2016-02-08T13:02:32-06:00 2015-03-31 351178661 BLUE & CO LLC 500 N MERIDIAN STREET SUITE 200 INDIANAPOLIS IN 46204 990 2014-04-01 611362001 THE MEDICAL CENTER AT FRANKLIN INC MEDI 2707451500 800 PARK STREET BOWLING GREEN KY 42102 RONALD SOWELL EVP - CFO EVP - CFO 2707451500 2016-02-01 1 ANGELA ZIRKELBACH CPA P00572603 3176334705 2016-02-01 2014 2016-08-17 19:52:53Z CONNIE D SMITH 800 PARK STREET BOWLING GREEN KY 42102 27215505 0 X WWW.THEMEDICALCENTERFRANKLIN.ORG X 2000 KY OUR MISSION IS TO CARE FOR PEOPLE AND IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. 7 6 204 4 11255 0 18241 750 21716725 25531424 217046 334842 12025 170659 21964037 26037675 0 0 0 0 8164783 8516685 0 0 0 10658565 11576551 18823348 20093236 3140689 5944439 37868945 42971483 10599144 9798912 27269801 33172571 X THE CORPORATE MISSION IS TO CARE FOR PEOPLE AND IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. 0 0 4514353 6638170 THE MEDICAL CENTER AT FRANKLIN ("MCF") IS RECOGNIZED BY MEDICARE AS A CRITICAL ACCESS HOSPITAL. MCF 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. ORGANIZATIONTHE MEDICAL CENTER AT FRANKLIN, 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 SIMPSON COUNTY, KENTUCKY. EFFECTIVE SEPTEMBER 2, 2003, THE MEDICAL CENTER AT FRANKLIN, INC. OBTAINED DESIGNATION AS A CRITICAL ACCESS FACILITY UNDER THE MEDICARE REGULATIONS.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. THE 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, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPISTS, PSYCHOLOGISTS, 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 FRANKLIN (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 FRANKLIN PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE THE MEDICAL CENTER AT FRANKLIN DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. THE MEDICAL CENTER AT FRANKLIN MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY. THE MEDICAL CENTER AT FRANKLIN'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 $160,429BAD DEBT (AT COST) 43,525COMMUNITY HEALTH SERVICES 313,389COMMUNITY BUILDING ACTIVITIES 14,895 FINANCIAL AND IN-KIND CONTRIBUTIONS 1,175HEALTH PROFESSIONALS EDUCATION 317,788TOTAL MEDICAL CENTER COMMUNITY BENEFITS $851,201BENEFITS 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 FRANKLIN 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. EXAMS 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 2015 THE HOSPITAL ADMITTED 792 ACUTE PATIENTS WHO RECEIVED 2,881 PATIENT DAYS OF CARE AND 296 SWING BED PATIENTS WHO RECEIVED 4,850 DAYS OF CARE. DURING FISCAL YEAR 2014 THE HOSPITAL ADMITTED 831 ACUTE PATIENTS WHO RECEIVED 3,338 PATIENT DAYS OF CARE AND 192 SWING BED PATIENTS WHO RECEIVED 3,563 DAYS OF CARE. 12848543 18893254 THE HOSPITAL SERVES THE COMMUNITY BY PROVIDING CERTAIN OUTPATIENT SERVICES, INCLUDING AN EMERGENCY DEPARTMENT, 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. 