2020-08-13T16:21:45-05:00 2019-09-30 201941244 HORNE LLP 661 SUNNYBROOK ROAD STE 100 RIDGELAND MS 39157 990 2018-10-01 640333594 KINGS DAUGHTERS MEDICAL CENTER KING 6018336011 P O BOX 948 BROOKHAVEN MS 396020948 ALVIN HOOVER CHIEF EXECUTIVE OFFICER 6018336011 2020-08-07 1 AMIE T WHITTINGTON CPA P01082167 6013261000 2020-08-07 23.126.208.57 2020-08-07 17:50:05 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F5A93BD5C42AC6C5209EA7E4A5E5DD2DEBBFD90D 2018 2020-11-06 18:47:13Z ALVIN HOOVER 427 HWY 51 NORTH BROOKHAVEN MS 39601 104394794 0 X KDMC.ORG X 1913 MS KINGS DAUGHTERS MEDICAL CENTER IS AN ACUTE CARE HOSPITAL LICENSED FOR 99 BEDS ENGAGED IN (AS STATED IN OUR MISSION STATEMENT) "PROVIDING QUALITY HEALTH AND WELLNESS SERVICES IN A CHRISTIAN ENVIRONMENT". 12 12 755 50 738624 0 180000 311714 101704067 101810649 286025 596188 1715722 1388527 103885814 104107078 21708 1500 0 0 41776181 43568314 0 0 0 60616706 59986338 102414595 103556152 1471219 550926 74810950 74947660 20116331 19704928 54694619 55242732 KINGS DAUGHTERS MEDICAL CENTER IS AN ACUTE CARE HOSPITAL LICENSED FOR 99 BEDS AND ENGAGES IN (AS STATED IN OUR MISSION STATEMENT) "PROVIDING QUALITY HEALTH AND WELLNESS SERVICES IN A CHRISTIAN ENVIRONMENT". 0 0 87352282 1500 102505742 INPATIENT CARE: DURING FY 2018, KINGS DAUGHTERS MEDICAL CENTER PROVIDED HEALTHCARE SERVICES TO ALL PERSONS SEEKING CARE. TOTAL ADMISSIONS- 2,507; PATIENT DAYS- 7,156; DELIVERED 723 BABIES; PERFORMED 5,902 SURGERIES; TREATED 24,195 EMERGENCY ROOM VISITS; 25,157 MEDICAL CLINIC VISITS; 25,887 PEDIATRIC CLINIC VISITS; 10,610 ORTHO CLINIC VISITS; 18,867 SPECIALTY CLINIC VISITS; 4,891 VISION CENTER VISITS AND PROVIDED CARE TO 66,131 OUTPATIENTS. CHARITY SERVICES PROVIDED AMOUNTED TO $3,524,715 WHILE UNCOLLECTIBLE ACCOUNTS APPROXIMATED $13,905,167. 129329 PATIENT EDUCATION: COMMUNITY EDUCATION AND HEALTH SCREENINGS EVENTS FOR CHILDBIRTH CLASSES, CPR, DIABETES MANAGEMENT, BLOOD PRESSURE SCREENINGS, AND OTHER HEALTH SCREENINGS WERE PROVIDED FREE OR AT MINIMAL COST. 87481611 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 71 0 1 755 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MS X ALVIN HOOVER CEO 6018336011 427 HWY 51 NORTH BROOKHAVEN MS 39601 ROBYN AKER BOARD CHAIRMAN 5.00 X 0 0 0 SYLVIA CAMPBELL BOARD SECRETARY 1.00 X 0 0 0 BILL JACOBS BOARD TREASURER 1.00 X 0 0 0 DR RICHARD RUSHING TRUSTEE 1.00 X 0 0 0 DR WORTH SIMMONS TRUSTEE 40.00 X 0 0 0 SONYA KIMBLE TRUSTEE 1.00 X 0 0 0 BETSY SMITH TRUSTEE 1.00 X 0 0 0 PAT SMITH TRUSTEE 1.00 X 0 0 0 MICHAEL TANNER TRUSTEE 1.00 X 0 0 0 KOREY WHITE