PINEVILLE COMMUNITY HEALTH CENTER INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PINEVILLE COMMUNITY HEALTH CENTER INC (EIN 84-1949748)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-06-15
- IRS object ID
- 202201669349300510
- Schema version
- 2020v4.2
- 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 | 2022-06-15T07:45:59-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2650 EASTPOINT PKWY SUITE 300 | AddressLine1Txt |
| City | LOUISVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40223 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 841949748 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINEVILLE COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PINE | BusinessNameControlTxt |
| Phone | 6063373051 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVENUE | AddressLine1Txt |
| City | PINEVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40977 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEVIN COUCH | PersonNm |
| Person Title | ADMINISTRATOR/CFO | PersonTitleTxt |
| Phone | 6063373051 | PhoneNum |
| Signature | 2022-06-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KEVIN | PersonFirstNm |
| Person Last | COUCH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CARRIE A MERRILL CPA | PreparerPersonNm |
| PTIN | P00832283 | PTIN |
| Phone | 5029923500 | PhoneNum |
| Preparation | 2022-06-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEVIN COUCH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVENUE | AddressLine1Txt |
| City | PINEVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40977 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,662,403 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PINEVILLEHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2019 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | PINEVILLE COMMUNITY HEALTH CENTER, INC PROVIDES MEDICAL SERVICES TO THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 189 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,409,289 | PYContributionsGrantsAmt |
| CY Contributions Grants | $393,149 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,155,891 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,297,090 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,619 | PYInvestmentIncomeAmt |
| CY Investment Income | $542 | CYInvestmentIncomeAmt |
| PY Other Revenue | $540,149 | PYOtherRevenueAmt |
| CY Other Revenue | $2,971,622 | CYOtherRevenueAmt |
| PY Total Revenue | $9,118,948 | PYTotalRevenueAmt |
| CY Total Revenue | $10,662,403 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $100 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,068,699 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,349,128 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,814,972 | PYOtherExpensesAmt |
| CY Other Expenses | $6,947,053 | CYOtherExpensesAmt |
| PY Total Expenses | $7,883,671 | PYTotalExpensesAmt |
| CY Total Expenses | $13,296,281 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,235,277 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,633,878 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,110,293 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,643,023 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,943,352 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,660,338 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,166,941 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,017,315 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PINEVILLE COMMUNITY HEALTH CENTER'S MISSION IS TO OFFER SAFE, QUALITY CARE TO SOUTHEASTERN KENTUCKY, AND TO ENHANCE OUR COMMUNITY THROUGH SERVICE WITH COMPASSION, CARING ACCOUNTABILITY, RESPECT AND EMPATHY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,465,599 | ExpenseAmt |
| Grant | $100 | GrantAmt |
| Revenue | $10,209,947 | RevenueAmt |
| Desc | PINEVILLE COMMUNITY HEALTH CENTER'S MISSION IS TO OFFER SAFE, QUALITY CARE TO SOUTHEASTERN KENTUCKY, AND TO ENHANCE OUR COMMUNITY THROUGH SERVICE WITH COMPASSION, CARING ACCOUNTABILITY, RESPECT AND EMPATHY. | Desc |
| Total Program Service Expenses | $11,465,599 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | 0 | 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 | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 189 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DALE FARRELL | PersonNm |
| Phone | 6063373051 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVENUE | AddressLine1Txt |
