Clinton County Hospital Inc: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- Clinton County Hospital Inc (EIN 61-6008014)
- Tax period
- 2015-09-01 to 2016-03-31
- Filed
- 2017-02-13
- IRS object ID
- 201740449349302054
- Schema version
- 2015v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-13T13:49:11-06:00 | ReturnTs |
| Tax Period End | 2016-03-31 | 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 | 2650 Eastpoint Parkway Suite 300 | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40223 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 616008014 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clinton County Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLIN | BusinessNameControlTxt |
| Phone | 6063876421 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 723 Burkesville Road | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42602 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ronald G Sowell | PersonNm |
| Person Title | Executive Vice President of CHC | PersonTitleTxt |
| Phone | 6063876421 | PhoneNum |
| Signature | 2017-02-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Angela Zirkelbach CPA | PreparerPersonNm |
| PTIN | P00572603 | PTIN |
| Phone | 5029923500 | PhoneNum |
| Preparation | 2017-02-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | Ronald G Sowell | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 723 Burkesville Road | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42602 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,999,357 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CLINTONCOUNTYHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1965 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | ACUTE HOSPITAL CARE | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 168 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,945 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,604 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,102,698 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,851,517 | CYProgramServiceRevenueAmt |
| PY Investment Income | $18,252 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,121 | CYInvestmentIncomeAmt |
| PY Other Revenue | $107,107 | PYOtherRevenueAmt |
| CY Other Revenue | $135,115 | CYOtherRevenueAmt |
| PY Total Revenue | $10,237,002 | PYTotalRevenueAmt |
| CY Total Revenue | $4,999,357 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,085,411 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,316,757 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,712,984 | PYOtherExpensesAmt |
| CY Other Expenses | $4,887,301 | CYOtherExpensesAmt |
| PY Total Expenses | $13,798,395 | PYTotalExpensesAmt |
| CY Total Expenses | $8,204,058 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,561,393 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,204,701 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,125,000 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,286,845 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$16,161,845 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Clinton County Hospital is dedicated to providing the highest quality care possible in a safe and secure environment. We are committed to the promotion of wellness and restoration of health in a cost-effective manner. We continuously strive to improve the quality of health in the communities we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $7,236,719 | ExpenseAmt |
| Revenue | $4,851,517 | RevenueAmt |
| Desc | Clinton County Hospital is a Not-for-Profit, 42 licensed-bed acute care hospital organized for the purpose of providing healthcare services to the residents of Clinton County. The hospital's primary sources of support are from patient revenue received from Medicare, state agencies and insurance companies. There were 8,820 bed days available for the fiscal year ended 2016.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Amounts determined to qualify as charity care are reported as deductions from Revenue on Page 9 Part X. The amount of charity care for the fiscal year ended 2016 was $126,767. | Desc |
| Total Program Service Expenses | $7,236,719 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | 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 | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | Yes (1) | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 168 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | 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 | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clinton County Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6063876421 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 723 Burkesville Rd | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42602 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KEITH MCWHORTER | |||||||
| Chair | 2.00 | Yes (X) | $0 | $0 | $1,551 | ||
| Rodney Little | |||||||
| VICE-CHAIR | 2.00 | Yes (X) | $0 | $0 | $2,295 | ||
| BoB TALBOTT | |||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $1,464 | ||
| W C POWELL MD | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TOMMY BERTRAM | |||||||
