2017-08-15T16:05:17-05:00 2016-09-30 621046406 JOHNSON HICKEY & MURCHISON PC 2215 OLAN MILLS DRIVE CHATTANOOGA TN 37421 990 2015-10-01 311131099 OHIO COUNTY HOSPITAL CORPORATION OHIO 2702987411 1211 OLD MAIN STREET HARTFORD KY 42347 SHELLIE SHOUSE CFO 2702987411 2017-08-15 1 BARRY R HUGGINS P00627334 4237560052 2015 2021-01-29 14:40:06Z SHELLIE SHOUSE 1211 OLD MAIN STREET HARTFORD KY 42347 38171853 0 X WWW.OHIOCOUNTYHOSPITAL.COM X 1984 KY THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES, MAKING A DIFFERENCE IN THE LIVES OF THE PEOPLE WE SERVE BY PROVIDING POSITIVE LIFE-CHANGING EXPERIENCES. 9 8 536 40 0 0 31909 36475 34674165 35101752 17753 10123 2661561 3023503 37385388 38171853 0 0 0 0 20197172 21818631 0 0 0 16490694 17000918 36687866 38819549 697522 -647696 17433598 17329515 7827294 8370907 9606304 8958608 X THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES, MAKING A DIFFERENCE IN THE LIVES OF THE PEOPLE WE SERVE BY PROVIDING POSITIVE LIFE-CHANGING EXPERIENCES. 0 0 34866835 38098802 THE MISSION OF OHIO COUNTY IS TO MAKE A DIFFERENCE IN THE LIVES OF OTHERS BY CARING, SERVING, AND EDUCATING INDIVIDUALS RELATIVE TO THEIR SPECIFIC HEALTH NEEDS. WE BELIEVE THAT THROUGH THESE ACTIONS, THE GENERAL HEALTH OF OHIO COUNTY HOSPITAL IS THE FRONTLINE OF COMMUNITY HEALTHCARE, PROVIDING A SAFETY NET 24 HOURS A DAY THROUGH OUR INPATIENT, OUTPATIENT AND EMERGENCY SERVICES. IN ORDER TO MEET THE CHANGING NEEDS OF THE COMMUNITY AND IMPROVE THE ACCESS TO HEALTH CARE, WE HAVE EXPANDED OUR SERVICES TO INCLUDE PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES. AND WHILE PATIENTS BENEFIT FROM OUR BEING CLOSE BY, ULTIMATELY IT IS THE WHOLE COMMUNITY THAT PROSPERS FROM OUR PRESENCE. THE HOSPITAL'S POSITIVE IMPACT ON THE COMMUNITY EXTENDS WELL BEYOND THE FOUR WALLS OF THE FACILITY. OUR COMMUNITY BENEFIT INCLUDES NOT ONLY THE COST OF PROVIDING CARE TO THE UNINSURED AND INDIGENT BUT ALSO BY IDENTIFYING UNMET COMMUNITY OR PUBLIC HEALTH NEEDS AND SEEKING TO ADDRESS THEM. EXAMPLES OF SUCH EFFORTS INCLUDING SUPPLYING CHILDHOOD IMMUNIZATION VACCINES TO OUR LOCAL HEALTH DEPARTMENT AT NO CHARGE. BECOMING A SMOKE-FREE FACILITY, AND OFFERING FREE SMOKING CESSATION COURSES SEVERAL TIMES A YEAR TO ALL COMMUNITY MEMBERS. OHIO COUNTY HOSPITAL WAS THE FOUNDING MEMBER OF A LOCAL HEALTH COALITION WHOSE FOCUS IS TO IMPLEMENT PREVENTATIVE HEALTH ACTIVITIES TO COMBAT THE LACK OF PHYSICAL ACTIVITY AND THE PREVELENCE OF OBESITY IN OUR AREA. WHETHER IT'S THROUGH THE PEOPLE WE EMPLOY, THE LOCAL BUSINESSES WE USE, OR THE CHARITIES AND COMMUNITY ACTIVITIES WE SUPPORT, WE ARE COMMITTED TO MAKING THE OHIO COUNTY AREA A HEALTHIER PLACE TO LIVE AND WORK. DURING 2015, THE HOSPITAL PROVIDED HEALTH CARE SERVICES TO OHIO COUNTY KENTUCKY AND SURROUNDING AREAS, INCLUDING INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES. OHIO COUNTY HOSPITAL PROVIDED $128,523 OF CHARITY CARE THROUGH ITS CHARITY CARE PROGRAM. 