2014-05-28T15:15:43-05:00 2013-09-30 621046406 JOHNSON HICKEY & MURCHISON PC 651 E FOURTH ST STE 200 CHATTANOOGA TN 37403 990 2012-10-01 311131099 OHIO COUNTY HOSPITAL CORPORATION OHIO 2702987411 1211 OLD MAIN STREET HARTFORD KY 42347 JOHN TICHENOR 2702987411 2014-05-27 1 BARRY R HUGGINS P00627334 4237560052 2012 2015-11-30 17:44:51Z BLAINE PIEPER 1211 OLD MAIN STREET HARTFORD KY 42347 34250113 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 8 460 50 0 0 116998 74136 29944255 31955727 5589 8697 1475519 2211553 31542361 34250113 0 0 0 0 16535223 17932868 0 0 0 14970911 15840514 31506134 33773382 36227 476731 17467563 18564946 8690346 9310998 8777217 9253948 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 30261459 34123104 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 ARE A HEALTHIER PLACE TO LIVE AND WORK. DURING 2012, THE HOSPITAL PROVIDED HEALTH CARE SERVICES TO OHIO COUNTY KENTUCKY AND SURROUNDING AREAS, INCLUDING INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES. OHIO COUNTY HOSPITAL PROVIDED $1,538,124 OF CHARITY CARE THROUGH ITS CHARITY CARE PROGRAM. IN ADDITION, THEY PROVIDED $67,188 WORTH OF PROFESSIONAL FEES AND $41,092.52 OF HOSPITAL/PHYSICIAN CLINIC SERVICES THAT WERE NOT REIMBURSED BY ANY STATE PROGRAMS. 30261459 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 28 0 1 460 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 JOHN TICHENOR 2702985495 1211 OLD MAIN STREET HARTFORD KY 42347 X JUANITA PARK 2.00 X X 0 0 0 JANE CANARY 2.00 X X 0 0 0 JONATHAN SHREWBURY OD 2.00 X X 0 0 0 WAYNE HUNSAKER 2.00 X 0 0 0 KELLY ROE 2.00 X 0 0 0 CARLA WALLACE 2.00 X 0 0 0 GERALD WESTERFIELD 2.00 X 0 0 0 LLOYD SPIVEY 2.00 X 0 0 0 DONALD K GREGORY 40.00 X 318563 0 25565 BRENDA NEWCOM 40.00 X 84870 0 24432 JANNA PATHI 40.00 X 292763 0 18353 MUKESH DESAI 40.00 X 590759 0 34770 JOSHUA SKIBBA 40.00 X 423401 0 18669 CHARLES RICCIO 40.00 X 643121 0 33388 JOEL JOHNSTON 40.00 X 331806 0 44113 CHARLES JARBOE 40.00 X 300605 0 33348 2985888 0 232638 18 0 1 0 EMCARE PHYSICIAN SERVICES 105 CONTINENTAL PLACE BRENTWOOD TN 37027 ER PHYSICIANS 357826 QUOROM HEALTH RESOURCES 7032 COLLECTION CENTER PLACE CHICAGO IL 60693 MANAGEMENT FEES 258462 2 41745 32391 74136 NET PATIENT SERVICES 621300 31955727 31955727 31955727 8697 8697 44176 0 44176 44176 44176 PHARMACY SALES 446110 1719851 1719851 MISCELLANEOUS INCOME 621300 312608 312608 WELLNESS PROGRAM 900099 71477 71477 63441 63441 2167377 34250113 34123104 0 52873 966246 966246 14236283 13335076 901207 296322 278756 17566 1433108 1348153 84955 1000909 941575 59334 258462 258462 54873 54873 59595 59595 2366093 1695961 670132 86383 86383 104399 86800 17599 2216312 