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BAPTIST HEALTH DEACONESS MADISONVILLE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BAPTIST HEALTH DEACONESS MADISONVILLE INC (EIN 61-0654587)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201113149349302871
Schema version
2010v3.4
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-10T14:31:27-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1400 E MAIN ST STE 200 PO BOX 1196AddressLine1
CityBOWLING GREENCity
StateKYState
ZIP Code421021196ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN610654587EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1TROVER CLINIC FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlTROVNameControl
Phone2708255201Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1900 HOSPITAL DRIVEAddressLine1
CityMADISONVILLECity
StateKYState
ZIP Code42431ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTHOMAS MOOREName
TitleCHIEF FINANCIAL OFFICERTitle
Phone2708255201Phone
Date Signed2011-08-22DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIM SCIFRESName
Phone2707810111Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1TROVER HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonE BERTON WHITAKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1900 HOSPITAL DRIVEAddressLine1
CityMADISONVILLECity
StateKYState
ZIP Code42431ZIPCode
FieldValueIRS element (for citing)
Gross Receipts237820894GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.TROVERFOUNDATION.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileKYStateLegalDomicile
Activity Or Mission DescriptionTO OPERATE AN ACUTE CARE HOSPITAL & MULTI-SPECIALTY PHYSICIAN GROUP PRACTICE SERVING RURAL COMMUNITIES IN KENTUCKY. OUR MISSION IS TO PROVIDE EXCELLENT CARE, EVERY TIME.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees2166TotalNbrEmployees
Total Nbr Volunteers13TotalNbrVolunteers
Total Gross UBI82916TotalGrossUBI
Net Unrelated Business Txbl Income46082NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2972503ContributionsGrantsPriorYear
Contributions Grants Current Year2713061ContributionsGrantsCurrentYear
Program Service Revenue Prior Year169558318ProgramServiceRevenuePriorYear
Program Service Revenue CY160735893ProgramServiceRevenueCY
Investment Income Prior Year-3729144InvestmentIncomePriorYear
Investment Income Current Year2022953InvestmentIncomeCurrentYear
Other Revenue Prior Year25819223OtherRevenuePriorYear
Other Revenue Current Year26921361OtherRevenueCurrentYear
Total Revenue Prior Year194620900TotalRevenuePriorYear
Total Revenue Current Year192393268TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year44210GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY70919GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year106257579SalariesEtcPriorYear
Salaries Etc Current Year102580405SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year86870665OtherExpensePriorYear
Other Expenses Current Year92563938OtherExpensesCurrentYear
Total Expenses Prior Year193172454TotalExpensesPriorYear
Total Expenses Current Year195215262TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1448446RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2821994RevenuesLessExpensesCY
Total Assets BOY177998415TotalAssetsBOY
Total Assets EOY176817645TotalAssetsEOY
Total Liabilities BOY55898697TotalLiabilitiesBOY
Total Liabilities EOY53057317TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY122099718NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY123760328NetAssetsOrFundBalancesEOY
Mission DescriptionTO OPERATE AN ACUTE CARE HOSPITAL & A MULTI-SPECIALTY PHYSICIAN GROUP PRACTICE SERVING RURAL COMMUNITIES IN KENTUCKY. OUR MISSION IS TO PROVIDE EXCELLENT CARE, EVERY TIME.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense168620457Expense
Grants70919Grants
Revenue184717151Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense168620457TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedfalseFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096286NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2166NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledKYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonE BERTON WHITAKERNamePerson
Telephone Number2708255201TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1900 HOSPITAL DRIVEAddressLine1
CityMADISONVILLECity
StateKYState
ZIP Code42431ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JANET BERRY
DIRECTOR1.0X000
G RUFFIN CHANDLER
DIRECTOR1.0X000
C MORRIS COFFMAN
DIRECTOR1.0X000
WILLIAM CORUM
DIRECTOR1.0X000
STEVE COX
DIRECTOR1.0X000
WILLIAM DONAN
DIRECTOR1.0X000
MARK E EASTIN III
DIRECTOR1.0X000
DAN MARTIN MD
DIRECTOR1.0X000
JUDITH L RHOADS ED D
DIRECTOR1.0X000
ALLEN RUDD
DIRECTOR/VP1.0X000X
JAMES MINER JR
DIRECTOR/CHAIRMAN1.0X000X
BERTON WHITAKER
DIRECTOR/CEO/PRESIDENT/SEC.40.0X5118660133747X
JACK L HAMMAN MD
DIR/VICE CHAIRMAN/PHYSICIAN40.0X125865024768X
MARK FITZMAURICE MD
DIRECTOR/PHYSICIAN40.0X360506047747
DIANNA GOODALE MD
DIRECTOR/PHYSICIAN40.0X270366019337
Roderick Tompkins
Director1.0X000
C THOMAS MOORE
CFO/TREASURER40.03597790116180X
ROBERT GROVES MD
CHIEF MEDICAL OFFICER40.0198020041986X
STACEY BEAVEN
VP NURSING40.0204199034288X
DAVID LANG
VP HUMAN RESOURCES40.0217199062749X
TIM DUKES
VP OPERATIONS40.0122362045922X
KAVITA ERICKSON MD
PHYSICIAN40.0574768045646X
JOHN HUBBARD MD
PHYSICIAN40.0573945034140X
JOHN DACOSTA MD
PHYSICIAN40.0682552023693X
KERRY PAAPE MD
PHYSICIAN40.0630779010481X
THOMAS STANFIELD MD
PHYSICIAN40.0519722045264X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5351928TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation685948TotalOtherCompensation
Number Individuals GT100 K122NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MCKESSON HBOC
PO BOX 98347CHICAGOIL60693COMPUTER SERVICES8464880
ARAMARK CTS INC
12483 COLLECTIONS CTR DRCHICAGOIL60693BIOMEDICAL SERVICES2249889
MUTUAL CREDIT SERVICES
PO BOX 149MADISONVILLEKY42431COLLECTION SERVICES923613
ARUP LABORATORIES
PO BOX 27694SALT LAKE CITYUT84127LAB SERVICES709713
INTERIM PHYSICIANS LLC
PO BOX 411161MST LOUISMO63141PHYSICIAN SERVICES733937
FieldValueIRS element (for citing)
Number Of Contractors GT100 K56NumberOfContractorsGT100K
Government Grants1557947GovernmentGrants
All Other Contributions1155114AllOtherContributions
Noncash Contributions10336NoncashContributions
