MARSHALL COUNTY HOSPITAL DISTRICT: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
MARSHALL COUNTY HOSPITAL DISTRICT (EIN 61-0601267)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-13
IRS object ID
201733179349306258
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 ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-13T14:43:43-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN273858252PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DEAN DORTON ALLEN FORD PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1106 W VINE STREET SUITE 600AddressLine1Txt
CityLEXINGTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP40507ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN610601267EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITAL DISTRICTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMARSBusinessNameControlTxt
Phone2705274800PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 OLD SYMSONIA ROADAddressLine1Txt
CityBENTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42025ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID G FUQUAPersonNm
Person TitleCEOPersonTitleTxt
Phone2705274800PhoneNum
Signature2017-11-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLEIGH MCKEEPreparerPersonNm
PTINP00169845PTIN
Phone8592552341PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address23.145.0.124IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-08IPDt
IP Tm16:33:07IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id68BE5A8853F1398D10A827FE6DB32A885535AAEEAtSubmissionCreationDeviceId
At Submission Filing Device Id539A75BDDEBE3FBE453CFB82E5D320AFC4F27C18AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID G FUQUAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 OLD SYMSONIA ROADAddressLine1Txt
CityBENTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42025ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$23,809,227GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MARSHALLCOUNTYHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1978FormationYr
Legal Domicile StateKYLegalDomicileStateCd
Activity Or MissionTO PROVIDE MEDICAL CARE TO PEOPLE IN MARSHALL AND SURROUNDING COUNTIESActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee310TotalEmployeeCnt
Total Volunteers39TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$241,959PYContributionsGrantsAmt
CY Contributions Grants$142,228CYContributionsGrantsAmt
PY Program Service Revenue$21,309,398PYProgramServiceRevenueAmt
CY Program Service Revenue$22,416,197CYProgramServiceRevenueAmt
PY Investment Income$11,018PYInvestmentIncomeAmt
CY Investment Income$28,607CYInvestmentIncomeAmt
PY Other Revenue$1,182,750PYOtherRevenueAmt
CY Other Revenue$1,222,195CYOtherRevenueAmt
PY Total Revenue$22,745,125PYTotalRevenueAmt
CY Total Revenue$23,809,227CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$11,045,130PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$11,579,040CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,526,123PYOtherExpensesAmt
CY Other Expenses$12,346,513CYOtherExpensesAmt
PY Total Expenses$22,571,253PYTotalExpensesAmt
CY Total Expenses$23,925,553CYTotalExpensesAmt
PY Revenues Less Expenses$173,872PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$116,326CYRevenuesLessExpensesAmt
Total Assets BOY$42,791,248TotalAssetsBOYAmt
Total Assets EOY$41,735,330TotalAssetsEOYAmt
Total Liabilities BOY$26,476,036TotalLiabilitiesBOYAmt
Total Liabilities EOY$25,536,444TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$16,315,212NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$16,198,886NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE MEDICAL CARE TO THE PEOPLE IN MARSHALL AND SURROUNDING COUNTIES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$21,437,998ExpenseAmt
Revenue$23,417,125RevenueAmt
DescMARSHALL COUNTY HOSPITAL DISTRICT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN MARSHALL COUNTY AND SURROUNDING COUNTIES IN KENTUCKY. IN 2016, THE HOSPITAL HAD 1,706 ACUTE DAYS, 526 ICU DAYS, AND 488 SWING DAYS.Desc
Total Program Service Expenses$21,437,998TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document30IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee310EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or Procedure0WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldKYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2705274800PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 OLD SYMSONIA ROADAddressLine1Txt
CityBENTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42025ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
PAUL SCHAPER MD
CHAIRMAN1.00Yes (X)$0$0$0
WENDY GIBSON OD
SECRETARY1.00Yes (X)$0$0$0
GARY SHEMWELL
BOARD MEMBER1.00Yes (X)$0$0$0
KENNETH SHADOWEN
TREASURER1.00Yes (X)$0$0$0
JEFF SMITH
BOARD MEMBER1.00Yes (X)$0$0$0
JANICE J KELLEY
CFO38.00$118,420$0$9,3772.00Yes (X)
PHYLLIS J BLACKWELL
COO38.00$114,578$0$9,2882.00Yes (X)
DAVID G FUQUA
CEO38.00$217,457$0$38,9012.00Yes (X)
BENNIE M FULBRIGHT
PHYSICIAN40.00$501,981$0$25,888Yes (X)
CHRISTINA M BROWN
PHYSICIAN40.00$217,291$0$1,535Yes (X)
JULIA T LYLES
PHYSICIAN32.00$160,321$0$24,868Yes (X)
DARLENE S HARVEY
PHARMACIST32.00$113,609$0$24,399Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,443,657TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$134,256TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MD PARTNERS PLLC
83 GERALDINE LANEGILBERTSVILLEKY42044ER PHYSICIANS$976,199
PINNACLE INC
PO BOX 352BENTONKY42025CONSTRUCTION SERVICES$366,436
EVIDENT
PO BOX 850309MOBILEAL36685IT SERVICES$324,568
SYSTEMS SOLUTIONS OF PADUCAH
115 CARLISLE CTPADUCAHKY42001IT SERVICES$255,479
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Related Organizations$142,228RelatedOrganizationsAmt
Total Contributions$142,228TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE621400$22,212,869$22,212,869
AMBULANCE SERVICE MGMT FEES621910$203,328$203,328
FieldValueIRS element (for citing)
Total Program Service Revenue$22,416,197TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,761TotalRevenueColumnAmt
Exclusion$8,761ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$77,826RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$77,826RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$77,826TotalRevenueColumnAmt
Exclusion$77,826ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$19,846OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$19,846OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,846TotalRevenueColumnAmt
Exclusion$19,846ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
AD VALOREM TAXES900099$1,000,928$1,000,928
CAFETERIA722210$97,502$97,502
SETTLEMENTS990099$27,164$27,164

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,775TotalRevenueColumnAmt
Exclusion$18,775ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,144,369OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$23,809,227TotalRevenueColumnAmt
Related Or Exempt Func Income$23,417,125RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$249,874ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$508,020TotalAmt
Management And General$508,020ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,893,091TotalAmt
Program Services$8,537,367ProgramServicesAmt
Management And General$355,724ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$89,472TotalAmt
Program Services$85,893ProgramServicesAmt
Management And General$3,579ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,439,413TotalAmt
Program Services$1,381,836ProgramServicesAmt
Management And General$57,577ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$649,044TotalAmt
Program Services$623,082ProgramServicesAmt
Management And General$25,962ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$22,797TotalAmt
Management And General$22,797ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$69,996TotalAmt
Management And General$69,996ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,950,565TotalAmt
Program Services$1,301,027ProgramServicesAmt
Management And General$649,538ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$48,617TotalAmt
Program Services$15,451ProgramServicesAmt
Management And General$33,166ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$84,765TotalAmt
Program Services$69,491ProgramServicesAmt
Management And General$15,274ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$510,857TotalAmt
Program Services$505,469ProgramServicesAmt
Management And General$5,388ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$34,508TotalAmt
Program Services$30,367ProgramServicesAmt
Management And General$4,141ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,084,134TotalAmt
