KNOX COMMUNITY HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- KNOX COMMUNITY HOSPITAL (EIN 31-0929576)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201703179349306355
- Schema version
- 2016v3.0
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-13T14:53:23-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 Lyra Drive Suite 450 | AddressLine1Txt |
| City | Columbus | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310929576 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Knox Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KNOX | BusinessNameControlTxt |
| Phone | 7403939623 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1330 Coshocton Road | AddressLine1Txt |
| City | Mount Vernon | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43050 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Bruce White | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7403939623 | PhoneNum |
| Signature | 2017-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Matthew Dasta | PreparerPersonNm |
| PTIN | P00544683 | PTIN |
| Phone | 6148852583 | PhoneNum |
| Preparation | 2017-11-01 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.109.186.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-01 | IPDt |
| IP Tm | 11:54:15 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | CBCE996F475CA3740CE88356C52AB1B9FF3D8150 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Bruce D White | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1330 Coshocton Road | AddressLine1Txt |
| City | Mount Vernon | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43050 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $164,197,216 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KNOXCOMMHOSP.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE COMPASSIONATE HEALTHCARE SERVICE THAT EXCEEDS THE EXPECTATIONS OF OUR COMMUNITY | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 1145 | TotalEmployeeCnt |
| Total Volunteers | 101 | TotalVolunteersCnt |
| Total Gross UBI | $32,831 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $1,106 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,297 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,719,051 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $148,492,782 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $157,763,114 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,208,342 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,280,596 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,739,306 | PYOtherRevenueAmt |
| CY Other Revenue | $3,215,637 | CYOtherRevenueAmt |
| PY Total Revenue | $153,446,727 | PYTotalRevenueAmt |
| CY Total Revenue | $163,978,398 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $12,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $16,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $73,970,343 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $81,095,074 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $67,480 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $63,433,346 | PYOtherExpensesAmt |
| CY Other Expenses | $67,023,418 | CYOtherExpensesAmt |
| PY Total Expenses | $137,415,689 | PYTotalExpensesAmt |
| CY Total Expenses | $148,134,492 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $16,031,038 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $15,843,906 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $149,198,877 | TotalAssetsBOYAmt |
| Total Assets EOY | $164,565,014 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $46,118,788 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $44,402,704 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $103,080,089 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $120,162,310 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of Knox Community Hospital is to provide compassionate healthcare service that exceeds the expectations of our community. As the only hospital in Knox County, we offer a wide spectrum of healthcare services to every person who needs us, regardless of their ability to pay. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $115,354,899 | ExpenseAmt |
| Grant | $16,000 | GrantAmt |
| Revenue | $160,506,127 | RevenueAmt |
| Desc | OUR ASSISTANCE TO OUR COMMUNITY GOES BEYOND OFFERING PRIMARY SERVICES AND IMPACTS OUR COMMUNITY'S HEALTH AND QUALITY OF LIFE. KNOX COMMUNITY HOSPITAL IS AN ACUTE CARE HOSPITAL SERVING KNOX COUNTY IN OHIO AND SURROUNDING AREAS. THE HOSPITAL OFFERS A WIDE SPECTRUM OF HEALTHCARE SERVICES INCLUDING: INPATIENT AND OUTPATIENT HEALTH CARE. FOR 2016 THE HOSPITAL HAD 3,166 INPATIENT ADMISSIONS, 26,392 ER VISITS, 150,443 OUTPATIENT VISITS, 84,466 RADIOLOGY PROCEDURES, AND 6,786 INPATIENT & OUTPATIENT SURGERIES (INCLUDING ENDOSCOPIES). AT THE END OF 2016, THE HOSPITAL HAD 43 EMPLOYED PHYSICIANS WITH 104,473 OFFICE CLINIC VISITS. KNOX COMMUNITY HOSPITAL PROVIDED $700,108 FINANCIAL ASSISTANCE AT COST IN 2016 AND THE HOSPITAL'S UNREIMBURSED MEDICAID COSTS WERE $5,017,422. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ADDITIONAL COMMUNITY BENEFITS AND COMMUNITY BUILDING ACTIVITIES AT COST TOTALED $1,110,337 FOR 2016. IN 2016, KNOX COMMUNITY HOSPITAL PROVIDED BIRTHING CENTER EDUCATION TO 207 PERSONS AND PRESENTED A VARIETY OF EDUCATION EVENTS ATTENDED BY MEMBERS OF OUR COMMUNITY. FREE MONTHLY SCREENINGS CONTINUED AT NO COST AND WERE UTILIZED AS FOLLOWS:890 BLOOD PRESSURE CHECKS, CHOLESTEROL SCREENINGS AND GLUCOSE SCREENINGS. 600 COLORECTAL CANCER SCREENING KITS WERE DISTRIBUTED WITH 247 KITS RETURNED FOR PROCESSING. WE CONTINUE TO OFFER SUPPORT GROUPS FOR PARKINSON'S DISEASE, BREAST CANCER, YOUNG BREAST CANCER SURVIVORS, CANCER AND DIABETES. THE EDUCATION DEPARTMENT AT KCH TRAINED 42 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NON-CLINICAL PERSONS TO BECOME TRAINERS IN COMMUNITY LED CPR, AED AND FIRST AID CLASSES. ADVANCE DIRECTIVE/LIVING WILL ASSISTANCE AND FREE NOTARY SERVICE WAS PROVIDED TO 204 PEOPLE. PHYSICIANS AND CLINICAL STAFF MEMBERS PARTICIPATE IN A LOCAL, MONTHLY RADIO CALL IN SHOW. SIX KCH EMPLOYEES, CERTIFIED APPLICATION COUNSELORS, HELPED COMMUNITY MEMBERS NAVIGATE AND APPLY FOR INSURANCE ON THE AHA HEALTHCARE MARKETPLACE WEBSITE.AS PARTNERS WITH AREA NURSING SCHOOLS, WE PROVIDED CLINICAL SUPERVISION AND PRECEPTING TO STUDENTS FOR OVER 24,242 HOURS. A QUARTERLY HEALTH EDUCATION PUBLICATION CONTINUED TO PROVIDE HEALTH INFORMATION TO ALL 26,000 HOMES IN KNOX COUNTY. THIS PUBLICATION ALSO PROVIDED