Total Contributions2713061TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENUE62111015084564215081413931503
HOME HEALTH & HOSPICE62161051582785158278
FAMILY PRACTICE RESIDENCY PROGRAM61160010312581031258
ANESTHESIA PROGRAM611600624374624374
OTHER61160030763413076341
FieldValueIRS element (for citing)
Total Program Service Revenue160735893TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2112560TotalRevenueColumn
Unrelated Business Revenue44767UnrelatedBusinessRevenue
Exclusion$2,067,793ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real344975Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real271928Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real73047Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column73047TotalRevenueColumn
Exclusion$73,047ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities31887063Securities
Other93800Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities31733063Securities
Other337407Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities154000Securities
Other-243607Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-89607TotalRevenueColumn
Exclusion-$89,607ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory37112598GrossSalesOfInventory
Cost Of Goods Sold13085228CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column24027370TotalRevenueColumn
Related Or Exempt Function Income24027370RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA SALES7222101086619$1,086,619
FITNESS FORMULA900099676082$676,082
GIFT SHOP453220112920$112,920

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column945323TotalRevenueColumn
Unrelated Business Revenue6646UnrelatedBusinessRevenue
Exclusion$938,677ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2820944TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column192393268TotalRevenueColumn
Related Or Exempt Function Income184731760RelatedOrExemptFunctionIncome
Unrelated Business Revenue82916UnrelatedBusinessRevenue
Exclusion$4,865,531ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total70919Total
Program Services70919ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2896887Total
Program Services1775316ProgramServices
Management And General1121571ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total362584Total
Program Services362584ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total84064889Total
Program Services71923713ProgramServices
Management And General12141176ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2504415Total
Program Services2134066ProgramServices
Management And General370349ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7347839Total
Program Services6256669ProgramServices
Management And General1091170ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5403791Total
Program Services4593222ProgramServices
Management And General810569ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total382544Total
Management And General382544ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total86561Total
Management And General86561ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total990Total
Management And General990ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total20157676Total
Program Services16347875ProgramServices
Management And General3809801ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total369504Total
Management And General369504ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total20741884Total
Program Services20700400ProgramServices
Management And General41484ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3508897Total
Program Services2456228ProgramServices
Management And General1052669ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3009435Total
Program Services2407548ProgramServices
Management And General601887ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total834244Total
Program Services250273ProgramServices
Management And General583971ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total282841Total
Program Services282841ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1530454Total
Program Services1530454ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11940591Total
Program Services10746532ProgramServices
Management And General1194059ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total4691200Total
Program Services3518400ProgramServices
Management And General1172800ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS1947925319479253
PROVIDER TAX EXPENSE25585422558542
MISCELLANEOUS EXPENSE298932212256221763700

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total195215262Total
Program Services168620457ProgramServices
Management And General26594805ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY14985BOY
EOY13204EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY35720459BOY
EOY25018725EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY24196144BOY
EOY21318383EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1580801BOY
EOY2857407EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2122878BOY
EOY2188890EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4137447BOY
EOY4192446EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis234190638LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec168167967LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY69232133BOY
EOY66022671EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY29779285BOY
EOY45260511EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY197679BOY
EOY197769EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11016604BOY
EOY9747639EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY177998415BOY
EOY176817645EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12608442BOY
EOY13087257EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY29200000BOY
EOY25780000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1444068BOY
EOY3189517EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12646187BOY
EOY11000543EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY55898697BOY
EOY53057317EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY121982558BOY
EOY123607102EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY117160BOY
EOY153226EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY122099718BOY
EOY123760328EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY177998415BOY
EOY176817645EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2821994ReconcilationRevenueExpenses
