2019-01-14T23:05:25-07:00 2018-02-28 990 2017-03-01 310949874 MONROE MEDICAL FOUNDATION INC MONR 2704879231 529 CAPP HARLAN ROAD TOMPKINSVILLE KY 42167 Rickie Brown Chief Financial Officer 2704879231 2019-01-14 96.31.62.120 2017 2019-02-21 02:37:17Z Monroe County Medical Center Jimmy Goodman 2841 Akersville Rd Fountain Run KY 42133 19140643 0 X www.mcmccares.com X 1979 KY ACUTE CARE HOSPITAL - Our mission is to be a rural healthcare organization who values compassion, respect and confidentiality, and to provide quality, safe, primary and specialty services for the citizens of Monroe County and surrounding area through detection, prevention and treatment of illness. We achieve this by operating a 49 bed acute care hospital, ambulance service and county 911 service. 9 7 289 0 0 0 564930 582669 17593448 18394049 133898 156305 7425 7620 18299701 19140643 50498 37000 0 0 10114355 10989154 0 0 0 8034205 8191245 18199058 19217399 100643 -76756 27313373 27211545 1944517 1919445 25368856 25292100 ACUTE CARE HOSPITAL - The mission of the Monroe Medical Foundation, Inc. is to be a rural healthcare organization who values compassion, respect and confidentiality, and provides quality, safe, primary and specialty services for the citizens of Monroe County and surrounding area through detection, prevention and treatment of illness. We achieve this by operating a 49 bed acute care hospital, ambulance service and county 911 service. 0 0 17298154 9000 18410169 Inpatient Care - Monroe Medical Foundation, Inc. operates a 49 bed acute care hospital. The hospital admitted 1,304 patients treated 7,071 patients in the emergency room, treated 24,458 patients as outpatient referrals and made 2,038 ambulance runs in FYE 2-28-18. The patients admitted to the hospital as regular inpatients consisted of approximately 59% Medicare patients and 20% Medicaid patients. Approximately 1% of patients admitted did not have Medicare or Medicaid, and did not have any type of insurance. The hospital also began providing Swing Bed services in December 2014. We admitted 83 patients to the swing bed status during the fiscal year, and we had 711 swing bed patient days. (Grants included 7 high school graduates' scholarships, 1 physician receiving assistance with his medical school loans and 1 individual in Medical School). 0 0 0 17298154 1 0 0 0 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 1 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 27 0 1 289 1 0 0 0 0 0 0 X 9 7 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Monroe County Medical Center 2704879231 529 CAPP HARLAN ROAD TOMPKINSVILLE KY 42167 Judy Rowland Board Member 1 0 X 0 0 0 Fowler Ross JR OD Board Member 1 0 X 0 0 0 Jimmy Goodman Board Member 1 0 X 0 0 0 Mike Starnes Board 1st Vice President 1 0 X X 0 0 0 Polly Baker Board President 1 0 X X 0 0 0 Kem Coe 2nd Vice President Sec Board Member 1 0 X X 0 0 0 Greg Crabtree DMD Board Member 1 0 X 0 0 0 Kimberly Eakle MD Board Member/ Physician 13 0 X 93250 0 0 Timothy Hume MD Board Member/Physician 13 0 X 67045 0 0 Anthony Carter MD Physician 40 0 X 560491 0 0 Vicky McFall Exec Director/CEO 40 0 X 0 0 0 Rickie Brown Chief Financial Officer 40 0 X 0 0 0 Deborah Bentley Director of Pharmacy 40 0 X 136031 0 0 Andrea McAlpin Pharmacist 40 0 X 123359 0 0 William M Carter MD Physician 40 0 X 180000 0 0 Lisa K Davis Chief Clinical Officer 40 0 X 100615 0 0 1260791 0 0 5 0 1 0 Quorum Health Resources LLC 1573 Mallory Lane Suite 200 Brentwood TN 37027 Management Contract & Provides CEO and CFO 712692 Inspire Medical Inc 2323 Lime Kiln Lane Louisville KY 40222 Emergency Room Physicians 1299019 MedHost of Tennessee Inc 2739 Momentum Place Chicago IL 60689 Computer Software Hardware and Maintenance 345154 Healthcare Therapy Services 1411 W County Line Road Suite A Greenwood IN 46142 Therapy Services 191852 Siemens Medical Solutions Inc 40 Liberty Boulevard Malvern PA 19355 Maintenance Service and Equipment Purchases 1527000 5 0 0 0 0 582669 0 0 582669 Hospital Services, Net of Contractual Adjustments and Charity Discounts and Allowance for Bad Debts 622000 18304616 18304616 0 0 Meaningful Use Money 622000 89433 89433 0 0 0 0 0 0 18394049 147805 0 0 147805 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8500 