| City | PINEVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40977 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KATHERINE REESE | |||||||
| CHAIRMAN | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DENISE SHUMATE | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KEN JONES | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RUSSELL THOMPSON | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KELLY UPCHURCH | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| VELUPILLAI WIGNAKUMAR | |||||||
| BOARD DIRECTOR (TERM END 2/25/21) | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ALAN COPPOCK | |||||||
| BOARD DIRECTOR (TERM END 12/31/21) | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TERRY NICHOLS | |||||||
| CEO (TERM 12/2020 - 9/2021) | 40.00 | $162,654 | $0 | $3,234 | Yes (X) | ||
| KEVIN COUCH | |||||||
| ADMINISTRATOR/CFO | 40.00 | $85,010 | $0 | $5,677 | Yes (X) | ||
| MARY BISHOP | |||||||
| CNO | 40.00 | $75,691 | $0 | $0 | Yes (X) | ||
| CAROL AYERS | |||||||
| PHARMD | 40.00 | $114,192 | $0 | $4,102 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $437,547 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $13,013 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PINEVILLE ER SERVICES | |||||
| 1625 NICHOLASVILLE RD 201 | LEXINGTON | KY | 40503 | PHYSICIAN STAFFING | $854,418 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | IT SERVICES | $375,552 |
| RNR PSYCHIATRIC HEALTHCARE | |||||
| 3213 CASHIERS CT | LEXINGTON | KY | 40513 | PHYSICIAN STAFFING | $130,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $393,149 | GovernmentGrantsAmt |
| Total Contributions | $393,149 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $7,297,090 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,297,090 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,297,090 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $542 | TotalRevenueColumnAmt |
| Exclusion | $542 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $143,709 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $143,709 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $143,709 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $143,709 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| DSH REVENUE | 900099 | $2,769,148 | $2,769,148 | |
| MISCELLANEOUS | 900099 | $58,765 | $58,765 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,827,913 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,662,403 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,209,947 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $59,307 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Program Services | $100 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $323,355 | TotalAmt |
| Program Services | $274,852 | ProgramServicesAmt |
| Management And General | $48,503 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,307,639 | TotalAmt |
| Program Services | $4,511,493 | ProgramServicesAmt |
| Management And General | $796,146 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,741 | TotalAmt |
| Program Services | $280,280 | ProgramServicesAmt |
| Management And General | $49,461 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $388,393 | TotalAmt |
| Program Services | $330,134 | ProgramServicesAmt |
| Management And General | $58,259 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,824 | TotalAmt |
| Management And General | $33,824 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,383 | TotalAmt |
| Management And General | $46,383 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,880,387 | TotalAmt |
| Program Services | $2,448,329 | ProgramServicesAmt |
| Management And General | $432,058 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,705 | TotalAmt |
| Program Services | $6,549 | ProgramServicesAmt |
| Management And General | $1,156 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,619 | TotalAmt |
| Program Services | $100,826 | ProgramServicesAmt |
| Management And General | $17,793 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,241 | TotalAmt |
| Program Services | $308,755 | ProgramServicesAmt |
| Management And General | $54,486 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $439,473 | TotalAmt |
| Program Services | $373,552 | ProgramServicesAmt |
| Management And General | $65,921 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,552 | TotalAmt |
| Program Services | $34,469 | ProgramServicesAmt |
| Management And General | $6,083 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $323,589 | TotalAmt |
