2012-05-21T15:44:11-05:00 2011-09-30 JOHNSON HICKEY & MURCHISON PC 651 E FOURTH ST STE 200 CHATTANOOGA TN 37403 990 2010-10-01 311131099 OHIO COUNTY HOSPITAL CORPORATION OHIO 2702987411 1211 OLD MAIN STREET HARTFORD KY 423471619 JOHN TICHENOR 2702987411 2012-05-16 1 BARRY R HUGGINS 4237560052 2010 2016-02-24 21:20:13Z BLAINE PIEPER 1211 OLD MAIN STREET HARTFORD KY 423471619 27776414 0 X WWW.OHIOCOUNTYHOSPITAL.COM X 1984 KY THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES, MAKING A DIFFERENCE IN THE LIVES OF THE PEOPLE WE SERVE BY PROVIDING POSITIVE LIFE-CHANGING EXPERIENCES. 9 8 408 50 0 0 68772 221615 26083425 26949560 20583 8525 264659 596714 26437439 27776414 0 0 0 0 12580933 13809777 0 0 0 13498995 14174384 26079928 27984161 357511 -207747 18096786 17061058 9148049 8320068 8948737 8740990 X THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES, MAKING A DIFFERENCE IN THE LIVES OF THE PEOPLE WE SERVE BY PROVIDING POSITIVE LIFE-CHANGING EXPERIENCES. 0 0 24701508 27501086 THE MISSION OF OHIO COUNTY HOSPITAL IS TO MAKE A DIFFERENCE IN THE LIVES OF OTHERS BY CARING, SERVING, AND EDUCATING INDIVIDUALS RELATIVE TO THEIR SPECIFIC HEALTH NEEDS. WE BELIEVE THAT THROUGH THESE ACTIONS, THE GENERAL HEALTH OF OHIO COUNTY AND SURROUNDING AREAS WILL IMPROVE. LOCATED IN A RURAL AREA, OHIO COUNTY HOSIPTAL IS THE FRONTLINE OF COMMUNITY HEALTHCARE, PROVIDING A SAFETY NET 24 HOURS A DAY THROUGH OUR INPATIENT, OUTPATIENT AND EMERGENCY SERVICES. IN ORDER TO MEET THE CHANGING NEEDS OF THE COMMUNITY AND IMPROVE THE ACCESS TO HEALTH CARE, WE HAVE EXPANDED OUR SERVICES TO INCLUDE PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES. AND WHILE PATIENTS BENEFIT FROM OUR BEING CLOSE BY, ULTIMATELY IT IS THE WHOLE COMMUNITY THAT PROSPERS FROM OUR PRESENCE.THE HOSPITAL'S POSITIVE IMPACT ON THE COMMUNITY EXTENDS WELL BEYOND THE FOUR WALLS OF THE FACILITY. OUR COMMUNITY BENEFIT INCLUDES NOT ONLY THE COST OF PROVIDING CARE TO THE UNINSURED AND INDIGENT BUT ALSO BY IDENTIFYING UNMET COMMUNITY OR PUBLIC HEALTH NEEDS AND SEEKING TO ADDRESS THEM. EXAMPLES OF SUCH EFFORTS INCLUDE SUPPLYING CHILDHOOD IMMUNIZATION VACCINES TO OUR LOCAL PUBLIC HEALTH DEPARMENT AT NO CHARGE. BECOMING A SMOKE-FREE FACILITY, AND OFFERING FREE SMOKING CESSATION COURSES SEVERAL TIMES A YEAR TO ALL COMMUNITY MEMBERS. OHIO COUNTY HOSPITAL WAS THE FOUNDING MEMBER OF A LOCAL HEALTH COALITION WHOSE FOCUS IS TO IMPLEMENT PREVENTATIVE HEALTH ACTIVITES TO COMBAT THE LACK OF PHYSICAL ACTIVITY AND THE PREVALENCE OF OBESITY IN OUR AREA. WHETHER IT'S THROUGH THE PEOPLE WE EMPLOY, THE LOCAL BUSINESSES WE USE, OR THE CHARITIES AND COMMUNITY ACTIVITIES WE SUPPORT, WE ARE COMMITTED TO MAKING THE OHIO COUNTY AREA A HEALTHIER PLACE TO LIVE AND WORK.DURING 2010, THE HOSPITAL PROVIDED HEALTH CARE SERVICES TO OHIO COUNTY, KENTUCKY AND SURROUNDING AREAS, INCLUDING INPATENT, OUTPATIENT, AND EMERGENCY SERVICES THE HOSPITAL SERVED APPROXIMATELY 2,679 