THE COMMUNITY HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- THE COMMUNITY HOSPITAL INC (EIN 61-0445841)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-05-29
- IRS object ID
- 201331499349300188
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-29T16:40:38-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KERBER ECK & BRAECKEL LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 W MAIN ST | AddressLine1 |
| City | CARBONDALE | City |
| State | IL | State |
| ZIP Code | 629012335 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610445841 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MUHLENBERG COMMUNITY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MUHL | NameControl |
| Phone | 2703388000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 HOPKINSVILLE ST | AddressLine1 |
| City | GREENVILLE | City |
| State | KY | State |
| ZIP Code | 423451124 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOSEPH SWAB | Name |
| Title | CFO | Title |
| Phone | 2703388000 | Phone |
| Date Signed | 2013-05-29 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARK DALLAS | Name |
| Phone | 6185291040 | Phone |
| Date Prepared | 2013-05-29 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN COUNTZLER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 HOPKINSVILLE ST | AddressLine1 |
| City | GREENVILLE | City |
| State | KY | State |
| ZIP Code | 42345 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 34083991 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MCHKY.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1938 | YearFormation |
| State Legal Domicile | KY | StateLegalDomicile |
| Activity Or Mission Description | PATIENT CARE - HEALTHCARE SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 591 | TotalNbrEmployees |
| Total Nbr Volunteers | 32 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 894460 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 462399 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 32659530 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 32843901 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 111548 | InvestmentIncomePriorYear |
| Investment Income Current Year | 422338 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 123873 | OtherRevenuePriorYear |
| Other Revenue Current Year | 190573 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 33789411 | TotalRevenuePriorYear |
| Total Revenue Current Year | 33919211 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 19447212 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 20148971 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14251991 | OtherExpensePriorYear |
| Other Expenses Current Year | 15332177 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 33699203 | TotalExpensesPriorYear |
| Total Expenses Current Year | 35481148 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 90208 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1561937 | RevenuesLessExpensesCY |
| Total Assets BOY | 21219725 | TotalAssetsBOY |
| Total Assets EOY | 20734954 | TotalAssetsEOY |
| Total Liabilities BOY | 2630740 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3835595 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18588985 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 16899359 | NetAssetsOrFundBalancesEOY |
| Mission Description | PATIENT CARE - HEALTHCARE SERVICES | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 35481148 | Expense |
| Revenue | 32832445 | Revenue |
| Description | HEALTH CARE DELIVERY & MANAGEMENT: THE HOSPITAL OPERATES A 90 BED ACUTE CARE AND A 45 BED SKILLED NURSING FACILITY WITH RELATED OUTPATIENT AND ANCILLARY SERVICES, INCLUDING A 24 HOUR EMERGENCY DEPARTMENT. MUHLENBERG COMMUNITY HOSPITAL (MCH) PARTICIPATES WITH MEDICARE, MEDICAID AND INDIGENT CARE PROGRAMS IN THE STATE OF KENTUCKY. THE HOSPITAL PROMOTES AND FURTHERS THE HEALTH AND GENERAL STANDARDS OF LIVING IN OUR COMMUNITY. THE ACTIVITY OF RENDERING HEALTH SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, ACCOMPLISHES THE HOSPITAL'S EXEMPT PURPOSE. | Description |