| Member (retired 2/1/2016) | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JD MULLINS JR | |||||||
| CEO | 36.00 | $82,237 | $0 | $18,824 | Yes (X) | ||
| Donald Hay MD | |||||||
| Gynecologist | 40.00 | $109,391 | $0 | $0 | Yes (X) | ||
| Shelia Kingry | |||||||
| Pharmacist | 36.00 | $108,831 | $0 | $0 | Yes (X) | ||
| Kevin Lowhorn | |||||||
| Pharmacist | 36.00 | $106,173 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $406,632 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $24,134 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | 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 |
|---|---|---|---|---|---|
| The ERX Group | |||||
| 9724 Kingston Pike Ste 405 | Knoxville | TN | 37922 | ER Physician Coverage | $1,538,008 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 366850309 | Computer Services | $392,181 |
| Premier Care Inc | |||||
| 603 Main Street | WIndermere | FL | 34786 | management fee | $291,336 |
| Resource Anesthesia PC | |||||
| 12752 Kingston Pike | knoxville | TN | 37934 | Anesthesia Physician coverage | $235,845 |
| Phillips Medical System NA | |||||
| PO Box 100355 | Atlanta | GA | 303840355 | Maintenance Contracts | $205,674 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $8,604 | GovernmentGrantsAmt |
| Total Contributions | $8,604 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Services R | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $4,851,517 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,851,517 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,851,517 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,121 | TotalRevenueColumnAmt |
| Exclusion | $4,121 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $32,056 | 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 | $32,056 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,056 | TotalRevenueColumnAmt |
| Exclusion | $32,056 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MIsc Revenue | 621300 | $93,577 | $93,577 |
| cafeteria revenue | 621300 | $9,482 | $9,482 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $103,059 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,999,357 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,851,517 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $139,236 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,750,222 | TotalAmt |
| Program Services | $2,061,832 | ProgramServicesAmt |
| Management And General | $688,390 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $566,535 | TotalAmt |
| Program Services | $566,535 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,245 | TotalAmt |
| Program Services | $80,065 | ProgramServicesAmt |
| Management And General | $9,180 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,218,890 | TotalAmt |
| Program Services | $1,218,890 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,028,944 | TotalAmt |
| Program Services | $968,781 | ProgramServicesAmt |
| Management And General | $60,163 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $754,751 | TotalAmt |
| Program Services | $693,201 | ProgramServicesAmt |
| Management And General | $61,550 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,886 | TotalAmt |
| Program Services | $1,886 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,904 | TotalAmt |
| Program Services | $598,904 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $709,269 | TotalAmt |
| Program Services | $709,269 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,056 | TotalAmt |
| Management And General | $148,056 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Miscellaneous | $332,494 | $332,494 |
| Dues & Subscriptions | $4,862 | $4,862 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,204,058 | TotalAmt |
| Program Services | $7,236,719 | ProgramServicesAmt |
| Management And General | $967,339 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $629,245 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,398,355 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,484 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $372,842 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,595 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,429,479 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,125,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $253,373 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,033,472 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,286,845 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$16,161,845 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$16,161,845 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,125,000 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,204,701 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $19,366,546 | 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 | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule 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 | $1,369 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,369 | 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 | 15.1% OF THE HOSPITAL'S ANNUAL MEMBERSHIP DUES OF KENTUCKY HOSPITAL ASSOCIATION ARE ALLOCATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