TRUSTEE 1.00 X 0 0 0 MARY LU REDD BOARD VICE CHAIRMAN 1.00 X 0 0 0 DR BILL SONES CHIEF OF STAFF - NONVOTING - PART YEAR 40.00 X 5000 0 0 JOSHUA ILES CHIEF OF STAFF - NONVOTING - PART YEAR 40.00 X 367250 0 30204 ALVIN HOOVER CEO 40.00 X X 0 0 0 TOM HOOD COO 40.00 X 0 0 0 WENDELL WILKES CFO-PART YEAR 40.00 X 0 0 0 CHERI BROOKS CNO 40.00 X 184634 0 26099 JOHN TURBA MD SURGEON 40.00 X 671603 0 18912 TIMOTHY SHANN MD 40.00 X 370210 0 29399 C MITCH HOLLAND MD PEDIATRICIAN 40.00 X 432435 0 42520 MARK BARRON MD ORTHOPAEDIC SURGEON 40.00 X 686104 0 14478 JEFFREY D ROSS MD 40.00 X 347396 0 28818 3064632 0 190430 56 0 1 0 BROOKHAVEN ANESTHESIA AND PAIN MANAGEMEN PO BOX 948 BROOKHAVEN MS 39601 PAIN MANAGEMENT 3601368 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 37027 HEALTHCARE MANAGEMENT 1535116 SOUTH CENTRAL UROLOGY SERVICES PLLC PO BOX 92301 CHICAGO IL 60675 HEALTHCARE - UROLOGY 1221750 ATHENA 1105 E CHURCH STREET CRYSTAL SPRINGS MS 39059 CLINIC BILLING SERVICES 667241 HEALOGICS WOUND CARE 28525 NETWORK PLACE CHICAGO IL 60673 WOUND CARE CLINIC MANAGEMENT 467656 40 150000 161714 311714 PATIENT SERVICES 621990 101810649 101810649 101810649 577094 577094 292508 287716 4792 4792 49982 -45190 19094 0 19094 19094 19094 OTHER 900099 1002383 313741 688642 CAFETERIA 722210 369248 369248 PHYSICIAN SERVICES 621110 6666 6666 5438 5438 1383735 104107078 102505742 738624 550998 1500 1500 556884 367250 189634 36788963 32180878 4608085 963713 841651 122062 2652576 1953947 698629 2606178 2130164 476014 1910632 710890 1199742 46846 46846 103360 103360 6649755 6649755 602988 11744 591244 809905 801463 8442 159404 89447 69957 67179 34781 32398 384090 384090 3884948 3884948 564521 216741 347780 SUPPLIES 15742359 15363176 379183 PROVISION FOR BAD DEBT 13905167 13905167 PURCHASED SERVICES 5516026 4629603 886423 PURCHASED LABOR 3072048 817385 2254663 6567110 2507031 4060079 103556152 87481611 16074541 0 6175249 7699193 9835867 9430799 1976164 1893005 825573 774000 99745479 58771233 42145607 40974246 13852490 14176417 74810950 74947660 7727450 8655612 7186401 6950858 5202480 3846126 0 252332 20116331 19704928 X 54694619 55242732 54694619 55242732 74810950 74947660 550926 -2813 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10399 10399 0 PART II-B, LINE 1: KING'S DAUGHTER MEDICAL CENTER PAYS DUES TO MISSISSIPPI HOSPITAL ASSOCIATION TOTALING $58,955, OF WHICH 14.59% ($8,601) IS ATTRIBUTABLE TO LOBBYING AND TO THE AMERICAN HOSPITAL ASSOCIATION TOTALING $7,909, OF WHICH 22.73% ($1,798) IS ATTRIBUTABLE TO LOBBYING. TOTAL DUES ATTRIBUTABLE TO LOBBYING ACTIVITIES IS $10,399. 