17362896 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 42 0 1 204 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X JAMES LARRY VAUGHN 2707451500 800 PARK STREET BOWLING GREEN KY 42102 TOMMY HOLDERFIELD CHAIRMAN 2.00 4.00 X X 0 0 0 GARY BROADY VICE CHAIRMAIN 2.00 2.00 X X 0 0 0 BEVERLY BOREN SECRETARY 2.00 2.00 X X 0 0 0 CHERI NATCHER DIRECTOR 2.00 0.00 X 0 0 0 DR A V WILWAYCO DIRECTOR 2.00 0.00 X 0 0 0 MICHAEL STEVE THURMOND DIRECTOR 2.00 0.00 X 0 0 0 CONNIE SMITH DIRECTOR/PRESIDENT & CEO 2.00 48.00 X X 0 809750 13369 BARBARA JEAN CHERRY CIO/EXECUTIVE VICE PRESIDENT 1.00 49.00 X 0 475032 13637 RONALD SOWELL CFO/EXECUTIVE VICE PRESIDENT 2.00 48.00 X 0 485251 13109 BETSY KULLMAN CNO/EXECUTIVE VICE PRESIDENT 2.00 48.00 X 0 279293 20264 SARAH MOORE EXECUTIVE VICE PRESIDENT 1.00 49.00 X 0 267108 11258 ERIC HAGAN VICE PRESIDENT/ADMINISTRATOR OF MCS & MCF 20.00 28.00 X 0 219816 27758 WADE STONE EXECUTIVE VICE PRESIDENT 1.00 49.00 X 0 246387 27339 VICKI TYLER DIRECTOR OF PATIENT CARE SERVICES 40.00 0.00 X 114627 0 9957 114627 2782637 136691 1 0 1 0 SOUTHEASTERN EMERGENCY PHYSICIANS PO BOX 634850 CINCINNATI OH 45263 ER PHYSICIAN SERVICES 722660 KENTUCKY PREMIERCARE 603 MAIN STREET WINDERMERE FL 34746 CLINICAL SERVICES 453664 MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA GA 30368 CAFETERIA SERVICES 312172 LOGANS UNIFORM RENTAL INC PO BOX 643958 CINCINNATI OH 45264 LAUNDRY SERVICES 174314 ANESTHESIA AND PAIN SPECIALISTS OF BOWLI 350 PARK STREET STE 203B BOWLING GREEN KY 42101 CLINICAL SERVICES 160550 5 750 750 OUTPATIENT SERVICES 621400 18893254 18893254 INPATIENT ROUTINE AND ANCILLARY S 621110 6638170 6638170 25531424 177689 177689 128645 236618 -107973 -107973 -107973 1098365 941212 157153 157153 157153 EHR INCENTIVE 900099 165203 165203 FOOD SERVICES 722514 82266 82266 ALL OTHER REVENUE 900099 31163 11255 19908 278632 26037675 25531424 11255 494246 X 6229409 5871658 357751 371462 350129 21333 1459355 1375545 83810 456459 429969 26490 504000 504000 16248 16248 45230 45230 3652112 3151179 500933 63183 13136 50047 1604846 1344520 260326 119319 119319 324196 323934 262 26734 16721 10013 200532 122739 77793 1376207 1075411 300796 98517 98517 MEDICAL SUPPLIES 2919423 2915318 4105 PHYSICIAN PRACTICE EXPE 352541 352541 TAXES & LICENSES 227322 227322 PATIENT TRANSPORATION 24412 24412 21729 1584 20145 20093236 17362896 2730340 0 1986561 2046817 3420619 3943205 459994 409360 100719 133783 27801645 15530934 13548356 12270711 18125735 23907209 226961 260398 37868945 42971483 2164764 2465181 98222 108073 6040300 5326990 2295858 1898668 10599144 9798912 X 27269801 33172571 27269801 33172571 37868945 42971483 X 5944439 14046 -55715 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2497 2497 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE KENTUCKY HOSPITAL ASSOCIATION AND THE NATIONAL RURAL HOSPITAL ASSOCIATION, TO WHICH THE HOSPITAL PAYS ANNUAL DUES. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING. 400000 400000 16979753 7413116 9566637 9851719 7777611 2074108 570173 340207 229966 12270711 LONG TERM PAYABLE AFFILIATE 438659 INTEREST RATE SWAP 330855 THIRD PARTY SETTLEMENTS 1129154 1898668 X 26232624 14046 14046 26218578 -180903 -180903 26037675 20329854 236618 236618 20093236 0 20093236 PART X, LINE 2: THE MEDICAL CENTER IS EXEMPT FROM FEDERAL INCOME TAXES AND RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE (IRC) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE IRC. THE MEDICAL CENTER FILES FEDERAL INCOME TAX RETURNS AS WELL AS INCOME TAX RETURNS IN KENTUCKY. THE MEDICAL CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION TOPIC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN IN A TAX RETURN. TOPIC 740 ALSO PROVIDES GUIDANCE ON DESCRIPTION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. THE MEDICAL CENTER DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS RECOGNIZED FOR 2015 AND 2014. THE MEDICAL CENTER'S PRACTICE IS TO RECOGNIZE INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUE -236,618. INTEREST RATE SWAP 55,715. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUE 236,618. 1 1 1 X 0 1 1 1 0 1 1 1 1312 637278 476849 160429 0.00800 1 1312 637278 476849 160429 0.00800 21 19031 313389 313389 0.01560 2 11 317788 317788 0.01580 2 0 1175 1175 0.00010 25 19042 632352 632352 0.03150 26 20354 1269630 476849 792781 0.03950 3 14620 14620 0.00070 1 1 275 275 0.00000 4 1 14895 14895 0.00070 1 2330115 43525 10836541 11356252 -519711 X 1 1 1 1 THE MEDICAL CENTER AT FRANKLIN INC 800 PARK STREET BOWLING GREEN KY 42101 WWW.THEMEDICALCENTERFRANKLIN.ORG 600069 X X X X THE MEDICAL CENTER AT FRANKLIN INC 1 0 0 1 X X X X X X X 12 1 1 0 1 X HTTP://WWW.THEMEDICALCENTERFRANKLIN.ORG X 1 13 1 HTTP://WWW.THEMEDICALCENTERFRANKLIN.ORG 0 0 1 X 200.000000000000 X X X 1 1 X X X 1 X WWW.THEMEDICALCENTERFRANKLIN.ORG X X 1 0 X X 1 0 0 THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 5: THE MEDICAL CENTER AT FRANKLIN PARTICIPATED IN A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY THE BARREN RIVER COMMUNITY HEALTH PLANNING COUNCIL. THE COMMUNITY HEALTH ASSESSMENT CONDUCTED BY THE BARREN RIVER COMMUNITY HEALTH PLANNING COUNCIL INCLUDED FOUR MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP) ASSESSMENTS. THE MAPP ASSESSMENTS ARE DESCRIBED BELOW. THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT PROVIDES A DEEP UNDERSTANDING OF THE ISSUES THAT RESIDENTS FEEL ARE IMPORTANT BY ANSWERING THE QUESTIONS "WHAT IS IMPORTANT TO OUR COMMUNITY?" "HOW IS QUALITY OF LIFE PERCEIVED IN OUR COMMUNITY? AND "WHAT ASSETS DO WE HAVE THAT CAN BE USED TO IMPROVE COMMUNITY HEALTH?" * THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) FOCUSES ON ALL OF THE ORGANIZATIONS AND ENTITIES THAT CONTRIBUTE TO THE PUBLIC'S HEALTH. THE LPHSA ANSWERS THE QUESTIONS "WHAT ARE THE COMPONENTS, ACTIVITIES, COMPETENCIES, AND CAPACITIES OF OUR LOCAL PUBLIC HEALTH SYSTEM? AND "HOW ARE THE ESSENTIAL SERVICES BEING PROVIDED TO OUR COMMUNITY?" * THE COMMUNITY HEALTH STATUS ASSESSMENT IDENTIFIES PRIORITY COMMUNITY HEALTH AND QUALITY OF LIFE ISSUES. QUESTIONS ANSWERED INCLUDE "HOW HEALTHY ARE OUR RESIDENTS?AND "WHAT DOES THE HEALTH STATUS OF OUR COMMUNITY LOOK LIKE?" *THE FORCES OF CHANGE ASSESSMENT FOCUSES ON IDENTIFYING FORCES SUCH AS LEGISLATION, TECHNOLOGY, AND OTHER IMPENDING CHANGES THAT AFFECT THE CONTEXT IN WHICH THE COMMUNITY AND ITS PUBLIC HEALTH SYSTEM OPERATE. THIS ANSWERS THE QUESTIONS "WHAT IS OCCURRING