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 |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $128,718 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $139,196 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$10,478 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 76 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,791,620 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,408,824 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $382,796 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04670 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 77 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,920,338 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,548,020 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $372,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04670 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 77 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,920,338 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,548,020 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $372,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04670 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,656,937 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,156,372 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,950,157 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$793,785 | 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 |
| 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 | CLINTON COUNTY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 723 Burkesville Road | AddressLine1Txt |
| City | Albany | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42602 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CLINTONCOUNTYHOSPITAL.COM | WebsiteAddressTxt |
| State License | 100078 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLINTON COUNTY 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 |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 12 | 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 | WWW.CHC.NET/SERVICES/HOSPITALS/THE_MEDICAL_CENTER_AT_ALBANY/COMMUNITY_HEALT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.CHC.NET/SERVICES/HOSPITALS/THE_MEDICAL_CENTER_AT_ALBANY/COMMUNITY_HEALT | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.clintoncountyhospital.com | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CLINTON COUNTY HOSPITAL | Part V, Section B, Line 5: The Hospital Facility took into account input from persons who represent the community through community surveys and focus groups. In addition the hospital had a community volunteer steering committee that represented individuals from organizations and agencies from the service area. |
| CLINTON COUNTY HOSPITAL | Part V, Section B, Line 7d: The Community Health needs assessment is available at WWW.CHC.NET/SERVICES/HOSPITALS/THE_MEDICAL_CENTER_AT_ALBANY/ COMMUNITY_HEALTh. The hospital took into account input from the community through the use of focus group discussions and community surveys. |
| CLINTON COUNTY HOSPITAL | Part V, Section B, Line 11: SOME PRIORITIES WILL NOT BE ADDRESSED BY THE HOSPITAL IN THE COMMUNITY HEALTH NEEDS ASSESMENT. SOME OF THESE ISSUES ARE INCLUDED BELOW WITH THE REASON FOR NOT ADDRESSING THE NEED: - NEED FOR MORE SPECIALISTS: THE HOSPITAL HAS ENGAGED CONVERSATIONS WITH SPECIALISTS, BUT IT IS NOT A TOP PRIORITY AT THIS TIME.- BILLING ISSUES: THE HOSPITAL CONTINUES TO WORK ON COMMUNICATION, HOWEVER, IT IS NOT DEEMED A TOP HEALTHCARE NEED PRIORITY AT THIS TIME.- COST OF SERVICES ARE TOO HIGH: THE HOSPITAL CONTINUES TO REVIEW, BUT IT IS NOT DEEMED A TOP HEALTHCARE NEED PRIORITY AT THIS TIME.- NEED FOR MENTAL HEALTH SERVICES: THE HOSPITAL DOES NOT HAVE THE RESOURCES AT THIS TIME TO MAKE IT A TOP PRIORITY.- NEED FOR DRUG TREATMENT FACILITIES: THE HOSPITAL DOES NOT HAVE THE RESOURCES AT THIS TIME TO MAKE IT A TOP PRIORITY.- TELEPHONE AUTOMATED SERVICE IS TOO CONFUSING AND LONG: THIS HAS NOT BEEN DEEMED A TOP HEALTHCARE NEED PRIORITY. ADDITIONALLY, A CALLER CAN TALK TO SOMEONE DIRECTLY BY DIALING ZERO. |
| CLINTON COUNTY HOSPITAL | Part V, Section B, Line 16i: Financial Assistance Policy is provided to all private pay patients residing in Kentucky upon admission. |
| CLINTON COUNTY HOSPITAL | Part V, Section B, Line 22d: A Clinton Co. Hospital Financial Counselor or designated business office representative will review individual cases and make a determination of financial assistance that may be offered.Clinton County Hospital determines the need for financial assistance by reviewing insurance coverage, other sources of payment, patient's historical financial profile and current financial situation. This allows for a fair and objective way to assist patients who are experiencing financial hardship. Partial and/or full charity care will be granted based on the individual's ability to pay. Eligible individuals include patients who do not have insurance and patients who have insurance but are underinsured. Patients must cooperate with any insurance claim submission and exhaust their insurance or potential insurance coverage before becoming eligible for financial assistance.Other factors affecting eligibility are: Income 1. 200% of the most recent Federal Poverty Income Guidelines will be the minimum level for 100% (full) charity write-off. 2. 201%-400% of the most recent Federal Poverty Guidelines will be eligible for a 50% discount. 3. Patients with an income over 400% of the most recent Federal Poverty Income Guidelines will be eligible for some degree of charity in special circumstances only. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7g: | The organization does not provide any subsidized health services attributable to physician clinics. |