Program Services$1,084,134ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,223,598TotalAmt
Program Services$2,223,598ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$374,137TotalAmt
Program Services$360,644ProgramServicesAmt
Management And General$13,493ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$2,711,832$2,630,477$81,355
BAD DEBT EXPENSE$1,375,166$1,375,166
REPAIRS AND MAINTENANCE$1,105,221$705,875$399,346
PROVIDER TAXES$215,180$215,180

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$535,140TotalAmt
Program Services$292,941ProgramServicesAmt
Management And General$242,199ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$23,925,553TotalAmt
Program Services$21,437,998ProgramServicesAmt
Management And General$2,487,555ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,353,588BOYAmt
EOY$1,625,357EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,181,775BOYAmt
EOY$10,828,747EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,281,385BOYAmt
EOY$2,652,053EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$448,666BOYAmt
EOY$438,911EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$307,637BOYAmt
EOY$321,032EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$44,837,710LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$21,882,732LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,151,344BOYAmt
EOY$22,954,978EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$2,316,853BOYAmt
EOY$2,314,252EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$750,000BOYAmt
EOY$600,000EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$42,791,248BOYAmt
EOY$41,735,330EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,834,062BOYAmt
EOY$1,826,444EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$23,710,000BOYAmt
EOY$22,755,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$931,974BOYAmt
EOY$955,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,476,036BOYAmt
EOY$25,536,444EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$16,315,212BOYAmt
EOY$16,198,886EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,315,212BOYAmt
EOY$16,198,886EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$42,791,248BOYAmt
EOY$41,735,330EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$116,326ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$1,659OtherActivitiesAmt
Total Lobbying Expenditures$1,659TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL IS A MEMBER OF THE KENTUCKY HOSPITAL ASSOCIATION. A PERCENTAGE OF THE MEMBERSHIP DUES PAID TO THIS ORGANIZATION IS USED FOR LOBBYING PURPOSES. THE HOSPITAL PAID DUES OF $10,986 TO THE KENTUCKY HOSPITAL ASSOCIATION OF WHICH 15.1% WAS FOR LOBBYING PURPOSES.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,234,612OtherCostOrOtherBasisAmt
Book Value$3,234,612BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$26,796,230OtherCostOrOtherBasisAmt
Depreciation$10,423,977DepreciationAmt
Book Value$16,372,253BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,434,733OtherCostOrOtherBasisAmt
Depreciation$3,002,798DepreciationAmt
Book Value$431,935BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,875,981OtherCostOrOtherBasisAmt
Depreciation$8,455,957DepreciationAmt
Book Value$2,420,024BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$496,154OtherCostOrOtherBasisAmt
Book Value$496,154BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$22,954,978TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
DEBT SINKING FUND$71,887C
DEBT SERVICE RESERVE$211,955C
DEPRECIATION RESERVE ACCOUNT$119,061C
RESTRICTED CASH, SAVINGS & CO$1,911,349C
FieldValueIRS element (for citing)
Total Book Value Securities$2,314,252TotalBookValueSecuritiesAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted Care0FPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$104,995TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$104,995NetCommunityBenefitExpnsAmt
Total Expense0.00440TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,272,849TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,444,129DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,828,720NetCommunityBenefitExpnsAmt
Total Expense0.07640TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,377,844TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,444,129DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,933,715NetCommunityBenefitExpnsAmt
