GRAYSON CO HOSPITAL FOUNDATION INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GRAYSON CO HOSPITAL FOUNDATION INC (EIN 61-0523298)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-07-11
- IRS object ID
- 201811929349300516
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-07-11T09:49:45-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 611189912 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BUCKLES TRAVIS & HART PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 4069 | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 427554069 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610523298 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GRAY | BusinessNameControlTxt |
| Phone | 2702599509 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WAYNE MERIWETHER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2702599400 | PhoneNum |
| Signature | 2018-06-29 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRADLEY K TRAVIS | PreparerPersonNm |
| PTIN | P01224802 | PTIN |
| Phone | 2702595604 | PhoneNum |
| Preparation | 2018-06-29 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DBA TWIN LAKES REGIONAL MEDICAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WAYNE MERIWETHER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $41,336,237 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TLRMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY MEDICAL HEALTHCARE TO THE GRAYSON COUNTY, KENTUCKY AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 503 | TotalEmployeeCnt |
| Total Volunteers | 38 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $12,939 | PYContributionsGrantsAmt |
| CY Contributions Grants | $9,954 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $42,251,358 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,580,162 | CYProgramServiceRevenueAmt |
| PY Investment Income | $71,599 | PYInvestmentIncomeAmt |
| CY Investment Income | $135,704 | CYInvestmentIncomeAmt |
| PY Other Revenue | $649,785 | PYOtherRevenueAmt |
| CY Other Revenue | $1,275,784 | CYOtherRevenueAmt |
| PY Total Revenue | $42,985,681 | PYTotalRevenueAmt |
| CY Total Revenue | $41,001,604 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,276,201 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,994,029 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,113,154 | PYOtherExpensesAmt |
| CY Other Expenses | $26,204,820 | CYOtherExpensesAmt |
| PY Total Expenses | $38,389,355 | PYTotalExpensesAmt |
| CY Total Expenses | $39,198,849 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,596,326 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,802,755 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $102,651,308 | TotalAssetsBOYAmt |
| Total Assets EOY | $102,636,354 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,326,920 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,509,211 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $86,324,388 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $88,127,143 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY MEDICAL HEALTHCARE TO THE GRAYSON COUNTY, KENTUCKY AREA. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $25,009,754 | ExpenseAmt |
| Revenue | $39,580,162 | RevenueAmt |
| Desc | TWIN LAKES REGIONAL MEDICAL CENTER PROVIDES QUALITY MEDICAL HEALTH CARE SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR THE ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND FINANCIAL STABILITY OF TWIN LAKES REGIONAL MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THIS AREA, THE HOSPITAL PROVIDES FREE CARE TO THE MOST INDIGENT OF PATIENTS AND WRITES OFF PORTIONS OF BILLS TO OTHER PATIENTS WHO HAVE DEMONSTRATED THE INABILITY TO PAY FOR ALL HEALTH CARE SERVICES RECEIVED. ADDITIONAL CHARGES ARE WRITTEN OFF DUE TO ARRANGEMENTS WITH MEDICARE, MEDICAID, AND OTHER THIRD PARTIES. THE TOTAL UNREIMBURSED CHARGES FORGONE IN FISCAL YEAR 2017 DUE TO CONTRACTUAL AGREEMENTS WITH PAYERS AMOUNTED TO 87,499,984.20. ALSO, 696,857 WAS PAID AS A "PROVIDER TAX" TO THE COMMONWEALTH OF KENTUCKY TO HELP DEFRAY THE COSTS OF COVERING INDIGENT PATIENTS UNDER A SPECIAL STATE PROGRAM. WRITE-OFFS FROM PATIENTS "UNWILLING" TO PAY - I.E. BAD DEBTS - ACCOUNTED FOR 4,029,934.16. THE PRIMARY MISSION OF TWIN LAKES REGIONAL MEDICAL CENTER IS TO HEAL THE SICK, RELIEVE PAIN AND SUFFERING, AND IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE WE SERVE. TLRMC'S VISION IS TO BE RECOGNIZED BY THE PEOPLE WE SERVE AS THE PROVIDER OF CHOICE FOR THEIR HEALTH CARE NEEDS AND AS A LEADING FORCE FOR PROGRESSIVE CHANGE WITHIN OUR COMMUNITY. TO ENHANCE QUALITY, THE HOSPITAL ACTIVELY OPERATES A PERFORMANCE IMPROVEMENT PROGRAM WHICH HELPS IDENTIFY BETTER PATIENT CARE AS WELL AS EFFICIENCIES IN OPERATIONS. TO ENHANCE OUR COMMUNITY, TLRMC PROVES TO BE A DRIVING FORCE IN CHANGE BY EDUCATING THE COMMUNITY ON HEALTH & WELLNESS ISSUES AND BY RECOGNIZING COMMUNITY NEEDS AND WORKING TO FULFILL THOSE NEEDS. THE HOSPITAL CARED FOR 2,138 INPATIENTS AND 93,186 OUTPATIENTS. TO ASSIST THOSE PATIENTS WITH LIMITED RESOURCES, TLRMC ALSO OFFERS A PATIENT FINANCIAL ASSISTANCE PROGRAM. THERE ARE SEVERAL OPTIONS FOR PATIENTS WHO ARE UNINSURED OR UNDERINSURED, AND TLRMC'S PATIENT FINANCIAL SERVICES DEPARTMENT EDUCATES THE PATIENTS OF THE DIFFERENT PROGRAMS. BASED ON THE RESULTS OF OUR LATEST COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), TWIN LAKES REGIONAL MEDICAL CENTER CREATED THE POPULATION HEALTH COMMITTEE. THIS GROUP IS MADE UP OF HOSPITAL EMPLOYEES AND REPRESENTATIVES FROM THE LOCAL HEALTH DEPARTMENT, SCHOOL SYSTEM, LOCAL FACTORIES, EXTENSION