2022-11-15T09:44:27-06:00 2021-12-31 FORVIS LLP PO BOX 1196 BOWLING GREEN KY 42102 990 2021-01-01 610482973 JENNIE STUART MEDICAL CENTER INC % MARK LARAMEE JENN 2708870100 320 W 18TH STREET HOPKINSVILLE KY 42240 MARK LARAMEE CFO 2708870239 2022-11-15 true MARK LARAMEE 999009999 JEFF SMITH P00289876 2707810111 2022-11-14 3 2021 2022-09-23 18:48:47Z ERIC LEE 320 W 18TH STREET HOPKINSVILLE KY 42240 184496011 false X WWW.JENNIESTUARTHEALTH.ORG X 1914 KY JSMC IS COMMITTED TO EXCELLENCE IN SERVICE, AND WE EXIST TO PROMOTE, PRESERVE AND ACCOMMODATE THE GROWING HEALTHCARE NEEDS OF OUR COMMUNITY. 12 10 1288 10 0 0 9183539 87102 142058974 174377273 1871834 3988437 853829 718131 153968176 179170943 138946 158077 0 0 65505890 69973583 0 0 0 73471776 86040117 139116612 156171777 14851564 22999166 247841315 272583736 131842718 123065363 115998597 149518373 JSMC IS COMMITTED TO EXCELLENCE IN SERVICE, AND WE EXIST TO PROMOTE, PRESERVE AND ACCOMMODATE THE GROWING HEALTHCARE NEEDS OF OUR COMMUNITY. false false 134344044 174377273 PROVIDE HOSPITAL INPATIENT, OUTPATIENT, AND EMERGENCY ROOM SERVICES TO AREA RESIDENTS. IN RECOGNITION OF ITS MISSION, JSMC WILL STRIVE TO PASSIONATELY PURSUE A CULTURE OF EXCEPTIONAL SERVICE AND A COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT. THE AMOUNT OF CHARITY CARE AT COST WAS APPROXIMATELY $369,000 FOR THE YEAR ENDED DECEMBER 31, 2021. 134344044 true true false true false false false false false true true false false true true false true false false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 77 0 true 1288 true false false false false false false false false false false false false X 12 10 false true false false false false false true true false false true true true true true true true true true true KY X MARK LARAMEE 2708870251 320 W 18TH STREET HOPKINSVILLE KY 42240 DAVID BEALLE PHYSICIAN 40.0 0.0 X 995926 0 19832 FREDERICK ROBBE III PHYSICIAN 40.0 0.0 X 929051 0 12869 TANNER PARRENT PHYSICIAN 40.0 0.0 X 914356 0 15935 RAMESH PATEL MED STAFF PRESIDENT/PHYSICIAN 1.0 0.0 X X 785282 0 14392 GERAME WELLS PHYSICIAN 40.0 0.0 X 733299 0 16967 KEITH TOMS VP OF INTEGRATED SERVICES 40.0 0.0 X 192220 0 14024 BETH MCGRAW CHIEF NURSING OFFICER 40.0 0.0 X 185334 0 11141 ANTHONY GIBSON AVP OF HUMAN RESOURCES 40.0 0.0 X 154215 0 5810 ALISSA YOUNG BOARD MEMBER 1.0 0.0 X 0 0 0 BETSY SHELTON BOARD MEMBER 1.0 0.0 X 0 0 0 CARTER HENDRICKS BOARD MEMBER 1.0 0.0 X 0 0 0 CHARLES TURNER MEMBER AT LARGE 1.0 0.0 X X 0 0 0 DERRICK WATSON BOARD CHAIR 1.0 0.0 X X 0 0 0 HOLLIS WHITE BOARD MEMBER 1.0 0.0 X 0 0 0 JANET CALHOUN SECRETARY / TREASURER 1.0 0.0 X X 0 0 0 LESLIE CARROLL BOARD VICE CHAIRMAN 1.0 0.0 X X 0 0 0 MARTY BOZARTH BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL CLARK MD PRESIDENT ELECT MEDICAL STAFF 1.0 0.0 X X 0 0 0 STEVE TRIBBLE BOARD MEMBER 1.0 0.0 X 0 0 0 ERIC LEE CEO 0.0 0.0 X 0 0 0 GREG MOORE CFO 40.0 0.0 X 0 0 0 4889683 0 110970 83 false true true HUDSON STAFFING PLLC 4625 NADINE LN