5302370 5302370 49609853 24642587 24967266 44554905 34126552 10428353 278351 2094 276257 40974246 ASSETS LIMITED AS TO USE - NONCURRENT 13180828 OTHER ASSETS 995589 14176417 DUE TO THIRD PARTY 252332 252332 90265217 -2813 -13617451 -13620264 103885481 221597 221597 104107078 89714291 -2813 287716 284903 89429388 14126764 14126764 103556152 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 287,716. PROVISION FOR BAD DEBTS -13,905,167. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE CLASSIFIED AS EXPENSE ON FORM 990 221,597. ROUNDING PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 287,716. PART XII, LINE 4B - OTHER ADJUSTMENTS: REVENUE CLASSIFIED AS EXPENSE ON FORM 990 221,597. PROVISON FOR BAD DEBTS 13,905,167. 1 1 1 X 1 X 1 1 1 0 1 1 1129002 1129002 0.01260 12124018 14958345 0 0.00000 13253020 14958345 1129002 0.01260 87023 87023 0.00100 38733 38733 0.00040 125756 125756 0.00140 13378776 14958345 1254758 0.01400 1 13905167 5562067 23445474 21476740 1968734 X 1 1 1 1 KING'S DAUGHTERS MEDICAL CENTER 427 HWY 51 N BROOKHAVEN MS 39602 X X X KING'S DAUGHTER MEDICAL CENTER 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_COMMUNITY_HEALTH_NEEDS_ASSESSMENT_11 X 1 17 1 HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_CHNA_IMPLEMENTATION.PDF 0 1 X 100.000000000000 250.000000000000 X X 1 1 X X X X 1 X HTTP://KDMC.ORG/INDEX.CFM/LINKSERVID/30BF903E-155D-D235-07F0C4A3E53A3FF8/SH X HTTP://KDMC.ORG/INDEX.CFM/LINKSERVID/30CA95B9-155D-D235-071A3A990A3AA6D7/SH X HTTPS://KDMC.ORG/PATIENTS-AND-VISITORS/PATIENT-FINANCIAL-RESOURCE/OVERVIEW/ X X X X X X X 1 X X 1 X X X 1 X 0 0 KING'S DAUGHTER MEDICAL CENTER PART V, SECTION B, LINE 5: AS A PART OF THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY INPUT WAS OBTAINED THROUGH VARIOUS PRIMARY SOURCES INCLUDING HEALTHCARE PROFESSIONALS, FOCUS GROUPS WITH SENIOR CITIZENS, LOCAL HEALTH DEPARTMENT REPRESENTATIVES, SCHOOL HEALTH NURSES, REPRESENTATIVES FROM UNDERSERVED POPULATIONS, SOCIAL WORKERS, AND OTHER COMMUNITY REPRESENTATIVES THAT HAVE A BROAD UNDERSTANDING OF THE COMMUNITY'S NEEDS.THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_COMMUNITY_HEALTH_NEEDS_ASSESSMENT_11-16-18.PDFTHE IMPLEMENTATION STRATEGY CAN BE ACCESSED AT:HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_CHNA_IMPLEMENTATION.PDF KING'S DAUGHTER MEDICAL CENTER PART V, SECTION B, LINE 11: KDMC ADDRESSED ALL SIGNIFICANT NEEDS DURING THE RECENT CHNA. THERE WERE, HOWEVER, SOME IDENTIFIED NEEDS THAT WERE NOT ADDRESSED DURING THE CHNA PROCESS WHICH INCLUDED