PORTSMOUTH HOSPITAL CORPORATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PORTSMOUTH HOSPITAL CORPORATION (EIN 45-3215312)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-14
- IRS object ID
- 202312269349302741
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-14T19:50:27-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1570 FRUITVILLE PIKE SUITE 400 | AddressLine1Txt |
| City | LANCASTER | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453215312 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PORTSMOUTH HOSPITAL CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PORT | BusinessNameControlTxt |
| Phone | 7409914000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1901 ARGONNE AVENUE | AddressLine1Txt |
| City | PORTSMOUTH | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45662 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AUTUMN MCFANN | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 7409914000 | PhoneNum |
| Signature | 2023-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | AUTUMN | PersonFirstNm |
| Person Last | MCFANN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KERRI N BOGDA CPA | PreparerPersonNm |
| PTIN | P00760402 | PTIN |
| Phone | 7177404863 | PhoneNum |
| Preparation | 2023-08-14 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KING'S DAUGHTERS MEDICAL CENTER OHIO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SARA MARKS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 LEXINGTON AVENUE | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 41101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,646,471 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KINGSDAUGHTERSHEALTH.COM/LOCATIONS | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO CARE. TO SERVE. TO HEAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 201 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,780,822 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,000,362 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $38,621,799 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$22,767 | PYInvestmentIncomeAmt |
| CY Investment Income | -$2,114 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $31,758,417 | PYTotalRevenueAmt |
| CY Total Revenue | $38,619,685 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,261 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,693 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,293,508 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,199,632 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,986,055 | PYOtherExpensesAmt |
| CY Other Expenses | $13,694,576 | CYOtherExpensesAmt |
| PY Total Expenses | $24,286,824 | PYTotalExpensesAmt |
| CY Total Expenses | $26,895,901 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,471,593 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $11,723,784 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,952,850 | TotalAssetsBOYAmt |
| Total Assets EOY | $26,660,626 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,999,368 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,598,967 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,953,482 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,061,659 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | KING'S DAUGHTERS MEDICAL CENTER OHIO IS LOCATED IN THE HISTORIC TOWN OF PORTSMOUTH, OH AT THE CONFLUENCE OF THE OHIO, SCIOTO, AND LITTLE SCIOTO RIVERS. WE HAVE BEEN SPECIFICALLY DESIGNED TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. CONTINUED ON SCHEDULE O.OUR PRIMARY SERVICE AREA IS THE COUNTY OF SCIOTO. ADDITIONAL COUNTIES WE SERVE ARE LAWRENCE, ADAMS, AND JACKSON IN OHIO AND GREENUP AND LEWIS IN KENTUCKY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,143,766 | ExpenseAmt |
| Grant | $1,693 | GrantAmt |
| Revenue | $38,621,799 | RevenueAmt |