Total Expense0.08080TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,650TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,650NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,500TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,500NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,150TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,150NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,383,994TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,444,129DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,939,865NetCommunityBenefitExpnsAmt
Total Expense0.08110TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,375,166BadDebtExpenseAmt
Reimbursed By Medicare$7,859,137ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$8,000,636CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$141,499MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 OLD SYMSONIA ROADAddressLine1Txt
CityBENTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42025ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITAL DISTRICTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.MARSHALLCOUNTYHOSPITAL.ORGOwnWebsiteURLTxt
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLWWW.MARSHALLCOUNTYHOSPITAL.ORGStrategyWebsiteURLTxt
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.MARSHALLCOUNTYHOSPITAL.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.MARSHALLCOUNTYHOSPITAL.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.MARSHALLCOUNTYHOSPITAL.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
MARSHALL COUNTY HOSPITAL DISTRICTPART V, SECTION B, LINE 5: MARSHALL COUNTY HOSPITAL PARTNERED WITH THE MARSHALL COUNTY HEALTH DEPARTMENT IN POLLING THE COMMUNITY TO FIND OUT THE COUNTY'S STRENGTHS AND WEAKNESSES AND HEALTH NEEDS THAT MIGHT BE GOING UNMET. THE ORGANIZATIONS HOSED A COMMUNITY FORUM AT THE KENTUCKY DAM CONVENTION CENTER IN SEPTEMBER 2015 AND INVITED AREA BUSINESS LEADERS, COUNTY AND CITY OFFICIALS, LAW ENFORCEMENT, INTERESTED CITIZENS, FAITH-BASED ORGANIZATIONS, HEALTHCARE PROVIDERS AND THE GENERAL PUBLIC TO PARTICIPATE. THE UNIVERSITY OF KENTUCKY'S DR. ANGIE CARMON LEAD THE GROUP IN DISCUSSING HEALTH CONCERNS FOR MARSHALL COUNTY CITIZENS. SURVEYS WERE DISTRIBUTED AFTER THE FORUM TO ASSESS THE COMMUNITY. OVER 700 COMPLETED SURVEYS WERE RECEIVED. THE FULL REPORT AND FINDINGS ARE POSTED ON THE HOSPITAL'S WEBSITE AT WWW.MARSHALLCOUNTYHOSPITAL.ORG.
MARSHALL COUNTY HOSPITAL DISTRICTPART V, SECTION B, LINE 6B: THE HOSPITAL PARTNERED WITH MARSHALL COUNTY HEALTH DEPARTMENT TO CONDUCT THE CHNA. SEE ADDITIONAL INFORMATION UNDER LINE 5 ABOVE.
MARSHALL COUNTY HOSPITAL DISTRICTPART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, EXECUTION OF THE IMPLEMENTATION STRATEGY, PARTICIPATION IN THE EXECUTION OF A COMMUNITY-WIDE PLAN, ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA, PRIORITIZATION OF HEALTH NEEDS IN THE COMMUNITY, AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN THE COMMUNITY.
PART V, SECTION BINDIVIDUALS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY ARE NOT CHARGED ANYTHING.

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART II, COMMUNITY BUILDING ACTIVITIES:THE ORGANIZATION DOES NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES TO REPORT.
PART III, LINE 2:THE HOSPITAL HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE HOSPITAL UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE BY PAYOR, REVENUE TRENDS BY PAYOR CLASSIFICATION AND AGED ACCOUNTS FROM DATE OF SERVICE BY PAYOR. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES.
PART III, LINE 3:THE HOSPITAL DOES NOT HAVE BAD DEBT EXPENSES RELATED TO THE PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY.
PART III, LINE 4:THE AMOUNTS REPRESENT UNPAID MEDICARE DEDUCTIBLES AND COINSURANCE AND ALL SELF-PAY ACCOUNTS THAT WERE UNPAID. THE HOSPITAL HAS BOTH INTERNAL AND EXTERNAL COLLECTION EFFORTS.
PART III, LINE 8:THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL. LINE 6 COSTS REPRESENT MEDICARE CHARGES MULTIPLIED BY A CALCULATED COST-TO-CHARGE RATIO FOR ANCILLARY SERVICES AND MEDICARE DAYS MULTIPLIED BY A CALCULATED PER DIEM AMOUNT FOR ROUTINE SERVICES. LINE 5 REVENUES REPRESENT 101% OF MEDICARE COSTS, LESS 2% SEQUESTRATION, WHICH IS MEDICARE'S REIMBURSEMENT METHODOLOGY FOR CRITICAL ACCESS HOSPITALS.