| Part II, Community Building Activities: | COMMUNITY BUILDING: CLINTON COUNTY HOSPITAL TAKES PRIDE IN BEING AN ACTIVE MEMBER OF OUR COMMUNITY. FROM SIMPLY BEING PRESENT AT MEETINGS LIKE THE CHAMBER OF COMMERCE AND COMMUNITY ADVISORY COMMITTEE OR TAKING THE LEAD IN ACTIVITIES LIKE HEALTH FAIRS, RELAY FOR LIFE AND CAREER DAY AT THE LOCAL HIGH SCHOOL. CLINTON COUNTY HOSPITAL BENEFITS THIS COMMUNITY IN MANY WAYS ABOVE AND BEYOND JUST BEING A HOSPITAL. WITH AN EAR TO THE GROUND, HOSPITAL EMPLOYEES LISTEN FOR THE MOST PRESSING AND URGENT NEEDS IN THE COMMUNITY AND PASS THEM ON TO ADMINISTRATION SO THAT ACTIONS CAN BE TAKEN. CLINTON COUNTY HOSpITAL IS LOCATED IN A SMALL RURAL AREA AND VERY SUPPORTIVE OF COMMUNITY NEEDS. |
| Part III, Line 4: | The audited footnote to the organizations financial statements describing bad debt expense: The hospital adopted Accounting Standards Update 2011-07, "Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Healthcare Entities." This requires certain healthcare entities to present provision for bad debts relating to patient service revenue as a deduction from patient service revenue in the statements of operations and changes in net assets rather than as an operating expense. All periods presented have been reclassified to conform to this presentation. The Hospital's adoption of this standard had no net impact on financial position, results of operations, or cash flows. This standard also requires healthcare entities to provide enhanced disclosure about their policies for recognizing revenue and assessing bad debts, as well as qualitative and quantitative information about changes in the allowance for doubtful 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. Management regularly reviews data about the major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts.For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulty that make the realization of amounts due unlikely). 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 current allowance for doubtful accounts policy is to reserve 85 percent of all self-pay accounts less than 120 days old and include all accounts 120 days old and older, net of contractual allowances already taken.Part III, line 3, Explanation for rational for including other bad debt amount in community benefit: No other bad debt amounts have been included as community benefit. The hospital has a detailed financial assistance policy. In addition, the hospital educates patients with limited ability to pay regarding financial assistance. For this reason, the organization believes it accurately captures all charity care deductions provided according to the financial assistance 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: | THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2015 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| Part III, Line 9b: | THE ORGANIZATION'S COLLECTION POLICY INCLUDES PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. AFTER THE FINANCIAL COUNSELOR AND CHIEF FINANCIAL OFFICER REVIEW AND APPROVE A CHARITY CARE APPLICATION, CHARITY CARE AMOUNTS AND DIRECT WRITE OFF AMOUNTS ARE DETERMINED AND DOCUMENTED. APPROVED CHARITY CARE ACCOUNTS ARE THEN SEPARATELY FILED AND HELD FOR AUDIT REVIEW. |
| Part VI, Line 2: | NEEDS ASSESSMENT: IN ADDITION TO THE COMMUNITHY HEALTH NEEDS ASSESMENT CONDUCTED IN 2012; INFORMATION CONCERNING LOCAL HEALTH CARE NEEDS IS PROVIDED TO THE HOSPITAL THROUGH LOCAL AGENCIES, PHYSICIANS AND PUBLIC HEALTH DEPARTMENTS. |
| Part VI, Line 3: | PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY: PATIENTS ARE OFFERED AN APPLICATION FOR ASSISTANCE, EITHER AT TIME OF REGISTRATION OR BY MAIL WITH AN EXPLANATION SHEET ON HOW TO APPLY AND ANY DOCUMENTS REQUIRED FOR APPROVAL. |
| Part VI, Line 4: | Community Description: The area served by Clinton County Hospital is rural in nature and somewhat remote. The education level, household income, and access to healthcare are all below the national average. |
| Part VI, Line 5: | Community Health Promotion: The organization furthers its exempt purpose by promoting health of the community through the following: The majority of the organization's governing body is comprised of persons who reside in the organization's primary service area. These volunteers are neither employees nor independent contractors of the organization, nor family members thereof. The hospital administration and employees take an active role in local health care initiatives and activities. Whenever possible surplus items are donated to public agencies. |
