2019-05-15T06:51:12-05:00 2018-06-30 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2017-07-01 610461753 COMMUNITY UNITED METHODIST HOSPITAL INC COMM 2708277700 PO BOX 48 HENDERSON KY 424190048 BENNY NOLEN CEO 2708277700 2019-05-14 1 CARRIE A MERRILL CPA P00832283 5029923500 2019-05-14 165.225.0.63 2019-05-14 14:25:45 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DFFF94E40E6042B53F95D34511187C45F8C68B42 2017 2019-02-21 02:37:17Z METHODIST HOSPITAL BENNY NOLEN PO BOX 48 HENDERSON KY 424190048 125503649 0 X METHODISTHOSPITAL.NET X 1948 KY IN LINE WITH ITS CHRISTIAN HERITAGE, TO PROVIDE A BROAD BASED HEALTHCARE DELIVERY SYSTEM FOCUSING ON THE COMPASSIONATE, HIGH QUALITY AND COST EFFECTIVE SERVICES THAT ADDRESS MENTAL, SPIRITUAL AND PHYSICAL NEEDS AND WORK TO IMPROVE THE HEALTH STATUS OF THE PEOPLE IN THE COMMUNITIES SERVED. 28 20 1577 69 0 0 406733 13657 137067902 120836836 670876 1169245 4348680 3412987 142494191 125432725 216405 216979 0 0 82358598 70846526 0 0 0 67675244 63528776 150250247 134592281 -7756056 -9159556 130343096 112090305 65031264 56273168 65311832 55817137 X IN LINE WITH ITS CHRISTIAN HERITAGE, TO PROVIDE A BROAD BASED HEALTHCARE DELIVERY SYSTEM FOCUSING ON THE COMPASSIONATE, HIGH QUALITY AND COST EFFECTIVE SERVICES THAT ADDRESS MENTAL, SPIRITUAL AND PHYSICAL NEEDS AND WORK TO IMPROVE THE HEALTH STATUS OF THE PEOPLE IN THE COMMUNITIES SERVED. 0 0 111933720 216979 123676768 COMMUNITY UNITED METHODIST HOSPITAL, INC. OFFERS A BROAD RANGE OF INPATIENT AND OUTPATIENT MEDICAL SERVICES INCLUDING EMERGENCY CARE, SURGICAL SERVICES, AMBULATORY CARE, RADIOLOGY SERVICES, PHYSICAL THERAPY, SLEEP DISORDERS, ORTHOPEDIC SERVICES, NICU, SWING BED, DIAGNOSTIC AND THERAPEUTIC SERVICES, AND WOUND CARE. THE COMMUNITIES WE SERVE INCLUDE HENDERSON, UNION AND WEBSTER COUNTIES. METHODIST HOSPITAL IS AN ACUTE CARE HOSPITAL IN HENDERSON, KY WITH 192 LICENSED BEDS. IN FISCAL YEAR 2018, METHODIST HOSPITAL SERVED 3,579 INPATIENTS FOR A TOTAL OF 15,561 INPATIENT DAYS OF SERVICE. METHODIST HOSPITAL ALSO PROVIDED 270,915 OUTPATIENT VISITS WHICH INCLUDED 22,939 EMERGENCY ROOM VISITS. UNION COUNTY METHODIST HOSPITAL IS A CRITICAL CARE HOSPITAL IN UNION COUNTY, KY. IN FISCAL YEAR 2018, UNION COUNTY SERVED 587 INPATIENTS FOR A TOTAL OF 1,126 PATIENT DAYS AND 2,889 SWING BED DAYS. UNION COUNTY ALSO PROVIDED 23,601 OUTPATIENT VISITS WHICH INCLUDED 7,080 EMERGENCY ROOM VISITS. 111933720 1 0 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 1 284 0 1 1577 1 1 1 0 0 0 0 0 0 0 X 28 20 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 KY X X BENNY NOLEN 2708277700 1305 NORTH ELM STREET HENDERSON KY 42419 DANE SHIELDS CHAIRMAN 2.00 X 0 0 0 MAYOR STEVE AUSTIN VICE CHAIR 2.00 X 0 0 0 BILL DILBERT TREASURER 2.00 X 0 0 0 REV C MICHAEL SWEENEY SECRETARY 2.00 X 0 0 0 GARLAND CERTAIN DIRECTOR 2.00 X 0 0 0 JIM CRAFTON DIRECTOR 2.00 X 0 0 0 DR JAMES FELLOWS DIRECTOR 10.00 X 116175 0 0 REV MARK GIBBONS DIRECTOR 2.00 X 0 0 0 SUSIE GIVENS DIRECTOR 2.00 X 0 0 0 MIKE HAZELWOOD DIRECTOR 2.00 X 0 0 0 PAUL HENDRICKSON DIRECTOR 2.00 X 0 0 0 DR VERNON HUMBERT DIRECTOR 10.00 X 62600 0 0 MELISSA CLEMENTS DIRECTOR 2.00 X 0 0 0 REV DAVID LATHAM DIRECTOR 2.00 X 0 0 0 SHANNA LEE DIRECTOR 2.00 X 0 0 0 WILLIAM ROBERT JR DIRECTOR 2.00 X 0 0 0 LIN SHANNON DIRECTOR 2.00 X 0 0 0 RAY NIX DIRECTOR 2.00 X 0 0 0 LIBBY PAYNE DIRECTOR 2.00 X 0 0 0 JIM VINCENT DIRECTOR 2.00 X 0 0 0 CHIP WILLIAMS DIRECTOR 2.00 X 0 0 0 ANN WHITE DIRECTOR 2.00 X 0 0 0 PASTOR JIM WOFFORD DIRECTOR 2.00 X 0 0 0 KRIS WILLIAMS DIRECTOR 2.00 X 0 0 0 BISHOP LEONARD FAIRLEY DIRECTOR 2.00 X 0 0 0 JAMES KEMP DIRECTOR 2.00 X 0 0 0 JIMMY PHILLIPS DIRECTOR 2.00 X 0 0 0 FRANK TULIPANO DIRECTOR 2.00 X 0 0 0 BENNY NOLEN CEO 50.00 X 261482 0 0 DAVE MASSENGALE CFO 50.00 X 178189 0 33031 DAVID B PARK VP - GENERAL COUNSEL 50.00 X 204613 0 25943 ARSHAD I HUSAIN MD ONCOLOGIST 50.00 X 781830 0 15902 JAMES YELTON MD ORTHOPEDIC DOCTOR 50.00 X 651239 0 36815 ALLAN LAM MD GASTROENTERO DOCTOR 50.00 X 603594 0 28835 RICO MADDELA FP INTERNAL MED 50.00 X 409444 0 33306 ALAN TRIPP SURGICAL SERVICES 50.00 X 384699 0 31385 JOHN LOGAN 7117-32918 MEDICAL DIRECTOR 50.00 X 220673 0 0 LOIS MORGAN 616-517 FORMER VP CHIEF NURSE 50.00 X 164997 0 20070 GARY COLBERG 617 FORMER CEO 50.00 X 237250 0 13301 BRUCE BEGLEY FORMER CEO 50.00 X 444672 0 10899 4721457 0 249487 70 1 1 0 MAULIK DESAI 3015 AUTUMN LAKE COVE OWENSBORO KY 42303 ER PHYSICIAN GROUP 2128694 HUNTZINGER GROUP 72 GLENMAURA NATIONAL BLVD MOOSIC PA 18507 IT CONSULTANTS 