HARDWARE STORE WHERE ITEMS ARE PURCHASED FOR THE HOSPITAL. | 0 | $5,756 |
| TODD MORGAN | |||
| BOARD MEMBERS | BOARD MEMBER TODD MORGAN OWNS KENTUCKY FARM BUREAU OF CUMBERLAND COUNTY WHERE CUMBELAND COUNTY HOSPITAL HOLDS AN INSURANCE POLICY. | 0 | $2,250 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | PER THE BY-LAWS, ANY PERSON OR ENTITY HAVING ITS PRINCIPAL OFFICE IN CUMBERLAND COUNTY, KY AND HAVING CUMBERLAND COUNTY, KY AS THE PRINCIPAL AREA OF ITS ACTIVITY MAY BECOME A MEMBER OF THE HOSPITAL ASSOCIATION. TO BECOME A MEMBER OF THE ASSOCIATION, A DONATION OF $100 MUST BE MADE TO THE ASSOCIATION. NINE DIRECTORS OF THE ELEVEN DIRECTOR BOARD MAY BE ELECTED BY THE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | PER THE BY-LAWS, ANY PERSON OR ENTITY HAVING ITS PRINCIPAL OFFICE IN CUMBERLAND COUNTY, KY AND HAVING CUMBERLAND COUNTY, KY AS THE PRINCIPAL AREA OF ITS ACTIVITY MAY BECOME A MEMBER OF THE HOSPITAL ASSOCIATION. TO BECOME A MEMBER OF THE ASSOCIATION, A DONATION OF $100 MUST BE MADE TO THE ASSOCIATION. NINE DIRECTORS OF THE ELEVEN DIRECTOR BOARD MAY BE ELECTED BY THE MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL CONTRACTS AND OTHER AGREEMENTS ARE REVIEWED BY MANAGEMENT TO ENSURE THAT NO CONFLICTS EXIST OR HAVE THE ABILITY TO ARISE. THE BOARD OF DIRECTORS MUST VOTE ON THE POLICY IF A CONFLICTING EVENT ARISES AND A CONFLICTING BOARD MEMBER MUST ABSBTAIN FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO AND CFO SALARIES ARE DETERMINED BY THE BOARD OF DIRECTORS. THE COO SALARY IS DETERMINED BY THE CEO. SALARY SURVEYS ARE OBTAINED FROM THE KENTUCKY HOSPITAL ASSOCIATION FOR THE TOP MANAGEMENT POSITIONS INCLUDING CEO, CFO, AND COO. THE INDEPENDENT BOARD UTILIZES THESE SALARY SURVEYS IN SETTING COMPENSATION FOR THESE POSITIONS. EACH EMPLOYEE IS EVALUATED ANNUALLY BY THEIR DEPARTMENT DIRECTOR TO DETERMINE IF A CHANGE IN SALARY IS WARRANTED. THE DIRECTORS ARE EVALUATED BY ADMINISTRATION ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 794,577. MANAGEMENT AND GENERAL EXPENSES 252,584. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,047,161. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 729,506. MANAGEMENT AND GENERAL EXPENSES 231,899. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 961,405. COLLECTION FEES: PROGRAM SERVICE EXPENSES 31,789. MANAGEMENT AND GENERAL EXPENSES 10,105. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,894. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAPPS PHARMACY DBA CUMBERLAND CTY PHAR | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 333 KEEN ST | AddressLine1Txt |
| City | BURKESVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42717 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611318396 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND COUNTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $363,982 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $2,332,063 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | 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 | 0 | 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 |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CAPPS PHARMACY | ||
| A | $72,000 | FMV |
| CAPPS PHARMACY | ||
| P | $1,743,557 | FMV |