Reconcilation Other Changes4482604ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementtruePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$990DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$15,900OtherActivitiesAmount
Total Lobbying Expenditures IIB16890TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierLOBBYING EXPENSESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationTHE FOUNDATION AND CERTAIN FOUNDATION EMPLOYEES ARE MEMBERS OF VARIOUS ASSOCIATIONS WHICH ATTRIBUTE A PORTION OF DUES TO LOBBYING EXPENSES. THE FOUNDATION HAS DISCLOSED A LOBBYING ALLOCATION OF $15,900 PER FORM 990. THESE ASSOCIATIONS INCLUDE THE AMERICAN HOSPITAL ASSOCIATION, AMERICAN MEDICAL ASSOCIATION, KENTUCKY MEDICAL ASSOCIATION, AS WELL AS VARIOUS OTHERS.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance116582BeginningOfYearBalance
Contributions47270Contributions
Other Expenditures10626OtherExpenditures
End Of Year Balance153226EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance82971BeginningOfYearBalance
Contributions100841Contributions
Other Expenditures67230OtherExpenditures
End Of Year Balance116582EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance61949BeginningOfYearBalance
Contributions35600Contributions
Other Expenditures14578OtherExpenditures
End Of Year Balance82971EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3194277OtherCostOrOtherBasis
Book Value3194277BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis66091271OtherCostOrOtherBasis
Depreciation36938822Depreciation
Book Value29152449BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis25967OtherCostOrOtherBasis
Depreciation25967Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis154543861OtherCostOrOtherBasis
Depreciation127756715Depreciation
Book Value26787146BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10335262OtherCostOrOtherBasis
Depreciation3446463Depreciation
Book Value6888799BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings66022671TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
DEBT SERVICE RESERVES1308113
CAPITAL PROJECTS1675535
SELF INSURANCE TRUST6610509
TEMP RESTRICTED BY DONOR153226
SPECIAL PROJECT CONTRA256
FieldValueIRS element (for citing)
Total Book Value Other Assets9747639TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (8 entries)

DescriptionDescriptionAmountAmount
AMOUNTS PAYABLE TO MEDICARE$441,577
ACCRUED INTEREST ON BONDS$19,614
SPECIAL PROJECTS CONTRA$256
ACCRUED SELF-INSURANCE LIABILI$7,464,000
BOND SWAP LIABILITY$64,862
OTHER LIABILITIES$1,003,421
WORKERS COMPENSATION ACCRUAL$827,116
BOND ARBITRAGE LIABILITY$1,179,697
FieldValueIRS element (for citing)
Total Of Amounts11000543TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierINTENDED USE OF ENDOWMENT FUNDSIdentifier
Return ReferenceSCH. D, PART V, LINE 4ReturnReference
ExplanationPATIENT CARE, HOSPICE BEREAVEMENT CAMP, MAHR CANCER CENTER, AND OTHER PATIENT CARE RELATED INITIATIVES.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense8551074TotalCommunityBenefitExpense
Direct Offsetting Revenue866652DirectOffsettingRevenue
Net Community Benefit Expense7684422NetCommunityBenefitExpense
Percent Of Total Expense0.04370PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense23462212TotalCommunityBenefitExpense
Direct Offsetting Revenue11245855DirectOffsettingRevenue
Net Community Benefit Expense12216357NetCommunityBenefitExpense
Percent Of Total Expense0.06950PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense32013286TotalCommunityBenefitExpense
Direct Offsetting Revenue12112507DirectOffsettingRevenue
Net Community Benefit Expense19900779NetCommunityBenefitExpense
Percent Of Total Expense0.11320PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense725601TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense725601NetCommunityBenefitExpense
Percent Of Total Expense0.00410PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense4882492TotalCommunityBenefitExpense
Direct Offsetting Revenue900379DirectOffsettingRevenue
Net Community Benefit Expense3982113NetCommunityBenefitExpense
Percent Of Total Expense0.02270PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense107182TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense107182NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1265370TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense1265370NetCommunityBenefitExpense
Percent Of Total Expense0.00720PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense6980645TotalCommunityBenefitExpense
Direct Offsetting Revenue900379DirectOffsettingRevenue
Net Community Benefit Expense6080266NetCommunityBenefitExpense
Percent Of Total Expense0.03460PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense38993931TotalCommunityBenefitExpense
Direct Offsetting Revenue13012886DirectOffsettingRevenue
Net Community Benefit Expense25981045NetCommunityBenefitExpense
Percent Of Total Expense0.14780PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense3884TotalCommunityBuildingExpense
Net Community Building Expense3884NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense3884TotalCommunityBuildingExpense
Net Community Building Expense3884NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$8,344,912BadDebtExpenseAmount
Amount Reimbursed By Medicare59948182AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare60224914CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-276732MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1REGIONAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1900 HOSPITAL DRIVEAddressLine1
CityMADISONVILLECity
StateKYState
ZIP Code42431ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
REGIONAL MEDICAL CENTER HHA
107 EAST MAIN STREETEARLINGTONKY42410HOME HEALTH AGENCY
GREEN RIVER HOSPICE
418 NORTH SCOTT STREETMADISONVILLEKY42431HOSPICE
REGIONAL MEDICAL CENTER OF HOPKINS COUNT
900 HOSPITAL DRIVEMADISONVILLEKY42431SKILLED NURSING FACILITY
THE SPORTS MEDICINE REHABILITATION GROUP
500 CLINIC DRIVEHOPKINSVILLEKY42440REHAB SERVICES
Trover Clinic
200 Clinic DriveMadisonvilleKY42431Physician Offices

Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Criteria used to determine eligibilty for discounted carePART I, LINE 3C:PROFILING THE POPULATION TO DETERMINE KEY HEALTH RISK FACTORS THROUGH THE USE OF STATISTICAL DATA AND ANALYSIS OF EMPLOYMENT AND OCCUPATIONAL DISEASE.