0 0 0 8500 8500 8500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7620 7620 0 0 7620 19140643 18410169 0 147805 0 0 37000 37000 0 0 0 0 679710 679710 0 0 0 0 0 0 8713414 8128017 585397 0 125470 117565 7905 0 819456 767830 51626 0 651104 610084 41020 0 711369 0 711369 0 1968 0 1968 0 32965 0 32965 0 0 0 0 0 0 0 0 0 0 0 505002 402924 102078 0 9058 9058 0 0 2265560 2200076 65484 0 322223 282777 39446 0 0 0 0 0 433487 331184 102303 0 28019 23929 4090 0 0 0 0 0 8287 7589 698 0 21592 21592 0 0 0 0 0 0 1053484 1029539 23945 0 122048 114455 7593 0 PHYSICIAN FEES 1632574 1632574 0 0 REPAIRS AND MAINTENANCE 333159 322677 10482 0 KENTUCKY PROVIDER TAX 319453 319453 0 0 390997 260121 130876 0 19217399 17298154 1919245 0 9452 14593 2474775 1662992 0 0 1866302 1955646 0 0 0 0 0 0 322471 372510 177638 161722 32087187 21664499 9904214 10422688 0 0 0 0 0 0 0 0 12558521 12621394 27313373 27211545 1234606 1224091 0 0 0 0 0 0 0 0 0 0 0 0 0 0 709911 695354 1944517 1919445 X 25135892 25126847 232964 165253 0 0 25368856 25292100 27313373 27211545 -76756 0 0 0 0 0 X 0 1 X 1 0 X 0 378922 378922 0 12381734 6048843 6332891 0 0 0 0 0 19326531 15615656 3710875 0 0 0 0 10422688 FUNDED DEPRECIATION 11733199 CASH RESTRICTED FOR ADULT DAYCARE 16879 OTHER RECEIVABLES 522836 OTHER ASSETS 7375 ESTIMATED THIRD PARTY SETTLEMENTS 341105 12621394 CAPITAL LEASE OBLIGATIONS 199613 ESTIMATED THIRD-PARTY SETTLEMENTS 495741 695354 19140643 0 0 0 0 0 19140643 0 0 0 19140643 19217399 0 0 0 0 0 19217399 0 0 0 19217399 1 1 X 1 X 1 X 1 1 1 0 1 1 448807 0 448807 0.023 3913287 2729373 1183914 0.062 0 0 0 0 0 0 4362094 2729373 1632721 0.085 29301 0 29301 0.0015 9000 0 9000 0.0005 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38301 0 38301 0.0020 0 0 4400395 2729373 1671022 0.0870 1 377952 75590 5463935 4940579 523356 X 1 1 Quorum Health Resources LLC Management Company 0 0 0 1 1 Monroe County Medical Center 529 Capp Harlan Road Tompkinsville KY 42167 mcmccares.com 100338 X X X Monroe County Medical Center 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X mcmccares.com X 1 16 1 mcmccares.com 0 0 1 X 100 200 1 1 X X X X 1 X mcmccares.com X mcmccares.com X mcmccares.com X X X X X 1 X 0 X X X 1 X 0 1 Schedule H, Part V, Section B, Line 5-Monroe County Medical Center In conducting the CHNA, the hospital facility took into account input from persons who represent broad interests of the community served by the hospital facility. It included 26 local expert advisors from the county. They included representatives from the Board of Education, Health Department, Department of Social Services, Community Action of Southern Kentucky, Monroe County Extension Office, Housing Authority, Drug Court, Community Outreach, Religious Official, County Judge Executive, Mayor of Tompkinsville, Mayor of Gamaliel, Local Nursing Home, State Representative, Life Skills, Cancer Support Group, Dietician, Dentists, Project 12 Coordinator and Monroe County Extension Office. Schedule H, Part V, Section B, Line 6b-Monroe County Medical Center The hospital facility's CHNA was conducted with various organizations other than hospital facilities. It was conducted in conjunction with leaders and experts from the local county and Quorum Health Resources. It included 26 local expert advisors from the county. They included representatives from the Board of Education, the Health Department, Department of Social Services, Community Action of Southern Kentucky, Monroe County Extension Office, Housing Authority, Drug Court, Community Outreach, Religious Official, County Judge Executive, Mayor of Tompkinsville, Mayor of Gamaliel, Local Nursing Home, State Representative, Life Skills, Cancer Support Group, Dietician, Dentists, Project 12 Coordinator, Monroe County Extension Office and other individuals of the Community. Schedule H, Part V, Section B, Line 11-Monroe County Medical Center 1. Substance Abuse - The hospital provides a location for CARES organization with volunteer representative from the hospital. The hospital provides a meeting space for Narcotics Anonymous group. The hospital promotes prescription take-back events and drug drop boxes in the community. The hospital ER physicians only prescribe narcotics for acute injuries, but