FRANKLIN TN 37064 STAFFING 2045198 THERAPY STAFFING SPECIALISTS INC 103 KEETON DRIVE HOPKINSVILLE KY 42240 PHYSICAL THERAPY 2873944 AMN WORKFORCE SOLUTIONS LLC 8840 CYPRESS WATERS BLVD STE 300 DALLAS TX 75019 STAFFING 1118796 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT SERVICES 1427451 MEDICAL STAFFING SOLUTIONS 9700 HWY 57 N STE A EVANSVILLE IN 60673 STAFFING 932660 21 73550 13552 87102 NET PATIENT REVENUE 621110 174351653 174351653 BIO MED INCOME 621110 25620 25620 174377273 2381390 2381390 0 0 93262 223555 -130293 0 -130293 -130293 6708560 5101513 1607047 1607047 1607047 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722514 256651 256651 MISC REVENUE 900099 591773 591773 848424 179170943 174377273 4706568 158077 158077 0 0 0 1275149 1275149 0 60057709 55111246 4946463 732903 668737 64166 4123256 3475240 648016 3784566 3429097 355469 1428056 1428056 257538 57790 199748 202862 202862 5447 5447 0 0 18641365 15829224 2812141 194712 194712 3694759 2055547 1639212 2853021 2345955 507066 0 2726808 2644452 82356 170669 141390 29279 0 38967 38967 3980352 3723632 256720 0 7575524 6020290 1555234 1410949 210701 1200248 MEDICAL SUPPLIES 32491678 32464179 27499 DUES & SUBSCRIPTIONS 398748 118105 280643 PROVIDER TAX 4822782 4822782 REPAIRS & MAINTENANCE 1886708 984613 902095 3259172 44020 3215152 156171777 134344044 21827733 0 31072393 29057284 101823274 125752069 0 0 16984182 20091732 0 0 0 0 43750 0 2432679 2382658 1709117 2619724 186882971 119632360 67398442 67250611 0 0 0 0 1441829 1384897 0 0 24935649 24044761 247841315 272583736 17982475 17151230 0 0 0 0 59715127 58859840 0 0 0 0 5670945 5207964 0 0 48474171 41846329 131842718 123065363 X 113819809 146838391 2178788 2679982 115998597 149518373 247841315 272583736 X 22999166 10750665 -230055 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5447 5447 false SCHEDULE C, PART 11-B, LINE 1I LOBBYING EXPENSE ----------------- JENNIE STUART PAYS DUES TO THE KENTUCKY HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE FOR LOBBYING. 1422853 205136 35480 1592509 1304660 155745 37552 1422853 1181161 197048 73549 1304660 1245729 -64568 1181161 1099514 146215 1245729 1.00000 false false 9150634 9150634 107687750 63879008 43808742 239365 109476 129889 68778188 55643876 13134312 1027034 1027034 67250611 DUE FROM RELATED PARTY 0 PENSION ASSET 20625386 INSURANCE RECOVERIES 2708983 OTHER ASSETS 710392 24044761 0 THIRD PARTY SETTLEMENTS 2649289 MEDICAL MALPRACTICE LIABILITY 8473957 LEASE LIABILITIES 21187502 MEDICARE ADVANCE PAYMENTS 9535581 41846329 190400707 10750665 413621 11164286 179236421 -65478 -65478 179170943 156671733 427982 427982 156243751 -71974 -71974 156171777 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ---------------- INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME OF WHICH IS RESTRICTED FOR OPERATIONS OF THE MEDICAL CENTER. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS ----------------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE THAT ADDRESSED THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN48 (ASC 740). MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI LINE 2D ---------- REVENUE REPORTED ON JENNIE STUART HEALTH FOUNDATION 990 413,621 LINE 4B --------- REVERSE AUDIT ELIM ENTRY FOR CONTRIBUTION TO FDN 158,077 RENTAL EXPENSE NETTED AGAINST REVENUE PER TAX RETURN (223,555) ------------ ( 65,478) SCHEDULE D, PART XII LINE 4B --------- REVERSE AUDIT ELIM ENTRY FOR CONTRIBUTION TO FDN 204,427 RENTAL EXPENSE NETTED AGAINST REVENUE PER TAX RETURN 223,555 ------------ 402,782 LINE 4B ---------- ELIMINATIONS ADJUSTMENTS ( 71,974) true true X true X 400. true X true true false false 4172838 14429262 0.00000 26343440 45818646 30516278 60247908 0.00000 30516278 60326093 0.00000 1575 1575 64986 64986 66561 66561 true 5159000 2579500 30232435 30961948 -729513 X true true PHYSICIANS HOLDINGS RENTAL ACTIVITY 0.57 0.43 1 1 JENNIE STUART MEDICAL CENTER 320 WEST 18TH STREET HOPKINSVILLE KY 42240 WWW.JENNIESTUARTHEALTH.ORG 100068 X X X JENNIE STUART MEDICAL CENTER 1 false false true X X X X X X X X X 19 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 19 true SEE SCHEDULE H, PART V, SECTION C false true X 139. 400. X X X X X true true X X X true X SEE SCHEDULE H, PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 CHNA COMMUNITY INPUT --------------------- INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT WAS ASKED FROM INDIVIDUALS WITH KNOWLEDGE OF THE COMMUNITY AND EXPERTISE. INPUT WAS PROVIDED THROUGH A COUPLE INTERNET-BASED SURVEYS WITH LOCAL EXPERT ADVISORS WHO REPRESENT THE HOSPITAL'S COMMUNITY AS WELL AS THOSE WHO WORK WITH VULNERABLE POPULATIONS AND WHO HAVE HEALTH KNOWLEDGE. SCHEDULE H, PART V, SECTION B, LINE 7 & 10 CHNA / IMPLEMENTATION STRATEGY ------------------------------- THE FULL CHNA AND IMPLEMENTATION STRATEGY REPORT MAY BE OBTAINED AT: HTTPS://WWW.JENNIESTUARTHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSM ENT SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS NOT IDENTIFIED ----------------------- THE HOSPITAL DID NOT ADDRESS EVERY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT BECAUSE SOME OF THE NEEDS FELL OUT OF THE SCOPE OF EXPERTISE AND RESOURCES OF THE HOSPITAL, WHILE OTHER NEEDS WERE ALREADY BEING ADDRESSED IN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 16 MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY ------------------------------------------------- THE ENTIRE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. INFORMATION REGARDING HOW TO OBTAIN THE FINANCIAL ASSISTANCE POLICY IS INCLUDED ON BILLING INVOICES AND IN POSTINGS IN THE HOSPITAL WAITING ROOMS. THE FULL FINANCIAL ASSISTANCE POLICY MAY BE OBTAINED AT: HTTPS://WWW.JENNIESTUARTHEALTH.ORG/PATIENT-VISITORS/FINANCIAL-ASSISTANCE-G UIDELINES 17 JENNIE STUART AMBULATORY SURGERY DEPT 8250 EAGLE WAY HOPKINSVILLE KY 42240 OUTPATIENT SURGERY DEPARTMENT JENNIE STUART MEDICAL IMAGING CENTER 110 NICK TERHUNE