2025-02-24T07:59:35-06:00 2023-12-31 882730877 CHERRY BEKAERT ADVISORY LLC 101 SOUTH 5TH STREET STE 2100 LOUISVILLE KY 40202 990 2023-01-01 610525158 BRECKINRIDGE HEALTH INC BREC 2707567000 1011 OLD HIGHWAY 60 EAST HARDINSBURG KY 40143 ANGEL PORTMAN CHIEF EXECUTIVE OFFICER 2707567000 2025-02-20 1 1 MELANIE MCPEAK P01346034 8885871719 2023 2025-03-06 01:10:19Z ANGELA PORTMAN 1011 OLD HIGHWAY 60 EAST HARDINSBURG KY 40143 31706439 0 X WWW.MYBRECKHEALTH.ORG X 1947 KY THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF ITS COMMUNITIES. 13 12 382 15 0 0 958431 19317 24632152 25349482 39393 9022 3387587 6328618 29017563 31706439 0 1450 0 0 14933739 14644250 0 0 0 12974284 13626201 27908023 28271901 1109540 3434538 18624978 21230291 11087114 10257889 7537864 10972402 X THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF ITS COMMUNITIES. 0 1 24104449 1450 26966943 BRECKINRIDGE HEALTH IS A 25-BED CRITICAL ACCESS HOSPITAL, PLUS 18-BED NURSING FACILITY, AND HAS 3 RURAL HEALTH CLINICS.IN 2002 BRECKINRIDGE MEMORIAL HOSPITAL, INC. BECAME BRECKINRIDGE HEALTH, INC. IN ORDER TO DESCRIBE ALL OF ITS DIVISIONS. BRECKINRIDGE HEALTH, INC. INCLUDES BRECKINRIDGE MEMORIAL HOSPITAL, BRECKINRIDGE MEMORIAL NURSING FACILITY, THE CLOVERPORT HEALTH CLINIC, MCDANIELS HEALTH CLINIC, BRECKINRIDGE PRIMARY CARE, BRECKINRIDGE HEALTH CLINIC, AND BRECKINRIDGE SURGICAL SERVICES.BRECKINRIDGE HEALTH, INC. IS ACCREDITED BY JOINT COMMISSION FOR HEALTHCARE ORGANIZATIONS, CERTIFIED FOR MEDICARE AND MEDICAID, AND LICENSED BY THE KENTUCKY DIVISION OF LICENSING AND REGULATION.BRECKINRIDGE HEALTH IS ALSO A MEMBER OF THE FOLLOWING ORGANIZATIONS: AMERICAN HOSPITAL ASSOCIATION, KENTUCKY HOSPITAL ASSOCIATION, KENTUCKY ASSOCIATION OF NOT-FOR-PROFIT HOMES AND SERVICES FOR THE AGING. 24104449 1 1 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 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 1 382 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 KY X ANGELA PORTMAN 2707567000 1011 OLD HIGHWAY 60 EAST HARDINSBURG KY 40143 ANGELA PORTMAN CHIEF EXECUTIVE OFFICER 40.00 0.00 X X 202500 0 26076 KIM FLOOD VICE CHAIR 2.00 0.00 X X 0 0 0 FAYE DOWELL TREASURER 2.00 0.00 X X 0 0 0 JANICE ELDER BOARD MEMBER 1.00 0.00 X 0 0 0 HOLLY GREGORY BOARD MEMBER 1.00 0.00 X 0 0 0 MITCH JACKSON BOARD MEMBER 1.00 0.00 X 0 0 0 KERRY KASEY BOARD MEMBER 1.00 0.00 X 0 0 0 TOM LOUGHRAN BOARD MEMBER 1.00 0.00 X 0 0 0 LAYMAN LUCAS BOARD MEMBER 1.00 0.00 X 0 0 0 BECKY POLLOCK BOARD MEMBER 1.00 0.00 X 0 0 0 JEFFREY ROBBINS BOARD MEMBER 1.00 0.00 X 0 0 0 DOTTIE WATSON BOARD MEMBER 1.00 0.00 X 0 0 0 SHERRY WILSON BOARD MEMBER 1.00 0.00 X 0 0 0 AMY ARNDELL CHIEF FINANCIAL OFFICER 40.00 0.00 X 136987 0 15199 BENJAMIN S SMITH PHYSICIAN 50.00 0.00 X 476788 0 6385 BRIAN T