| Program Services | $275,051 | ProgramServicesAmt |
| Management And General | $48,538 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,622 | TotalAmt |
| Program Services | $269,129 | ProgramServicesAmt |
| Management And General | $47,493 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $267,368 | TotalAmt |
| Program Services | $227,263 | ProgramServicesAmt |
| Management And General | $40,105 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,367,293 | $1,367,293 | |
| REPAIRS AND MAINTENANCE | $305,537 | $259,706 | $45,831 |
| PROVIDER HRIP TAX | $178,846 | $178,846 | |
| DUES AND SUBSCRIPTIONS | $57,973 | $49,277 | $8,696 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $199,641 | TotalAmt |
| Program Services | $169,695 | ProgramServicesAmt |
| Management And General | $29,946 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,296,281 | TotalAmt |
| Program Services | $11,465,599 | ProgramServicesAmt |
| Management And General | $1,830,682 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $138,733 | BOYAmt |
| EOY | $227,292 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,765,499 | BOYAmt |
| EOY | $292,275 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,403,806 | BOYAmt |
| EOY | $2,342,005 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $295,971 | BOYAmt |
| EOY | $254,268 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,939 | BOYAmt |
| EOY | $48,491 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,757,527 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $320,038 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,584 | BOYAmt |
| EOY | $6,437,489 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $41,203 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $449,761 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,110,293 | BOYAmt |
| EOY | $9,643,023 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $603,926 | BOYAmt |
| EOY | $1,469,291 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,051,512 | BOYAmt |
| EOY | $9,208,262 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,616 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,298 | BOYAmt |
| EOY | $982,785 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,943,352 | BOYAmt |
| EOY | $11,660,338 | 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 | $1,166,941 | BOYAmt |
| EOY | -$2,017,315 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,166,941 | BOYAmt |
| EOY | -$2,017,315 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,110,293 | BOYAmt |
| EOY | $9,643,023 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,633,878 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$550,378 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $400,000 | OtherCostOrOtherBasisAmt |
| Book Value | $400,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,877,180 | OtherCostOrOtherBasisAmt |
| Depreciation | $80,905 | DepreciationAmt |
| Book Value | $3,796,275 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,480,347 | OtherCostOrOtherBasisAmt |
| Depreciation | $239,133 | DepreciationAmt |
| Book Value | $2,241,214 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,437,489 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO CITY | Desc |
| Amt | $982,785 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $982,785 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | Yes (1) | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $184,709 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,174,906 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,107,964 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,016,973 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,292,673 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,191,879 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,292,673 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,191,879 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,113,583 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,054,156 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,122,298 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,068,142 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | PINEVILLE COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVE | AddressLine1Txt |
| City | PINEVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40977 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.PINEVILLEHOSPITAL.ORG/ | WebsiteAddressTxt |
