2013-08-13T19:14:05-05:00 2012-03-31 BKD LLP 400 E MAIN ST STE 200 PO BOX 1196 BOWLING GREEN KY 421021196 990 2011-04-01 610920842 BOWLING GREEN WARREN COUNTY COMM HOSP INC % JAMES LARRY VAUGHN BOWL 2707451500 800 PARK STREET BOWLING GREEN KY 42102 RONALD G SOWELL 2013-09-01 true KIM SCIFRES 2707810111 2011 2016-02-24 21:20:13Z X THE MEDICAL CENTER CONNIE SMITH 800 PARK STREET BOWLING GREEN KY 421029876 443669302 false X www.mcbg.org X 1977 KY PROVIDES INPATIENT AND OUTPATIENT ACUTE CARE SERVICES BY OR UNDER THE SUPERVISION OF PHYSICIANS IN BOWLING GREEN & SCOTTSVILLE, KENTUCKY AND IN THE SURROUNDING COUNTIES. 13 7 2669 94 5057851 138593 76299 265385229 292727842 3683213 4911855 13731720 14374081 282938755 312090077 0 8484 0 0 113024675 122435275 0 0 0 152235034 166053862 265259709 288497621 17679046 23592456 287439867 312943895 163003839 185841395 124436028 127102500 X PROVIDES INPATIENT AND OUTPATIENT ACUTE CARE SERVICES BY OR UNDER THE SUPERVISION OF PHYSICIANS IN BOWLING GREEN & SCOTTSVILLE, KENTUCKY AND IN THE SURROUNDING COUNTIES. false false 161754662 171485617 THE HOSPITAL IS AN ACUTE CARE HOSPITAL ENGAGED IN PROVIDING SERVICE 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. PLEASE SEE SCHEDULE O FOR FURTHER INFORMATION. 91581417 121242225 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. 253336079 true true false true false false false false true true false false false true true true true false false false false false false false false true true false true true true false false false false false false false true true true false false false false true true true false false false true 196 0 true 2669 true true true false false false false false false false false false X 13 7 false false false false true true true true true false false true true true true true true true true true true KY X JAMES LARRY VAUGHN 2707451500 800 PARK STREET BOWLING GREEN KY 42102 X BOB HOVIOUS 1.0 X X 0 0 0 DR PAUL COOK 1.0 X X 0 0 0 JANET JOHNSON 1.0 X 0 0 0 JOE NATCHER 1.0 X X 0 0 0 DONNA BLACKBURN 1.0 X 0 0 0 CURTIS SULLIVAN 1.0 X 0 0 0 ELI JACKSON III DMD 1.0 X 0 0 0 CATHY BISHOP 1.0 X 0 0 0 HUGH SIMS MD 1.0 X 0 0 0 KAL SAHETYA MD 1.0 X 0 0 0 MARK BIGLER MD 1.0 X 0 0 0 CONNIE SMITH 2.0 X X 0 731518 28142 JOHN DESMARAIS 1.0 X 0 0 0 SARAH MOORE 2.0 X 0 233775 96714 BETSY KULLMAN 2.0 X 0 246276 91892 BARBARA JEAN CHERRY 2.0 X 0 442048 37151 RONALD G SOWELL 1.0 X 0 425578 42344 ERIC HAGAN 40.0 X 188695 0 35210 DAVID REEVES 40.0 X 161359 0 54119 WADE R STONE 40.0 X 187930 0 25608 LLOYD ASP 40.0 X 197763 0 73982 CURTIS BAKER 40.0 X 175473 0 18677 EDDIE SCOTT 40.0 X 152661 0 31904 1063881 2079195 535743 31 false true false ARAMARK CORPORATION 12483 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 BIOMED EQUIP REPAIR 3032896 DISABILITY MEDICAL CONSULTANTS 1131 FAIRWAY ST BOWLING GREEN KY 42103 PROFESSIONAL SVCS 1132508 MORRISON MANAGEMENT SPECIALIST INC PO BOX 102289 ATLANTA GA 30368 CAFETERIA SERVICES 2144983 LOGANS UNIFORM RENTAL INC PO BOX 6493958 CINCINNATI OH 45264 LAUNDRY SERVICES 1732487 EXECUTIVE HEALTH RESOURCES INC 15 CAMPUS BLVD SUITE 200 NEWTOWN SQUARE PA 19073 PROFESSIONAL SVCS 1086915 34 59929 16370 76299 INPATIENT SERVICES 621110 171485617 171485617 OUTPATIENT SERVICES 621400 121242225 121242225 292727842 3417026 3417026 0 0 2332481 2424963 -92482 -92482 -92482 130535741 113350 128910739 243523 1625002 -130173 1494829 1494829 0 0 0 RETAIL PHARMACY SALES 446110 6617512 1641143 4976369 MEDICAL EQUIPMENT SALES 453000 3421186 1243488 2177698 CONTRACT LABOR 900099 1204662 1204662 3223203 1984193 1239010 14466563 312090077 297160185 5057851 9795742 0 8484 8484 0 0 223905 223905 0 89500635 84753984 4746651 6168391 5820594 347797 19998283 18870704 1127579 6544061 6174735 369326 12816000 12816000 1295377 2710 1292667 314455 314455 11661 11661 0 0 21765773 21765773 651786 168089 483697 16358063 12337883 4020180 3341364 3341364 