Part 1, Column FPART I, LINE 7, COLUMN F:BAD DEBTS INCLUDED IN PART IX, LINE 24 TOTALED $19,479,253. THIS AMOUNT HAS BEEN REMOVED FROM TOTAL EXPENSES CALCULATED IN COLUMN F ON SCHEDULE H, PART I.
Bad Debt FootnotePART III, LINE 4:THE AUDITED FINANCIAL STATEMENTS DOES NOT CONTAIN A FOOTNOTE WHICH DESCRIBES BAD DEBT. A COST-TO-CHARGE RATIO IS USED AS THE COSTING METHODOLOGY IN CALCULATING THE AMOUNTS REPORTED IN LINES 2 AND 3.
Collection PracticesPART III, LINE 9B:ONCE A PATIENT HAS BEEN DETERMINED TO QUALIFY FOR CHARITY CARE, THE PATIENT IS CLASSIFIED AS SUCH FOR THREE MONTHS. IF THE PATIENT RETURNS FOR SERVICES WITHIN THREE MONTHS, THEY ARE AUTOMATICALLY QUALIFIED FOR CHARITY CARE, WHICH IMPROVES THEIR ACCESS TO HEALTHCARE SERVICES.
Needs AssessmentSchedule H, Part VI, Line 2THE ORGANIZATION ASSESSES THE HEALTH CARE NEED OF THE COMMUNITY BY PROFILING THE POPULATION TO DETERMINE KEY HEALTH RISK FACTORS THROUGH THE USE OF STATISTICAL DATA AND ANALYSIS OF EMPLOYMENT AND OCCUPATIONAL DISEASE. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE FOUNDATION IDENTIFIES UNINSURED PATIENTS BY REQUESTING INSURANCE INFORMATION AT THE TIME OF THE APPOINTMENT REQUEST. IF THE PATIENT HAS NO INSURANCE BENEFITS, APPOINTMENT SCHEDULING STAFF WILL INFORM THE PATIENT OF THE TROVER SELF-PAY POLICY. NEW PATIENTS WHO ARE UNABLE TO PAY AT THE TIME OF SERVICE MUST BE REFERRED TO FINANCIAL COUNSELING BEFORE AN APPOINTMENT CAN BE SCHEDULED. DURING FINANCIAL COUNSELING, PATIENTS WILL BE INFORMED OF THE KENTUCKY PHYSICIANS CARE PROGRAM (KPC) IN COORDINATION WITH THE DISPROPORTIONATE SHARE HOSPITAL (DSH) PROGRAM. THEY WILL ALSO BE COUNSELED ON POTENTIAL ELIGIBILITY FOR MEDICAID AND DISABILITY PROGRAMS. PATIENTS WILL ALSO BE ADVISED OF THE TROVER FINANCIAL ASSISTANCE POLICY AND APPLICATION WILL BE PROVIDED.
Community InformationSchedule H, Part VI, Line 4THE ORGANIZATION IS BASED IN MADISONVILLE, KENTUCKY, SERVES NUMEROUS RURAL COMMUNITIES AND OFFERS A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES. TROVER SERVES SIX COUNTY MARKETS WITH POPULATION BASE OF 195,000.
Promotion of Community HealthSchedule H, Part VI, Line 5TROVER HEALTH SYSTEM PROMOTES THE HEALTH OF THE COMMUNITY THROUGH OPEN MEDICAL STAFF, SERVICE ON COMMUNITY BOARDS, 24 HOUR EMERGENCY DEPARTMENT, OCCUMED PROGRAM, FREE ATHLETIC PHYSICALS, HEALTH FAIRS AND SCREENINGS, COURTESY MEMBERSHIP TO FITNESS FOR ATHLETES, POLICE OFFICERS AND FIRE DEPARTMENT, EDUCATIONAL PROGRAMS, ATHLETIC TRAINERS AT SCHOOL EVENTS, AND A CENTERING PREGNANCY PROGRAM.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
AMERICAN RED CROSS
114 NORTH MAIN STMADISONVILLEKY42431616001690501(C)(3)7545GENERAL SUPPORT
CITY OF MADISONVILLE
PO BOX 705MADISONVILLEKY42431616001864CITY MADISONVIL7500GENERAL SUPPORT
GLEMA MAHR CENTER ARTS
2000 COLLEGE DRMADISONVILLEKY42431611320380KCTCS10500GENERAL SUPPORT
HOPKINS COUNTY COMMUNITY CLINIC
PO BOX 1794MADISONVILLEKY42431611710391510(c)(3)6700GENERAL SUPPORT
MADISONVILLE COMMUNITY COLLEGE
2000 COLLEGE DRMADISONVILLEKY42431611320380501(c)(3)12000GENERAL SUPPORT
UNITED WAY
PO BOX 366MADISONVILLEKY42431610732633501(c)(3)6800GENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants6TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierMONITORING THE USE OF GRANT FUNDSIdentifier
Return ReferenceSCH. D, PART I, LINE 2ReturnReference
ExplanationTHERE IS ONE STAFF MEMBER WHO IS RESPONSIBLE FOR APPROVING ALL DONATIONS. THEY SELECT THE ORGANIZATION BASED ON NONPROFIT CRITERIA. AN ANNUAL BUDGET IS ESTABLISHED TO DETERMINE THE TOTAL AMOUNT OF FUNDS TO BE DISTRIBUTED EACH YEAR.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgs
BERTON WHITAKER
4626510004921501253500839706456130
C THOMAS MOORE
30038501400004539409539702078304759590
JACK L HAMMAN MD
12586500000177000706801506330
MARK FITZMAURICE MD
217919012608701650003381001393704082530
DIANNA GOODALE MD
1695740100792000690001243702897030
ROBERT GROVES MD
1733080002471202802601396002400060
STACEY BEAVEN
185358000188410253850890302384870
DAVID LANG
186434000307650527950995402799480
TIM DUKES
1068820001548003062901529301682840
KAVITA ERICKSON MD
5582680001650003381001183606204140
JOHN HUBBARD MD
5739450000033810033006080850
JOHN DACOSTA MD
585510097042000690001679307062450
KERRY PAAPE MD
53373709704200069000358106412600
THOMAS STANFIELD MD
40618009704201650003381001145405649860

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
BENEFITS PROVIDED TO CEOSCH. J, PART I, LINE 1ATHE FOUNDATION PAYS COUNRTY CLUB & ROTARY CLUB DUES FOR BERTON WHITAKER, DIRECTOR/CEO/PRESIDENT. ONLY THE CEO IS ELIGIBLE FOR THIS BENEFIT. USE OF THE COUNTRY CLUB MEMBERSHIP IS EXCLUSIVELY FOR BUSINESS PURPOSES.
