2022-06-15T07:45:59-05:00 2021-06-30 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2020-07-01 841949748 PINEVILLE COMMUNITY HEALTH CENTER INC PINE 6063373051 850 RIVERVIEW AVENUE PINEVILLE KY 40977 KEVIN COUCH ADMINISTRATOR/CFO 6063373051 2022-06-13 1 KEVIN COUCH 999009999 CARRIE A MERRILL CPA P00832283 5029923500 2022-06-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KEVIN COUCH 850 RIVERVIEW AVENUE PINEVILLE KY 40977 10662403 0 X WWW.PINEVILLEHOSPITAL.ORG X 2019 KY PINEVILLE COMMUNITY HEALTH CENTER, INC PROVIDES MEDICAL SERVICES TO THE COMMUNITY. 9 9 189 0 0 0 4409289 393149 4155891 7297090 13619 542 540149 2971622 9118948 10662403 0 100 0 0 4068699 6349128 0 0 0 3814972 6947053 7883671 13296281 1235277 -2633878 5110293 9643023 3943352 11660338 1166941 -2017315 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. 0 0 11465599 100 10209947 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. 11465599 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 47 0 1 189 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 KY X DALE FARRELL 6063373051 850 RIVERVIEW AVENUE PINEVILLE KY 40977 KATHERINE REESE CHAIRMAN 2.00 X 0 0 0 DENISE SHUMATE BOARD DIRECTOR 2.00 X 0 0 0 KEN JONES BOARD DIRECTOR 2.00 X 0 0 0 RUSSELL THOMPSON BOARD DIRECTOR 2.00 X 0 0 0 KELLY UPCHURCH BOARD DIRECTOR 2.00 X 0 0 0 VELUPILLAI WIGNAKUMAR BOARD DIRECTOR (TERM END 2/25/21) 2.00 X 0 0 0 ALAN COPPOCK BOARD DIRECTOR (TERM END 12/31/21) 2.00 X 0 0 0 TERRY NICHOLS CEO (TERM 12/2020 - 9/2021) 40.00 X 162654 0 3234 KEVIN COUCH ADMINISTRATOR/CFO 40.00 X 85010 0 5677 MARY BISHOP CNO 40.00 X 75691 0 0 CAROL AYERS PHARMD 40.00 X 114192 0 4102 437547 0 13013 2 0 1 0 PINEVILLE ER SERVICES 1625 NICHOLASVILLE RD 201 LEXINGTON KY 40503 PHYSICIAN STAFFING 854418 CPSI PO BOX 850309 MOBILE AL 36685 IT SERVICES 375552 RNR PSYCHIATRIC HEALTHCARE 3213 CASHIERS CT LEXINGTON KY 40513 PHYSICIAN STAFFING 130000 3 393149 393149 NET PATIENT SERVICE REVENUE 900099 7297090 7297090 7297090 542 542 143709 0 143709 143709 143709 DSH REVENUE 900099 2769148 2769148 MISCELLANEOUS 900099 58765 58765 2827913 10662403 10209947 0 59307 X 100 100 323355 274852 48503 5307639 4511493 796146 329741 280280 49461 388393 330134 58259 33824 33824 46383 46383 2880387 2448329 432058 7705 6549 1156 118619 100826 17793 363241 308755 54486 439473 373552 65921 40552 34469 6083 323589 275051 48538 316622 269129 47493 267368 227263 40105 MEDICAL SUPPLIES 1367293 1367293 REPAIRS AND MAINTENANCE 305537 259706 45831 PROVIDER HRIP TAX 178846 178846 DUES AND SUBSCRIPTIONS 57973 49277 8696 199641 169695 29946 13296281 11465599 1830682 0 138733 227292 2765499 292275 1403806 2342005 295971 254268 22939 48491 6757527 320038 33584 6437489 41203 449761 0 5110293 9643023 603926 1469291 3051512 9208262 47616 0 240298 982785 3943352 11660338 X 1166941 -2017315 1166941 -2017315 5110293 9643023 -2633878 -550378 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 400000 400000 3877180 80905 3796275 2480347 239133 2241214 6437489 DUE TO CITY 982785 982785 1 1 1 X 1 X 0 1 1 1 0 184709 2174906 0 0.00000 4107964 4016973 90991 0.00680 4292673 6191879 90991 0.00680 4292673 6191879 90991 0.00680 1 1113583 0 3054156 4122298 -1068142 X 1 1 1 1 PINEVILLE COMMUNITY HEALTH CENTER INC 850 RIVERVIEW AVE PINEVILLE KY 40977 HTTPS://WWW.PINEVILLEHOSPITAL.ORG/ 100020 X PINEVILLE COMMUNITY HEALTH CENTER 1 1 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.PINEVILLEHOSPITAL.ORG X 1 19 1 WWW.PINEVILLEHOSPITAL.ORG 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.PINEVILLEHOSPITAL.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.PINEVILLEHOSPITAL.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.PINEVILLEHOSPITAL.ORG/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X 1 X 0 0 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. 1 1 - TOTAL CARE RURAL HEALTH CLINIC 121 VIRGINIA AVENUE PINEVILLE KY 40977 RURAL HEALTH CLINIC 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 0 0 0 0 0 0 0 0 0 TERRY NICHOLS CEO (TERM 12/2020 - 9/2021) 150654 0 12000 0 0 0 0 0 3234 0 165888 0 0 0 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 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.