1883896 332416 159614 115552 44062 212006 212006 954947 954947 393579 14656 378923 MEDICAL SUPPLIES AND DR 5346132 5346132 BAD DEBT 2602981 2602981 TAXES AND LICENSES 492621 492621 OTHER SUPPLIES 336364 280954 55410 196153 111385 84768 33773382 30261459 3511923 0 1733210 2603474 1064120 1073592 4417612 4699005 775893 817332 833134 882180 171589 162984 24241976 16311306 8180599 7930670 291406 395709 17467563 18564946 2196201 2448095 357694 356535 4880000 4280000 599378 615668 657073 1610700 8690346 9310998 X 8777217 9253948 8777217 9253948 17467563 18564946 476731 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3137 3137 0 EXPLANATION OF LOBBYING ACTIVITIES: 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. 441841 441841 8358602 3905498 4453104 14822480 12088030 2734450 619053 317778 301275 7930670 THIRD PARTY SETTLEMENTS 1407316 RETIREMENT BENEFITS 203384 1610700 X 34250113 0 34250113 0 34250113 33773382 0 33773382 0 33773382 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013 AND 2012. AS OF SEPTEMBER 30, 2013 AND 2012, 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 2010. 1 1 1 X 0 1 1 0 0 1219086 478757 740329 0.02380 3929410 3002634 926776 0.02970 5148496 3481391 1667105 0.05350 50139 50139 0.00160 50139 50139 0.00160 5198635 3481391 1717244 0.05510 1 1294983 762217 8711237 8684595 26642 X 1 0 1 1 OHIO COUNTY HOSPITAL CORPORATION

1211 OLD MAIN STREET HARTFORD KY 42347

X X X OHIO HOSPITAL CORPORATION 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X X 1 0 1 1 100.000000000000 0 1 X 1 1 X 1 X 0 1 X 0 0 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 $ 2602981. PART II: OHIO COUNTY HOSPITAL USED THE INFORMATION COLLECTED FROM THE MAPPS SURVEY PROCESS TO DETERMINE WHICH HEALTH NEEDS COULD BE IMPACTED BY COLLABORATION BETWEEN OUR FACILITY AND THE OHIO COUNTY HEALTH COALITION. THESE KEY HEALTH-CARE ISSUES WERE ALIGNED WITH THE MISSION AND PRIORITIES OF OHIO COUNTY HOSPITAL AND WERE INCORPORATED INTOTHE 2013 STRATEGIC PLAN. IT WAS DETERMINED THAT OHIO COUNTY HOSPITAL HAD THE RESOURCES AND ABILITY TO IMPACT EACH OF THE THREE KEY AREAS OF FOCUS:IMPROVE COMMUNITY LIFESTYLE CHOICESOHIO COUNTY HOSPITAL IS THE LEADER IN PROMOTING HEALTH AND WELLNESS IN THE COMMUNITY. THE HOSPITAL PROVIDES FINANCIAL SPONSORSHIP, AS WELL AS COORDINATES AND PROVIDES EMPLOYEE VOLUNTEERS, FOR THE MAJORITY OF THE HEALTH OUTREACH INITIATIVES IN OHIO COUNTY. EXAMPLES OF THESE PROGRAMS INCLUDE: RELAY FOR LIFE, GO RED HEART EDUCATION LUNCH & LEARN, SENIOR HEALTH FAIR, COMMUNITY-WIDE HEALTH FAIR, HEALTHY EATING FOOD DEMONSTRATIONS HOSTED AT LOCAL GROCERY STORES, BREAST CANCER AWARENESS EVENTS, GRIEF SUPPORT GROUP THROUGH