| Desc | LOCATED IN PORTSMOUTH, OHIO, KING'S DAUGHTERS MEDICAL CENTER OHIO (PORTSMOUTH HOSPITAL CORPORATION) PROVIDES A COMFORTABLE, SMALL-HOSPITAL ENVIRONMENT WITH ACCESS TO TECHNOLOGY AND SPECIALISTS NORMALLY FOUND ONLY AT LARGER INSTITUTIONS.SERVING AS A HEALTHCARE CHOICE FOR RESIDENTS OF PORTSMOUTH, SCIOTO COUNTY AND SURROUNDING AREAS, KING'S DAUGHTERS MEDICAL CENTER OHIO (KDOH) PROVIDES SERVICES RANGING FROM PRIMARY CARE TO SURGICAL SERVICES; INPATIENT CARE TO OUTPATIENT DIAGNOSTICS; FROM SPECIALTY CARE TO URGENT CARE. CONTINUED ON SCHEDULE O.KING'S DAUGHTERS MEDICAL CENTER OHIO PROVIDES ACCESS TO THE FOLLOWING HEALTHCARE SERVICES: PRIMARY CARE, INCLUDING A PARTNERSHIP WITH SHAWNEE STATE UNIVERSITY FOR STUDENT HEALTH SERVICES URGENT CARE SERVICES AVAILABLE 24/7/365 SPECIALIST PHYSICIANS IN HEART AND VASCULAR; ORTHOPEDICS; DIGESTIVE HEALTH; GENERAL SURGERY; NEUROLOGY (EPILEPTOLOGIST); SURGICAL BREAST ONCOLOGY; PLASTIC & RECONSTRUCTIVE SURGERY; UROLOGY; ENT INPATIENT SERVICES, INCLUDING AN EPILEPSY MONITORING UNIT (EMU) SURGICAL CARE IMAGING SERVICES, INCLUDING MRI, CT, NUCLEAR MEDICINE, 3D MAMMOGRAPHY, X-RAY, AND GENERAL AND VASCULAR ULTRASOUND CARDIAC DIAGNOSTIC SERVICES, INCLUDING EKG, STRESS TESTING AND NUCLEAR MEDICINE PULMONARY DIAGNOSTICS NUTRITION COUNSELINGKDOH OFFERS FREE SCREENINGS IN HEART AND VASCULAR AND ORTHOPEDIC SPECIALTIES; OFFERS A LOW-COST BLOOD PROFILE PROGRAM; PARTICIPATES IN AND SUPPORTS COMMUNITY EVENTS; AND SPONSORS A FARMERS MARKET ON ITS GROUNDS DURING THE SUMMER MONTHS. | Desc |
| Total Program Service Expenses | $24,143,766 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 201 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURIE STEWART CONTROLLER | PersonNm |
| Phone | 6064089640 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 LEXINGTON AVENUE | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 41101 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| KRISTIE WHITLATCH NON-VOTING | |||||||||
| PRESIDENT | 1.25 | 59.50 | Yes (X) | Yes (X) | $0 | $2,269,672 | $2,437 | ||
| DAVID JONES | |||||||||
| BOARD CHAIRMAN | 0.25 | 6.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARK NEWMAN | |||||||||
| BOARD VICE CHAIR | 0.25 | 5.75 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN ADDINGTON | |||||||||
| DIRECTOR | 0.25 | 2.50 | Yes (X) | $0 | $0 | $0 | |||
| MARK BIRDWHISTELL | |||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | |||
| TOM BURNETTE | |||||||||
| DIRECTOR | 0.25 | 2.75 | Yes (X) | $0 | $0 | $0 | |||
| CRAIG COLLINS | |||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | |||
| ERIC MONDAY | |||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | |||
| JOHN STEWART | |||||||||
| DIRECTOR | 0.25 | 2.75 | Yes (X) | $0 | $0 | $0 | |||
| AUTUMN MCFANN NON-VOTING | |||||||||
| TREASURER | 1.25 | 59.50 | Yes (X) | $0 | $641,478 | $79,681 | |||
| SHERYL MAHANEY NON-VOTING | |||||||||
| SECRETARY | 1.25 | 59.50 | Yes (X) | $0 | $681,233 | $32,931 | |||
| SARA MARKS | |||||||||
| VP/COO | 1.25 | 59.00 | $0 | $652,411 | $90,218 | Yes (X) | |||
| TAMALA CONLEY | |||||||||
| EXECUTIVE DIRECTOR PHC | 10.00 | 40.00 | $0 | $171,272 | $36,401 | Yes (X) | |||
| CRAIG HAZELBAKER | |||||||||
| PHARMACY SUPERVISOR | 40.00 | $156,294 | $0 | $23,004 | Yes (X) | ||||
| MELISSA WATSON | |||||||||
| PHARMACIST | 40.00 | $168,575 | $0 | $23,044 | Yes (X) | ||||
| JAMES NEAL | |||||||||
| CNO/ADMINISTRATOR | 45.00 | $113,518 | $0 | $31,519 | Yes (X) | ||||
| ELIZABETH HUFFMAN | |||||||||
| RN | 40.00 | 5.00 | $86,488 | $23,233 | $20,027 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $524,875 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,439,299 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $339,262 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RIVERSIDE ANESTHESIA PSC | |||||
| 425 LEWIS HARGETT CIRCLE | LEXINGTON | KY | 40503 | ANESTHESIA SERVICES | $1,119,716 |
| TONY VIRGIN MD | |||||
| BOX 8 STATE ROUTE 141 | KITTS HILL | OH | 45645 | PHYSICIAN | $171,800 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | $38,381,799 | $38,381,799 |
| PHARMACY REVENUE | 621110 | $240,000 | $240,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $38,621,799 | TotalProgramServiceRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $24,672 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $26,786 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$2,114 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,114 | TotalRevenueColumnAmt |
| Exclusion | -$2,114 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,619,685 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,621,799 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$2,114 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,693 | TotalAmt |
| Program Services | $1,693 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,117,985 | TotalAmt |
| Program Services | $8,929,122 | ProgramServicesAmt |
| Management And General | $1,188,863 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $267,692 | TotalAmt |
| Program Services | $236,238 | ProgramServicesAmt |