PART III, LINE 9B:AT ADMISSION, ALL PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE FILL OUT A DISPROPORTIONATE SHARE HOSPITAL (DSH) FORM, WHICH IS MAILED BI-WEEKLY TO THE DISABILITY MEDICAL CONSULTANTS (DMC). A PATIENT WHO APPLIES FOR FREE CARE COVERAGE (DSH) OF HIS/HER HOSPITAL SERVICES WILL, UPON REQUEST, RECEIVE A WRITTEN NOTICE OF THE HOSPITAL'S DECISION ON THE REQUEST WITHIN TWO MONTHS OF SUBMISSION OF A COMPLETED APPLICATION AND OTHER REQUIRED INFORMATION. DETERMINATION FOR FREE CARE IS MADE ON AN ACCOUNT BY ACCOUNT BASIS. WITHIN 180 DAYS OF THE DETERMINATION OF THE PATIENT'S INABILITY TO PAY FOR SERVICES, THE HOSPITAL WILL SEND THE PATIENT, HIS/HER GUARANTOR OR OTHER FINANCIALLY RESPONSIBLE PARTY AN INITIAL STATEMENT OF CHARGES CLEARLY STATING THE AMOUNT FOR WHICH THE PATIENT, GUARANTOR OR OTHER FIANCIALLY RESPONSIBLE PARTY IS RESPONSIBLE. AN ITEMIZED BILL WILL BE SENT UPON REQUEST OF THE PATIENT, AND IF NO RESPONSE, A SECOND AND THIRD STATEMENT WILL BE SENT TO THE RESPONSIBLE PARTY. FINALLY, A LETTER IS SENT STATING THAT COLLECTION AGENCY ACTION WILL BE TAKEN. THEREAFTER, IF THE ACCOUNT IS EQUAL TO OR EXCEEDS $1,000, THE HOSPITAL WILL AGAIN INVESTIGATE ALL POTENTIAL PAYMENT SOURCES BEFORE TURNING THE ACCOUNT OVER TO COLLECTIONS. THIS INCLUDES SENDING ANOTHER LETTER THROUGH THE DSH PROGRAM. IF THE AMOUNT IS LESS THAN $1,000 THE HOSPITAL WILL WRITE THE ACCOUNT OFF TO BAD DEBT AND SEND TO A COLLECTION AGENCY.
PART VI, LINE 2:IN MARCH 2009, MARCIA WHITE, PUBLIC RELATIONS AND FOUNDATION DIRECTOR, BEGAN SERVING ON A COMMITTEE OF BUSINESS OWNERS, OFFICIALS AND OTHER HEALTHCARE PROVIDERS. THIS COMMITTEE WAS FORMED TO ASSESS THE NEEDS OF MARSHALL COUNTY RESIDENTS REGARDING HEALTH CARE, SECURITY, AND ENVIRONMENTAL AND EDUCATIONAL CONCERNS THROUGH A GRANT RECEIVED BY THE MARSHALL COUNTY HEALTH DEPARTMENT. THIS ASSESSMENT IS BASED ON INFORMATION OBTAINED THROUGH THREE SURVEYS SENT OUT JUNE 2009, JULY 2009 AND SEPTEMBER 2010.VALUABLE INFORMATION HAS BEEN OBTAINED THROUGH THESE SURVEYS ON HOW THE RESIDENTS OF MARSHALL COUNTY PERCEIVE THE PLACE IN WHICH THEY LIVE AND THE HEALTH CARE THEY RECEIVE.