NON-FIXED PAYMENTSSCH. J, PART I, LINE 7SEVERAL FOUNDATION PHYSICIANS ARE COMPENSATED BASED UPON AN INCENTIVE COMPENSATION PLAN. THE INCENTIVE COMPENSATION PAYMENTS ARE NOT CONTINGENT UPON THE GROSS REVENUES OR NET EARNINGS OF THE ORGANIZATION, BUT ARE BASED UPON THE PHYSICIAN'S INDIVIDUAL PRODUCTIVITY AND QUALITY MEASURES.
NON-QUALIFIED RETIREMENT PLANSCHEDULE J, PART I, LINE 4BINCREASE IN ACTUARIAL VALUE OF NONQUALIFIED RETIREMENT PLAN: STACEY BEAVEN $15,954 TIM DUKES $13,720 DAVID LANG $24,299 C. THOMAS MOORE $61,587 BERTON WHITAKER $91,540

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
CITY OF MADISONVILLE KENTUCKY
616001864558656AA22006-11-0177000000DEFEASE CERTAIN SERIES 1998 BOtruefalsefalse
CITY OF MADISONVILLE KENTUCKY
6160018642010-12-2125780000REFUND CERTAIN SERIES 2007 BONDSfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
0081558274130811335326002712151007918474689937672725092009falsefalsetruetrue
00257800000002064000002389806516755352011falsefalsefalsetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsetruefalsefalsetrue0.003000.000000.00300true
falsetruefalsefalsetrue0.003000.000000.00300true

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
LEHMAN BROTHERS
falsetruetrue30.falsetruetrueAEGON10.truefalsefalse
(no name)
falsetruefalsefalsefalsefalse

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
IdentifierTOTAL PROCEEDS OF ISSUEIdentifier
Return ReferencePART II, LINE 3, COLUMN AReturnReference
ExplanationTHIS AMOUNT DIFFERS FROM THE ISSUE PRICE BY THE AMOUNT OF CUMULATIVE INVESTMENT EARNINGS OF THE PROCEEDS.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (8 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
BEVERLY HAMMAN
FAMILY MEMBER - DIRECTOR16276EMPLOYEE COMPENSATIONfalse
AMANDA ROBINSON
FAMILY MEMBER - CHAIRMAN71040EMPLOYEE COMPENSATIONfalse
CARROL STEINFIELD
FAMILY MEMBER - DIRECTOR245367EMPLOYEE COMPENSATIONfalse
C THOMAS MOORE
WKMMS - OFFICER38831CONTRACT SERVICESfalse
THOMAS BEAVEN
FAMILY MEMBER - KEY EMPL1847EMPLOYEE COMPENSATIONfalse
CHAMBER OF COMMERCE
DIRECT RELATIONSHIP11790MEMBERSHIP DUESfalse
CHAMBER OF COMMERCE
DIRECT RELATIONSHIP3100GIFT CARDSfalse
CHAMBER OF COMMERCE
DIRECT RELATIONSHIP6781OTHER SUPPORTfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 4* Regional Medical Center is an acute care hospital serving numerous rural communities and offering a broad range of inpatient and outpatient services. Regional Medical Center provides a substantial amount of charity care as detailed below in the Community Service section. Regional Medical Center provided care for 9,814 inpatient adult, pediatric, and nursery admissions during 2010. Patient days for 2010 totaled 42,143. There were 813 live births, of which over 64% were Medicaid births. Surgery visits totaled 6,907 for the year. Regional Medical Center's Mahr Cancer Center is approved by the American College of Surgeons' Commission on Cancer, receiving the No. 1 overall rating. The Mahr Center provided services to over 21,870 patient visits during 2010, and is affiliated with the James Graham Brown Cancer Center at the University of Louisville. * Trover Clinic is a multi-specialty physician group practice with over 100 providers offering a broad range of medical services including specialty and subspecialty services. Trover Clinic operated five Clinics in rural communities bringing healthcare to medically underserved areas. Trover Clinic provided a total of 344,922 patient encounters during 2010. * Trover Foundation Residency Program is an educational program in which Foundation physicians instruct and work with Residents. The Residency Program is affiliated with the University Of Louisville School Of Medicine. Eighteen residents were involved in the Residency Program during 2010. * Trover Foundation Education Division provides numerous educational programs that benefit the communities of western Kentucky. In addition to the Family Practice Residency Program, the Foundation collaborates with Murray State University to offer a graduate degree in nurse anesthesia. The program is dedicated to graduating nurse anesthetists of the highest professional competence who are committed to returning to rural areas to practice. Regional Medical Center serves as the primary clinical site. The Foundation also coordinates the West Area Health Education Center (AHEC) program, connecting the academic health centers at the University of Kentucky and University of Louisville with medically underserved communities throughout the state, in an effort to address Kentucky health care access problems. The Foundation is a regional campus for the University Of Louisville School Of Medicine through the Foundation's Off-Campus Teaching Center. The Center provides individualized clinical training in a small-town environment, with a goal towards increasing the number of physicians in rural areas. The Foundation is a location for the University of Kentucky's Center for Rural Health, created to improve the health status of the rural population of the state. The Education Division sponsors the Delta Project for 20 counties in the state of Kentucky. The goal of the Delta Project is to improve the health status and health care system in each county served. During 2010, 23,010 students were contacted in approximately 50 different schools. * Green River Hospice is a program assisting terminally ill patients and their families through the death and bereavement process. The Hospice provided service for 12,739 hospice days during 2010. 2010 COMMUNITY SERVICE: Community Service Detail Hours No. of Events Contacts ------------------------------------------------------------- Educational Events 8,473 336 26,045 Community Events 1,101 28 3,912 Health Fairs/Screenings 225 17 2,790 Donations/Support 6,847 3,050 48,882 Support Groups 3,176 22 733 -------- ------- -------- Total 19,822 3,453 82,362 Total Events 3,453 Total Employee Hours 19,822 Total Community Contacts 82,362 Volunteer Hours 14,656
