2012-07-25T15:34:05-05:00 2011-09-30 BUCKLES TRAVIS VANMETER & HART PLLC PO BOX 4069 LEITCHFIELD KY 427554069 990 2010-10-01 610445841 MUHLENBERG COMMUNITY HOSPITAL INC MUHL 2703388000 440 HOPKINSVILLE ST GREENVILLE KY 423451124 JOHN COUNTZLER 2703388000 2012-07-11 true BRADLEY K TRAVIS 2702595604 2012-07-11 2010 2016-02-24 21:20:13Z JOHN COUNTZLER 440 HOPKINSVILLE ST GREENVILLE KY 423450387 88283446 false X WWW.MCHKY.ORG X 1938 KY PATIENT CARE - HEALTHCARE SERVICES 8 6 573 35 0 625896 894460 83199938 87153565 107080 111548 627943 123873 84560857 88283446 0 0 19904503 19447212 0 0 64720337 68746026 84624840 88193238 -63983 90208 23001387 21219725 4502610 2630740 18498777 18588985 PATIENT CARE - HEALTHCARE SERVICES false false 79899966 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. 79899966 true true false false false false false false false false true true false false true false true false false false false false false false false false true true false false true false false false false false true true false true false false false false true false false false false true 48 0 true 573 true false false false false false false false false false false false false X 8 6 false true false false false false false true true false false true true true true true true true true true false X JOHN COUNTZLER 2703388275 440 HOPKINSVILLE ST GREENVILLE KY 423450387 CHARLES R LEWIS 2.00 X 0 0 0 DR MARY W BROWN 2.00 X 0 0 0 DR WILLARD KEITH 2.00 X 0 0 0 DR FREDDIE MAYES 2.00 X 0 0 0 DAVID JERNIGAN 2.00 X 0 0 0 TAMMY S BREWER 2.00 X 0 0 0 W LEE FAUNTLEROY 2.00 X 0 0 0 DR HEATH SUTTON 2.00 X 0 0 0 KATHLEEN MITCHELL 40.00 X 22646 0 0 JOHN COUNTZLER 40.00 X 0 0 0 JOSEPH SWAB 40.00 X 0 0 0 VINCENT GENOVESE 40.00 X 392580 0 6125 DENNIS KNOEPFLER 40.00 X 346658 0 6125 MARTIN LIKINS 40.00 X 116025 0 0 ANN MURPHY 40.00 X 107855 0 1088 JOHN CLEMENTS 40.00 X X 133495 0 3337 1119259 16675 5 true true false ALLIANT MANAGEMENT SERVICES 2650 EASTPOINT PKWY SUITE 310 LOUISVILLE KY 40223 MANAGEMENT SVCS 429909 GWC SYSTEMS 1232 STATE ROUTE 973 GREENVILLE KY 42345 IT CONSULTANT 154658 SODEXO 9801 WASHINGTON BLVD MS31 GAITHERSBERG MD 20878 DIETARY/CAFETER 146157 KENTUCKY EMERGENCY ROOM PHYSICIANS 320 DAWN DRIVE GREENVILLE KY 42345 ER PHYSICIANS 138325 QUEST DIAGNOSTICS PO BOX 101071 ATLANTA GA 30374 LABORATORY SVCS 130982 8 422217 472243 417000 894460 PROGRAM SERVICE REVENUE 87153565 87153565 87153565 111548 111548 17025 17025 17025 17025 DIETARY/ CAFETERIA 132413 132413 MUHLENBERG MEDICAL PROPERTIES 48331 48331 MUHLENBERG SURGERY CENTER REV -11706 -11706 -62190 -62190 106848 88283446 87202923 186063 14957130 11520539 3436591 99891 74918 24973 3257686 2443264 814422 1132505 861444 271061 407773 407773 124972 124972 31640 31640 1553927 587649 966278 184567 27525 157042 36475 5868 30607 89682 89682 721294 468841 252453 162782 153771 9011 70038 44902 25136 1338796 870217 468579 308303 308303 CONTRACTUALS / BAD DEBT - 54494035 54494035 SUPPLIES - P/S 4917837 4917837 PHYSICIAN FEES - P/S 1429763 1429763 PROVIDER & OTHER TAXES - 853611 853611 EQUIPMENT RENTAL - P/S 785809 785809 1234722 51670 1183052 88193238 79899966 8293272 0 1500 1825 885726 5930735 6486848 1138310 1186162 248111 355788 36840622 28874042 8386454 7966580 6397483 4515213 707309 13068 23001387 21219725 2757471 2578740 1693139 52000 52000 4502610 2630740 X 18498777 18588985 18498777 18588985 23001387 21219725 90208 