0 3961694 3379069 582625 896600 831923 64677 0 0 4317270 3546122 771148 0 11466125 9353895 2112230 2537581 2408898 128683 BAD DEBT EXPENSE 15815652 15815652 MEDICAL SUPPLIES 60626323 60537927 88396 OTHER TAXES AND LICENSES 4041504 4008108 33396 PHYSICIAN PRACTICE EXPENSES 5311585 5311585 525049 210165 314884 288497621 253336079 35161542 0 7816814 8728976 111833025 129289950 0 0 28444866 37652287 0 0 0 0 0 0 5986354 7067743 5150305 7717987 288613344 190244675 100152490 98368669 18033723 14590692 2952652 0 0 3299153 0 0 7069638 6228438 287439867 312943895 29737220 33183927 0 0 967759 879917 98165000 94750000 0 0 0 0 6875897 4993762 0 0 27257963 52033789 163003839 185841395 X 122982371 125623203 0 0 1453657 1479297 124436028 127102500 287439867 312943895 X 23592456 -20925984 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11661 11661 LOBBYING EXPENSES SCHEDULE C, PART II-B, LINE 1i THE CORPORATION IS A MEMBER OF THE KENTUCKY HOSPITAL ASSOCIATION. THE PORTION OF THE DUES PAID WHICH ARE ATTRIBUTABLE TO LOBBYING TOTAL $11,661. 117185927 19894588 1145030 6991557 303559 130930429 88386125 27352333 4772379 3149367 175543 117185927 71881958 6761029 9206992 -713721 177575 88386125 67604167 24386804 -6555166 13553847 71881958 0.98470 0.01530 0.00000 false false 7598362 7598362 134326372 71363445 62962927 141380187 115095041 26285146 5308420 3786186 1522234 98368669 0 INVESTMENT - RATE SWAP 3/2008 10318435 ACCRUED RETIREMENT, LONG-TERM 39545609 LONG-TERM PL/GL LIABILITY 2169745 52033789 312090077 288497621 23592456 -1167320 -19758682 -20926002 2666454 312591617 -1167320 -1167320 313758937 -1668860 -1668860 312090077 290192121 2556136 2556136 287635985 861636 861636 288497621 ENDOWMENT FUNDS SCH D, PART V, LINE 4 --------------------- THE MEDICAL CENTER'S ENDOWMENT CONSISTS OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS (BOARD-DESIGNATED ENDOWMENT FUNDS). AS REQUIRED BY GAAP, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING BOARD-DESIGNATED ENDOWMENT FUNDS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. UNRESTRICTED NET ASSETS INCLUDED $87,033,191 OF BOARD-DESIGNATED ENDOWMENT FUNDS FOR FUTURE CAPITAL IMPROVEMENTS AND OTHER PURPOSES AS DETERMINED BY THE BOARD OF DIRECTORS. PERMANENTLY RESTRICTED NET ASSETS INCLUDED $1,352,934 OF DONOR-RESTRICTED ENDOWMENT FUNDS. INCOME TAX STATUS SCH D, PART X, LINE 2 --------------------- MOST OF THE INCOME RECEIVED BY THE MEDICAL CENTER IS EXEMPT FROM TAXATION UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. SOME OF ITS INCOME IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE MEDICAL CENTER FILES FEDERAL INCOME TAX RETURNS, AS WELL AS AN INCOME TAX RETURN IN KENTUCKY. THE MEDICAL CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. 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 2012 OR 2011. THE MEDICAL CENTER'S PRACTICE IS TO RECOGNIZE INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. RECONCILIATION TO AUDIT REPORT - NET ASSETS SCH D, PART XI, LINE 8 --------------------- OTHER CHANGES IN NET ASSETS: CHANGE IN FV OF INTEREST RATE SWAP ($5,749,415) CHANGE IN MINIMUM PENSION LIABILITY ($14,276,284) TRANSFER FROM AFFILIATES $267,017 ----------- ($19,758,682) RECONCILIATION TO AUDIT REPORT - REVENUES SCH D, PART XII --------------------- LINE 4B: OTHER AMOUNTS INCLUDED ON TAX RETURN NOT ON LINE 1: RECLASSIFICATION OF REVENUES & EXPENSES $861,636 RENTAL EXPENSE SHOWN NET OF REV PER TAX RETURN ($2,424,963) LOSS ON DISPOSALS INCLUDED IN EXP PER AUDIT ($131,173) INVESTMENT INCOME - PERMANENTLY RESTRICTED ASSETS 25,640 ------------- ($1,668,860) RECONCILIATION TO AUDIT REPORT - EXPENSES SCH D, PART XIII --------------------- LINE 2D: AMOUNTS INCLUDED ON LINE 1 BUT NOT ON TAX RETURN: RENTAL EXPENSES SHOWN NET OF REV PER TAX RETURN $2,424,963 LOSS ON DISPOSALS INCLUDED IN EXP PER AUDIT $131,173 ---------- $2,556,136 LINE 4B: AMOUNTS INCLUDED ON TAX RETURN BUT