O'DONOGHUE PHYSICIAN 50.00 0.00 X 276051 0 5056 JOHN E ROE CRNA 40.00 0.00 X 193119 0 3565 MEENA S PATEL PHYSICIAN 50.00 0.00 X 180755 0 3338 CHRISTA K DOWELL NURSE PRACTITIONER 40.00 0.00 X 161626 0 3094 1627826 0 62713 13 0 1 0 CONCORD MEDICAL GROUP OF KY PLLC 1602 AVENUE Q LUBBOCK TX 79401 EMERGENCY ROOM SERVICES 1036299 ORACLE AMERICA INC 500 ORACLE PARKWAY REDWOOD SHORES CA 94065 ELECTRONIC HEALTH RECORDS 753504 BLUE MANAGEMENT SERVICES LLC 2650 EASTPOINT PARKWAY SUITE 200 LOUISVILLE KY 40223 HOSPITAL MGT SERVICES 613173 ATHENAHEALTH INC PO BOX 415615 BOSTON MA 02241 ELECTRONIC HEALTH RECORDS 504644 SPINE CONSULTANTS LLC 2514 VILLAGE GREEN PLACE CHAMPAIGN IL 61822 SURGERY SERVICES 500320 15 10317 9000 19317 PATIENT SERVICES 621990 25349482 25349482 25349482 7272 7272 4074 0 4074 4074 4074 1750 0 1750 1750 1750 340B REVENUE 900099 1548416 1548416 CAFETERIA SALES 722514 44151 44151 INTEREST ON PATIENT ACCOUNTS 900099 36430 36430 4695547 32615 4662932 6324544 31706439 26966943 0 4720179 X 1450 1450 380763 380763 10826561 9491142 1335419 83765 81397 2368 2572861 2211819 361042 780300 663255 117045 674766 674766 14060 14060 58085 58085 4242194 4098990 143204 51472 51472 339086 339086 1361623 1149395 212228 84344 84344 260070 177108 82962 911844 620966 290878 545374 545374 MEDICAL AND OTHER SUPPL 3296098 2801466 494632 BAD DEBT EXPENSE 1267284 1267284 PROVIDER TAX 266521 266521 FOOD EXPENSE 249435 249435 3945 3945 28271901 24104449 4167452 0 645024 739063 5187116 5323791 3166799 5614519 868611 649424 300174 325709 22100771 14083957 7878564 8016814 26291 51234 552399 509737 18624978 21230291 2671233 2373116 5641000 5386000 914673 722314 1860208 1776459 11087114 10257889 X 7537864 10972402 7537864 10972402 18624978 21230291 3434538 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1453 1453 0 PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE KENTUCKY HOSPITAL ASSOCIATION. TOTAL DUES PAID TO THE ORGANIZATION ATTRIBUTABLE TO LOBBYING EXPENSES FOR 2023 AMOUNT TO $1,453. 0 102140 102140 10407748 5571302 4836446 10801338 8053284 2748054 789545 459371 330174 8016814 THIRD PARTY PAYOR SETTLEMENTS 1285644 RIGHT OF USE LEASE LIABILITY 490815 1776459 X 30439155 -1267284 -1267284 31706439 0 31706439 27004617 0 27004617 1267284 1267284 28271901 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECOGNIZES UNCERTAIN INCOME TAX POSITIONS USING A "MORE-LIKELY-THAN-NOT" APPROACH AS DEFINED IN THE ASC. NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -1,267,284. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,267,284. 