PROGRAM SERVICE ACCOMPLISHMENTS (CONT.)CHARITY AND COMMUNITY BENEFIT CARE: Trover Foundation provides care to patients who meet guidelines established in the Foundation's charity care policy at no charge or at charges less than established rates. Other uncompensated care relates principally to contractual allowances for government payors, discounts taken by commercial payors and bad debts. The Foundation provided uncompensated care, based on established rates, for the year ended December 31, 2010 in the amount of $245,297,000. This represents approximately 59% of total revenue determined from Foundation's established rates in 2010. The following summary quantifies additional community benefit expense in terms of uncompensated care, services to the indigent and benefits to the broader community during 2010: Uncompensated care: Bad debt expense (at cost) $ 8,345,000 Benefits for the poor: Traditional charity care $ 7,684,000 Unpaid costs of Medicaid 12,217,000 ------------- Total quantifiable benefits for the poor $19,901,000 Benefits for the broader community: Community Health Improvement Services $ 726,000 Health Professions Education 3,982,000 Research 107,000 Donations/Support 1,265,000 ------------- Total quantifiable benefits for the broader community $ 6,080,000 ------------- Total quantifiable community benefits $25,981,000 Community benefits expense represents approximately 15% of total Foundation expense for the year ended December 31, 2010. In addition to the above, the Foundation provides a wide range of community benefits including coordination of charitable activities by Foundation staff. EDUCATIONAL EVENTS: Trover's mission is excellent care every time. In order to support this mission, Trover Foundation strives to be involved in numerous educational programs. The Family Practice Residency Program completed training for six Family Practice physicians. Total number of residents in training during 2010 was 18. The Certified Registered Nurse Anesthesia Program trained 182 nurses to become CRNAs since the program's inception. The University of Louisville/ Trover Foundation Medical Campus provided training for 18 3rd and 4th year medical students. It provided educational activities for high school students interested in a medical career, including shadowing and enhancement classes. Centering Pregnancy Smiles is a partnership between UK, the Foundation, the Hopkins County Health Department, the national Centering Pregnancy initiative and other federal, state, and local leaders. The alliance, established to end the cycle of preterm births, low birth weight, and poor oral health in Kentucky, has already saved Kentucky an estimated $2.0 million in medical procedures needed by those babies at birth. The program assisted over 216 local mothers during 2010. In 336 different events, the Foundation offered everything from tours to seminars to participation in community educational events. Thousands of students in western Kentucky benefited in some way from the Foundation's efforts. Nearly 8,500 hours were dedicated to educational events involving over 26,000 individuals throughout the service area. In June 2010, 68 coaches, athletic trainers, and physicians attended the 25th annual Sports Medicine Symposium to learn more about effective management and prevention of sports injuries. The interactive sports seminar puts coaches in direct contact with certified athletic trainers, physicians and other professionals. Foundation physicians also participated in a Women's Health Forum sponsored in part by the Foundation. Physicians gave presentations on women's health issues. There were also exhibits about women's health. This event attracted almost 50 participants. The Foundation also participates in the World's Greatest Baby Showers throughout the service area, with over 370 participants. These events are held to help educate expectant mothers about their pregnancy and about taking care of their babies. An OB/GYN, a Family Practice physician, or pediatrician typically participate. Trover Foundation sponsors an annual Asthma Camp, a week-long day camp for children ages 6 to 12 who have documented asthma. A variety of supervised activities are planned for children whose asthma might prevent them from attending summer camp. Asthma education is an important component of the camp, with breathing exercises, relaxation techniques, proper use of medications, and monitoring routines among the topics covered. The Foundation provides 2 to 3 respiratory therapists each day of the camp. The Foundation maintains a website for consumer health education topics in both English and Spanish. The website includes daily consumer health news, and interactive consumer health tools such as quizzes and calculators. The fees for maintaining this website were over $12,000 in 2010. Other educational events sponsored or supported by the Foundation include the first Step Nursing Program, Rural Health Scholar Program, shadowing opportunities for students, and Breast Cancer Awareness Bingo in Muhlenberg County.