NOT ON LINE 1: RECLASSIFICATION OF REVENUE & EXPENSE $861,636 true true X true X false true true true false true true 2 6418 14908906 3132240 11776666 0.04320 2 35335324 29380531 5954793 0.02180 4 6418 50244230 32512771 17731459 0.06500 306 38883 3124272 3124272 0.01150 7 865 3370377 3370377 0.01240 2 15399 12707295 7677911 5029384 0.01840 160 61853 61853 0.00020 475 55147 19263797 7677911 11585886 0.04250 479 61565 69508027 40190682 29317345 0.10750 3 2340 2340 2 2 29417 29417 0.00010 5 835415 835415 0.00310 1 3250 3250 11 2 870422 870422 0.00320 true 15815652 4707499 110296589 128810394 -18513805 X true true 2 1 THE MEDICAL CENTER BOWLING GREEN CAMPUS

800 PARK STREET BOWLING GREEN KY 42101

X X X 2 THE MEDICAL CENTER SCOTTSVILLE CAMPUS

456 BURNLEY ROAD SCOTTSVILLE KY 42164

X X X X NURSING FACILITY THE MEDICAL CENTER BOWLING GREEN CAMPUS 1 true true 200. false true X X X true false X X X X true false X X true X false false THE MEDICAL CENTER SCOTTSVILLE CAMPUS 2 true true 200. false true X X X X true false X X X X true false X X true X false false 1 THE MEDICAL CENTER HEALTH & WELLNESS CTR

1857 TUCKER WAY BOWLING GREEN KY 42104

COMMUNITY WELLNESS CENTER CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE SCH H, PART I, LINE 3C --------------- THE INCOME LIMIT FOR CHARITY 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. COMMUNITY BENEFIT REPORT SCH H, PART I, LINE 6 --------------- THE ANNUAL REPORT TO THE COMMUNITY IS MADE AVAILABLE TO THE PUBLIC VIA NEWSPAPER INSERTS, DIRECT MAILINGS, AND IS POSTED ON THE MEDICAL CENTER'S WEBSITE AT WWW.MCBG.ORG. BENEFITS AT COST SCH H, PART I, LINE 7 --------------- THE AMOUNTS REPORTED ON LINE 7G ARE DETERMINED BY MULTIPLYING REVENUE BY THE MEDICARE COST TO CHARGE RATIO. BAD DEBTS INCLUDED IN PART IX, LINE 25 TOTALED $15,815,652. 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 WAS DETERMINED USING THE HOSPITAL COST ACCOUNTING SYSTEM. FOR SUBSIDIZED SERVICES THE HOSPITAL'S COST ACCOUNTING SYSTEM IS USED TO DETERMINE COSTS RELATED TO THE SPECIFIC SERVICE EXCLUDING TRADITIONAL MEDICAID AND MEDICAID MANAGED PATIENTS. COSTS FOR CHARITY AND BAD DEBT ACCOUNTS ARE DEDUCTED USING A RATIO OF COST TO CHARGE SPECIFIC TO THAT SUBSIDIZED SERVICE. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS. BAD DEBT EXPENSE SCH H, PART III, LINE 4 --------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BAD DEBT IS CLASSIFIED AS AN OPERATING EXPENSE. THIS TREATMENT IS CONSISTENT WITH THE HFMA PRINCIPLES AND PRACTICE BOARD STATEMENT NO. 15 AND WITH THE AICPA AUDIT AND ACCOUNTING GUIDE FOR HEALTH CARE ORGANIZATIONS. CALCULATION OF MEDICARE ALLOWABLE COSTS SCH H, PART III, LINE 6 --------------- COSTS REPORTED ON LINE 6 ARE OBTAINED FROM THE MEDICARE COST REPORT WHICH ARE BASED ON A COST TO CHARGE RATIO. COLLECTION PRACTICES SCH H, PART III, LINE 9B --------------- THE MEDICAL CENTER 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 DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. THE MEDICAL CENTER 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 UNCOMPENSATED 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 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 DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO BE TRADITIONAL CHARITY CARE. THEREFORE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE. NEEDS ASSESSMENT SCH H, PART VI, QUESTION 2 --------------- THE MEDICAL CENTER IS BUILT UPON THE FOUNDATION OF SERVING OUR COMMUNITY, DAY IN AND DAY OUT, WITH QUALITY DEPENDABLE HEALTHCARE. THE MEDICAL CENTER HAS NOT HISTORICALLY COMPLETED FORMAL HEALTH NEEDS ASSESSMENTS; HOWEVER, AS NEEDS ARISE IN THE COMMUNITY AND SURROUNDING COUNTIES, THE MEDICAL CENTER RESPONDS. The Medical Center is part of an integrated healthcare Delivery system as described in Question 6 below. The multiple facilities including the Commonwealth Health Free Clinic are evidence of the Medical Center's commitment to responding to Health needs in our community and the surrounding rural counties. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCH H, PART VI, QUESTION 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. THE MEDICAL CENTER ALSO MAINTAINS A WEBSITE FOR BILLING AND COLLECTIONS QUESTIONS. FINANCIAL ASSISTANCE POLICIES ARE POSTED TO THIS WEBSITE AS WELL AS FREQUENTLY ASKED QUESTIONS REGARDING BILLINGS. COMMUNITY INFORMATION SCH H, PART VI, QUESTION 4 --------------- BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION(THE MEDICAL CENTER) IS DESIGNATED AS A REGIONAL REFERRAL CENTER BY THE BARREN RIVER REGIONAL HEALTH PLANNING COUNCIL, AN AGENCY OF THE COMMONWEALTH OF KENTUCKY. THE MEDICAL CENTER SERVES PATIENTS THROUGHOUT AN AREA COMPRISING TEN COUNTIES, CALLED THE BARREN RIVER AREA DEVELOPMENT DISTRICT (THE DISTRICT), IN SOUTH CENTRAL KENTUCKY. THE POPULATION OF THE MEDICAL CENTER'S PRIMARY SERVICE AREA IS APPROXIMATELY 286,000 PEOPLE. THE COMMUNITY IS GROWING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THERE ARE TWO ACUTE CARE HOSPITALS IN THE COMMUNITY. THE PERCENTAGE OF UNINSURED PERSONS IN THE COUNTIES SERVED BY THE MEDICAL CENTER RANGE FROM 18% TO 24%, WHICH IS HIGHER THAN THE KENTUCKY AVERAGE. THE NUMBER OF RESIDENTS IN THE DISTRICT IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES VARY BY COUNTY AND RANGE FROM 18.5% TO 27.1% COMPARED TO THE KENTUCKY POVERTY RATE OF 17.7%. THE THREE HIGHEST POPULATED COUNTIES IN THE DISTRICT ARE WARREN, BARREN AND ALLEN WHOSE AVERAGE MEDIAN HOUSEHOLD INCOME IS $43,954, $38,374 AND $35,247 RESPECTIVELY. APPROXIMATELY 64% OF THE DISTRICT'S POPULATION IS CLASSIFIED AS RURAL. THE PERCENTAGE OF THE POPULATION IN THE COMMUNITY OVER 65 YEARS OLD IS APPROXIMATELY 15%. ACCORDING TO THE EVERYBODY SURVEY CONDUCTED BY THE BARREN RIVER DISTRICT HEALTH DEPARTMENT, THE MOST SERIOUS HEALTH PROBLEMS IN THE COMMUNITY ARE OBESITY, ALCOHOL AND DRUG ADDITION, HEART ATTACK, STROKE, HIGH BLOOD PRESSURE, CANCER AND DIABETES. THIS SURVEY ALSO IDENTIFIED PROBLEM HEALTH BEHAVIORS FOR THE DISTRICT WHICH INCLUDE ALCOHOL AND DRUG ABUSE, NOT ENOUGH PHYSICAL ACTIVITY, TOBACCO USE AND POOR DIET. PROMOTION OF COMMUNITY HEALTH SCH H, PART VI, QUESTION 5 --------------- COMMUNITY BUILDING ACTIVITIES INCLUDE PARTICIPATION IN THE CHAMBER OF COMMERCE, DOWNTOWN REDEVELOPMENT AND LEADERSHIP BOWLING GREEN. AFFILIATED HEALTH CARE SYSTEM ROLES SCH H, PART VI, QUESTION 6 ------------------ BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION ("THE MEDICAL CENTER") 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. 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: Bowling Green Warren County Community Hospital's Bowling Green Facility is a general acute care hospital licensed for 337 beds, with 330 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 a total of 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 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 CORPORATION ("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 FOR-PROFIT CORPORATIONS AND PARTNERSHIPS. CHC OWNS AND OPERATES NINE PHYSICIAN PRACTICES EMPLOYING GENERAL PRACTITIONERS, CARDIAC SURGEONS, VASCULAR SURGEONS, A NEUROSURGEON, NEUROLOGISTS, OBSTETRIC/GYNECOLOGISTS, HOSPITALISTS, AN OTOLARYNGOLOGIST 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 TWO MANAGED CARE ORGANIZATIONS PROVIDING MEDICAID MANAGED CARE SERVICE FOR THE STATE OF KENTUCKY. IT ALSO SERVICES OVER 380,000 MEMBERS BY PROVIDING ACCESS TO OVER 17,000 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 REHABILITATION THERAPY SERVICES. CHC'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. 