TRANSPORTATION, CRIME, AND THE LACK OF PARENTAL INVOLVEMENT. KDMC DID NOT ADDRESS TRANSPORTATION DUE TO THE SERVICES THAT ARE CURRENTLY AVAILABLE IN THE AREA SUCH AS THE STATE MEDICAID TRANSPORTATION SERVICE. FURTHERMORE, KDMC'S EMS SERVICE PROVIDES TRANSPORTATION HOME AT NO CHARGE FOR THE INDIGENT, AND KDMC INTERACTS WITH LOCAL CHURCHES TO PROVIDE ASSISTANCE IN PATIENT TRANSPORTS. THE OTHER IDENTIFIED NEEDS OF CRIME AND THE LACK OF PARENTAL INVOLVEMENT WERE NOT ADDRESSED BY KDMC DUE TO A LACK OF EXPERTISE AND RESOURCES TO ADEQUATELY IMPACT THE COMMUNITY.THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_COMMUNITY_HEALTH_NEEDS_ASSESSMENT_11-16-18.PDFTHE IMPLEMENTATION STRATEGY CAN BE ACCESSED AT:HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_CHNA_IMPLEMENTATION.PDF KING'S DAUGHTER MEDICAL CENTER PART V, SECTION B, LINE 16J: FINANCIAL BROCHURES ARE GIVEN OUT TO EACH PATIENT AT REGISTRATION. THE BROCHURES ARE PLACED IN THE WAITING ROOMS, AT PHYSICIAN OFFICES AND GIVEN OUT TO THE COMMUNITY THRU CHURCHES, SERVICE ORGANIZATIONS, AND EMPLOYEES TAKING TO FRIENDS. FINANCIAL COUNSELING IS PROVIDED UPON REGISTRATION AND/OR DISCHARGE. A MESSAGE IS ON STATEMENTS AND LETTERS LETTING PATIENTS KNOW WHERE TO CALL TO GET FINANCIAL ASSISTANCE INFORMATION. SIGNS ARE POSTED AT ALL REGISTRATION AREAS AND WAITING ROOMS TELLING PATIENTS, VISITORS, ETC. WHERE TO CALL FOR FINANCIAL ASSISTANCE.THE FAP CAN BE ACCESSED AT: HTTPS://KDMC.ORG/PATIENTS-AND-VISITORS/PATIENT-FINANCIAL-RESOURCE/FINANCIAL-ASSISTANCE-PROGRAM/THE FAP APPLICATION CAN BE ACCESSED AT:HTTPS://KDMC.ORG/PATIENTS-AND-VISITORS/PATIENT-FINANCIAL-RESOURCE/FINANCIAL-ASSISTANCE-APPLICATION-KDMC-BROOKHAVEN-MS/THE FAP PLAIN LANGUAGE SUMMARY CAN BE ACCESSED AT:HTTPS://KDMC.ORG/PATIENTS-AND-VISITORS/PATIENT-FINANCIAL-RESOURCE/OVERVIEW/ KING'S DAUGHTER MEDICAL CENTER PART V, SECTION B, LINE 20E: ALL PATIENTS ARE ASKED AT TIME OF REGISTRATION IF THEY ARE INTERESTED IN FILLING OUT A FINANCIAL ASSISTANCE APPLICATION. THEY EACH FILL OUT AN APPLICATION ACCORDING TO SIZE OF FAMILY, INCOME AND ANY OTHER INFORMATION REQUIRED. A LETTER IS SENT OUT TELLING THE PERSON IF THEY QUALIFY OR NOT OR IF ANY FURTHER INFORMATION IS NEEDED. A LETTER GOES OUT AT 240 DAYS TO INFORM THEM THAT THE TIME FOR QUALIFYING IS AT AN END. NO ONE IS TURNED OUT TO COLLECTIONS UNTIL A TIME OF 121 DAYS HAVE PASSED. 