| Total Program Service Expense | 35481148 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 44 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 591 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOE SWAB | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2703388277 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 HOPKINSVILLE ST | AddressLine1 |
| City | GREENVILLE | City |
| State | KY | State |
| ZIP Code | 42345 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DR VINCENT P GENOVESE | |||||||
| BOARD MEMBER | 40.00 | X | 392173 | 0 | 0 | ||
| CHARLES R LEWIS | |||||||
| CHAIRMAN | 2.00 | X | 0 | 0 | 0 | ||
| DAVID JERNIGAN | |||||||
| VICE-CHAIRMA | 2.00 | X | 0 | 0 | 0 | ||
| W LEE FAUNTLEROY | |||||||
| SECRETARY/TR | 2.00 | X | 0 | 0 | 0 | ||
| TAMMY S BREWER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DR MARY WEBB BROWN | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| LANIE WEBB GARDNER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DR WILLARD KEITH | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DR FREDDIE MAYES | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JOHN COUNTZLER | |||||||
| CEO | 40.00 | 117322 | 0 | 0 | X | ||
| KATHLEEN MITCHELL | |||||||
| CNO | 40.00 | 107741 | 0 | 0 | X | ||
| JOSEPH SWAB | |||||||
| CFO | 40.00 | 36343 | 0 | 0 | X | ||
| DR DENNIS KNOEPFLER | |||||||
| PHYSICIAN | 40.00 | 346963 | 0 | 0 | X | ||
| LAURA STILES | |||||||
| RPH | 40.00 | 108556 | 0 | 0 | X | ||
| ANN C MURPHY | |||||||
| RPH | 40.00 | 108013 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1217111 | TotalReportableCompFromOrg |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | true | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ALLIANT MANAGEMENT SERVICES | |||||
| 2650 EASTPOINT PKWY SUITE 310 | LOUISVILLE | KY | 40223 | MANAGEMENT SERV | 444222 |
| KY EMERGENCY ROOM PHYSICIAN | |||||
| 320 DAWN DRIVE | GREENVILLE | KY | 42345 | ER PHYS/HOSPITA | 401690 |
| SODEXHO | |||||
| 9801 WASHINGTON BLVD | GAITHERSBERG | MD | 20878 | DIETERYSRVCMGMT | 149651 |
| GWC SYSTEMS | |||||
| 1232 STATE ROUTE 973 | GREENVILLE | KY | 42345 | IT CONSULTING | 130946 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 101071 | ATLANTA | GA | 30374 | LABORATORY SERV | 114975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 357600 | GovernmentGrants |
| All Other Contributions | 104799 | AllOtherContributions |
| Total Contributions | 462399 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Total Revenue Column | 32843901 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32843901 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 32843901 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 433794 | TotalRevenueColumn |
| Exclusion | $433,794 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 29739 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 29739 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29739 | TotalRevenueColumn |
| Exclusion | $29,739 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 153324 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 164780 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -11456 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -11456 | TotalRevenueColumn |
| Related Or Exempt Function Income | -11456 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|
| DIETARY / CAFETERIA | 128217 | $128,217 |
| MISCELLANEOUS | 32617 | $32,617 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 160834 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33919211 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32832445 | RelatedOrExemptFunctionIncome |
| Exclusion | $624,367 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261406 | Total |
| Program Services | 261406 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15287160 | Total |
| Program Services | 15287160 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1905 | Total |
| Program Services | 1905 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3419820 | Total |
| Program Services | 3419820 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1178680 | Total |
| Program Services | 1178680 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 567530 | Total |
| Program Services | 567530 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115062 | Total |
| Program Services | 115062 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56376 | Total |