OR MIGHT OCCUR THAT AFFECTS THE HEALTH OF OUR COMMUNITY OR THE LOCAL PUBLIC HEALTH SYSTEM? AND "WHAT SPECIFIC THREATS OR OPPORTUNITIES ARE GENERATED BY THESE OCCURRENCES?" THE MAPP ASSESSMENTS ARE FURTHER DESCRIBED IN THE COMMUNITY HEALTH ASSESSMENT REPORT AT HTTP://WWW.THEMEDICALCENTERFRANKLIN.ORG/ABOUT_US/COMMUNITY_HEALTH_NEEDS_ASSESSMENT.ASPX. ORGANIZATIONS INVOLVED IN THE ASSESSMENT PROCESS INCLUDED THE ADMINISTRATIVE OFFICE OF THE COURTS, ALLEN COUNTY HEALTH DEPARTMENT, BALE CENTER, BANK OF EDMONSON COUNTY, BARREN COUNTY FISCAL COURT, BARREN COUNTY SCHOOL SYSTEM, BARREN RIVER AREA DEVELOPMENT DISTRICT, BARREN RIVER DISTRICT HEALTH DEPARTMENT, BOWLING GREEN AREA CHAMBER OF COMMERCE, BOWLING GREEN CITY SCHOOLS, BOWLING GREEN DAILY NEWS, BOWLING GREEN MEDICAL CENTER, BUTLER CO FISCAL COURT, BUTLER COUNTY HEALTH DEPT (BRDHD), BUTLER COUNTY SCHOOLS, CAVERNA MEMORIAL HOSPITAL, CITY OF MORGANTOWN, COMMONWEALTH HEALTH CORPORATION, COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, COMMUNITY ACTION OF SOUTHERN KENTUCKY, COMMUNITY FARM ALLIANCE, COMMUNITY FOUNDATION OF SOUTH CENTRAL KENTUCKY, CTG KENTUCKY, COVENTRY CARES, EDMONSON CARE AND REHAB, EDMONSON COUNTY FISCAL COURT, EDMONSON COUNTY HEALTH DEPT (BRDHD), EDMONSON COUNTY SCHOOLS, FAIRVIEW COMMUNITY HEALTH CENTER, FRANKLIN/SIMPSON CHAMBER OF COMMERCE, GLASGOW FAMILY MEDICINE, GRAVES GILBERT CLINIC, GREENVIEW REGIONAL HOSPITAL, HARMON HART COUNTY EXTENSION OFFICE, HART COUNTY HEALTH DEPT (BRDHD), HART COUNTY SCHOOLS, KY TRANSPORTATION CABINET, REGION 3 OFFICE KY STATE REPRESENTATIVE, DISTRICT 17 KY STATE REPRESENTATIVE, DISTRICT 21 KY STATE REPRESENTATIVE, DISTRICT 22 KY STATE REPRESENTATIVE, DISTRICT 23 KY STATE REPRESENTATIVE, LIFESKILLS, INC, LOGAN ALUMINUM, LOGAN COUNTY HEALTH EPT (BRDHD), LOGAN COUNTY SCHOOLS, LOGAN MEMORIAL HOSPITAL, MEDICAL CENTER OF FRANKLIN, MEDICAL CENTER OF SCOTTSVILLE, METCALFE COUNTY EXTENSION OFFICE, METCALFE COUNTY HEALTH DEPT (BRDHD), MNT, INC, MONROE COUNTY HEALTH DEPARTMENT, MONROE COUNTY MEDICAL CENTER, MONROE COUNTY SCHOOLS, RUSSELLVILLE CITY SCHOOL SYSTEM, SIMPSON COUNTY HEALTH DEPT (BRDHD), SIMPSON COUNTY SCHOOL SYSTEM, SOUTH CENTRAL KENTUCKY AREA HEALTH EDUCATION CENTER, TJ SAMSON COMMUNITY HOSPITAL, UNITED WAY OF SOUTHERN KENTUCKY, WARREN COUNTY HEALTH DEPT (BRDHD), WARREN COUNTY SCHOOLS, AND WELLCARE WESTERN KENTUCKY UNIVERSITY. ADDITIONALLY, COUNTY ASSESSMENT TEAMS CONDUCTED A COMMUNITY-WIDE COMMUNITY HEALTH SURVEY WHICH WAS COMPLETED BY 12,056 RESPONDENTS AND KEY INFORMANT INTERVIEWS WITH OVER 200 LOCAL RESIDENTS REPRESENTING 1) PEOPLE DIRECTLY AFFECTED BY ONE OF THE PRIORITY HEALTH ISSUES, 2) COMMUNITY LEADERS WHO SET POLICY RELATED TO ONE OR MORE PRIORITY HEALTH ISSUES, AND 3) PHYSICIANS AND OTHER HEALTH CARE PROVIDERS.BELOW IS A SUMMARY OF THESE INTERVIEWS, 47 SMOKERS ON THEIR ATTEMPTS TO QUIT, 42 ADULTS DIAGNOSED WITH DIABETES OR FAMILY MEMBER OF SOMEONE WITH DIABETES, 32 INDIVIDUALS ON NUTRITION AND PHYSICAL ACTIVITY IN RELATION TO WEIGHT CONTROL, 27 INDIVIDUALS ON OUR BUILT ENVIRONMENT, 7 WORKSITE MANAGERS OR HUMAN RESOURCE DIRECTORS, 6 HEALTH EDUCATORS