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 "WORKING POOR" OF SOUTH-CENTRAL KENTUCKY. THE "WORKING POOR" ARE THOSE INDIVIDUALS WHO HAVE DONE THEIR BEST TO STAY IN THE WORK FORCE BUT DO NOT HAVE INSURANCE OR ANY FORM OF SOCIAL ASSISTANCE AND DO NOT HAVE THE MEANS TO PAY FOR THEIR HEALTHCARE. CHFC OFFERS SERVICES INCLUDING: NON-EMERGENCY CLINICAL SERVICES, DENTISTRY, SENIOR CITIZEN'S PHARMACEUTICAL PROGRAM, COMMUNITY HEALTH EDUCATION AND COUNSELING, DISEASE/CONDITION SPECIFIC EDUCATION AND COUNSELING. IN ADDITION, THE DENTAL PROGRAM HAS BEEN EXPANDED TO INCLUDE INDIVIDUALS WITH INCOME AT OR BELOW 225% OF FEDERAL POVERTY GUIDELINES. THE MEDICAL CENTER AT FRANKLIN, INC. ------------------------------------ ("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 REGIONAL SPECIALTY HOSPITAL, INC. -------------------------------------------- COMMONWEALTH REGIONAL SPECIALTY HOSPITAL 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, INC. ------------------------------------- CHC ENDORSED THE ESTABLISHMENT OF COMMONWEALTH HEALTH FOUNDATION ("THE FOUNDATION") FOR THE PURPOSE OF FOSTERING, SUPPORTING AND INITIATING ACTIVITIES FOR THE ADVANCEMENT OF THE HEALTH CARE 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. CRITERIA FOR DETERMINING ELIGIBILITY OF DISCOUNTED CARE SCH H, PART V, LINE 10 --------------- DURING THE YEAR ENDED 3/31/12, THE MEDICAL CENTER AT BOWLING GREEN AND THE MEDICAL CENTER AT SCOTTSVILLE discontinued providing discounted care for patients with incomes between 150% and 200% of the Federal Poverty level. Instead, THE MEDICAL CENTER AT BOWLING GREEN AND MEDICAL CENTER AT SCOTTSVILLE UPDATED THEIR FINANCIAL ASSISTANCE POLICY TO PROVIDE FREE CARE FOR PERSONS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. OTHER FACTORS USED IN DETERMINING AMOUNTS CHARGED TO PATIENTS SCH H, PART V, LINE 11 --------------- NUMBER IN HOUSEHOLD IS USED FOR DETERMINING FPL FOR COMPARISON TO REPORTED INCOME INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE SCH H, PART VI, LINE 19 --------------- THE HOSPITAL FACILITIES WROTE OFF 100% OF CHARGES TO FAP - ELIGIBLE INDIVIDUALS. true SCHOLARSHIPS FOR STUDENTS AT WESTERN KY UNIVERSITY 2 8484 Procedures for Monitoring the Use of Grants SCHEDULE I, PART I, LINE 2 --------------------------- The hospital contributes directly to a scholarship program maintained within Western Kentucky University's College Heights Foundation. The scholarship is made annually and is equivalent to the in-state tuition plus an allowance for books. It may be awarded to either one student or divided between two students. The scholarship is payable over two semesters. Recipients must be beginning freshmen and must be graduates of Allen County High School, Scottsville, KY. Recipients must be full-time students at Western Kentucky University. applicants must complete a standard Western Kentucky University scholarship application no later than March 1. Recipients must have a cumulative GPA of at least 3.0 in the fall semester to receive the scholarship for the spring semester. Awards are to be made in the form of a letter from the university scholarship committee, with the letter to contain appropriate recognition of the Medical Center at Scottsville, which is the name of the hospital's Scottsville, KY location. Bowling Green Warren County Community Hospital Corporation, Inc. is frequently asked to contribute to a variety of organizations and fund raising projects. Because Bowling Green Warren County Community Hospital Corporation, Inc. was established to support the healthcare mission of the non-profit Bowling Green Warren County Community Hospital Corporation and other non-profit affiliates of Commonwealth Health Corporation, it is the corporation's goal to be a supportive citizen and, when practical and possible, to make reasonable contributions which are beneficial to the community and parallel to our exempt purpose which focuses on the community's healthcare needs. X X X X X false true false false false false false false false CONNIE SMITH 0 509454 0 0 0 222064 0 21253 0 6889 0 759660 0 0 SARAH MOORE 0 228185 0 0 0 5590 0 