A CALENDAR OF COMMUNITY HEALTH EDUCATION EVENTS AND FREE SCREENINGS. THE BREAST HEALTH NAVIGATOR AT KCH APPLIED FOR AND RECEIVED FUNDS FROM THE SUSAN G. KOMEN FOUNDATION TO PROVIDE SCREENING MAMMOGRAMS AND FOLLOW UP CARE AS NEEDED FOR WOMEN WHO ARE UNINSURED OR UNDERINSURED. KCH PROVIDES THE COMMUNITY AT LARGE WITH THE SERVICES OF BOTH A BREAST HEALTH NAVIGATOR AND A PATIENT NAVIGATOR AT NO CHARGE.THE ESTIMATED PREVALENCE OF DIABETES AMONG KNOX COUNTY ADULT RESIDENTS IS STEADY AT 6.5 PERCENT. KNOX COMMUNITY HOSPITAL RECOGNIZES THE NEED FOR EDUCATION AND SCREENINGS TO SERVE THIS POPULATION. IN 2016 WE OFFERED WELL-PUBLICIZED FREE MONTHLY GLUCOSE SCREENINGS. ANOTHER PROGRAM THAT HAS CONTINUED WAS A "GROCERY TOUR" HOSTED BY OUR DIABETES EDUCATION COORDINATOR. COLLABORATING WITH AN AREA GROCERY STORE, THE COMMUNITY TAKES A TOUR THAT EXAMINES FOOD PACKAGE LABELING AND INFORMATION. SUPPORT IS OFFERED TO ASSIST IN MAKING GOOD FOOD CHOICES FOR THOSE WITH DIABETES. WE CONTINUED THE "PREDIABETES 101," A PROGRAM TO PROVIDE PRACTICAL WAYS TO PREVENT THE DIAGNOSIS OF DIABETES. COMMUNITY MEMBERS UTILIZE THE HOSPITAL AS A VEHICLE TO CONNECT WITH AND CONTRIBUTE TO THE OVERALL WELL-BEING OF THE COMMUNITY THROUGH PHILANTHROPY AND VOLUNTEERING. A VOLUNTEER FORCE OF 101 CONTRIBUTED 15,293 HOURS IN 2016. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $115,354,899 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 177 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1145 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Ambrosiani | PersonNm |
| Phone | 7403939623 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1330 COSHOCTON RD | AddressLine1Txt |
| City | Mt Vernon | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43050 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Christopher Hetrick | ||||||||
| Trustee | 40.00 | Yes (X) | $643,863 | $0 | $45,667 | |||
| Joan Jones | ||||||||
| Trustee | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Joe Street | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Thomas R FOSNAUGHT | ||||||||
| Treasurer | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| thomas d mckinley md | ||||||||
| truSTEE | 40.00 | Yes (X) | $383,961 | $0 | $45,270 | |||
| GORDON YANCE | ||||||||
| truSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Patrick McLarnan | ||||||||
| Vice President | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Korey Kidwell | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| JEFFERY BOUCHER | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Juan De Pascuale | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Inge Krajenksi | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Charles Brenneman | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Ann Schnormeier | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| AMY D MURNEN MD | ||||||||
| TRUSTEE | 40.00 | Yes (X) | $219,735 | $0 | $26,571 | |||
| IAN WATSON | ||||||||
| President | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BRUCE WHITE | ||||||||
| CEO | 40.00 | $327,980 | $0 | $75,264 | Yes (X) | |||
| MICHAEL AMBROSIANI | ||||||||
| CFO | 40.00 | $218,531 | $0 | $49,588 | Yes (X) | |||
| BRUCE BEHNER | ||||||||
| COO | 40.00 | $218,531 | $0 | $49,518 | Yes (X) | |||
| jeffrey c northup CMO | ||||||||
| chief medical officer | 40.00 | $328,303 | $0 | $16,795 | Yes (X) | |||
| HYDI F LAIDLAW-SMITH | ||||||||
| GENERAL SURGEON | 40.00 | $728,100 | $0 | $45,090 | Yes (X) | |||
| GREGORY CUSH | ||||||||
| Orthopaedic Surgeon | 40.00 | $1,099,900 | $0 | $44,127 | Yes (X) | |||
| Kenneth H Doolittle II | ||||||||
| Orthopaedic Surgeon | 40.00 | $1,039,499 | $0 | $45,090 | Yes (X) | |||
| Michael D Heuman | ||||||||
| General Surgeon | 40.00 | $781,137 | $0 | $45,090 | Yes (X) | |||
| Jarrett B Helming | ||||||||
| Orthopaedic Surgeon | 40.00 | $705,567 | $0 | $40,373 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,695,107 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $528,443 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 73 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ohio state university-cambridge health | |||||
| 700 Ackerman Road Suite 630 | Columbus | OH | 43202 | ON-CALL, QUALITY IMPROVEMENT & Prof Serv | $2,314,644 |
| QUORUM HEALTH RESOURCES LLC | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370271018 | HOSPITAL MANAGEMENT SERVICES | $1,489,640 |
| Origin Inc - Shiftwise | |||||
| PO Box 70870 | St Paul | MN | 551709705 | STAFFING AGENCY | $1,282,201 |
| Premier Urology Corp | |||||
| PO BOX 677 | Lewis Center | OH | 43035 | UROLOGY SERVICES | $1,148,495 |
| Allscripts LLC | |||||
| 24630 Network Place | Chicago | IL | 606731246 | PRACTICE MGMT & ELECTRONIC RECORD TECH | $867,656 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 43 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,719,051 | RelatedOrganizationsAmt |
| Total Contributions | $1,719,051 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient Service Revenu | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $157,763,114 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $157,763,114 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $157,763,114 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,026,847 | TotalRevenueColumnAmt |
| Exclusion | $1,026,847 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,272 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,272 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,272 | TotalRevenueColumnAmt |
| Exclusion | $13,272 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $472,567 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $218,818 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $253,749 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $253,749 | TotalRevenueColumnAmt |
| Exclusion | $253,749 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| MISCELLANEOUS | 900099 | $1,327,423 | $1,294,592 | $32,831 | |
| pharmacy | 900099 | $949,050 | $949,050 | ||
| FOOD & NUTRITION | 900099 | $426,521 | $426,521 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $499,371 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $499,371 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,202,365 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $163,978,398 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $160,506,127 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $32,831 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,720,389 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,000 | TotalAmt |