| Management And General | $31,454 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,100,792 | TotalAmt |
| Program Services | $1,853,949 | ProgramServicesAmt |
| Management And General | $246,843 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $713,163 | TotalAmt |
| Program Services | $617,385 | ProgramServicesAmt |
| Management And General | $95,778 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,740 | TotalAmt |
| Management And General | $241,740 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $925 | TotalAmt |
| Program Services | $925 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,853,650 | TotalAmt |
| Program Services | $1,788,742 | ProgramServicesAmt |
| Management And General | $64,908 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,274 | TotalAmt |
| Program Services | $113,121 | ProgramServicesAmt |
| Management And General | $32,153 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,946 | TotalAmt |
| Management And General | $573,946 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,159 | TotalAmt |
| Program Services | $6,915 | ProgramServicesAmt |
| Management And General | $244 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,819 | TotalAmt |
| Management And General | $29,819 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,757,658 | TotalAmt |
| Program Services | $1,757,658 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,360 | TotalAmt |
| Management And General | $112,360 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $5,301,448 | $5,243,784 | $57,664 |
| BAD DEBT EXPENSE | $2,314,659 | $2,314,659 | |
| REPAIRS AND MAINTENANCE | $1,033,199 | $968,060 | $65,139 |
| RENTAL FEES | $174,208 | $174,208 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,531 | TotalAmt |
| Program Services | $137,307 | ProgramServicesAmt |
| Management And General | $11,224 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,895,901 | TotalAmt |
| Program Services | $24,143,766 | ProgramServicesAmt |
| Management And General | $2,752,135 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $398,914 | BOYAmt |
| EOY | $395,199 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,181,920 | BOYAmt |
| EOY | $3,538,772 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,306,682 | BOYAmt |
| EOY | $1,708,739 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,237 | BOYAmt |
| EOY | $95,619 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,263,423 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,360,025 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,935,802 | BOYAmt |
| EOY | $20,903,398 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,295 | BOYAmt |
| EOY | $18,899 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,952,850 | BOYAmt |
| EOY | $26,660,626 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,963,587 | BOYAmt |
| EOY | $2,307,884 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,035,781 | BOYAmt |
| EOY | $1,291,083 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,999,368 | BOYAmt |
| EOY | $3,598,967 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,953,482 | BOYAmt |
| EOY | $23,061,659 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,953,482 | BOYAmt |
| EOY | $23,061,659 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,952,850 | BOYAmt |
| EOY | $26,660,626 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $11,723,784 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$13,615,607 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $925 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $925 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | $925: A PORTION OF THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,528,722 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,644,413 | DepreciationAmt |
| Book Value | $16,884,309 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,754,393 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,929,735 | DepreciationAmt |
| Book Value | $2,824,658 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,980,308 | OtherCostOrOtherBasisAmt |
| Depreciation | $785,877 | DepreciationAmt |
| Book Value | $1,194,431 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,903,398 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| LEASE LIABILITY | $18,899 |