HOSPICE, GO BLUE PROSTRATE CANCER EDUCATION EVENTS, ANNUAL OCH FALL INTO FITNESS 5K AND OCH SUMMER SIZZLE 5K. OHIO COUNTY HOSPITAL ALSO PROVIDES MEETING SPACE FOR RETIRED TEACHERS ASSOCIATION,FREE SMOKING CESSATION PROGRAM, HOSPITAL EMPLOYEE UNITED WAY FUND-DRIVE, HABITAT FOR HUMANITY FALL FESTIVAL, AND HEALTH STUDENTS CAREER DAY. HOSPITAL STAFF PARTICIPATES IN THE COMMUNITY SCHOOL SYSTEM BACK TO SCHOOL BASHES TO DISTRIBUTE INFORMATION ON CHILDHOOD IMMUNIZATIONS AND WELL-CHILD VISITS. ADDITIONALLY,HOSPITAL STAFF ARE VOLUNTEERS IN THE 4-H BODY WALK AN INTERACTIVE DISPLAY TO TEACH MIDDLE SCHOOL STUDENTS ABOUT THE HUMAN BODY; OHIO COUNTY HOSPITAL ALSO PROVIDES OVER 100 HEALTHY MEALS TO THE VOLUNTEERS WHO WORK AT THE BODYWALK EVENT.CELEBRATE THE CHILD AN EVENT THAT DRAWS THOUSANDS OF COMMUNITY MEMBERS ANNUALLY AND FOCUS ON COMMUNITY ASSET BUILDING, AS WELL AS SAFETY AND HEALTH ISSUES. OCHS DIRECTOR OF COMMUNITY RELATIONS IS ACTIVE ON THE EVENT PLANNING COMMITTEE. OHIO COUNTY HOSPITAL SUBSIDIZES THE ADVERTISEMENT AND SUPPLIES FOR THE EVENT. IN ADDITION, SEVERAL STAFF PARTICIPATE IN A HOSPITAL BOOTH WHICH FOCUS ON CHILDREN MAKING HEALTHY FOOD AND EXERCISE CHOICES.LONGEST DAY OF PLAY - AN ANNUAL SUMMER EVENT WHERE FAMILIES CAN PARTICIPATE IN OVER 30 OUTDOOR PHYSICAL ACTIVITIES AT THE OHIO COUNTY PARK. IN 2013, OVER 1500 COMMUNITY MEMBERS AND VOLUNTEERS ATTENDED THE EVENT. HOSPITAL EMPLOYEES AND MEMBERS OF THE MEDICAL STAFF MAKE UP 25% OF THE VOLUNTEERS AT LONGEST DAY OF PLAY. THE HOSPITAL SUBSIDIZES THE ADVERTISEMENT AND SUPPLIES FOR THE EVENT, AS WELL PROVIDES FOOD FOR THE FREE HEALTHY PICNIC LUNCH.NEW YEARS NOON DANCE A FREE COMMUNITY DANCE PARTY HELD FOR FAMILIES AT NOON ON NEW YEARS EVE. THE EVENT WAS HELD AT THE OHIO COUNTY FAMILY WELLNESS CENTER. OHIO COUNTY HOSPITAL COORDINATED THE EVENT, PAID FOR ALL SUPPLIES, ADVERTISING, DJ SERVICES AND HEALTHY SNACKS. FAMILIES WERE PROVIDED INFORMATION ABOUT HEALTHY FOOD CHOICES AND THE BENEFITS OF EXERCISE.OHIO COUNTY HEALTH COALITION - A GROUP OF HEALTH-CARE FACILITIES, CIVIC GROUPS, INDUSTRY LEADERS AND COMMUNITY MEMBERS THAT MEET ON A MONTHLY BASIS REGARDING LOCAL HEALTH CARE ISSUES. OHIO COUNTY HEALTH COALITION IS A PART OF A REGIONAL HEALTH COALITION UNDER THE DIRECTION OF GREEN RIVER AREA DEVELOPMENT DISTRICT (GRADD). OHIO COUNTY HOSPITAL PROVIDES A FINANCIAL CONTRIBUTION TO GRADD TO HELP OFFSET THE EXPENSES OF THE HEALTH COALITIONS. MRS. ROBINSON, DIRECTOR OF COMMUNITY RELATIONS WITH OCH, SERVES AS CHAIR FOR EXECUTIVE COMMITTEE AND REPRESENTS OHIO COUNTY ON BOTH A LOCAL AND REGIONAL LEVEL. SEVERAL HOSPITAL EMPLOYEES ARE PART OF THE MEMBERSHIP BODY AND OCH PROVIDES THE