| Program Services | $16,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,340,904 | TotalAmt |
| Program Services | $1,247,559 | ProgramServicesAmt |
| Management And General | $1,093,345 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,221,109 | TotalAmt |
| Program Services | $46,647,687 | ProgramServicesAmt |
| Management And General | $12,511,860 | ManagementAndGeneralAmt |
| Fundraising | $61,562 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,190,627 | TotalAmt |
| Program Services | $927,498 | ProgramServicesAmt |
| Management And General | $263,129 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,750,093 | TotalAmt |
| Program Services | $11,478,432 | ProgramServicesAmt |
| Management And General | $3,271,661 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,592,341 | TotalAmt |
| Program Services | $2,810,324 | ProgramServicesAmt |
| Management And General | $782,017 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,417 | TotalAmt |
| Program Services | $41,199 | ProgramServicesAmt |
| Management And General | $55,218 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,364,267 | TotalAmt |
| Program Services | $11,882,368 | ProgramServicesAmt |
| Management And General | $5,476,690 | ManagementAndGeneralAmt |
| Fundraising | $5,209 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,239 | TotalAmt |
| Management And General | $85,239 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,549,001 | TotalAmt |
| Program Services | $1,420,279 | ProgramServicesAmt |
| Management And General | $128,567 | ManagementAndGeneralAmt |
| Fundraising | $155 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,037,085 | TotalAmt |
| Program Services | $145,476 | ProgramServicesAmt |
| Management And General | $2,891,609 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,208 | TotalAmt |
| Program Services | $172,294 | ProgramServicesAmt |
| Management And General | $194,914 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,653,031 | TotalAmt |
| Management And General | $1,653,031 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,852,543 | TotalAmt |
| Program Services | $2,810,976 | ProgramServicesAmt |
| Management And General | $3,041,567 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,086,645 | TotalAmt |
| Program Services | $161,475 | ProgramServicesAmt |
| Management And General | $925,170 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies and Drugs | $21,736,052 | $21,736,052 | ||
| bad debt | $8,233,487 | $8,233,487 | ||
| Medical Professional Fe | $4,489,607 | $4,489,607 | ||
| MISCELLANEOUS | $692,018 | $575,205 | $116,259 | $554 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $780,818 | TotalAmt |
| Program Services | $558,981 | ProgramServicesAmt |
| Management And General | $221,837 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,134,492 | TotalAmt |
| Program Services | $115,354,899 | ProgramServicesAmt |
| Management And General | $32,712,113 | ManagementAndGeneralAmt |
| Fundraising | $67,480 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,850 | BOYAmt |
| EOY | $4,600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,719,624 | BOYAmt |
| EOY | $20,234,867 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,399,416 | BOYAmt |
| EOY | $19,299,875 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,532,098 | BOYAmt |
| EOY | $1,644,626 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,411,186 | BOYAmt |
| EOY | $2,594,280 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $115,430,624 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $67,353,593 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,378,245 | BOYAmt |
| EOY | $48,077,031 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,147,044 | BOYAmt |
| EOY | $66,497,368 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,606,414 | BOYAmt |
| EOY | $6,212,367 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,198,877 | BOYAmt |
| EOY | $164,565,014 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,871,560 | BOYAmt |
| EOY | $11,652,142 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,467,633 | BOYAmt |
| EOY | $31,980,254 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $779,595 | BOYAmt |
| EOY | $770,308 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,118,788 | BOYAmt |
| EOY | $44,402,704 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,925,922 | BOYAmt |
| EOY | $119,353,859 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,154,167 | BOYAmt |
| EOY | $808,451 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,080,089 | BOYAmt |
| EOY | $120,162,310 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,198,877 | BOYAmt |
| EOY | $164,565,014 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $15,843,906 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,492,803 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$254,488 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,616 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,616 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Ohio Hospital Association and the American Hospital Association dues were allocated towards lobbying expenses equaling $2,616 in total. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,154,167 | BeginningYearBalanceAmt |
| Contributions | $100,926 | ContributionsAmt |
| Other Expenditures | $446,642 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $808,451 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $222,929 | BeginningYearBalanceAmt |
| Contributions | $86,764 | ContributionsAmt |
| Investment Earnings Or Losses | $911,462 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $66,988 | OtherExpendituresAmt |
| End Year Balance | $1,154,167 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $140,189 | BeginningYearBalanceAmt |
| Contributions | $134,437 | ContributionsAmt |
| Other Expenditures | $51,697 | OtherExpendituresAmt |
| End Year Balance | $222,929 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $131,355 | BeginningYearBalanceAmt |
| Contributions | $53,949 | ContributionsAmt |
| Other Expenditures | $45,115 | OtherExpendituresAmt |
| End Year Balance | $140,189 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $71,099 | BeginningYearBalanceAmt |
| Contributions | $142,821 | ContributionsAmt |
| Other Expenditures | $82,565 | OtherExpendituresAmt |