| DUE TO MEDICARE | $1,272,184 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,291,083 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE MEDICAL CENTER, KHF, KBNH, CDC, KHI, KDMT, KDMS, KDHF, AND KDOH HAVE BEEN RECOGNIZED BY THE IRS AS SECTION 501(C)(3) CHARITABLE ORGANIZATIONS. SECTION 501(C)(3) ORGANIZATIONS ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. THESE ORGANIZATIONS DO NOT ENGAGE IN SIGNIFICANT UNRELATED ACTIVITIES; THEREFORE, NO TAX IS RECORDED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,369 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $66,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,064,255 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,592,391 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,130,624 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,592,391 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $66,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $96,562 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $96,562 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,068 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,068 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $105,630 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $105,630 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,236,254 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,592,391 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $171,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $737,551 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,668,158 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,866,175 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$198,017 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PORTSMOUTH HOSPITAL CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1901 ARGONNE RD | AddressLine1Txt |
| City | PORTSMOUTH | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45662 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.KDMCOHIO.COM | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | URGENT CARE - 24 HOURS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | KINGSDAUGHTERSHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | KINGSDAUGHTERSHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO | PART V, SECTION B, LINE 5: THE NEED ASSESSMENT WAS CONDUCTED WITH INPUT FROM THE BROAD COMMUNITY THROUGH AN ASSESSMENT CONDUCTED BY PRC FOR SOUTHERN OHIO MEDICAL CENTER, KING'S DAUGHTERS OHIO (KDOH) AND THE SCIOTO COUNTY AND PORTSMOUTH CITY HEALTH DEPARTMENTS. INPUT WAS GATHERED FROM A BROAD COMMUNITY QUESTIONNAIRE, A KEY INFORMANT QUESTIONNAIRE AND FOCUS GROUPS. WHILE KDOH ONLY USED THE SCIOTO COUNTY INFORMATION, THE ASSESSMENT PROVIDED ADDITIONAL INFORMATION ABOUT COUNTIES AND COMMUNITIES BEYOND KDOH'S SERVICE AREA. KDOH SUPPLEMENTED THE PRC REPORT WITH ADDITIONAL INFORMATION TO PREPARE ITS COMMUNITY HEALTH NEED ASSESSMENT AND DEVELOP THE IMPLEMENTATION PLAN. |
| PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO | PART V, SECTION B, LINE 6A: SOUTHERN OHIO MEDICAL CENTER (SOMC) |
| PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO | PART V, SECTION B, LINE 11: "THE 2021-22 COMMUNITY HEALTH NEED ASSESSMENT IDENTIFIED THE FOLLOWING NEEDS THAT THE MEDICAL CENTER WILL BE ADDRESSING: CHRONIC CONDITIONS: BREAST AND COLON CANCERS PREVENTIVE CARE: PHYSICAL ACTIVITY/WELLNESS, MENTAL HEALTH, NUTRITIONCHRONIC CONDITIONS:BREAST CANCER: KDOH WILL BE ADDRESSING BREAST CANCER THROUGH INCREASING SCREENING MAMMOGRAMS TO HELP IN EARLY IDENTIFICATION AND DIAGNOSIS OF BREAST CANCER. EARLY IDENTIFICATION AND TREATMENT REDUCE THE BURDEN OF BREAST CANCER AND IMPROVE PATIENT OUTCOMES.COLON CANCER: COLON CANCER WILL BE ADDRESSED BY INCREASING EDUCATION ABOUT COLON CANCER AND THE NEED FOR SCREENING AMONG THOSE 45 YEARS OF AGE AND OLDER. THE EARLIER COLON CANCER IS DETECTED THE BETTER THE PATIENT OUTCOMES.PREVENTIVE CARE: PHYSICAL ACTIVITY/WELLNESS: KDOH WILL PROVIDE COMMUNITY EDUCATION FOCUSED ON HEALTHY LIFESTYLES AND WELLNESS. AS PART OF THIS PRIORITY, KDOH PLANS TO HOST OR SPONSOR AT LEAST FOUR EVENTS PROMOTING PHYSICAL ACTIVITY, ESPECIALLY FOR CHILDREN. IN ADDITION, KDOH WILL HOST AT LEAST SIX HEALTH SCREENING ACTIVITIES RELATED TO BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR, NUTRITION AN.D NICOTINE EDUCATION.MENTAL HEALTH: KDOH PLANS TO PROVIDE COMMUNITY EDUCATION REGARDING THE SUICIDE PREVENTION HOTLINE AND MENTAL HEALTH AWARENESS. IN ADDITION, KDOH WILL PARTNER WITH KDMC TO PUBLISH SOCIAL MEDIA POSTS FOCUSED ON MENTAL HEALTH ON KDOH'S SOCIAL MEDIA PAGES. NUTRITION: KDOH WILL PROVIDE COMMUNITY EDUCATION ON HEALTHY EATING AND EDUCATIONAL PROGRAMS