1 1 X 1 X 1 X 1 1 1 0 1 1 128962 128962 0.00460 5988104 9654570 0 0.00000 6117066 9654570 128962 0.00460 29631 29631 0.00100 29631 29631 0.00100 6146697 9654570 158593 0.00560 1 1267284 82888 1 1 1 1 BRECKINRIDGE MEMORIAL HOSPITAL 1011 OLD HIGHWAY 60 HARDINSBURG KY 40143 WWW.MYBRECKHEALTH.ORG 600070 X X X X BRECKINRIDGE MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 22 1 0 1 1 X WWW.MYBRECKHEALTH.ORG X 1 22 1 WWW.MYBRECKHEALTH.ORG 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X WWW.MYBRECKHEALTH.ORG X WWW.MYBRECKHEALTH.ORG X WWW.MYBRECKHEALTH.ORG X X X X X 1 X X 1 X X X 1 X 0 0 BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL MET WITH HEALTH DEPARTMENT, OTHER LOCAL HEALTH PROVIDERS, LOCAL MINISTERS HOSPITAL BOARD, FOUNDATION BOARD AND COMMUNITY LEADERS. BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: BRECKINRIDGE MEMORIAL HOSPITAL BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BRECKINRIDGE MEMORIAL NURSING FACILITY; CHRISTA DOWELL, APRN AND JILL JAGGERS, APRN AT MCDANIEL'S FAMILY CARE; MANDY BUTLER, APRN AT THE CLOVERPORT HEALTH CLINIC; DR. BEN SMITH, DR. BRIAN O'DONOGHUE, MISTY GILLEY, APRN, JULY NIXON, PA-C, AND CATHY LEWIS, APRN AT THE BRECKINRIDGE PRIMARY CARE CLINIC; DR. MEENA PATEL AT BRECKINRIDGE HEALTH CLINIC (PEDIATRICS); BRECKINRIDGE SURGICAL SERVICES, PODIATRY; BRECKINRIDGE HEALTH ORTHOPEDICS; ONCOLOGY; AND OUTCLINIC PATIENT BULDING BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: BRECKINRIDGE HEALTH, INC. (BHI) ISSUED AN IMPLEMENTATION STRATEGY TO ADDRESS ALL THREE AREAS OF CONCERN IDENTIFIED IN THE MOST RECENT CHNA: HEART HEALTH, BEHAVIOR/MENTAL HEALTH, AND CANCER. HEART HEALTHBHI APPROACHES HEART HEALTH WITH QUALITY IMPROVEMENT GOALS TO EDUCATE THE COMMUNITY ON HEART SERVICES, IMPROVE ACUTE DIAGNOSTIC PROTOCOLS RELATED TO HEART DISEASE, AND PROMOTE ONGOING CARE. PROGRESS IN THIS FOCUS AREA WILL BE MEASURED VIA REDUCTION IN MORTALITY RELATED TO HEART DISEASE; INCREASE TO HEART HEALTH SCREENINGS THROUGH PRIMARY CARE PHYSICIANS' OFFICES; AND INCREASE IN MULTI-DISCIPLINE INTERVENTIONS, SUCH AS DIETICIAN SERVICES AND CARDIAC REHAB. TO ADDRESS ITS GOALS IN THE HEART HEALTH ARENA, BHI HAS CONTINUED WITH THE STEM PROTOCOL WITH NORTON'S, REVIEWS QUALITY DATA FOR IMPROVEMENT, AND PLANS TO OBTAIN CHEST PAIN CENTER ACCREDITATION. BHI ALSO PROVIDES EDUCATION TO THE COMMUNITY THROUGH A QUARTERLY NEWSLETTER AND FREE PUBLIC EDUCATION EVENTS, AS WELL AS IN-PERSON EDUCATION REGARDING AVAILABLE SERVICES AT PCP OFFICES. CPR CLASSES ARE ALSO OFFERED IN THE COMMUNITY.BHI'S EFFORTS IN THIS AREA ARE EXPECTED TO INCREASE COMMUNITY AWARENESS AND DECREASE CARDIAC EVENTS WITHIN THE COMMUNITY. THE COMMUNITY IS EXPECTED TO EMBRACE AND EXPERIENCE A GREATER LEVEL OF OVERALL WELLNESS.BEHAVIORAL/MENTAL HEALTHTHE PLAN TO ADDRESS BEHAVIOR AND MENTAL HEALTH CENTERS ON INCREASING ACCESS TO MENTAL HEALTH SERVICES IN AN OUTPATIENT SETTING, AND DECREASING STIGMA