| State License | 100020 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINEVILLE COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (1) | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | WWW.PINEVILLEHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.PINEVILLEHOSPITAL.ORG | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 | HTTPS://WWW.PINEVILLEHOSPITAL.ORG/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.PINEVILLEHOSPITAL.ORG/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.PINEVILLEHOSPITAL.ORG/FINANCIAL-ASSISTANCE | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PINEVILLE COMMUNITY HEALTH CENTER | PART V, SECTION B, LINE 5: THE COMMUNITY STEERING COMMITTEE PLAYS A VITAL ROLE TO THE CHNA PROCESS. CEDIK PROVIDES A LIST OF COMMUNITY LEADERS, AGENCIES AND ORGANIZATIONS TO THE HOSPITAL TO ASSIST THEM IN THE RECRUITMENT OF MEMBERS THAT WOULD FACILITATE BROAD COMMUNITY INPUT. THESE COMMITTEE MEMBERS REPRESENT ORGANIZATIONS AND AGENCIES THAT SERVE THE BELL COUNTY POPULATION IN A VARIETY OF AREAS THAT RELATE TO A POPULATIONS HEALTH.IN JULY 2020, MEMBERS OF THE PCHC, INC. CHNA STEERING COMMITTEE PARTICIPATED IN A FOCUS GROUP FOR THIS COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMITTEE MEMBERSHIP INCLUDES REPRESENTATION FROM THE HEALTH DEPARTMENT, BEHAVIORAL HEALTH, PUBLIC SCHOOLS, FAMILY RESOURCE CENTERS, COOPERATIVE EXTENSION AND COMMUNITY BASED SERVICES. THEMEMBERS BRING KNOWLEDGE AND EXPERTISE RELATED TO HEALTH NEEDS OF THE POPULATIONS THEY SERVE.IN ADDITION, A TOTAL OF THREE KEY INFORMANT INTERVIEWS WERE COMPLETED IN LATE SUMMER AND FALL OF 2020. |
| PINEVILLE COMMUNITY HEALTH CENTER | PART V, SECTION B, LINE 16J: INFORMATION ON THE PINEVILLE COMMUNITY HEALTH CENTER FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ON HOW TO CONTACT PINEVILLE COMMUNITY HEALTH CENTER FOR ASSISTANCE AND FURTHER INFORMATION, AS WELL AS INFORMATION ON PAYMENT OPTIONS, WILL BE POSTED IN HOSPITAL AND CLINIC REGISTRATION AND ADMITTING LOCATIONS, AND IN THE HOSPITAL EMERGENCY DEPARTMENT AND ON PATIENT STATEMENTS. THIS INFORMATION MAY ALSO BE OBTAINED FROM FINANCIAL COUNSELORS THROUGHOUT THE ORGANIZATION.THE PINEVILLE COMMUNITY HEALTH CENTER FINANCIAL ASSISTANCE POLICY, APPLICATION, PLAIN LANGUAGE SUMMARY, BILLING AND COLLECTIONS POLICY; AND SELF-PAY POLICY WILL BE AVAILABLE IN THE BUSINESS OFFICE. THIS INFORMATION IS ALSO AVAILABLE FREE OF CHARGE. IF YOU NEED HELP IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION, YOU MAY CALL (606)337-3051 TO SPEAK WITH A FINANCIAL COUNSELOR.IN ADDITION, PINEVILLE COMMUNITY HEALTH CENTER INCLUDES REFERENCE TO PAYMENT POLICIES AND FINANCIAL ASSISTANCE ON ALL PRINTED PINEVILLE COMMUNITY HEALTH CENTER MONTHLY PATIENT STATEMENTS AND COLLECTION LETTERS. INFORMATION ON THE PINEVILLE COMMUNITY HEALTH CENTER FINANCIAL ASSISTANCE POLICY IS AVAILABLE, AT ANY TIME, UPON PATIENT REQUEST. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - TOTAL CARE RURAL HEALTH CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 VIRGINIA AVENUE | AddressLine1Txt |
| City | PINEVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40977 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 3: | THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS WERE TAKEN DIRECTLY OFF MEDICARE COST REPORT FILED WITH THE 6/30/21 YEAREND. |
| PART III, LINE 9B: | ALL UNINSURED PATIENTS RECEIVED AN AUTOMATIC DISCOUNT FROM GROSS CHARGES. AT REGISTRATION, PATIENTS ARE NOTIFIED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEY ARE OFFERED PAMPHLETS DETAILING THE PROGRAM. IF THE PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE AND IS APPROVED FOR FINANCIAL ASSISTANCE, THE PATIENT WILL RECEIVE A DISCOUNT OF 100% ON THE OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL ATTEMPT TO COLLECT ANY BALANCE REMAINING ON THE UNINSURED ACCOUNT AFTER ALL FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED USING A SERIES OF STATEMENTS, LETTERS, AND TELEPHONE CALLS. THE HOSPITAL WILL ALSO OFFER PATIENTS INTEREST-FREE EXTENDED PAYMENT PLANS. IF THE ACCOUNT REMAINS UNPAID, THE ACCOUNT MAY BE TURNED OVER TO A COLLECTION AGENCY. |
| PART VI, LINE 3: | -AT THE TIME OF REGISTRATION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS DISCUSSED WITH EACH PATIENT. THE PATIENT IS OFFERED A PAMPHLET REGARDING THE POLICY, ELIGIBILITY REQUIREMENTS AND THE ASSOCIATED APPLICATION PROCESS. THE PATIENT MUST SIGN A FORM INDICATING THAT THEY RECEIVED THIS INFORMATION.-THE HOSPITAL HAS A REPRESENTATIVE ON SITE TO ASSIST PATIENTS WITH THE FINANCIAL AID APPLICATION PROCESS.-PATIENTS ARE REMINDED TO CONTACT CUSTOMER SERVICE REGARDING FINANCIAL AID AND FEDERAL/STATE ASSISTANCE DIRECTLY ON THE PATIENT BILL ITSELF.-THE HOSPITAL'S WEBSITE HAS A LINK TO THE FINANCIAL AID APPLICATION. |
| PART VI, LINE 4: | AS OF THE CENSUS OF 2000, THERE WERE 2,093 PEOPLE, 871 HOUSEHOLDS, AND 518 FAMILIES RESIDING IN THE CITY. THE POPULATION DENSITY WAS 1,452.1 PEOPLE PER SQUARE MILE. THERE WERE 961 HOUSING UNITS AT AN AVERAGE DENSITY OF 666.7 PER SQUARE MILE. THE RACIAL MAKEUP OF THE CITY WAS 92.74% WHITE, 4.30% AFRICAN AMERICAN, 0.24% NATIVE AMERICAN, 0.24% ASIAN, 0.14% FROM OTHER RACES, AND 2.34% FROM TWO OR MORE RACES. HISPANIC OR LATINO OF ANY RACE WERE 0.91% OF THE POPULATION.THERE WERE 871 HOUSEHOLDS OUT OF WHICH 27.6% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 34.6% WERE MARRIED COUPLES LIVING TOGETHER, 20.8% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 40.5% WERE NON-FAMILIES. 38.6% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 20.1% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.17 AND THE AVERAGE FAMILY SIZE WAS 2.90.IN THE CITY, THE POPULATION WAS SPREAD OUT WITH 22.5% UNDER THE AGE OF 18, 8.6% FROM 18 TO 24, 24.2% FROM 25 TO 44, 24.9% FROM 45 TO 64, AND 19.8% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 40 YEARS. FOR EVERY 100 FEMALES, THERE WERE 82.0 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER, THERE WERE 76.1 MALES.THE MEDIAN INCOME FOR A HOUSEHOLD IN THE CITY WAS $12,435, AND THE MEDIAN INCOME FOR A FAMILY WAS $20,625. MALES HAD A MEDIAN INCOME OF $24,125 VERSUS $23,229 FOR FEMALES. THE PER CAPITA INCOME FOR THE CITY WAS $12,692. ABOUT 37.1% OF FAMILIES AND 44.2% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 58.8% OF THOSE UNDER AGE 18 AND 30.0% OF THOSE AGE 65 OR OVER. |
| PART VI, LINE 6: | NA |
| PART VI, LINE 7, REPORTS FILED WITH STATES | KY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERRY NICHOLS | PersonNm |
| Title | CEO (TERM 12/2020 - 9/2021) | TitleTxt |
| Base Compensation Filing Org | $150,654 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $12,000 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $3,234 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $165,888 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KATHERINE REESE | |||
| BOARD MEMBER OWNS BANK | $0 | BOARD MEMBER KATHERINE REESE OWNS FIRST STATE BANK OF THE SOUTHEAST IN WHICH PINEVILLE COMMUNITY HEALTH CENTER HAS A FULLY UTILIZED LINE OF CREDIT IN THE AMOUNT OF $2,500,000 | 0 |
| KEN JONES | |||
| BOARD MEMBER IS PRESIDENT OF BANK | $0 | BOARD MEMBER KEN JONES IS PRESIDENT OF FIRST STATE BANK OF THE SOUTHEAST IN WHICH PINEVILLE COMMUNITY HEALTH CENTER HAS A FULLY UTILIZED LINE OF CREDIT IN THE AMOUNT OF $2,500,000 | 0 |
| VELUPILLAI WIGNAKUMAR | |||
| BOARD MEMBER IS OWNER OF ER COMPANY | $0 | BOARD MEMBER VELUPILLAI PROVIDED ON-CALL SERVICES AND OWNS THE ER COMPANY WHICH BILLS PINEVILLE COMMUNITY HEALTH CENTER ANNUAL FEES OF $1,296,204. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | THE BUSINESS AFFAIRS OF THE HOSPITAL ARE MANAGED BY THE BOARD OF DIRECTORS WHICH DOES NOT DELEGATE AUTHORITY TO COMMITTEES. THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE GOVERNING BODY RECEIVES AND REVIEWS A COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW. FOR FYE 6.30.2021 THE BOARD WILL REVIEW THE 990 AT THE NEXT SCHEDULED BOARD MEETING WHICH IS AFTER THE FILING DATE. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE THEIR PERSONAL INFLUENCE ON THE MATTER, AND HE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. THE FOREGOING REQUIREMENTS SHOULD NOT BE AS PREVENTING THE GOVERNING BOARD MEMBERS FROM BRIEFLY STATING THEIR POSITION IN THE MATTER, FROM ANSWERING PERTINENT QUESTIONS OF OTHER BOARD MEMBERS SINCE THEIR KNOWLEDGE MAY BE OF GREAT ASSISTANCE. THE POLICY WILL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF GOVERNING BOARD MEMBERS AND THAT ANY NEW MEMBER BE ADVISED OF THE POLICY UPON ENTERING THE DUTIES OF THEIR OFFICE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,762,611. MANAGEMENT AND GENERAL EXPENSES 311,049. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,073,660. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 346,265. MANAGEMENT AND GENERAL EXPENSES 61,106. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 407,371. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 339,453. MANAGEMENT AND GENERAL EXPENSES 59,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 399,356. |