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT.)COMMUNITY EVENTS: Trover Foundation has always been an organization that the community looks to for support of community events. Whether it is financial support, the human resources of our employees, or both, the people of western Kentucky have come to rely on Trover to help make community events successful. In order to improve the general well being of the communities served, Trover is involved in many community events such as Clay Days, Dawson Springs Barbecue, Hopkins County Fair, and the Coalfield Festival just to name a few. Trover was again the sponsor of a downtown event, Friday Night Live. But Trover's real passion is health care. For that reason, we give emphasis to helping organizations with health care missions. A shining example is the monetary and physical support given to The American Cancer Society Relay for Life. Raising contributions in the thousands, Trover employees gave generously of their time to this effort in 2010. Other events such as this include the March of Dimes Walk, Muscular Dystrophy, Alzheimer's Walk, American Heart Walk, Cystic Fibrosis Foundation and Juvenile Diabetes. Other community organizations provided support by Trover Foundation include Big Brothers/Big Sisters, United Way of Hopkins County, Madisonville Community College, local Chambers of Commerce, Habitat for Humanity, American Red Cross, Lion's Club, Rotary Club, Kiwanis Club, Door of Hope, YMCA, Madisonville-Hopkins County Economic Development Corporation and many more. HEALTH FAIRS, SCREENINGS AND CLINICAL STUDIES: Trover Foundation served over 2,800 individuals through health fairs and screenings in 2010. The Foundation provided blood sugar and blood pressure screenings regularly at satellite locations. Working with the Kentucky Cancer Program, The Mahr Cancer Center provided prostrate cancer screenings and colorectal screenings for several hundred people. Additionally the organization participated in a health fair at the local mall providing screenings and health education. The Foundation provided free sports physicals to oveR 1,800 high school students in Hopkins, Christian, Crittenden, Caldwell, McLean, Webster, Union, Muhlenburg, Ohio, Trigg, Todd and Lyon Counties. Trover Foundation also operates a full-time dedicated research center, established to ensure that the community has early access to promising new medicine and medical treatment. The Trover Center for Clinical Studies has participated in projects sponsored by Aventis, Merck, GlaxoSmithKline, Duke University, University of Louisville School of Medicine and others. Uncompensated expenses of operating the research center amounted to over $107,000 during 2010. DONATIONS/SUPPORT: Trover Foundation supported its communities through financial and in-kind donations valued at greater than $70,000. Approximately 3,050 events were supported. Examples include give-aways for local school events, tours, in-class speakers, sponsorship of both school and non-school related ball teams, cheerleading, dance teams, community events, high school bands, and similar events, as well as financial support for community events at Glema Mahr Center for the Arts. The Foundation's Fitness Formula fitness center provided free or discounted memberships during 2010 valued at over $975,000. The free or discounted memberships were given to coaches, athletes, senior citizens, emmployees, and rehab patients, schools, and other community organizations. During 2010, the Foundation provided over $11,000 in financial assistance to individuals in emergency need of medicine, transportation, etc. related to their health conditions. The Foundation was a major contributor to the University Of Kentucky College Of Health Sciences New Building Fund, which will finance construction of allied health professions educational facilities. The Foundation was a major sponsor for Relay for Life in western Kentucky. Trover also provided support for charities such as United Way of Hopkins County (total gift of almost $54,000 including employee contribution), March of Dimes, American Red Cross, Big Brothers/Big Sisters, Project Graduation, Door of Hope, High school and youth athletic programs, Kiwanis Club, Rotary Club, YMCA, and many more. The Sports Medicine Center provided free athletic trainer coverage at 7 area schools for all sports. Nine hundred thirty eight games were covered in 2010, as well as 1,767 practices for a total of 5,746 hours of employee time, valued at approximately $154,000. In 2010, the Foundation provided direct financial support as well as insurance coverage for Foundation care providers volunteering at the local community clinic. This clinic provides health care for the working poor.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT.)SUPPORT GROUPS: The support groups offered at no cost by the Foundation served over 730 patients and families with over 3,200 hours of employee time. These groups discuss such topics as Alzheimer's disease, cancer, diabetes, Fibromyalgia, Multiple Sclerosis, asthma, and several others. To enhance access, some support groups are held in the satellite locations. Most groups meet once or twice a month, typically at night for optimum patient convenience. This also requires staff to work additional hours above their normal workloads. The Foundation employs a full-time chaplain for our employees, patients, and guests, as well as a full-time chaplain for the Hospice program. These services, provided at a cost to the Foundation of almost $100,000, include consultation, pastoral care, counseling, and in-service seminars. EMERGENCY: The Regional Medical Center Emergency Department operates 24 hours a day, 365 days a year. In 2010, the department served over 30,885 patients. The department served as the area referral center for serious or traumatic injuries and disease. Care is provided regardless of ability to pay for medically necessary, non-elective care. VOLUNTEER DEPARTMENT: In 2010, Foundation volunteers gave 14,656 hours to the community. This program exists solely for service and is not a fund-raising group for the Foundation. Volunteers provide help to community members who use the hospital including the gift shop, waiting rooms, information desk, patient mail delivery, and other areas. The program also offers nursing scholarships.