6 1 - KDMC PEDIATRIC ADOLESCENT CLINIC 509 BROOKMAN DRIVE BROOKHAVEN MS 396012326 PEDIATRIC CLINIC 2 - KDMC ORTHOPEDIC & SPORTS MEDICINE CLINIC 601 BROOKMAN DRIVE BROOKHAVEN MS 39601 ORTHOPEDIC CLINIC 3 - KING'S DAUGHTERS MEDICAL CLINIC 950 BROOKWAY BOULEVARD BROOKHAVEN MS 39601 MEDICAL CLINIC 4 - KDMC SPECIALTY CLINIC 940 BROOKWAY BLVD BROOKHAVEN MS 39601 SPECIALTY CLINIC 5 - KDMC VISION CENTER 624 HIGHWAY 51 N BROOKHAVEN MS 39601 VISION CENTER 6 - BEHAVIORAL WELLNESS CENTER 439 NORTH JACKSON ST SUITE D BROOKHAVEN MS 39601 BEHAVIORAL WELLNESS PART I, LINE 7: MEDICARE COST-TO-CHARGE RATIO ONLY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13,905,167. PART II, COMMUNITY BUILDING ACTIVITIES: KDMC ENCOURAGES ALL MANAGERS TO PARTICIPATE IN AREA SERVICE ORGANIZATIONS IN ORDER TO PROVIDE COMMUNITY ACCESS POINTS AND TO SOLICIT ADDITIONAL SUGGESTIONS FOR IMPROVING OUR SERVICE TO THE COMMUNITY AND PROVIDE FOR UNMET NEEDS. KDMC SPONSORS AND ENCOURAGES STAFF TO PARTICIPATE IN A VARIETY OF COMMUNITY EVENTS - RELAY FOR LIFE, EXCHANGE CLUB FAIR, THINK PINK EVENTS, ETC. PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED AS AMOUNT ON AUDITED FINANCIAL STATEMENTS. BAD DEBT THAT WOULD HAVE QUALIFIED FOR CHARITY CARE, IF FINANCIAL INFORMATION WAS AVAILABLE TO VERIFY, IS ESTIMATED AT 40%. PER NOTE 1 OF THE FINANCIAL STATEMENTS, PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE MEDICAL CENTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 93.0 PERCENT AND 90.0 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2019 AND 2018, RESPECTIVELY.IT IS THE POLICY OF KDMC TO PROVIDE CHARITY ADJUSTMENT RELIEF TO ALL PERSONS THAT HAVE A DOCUMENTED NEED FOR CHARITY CONSIDERATION. WE ATTEMPT, WITH EACH CONTACT TO COLLECT FROM THOSE PATIENTS WHO EXPRESS DIFFICULTY IN PAYING THEIR OBLIGATION, TO ACQUIRE DOCUMENTATION THAT WILL ALLOW US TO VERIFY THAT THEY DO, IN FACT, QUALIFY FOR CHARITY. MOST OF THESE PATIENTS WILL NOT PROVIDE ANY DOCUMENTATION THAT WILL ALLOW THAT DETERMINATION TO BE MADE. WE RESEARCH MANY OF THESE ACCOUNTS NOTING THAT THE PATIENT IS NOT EMPLOYED AND, BASED ON THAT DETERMINATION, FEEL THAT AT LEAST 40% OF OUR BAD DEBTS COULD BE CLASSIFIED AS CHARITY IF WE COULD PERSUADE THE PATIENT TO COMPLETE THE CHARITY APPLICATION AND SUBMIT SOME MINIMAL DOCUMENTATION. IT IS OUR OPINION THAT MOST OF THESE PATIENTS ARE NOT SUBMITTING APPLICATIONS OR DOCUMENTATION BECAUSE THEY ARE AWARE THAT, DUE TO THEIR LACK OF EMPLOYMENT AND/OR SIGNIFICANT ASSETS, WE WILL HAVE NO LEGAL RECOURSE FOR COLLECTING THE BALANCE DUE.IN FEBRUARY 2013 THE CHARITY POLICY WAS UPDATED TO ALLOW ACCOUNTS TO BE CLASSIFIED AS CHARITY BASED ON THE NEW SOFTWARE THAT WAS INSTALLED. THIS SOFTWARE HELPS TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR ASSISTANCE. WHEN