SERVICE LEADERS, GOVERNMENT OFFICIALS AND OTHERS. THE COMMITTEE MEETS MONTHLY AT THE HOSPITAL AND LED THE EFFORT TO GET A SMOKE FREE COMMUNITY ORDINANCE PASSED. THE GROUP IS NOW WORKING ON MAKING POSITIVE DIFFERENCES IN THE HEALTH OF OUR COMMUNITY IN SUCH TOPICS AS DIABETES, EXERCISE, NUTRITION AND GENERAL HEALTH. THE HOSPITAL PARTNERED WITH THE UNIVERSITY OF KENTUCKY COOPERATIVE EXTENSION SERVICE AND HOSTED A LOCAL FARMER'S MARKET ON THE HOSPITAL CAMPUS. TIME AND SOME ADVERTISING BUDGET WERE GIVEN TO PROMOTING THIS EFFORT TO SUPPORT LOCAL FARMERS AND TO MAKE FRESH VEGETABLES MORE READILY AVAILABLE TO THE COMMUNITY. THE HOSPITAL PROVIDED FREE MEETING SPACE TO SEVERAL GROUPS THROUGHOUT THE YEAR AND SEVERAL CLASSES WERE SPONSORED BY THE HOSPITAL THAT EDUCATED INTERESTED COMMUNITY RESIDENTS ON HEALTH & WELLNESS ISSUES. THEY INCLUDE: A. C.P.R. TO HEALTHCARE PROVIDERS AND TO THE COMMUNITY B. PREPARED CHILDBIRTH AND BREAST FEEDING CLASSES C. COUNTY-WIDE BABY SHOWER IN GRAYSON COUNTY - PROVIDES INFORMATION TO WOMEN WHO ARE PREGNANT OR WANT TO BECOME PREGNANT D. COMMUNITY-WIDE BABY SHOWER IN BRECKINRIDGE COUNTY - PROVIDES INFORMATION TO WOMEN WHO ARE PREGNANT OR WANT TO BECOME PREGNANT E. SPONSORS THE AMERICAN RED CROSS BLOOD MOBILE TWO OR THREE TIMES EACH YEAR F. PROVIDED HEALTH INFORMATION AT THE RELAY FOR LIFE G. PARTICIPATED IN UNITED WAY MEETNGS UPON REQUEST, THE HOSPITAL ALSO PARTICIPATES IN LOCAL EDUCATION BY PROVIDING HOSPITAL EMPLOYEES AS SPEAKERS FOR CLASSROOMS OR CIVIC ORGANIZATIONS SUCH AS THE FOLLOWING EXAMPLES: H. PARTICIPATED IN OPERATION PREPARATION I. WRECC SAFETY DAY J. HEALTH ADVISORY MEETINGS FOR THE HEAD START PROGRAM K. ASSISTED IN PROVIDING TRANSLATION SERVICES L. PARTICIPATED IN PLASTIKON HEALTH FAIR M. PARTICIPATED IN WORK DAY DEMO AT CLARKSON ELEMENTARY SCHOOL N. PROVIDED SPEAKERS FOR MANY HEALTH FAIRS, SCHOOLS, AND COMMUNITY EVENTS O. NARCAN EDUCATION FOR LEITCHFIELD CITY POLICE AND GRAYSON COUNTY SHERIFF DEPARTMENTS IN ADDITION TO SERVING OUR LOCAL COMMUNITY NEEDS, TLRMC HAS ALSO TAKEN ON MEASURES TO IMPROVE AMERICA. BY PARTICIPATING IN THE CODE GREEN - RECYCLING PROJECT, TLRMC HOPES TO REDUCE WASTE AND IMPROVE THE ENVIRONMENT. TWIN LAKES REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS HAS PLEDGED TO BUY AMERICAN-MADE PRODUCTS WHEN WE CAN FIND A PRODUCT OF EQUAL OR GREATER QUALITY. TLRMC ENCOURAGES OTHER COMPANIES AND INDIVIDUALS TO DO THE SAME. | Desc |
| Total Program Service Expenses | $25,009,754 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 503 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | COMPANY OFFICIALS | PersonNm |
| Phone | 2702599400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| LINDA FRENCH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BECKY MILLER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOEL BERNARD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RON TYRER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RYAN BRATCHER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EDWIN MCKINNEY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ANDREW JENKINS MD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID DOWNS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TREVOR RAY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KEVIN BROOKS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| WAYNE MERIWETHER | ||||||||
| CEO | 40.00 | $0 | $0 | $0 | Yes (X) | |||
| CATHERINE D CLEMONS | ||||||||
| CHIEF OPERAT | 40.00 | $141,854 | $0 | $13,754 | Yes (X) | |||
| ANGELA GIBSON | ||||||||
| DIRECTOR OF | 40.00 | $137,806 | $0 | $5,541 | Yes (X) | |||
| ANITA PLEACHER | ||||||||
| PHARMACIST | 40.00 | $128,718 | $0 | $1,287 | Yes (X) | |||
| RICHARD DONOVAN | ||||||||
| PHARMACIST | 40.00 | $123,009 | $0 | $8,497 | Yes (X) | |||
| DAVID LOGSDON | ||||||||
| CHIEF NURSIN | 40.00 | $129,434 | $0 | $7,497 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $660,821 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $36,576 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LABORATORY CORPORATION OF AMERICA | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | PROFESSIONAL SE | $686,591 |
| SAMER BLEIBEL | |||||
| 304 WALLACE AVE | LEITCHFIELD | KY | 42754 | PROFESSIONAL SE | $481,800 |
| ANDREW JENKINS MD | |||||
| 223 BYRTLE GROVE RD | LEITCHFIELD | KY | 42754 | PROFESSIONAL SE | $339,200 |
| LEITCHFIELD PEDIATRIC CLINC | |||||
| 908 WALLACE AVE | LEITCHFIELD | KY | 42754 | PROFESSIONAL SE | $162,625 |
| JOHNSON CONTROLS INC | |||||
| PO BOX 730068 | DALLAS | TX | 75373 | PROFESSIONAL SE | $142,941 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $9,954 | AllOtherContributionsAmt |
| Noncash Contributions | $9,904 | NoncashContributionsAmt |
| Total Contributions | $9,954 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT SERVICES | $39,389,799 | $39,389,799 |
| CAFETERIA REVENUE | $167,968 | $167,968 |
| FITNESS CENTER & OTHER INCOME | $22,395 | $22,395 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,580,162 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $135,704 | TotalRevenueColumnAmt |
| Exclusion | $135,704 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $644,718 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $334,633 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $310,085 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $310,085 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $310,085 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| TAX REVENUE | $622,807 | $622,807 |
| NONOPERATING GAIN(LOSS) | $177,187 | $177,187 |