REVIEW OF FORM 990FORM 990, PART VI, SECTION B, LINE 11The internally prepared Form 990 is reviewed and approved by tax consultants. Copies are given to each voting member of the Board prior to filing for their review. The Form 990 is then presented at a monthly meeting of the Foundation Board of Directors either before or after it is filed.
MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST STATEMENTS ARE COMPLETED FOR EACH BOARD MEMBER, PRINCIPAL OFFICER, AND COMMITTEE MEMBER WITH BOARD DELEGATED POWERS. THE CHAIRMAN OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR BEING FAMILIAR WITH THE STATEMENTS AND IDENTIFYING EXISTING OR CONTEMPLATED TRANSACTIONS OR RELATIONSHIPS WHICH MAY GIVE RISE TO A CONFLICT OF INTEREST. AFFECTED BOARD MEMBERS, OFFICERS, AND COMMITTEE MEMBERS ARE ALSO RESPONSIBLE FOR BRINGING CONFLICTS WHICH THEY MAY BE A PART OF TO THE ATTENTION OF THE BOARD. SUCH AFFECTED PARTIES ARE REQUIRED TO WITHDRAW FROM THE MEETINGS FOR THE TIME IN WHICH THE MATTER CONTINUES UNDER DISCUSSION. IF THE MATTER IS BROUGHT TO A VOTE, THE AFFECTED PARTY WILL NOT VOTE ON IT. IF THE MATTER REQUIRES A SPECIAL CALLED MEETING, THE AFFECTED PARTY WILL NOT BE COUNTED IN ESTABLISHING A QUORUM. THE BOARD WILL ALSO APPOINT A NON-INTERESTED PERSON TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION.
PROCESS FOR DETERMINING COMPENSATIONFORM 990, PART VI, SECTION B, LINE 15A AND 15BCOMPENSATION PACKAGES FOR FOUNDATION EXECUTIVES AND OTHER OFFICERS AND KEY EMPLOYEES ARE COMPARED WITH INDEPENDENT SURVEYS & RECOMMENDATIONS OF CONSULTANTS. COMPENSATION IS ULTIMATELY APPROVED BY THE COMPENSATION COMMITTEE AND DOCUMENTED IN A WRITTEN EMPLOYMENT CONTRACT.
MAKING DOCUMENTS AVAILABLE TO THE PUBLICFORM 990, PART VI, SECTION C, LINE 19THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST IN THE FOUNDATION'S ADMINISTRATIVE OFFICES.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MEDICAL CENTER AMBULANCE SERVICES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1629 LAFFOON STREETAddressLine1
CityMADISONVILLECity
StateKYState
ZIP Code42431ZIPCode
FieldValueIRS element (for citing)
EIN610946210EIN
Primary ActivitiesAMBULANCE SVCPrimaryActivities
Legal Domicile StateKYLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1MUHLENBERG MEDICAL CENTER LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11010 MEDICAL CENTER DRIVEAddressLine1
CityPOWDERLYCity
StateKYState
ZIP Code42367ZIPCode
FieldValueIRS element (for citing)
EIN611303514EIN
Primary ActivityHEALTHCARE SVPrimaryActivity
Legal Domicile StateKYLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1W KY MED MGT SVBusinessNameLine1
FieldValueIRS element (for citing)
Share Of Total Income-11995ShareOfTotalIncome
Share Of EOY Assets71686ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
Code V-$11,995CodeVAmount
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.19350PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
MUTUAL CREDIT SERVICES INC
PO BOX 149MADISONVILLEKY42431610660705COLLECTION AGKYNAC-10902812961.00000
REGIONAL SURGICAL ALLIANCE LLC
900 HOSPITAL DRIVEMADISONVILLEKY42431383734043HEALTHCARE SVKYNAC-19001.00000
WESTERN KY MEDICAL MANAGEMT SERVICES INC
900 HOSPITAL DRIVEMADISONVILLEKY42431371519513HC MSOKYNAC-1554971742091.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
MEDICAL CENTER AMBULANCE SERVICES INC
A40896
WESTERN KY MEDICAL MANAGEMENT SERVICES INC
1264000
MEDICAL CENTER AMBULANCE SERVICES INC
235171
MUTUAL CREDIT SERVICES INC
498786
MUTUAL CREDIT SERVICES INC
P498786
WESTERN KY MEDICAL MANAGEMENT SERVICES INC
P895382
MEDICAL CENTER AMBULANCE SERVICES INC
P199740