OR SCHOOL FAMILY RESOURCE/YOUTH SERVICE CENTER STAFF, 6 HEALTH EDUCATORS OR SCHOOL FAMILY RESOURCE/YOUTH SERVICE CENTER STAFF RESOURCE/YOUTH SERVICE CENTER STAFF. THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 6A: THE HOSPITAL'S CHNA WAS CONDUCTED WITH BOWLING GREEN WARREN COUNTY HOSPITAL CORPORATION (THE MEDICAL CENTER) CAVERNA MEMORIAL HOSPITAL, COMMONWEALTH REGIONAL HOSPITAL, GREENVIEW REGIONAL HOSPITAL, LOGAN MEMORIAL HOSPITAL, MEDICAL CENTER AT SCOTTSVILLE, MONROE COUNTY MEDICAL CENTER, TJ SAMSON COMMUNITY HOSPITAL. THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 7D: A COPY OF THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND STRATEGIC IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.THEMEDICALCENTERFRANKLIN.ORG/ABOUT_US/DOCUMENTS/FRANKLIN.PDF THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 11: THE MEDICAL CENTER AT FRANKLIN PROVIDES FREE CARE FOR PERSONS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 13B: NUMBER IN HOUSEHOLD IS USED FOR DETERMINING FLP FOR COMPARISON TO REPORTED INCOME. THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY WROTE OFF 100% OF CHARGES TO FAP DUE TO ELIGIBLE INDIVIDUALS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY THE MEDICAL CENTER AT FRANKLIN INC PART V, SECTION B, LINE 16A WEBSITE: WWW.THEMEDICALCENTERFRANKLIN.ORG 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 $2,330,115. 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: THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE HOSPITAL ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AN OPERATING EXPENSE FOR FINANCIAL REPORTING PURPOSES. 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 FRANKLIN ("MCF") PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE MCF DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. MCF 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. MCF 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 FRANKLIN ("MCF") IS BUILT UPON THE FOUNDATION OF SERVING OUR COMMUNITY, DAY IN AND DAY OUT, WITH QUALITY DEPENDABLE HEALTHCARE. MCF HAS NOT HISTORICALLY COMPLETED FORMAL HEALTH NEEDS ASSESSMENTS, HOWEVER, AS NEEDS ARISE IN THE COMMUNITY AND SURROUNDING COUNTIES, MCF RESPONDS. MCF 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 FRANKLIN ("MCF") IS AN ACUTE CARE HOSPITAL WHICH SERVES THE RESIDENTS OF FRANKLIN AND SIMPSON COUNTY. THE COMMUNITY IS GROWING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THE PERCENTAGE OF UNINSURED PERSONS IN THE COMMUNITIES SERVED BY MCF IS HIGHER THAN THE KENTUCKY AVERAGE. AS OF THE CENSUS OF 2000, THERE WERE 16,405 PEOPLE, 6,415 HOUSEHOLDS, AND 4,638 FAMILIES RESIDING IN THE COUNTY. THE POPULATION DENSITY WAS 70 PER SQUARE MILE (27/KM2). THERE WERE 7,016 HOUSING UNITS AT AN AVERAGE DENSITY OF 30 PER SQUARE MILE (12/KM2). THE RACIAL MAKEUP OF THE COUNTY WAS 87.84% WHITE, 10.22% BLACK OR AFRICAN AMERICAN, 0.17% NATIVE AMERICAN, 0.55% ASIAN, 0.6% PACIFIC ISLANDER, 0.30% FROM OTHER RACES, AND 0.87% FROM TWO OR MORE RACES, 0.91% OF THE POPULATION WAS HISPANICS OR LATINOS OF ANY RACE. THE POPULATION ESTIMATE 2011 PROVIDED BY THE