| MANAGEMENT FEES | $165,705 | $165,705 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $965,699 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,001,604 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,855,946 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $135,704 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,994,029 | TotalAmt |
| Program Services | $10,627,708 | ProgramServicesAmt |
| Management And General | $2,366,321 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $417,230 | TotalAmt |
| Management And General | $417,230 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,817,115 | TotalAmt |
| Program Services | $2,509,486 | ProgramServicesAmt |
| Management And General | $307,629 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| ADMINISTRATIVE & GENERAL | $11,097,915 | $11,097,915 | |
| PROVISION FOR BAD DEBTS | $2,216,014 | $2,216,014 | |
| PHARMACY | $2,148,998 | $2,148,998 | |
| LABORATORY | $1,990,339 | $1,990,339 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,517,209 | TotalAmt |
| Program Services | $5,517,209 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,198,849 | TotalAmt |
| Program Services | $25,009,754 | ProgramServicesAmt |
| Management And General | $14,189,095 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,244,841 | BOYAmt |
| EOY | $21,173,806 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,075,532 | BOYAmt |
| EOY | $5,712,173 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,707,915 | BOYAmt |
| EOY | $42,145,706 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,844,239 | BOYAmt |
| EOY | $1,822,850 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,324 | BOYAmt |
| EOY | $396,438 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $70,115,394 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $40,746,392 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,405,349 | BOYAmt |
| EOY | $29,369,002 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,920,108 | BOYAmt |
| EOY | $2,016,379 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,651,308 | BOYAmt |
| EOY | $102,636,354 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,667,604 | BOYAmt |
| EOY | $3,080,764 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,264,742 | BOYAmt |
| EOY | $10,356,581 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,394,574 | BOYAmt |
| EOY | $1,071,866 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,326,920 | BOYAmt |
| EOY | $14,509,211 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,324,388 | BOYAmt |
| EOY | $88,127,143 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,324,388 | BOYAmt |
| EOY | $88,127,143 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,651,308 | BOYAmt |
| EOY | $102,636,354 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,802,755 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $744,229 | OtherCostOrOtherBasisAmt |
| Book Value | $744,229 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,794,672 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,270,443 | DepreciationAmt |
| Book Value | $22,524,229 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,776,878 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,782,368 | DepreciationAmt |
| Book Value | $4,994,510 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,799,615 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,693,581 | DepreciationAmt |
| Book Value | $1,106,034 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $29,369,002 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE | $729,457 |
| LONG-TERM DEBT | $342,409 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,071,866 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $40,924,746 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $40,924,746 | RevenueSubtotalAmt |
| Other Revenues Not Included | $76,858 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $76,858 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $41,001,604 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $42,573,960 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $3,451,969 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $3,451,969 | ExpensesNotReportedAmt |
| Expenses Subtotal | $39,121,991 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $76,858 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $76,858 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $39,198,849 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE HOSPITAL AS WELL AS THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE HOSPITAL'S FINANCIAL STATEMENTS. MANAGEMENT IS NOT AWARE OF ANY ACTIVITY WITHIN THE HOSPITAL OR FOUNDATION DURING THE CURRENT OR PRIOR REPORTING PERIODS THAT WOULD JEOPARDIZE OR OTHERWISE CALL INTO QUESTION THE HOSPITAL OR FOUNDATION'S COMPLIANCE WITH THE ABOVE INTERNAL REVENUE CODE SECTION. THE ORGANIZATION'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 99) FOR FISCAL YEARS 2015, 2016 AND 2017 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR THREE YEARS AFTER THEY WERE FILED. CURRENTLY, THE HOSPITAL AND FOUNDATION HAVE NO REPORTING REQUIREMENTS WITH ANY STATE OR LOCAL TAX JURISDICTIONS. THE HOSPITAL HAS INVESTMENT INTEREST IN THREE COMPANIES AS DESCRIBED IN NOTE 8. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION'S POLICY FOR RECORDING ANY TAX RELATED INTEREST AND PENALTIES IS TO RECOGNIZE THESE ITEMS AS OPERATING EXPENSES; HOWEVER, NONE WERE INCURRED OR RECORDED DURING THE CURRENT OR PRIOR OPEN OPERATING PERIODS. |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | VALUE OF DONATED ITEMS 9,904 DONATED SERVICES 66,954 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | OPERATING LOSS REPORTED UNDER ID 61-1269278 3,451,969 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | DONATED SERVICES 66,954 USE OF DONATED ITEMS 9,904 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 68 | PersonsServedCnt |