| End Year Balance | $131,355 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $572,605 | OtherCostOrOtherBasisAmt |
| Book Value | $572,605 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,249,657 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,547,720 | DepreciationAmt |
| Book Value | $25,701,937 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $767,511 | OtherCostOrOtherBasisAmt |
| Depreciation | $668,304 | DepreciationAmt |
| Book Value | $99,207 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $66,272,359 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,137,569 | DepreciationAmt |
| Book Value | $19,134,790 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,568,492 | OtherCostOrOtherBasisAmt |
| Book Value | $2,568,492 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $48,077,031 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| LEASEHOLD DEPOSITS | $721,623 |
| related party payable | $48,685 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $770,308 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The hospital's restricted funds are used for minor expenses relating to care for indigent patients and Komen and HRSA grant funds used for the Hospital. |
| Part X, Line 2: | FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 SUPERSEDED BY ASC 740-10: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN 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 THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2016 AND 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,931,730 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,231,622 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $700,108 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00470 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,401,381 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,383,959 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,017,422 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03390 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,333,111 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,615,581 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,717,530 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03860 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 110236 | PersonsServedCnt |
| Total Community Benefit Expns | $343,565 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,821 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $338,744 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1289 | PersonsServedCnt |
| Total Community Benefit Expns | $640,153 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,484 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $638,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $89,111 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $89,111 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 677 | PersonsServedCnt |
| Total Community Benefit Expns | $43,813 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $43,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 112202 | PersonsServedCnt |
| Total Community Benefit Expns | $1,116,642 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,305 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,110,337 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 112202 | PersonsServedCnt |
| Total Community Benefit Expns | $26,449,753 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,621,886 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,827,867 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04610 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,925 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,828 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,828 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 20 | PersonsServedCnt |
| Total Community Benefit Expns | $5,484 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,484 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 20 | PersonsServedCnt |
| Total Community Benefit Expns | $29,237 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,237 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $8,233,487 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $32,413,192 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $35,373,270 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,960,078 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 KNOX DIAGNOSTIC IMAGING LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MEDICAL SERVICES/ECHOCARDIOLOGY SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.50000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 0.02330 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.35620 | PhysiciansProfitOrOwnershipPct |
| 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 | KNOX COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1330 COSHOCTON RD | AddressLine1Txt |
| City | MOUNT VERNON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43050 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.knoxcommhosp.org | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DSH Hospital; Sole Community Hospital | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KNOX COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.kch.org/resources/HEALTH-NEEDS-ASSESSMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.kch.org/resources/HEALTH-NEEDS-ASSESSMENT | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | 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 (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.kch.org/resources/financial-assistance-application | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| KNOX COMMUNITY HOSPITAL | Part V, Section B, Line 5: We solicited comments about the existing CHNA report from a group of individuals selected to represent each of the unique population groups as delineated in the regulations. This resulted in sixteen written comments that were taken into consideration during this process.We deployed a CHNA "Round 1" survey to our Local Expert Advisors to gain input on local health needs and the needs of priority populations. Local Expert Advisors were local individuals selected according to criteria required by the Federal guidelines and regulations and the hospital's desire to represent the region's geographically- and ethnically-diverse population. We received community input from 18 Local Expert Advisors.Information analysis augmented by local opinions showed how Knox County relates to its peers in terms of primary and