U.S. DEPARTMENT OF COMMERCE IS 17,378 FOR SIMPSON COUNTY. THERE WERE 6,415 HOUSEHOLDS OUT OF WHICH 33.80% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 56.80% WERE MARRIED COUPLES LIVING TOGETHER, 11.50% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 27.70% WERE NON-FAMILIES, 24.20% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 10.40% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.52 AND THE AVERAGE FAMILY SIZE WAS 2.97. THE AGE DISTRIBUTION WAS 26.20% UNDER THE AGE OF 18, 8.50% FROM 18 TO 24, 29.20% FROM 25 TO 44, 23.00% FROM 45 TO 64, AND 13.10% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 36 YEARS. FOR EVERY 100 FEMALES THERE WERE 95.30 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER, THERE WERE 91.60 MALES. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $36,432, AND THE MEDIAN INCOME FOR A FAMILY WAS $42,525. MALES HAD A MEDIAN INCOME OF $32,160 VERSUS $22,667 FOR FEMALES. THE PER CAPITAL INCOME FOR THE COUNTY WAS $17,150. ABOUT 8.50% OF FAMILIES AND 11.60% OF THE POPULATION WERE BELOW THE POVERTY LINE - INCLUDING 14.00% OF THOSE UNDER AGE 18 AND 15.90% OF THOSE AGE 65 OR OVER. THE BARREN RIVER COMMUNITY HEALTH PLANNING COUNCIL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2012 AND DETERMINED THE REGION'S PRIORITY HEALTH ISSUES TO INCLUDE CARDIOVASCULAR DISEASE COMMUNITY EDUCATION & PROGRAMS ACCESS TO CARE FOR OBESITY. PART VI, LINE 6: THE MEDICAL CENTER AT FRANKLIN ("MCF") 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. 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 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 FOURTEEN PHYSICIAN PRACTICES EMPLOYING GENERAL PRACTITIONERS, CARDIAC SURGEONS, VASCULAR SURGEONS, NEUROSURGEONS, NEUROLOGISTS, OBSTETRIC/GYNECOLOGISTS, HOSPITALISTS, AN OTOLARYNGOLOGIST, AN ORTHOPAEDIST, AND PSYCHIATRISTS. 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 CENTERCARE HEALTH BENEFITS PROGRAM ("CENTERCARE"), 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, CENTERCARE SERVES AS THE STATEWIDE NETWORK FOR MANAGED CARE ORGANIZATIONS PROVIDING MEDICAID MANAGED CARE SERVICE FOR THE STATE OF KENTUCKY. IT ALSO SERVICES OVER 450,000 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. CCH'S FOR-PROFIT ACTIVITIES INCLUDE URGENTCARE OF BOWLING GREEN, INC ("URGENTCARE"). URGENTCARE IS A WHOLLY-OWNED CORPORATION WHICH SERVES AS A 50% OWNER IN A PRIMARY CARE CENTER.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." 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 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.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. 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. X X X X X 0 1 0 0 0 0 0 0 0 CONNIE SMITH DIRECTOR/PRESIDENT & CEO 0 601562 0 0 0 208188 0 0 0 13369 0 823119 0 0 BARBARA JEAN CHERRY CIO/EXECUTIVE VICE PRESIDENT 0 407200 0 0 0 67832 0 0 0 13637 0 488669 0 0 RONALD SOWELL CFO/EXECUTIVE VICE PRESIDENT 0 407728 0 0 0 77523 0 0 0 13109 0 498360 0 0 BETSY KULLMAN CNO/EXECUTIVE VICE PRESIDENT 0 272628 0 0 0 6665 0 0 0 20264 0 299557 0 0 SARAH MOORE EXECUTIVE VICE PRESIDENT 0 260493 0 0 0 