BLVD HOPKINSVILLE KY 42240 DIAGNOSTIC IMAGING JSMG DEPT OF GASTROENTEROLOGY 231 BURLEY AVE HOPKINSVILLE KY 42245 PHYSICIAN OFFICE JSMG DEPT OF GENERAL SURGERY 1724 KENTON ST SUITE 2B HOPKINSVILLE KY 42249 PHYSICIAN OFFICE JSMG DEPT OF DERMATOLOGY 10755 EAGLE WAY HOPKINSVILLE KY 42243 PHYSICIAN OFFICE JSMG DEPT OF FAMILY HEALTH 223 BURLEY AVE HOPKINSVILLE KY 42242 PHYSICIAN OFFICE JSMG DEPT OF UROLOGY 219 W 17TH ST HOPKINSVILLE KY 42247 PHYSICIAN OFFICE JSMG DEPT OF GENERAL SURGERY 1722 HIGH ST HOPKINSVILLE KY 42248 PHYSICIAN OFFICE JSMG WKY ORTHOPEDIC AND SPORTS MEDICINE 10755 EAGLE WAY HOPKINSVILLE KY 42246 PHYSICIAN OFFICE JSMG DEPT OF FAMILY HEALTH 120 N MAIN ST TRENTON KY 42286 PHYSICIAN OFFICE JSMG DEPT OF FAMILY HEALTH 222 W 18TH ST HOPKINSVILLE KY 42241 PHYSICIAN OFFICE JSMG DEPT OF OBSTETRICS AND GYNECOLOGY 1717 HIGH STREET SUITE 4B HOPKINSVILLE KY 42244 PHYSICIAN OFFICE JENNIE STUART EXPRESS LAB 110 NICK TERHUNE BOULEVARD HOPKINSVILLE KY 42240 EXPRESS LAB JENNIE STUART PHYSICAL THERAPY 10755 EAGLE WAY HOPKINSVILLE KY 42240 PHYSICAL THERAPY JENNIE STUART HOME HEALTH 320 WEST 18TH STREET HOPKINSVILLE KY 42240 HOME HEALTH JENNIE CARE 10755 EAGLE WAY HOPKINSVILLE KY 42240 PHYSICIAN OFFICE JSMG DEPT OF ENT 10755 EAGLE WAY HOPKINSVILLE KY 42240 PHYSICIAN OFFICE SCHEDULE H, PART III, SECTION A, LINE 2 & 3 BAD DEBT EXPENSE ---------------- THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2020. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. APPROXIMATELY 50% OF ACCOUNTS WRITTEN OFF AS BAD DEBT WOULD QUALIFY FOR CHARITY CARE IF THE NECESSARY DOCUMENTATION WERE RECEIVED BY JENNIE STUART MEDICAL CENTER. SCHEDULE H, PART III, LINE 8 CALCULATION OF MEDICARE ALLOWABLE COSTS ---------------------------------------- COSTS REPORTED ON LINE 6 ARE OBTAINED USING THE MEDICARE COST REPORT COST TO CHARGE RATIO. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT ----------------- DURING THE STRATEGIC BUSINESS PLANNING SESSION, THE ADMINISTRATIVE GROUP ANALYZES NEW SERVICES THAT MAY BE NEEDED. THIS PLAN IS BASED ON 5 PILLARS, ONE OF WHICH IS GROWTH. JSMC RECRUITS AND ENGAGES KEY STAKEHOLDERS AND WORKS TO HELP ASSESS RESULTS IN ADDRESSING COMMUNITY WIDE NEEDS. FEEDBACK FROM SURVEYS AND CITIZENS IN OUR COMMUNITY PROVIDE US WITH INPUT AND FEEDBACK. SEE THE FULL REPORT ON THE HOSPITAL'S WEBSITE AT: HTTP://WWW.JENNIESTUARTHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSME NT/ SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ------------------------------------------------ SIGNS AND MONITORS ARE DISPLAYED IN REGISTRATION AREAS TO NOTIFY PATIENTS REGARDING THE PROGRAMS AVAILABLE. COPIES OF THE FAP AND BILLING AND COLLECTION POLICIES ARE AVAILABLE ON THE HOSPITAL WEBSITE AS WELL AS IN PAPER FORM BY REQUEST. ALSO, COUNSELORS ARE AVAILABLE TO PROVIDE INFORMATION AND WORK WITH PATIENTS. ALL REGISTRARS AND BILLING CLERKS RECEIVE EDUCATION REGARDING POLICIES AND PRACTICES. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION ----------------------- JSMC IS THE ONLY NON-MILITARY ACUTE CARE FACILITY IN CHRISTIAN COUNTY, KENTUCKY. CHRISTIAN, TODD, AND TRIGG COUNTIES MAKE UP JSMC'S PRIMARY SERVICE AREA. JSMC'S SECONDARY SERVICE AREA IS COMPRISED OF CALDWELL, HOPKINS, AND MUHLENBERG COUNTIES IN KENTUCKY. HOPKINSVILLE IS THE 7TH LARGEST CITY IN KY AND IS APPROXIMATELY 75 MILES FROM NASHVILLE, TN. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH ------------------------------ JENNIE STUART IS ONE OF THE MOST WIDELY ENGAGED OPERATING ENTITIES IN OUR REGION, WORKING WITH A MULTITUDE OF KEY COMMUNITY IMPACT ORGANIZATIONS TO MEET THE NEEDS OF THE PEOPLE OF OUR COMMUNITY AND WESTERN KENTUCKY. OUR PRIMARY COLLABORATIVE ENTITY IN MEETING THE NEEDS OF OUR PATIENTS AND THE COMMUNITY IS THE MEDICAL STAFF OF JENNIE STUART MEDICAL CENTER AND JENNIE STUART MEDICAL GROUP. ADDITIONALLY, WE HAVE FOCUSED RELATIONSHIPS WITH JENNIE STUART FAMILY HEALTH, CONVENIENT CARE, OB/GYN ASSOCIATES, LIFELINC ANESTHESIA, ALIGN MD, AND PENNYRILE RADIOLOGY TO SPECIFICALLY ADDRESS THE HEALTHCARE NEEDS FOR MULTIPLE AT-RISK, UNDERSERVED PATIENT POPULATIONS. JENNIE STUART'S BOARD HAS ALSO APPROVED MAJOR INITIATIVES FOR HEALTH, EDUCATION AND WELLNESS COLLABORATIONS WITH PENNYROYAL MENTAL HEALTH, HOPKINSVILLE/CHRISTIAN COUNTY AMBULANCE SERVICE, HOPKINSVILLE COMMUNITY COLLEGE, AND HOPKINSVILLE/CHRISTIAN COUNTY YMCA. JSMC OFFERED FREE PROSTATE SCREENINGS, WELLNESS TESTS AND EDUCATION DIABETES TESTING AND EDUCATION, CPR CLASSES, WEIGHT LOSS SEMINARS AND EDUCATION, AND OUR ANNUAL WOMENS SHOW WHICH PROVIDED HEALTHCARE AND WELLNESS INFORMATION TO WOMEN IN OUR COMMUNITY. ALSO, FREE TESTING SUCH AS CAROTID ARTERY TESTING, HEARING TESTING, BLOOD SUGAR TESTING, MAMMOGRAMS, AND PAP TESTING. SCHEDULE H, PART I, LINE 7, COL (F) & SCHEDULE H, PART II, COL (F) PERCENT OF TOTAL EXPENSE: ------------------------ TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY ------------------- THE MEDICARE COST TO CHARGE RATIO WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. true JENNIE STUART HEALTH FOUNDATION PO BOX 608 HOPKINSVILLE KY 42241 822980765 501(C)3 158077 ADMIN SUPPORT 1 SCHEDULE I, PART I, LINE 2 MONITORING THE USE OF GRANT FUNDS ------------------------------------ ADMINISTRATIVE EXPENSES FOR THE JENNIE STUART HEALTH FOUNDATION, A PHILANTHROPIC SUBSIDIARY OF JENNIE STUART HEALTH, ARE PROVIDED BY JENNIE STUART HEALTH TO ALLOW THE FOUNDATION TO DIRECTLY SUPPORT COMMUNITY CARE AND SERVICE EXPANSION. X true true X false false false false false true false false false ERIC LEE CEO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GREG MOORE CFO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RAMESH PATEL MED STAFF PRESIDENT/PHYSICIAN 759011 0 25052 0 1219 0 8700 0 5692 0 799674 0 0 0 ANTHONY GIBSON AVP OF HUMAN RESOURCES 154215 0 0 0 0 0 0 0 5810 0 160025 0 0 0 BETH MCGRAW CHIEF NURSING OFFICER 171902 0 13192 0 240 0 5331 0 5810 0 196475 0 0 0 KEITH TOMS VP OF INTEGRATED