chronic needs and other issues of uninsured persons, low-income persons, and minority groups. Respondents commented on whether they believe certain population groups ("Priority Populations") need help to improve their condition, and if so, who needs to do what to improve the conditions of these groups.When the analysis was complete, we put the information and summary conclusions before our Local Expert Advisors who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional comments of need, and new needs did emerge from this exchange. Having taken steps to identify potential community needs, the Local Experts then participated in a structured communication technique called a "Wisdom of Crowds" method. The premise of this approach relies on a panel of experts with the assumption that the collective wisdom of participants is superior to the opinion of any one individual, regardless of their professional credentials.In the hospital process, each Local Expert had the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. While there were a few opinions of the data conclusions not being completely accurate, the vast majority of comments agreed with our findings. We developed a summary of all needs identified by any of the analyzed data sets. The Local Experts then allocated 100 points among the potential significant need candidates, including the opportunity to again present additional needs that were not identified from the data. A rank order of priorities emerged, with some needs receiving none or virtually no support, and other needs receiving identical point allocations.We dichotomized the rank order of prioritized needs into two groups: "Significant and "Other Identified Needs." Our criteria for identifying and prioritizing Significant Needs was based on a descending frequency rank order of the needs based on total points cast by the Local Experts, further ranked by a descending frequency count of the number of local experts casting any points for the need. By ourdefinition, a Significant Need had to include all rank ordered needs until at least fifty percent (50%) of all points were included and to the extent possible, represented points allocated by a majority of voting local experts. The determination of the break point "Significant" as opposed to "Other" was a qualitative interpretation by QHR and the KCH executive team where a reasonable break point in rank order occurred. |
| Schedule H, Part V, Section B, Line 11 | SIGNIFICANT NEEDS:1. CARDIOVASCULAR HEALTH 2012 SIGNIFICANT NEED; 2015 UNFAVORABLE COMPARED TO PEERS, HIGHER MORTALITY THAN AVERAGE, #1 CAUSE OF DEATH, HEART FAILURE 15% ABOVE AVERAGE2. CANCER 2012 SIGNIFICANT NEED; 2015 #2 CAUSE OF DEATH AND HIGHER THAN EXPECTED, PAP/CERVIX TEST BELOW AVERAGE, BREAST AND COLON RATES UNFAVORABLE COMPARED TO PEERS AND LUNG SOMEWHAT A CONCERN.KCH DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION STRATEGY FOR SIGNIFICANT NEEDS 1 AND 2:WE ARE CHOOSING NOT TO RESPOND TO CARDIOVASCULAR HEALTH AND CANCER AT THIS TIME, ESSENTIALLY BECAUSE THEY ARE CORE ELEMENTS OF OUR OVERALL ORGANIZATIONAL BUSINESS AND STRATEGIC PLANNING. WE'RE NOT ANTICIPATING ANY NEW PROJECTS OR INITIATIVES IN EITHER AREA, AND WE BELIEVE WE ARE ALREADY PROVIDE OUTSTANDING HEALTHCARE SERVICES IN THESE AREAS. WE FEEL WE CAN HAVE A GREATER IMPACT BY PUTTING NEW ATTENTION AND DOLLARS TOWARD THE FOLLOWING OTHER NEEDS.3. DIABETES 2012 SIGNIFICANT NEED; 2015 #6 CAUSE OF DEATH AND HIGHER THAN EXPECTEDKCH HAS ESTABLISHED A PATIENT-CENTERED MEDICAL HOME TO CARE FOR PATIENTS WITH CHRONIC DISEASES INCLUDING DIABETES. *IMPLEMENTING COMMUNITY HEALTH COACHES IN CHRONIC DISEASE MANAGEMENT IN COOPERATION WITH 2 LOCAL UNIVERSITY STUDENTS TO BEGIN IN 2017. *IMPLEMENTING TRANSITIONAL CARE AND CHRONIC CARE MANAGEMENT SERVICES TO BEGIN IN 2017.*DR. JAIME GOODMAN, ENDOCRINOLOGIST - HIRED MARCH 2015.*RN DIABETES EDUCATOR BECAME CERTIFIED AND IS SEEING PATIENTS. *INCREASED FREE SCREENING EVENTS.*PROVIDED FREE EDUCATION THROUGH PUBLIC SCHOOL HEALTH CLASSES ABOUT DIABETES RISK AND PREVENTION.*INCREASED ATTENDANCE AT LIVING WITH DIABETES - DIABETES SELF-MANAGEMENT EDUCATION CLASSES.*PROVIDED COMMUNITY EDUCATION AND INFORMATION VIA LOCAL RADIO OUTLETS THROUGH PUBLIC SERVICE ANNOUNCEMENTS AND MONTHLY RADIO PROGRAMS.4. OBESITY DEATHS ABOVE OH AND US AVG.; MORBID/OBESE 9% ABOVE AVG. IMPACTS 33% OF POP.; HEALTHY EATING HABITS 6% BELOW AVG. IMPACTS 28% OF POP.*RE-DESIGNING AND EXPANDING PATHWAY TO CHANGE WEIGHT MANAGEMENT PROGRAM TO INCREASE ENROLMENT BY EXPANDING PATIENTS' WELLNESS GOALS ON MULTIPLE LEVELS. *ESTABLISHED A DIETICIAN LED GROCERY STORE TOUR HELD MULTIPLE TIMES THROUGHOUT THE YEAR.*BEGAN PLANNING FOR A MEDICAL AND SURGICAL OBESITY MANAGEMENT SERVICE LINE TO BEGIN IN 2017.*DIETICIANS AND KCH FOOD SERVICE DIRECTOR NOW PROVIDE HEALTHY OPTIONS IN THE CAFETERIA.*PROVIDING COMMUNITY EDUCATION AND INFORMATION RELATED TO NUTRITION AND HEALTHY DIETS ON MULTIPLE MEDIA OUTLETS.5. MATERNAL AND INFANT CARE 2012 SIGNIFICANT NEED; 2015 BIRTHS TO OLDER WOMEN AND NO CARE IN FIRST TRIMESTER UNFAVORABLE COMPARED TO PEERS, VERY LOW BIRTH WEIGHT SOMEWHAT A CONCERN, OTHER METRICS FAVORABLE, VISITING OB/GYN 7% BELOW AVERAGE.*COLLABORATING WITH OTHER COMMUNITY ORGANIZATIONS TO STRATIFY THE POPULATION TO IDENTIFY SPECIFIC NEEDS OF TARGETED POPULATIONS.*INCREASED NUMBER OF KCH BIRTHING CENTER RNS CERTIFIED IN EXTERNAL FETAL MONITORING*HIRED THIRD OB/GYN AND NURSE MIDWIFE.*BEGAN RECRUITMENT FOR 2 PEDIATRICIANS.*BEGAN PLANS TO BUILD A NEW STATE OF THE ART BIRTHING CENTER. |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | A cost-to-charge ratio methodology was used to calculate the amounts reported in the table for Part 1, Line 7. The cost-to-charge ratio was derived from Worksheet 2 of the 2016 IRS Instructions for Schedule H. |