FOCUSED ON NUTRITION. THIS WILL BE DONE THROUGH THE MOBILE MARKET AND OTHER OPPORTUNITIES. KDOH WILL PARTICIPATE IN AT LEAST FOUR EVENTS, OF WHICH TWO WILL FOCUS ON SENIOR CITIZENS. THE IDENTIFIED NEEDS OF OVERWEIGHT/OBESITY, DIABETES, AND HEART DISEASE ARE BEING ADDRESS WITHIN THE PREVENTIVE CARE INITIATIVES. THE IDENTIFIED NEEDS OF SUBSTANCE USE DISORDER, RESPIRATORY ILLNESSES, INFANT HEALTH AND FAMILY PLANNING, INJURY AND VIOLENCE, KIDNEY DISEASE, ORAL HEALTH, POTENTIALLY DISABLING CONDITIONS, RESPIRATORY DISEASE, AND TOBACCO USE ARE OUTSIDE THE SCOPE OF SERVICES PROVIDED BY KDOH. THERE ARE ALSO OTHER ORGANIZATIONS IN THE KDOH SERVICE AREA THAT PROVIDE SERVICES TO ADDRESS THESE NEEDS." |
| PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO | PART V, SECTION B, LINE 24: FAP ELIGIBLE PATIENTS ARE CHARGED THE GROSS CHARGE FOR ANY SERVICES EXCLUDED FROM ELIGIBILITY AS DEFINED WITHIN THE FAP, WHICH ARE DEFINED AS ELECTIVE SERVICES AND THEREFORE NOT MEDICALLY NECESSARY. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | KDOH USED WORKSHEET 2 PROVIDED IN THE SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST TO CHARGE RATIO. THIS RATIO WAS USED TO CALCULATE CHARITY CARE AT COST (A. ABOVE). TO CALCULATE THE UNPAID COSTS OF MEDICAID (B), THE HOSPITAL'S COST ACCOUNTING SYSTEM WAS USED. REMAINING ITEMS WERE REPORTED AT NET EXPENSE. |
| PART I, LN 7 COL(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 $2,314,659. |
| PART III, LINE 2: | BAD DEBT EXPENSE IS RECORDED AFTER ANY DISCOUNTS AND PAYMENTS ARE MADE ON PATIENT ACCOUNTS.KDOH USED WORKSHEET 2 PROVIDED IN THE SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST OF CHARGE RATIO. THIS RATIO WAS USED TO CALCULATE BAD DEBT EXPENSE AT COST. |
| PART III, LINE 3: | BAD DEBT EXPENSE IS RECORDED AFTER ANY DISCOUNTS AND PAYMENTS ARE MADE ON PATIENT ACCOUNTS. HOWEVER, THE BUSINESS OFFICE DOES NOT KEEP TRACK OF "NO-RESPONSE" APPLICATIONS AND DOES NOT FEEL THAT THE PORTION CONSIDERED TO BE A COMMUNITY BENEFIT IS MATERIAL. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICE PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND INSURED PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY REPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOSPITAL A DISSERVICE. THE SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. THE HOSPITAL USES ALLOWABLE COSTS PER THE MEDICARE COST REPORT, FY2021 COST REPORT DATA, AND PROVIDER SUMMARY REPORT (PSR) WAS USED TO COMPUTE THE INFORMATION. |
| PART III, LINE 9B: | THE HOSPITAL HAS A WRITTEN POLICY FOR BAD DEBT. UNINSURED PATIENTS ARE SCREENED FOR ELIGIBILITY FOR MEDICARE, MEDICAID, AND OTHER SUCH PROGRAMS BY A CONTRACTED VENDOR. ALL PATIENTS, INSURED AND UNINSURED, WITH VALID MAILING ADDRESSES, RECEIVE POST-DISCHARGE BILLING STATEMENTS OVER THE COURSE OF A 120 DAY PERIOD. IF THERE ARE NO ACTIVE DISPUTES OR OTHER PAYMENT SOURCES AVAILABLE, AND THE BALANCE IS UNPAID AT THE END OF THE STATEMENT PERIOD, THE ACCOUNT WILL BE PLACED WITH A COLLECTION AGENCY TO REPORT AS A BAD DEBT. EACH STATEMENT INCLUDES INFORMATION REGARDING THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM ALONG WITH A NUMBER WHERE REPRESENTATIVES CAN BE REACHED FOR ASSISTANCE. |
| PART VI, LINE 2: | IN ADDITION TO THE TRIANNUAL CHNA, KDOH CONTINUOUSLY MONITORS HOSPITAL DATA AND COMMUNITY SPREAD DISEASES LIKE SEASONAL FLU AND COVID-19. DEPENDING ON THE ISSUE, KDOH RESPONDS WITH STRATEGIES TO HELP MITIGATE THE ISSUE. |
| PART VI, LINE 3: | THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY PROVIDES DIRECTION FOR FREE OR DISCOUNTED SERVICES TO RESIDENTS OF THE COMMUNITY WHO HAVE INADEQUATE FINANCIAL RESOURCES TO PAY FOR NECESSARY HEALTHCARE SERVICES PROVIDED BY KING'S DAUGHTERS. THE POLICY STATES THAT THE MEDICAL CENTER WILL NOT DENY CARE TO ANY PATIENT REQUIRING CARE DUE TO THEIR INABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY PROVIDES GUIDANCE TO PROVIDING ASSISTANCE BASED ON SLIDING SCALE METHODOLOGY AND THE FEDERAL POVERTY GUIDELINES ESTABLISHED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. PATIENTS REQUIRING CARE WITH INCOME BELOW 300% OF THE FEDERAL POVERTY LEVEL QUALIFY FOR FREE OR REDUCED COST SERVICES. KING'S DAUGHTERS ALSO CONTRACTS WITH OUTSIDE VENDORS TO ASSIST PATIENTS IN GOVERNMENT ENROLLMENT PROGRAMS. THERE ARE SIGNS POSTED IN VARIOUS REGISTRATION AREAS INFORMING PATIENTS OF THE PHONE NUMBER TO CALL IF THEY NEED FINANCIAL ASSISTANCE. ON EACH PATIENT STATEMENT THE INFORMATION IS ALSO PRINTED WITH THE PHONE NUMBER. ALL SELF-PAY PATIENTS RECEIVE CORRESPONDENCE AND PHONES CALLS AND INPATIENTS RECEIVE VISITS FROM OUR MEDICAID ELIGIBILITY VENDOR IN REFERENCE TO GOVERNMENT PROGRAMS. |