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 11466574 8351485 3115089 23647699 20108831 3538868 1726349 413726 1312623 7966580 633769 C ASSETS LIMITED AS TO USE (CASH & EQU 3881444 F 4515213 NOTE PAYABLE - MCH FOUNDATION 52000 52000 88283446 88193238 90208 90208 88283446 88283446 88283446 88193238 88193238 88193238 true true true X false true true true false true true 1294751 258768 1035983 0.01170 6265070 3941145 2323925 0.02640 7559821 4199913 3359908 0.03810 154349 154349 0.00180 154349 154349 0.00180 7714170 4199913 3514257 0.03980 true 1724714 862357 12903330 13907862 -1004532 X true true ALLIANT MANAGEMENT S PROVIDES CEO, PURCHASING AGREEMENT, EDUC 1 1 MUHLENBERG COMMUNITY HOSPITAL INC

440 HOPKINSVILLE ST GREENVILLE KY 423450387

X X X HOME HEALTH-EMS-SKILLED NURSIN MUHLENBERG COMMUNITY HOSPITAL INC 1 true true 200.0 false true X true false true X X true X X X X X true X false false 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 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 BEEN 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 44 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 31499 IN 2010 LOCATED 115 MILES NORTH OF NASHVILLE TN 125 MILES SOUTHWEST 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 2007 IS 20 FROM MUHLENBERG COUNTY AND AN AVERAGE OF 169 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 FOR ALL OF KENTUCKY THE AVERAGE UNEMPLOYMENT RATE IN MUHLENBERG COUNTY FOR CALENDAR YEAR 2010 WAS 11 COMPARED TO THE STATE AVERAGE OF 105 HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI MUHLENBERG COMMUNITY HOSPITAL AND ITS EMPLOYEES HAVE A RICH HISTORY OF PLANNING ANDOR SPONSORING EVENTS DESIGNED TO EDUCATE THE COMMUNITY ON HEALTHY LIVING AND WELLNESS FACTORS EVENTS DURING FISCAL YEAR ENDING 93011 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 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 19D PART V LINE 19D THE HOSPITAL FOLLOWS THE ESTABLISHED POLICY FOR FINANCIAL ASSISTANCE X X false false false false false false false false false VINCENT GENOVESE 392580 6125 398705 DENNIS KNOEPFLER 346658 6125 352783 JOHN CLEMENTS 133495 3337 136832 KENTUCKY EMERGENCY ROOM PHYSICIANS W KEITH - OWNER 138325 ER PHYSICIAN SERVICE false CLARENCE BREWERFIRST SECURITY BANK FAMILY MEMBER O 250000 CERTIFICATE OF DEPOS false ADDITIONAL INFORMATION SCHEDULE L PART V 1 THE TRANSACTIONS WITH KENTUCKY EMERGENCY ROOM PHYSICIANS KERP IS 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 2THE CERTIFICATE OF DEPOSIT WAS OPENED WITH FIRST SECURITY BANK BECAUSE THEY OFFERED HIGHER INTEREST RATES AT THE TIME BASED UPON THE AMOUNT AND TERMS X 1 417000 false false false 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. 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 WILL REVIEW 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. THE MUHLENBERG COMMUNITY HOSPITAL F FOUNDATION INC 440 HOPKINSVILLE ST GREENVILLE KY 423450387 261600611 FUNDRAISIN KY 501C3 9 MCH false MUHLENBERG SURGERY CENTER LLC 1008 MEDICAL CENTER DRIVE POWDERLY KY 42367 611398071 SURGERY CE KY N/A false false 1.00000 MUHLENBERG MEDICAL PROPERTIES IV LL 1010 MEDICAL CENTER DRIVE POWDERLY KY 42367 010571762 LESSOR OF KY N/A false false 0.49000 GENESIS HEALTH ALLIANCE LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47714 208223181 PURCHASING IN N/A false false 0.04170 false false false false false false false false false false false false false false false true false false