| Program Services | 56376 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3126129 | Total |
| Program Services | 3126129 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 182520 | Total |
| Program Services | 182520 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 683579 | Total |
| Program Services | 683579 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123553 | Total |
| Program Services | 123553 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1898968 | Total |
| Program Services | 1898968 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125304 | Total |
| Program Services | 125304 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80927 | Total |
| Program Services | 80927 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47864 | Total |
| Program Services | 47864 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1423368 | Total |
| Program Services | 1423368 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 539652 | Total |
| Program Services | 539652 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MEDICAL SUPPLIES & DRUGS | 5318458 | 5318458 |
| PROVIDER & OTHER TAXES | 871627 | 871627 |
| MEMBERSHIPS & SUBSCRIPTIO | 111786 | 111786 |
| MISCELLANEOUS | 59474 | 59474 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35481148 | Total |
| Program Services | 35481148 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1825 | BOY |
| EOY | 717399 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 430037 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6486848 | BOY |
| EOY | 6840313 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1186162 | BOY |
| EOY | 1179243 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 355788 | BOY |
| EOY | 558592 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 39868565 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 31527001 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7966580 | BOY |
| EOY | 8341564 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4515213 | BOY |
| EOY | 1187132 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 707309 | BOY |
| EOY | 1122721 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 357953 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21219725 | BOY |
| EOY | 20734954 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2578740 | BOY |
| EOY | 2749204 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 874244 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52000 | BOY |
| EOY | 212147 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2630740 | BOY |
| EOY | 3835595 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18588985 | BOY |
| EOY | 16899359 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18588985 | BOY |
| EOY | 16899359 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21219725 | BOY |
| EOY | 20734954 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1561937 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -127689 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 208485 | OtherCostOrOtherBasis |
| Book Value | 208485 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11549755 | OtherCostOrOtherBasis |
| Depreciation | 8653036 | Depreciation |
| Book Value | 2896719 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27103693 | OtherCostOrOtherBasis |
| Depreciation | 22451879 | Depreciation |
| Book Value | 4651814 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1006632 | OtherCostOrOtherBasis |
| Depreciation | 422086 | Depreciation |
| Book Value | 584546 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8341564 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 304728 | BookValue |
| Method Of Valuation | C | MethodOfValuation |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BOARD DESIGNATED FUNDS | Description |
| Book Value | 882404 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1187132 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD-PARTY PAYORS | $160,147 |