| PART VI, LINE 4: | KDOH'S SERVICE AREA OF SCIOTO COUNTY COVERS MORE THAN 610 SQUARE MILES, WITH A POPULATION DENSITY OF 120 PEOPLE PER SQUARE MILE. THE POPULATION IS NEARLY EVENLY DIVIDED BETWEEN URBAN AND RURAL, WITH 54.28% RURAL AND 45.72% URBAN. ACCORDING TO THE US CENSUS BUREAU JULY 1, 2021 UPDATE, SCIOTO COUNTY HAS 73,346 RESIDENTS. OF THE RESIDENTS, 94.1% ARE WHITE, 2.8% BLACK, AND 3.1% REPRESENT ALL OTHER RACES. HISPANIC/LATINOS REPRESENT 1.6% OF THE POPULATION. FOURTEEN PERCENT OF RESIDENTS OVER THE AGE OF 24 HAVE NOT GRADUATED HIGH SCHOOL, COMPARED TO 9.2% IN OHIO AND 11.5% NATIONALLY. SCIOTO COUNTY'S OVERALL POVERTY RATE OF 22.8% IS HIGHER THAN OHIO (13.4%) AND THE NATION (11.6%). THE CHILD POVERTY RATE IS 40% WHICH IS HIGHER THAN OHIO (17%) AND THE UNITED STATES (19%). THE MEDIAN INCOME FOR THE COUNTY IS $41,866, WHICH IS WELL BELOW THE STATE ($58,116) AND NATION ($64,944). PER-CAPITA INCOME IN THE COUNTY IS $23,512; COMPARED TO $32,465 FOR OHIO AND $35,384 FOR THE UNITED STATES. THE US CENSUS, SHOWS THAT 7.9% OF THE COUNTY RESIDENTS UNINSURED, COMPARED TO 7.8% IN OHIO AND 9.8% NATIONWIDE. |
| PART VI, LINE 5: | KDOH PROVIDES FREE EDUCATIONAL AND SCREENING SERVICES IN SCIOTO COUNTY, THE PRIMARY MARKET. KDOH WORKS WITH CHURCHES, SCHOOLS, BUSINESSES, AND COMMUNITY GROUPS TO HELP IMPROVE HEALTH THROUGHOUT THE COUNTY. THE FOLLOWING ACTIVITIES, WHICH CONTRIBUTE TO COMMUNITY HEALTH WERE PROVIDED:SCREENING AND HEALTH EDUCATION ACTIVITIES:SCREENINGS, IMMUNIZATIONS AND PHYSICALS: FLU SHOTS 127 PROVIDED HEALTHY HEART SCREENING 101 SERVED MOBILE MAMMOGRAPHY 152 SERVED SPORTS PHYSICALS 369 SERVED LOW-COST BLOOD PROFILES 815 SERVEDHEALTH EDUCATION: ALCOHOL AND OTHER DRUGS 94 SERVED AED 14 SERVED BICYCLE SAFETY 300 ADULTS AND 150 CHILDREN SERVED BONE HEALTH 176 ADULTS, AND 249 CHILDREN SERVED BREAST CANCER 359 SERVED CONGESTIVE HEART FAILURE 127 SERVED COLON CANCER 288 SERVED COVID-19 44 SERVED DENTAL HEALTH 2 ADULTS AND 24 CHILDREN SERVED DIABETES - 1,077 ADULTS AND 583 CHILDREN SERVED FIT TESTING 14 SERVED HANDWASHING 1,062 ADULTS; 734 CHILDREN/YOUTH SERVED HANDS ONLY CPR 14 SERVED HEART 842 ADULTS; 500 CHILDREN/YOUTH SERVED HYPERTENSION 101 ADULTS SERVED LUNG CANCER 354 ADULTS SERVED NUTRITION 5,505 ADULTS; 744 CHILDREN/YOUTH SERVED SAFE MEDICATION PRACTICES 94 ADULTS SERVED SKIN CANCER 76 ADULTS; 197 CHILDREN/YOUTH SERVED SMOKELESS TOBACCO/VAPING 101 ADULTS SERVED STROKE 788 ADULTS AND 150 CHILDREN SERVED SUBSTANCE USE DISORDER 62 ADULTS SERVED SUMMER SAFETY 459 ADULTS AND 213 CHILDREN SERVED TOBACCO 1,078 ADULTS; 765 CHILDREN/YOUTH SERVED TOBACCO CESSATIONS COUNSELING/GROUP 154 SERVEDOTHER COMMUNITY ACTIVITIES:BLOOD DRIVES- KDOH PARTNERED WITH THE AMERICAN RED CROSS TO INCREASE BLOOD DONATIONS BY ENCOURAGING TEAM MEMBERS TO PARTICIPATE IN LOCAL BLOOD DRIVES DURING WORK HOURS. TEN DONATIONS WERE PROVIDED.BACKPACK PROGRAM-TEAM MEMBERS DONATED OVER 200 ITEMS OF SCHOOL AND DISINFECTING SUPPLIES TO PORTSMOUTH ELEMENTARY SCHOOL CHILDREN TO ENSURE STUDENTS START THE YEAR WITH THE NECESSARY SCHOOL SUPPLIES.ADOPT-A-FAMILY-TEAM MEMBERS ADOPTED THREE FAMILIES WITH A TOTAL OF 12 FAMILY MEMBERS AT CHRISTMAS PROVIDING GIFTS AND FOOD.SALVATION ARMY- KDOH TEAM MEMBERS DONATED TIME, GIFTS AND FOOD TO THE SALVATION ARMY CHRISTMAS EVENT. |
| PART VI, LINE 6: | KING'S DAUGHTERS MEDICAL CENTER OHIO IS PART OF AN AFFILIATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM OPERATES ANOTHER HOSPITAL, KING'S DAUGHTERS MEDICAL CENTER (KDMC) IN ASHLAND, KY. KDOH HAS BEEN SPECIFICALLY DESIGNED TO MEETING THE HEALTHCARE NEEDS OF PORTSMOUTH AND ITS SURROUNDING AREAS. KDOH OFFERS SURGICAL AND URGENT CARE SERVICES. KDOH PROVIDES CHARITY CARE AND PARTICIPATES IN GOVERNMENT PROGRAMS. THE SYSTEM PROVIDES PHYSICIAN SERVICES THROUGH KING'S DAUGHTERS MEDICAL SPECIALTIES, INC. ("KDMS"). KDMS PROVIDES CHARITY CARE AND PARTICIPATES IN GOVERNMENT PROGRAMS. KING'S DAUGHTERS ALSO INCLUDES TWO OTHER AFFILIATES - KING'S DAUGHTERS MEDICAL TRANSPORT, WHICH SEEKS TO CONTINUOUSLY IMPROVE THE PRE- AND POST-HOSPITAL HEALTHCARE PROVIDED IN ALL OF ITS SERVICES AREAS WHILE ENSURING THAT EMERGENCY AND NON-EMERGENCY AMBULANCE SERVICE WILL BE AVAILABLE TO ALL THOSE IN NEED; AND KINGSBROOK NURSING HOME, WHICH PROVIDES QUALITY CARE TO PATIENTS, MEETING THE NEEDS AND DESIRES OF RESIDENTS AT VARIOUS LEVELS OF CARE, INCLUDING SHORT-TERM AND LONG-TERM CARE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KRISTIE WHITLATCH NON-VOTING | ||||||||||||||