send chronic pain issues to PCOs. The hospital facilitated bringing in pain management clinic to help provide treatment and alternatives to prescription pain medicine. The pain management clinic left the community in December 2017. We are looking to replace them. The hospital sponsors Project 12, a local coalition to help educate on and address substance abuse in the community. The hospital provides CMEs to the medical staff on opioid addiction,. The hospital provided a sample contract to physician offices to use with patients to manage narcotics' prescriptions. The hospital did not implement other strategies due to resource constraints and a lack of expertise or competency to address this need. Also, our hospital employed physician is obtaining education to prescribe suboxone as an alternative to opiod addiction. Hospital administration has met with one company to provide intensive outpatient counseling. We are continuing to interview companies. 2. Heart Disease, Diabetes and Obesity - Hospital dietician provides free counseling to anyone in the community for diabetes, heart healthy habits, etc.. The Diabetic support group sponsored by the hospital meets monthly at the hospital. The hospital sponsors the annual diabetes health fair that provides free hemoglobin A1C screenings. The hospital participates weekly in the radio talk show, Monroe Mondays, to cover key health topics including diabetes, heart disease, and healthy living. Hospital purchased a new CT Scanner with the ability of performing Calcium Scoring procedures. We have performed 332 to date with 10.24% positive for early detection. Hospital administration and medical staff met with a company to provide dialysis locally. They determined the population did not meet the company's service demands. 3. Cancer - The hospital purchased a new 3D mammography machine and now offers 3D with 100% increase in mammograms. ACO Care Coordinator works with patients to help afford medications through Kentucky Prescription Assistance Program, and promotes wellness screenings including cholesterol, mammograms and colonoscopies. Hospital is a sponsor of Relay for Life. Hospital provides tobacco cessation education to every patient. Hospital provided education program for medical staff on Low Dose CT Screening by Kentucky Cancer Program. CT Scanner was purchased with low dose software and has performed 75 procedures with 21.33% positive for early detection. We also signed a contract with a local hospice company to provide local inpatient services to terminal patients. These are just a few of the things the hospital is doing for this need. Schedule H, Part V, Section B, Line 24-Monroe County Medical Center All patients are initially charged the same rates. If the patient meets the financial assistance policy provisions, the charges are discounted according to the provisions of the Financial Assistance Policy. 5 Monroe County Ambulance Service 429 Capp Harlan Road Tompkinsville KY 42167 Ambulance Service operated for the county. Monroe County 911 Service 429 Capp Harlan Road Tompkinsville KY 42167 911 Service operated for the county. Monroe County Medical Center Medical Practice 604 N Main Tompkinsville KY 42167 Physician Office Practice Monroe County Medical Center Medical Practice 606 N Main Street Tompkinsville KY 42167 Physician Office Practice Monroe County Medical Center Adult Daycare 417 Capp Harlan Road Tompkinsville KY 42167 Adult Daycare Service Schedule H, Part I, Line 6a The hospital facility's CHNA was conducted with various organizations other than hospital facilities. It was conducted in conjunction with leaders and experts from the local county and Quorum Health Resources. It included 26 local expert advisors from the county. they included representatives from the Board of Education, the Health Department, Department of Social Services, Community Action of Southern Kentucky, Monroe County Extension Office, Housing Authority, Drug Court, Community Outreach, Religious Official, County Judge Executive, Mayor of Tompkinsville, Mayor of Gamaliel, Local Nursing Home, State Representative, Life Skills, Cancer Support Group, Dietician, Dentists, Project 12 Coordinator, Monroe County Extension Office and other individuals