1102789 NEIL TROOST 8510 TSCHARNER ROAD HENDERSON KY 42420 ER PHYSICIAN 739510 KEVIN WILKING 8601 RANLEIGHT COURT NEWBURGH IN 47630 ANESTHESIOLOGIST 600000 QUEST DIAGNOSTICS 14225 NEWBROOK DRIVE CHANTILLY VA 20151 CLINICAL LABORATORY 594030 59 13657 13657 NET PATIENT SERVICES 621110 120836836 120836836 120836836 697314 697314 18026 0 18026 18026 18026 405749 74707 0 8525 405749 66182 471931 471931 88744 62399 26345 26345 MISCELLANEOUS 900099 2839932 2839932 CAFETERIA 900099 539528 539528 FOUNDATION 900099 -10844 -10844 3368616 125432725 123676768 0 1742300 X 120000 120000 96979 96979 1337604 1112523 225081 51668153 42973869 8694284 1553150 1291799 261351 12555849 10443056 2112793 3731770 3103819 627951 3300 2937 363 382722 340623 42099 17915481 14900814 3014667 220422 183331 37091 4621854 3844127 777727 1585304 1318542 266762 163373 135882 27491 1137429 1137429 7168342 5962113 1206229 1706510 1419353 287157 DRUGS & GASES 9780475 9780475 MEDICAL SUPPLIES 6958189 6958189 MINOR EQUIPMENT & RENTA 2789837 2789837 REPAIRS & MAINT 2782817 2314548 468269 6312721 2840904 3471817 134592281 111933720 22658561 0 11906482 4277736 12994371 13757861 22259630 15549772 275000 250000 2250059 2524008 1882875 1634785 180923723 114117933 70703386 66805790 6327647 6076504 1743646 1213849 130343096 112090305 17903247 13839036 27197532 22899638 19930485 19534494 65031264 56273168 X 63895620 54411769 1416212 1405368 65311832 55817137 130343096 112090305 X -9159556 408894 -620233 -123800 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 9601 9601 0 PART II-B, LINE 1: MEMBERSHIP DUES TO HOSPITAL ASSOCIATIONS OF WHICH A PORTION OF THE DUES ARE USED FOR LOBBYING EXPENSES BY THE TRADE ORGANIZATION. 800816 800816 104858217 50085015 54773202 2732958 1992315 740643 72258687 61789364 10469323 273045 251239 21806 66805790 INVESTMENT IN JOINT VENTURE 13979 C INVESTMENT IN PREMIER 1870777 C INVESTMENT IN NET ASSETS OF FOUNDATION 1405368 C AWUL 2786380 C 6076504 OTHER CURRENT LIABILITIES 25000 PROFESSIONAL LIABILITY CLAIMS 3783189 PENSION LIABILITY 14601649 THIRD PARTY PAYOR 1124656 19534494 X 125780218 408894 -61401 347493 125432725 0 125432725 134654680 62399 62399 134592281 0 134592281 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF JUNE 30, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION VALUE CHANGE -257,945. INTEREST RATE SWAP 134,145. COGS 62,399. PART XII, LINE 2D - OTHER ADJUSTMENTS: COGS 62,399. 1 1 X 1 X 1 X 1 1 1 0 1 1 1583025 662478 920547 0.00680 31847560 27838185 4009375 0.02980 33430585 28500663 4929922 0.03660 190638 1190 189448 0.00140 1428798 417394 1011404 0.00750 249045 249045 0.00190 1868481 418584 1449897 0.01080 35299066 28919247 6379819 0.04740 90736 7494 83242 0.00060 90736 7494 83242 0.00060 1 2582850 601869 24253787 25553640 -1299853 X 1 1 2 1 METHODIST HOSPITAL 1305 N ELM STREET HENDERSON KY 42420 100173 X X X 2 METHODIST HOSPITAL UNION COUNTY 4604 US HWY 60 W MORGANFIELD KY 42437 600057 X X X METHODIST HOSPITAL 1 0 0 1 X X X X X X X X X X 15 1 1 1 1 X WWW.METHODISTHOSPITAL.NET/CHNA.ASPX X GRRHC.WILDAPRICOT.ORG X X 1 15 1 WWW.METHODISTHOSPITAL.NET/CHNA.ASPX 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTAN X WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTAN X WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTAN X X X X 1 X 0 X X X X 1 X 0 1 METHODIST HOSPITAL UNION COUNTY 2 0 0 1 X X X X X X X X X 15 1 1 1 1 X WWW.METHODISTHOSPITAL.NET/CHNA.ASPX GRRHC.WILDAPRICOT.ORG X X 1 15 1 WWW.METHODISTHOSPITAL.NET/CHNA.ASPX 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTAN X WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTAN X WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTAN X X X X 1 X 0 X X X X 1 X 0 1 METHODIST HOSPITAL PART V, SECTION B, LINE 5: THE PROCESS INCLUDED A THREE STEP PROCESS OF DATA ANALYSIS, PUBLIC COMMENT VIA WRITTEN AND ELECTRONIC SURVEYS AND INDIVIDUAL COUNTY PUBLIC FORUMS. IN ORDER TO ASSURE ACCESS TO ALL CITIZENS, INCLUDING THE MOST VULNERABLE, COPIES OF MANUAL SURVEYS WERE PROVIDED TO LOCAL HEALTH DEPARTMENTS. HEALTHY HENDERSON, A COALITION OF HEALTH AND COMMUNITY LEADERS FROM ACROSS THE SERVICE REGION, WAS ALSO CREATED. THE PURPOSE OF HEALTHY HENDERSON IS TO PROMOTE HEALTH AND WELLNESS THROUGHOUT THE COMMUNITY. METHODIST HOSPITAL UNION COUNTY PART V, SECTION B, LINE 5: THE PROCESS INCLUDED A THREE STEP PROCESS OF DATA ANALYSIS, PUBLIC COMMENT VIA WRITTEN AND ELECTRONIC SURVEYS AND INDIVIDUAL COUNTY PUBLIC FORUMS. IN ORDER TO ASSURE ACCESS TO ALL