REGARDING MENTAL HEALTH ISSUES IN THE COMMUNITY. BHI ALSO PLANS TO INCREASE COMMUNITY AWARENESS OF MENTAL HEALTH SUPPORT WITHIN THE COMMUNITY, AND INCREASE REFERRALS TO MENTAL HEALTH PROGRAMS (GOAL OF SUCCESSFUL COMPLETION OF PROGRAMS). BHI REFERS PATIENTS TO OTHER FACILITIES AS NEEDED FOR MENTAL HEALTH SERVICES BOTH OUTPATIENT AND INPATIENT. BHI IS CLOSELY MONITORING THE BEHAVIORAL HEALTH RESOURCES CURRENTLY AVAILABLE TO PATIENTS, AND SUPPORTING THE PRIMARY CARE PHYSICIANS WHO ARE CURRENTLY ATTEMPTING THEMSELVES TO MANAGE THEIR PATIENTS' BEHAVIORAL HEALTH NEEDS IN-OFFICE WHEN PATIENTS HAVE REFUSED REFERRAL. BHI PLANS TO ADDRESS THE GROWING NEED IN THIS AREA BY ROLLING OUT A NEW BEHAVIORAL HEALTH SERVICE LINE IN 2025, AND HIRING A NEW PROVIDER. COMMUNITY EDUCATION EVENTS SUCH AS LUNCH AND LEARNS ARE ALSO PLANNED.BHI WORKS WITH THE COMMUNITY TO ADDRESS THE NEEDS OF BEHAVIORAL/MENTAL HEALTH SUPPORT GROUPS, AND EDUCATES THE COMMUNITY ON SUPPORT GROUPS CURRENTLY HELD IN THE COUNTY THROUGH THE SOCIAL MEDIA AND A NEWSLETTER. BY MONITORING THE NEEDS OF THE PATIENT DEMOGRAPHIC, BHI WILL BE ABLE TO REFER PATIENTS TO THE SERVICES NEEDED. IF THE NEED CONTINUES TO GROW, BHI WILL LOOK INTO THE POTENTIAL NEED FOR NEW SERVICES WITHIN THE COMMUNITY.CANCERBHI HAS IDENTIFIED A LACK OF CANCER SUPPORT IN THE COMMUNITY, AND PLANS TO EXPAND THE VARIETY OF SERVICES BRECKINRIDGE HEALTH HAS TO OFFER, AND PROVIDE ONCOLOGY SERVICES TO INCLUDE PSYCHOSOCIAL SUPPORT, DIETARY CONSULTATIONS, FINANCIAL ASSISTANCE, AND CHEMO INFUSION. IN ORDER TO SUPPORT THE INCREASED VARIETY OF SERVICES, BHI WILL PARTNER WITH A TERTIARY SYSTEM OR INDEPENDENT PROVIDER FOR CHEMOTHERAPY REFERRALS, AND BUILD A PARTNERSHIP WITH NATIONAL RURAL ONCOLOGY COLLABORATIVE TO EXPAND ITS SUPPORTIVE SERVICES. FREE INTERACTIVE SESSIONS LED BY HEALTH PROFESSIONALS OR VOLUNTEERS ARE HELD ON-SITE TO EDUCATE THE COMMUNITY, FOCUSED ON HEALTHY LIFESTYLES, EDUCATIONAL PROGRAMMING, AND SUPPORT FOR PATIENTS AND LOVED ONES IMPACTED BY CANCER. BHI'S DEDICATED STAFF IS DESIGNING A CANCER SUPPORT PROGRAM BASED ON WHAT THE COMMUNITY NEEDS, AND WILL PROVIDE SUPPORT IN A WELCOMING ENVIRONMENT.BHI ALSO IDENTIFIED A NEED FOR UPDATED EQUIPMENT - IN 2023, BHI UPGRADED TO A 3D MAMMOGRAM MACHINE TO MEET THE ACCEPTED STANDARD OF CARE AND TO INCREASE THE ODDS OF EARLY DETECTION. THE COMMUNITY IS EXPECTED TO SEE MORE ACCURATE RESULTS AND REDUCED NEED FOR FURTHER TESTING - AND WILL BENEFIT FROM REDUCED TRAVEL AND FINANCIAL BURDEN FOR TREATMENT. BRECKINRIDGE MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: THE FINANCIAL COUNSELOR FOLLOWS UP WITH EACH AND EVERY UNINSURED INDIVIDUAL AND DOCUMENTS EACH DATE OF SERVICE INCURRED. INDIVIDUALS ARE NOTIFIED OF OUR FINANCIAL AID POLICY. DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IS DOCUMENTED. WE HAVE AN EARLY OUT VENDOR THAT CALLS ON ALL BALANCES (UNINSURED AND AFTER INSURANCE SELF-PAY). WE ALSO MEET ALL REQUIREMENTS SET FORTH BY 501(R). ALL STATEMENTS INCLUDED A PLAIN LANGUAGE SUMMARY OF THE FAP. THE THIRD STATEMENT HAS THE "ECA NOTICE THAT EXPLAINS THE BALANCE WILL BE PLACED WITH A COLLECTOR. 