2016-05-16T11:17:45-05:00 2015-06-30 BKD LLP 360 E 8TH AVE STE 201 PO BOX 1196 BOWLING GREEN KY 421021196 990 2014-07-01 610624096 Cumberland County Hospital Association Inc % RICK NEIKIRK CUMB 2708642511 PO Box 280 Burkesville KY 42717 RICK NEIKIRK CEO 2708642511 2016-05-16 true JESSICA FREEMAN P01261457 2707810111 2014 2016-08-17 19:52:53Z Rick Neikirk CEO PO Box 280 Burkesville KY 42717 17806067 false X www.cchospital.org X 1964 KY CUMBERLAND COUNTY HOSPITAL SEEKS TO BECOME THE NETWORK LEADER IN PROVIDING, COORDINATING, AND CONTRACTING THE FULL CONTINUUM OF HEALTH CARE SERVICES REQUIRED BY RESIDENTS. 10 8 238 11 30000 2495 228868 231833 16610451 17186746 18965 11211 241873 376277 17100157 17806067 0 0 0 0 8674141 9149757 0 0 0 8780624 8988322 17454765 18138079 -354608 -332012 16790052 16775689 11618162 11935811 5171890 4839878 CUMBERLAND COUNTY HOSPITAL SEEKS TO BECOME THE NETWORK LEADER IN PROVIDING, COORDINATING, AND CONTRACTING THE FULL CONTINUUM OF HEALTH CARE SERVICES REQUIRED BY RESIDENTS OF CUMBERLAND COUNTY. false false 15611640 17186856 CUMBERLAND COUNTY HOSPITAL, IN PARTNERSHIP WITH ITS MEDICAL STAFF, EMPLOYEES, AND OTHER PROVIDERS, STRIVES TO BE RECOGNIZED FOR HIGH QUALITY, COST-EFFECTIVE CARE RESULTING IN COMMUNITY PRIDE, CONFIDENCE, AND SUPPORT. THE HOSPITAL ACKNOWLEDGES THE PARTNERSHIPS REQUIRED WITH ITS MEDICAL STAFF, ITS EMPLOYEES, AND OTHER PROVIDERS TO ACHIEVE THIS VISION. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN CUMBERLAND COUNTY, KY AND SURROUNDING COUNTIES. THE HOSPITAL PROVIDED APPROXIMATELY $101,000 IN CHARITY CARE DURING THE YEAR ENDED JUNE 30, 2015. 15611640 true true false true false false false false false false true false false true false false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 71 0 true 238 true false false false false false false false false false false X 10 8 false false false false true true false true true false false true true true true true true true true false KY X RICK NEIKIRK 2708642511 PO BOX 280 Burkesville KY 42717 Joe David Brown VICE CHAIRMAN OF BOARD 1.0 0.0 X X 0 0 0 Steve Burns COO, EMPLOYEE BOARD MEMBER 40.0 0.0 X X 80617 0 4393 DR ROBERT FLOWERS SR Board Member/PHYSICIAN 40.0 0.0 X 578465 0 9613 James Long Board Member 1.0 0.0 X 0 0 0 Todd Morgan Board Member 1.0 0.0 X 0 0 0 ELIZABETH NORRIS Secretary/Treasurer of Board 1.0 0.0 X X 0 0 0 DAVID T LONG Board Member 1.0 0.0 X 0 0 0 Doug Butler Chairman of the Board 1.0 0.0 X X 0 0 0 VICKIE WELLS BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN HURT BOARD MEMBER 1.0 0.0 X 0 0 0 Richard Neikirk CEO 40.0 0.0 X 183037 0 11491 RICHIE CAPPS CFO 40.0 0.0 X 129552 0 10153 Dr Samuel Rice DIRECTOR OF INPATIENT SERVICES 40.0 0.0 X 460164 0 6000 Dr Christian Konsavage Physician 40.0 0.0 X 182398 0 6000 PEGGY FLOWERS DIRECTOR OF FRHC/RN 40.0 0.0 X 119267 0 9887 DR ROBERT FLOWERS JR PHYSICIAN 40.0 0.0 X 172143 0 6000 VICTORIA KINGREY APRN/OFFICE DIRECTOR 40.0 0.0 X 125613 0 9969 MEGAN SELLS PHARMACIST 40.0 0.0 X 125311 0 9133 2156567 0 82639 9 false true false Inspire Medical Inc 2323 Lime Kiln Lane LOUISVILLE KY 40222 ER Coverage 448166 DR JAINARAYN SINGH 212 TROON DRIVE PRINCETON KY 42445 RADIOLOGY DIRECTOR 120000 SIMPSON CONSTRUCTION PO BOX 2481 RUSSEL SPRINGS KY 42642 CONSTRUCTION SERVICE 132506 3 229426 2407 231833 HOSPITAL SERVICES - NET OF THIRD PARTY 621110 17186746 17186746 CONRACTUAL ADJUSTMENTS 17186746 11211 11211 0 0 77199 77199 0 77199 30000 47199 0 0 0 0 EHR INCENTIVES 900099 186556 186556 REBATES 900099 4111 4111 CAFETERIA 722514 48265 48265 60146 110 60036 299078 17806067 17186856 30000 357378 0 0 0 0 1003709 