| Total Community Benefit Expns | $20,654 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,654 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 27693 | PersonsServedCnt |
| Total Community Benefit Expns | $4,243,597 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $267,684 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,975,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10140 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 27761 | PersonsServedCnt |
| Total Community Benefit Expns | $4,264,251 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $267,684 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,996,567 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10200 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 12 | ActivitiesOrProgramsCnt |
| Persons Served | 1550 | PersonsServedCnt |
| Total Community Benefit Expns | $6,098 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 12 | ActivitiesOrProgramsCnt |
| Persons Served | 1550 | PersonsServedCnt |
| Total Community Benefit Expns | $6,098 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 29311 | PersonsServedCnt |
| Total Community Benefit Expns | $4,270,349 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $267,684 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,002,665 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10210 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $25,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 3000 | PersonsServedCnt |
| Total Community Benefit Expns | $1,437 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,437 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 3000 | PersonsServedCnt |
| Total Community Benefit Expns | $26,437 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,437 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,150,777 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $594,942 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,941,252 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,731,301 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,790,049 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN LAKES MEDICAL F | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MEDICAL PRACTICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 1.00000 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Business Name Line2 | TWIN LAKES REGIONAL MEDICAL CENTER | BusinessNameLine2Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Business Name Line2 | TWIN LAKES REGIONAL MEDICAL CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.TLRMC.COM | OwnWebsiteURLTxt |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.TLRMC.COM | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 5 | IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), TWIN LAKES REGIONAL MEDICAL CENTER (TLRMC) DEVELOPED A SURVEY TO GATHER HEALTH INFORMATION AND OPINIONS OF GRAYSON COUNTY RESIDENTS 18 AND OVER. THE SURVEY WAS CONDUCTED IN SEPTEMBER AND OCTOBER 2015 USING AN ONLINE SURVEY TOOL AND BY DISTRIBUTING PRINTED COPIES IN VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. REGISTRATION CLERKS AT THE HOSPITAL HANDED OUT THE SURVEY TO PATIENTS AND FAMILY MEMBERS. THE ONLINE SURVEY WAS PROMOTED THROUGH NEWSPAPER ADVERTISEMENTS, BUSINESS CARDS AND ON THE TLRMC FACEBOOK PAGE. EMAILS WITH A LINK TO THE SURVEY WERE SENT TO GRAYSON COUNTY CHAMBER OF COMMERCE MEMBERS, LOCAL INDUSTRIES, AND EMPLOYEES OF THE GRAYSON COUNTY SCHOOL SYSTEM AND THE HOSPITAL. PRINTED COPIES WERE DELIVERED TO AN ASSISTED LIVING FACILITY, THE GRAYSON COUNTY HEALTH DEPARTMENT, BIG CLIFTY MEDICAL COMPLEX AND THE CANEYVILLE FAMILY PRACTICE. INFORMATION GAPS THAT LIMITED THE ABILITY OF TLRMC TO ASSESS THE COMMUNITY'S HEALTH NEEDS WERE IDENTIFIED. THE PRIMARY OBSTACLE WAS REACHING ELDERLY, LOW-INCOME AND/OR RURAL RESIDENTS DUE TO A LACK OF INTERNET ACCESS AND WILLINGNESS TO PARTICIPATE. TLRMC MADE EFFORTS TO REACH THESE INDIVIDUALS WITH WRITTEN SURVEYS. 757 GRAYSON COUNTY RESIDENTS PARTICIPATED IN THE SURVEY. THE QUESTIONS WERE IN THREE PRIMARY CATEGORIES: DEMOGRAPHICS, PERSONAL HEALTH INFORMATION, AND PERCEIVED HEALTH NEEDS OF THE COMMUNITY. THE TWIN LAKES REGIONAL MEDICAL CENTER'S CHNA TEAM TABULATED THE RESULTS FROM THE SURVEYS (ONLINE AND PRINTED) AND SUPPLEMENTED THEM WITH HEALTH STATISTICS AND DEMOGRAPHIC INFORMATION. TLRMC THEN INVITED REPRESENTATIVES FROM A VARIETY OF BACKGROUNDS TO A COMMUNITY FORUM/FOCUS GROUP ON FEBRUARY 2, 2016 TO REVIEW THE SURVEY RESULTS AND PROVIDE RECOMMENDATIONS FOR THE HOSPITAL'S COMMUNITY BENEFIT FOCUS. PROFESSIONS REPRESENTED INCLUDED PHYSICIANS; SCHOOL ADMINISTRATORS, TEACHERS AND STAFF; THE GRAYSON COUNTY HEALTH DEPARTMENT; LOCAL INDUSTRY/MANUFACTURING; HOSPITAL BOARD MEMBERS; LAW ENFORCEMENT; AND HOSPITAL LEADERSHIP. ONCE THE INFORMATION WAS PRESENTED A GROUP DISCUSSION WAS HELD. ATTENDEES WERE ASKED FOR THEIR TOP HEALTH PRIORITIES WITHOUT CONCERN ABOUT THE PRACTICALITY OF THE HOSPITAL'S ABILITY TO IMPACT THE ISSUES. THESE RESULTS WERE THEN PRESENTED TO THE POPULATION HEALTH COMMITTEE FOR THEIR CONSIDERATION AND INPUT. TO PUT THE 2012 CHNA REPORT INTO ACTION, TWIN LAKES REGIONAL MEDICAL CENTER CREATED THE POPULATION HEALTH COMMITTEE. THIS GROUP OF PEOPLE WORKS ON IMPROVING THE HEALTH OF OUR COMMUNITY GUIDED BY THE COMMUNITY HEALTH FOCUS POINTS