6 1 - CLOVERPORT CLINIC 209 ELM ST CLOVERPORT KY 40111 CLINIC 2 - MCDANIELS' CLINIC 9798 KY-259 MCDANIELS KY 40152 CLINIC 3 - BRECKINRIDGE PRIMARY CARE 107 OLD HWY 60 HARDINSBURG KY 40143 CLINIC 4 - BRECKINRIDGE NURSING FACILITY 1011 OLD HWY 60 HARDINSBURG KY 40143 ELDER CARE 5 - BRECKINRIDGE HEALTH CLINIC 203 FAIRGROUNDS ROAD HARDINSBURG KY 40143 CLINIC 6 - BRECKINRIDGE SURGICAL SERVICES 105 CHAMBLISS DRIVE HARDINSBURG KY 40143 CLINIC PART I, LINE 7: BRECKINRIDGE HEALTH UTILIZES A COST ACCOUNTING SYSTEM THAT IDENTIFIES THE COST OF DELIVERING CARE AT THE INDIVIDUAL PROCEDURE AND SUPPLY LEVEL FOR DIRECT COSTS AND THEN ALLOCATES OVERHEAD COSTS. COSTS ARE DETERMINED FOR EACH PATIENT BASED UPON THE SPECIFIC PROCEDURES PERFORMED AND SUPPLIES USED FOR EACH PATIENT. PART I, LN 7 COL(F): A SEPARATE FOOTNOTE FOR BAD DEBT EXPENSE IS NOT INCLUDED IN THE AUDITED FINANCIAL STATEMENTS. BAD DEBT IS DETERMINED BY REVIEWING ACCOUNTS OWED AND REVIEWING WHICH PROGRAMS ARE AVAILABLE TO THOSE PATIENTS WHO CANNOT PAY THEIR BILL. ONCE A REVIEW IS COMPLETED AND PATIENTS WHO ARE NOT ELIGIBLE FOR OTHER PROGRAMS ARE IDENTIFIED THE FACILITY ATTEMPTS TO COLLECT THE UNPAID BALANCE. ONCE ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED THE FACILITY DETERMINES THE AMOUNTS THAT ARE UNCOLLECTIBLE AND WRITES THOSE BALANCES OFF. PART III, LINE 2: BAD DEBT IS DETERMINED TO BE 90% OF THE SELF-PAY ACCOUNTS RECEIVABLE. THIS IS BASED UPON HISTORIC TRENDS. PART III, LINE 3: THE FINANCIAL COUNSELOR FOLLOWS UP WITH EACH AND EVERY UNINSURED INDIVIDUAL TO ASSIST WITH DETERMINING MEDICAID AND FINANCIAL ASSISTANCE ELIGIBILITY. IN SOME INSTANCES, THE PATIENT IS NONCOMPLIANT WITH PROVIDING THE NEEDED DOCUMENTATION. ALSO, WHEN PATIENTS GO THROUGH THE ER AFTER HOURS, THE FINANCIAL COUNSELOR IS NOT ABLE TO MEET WITH THE PATIENT AT THAT TIME. SHE DOES FOLLOW UP AFTER THE ER VISIT TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, BUT SINCE IT IS AFTER THE FACT SOME COULD SLIP THROUGH THE CRACKS. WE ARE CONSTANTLY TRYING TO IMPROVE OUR PROCESS WITH THE GOAL OF CAPTURING 100% ELIGIBILITY. BASED ON DEMOGRAPHICS AND INCOME LEVELS, $82,888 IS THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: THE ORGANIZATION IS A CRITICAL ACCESS HOSPITAL, SO IT DOES NOT HAVE A MEDICARE SURPLUS OR SHORTFALL. PART III, LINE 9B: COLLECTION PRACTICES ARE THE SAME FOR THOSE WHO QUALIFY FOR ASSISTANCE