90018 0 6696 0 330489 0 0 BETSY KULLMAN 0 240426 0 0 0 5850 0 79262 0 12630 0 338168 0 0 BARBARA JEAN CHERRY 0 364739 0 0 0 77309 0 28842 0 8309 0 479199 0 0 RONALD G SOWELL 0 365232 0 0 0 60346 0 34529 0 7815 0 467922 0 0 DAVID REEVES 150201 0 0 0 11158 0 34985 0 19134 0 215478 0 0 0 WADE R STONE 184544 0 0 0 3386 0 7948 0 17660 0 213538 0 0 0 LLOYD ASP 191426 0 0 0 6337 0 61702 0 12280 0 271745 0 0 0 CURTIS BAKER 173618 0 0 0 1855 0 9406 0 9271 0 194150 0 0 0 EDDIE SCOTT 151331 0 0 0 1330 0 20841 0 11063 0 184565 0 0 0 ERIC HAGAN 181421 0 0 0 7274 0 15480 0 19730 0 223905 0 0 0 NONQUALIFIED RETIREMENT PLAN SCHEDULE J, 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 $188,650 RONALD SOWELL $53,974 JEAN CHERRY $68,921 COUNTY OF WARREN KENTUCKY 616000710 934864AA7 2008-03-20 77010000 SEE PART V false false false COUNTY OF WARREN KENTUCKY 616000710 934860BT3 2007-03-15 30885000 SEE PART V false false false 0 0 77010000 4826038 0 0 1398574 2140903 26469520 0 42174965 0 2010 true false true true 0 0 31867132 2133000 0 0 637343 0 0 0 29096790 0 true false true true false true true true false 0.00040 0.00060 0.00100 true false false false false 0 0.00130 0.00130 true false true true DEUTCHE BANK 30. false false false 0 false false false false false 0 false 0 false false BOND A - DESCRIPTION OF PURPOSE SCH K, PART I, LINE A, COLUMN F TO (1) REFUND THE OUTSTANDING PRINCIPAL AMOUNT OF THE ISSUER'S HOSPITAL REVENUE BONDS, SERIES 1998 (BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION) ISSUED ON JANUARY 15, 1998, (2) FINANCE THE COSTS OF MAJOR FACILITY ADDITIONS, INTERIOR RENOVATIONS, EQUIPMENT, AND FURNISHINGS AND SITE DEVELOPMENT AT THE MEDICAL CENTER AT BOWLING GREEN, (3) FUND A DEBT SERVICE RESERVE FUND FOR THE BONDS, (4) FUND INTEREST ON THE BONDS. AND (5) PAY COSTS OF ISSUING THE BONDS. BOND B - DESCRIPTION OF PURPOSE SCH K, PART I, LINE B, COLUMN F TO (1) CURRENTLY REFUND VARIABLE RATE DEMAND HOSPITAL REVENUE BONDS, SERIES 2001 (BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION PROJECT) THAT WERE ISSUED ON AUGUST 2, 2001, (2) FUND A DEBT SERVICE RESERVE FUND FOR THE BONDS, AND (3) PAY COSTS OF ISSUING THE BONDS. BONDS, AND (3) PAY COSTS OF ISSUING THE BONDS. SOUTHERN FOODS INC JOE NATCHER, OWNER OF SFI 377441 FOOD SERVICE - SEE PART V false GRAVES GILBERT CLINIC RON SOWELL, OFFICER 18000 LEASING - SEE PART V false GRAVES GILBERT CLINIC RON SOWELL, OFFICER 43085 PHYSICIAN SERVICES-SEE PT V false AIRGAS MID-AMERICA B JEAN CHERRY, OFFICER 199100 MEDICAL SUPPLIES - SEE PT V false KAL SAHETYA DIRECTOR 14380 LEASING - SEE PART V false KIMBERLY JACKSON ELI JACKSON, DIRECTOR 9601 COMP OF WIFE - SEE PART V false KIMBERLY JACKSON ELI JACKSON, DIRECTOR 20967 LEASING - SEE PART V false ERIN DEMARAIS JOHN DEMARAIS, DIRECTOR 40366 COMP OF DAUGHTER - SEE PT V false STEPHANIE BLACKBURN DONNA BLACKBURN, DIRECTOR 48502 COMP OF DTR-IN-LAW - SEE PT V false RONNIE MOORE SARAH MOORE, OFFICER 22193 COMP OF HUSBAND - SEE PT V false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCH L, PART IV, COLUMN D JOE NATCHER, DIRECTOR FOR BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION ("THE MEDICAL CENTER"), IS THE OWNER OF SOUTHERN FOODS, INC., A FOOD SERVICE DISTRIBUTOR. SOUTHERN FOODS, INC. SUPPLIES THE MEDICAL CENTER WITH FOOD AND RELATED ITEMS. ALL TRANSACTIONS ARE CONDUCTED ON AN ARMS LENGTH BASIS. RONALD SOWELL IS AN OFFICER OF THE MEDICAL CENTER. MR. SOWELL'S WIFE, DR. DEBRA SOWELL, IS THE MEDICAL DIRECTOR OF GRAVES GILBERT CLINIC (GGC). THE MEDICAL CENTER LEASES PROPERTY TO GGC AND ALSO PURCHASES PHYSICIAN SERVICES FROM THEM. ALL TRANSACTIONS ARE CONDUCTED ON AN ARMS LENGTH BASIS. 