SET IN THE 2012 CHNA. THE POPULATION HEALTH COMMITTEE IS MADE UP OF HOSPITAL EMPLOYEES, INDUSTRIAL LEADERS, THE GRAYSON COUNTY SCHOOLS SUPERINDENDENT, REGISTERED DIETICIANS, A PHARMACIST, A REPRESENTATIVE FROM THE KENTUCKY CANCER PROGRAM AND A REPRESENTATIVE FROM THE GRAYSON COUNTY HEALTH DEPARTMENT. THE TWIN LAKES REGIONAL MEDICAL CENTER CEO CHAIRS THE COMMITTEE. THE POPULATION HEALTH COMMITTEE MEETS MONTHLY TO DISCUSS AND IMPLEMENT PLANS ON IMPROVING THE HEALTH OF THE COMMUNITY. ON FRIDAY, MARCH 4, 2016, THE POPULATION HEALTH COMMITTEE MET TO CONSIDER THE INPUT OF THE COMMUNITY FOCUS GROUP, THE SIZE AND SEVERITY OF THE NEEDS, AVAILABLE DATA, AND THE ABILITY TO HAVE AN IMPACT AS A HOSPITAL. THE COMMITTEE MADE THEIR RECOMMENDATIONS OF COMMUNITY HEALTH FOCUS POINTS TO THE HOSPITAL. AFTER CAREFULLY CONSIDERING THE RESULTS OF THE COMMUNITY HEALTH SURVEY, THE MOST RECENT HEALTH AND DEMOGRAPHIC INFORMATION AVAILABLE, AND INPUT FROM THE COMMUNITY FORUM/FOCUS GROUP AND THE POPULATION HEALTH COMMITTEE, THE FOLLOWING NEEDS WERE IDENTIFIED BY HOSPITAL LEADERSHIP AS THE COMMUNITY HEALTH FOCUS POINTS FOR TWIN LAKES REGIONAL MEDICAL CENTER IN 2016 - 2019. SMOKING, INFORMATION/AWARENESS OF HEALTH ISSUES, LACK OF PHYSICAL ACTIVITY OPTIONS, AND NUTRITION/OBESITY. THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT WAS APPROVED BY THE BOARD OF DIRECTORS FOR TWIN LAKES REGIONAL MEDICAL CENTER ON TUESDAY, MARCH 15, 2016. THE PUBLICATION OF THIS REPORT IS ANOTHER STEP TO A HEALTHIER GRAYSON COUNTY. IT IS THE INTENTION OF TWIN LAKES REGIONAL MEDICAL CENTER THAT THE CONTENTS OF THIS REPORT BE USED TO INFORM GRAYSON COUNTY RESIDENTS OF WHAT THEIR FELLOW CITIZENS THINK ARE THE MOST IMPORTANT HEALTH ISSUES IN THEIR COMMUNITY. ADDITIONALLY, TLRMC HOPES THIS REPORT WILL SERVE AS A FOUNDATION TO BUILD LASTING RELATIONSHIPS BETWEEN TWIN LAKES REGIONAL MEDICAL CENTER, COMMUNITY PARTNERS AND RESIDENTS OF GRAYSON COUNTY. IN ORDER TO ADDRESS THE PRIORITIZED NEEDS, TLRMC WILL ENGAGE KEY INTERNAL AND COMMUNITY PARTNERS. CUSTOMIZED STRATEGIES HAVE BEEN DEVELOPED AND WILL BE CONTINUED. THE STRATEGIES INCLUDE, BUT ARE NOT LIMITED TO, MODIFYING POLICIES, PUBLIC AND PRIVATE; PROVIDING SUPPORT, INFORMATION AND INCENTIVES; IMPROVING ACCESS; ENHANCING SKILLS; AND CHANGING CONSEQUENCES. FOLLOW-UP SURVEYS WILL MEASURE THE SUCCESS OF EACH INITIATIVE AND PROVIDE THE NEXT AREAS OF FOCUS FOR THE HOSPITAL. TO INFORM THE PUBLIC AND PARTNERS OF OUR GOALS AND TO INCREASE AWARENESS OF OUR PLAN, TWIN LAKES REGIONAL MEDICAL CENTER WILL PUBLISH THE FULL CHNA REPORT ON THE HOSPITAL'S WEBSITE (WWW.TLRMC.COM), PROMOTE THE REPORT ON SOCIAL MEDIA CHANNELS SUCH AS FACEBOOK AND TWITTER, AND SUBMIT TO LOCAL NEWS MEDIA. PRINTED COPIES WILL BE AVAILABLE FOR THE PUBLIC AT THE HOSPITAL AS WELL. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 7D | LOCAL NEWSPAPERS. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 11 | THE FOLLOWING NEEDS WERE IDENTIFIED BUT NOT ADOPTED AS TOP PRIORITIES OF THE HOSPITAL AND THE REASONS WHY. ALCOHOL AND/OR DRUG ABUSE - BEING MET BY OTHER COMMUNITY GROUPS AND PARTNERSHIPS THE HOSPITAL IS ALREADY INVOLVED WITH. TEEN PREGNANCY - THE RATES IN GRAYSON COUNTY ARE DECREASING AND THIS DID NOT SEEM LIKE AN EFFECTIVE FOCUS FOR THE HOSPITAL. LACK OF DENTAL CARE - NOT AN AREA THE HOSPITAL CAN MAKE A SIGNIFICANT IMPACT ON. PSYCHIATRIC/MENTAL HEALTH SERVICES - SOME SERVICES ALREADY PROVIDED IN THE COMMUNITY AND THE HOSPITAL WOULD HAVE TO PUT SIGNIFICANT RESOURCES INTO MAKING A DIFFERENCE AT THE COST OF OTHER HIGHER PRIORITY NEEDS. |
| FACILITY 1, GRAYSON COUNTY HOSPITAL FOUNDATION - PART V, LINE 16J | THE POLICY WAS PROVIDED TO PATIENTS AT REGISTRATION. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE | TWIN LAKES REGIONAL MEDICAL CENTER'S PATIENT FINANCIAL ASSISTANCE PROGRAM UTILIZES THE FEDERAL POVERTY GUIDELINES AND AN ASSET TEST CONSISTING OF RESIDENCE, VEHICLES, AND CASH INVESTMENTS TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | IN DETERMINING THE AMOUNTS FOR PART 1, LINE 7, COST ACCOUNTING WAS USED. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE TOTAL BAD DEBT EXPENSE AT COST REPRESENTS THE TOTAL AMOUNT EXPECTED TO BE COLLECTED, BUT DEEMED UNCOLLECTIBLE. BASED ON THE COMMUNITY'S DEMOGRAPHICS, INCOME LEVEL, INDIVIDUAL ASSETS, AND HEALTH COVERAGE, 51.70% WAS DETERMINED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE PROGRAM. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT OR THIRD-PARTY PAYOR. IF THE HOSPITAL RECEIVES NO PAYMENT OR COMMUNICATION TO ARRANGE PAYMENT THE ACCOUNT IS SENT TO COLLECTION AND RECOGNIZED AS BAD DEBT AT THAT TIME. |
| PART III, LINE 8 - MEDICARE EXPLANATION | TWIN LAKES REGIONAL MEDICAL CENTER BELIEVES THAT ALL OF THE 1.8 MILLION MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. THE COSTS TO CARE FOR THE ELDERLY AND MEDICARE PATIENTS ARE ABSORBED BY THE HOSPITAL DUE TO LACK OF REIMBURSEMENTS FROM MEDICARE. THE HOSPITAL CONTINUES TO PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF MEDICARE BENEFICIARIES. THEREFORE, TWIN LAKES REGIONAL MEDICAL CENTER IS FULFILLING A COMMUNITY NEED BY CARING FOR MEDICARE PATIENTS, WHO TYPICALLY HAVE LOW, FIXED INCOMES; AND RELIEVING THE GOVERNMENT FOR THEIR LACK OF PROVIDING SUFFICIENT PAYMENTS TO COVER THE COST OF CARING FOR THEM. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | IF THE PATIENT DOES NOT HAVE ANY INSURANCE COVERAGE, AND THE PATIENT DOES NOT QUALIFY FOR ANY TYPE OF FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, THEN THE ACCOUNT CAN BE CONSIDERED FOR BAD DEBT PLACEMENT FORTY-FIVE DAYS AFTER THE PATIENT RECEIVED THEIR FIRST STATEMENT IF THERE HAS BEEN NO RESPONSE FROM THE PATIENT. AFTER A PERIOD OF TIME HAS PASSED WITH NO RESOLUTION, THE ACCOUNT WILL BE SENT TO OUR COLLECTION AGENCY. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | TWIN LAKES REGIONAL MEDICAL CENTER ASSESSES THE COMMUNITY'S HEALTH CARE NEEDS BY OBTAINING INFORMATION FROM A VARIETY OF SOURCES INCLUDING: A. COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY TWIN LAKES REGIONAL MEDICAL CENTER B. DEMOGRAPHIC DATABASES C. LOCAL AND REGIONAL HEALTH DEPARTMENTS AND RELATED DATABASES D. KENTUCKY HOSPITAL ASSOCIATION REPORTS AND DATABASES E. MARKET ANALYSIS F. FEEDBACK FROM PHYSICIANS AND EMPLOYEES AND OTHER INTERESTED COMMUNITY GROUPS G. HOSPITAL-GENERATED REPORTS ON UTILIZATION OF SERVICES H. BOARD OF DIRECTORS MADE UP OF LOCAL, COUNTY RESIDENTS |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | TWIN LAKES REGIONAL MEDICAL CENTER REACHES OUT TO EDUCATE PATIENTS ABOUT THEIR PATIENT FINANCIAL ASSISTANCE PROGRAM. A BROCHURE IS AVAILABLE AT SEVERAL LOCATIONS THROUGHOUT THE HOSPITAL INCLUDING THE BUSINESS OFFICE AND REGISTRATION AREA. A PDF VERSION OF THE BROCHURE IS POSTED ON THE HOSPITAL'S WEBSITE. THE HOSPITAL ALSO PUBLISHED THE COMMUNITY BENEFITS REPORT ON THE HOSPITAL'S WEBSITE AND FACEBOOK PAGE IN JUNE 2017, AND SUBSEQUENTLY IN THE TWO LOCAL NEWSPAPERS, WHICH INCLUDED THE SAME INFORMATION PROMINENTLY DISPLAYED. WHEN SELF PAY PATIENTS PRESENT TO THE HOSPITAL FOR SERVICES, THE REGISTRAR DIRECTS THE PATIENTS TO THE FINANCIAL COUNSELOR FOR ASSISTANCE ON MEDICAID/COMMERCIAL PLANS AVAILABLE THROUGH THE ACA. ALSO, AT THAT TIME OUR FINANCIAL ASSISTANCE PROGRAM IS ALSO APPLIED TO THEIR PERSONAL SITUATION FOR POSSIBLE HELP. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | THE PRIMARY SERVICE AREA FOR TWIN LAKES REGIONAL MEDICAL CENTER IS GRAYSON COUNTY, KY (POPULATION 26,000) LOCATED 75 MILES SOUTHWEST OF LOUISVILLE, KY. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES PARTS OF 6 SURROUNDING COUNTIES. THE ESTIMATED PERCENTAGE OF PEOPLE LIVING BELOW THE POVERTY LEVEL, AS DETERMINED BY THE U.S. CENSUS BUREAU, IS 22.1% FOR THE PRIMARY SERVICE AREA. THE AREA IS MOSTLY RURAL WITH A HIGHER PERCENTAGE OF PERSONS OVER THE AGE OF 65 AND A SIGNIFICANTLY LOWER MEDIAN HOUSEHOLD INCOME COMPARED TO THE STATE OF KENTUCKY. THE UNEMPLOYMENT RATE FOR THE MOST RECENT 12 MONTHS AVERAGED 6.7%. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | TWIN LAKES REGIONAL MEDICAL CENTER AND ITS EMPLOYEES HAVE A RICH HISTORY OF PLANNING AND/OR SPONSORING EVENTS DESIGNED TO EDUCATE THE COMMUNITY ON HEALTHY LIVING AND WELLNESS FACTORS. EVENTS DURING FYE 2017 INCLUDED THE COMMUNITY BABY SHOWER, NUTRITION DAY AT LOCAL SCHOOLS, CPR CLASSES, PREPARED CHILDBIRTH AND BREAST FEEDING CLASSES, AND HEALTH FAIRS AND SCREENINGS FOR THE COMMUNITY AND PRIVATE ORGANIZATIONS. TWIN LAKES REGIONAL MEDICAL CENTER ADHERES TO THE FOLLOWING IRS EXEMPTION REQUIREMENTS: A. ACCEPT AND TREAT MEDICARE AND MEDICAID PATIENTS B. EMERGENCY DEPARTMENT OPEN TO ALL EMERGENT CASES, REGARDLESS OF ABILITY TO PAY C. OPEN MEDICAL STAFF THAT ALLOWS CREDENTIALED PHYSICIANS TO PRACTICE AT FACILITY D. OPERATE UNDER COMMUNITY BOARD'S CONTROL IT IS THE MISSION AND ONGOING GOAL OF THE LEADERSHIP AND EMPLOYEES OF TWIN LAKES REGIONAL MEDICAL CENTER TO DO THE BEST JOB POSSIBLE TREATING THE SICK AND INJURED, ADDRESSING COMMUNITY WELLNESS NEEDS AND PROMOTING HEALTHY LIVING AT EVERY OPPORTUNITY. THROUGH OUR MANY COMMUNITY BENEFIT ACTIVITIES, OUR CHARITY CARE PROGRAM AND OUR ACCEPTANCE OF PATIENTS COVERED BY FEDERAL AND STATE PROGRAMS, TLRMC MAKES A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. |
| ADDITIONAL INFORMATION | IN ADDITION TO PROVIDING THE COMMUNITY BENEFIT REPORT IN THE LOCAL PAPER, TLRMC ALSO PARTICIPATES IN THE STATE-WIDE COMMUNITY BENEFIT REPORT WITH KENTUCKY HOSPITAL ASSOCIATION THAT IS PRESENTED TO OUR COMMONWEALTH. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|
| CATHERINE D CLEMONS | |||
| CHIEF OPERATING OFFI | $141,854 | $13,754 | $155,608 |
| DAVID LOGSDON | |||
| CHIEF NURSING OFFICE | $129,434 | $7,497 | $136,931 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Business Name Line2IssuerName/BusinessNameLine2Txt | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|---|
| GRAYSON COUNTY PUBLIC HOSPITAL DIST | |||||||||
| A | GRAYSON COUNTY PUBLIC HOSPITAL DIST | 610523298 | 389681CF2 | 2007-04-15 | $5,930,000 | REFUND EXISTING 1978, 1993 & 1999 BONDS AND SURGERY DEPARTMENT RENOVATION | false | false | false |
| GRAYSON COUNTY PUBLIC HOSPITAL DIST | |||||||||
| B | GRAYSON COUNTY PUBLIC HOSPITAL DIST | 610523298 | 2014-08-28 | $9,970,000 | REFUND EXISTING 2009 BOND ISSUE. | false | false | false | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $5,243,419 | $5,755,733 | $1,789,883 | $118,395 | $502,730 | 2008 | false | Yes (true) | Yes (true) | Yes (true) |
| B | $300,000 | $9,970,000 | $1,757,620 | $131,358 | 2014 | false | Yes (true) | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | Yes (true) |
| B | false | false | false | false | false | false | Yes (true) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | false | false | false |
| B | false | false | false | false | false | false | false | false | false |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | false |
| B | false |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| ISAAC MILLER | |||
| SON OF DIRECTOR | $154,167 | PHYSICIAN ASSIST PRO | false |
| MIDWAY PHARMACY OF CLARKSON INC | |||
| DIRECTOR | $52,524 | RENT OF PHARMACY SPA | false |
| DR TAREK EL-MASRI | |||