SERVICES 191921 0 52 0 247 0 4672 0 9352 0 206244 0 0 0 DAVID BEALLE PHYSICIAN 638697 0 356455 0 774 0 8700 0 11132 0 1015758 0 0 0 FREDERICK ROBBE III PHYSICIAN 645831 0 282806 0 414 0 8700 0 4169 0 941920 0 0 0 GERAME WELLS PHYSICIAN 422605 0 310424 0 270 0 8700 0 8267 0 750266 0 0 0 TANNER PARRENT PHYSICIAN 467765 0 446429 0 162 0 8700 0 7235 0 930291 0 0 0 SCHEDULE J, PART I, LINE 1A BENEFITS PROVIDED ------------------ COUNTRY CLUB MEMBERSHIP DUES WERE PAID FOR THE CEO AND WERE EXCLUDED FROM TAXABLE COMPENSATION. SCHEDULE J, PART II COMPENSATION FROM UNRELATED ORGANIZATIONS ------------------------------------------ THE HOSPITAL CONTRACTS THE SERVICES OF ERIC LEE (CEO) AND GREG MOORE (CFO) WITH QHR (FORMERLY QUORUM HEALTH RESOURCES, INC.), AN UNRELATED ORGANIZATION. QHR WAS PAID $974,519 FOR SERVICES PROVIDED BY THESE INDIVIDUALS DURING 2021. SCHEDULE J, PART II COMPENSATION REPORTED --------------------- THE FOLLOWING INDIVIDUALS' COMPENSATION IS PAID FROM JENNIE STUART MEDICAL GROUP, A DISREGARDED ENTITY OF JENNIE STUART MEDICAL CENTER: - DAVID BEALLE - RAMESH PATEL - FREDERICK ROBBE III - TANNER PARRENT - GERAME WELLS - ROBERT LEWE SCHEDULE J, PART I, LINE 6A LEADERSHIP INCENTIVE PLAN -------------------------- JSMC'S ANNUAL INCENTIVE PLAN IS BASED ON THE FOLLOWING GUIDING PRINCIPLES: - SUPPORT THE MISSION OF JSMC - RETAIN AND MOTIVATE A HIGH PERFORMANCE EXECUTIVE TEAM - REWARD SUCCESS IN ACHIEVING MEASURABLE FINANCIAL, QUALITY AND STRATEGIC GOALS - ALIGN INCENTIVE COMPENSATION AWARDS WITH THE STRATEGIC PLAN OF JSMC - ENCOURAGE HIGH LEVELS OF TEAM AND INDIVIDUAL PERFORMANCE PLAN PARTICIPANTS INCLUDE SELECT LEADERS AND MANAGERS AT JSMC. THE ANNUAL INCENTIVE AWARD LEVELS ARE: - THRESHOLD = 5% OF BASE SALARY - TARGET = 10% OF BASE SALARY - MAXIMUM = 15% OF BASE SALARY PERFORMANCE MEASURES ARE BASED ON THE PARTICIPANT'S PROGRESS AGAINST THE FOLLOWING METRICS: 1. PATIENT EXPERIENCE - HCAHPS SCORES MEETING AND/OR EXCEEDING TARGET 2. QUALITY - READMISSION RATES MEETING AND/OR EXCEEDING TARGET 3. FINANCIAL - OPERATING MARGIN MEETING AND/OR EXCEEDING VARIOUS TIERS A COUNTY OF CHRISTIAN KENTUCKY 616000824 170692CPO 2016-12-21 62052293 REFUND OUTSTANDING BONDS/CAPITAL false false false A 1615000 0 62052293 4994713 0 45910620 1146961 0 0 10000000 0 0 2019 false true true true A false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false true A false false false true false false 0 true NAXIS FUNDING GROUP 10.1 true false true A true SCHEDULE K, PART I, COLUMN F PURPOSE OF THE BOND ------------------- 1. ADVANCE REFUNDING ON BONDS ISSUED 09/18/2008 2. CONSTRUCTION AND EQUIPPING OF THE CAPITAL ADDITIONS AND IMPROVEMENTS TO THE ORGANIZATION'S MAIN HOSPITAL CAMPUS AND AMBULATORY CARE CAMPUS SCHEDULE K, PART IV, LINE 2C REBATE COMPUTATION ------------------------------ THE ARBITRAGE REBATE CALCULATION WAS PERFORMED IN FEBRUARY 2020, COVERING THE PERIOD OF DECEMBER 21, 2016 TO JANUARY 31, 2020. NO ARBITRAGE REBATE LIABILITY