CITIZENS, INCLUDING THE MOST VULNERABLE, COPIES OF MANUAL SURVEYS WERE PROVIDED TO LOCAL HEALTH DEPARTMENTS. HEALTHY HENDERSON, A COALITION OF HEALTH AND COMMUNITY LEADERS FROM ACROSS THE SERVICE REGION, WAS ALSO CREATED. THE PURPOSE OF HEALTHY HENDERSON IS TO PROMOTE HEALTH AND WELLNESS THROUGHOUT THE COMMUNITY. METHODIST HOSPITAL PART V, SECTION B, LINE 6A: METHODIST HOSPITAL AND METHODIST HOSPITAL UNION COUNTY CONDUCTED THEIR OWN CHNAS, BUT ALSOPARTNERED WITH THE GREEN RIVER AREA DEVELOPMENT DISTRICT WHICH INCLUDES THE OWENSBORO HEALTH SYSTEM AND OHIO COUNTY HOSPITAL. METHODIST HOSPITAL UNION COUNTY PART V, SECTION B, LINE 6A: METHODIST HOSPITAL AND METHODIST HOSPITAL UNION COUNTY CONDUCTED THEIR OWN CHNAS, BUT ALSOPARTNERED WITH THE GREEN RIVER AREA DEVELOPMENT DISTRICT WHICH INCLUDES THE OWENSBORO HEALTH SYSTEM AND OHIO COUNTY HOSPITAL. METHODIST HOSPITAL PART V, SECTION B, LINE 6B: METHODIST HOSPITAL AND METHODIST HOSPITAL UNION COUNTY CONDUCTED THEIR OWN CHNAS, BUT ALSOPARTNERED WITH THE GREEN RIVER AREA DEVELOPMENT DISTRICT WHICH INCLUDES THE OWENSBORO HEALTH SYSTEM AND OHIO COUNTY HOSPITAL. METHODIST HOSPITAL UNION COUNTY PART V, SECTION B, LINE 6B: METHODIST HOSPITAL AND METHODIST HOSPITAL UNION COUNTY CONDUCTED THEIR OWN CHNAS, BUT ALSOPARTNERED WITH THE GREEN RIVER AREA DEVELOPMENT DISTRICT WHICH INCLUDES THE OWENSBORO HEALTH SYSTEM AND OHIO COUNTY HOSPITAL. METHODIST HOSPITAL PART V, SECTION B, LINE 7D: METHODIST HOSPITAL PRESENTED ITS CHNA TO THE HENDERSON REGIONAL HOSPITAL FOUNDATION, THE HENDERSON HEALTH COALITION AND THE GREEN RIVER AREA HEALTH COUNCIL METHODIST HOSPITAL UNION COUNTY PRESENTED ITS CHNA TO THE UNION COUNTY HEALTH COALITION. METHODIST HOSPITAL UNION COUNTY PART V, SECTION B, LINE 7D: METHODIST HOSPITAL PRESENTED ITS CHNA TO THE HENDERSON REGIONAL HOSPITAL FOUNDATION, THE HENDERSON HEALTH COALITION AND THE GREEN RIVER AREA HEALTH COUNCIL METHODIST HOSPITAL UNION COUNTY PRESENTED ITS CHNA TO THE UNION COUNTY HEALTH COALITION. METHODIST HOSPITAL PART V, SECTION B, LINE 11: HENDERSON COUNTY HEALTHY HENDERSON COALITION SERVES AS THE ACCOUNTABILITY GROUP FOR THE COMMUNITY HEALTH IMPROVEMENT INITIATIVES, USING A STRONG NETWORK OF COMMUNITY PARTNERS WITHIN THE COMMUNITY TO AFFECT CHANGE. SELECTED NEEDS IDENTIFIED THROUGH OUR CHNA WERE TEEN ISSUES, REDUCING OBESITY AND DIABETES, TOBACCO CESSATION INCLUDING E-CIGARETTES, AND REDUCING SUBSTANCE ABUSE. PARTNER WITH LOCAL ORGANIZATIONS TO OFFER DIABETES EDCUATION, AWARENESS, AND PREVENTION THROUGHOUT THE COMMUNITY (ABC'S OF DIABETES PRESENTATION), ANNUAL EVENTS INCLUDE DIABETES ALERT DAY WITH FREE A1CS AND HUNTING DOWN DIABETES WALK/RUN. HAVE IMPLEMENTED A FOOD NUTRITION CHOICE OPTION AT OUR LOCAL COMMUNITY BALL PARK, PARTNERED WITH LOCAL PROGRAMS TO OFFER CHRONIC DISEASE MANAGEMENT (DIABETES IN PARTICULAR) THROUGHOUT THE COMMUNITY. WE HAVE PROVIDED SMOKING CESSATION PROGRAMS IN OUR FACILITIES FOR EMPLOYEES OF THE HOSPITAL AND ALSO THE COMMUNITY, PARTICIPATED IN OUR PHYSICIAN RESIDENCY PROGRAM FOR EDUCATION AND RESEARCH WITH SMOKING CESSATION. WE ALSO HAVE OFFERED FREE PROSTATE SCREENING, FREE AIC TESTING, AND FREE COLONOSCOPIES TO PARTICIPANTS. IN A WALK/RUN EVENT UNION COUNTY FOCUSED ON ACCESS TO HEALTHCARE BY EDUCATING THE PUBLIC ABOUT SERVICES ARE AVAILABLE IN THE COUNTY, REDUCED SMOKING VIA EDUCATION AND SMOKE-FREE INITIATIVES ALONG WITH E-CIG EDUCATION, AND FOCUS ON REDUCING OBESITY AND INCREASE PHYSICAL ACTIVITY VIA GARDEN PROGRAM AND CURRICULUM, BEST BITES CAMPAIGN FOR HEALTHY FOOD CHOICES DIABETES SUPPORT CLASSES, ACTIVE HEALTHY KIDS DAY AND A GRANT TO EXTEND THE CITY WALKING PATH IN CONNECTION WITH THE CITY OF MORGANFIELD FREE INSULIN TESTING GIVEN AT THE HOSPITAL. METHODIST HOSPITAL UNION COUNTY PART V, SECTION B, LINE 11: HENDERSON COUNTY HEALTHY HENDERSON COALITION SERVES AS THE ACCOUNTABILITY GROUP FOR THE COMMUNITY HEALTH IMPROVEMENT INITIATIVES, USING A STRONG NETWORK OF COMMUNITY PARTNERS WITHIN THE COMMUNITY TO AFFECT CHANGE. SELECTED NEEDS IDENTIFIED THROUGH OUR CHNA WERE TEEN ISSUES, REDUCING OBESITY AND DIABETES, TOBACCO CESSATION INCLUDING E-CIGARETTES, AND REDUCING SUBSTANCE ABUSE. PARTNER WITH LOCAL ORGANIZATIONS TO OFFER DIABETES EDCUATION, AWARENESS, AND PREVENTION THROUGHOUT THE COMMUNITY (ABC'S OF DIABETES PRESENTATION), ANNUAL EVENTS INCLUDE DIABETES ALERT DAY WITH FREE A1CS AND HUNTING DOWN DIABETES WALK/RUN. HAVE IMPLEMENTED A FOOD NUTRITION CHOICE OPTION AT OUR LOCAL COMMUNITY BALL PARK, PARTNERED WITH LOCAL PROGRAMS TO OFFER