2017-11-13T14:53:23-06:00 2016-12-31 351178661 Blue & Co LLC 8800 Lyra Drive Suite 450 Columbus OH 43240 990 2016-01-01 310929576 Knox Community Hospital KNOX 7403939623 1330 Coshocton Road Mount Vernon OH 43050 Bruce White CEO 7403939623 2017-11-01 1 Matthew Dasta P00544683 6148852583 2017-11-01 38.109.186.2 2017-11-01 11:54:15 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CBCE996F475CA3740CE88356C52AB1B9FF3D8150 2016 2017-02-10 21:41:12Z Bruce D White 1330 Coshocton Road Mount Vernon OH 43050 164197216 0 X WWW.KNOXCOMMHOSP.ORG X 1977 OH TO PROVIDE COMPASSIONATE HEALTHCARE SERVICE THAT EXCEEDS THE EXPECTATIONS OF OUR COMMUNITY 15 11 1145 101 32831 1106 6297 1719051 148492782 157763114 2208342 1280596 2739306 3215637 153446727 163978398 12000 16000 0 0 73970343 81095074 0 0 67480 63433346 67023418 137415689 148134492 16031038 15843906 149198877 164565014 46118788 44402704 103080089 120162310 X 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. 0 0 115354899 16000 160506127 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. 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 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. 115354899 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 177 0 1 1145 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X Michael Ambrosiani 7403939623 1330 COSHOCTON RD Mt Vernon OH 43050 Christopher Hetrick Trustee 40.00 X 643863 0 45667 Joan Jones Trustee 1.50 X 0 0 0 Joe Street SECRETARY 2.00 X X 0 0 0 Thomas R FOSNAUGHT Treasurer 2.00 X X 0 0 0 thomas d mckinley md truSTEE 40.00 X 383961 0 45270 GORDON YANCE truSTEE 1.50 X 0 0 0 Patrick McLarnan Vice President 2.00 X X 0 0 0 Korey Kidwell TRUSTEE 1.50 X 0 0 0 JEFFERY BOUCHER TRUSTEE 1.50 X 0 0 0 Juan De Pascuale TRUSTEE 1.50 X 0 0 0 Inge Krajenksi TRUSTEE 1.50 X 0 0 0 Charles Brenneman TRUSTEE 1.50 X 0 0 0 Ann Schnormeier TRUSTEE 1.50 X 0 0 0 AMY D MURNEN MD TRUSTEE 40.00 X 219735 0 26571 IAN WATSON President 5.00 X X 0 0 0 BRUCE WHITE CEO 40.00 X 327980 0 75264 MICHAEL AMBROSIANI CFO 40.00 X 218531 0 49588 BRUCE BEHNER COO 40.00 X 218531 0 49518 jeffrey c northup CMO chief medical officer 40.00 X 328303 0 16795 HYDI F LAIDLAW-SMITH GENERAL SURGEON 40.00 X 728100 0 45090 GREGORY CUSH Orthopaedic Surgeon 40.00 X 1099900 0 44127 Kenneth H Doolittle II Orthopaedic Surgeon 40.00 X 1039499 0 45090 Michael D Heuman General Surgeon 40.00 X 781137 0 45090 Jarrett B Helming Orthopaedic Surgeon 40.00 X 705567 0 40373 6695107 0 528443 73 0 1 0 ohio state university-cambridge health 700 Ackerman Road Suite 630 Columbus OH 43202 ON-CALL, QUALITY IMPROVEMENT & Prof Serv 2314644 QUORUM HEALTH RESOURCES LLC 105 CONTINENTAL PLACE BRENTWOOD TN 370271018 HOSPITAL MANAGEMENT SERVICES 1489640 Origin Inc - Shiftwise PO Box 70870 St Paul MN 551709705 STAFFING AGENCY 1282201 Premier Urology Corp PO BOX 677 Lewis Center OH 43035 UROLOGY SERVICES 1148495 Allscripts LLC 24630 Network Place Chicago IL 606731246 PRACTICE MGMT & ELECTRONIC RECORD TECH 867656 43 1719051 1719051 Patient Service Revenu 621110 157763114 157763114 157763114 1026847 1026847 13272 0 13272 13272 13272 472567 218818 253749 253749 253749 MISCELLANEOUS 900099 1327423 1294592 32831 pharmacy 900099 949050 949050 FOOD & NUTRITION 900099 426521 426521 499371 499371 3202365 163978398 160506127 32831 1720389 X 16000 16000 2340904 1247559 1093345 59221109 46647687 12511860 61562 1190627 927498 263129 14750093 11478432 3271661 3592341 2810324 782017 96417 41199 55218 17364267 11882368 5476690 5209 85239 85239 1549001 1420279 128567 155 3037085 145476 2891609 367208 172294 194914 1653031 1653031 5852543 2810976 3041567 1086645 161475 925170 Supplies and Drugs 21736052 21736052 bad debt 8233487 8233487 Medical Professional Fe 4489607 4489607 MISCELLANEOUS 692018 575205 116259 554 780818 558981 221837 148134492 115354899 32712113 67480 4850 4600 15719624 20234867 17399416 19299875 1532098 1644626 2411186 2594280 115430624 67353593 45378245 48077031 58147044 66497368 8606414 6212367 149198877 164565014 10871560 11652142 34467633 31980254 779595 770308 46118788 44402704 X 101925922 119353859 1154167 808451 103080089 120162310 149198877 164565014 X 15843906 1492803 -254488 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2616 2616 0 Part II-B, Line 1: Ohio Hospital Association and the American Hospital Association dues were allocated towards lobbying expenses equaling $2,616 in total. 