34866835 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 536 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 KY X SHELLIE SHOUSE 2702985495 1211 OLD MAIN STREET HARTFORD KY 42347 JANE CANARY VICE PRESIDENT 2.00 X X 0 0 0 JONATHAN SHREWSBURY OD PRESIDENT 2.00 X X 0 0 0 JIM DUKE SECRETARY/TREASURER 2.00 X X 0 0 0 KELLY ROE DIRECTOR 2.00 X 0 0 0 CARLA WALLACE DIRECTOR 2.00 X 0 0 0 GERALD WESTERFIELD DIRECTOR 2.00 X 0 0 0 LLOYD SPIVEY DIRECTOR 2.00 X 0 0 0 JOSHUA SKIBBA CARDIOLOGIST/CMO 40.00 X X 422957 0 53475 BRUCE DURHAM MEDICAL STAFF REPRESENTATIVE 2.00 X 252558 0 27480 ATHENA MINOR CHIEF CLINICAL OFFICER 40.00 X 81568 0 15617 MUKESH DESAI UROLOGIST 40.00 X 628738 0 57614 CHARLES RICCIO GASTROENTEROLOGIST 40.00 X 538461 0 55780 BENJAMIN SMITH PHYSICIAN 40.00 X 825675 0 7246 STEVEN MILLS PHYSICIAN 40.00 X 437719 0 28149 CHARLES JARBOE PHYSICIAN ER 40.00 X 353180 0 39769 3540856 0 285130 22 0 1 0 EMCARE PHYSICIAN SERVICES 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ER PHYSICIANS 522987 ORTHEPEDIC & SPORTS MEDICINE 2831 NEW HARTFORD RD OWENSBORO KY 42303 ORTHEPEDIC SURGERIES 303339 QUOROM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT FEES 280986 GEORGE GILLIAM MD 2100 SOUTH STRATFORD DRIVE OWENSBORO KY 42301 PHYSICIAN SURGICAL 169954 ELIZABETH OTTMAN MD 3663 FIELDS ROAD OWENSBORO KY 42303 OB GYN SERVICES 130019 5 500 35975 36475 NET PATIENT SERVICES 621300 35101752 35101752 35101752 10123 10123 26453 0 26453 26453 26453 PHARMACY SALES 446110 2383838 2383838 MISCELLANEOUS INCOME 621300 452886 452886 WELLNESS PROGRAM 900099 85056 85056 75270 75270 2997050 38171853 38098802 0 36576 853654 853654 17952042 16832052 1119990 104692 94323 10369 1671239 1569258 101981 1237004 1162784 74220 287588 287588 50571 3997 46574 60000 60000 3354788 2762736 592052 65729 65729 131470 104093 27377 2208573 1782415 426158 140079 91669 48410 179854 179854 898142 898142 514012 514012 MEDICAL SUPPLIES AND DR 5994996 5994996 BAD DEBT 2064633 2064633 TAXES AND LICENSES 479989 479989 OTHER SUPPLIES 182253 112954 69299 388241 293546 94695 38819549 34866835 3952714 0 1338379 1523810 370851 373231 5949736 5849648 942305 521974 1077421 1095523 149875 210900 26402370 19111961 7184390 7290409 420641 464020 17433598 17329515 3124680 2853642 3015000 2865000 1008124 1668772 679490 983493 7827294 8370907 X 9606304 8958608 9606304 8958608 17433598 17329515 -647696 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2874 2874 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE KENTUCKY HOSPITAL ASSSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE USED FOR LOBBYING. 