MEAL AT EACH MEETING, AS WELL AS, THE MONTHLY MEAL FOR THE MCLEAN COUNTY HEALTH COALITION. MCLEAN COUNTY IS A NEIGHBORING COUNTY THAT DOES NOT HAVE A HOSPITAL IN ITS COMMUNITY. OHIO COUNTY HOSPITAL WILL CONTINUE TO ACTIVELY PARTICIPATE IN PROGRAMS AND EFFORTS SPONSOREDBY GRADD HEALTH COUNCIL AND OHIO COUNTY HEALTH COALITION TO IMPROVE THE HEALTH OF THE COMMUNITY.INCREASE ACCESS TO HEALTHCAREOHIO COUNTY HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.OCH WILL CONTINUE TO COOPERATE AND WORK WITH ALL MEDICAID MANAGED CARE PROVIDERS TO IMPROVE SERVICES FOR COVERED INDIVIDUALS.OCH WILL REVIEW AND UPDATE ITS CHARITY CARE POLICY TO PROVIDE EXPANDED FINANCIAL ASSISTANCE TO PATIENTS WHO ARE UNABLE TO QUALIFY FOR INSURANCE.DURING THE 2013 FISCAL YEAR, OCH RECRUITED ONE FAMILY MEDICINE PHYSICIAN AND TWO ADDITIONAL FAMILY MEDICINE NURSE PRACTITIONERS.OCH WILL FURTHER EXPAND QUICK CARE SERVICES WHICH PROVIDE A LOWER-COST ALTERNATIVE TO NON-EMERGENCY ER VISITS. STAFF OF PRIMARY CARE OFFICES WILL IDENTIFY REPEAT QUICK CARE PATIENTS WITH CHRONIC ILLNESSES, WHO DO NOT HAVE AN ESTABLISHED MEDICAL HOME, AND HELP TO FACILITATE AN APPOINTMENT WITH AN OHIO COUNTY FAMILY CARE PROVIDER.OCH WILL CONTINUE TO DEVELOP THE HOSPITALS HEALTH IMPROVEMENT PROGRAM, BENEFITING UNINSURED AND/OR UNDER-INSURED MEMBERS OF OUR COMMUNITY. THIS PROGRAM OFFERS ACCESS TO PRIMARY CARE SERVICES, PREVENTIVE SCREENINGS, NUTRITIONAL AND PHYSICAL ACTIVITY COUNSELING, SMOKING CESSATION ASSISTANCE, AS WELL AS SUBSIDIZED MEMBERSHIPS INTO A LOCAL FITNESS FACILITIES. PROGRAM ELIGIBILITY IS BASED ON THE FEDERAL POVERTY LEVEL GUIDELINES. THE COST OF THE SERVICES THAT PARTICIPANTS RECEIVE IS SUBSIDIZED BY OHIO COUNTY HOSPITAL.REDUCE SUBSTANCE ABUSEOCH WILL PROVIDE THE MEETING PLACE, TRAINED FACILITATORS, AND SUPPLIES FOR COOPER-CLAYTON SMOKING CESSATION COURSE OFFERED FREE TO COMMUNITY, AND WILL OFFER THESE AT LEAST TWICE PER YEAR.OCH WILL WORK IN CONJUNCTION WITH COMMUNITY PARTNERS TO SEEK IMPLEMENTATION OF SMOKE FREE PUBLIC ENVIRONMENTS THROUGHOUT THE COMMUNITY. THIS WILL INCLUDE FACILITATING DIALOGUE WITH LOCAL AND STATE LEVEL OFFICIALS REGARDING THE HEALTH BENEFITS OF ADOPTING A COMMUNITY-WIDE SMOKE FREE ORDINANCE.OCH AND ASSOCIATED PROVIDER OFFICES WILL FOLLOW A CONTROLLED SUBSTANCE PRESCRIPTION POLICY WHICH INCLUDES ROUTINE DRUG TESTING TO ASSURE PROPER UTILIZATION OF NARCOTIC SUBSTANCES.OCH WILL FULLY UTILIZE THE STATE KASPER REPORT SYSTEM TO ASSIST IN MONITORING CONTROLLED SUBSTANCE PRESCRIPTION DRUG USE BY PATIENTS.OCH STAFF WILL PROVIDE INSTRUCTIONS REGARDING PRESCRIBED MEDICATIONS AND THEIR PROPER USE FOR ALL PATIENTS UPON DISCHARGE FROM THE HOSPITAL.OHIO