| Part III, Line 4: | FINANCIAL STATEMENT FOOTNOTE "ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS": ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE HOSPITAL'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 92% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2016 AND 83% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2015. IN ADDITION, THE HOSPITAL'S PROVISION FOR BAD DEBTS INCREASED APPROXIMATELY $121,487 FROM $8,112,000 FOR FISCAL YEAR 2015 TO $8,233,487 FOR FISCAL YEAR 2016. THE INCREASE IN THE PROVISION IS THE RESULT OF AN INCREASE IN SELF-PAY RESPONSIBILITY. THE HOSPITAL HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2016 AND 2015.THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD PARTY PAYORS RELATING TO DOUBTFUL ACCOUNTS.COSTING METHODOLOGY:A COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 OF THE 2016 IRS INSTRUCTIONS FOR SCHEDULE H AS A COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART III, LINE 2 AND LINE 3 FOR THE ORGANIZATION'S BAD DEBT EXPENSE AT COST.KNOX COMMUNITY HOSPITAL PROVIDES DETAILED INFORMATION ABOUT THE POVERTY GUIDELINES ON POSTED SIGNS THROUGHOUT THE FACILITY AS WELL AS THE HOSPITAL WEBSITE. THE HOSPITAL REGISTRARS ALSO EDUCATE ALL PATIENTS THAT ARE SELF-PAY OR EXPRESS A NEED FOR FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| Part III, Line 8: | MEDICARE IS THE LARGEST PAYOR OF KNOX COMMUNITY HOSPITAL AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SUCH SERVICES. IF THE MEDICARE PARTICIPATION IS PREMISED ON THIS FACT, THEN PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE AVAILABILITY, WHICH IS A COMMUNITY BENEFIT. ALONG THE SAME LINES, THE IRS REVENUE RULING 69-545 ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS. ACCORDING TO THIS RULING, IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN IT IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS ALSO IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. |
| Part III, Line 9b: | Knox Community Hospital has the same collection policy and procedures that apply equally to all patients, both charity care and non-charity care patients. If a patient qualifies for charity care or financial assistance, the procedures outlined in the Charity Care Policy and Financial Assistance Policy will be followed. The Debt Collection Policy does not apply to patients qualifying for charity care or financial assistance. |
| Part VI, Line 2: | In 2015, Knox Community Hospital completed a Community Health Needs Assessment. As in the past, KCH worked with a number of health partners and agencies to develop this assessment. We solicited and received written comments from a number of local experts and community leaders. Through this process, KCH identified several significant community health needs, evaluated the impact of our actions taken since our most recent CHNA (2012) where applicable, and developed strategic implementation plans for addressing the needs over the next three years. Knox Community Hospital used a comprehensive approach to develop the Community Health Needs Assessment. Input was solicited and received from public health experts, other departments or agencies, priority populations, chronic disease groups, and others with the broad interest of the community in mind. We performed several independent data analyses, based on secondary source data, and augmented this with local survey data and resolved any data inconsistency or discrepancies from the combined opinions formed from local experts.Preliminary conclusions were presented to a local group of experts, who were asked to validate prior assessments and to establish a priority among various identified health and medical issues.Participation by the local experts resulted in a rank order of priorities and formed the basis for the hospital's response to community health needs. |
| Part VI, Line 3: | Detailed information about the poverty guidelines is posted on signs throughout the facility and that information is repeated on the hospital website. Every patient statement includes information about financial assistance and an application for that assistance. At registration, those who are self-pay or express a need for assistance are educated by the registrars about resources available. This includes patient financial counselors.Knox Community Hospital implemented a sliding scale for up to 400% of the federal poverty level to assist patients with their portion of charges. Case managers advocate for assistance by referring patients to Knox Community Hospital financial counselors, too. In addition, the employed physicians in the Departments of Primary and Specialty care participate in the KCH financial assistance program.We offer a 20% discount off gross charges to the uninsured, and a 10% prompt pay discount on co-insurance amounts to those with insurance if they pay their portion within 30 days of their first statement. |
| Part VI, Line 4: | KNOX COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA IS KNOX COUNTY, OHIO. THE 2016 ESTIMATE OF THE POPULATION OF KNOX COUNTY IS 60,814. THERE ARE APPROXIMATELY 116 PEOPLE PER SQUARE MILE. KNOX COUNTY IS PREDOMINANTLY WHITE, CAUCASIANS COMPRISING 96.7% OF THE POPULATION. CONSIDERED A RURAL AREA OF OHIO, KCH IS THE ONLY HOSPITAL IN KNOX COUNTY.THE MEDIAN HOUSEHOLD INCOME IN 2015 WAS ESTIMATED TO BE $48,533. THE UNEMPLOYMENT RATE AS OF APRIL 2015 WAS 4.1%, WHICH IS LOWER THAN THE US RATE FOR THAT PERIOD OF TIME. 15.3 PERCENT OF THE POPULATION LIVES BELOW THE FEDERAL POVERTY LEVEL. THE PERCENTAGE OF THE POPULATION UNDER 65 WITHOUT INSURANCE IS 10.1%. THE PERCENTAGE OF RESIDENTS OVER THE AGE OF 65 HAS RISEN TO 16.7%. OUR ELDERLY POPULATION IS SLIGHTLY HIGHER THAN THE STATE OR NATIONAL AVERAGE. IN ADDITION, 10.3% OF THE POPULATION IS DISABLED. KNOX COMMUNITY HOSPITAL RECOGNIZES THE UNIQUE HEALTH CHALLENGES THESE VULNERABLE POPULATIONS ENCOUNTER AND OFFERS PROGRAMS AND FREE SCREENINGS TO ASSIST THEM. 89% OF RESIDENTS OVER THE AGE OF 25 HAVE A HIGH SCHOOL EDUCATION OR HIGHER. |
| Part VI, Line 5: | In 2016, Knox Community Hospital provided birthing center education to 207 persons and presented a variety of education events attended by members of our community. 890 blood pressure, cholesterol and glucose free monthly screenings continued to be utilized by the community. 