574070 429639 0 6725124 5905973 819151 167178 167178 714241 702436 11805 539505 539505 11100 11100 16920 16920 78032 78032 0 0 0 1733458 1669770 63688 10670 3375 7295 856464 727736 128728 780 780 0 339606 335453 4153 46832 36531 10301 0 0 412124 412124 0 841057 841057 199482 64649 134833 BAD DEBTS 1798246 1798246 PROVIDER TAX 180458 180458 DUES & SUBSCRIPTIONS 29507 14178 15329 MEDICAL SUPPLIES 2124708 2124708 308878 42598 266280 18138079 15611640 2526439 0 651872 436666 5000 5000 0 0 3280790 2780402 0 0 0 0 0 0 396813 410450 77774 74257 17687384 7383391 10588516 10303993 0 0 0 0 0 0 0 0 1789287 2764921 16790052 16775689 1533851 1623655 0 0 0 0 10084311 10312156 0 0 0 0 0 0 0 0 0 0 11618162 11935811 X 5171890 4839878 0 0 0 0 5171890 4839878 16790052 16775689 -332012 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1511 1511 false false SCHEDULE C, PART II-B, LINE 1I LOBBYING EXPENSES ----------------- A percentage of dues paid to the Kentucky Hospital Association are attributable to lobbying activities. false false 547269 547269 10557191 3333676 7223515 5738696 805644 1933052 844228 244071 600157 10303993 OTHER RECEIVABLES 755481 RESTRICTED FUNDS 754496 INTERNALLY DESIGNATED ASSETS 146202 DUE FROM THIRD PARTIES 1108742 2764921 SCHEDULE D, PART X, LINE 2 INCOME TAXES ------------- The organization's audited financial statements did not include a footnote that addressed the organization's liability for uncertain tax positions under FIN48 (ASC 740). Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review,management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. true true X false false true true false false 80961 185940 0 0.00000 3712466 2309147 1403319 0.08890 3793427 2495087 1403319 0.08890 5750 1380 4370 0.00030 584569 459361 125208 0.00790 590319 460741 129578 0.00820 4383746 2955828 1532897 0.09710 false 1248246 588764 6452502 6263938 188564 X true false 1 1 CUMBERLAND COUNTY HOSPITAL 299 GLASGOW ROAD BURKESVILLE KY 42717 X X X CUMBERLAND COUNTY HOSPITAL 1 false false true X X X X X X X X X 12 true false false true X www.cchospital.org X true 12 true www.cchospital.org false false true X true true X true X www.cchospital.org X X X X true X false X X X true X false false PART V, SECTION B, LINE 5 INPUT FROM COMMUNITY -------------------- CUMBERLAND COUNTY HOSPITAL INTERVIEWED TEN KEY INFORMANTS FROM THE COMMUNITY IN ORDER TO ASSESS PUBLIC PERCEPTIONS OF THE COUNTY'S HEALTH STATUS AND UNMET NEEDS. THE INTERVIEWEES WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, THEIR AFFILIATION WITH THE LOCAL GOVERNMENT, FROM THE SCHOOLS OR INDUSTRY AND THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. THE KEY INFORMANTS WERE: A MEMBER FROM THE CUMBERLAND COUNTY HEALTH DEPARTMENT, THE DIRECTOR FOR BFT RURAL HEALTH CLINIC, AN EMPLOYEE FROM THE CUMBERLAND COUNTY HOSPITAL, ADMINISTRATION FROM THE CUMBERLAND VALLEY MANOR (NURSING HOME), THE ADANTA GROUP (BEHAVIORAL HEALTH), THE CITY MAYOR, THE COUNTY JUDGE EXECUTIVE, EMERGENCY MANAGEMENT SERVICES DIRECTOR, SUPERINTENDANT, AND DIRECTOR OF LIFELINE HOME HEALTH AGENCY. PART V, SECTION B, LINE 11 ADDRESSING NEEDS IDENTIFIED IN CHNA ----------------------------------- THE HOSPITAL IS REACHING OUT TO THE COMMUNITY MORE BY USING MEDIA ROUTES SUCH AS THE RADIO TO ADVERTISE HEALTH EDUCATION. THERE IS AN ATTEMPT TO COLLABORATE MORE IN THE COMMUNITY, AND MORE HEALTH CARE IS BEING BROUGHT INTO THE COMMUNITY BY THE HOSPITAL. THE FOLLOWING ISSUES IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT HAVE NOT BEEN ADDRESSED DUE TO BEING OUTSIDE THE SCOPE OF EXPERTISE AND RESOURCES OF CUMBERLAND COUNTY HOSPITAL: CHILDREN IN POVERTY SEXUALLY TRANSMITTED INFECTIONS TEEN BIRTH RATE PART V, SECTION B, LINE 13 DETERMINING ELIGIBILITY FOR PROVING FREE AND DISCOUNTED CARE ------------------------------------------------------------ DETERMINING FREE CARE: State guidelines are followed for eligibility requirements as set forth by DMS for Disproportionate Share Hospital Programs for the current year. Upon completion of the application, it can be determined whether the patient is eligible for charity. If the patient is eligible 100% will be adjusted. The income limits are for a household size of one an annual income of $13,520 or lower qualifies. for each additional person in the household the income limit is increased $4,680.00. DETERMINING DISCOUNTED CARE: ALL patients with a private pay balance of any form (deductible, all charges etc.) qualify for a 40% discount immediately with a prompt payment or prompt repayment plan. PART V, SECTION B, LINE 22 DETERMINATION OF CHARGES TO FAP-ELIGIBLE INDIVIDUALS ---------------------------------------------------- IF A PATIENT COMPLETES THE FAP APPLICATION FOR CHARITY CARE AND IT IS DETERMINED THAT HE/SHE QUALIFIES, 100% OF THE CHARGES ARE DISCOUNTED. 2 BF TAYLOR CLINIC 299A GLASGOW RD BURKSEVILLE KY 42717 RURAL HEALTH CLINIC FLOWERS RURAL HEALTH CLINIC 333 KEEN ST BURKSEVILLE KY 42717 RURAL HEALTH CLINIC PART I, LINE 3C DETERMINING ELIGIBILITY ----------------------- THE QUALIFICATION INCOME REQUIREMENTS ARE AS FOLLOWS: WITH A HOUSEHOLD SIZE OF 1, THE ACCOUNT WILL BE 50% CHARITY IF ANNUAL INCOME IS $13,520 OR LESS. ADD $4,680 TO THE INCOME FOR EACH ADDITIONAL PERSON IN THE HOUSEHOLD. PART I, LINE 7 BAD DEBTS --------- Bad Debts Included in Part IX, Line 25 totaled $1,248,246. This amount has been removed from total expenses calculated in Column F on Schedule H, Part I and II. PART I, LINE 7 COST OF CHARITY CARE --------------------- Cost of Charity Care was calculated with a cost to charge ratio using worksheet 2. Cost of Medicaid was calculated with a cost to charge ratio using worksheet 3. Cost of Medicare was based on the Medicare Cost Report. PART III, LINE 4 BAD DEBT EXPENSE ---------------- THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT. IN DETERMINING WHAT AMOUNTS SHOULD BE INCLUDED IN BAD DEBT, CCH HAS A BAD DEBT POLICY THAT THEY FOLLOW. THE AMOUNTS WRITTEN OFF TO BAD DEBT ARE THE ACTUAL WRITE OFFS MADE DURING THE YEAR PLUS THE ALLOWANCE FOR BAD DEBTS THAT IS CALCULATED BASED ON PREVIOUS YEARS ACTIVITY THAT IS APPLIED TO CURRENT ACCOUNTS. ALL PAYMENTS THAT ARE MADE ARE APPLIED DIRECTLY TO THE ACCOUNT IN CONJUNCTION WITH ANY CONTRACTUAL'S TO INSURANCE COMPANIES OR DISCOUNTS. APPLIED DIRECTLY TO THE ACCOUNT IN CONJUNCTION WITH ANY CONTRACTUALS TO INSURANCE COMPANIES OR DISCOUNTS. PART VI, LINE 2 NEEDS ASSESSMENT ---------------- Cumberland County Hospital is designated as a Critical Access Hospital. As such Cumberland County Hospital provides inpatient, outpatient and emergency care services to patients in Cumberland County, Kentucky and surrounding counties. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ----------------------------------------------- PATIENTS ARE INFORMED OF PATIENT ASSISTANCE AT TIME OF REGISTRATIONS, BY THE DISCHARGE NURSE, IF INPATIENT, AND ARE MAILED A LETTER. PART VI, LINE 4 COMMUNITY INFORMATION ---------------------- The population of Cumberland County, Kentucky is approximately 6,800. Cumberland County Hospital qualifies for a disproportionate share payment on ther medicare cost report due to the larger than normal share of medicaid patient volume served by the hospital. Nearly 35% of the counties' residents are enrolled in Medicaid. The community health fair is a huge success. It is an excellent way the Cumberland County Hosptial shares important health information with the community. Cumberland County Hospital also has radio spots on the local radio station to discuss specific health needs and to share health information with the community. X X false false false false false false false false false DR ROBERT FLOWERS SR Board Member/PHYSICIAN 578465 0 0 0 0 0 8254 0 1359 0 588078 0 0 0 Dr Samuel Rice DIRECTOR OF INPATIENT SERVICES 460164 0 0 0 0 0 0 0 6000 0 466164 0 0 0 Dr Christian Konsavage Physician 182398 0 0 0 0 0 0 0 6000 0 188398 0 0 0 Richard Neikirk CEO 183037 0 0 0 0 0 5491 0 6000 0 194528 0 0 0 DR ROBERT FLOWERS JR PHYSICIAN 172143 0 0 0 0 0 0 0 6000 0 178143 0 0 0 SCH J, PART II COMPENSATION ------------ DR. SAMUEL RICE AND DR. ROBERT FLOWERS WERE BOTH W-2 WAGE EMPLOYEES AT BFT CLINIC AND INDEPENDENT CONTRACTORS FOR ER COVERAGE FOR THE YEAR. DR. RICE'S TOTAL COMPENSATION OF $466,164 CONSISTS OF $274,423 OF W-2 COMPENSATION AND $190,741 OF 1099 COMPENSATION. DR. FLOWERS' TOTAL COMPENSATION OF $588,078 CONSISTS OF $284,751 OF W-2 COMPENSATION AND $303,327 OF 1099 COMPENSATION. FORM 990, PART VI, SECTION A, LINE 6 & 7A ORGANIZATIONAL MEMBERS OR STOCKHOLDERS -------------------------------------- PER THE BY-LAWS, ANY PERSON OR ENTITY HAVING ITS PRINCIPAL OFFICE IN CUMBERLAND COUNTY, KY AND HAVING CUMBERLAND COUNTY, KY AS THE PRINCIPAL AREA OF ITS ACTIVITY MAY BECOME A MEMBER OF THE HOSPITAL ASSOCIATION. TO BECOME A MEMBER OF THE ASSOCIATION, A DONATION OF $100 MUST BE MADE TO THE ASSOCATION. NINE DIRECTORS OF THE ELEVEN DIRECTOR BOARD MAY BE ELECTED BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C MONITORING OF THE CONFLICT OF INTEREST POLICY --------------------------------------------- All contracts and other agreements are reviewed by management to ensure that no conflicts exist or have the ability to arise. The Board of Directors must vote on the policy if a conflicting event arises and a conflicting board member must abstain from voting. FORM 990, PART VI, SECTION B, LINE 15A DETERMINING COMPENSATION OF THE CEO AND TOP MANAGEMENT OFFICIALS ---------------------------------------------------------------- THE CEO AND CFO SALARIES ARE DETERMINED BY THE BOARD OF DIRECTORS. THE COO SALARY IS DETERMINED BY THE CEO. SALARY SURVEYS ARE OBTAINED FROM THE KENTUCKY HOSPITAL ASSOCIATION FOR THE TOP MANAGEMENT POSITIONS INCLUDING CEO, CFO, AND COO. THE INDEPENDENT BOARD UTILIZES THESE SALARY SURVEYS IN SETTING COMPENSATION FOR THESE POSITIONS. FORM 990, PART VI, SECTION B, LINE 15B DETERMINING COMPENSATION - OTHER OFFICERS & KEY EMPLOYEES ---------------------------------------------------------- EACH EMPLOYEE IS EVALUATED ANNUALLY BY THEIR DEPARTMENT DIRECTOR TO DETERMINE IF A CHANGE IN SALARY IS WARRANTED. THE DIRECTORS ARE EVALUATED BY ADMINISTRATION ANNUALLY. FORM 990, PART VI, SECTION B, LINE 19 MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ---------------------------------------- The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. FORM 990, PART VI, SECTION B, LINE 11 REVIEW OF FORM 990 ------------------ A COPY OF THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. Capps Pharmacy dba Cumberland Cty Phar 333 Keen Street Burkesville KY 42717 611318396 Pharmacy KY Cumberland Cty C 6837206 2512513 1.00000 true true false false false false false false true false false false false false false false false false true false CAPPS PHARMACY A 24000 FMV CAPPS PHARMACY H 300000 FMV