CHRONIC DISEASE MANAGEMENT (DIABETES IN PARTICULAR) THROUGHOUT THE COMMUNITY. WE HAVE PROVIDED SMOKING CESSATION PROGRAMS IN OUR FACILITIES FOR EMPLOYEES OF THE HOSPITAL AND ALSO THE COMMUNITY, PARTICIPATED IN OUR PHYSICIAN RESIDENCY PROGRAM FOR EDUCATION AND RESEARCH WITH SMOKING CESSATION. WE ALSO HAVE OFFERED FREE PROSTATE SCREENING, FREE AIC TESTING, AND FREE COLONOSCOPIES TO PARTICIPANTS. IN A WALK/RUN EVENT UNION COUNTY FOCUSED ON ACCESS TO HEALTHCARE BY EDUCATING THE PUBLIC ABOUT SERVICES ARE AVAILABLE IN THE COUNTY, REDUCED SMOKING VIA EDUCATION AND SMOKE-FREE INITIATIVES ALONG WITH E-CIG EDUCATION, AND FOCUS ON REDUCING OBESITY AND INCREASE PHYSICAL ACTIVITY VIA GARDEN PROGRAM AND CURRICULUM, BEST BITES CAMPAIGN FOR HEALTHY FOOD CHOICES DIABETES SUPPORT CLASSES, ACTIVE HEALTHY KIDS DAY AND A GRANT TO EXTEND THE CITY WALKING PATH IN CONNECTION WITH THE CITY OF MORGANFIELD FREE INSULIN TESTING GIVEN AT THE HOSPITAL. METHODIST HOSPITAL PART V, SECTION B, LINE 24: ALL PAYERS, INCLUDING ENTITLEMENT PROGRAMS, INSURANCE COMPANIES AND PATIENTS WITHOUT INSURANCE ARE BILLED AT HOSPITAL'S STANDARD RATE. REIMBURSEMENT AND DISCOUNTS ARE BASED ON ENTITLEMENT ALLOWABLE CONTRACTUALLY, MUTUALLY AGREEABLE REDUCTIONS OF CHARGES WITH INSURANCE COMPANIES AND MUTUALLY AGREEABLE REDUCTIONS OF CHARGES WITH PATIENTS. METHODIST HOSPITAL UNION COUNTY PART V, SECTION B, LINE 24: ALL PAYERS, INCLUDING ENTITLEMENT PROGRAMS, INSURANCE COMPANIES AND PATIENTS WITHOUT INSURANCE ARE BILLED AT HOSPITAL'S STANDARD RATE. REIMBURSEMENT AND DISCOUNTS ARE BASED ON ENTITLEMENT ALLOWABLE CONTRACTUALLY, MUTUALLY AGREEABLE REDUCTIONS OF CHARGES WITH INSURANCE COMPANIES AND MUTUALLY AGREEABLE REDUCTIONS OF CHARGES WITH PATIENTS. SCH H PART V PART B LINE 16 A, B & C THE FAP, THE FAP APPLICATION AND THE FAP PLAIN LANGUAGE SUMMARY ARE AVAIALABLE AT HTTPS://WWW.METHODISTHOSPITAL.NET/PATIENTS-VISITORS/FOR-PATIENTS/FINANCIAL-ASSISTANCE.ASPX. 21 1 - METHODIST PEDIATRICS - IMPERIAL 110 THIRD STREET SUITE 180 HENDERSON KY 42420 PEDIATRIC PHYSICIAN SVCS 2 - METHODIST GASTROENTEROLOGY 1305 N ELM STREET HENDERSON KY 42420 GASTROENTEROLOGY PHYSICIAN SVCS 3 - METHODIST FAMILY PRACTICE 1284 US HWY 60 WEST MORGANFIELD KY 42437 FAMILY PRACTICE PHYSICIAN SVCS 4 - WOMEN'S HEALTH SERVICES-HENDERSON 736 ELM STREET HENDERSON KY 42420 WOMEN'S HEALTH PHYSICIAN SVCS 5 - METHODIST ORTHOPEDIC SERVICES 471 KLUTEY PARK PLAZA HENDERSON KY 42420 ORTHOPEDIC PHYSICIAN SVCS 6 - METHODIST SURGICAL SERVICES 110 THIRD STREET SUITE 105 HENDERSON KY 42420 SURGICAL PHYSICIAN SVCS 7 - METHODIST PEDIATRICS - ELM 2000 N ELM STREET SUITE 1B HENDERSON KY 42420 PEDIATRIC PHYSICIAN SVCS 8 - METHODIST FAMILY MEDICINE - STURGIS 9064 US HWY 60 STURGIS KY 42459 FAMILY MEDICINE PHYSICIAN SVCS 9 - METHODIST FAMILY MEDICINE - IMPERIAL 110 THIRD STREET SUITE 250 HENDERSON KY 42420 FAMILY MEDICINE PHYSICIAN SVCS 10 - METHODIST FAMILY MEDICINE - ATKINSON 1413 N ELM STREET SUITE 204 HENDERSON KY 42420 FAMILY MEDICINE PHYSICIAN SVCS 12 - WOMEN'S HEALTH SERVICES - MADISONVILLE 44 MCCOY AVENUE MADISONVILLE KY 42431 WOMEN'S HEALTH PHYSICIAN SVCS 13 - METHODIST FAMILY MEDICINE - NORTH ELM 2000 N ELM STREET SUITE 1A HENDERSON KY 42420 FAMILY MEDICINE PHYSICIAN SVCS 14 - METHODIST FAMILY MEDICINE - 8TH ST 319 8TH STREET SUITE 1 HENDERSON KY 42420 FAMILY MEDICINE PHYSICIAN SVCS 15 - METHODIST FAMILY MEDICINE - SEBREE 47 W WEBSTER STREET SEBREE KY 42455 FAMILY MEDICINE PHYSICIAN SVCS 16 - CONTINUITY CARE CLINIC 411 LETCHER ST HENDERSON KY 42420 RESIDENT/ FAMILY MEDICAL CLINIC 17 - METHODIST HEMATOLOGY ONCOLOGY 110 WATER STREET HENDERSON KY 42420 ONCOLOGY PHYSICIAN SVCS 18 - WEBSTER COUNTY FAMILY MEDICINE 1355 HWY 41-A SOUTH DIXON KY 42409 FAMILY MEDICINE PHYSICIAN SVCS 19 - METHODIST HOSPITAL AUXILLARY 1305 N ELM STREET HENDERSON KY 42420 HOSPITAL AUXILLARY PHYSICIAN SVCS 20 - METHODIST OCCUPATIONAL MEDICINE 110 THIRD STREET SUITE 120 HENDERSON KY 42420 OCCUPATIONAL PHYSICIAN SVCS 21 - MULTI-SPECIALTY CLINIC 110 2ND STREET HENDERSON KY 42420 HOMECARE PHYSICIAN SVCS 22 - METHODIST CONVENIENT CARE 110 2ND STREET HENDERSON KY 42420 CONVENIENT CARE CLINIC PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES INCLUDE THE HOSPITAL'S PARTICIPATION WITH GREEN RIVER AREA DISTRICT DEVELOPMENT, A LOCAL GROUP DEDICATED TO ADDRESSING THE HEALTHCARE NEEDS OF COMMUNITIES SERVED. ALSO, A PART OF COMUNITY BUILDING ACTIVITIES, VARIOUS HOSPITAL ADMINISTRATION STAFF VOLUNTEER TIME AS BOARD MEMBERS OR MEMBERS OF COMMUNITY ORGANIZATION AND COALITIONS TO KEEP ABREAST OF HEALTHCARE NEEDS, CONCERNS AND ISSUES WITHIN THE AREA. PART III, LINE 2: THE HOSPITAL HAS AGREEMENTS WITH THIRD PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHER FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. THE HOSPITAL ESTIMATES AN ALLOWANCE FOR UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE BASED ON EVALUATION OF THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS AND OTHER FACTORS UNIQUE TO THE SERVICE AREA AND THE HEALTHCARE INDUSTRY. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 2 IS USING THE COST-TO-CHARGE RATIO. THE RATIO WAS CALCULATED FROM WORKSHEET A, ESTIMATED BAD DEBT EXPENSE (AT COST). PART III, LINE 3: THE AMOUNT OF BAD DEBT ESTIMATED TO HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY USING THE POVERTY RATE FOR HENDERSON COUNTY. PART III, LINE 4: THE FOOTNOTE DESCRIBING THE HOSPITAL'S BAD DEBT EXPENSE CAN BE FOUND ON PAGES 8-10 OF THE MOST RECENT AUDITED FINANCIAL STATEMENTS WHICH ARE ATTACHED WITH THIS SCHEDULE H. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE TAKEN DIRECTLY OFF MEDICARE COST REPORT FILED WITH THE 6/30/18 YEAREND. THE CALCULATION INCLUDED MEDICARE INPATIENT AND OUTPATIENT CHARGES LESS MEDICARE REIMBURSEMENT LESS GME RECEIVED. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS THE REIMBURSEMENT RECEIVED DID NOT COVER THE COST OF PROVIDING SERVICES. PART III, LINE 9B: HOSPITAL POLICY ON CHARITY CARE PROVIDES GUIDANCE ON HOW TO PROVIDE FINANCIAL ASSISTANCE FOR PATIENTS IN NEED. HOSPITAL POLICY ON INDIGENT CARE OUTLINES THE DISPROPORTIONATE SHARE HOSPITAL (DSH) PROGRAM THROUGH THE STATE OF KENTUCKY TO SERVE THE INDIGENT CARE NEEDS OF ALL PATIENTS WITHOUT ANY TYPE OF HEALTH INSURANCE. PATIENTS MUST COMPLETE A DSH APPLICATION AND MEET THE KENTUCKY DEPARTMENT OF MEDICAID SERVICES DSH PROGRAM MANUAL GUIDELINES. PART VI, LINE 2: HOSPITAL CONTINUES TO WORK WITH THE GREEN RIVER AREA DISTRICT DEVELOPMENT TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED. THE MISSION IS TO IMPROVE THE HEALTH AND QUALITY OF LIFE WITHIN OUR REGION THROUGH EDUCATION, MOTIVATION, EVALUATION AND AVAILABILITY. THE HOSPITAL HAS A BOARD OF DIRECTORS WHICH CONSIST OF 32 INDIVIDUALS FROM THE HOSPITAL SERVICE AREA. ONE PURPOSE OF THIS LARGE BOARD IS TO REPRESENT THE COMMUNITY SAN STAY IN TOUCH WITH COMMUNITY NEEDS. THE BOARD HAS ESTABLISHED A COMMUNITY BENEFIT COMMITTEE WHICH SPECIFICALLY ADDRESSES COMMUNITY BENEFITS PROVIDED BY THE HOSPITALS. METHODIST HOSPITAL UNION COUNTY HAS AN 8 MEMBER ADVISORY BOARD WHICH IN PART SERVES IN THE ROLE TO DETERMINE COMMUNITY NEEDS AND REPORTS DIRECTLY TO THE BOARD OF METHODIST HOSPITAL. THE COMMUNITY BASED HEALTHY HENDERSON COALITION HAS MEMBERS ON THE COMMUNITY BENEFITS COMMITTEE OF THE METHODIST HOSPITAL BOARD OF DIRECTORS. PART VI, LINE 3: HOSPITAL HAS FINANCIAL COUNSELORS TO INTERVIEW PATIENTS WHO MAY HAVE FINANCIAL NEED. THE PROCESS IS PART OF PATIENT REGISTRATION. AN INTERVIEW CAN TAKE PLACE AT ANY TIME THE PATIENT IS IN THE HOSPITAL. AFTER THE PATIENT LEAVES THE HOSPITAL, CONTACT IS MADE IN AN EFFORT TO ASSIST THE INDIVIDUAL WITH APPLYING FOR GOVERNMENT ENTITLEMENT PROGRAMS. EACH PATIENT REGISTERED AS A SELF-PAY AUTOMATICALLY RECEIVES PRINTED INFORMATION TITLED "ELIGIBILITY FOR FINANCIAL ASSISTANCE." THIS DOCUMENT EXPLAINS ABOUT THE KENTUCKY MEDICAID DISPROPORTIONATE SHARE HOSPITAL DSH PROGRAM. IT CONTAINS A LIST OF INFORMATION THE PATIENT IS REQUIRED TO PROVIDE WITH THE DSH APPLICATION, ELIGIBILITY FOR THE PROGRAM IS DETERMINED FROM THE SUBMITTED DOCUMENTS. IF THE PATIENT DOES NOT QUALIFY FOR THE DSH PROGRAM THEN THE DOCUMENTATION IS USED BY THE HOSPITAL FOR FINANCIAL ASSISTANCE DETERMINATION. IN ADDITION, DISCUSSION WITH PATIENTS CONCERNING VARIOUS PROGRAMS, HOSPITAL ASSISTANCE, ETC. PART VI, LINE 4: HOSPITAL IS LOCATED IN THE GREEN RIVER AREA DEVELOPMENT DISTRICT (GRADD) IN THE NORTHWESTERN PORTION OF KENTUCKY ALONG THE OHIO RIVER AND DIVIDED BY THE GREEN RIVER. THE TOTAL POPULATION OF GRADD IS APPROXIMATELY 215,217 AND IS PROJECTED TO HAVE MINOR GROWTH OF 1-2% OVER THE NEXT FIVE YEARS. METHODIST HOSPITAL'S PRIMARY SERVICE AREA COVERS PATIENTS FROM THE COUNTIES OF HENDERSON, UNION AND WEBSTER AND INCLUDES A SECONDARY MARKET OF PATIENTS FROM EACH OF THE SURROUNDING COUNTIES AND SOUTHERN INDIANAN AND SOUTHERN ILLINOIS. THE TOTAL POPULATION IN THE PRIMARY AND SECONDARY SERVICE AREA IS APPROXIMATELY 75,000. THIS ORGANIZATION OWNS METHODIST HOSPITAL IN HENDERSON COUNTY AND METHODIST HOSPITAL UNION