| MCH FOUNDATION - NOTE PAYABLE | $52,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 212147 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | MUHLENBERG COMMUNITY HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT IS NOT AWARE OF ANY ACTIVITY WITHIN THE HOSPITAL DURING THE CURRENT OR PRIOR REPORTING PERIODS THAT WOULD JEOPARDIZE OR OTHERWISE CALL INTO QUESTION THE HOSPITAL'S COMPLIANCE WITH THE ABOVE INTERNAL REVENUE CODE SECTION. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1850579 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 268075 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1582504 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04460 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7171260 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4660568 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2510692 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07080 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9021839 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4928643 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4093196 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11540 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 104495 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 104495 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 104495 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 104495 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9126334 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4928643 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4197691 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11830 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,654,648 | BadDebtExpenseAmount |
| Amount Attributable To | 827324 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 13599051 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14910669 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1311618 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MUHLENBERG COMMUNITY HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 HOPKINSVILLE ST | AddressLine1 |
| City | GREENVILLE | City |
| State | KY | State |
| ZIP Code | 423450387 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | HOME HEALTH-EMS-SKILLED NURSIN | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MUHLENBERG COMMUNITY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0 | FPGFreePercent |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| COMMUNITY BUILDING ACTIVITIES | PART II | MUHLENBERG COMMUNITY HOSPITAL HAS AN ONGOING COMMITMENT TO ITS COMMUNITY DUE TO MUHLENBERG COUNTYS HIGH RATE OF JOBLESSNESS THE HOSPITAL DECIDED IT WAS IN THE COMMUNITYS BEST INTEREST TO SUPPORT LOCAL VENDORS WHEN POSSIBLE AND TO SUPPORT COMMUNITY EFFORTS TO BRING NEW INDUSTRY TO THE REGION THE HOSPITAL ALSO SUPPORTS LOCAL DISASTER PREPAREDNESS ACTIVITIES |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | THE TOTAL BAD DEBT EXPENSE AT COST REPRESENTS THE TOTAL AMOUNT EXPECTED TO BE COLLECTED BUT DEEMED UNCOLLECTIBLE BASED ON THE COMMUNITYS DEMOGRAPHICS INCOME LEVEL INDIVIDUAL ASSETS AND HEALTH COVERAGE 50 WAS DETERMINED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITALS PATIENT FINANCIAL ASSISTANCE PROGRAM PATIENTS ARE SCREENED FOR DSH AND CHARITY BASED ON APPLICATIONS THE ONES WHO DO NOT QUALIFY BECOME BAD DEBT ACCOUNTS FINANCIAL STATEMENT FOOTNOTE PATIENT ACCOUNTS RECEIVABLE ARE ORDINARILY DUE THIRTY DAYS AFTER THE ISSUANCE OF THE INVOICE AT THE EXPIRATION OF THE THIRTY DAYS IF NO RESPONSE IS RECEIVED FROM THE PATIENT A STATEMENT IS GENERATED AND FORWARDED TO AN OUTSOURCE AGENCY HEALTH CLAIMS MANAGEMENT HCM HCM WILL GENERATE AND PROCESS A TOTAL OF THREE STATEMENTS TO COLLECT THE AMOUNT DUE ADDITIONAL STATEMENTS COULD BE GENERATED IF A PAYMENT ARRANGEMENT HAS BEN APPROVED IF THE HOSPITAL RECEIVES NO PAYMENT OR COMMUNICATION TO ARRANGE PAYMENT THE ACCOUNT IS SENT TO COLLECTION AND RECOGNIZED AS BAD DEBT AT THAT TIME |
| MEDICARE EXPLANATION | PART III LINE 8 | THE TOTAL MEDICARE ALLOWABLE COSTS OF CARE REPRESENTS THE AMOUNT REPORTED IN THE HOSPITALS MEDICARE COST REPORT MUHLENBERG COMMUNITY HOSPITALS MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT DUE TO THE COMMUNITY IT SERVES MEDICARE REPRESENTS 42 OF THE HOSPITALS PAYOR MIX WITH MEDICARE REPRESENTING SUCH A LARGE PORTION OF THE PAYOR MIX THE HOSPITAL DEPENDS ON MEDICARE PAYMENTS IF MEDICARE PAYS LESS THAN COST IT IS DETRIMENTAL TO THE HOSPITAL AND THEREFORE SHOULD BE CONSIDERED AS COMMUNITY BENEFIT |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | PATIENT ACCOUNTS THAT ARE APPROVED FOR CHARITY ARE WRITTEN OFF TO OUR HOSPITAL CHARITY ADJUSTMENT THE PATIENT IS NOTIFIED OF CHARITY APPROVAL BY MAIL NO FURTHER STATEMENTS OF ACCOUNT OR OTHER CORRESPONDENCE ARE ISSUED |