of the Community. Schedule H, Part I, Line 7 Ratio of Patient Care Cost to Charges was used as the costing methodology. Schedule H, Part I, Line 7g There were no costs attributable to a physician clinic included as subsidized health services in line 7(g). Schedule H, Part III, Section A, Line 4 The notes in the financial statements that describe bad debt expense are located on pages 10 and page 11 of the Audit Report. The costing methodology used to determine the amounts reported on Part III, Section A, Line 2 is based on the ratio of Patient Care Cost to Charges applied to the gross amounts written off as bad debts. Schedule H, Part III, Section B, Line 8 There is no shortfall on Medicare. The costing methodology used is the Ratio of Patient Care Cost to Charges applied to the gross charges. Schedule H, Part III, Section C, Line 9b Upon registration, financial information is gathered when possible, to determine if they qualify for charity or financial assistance. If they are not able to provide the information at that time, they are given a financial information form to complete later. If they are admitted to the hospital, the patient financial counselor goes to the patient room and discusses the charity and financial assistance information with the patient. If we are unable to obtain the necessary information from the patient at that time, we send the information to a contracted company to obtain the necessary information, and assist them in obtaining the information and financial assistance they qualify for. Schedule H, Part VI, Line 2 The hospital also has suggestion boxes for patients, visitors and employees to obtain suggestions for new or better health services. In addition, the hospital obtains input from the physicians, visitors and employees at the annual Board/Medical Staff planning retreat. Schedule H, Part VI, Line 3 The Financial Assistance Policy Plain Language Summary is posted on the wall in the registration offices. There are also copies of the Financial Assistance Applications in the registration areas available for the patients. In addition, the Financial Policy Plain Language Summary is posted in the exam rooms in the emergency department and in various ancillary outpatient waiting areas. If the patients do not have Medicare, Medicaid or any other type of insurance, the patient information is provided to a contracted company to follow up with the patients to help them obtain medical cards and assists them in getting the necessary information to qualify for financial assistance. If the patient is admitted, the Patient Financial Counselor visits the patient in the patient room and discusses their financial options. The hospital's Financial Assistance Policy is also posted on the hospital's web site. Schedule H, Part VI, Line 4 The Monroe County Medical Center is located in Monroe County, Kentucky which is a rural area of Kentucky. The hospital primarily serves the citizens of Monroe County and parts of the joining counties. The population of Monroe County is approximately 10,700. Only approximately 14.8% of persons age 25 and above have a bachelor's degree or higher compared to 30.4% for the national average. The Median household income is approximately $35,665 compared to the national median household income of $59,039. Approximately 24.3% of the persons in Monroe County live below the poverty level compared to 12.3% for the national average. The unemployment rate for Monroe County is 4.3% compared to the national average of 4.1%. The primary industries in Monroe County are a concrete plant manufacturer, lumber and agriculture. Schedule H, Part VI, Line 5 The Monroe County Medical Center has an open medical staff to promote patient care for the citizens of our community. The Board of Directors of the Monroe Medical Foundation, Inc. is made up of nine individuals. All of them reside in Monroe County, and serve on the Board with no pay for providing those services. They serve because they are interested in the Community and want to give something back to the Community by helping assure that good medical services are provided to the citizens of Monroe and surrounding counties. The current Board is made up of a retired local businessman, a pharmacist, a retired banker, a retired banker and farmer, a retired school teacher, a dentist, an optometrist, the chief of the medical staff and the vice chief of the medical staff. Any surplus funds of the Monroe Foundation, Inc. are used to upgrade the building, purchase updated equipment and provide other wellness services and quality healthcare for our community. Schedule H, Part VI, Line 6 The hospital is managed by Quorum Health Resources, LLC to provide the day-to-day management of the hospital; however, the Board of Directors has the ultimate decision making authority of the hospital. 