PART VI, LINE 3:DURING THE ADMISSIONS PROCESS, THE ADMISSIONS CLERK INFORMS ANY PATIENTS WITHOUT INSURANCE COVERAGE ABOUT THE AVAILABLITY OF FREE CARE COVERAGE UNDER THE DISPROPORTIONATE SHARE HOSPITAL PROGRAM (DSH) AND PROVIDES THEM WITH THE FORM TO DETERMINE ELIGIBILTY FOR BOTH THE DSH PROGRAM AND MEDICAID. THE HOSPITAL WILL PROVIDE REASONABLE ASSISTANCE IN COMPLETING THIS FORM. THE HOSPITAL WILL ALSO ADVISE PATIENTS ABOUT ELIGIBILITY FOR AND OBTAINING PUBLIC ASSISTANCE. THE COMPLETED FORM IS MAILED OUT BI-WEEKLY TO DISABILITY MEDICAL CONSULTANTS (DMC), WHO DETERMINE THOSE ELIGIBLE FOR THE DSH PROGRAM. IN ADDITION, THE FINANCIAL COUNSELOR WILL PERSONALLY SPEAK WITH ALL UNINSURED INPATIENTS WHEN FEASIBLE. UPON REQUEST, THE PATIENT WILL RECEIVE WRITTEN NOTICE OF HIS ELIGIBILITY FOR THE DSH PROGRAM WITHIN TWO MONTHS OF SUBMITTING THE COMPLETED APPLICATION AND ANY OTHER REQUIRED INFORMATION.IF THE PATIENT IS A RESIDENT OF KENTUCKY, DOES NOT HAVE HEALTH INSURANCE, MEETS THE INCOME GUIDELINES AND HAS BEEN DENIED MEDICAL CARE BY MEDICAID, THE PATIENT'S BILL WILL BE COVERED UNDER THIS PROGRAM.
PART VI, LINE 4:MARSHALL COUNTY, NESTLED ON THE SHORES OF ONE OF THE LARGEST MANMADE LAKES IN THE EASTERN UNITED STATES, HAS AN UNSURPASSED QUALITY OF LIFE. THE SMALL TOWN ATMOSPHERE, COMBINED WITH THE ACCESS TO LARGER METROPOLITAN AREAS, THE LAND BETWEEN THE LAKES NATIONAL RECREATION AREA, THE HIGHLY RATED SCHOOL SYSTEM, AND ABUNDANCE OF JOB OPPORTUNITIES, MAKES THIS AN IDEAL PLACE TO LIVE, WORK AND SUCCEED. MARSHALL COUNTY HAS A POPULATION OF APPROXIMATELY 30,953 PEOPLE WITH A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $44,157 AND A CURRENT UNEMPLOYMENT RATE OF 8%. THE HOSPITAL IS THE 8TH LARGEST EMPLOYER IN MARSHALL COUNTY. PER THE 2016 CENSUS, THE COUNTY IS COMPRISED OF 51% FEMALE AND 49% MALE AND IS APPROXIMATELY 98% CAUCASIAN. THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IS APPROXIMATELY 11.6%. APPROXIMATELY 2% OF THE EMPLOYED POPULATION RECEIVES PUBLIC ASSISTANCE INCOME. APPROXIMATELY 66% OF THE HOSPITAL'S NET PATIENT SERVICE REVENUE IS COMPRISED OF PARTICIPANTS IN MEDICARE AND MEDICAID PROGRAMS.
PART VI, LINE 5:MARSHALL COUNTY HOSPITAL IS ACTIVE IN EDUCATING THE COMMUNITY. MARCIA WHITE, THE PUBLIC RELATIONS AND FOUNDATION DIRECTOR HAS VISITED SENIOR CITIZENS, RESIDENTS OF THE LOCAL ASSISTED LIVING FACILITY, HOSTED NUMEROUS "LUNCH AND LEARNS" WITH VARIOUS SPEAKERS, AND REPRESENTED THE HOSPITAL AT ALL AREA FAIRS WITH EDUCATIONAL INFORMATION, AS WELL AS FREE SCREENINGS TO THE PUBLIC. THE HOSPITAL ALSO PUBLISHES EDUCATIONAL MATERIAL IN THE LOCAL NEWSPAPERS, RADIO, ON-LINE PRODUCTIONS AND THE EMPLOYEE NEWSLETTER.