530032 530032 8562223 4570447 3991776 16817542 14143501 2674041 492573 398013 94560 7290409 THIRD PARTY SETTLEMENTS 627170 RETIREMENT BENEFITS 356323 983493 X 38171853 0 38171853 0 38171853 38819549 0 38819549 0 38819549 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS WITH PROVISIONS OF FASB ASC 740-10 "ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES" WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS WITHIN THE FINANCIAL STATEMENTS. THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2016 AND 2015. AS OF SEPTEMBER 30, 2016 AND 2015, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTIONS. WITH A FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2013. 1 1 1 X 0 1 1 0 0 513397 90304 423093 0.01150 8854057 5545026 3309031 0.09000 9367454 5635330 3732124 0.10150 46035 46035 0.00130 46035 46035 0.00130 9413489 5635330 3778159 0.10280 1 956642 58551 8910104 8846369 63735 X 1 0 1 1 OHIO COUNTY HOSPITAL CORPORATION 1211 OLD MAIN STREET HARTFORD KY 42347 1629007430 X X X OHIO COUNTY HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X 12 1 0 0 1 X WWW.OHIOCOUNTYHOSPITAL.COM X 1 12 1 WWW.OHIOCOUNTYHOSPITAL.COM 1 0 1 X 100.000000000000 1 1 1 X 1 X 0 X 1 X 0 0 OHIO COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 5: GREEN RIVER DISTRICT HEALTH DEPARTMENT (GRDHD) PARTNERED WITH UNIVERSITY OF KENTUCKY'S APPALACHIA PUBLIC HEALTH TRAINING CENTER TO PERFORM COMMUNITY HEALTH NEED ASSESSMENTS IN OHIO COUNTY USING THE MAPP PROCESS. THE MAPP PROCESS INCLUDED IDENTIFYING COMMUNITY PARTNERS. A COMPLETED SEARCH OF EXISTING HEALTHCARE RELATED INFORMATION AND DATA FROM PUBLIC INFORMATION SOURCES. PARTNERS MET IN AN INITIAL PUBLIC HEALTH FORUM DESIGNED TO REVIEW KEY HEALTH RELATED STATISTICS AND ANALYSIS FOR THE COUNTY, COMPLETED A PAPER SURVEY THAT WAS DISTRIBUTED IN LOCAL HEALTH DEPARTMENT CLINICS AND HAD AN ONLINE SURVEY, HELD A SECOND MEETING OF COMMUNITY PARTNERS TO EVALUATE ANALYSIS PREVIOUSLY COMPLETED AND CONSIDER RESULTS OF SURVEYS. OHIO COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 18D: THE ONLY FINANCIAL AID PROGRAM IS WHAT THE STATE OFFERS AS THE "DSH" PROGRAM. THE HOSPITAL USE AND OUTSIDE COMPANY-DMC WHO DETERMINES IF ALL OF THE PRIVATE PAY PATIENTS FIRST ARE ELIGIBLE FOR MEDICAID AND IF THEY ARE NOT THEY DETERMINE IF THEY ARE ELIGIBLE FOR THE STATE INDIGENT PROGRAM. IF THEY ARE ELIGIBLE FOR THE STATE PROGRAM THE ENTIRE BALANCE IS WRITTEN OFF. THE HOSPITAL DOES NOT HAVE ANY KIND OF OTHER FAP OR SEPARATE CHARITY CARE POLICY. IF THE PRIVATE PAY PATIENTS ARE ELIGIBLE FOR EITHER OF THE TWO PROGRAMS, THE HOSPITAL HAVE BEGAN OFFERING (OCTOBER 2011), A PRIVATE PAY DISCOUNT WHICH INITIALLY DISCOUNTS 40% OFF THE PATIENT'S ACCOUNT BALANCE. ALL OF THE PRIVATE PAY PATIENTS RECEIVE 3 STATEMENTS, 2 LETTERS AND SOMETIMES A OTHER LETTER BEFORE BEING SENT TO OUR COLLECTIONS AGENCY. THE COLLECTION AGENCY THEN DETERMINES THE ABILITY TO PAY AND THEY TAKE ACTIONS BASED ON THE RESULTS OF THEIR FINDINGS. OHIO COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 20E: ADMITTING CLERKS PROVIDE EACH UNINSURED PATIENT A CHARITY CARE APPLICATION AND ENCOURAGE HER TO COMPLETE THE FORM. IT MUST BE DOCUMENTED THAT THE PATIENT HAS NO CURRENT VALID INSURANCE COVERAGE AND IS NOT ELIGIBLE TO APPLY FOR PUBLIC ASSISTANCE OR OTHER INSURANCE. THE PATIENT MUST MEET THE CRITERIA ESTABLISHED BY THE STATE TO QUALIFY FOR THE CHARITY CARE PROGRAM. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,064,633. PART III, LINE 4: EXPLANATION FOR HOW BAD DEBT IS CALCULATED IS PROVIDED IN THE FOOTNOTE OF THE FINANICIALS.ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT THE HOSPITAL EXPECTS TO COLLECT. THE HOSPITAL MAINTAINS ALLOWANCES FOR DOUBTFUL ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM THE INABILITY OF ITS PATIENTS TO MAKE REQUIRED PAYMENTS. MANAGEMENT CONSIDERS THE FOLLOWING FACTORS WHEN DETERMINING THE COLLECTABILITY OF PATIENT ACCOUNTS: PAYOR CREDIT-WORTHINESS, PAST TRANSACTION HISTORY WITH THE PAYOR, CURRENT ECONOMIC INDUSTRY TRENDS, AND CHANGES IN PAYOR PAYMENT TERMS. IF THE FINANCIAL CONDITION OF THE HOSPITAL'S PAYORS OR PATIENTS WERE TO DETERIORATE, ADVERSELY AFFECTING THEIR ABILITY TO MAKE PAYMENTS, ADDITIONAL ALLOWANCES WOULD BE REQUIRED. BASED ON MANAGEMENT'S ASSESSMENT, THE HOSPITAL PROVIDES FOR ESTIMATED UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO EARNINGS AND A CREDIT TO ALLOWANCE. BALANCES THAT REMAIN OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE AMOUNT IN LINE 7 WAS THE COST TO CHARGE RATIO. PART III, LINE 9B: ALL ACCOUNTS MOVE THROUGH THE REGISTRATION, MEDICAL CODING AND INSURANCE BILLING PROCESS. IF THE PATIENT HAS AN INSURANCE OR GOVERNMENT PLAN THAT PAYER WILL BE BILLED. ONCE THEY PAY, THE ACCOUNT IS REVIEWED FOR CORRECT BALANCE. THEN CPSI ASSIGNS A CYCLE CODE TO EACH ACCOUNT WHICH DRIVES WHEN A STATEMENT WILL BE ISSUED. THE STATEMENTS THEN FOLLOW IN 28 DAY CYCLES. EACH PATIENT SHOULD RECEIVE AT LEAST 3 STATEMENTS AND 2 LETTERS. WITH THIS CYCLE EVERY PATIENT WILL RECEIVE STATEMENTS FOR GREATER THAN 120 DAY PERIOD. IN THE EVENT THAT THE PATIENT MAKES ANY PAYMENT AT ALL, THE STATEMENT CYCLE IS SET BACK TO THE BEGINNING.A PATIENT WITH NO INSURANCE GOES THROUGH REGISTRATION, A REVIEW FOR ANY POSSIBLE PAYER AND KENTUCKY DSH PROGRAM. ONCE IT HAS BEEN DETERMINED THAT THERE IS NO OTHER PAYER SOURCE, THE DSH APPLICATIONS ARE SENT TO DMS CONSULTANTS FOR REVIEW OF POTENTIAL MEDICAID OR DSH APPROVAL. DMC NOTIFIES OHIO COUNTY HOSPITAL IF THE PATIENT HAS EITHER INSURANCE, MEDICAID OR HAS BEEN APPROVED FOR THE DSH PROGRAM. ADJUSTMENTS ARE MADE ACCORDINGLY FROM THESE FINDINGS. IF NO INSURANCE AND NOT QUALIFIED FOR ANY PROGRAMS A DENIAL IS SENT TO THE PATIENT.THE PRIVATE PAY PATIENTS ARE ALSO RECEIVING THE SAME BILLING CYCLE AS ALL OTHER PAYERS. DURING THIS CYCLE WE ALSO RECEIVE INCOMING CALLS AND PATIENT WALK IN'S, AS WELL AS MAKING PHONE CALLS AS TIME PERMITS FOR ADDITIONAL ATTEMPTS TO COLLECT.ALL ACCOUNTS ARE DOCUMENTS AS STATEMENTS, LETTERS AND PHONE CALL ATTEMPTS ARE MADE AT THE ATTEMPT TO COLLECT THE BALANCE OF THE ACCOUNT.IN THE EVENT THAT OHIO