COUNTY, A CRITICAL ACCESS HOSPITAL IN UNION COUNTY, THE ONLY TWO HOSPITALS IN THE PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA INCLUDES DESIGNATED MEDICALLY UNDERSERVED COUNTIES AND METHODIST HOSPITAL HAS SUPPORTED THE MEDICAL CARE IN THOSE COMMUNITIES BY PROVIDING TWO PRIMARY CARE CLINICS IN WEBSTER COUNTY AND TWO IN UNION COUNTY AS WELL AS SIX OTHER PRIMARY CARE CLINICS IN HENDERSON COUNTY WITH PHYSICIANS AND NURSE PRACTITIONERS. PART VI, LINE 5: METHODIST HOSPITAL, IN KEEPING WITH ITS CHRISTIAN HERITAGE, EXISTS TO PROVIDE A BROAD BASED HEALTHCARE DELIVERY SYSTEM IN PARTNERSHIP WITH OUR MEDICAL STAFF, THE FOCUS WILL BE ON THE C0MPASSIONATE, HIGH QUALITY, AND COST EFFECTIVE SERVICES THAT ADDRESS MENTAL, SPIRITUAL, AND PHYSICAL NEEDS, AND WORKS TO IMPROVE THE HEALTH STATUS OF THE PEOPLE IN THE COMMUNITIES. THE MAJORITY OF COMMUNITY UNITED METHODIST HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS WHO LIVE AND WORK IN THE HOSPITAL SERVICES AREA. THE HOSPITAL EXTENDS MEDCAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. DURING THE FISCAL YEAR ENDED JUNE 30, 2017, COMMUNITY UNITED METHODIST HOSPITAL, INC. AS PART OF ITS MISSION CONTINUES TO PROVIDE UNCOMPENSATED CARE TO THE RESIDENTS OF THE AREA. EXAMPLES OF SERVICES PROVIDED FOR THE BENEFIT OF THE COMMUNITY ARE AS FOLLOWS - ADULT AND PEDIATRIC CPR COURSES OFFERED FREE OR AT A NOMINALCOST -SMOKING CESSATION PROGRAM OFFERED AT NOMINAL COST TO PARTICIPANTS - CHILDBIRTH EDUCATION CLASSES (INCLUDING PREPARED CHILDBIRTH, BREAST FEEDING, ETC) OFFERED TO THE PUBLIC AT A NOMINAL COST - OUTREACH PROGRAMS AT LOCAL ELEMENTARY AND JUNIOR HIGH SCHOOLS TO EDUCATE YOUNG PEOPLE ON A VARIETY OF TOPICS, INCLUDING CHEMICAL DEPENDENCY AND CHILDBIRTH -PROVIDE EDUCATION TO WOMEN'S ADDICTION RECOVERY MANOR CENTER 3-4 TIMES PER YEAR FOR EDUCATIONAL SESSIONS UPON REQUEST - BROCHURES ON A WIDE VARIETY OF MEDICAL TOPICS ARE AVAILABLE TO THE PUBLIC AT NO CHARGE - MULTI-DISCIPLINARY CONTINUING EDUCATION PROGRAMS FOR OTHER MEDICAL PROFESSIONALS AND ANCILLARY PERSONNEL - COMMUNITY EDUCATION PROGRAMS PROVIDED FREE TO THE PUBLIC ON VARIOUS HEALTHCARE TOPICS CANCER, STROKE, HEART ATTACK, DIABETES, STRESS, LIFESTYLE, ETC. - PROMOTION OF HEALTHCARE PROFESSIONALS THROUGH ASSOCIATION WITH HENDERSON COMMUNITY COLLEGE, ITT BRECKENRIDGE, MADISONVILLE COMMUNITY COLLEGE, AND WITH INTERNSHIP SAND CLINICAL AFFILIATIONS WITH OTHER UNIVERSITIES FOR PHARMACY, PHYSICAL THERAPY, RADIOLOGY, HEALTHCARE ADMINISTRATION AND DIETETICS -FREE CHOLESTEROL SCREENINGS PROVIDED THE FIRST THURSDAY OF EVERY MONTH TO THE GENERAL PUBLIC - BLOOD PRESSURE SCREENINGS DONE MONTHLY AT PLEASANT POINT AND TWICE A YEAR AT SENIOR CITIZEN COMPLEXES -BLOOD SUGAR SCREENING PROVIDED MONTHLY AT PLEASANT POINT AND COLONIAL ASSISTED LIVING - HEALTH FAIRS ARE HELD FOR LOCAL INDUSTRY AS WELL AS THE GENERAL PUBLIC, PROVIDING A WIDE RANGE OF SCREENING TESTS AND EDUCATIONAL MATERIALS IN HENDERSON, UNION AND WEBSTER COUNTIES -SPEAKERS PROVIDED TO COMMUNITY ORGANIZATIONS FOR PRESENTATIONS ON SUCH HEALTHCARE TOPICS AS CANCER, ALZHEIMER'S DISEASE, BLOOD PRESSURE, CHOLESTEROL, ETC. - WELLNESS PROGRAM OFFERED TO LOCAL BUSINESSES INCLUDES ONSITE HEALTH FAIRS, RISK APPRAISAL, NURSE VISITS, DIABETES, WEIGHT LOSS, AND EDUCATIONAL PROGRAMS - FLU SHOTS PROVIDED TO INDUSTRY AND SCHOOLS - DISCOUNT OF 50% OFFERED ON FIRST MAMMOGRAPHY SCREENING DURING BREAST CANCER AWARENESS MONTH - A DISCOUNT AGREEMENT WITH THE HEALTH DEPARTMENT ON MAMMOGRAPHY REFERRALS - NEONATAL SERVICES PROVIDED A REDUCED RATE FOR LOW INCOME WOMEN - OUTPATIENT LACTATION CONSULTING FEES WAIVED FOR LOW INCOME MOTHERS - METHODIST HOSPITAL ALSO PROVIDES FOR ADULTS WHO HAVE CHRONIC HEALTH CARE NEEDS THROUGH THE CONTINUITY CARE CLINIC THIS CLINIC OPERATES 4 DAYS PER WEEK WITH MEDICAL RESIDENTS AND THEIR SUPERVISORS - METHODIST HOSPITAL SERVES AS A PRECEPTOR SITE FOR VARIOUS UNIVERSITIES AND COLLEGES FOR ADMINISTRATIVE, PHYSICAL AND OCCUPATIONAL THERAPIES, AND NURSING STUDENTS - HOSPITAL MANAGEMENT PARTICIPATES IN AND ROUTINELY DONATES USE OF THE HOSPITAL FACILITY TO VARIOUS NON-PROFIT COMMUNITY ORGANIZATIONS SUCH AS YMCA, SALVATION ARMY, UNITED WAY, JUNIOR PRO BALL, ETC. EMPLOYEES ARE MEMBERS OF VARIOUS COMMUNITY ORGANIZATIONS AND REGULARLY ATTEND MEETINGS TO KEEP MH ACTIVELY INVOLVED IN THE COMMUNITY - AMERICAN HEART ASSOCIATION, KENTUCKY CANCER PROGRAM, DIABETES COALITION, HEALTHY HENDERSON FOR EXAMPLE - ASSISTED IN PLANNING AND ORGANIZING OF VARIOUS ACTIVITIES FOR COMMUNITY