600 colorectal cancer screening kits were distributed with 247 kits returned for processing. We continue to offer support groups for Parkinson's disease, breast cancer, young breast cancer survivors, cancer and diabetes. The Education Department trained 42 non-clinical persons to become trainers in community led CPR, AED and first aid classes. Advance Directive/Living Will assistance and free notary service was provided to 204 persons. Physicians and clinical staff members participate in a local, monthly radio call in show. Six KCH certified application counselors helped community members navigate and apply for insurance on the AHA healthcare marketplace website.As partners with area nursing schools, we provided clinical supervision and precepting to students for over 24,242 hours. A quarterly health education publication continued to provide health information to all 26,000 homes in Knox County. This publication also provided a calendar of community health education events and free screenings. The breast health navigator at KCH applied for and received funds from the Susan G. Komen Foundation to provide screening mammograms and follow up care as needed for women who are uninsured or underinsured. KCH provides the community at large the services of both a breast health navigator and a patient navigator at no charge.The estimated prevalence of diabetes among Knox County adult residents is steady at 6.5 percent. Knox Community Hospital recognizes the need for education and screenings to serve this population. In 2016 we offered well-publicized free monthly glucose screenings. Another program that has continued was a "grocery tour" hosted by our diabetes education coordinator. Collaborating with an area grocery store, the community takes a tour that examines food package labeling and information. Support is offered to assist in making good food choices for those with diabetes. We continued the "PreDiabetes 101," a program to provide practical ways to prevent the diagnosis of diabetes.Community members utilize the hospital as a vehicle to connect with and contribute to the overall well-being of the community through philanthropy and volunteering. A volunteer force of 101 contributed 15,293 hours in 2016. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships | GrantTypeTxt |
| Recipient | 16 | RecipientCnt |
| Cash Grant | $16,000 | CashGrantAmt |
| Non Cash Assistance | Health Career Scholarships provided to area high school graduates. | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Knox Community Hospital Auxiliary awards health career scholarships to area high school graduates. All applications are reviewed by the auxiliary scholarship committee; and recipients are selected based on their scholastic standing, community involvement, and financial need. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Christopher Hetrick | ||||||||||||||
| Trustee | $643,863 | $0 | $0 | $0 | $0 | $0 | $18,000 | $0 | $27,667 | $0 | $689,530 | $0 | $0 | $0 |
| thomas d mckinley md | ||||||||||||||
| truSTEE | $252,773 | $0 | $131,188 | $0 | $0 | $0 | $18,000 | $0 | $27,270 | $0 | $429,231 | $0 | $0 | $0 |
| AMY D MURNEN MD | ||||||||||||||
| TRUSTEE | $195,135 | $0 | $24,600 | $0 | $0 | $0 | $18,000 | $0 | $8,571 | $0 | $246,306 | $0 | $0 | $0 |
| BRUCE WHITE | ||||||||||||||
| CEO | $320,720 | $0 | $0 | $0 | $7,260 | $0 | $0 | $0 | $75,264 | $0 | $403,244 | $0 | $0 | $0 |
| MICHAEL AMBROSIANI | ||||||||||||||
| CFO | $218,531 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $49,588 | $0 | $268,119 | $0 | $0 | $0 |
| BRUCE BEHNER | ||||||||||||||
| COO | $218,531 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $49,518 | $0 | $268,049 | $0 | $0 | $0 |
| jeffrey c northup CMO | ||||||||||||||
| chief medical officer | $325,785 | $0 | $2,518 | $0 | $0 | $0 | $4,976 | $0 | $11,819 | $0 | $345,098 | $0 | $0 | $0 |
| HYDI F LAIDLAW-SMITH | ||||||||||||||
| GENERAL SURGEON | $530,922 | $0 | $197,178 | $0 | $0 | $0 | $18,000 | $0 | $27,090 | $0 | $773,190 | $0 | $0 | $0 |
| GREGORY CUSH | ||||||||||||||
| Orthopaedic Surgeon | $500,000 | $0 | $599,900 | $0 | $0 | $0 | $18,000 | $0 | $26,127 | $0 | $1,144,027 | $0 | $0 | $0 |
| Kenneth H Doolittle II | ||||||||||||||
| Orthopaedic Surgeon | $804,103 | $0 | $235,396 | $0 | $0 | $0 | $18,000 | $0 | $27,090 | $0 | $1,084,589 | $0 | $0 | $0 |
| Michael D Heuman | ||||||||||||||
| General Surgeon | $504,653 | $0 | $276,484 | $0 | $0 | $0 | $18,000 | $0 | $27,090 | $0 | $826,227 | $0 | $0 | $0 |
| Jarrett B Helming | ||||||||||||||
| Orthopaedic Surgeon | $606,103 | $0 | $84,464 | $0 | $15,000 | $0 | $18,000 | $0 | $22,373 | $0 | $745,940 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | Hospital purchases one annual membership to local country club for recruiting and fundraising activities for officers. |
| Part I, Line 7 | SCHEDULE J, PART II: THE CEO, COO, AND CFO OF THE HOSPITAL ARE PAID BY AN UNRELATED ORGANIZATION FOR SERVICES RENDERED TO THE ORGANIZATION THROUGH A MANAGEMENT AGREMENT WITH QUORUM HEALTH RESOURCES, LLC. DR. GREGORY CUSH IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HIS SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S HE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR A GENERAL ORTHOPEDIC SURGEON. HE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HIS WRVU'S ARE REVIEWED QUARTERLY. AT THE END OF EACH QUARTER, IF HIS EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HIS ESTIMATED SALARY, PAYMENT IS MADE TO HIM FOR THE EXCESS AMOUNT. DR. KENNETH DOOLITTLE IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HIS SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S HE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR A GENERAL ORTHOPAEDIC SURGEON. HE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HIS WRVU'S ARE REVIEWED SEMIANNUALLY. AT THE END OF EACH SIX MONTH PERIOD, IF HIS EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HIS ESTIMATED SALARY, PAYMENT IS MADE TO HIM FOR THE EXCESS AMOUNT. DR. MICHAEL HEUMAN IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HIS SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S HE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR A GENERAL SURGEON. HE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HIS WRVU'S ARE REVIEWED QUARTERLY. AT THE END OF EACH QUARTER, IF HIS EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HIS ESTIMATED SALARY, PAYMENT IS MADE TO HIM FOR THE EXCESS AMOUNT. DR JARRETT HELMING IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HIS SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S HE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR A ORTHOPEDIC SURGEON-SPORTS MEDICINE. HE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HIS WRVU'S ARE REVIEWED SEMIANNUALLY. AT THE END OF EACH SIX MONTH PERIOD, IF HIS EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HIS ESTIMATED SALARY, PAYMENT IS MADE TO HIM FOR THE EXCESS AMOUNT. DR. CHRISTOPHER HETRICK IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HIS SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S HE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR OTORHINOLARYNGOLOGY. HE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HIS WRVU'S ARE REVIEWED SEMIANNUALLY. AT THE END OF EACH SIX MONTH PERIOD, IF HIS EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HIS ESTIMATED SALARY, PAYMENT IS MADE TO HIM FOR THE EXCESS AMOUNT. DR. HYDI LAIDLAW-SMITH IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HER SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S SHE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR A GENERAL SURGEON. SHE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HER WRVU'S ARE REVIEWED SEMIANNUALLY. AT THE END OF EACH SIX MONTH PERIOD, IF HER EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HER ESTIMATED SALARY, PAYMENT IS MADE TO HER FOR THE EXCESS AMOUNT. DR. THOMAS MCKINLEY IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HIS SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S HE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR AN INTERNIST. HE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HIS WRVU'S ARE REVIEWED QUARTERLY. AT THE END OF EACH QUARTER, IF HIS EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HIS ESTIMATED SALARY, PAYMENT IS MADE TO HIM FOR THE EXCESS AMOUNT. DR. AMY MURNEN IS PAID BASED ON WORK RVU ("WRVU" - RELATIVE VALUE UNIT) PROGRAM. HER SALARY IS BASED ON THE AGGREGATE NUMBER OF WRVU'S SHE PRODUCES MULTIPLIED BY THE COMPENSATION/WORK RVU CONVERSION FACTOR AS PUBLISHED IN THE MGMA PHYSICIAN COMPENSATION FOR A FAMILY MEDICINE PHYSICIAN. SHE IS PAID AN ESTIMATED SALARY IN EQUAL BIWEEKLY INSTALLMENTS AND HER WRVU'S ARE REVIEWED SEMIANNUALLY. AT THE END OF EACH SIX MONTH PERIOD, IF HER EARNED INCOME (WRVU'S X CONVERSION FACTOR) EXCEEDS HER ESTIMATED SALARY, PAYMENT IS MADE TO HER FOR THE EXCESS AMOUNT. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GORDON YANCE | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SEe Part V below | RelationshipDescriptionTxt |
| Transaction | See Part V | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L part iv | FormAndLineReferenceDesc |
| Explanation | GORDON YANCE IS A MEMBER OF THE GOVERNING BODY AND A TRUSTEE OF THE FINANCIAL INSTITUTION THAT IS USED BY KNOX COMMUNITY HOSPITAL. DURING THE YEAR, THE HOSPITAL PAID $328,915 TO THE INSTITUTION FOR ASSET MANAGEMENT FEES. TO AVOID A CONFLICT OF INTEREST, MR. YANCE ABSTAINS FROM VOTING ON ANY ISSUES RELATED TO THE BANKING ARRANGEMENT. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | KNOX COMMUNITY HOSPITAL HAS ENTERED INTO AN INDEPENDENT CONTRACT AGREEMENT WITH QUORUM HEALTH RESOURCES, LLC TO PROVIDE MANAGEMENT SERVICES UNDER THE DIRECTION, CONTROL AND AUTHORITY OF THE HOSPITAL'S BOARD OF TRUSTEES. QUORUM HEALTH RESOURCES, LLC IS ONE OF THE HOSPITAL'S TOP FIVE INDEPENDENT CONTRACTORS OF WHICH $1,489,640 WAS PAID. OF THIS AMOUNT $765,042 RELATES TO COMPENSATION LISTED IN 990 PART PART VII AND SCHEDULE J, PART II FOR THE CEO, CFO, AND COO'S COMPENSATION. |
| Form 990, Part VI, Section B, line 11b | The process of reviewing the Form 990 entails a detailed review by the organization's accounting department and audit and compliance committee. The full governing body is presented a copy of the Form 990 including requested schedules prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | All members are required to read and sign an annual conflict of Interest statement which educates them on their responsibility to declare potential and seeming conflicts of interest. The statements are presented to and reviewed by the Board Executive Committee. This is important because the membership composition of the Executive Committee consists of the chair of each committee of the Board. That way, each committee chair is aware of the disclosed conflicts and potential conflicts of interest for the members who serve on their committee. Chairs are aware that any and all potential conflicts of interest which may come into play during any Board activity and any Board committee work should be identified and declared to the group. The member with the conflict may be asked to recuse themselves from any vote, discussion, or attendance at a meeting regarding the matter. |
| Form 990, Part VI, Section B, line 15 | The Executive committee is the compensation committee/arm of the governing body. Quorum Health Resources, LLC provides the national perspective; using their surveys, ranges are established. The Executive Committee makes the proposal for the full board to approve. The Executive committee is comprised of independent directors per board policy. Paid physician board members are not independent directors and are excluded from the Executive Committee of the board. |
| 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 | Other Purchased Services: Program service expenses 11,882,368. Management and general expenses 5,476,690. Fundraising expenses 5,209. Total expenses 17,364,267. |
| Form 990, Part XI, line 9: | CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 100,926. CHANGE IN INTEREST IN KNOX COMMUNITY HOSPITAL FOUNDATION -355,414. |
| Form 990 Part XII, Line 2c | THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Knox Community Pain management LLC | |||||||||||||
| 1330 Coshocton Rd | Mount Vernon | OH | 43050 | 452919911 | Pain Management Services | OH | N/A | Related | $87,886 | $60,806 | 0 | Yes (1) | 0.51000 |
| Knox Diagnostic Imaging Center LLC | |||||||||||||
| 1330 Coshocton Rd | Mount Vernon | OH | 43050 | 920179889 | Medical Services/ Echocardiology services | OH | N/A | related | $132,142 | $304,992 | 0 | Yes (1) | 0.50000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KCH DEVELOPMENT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1330 coshocton road | AddressLine1Txt |
| City | mount vernon | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43050 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311193847 | EIN |
| Primary Activities | medical building | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$26,210 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $203,378 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Knox Diagnostic Imaging Center LLC | ||
| J | $14,110 | actual |
| Knox Diagnostic Imaging Center LLC | ||
| J | $54,795 | actual |
| Knox Diagnostic Imaging Center LLC | ||
| O | $322,344 | actual |
| Knox Diagnostic Imaging Center LLC | ||
| Q | $55,923 | actual |
| KCH Development | ||
| Q | $10,000 | actual |
| Knox Community Pain Management LLC | ||
| J | $9,984 | actual |
| Knox Community Pain Management LLC | ||
| J | $26,420 | actual |
| Knox Community Pain Management LLC | ||
| O | $291,780 | actual |
| Knox Community Pain Management LLC | ||
| Q | $107,998 | actual |
Comments