COUNTY HOSPITAL STAFF HAS BEEN UNABLE TO COLLECT THE OUTSTANDING DEBT, ACCOUNTS ARE TURNED OVER TO AN OUTSIDE COLLECTION AGENCY. THE AGENCY THEN FOLLOWS AS DIRECTED BY OCH TO ATTEMPT FOR AN ADDITIONAL 120 DAYS OR NO PAYMENT WITHIN THE LAST 12 MONTHS. THEIR ATTEMPTS ALSO INCLUDES LETTERS, PHONE CALLS AND PLACED ON CREDIT REPORTING SYSTEMS.IN THE EVENT THAT THE COLLECTION AGENCY HAS BEEN UNSUCCESSFUL AT THE COLLECTION, THE ACCOUNTS WILL BE DEEMED UNCOLLECTIBLE, CLOSED AND RETURNED FROM CREDIT REPORTING AND THEN CANCELED BACK TO HOSPITAL. HOSPITAL STAFF THEN PLACES A NOTE ON THAT ACCOUNT THAT IT HAS BEEN DEEMED UNCOLLECTIBLE. HOSPITAL OR COLLECTION AGENCY MAKES NO FURTHER ATTEMPTS AT COLLECTION AT THIS POINT.HOSPITAL COMPILES A REPORT FOR THE UNCOLLECTIBLE DEDUCTIBLE AND CO INSURANCE THAT HAVE BEEN DEEMED IN THE SAME COST REPORTING FISCAL YEAR PERIOD. THIS REPORT IS PROVIDED TO CMS WHEN EVER NECESSARY. MOST COMMONLY ATTACHED TO THE COST REPORT. PART VI, LINE 2: IN DECEMBER 2012, OHIO COUNTY HOSPITAL, IN CONJUNCTION WITH THE OHIO COUNTY HEALTH COALITION, GREEN RIVER DISTRICT HEALTH DEPARTMENT AND OTHER KEY COMMUNITY STAKEHOLDERS, CONDUCTED A PLANNING RETREAT TO REVIEW THE GREEN RIVER COMMUNITY HEALTH ASSESSMENT HEALTH IMPROVEMENT PLAN. THIS DOCUMENT IS A COMPREHENSIVE COLLECTION AND ANALYSIS OF DATA REGARDING HEALTH ISSUES AND NEEDS BROKEN DOWN BY COUNTY FOR GREEN RIVER DEVELOPMENT DISTRICT (GRADD). THE INFORMATION FOR THE REPORT WAS OBTAINED BY UTILIZATION OF A COMMUNITY HEALTH ASSESSMENT PROCESS BASED ON MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP).IN OHIO COUNTY, THE MAPP PROCESS INCLUDED THE FOLLOWING KEY STEPS:COMMUNITY PARTNERS WERE IDENTIFIED FROM THE OHIO COUNTY HEALTH COALITION, OTHER HEALTH CARE AGENCIES, LOCAL GOVERNMENT, SCHOOLS, BUSINESSES, CIVIC ORGANIZATIONS, AND VOLUNTEERS FROM THE GENERAL PUBLIC.COMPLETED A SEARCH OF EXISTING HEALTH CARE-RELATED INFORMATION AND DATA FROM PUBLIC INFORMATION SOURCES; THE PARTNERS MET IN AN INITIAL PUBLIC HEALTH FORUM DESIGNED TO REVIEW KEY HEALTH-RELATED STATISTICS FOR THE COUNTY AND TO COMPLETE A STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS (SWOT) ANALYSIS FOR THE COUNTY;COMPLETED A PAPER SURVEY, DISTRIBUTED IN LOCAL HEALTH DEPARTMENT CLINICS, AND AN ON-LINE SURVEY, TO OBTAIN WIDER INPUT FROM INDIVIDUALS INTO THE COMMUNITY'S HEALTH NEEDS.HELD A SECOND MEETING OF COMMUNITY PARTNERS TO EVALUATE THE SWOT ANALYSIS PREVIOUSLY COMPLETED AND TO CONSIDER RESULTS FROM THE COMPLETED SURVEYS. THIS FORUM WORKED TO IDENTIFY AND GROUP SIMILAR HEALTH RELATED CONCERNS FOR THE COUNTY AS FOLLOWS: 1) IMPROVE COMMUNITY LIFESTYLE CHOICES; 2) INCREASE HEALTH CARE ACCESS; AND 3) REDUCE SUBSTANCE ABUSE. THE OHIO COUNTY HEALTH COALITION WAS DETERMINED TO BE THE ORGANIZATION WITH PRIME RESPONSIBILITY FOR ADDRESSING THESE STRATEGIC HEALTH CARE INITIATIVES ON AN ON-GOING BASIS.A GREEN RIVER COMMUNITY HEALTH ASSESSMENT