PEOPLE THROUGH ITS CHARITY CARE PROGRAM, PROVIDING 1,319,324 WORTH OF CHARITY CARE. 24701508 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 30 0 1 408 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 KY X JOHN TICHENOR 2702985495 1211 OLD MAIN STREET HARTFORD KY 42347 X JUANITA PARK 2.00 X X 0 0 0 JANE CANARY 2.00 X X 0 0 0 JONATHAN SHREWBURY OD 2.00 X X 0 0 0 RUTH FIELDS 2.00 X 0 0 0 WAYNE HUNSAKER 2.00 X 0 0 0 KELLY ROE 2.00 X 0 0 0 CARLA WALLACE 2.00 X 0 0 0 GERALD WESTERFIELD 2.00 X 0 0 0 DRANDERSON ROWLAND 40.00 X X 223593 0 12363 BLAIN PIEPER 40.00 X 143064 0 16452 JOHN TICHENOR 40.00 X 106378 0 11494 BRENDA NEWCOM 40.00 X 80725 0 8852 JANNA PATHI 40.00 X 489155 0 11384 DONALD K GREGORY 40.00 X 411794 0 11074 HEATHER GARRETT 40.00 X 259540 0 7678 STEVEN MILLS DO 40.00 X 221934 0 10119 MUKESH DESAI 40.00 X 352980 0 5918 JOEL JOHNSTON 40.00 X 214388 0 8789 2503551 0 104123 15 0 1 1 EMCARE PHYSICIAN SERVICES 7032 COLLECTION CENTER PLACE CHICAGO IL 60693 ER PHYSICIANS 312643 QUOROM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT FEES 236743 2 192481 29134 221615 NET PATIENT SERVICES 621300 26949560 26949560 26949560 8525 8525 45188 45188 45188 45188 MISCELLANEOUS INCOME 621300 470393 470393 CAFETERIA INCOME 722210 54579 54579 WELLNESS PROGRAM 900099 17243 17243 9311 9311 551526 27776414 27501086 0 53713 1095381 826072 269309 10474293 9927972 546321 221414 205804 15610 1190681 1106738 83943 828008 769633 58375 236743 236743 43705 43705 76455 76455 2085822 1507701 578121 75550 75550 81922 73079 8843 2078516 1747787 330729 131058 118568 12490 131723 131723 945870 945870 412879 17491 395388 MEDICAL SUPPLIES AND DR 4558311 4558311 BAD DEBT 2361947 2361947 TAXES AND LICENSES 491499 491499 OTHER SUPPLIES 297945 231868 66077 DUES AND SUBSCRIPTIONS 87142 62865 24277 77297 32529 44768 27984161 24701508 3282653 0 3894312 2015945 4079930 1455516 3388052 4209202 86073 659701 739514 194835 150562 22858227 14599884 5633150 8258343 160733 231976 18096786 17061058 1915589 1602919 281750 262927 5930000 5455000 620710 404221 400000 595001 9148049 8320068 X 8948737 8740990 8948737 8740990 18096786 17061058 -207747 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1934 1934 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL PAYS DUES TO THE KENTUCKY HOSPITAL ASSSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE USED FOR LOBBYING. 416987 416987 7877025 3434028 4442997 13687380 10910175 2777205 876835 255681 621154 8258343 THIRD PARTY SETTLEMENTS 595001 595001 27776414 27984161 -207747 0 -207747 27776414 0 27776414 0 27776414 27984155 0 27984155 6 6 27984161 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: PART X, LINE 2: THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW, HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPTAL FILES TAX RETURNS IN THE US FEDERAL JURISDICTION WITH A FEW EXCEPTIONS. THE HOSPITAL IS NO LONGER SUBJECT TO US FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008. PART XIII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING 6. 1 1 1 X 0 1 1 0 0 1413560 333891 1079669 0.04210 4607431 3901004 706427 0.02760 6020991 4234895 1786096 0.06970 21207 21207 0.00080 21207 21207 0.00080 6042198 4234895 1807303 0.07050 2285808 342871 8721962 8635606 86356 X 1 0 1 1 OHIO COUNTY HOSPITAL CORPORATION