1154167 100926 446642 0 808451 222929 86764 911462 66988 1154167 140189 134437 51697 222929 131355 53949 45115 140189 71099 142821 82565 131355 1.00000 0 0 572605 572605 45249657 19547720 25701937 767511 668304 99207 66272359 47137569 19134790 2568492 2568492 48077031 LEASEHOLD DEPOSITS 721623 related party payable 48685 770308 X 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. 1 1 1 X 1 X 1 1 0 1 1 1931730 1231622 700108 0.00470 23401381 18383959 5017422 0.03390 25333111 19615581 5717530 0.03860 110236 343565 4821 338744 0.00230 1289 640153 1484 638669 0.00430 89111 89111 0.00060 677 43813 43813 0.00030 112202 1116642 6305 1110337 0.00750 112202 26449753 19621886 6827867 0.04610 20925 20925 0.00010 2828 2828 0.00000 20 5484 5484 0.00000 20 29237 29237 0.00010 1 8233487 32413192 35373270 -2960078 X 1 1 1 KNOX DIAGNOSTIC IMAGING LLC MEDICAL SERVICES/ECHOCARDIOLOGY SERVICES 0.50000 0.02330 0.35620 1 1 KNOX COMMUNITY HOSPITAL 1330 COSHOCTON RD MOUNT VERNON OH 43050 www.knoxcommhosp.org X X X DSH Hospital; Sole Community Hospital KNOX COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://www.kch.org/resources/HEALTH-NEEDS-ASSESSMENT X 1 15 1 http://www.kch.org/resources/HEALTH-NEEDS-ASSESSMENT 0 1 X 200.000000000000 350.000000000000 X X X X X 1 1 X X X X 1 X http://www.kch.org/resources/financial-assistance-application X 1 0 1 0 0 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. 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. 1 Scholarships 16 16000 Health Career Scholarships provided to area high school graduates. Part I, Line 2: 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. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 Christopher Hetrick Trustee 643863 0 0 0 0 0 18000 0 27667 0 689530 0 0 0 thomas d mckinley md truSTEE 252773 0 131188 0 0 0 18000 0 27270 0 429231 0 0 0 AMY D MURNEN MD TRUSTEE 195135 0 24600 0 0 0 18000 0 8571 0 246306 0 0 0 BRUCE WHITE CEO 320720 0 0 0 7260 0 0 0 75264 0 403244 0 0 0 MICHAEL AMBROSIANI CFO 218531 0 0 0 0 0 0 0 49588 0 268119 0 0 0 BRUCE BEHNER COO 218531 0 0 0 0 0 0 0 49518 0 268049 0 0 0 jeffrey c northup CMO chief medical officer 325785 0 2518 0 0 0 4976 0 11819 0 345098 0 0 0 HYDI F LAIDLAW-SMITH GENERAL SURGEON 530922 0 197178 0 0 0 18000 0 27090 0 773190 0 0 0 GREGORY CUSH Orthopaedic Surgeon 500000 0 599900 0 0 0 18000 0 26127 0 1144027 0 0 0 Kenneth H Doolittle II Orthopaedic Surgeon 804103 0 235396 0 0 0 18000 0 27090 0 1084589 0 0 0 Michael D Heuman General Surgeon 504653 0 276484 0 0 0 18000 0 27090 0 826227 0 0 0 Jarrett B Helming Orthopaedic Surgeon 606103 0 84464 0 15000 0 18000 0 22373 0 745940 0 0 0 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. GORDON YANCE SEe Part V below See Part V 0 SCHEDULE L part iv 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. 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. Knox Community Pain management LLC 1330 Coshocton Rd Mount Vernon OH 43050 452919911 Pain Management Services OH N/A Related 87886 60806 0 1 0.51000 Knox Diagnostic Imaging Center LLC 1330 Coshocton Rd Mount Vernon OH 43050 920179889 Medical Services/ Echocardiology services OH N/A related 132142 304992 0 1 0.50000 KCH DEVELOPMENT 1330 coshocton road mount vernon OH 43050 311193847 medical building OH N/A C -26210 203378 1.00000 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 Knox Diagnostic Imaging Center LLC J 14110 actual Knox Diagnostic Imaging Center LLC J 54795 actual Knox Diagnostic Imaging Center LLC O 322344 actual Knox Diagnostic Imaging Center LLC Q 55923 actual KCH Development Q 10000 actual Knox Community Pain Management LLC J 9984 actual Knox Community Pain Management LLC J 26420 actual Knox Community Pain Management LLC O 291780 actual Knox Community Pain Management LLC Q 107998 actual