PART VI, LINE 6:THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DAVID G FUQUA
CEO$217,457$0$0$0$0$0$12,114$0$26,787$0$256,358$0$0$0
BENNIE M FULBRIGHT
PHYSICIAN$501,981$0$0$0$0$0$3,138$0$22,750$0$527,869$0$0$0
CHRISTINA M BROWN
PHYSICIAN$217,291$0$0$0$0$0$1,535$0$0$0$218,826$0$0$0
JULIA T LYLES
PHYSICIAN$160,321$0$0$0$0$0$2,880$0$21,988$0$185,189$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CHRISTIAN COUNTY KENTUCKYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN616000824BondIssuerEIN
Bond Issued2008-04-24BondIssuedDt
Issue Price$30,000,000IssuePriceAmt
PurposeACQUISITION, CONSTRUCTION, & EQUIPPING OF NEW ACUTE CARE HOSPITALPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds$30,000,000TotalProceedsAmt
Capitalized Interest$655,119CapitalizedInterestAmt
Capital Expenditures$30,042,765CapitalExpendituresAmt
Substantial Completion2008SubstantialCompletionYr
Current Refunding0CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And RecYes (1)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1US BANK NATIONALBusinessNameLine1Txt
Business Name Line2ASSOCIATIONBusinessNameLine2Txt
FieldValueIRS element (for citing)
Term Of Hedge25.000000000000TermOfHedgePct
Superintegrated Hedge0SuperintegratedHedgeInd
Hedge Terminated0HedgeTerminatedInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K ADDENDUM:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL HAS A LEASE WITH KACO LEASING TRUST AND FILES SCHEDULE K TO PROVIDE COMPLETE REPORTING RELATING TO THIS LEASE. AS A RESULT, SOME QUESTIONS APPLICABLE TO BOND COMPLIANCE DO NOT APPLY.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BAN OFFICER OF THE BOARD REVIEWS THE 990 ON BEHALF OF THE BOARD OF DIRECTORS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE HOSPITAL PROVIDES THE CONFLICT OF INTEREST POLICY TO THE BOARD AND EMPLOYEES. BOARD MEMBERS FILL OUT THE CONFLICT OF INTEREST POLICY ANNUALLY. THE HOSPITAL'S COMPLIANCE MANUAL HAS A SECTION ON CONFLICTS OF INTEREST AND DEPARTMENT DIRECTORS ARE REQUIRED TO SIGN THAT THEY HAVE READ AND WILL ABIDE BY IT.
FORM 990, PART VI, SECTION B, LINE 15THE HOSPITAL PARTICIPATES IN THE KENTUCKY HOSPITAL ASSOCIATION'S SALARY SURVEY IN ORDER TO HAVE ACCESS TO STATE WIDE COMPARABLE SALARY DATA.
FORM 990, PART VI, SECTION C, LINE 19THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE DISCRETION OF THE BOARD OF DIRECTORS AND MANAGEMENT.
FORM 990, PART XII, LINE 2CTHE HOSPITAL'S BOARD AND SENIOR MANAGEMENT ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITAL & HEALTHCARE FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 OLD SYMSONIA ROADAddressLine1Txt
CityBENTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42025ZIPCd
FieldValueIRS element (for citing)
EIN611157518EIN
Primary ActivitiesSOLICIT CHARITABLE CONTRIBUTIONS FOR THE BENEFIT OF MARSHALL COUNTY HOSPITALPrimaryActivitiesTxt
Legal Domicile StateKYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity Status509(A)(3) TYPE IPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITAL DISTRICTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY MRI LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 OLD SYMSONIA ROADAddressLine1Txt
CityBENTONCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42025ZIPCd
FieldValueIRS element (for citing)
EIN465453921EIN
Primary ActivitiesMRI FACILITYPrimaryActivitiesTxt
Legal Domicile StateKYLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITAL DISTRICTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Share Of Total Income-$81,210ShareOfTotalIncomeAmt
Share Of EOY Assets$614,646ShareOfEOYAssetsAmt
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
Ownership0.50000OwnershipPct
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MARSHALL COUNTY HOSPITAL & HEALTHCARE FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$142,228InvolvedAmt
Method Of Amount DeterminationCOSTMethodOfAmountDeterminationTxt

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