| DIRECTOR | $37,884 | RENT OF OFFICE SPACE | false |
| FUTURE DESIGNS INC | |||
| DIRECTOR | $4,175 | PURCHASE OF BLDG MAT | false |
| DR KENNETH GREEN | |||
| DIRECTOR | $18,420 | RENT OF OFFICE SPACE | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | ISAAC MILLER IS THE SON OF DIRECTOR BECKY MILLER. HE IS PARTICIPATING IN THE PHYSICIAN ASSISTANCE PROGRAM. DIRECTOR TREVOR RAY IS A SHAREHOLDER IN MIDWAY PHARMACY OF CLARKSON, INC. MIDWAY PHARMACY OF CLARKSON, INC. RENTS SPACE FROM TWIN LAKES REGIONAL MEDICAL CENTER FOR TWO PHARMACY LOCATIONS. DR. TAREK EL-MASRI IS A DIRECTOR OF TWIN LAKES REGIONAL MEDICAL CENTER. HIS MEDICAL PRACTICE RENTS OFFICE SPACE FROM TLRMC. KEVIN BROOKS IS A SHAREHOLDER IN FUTURE DESIGNS, INC. FUTURE DESIGNS, INC. SOLD BUILDING MATERIALS TO TLRMC. DR. KENNETH GREEN IS A DIRECTOR OF TWIN LAKES REGIONAL MEDICAL CENTER. HIS MEDICAL PRACTICE RENTS OFFICE SPACE FROM TLRMC. THE HOSPITAL AND GRAYSON COUNTY HOSPITAL DISTRICT BOTH MAINTAIN BANK ACCOUNTS AT THE CECILIAN BANK. LARRY PERKINS AND DAVID DOWNS, BOTH DIRECTORS OF GRAYSON COUNTY HOSPITAL FOUNDATION, INC., ARE EMPLOYED BY THE CECILIAN BANK. THE CASH BALANCES HELD AT JUNE 30, 2017 AND 2016 WERE 15,939,881 AND 17,445,257, RESPECTIVELY. THE HOSPITAL AND FOUNDATION BOTH MAINTAIN BANK ACCOUNTS AT WILSON & MUIR BANK & TRUST. RYAN BRATCHER, A DIRECTOR OF THE HOSPITAL, IS EMPLOYED BY WILSON & MUIR BANK & TRUST. THE CASH BALANCES HELD AT JUNE 30, 2017 AND 2016 WERE 3,447,779 AND 3,097,392, RESPECTIVELY. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | THE PURPOSE OF THE HOSPITAL VOUNTEER AUXILIARY IS TO RENDER SERVICE TO TWIN LAKES REGIONAL MEDICAL CENTER, ITS PATIENTS AND STAFF, AND TO ASSIST THE HOSPITAL IN PROMOTING THE HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH OBJECTIVES ESTABLISHED BY THE HOSPITAL. THE MISSION OF THE VOLUNTEER AUXILIARY IS TO "SUPPORT TWIN LAKES REGIONAL MEDICAL CENTER IN MEETING THE HEALTH CARE NEEDS OF THE PEOPLE IT SERVES IN THE MOST CARING, COMPASSIONATE, AND EFFECTIVE MANNER POSSIBLE." THE AUXILIARY'S PRIMARY DUTY WITHIN THE HOSPITAL IS STAFFING THE INFORMATION DESK IN THE MAIN LOBBY FROM 8 A.M. - 4 P.M., MONDAY - FRIDAY. ROUTINE DUTIES THERE INCLUDE PROVIDING GENERAL HOSPITAL INFORMATION AND DIRECTIONS TO PATIENTS AND THE PUBLIC; MAKING WHEELCHAIRS AVAILABLE TO VISITORS AND PATIENTS; ASSISTING PEOPLE REGISTER USING THE DIGITAL REGISTRATION KIOSK; PROVIDING ESCORTS WHEN NEEDED; AND DELIVERING FLOWERS TO PATIENTS. THE VOLUNTEERS ALSO OPERATE THE TLRMC GIFT SHOP. PROCEEDS FROM THE GIFT SHOP ARE USED BY THE VOLUNTEERS TO PROVIDE SCHOLARSHIPS AND TO PURCHASE EQUIPMENT FOR THE HOSPITAL SUCH AS BLANKET WARMERS, WHEELCHAIRS, TELEVISIONS, AND OTHER ITEMS. MEMBERS OF THE AUXILIARY HAND MAKE SOCK MONKEYS AND OTHER STUFFED ANIMALS FOR CHILDREN COMING TO THE HOSPITAL. THE ANIMALS ARE GIVEN TO THE YOUNG PATIENTS AND THEIR FAMILIES AT NO CHARGE. THE VOLUNTEERS RAISE THE MONEY NEEDED TO PURCHASE ANY SUPPLIES AND DONATE MATERIALS IN ADDITION TO THEIR TIME AND TALENTS. THE SOCK MONKEY PROGRAM HAS BEEN HONORED BY THE KENTUCKY HOSPITAL ASSOCIATION. |
| FORM 990, PAGE 2, PART III, LINE 4A | ADDITIONAL CHARGES ARE WRITTEN OFF DUE TO ARRANGEMENTS WITH MEDICARE, MEDICAID, AND OTHER THIRD PARTIES. THE TOTAL UNREIMBURSED CHARGES FORGONE IN FISCAL YEAR 2017 DUE TO CONTRACTUAL AGREEMENTS WITH PAYERS AMOUNTED TO 87,499,984.20. ALSO, 696,857 WAS PAID AS A "PROVIDER TAX" TO THE COMMONWEALTH OF KENTUCKY TO HELP DEFRAY THE COSTS OF COVERING INDIGENT PATIENTS UNDER A SPECIAL STATE PROGRAM. WRITE-OFFS FROM PATIENTS "UNWILLING" TO PAY - I.E. BAD DEBTS - ACCOUNTED FOR 4,029,934.16. THE PRIMARY MISSION OF TWIN LAKES REGIONAL MEDICAL CENTER IS TO HEAL THE SICK, RELIEVE PAIN AND SUFFERING, AND IMPROVE THE QUALITY OF LIFE FOR THE PEOPLE WE SERVE. TLRMC'S VISION IS TO BE RECOGNIZED BY THE PEOPLE WE SERVE AS THE PROVIDER OF CHOICE FOR THEIR HEALTH CARE NEEDS AND AS A LEADING FORCE FOR PROGRESSIVE CHANGE WITHIN OUR COMMUNITY. TO ENHANCE QUALITY, THE HOSPITAL ACTIVELY OPERATES A PERFORMANCE IMPROVEMENT PROGRAM WHICH HELPS IDENTIFY BETTER PATIENT CARE AS WELL AS EFFICIENCIES IN OPERATIONS. TO ENHANCE OUR COMMUNITY, TLRMC PROVES TO BE A DRIVING FORCE IN CHANGE BY EDUCATING THE COMMUNITY ON HEALTH & WELLNESS ISSUES AND BY RECOGNIZING COMMUNITY NEEDS AND WORKING TO FULFILL THOSE NEEDS. THE HOSPITAL CARED FOR 2,138 INPATIENTS AND 93,186 OUTPATIENTS. TO ASSIST THOSE PATIENTS WITH LIMITED RESOURCES, TLRMC ALSO OFFERS A PATIENT FINANCIAL ASSISTANCE PROGRAM. THERE ARE SEVERAL OPTIONS FOR PATIENTS WHO ARE UNINSURED OR UNDERINSURED, AND TLRMC'S PATIENT FINANCIAL SERVICES DEPARTMENT EDUCATES THE PATIENTS OF THE DIFFERENT PROGRAMS. BASED ON THE RESULTS OF OUR LATEST COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), TWIN LAKES REGIONAL MEDICAL CENTER CREATED THE POPULATION HEALTH COMMITTEE. THIS GROUP IS MADE UP OF HOSPITAL EMPLOYEES AND REPRESENTATIVES FROM THE LOCAL HEALTH DEPARTMENT, SCHOOL SYSTEM, LOCAL FACTORIES, EXTENSION SERVICE LEADERS, GOVERNMENT OFFICIALS AND OTHERS. THE COMMITTEE MEETS MONTHLY AT THE HOSPITAL AND LED THE EFFORT TO GET A SMOKE FREE COMMUNITY ORDINANCE PASSED. THE GROUP IS NOW WORKING ON MAKING POSITIVE DIFFERENCES IN THE HEALTH OF OUR COMMUNITY IN SUCH TOPICS AS DIABETES, EXERCISE, NUTRITION AND GENERAL HEALTH. THE HOSPITAL PARTNERED WITH THE UNIVERSITY OF KENTUCKY COOPERATIVE EXTENSION SERVICE AND HOSTED A LOCAL FARMER'S MARKET ON THE HOSPITAL CAMPUS. TIME AND SOME ADVERTISING BUDGET WERE GIVEN TO PROMOTING THIS EFFORT TO SUPPORT LOCAL FARMERS AND TO MAKE FRESH VEGETABLES MORE READILY AVAILABLE TO THE COMMUNITY. THE HOSPITAL PROVIDED FREE