AS FOR THOSE WHO DO NOT. THE FINANCIAL COUNSELOR FOLLOWS UP WITH EACH AND EVERY UNINSURED INDIVIDUAL TO ASSIST WITH DETERMINING MEDICAID AND FINANCIAL ASSISTANCE ELIGIBILITY. BEFORE ANY ACCOUNT IS SENT TO COLLECTIONS, IT IS REVIEWED FOR DSH FUNDS AND CHARITY CARE. PART VI, LINE 2: EVERY THREE YEARS THE HOSPITAL DOES A COMMUNITY SURVEY. WE CONTACT RESIDENTS OF OUR SERVICE AREA TO GET THEIR FEELING ABOUT THE HOSPITAL AND WHAT IS NEEDED IN OUR COMMUNITY. OUR BOARD AND EMPLOYEES ALSO RELAY TO THE FACILITY WHAT IS NEEDED. THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF THIS COMMUNITY. PART VI, LINE 3: AT TIME OF REGISTRATION, THE FACILITY ADMISSIONS PERSONNEL DISCUSS WITH THE PATIENTS COVERAGE THEY MAY HAVE. FOR THOSE PATIENTS WHO DO NOT HAVE 3RD PARTY COVERAGE, THE POTENTIAL PROGRAMS ARE DISCUSSED. FACILITY COLLECTS INFORMATION AND THEN ASSISTS PATIENTS IN APPLYING FOR ASSISTANCE. ALL PRIVATE PATIENTS ARE ALSO SCREENED FOR STATE PROGRAMS. PART VI, LINE 4: BRECKINRIDGE HEALTH IS A CRITICAL ACCESS HOSPITAL LOCATED IN HARDINSBURG, KENTUCKY. THE FACILITY HAS 25 MEDICAL/SURGICAL BEDS AND 18 EXTENDED CARE/SKILLED NURSING BEDS. THE HOSPITAL SERVES BRECKINRIDGE COUNTY AND PORTIONS OF OHIO, MEADE, GRAYSON AND HANCOCK COUNTIES. THE HOSPITAL WAS FOUNDED IN 1947. PART VI, LINE 5: THE ORGANIZATION'S EXPLICIT PURPOSE IS TO CONTINUALLY REDUCE THE BURDEN OF ILLNESS, INJURY DISABILITY AND TO IMPROVE THE HEALTH AND FUNCTIONING OF THE PEOPLE OF THIS COMMUNITY. THE BOARD OF DIRECTORS IS COMPRISED OF COMMUNITY MEMBERS WHO REPRESENT THE WHOLE COMMUNITY. THIS GROUP ALONG WITH HOSPITAL MANAGEMENT, EMPLOYEES, AND PHYSICIANS UNDERSTANDS THE COMMUNITY EXPECTS THE ORGANIZATION TO PROVIDE HIGH QUALITY HEALTHCARE. ALL THE PARTIES UNDERSTAND THAT A DELICATE BALANCE IS REQUIRED TO MEET FISCAL NEEDS OF THE COMMUNITY AND TO PROVIDE HEALTHCARE TO ALL MEMBERS OF THE COMMUNITY. THE GROUP STRIVES CONSTANTLY TO MEET BOTH RESPONSIBILITIES. BRECKINRIDGE HEALTH OFFERS MANY EDUCATIONAL PROGRAMS ON DIABETES AWARENESS AND MANAGEMENT, HEALTHY HABITS, NUTRITION, CPR, SPORTS INJURY PREVENTION, FLU PREVENTION, ETC. OUR TRANQUILITY DEPARTMENT ALSO HOSTED SEVERAL LUNCH-AND-LEARNS WHERE WE EDUCATED THE COMMUNITY ABOUT SEVERAL TOPICS SUCH AS SOCIAL MEDIA AND YOUR WELL-BEING, NUTRITION, AND WEIGHT LOSS. WE ACTIVELY SUPPORT POCKETFUL OF HOPE (LOCAL CANCER CHARITY) AND COWBOYS FOR KIDS (CHILDREN'S CANCER CHARITY). ANNUALLY, WE HOLD A BACK 2 SCHOOL SUPPLY DRIVE TO ASSIST LOW-INCOME CHILDREN AND THE SCHOOL SYSTEM WITH MUCH NEEDED SCHOOL SUPPLIES. WE DONATE FIRST AID KITS FOR ALL THE LOCAL SCHOOL FESTIVALS. WE PARTICIPATED IN THE ENGAGE AT EVERY AGE WITH THE LOCAL LIBRARY TO ENCOURAGE ACTIVE PARTICIPATION IN THE LIVES OF YOUNG CHILDREN. WE ALSO PARTICIPATED