2022-08-15T11:47:36-05:00 2021-09-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2020-10-01 453215312 PORTSMOUTH HOSPITAL CORPORATION PORT 7409914000 1901 ARGONNE AVENUE PORTSMOUTH OH 45662 AUTUMN MCFANN TREASURER 7409914000 2022-08-12 1 AUTUMN MCFANN 999009999 KERRI N BOGDA CPA P00760402 7177404863 X 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KING'S DAUGHTERS MEDICAL CENTER OHIO KRISTIE WHITLATCH 2201 LEXINGTON AVENUE ASHLAND KY 41101 32228417 0 X WWW.KINGSDAUGHTERSHEALTH.COM/LOCATIONS X 2010 OH TO CARE. TO SERVE. TO HEAL. 8 8 187 8 0 0 2103715 1780822 21269778 30000362 0 -22767 0 0 23373493 31758417 0 7261 0 0 9968655 11293508 0 0 0 11667489 12986055 21636144 24286824 1737349 7471593 24693703 28952850 31275229 3999368 -6581526 24953482 X 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. 0 0 21623881 7261 30000362 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. 21623881 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 187 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X LAURIE STEWART CONTROLLER 6064089640 2201 LEXINGTON AVENUE ASHLAND KY 41101 KRISTIE WHITLATCH NON-VOTING PRESIDENT 1.25 60.75 X X 0 935505 40469 AUTUMN MCFANN NON-VOTING TREASURER 1.25 60.75 X X 0 488592 37309 SHERYL MAHANEY NON-VOTING SECRETARY 1.25 60.75 X X 0 482139 43259 DAVID JONES BOARD CHAIRMAN 0.25 6.25 X X 0 0 0 MARK NEWMAN BOARD VICE CHAIR 0.25 6.25 X X 0 0 0 STEPHEN ADDINGTON DIRECTOR 0.25 2.50 X 0 0 0 MARK BIRDWHISTELL DIRECTOR 0.25 2.50 X 0 0 0 TOM BURNETTE DIRECTOR 0.25 2.50 X 0 0 0 CRAIG COLLINS DIRECTOR 0.25 2.50 X 0 0 0 ERIC MONDAY DIRECTOR 0.25 2.50 X 0 0 0 JOHN STEWART DIRECTOR 0.25 2.50 X 0 0 0 SARA MARKS VP/COO 1.25 60.50 X 0 421725 47343 KEVIN MARSHALL CNO/ADMINISTRATOR 45.00 X 124641 0 32771 CRAIG HAZELBAKER PHARMACY SUPERVISOR 40.00 X 151286 0 26551 TAMALA CONLEY EXECUTIVE DIRECTOR PHC (7/21 - 9/21) 10.00 40.00 X 0 147701 39362 MELISSA WATSON PHARMACIST 40.00 X 100696 58305 26910 JAMES NEAL CNO/ADMINISTRATOR 45.00 X 101791 0 32892 478414 2533967 326866 4 0 1 0 RIVERSIDE ANESTHESIA PSC 425 LEWIS HARGETT CIRCLE LEXINGTON KY 40503 ANESTHESIA SERVICES 978642 TONY VIRGIN MD BOX 8 STATE ROUTE 141 KITTS HILL OH 45645 PHYSICIAN 140564 CHARLES CONLEY DO 540 EVES COURT ASHLAND KY 41101 PHYSICIAN 103320 3 1780822 1780822 NET PATIENT REVENUE 621110 29680362 29680362 PHARMACY REVENUE 621110 320000 320000 30000362 447233 470000 -22767 -22767 -22767 31758417 30000362 0 -22767 7261 7261 8951150 7885962 1065188 401579 353791 47788 1320100 1163008 157092 620679 533722 86957 241740 241740 1055 1055 2260735 2061550 199185 750 582 168 127471 98758 28713 523105 523105 1245 1192 53 42597 42597 1617556 1617556 94379 94379 MEDICAL SUPPLIES 5340884 5235891 104993 BAD DEBT EXPENSE 1553541 1553541 REPAIRS AND MAINTENANCE 924538 874161 50377 RENTAL FEES 153302 153302 103157 82549 20608 24286824 21623881 2662943 0 306710 398914 3007509 4181920 1337601 2306682 79877 99237 40551562 18615760 19655113 21935802 306893 30295 24693703 28952850 1427680 2963587 29847549 1035781 31275229 3999368 X -6581526 24953482 -6581526 24953482 24693703 28952850 X 7471593 24063415 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 1055 1055 0 PART II-B, LINE 1: $1,055: A PORTION OF THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING EXPENSES. 22196168 4964317 17231851 16392611 12917510 3475101 1962783 733933 1228850 21935802 LEASE LIABILITY 26173 DUE TO MEDICARE 1009608 1035781 X PART X, LINE 2: 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. 1 1 X 1 X 1 X 1 1 0 1 1 40692 40692 0.00180 6065751 6058234 7517 0.00030 6106443 6058234 48209 0.00210 70924 70924 0.00310 11010 11010 0.00050 81934 81934 0.00360 6188377 6058234 130143 0.00570 1 594109 4581561 5442484 -860923 X 1 1 1 1 PORTSMOUTH HOSPITAL CORPORATION 1901 ARGONNE RD PORTSMOUTH OH 45662 WWW.KDMCOHIO.COM X X X URGENT CARE - 24 HOURS PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X WWW.KINGSDAUGHTERSHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 18 1 KINGSDAUGHTERSHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES/ X KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES/ X KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES/ X X X X X X 1 X 0 X X X 1 X 0 1 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 SCIOTO COUNTY 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: IN 2019, KDOH CONDUCTED A NEW CHNA, THROUGH WHICH FIVE PRIMARY NEEDS WERE IDENTIFIED OBESITY; TOBACCO USE/SMOKING; CARDIOVASCULAR DISEASE; CANCER; AND DIABETES. THE HOSPITAL DEVELOPED AN IMPLEMENTATION PLAN, WHICH COVERS TWO YEARS, TO ADDRESS THESE NEEDS. EACH NEED WAS ADDRESSED USING MULTIPLE APPROACHES, AS FOLLOWS:- OBESITY/NUTRITION: KDOH IS ADDRESSING OBESITY/NUTRITION THROUGH EDUCATION PROGRAMS AT SCHOOLS, COMMUNITY EVENTS, COUNTY FAIRS AND THE LOCAL FARMER'S MARKET. DUE TO COVID-19, KDOH TOOK THEIR NUTRITION PROGRAMS MOBILE THROUGH A MOBILE MARKET THAT PROVIDED EDUCATION AND HEALTHY FOODS. KDMC ALSO IS ADDRESSING FOOD INSECURITY THROUGH PROGRAMS THAT HELP FEED PEOPLE INCLUDING FOOD DRIVES AND DONATIONS. IN ADDITION TO ADDRESS OBESITY, KDOH IS SUPPORTING PHYSICAL OPPORTUNITIES IN THE COUNTY.- HEART DISEASE: HEART DISEASE IS THE NUMBER ONE CAUSE OF DEATH IN THE COUNTY. TO ADDRESS HEART DISEASE, KDOH IS PROVIDING FREE HEALTHY HEART SCREENINGS (INCLUDES CHOLESTEROL, BLOOD SUGAR AND BLOOD PRESSURE SCREENINGS). IN ADDITION, HEART EDUCATION IS BEING PROVIDED WHICH FOCUSES ON PREVENTION AND THE SIGNS AND SYMPTOMS OF A HEART ATTACK.- CANCER PREVENTION/EARLY DETECTION (INCLUDING TOBACCO USE): KDOH ADOPTED STRATEGIES TO HELP REDUCE THE OVERALL CANCER DEATH RATE IN THE COUNTY. USING AN EARLY DETECTION THROUGH SCREENING APPROACH, KDOH IS WORKING TO INCREASE SCREENINGS FOR LUNG, COLON, AND BREAST CANCERS. IN ADDITION, KDOH IS WORKING TO REDUCE TOBACCO USE THROUGH EDUCATION, PREVENTION AND CESSATION PROGRAMS.KDOH ADDRESSED ALL OF THE SIGNIFICANT NEEDS IDENTIFIED THROUGH THE CHNA. 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. 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 $1,553,541. 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. THE BUSINESS OFFICE DOES NOT KEEP TRACK OF "NO-RESPONSE" APPLICATIONS ANNUALLY 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: KING'S DAUGHTERS CONDUCTED A COMMUNITY HEALTH NEED ASSESSMENT (CHNA) IN PARTNERSHIP WITH SOUTHERN OHIO MEDICAL CENTER AND THE PORTSMOUTH AND SCIOTO COUNTY HEALTH DEPARTMENTS. ALSO INVOLVED IN THE PROCESS WAS THE SCIOTO COUNTY HEALTH COALITION THE ASSESSMENT WAS CONDUCTED FROM NOVEMBER 2018-MAY 2019. THE GOALS OF THE ASSESSMENT PROCESS WERE TO: -DETERMINE WHAT VARIOUS AGENCIES WERE DOING TO MEET AND/OR IMPROVE HEALTHCARE NEEDS IN THE COMMUNITIES KDOH SERVES. -LEARN MORE ABOUT WHAT HEALTHCARE NEEDS ARE NOT BEING MET AND WHY. -DETERMINE STRENGTHS AND WEAKNESS OF CURRENT RESOURCES. -INVESTIGATE WHAT ELSE CAN BE DONE TO IMPROVE THE HEALTH OF THE COMMUNITY. KING'S DAUGHTERS USED THE FOLLOWING TO GATHER INFORMATION FOR THE ASSESSMENT: -PRIMARY DATA COLLECTED BY PRC CONSULTING WHICH COVERED COMMUNITY AND KEY INFORMANT SURVEYS -SECONDARY DATA WAS COLLECTED FROM LOCAL, STATE AND NATIONAL SOURCES 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: SCIOTO COUNTY COVERS MORE THAN 610 SQUARE MILES, WITH A POPULATION DENSITY OF 123 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 2020 SURVEY, SCIOTO COUNTY HAS 75,314 RESIDENTS. OF THE RESIDENTS, 94.4% ARE WHITE, 2.7% BLACK, AND 2.9% REPRESENT ALL OTHER RACES. FIFTEEN PERCENT OF RESIDENTS OVER THE AGE OF 24 HAVE NOT GRADUATED HIGH SCHOOL, COMPARED TO 9.6% IN OHIO AND 12% NATIONALLY. ACCORDING TO THE US CENSUS BUREAU, THE COUNTY HAS 94.4% WHITE, 2.7% BLACK AND 1.4% HISPANIC. SCIOTO COUNTY'S POVERTY RATE OF 21.9% IS HIGHER THAN OHIO (12.6%) AND THE NATION (11.9%). THE MEDIAN INCOME FOR THE COUNTY IS $41,530, WHICH IS WELL BELOW THE STATE ($56,602) AND NATION ($60,293). PER-CAPITA INCOME IN THE COUNTY IS $23,719; COMPARED TO $31,552 FOR OHIO AND $32,621 FOR THE UNITED STATES. THE US CENSUS, SHOWS THAT 8.3% OF THE COUNTY RESIDENTS UNINSURED, COMPARED TO 7.8% IN OHIO AND 10.2% 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, BUT ARE NOT SPECIFIC TO THE IMPLEMENTATION PLAN GOALS AND OBJECTIVES WERE PROVIDED:1) COVID RESPONSE: IN RESPONSE TO THE PANDEMIC, KDOH PROVIDED ACCESS TO COVID-19 SCREENING WITH MORE THAN 21,500 TESTS PROVIDED. IN ADDITION, TO SUPPORT THE EFFORTS OF THE COMMUNITY KDOH PROVIDED THERE WERE 238 COVID-19 VACCINATIONS PROVIDED.2)OTHER SCREENING AND HEALTH EDUCATION ACTIVITIES:SCREENINGS, IMMUNIZATIONS AND PHYSICALS:- FLU SHOTS 154 PROVIDED- HEALTHY HEART SCREENING 498 ADULTS SERVED- SPORTS PHYSICALS- 317 SERVED- LOW-COST BLOOD PROFILES 513 SERVEDHEALTH EDUCATION:- ALCOHOL AND OTHER DRUGS 259 SERVED- BONE HEALTH 43 SERVED- CONGESTIVE HEART FAILURE 171 SERVED- DENTAL HEALTH 43 SERVED- DIABETES - 1,724 SERVED- FIRST AID 39 SERVED- FLU 7 ADULTS; 42 CHILDREN/YOUTH SERVED- HANDWASHING 1,627 ADULTS; 1,588 CHILDREN/YOUTH SERVED- HYPERTENSION 215 ADULTS SERVED- SAFE MEDICATION PRACTICES 125 ADULTS SERVED- SKIN CANCER 193 ADULTS; 70 CHILDREN/YOUTH SERVED- SMOKELESS TOBACCO/VAPING 171 ADULTS SERVED- SUBSTANCE USE DISORDER4 1,072 ADULTS AND 780 YOUTH SERVED- SUMMER SAFETY 76 SERVEDOTHER COMMUNITY ACTIVITIES:- BLOOD DRIVES- KDOH PARTNERED WITH THE KENTUCKY BLOOD BANK TO INCREASE BLOOD DONATIONS BY ENCOURAGING TEAM MEMBERS TO PARTICIPATE IN LOCAL BLOOD DRIVES DURING WORK HOURS.- BACKPACK PROGRAM-TEAM MEMBERS DONATED OVER 100 ITEMS OF SCHOOL SUPPLIES, DISINFECTING, AND MASKS TO PORTSMOUTH EAST ELEMENTARY SCHOOL CHILDREN TO ENSURE STUDENTS START THE YEAR WITH THE NECESSARY SCHOOL SUPPLIES.- ADOPT-A-FAMILY-TEAM MEMBERS ADOPTED TWO FAMILIES WITH A TOTAL OF FIFTEEN FAMILY MEMBERS AT CHRISTMAS PROVIDING GIFTS AND FOOD.SALVATION ARMY-COVID-19 PREVENTED KDOH TEAM MEMBERS FROM DONATING TIME AT THE SALVATION ARMY CHRISTMAS EVENT BUT FOOD AND GIFTS WERE PROVIDED. 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. 0 1 0 0 0 0 0 1 0 KRISTIE WHITLATCH NON-VOTING PRESIDENT 0 677159 0 188424 0 69922 0 24625 0 15844 0 975974 0 33599 AUTUMN MCFANN NON-VOTING TREASURER 0 368175 0 105244 0 15173 0 21375 0 15934 0 525901 0 0 SHERYL MAHANEY NON-VOTING SECRETARY 0 337930 0 106630 0 37579 0 24625 0 18634 0 525398 0 27204 SARA MARKS VP/COO 0 318464 0 99059 0 4202 0 21375 0 25968 0 469068 0 0 TAMALA CONLEY EXECUTIVE DIRECTOR PHC (7/21 - 9/21) 0 128850 0 18302 0 549 0 11365 0 27997 0 187063 0 0 MELISSA WATSON PHARMACIST 97812 58274 2814 0 70 31 11988 0 11048 3874 123732 62179 0 0 CRAIG HAZELBAKER PHARMACY SUPERVISOR 146826 0 4053 0 407 0 11396 0 15155 0 177837 0 0 0 KEVIN MARSHALL CNO/ADMINISTRATOR 112931 0 11513 0 197 0 7568 0 25203 0 157412 0 0 0 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, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: - KRISTIE WHITLATCH: $26,376; - AUTUMN MCFANN: $14,333; - SHERYL MAHANEY: $6,828; - SARA MARKS: $3,362 THE FOLLOWING INDIVIDUALS RECEIVED 457(F) EXECUTIVE RETENTION PLAN PAYOUTS: - KRISTIE WHITLATCH: $33,599; - SHERYL MAHANEY: $27,204; 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. 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. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE APRIL 2021, 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. IN JANUARY 2021, MERCER PERFORMED A REIVEW 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 DUE TO RESTRUCTURING 24,063,415. FORM 990, PART XII, LINE 3B: THE ORGANIZATION AND AFFILIATES RECEIVED FEDERAL FUNDING DURING THE YEAR WHICH REQUIRES A SINGLE AUDIT. THE AUDIT IS SCHEDULED TO BE COMPLETED IN ACCORDANCE WITH THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. 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 FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) LINE 12B, II ASHLAND HOSPITAL COPORATION 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 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 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 611079090 RENTALS KY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1