| NEEDS ASSESSMENT | PART VI | MUHLENBERG COMMUNITY HOSPITAL ASSESSES THE COMMUNITYS HEALTH CARE NEEDS BY OBTAINING INFORMATION FROM A VARIETY OF SOURCES INCLUDING A DEMOGRAPHIC DATABASES B LOCAL AND REGIONAL HEALTH DEPARTMENTS AND RELATED DATABASES C KENTUCKY HOSPITAL ASSOCIATION REPORTS AND DATABASES D MARKET ANALYSIS E FEEDBACK FROM PHYSICIANS AND OTHER INTERESTED COMMUNITY GROUPS F HOSPITALGENERATED REPORTS ON UTILIZATION OF SERVICES G BOARD OF DIRECTORS MADE UP OF LOCAL COUNTY RESIDENTS |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | MUHLENBERG COMMUNITY HOSPITAL REACHES OUT TO EDUCATE PATIENTS ABOUT THE PATIENT FINANCIAL ASSISTANCE PROGRAM THE PATIENT FINANCIAL ASSISTANCE PROGRAM INFORMATION IS INCLUDED IN THE PATIENT INFORMATION HANDBOOK THAT IS GIVEN TO EVERY PATIENT AT THE TIME OF REGISTRATION THE ADMISSION CONSENT FORM ALSO INCLUDES AN ACKNOWLEDGEMENT BY THE PATIENT THAT THEY WERE GIVEN THE HANDBOOK IN ADDITION SELFPAY PATIENTS ARE INFORMED OF FEDERAL STATE AND LOCAL GOVERNMENTAL ASSISTANCE PROGRAMS WITHIN 24 HOURS OF ADMISSION SELFPAY PATIENTS ARE VISITED BY A FINANCIAL COUNSELOR AND INFORMED OF THE AVAILABLE PROGRAMS |
| COMMUNITY INFORMATION | PART VI | THE PRIMARY SERVICE AREA FOR MUHLENBERG COMMUNITY HOSPITAL IS MUHLENBERG COUNTY KENTUCKY POPULATION OF 31272 IN 2011 LOCATED 115 MILES NORTH OF NASHVILLE TN 125 MILES WOUTHWEST OF LOUISVILLE KY AND 70 MILES SOUTH OF EVANSVILLE IN THE HOSPITALS SECONDARY SERVICE AREA INCLUDES PARTS OF HOPKINS TODD OHIO MCLEAN BUTLER LOGAN AND CHRISTIAN COUNTIES WHICH ARE THE SURROUNDING COUNTIES THE ESTIMATED PERCENTAGE OF PEOPLE LIVING BELOW THE POVERTY LEVEL AS DETERMINED BY THE US CENSUS BUREAU 20072011 IS 205 FOR MUHLENBERG COUNTY AND AN AVERAGE OF 198 OF THE SECONDARY SERVICE AREA THE AREA IS MOSTLY RURAL WITH A HIGHER PERCENTAGE OF PERSONS OVER THE AGE OF 65 AND A SIGNIFICANTLY LOWER MEDIAN HOUSEHOLD INCOME THAN FORALL OF KENTUCKY THE AVERAGE UNEMPLOYMENT RATE IN MUHLENBERG COUNTY FOR THE THE CALENDAR YEAR 2011 WAS 98 COMPARED TO THE STATE AVERAGE OF 95 |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | HEALTH AND COMMUNITY IN RELATION TO EXEMPT PURPOSE MUHLENBERG COMMUNITY HOSPITAL AND ITS EMPLOYEES HAVE A RICH HISTORY OF PLANNING ANDOR SPONSORING EVENTS DESIGNED TO EDUCATE THE COMMUNITY ON HEALTHY LIVINGAND WELLNESS FACTORS EVENTS DURING THE FISCAL YEAR ENDING 9302012 INCLUDED HEALTH FAIRS AND SCREENINGS FOR THE COMMUNITY AND PRIVATE ORGANIZATIONS MUHLENBERG COMMUNITY HOSPITAL ADHERES TO THE FOLLOWING IRS EXEMPTION REQUIREMENTS A ACCEPT AND TREAT MEDICARE AND MEDICAID PATIENTS B EMERGENCY DEPARTMENT OPEN TO ALL EMERGENT CASES REGARDLESS OF ABILITY TO PAY C OPEN MEDICAL STAFF THAT ALLOWS CREDENTIALED PHYSICIANS TO PRACTICE AT THE FACILITY D OPERATE UNDER COMMUNITY BOARDS CONTROL IT IS THE MISSION AND ONGOING GOAL OF THE LEADERSHIP AND EMPLOYEES OF MUHLENBERG COMMUNITY HOSPITAL TO DO THE BEST JOB POSSIBLE TREATING THE SICK AND INJURED ADDRESSING COMMUNITY WELLNESS NEEDS AND PROMOTING HEALTHY LIVING AT EVERY OPPORTUNITY THROUGH OUR MANY COMMUNITY BENEFIT ACTIVITIES OUR CHARITY CARE PROGRAM AND OUR ACCEPTANCE OF PATIENTS COVERED BY FEDERAL AND STATE PROGRAMS MUHLENBERG COMMUNITY HOSPITAL MAKES A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE IN THE COMMUNITY WE SERVE |
| MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 13G | PART V LINE 13G | THE HOSPITAL SCREENS ALL PATIENTS FOR MEDICAID DSH AND CHARITY |
| MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | THIS HOSPITAL FOLLOWS THE ESTABLISHED POLICY FOR FINANCIAL ASSISTANCE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|
| DR VINCENT P GENOVESE | |
| 392173 | 392173 |
| JOHN COUNTZLER | |
| 117322 | 117322 |
| JOSEPH SWAB | |
| 36343 | 36343 |
| DR DENNIS KNOEPFLER | |
| 346963 | 346963 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE J, PART III | ReturnReference |