COUNTY HOSPITAL WILL ALSO CONTINUE TO SUPPORT THE OHIO COUNTY HEALTH COALITIONS AND LOCAL CIVIC GROUP "TOGETHER WE CARE" EFFORTS IN THIS AREA BY PROVIDING LEADERSHIP OVERSIGHT, MONETARY SUPPORT AND ATTENDANCE AT MONTHLY MEETINGS BY VARIOUS HOSPITAL PERSONNEL.SPECIFICALLY IN REGARDS TO PRESCRIPTION ABUSE / MISUSE. PART III, LINE 4: LINE 2 PART III 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 BOX 51 WAS THE COST TO CHARGE RATIO. PART III, LINE 9B: IF A PATIENT HAS BEEN APPROVED BY THE CHARITY CARE PROGRAM WITHIN A SIX MONTH TIME FRAME, THE ACCOUNT IS WRITTEN OFF AS A CHARITY CARE ADJUSTMENT. THE FINANCIAL COUNSELORS CHECK EACH PRIVATE PAY ACCOUNT AND WILL FOLLOW UP TO MAKE SURE THAT THEY HAVE RECEIVED AND ARE GOING TO COMPLETE THEIR PAPERWORK. THE HOSPITAL CONTRACTS WITH DMC, INC, AND THEY WILL ASSIST PATIENTS WITH CHARITY CARE PAPERWORK IF THEY DO NOT QUALIFY FOR MEDICAID. OHIO HOSPITAL CORPORATION PART V, SECTION B, LINE 3: 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 HOSPITAL CORPORATION PART V, SECTION B, LINE 10: OHIO COUNTY HOSPITAL PROVIDES SERVICES WITHOUT CHARGE TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY.ADMITTING CLERKS PROVIDE EACH UNINSURED PATIENT A CHARITY CARE APPLICATION AND ENCOURAGE HIM OR HER TO COMPLETE IT. THE APPLICATION CONTAINS DEMOGRAPHIC AND FINANCIAL INFORMATION USED IN DETERMINING IF SOMEONE IS ELIGIBLE FOR CHARITY CARE. ALL COMPLETED APPLICATIONS ARE FORWARDED TO DISABILITY & MEDICAL CONSULTANTS, INC. (DMC). DMC USES THE INFORMATION ON THE APPLICATION TO DETERMINE IF THE PATIENT MEETS THE STATE CRITERIA FOR CHARITY CARE.IT MUST BE DOCUMENTED THAT THE PATIENT:1.HAS NO CURRENT VALID INSURANCE COVERAGE AND IS NOT ELIGIBLE TO APPLY FOR PUBLIC ASSISTANCE OR OTHER INSURANCE. PERSONS WITH EXHAUSTED MEDICARE AND MEDICAID BENEFITS WOULD BE CONSIDERED WITHOUT VALID INSURANCE, UNLESS THEY ARE ELIGIBLE TO APPLY FOR ADDITIONAL DAYS. 2.THE PATIENT MUST MEET THE CRITERIA ESTABLISHED BY THE STATE TO QUALIFY FOR THE CHARITY CARE PROGRAM. THE STATE REQUIRES THAT FINANCIAL PROOF FOR CHARITY (SUCH AS TAX RETURNS, PAY STUBS, ECT.) BE PROVIDED FOR ALL INPATIENT PROCEDURES AND MAJOR OUTPATIENT PROCEDURES, WITH MAJOR BEING DEFINED BY THE HOSPITAL. OHIO COUNTY HOSPITAL DESIGNATES THAT OUTPATIENT SURGERIES BE CONSIDERED MAJOR AND WILL REQUIRE PROOF FOR THE SAME.THOSE ACCOUNTS MEETING STATE INDIGENT CARE GUIDELINES, AS DETERMINED BY DMC, WILL BE SO DESIGNATED IN THE COMPUTER SYSTEM. A COLLECTIONS REPORT WILL BE GENERATED AND FORWARDED TO DATA PROCESSING FOR ACCOUNT WRITE-OFF. THE CONTROLLER PERFORMS A MONTHLY REVIEW OF CHARITY CARE WRITE-OFFS FOR REASONABLENESS. THE DOCUMENTATION AND CHARITY LIST IS FORWARDED TO THE BUSINESS OFFICE MANAGER, WHO WILL PREPARE OR DESIGNATE SOMEONE TO PREPARE, THE REPORT TO BE SENT TO THE STATE. OHIO HOSPITAL CORPORATION PART V, SECTION B, LINE 16E: 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. 