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. DR. KAL SAHETYA IS A DIRECTOR OF THE MEDICAL CENTER. DR. SAHETYA PERFORMED PROFESSIONAL SERVICES FOR THE MEDICAL CENTER. ALL TRANSACTIONS ARE CONDUCTED ON ARMS LENGTH BASIS. JOHN DESMARAIS SERVED AS A DIRECTOR OF THE MEDICAL CENTER. MR. DESMARAIS' DAUGHTER, ERIN DESMARAIS, IS EMPLOYED BY THE MEDICAL CENTER. DONNA BLACKBURN SERVES AS A DIRECTOR OF THE MEDICAL CENTER. MS. BLACKBURN'S DAUGHTER-IN-LAW, STEPHANIE BLACKBURN, IS EMPLOYED BY THE MEDICAL CENTER. ELI JACKSON SERVES AS A DIRECTOR OF THE MEDICAL CENTER. MR. JACKSON'S WIFE, KIMBERLY JACKSON, IS EMPLOYED BY THE MEDICAL CENTER. THE MEDICAL CENTER ALSO RENTS SPACE FROM ELI AND KIMBERLY JACKSON FOR THE MEDICAL CENTER'S WELLNESS CENTER. ALL TRANSACTIONS ARE CONDUCTED ON AN ARMS LENGTH BASIS. SARAH MOORE SERVES AS AN OFFICER OF THE MEDICAL CENTER. MRS. MOORE'S HUSBAND, RONNIE MOORE, IS EMPLOYED BY THE MEDICAL CENTER. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A ------------------------------ ORGANIZATION ------------ BOWLING GREEN - WARREN COUNTY COMMUNITY HOSPITAL CORPORATION, DBA THE MEDICAL CENTER ("THE MEDICAL CENTER"), 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 SOUTH-CENTRAL KENTUCKY. BEGUN IN 1926, THE MEDICAL CENTER HAS A RICH HERITAGE OF SERVING OUR COMMUNITY'S HEALTHCARE NEEDS AND BEING THE LEADER IN PROVIDING QUALITY CARE IN A TECHNOLOGICALLY ADVANCED SETTING. THE MEDICAL CENTER IS LICENSED BY THE CABINET FOR HEALTH AND FAMILY SERVICES, COMMONWEALTH OF KENTUCKY, PURSUANT TO KRS CHAPTER 216B AND THE REGULATIONS PROMULGATED THEREUNDER. OPERATING WITH CAMPUSES IN BOWLING GREEN, KY AND SCOTTSVILLE, KY, THE MEDICAL CENTER LICENSED BEDS INCLUDE: BOWLING SCOTTS- GREEN VILLE TOTAL ----- ------ ----- ACUTE CARE 313 313 CRITICAL ACCESS ACUTE 25 25 PSYCHIATRIC 24 24 NURSING FACILITY 110 110 ------ ------ ----- SUBTOTAL - BEDS 337 135 472 SERVICES --------- THE MEDICAL CENTER 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. SERVICES OFFERED INCLUDE: - ACUTE MEDICAL CARE - SKILLED MEDICAL CARE - INTENSIVE/CORONARY CARE - PHARMACY - INVASIVE CARDIOLOGY - PHYSICAL THERAPY - LABORATORY, CLINICAL AND PATHOLOGY - RADIATION MEDICINE (INPATIENT / OUTPATIENT ONCOLOGY) - HOME HEALTH SERVICES - SURGICAL INPATIENT SERVICES - SURGICAL OUTPATIENT SERVICES - EMERGENCY ROOM SERVICES - OUTPATIENT SERVICES - RESPIRATORY THERAPY SERVICES - RADIOLOGY, INCLUDING MAMMOGRAPHY, DIAGNOSTIC X-RAY, NUCLEAR MEDICINE, CAT SCANNING, ULTRASOUND, CARDIOLOGY, POSITRON EMISSION TOMOGRAPHY THE MEDICAL CENTER'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 WORK 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: (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 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 DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. THE MEDICAL CENTER 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 UNCOMPENSATED 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 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 DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO BE TRADITIONAL CHARITY CARE. THEREFORE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE. BENEFITS FOR THE BROADER COMMUNITY INCLUDE SERVICES PROVIDED TO OTHER NEEDY INDIVIDUALS WHO MAY NOT QUALIFY AS INDIGENT BUT WHO NEED SPECIAL SERVICES AND SUPPORT. EXAMPLES 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. IN ADDITION TO THE ABOVE, THE MEDICAL CENTER PROVIDES A WIDE RANGE OF COMMUNITY BENEFITS INCLUDING COORDINATION OF CHARITABLE ACTIVITIES BY THE MEDICAL CENTER STAFF AND PROVIDING MEDICAL CENTER SPACE FOR COMMUNITY GROUPS THAT CANNOT BE QUANTIFIED. SIGNIFICANT PROGRAM SERVICE ACHIEVEMENTS DAYS OF ACUTE PATIENT CARE (INCLUDING NURSERY) 96,876 DAYS OF SKILLED NURSING CARE 38,642 BIRTHS 2,343 OPEN HEART PROCEDURES 341 SURGERIES 14,058 EMERGENCY ROOM VISITS 54,949 AMBULANCE RUNS 19,459 MEMBERS OF THE ORGANIZATION FORM 990, PART VI, SECTION A, LINE 6 & 7 ------------------------------ ARTICLE 2 OF THE BYLAWS IDENTIFIES COMMONWEALTH HEALTH CORPORATION BOARD OF DIRECTORS AS THE MEMBER. ARTICLE 2 OF THE BYLAWS SAYS THE MEMBER SHALL APPOINT A NOMINATING