| Explanation | MUHLENBERG COMMUNITY HOSPITAL HIRED ALLIANT MANAGEMENT SERVICES (ALLIANT) TO PROVIDE MANAGEMENT SERVICES FOR THE HOSPITAL. ALLIANT IS RESPONSIBLE FOR PROVIDING THE HOSPITAL WITH A CEO AND CFO AS WELL AS PAYING THEIR ANNUAL SALARIES. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENTUCKY EMERGENCY ROOM PHYSICIANS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | DR. KEITH-OWNER | Relationship |
| Amount Of Transaction | 401690 | AmountOfTransaction |
| Description Of Transaction | ER PHYSICIAN SERVICE | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | REGARDING TRANSACTIONS DISCLOSED IN PART IV ABOVE THE TRANSACTIONS WITH KENTUCKY EMERGENCY ROOM PHYSICIANS KERP ARE FOR EMERGENCY DEPARTMENT AND HOSPITALIST COVERAGE THESE PAYMENTS REPRESENT TRANSACTIONS BASED ON FAIR MARKET VALUE OF SERVICES PROVIDED THE KERP TRANSACTIONS ARE REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS | FORM 990, PAGE 1, PART I, LINE 6 | VOLUNTEERS PROVIDE NON-CLINICAL SERVICES, INCLUDING OFFICE ASSISTANCE, STAFFING THE INFORMATION DESK, AND OPERATING THE GIFT SHOP. |
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | DR MARY K BROWN LANIE WEBB GARDNER BOARD MEMBER BOARD MEMBER FAMILY RELATIONSHIP CHARLES R LEWIS DR WILLARD KEITH BRD.CHAIRMAN BOARD MEMBER BUSINESS RELATIONSHIP |
| MANAGEMENT DELEGATED | FORM 990, PAGE 6, PART VI, LINE 3 | THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL IS EMPLOYED BY ALLIANT MANAGEMENT SERVICES AND IS RESPONSIBLE FOR CONTROLLING MANAGEMENT DUTIES. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE CEO REVIEWS THE 990 WITH THE BOARD OF DIRECTORS BEFORE IT IS SUBMITTED TO THE INTERNAL REVENUE SERVICE. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | ALL MANAGEMENT EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO UPDATE AND SIGN OFF ON A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | ALLIANT MANAGEMENT SERVICES EMPLOYS THE HOSPITAL'S CEO AND CFO. THEY PERFORM COMPARABILITY STUDIES AND RECOMMEND SALARY PACKAGES TO THE HOSPITAL'S PERSONNEL COMMITTEE. THE SALARY PACKAGES ARE REVIEWED AND APPROVED BY THE HOSPITAL'S PERSONNEL COMMITTEE. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | COMPARABILITY DATA IS REVIEWED REGARDING THE CEO AND CFO'S SALARY PACKAGES. THE SALARY PACKAGES ARE REVIEWED AND APPROVED BY THE HOSPITAL'S FINANCE COMMITTEE ON AN ANNUAL BASIS. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | OTHER CHANGES IN NET ASSETS INCLUDES A 6 VARIANCE DUE TO ROUNDING AND A DECREASE OF 127,695 RELATED TO THE CHANGE IN NET UNREALIZED LOSSES ON INVESTMENTS, OTHER THAN TRADING SECURITIES. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MUHLENBERG SURGERY CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1008 MEDICAL CENTER DRIVE | AddressLine1 |
| City | POWDERLY | City |
| State | KY | State |
| ZIP Code | 42367 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611398071 | EIN |
| Primary Activities | SURGERY | PrimaryActivities |
| Legal Domicile State | KY | LegalDomicileState |
| Total Income | 743447 | TotalIncome |
| EOY Assets | 1112488 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCH | BusinessNameLine1 |
| Business Name Line2 | COMMUNITY HOSPITAL | BusinessNameLine2 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MUHLENBERG COMMUNITY HOSPITAL F | BusinessNameLine1 |
| Business Name Line2 | OUNDATION | BusinessNameLine2 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 HOPKINSVILLE ST | AddressLine1 |
| City | GREENVILLE | City |
| State | KY | State |
| ZIP Code | 423450387 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 261600611 | EIN |
| Primary Activities | FUNDRAISIN | PrimaryActivities |
| Legal Domicile State | KY | LegalDomicileState |
| Exempt Code Section | 501C3 | ExemptCodeSection |
| Public Charity Status | 9 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MUHLENBERG MEDICAL PROPERTIES IV LL | |||||||||||||
| 1010 MEDICAL CENTER DRIVE | POWDERLY | KY | 42367 | 010571762 | LESSOR | KY | N/A | RELATED | 40000 | 304728 | false | true | 0.49000 |
| GENESIS HEALTH ALLIANCE LLC | |||||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47714 | 208223181 | PURCHASING | IN | N/A | RELATED | 1166 | 9197 | false | true | 0.04350 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |