GRAYSON CO HOSPITAL FOUNDATION INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- GRAYSON CO HOSPITAL FOUNDATION INC (EIN 61-0523298)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202211369349312016
- Schema version
- 2020v4.0
- Note
- A later return for the same period supersedes this one.
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T15:26:18-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 611189912 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BUCKLES TRAVIS & HART PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 4069 | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 427554069 | 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 | 610523298 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GRAY | BusinessNameControlTxt |
| Phone | 6159488046 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E MARKET STREET | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TREVOR RAY | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 6159488046 | PhoneNum |
| Signature | 2022-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TREVOR | PersonFirstNm |
| Person Last | RAY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRADLEY K TRAVIS | PreparerPersonNm |
| PTIN | P01224802 | PTIN |
| Phone | 2702595604 | PhoneNum |
| Preparation | 2022-05-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DBA TWIN LAKES REGIONAL MEDICAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TREVOR RAY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E MARKET ST | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,466,171 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TLRMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY MEDICAL HEALTHCARE TO THE GRAYSON COUNTY, KENTUCKY AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 557 | TotalEmployeeCnt |
| Total Volunteers | 28 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $4,300,017 | PYContributionsGrantsAmt |
| CY Contributions Grants | $13,167 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $42,848,332 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,072,214 | CYProgramServiceRevenueAmt |
| PY Investment Income | $201,140 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,130,270 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,287,778 | PYOtherRevenueAmt |
| CY Other Revenue | $7,077,945 | CYOtherRevenueAmt |
| PY Total Revenue | $49,637,267 | PYTotalRevenueAmt |
| CY Total Revenue | $37,293,596 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,849,762 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,710,641 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,178,666 | PYOtherExpensesAmt |
| CY Other Expenses | $20,781,411 | CYOtherExpensesAmt |
| PY Total Expenses | $43,028,428 | PYTotalExpensesAmt |
| CY Total Expenses | $28,492,052 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,608,839 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,801,544 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $125,887,436 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,653,942 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $21,683,488 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,175,404 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $104,203,948 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,478,538 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY MEDICAL HEALTHCARE TO THE GRAYSON COUNTY, KENTUCKY AREA. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,232,154 | ExpenseAmt |
| Revenue | $22,072,214 | RevenueAmt |
| Desc | TWIN LAKES REGIONAL MEDICAL CENTER PROVIDES QUALITY MEDICAL HEALTH CARE SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR THE ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND FINANCIAL STABILITY OF TWIN LAKES REGIONAL MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THIS AREA, THE HOSPITAL PROVIDES FREE CARE TO THE MOST INDIGENT OF PATIENTS AND WRITES OFF PORTIONS OF BILLS TO OTHER PATIENTS WHO HAVE DEMONSTRATED THE INABILITY TO PAY FOR ALL HEALTH CARE SERVICES RECEIVED. A LETTER OF INTENT WAS SIGNED ON APRIL 13, 2020 TO TRANSFER THE OPERATING ASSETS OF THE GRAYSON COUNTY HOSPITAL FOUNDATION, INC. (THE "HOSPITAL") AND THE TWIN LAKES MEDICAL FOUNDATION, INC. TO OWENSBORO HEALTH, INC., A NOT FOR PROFIT HEALTH SYSTEM. THE TRANSACTION WAS FINALIZED AND BECAME EFFECTIVE JANUARY 1, 2021. UNDER THE TERMS OF THE AGREEMENT, A PORTION OF THE PROCEEDS WERE USED TO SATISFY THE OUTSTANDING BONDS ISSUED BY THE GRAYSON COUNTY PUBLIC HOSPITAL DISTRICT CORPORATION (THE "CORPORATION"). UPON THE DEFEASANCE OF THE BONDS, THE LAND AND FACILITIES OWNED BY THE CORPORATION WERE TRANSFERRED TO A NEW CORPORATION FORMED BY OWENSBORO HEALTH, OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INC., TO OPERATE THE HOSPITAL. THE NET PROCEEDS FROM THE TRANSACTION AND RETAINED ASSETS WERE TRANSFERRED TO THE GRAYSON COUNTY HEALTHCARE FOUNDATION, INC., A NEW NOT FOR PROFIT CORPORATION FORMED TO PROVIDE GRANTS AND SUPPORT HEALTHCARE IN THE COUNTY. DURING THE SIX MONTHS OF THE FISCAL YEAR THE FOUNDATION OPERATED, CHARGES WERE WRITTEN OFF DUE TO AGREEMENTS WITH MEDICARE, MEDICAID, AND OTHER THIRD PARTIES. THE TOTAL UNREIMBURSED CHARGES FORGONE IN FISCAL YEAR 2021 DUE TO CONTRACTUAL AGREEMENTS WITH PAYERS AMOUNTED TO 53,393,618. ALSO, 392,330 WAS PAID AS A "PROVIDER TAX" TO THE COMMONWEALTH OF KENTUCKY TO HELP DEFRAY THE COSTS OF COVERING INDIGENT PATIENTS UNDER A SPECIAL STATE PROGRAM. WRITE-OFFS FROM PATIENTS "UNWILLING" TO PAY - I.E. BAD DEBTS - ACCOUNTED FOR 2,539,487. THE PRIMARY MISSION OF TWIN LAKES REGIONAL MEDICAL CENTER IS TO HEAL THE SICK, RELIEVE PAIN AND SUFFERING, AND IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE WE SERVE. TLRMC'S VISION IS TO BE RECOGNIZED BY THE PEOPLE WE SERVE AS THE PROVIDER OF CHOICE FOR THEIR HEALTH CARE NEEDS AND AS A LEADING FORCE FOR PROGRESSIVE CHANGE WITHIN OUR COMMUNITY. TO ENHANCE QUALITY, THE HOSPITAL ACTIVELY OPERATES A PERFORMANCE IMPROVEMENT PROGRAM WHICH HELPS IDENTIFY BETTER PATIENT CARE AS WELL AS EFFICIENCIES IN OPERATIONS. TO ENHANCE OUR COMMUNITY, TLRMC PROVES TO BE A DRIVING FORCE IN CHANGE BY EDUCATING THE COMMUNITY ON HEALTH & WELLNESS ISSUES AND BY RECOGNIZING COMMUNITY NEEDS AND WORKING TO FULFILL THOSE NEEDS. THE HOSPITAL CARED FOR 976 INPATIENTS AND 44,157 OUTPATIENTS. TO ASSIST THOSE PATIENTS WITH LIMITED RESOURCES, TLRMC ALSO OFFERS A PATIENT FINANCIAL ASSISTANCE PROGRAM. THERE ARE SEVERAL OPTIONS FOR PATIENTS WHO ARE UNINSURED OR UNDERINSURED, AND TLRMC'S PATIENT FINANCIAL SERVICES DEPARTMENT EDUCATES THE PATIENTS OF THE DIFFERENT PROGRAMS. | Desc |
| Total Program Service Expenses | $15,232,154 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (true) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 557 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | COMPANY OFFICIALS | PersonNm |
| Phone | 6159488046 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E MARKET ST | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| CATHERINE D CLEMONS | |||||||
| CHIEF OPERAT | 40.00 | Yes (X) | $226,430 | $0 | $26,000 | ||
| TRINA DAVES | |||||||
| CHIEF NURSIN | 40.00 | Yes (X) | $154,770 | $0 | $19,500 | ||
| ANGELA GIBSON | |||||||
| DIRECTOR OF | 40.00 | Yes (X) | $160,968 | $0 | $8,464 | ||
| ANITA PLEACHER | |||||||
| PHARMACIST | 40.00 | Yes (X) | $155,244 | $0 | $1,552 | ||
| CHLOE ADAMS | |||||||
| PHARMACIST | 40.00 | Yes (X) | $132,646 | $0 | $7,959 | ||
| JOEL BERNARD | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GLENNA BLACK | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| RYAN BRATCHER | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KEVIN BROOKS | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ANTHONY SMITH DO | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| DAVID DOWNS | |||||||
| VICE-PRESIDE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DENNIS FENTRESS | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| EDWIN MCKINNEY | |||||||
| SECRETARY/TR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| BRETT ABNEY OD | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| TREVOR RAY | |||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $830,058 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $63,475 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NELSON MULLINS RILEY & SCARBOROUGH | |||||
| PO DRAWER 11009 | COLUMBIA | SC | 29211 | PROFESSIONAL SE | $776,190 |
| SAMER BLEIBEL MD | |||||
| 7058 CEDARBANK DR | WEST BLOOMFIELD | MI | 48324 | PROFESSIONAL SE | $487,104 |
| ANDREW JENKINS MD | |||||
| 223 BYRTLE GROVE RD | LEITCHFIELD | KY | 42754 | PROFESSIONAL SE | $322,656 |
| STROUDWATER ASSOCIATES | |||||
| 1685 CONGRESS ST STE 202 | PORTLAND | ME | 04102 | PROFESSIONAL SE | $199,606 |
| JERRY RANDLE MCCLEESE | |||||
| 45 COUNTRY LANE | MOREHEAD | KY | 40351 | PROFESSIONAL SE | $168,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $13,167 | AllOtherContributionsAmt |
| Noncash Contributions | $13,167 | NoncashContributionsAmt |
| Total Contributions | $13,167 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT SERVICES | $21,971,187 | $21,971,187 |
| CAFETERIA REVENUE | $98,097 | $98,097 |
| FITNESS CENTER & OTHER INCOME | $2,930 | $2,930 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,072,214 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,673 | TotalRevenueColumnAmt |
| Exclusion | $170,673 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $216,643 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $172,575 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $44,068 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,068 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,068 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,959,597 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,959,597 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,959,597 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,959,597 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| NONOPERATING GAIN(LOSS) | $6,258,905 | $6,258,905 |
| TAX REVENUE | $706,572 | $706,572 |
| MANAGEMENT FEES | $68,400 | $68,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $7,033,877 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,293,596 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,109,756 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $170,673 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,710,641 | TotalAmt |
| Program Services | $6,093,142 | ProgramServicesAmt |
| Management And General | $1,617,499 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,282 | TotalAmt |
| Management And General | $131,282 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,144,735 | TotalAmt |
| Program Services | $970,048 | ProgramServicesAmt |
| Management And General | $174,687 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| ADMINISTRATIVE & GENERAL | $11,336,330 | $11,336,330 | |
| PROVISION FOR BAD DEBTS | $2,949,986 | $2,949,986 | |
| LABORATORY | $1,038,919 | $1,038,919 | |
| PHARMACY | $808,964 | $808,964 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,371,195 | TotalAmt |
| Program Services | $3,371,095 | ProgramServicesAmt |
| Management And General | $100 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,492,052 | TotalAmt |
| Program Services | $15,232,154 | ProgramServicesAmt |
| Management And General | $13,259,898 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,702,349 | BOYAmt |
| EOY | $24,927,829 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,562,590 | BOYAmt |
| EOY | $3,706,411 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,730,897 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,903,114 | BOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $579,899 | BOYAmt |
| EOY | $1,019,702 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,195,235 | BOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,213,352 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,887,436 | BOYAmt |
| EOY | $29,653,942 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,717,606 | BOYAmt |
| EOY | $3,036,986 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,975,000 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,930,000 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,731,400 | BOYAmt |
| EOY | $10,138,418 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $329,482 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,683,488 | BOYAmt |
| EOY | $13,175,404 | 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 | $104,203,948 | BOYAmt |
| EOY | $16,478,538 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,203,948 | BOYAmt |
| EOY | $16,478,538 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,887,436 | BOYAmt |
| EOY | $29,653,942 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,801,544 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$96,526,954 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $37,276,093 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $37,276,093 | RevenueSubtotalAmt |
| Other Revenues Not Included | $17,503 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $17,503 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $37,293,596 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $30,706,237 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $2,231,688 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $2,231,688 | ExpensesNotReportedAmt |
| Expenses Subtotal | $28,474,549 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $17,503 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $17,503 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $28,492,052 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE HOSPITAL AS WELL AS THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF TE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE HOSPITAL'S FINANCIAL STATEMENTS. MANAGEMENT IS NOT AWARE OF ANY ACTIVITY WITHIN THE HOSPITAL OR FOUNDATION DURING THE CURRENT OR PRIOR REPORTING PERIODS THAT WOULD JEOPARDIZE OR OTHERWISE CALL INTO QUESTION THE HOSPITAL OR FOUNDATION'S COMPLIANCE WITH THE ABOVE INTERNAL REVENUE CODE SECTION. THE ORGANIZATION'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) FOR FISCAL YEARS 2019, 2020 AND 2021 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR THREE YEARS AFTER THEY WERE FILED. CURRENTLY, THE HOSPITAL AND FOUNDATION HAVE NO REPORTING REQUIREMENTS WITH ANY STATE OR LOCAL TAX JURISDICTIONS. THE HOSPITAL HAS INVESTMENT INTEREST IN THREE COMPANIES AS DESCRIBED IN NOTE 8. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION'S POLICY FOR RECORDING ANY TAX RELATED INTEREST AND PENALTIES IS TO RECOGNIZE THESE ITEMS AS OPERATING EXPENSES; HOWEVER, NONE WERE INCURRED OR RECORDED DURING THE CURRENT OR PRIOR OPEN OPERATING PERIODS. |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | VALUE OF DONATED ITEMS 13,167 DONATED SERVICES 4,336 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | OPERATING LOSS REPORTED UNDER ID 61-1269278 2,231,688 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | DONATED SERVICES 4,336 USE OF DONATED ITEMS 13,167 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $23,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $2,266,538 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,266,538 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07950 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $2,289,988 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,289,988 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08040 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 282 | PersonsServedCnt |
| Total Community Benefit Expns | $6,505 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,505 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 282 | PersonsServedCnt |
| Total Community Benefit Expns | $6,505 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,505 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 282 | PersonsServedCnt |
| Total Community Benefit Expns | $2,296,493 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,296,493 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08060 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $28,700 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $28,700 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $720,045 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $290,985 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,618,050 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,898,897 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,280,847 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN LAKES MEDICAL F | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MEDICAL PRACTICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 1.00000 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Business Name Line2 | TWIN LAKES REGIONAL MEDICAL CENTER | BusinessNameLine2Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.TLRMC.COM | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Business Name Line2 | TWIN LAKES REGIONAL MEDICAL CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.TLRMC.COM | OwnWebsiteURLTxt |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.TLRMC.COM | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.TLRMC.COM | FAPAvailableOnWebsiteURLTxt |
| 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 (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 3E | SIGNIFICANT HEALTH NEEDS THAT HAVE BEEN IDENTIFIED ARE MENTAL HEALTH, SUBSTANCE ABUSE, CHILDHOOD HEALTH AND COMMUNITY HEALTH INFORMATION. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 5 | IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), TWIN LAKES REGIONAL MEDICAL CENTER (TLRMC) DEVELOPED A SURVEY TO GATHER HEALTH INFORMATION AND OPINIONS OF GRAYSON COUNTY RESIDENTS 18 AND OVER. THE SURVEY WAS CONDUCTED IN OCTOBER AND NOVEMBER 2018 USING AN ONLINE SURVEY TOOL AND BY DISTRIBUTING PRINTED COPIES IN VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. THE ONLINE SURVEY WAS PROMOTED THROUGH NEWSPAPER STORIES, EMAILS AND ON ITS FACEBOOK PAGE. EMAILS WITH A LINK TO THE SURVEY WERE SENT TO GRAYSON COUNTY CHAMBER OF COMMERCE MEMBERS, LOCAL INDUSTRIES, AND EMPLOYEES OF THE GRAYSON COUNTY SCHOOL SYSTEM AND THE HOSPITAL. PRINTED COPIES WERE DELIVERED TO AN ASSISTED LIVING FACILITY, THE GRAYSON COUNTY ALLIANCE FOOD BANK, THE GRAYSON COUNTY HEALTH DEPARTMENT, BIG CLIFTY MEDICAL COMPLEX AND THE CANEYVILLE FAMILY PRACTICE. INFORMATION GAPS THAT LIMITED THE ABILITY OF TLRMC TO ASSESS THE COMMUNITY'S HEALTH NEEDS WERE IDENTIFIED. THE PRIMARY OBSTACLE WAS REACHING ELDERLY, LOW-INCOME AND/OR RURAL RESIDENTS DUE TO A LACK OF INTERNET ACCESS AND WILLINGNESS TO PARTICIPATE. TLRMC MADE EFFORTS TO REACH THESE INDIVIDUALS WITH WRITTEN SURVEYS. AROUND 457 GRAYSON COUNTY RESIDENTS PARTICIPATED IN THE SURVEY. THE SURVEY QUESTIONS WERE IN THREE PRIMARY CATEGORIES: DEMOGRAPHICS, PERSONAL HEALTH INFORMATION, AND PERCEIVED HEALTH NEEDS OF THE COMMUNITY. THE TWIN LAKES REGIONAL MEDICAL CENTER'S DIRECTOR OF MARKETING TABULATED THE RESULTS FROM THE SURVEYS (ONLINE AND PRINTED) AND SUPPLEMENTED THEM WITH HEALTH STATISTICS AND DEMOGRAPHIC INFORMATION. TLRMC THEN INVITED REPRESENTATIVES FROM A VARIETY OF BACKGROUNDS TO A COMMUNITY FORUM/FOCUS GROUP ON APRIL 23, 2019 TO REVIEW THE SURVEY RESULTS AND PROVIDE RECOMMENDATIONS FOR THE HOSPITAL'S COMMUNITY HEALTH FOCUS. PROFESSIONS REPRESENTED INCLUDED PHYSICIANS; SCHOOL ADMINISTRATORS AND STAFF; THE GRAYSON COUNTY HEALTH DEPARTMENT; DIETICIAN; LOCAL INDUSTRY/MANUFACTURING; CANCER ADVOCATE; HOSPITAL BOARD MEMBERS; LAW ENFORCEMENT; HOSPITAL LEADERSHIP AND CITY GOVERNMENT LEADERS. ONCE THE INFORMATION WAS PRESENTED A GROUP DISCUSSION WAS HELD. ATTENDEES WERE ASKED FOR THEIR TOP HEALTH PRIORITIES WITHOUT CONCERN ABOUT THE PRACTICALITY OF THE HOSPITAL'S ABILITY TO IMPACT THE ISSUES. AFTER CAREFULLY CONSIDERING THE RESULTS OF THE COMMUNITY HEALTH SURVEY, THE MOST RECENT HEALTH AND DEMOGRAPHIC INFORMATION AVAILABLE, AND INPUT FROM THE COMMUNITY HEALTH FOCUS GROUP, THE FOLLOWING NEEDS WERE IDENTIFIED BY HOSPITAL LEADERSHIP AS THE COMMUNITY HEALTH FOCUS POINTS FOR TWIN LAKES REGIONAL MEDICAL CENTER IN 2019 - 2022. MENTAL HEALTH, SUBSTANCE ABUSE, CHILDHOOD HEALTH AND COMMUNITY HEALTH INFORMATION. THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT WAS APPROVED BY THE BOARD OF DIRECTORS FOR TWIN LAKES REGIONAL MEDICAL CENTER ON TUESDAY, MAY 21, 2019. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 7D | LOCAL NEWSPAPERS. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 11 | TLRMC CREATED THE POPULATION HEALTH COMMITTEE. THIS GROUP OF PEOPLE WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITY GUIDED BY THE IDENTIFIED PRIORITY HEALTH NEEDS FIRST NAMED IN THE 2012 CHNA, OF WHICH WERE IDENTIFIED IN THE 2015 CHNA, AND NOW THE AREA OF FOCUS IN ITS MOST RECENT CHNA. THE POPULATION HEALTH COMMITTEE IS MADE UP OF HOSPITAL EMPLOYEES, INDUSTRIAL LEADERS, THE GRAYSON COUNTY SCHOOLS' SUPERINTENDENT, REGISTERED DIETICIANS, A PHARMACIST, A REPRESENTATIVE FROM THE KENTUCKY CANCER PROGRAM AND A REPRESENTATIVE FROM THE GRAYSON COUNTY HEALTH DEPARTMENT. THE TLRMC CEO CHAIRS THE COMMITTEE. THE POPULATION HEALTH COMMITTEE MEETS MONTHLY TO DISCUSS AND IMPLEMENT PLANS ON IMPROVING THE HEALTH OF THE COMMUNNITY. THE PUBLICATION OF THE CHNA IS ANOTHER STEP TO A HEALTHIER GRAYSON COUNTY. IT IS THE INTENTION OF TLRMC THAT THE CONTENTS OF THIS REPORT BE USED TO ASSIST IN CREATING AWARENESS BY INFORMING GRAYSON COUNTY RESIDENTS OF THE PRIORITIZED HEALTH ISSUES IDENTIFIED BY THE COMMUNITY. ALSO AS A STRATEGY, TLRMC USES THE CHNA REPORT AS A FOUNDATION TO BUILD LASTING RELATIONSHIPS BETWEEN TLRMC, COMMUNITY PARTNERS AND RESIDENTS OF GRAYSON COUNTY. IN ORDER TO ADDRESS THE PRIORITIZED NEEDS, TLRMC HAS ENGAGED KEY INTERNAL AND COMMUNITY PARTNERS. THE STRATEGIES USED TO IMPACT THE PRIORITY HEALTH AREAS INCLUDE, BUT ARE NOT LIMITED TO, MODIFYING POLICIES, PUBLIC AND PRIVATE; PROVIDING SUPPORT, INFORMATION AND INCENTIVES; IMPROVING ACCESS; ENHANCING SKILLS; AND CHANGING CONSEQUENCES. FOLLOW-UP SURVEYS WILL MEASURE THE SUCCESS OF EACH INITIATIVE AND PROVIDE THE NEXT AREAS OF FOCUS FOR THE HOSPITAL. PRIORITY NEEDS IN MOST RECENT CHNA: MENTAL HEALTH, SUBSTANCE ABUSE, CHILDHOOD HEALTH, COMMUNITY HEALTH INFORMATION TLRMC IS WORKING COLLABORATIVELY WITH COMMUNITY PARTNERS TO ADDRESS THE IDENTIFIED PRIORITY AREAS. THE POPULATION HEALTH COMMITTEE IS ACCESSING SUPPLEMENTAL DATA, RESOURCE INFORMATION AND ADDITIONAL PARTNERS TO ASSIST IN A GREATER UNDERSTANDING OF THE PRIORITY HEALTH ISSUES AND POSSIBLE STRATEGIES. AS THE HEALTH ISSUES ARE CORRELATED TO SOCIAL DETERMINANTS OF HEALTH, NAMELY POVERTY, TRANSPORTATION, EDUCATION AND HOUSING, TLRMC WILL BE LOOKING TO EXPAND UPON INTERNAL AND EXTERNAL STRATEGIES NOW USED TO ADDRESS COMMUNITY HEALTH. MENTAL HEALTH: IN ADDITION TO PARTNERING WITH THE LOCAL MENTAL HEALTH CENTERS SERVING GRAYSON COUNTY AND OTHER PROVIDERS, TLRMC IS PLANNING POTENTIAL NEW SERVICES FOR A GERIATRIC BEHAVIORAL HEALTH SERVICES, TELEHEALTH BEHAVIORAL HEALTH INTERVENTIONS AND INTENSIVE OUTPATIENT PROGRAMS AND WILL ENGAGE WITH ADDITIONAL MENTAL HEALTH RESOURCES AVAILABLE TO THE COMMUNITY AT LARGE. MENTAL HEALTH ISSUES AMONG BOTH YOUTH AND ADULTS ARE INCREASING AND HAVE BEEN EXACERBATED BY THE WORLD-WIDE PANDEMIC. WHILE THIS HAS MADE COMMUNITY EDUCATION A CHALLENGE, TLRMC WILL BE CONTINUING TO WORK WITH THE POPULATION HEALTH COMMITTEE TO EXPOLORE STRATEGIES TO ADDRESS THIS GROWING ISSUE. SUBSTANCE USE: SINCE APRIL 2019, TLRMC HAS CONTINUED TO BE A MEMBER OF THE KENTUCKY OPIOID RESPONSE EFFORT'S KENTUCKY STATEWIDE OPIOID STEWARDSHIP PROGRAM (KY-SOS) IN AN EFFORT TO ADDRESS INAPPROPRIATE OR EXCESS OPIOID PRESCRIBING. THE OPIOID STEWARDSHIP TEAM AT TLRMC MEETS REGULARLY AND PARTICIPATES IN DATA COLLECTION AND REPORTING AS REQUIRED OF KY-SOS. TREATMENT: TLRMC OFFERS MEDICAL DETOX FROM ALCOHOL, OPIOIDS AND OTHER ADDICTIVE SUBSTANCES. AS THE BODY RIDS ITSELF OF TOXINS, WITHDRAWAL SYMPTOMS AND CRAVINGS ARE SAFELY MANAGED UNDER THE 24-HOUR SUPERVISION OF TRAINED PROFESSIONALS. NON-ADDICTIVE MEDICATIONS MAY BE PRESCRIBED TO LESSEN WITHDRAWAL SYMPTOMS, IN ADDITION TO NUTRITIONAL SUPPLEMENTS AND FLUIDS. PAIN WILL BE MANAGED THROUGH THE USE OF NON-NARCOTIC MEDICATIONS AND OTHER PROVEN THERAPIES. PATIENTS ARE USUALLY STABILIZED WITHIN A WEEK. MATERNAL OPIOID MEDICAL STABILIZATION (MOMS): ANY EXPECTANT MOTHER SUFFERING FROM OPIOID USE DISORDER MAY BE CONSIDERED FOR THE TLRMC MOMS PROGRAM. A NON-ADDICTIVE MEDICATION WILL BE PRESCRIBED UNDER THE 24-HOUR SUPERVISION OF CARING AND SPECIALLY TRAINED MEDICAL PROFESSIONALS. STUDIES SHOW THAT, COMPARED TO UNTREATED PREGNANT WOMEN WITH OPIOID ADDICTION, THOSE RECEIVING MEDICATION ASSISTED TREATMENT GAVE BIRTH TO INFANTS WITH LOWER RISK OF A CONDITION CALLED NEONATAL ABSTINENCE SYNDROME (NAS). OTHER BENEFITS OF MOMS INCLUDE SHORTER TREATMENT TIME FOR BABY, AS WELL AS AN INCREASED LIKELIHOOD OF A FULL TERM PREGNANCY, HEALTHIER BIRTH WEIGHT, AND A DESIRABLE HEAD CIRCUMFERENCE AT BIRTH. NOTE: THIS PROGRAM ALSO IMPACTS THE PRIORITY HEALTH AREA, "CHILDREN'S HEALTH." THE TYPICAL LENGTH OF STAY IN THE MOMS PROGRAM IS TWO TO SEVEN DAYS, FOLLOWED BY AN INDIVIDUALIZED TREATMENT PLAN, INCLUDING CONTINUED OUTPATIENT TREATMENT AND COMMUNITY-SUPPORT SERVICES TO MEET THE NEEDS OF THE MOTHER AND HER UNBORN BABY. MEDICATION ASSISTED TREATMENT: IN RESPONSE TO THE NATIONWIDE OPIOID CRISIS, TLRMC OFFERS MEDICATION-ASSISTED TREATMENT OPTIONS FOR OPIOID ADDICTION. TLRMC ADDICTION SERVICES USES FDA-APPROVED MEDICATIONS, SUCH AS SUBUTEX AND SUBOXONE, TO PROVIDE RELIEF FROM OPIOID-WITHDRAWAL SYMPTOMS AND TO HELP THE PATIENT QUIT USING ADDICTIVE DRUGS. TLRMC DIRECTOR OF ADDICTION SERVICES SERVES AS A COMMUNITY CONDUIT TO PROVIDE EDUCATION AND INFORMATION REGARDING THIS PREVALENCE OF SUBSTANCE USE DISORDER AND EDUCATION WHEN POSSIBLE TO THE COMMUNITY REGARDING SUBSTANCE USE PREVENTION. CHILDREN'S HEALTH: TLRMC HAS RECOGNIZED AND ACKNOWLEDGED IN ITS PREVIOUS WORK IN THE DEVELOPMENT OF CHNAS THE ISSUES OF OBESITY, NUTRITIONAL HEALTH AND THE SAFETY AND WELL-BEING OF CHILDREN. THE HOSPITAL HAS DEPLOYED ITS TEAM MEMBERS TO SERVE ON LOCAL BOARDS SUCH AS CASA (COURT APPOINTED SPECIAL ADVOCATES) AND THE POVERTY COALITION TO SPECIFICALLY ADDRESS NEEDS OF THE COUNTY'S CHILDREN. A PARTNERSHIP WITH THE EXTENSION MASTER GARDENER'S CLUB RESULTED IN THE FORMATION OF A COMMUNITY GARDEN TO ADDRESS FOOD INSECURITY AND ACCESS TO FRESH PRODUCE FOR CHILDREN AND FAMILIES. COMMUNITY COLLABORATIVE EFFORTS HAVE INITIATED IN THE PURSUIT OF A SAFE HAVEN BABY BOX, A SAFETY DEVICE PROVIDED UNDER A STATE'S SAFE HAVEN LAW TO PROTECT AND CARE FOR BABIES SHOULD A MOTHER IN CRISIS NEEDS TO SURRENDER HER BABY. TLRMC PARTICIPATES IN LOCAL COUNTY BABY SHOWERS, EDUCATIONAL SAFETY AND HEALTH EVENTS TO PROMOTE A COMMUNITY WHICH CARES FOR AND ADDRESSES THE HEALTH NEEDS OF ITS COMMUNITY. LASTLY, AS NOTED PREVIOUSLY, THE MOMS PROGRAM DIRECTLY IMPACTS CHILDREN AS PREGNANT MOMS WITH SUBSTANCE USE ISSUES ARE WORKING TO MAINTAIN A CLEAN AND SOBER LIFESTYLE AS THEY CARRY THEIR BABIES TO TERM. BABIES ARE BORN HAVING NOT BEEN EXPOSED TO SUBSTANCES, REDUCING THEIR HARM, RISK FOR NAS, DEVELOPMENTAL DELAYS, AND SO FORTH. MOMS THEN WORK TO STAY SUBSTANCE FREE AND HAVE ACCESS TO OTHER RESOURCES TO HELP RAISE HEALTHY CHILDREN WHO CAN BE SAFE, THRIVE AND LEARN. COMMUNITY HEALTH INFORMATION: THE POPULATION HEALTH COMMITTEE WHICH STARTED AS A RESULT OF THE CHNA PROCESS IS A COMMUNITY DRIVER AND THE COMMITTEE IS INCLUSIVE OF THE MANY PARTNERS WHO HAVE COME TOGETHER TO ADDRESS THE HEALTH NEEDS OF GRAYSON COUNTIANS. INFORMATION IS SHARED BY COMMUNITY PARTNERS AND THIS WAS NEVER MORE EVIDENT THAN THE NEEDS PRESENTED BY COVID 19. WHILE MANY FACE TO FACE GATHERINGS AND EDUCATIONAL PROGRAMS WERE CANCELLED, SOME ENTITIES HAVE PROVIDED VIRTUAL EDUCATION AND TLRMC PROVIDED EDUCATIONAL MATERIALS WHEN REQUESTED TO ASSIST THE COMMUNITY AND SHARED COMMUNITY COVID RELATED INFORMATION, PARTNERING WITH LOCAL PUBLIC HEALTH OFFICIALS AND MEDIA. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 16J | THE POLICY WAS PROVIDED TO PATIENTS AT REGISTRATION. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | TWIN LAKES REGIONAL MEDICAL CENTER'S PATIENT FINANCIAL ASSISTANCE PROGRAM UTILIZES THE FEDERAL POVERTY GUIDELINES AND AN ASSET TEST CONSISTING OF RESIDENCE, VEHICLES, AND CASH INVESTMENTS TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| SCHEDULE H, PART I, LINE 7 | IN DETERMINING THE AMOUNTS FOR PART 1, LINE 7, COST ACCOUNTING WAS USED. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| SCHEDULE H, PART III, LINE 2 | THE TOTAL BAD DEBT EXPENSE AT COST REPRESENTS THE TOTAL AMOUNT EXPECTED TO BE COLLECTED, BUT DEEMED UNCOLLECTIBLE. BASED ON THE COMMUNITY'S DEMOGRAPHICS, INCOME LEVEL, INDIVIDUAL ASSETS, AND HEALTH COVERAGE, 40% WAS DETERMINED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE PROGRAM. |
| SCHEDULE H, PART III, LINE 4 | DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT OR THIRD-PARTY PAYOR. IF THE HOSPITAL RECEIVES NO PAYMENT OR COMMUNICATION TO ARRANGE PAYMENT THE ACCOUNT IS SENT TO COLLECTION AND RECOGNIZED AS BAD DEBT AT THAT TIME. |
| SCHEDULE H, PART III, LINE 8 | TWIN LAKES REGIONAL MEDICAL CENTER BELIEVES THAT ALL OF THE 1.3 MILLION MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. THE COSTS TO CARE FOR THE ELDERLY AND MEDICARE PATIENTS ARE ABSORBED BY THE HOSPITAL DUE TO LACK OF REIMBURSEMENTS FROM MEDICARE. THE HOSPITAL CONTINUES TO PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF MEDICARE BENEFICIARIES. THEREFORE, TWIN LAKES REGIONAL MEDICAL CENTER IS FULFILLING A COMMUNITY NEED BY CARING FOR MEDICARE PATIENTS, WHO TYPICALLY HAVE LOW, FIXED INCOMES; AND RELIEVING THE GOVERNMENT FOR THEIR LACK OF PROVIDING SUFFICIENT PAYMENTS TO COVER THE COST OF CARING FOR THEM. |
| SCHEDULE H, PART III, LINE 9B | IF THE PATIENT DOES NOT HAVE ANY INSURANCE COVERAGE, AND THE PATIENT DOES NOT QUALIFY FOR ANY TYPE OF FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, THEN THE ACCOUNT CAN BE CONSIDERED FOR BAD DEBT PLACEMENT FORTY-FIVE DAYS AFTER THE PATIENT RECEIVED THEIR FIRST STATEMENT IF THERE HAS BEEN NO RESPONSE FROM THE PATIENT. AFTER A PERIOD OF TIME HAS PASSED WITH NO RESOLUTION, THE ACCOUNT WILL BE SENT TO OUR COLLECTION AGENCY. |
| SCHEDULE H, PART VI, LINE 2 | AS DESCRIBED IN FORM 990, SCEDULE H, PART V, SECTION B LINE 5, 6B, TLRMC DEFINED THE HEALTH OF ITS COMMUNITY THROUGH ITS CHNA CONDUCTED WITH MULTIPLE COMMUNITY PARTNERS GUIDED BY THE POPULATION HEALTH COMMITTEE. THIS IS ACCOMPLISHED BY SURVEYING LOCAL RESIDENTS AND ORGANIZATIONS AND CONDUCTING FOCUS GROUPS BUT NOT LIMITED TO THAT DATA AS ADDITIONALLY SECONDARY ANALYSIS OF DATA IS REVIEWED, OTHER ASSESSMENTS SUCH AS THE GRAYSON COUNTY EXTENSION COMMUNITY ASSESSMENTS AND OTHER DATA POINTS ARE CONSIDERED. MOVING FORWARD, AS A PART OF OWENSBORO HEALTH, ADDITIONAL RESOURCES WILL BE UTILIZED TO ASSESS THE HEALTH OF THE COMMUNITY. |
| SCHEDULE H, PART VI, LINE 3 | TWIN LAKES REGIONAL MEDICAL CENTER REACHES OUT TO EDUCATE PATIENTS ABOUT THEIR PATIENT FINANCIAL ASSISTANCE PROGRAM. A BROCHURE IS AVAILABLE AT SEVERAL LOCATIONS THROUGHOUT THE HOSPITAL INCLUDING THE BUSINESS OFFICE AND REGISTRATION AREA. A PDF VERSION OF THE BROCHURE IS POSTED ON THE HOSPITAL'S WEBSITE. THE HOSPITAL ALSO PUBLISHED THE COMMUNITY BENEFITS REPORT ON THE HOSPITAL'S WEBSITE AND FACEBOOK PAGE IN JUNE 2018, AND SUBSEQUENTLY IN THE LOCAL NEWSPAPER, WHICH INCLUDED THE SAME INFORMATION PROMINENTLY DISPLAYED. WHEN SELF PAY PATIENTS PRESENT TO THE HOSPITAL FOR SERVICES, THE REGISTRAR DIRECTS THE PATIENTS TO THE FINANCIAL COUNSELOR FOR ASSISTANCE ON MEDICAID/COMMERCIAL PLANS AVAILABLE THROUGH THE ACA. ALSO, AT THAT TIME OUR FINANCIAL ASSISTANCE PROGRAM IS ALSO APPLIED TO THEIR PERSONAL SITUATION FOR POSSIBLE HELP. |
| SCHEDULE H, PART VI, LINE 4 | THE PRIMARY SERVICE AREA FOR TWIN LAKES REGIONAL MEDICAL CENTER IS GRAYSON COUNTY, KY (POPULATION 26,000) LOCATED 75 MILES SOUTHWEST OF LOUISVILLE, KY. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES PARTS OF 6 SURROUNDING COUNTIES. THE ESTIMATED PERCENTAGE OF PEOPLE LIVING BELOW THE POVERTY LEVEL, AS DETERMINED BY THE U.S. CENSUS BUREAU, IS 20.3% FOR THE PRIMARY SERVICE AREA. THE AREA IS MOSTLY RURAL WITH A HIGHER PERCENTAGE OF PERSONS OVER THE AGE OF 65 AND A SIGNIFICANTLY LOWER MEDIAN HOUSEHOLD INCOME COMPARED TO THE STATE OF KENTUCKY. |
| SCHEDULE H, PART VI, LINE 5 | IN ADDITION TO THE HEALTH PROMOTION STRATEGIES AND CONCEPTS PREVIOUSLY DESCRIBED, TLRMC WORKS CLOSELY WITH ITS LOCAL CHAMBER OF COMMERCE, LOCAL DEPARTMENT OF PUBLIC HEALTH, LOCAL AND STATE ELECTED OFFICIALS AND COMMUNITY LEADERS TO EDUCATE ON THE PRIORITY HEALTH ISSUES, DISCUSS OTHER EXISTING RELATED NEEDS AND WORK TOGETHER TO DEVELOP SOLUTIONS AND TACTICS TO ADDRESS THEM. TLRMC PROVES TO BE A DRIVING FORCE IN CHANGE BY EDUCATING THE COMMUNITY ON HEALTH AND WELLNESS ISSUES AND BY RECOGNIZING COMMUNITY NEEDS AND WORKING TO FULFILL THOSE NEEDS. |
| SCHEDULE H, PART VI | IN ADDITION TO PROVIDING THE COMMUNITY BENEFIT REPORT IN THE LOCAL PAPER, TLRMC ALSO PARTICIPATES IN THE STATE-WIDE COMMUNITY BENEFIT REPORT WITH KENTUCKY HOSPITAL ASSOCIATION THAT IS PRESENTED TO OUR COMMONWEALTH. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|
| CATHERINE D CLEMONS | |||
| CHIEF OPERATING OFFI | $226,430 | $26,000 | $252,430 |
| TRINA DAVES | |||
| CHIEF NURSING OFFICE | $154,770 | $19,500 | $174,270 |
| ANGELA GIBSON | |||
| DIRECTOR OF PHARMACY | $160,968 | $8,464 | $169,432 |
| ANITA PLEACHER | |||
| PHARMACIST | $155,244 | $1,552 | $156,796 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| MIDWAY PHARMACY OF CLARKSON INC | |||
| DIRECTOR | $11,862 | RENT OF PHARMACY SPA | false |
| FUTURE DESIGNS INC | |||
| DIRECTOR | $165 | PURCHASE OF BLDG MAT | false |
| LEITCHFIELD PEDIATRIC CLINIC | |||
| DIRECTOR | $58,750 | PEDIATRIC CALL REIMB | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | DIRECTOR TREVOR RAY IS A SHAREHOLDER IN MIDWAY PHARMACY OF CLARKSON, INC. MIDWAY PHARMACY OF CLARKSON, INC. RENTS SPACE FROM TWIN LAKES REGIONAL MEDICAL CENTER FOR A PHARMACY LOCATION. KEVIN BROOKS IS A SHAREHOLDER IN FUTURE DESIGNS, INC. FUTURE DESIGNS, INC. SOLD BUILDING MATERIALS TO TLRMC. DR. ANTHONY SMITH IS A DIRECTOR OF TWIN LAKES REGIONAL MEDICAL CENTER. HIS MEDICAL PRACTICE, LEITCHFIELD PEDIATRIC CLINIC, PROVIDES PEDIATRIC CALL SERVICE TO TLRMC. THE HOSPITAL AND GRAYSON COUNTY HOSPITAL DISTRICT BOTH MAINTAIN BANK ACCOUNTS AT THE CECILIAN BANK. DAVID DOWNS, A DIRECTOR OF GRAYSON COUNTY HOSPITAL FOUNDATION, INC., IS EMPLOYED BY THE CECILIAN BANK. GARRY WATKINS, A DIRECTOR OF GRAYSON COUNTY HOSPITAL DISTRICT, IS ALSO A DIRECTOR OF THE CECILIAN BANK. THE CASH BALANCES HELD AT JUNE 30, 2021 AND 2020 WERE 16,809,767 AND 13,502,014, RESPECTIVELY. THE LOAN BALANCE WAS 3,731,400 AT JUNE 30, 2020. THE HOSPITAL AND FOUNDATION BOTH MAINTAIN BANK ACCOUNTS AT WILSON & MUIR BANK & TRUST. RYAN BRATCHER, A DIRECTOR OF THE HOSPITAL, IS EMPLOYED BY WILSON & MUIR BANK & TRUST. THE CASH BALANCES HELD AT JUNE 30, 2021 AND 2020 WERE 688,656 AND 8,930,154, RESPECTIVELY. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | THE PURPOSE OF THE HOSPITAL VOLUNTEER AUXILIARY IS TO RENDER SERVICE TO TWIN LAKES REGIONAL MEDICAL CENTER, ITS PATIENTS AND STAFF, AND TO ASSIST THE HOSPITAL IN PROMOTING THE HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH OBJECTIVES ESTABLISHED BY THE HOSPITAL. THE MISSION OF THE VOLUNTEER AUXILIARY IS TO "SUPPORT TWIN LAKES REGIONAL MEDICAL CENTER IN MEETING THE HEALTH CARE NEEDS OF THE PEOPLE IT SERVES IN THE MOST CARING, COMPASSIONATE, AND EFFECTIVE MANNER POSSIBLE." THE AUXILIARY'S PRIMARY DUTY WITHIN THE HOSPITAL IS STAFFING THE INFORMATION DESK IN THE MAIN LOBBY FROM 8 A.M. - 4 P.M., MONDAY - FRIDAY. ROUTINE DUTIES THERE INCLUDE PROVIDING GENERAL HOSPITAL INFORMATION AND DIRECTIONS TO PATIENTS AND THE PUBLIC; MAKING WHEELCHAIRS AVAILABLE TO VISITORS AND PATIENTS; PROVIDING ESCORTS WHEN NEEDED; AND DELIVERING FLOWERS TO PATIENTS. THE VOLUNTEERS ALSO OPERATE THE TLRMC GIFT SHOP. PROCEEDS FROM THE GIFT SHOP ARE USED BY THE VOLUNTEERS TO PROVIDE SCHOLARSHIPS AND TO PURCHASE EQUIPMENT FOR THE HOSPITAL SUCH AS BLANKET WARMERS, WHEELCHAIRS, TELEVISIONS, AND OTHER ITEMS. DURING 2020, WHEN THE COVID 19 PANDEMIC CREATED A SHORTAGE OF MASKS, THE VOLUNTEERS PURCHASED MATERIALS AND SEWED TOGETHER MASKS FOR THE HOSPITAL STAFF. MEMBERS OF THE AUXILIARY HAND MAKE SOCK MONKEYS AND OTHER STUFFED ANIMALS FOR CHILDREN COMING TO THE HOSPITAL. THE ANIMALS ARE GIVEN TO THE YOUNG PATIENTS AND THEIR FAMILIES AT NO CHARGE. THE VOLUNTEERS RAISE THE MONEY NEEDED TO PURCHASE ANY SUPPLIES AND DONATE MATERIALS IN ADDITION TO THEIR TIME AND TALENTS. THE SOCK MONKEY PROGRAM HAS BEEN HONORED BY THE KENTUCKY HOSPITAL ASSOCIATION. |
| FORM 990, PAGE 2, PART III, LINE 4A | TWIN LAKES REGIONAL MEDICAL CENTER PROVIDES QUALITY MEDICAL HEALTH CARE SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR THE ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND FINANCIAL STABILITY OF TWIN LAKES REGIONAL MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THIS AREA, THE HOSPITAL PROVIDES FREE CARE TO THE MOST INDIGENT OF PATIENTS AND WRITES OFF PORTIONS OF BILLS TO OTHER PATIENTS WHO HAVE DEMONSTRATED THE INABILITY TO PAY FOR ALL HEALTH CARE SERVICES RECEIVED. A LETTER OF INTENT WAS SIGNED ON APRIL 13, 2020 TO TRANSFER THE OPERATING ASSETS OF THE GRAYSON COUNTY HOSPITAL FOUNDATION, INC. (THE "HOSPITAL") AND THE TWIN LAKES MEDICAL FOUNDATION, INC. TO OWENSBORO HEALTH, INC., A NOT FOR PROFIT HEALTH SYSTEM. THE TRANSACTION WAS FINALIZED AND BECAME EFFECTIVE JANUARY 1, 2021. UNDER THE TERMS OF THE AGREEMENT, A PORTION OF THE PROCEEDS WERE USED TO SATISFY THE OUTSTANDING BONDS ISSUED BY THE GRAYSON COUNTY PUBLIC HOSPITAL DISTRICT CORPORATION (THE "CORPORATION"). UPON THE DEFEASANCE OF THE BONDS, THE LAND AND FACILITIES OWNED BY THE CORPORATION WERE TRANSFERRED TO A NEW CORPORATION FORMED BY OWENSBORO HEALTH, OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INC., TO OPERATE THE HOSPITAL. THE NET PROCEEDS FROM THE TRANSACTION AND RETAINED ASSETS WERE TRANSFERRED TO THE GRAYSON COUNTY HEALTHCARE FOUNDATION, INC., A NEW NOT FOR PROFIT CORPORATION FORMED TO PROVIDE GRANTS AND SUPPORT HEALTHCARE IN THE COUNTY. DURING THE SIX MONTHS OF THE FISCAL YEAR THE FOUNDATION OPERATED, CHARGES WERE WRITTEN OFF DUE TO AGREEMENTS WITH MEDICARE, MEDICAID, AND OTHER THIRD PARTIES. THE TOTAL UNREIMBURSED CHARGES FORGONE IN FISCAL YEAR 2021 DUE TO CONTRACTUAL AGREEMENTS WITH PAYERS AMOUNTED TO 53,393,618. ALSO, 392,330 WAS PAID AS A "PROVIDER TAX" TO THE COMMONWEALTH OF KENTUCKY TO HELP DEFRAY THE COSTS OF COVERING INDIGENT PATIENTS UNDER A SPECIAL STATE PROGRAM. WRITE-OFFS FROM PATIENTS "UNWILLING" TO PAY - I.E. BAD DEBTS - ACCOUNTED FOR 2,539,487. THE PRIMARY MISSION OF TWIN LAKES REGIONAL MEDICAL CENTER IS TO HEAL THE SICK, RELIEVE PAIN AND SUFFERING, AND IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE WE SERVE. TLRMC'S VISION IS TO BE RECOGNIZED BY THE PEOPLE WE SERVE AS THE PROVIDER OF CHOICE FOR THEIR HEALTH CARE NEEDS AND AS A LEADING FORCE FOR PROGRESSIVE CHANGE WITHIN OUR COMMUNITY. TO ENHANCE QUALITY, THE HOSPITAL ACTIVELY OPERATES A PERFORMANCE IMPROVEMENT PROGRAM WHICH HELPS IDENTIFY BETTER PATIENT CARE AS WELL AS EFFICIENCIES IN OPERATIONS. TO ENHANCE OUR COMMUNITY, TLRMC PROVES TO BE A DRIVING FORCE IN CHANGE BY EDUCATING THE COMMUNITY ON HEALTH & WELLNESS ISSUES AND BY RECOGNIZING COMMUNITY NEEDS AND WORKING TO FULFILL THOSE NEEDS. THE HOSPITAL CARED FOR 976 INPATIENTS AND 44,157 OUTPATIENTS. TO ASSIST THOSE PATIENTS WITH LIMITED RESOURCES, TLRMC ALSO OFFERS A PATIENT FINANCIAL ASSISTANCE PROGRAM. THERE ARE SEVERAL OPTIONS FOR PATIENTS WHO ARE UNINSURED OR UNDERINSURED, AND TLRMC'S PATIENT FINANCIAL SERVICES DEPARTMENT EDUCATES THE PATIENTS OF THE DIFFERENT PROGRAMS. |
| FORM 990, PAGE 6, PART VI, LINE 3 | THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL ARE EMPLOYED BY ALLIANT MANAGEMENT SERVICES AND ARE RESPONSIBLE FOR CONTROLLING MANAGEMENT DUTIES. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS STOCKHOLDERS. EACH SHARE OF STOCK IS VALUED AT 25. STOCKHOLDERS MUST BE AT LEAST 18 YEARS OLD AND A RESIDENT OF GRAYSON COUNTY, KENTUCKY. |
| FORM 990, PAGE 6, PART VI, LINE 7A | NINE MEMBERS OF THE BOARD OF DIRECTORS ARE ELECTED BY THE STOCKHOLDERS AND THE OTHER MEMBER IS THE PRESIDENT OF THE MEDICAL STAFF (WHOM IS VOTED ON BY THE MEDICAL STAFF). |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS SUBMITTED TO THE GOVERNING BOARD FOR REVIEW AND APPROVAL BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CORPORATE COMPLIANCE REQUIRES EACH EMPLOYEE AND BOARD MEMBER TO UPDATE AND SIGN OFF ON A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | ALLIANT MANAGEMENT SERVICES, ACTING AS THE MANAGEMENT COMPANY, BRINGS COMPARABLE NATIONAL DATA TO THE BOARD OF DIRECTORS FOR THE BOARD TO DETERMINE WHAT COMPENSATION IS TO BE PAID. |
| FORM 990, PAGE 6, PART VI, LINE 15B | ALLIANT MANAGEMENT SERVICES, ACTING AS THE MANAGEMENT COMPANY, BRINGS COMPARABLE NATIONAL DATA TO THE BOARD OF DIRECTORS FOR THE BOARD TO DETERMINE WHAT COMPENSATION IS TO BE PAID. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 24E | MATERIALS MANAGEMENT 559,850 0 0 MEDICAL & SURGICAL 548,096 0 0 SURGERY 450,248 0 0 PHYSICAL THERAPY 432,178 0 0 EMERGENCY ROOM 307,857 0 0 PROVIDER BASED CLINICS 177,687 0 0 WOUND CARE 172,068 0 0 RADIOLOGY 155,103 0 0 PAIN MANAGEMENT 110,864 0 0 MRI 67,807 0 0 NUCLEAR MEDICINE 63,480 0 0 CT SCANS 57,773 0 0 RESPIRATORY THERAPY 54,565 0 0 OBSTETRICS 52,834 0 0 SLEEP CENTER 36,802 0 0 INTENSIVE CARE 36,727 0 0 ANESTHESIOLOGY 35,684 0 0 INFUSION CENTER 17,200 0 0 USE OF DONATED ITEMS 13,167 0 0 SPECIALTY CLINIC 13,012 0 0 CARDIAC 7,860 0 0 CANEYVILLE RURAL HEALTH 274 0 0 MISCELLANEOUS 0 100 0 OCCUPATIONAL THERAPY -41 0 0 TOTAL 3,371,095 100 0 |
| FORM 990, PART XI, LINE 9 | ADJUSTMENT POSTED BY CONSULTANTS -40,242,036 TLMF ADJ POSTED BY CONSULTANTS -56,284,918 TOTAL -96,526,954 EQUITY ADJUSTMENTS WERE POSTED BY THE CONSULTING COMPANY ENGAGED TO WIND DOWN OPERATIONS OF THE HOSPITAL RELATED TO THE SALE OF THE OPERATING ASSETS OF THE HOSPITAL AND TO TRANSFER THE REMAINING ASSETS TO THE NEW HEALTHCARE FOUNDATION. THE FINANCIAL STATEMENT AUDITORS ARE STILL TRYING TO RECONCILE THESE NUMBERS. THE 990 WILL BE AMENDED WHEN THESE ADJUSTMENTS HAVE BEEN CORRECTED. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN LAKES MEDICAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611269278 | EIN |
| Primary Activities | MEDICAL PR | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 10 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GCHF | BusinessNameLine1Txt |
| Business Name Line2 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TWIN LAKES HOME HEALTH AGENCY LLC | |||||||||||||
| 901 S HUGH WALLIS ROAD | LAFAYETTE | LA | 70508 | 271000828 | HOME HEALT | LA | N/A | RELATED | $79,316 | $117,275 | false | Yes (true) | 0.25000 |
| TWIN LAKES REGIONAL PAIN MANAGEMENT | |||||||||||||
| 910 WALLACE AVE | LEITCHFIELD | KY | 42754 | 472329929 | PAIN MANAG | KY | N/A | RELATED | $133,853 | $193,247 | false | Yes (true) | 0.51000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WTK HOLDINGS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610608823 | EIN |
| Primary Activities | HOLDING CO | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GCHF | BusinessNameLine1Txt |
| Business Name Line2 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Share Of Total Income | $104,084 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $2,222,362 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| D | $2,961,289 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| J | $114,400 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| L | $68,393 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| Q | $2,778,496 | FAIR MARKET VALUE |
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