HEALTH IMPROVEMENT PLAN WAS DEVELOPED FOR THE REGION AND EACH OF THE DISTRICT'S COUNTIES. THIS PLAN WAS REVIEWED WITH THE OHIO COUNTY HEALTH COALITION AND OTHER COMMUNITY PARTNERS.OHIO COUNTY HOSPITAL USED THE INFORMATION COLLECTED FROM THE MAPP'S SURVEY PROCESS TO DETERMINE WHICH HEALTH NEEDS COULD BE MOST IMPACTED BY COLLABORATION BETWEEN OUR FACILITY AND THE OHIO COUNTY HEALTH COALITION. IT WAS DETERMINED THAT THE OHIO COUNTY HOSPITAL HAD THE NECESSARY RESOURCES AND ABILITY TO IMPACT THE FOLLOWING HEALTH NEEDS: IMPROVING COMMUNITY LIFESTYLE CHOICES, INCREASE ACCESS TO HEALTHCARE, AND REDUCE SUBSTANCE ABUSE. THESE KEY HEALTHCARE ISSUES ALIGNED WITH THE MISSION AND PRIORITIES OF OHIO COUNTY HOSPITAL AND WERE INCORPORATED INTO THE2013 STRATEGIC PLAN.THE GREEN RIVER ASSESSMENT COMMUNITY PLAN AND OHIO COUNTY HOSPITAL'S STRATEGIC IMPLEMENTATION PLAN WERE ADOPTED BY BOARD RESOLUTION FROM OHIO COUNTY HOSPITAL'S TRUSTEES ON JUNE 13, 2013. THE HEALTH IMPROVEMENT PLAN WAS MADE WIDELY AVAILABLE TO THE COMMUNITY VIA THE HOSPITAL'S WEBSITE, AS WELL AS THROUGH HARD COPIES LOCATED AT THE HOSPITAL'S FRONT DESK. PART VI, LINE 3: OHIO COUNTY HOSPITAL'S ADMITTING AND BUSINESS OFFICE STAFF PROVIDES CHARITY CARE APPLICATIONS TO ANY PATIENT THAT DOESN'T HAVE INSURANCE DURING THE REGISTRATION PROCESS. IF THE PATIENT DOESN'T COMPLETE THE APPLICATION AT THAT TIME, THEIR DEMOGRAPHIC INFORMATION IS THEN SENT TO AN OUTSIDE COMPANY, DMC, INC, AND THEY DETERMINE IF THE PATIENT IS ELIGIBLE FOR EITHER MEDICAID OR CHARITY CARE. DMC WILL FOLLOW-UP WITH THE PATIENT TO GET ADDITIONAL INFORMATION AS NEEDED. ONCE THE ACCOUNT IS BILLED AND IS IN THE COLLECTION PROCESS, OUR PRIVATE PAY COUNSELORS CHECK EACH ACCOUNT TO MAKE SURE THAT IT HAS BEEN CHECKED FOR INDIGENT CARE ELIGIBILITY. PART VI, LINE 4: HISTORICALLY 90% OF ALL ADMISSIONS AND 95% OF ALL OUTPATIENT SERVICES PERFORMED AT OHIO COUNTY HOSPITAL ARE PROVIDED TO RESIDENTS OF OHIO COUNTY; 94% OF ALL MEDICARE INPATIENT ADMISSIONS ARE GENERATED FROM THE OHIO COUNTY AREA. THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE RESIDENTS OF THE INCORPORATED CITIES OF HARTFORD, BEAVER DAM, ROSINE, FORDSVILLE, HORSE BRANCH AND CROMWELL. OHIO COUNTY IS GEOGRAPHICALLY THE FIFTH LARGEST COUNTY IN KENTUCKY. TOTAL POPULATION AS OF 2013 WAS 23,988.THE PER CAPITA INCOME (MEAN INCOME FOR EVERY MAN, WOMAN, AND CHILD IN A PARTICULAR GROUP) HAS DECREASED FROM THE PREVIOUS YEAR TO $18,409.00 COMPARED TO THE KENTUCKY AVERAGE OF $23,210. OHIO COUNTY IS A DESIGNATED A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND A MEDICALLY UNDERSERVICED AREA / POPULATION (MUA/P). IN 2013, THE PERCENTAGE OF OHIO COUNTY'S POPULATION LIVING BELOW THE POVERTY LEVEL INCREASED TO 20.89%. ACCORDING TO KENTUCKY HEALTH FACTS, THE RATE FOR UNINSURED ADULTS (UNDER 65 YEARS) IS 22%, WHICH IS SECOND HIGHEST IN THE GRADD REGION, AND THE RATE FOR UNINSURED CHILDREN (UNDER 19 YEARS) IS 