1211 OLD MAIN STREET HARTFORD KY 42347

X X X OHIO HOSPITAL CORPORATION 1 1 1 100.000000000000 0 1 X 1 1 X 1 X 0 1 X 0 0 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2361947. PART II: OHIO COUNTY HOSPITAL IS A MAJOR FINANCIAL CONTRIBUTOR, AND ALSO PROVIDES STAFF TO COORDINATE LONGEST DAY OF PLAY AND CELEBRATE THE CHILD, TWO OF THE LARGEST COMMUNITY OUTREACHES TARGETED TO CHILDREN. BOTH OF THESE EVENTS ARE PROVIDED FREE TO THE YOUTH OF THE COMMUNITY. CELEBRATE THE CHILD DRAWS THOUSANDS OF COMMUNITY MEMBERS ANNUALLY AND FOCUSES ON COMMUNITY ASSET BUILDING. OHIO COUNTY HOSPITAL SUBSIDIZES THE ADVERTISEMENT AND SUPPLIES FOR THE EVENT AND OUR STAFF PARTICIPATES IN A HOSPITAL BOOTH WHICH FOCUSES ON CHILDREN MAKING HEALTH FOOD CHOICES. LONGEST DAY OF PLAY IS AN ANNUAL SUMMER EVENT WHERE FAMILIES CAN PARTICIPATE IN OVER 30 OUTDOOR PHYSICAL ACTIVITIES. OVER 500 COMMUNITY MEMBERS ATTEND IN ADDITION TO THE HUNDRED PLUS COMMUNITY VOLUNTEERS. HOSPITAL EMPLOYEES AND MEMBERS OF THE MEDICAL STAFF MAKE UP 25% OF THE VOLUNTEERS AT LONGEST DAY OF PLAY. THE HOSPITAL SUBSIDIZES THE ADVERTISEMENT AND SUPPLIES TO THE EVENT, AS WELL AS PROVIDING FOOD FOR THE FREE HEALTHY PICNIC LUNCH. OHIO COUNTY HOSPITAL IS THE LEADER IN PROMOTING HEALTH AND WELLNESS IN THE COMMUNITY. THE HOSPITAL PROVIDES FINANCIAL SPONSORSHIP, AS WELL AS COORDINATES AND PROVIDES EMPLOYEE VOLUNTEERS, FOR THE MAJORITY OF THE HEALTH OUTREACH INITIATIVES IN OHIO COUNTY. EXAMPLES OF THESE PROGRAMS INCLUDE: RELAY FOR LIFE, GO RED HEART EDUCATION LUNCH & LEARN, SENIOR HEALTH FAIR, COMMUNITY-WIDE HEALTH FAIR, BREAST CANCER AWARENESS EVENTS, OHIO COUNTY CANCER COALITION, DIABETES SUPPORT GROUP, GRIEF SUPPORT GROUP THROUGH HOSPICE, GO BLUE PROSTATE CANCER SCREENING LUNCH AND LEARN, OCH FALL INTO FITNESS 5K, COMMUNITY FITNESS CHALLENGE, SENIOR DAY AT THE MALL, PROVIDE MEETING SPACE FOR RETIRED TEACHERS ASSOCIATION, FREE SMOKING CESSATION PROGRAM, HOSPITAL EMPLOYEE UNITED WAY FUND DRIVE, HABITAT FOR HUMANITY FALL FESTIVAL, HEALTH STUDENTS CAREER DAY, BACK TO SCHOOL BASHES TO PROVIDE IMMUNIZATION AND HEALTHCARE PROVIDERS INFORMATION. ADDITIONALLY, HOSPITAL STAFF IS INVOLVED IN COMMUNITY READER DAYS, LEADERSHIP OHIO COUNTY REALITY STORE, STUDENT MENTORING PROGRAM THROUGHOUT THE SCHOOL SYSTEM, AND THE 4-H BODY WALK - AN INTERACTIVE DISPLAY TO TEACH MIDDLE SCHOOL STUDENTS ABOUT THE HUMAN BODY. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT THE HOSPITAL EXPECTS TO COLLECT. THE HOSPITAL MAINTAINS ALLOWANCES FOR DOUBTFUL ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM THE INABILITY OF ITS PATIENTS TO MAKE REQUIRED PAYMENTS. MANAGEMENT CONSIDERS THE FOLLOWING FACTORS WHEN DETERMINING THE COLLECTABILITY OF PATIENT ACCOUNTS: PAYOR CREDIT-WORTHINESS, PAST TRANSACTION HISTORY WITH THE PAYOR, CURRENT ECONOMIC INDUSTRY TRENDS, AND CHANGES IN PAYOR PAYMENT TERMS. IF THE FINANCIAL CONDITION OF THE HOSPITAL'S PAYORS OR PATIENTS WERE TO DETERIORATE, ADVERSELY AFFECTING THEIR ABILITY TO MAKE PAYMENTS, ADDITIONAL ALLOWANCES WOULD BE REQUIRED. BASED ON MANAGEMENT'S ASSESSMENT, THE HOSPITAL PROVIDES FOR ESTIMATED UNCOLLECTIBLE AMOUNTS THROUGH A CHARGE TO EARNINGS AND A CREDIT TO ALLOWANCE. BALANCES THAT REMAIN OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 9B: IF A PATIENT HAS BEEN APPROVED BY THE CHARITY CARE PROGRAM WITHIN A SIX MONTH TIME FRAME, THE ACCOUNT IS WRITTEN OFF AS A CHARITY CARE ADJUSTMENT. THE FINANCIAL COUNSELORS CHECK EACH PRIVATE PAY ACCOUNT AND WILL FOLLOW UP TO MAKE SURE THAT THEY HAVE RECEIVED AND ARE GOING TO COMPLETE THEIR PAPERWORK. THE HOSPITAL CONTRACTS WITH DMC, INC, AND THEY WILL ASSIST PATIENTS WITH CHARITY CARE PAPERORK IF THEY DO NOT QUALIFY FOR MEDICAID. OHIO HOSPITAL CORPORATION PART V, SECTION B, LINE 15E: THE ONLY FINANCIAL AID PROGRAM IS WHAT THE STATE OFFERS AS THE "DSH" PROGRAM. THE HOSPITAL USE AND OUTSIDE COMPANY-DMC WHO DETERMINES IF ALL OF THE PRIVATE PAY PATIENTS FIRST ARE ELIGIBLE FOR MEDICAID AND IF THEY ARE NOT THEY DETERMINE IF THEY ARE ELIGIBLE FOR THE STATE INDIGENT PROGRAM. IF THEY ARE ELIGIBLE FOR THE STATE PROGRAM THE ENTIRE BALANCE IS WRITTEN OFF. THE HOSPITAL DOES NOT HAVE ANY KIND OF OTHER FAP OR SEPARATE CHARITY CARE POLICY. IF THE PRIVATE PAY PATIENTS ARE ELIGIBLE FOR EITHER OF THE TWO PROGRAMS, THE HOSPITAL HAVE BEGAN OFFERING (OCTOBER 2011), A PRIVATE PAY DISCOUNT WHICH INITIALLY DISCOUNTS 40% OFF THE PATIENT'S ACCOUNT BALANCE. ALL OF THE PRIVATE PAY PATIENTS RECEIVE 3 STATEMENTS, 2 LETTERS AND SOMETIMES A OTHER LETTER BEFORE BEING SENT TO OUR COLLECTIONS AGENCY. THE COLLECTION AGENCY THEN DETERMINES THE ABILITY TO PAY AND THEY TAKE ACTIONS BASED ON THE RESULTS OF THEIR FINDINGS. PART VI, LINE 2: OHIO COUNTY HOSPITAL (OCH) PARTICPATES IN THE OHIO COUNTY HEALTH COALITION, ALONG WITH NUMEROUS OTHER HEALTH-RELATED ORGANIZATIONS, LOCAL BUSINESSES, AND CIVIC GROUPS. THE FOCUS OF THE COALITION, WHICH MEETS MONTHLY, IS TO SPEARHEAD INITIATIVES THAT ADDRESS THE HEALTH STATUS OF OUR COMMNUNITY. THE COALITION UTILIZES A YEARLY HEALTH REPORT CARD TO IDENTIFY PERTINENT HEALTH INITIATIVES AND FORM COMMITTEES TO ADDRESS THESE CONCERNS. MEMBERS OF THE HOSPITAL'S ADMINISTRATIVE TEAM AND HOSPITAL CLINICAL PERSONNEL SERVE ON THE HEALTH COALITION'S EXECUTIVE COUNCIL AND CHAIR SEVERAL SUB-COMMITTEES TO PROVIDE OVERSIGHT AND GUIDANCE ON LOCAL HEALTH INITIATIVES AND OUTREACH PROGRAMS. THE HOSPITAL ALSO SPONSORS SEVERAL OF THE COMMUNITY EVENTS THAT ARE ORGANIZED BY THE HEALTH COALITION AND COORDINATES FOR MEMBERS OF THE MEDICAL STAFF