ORGANIZATIONS RELAY FOR LIFE (AMERICAN CANCER SOCIETY), RACE FOR THE CURE (BREAST CANCER), REGIONAL SENIOR GAMES, HUNTING DOWN DIABETES - BUILDING, MAINTENANCE , COMPUTER EQUIPMENT, AND SOME MEDICAL EQUIPMENT PROVIDED TO THE HENDERSON CITY/COUNTY AMBULANCE SERVICE AT NO CHARGE - PROVIDE FOR TRANSPORTATION COSTS FOR PATIENTS NEEDING ASSISTANCE TO THEIR HOMES FROM THE HOSPITAL - CASH AND IN IN-KIND CONTRIBUTIONS TO SUPPORT VARIOUS OTHER NON-PROFITS LOCATED IN HENDERSON, WEBSTER AND UNION COUNTIES - CASH DONATION TO ECONOMIC DEVELOPMENT ENTITY TO FOSTER DEVELOPMENT IN THE AREA - PLEDGE SUPPORT OF NURSING PROGRAM AT LOCAL COLLEGE - SCHOLARSHIPS OFFERED TO NURSING, PHYSICAL THERAPY, RADIOLOGY AND PHARMACY STUDENTS - PARTICIPATION IN LOCAL CAREER DAYS TO PROVIDE INFORMATION ON HEALTH CAREERS TO HIGH SCHOOL, COLLEGE, AND TECHNICAL SCHOOL STUDENTS - HIGH SCHOOL AND COLLEGE STUDENTS GAIN VALUABLE EXPERIENCE THROUGH THE HEALTH CAREERS PROGRAM THAT PUTS THEM IN A HOSPITAL SETTING WHILE EXPLORING HEALTHCARE CAREERS - PRESENTATIONS MADE TO LOCAL HIGH SCHOOLS TO PROMOTE HEALTH CAREERS AND LECTURE ON HEALTHCARE TOPICS - HOSTED BI-ANNUAL BLOOD DRIVES FOR THE AMERICAN RED CROSS. PART VI, LINE 7, REPORTS FILED WITH STATES KY 0 KYNDLE PO BOX 764 HENDERSON KY 42419 610463069 501(C)3 50000 ECONOMIC DEVELOPMENT COLLEGE FOUNDATION INC 2660 S GREEN STREET HENDERSON KY 42419 616035281 501(C)3 70000 TO SUPPORT NURSING PROGRAM. 2 0 EDUCATIONAL ASSISTANCE 35 96979 SCHEDULE I, PART III PART III -EDUCATIONAL ASSISTANCE- EACH RECEIPIENT MUST FILL OUT AN APPLICATION FOR EDUCATIONAL ASSISTANCE AND IT IS SENT TO A COMMITTEE TO BE APPROVED OR DENIED. ONCE THE APPLICATION IS APPROVED THE EMPLOYEE IS NOTIFIED. ONCE THE APPLICANT FINISHES HIS/HER CLASS WITH A PASSING GRADE OF A C OR BETTER, THE HOSPITAL WILL REIMBURSE THE EMPLOYEE FOR THE COST OF BOOKS, TUITION AND LAB FEES UP TO 3,000 FOR ASSOCIATES AND 4,000 FOR BACHELORS OR MASTERS PER CALENDAR YEAR. IF THE EMPLOYEE LEAVES EMPLOYMENT THEY ARE REQUIRED TO PAY BACK ANY FUNDS REIMBURSED WITHIN THE LAST YEAR RETROACTIVE SCHOLARSHIP. THE SCHOLARSHIP IS APPROVED AFTER DISCUSSION BETWEEN RECRUITERS, DEPARTMENT DIRECTORS AND HR DIRECTOR BASED ON THE POSITION, HOW HARD IT WAS TO FILL, AND THAT THE APPLICANT WOULD NOT ACCEPT OFFER IF THEY DID NOT GET THE RETRO PAYMENT. MUST COMPLETE A 2 YEAR WORK AGREEMENT WITH METHODIST HOSPITAL OR FUNDS ARE REQUIRED TO BE REPAID. 1 X X X X 1 0 0 0 0 0 0 0 0 BENNY NOLEN CEO 261482 0 0 0 0 0 0 0 0 0 261482 0 0 0 DAVE MASSENGALE CFO 178189 0 0 0 0 0 4196 0 28835 0 211220 0 0 0 DAVID B PARK VP - GENERAL COUNSEL 193091 0 0 0 11522 0 4118 0 21825 0 230556 0 0 0 ARSHAD I HUSAIN MD ONCOLOGIST 458559 0 305271 0 18000 0 6480 0 9422 0 797732 0 0 0 JAMES YELTON MD ORTHOPEDIC DOCTOR 649963 0 1276 0 0 0 6480 0 30335 0 688054 0 0 0 ALLAN LAM MD GASTROENTERO DOCTOR 504181 0 99413 0 0 0 0 0 28835 0 632429 0 0 0 RICO MADDELA FP INTERNAL MED 409444 0 0 0 0 0 4471 0 28835 0 442750 0 0 0 ALAN TRIPP SURGICAL SERVICES 384699 0 0 0 0 0 0 0 31385 0 416084 0 0 0 JOHN LOGAN 7117-32918 MEDICAL DIRECTOR 220673 0 0 0 0 0 0 0 0 0 220673 0 0 0 LOIS MORGAN 616-517 FORMER VP CHIEF NURSE 144975 0 0 0 20022 0 2026 0 18044 0 185067 0 0 0 GARY COLBERG 617 FORMER CEO 237250 0 0 0 0 0 0 0 13301 0 250551 0 0 0 BRUCE BEGLEY FORMER CEO 444672 0 0 0 0 0 0 0 10899 0 455571 0 0 0 A COUNTY OF HENDERSON KY SERIES 2009A 616000814 2009-12-30 12000000 SEE PART VI 0 0 0 B COUNTY OF HENDERSON KY SERIES 2009B 616000814 2009-12-30 18000000 SEE PART VI 0 0 0 C COUNTY OF HENDERSON KY SERIES 2010 616000814 2010-02-16 14210000 SEE PART VI 0 0 0 D COUNTY OF HENDERSON KY SERIES 2013 616000814 2013-01-25 7000000 SEE PART VI 0 0 0 A 12000000 12000000 2010 0 0 1 1 B 18000000 102783 17897217 2010 1 0 1 1 C 14210000 14210000 2010 1 0 1 1 D 7000000 6914642 85358 2013 0 0 1 1 A 0 0 1 0 0 0 0 1 B 0 0 1 0 0 0 0 1 C 0 0 1 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 1 1 FIFTH THIRD BANK 5.000000000000 0 0 0 0 0 C 0 0 0 0 1 1 FIFTH THIRD BANK 5.000000000000 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 HALEY HALBIG RELATED KEY EMPLOYEE 25640 HALEY HALBIG IS AN EMPLOYEE OF THE HOSPITAL. SHE IS ALSO RELATED TO LOIS MORGAN, A KEY EMPLOYEE. 0 AMY DAVENPORT RELATED BOARD MEMBER 14187 AMY DAVENPORT IS AN EMPLOYEE OF THE HOSPITAL. SHE IS ALSO RELATED TO DR. VERNON HUMBERT, A BOARD MEMBER. 0 EM FORD COMPANY BOARD MEMBER/OWNER 318760 BOARD MEMBER MIKE HAZELWOOD IS THE OWNER OF EM FORD & COMPANY. EM FORD & COMPANY PROVIDES INSURANCE COVERAGE TO THE HOSPITAL AND THE EXPENSE IS 318,760. 