MEETING SPACE TO SEVERAL GROUPS THROUGHOUT THE YEAR AND SEVERAL CLASSES WERE SPONSORED BY THE HOSPITAL THAT EDUCATED INTERESTED COMMUNITY RESIDENTS ON HEALTH & WELLNESS ISSUES. THEY INCLUDE: A. C.P.R. TO HEALTHCARE PROVIDERS AND TO THE COMMUNITY B. PREPARED CHILDBIRTH AND BREAST FEEDING CLASSES C. COUNTY-WIDE BABY SHOWER IN GRAYSON COUNTY - PROVIDES INFORMATION TO WOMEN WHO ARE PREGNANT OR WANT TO BECOME PREGNANT D. COMMUNITY-WIDE BABY SHOWER IN BRECKINRIDGE COUNTY - PROVIDES INFORMATION TO WOMEN WHO ARE PREGNANT OR WANT TO BECOME PREGNANT E. SPONSORS THE AMERICAN RED CROSS BLOOD MOBILE TWO OR THREE TIMES EACH YEAR F. PROVIDED HEALTH INFORMATION AT THE RELAY FOR LIFE G. PARTICIPATED IN UNITED WAY MEETNGS UPON REQUEST, THE HOSPITAL ALSO PARTICIPATES IN LOCAL EDUCATION BY PROVIDING HOSPITAL EMPLOYEES AS SPEAKERS FOR CLASSROOMS OR CIVIC ORGANIZATIONS SUCH AS THE FOLLOWING EXAMPLES: H. PARTICIPATED IN OPERATION PREPARATION I. WRECC SAFETY DAY J. HEALTH ADVISORY MEETINGS FOR THE HEAD START PROGRAM K. ASSISTED IN PROVIDING TRANSLATION SERVICES L. PARTICIPATED IN PLASTIKON HEALTH FAIR M. PARTICIPATED IN WORK DAY DEMO AT CLARKSON ELEMENTARY SCHOOL N. PROVIDED SPEAKERS FOR MANY HEALTH FAIRS, SCHOOLS, AND COMMUNITY EVENTS O. NARCAN EDUCATION FOR LEITCHFIELD CITY POLICE AND GRAYSON COUNTY SHERIFF DEPARTMENTS IN ADDITION TO SERVING OUR LOCAL COMMUNITY NEEDS, TLRMC HAS ALSO TAKEN ON MEASURES TO IMPROVE AMERICA. BY PARTICIPATING IN THE CODE GREEN - RECYCLING PROJECT, TLRMC HOPES TO REDUCE WASTE AND IMPROVE THE ENVIRONMENT. TWIN LAKES REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS HAS PLEDGED TO BUY AMERICAN-MADE PRODUCTS WHEN WE CAN FIND A PRODUCT OF EQUAL OR GREATER QUALITY. TLRMC ENCOURAGES OTHER COMPANIES AND INDIVIDUALS TO DO THE SAME. |
| FORM 990, PAGE 6, PART VI, LINE 3 | THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL ARE EMPLOYED BY ALLIANT MANAGEMENT SERVICES AND ARE RESPONSIBLE FOR CONTROLLING MANAGEMENT DUTIES. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS STOCKHOLDERS. EACH SHARE OF STOCK IS VALUED AT 25. STOCKHOLDERS MUST BE AT LEAST 18 YEARS OLD AND A RESIDENT OF GRAYSON COUNTY, KENTUCKY. |
| FORM 990, PAGE 6, PART VI, LINE 7A | NINE MEMBERS OF THE BOARD OF DIRECTORS ARE ELECTED BY THE STOCKHOLDERS AND THE OTHER MEMBER IS THE PRESIDENT OF THE MEDICAL STAFF (WHOM IS VOTED ON BY THE MEDICAL STAFF). |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS SUBMITTED TO THE GOVERNING BOARD FOR REVIEW AND APPROVAL BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CORPORATE COMPLIANCE REQUIRES EACH EMPLOYEE AND BOARD MEMBER TO UPDATE AND SIGN OFF ON A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | ALLIANT MANAGEMENT SERVICES, ACTING AS THE MANAGEMENT COMPANY, BRINGS COMPARABLE NATIONAL DATA TO THE BOARD OF DIRECTORS FOR THE BOARD TO DETERMINE WHAT COMPENSATION IS TO BE PAID. |
| FORM 990, PAGE 6, PART VI, LINE 15B | ALLIANT MANAGEMENT SERVICES, ACTING AS THE MANAGEMENT COMPANY, BRINGS COMPARABLE NATIONAL DATA TO THE BOARD OF DIRECTORS FOR THE BOARD TO DETERMINE WHAT COMPENSATION IS TO BE PAID. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 24E | MATERIALS MANAGEMENT 1,000,004 0 0 MEDICAL & SURGICAL 942,450 0 0 PHYSICAL THERAPY 713,629 0 0 SURGERY 705,299 0 0 WOUND CARE 414,009 0 0 EMERGENCY ROOM 383,942 0 0 RADIOLOGY 317,836 0 0 NUCLEAR MEDICINE 145,522 0 0 PAIN MANAGEMENT 144,485 0 0 SLEEP CENTER 135,967 0 0 MRI 127,082 0 0 RESPIRATORY THERAPY 109,378 0 0 OBSTETRICS 83,570 0 0 CT SCANS 75,156 0 0 INTENSIVE CARE 66,384 0 0 ANESTHESIOLOGY 59,984 0 0 PROVIDER BASED CLINICS 22,299 0 0 INFUSION CENTER 21,089 0 0 SPECIALTY CLINIC 21,032 0 0 CARDIAC 17,677 0 0 USE OF DONATED ITEMS 9,904 0 0 OCCUPATIONAL THERAPY 511 0 0 TOTAL 5,517,209 0 0 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN LAKES MEDICAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611269278 | EIN |
| Primary Activities | MEDICAL PR | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 10 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GCHF | BusinessNameLine1Txt |
| Business Name Line2 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TWIN LAKES HOME HEALTH AGENCY LLC | |||||||||||||
| 901 S HUGH WALLIS ROAD | LAFAYETTE | LA | 70508 | 271000828 | HOME HEALT | LA | N/A | RELATED | $45,567 | $95,182 | false | false | 0.25000 |
| TWIN LAKES REGIONAL PAIN MANAGEMENT | |||||||||||||
| 908 WALLACE AVE | LEITCHFIELD | KY | 42754 | 472329929 | PAIN MANAG | KY | N/A | RELATED | $83,534 | $113,036 | false | false | 0.51000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WTK HOLDINGS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 WALLACE AVE | AddressLine1Txt |
| City | LEITCHFIELD | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42754 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610608823 | EIN |
| Primary Activities | HOLDING CO | PrimaryActivitiesTxt |
| Legal Domicile State | KY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GCHF | BusinessNameLine1Txt |
| Business Name Line2 | GRAYSON COUNTY HOSPITAL FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Share Of Total Income | $44,879 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,745,654 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| D | $3,437,791 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| J | $268,719 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| L | $165,705 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| O | $21,749 | FAIR MARKET VALUE |
| TWIN LAKES MEDICAL FOUNDATION INC | ||
| Q | $3,176,520 | FAIR MARKET VALUE |
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