COMMITTEE WHICH SHALL MEET AND DESIGNATE NOMINEES FOR ALL POSITIONS TO BE FILLED BY APPOINTMENT BY THE MEMBER. REVIEW OF FORM 990 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 THIS 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. MONITORING THE CONFLICT ON INTEREST POLICY 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, ADMINISTRATION, THE MEDICAL STAFF AND ALL EMPLOYEES ARE EXPECTED TO AVOID CONFLICTS OF INTEREST. FURTHER, IT REQUIRES DISCLOSURE OF ANY POTENTIAL 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 ITS 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. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, LINES 15A AND 15B ------------------------------ COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS SET BY THE REGULATORY COMPLIANCE COMMITTEE (RCC) OF THE BOARD OF DIRECTORS. COMPENSATION FOR OFFICERS OF THE CORPORATION IS REVIEWED BY THE SAME COMMITTEE. THE RCC RETAINS AN INDEPENDENT CONSULTANT TO CONDUCT ANNUAL SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN THE HEALTHCARE INDUSTRY AND USES ITS REPORT IN ITS COMPENSATION DECISION. MAKING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 ------------------------------ DOCUMENTS ARE MADE AVAILABLE IF REQUIRED AND IN THE MANNER REQUIRED BY GOVERNING AGENCY OR BOND AUTHORITY. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 ------------------------------ OTHER CHANGES IN NET ASSETS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP ($5,749,415) CHANGE IN MINIMUM PENSION LIABILITY ($14,276,284) TRANSFER FROM AFFILIATES $267,017 UNREALIZED LOSSES ($1,167,320) ROUNDING $18 ------------ ($20,925,984) AMENDED RETURN CHANGES ------------------------------ Schedule J, Column A(iii) was updated to reflect corrected amounts of taxable compensation for certain individuals paid by the filing organization or paid by a related organization. Corrected W-2s and amended 941s were also filed. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CONNIE SMITH TITLE:DIRECTOR & PRESIDENT/CEO HOURS:48 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SARAH MOORE TITLE:EXECUTIVE VICE PRESIDENT HOURS:48 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BETSY KULLMAN TITLE:CNO/EXECUTIVE VICE PRESIDENT HOURS:48 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BARBARA JEAN CHERRY TITLE:CIO/EXECUTIVE VICE PRESIDENT HOURS:48 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RONALD G SOWELL TITLE:CFO/EXECUTIVE VICE PRESIDENT HOURS:49 MEDICAL CENTER PHARMACY OF BOWLING GREEN 800 PARK STREET BOWLING GREEN KY 42101 061778164 PHARMACY KY 3974853 1387539 NA MEDICAL CENTER EMS LLC 800 PARK STREET BOWLING GREEN KY 42101 562332847 EMERG MED SVC KY 5424908 768352 NA BLUEGRASS OUTPATIENT CTR OF BOWLING GRN 800 PARK STREET BOWLING GREEN KY 42101 263564003 OUTPATIENT KY 0 NA THE MEDICAL CENTER AT FRANKLIN INC 800 PARK STREET BOWLING GREEN KY 42101 611362001 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH CORPORATION INC 800 PARK STREET BOWLING GREEN KY 42101 311118087 SUPPORT KY 501(C)(3) 9 NA false COMMONWEALTH REGIONAL SPECIALTY HOSPITAL 800 PARK STREET BOWLING GREEN KY 42101 542142034 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH FREE CLINIC INC 800 PARK STREET BOWLING GREEN KY 42101 611292739 HEALTHCARE KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH FOUNDATION INC 800 PARK STREET BOWLING GREEN KY 42101 611362000 SUPPORT KY 501(C)(3) 7 CHC INC false URGENTCARE PROPERTIES 800 PARK STREET BG KY 42101 611197268 REAL ESTATE KY NA N/A false 0 false MEDICAL PLAZA PARTNERS LTD 800 PARK STREET BG KY 42101 611080340 REAL ESTATE KY BGWCCHC RELATED 265180 569362 false 0 false 0.92260 URGENTCARE OF BOWLING GREEN INC 800 PARK STREET BOWLING GREEN KY 42101 611035393 HEALTHCARE KY NA c true false true false false false false false true true true true false false true true false false COMMONWEALTH HEALTH CORPORATION 29638000 FMV