0 BETTY TEER RELATED OFFICER 58668 BETTY TEER IS AN EMPLOYEE OF THE HOSPITAL. SHE IS RELATED TO BRUCE BEGLEY, A FORMER OFFICER OF THE HOSPITAL. 0 MELANIE HUMBERT RELATED BOARD MEMBER 40769 MELANIE HUMBERT IS AN EMPLOYEE OF THE HOSPITAL. SHE IS ALSO RELATED TO DR. VERNON HUMBERT, A BOARD MEMBER. 0 SHARON SHIELDS RELATED BOARD MEMBER 197502 SHARON SHIELDS IS AN EMPLOYEE OF THE HOSPITAL. SHE IS RELATED TO DANE SHIELDS, A BOARD MEMBER. 0 TONIA LILES RELATED BOARD MEMBER 71099 TONIA LILES IS AN EMPLOYEE OF THE HOSPITAL. SHE IS ALSO RELATED TO DR. VERNON HUMBERT, A BOARD MEMBER. 0 ROBERTA PHILLIPS RELATED BOARD MEMBER 45709 ROBERTA PHILLIPS IS AN EMPLOYEE OF THE HOSPITAL. SHE IS ALSO RELATED TO JIMMY PHILLIPS, A BOARD MEMBER. 0 JENNIFER PHILLIPS RELATED BOARD MEMBER 44050 JENNIFER PHILLIPS IS AN EMPLOYEE OF THE HOSPITAL. SHE IS ALSO RELATED TO JIMMY PHILLIPS, A BOARD MEMBER. 0 TIMOTHY BARRON RELATED BOARD MEMBER 70874 TIMOTHY BARRON IS AN EMPLOYEE OF THE HOSPITAL. HE IS RELATED TO STEVE AUSTIN, A BOARD MEMBER. 0 DREW CLEMENTS RELATED BOARD MEMBER 93264 DREW CLEMENTS IS AN EMPLOYEE OF THE HOSPITAL. HE IS RELATED TO MELISSA CLEMENTS, A BOARD MEMBER. 0 JOHN LEE RELATED BOARD MEMBER 255021 JOHN LEE IS AN EMPLOYEE OF THE HOSPITAL. HE IS RELATED TO SHANNA LEE, A BOARD MEMBER. 0 FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY UNITED METHODIST HOSPITAL, INC. IS GOVERNED BY A BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE NOMINATING COMMITTEE OF THE BOARD OF DIRECTORS CONSIDER THE APPROPRIATE BOARD MEMBER CANDIDATES BASED ON CRITERIA. THE COMMITTEE MAKES BOARD MEMBER RECOMMENDATIONS TO THE BOARD WHICH VOTES AT A REGULARLY SCHEDULED MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 INFORMATION IS COMPILED BY HOSPITAL MANAGEMENT AND THE RETURN IS PREPARED BY AN INDPENDENT THIRD PARTY CERTIFIED PUBLIC ACCOUNTING FIRM FAMILIAR WITH HOSPITAL OPERATIONS, POLICIES, AND COMMITTEE/BOARD ACTIONS. THE FINAL RETURN IS REVIEWED BY THE DIRECTOR OF FINANCE, CFO, AND BY THE FINANCE COMMITTEE (OF THE BOARD OF DIRECTORS). ONCE THE RETURNS HAVE BEEN REVIEWED, THEY ARE SENT TO THE FULL BOARD OF DIRECTORS FOR APPROVAL. THE BOARD OF DIRECTORS ARE INFORMED THAT THE FORM 990 IS AVAILABLE IN ITS ENTIRETY. FORM 990, PART VI, SECTION B, LINE 12C ONGOING MONITORING BY THE COMPLIANCE OFFICER (MH CHIEF OPERATING OFFICER). FORM 990, PART VI, SECTION B, LINE 15 EVERY YEAR SURVEYS ARE SENT TO THE BOARD MEMBERS, MEDICAL STAFF, AND DIRECTORS. SURVEYS ARE RETURNED AND TABULATED CONFIDENTIALLY AND THE AGGREGATED RESPONSES ARE SHARED WITH THE COMPENSATION COMMITTEE AND THE BOARD. COMPENSATION IS REVIEWED BY USING THIRD PARTY EXECUTIVE COMPENSATION SURVEYS. CURRENTLY COMPENSATION AND THIRD PARTY EXECUTIVE COMPENSATION SURVEYS ARE THEN REVIEWED BY THE ADMINISTRATIVE PERSONNEL COMMITTEE WHO THEN RECOMMENDS APPROVAL TO THE INDEPENDENT BOARD. THE BOARD HAS FINAL APPROVAL ON COMPENSATION FOR THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 11,332,745. MANAGEMENT AND GENERAL EXPENSES 2,265,746. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,598,491. LEGAL & PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,944,092. MANAGEMENT AND GENERAL EXPENSES 622,681. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,566,773. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 499,977. MANAGEMENT AND GENERAL EXPENSES 101,153. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 601,130. TEMPORARY SERVICES: PROGRAM SERVICE EXPENSES 122,886. MANAGEMENT AND GENERAL EXPENSES 24,862. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 147,748. OTHER FEES-MNGMNT-990: PROGRAM SERVICE EXPENSES 1,114. MANAGEMENT AND GENERAL EXPENSES 225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,339. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -257,945. CHANGE IN INTEREST RATE SWAP 134,145. FORM 990, PART XII THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. HENDERSON REGIONAL HOSPITAL FOUNDATION 1305 NORTH ELM ST HENDERSON KY 42420 610944432 SUPPORT THE HOSPITAL KY 501(C)3 LINE 11 N/A 0 UNION COUNTY METHODIST HOSPITAL FOUNDATION 4604 US HWY 60 WEST MORGANFIELD KY 42437 611230297 SUPPORT THE HOSPITAL KY 501(C)3 LINE 11 N/A 0 KENTUCKY HOMECARE OF HENDERSON LLC 420 WEST PINHOOK ROAD LAFAYETTE LA 70503 264812417 HOME HEALTH KY N/A RELATED 25980 368991 0 0 COMMUNITY CARE NETWORK INC 220 A SECOND STREET HENDERSON KY 42420 611254545 HOSPITAL NETWORK KY N/A C 52261 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1