| Part VI, Line 6: | Affiliated Health Care System: The organization is not part of an affiliated health care system. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail (6 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| Commonwealth Health Corporation | |||||||||
| Accounts Receivable | 2016-03-31 | $1,398,355 | Fair value was determined by the present value of cash inflows of such asset and based upon the sale of all the Hospital's assets as discussed in the Prior Year financials statements. | 311118087 | 800 Park Street | BOwling Green | KY | 42101 | 501(c)(3) |
| Commonwealth Health Corporation | |||||||||
| Inventory | 2016-03-31 | $372,842 | Fair value was determined by the present value of cash inflows of such asset | 311118087 | 800 Park Street | BOwling Green | KY | 42101 | 501(c)(3) |
| Commonwealth Health Corporation | |||||||||
| prepaid expenses | 2016-03-31 | $164,595 | Fair value was determined by the present value of cash inflows of such asset | 311118087 | 800 Park Street | BOwling Green | KY | 42101 | 501(c)(3) |
| Commonwealth Health Corporation | |||||||||
| Assets whose use is limited | 2016-03-31 | $629,245 | Fair value was determined by the present value of cash inflows of such asset | 311118087 | 800 Park Street | BOwling Green | KY | 42101 | 501(c)(3) |
| Commonwealth Health Corporation | |||||||||
| Property and Equipment | 2016-03-31 | $1,429,479 | Fair value was determined by the present value of cash inflows of such asset | 311118087 | 800 Park Street | BOwling Green | KY | 42101 | 501(c)(3) |
| Commonwealth Health Corporation | |||||||||
| Other Assets | 2016-03-31 | $130,484 | Fair value was determined by the present value of cash inflows of such asset | 311118087 | 800 Park Street | BOwling Green | KY | 42101 | 501(c)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 0 | DirectorOfSuccessorInd |
| Employee Of Successor | 0 | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | Yes (1) | BondsOutstandingInd |
| Bond Liabilities Discharged | Yes (1) | BondLiabilitiesDischargedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 6c: | FormAndLineReferenceDesc |
| Explanation | The Hospital filed for Chapter 11 bankruptcy in October 2014. All of the liabilities were subject to settlement under the reorganization proceedings. The Bankruptcy Court agreed to the sale of Clinton County Hospital to Commonwealth Health Corporatition for $4,125,000 on March 31, 2016. CHC purchased the assets free and clear of Clinton County Hospital's liabilities. The court approved the disposition of the sale proceeds and the proceeds were allocated as follows: a.) $3,775,000 to the USDA Rural Development and b.) $350,000 to First and Farmers Bank. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 3 | Clinton County Hospital was acquired by Commonwealth Health Corporation on March 31, 2016. Clinton County Hospital was dissolved as of March 2016. |
| Form 990, Part VI, Section B, line 11 | This entity was dissolved and the board members listed on the return are no longer available. THe management Company, Commonweath Health Corporation, Inc (CHC), was assigned by the United States Bankruptcy Court on February 4, 2016. CHC's management has reviewed the 990 including requested schedules, as ultimately filed with the IRS, prior to the filing. |
| Form 990, Part VI, Section B, line 12c | The written conflict of interest policy is regularly and consistently monitored and compliance enforced by the Administrator of the hospital and Chairperson of the Board of Directors. The scope of this policy includes members of the Board of Directors, Medical Staff, and all persons employed by Clinton County Hospital. The policy is in place to prevent actual or potential conflicts of interests from being violated and provide procedures and guidelines for determination of an actual or potential conflict of interest. The covered persons are to conduct their relationships in compliance with this policy to ensure that decisions are made for the best interest of the hospital. A self disclosure from covered persons in writing to the Administrator of the Hospital or Chairperson of the Board is required on any actual or contemplated transaction which appears to violate the conflict of interest policy. Based on the decision of the board the individual may be required to discontinue the situation or institute other appropriate actions. |
| Form 990, Part VI, Section B, line 15 | THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS SET BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS VOTE ON AN OVERALL PERCENTAGE RAISE ANNUALLY FOR ALL EMPLOYEES INCLUDING KEY EMPLOYEES. THE CHIEF EXECUTIVE OFFICER CAN GIVE SINGLE RAISES OVER AND BEYOND THE ANNUAL RAISE. |
| Form 990, Part VI, Section C, line 19 | THe organization does not make its governing documents, conflict of interest policy, or financial statements available to the public. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 1,218,890. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,218,890. |
| Form 990, Part XI, line 9: | Bankruptcy and release of Clinton County Hospital liabilities 23,491,546. Sale of Clinton County Hospital -4,125,000. |
| Form 990, Part XI, Line 2c, Oversight of Audit: | THE BOARD OF DIRECTORS ASSUMES RESPONSiBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. |