7%. STATISTICS ALSO REPORT THAT 20% OF ADULTS IN THE OHIO COUNTY EXPERIENCED A TIME IN THE PAST YEAR NEEDED TO SEE A DOCTOR BUT DID NOT BECAUSE OF THE COST. PART VI, LINE 5: OHIO COUNTY HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF COMMUNITY VOLUNTEERS WHO ARE COMMITTED TO THE HEALTH AND WELFARE OF THE COMMUNITY AND DEDICATED TO ENSURING THE VIABILITY OF THE HOSPITAL FOR YEARS TO COME. THE BOARD EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE SERVICE AREA. SURPLUS FUNDS PROVIDE FOR CONTINUITY OF HEALTHCARE SERVICES DURING PERIODS OF ECONOMIC DOWNTURN, RECRUITMENT OF ADDITIONAL PROVIDERS TO IMPROVE THE ACCESS TO HEALTHCARE, AND ARE REINVESTED IN NEW TECHNOLOGY AND EQUIPMENT AS NEEDED. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS STAFFED 24 HOURS A DAY/7 DAYS A WEEK AND SERVES ALL CITIZENS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PROVIDES REPRESENTATION AND SUPPORT TO THE OHIO COUNTY CHAMBER BOARD OF DIRECTORS, OHIO COUNTY TOURISM, OHIO COUNTY INDUSTRIAL FOUNDATION, AND LEADERSHIP OHIO COUNTY PROGRAM, WHICH ARE ORGANIZATIONS WORKING TOWARDS THE ECONOMIC GROWTH OF OUR AREA. PART VI, LINE 7, REPORTS FILED WITH STATES KY X X 0 0 0 0 0 0 0 0 0 JOSHUA SKIBBA CARDIOLOGIST/CMO 422957 0 0 0 0 0 42344 0 11131 0 476432 0 0 0 BRUCE DURHAM MEDICAL STAFF REPRESENTATIVE 236183 0 16375 0 0 0 21297 0 6183 0 280038 0 0 0 MUKESH DESAI UROLOGIST 628738 0 0 0 0 0 51431 0 6183 0 686352 0 0 0 CHARLES RICCIO GASTROENTEROLOGIST 538461 0 0 0 0 0 50077 0 5703 0 594241 0 0 0 BENJAMIN SMITH PHYSICIAN 540722 0 284953 0 0 0 0 0 7246 0 832921 0 0 0 STEVEN MILLS PHYSICIAN 351062 0 86657 0 0 0 21966 0 6183 0 465868 0 0 0 CHARLES JARBOE PHYSICIAN ER 353180 0 0 0 0 0 28638 0 11131 0 392949 0 0 0 A OHIO COUNTY PUBLIC FACILITIES CORPORATION 616000805 2010-09-29 3620000 MEDICAL OFFICE BUILDING CONSTRUCTION 0 0 0 A 3015000 273400 70000 2011 0 0 1 1 A 0 0 0 0 1 0 0 A 1 1 0 0 0 0 DR BRUCE DURHAM SIGNON BONUS X 20000 10500 0 1 1 DR CHRISTEL MIRANDA SIGNON BONUS X 32814 9115 0 1 1 DR GILBRT LUCENO SIGNON BONUS X 32814 9115 0 1 1 28730 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL CONTRACTS WITH QUORUM HEALTH RESOURCES, INC (QHR) TO PROVIDE MANAGEMENT SERVICES UNDER AN AGREEMENT WHICH EXPIRES IN 2018. THE CONTRACT REQUIRES QHR TO SUPPLY A CHIEF EXECUTIVE OFFICER AND A CHEIF FINANCIAL OFFICER WHOSE SALARY AND BENEFITS COST ARE PASSED DIRECTLY THROUGH TO THE HOSPITAL. THE HOSPITAL'S EXPENSE FOR THE MANAGEMENT FEE TOTALED APPOXIMATELY $287,588 FOR THIS YEAR. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS ARE COVERED UNDER THIS POLICY AND ANY CONFLICTS ARE RESOLVED AT MONTHLY BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS RECEIVED A COMPENSATION REVIEW BY QHR AND THE GOVERNING BOARD. OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION RECEIVE ANNUAL REVIEWS BASED ON CURRENT MARKET DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.