WE UPDATED THE POLICY TO ALLOW THE HOSPITAL TO TAKE A SIGNED AFFIDAVIT FOR THOSE PEOPLE WHO DO NOT WORK AND DO NOT FILE INCOME TAX IT HAS SHOWN TO QUALIFY MANY MORE PATIENTS WHO WOULD NOT OR COULD NOT BRING THE REQUIRED FINANCIAL INFORMATION BACK TO THE FACILITY. THIS IS DONE AT TIME OF SERVICE SINCE MANY OF OUR PATIENTS DO NOT HAVE THE RESOURCES TO PAY. WE HAVE BEGUN A PROGRAM TO EDUCATE THE COMMUNITY BY PUTTING THE FINANCIAL ASSISTANCE APPLICATION ON OUR WEBSITE, NOTICES OF OUR PROGRAM IN THE NEWSPAPER AND WITH OTHER COMMUNITY PROGRAMS SUCH AS OUT REACH MINISTRIES AND LOCAL CHURCHES. SIGNS ARE POSTED IN DIFFERENT AREAS OF THE FACILITY AND PAMPHLETS ARE AVAILABLE TO THE PUBLIC. PART III, LINE 9B: THE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. THE CRITERIA FOR CHARITY CARE CONSIDERS ITEMS SUCH AS FAMILY INCOME, NET WORTH, EXTENT OF FINANCIAL OBLIGATIONS FOR HEALTHCARE SERVICES, ETC. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR CHARITY CARE. COLLECTION PRACTICES FOR NON-CHARITY PATIENTS INCLUDES LETTERS, PHONE CALLS AND OTHER FOLLOW-UP EFFORTS. GUARANTORS WITH JOBS OR ASSETS ARE PURSUED IN JUSTICE OR CIRCUIT COURT WITH JUDGEMENTS AND GARNISHMENTS WHEN REQUIRED. PART VI, LINE 2: SURVEYS ARE CONDUCTED ON ALL DISCHARGED PATIENTS INCLUDING QUESTIONS SOLICITING FEEDBACK FROM THEM ON ADDITIONAL NEEDS NOT BEING MET BY THE HOSPITAL. CONSULTANTS ARE UTILIZED TO PROVIDE PHYSICIAN NEEDS ASSESSMENTS IN THE SERVICE AREA BASED ON DEMOGRAPHICS AND OTHER PERTINENT INFORMATION.THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_COMMUNITY_HEALTH_NEEDS_ASSESSMENT_11-16-18.PDFTHE IMPLEMENTATION STRATEGY CAN BE ACCESSED AT:HTTPS://KDMC.ORG/KDMC/ASSETS/FILE/2018_CHNA_IMPLEMENTATION.PDF PART VI, LINE 3: NOTICES RELATED TO FINANCIAL ASSISTANCE ARE POSTED IN ALL ADMISSION AREAS. A MASH (MEDICAL ASSISTANCE SERVICES FOR HEALTHCARE) COORDINATOR IS ON SITE DURING REGULAR BUSINESS HOURS TO ASSIST SELF-PAY PATIENTS IN DETERMINING THEIR ELIGIBILITY FOR GOVERNMENT ASSISTANCE AND HELP IS PROVIDED IN GETTING QUALIFIED. PATIENT ACCOUNT REPS AND COLLECTIONS STAFF ASSIST ALL PATIENTS WITH REFERRALS. PART VI, LINE 4: THE HOSPITAL SERVES ALL PERSONS WITHIN OUR SERVICE AREA, PRIMARILY LINCOLN COUNTY, BUT INCLUDING THE SURROUNDING AREAS IN FRANKLIN, LAWRENCE, COPIAH AND PIKE COUNTIES. KDMC IS THE ONLY HOSPITAL IN LINCOLN COUNTY. THE SURROUNDING COUNTIES HAVE COUNTY OWNED HOSPITAL FACILITIES WHOSE SERVICES ARE NOT AS COMPREHENSIVE AS KDMC. PART VI, LINE 5: 1) KDMC'S GOVERNING BOARD IS SELECTED BY THE WILLING HEARTS CIRCLE, A SELF-PERPETUATING GROUP OF INTERESTED COMMUNITY LEADERS, NONE OF WHICH ARE EMPLOYEES, CONTRACTORS OR FAMILY MEMBERS THEREOF AND CONSISTS OF WHC MEMBERS AND AREA BUSINESS LEADERS. 2) KDMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO REQUEST SUCH MEMBERSHIP. 3) KDMC IS A NOT-FOR-PROFIT ORGANIZATION THAT REINVESTS ALL SURPLUS FUNDS TO NEW EQUIPMENT AND FACILITIES. 1 PART I, LINE 2: THE HOSPITAL'S ONLY GRANTS ARE SCHOLARSHIPS. THE HOSPITAL MONITORS THE GRANT FUNDS, AS FOLLOWS. EACH CHECK REQUEST INCLUDES COPY OF ORIGINAL SCHOLARSHIP AGREEMENT AND RECEIPTS THAT ARE APPLICABLE TO THAT PARTICULAR CHECK REQUEST. IN ADDITION, HR MAINTAINS AN EXCEL SPREADSHEET THAT INDICATES HOW MUCH IS PAID EACH SEMESTER TO EACH STUDENT, KEPT IN YEARS OF EXPECTED GRADUATION FORMAT. X X 0 0 0 0 0 0 0 0 0 JOSHUA ILES CHIEF OF STAFF - NONVOTING - PART YE 367250 0 0 0 0 0 13250 0 16954 0 397454 0 0 0 CHERI BROOKS CNO 184634 0 0 0 0 0 8987 0 17112 0 210733 0 0 0 JOHN TURBA MD SURGEON 671603 0 0 0 0 0 0 0 18912 0 690515 0 0 0 TIMOTHY SHANN MD 370210 0 0 0 0 0 7950 0 21449 0 399609 0 0 0 C MITCH HOLLAND MD PEDIATRICIAN 432435 0 0 0 0 0 20251 0 22269 0 474955 0 0 0 MARK BARRON MD ORTHOPAEDIC SURGEON 686104 0 0 0 0 0 7950 0 6528 0 700582 0 0 0 JEFFREY D ROSS MD 347396 0 0 0 0 0 12587 0 16231 0 376214 0 0 0 A LINCOLN COUNTY MISSISSIPPI 646000622 2009-01-29 9000000 EXPANSION AND RENOVATION OF ICU AND ER 0 0 0 A 9000000 40279 8959721 2009 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 3 QUORUM HEALTH RESOURCES HAS PROVIDED MANAGEMENT SERVICES TO KDMC SINCE 1991. THE BOARD FELT THAT A NATIONAL HEALTHCARE MANAGEMENT FIRM WOULD BE BETTER EQUIPPED TO PROVIDE/SUGGEST INDIVIDUALS FOR LEADERSHIP POSITIONS FOR THE HOSPITAL AND TO PROVIDE EXPERT GUIDANCE IN DEALING WITH THE MANY AND EVER CHANGING CHALLENGES FACING HEALTHCARE PROVIDERS IN TODAY'S ENVIRONMENT. ALVIN HOOVER IS THE CEO OF KINGS DAUGHTERS MEDICAL CENTER; HOWEVER HIS SALARY IS PAID BY QUORUM HEALTH RESOURCES. QUORUM CONTRACTS HOOVER OUT AS A CEO AND THEN THE MEDICAL CENTER PAYS QUORUM FOR HIS WORK. IN TURN, HOOVER IS PAID BY QUORUM. DURING FYE 2019, HOOVER WAS PAID $490,710.41 IN SALARY, TAXES,BENEFITS, ETC BY QUORUM FOR THE WORK HE DID FOR THE MEDICAL CENTER. THIS AMOUNT IS A PART OF THE TOTAL FEES PAID TO QUORUM, AS REPORTED ON PART VII, SECTION B. WENDELL WILKES IS THE PART YEAR CFO OF KINGS DAUGHTERS MEDICAL CENTER; HOWEVER HIS SALARY IS PAID BY QUORUM HEALTH RESOURCES. QUORUM CONTRACTS WILKES OUT AS A CFO AND THEN THE MEDICAL CENTER PAYS QUORUM FOR HIS WORK. IN TURN, WILKES IS PAID BY QUORUM. DURING