1 High School Senior Scholarships 7 9000 0 Medical Student Loan Payments 1 28000 0 Schedule I, Part I, Line 2 The hospital Board of Directors approve the payment of all the grant and assistance funds. They are monitored by the CEO and CFO after approval by the Board. 0 0 0 0 0 1 0 0 0 Anthony Carter MD Physician 200000 0 362087 0 0 0 6000 0 3427 0 571514 0 0 0 William M Carter MD Physician 180000 0 0 0 30350 0 0 0 2564 0 212914 0 0 0 Schedule J, Part I, Line 6 The agreements with the physicians state that the Monroe County Medical Center will pay the physician a base salary plus incentive compensation in an amount equal to a certain percentage of the excess of the Medical Center's total collections for physician's personally performed professional medical services over the amount of the Physician's salary and overhead expense. Jack Anderson DO Former Board Member and Chief of Medical Staff 28000 Payment of Medical Student Loan Recruitment Jack Anderson DO Former Board of Directors and Chief of Medical Staff 63025 Hospitalist Services and Stress Tests 0 Jo Ann Brown Spouse of CFO 53757 Employee Wages of RN 0 Form 990, Part VI, Section A, Line 3 The Monroe Medical Foundation, Inc. has contracted with a management company, Quorum Health Resources, LLC to provide Management services to the hospital. The CEO and CFO are employees of the management company, but they are still under the control of the Board of Directors. The CEO and CFO report to the Board of Directors each month at the Board meetings and other times as necessary. Form 990, Part VI, Section B, Line 11b The Form 990 is prepared by the CFO and is reviewed with the CEO before it is filed. Form 990, Part VI, Section B, Line 12c Each member of the Board of Directors and the CEO and CFO completes a conflict of interest questionnaire annually. Any time there is a a conflict of interest with any Board Member on any issue being discussed by the Board of Directors, the Board member who has the conflict abstains from any vote on the issue. Form 990, Part VI, Section B, Line 15 The process for determining compensation of the CEO and CFO includes a review and approval by Quorum Health Resources, LLC, the management company, and the Board of Directors. Each member of the Board of Directors completes an evaluation of the CEO, and submits it to the Quorum Regional Vice President. The Regional Vice President presents the evaluations and his recommendations to the Board of Directors based on the evaluations and the salary scale of the management company. The Board of Directors approves or disapproves the recommendation of the Quorum Regional Vice President. The CEO completes the evaluation of the CFO and submits it to the Quorum Regional Vice President . The Regional Vice President presents his recommendations to the Board of Directors based on the evaluation and the salary scale of the management company. The Board of Directors approves or disapproves the recommendation of the Quorum Regional Vice President. Form 990, Part VI, Section C, Line 19 The governing documents, conflict of interest policy and financial statements are available to the public upon request in the Administration office of the Monroe County Medical Center, 529 Capp Harlan Road, Tompkinsville, Kentucky 42167 I prefer not to file the Form 990 before our independent audit is completed and presented to our Board in case there are any adjustments to the financial statements. The independent audit was not completed and presented to our Board by the original due date of July 15, 2017. I filed the Automatic 6 month extension on July 14, 2018 which extended it to January 15, 2019.