HAS BEEN RECORDED AS A RESULT OF THE EVALUATION. FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF MANAGEMENT DUTIES ------------------------------- THE MEDICAL CENTER CONTRACTS WITH QUORUM HEALTH RESOURCES, LLC TO PROVIDE MANAGEMENT SERVICES UNDER AN AGREEMENT WHICH EXPIRES AUGUST 31, 2026. FORM 990, PART VI, SECTION B, LINE 11 REVIEW OF FORM 990 ------------------- THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE ITS FORM 990. ONCE THE FORM 990 IS PREPARED BY THE ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT, THE FINAL FORM IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING. QUESTIONS AND COMMENTS RAISED DURING THE MEETING REGARDING THE FINAL FORM 990 ARE ADDRESSED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12B AND 12C MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ EACH OFFICER FROM DEPARTMENT MANAGER TO THE PRESIDENT, MEMBER OF MEDICAL STAFF, QUALIFIED PROFESSIONAL OR LICENSED INDEPENDENT PRACTITIONER, EACH MEMBER OF THE BOARD, AND EACH MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS MUST SIGN ANNUALLY A STATEMENT AND MAKE DISCLOSURES WHICH ARE PRESENTED TO THE BOARD FOR REVIEW, BEFORE THE FIRST BOARD MEETING OF EACH NEW YEAR. DOCUMENTATION OF THE ANNUAL BOARD REVIEW WILL BE RECORDED IN THE MINUTES. PERIODIC REVIEW SHALL BE CONDUCTED TO ENSURE THE MEDICAL CENTER OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. FORM 990, PART VI, SECTION B, LINE 15A AND 15B PROCESS FOR DETERMINING COMPENSATION ------------------------------------- AN ANNUAL COMPENSATION REVIEW WAS CONDUCTED IN 2021 FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS AND OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ----------------------------------------- THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 8 RECONCILIATION OF NET ASSETS ---------------------------- OTHER CHANGES IN NET ASSETS: DISTRIBUTIONS TO NONCONTROLLING INTEREST $(230,050) ROUNDING $( 5) FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIANS/ PROFESSIONAL SVCS TOTAL FEES:3095745 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED LAB SERVICES TOTAL FEES:1399866 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:14145754 FAIRVIEW PHYSICIANS NETWORK LLC 320 W 18TH STREET HOPKINSVILLE KY 42240 452032126 PHYSCIAN SRVS KY 10539413 4231755 JSMC WESTERN KENTUCKY MEDICAL DEVELOPMENTLLC PO BOX 2400 HOPKINSVILLE KY 42241 RENTAL KY JSMC JENNIE STUART HEALTH FOUNDATION PO BOX 608 HOPKINSVILLE KY 42241 822980765 SUPPORT KY 501(C)(3) 12B-11 JSMC true PHYSICIANS' HOLDINGS 320 W18 HOPKINSVILLE KY 42240 261608818 BUILDING RENT KY JSMC EXCLUDED 252975 1541984 false 0 false 0.57000 KENTUCKY HEALTHCARE HOLDINGS I LLC 109 WESTPARK DRIVE BRENTWOOD TN 37027 842468059 REAL ESTATE TN NA RELATED 170271 830567 false 0 false 0.50000 false false false false false false false false false true true false false false false false false true false PHYSICIANS' HOLDINGS LLC J 31566 FMV PHYSICIANS' HOLDINGS LLC K 605666 FMV