IN THE BRECKINRIDGE COUNTY COMMUNITY-WIDE BABY SHOWER TO PROVIDE BABY SUPPLIES TO EXPECTING MOMS. WE ALSO PARTNERED WITH A LOCAL GYM TO START A WALKING GROUP TO ENCOURAGE EXERCISE AND HEALTHY HABITS. WE ASSIST OUR LOCAL SCHOOL TEAMS BY MAKING OUR DIRECTOR OF PHYSICAL THERAPY AVAILABLE TO THEM AS WELL AS PROVIDING FREE SPORTS PHYSICALS. WE REGULARLY PUBLISH ARTICLES ON FACEBOOK TO EDUCATE THE COMMUNITY ON HEALTH AND WELLNESS. WE PARTICIPATE IN THE COMMUNITY CARE COORDINATION TASK FORCE, MONTHLY DIABETES SUPPORT GROUP, BRECKINRIDGE COUNTY COALITION, CHAMBER OF COMMERCE, CAREER FAIRS AT THE LOCAL SCHOOLS, AND THE PHANTOM PROJECT, WHICH REACHED OVER 100,000 PEOPLE ACROSS THE COUNTRY. THE PHANTOM PROJECT EDUCATED THE COMMUNITY ON THE DANGERS OF DISTRACTED DRIVING. BRECKINRIDGE HEALTH ALSO STARTED A YOUTUBE CHANNEL TO SPOTLIGHT SEVERAL SERVICES WE OFFER AND TO EDUCATE THE COMMUNITY. WE PROVIDE HEALTH INFORMATION AND BLOOD PRESSURE CHECKS AT LOCAL 5KS, COMMUNITY APPRECIATION EVENTS, THE COUNTY FAIR, AND THE LOCAL HOE DOWN DAY. WE PROVIDE GUEST SPEAKERS TO LOCAL EVENTS AS WELL. X 0 0 0 0 0 0 0 1 0 BENJAMIN S SMITH PHYSICIAN 185731 0 291057 0 0 0 0 0 6385 0 483173 0 0 0 BRIAN T O'DONOGHUE PHYSICIAN 252001 0 24050 0 0 0 0 0 5056 0 281107 0 0 0 ANGELA PORTMAN CHIEF EXECUTIVE OFFICER 175273 0 27227 0 0 0 7281 0 18795 0 228576 0 0 0 JOHN E ROE CRNA 193069 0 50 0 0 0 0 0 3565 0 196684 0 0 0 MEENA S PATEL PHYSICIAN 180000 0 755 0 0 0 0 0 3338 0 184093 0 0 0 CHRISTA K DOWELL NURSE PRACTITIONER 90000 0 71626 0 0 0 0 0 3094 0 164720 0 0 0 AMY ARNDELL CHIEF FINANCIAL OFFICER 119679 0 17308 0 0 0 4715 0 10484 0 152186 0 0 0 PART I, LINE 7 PROVIDERS HAVE A WORK RELATIVE VALUE UNIT (WRVU) INCENTIVE GOAL AND BONUS PLAN ENCOURAGES CLINICAL PRODUCTIVITY. PHYSICIANS, NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS ARE ELIGIBLE TO RECEIVE A BONUS FOR ABOVE MEDICAL GROUP MANAGEMENT ASSOCIATION MEDIAN PRODUCTIVITY (SPECIALTY SPECIFIC). A BRECKINRIDGE COUNTY BUILDINGS COMMISSION 300306470 2009-10-16 6100000 HOSPITAL EXPANSION FINANCING SERIES A BOND ISSUE 0 0 0 B BRECKINRIDGE COUNTY BUILDINGS COMMISSION 300306470 2009-10-16 1900000 HOSPITAL EXPANSION FINANCING SERIES A BOND ISSUE 0 0 0 A 2010000 6100000 18000 6082000 2010 0 0 1 1 B 604000 1900000 11000 1889000 2010 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART III, LINE 3 BRECKINRIDGE HEALTH ENTERED INTO A JOINT VENTURE WITH BRECKINRIDGE MEMORIAL HOSPITAL PAIN MANAGEMENT LLC, TO PROVIDE PAIN MANAGEMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 3 BRECKINRIDGE HEALTH INC. (BHI) CONTRACTS WITH ALLIANT MANAGEMENT SERVICES (ALLIANT) TO PROVIDE MANAGEMENT SERVICES FOR BHI. ALLIANT PREPARES COST REPORTS FOR THIRD-PARTY PAYORS; PROVIDES TECHNICAL AND CONSULTING