6615 0 0 0 11258 0 278366 0 0 ERIC HAGAN VICE PRESIDENT/ADMINISTRATOR OF MCS 0 215947 0 0 0 3869 0 0 0 27758 0 247574 0 0 WADE STONE EXECUTIVE VICE PRESIDENT 0 244569 0 0 0 1818 0 0 0 27339 0 273726 0 0 PART I, LINE 4B 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 $187,054 RONALD SOWELL $72,627 JEAN CHERRY $62,936. A COUNTY OF SIMPSON KENTUCKY 616000771 828899AA2 2010-12-15 9432000 REFUNDING OF 2006 BONDS AND NEW CONSTRUCTION 0 0 0 A 8252618 110000 3812835 4329783 2011 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 1 BB&T 10.000000000000 0 0 0 0 0 A 0 AIRGAS MID- AMERICA BARBARA JEAN CHERRY, OFFICER 34507 MEDICAL SUPPLIES - BARBARA JEAN CHERRY IS AN EXECUTIVE VICE PRESIDENT FOR THE MEDICAL CENTER. MRS. CHERRY'S SPOUSE IS THE CHIEF FINANCIAL OFFICER OF AIRGAS MID-AMERICA. AIRGAS MID-AMERICA SUPPLIES MEDICAL GAS TO THE MEDICAL CENTER. JEAN CHERRY DOES NOT PARTICIPATE IN THE NEGOTIATIONS OF CONTRACTS WITH AIRGAS MID-AMERICA AND ALL TRANSACTIONS ARE CONDUCTED ON AN ARM'S LENGTH BASIS. 0 FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION'S ARTICLES OF INCORPORATION SPECIFY THE CORPORATION SHALL HAVE ONE(1) MEMBER, WHICH MEMBER SHALL BE COMMONWEALTH HEALTH CORPORATION, INC. 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 A, LINE 7A THE CORPORATION'S ARTICLES OF INCORPORATION SPECIFY THE CORPORATION SHALL HAVE ONE(1) MEMBER, WHICH MEMBER SHALL BE COMMONWEALTH HEALTH CORPORATION, INC. 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 11 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, THE 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 FOR CHC AND/OR AFFILIATES. 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 OFFICERS OF THIS ENTITY ARE EMPLOYEES OF COMMONWEALTH HEALTH CORPORATION. CHC 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 OTHER FEES FOR NON-EMPLOYEES: PROGRAM SERVICE EXPENSES 3,151,179. MANAGEMENT AND GENERAL EXPENSES 500,933. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,652,112. FORM 990, PART XI, LINE 9: CHANGE IN FV OF INTEREST RATE SWAP AGREEMENT -55,715. 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; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORP 800 PARK STREET BOWLING GREEN KY 42101 610920842 HOSPITAL KY 501(C)(3) LINE 3 CHC INC 0 COMMONWEALTH HEALTH FREE CLINIC INC 800 PARK STREET BOWLING GREEN KY 42101 611292739 HEALTH CARE KY 501(C)(3) LINE 3 CHC INC 0 COMMONWEALTH HEALTH CORPORATION 800 PARK STREET BOWLING GREEN KY 42101 311118087 SUPPORT KY 501(C)(3) LINE 9 N/A 0 COMMONWEALTH REGIONAL SPECIALTY HOSPITAL 800 PARK STREET BOWLING GREEN KY 42101 542142034 HOSPITAL KY 501(C)(3) LINE 3 CHC INC 0 COMMONWEALTH HEALTH FOUNDATION INC 800 PARK STREET BOWLING GREEN KY 42101 611362000 SUPPORT KY 501(C)(3) LINE 7 CHC INC 0 URGENTCARE PROPERTIES 800 PARK STREET BOWLING GREEN KY 42101 611197268 REAL ESTATE KY N/A RELATED 0 0 MEDICAL PLAZA PARTNERS LTD 800 PARK STREET BOWLING GREEN KY 42101 611080340 REAL ESTATE KY N/A RELATED 0 0 URGENTCARE OF BOWLING GREEN INC 800 PARK STREET BOWLING GREEN KY 42101 611035393 HEALTHCARE KY N/A C 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0