TO PROVIDE INFORMATIVE HEALTH TALKS. OHIO COUNTY HEALTH COALITION HEALTH REPORT CARD IS A YEARLY ASSESSMENT OF THE HEALTH STATUS OF OHIO COUNTIANS. THIS ASSESSMENT TOOL IS ORGANIZED AROUND A SET OF RISK FACTORS AND DIESEASE OUTCOMES GROUPED INTO THE FOLLOWING CATEGORIES: BEHAVIORAL/SOCIAL FACTORS, DEMOGRAPHICS, AND HEALTH ACCESS AND HEALTH OUTCOMES. IN ADDITION, RATES ARE MONITORED FOR FOUR TYPES OF CANCERS. THE HEALTH REPORT CARD IS PRODUCED THROUGH THE GREEN RIVER REGIONAL HEALTH COUNCIL FOR OHIO COUNTY AND OUR NEIGHBORING COMMUNITIES. IT BENCHMARKS EACH COMMUNITY'S HEALTH STATUS TO PREVIOUS YEAR'S OUTCOMES, AS WELL AS STATE AND NATIONAL AVERAGE. PART VI, LINE 3: OHIO COUNTY HOSPITAL'S ADMITTING AND BUSINESS OFFICE STAFF PROVIDES CHARITY CARE APPLICATIONS TO ANY PATIENT THAT DOESN'T HAVE INSURANCE DURING THE REGISTRATION PROCESS. IF THE PATIENT DOESN'T COMPLETE THE APPLICATION AT THAT TIME, THEIR DEMOGRAPHIC INFORMAITON IS THEN SENT TO AN OUTSIDE COMPANY, DMC, INC, AND THEY DETERMINE IF THE PATIENT IS ELIGIBLE FOR EITHER MEDICAID OR CHARITY CARE. DMC WILL FOLLOW-UP WITH THE PATIENT TO GET ADDITIONAL INFORMATION AS NEEDED. ONCE THE ACCOUNT IS BILLED AND IS IN THE COLLECTION PROCESS, OUR PRIVATE PAY COUNSELORS CHECK EACH ACCOUNT TO MAKE SURE THAT IT HAS BEEN CHECKED FOR INDIGENT CARE ELIGIBILITY. PART VI, LINE 4: OHIO COUNTY IS A RURAL COMMUNITY LOCATED IN WESTERN KENTUKY WITH A PRIMARY SERVICE ARE THAT INCLUDES A POPULATION ESTIMATED AS 21,488. OHIO COUNTY HAS SIX (6) INCORPORATED CITIES. BEAVER DAM IS THE LARGEST AND HARTFORD IS THE COUNTY SEAT. OTHER CITIES INCLUDE: CENTERTOWN, FORDSVILLE, MCHENRY, AND ROCKPORT. IT IS THE FIFTH LARGEST OF THE 120 COUNTIES IN KENTUCKY COVERING 596.73 SQUARE MILES. OHIO COUNTY HAS BEEN DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND A MEDICALLY UNDERSERVED AREA/POPULATION (MUA/P). THE PER CAPITA INCOME PER HOUSEHOLD IS $20,401 WHICH IS SIGNIFICANTLY BELOW THE STATE AVERAGE OF $27,625 AND NATIONAL AVERAGE OF $30,689. OHIO COUNTY ALSO FALLS BELOW STATE AND NATIONAL AVERAGE OF PERCENTAGE OF ADULTS AGE 25 OR OVER WITH A HIGH SCHOOL DIPLOMA. THE SENIOR POPULATION OF CITIZENS 65 PLUS YEARS OF AGE ACCOUNTS FOR 15.8% OF THE TOTAL POPULATION COMPARED TO THE NATIONAL AVERAGE OF 12.9%. FINALLY, APPROXIMATELY 25% OF OHIO COUNTIAN'S HEALTH INSURANCE IS COVERED THROUGH KENTUCKY MEDICAID AND APPROXIMATELY 19% ARE UNINSURED. PART VI, LINE 6: OHIO COUNTY HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF COMMUNITY VOLUNTEERS WHO ARE COMMITTED TO THE HEALTH AND WELFARE OF THE COMMUNITY AND DEDICATED TO ENSURING THE VIABILITY OF THE HOSPITAL FOR YEARS TO COME. THE BOARD EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN THE SERVICE AREA. SURPLUS FUNDS PROVIDE FOR CONTINUITY OF HEALTHCARE SERVICES DURING PERIODS OF ECONOMIC DOWNTURN, RECRUITMENT OF ADDITIONAL PROVIDERS TO IMPROVE THE ACCESS TO HEALTHCARE, AND REINVESTED IN NEW TECHNOLOGY AND EQUIPMENT AS NEEDED. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS STAFFED 24 HOURS A DAY/7 DAYS A WEEK AND SERVES EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL RESEARCHES AND COMPLETES NUMEROUS GRANT APPLICATIONS APPLICABLE TO PROMOTING THE HEALTH OF OUR COMMUNITY. THE HOSPITAL PROVIDES REPRESENTATION AND SUPPORT TO THE OHIO COUNTY CHAMBER BOARD OF DIRECTORS, OHIO COUNTY TOURISM, AND LEADERSHIP OHIO COUNTY PROGRAM, WHICH ARE ORGANIZATIONS WORKING TOWARDS THE ECONOMIC GROWTH OF OUR AREA. X X 0 0 0 0 0 0 0 0 0 DRANDERSON ROWLAND 177146 0 46252 0 195 0 5912 0 6451 0 235956 0 247695 0 BLAIN PIEPER 143064 0 0 0 0 0 0 0 16452 0 159516 0 154870 0 JANNA PATHI 489155 0 0 0 0 0 7350 0 4034 0 500539 0 506783 0 DONALD K GREGORY 408394 0 2462 0 938 0 0 0 11074 0 422868 0 407177 0 HEATHER GARRETT 216531 0 42800 0 209 0 0 0 7678 0 267218 0 231401 0 STEVEN MILLS DO 201805 0 9424 0 10705 0 6005 0 4114 0 232053 0 224267 0 MUKESH DESAI 352399 0 0 0 581 0 0 0 5918 0 358898 0 0 0 JOEL JOHNSTON 213365 0 0 0 1023 0 0 0 8789 0 223177 0 0 0 PART I, LINE 1A SUPPLEMENTAL INFORMATION PART III JOHN TECHENOR AND BLAINE PIEPER ARE CONTRACTED THROUGH QUORUM HEALTH RESOURCES, INC FOR THEIR MANAGEMENT SERVICES. OHIO COUNTY PUBLIC FACILITIES CORPORATION 616000805 000677292 2005-08-01 4240000 HOSPITAL CONSTRUCTION 0 0 0 OHIO COUNTY PUBLIC FACILITIES CORPORATION 616000805 2010-09-29 3620000 MEDICAL OFFICE BUILDING CONSTRUCTION 0 0 0 1890000 424000 74823 3741177 2006 1 0 1 1 3565000 273400 70000 3550000 2011 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0 DR STEVEN MILLS STUDENT LOAN/BONUS X 117224 24422 0 1 1 DR DAVID RZIK STUDENT LOAN/BONUS X 76500 68906 0 1 1 DR DESAI SIGNON BONUS X 25000 23333 0 1 1 116661 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL CONTRACTS WITH QUORUM HEALTH RESOURCES, INC (QHR)TO PROVIDE MANAGEMENT SERVICES UNDER AN AGREEMENT WHICH EXPIRES IN 2013. THE CONTRACT REQUIRED QHR TO SUPPLY A CHIEF EXECUTIVE OFFICER AND A CHIEF FINANCIAL OFFICER WHOSE SALARY AND BENEFITS COST ARE PASSED DIRECTLY THROUGH TO THE HOSPITAL. THE HOSPITAL'S EXPENSE FOR THE MANAGEMENT FEE TOTALED APPOXIMATELY $236,743 FOR THIS YEAR. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS ARE COVERED UNDER THIS POLICY AND ANY CONFLICTS ARE RESOLVED AT MONTHLY BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS RECEIVED A COMPENSATION REVIEW IN APRIL 2011 BY QHR AND THE COVERNING BOARD. OTHER OFFICERS AND KEY EMPLOYEES RECEIVE ANNUAL REVIEWS BASED ON CURRENT MARKET DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. COMPENSATION OF OFFICERS, DIRECTORS, KEY EMPLOYEES & HIGHEST PAID EMPLOYEES FORM 990, PART VII, SECTION B, LINE 1 SOME OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST PAID EMPLOYEES ARE COMPENSATED BY THE ORGANIZATION IN MORE THAN ONE CAPACITY. JANNA PATHI IS COMPENSATED AS A SURGEON AND ALSO AS THE CMO. DONALD GREGORY IS COMPENSATED AS AN ER PHYSICIAN AND ALSO AS THE HOSPITALIST.