ASSISTANCE; AND PROVIDES THE CEO AND CFO POSITIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY THE ORGANIZATION'S ACCOUNTING FIRM AND REVIEWED BY THE CHIEF EXECUTIVE AND CHIEF FINANCIAL OFFICERS. FORM 990, PART VI, SECTION B, LINE 12C ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER IS REQUIRED TO BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORDS, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION; ANY GOVERNING BOARD MEMBER HAVING DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER IS PROHIBITED TO VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSENTATION FROM VOTING AND THE QUORUM SITUATION. THIS POLICY IS REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF GOVERNING BOARD MEMBERS AND ANY NEW MEMBERS ADVISED OF THE POLICY UPON ENTERING ON THE DUTIES OF THE OFFICE. FORM 990, PART VI, SECTION B, LINE 15 AS PART OF THE AGREEMENT WITH ALLIANT MANAGEMENT SERVICES, INC., THE BOARD IS PROVIDED WITH COMPENSATION SURVEYS FOR SENIOR LEADERSHIP. THE BOARD APPROVES COMPENSATION BASED ON THE STUDIES PROVIDED BY ALLIANT. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATION'S MEETINGS ARE OPEN TO THE PUBLIC AND SIGNIFICANT ACTIONS ARE AVAILABLE TO LOCAL MEDIA. ANY REQUEST FOR DOCUMENTS WOULD BE PRESENTED TO THE BOARD AND WOULD BE PROVIDED TO THE REQUESTING PARTY UNLESS THERE WAS A REASON NOT TO HONOR THEIR REQUEST. FORM 990, PART VI, SECTION B, LINE 15: THE ORGANIZATION USES ALLIANT MANAGEMENT TO PROVIDE ITS CEO AND CFO; THEREFORE, THE ORGANIZATION DOES NOT PAY COMPENSATION DIRECTLY TO THESE INDIVIDUALS. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 811,488. MANAGEMENT AND GENERAL EXPENSES 143,204. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 954,692. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 2,129,964. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,129,964. COLLECTION FEES: PROGRAM SERVICE EXPENSES 32,293. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,293. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,125,245. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,125,245. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. THE ORGANIZATION HAS A FINANCE COMMITTEE THAT OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE INDEPENDENT AUDITOR MEETS WITH THE FINANCE COMMITTEE AT THE CONCLUSION OF THE AUDIT. BRECKINRIDGE MEMORIAL HOSPITAL PAIN MANAGEMENT LLC 1011 OLD HIGHWAY 60 HARDINSBURG KY 40143 932458739 HEALTHCARE KY BRECKINRIDGE HEALTH INC RELATED -26058 101503 0 1 0.51000 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 BRECKINRIDGE MEMORIAL HOSPITAL PAIN MANAGEMENT LLC A 70 CASH BRECKINRIDGE MEMORIAL HOSPITAL PAIN MANAGEMENT LLC L 76561 CASH BRECKINRIDGE MEMORIAL HOSPITAL PAIN MANAGEMENT LLC R 51000 CASH