FYE 2019, WILKES WAS PAID $264,982.39 IN SALARY, TAXES, BENEFITS, ETC BY QUORUM FOR THE WORK HE DID FOR THE MEDICAL CENTER. THIS AMOUNT IS A PART OF THE TOTAL FEES PAID TO QUORUM, AS REPORTED PART VII, SECTION B. TOM HOOD IS THE COO OF KINGS DAUGHTERS MEDICAL CENTER; HOWEVER HIS SALARY IS PAID BY QUORUM HEALTH RESOURCES. QUORUM CONTRACTS HOOD OUT AS A COO AND THEN THE MEDICAL CENTER PAYS QUORUM FOR HIS WORK. IN TURN, HOOD IS PAID BY QUORUM. DURING FYE 2019, HOOD WAS PAID $322,861.56 IN SALARY, TAXES,BENEFITS, ETC BY QUORUM FOR THE WORK HE DID FOR THE MEDICAL CENTER. THIS AMOUNT IS A PART OF THE TOTAL FEES PAID TO QUORUM, AS REPORTED ON PART VII, SECTION B. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED WITH THE FINANCE COMMITTEE OF THE BOARD AND MADE AVAILABLE TO ALL BOARD MEMBERS AT THE NEXT SCHEDULED MEETING OF EACH GROUP AS SOON AS THE COMPLETED 990 IS PREPARED. FORM 990, PART VI, SECTION B, LINE 12C KDMC MAINTAINS CURRENT LISTINGS OF EMPLOYEES AND DIRECTORS WHICH ARE REVIEWED BY MANAGEMENT UPON CONTRACTING FOR GOODS OR SERVICES TO ASSURE THAT NO CONFLICTS EXIST OR OCCUR. ALL CONTRACTS FOR GREATER THAN $25,000 TOTAL VALUE OR OF A DURATION OF 3 YEARS OR MORE REQUIRE BOARD APPROVAL. THE BOARD REVIEWS ALL SUCH CONTRACTS TO ASSURE THAT NO CONFLICTS EXIST. FORM 990, PART VI, SECTION B, LINE 15 QUORUM HEALTH RESOURCES RECOMMENDS COMPENSATION FOR THEIR EMPLOYEES (CEO, COO AND CFO) BASED ON THEIR NATIONWIDE EXPERIENCE IN PROVIDING SIMILAR SERVICES AND COMPENSATION PACKAGES FOR THEIR EMPLOYEES. THE KDMC BOARD APPROVES THOSE COMPENSATION ARRANGEMENTS EACH YEAR. ALL EMPLOYEES ARE EVALUATED ANNUALLY. RANGES FOR JOB CLASSIFICATIONS ARE SET USING MHA BI-ANNUAL SALARY SURVEYS OF OVER 35 MISSISSIPPI HOSPITALS. SALARY GRADES AND RANGES ARE REVIEWED ANNUALLY DURING THE BUDGET PROCESS AND ADJUSTED AS NEEDED FOLLOWING DISCUSSIONS WITH SENIOR MANAGEMENT AND APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 KDMC PROVIDES COPIES OF ANY DOCUMENT NOT PROTECTED BY PRIVACY LAWS OR CONFIDENTIALITY AGREEMENTS TO ANY PARTIES WHO REQUEST SUCH DOCUMENTS BY ASKING AT THE SWITCHBOARD/RECEPTION DESK OR FROM ADMINISTRATION. FORM 990, PART XII, LINE 2C THE SELECTION AND OVERSIGHT OF THE INDEPENDENT AUDITOR HAS NOT CHANGED FROM PRIOR YEAR. KDMC PHYSICIAN CLINICS LLC PO BOX 948 BROOKHAVEN MS 396020948 461590861 BILLING MS KINGS DAUGHTER MEDICAL CENTER KING'S DAUGHTER FOUNDATION P O BOX 948 BROOKHAVEN MS 396020948 621373067 FUNDRAISING MS 501(C)(3) 509(A)(3)(1) KING'S DAUGHTERS MEDICAL CENTER 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0