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 COMMUNITYS 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; AND3) 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 DISTRICTS COUNTIES. THIS PLAN WAS REVIEWED WITH THE OHIO COUNTY HEALTH COALITION AND OTHER COMMUNITY PARTNERS.OHIO COUNTY HOSPITAL USED THE INFORMATION COLLECTED FROM THE MAPPS 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 HOSPITALS STRATEGIC IMPLEMENTATION PLAN WERE ADOPTED BY BOARD RESOLUTION FROM OHIO COUNTY HOSPITALS TRUSTEES ON JUNE 13, 2013. THE HEALTH IMPROVEMENT PLAN WAS MADE WIDELY AVAILABLE TO THE COMMUNITY VIA THE HOSPITALS WEBSITE, AS WELL AS THROUGH HARD COPIES LOCATED AT THE HOSPITALS 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 HOSPITALS 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 COUNTYS 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. X X 0 0 0 0 0 0 0 0 0 DONALD K GREGORY 303374 0 13863 0 1326 0 6864 0 18701 0 344128 0 0 0 JANNA PATHI 272293 0 0 0 20470 0 10560 0 7793 0 311116 0 0 0 MUKESH DESAI 573259 0 0 0 17500 0 12488 0 22282 0 625529 0 0 0 JOSHUA SKIBBA 405361 0 0 0 18040 0 10298 0 8371 0 442070 0 0 0 CHARLES RICCIO 493467 0 128590 0 21064 0 5775 0 27613 0 676509 0 0 0 JOEL JOHNSTON 329892 0 0 0 1914 0 8465 0 35648 0 375919 0 0 0 CHARLES JARBOE 298691 0 0 0 1914 0 5543 0 27805 0 333953 0 0 0 A OHIO COUNTY PUBLIC FACILITIES CORPORATION 616000805 000677292 2005-08-01 4240000 HOSPITAL CONSTRUCTION 0 0 0 B OHIO COUNTY PUBLIC FACILITIES CORPORATION 616000805 2010-09-29 3620000 MEDICAL OFFICE BUILDING CONSTRUCTION 0 0 0 A 980000 424000 74823 2006 1 0 1 1 B 3300000 273400 70000 2011 0 0 1 1 A 0 0 0 0 1 0 0 B 0 0 0 0 1 0 0 A 1 1 0 0 0 0 B 1 1 0 0 0 0 DR DESAI SIGNON BONUS X 145737 77726 0 1 1 DR BRUCE DURHAM SIGNON BONUS X 20000 20000 0 1 1 97726 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 2013. THE CONTRACT REQUIRED QHR TO SUPPLY A CHIEF EXECUTIVE OFFICER, JOHN TICHENOR AND A CHIEF FINANCIAL OFFICER, BLAIN PIEPER WHOSE SALARY AND BENEFITS COST ARE PASSED DIRECTLY THROUGH TO THE HOSPITAL. THE HOSPITAL'S EXPENSE FOR THE MANAGEMENT FEE TOTALED APPOXIMATELY $258,462 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. ALLOCATION OF WAGES FOR ER PHYSICIAN AND HOSPITALIST DR. DONALD K GREGORY HOSPITALIST WAGE $157,692 ER PHYSICIAN WAGES $160,871 ALLOCATION OF WAGES FOR CMO AND SURGEON DR. JANNA PATHI CMO WAGES $142,475 SURGEON WAGES $150288