| PRESIDENT | $0 | $201,814 | $0 | $0 | $0 | $2,067,858 | $0 | $0 | $0 | $2,437 | $0 | $2,272,109 | $0 | $169,891 |
| SARA MARKS | ||||||||||||||
| VP/COO | $0 | $395,578 | $0 | $173,348 | $0 | $83,485 | $0 | $63,050 | $0 | $27,168 | $0 | $742,629 | $0 | $50,000 |
| AUTUMN MCFANN NON-VOTING | ||||||||||||||
| TREASURER | $0 | $434,390 | $0 | $138,000 | $0 | $69,088 | $0 | $63,050 | $0 | $16,631 | $0 | $721,159 | $0 | $50,000 |
| SHERYL MAHANEY NON-VOTING | ||||||||||||||
| SECRETARY | $0 | $365,660 | $0 | $182,037 | $0 | $133,536 | $0 | $16,300 | $0 | $16,631 | $0 | $714,164 | $0 | $82,011 |
| TAMALA CONLEY | ||||||||||||||
| EXECUTIVE DIRECTOR PHC | $0 | $137,396 | $0 | $27,642 | $0 | $6,234 | $0 | $7,830 | $0 | $28,571 | $0 | $207,673 | $0 | $0 |
| MELISSA WATSON | ||||||||||||||
| PHARMACIST | $166,152 | $0 | $2,321 | $0 | $102 | $0 | $7,626 | $0 | $15,418 | $0 | $191,619 | $0 | $0 | $0 |
| CRAIG HAZELBAKER | ||||||||||||||
| PHARMACY SUPERVISOR | $147,994 | $0 | $7,651 | $0 | $649 | $0 | $7,059 | $0 | $15,945 | $0 | $179,298 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | GROSS-UP PAYMENTS: SHERYL MAHANEY $31,037; SARA MARKS $19,848; TAMALA CONLEY $5,165 |
| PART I, LINE 1B | THE GROSS UPS ARE APPROVED BY THE PRESIDENT/CEO. |
| PART I, LINE 3 | COMPENSATION FOR THE CEO IS DETERMINED BY ASHLAND HOSPITAL CORPORATION (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. |
| PART I, LINES 4A-B | KRISTIE WHITLATCH (PRESIDENT) RECEIVED A CHANGE-OF-CONTROL PAYMENT OF $2,066,538 DURING THE CALENDAR YEAR 2021. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: - KRISTIE WHITLATCH: $66,075; - AUTUMN MCFANN: $18,248; - SHERYL MAHANEY: $16,876; - SARA MARKS: $12,377 THE CEO AND CERTAIN VICE PRESIDENTS, WHOSE BENEFIT IN THE QUALIFIED TAX SHELTERED ANNUITY PLAN IS LIMITED DUE TO THE IRS COMPENSATION AND BENEFIT LIMITS, RECEIVE A BENEFIT RESTORATION CONTRIBUTION UNDER THE DEFERRED ANNUITY PLAN THAT IS PAID AS A TAXABLE DISTRIBUTION TO THE PARTICIPANT ANNUALLY. THE FOLLOWING INDIVIDUALS RECEIVED 457(F) EXECUTIVE RETENTION PLAN PAYOUTS: - KRISTIE WHITLATCH: $169,891; - SHERYL MAHANEY: $82,011; - AUTUMN MCFANN: $50,000; - SARA MARKS: $50,000 |
| PART I, LINE 7 | NONFIXED PAYMENTS ARE MADE AS A PART OF THE MEDICAL CENTER'S TEAM INCENTIVE AWARD (TIA) PLAN. ALL TEAM MEMBERS ARE ELIGIBLE FOR THE TIA. THE TIA IS PAID OUT BASED UPON SUCCESSFUL COMPLETION OF BOTH QUANTITATIVE AND QUALITATIVE STRATEGIC GOALS, SET ANNUALLY BY THE MEDICAL CENTER LEADERSHIP TEAM AND APPROVED BY THE BOARD OF DIRECTORS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ROYAL BLUE HEALTH, LLC (RBH) IS THE SOLE CORPORATE MEMBER OF PORTSMOUTH HOSPITAL CORPORATION (PHC). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE PHC BOARD IS FOLDED INTO THE MAIN BOARD OF TRUSTEES OF THE HEALTH SYSTEM. THE BUSINESS OF PHC IS MANAGED AS AN AGENDA ITEM BY THE FULL BOARD INDEPENDENTLY OR THROUGH ITS COMMITTEE STRUCTURE. |
| FORM 990, PART VI, SECTION A, LINE 7B | AS THE PARENT ORGANIZATION OF THE HEALTH CARE SYSTEM, AS WELL AS THE SOLE MEMBER OF PHC, RBH HAS ALL GOVERNING AUTHORITY. ANY LOCAL BOARD OF DIRECTORS IS ADVISORY ONLY. AT THIS TIME THERE IS NOT AN ADVISORY BOARD FOR PHC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WILL BE REVIEWED BY THE CFO AND CONTROLLER BEFORE IT IS FILED WITH THE IRS. THE 990 WILL BE KEPT ON FILE AND AVAILABLE FOR REVIEW BY BOARD MEMBERS UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | PORTSMOUTH HOSPITAL CORPORATION DBA KING'S DAUGHTERS MEDICAL CENTER OHIO (KDOH), THROUGH ITS SOLE MEMBER, REQUIRES ALL DIRECTORS AND OFFICERS TO COMPLY WITH ITS CONFLICTS OF INTEREST POLICY, WHICH TRACKS THE IRS'S RECOMMENDED POLICY WITH RESPECT TO SUCH OFFICERS AND DIRECTORS. MEMBERS OF THE KDOH'S BOARD OF DIRECTORS MUST ANNUALLY IDENTIFY, IN WRITING, ANY INTEREST THAT COULD GIVE RISE TO A CONFLICT, SUCH AS A LEADERSHIP POSITION IN A CONFLICTING ORGANIZATION; DISCLOSURE IS NOT LIMITED TO FINANCIAL CONFLICTS. IN ADDITION, EMPLOYEES OF KDOH CERTIFY THAT NO CONFLICTS OF INTEREST EXIST OR OBTAIN AN ADVANCE WAIVER OF ANY CONFLICTS. KDOH'S GENERAL COUNSEL OBTAINS ALL RELEVANT DISCLOSURES AND SIGNATURES. IF A CONFLICT OF INTEREST IS REPORTED, THE VICE PRESIDENT TO WHOM THE REPORTING EMPLOYEE DIRECTLY OR INDIRECTLY REPORTS, TOGETHER WITH THE CEO, DETERMINES IF A CONFLICT EXISTS. IF THE REPORTING EMPLOYEE IS A VICE PRESIDENT, THE CEO, IN CONSULTATION WITH THE GENERAL COUNSEL, DETERMINES IF A CONFLICT EXISTS. BOARD MEMBERS COMPLETE ANNUAL ATTESTATIONS IDENTIFYING POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT EXISTS, IT IS REPORTED TO THE CHAIRMAN OF THE BOARD, THE CEO, AND/OR GENERAL COUNSEL AS APPROPRIATE. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE EMPLOYEE OR BOARD MEMBER IS REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND HAS NO ROLE IN THE INSTANCE IN WHICH THE CONFLICT EXISTS. A BOARD MEMBER WHO REPORTS A POTENTIAL OR ACTUAL CONFLICT OF INTEREST MUST ABSTAIN FROM ANY RELEVANT DISCUSSION OR VOTE. IF A CONFLICT OF INTEREST IS DISCOVERED AFTER THE FACT, THE CEO AND VICE PRESIDENT, TOGETHER WITH THE GENERAL COUNSEL, IF APPROPRIATE, REVIEWS THE INSTANCE IN WHICH THE CONFLICT OCCURRED. THOSE LEADERS ENSURE THAT THE CONFLICTED INDIVIDUAL DID NOT INFLUENCE DECISION MAKING OR PROFIT FROM THE CONFLICT. THE CONFLICTED INDIVIDUAL IS REMOVED FROM ANY FURTHER INVOLVEMENT. IN ADDITION, ANY FAILURE TO REPORT CONFLICTS OF INTEREST VIOLATES THE POLICY AND COULD RESULT IN DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR REMOVAL FROM THE MEDICAL CENTER'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | AT THE DIRECTION OF THE BOARD OF DIRECTORS, KDMC SET COMPENSATION FOR THE TEAM MEMBERS AND LEADERS USING SEDONA PARTNERS AS WELL AS REVIEW OF LOCAL AND REGIONAL SALARY INFORMATION PROVIDED THROUGH A MARSHALL UNIVERSITY SURVEY. MERCER PERIODICALLY PERFORMS A REVIEW OF EXECUTIVE COMPENSATION AND BENEFITS. THE PRIMARY OBJECTIVE OF KING'S DAUGHTERS COMPENSATION PHILOSOPHY IS TO HAVE COMPENSATION AND BENEFITS SET THAT REFLECT OTHER SIMILAR INDEPENDENT NOT FOR PROFIT HEALTHCARE SERVICES AS WELL AS THE WORK PERFORMANCE OF THE ORGANIZATION. SULLIVAN COTTER, AN INDEPENDENT COMPENSATION EXPERT, REVIEWS ALL PHYSICIAN COMPENSATION AND BENEFITS FOR DETERMINATION OF FAIR MARKET VALUE. |
| FORM 990, PART VI, SECTION C, LINE 19 | ON A QUARTERLY BASIS, THE FINANCIAL STATEMENTS ARE REPORTED TO EMMA (ELECTRONIC MUNICIPAL MARKET ACCESS) AND MADE AVAILABLE ON THEIR WEBSITE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | FORGIVENESS OF INTERCOMPANY PAYABLE -13,615,607. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ASHLAND NURSING HOME CORPORATION | |||||||||||
| 2500 STATE ROUTE 5 | ASHLAND | KY | 41102 | 611386016 | NURSING HOME | KY | 501(C)(3) | LINE 10 | ASHLAND HOSPITAL COPORATION | 0 | |
| CHILD DEVELOPMENT CENTER CORPORATION | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 010560598 | CHILD CARE | KY | 501(C)(3) | LINE 10 | ASHLAND HOSPITAL COPORATION | 0 | |
| KENTUCKY HEART INSTITUTE INC | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 611255904 | PHYSICIANS | KY | 501(C)(3) | LINE 10 | ASHLAND HOSPITAL COPORATION | 0 | |
| KENTUCKY HEART FOUNDATION INC | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 260791997 | MEDICAL RESEARCH | KY | 501(C)(3) | LINE 7 | ASHLAND HOSPITAL COPORATION | 0 | |
| KENTUCKY MEDICAL LOGISTICS INC | |||||||||||
| 425 22ND STREET | ASHLAND | KY | 41101 | 264736971 | MEDICAL TRANSPORT | KY | 501(C)(3) | LINE 10 | ASHLAND HOSPITAL COPORATION | 0 | |
| KING'S DAUGHTERS HEALTH SYSTEM | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 274553836 | HEALTHCARE | KY | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| KING'S DAUGHTERS MEDICAL SPECIALTIES INC | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 264183569 | PHYSICIANS | KY | 501(C)(3) | LINE 10 | ASHLAND HOSPITAL COPORATION | 0 | |
| ASHLAND HOSPITAL CORPORATION | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 610444716 | HEALTHCARE | KY | 501(C)(3) | LINE 3 | ROYAL BLUE HEALTH LLC | 0 | |
| ROYAL BLUE HEALTH LLC | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 862993817 | HEALTHCARE | KY | 501(C)(3) | LINE 12B, II | KING'S DAUGHTERS HEALTH SYSTEM | 0 | |
| KING'S DAUGHTERS HEALTH FOUNDATION INC | |||||||||||
| 2201 LEXINGTON AVENUE | ASHLAND | KY | 41101 | 611035701 | FUNDRAISING | KY | 501(C)(3) | LINE 12B, II | ASHLAND HOSPITAL COPORATION | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHLAND MEDICAL PROPERTIES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2201 LEXINGTON AVE | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 41101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611079090 | EIN |
| Primary Activities | RENTALS | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Comments